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Lally AE, Morina A, Vermont LN, Tirabassi JN, Leone LA. Impacts of the COVID-19 Pandemic on Mobile Produce Market Operations: Adaptations, Barriers, and Future Directions for Increasing Food Access. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11390. [PMID: 36141664 PMCID: PMC9517362 DOI: 10.3390/ijerph191811390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/26/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Mobile produce markets were increasingly recognized as an effective and accepted approach to improving access to fruits and vegetables in lower-income and at-risk communities during the first year of the COVID-19 pandemic in the United States. This study provides insights into how mobile market operations were impacted by, and evolved in response to, challenges posed by the pandemic. METHODS A survey evaluating impacts of the pandemic on mobile markets was distributed to a database of mobile market operators in the United States. Respondents were asked to describe impacts to their mobile market's operations, and what adaptations were needed to continue to effectively serve their communities during 2020. RESULTS Surveys representing 48 unique mobile markets were collected from March to July 2021. Of the respondents, 63% reported an increase in demand for mobile market services from community members. Furthermore, 65% increased the amount of produce they distributed in 2020 as compared to 2019, often through adopting low or no-cost models or participating in pandemic government programs. DISCUSSION Emergency adaptations employed by mobile markets can inform long-term operational modifications for not only mobile markets, but also other food access programs, beyond the COVID-19 pandemic.
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Affiliation(s)
- Anne E. Lally
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
- Department of Anthropology, The College of Arts and Sciences, University at Buffalo, Buffalo, NY 14261, USA
| | - Alban Morina
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Leah N. Vermont
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Jill N. Tirabassi
- Department of Family Medicine, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA
| | - Lucia A. Leone
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
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Vermont LN, Kasprzak C, Lally A, Claudio A, Tumiel-Berhalter L, Haynes-Maslow L, Ammerman A, Raja S, Leone LA. A Randomized Controlled Trial of a Research-Tested Mobile Produce Market Model Designed to Improve Diet in Under-Resourced Communities: Rationale and Design for the Veggie Van Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9832. [PMID: 36011468 PMCID: PMC9408281 DOI: 10.3390/ijerph19169832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
Mobile produce markets are increasingly popular retail vendors used for providing access to fresh fruits and vegetables (F&V) in under-resourced communities; however, evaluation is limited due to design and implementation challenges. This protocol presents the original design of a randomized control trial aimed at assessing the effectiveness of the evidence-based Veggie Van (VV) mobile market model. Nine US community partner organizations were asked to partner with four community sites serving lower-income areas. Sites are randomized to either intervention or control. Intervention sites will host a mobile market for one year while the control sites will host planning events, with the goal to open a market afterward. Eligible participants are aged ≥ 18, the primary household shopper, live nearby/regularly frequent the site, and have expressed interest in learning about a mobile market. The primary outcome, F&V consumption, will be assessed via dietary recall at baseline and 12 months and compared between the intervention and control sites. This research advances work on the VV model and methods for mobile market evaluation with the addition of more robust measures and the study design. Determining the effectiveness of the VV model is imperative to justify taking it to scale to enhance the impact of mobile markets.
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Affiliation(s)
- Leah N. Vermont
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Christina Kasprzak
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Anne Lally
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Alicia Claudio
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Laurene Tumiel-Berhalter
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA
| | - Lindsey Haynes-Maslow
- Department of Agricultural and Human Sciences, North Carolina State University, Raleigh, NC 27695, USA
| | - Alice Ammerman
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Samina Raja
- Department of Urban and Regional Planning, School of Architecture and Planning, University at Buffalo, Buffalo, NY 14214, USA
| | - Lucia A. Leone
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
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Teggart K, Ganann R, Sihota D, Moore C, Keller H, Senson C, Phillips SM, Neil-Sztramko SE. Group-based nutrition interventions to promote healthy eating and mobility in community-dwelling older adults: a systematic review. Public Health Nutr 2022; 25:1-32. [PMID: 35570675 PMCID: PMC9991860 DOI: 10.1017/s136898002200115x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 02/28/2022] [Accepted: 05/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To identify the efficacy of group-based nutrition interventions to increase healthy eating, reduce nutrition risk, improve nutritional status and improve physical mobility among community-dwelling older adults. DESIGN Systematic review. Electronic databases MEDLINE, CINAHL, EMBASE, PsycINFO and Sociological Abstracts were searched on July 15, 2020 for studies published in English since January 2010. Study selection, critical appraisal (using the Joanna Briggs Institute's tools) and data extraction were performed in duplicate by two independent reviewers. SETTING Nutrition interventions delivered to groups in community-based settings were eligible. Studies delivered in acute or long-term care settings were excluded. PARTICIPANTS Community-dwelling older adults aged 55+ years. Studies targeting specific disease populations or promoting weight loss were excluded. RESULTS Thirty-one experimental and quasi-experimental studies with generally unclear to high risk of bias were included. Interventions included nutrition education with behaviour change techniques (BCT) (e.g. goal setting, interactive cooking demonstrations) (n 21), didactic nutrition education (n 4), interactive nutrition education (n 2), food access (n 2) and nutrition education with BCT and food access (n 2). Group-based nutrition education with BCT demonstrated the most promise in improving food and fluid intake, nutritional status and healthy eating knowledge compared with baseline or control. The impact on mobility outcomes was unclear. CONCLUSIONS Group-based nutrition education with BCT demonstrated the most promise for improving healthy eating among community-dwelling older adults. Our findings should be interpreted with caution related to generally low certainty, unclear to high risk of bias and high heterogeneity across interventions and outcomes. Higher quality research in group-based nutrition education for older adults is needed.
