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Objective: To conduct a scoping review to summarize the state of the evidence on associations between participation in nonfood social safety net programs (eg, income assistance, housing assistance) in the United States and food- and nutrition insecurity-related outcomes., Background: Food and nutrition insecurity are persistent public health challenges in the United States that increase chronic disease risk and exacerbate health disparities. Several food assistance programs enhance food and nutrition security. Nonfood social safety net programs, however, may also improve these outcomes by relieving households' financial strain. Understanding the scope of research on nonfood social safety net programs' associations with not only food insecurity but also nutrition insecurity is needed to understand their potential to reduce the burden of diet-related chronic disease., Methods: Six databases were systematically searched for peer-reviewed articles. Articles were included if they were published between 1995 and 2023; conducted in the United States; available in English; included a dependent variable of food- and/or nutrition insecurity-related measures; and included an independent variable of participation in a federally funded, nonfood social safety net program., Results: Included articles (n = 65) reported on studies that examined 10 unique social safety net programs; 8 studies examined program interactions. Twenty studies focused on COVID-19 pandemic-era programs. Fifty-eight studies used food insecurity, food insufficiency, or food hardship as outcomes, and 11 studies used nutrition insecurity-related outcomes. Overall, results suggest that participation in nonfood social safety net programs is associated with reductions in food insecurity. Current evidence for an association between program participation and nutrition insecurity-related outcomes is limited., Conclusion: Further research is warranted on the association between nonfood social safety net programs and nutrition insecurity; potential interactions between social safety net programs; associations between the expiration of pandemic-era programs and food and nutrition insecurity; and how program impacts might differ among populations with persistent disparities in food and nutrition insecurity., (© The Author(s) 2025. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Although interventions to change nutrition policies, systems, and environments (PSE) for children are generally cost effective for preventing childhood obesity, existing evidence suggests that nutrition education curricula, without accompanying PSE changes, are more commonly implemented., Objectives: This study aimed to estimate the societal costs and potential for cost-effectiveness of 3 nutrition education curricula frequently implemented in United States public schools for childhood obesity prevention., Methods: In 2021, we searched for nutrition education curricula in the Supplemental Nutrition Assistance Program (SNAP)-Ed Toolkit, a catalog of interventions for obesity prevention coordinated by the federal government. Standard costing methodologies estimated the societal costs from 2023 to 2032 of nationwide implementation of each identified curriculum. Using the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) microsimulation model, which projects the costs, health care costs saved, and cases of obesity prevented for childhood obesity prevention interventions, we conducted threshold analyses for each curriculum, estimating the cost per quality-adjusted life-year for a range of hypothetical effects on child BMI to determine how large of an effect each curriculum would need to have to meet a cost-effectiveness threshold of $150,000 per quality-adjusted life-year., Results: Three nutrition education curricula without PSE were identified from SNAP-Ed; none had evidence of an impact on obesity risk. From 2023 to 2032, the estimated implementation costs of the curricula nationwide ranged from $1.80 billion (95% upper interval: $1.79, $1.82 billion) to $3.48 billion (95% upper interval: $3.44, $3.51 billion). Each curriculum would have to reduce average child BMI by 0.10 kg/m 2 or more-an effect size that has not been reported by any of the 3 curricula, or by more comprehensive existing prevention programs-to be considered cost effective at this threshold., Conclusions: SNAP-Ed-endorsed nutrition education curricula alone are unlikely to be cost effective for preventing childhood obesity. Continued efforts to implement interventions with strong evidence for effectiveness, including PSE approaches, are needed., Competing Interests: Conflict of interest The authors report no conflicts of interest., (Copyright © 2024 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Introduction: Amid national efforts to align priorities for nutrition and food assistance programs, little is known about the implementation of community-led efforts for children. This study aimed to estimate U.S. public school participation in weekend backpack programs (WBPs), to document program structure, and to consider characteristics of programs with more nutritious food offerings., Methods: The prevalence of WBP participation in 2022 was estimated using a state-stratified, random sample of n=413 public schools. Administrators from WBPs at 49 schools completed measures of implementation characteristics and nutritional quality