Background Cardiovascular disease (CVD) annually claims more lives and costs more dollars than any other disease globally amid widening health disparities, despite the known significant reductions in this burden by low cost dietary changes. The world's first medical school-based teaching kitchen therefore launched CHOP-Medical Students as the largest known multisite cohort study of hands-on cooking and nutrition education versus traditional curriculum for medical students. Methods This analysis provides a novel integration of artificial intelligence-based machine learning (ML) with causal inference statistics. 43 ML automated algorithms were tested, with the top performer compared to triply robust propensity score-adjusted multilevel mixed effects regression panel analysis of longitudinal data. Inverse-variance weighted fixed effects meta-analysis pooled the individual estimates for competencies. Results 3,248 unique medical trainees met study criteria from 20 medical schools nationally from August 1, 2012, to June 26, 2017, generating 4,026 completed validated surveys. ML analysis produced similar results to the causal inference statistics based on root mean squared error and accuracy. Hands-on cooking and nutrition education compared to traditional medical school curriculum significantly improved student competencies (OR 2.14, 95% CI 2.00–2.28, p < 0.001) and MedDiet adherence (OR 1.40, 95% CI 1.07–1.84, p = 0.015), while reducing trainees' soft drink consumption (OR 0.56, 95% CI 0.37–0.85, p = 0.007). Overall improved competencies were demonstrated from the initial study site through the scale-up of the intervention to 10 sites nationally (p < 0.001). Discussion This study provides the first machine learning-augmented causal inference analysis of a multisite cohort showing hands-on cooking and nutrition education for medical trainees improves their competencies counseling patients on nutrition, while improving students' own diets. This study suggests that the public health and medical sectors can unite population health management and precision medicine for a sustainable model of next-generation health systems providing effective, equitable, accessible care beginning with reversing the CVD epidemic.

Context: Sugar-sweetened beverage (SSB) taxes offer a promising public health strategy to decrease consumption of sugary beverages. To date, 7 US cities have successfully implemented SSB taxes; however, only a few studies have examined adoption and implementation processes. Objectives: To describe public health and policy lessons learned during the first 2.5 years of implementation of the Oakland, California, penny-per-ounce SSB tax, Measure HH. Design: A mixed-methods, longitudinal, qualitative case study was conducted using a combination of key informant interviews with implementation stakeholders as well as analyses of archival documents and media documents from 2016 to 2019. Interviews were digitally recorded and professionally transcribed. Interview transcripts, archival documents, and media documents were analyzed by 3 coders using Atlas.ti v8. Analyses employed principles of constant comparative analysis to identify themes related to lessons learned. Setting: Oakland, California. Participants: Key informants (n = 15), archival documents (n = 43), and media documents (n = 90). Intervention: Oakland, California's SSB tax (Measure HH). Results: Implementation lessons included both success stories and challenges. Successes included contracting a thirdparty tax administrator to support tax collection and education; leveraging a pro-tax coalition to counteract industry attacks and to protect tax revenue; and offering "quick win" funding to support local needs. Challenges were associated with implementing a "general" tax versus a "special" tax; the lack of explicit revenue allocation in the ordinance to support city-level implementation and oversight; and, the original ordinance language for tax application to distributors. Conclusions:The study offers a range of recommendations-derived from lessons learned over several years of implementation-to policy makers and advocates engaged in SSB tax adoption and implementation efforts in their jurisdictions. SSB tax implementation requires sufficient agency administrative capacity and a strong pro-tax coalition that engages local community organizations to respond to public health needs.

Purpose: To describe media coverage and framing of Oakland, California’s, sugar-sweetened beverage tax. Design: Media content analysis. Sample: Media documents (n = 90), published January 1, 2016-August 31, 2019, were retrieved from Oakland news outlets and ProQuest, NexusUni, EBSCO, and Google. Analysis: Documents were coded using constant comparative analysis in Atlas.ti v8; with descriptive analyses conducted using Stata/SE v. 15.1. Results: Documents were published evenly between pre- and post-ballot periods (n = 45); the majority (n = 47) provided neutral framing. Protax documents (n = 33) highlighted SSB consumption and health associations and countered antitax messaging; antitax documents (n = 10) focused on misinformation and sowing public confusion. Conclusion: Neutral media educates and raises awareness. Published prior to a vote, the media may help influence public opinion regarding SSB taxes. SSB tax media advocacy campaigns, giving particular attention to timing and perspective-based framing, may help to secure adoption and support implementation.