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Affiliation(s)
- Kylie Teggart
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Rebecca Ganann
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Davneet Sihota
- Global Health Graduate Program, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Caroline Moore
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Heather Keller
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
- Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Christine Senson
- Healthy and Safe Communities Department, City of Hamilton Public Health Services, Hamilton, ON, Canada
| | - Stuart M Phillips
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Sarah E Neil-Sztramko
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ONL8S 4L8, Canada
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Implementing a Rural Natural Experiment: A Protocol for Evaluating the Impacts of Food Coops on Food Consumption, Resident's Health and Community Vitality. Methods Protoc 2022; 5:mps5020033. [PMID: 35448698 PMCID: PMC9025453 DOI: 10.3390/mps5020033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/09/2022] [Accepted: 04/11/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Local food environments are recognized by experts as a determinant of healthy eating. Food cooperatives (coop) can promote the accessibility to healthier foods and thus improve the health of the population, particularly in remote rural communities. Objective: To measure the effects of implementing a food coop in a disadvantaged community with poor access to food. We have two main research questions: (1). Does the establishment of a food coop in rural areas described as food deserts have an impact on accessibility, frequency of use, food consumption, food quality, and ultimately the health of individuals? (2). Does the establishment of a food coop in rural areas described as food deserts have an impact on food security and community vitality? Design: A natural experiment with a mixed pre/post method will be used. The sample is composed of households that came from geographically isolated communities (population: 215 to 885 inhabitants) which qualified as food deserts and located in rural areas of Quebec (Canada). All communities plan to open a food coop (in the years 2022–2023), and as their opening will be staggered over time, participants from communities with a new food coop (intervention) will be compared to communities awaiting the opening of their food coop (control). Data collection was carried out at three time points: (1) before; (2) 1 to 5 months after; and (3) 13 to 17 months after the opening of the coop. Questionnaires were used to measure sociodemographic variables, dietary intake, residents’ health, and community vitality. Semi-structured interviews were conducted with community stakeholders. Results: Few natural experiments have been conducted regarding the impact of implementing food coops. Gathering concrete data on the effectiveness and processes surrounding these interventions through natural experiments will help to quantify their impact and guide knowledge users and policymakers to make more informed decisions.
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Community-based culinary and nutrition education intervention promotes fruit and vegetable consumption. Public Health Nutr 2021; 25:437-449. [PMID: 34482851 PMCID: PMC8883782 DOI: 10.1017/s1368980021003797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The main objective of this study was to evaluate the impact of the Market to MyPlate (M2MP) program on fruit and vegetable consumption and cooking behaviours. Secondary objectives were to examine factors that affected participant retention and program completion, and analyse program feedback provided by participants. DESIGN This study conducted a mixed methods evaluation embedded within a cluster randomised controlled trial of the M2MP intervention. Adult participants completed a pre- and post-program survey reporting on their fruit and vegetable consumption and cooking behaviours. A subsample participated in structured interviews, providing feedback about M2MP and the impact of the program. SETTING Seven weekly classes took place in community centres and extension offices in central Illinois. PARTICIPANTS 120 adults and their families participated. Class cohorts were randomly assigned to one of three treatment groups: (1) nutrition education and cooking classes with produce allocations (PAE, n 39); (2) nutrition education and cooking classes only (EO, n 36) or (3) control group (n 45). RESULTS Compared to control, PAE participants reported larger increases from pre- to post-intervention in fruit (P = 0·001) and vegetable consumption (P = 0·002), with no differences in cooking frequency. Interview analyses identified key themes in behaviour changes due to M2MP, including reported increases in dietary variety, cooking self-efficacy and children's participation in cooking. CONCLUSIONS PAE participants who received an intervention that directly increased their access to fresh produce (via produce allocations) increased their reported fruit and vegetable consumption. Though participants' cooking frequency did not change, interviewees reported increased variety, cooking confidence and family participation in cooking.