of foods offered. In 2022-2023, using a multivariable-adjusted linear regression model, the authors explored the association between hypothesized implementation characteristics and Healthy Eating Index-2015 scores of foods provided., Results: Half of public schools (53.7%, 95% CI: 46.8%, 60.7%) in the national sample reported participating in WBPs. Many WBPs in the subsample were affiliated with anti-hunger organizations (41%), led by school counselors and volunteers (55%), and funded by grants (51%). WBPs spent an average of $0.56 (sd=$0.36) per item. Foods provided averaged a Healthy Eating Index-2015 score of 58.4 (sd=12.3), similar to children's average diets. About half of WBPs (41%) reported accessing nutrition resources., Conclusions: Despite the decentralized structure and absence of dedicated funding mechanisms, WBPs were common in our national sample of schools, suggesting widespread perceptions of unmet food needs and extensive efforts from community members to mitigate weekend hunger. Further research on food procurement methods and program impacts on child nutrition outcomes is needed to advance national priorities for nutrition and food security., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The evidence-based nutrition standards of the Healthy, Hunger-Free Kids Act of 2010 significantly improved school meal nutrition, yet little is known about how school food authorities (SFAs) were supported to translate the standards into practice in schools., Objective: This study tested whether or not 2 implementation supports, SFA receipt of training/technical assistance (TA) and purchase of new equipment, for implementing the nutrition standards were associated with the nutritional quality of school lunches., Design: This study used a cross-sectional design., Participants/setting: The study sample included 365 SFAs derived from the US Department of Agriculture's School Nutrition and Meal Cost Study (2014 to 2015 school year), the only national data of school nutrition environments since the Healthy, Hunger-Free Kids Act of 2010., Main Outcome Measures: Implementation supports included reported participation in training/TA and the purchase of new equipment between the 2012 to 2013 (year of policy adoption) and 2014 to 2015 school years. The primary outcome, nutritional quality of school lunches served, was defined as low/high Healthy Eating Index 2010 scores during the 2014 to 2015 school year. Secondary implementation supports included the number of areas covered by training/TA, the adequacy of training/TA, and the degree of implementation challenges., Statistical Analyses: Multivariable-adjusted logistic regression models assessed if receipt of implementation supports was associated with lunch Healthy Eating Index 2010 scores., Results: The median lunch Healthy Eating Index 2010 score was 81.7 (95% CI 80.4 to 82.9). Most SFAs (78.4%, 95% CI 72.0% to 85.0%) reported having participated in training/TA and one-third (33.8%, 95% CI 24.4% to 43.2%) reported having purchased new equipment-neither were associated with the odds of having higher Healthy Eating Index 2010 scores for lunches served at the time of data collection., Conclusions: Many SFAs accessed implementation supports to adopt the nutrition standards. Information on dose, quality, and nutrition-related impact of implementation supports using measures of change are needed to determine how best to support SFAs with implementation of new nutrition standards., (Copyright © 2024 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Much of the chronic disease burden in the U.S. population can be traced to poor diet. There has been a sustained focus on influencing children's diets and encouraging healthier eating habits by changing policies for what foods and beverages can be served to children through large federally-funded nutrition assistance programs. Yet without attention to how nutrition policies are implemented, and the surrounding context for these policies, these policy changes may not have the intended results. In this perspective, we used Bullock et al.'s (2021) Process Model of Implementation from a Policy Perspective to analyze how the complexities of the implementation process of large-scale nutrition policies can dilute potential health outcomes. We examine the Child and Adult Care Food Program (CACFP), a federal program focused on supporting the provision of nutritious meals to over 4 million children attending childcare, as a case study. We examine how the larger societal contexts of food insecurity, attitudes towards the social safety net, and a fragmented childcare system interact with CACFP. We review the "policy package" of CACFP itself, in terms of its regulatory requirements, and the various federal, state, and local implementation agencies that shape CACFP's on-the-ground implementation. We then review the evidence for how each component of the CACFP policy implementation process impacts uptake, costs, feasibility, equity, and effectiveness at improving children's nutrition. Our case study demonstrates how public health researchers and practitioners must consider the complexities of policy implementation processes to ensure effective implementation of nutrition policies intended to improve population health., Competing Interests: NF is employed by Seed 2 Roots LLC. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Kenney, Poole, Frost, Kinderknecht, Mozaffarian and Andreyeva.)

Objective: This study aimed to estimate the 10-year cost-effectiveness of school-based BMI report cards, a commonly implemented program for childhood obesity prevention in the US where student BMI is reported to parents/guardians by letter with nutrition and physical activity resources, for students in grades 3 to 7., Methods: A microsimulation model, using data inputs from evidence reviews on health impacts and costs, estimated: how many students would be reached if the 15 states currently measuring student BMI (but not reporting to parents/guardians) implemented BMI report cards from 2023 to 2032; how many cases of childhood obesity would be prevented; expected changes in childhood obesity prevalence; and costs to society., Results: BMI report cards were projected to reach 8.3 million children with overweight or obesity (95% uncertainty interval [UI]: 7.7-8.9 million) but were not projected to prevent any cases of childhood obesity or significantly decrease childhood obesity prevalence. Ten-year costs totaled $210 million (95% UI: $30.5-$408 million) or $3.33 per child per year with overweight or obesity (95% UI: $3.11-$3.68)., Conclusions: School-based BMI report cards are not cost-effective childhood obesity interventions. Deimplementation should be considered to free up resources for implementing effective programs., (© 2023 The Obesity Society.)

Background: This study explored reasons for the adoption of a policy to distribute report cards to parents about children's weight status ("BMI report cards") in Massachusetts (MA) public schools in 2009 and the contextual factors influencing the policy removal in 2013., Methods: We conducted semi-structured, qualitative interviews with 15 key decision-makers and practitioners involved with implementing and de-implementing the MA BMI report card policy. We analyzed interview data using a thematic analytic approach guided by the Consolidated Framework for Implementation Research (CFIR) 2.0., Results: Primary themes were that (1) factors other than scientific evidence mattered more for policy adoption, (2) societal pressure spurred policy adoption, (3) problems with the policy design contributed to inconsistent implementation and dissatisfaction, and (4) media coverage, societal pressure, and organizational politics and pressure largely prompted de-implementation., Conclusions: Numerous factors contributed to the de-implementation of the policy. An orderly process for the de-implementation of a policy in public health practice that manages drivers of de-implementation may not yet exist. Public health research should further focus on how to de-implement policy interventions when evidence is lacking or there is potential for harm., (© 2023. The Author(s).)

Background: Economic and supply chain shocks resulting from the COVID-19 pandemic in 2020 led to substantial increases in the numbers of individuals experiencing food-related hardship in the US, with programs aimed at addressing food insecurity like the Supplemental Nutrition Assistance Program (SNAP) and food pantries seeing significant upticks in utilization. While these programs have improved food access overall, the extent to which diet quality changed, and whether they helped mitigate diet quality disruptions, is not well understood., Objective: To evaluate food insecurity, food pantry and/or SNAP participation associations with both diet quality as well as perceived disruptions in diet during the COVID-19 pandemic among Massachusetts adults with lower incomes., Methods: We analyzed complete-case data from 1,256 individuals with complete data from a cross-sectional online survey of adults (ages 18 years and above) living in Massachusetts who responded to "The MA Statewide Food Access Survey" between October 2020 through January 2021. Study recruitment and survey administration were performed by The Greater Boston Food Bank. We excluded respondents who reported participation in assistance programs but were ineligible ( n = 168), those who provided straightlined responses to the food frequency questionnaire component of the survey ( n = 34), those with incomes above 300% of the federal poverty level ( n = 1,427), those who completed the survey in 2021 ( n = 8), and those who reported improved food insecurity ( n = 55). Current dietary intake was assessed via food frequency questionnaire. Using Bayesian regression models, we examined associations between pandemic food insecurity, perceived disruption in diet, diet quality, and intakes of individual foods among those who completed a survey in 2020. We assessed interactions by pantry and SNAP participation to determine whether participation moderated these relationships., Results: Individuals experiencing food insecurity reported greater disruption in diet during the pandemic and reduced consumption of healthy/unhealthy foods. Pantry participation attenuated significant associations between food insecurity and lower consumption of unhealthy ( b = -1.13 [95% CI -1.97 to -0.31]) and healthy foods ( b = -1.07 [-1.82 to -0.34]) to null (unhealthy foods: -0.70 [-2.24 to 0.84]; healthy foods: 0.30 [-1.17 to 1.74]), whereas SNAP participation attenuated associations for healthy foods alone (from -1.07 [-1.82 to -0.34] to -0.75 [-1.83 to 0.32]). Results were robust to choice of prior as well as to alternative modeling specifications., Conclusion: Among adults with lower incomes, those experiencing food insecurity consumed less food, regardless of healthfulness, compared to individuals not experiencing food insecurity. Participation in safety-net programs, including SNAP and pantry participation, buffered this phenomenon. Continued support of SNAP and the food bank network and a focus on access to affordable healthy foods may simultaneously alleviate hunger while improving nutrition security., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Lee, Poole, Zack, Fiechtner, Rimm and Kenney.)

Objectives. To detail baseline drinking water sample lead concentrations and features of US state-level programs and policies to test school drinking water for lead in 7 states' operating programs between 2016 and 2018. Methods. We coded program and policy documents using structured content analysis protocols and analyzed state-provided data on lead concentration in drinking water samples collected in public schools during initial testing phases. Results. We analyzed data from 5688 public schools, representing 35% of eligible schools in 7 states. The number of samples per school varied. The proportion of schools identifying any sample lead concentration exceeding 5 parts per billion varied (13%-81%). Four states exceeded 20%. Other program features varied among states. Instances of lead above the state action level were identified in all states. Conclusions. In 2018, many US public school students attended schools in states without drinking water lead-testing programs. Testing all drinking water sources may be recommended. Public Health Implications. Initiating uniform school drinking water lead testing programs and surveillance over time could be used to reduce risk of lead exposure in drinking water. ( Am J Public Health . 2022;112(S7):S679-S689. https://doi.org/10.2105/AJPH.2022.306961).

Policies requiring childcare settings to promote healthy eating, physical activity, and limited screentime have the potential to improve young children's health. However, policies may have limited impact without effective implementation strategies to promote policy adoption. In this mixed-methods study, we evaluated the type, quality, and dose of implementation strategies for state-level childcare licensing regulations focused on healthy eating, physical activity, or screentime using: (1) a survey of state licensing staff and technical assistance providers (n = 89) in 32 states; (2) a structured review of each state's childcare licensing and training websites for childcare providers; and (3) in-depth, semi-structured interviews with 31 childcare licensing administrators and technical assistance providers across 17 states. Implementation strategies for supporting childcare providers in adopting healthy eating, physical activity, and screentime regulations vary substantially by state, in quantity and structure. Childcare programs' financial challenges, staff turnover, and lack of adequate facilities were identified as key barriers to adoption. Access to federal food programs was seen as critical to implementing nutrition regulations. Implementation resources such as training and informational materials were rarely available in multiple languages or targeted to providers serving low-income or racially/ethnically diverse families. There is a substantial need for implementation supports for ensuring policies are successfully and equitably implemented in childcare.

By feeding more than thirty million schoolchildren daily, the National School Lunch Program's food offerings substantially influence a contributing factor to climate change: US food production methods. Modifying school lunch nutrition standards could be a policy strategy to reduce climate change while promoting human health. To estimate how school lunches could be adjusted to encourage both outcomes, we compared the composition of school lunches with the EAT-Lancet Commission's healthy reference diet science-based benchmarks for reducing food system impacts on climate change. Analyzing more than 5,000 lunches served in the US during school year 2014-15, we found that they exceeded EAT-Lancet targets for dairy, fruit, refined grains, red meat, and starchy vegetables while containing insufficient whole grains, legumes, vegetables, and nuts. In addition, estimated food costs were higher for school lunches than for lunches meeting EAT-Lancet targets. Our findings suggest that redesigning school lunches could provide high-quality nutrition while benefiting the environment and reducing food costs.

This study aimed to determine the impact of 2017 revisions to the Child and Adult Care Food Program (CACFP) nutrition standards on foods and beverages served and meal costs in family child care homes (FCCHs). Our pre-post study utilized four weeks of menus and food receipts from 13 FCCH providers in Boston, MA prior to CACFP nutrition standards changes in 2017 and again one year later, resulting in n = 476 menu observation days. We compared daily servings of food and beverage items to the updated standards. Generalized estimating equation models tested for changes in adherence to the standards and meal costs. FCCHs offered more whole grains and less juice and refined grains from baseline to follow-up. FCCHs were more likely to meet the revised whole grain standard at follow-up (OR = 2.7, 95% CI: 1.4, 5.2, p = 0.002), but rarely met all selected standards together. Inflation-adjusted meal costs increased for lunch (+$0.27, p = 0.001) and afternoon snack (+$0.25, p = 0.048). FCCH providers may need assistance with meeting CACFP standards while ensuring that meal costs do not exceed reimbursement rates.

Objective: To estimate the impact of recent changes to the Child and Adult Care Food Program (CACFP) meal pattern on young children's diets in family child care homes (FCCHs) serving racially/ethnically diverse children., Design: In a natural experimental study of thirteen CACFP-participating FCCHs, we used digital photographs taken of children's plates before and after meals matched with menus to measure children's dietary intake both prior to implementation of the new meal patterns (summer/fall of 2017) and again 1 year later (summer/fall of 2018). Generalised estimating equations tested for change in intake of fruits, vegetables, whole grains, 100 % juice, grain-based desserts, meat/meat alternates and milk, adjusting for clustering of observations within providers., Setting: FCCHs in Boston, MA, USA., Participants: Three- to 5-year-old children attending FCCHs., Results: We observed 107 meals consumed by twenty-eight children at the thirteen FCCHs across an average of 2·5 (sd 1·3) d before the CACFP policy change, and 239 meals consumed by thirty-nine children across 3·8 d (sd 1·4) 1 year later. During lunch, fruit intake increased by about a third of a serving (+0·38 serving, 95 % CI 0·04, 0·73, P = 0·03), and whole grain intake increased by a half serving (+0·50 serving, 95 % CI 0·19, 0·82, P = 0·002). No changes were seen in other meal components., Conclusion: Young children's dietary intake in CACFP-participating FCCHs improved following the CACFP meal pattern change, particularly for fruits and whole grains, which were targets of the new policy. Additional research should examine impacts of the changes in other child care settings, age groups and locales.

In 2017, the US Department of Agriculture's Child and Adult Care Food Program's (CACFP's) nutrition standards were updated to improve nutrition and meal quality while remaining feasible for child care providers to implement. We conducted a pre-post study of 13 family child care home (FCCH) providers in Boston, Massachusetts, to compare reported opportunities for training and technical assistance and knowledge of new nutrition standards before the effective date of the updates (October 1, 2017) and 1 year later. The McNemar test was used to test for differences in provider responses. Few FCCH providers received training or technical assistance or had knowledge of most new standards at baseline or at follow-up; however, provider-reported knowledge of the whole-grain standard improved over time (from 6 providers to 12 providers) (P = .03). One year post implementation, FCCH providers still needed additional training, technical assistance, or other support to meet the new nutrition standards for meals served to children.

Background: Early care and education (ECE) settings represent an important point of intervention for childhood obesity prevention efforts. The objective of this paper was to compare ECE licensing regulations for each Canadian province/territory to evidence-based, obesity prevention standards., Methods: Two authors reviewed existing ECE regulations for each province/territory and examined whether the regulatory text supported standards for nutrition (n = 11), physical activity (n = 5) and screen time (n = 4). Provinces/territories were evaluated on the strength of regulatory language for each standard (i.e. fully, partially, or not addressed) and a total comprehensiveness score (maximum score of 20). ECE centres and homes were examined separately., Results: The majority of provinces/territories required providers to follow Canada's Food Guide, but few had regulations for specific foods or beverages. Most provinces/territories included standards related to written menus and drinking water, but the strength of these standards was weak. Many provinces/territories required physical activity and outdoor opportunities to be provided daily, but few included a time requirement. Only two provinces included any screen time standards. Total comprehensiveness scores averaged 5.7 for centres and 5.4 for homes., Conclusions: Canadian provinces/territories have insufficient obesity prevention regulations in ECE settings, highlighting a potential point of intervention to prevent obesity., (© The Author(s) 2020. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The objective of this study is to identify promising strategies for improving drinking-water access and consumption among children aged 0 to 5 years. MEDLINE/PubMed, Embase, ERIC, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched in this review. Studies included peer-reviewed, full-text studies from high-income countries, published in English between January 1, 2000, and January 12, 2018, that evaluated interventions to increase water access or consumption in children aged 0 to 5 years. Twenty-five studies met inclusion criteria; 19 used an effective intervention strategy to increase water access or water consumption. Three studies addressed both water access and consumption. Frequently used strategies included policy and practice changes, increasing water access and convenience, and education, training, or social support for caregivers. Studies were of fair methodological quality (average score: 18.8 of 26) for randomized studies and of moderate quality (5.1 of 9) for non-randomized studies. To date, few high-quality studies with objectively measured outcomes have clearly demonstrated strategies that may influence water intake and consumption among young children aged 0 to 5 years., (© 2019 World Obesity Federation.)

Point-of-decision prompts are cost-effective strategies to promote physical activity in public spaces. This study explored how adult and child guests of a conservatory with botanical gardens perceived point-of-decision prompts that aimed to promote physical activity. Seven point-of-decision prompts were developed and displayed throughout the conservatory. Adult guests ( n = 140) were invited to complete a voluntary and anonymous survey to assess awareness of point-of-decision prompts, adult-child interactions, and physical activity engagement. Descriptive statistics were calculated using SPSS version 23. Sixty-one percent of guests ( n = 86) who responded to the survey noticed the point-of-decision prompts. Over 65% ( n = 56) of those guests completed at least one of the physical activities, and 53% ( n = 46) completed one to three. Of guests attending with (a) child(ren) ( n = 17) who completed the survey, over half ( n = 9) engaged in at least one physical activity together. In sum, the point-of-decision prompts were noticed by some guests in this public space. More research is needed to determine whether point-of-decision prompts are able to lead to sustainable behavior change.

In 2013, a team of public health professionals at Tulane University launched a project to explore strategies for shaping a healthier Louisiana. The team investigated methods for improving diet and physical activity behaviors in early childhood, school, and community settings that could be translated into specific policies. Through key informant interviews and scans of academic journals and reports issued by public health agencies, the team generated a set of actionable steps that could increase healthful behaviors. Previous efforts to address similar topics in Louisiana and other states, and their reception from policy makers, were also considered during analysis. Subsequently, a state legislator used the team's work to introduce public health legislation in 2014. The legislation led to a number of incremental changes in state policy and resolutions for additional policy-relevant studies. This case study summarizes the promising physical activity and nutrition strategies that were considered by the Tulane team, how the team's work product was integrated into state legislation, the outcomes of the legislation, and a set of recommendations for how Louisiana can expand on this work. This article demonstrates how the work of public health professionals can have a positive influence on the policy-making process through research and education.

The purpose of this review was to better understand the impact of universal campaign interventions with a media component aimed at preventing child physical abuse (CPA). The review included 17 studies featuring 15 campaigns conducted from 1989 to 2011 in five countries. Seven studies used experimental designs, but most were quasi-experimental. CPA incidence was assessed in only three studies and decreased significantly in two. Studies also found significant reductions in relevant outcomes such as dysfunctional parenting, child problem behaviors and parental anger as well as increases in parental self-efficacy and knowledge of concepts and actions relevant to preventing child abuse. The following risk factors were most frequently targeted in campaigns: lack of knowledge regarding positive parenting techniques, parental impulsivity, the stigma of asking for help, inadequate social support and inappropriate expectations for a child's developmental stage. The evidence base for universal campaigns designed to prevent CPA remains inconclusive due to the limited availability of rigorous evaluations; however, Triple-P is a notable exception. Given the potential for such interventions to shift population norms relevant to CPA and reduce rates of CPA, there is a need to further develop and rigorously evaluate such campaigns., (© The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)