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Zaslavsky O, Su Y, Kim B, Roopsawang I, Wu KC, Renn BN. Behavior change factors and retention in dietary interventions for older adults: scoping review. THE GERONTOLOGIST 2021; 62:e534-e554. [PMID: 34477843 DOI: 10.1093/geront/gnab133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although poor diet is a major driver of morbidity and mortality in people 60 and older, few dietary interventions are widely implemented for this population. We mapped behavior change theories, agents, and techniques in dietary interventions for adults 60+ and explored relationships between these factors and ability to retain at least 80% of the study participants. RESEARCH DESIGN AND METHODS We conducted a scoping review using MEDLINE, CINAHL, and Web of Science through April 2021 for dietary interventions in adults 60 and older. We collated, summarized, and calculated frequency distributions of behavior change theories, behavior change agents, and behavior change techniques (BCTs) using BCTv1 taxonomy with regard to participant retention across 43 studies. RESULTS Only 49% and 30% of the studies reported behavior theory and change agents respectively. Of the studies reporting on theory and agents, the most common were social cognitive theory and the related mechanism of self-efficacy. The most common BCTv1 were "shaping knowledge" and "goals and planning." Several BCTv1 such as "antecedents" and "reward and threat" and evidence for concordance between BCTs and change agents were more common in interventions with higher retention rates. DISCUSSION AND IMPLICATIONS Mechanistically concordant studies with BCTs that involve resource allocation and positive reinforcement through rewards may be advantageous for retention in dietary intervention for older adults. Future studies should continue developing theory and mechanism-oriented research. Furthermore, future studies should consider diversifying the portfolio of currently deployed BCTs and strengthening a concordance between BCTs and mechanisms of change.
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Affiliation(s)
- Oleg Zaslavsky
- Biobehavioral Nursing and Health Informatics Department, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Yan Su
- School of Nursing, University of Washington, Seattle, Washington, USA
| | - Boeun Kim
- School of Nursing, University of Washington, Seattle, Washington, USA
| | - Inthira Roopsawang
- Ramathibodi School of Nursing, Faculty of Medicine Ramthibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kuan-Ching Wu
- School of Nursing, University of Washington, Seattle, Washington, USA
| | - Brenna N Renn
- Department of Psychology, University of Nevada, Las Vegas, Nevada, USA.,Department of Psychiatry and Behavior Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
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Riemer S, Walkinshaw LP, Auvinen A, Marcinkevage J, Daniel M, Jones-Smith JC. Qualitative Study on Participant Perceptions of a Supermarket Fruit and Vegetable Incentive Program. J Acad Nutr Diet 2021; 121:1497-1506. [PMID: 33309590 PMCID: PMC9979618 DOI: 10.1016/j.jand.2020.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 09/23/2020] [Accepted: 10/07/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Complete Eats Rx is a fruit and vegetable prescription program designed to incentivize fruit and vegetable consumption among Supplemental Nutrition Assistance Program (SNAP) participants via $10 incentives distributed either weekly or per encounter to purchase fruits and vegetables at a mid-price supermarket chain in Washington State. OBJECTIVE To better understand SNAP participants' experience, and to determine perceived impacts and consequences of the program. DESIGN Qualitative analysis of nine photovoice sessions. Participants chose the topics for discussion. Sessions were audiorecorded and transcribed. Thematic content analysis was performed to identify key emergent themes using Atlas.ti. SETTING Spokane, Seattle, and Yakima, Washington. PARTICIPANTS Twenty-six individuals who received a fruit and vegetable prescription within the past 6 months, 23 of whom attended all three photovoice sessions offered at their site. Participants were recruited from three participating health care or public health organizations in Spokane, Seattle, and Yakima, Washington. ANALYSIS Transcriptions were coded using inductive methods. Coded statements were organized into major themes. Coding structures and analysis were strengthened by iterative interactions between researchers. RESULTS Participants reported Complete Eats Rx was an important resource for families and improved food security, diet quality, and the ability to purchase healthy foods, including a greater variety of fruits and vegetables. Primary barriers to food security and fruit and vegetable consumption included limited geographic accessibility and the high cost of fruits and vegetables, exacerbated by other financial constraints such as rising housing costs. Participants reported supermarket checkout difficulty because of embarrassment, stigmatization, and inability to redeem incentives. The most frequently mentioned barrier to perceived program acceptability was having only one supermarket chain as the acceptor of the incentive. CONCLUSION Partnering with supermarkets to accept fruit and vegetable incentives is a unique strategy to increase produce purchasing that can be adopted by other localities. Focus on geographic accessibility, appropriate price points, and positive shopping experiences via expansion to local grocers, improvements in staff interactions, and a transition to an electronic system may improve incentive redemption and usability.
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Dunn CG, Vercammen KA, Bleich SN, Mulugeta W, Granick J, Carney C, Zack RM. Participant Perceptions of a Free Fresh Produce Market at a Health Center. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:573-582. [PMID: 34246412 DOI: 10.1016/j.jneb.2021.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/18/2021] [Accepted: 03/25/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To examine participant perceptions of a free, monthly produce market at a health center in Massachusetts. DESIGN Participants were recruited at a produce market between June 2019 and January 2020 and engaged in a 30-65-minute focus group (n = 3 English language; n = 2 Spanish; n = 2 Arabic) conducted by trained facilitators using a semistructured guide. PARTICIPANTS Adults (n = 49) who had attended the market at least twice in the previous 6 months. MAIN OUTCOME MEASURES Participant-reported facilitators, barriers, perceived benefits, and opportunities for improvement. ANALYSIS Conventional content analysis. RESULTS Reported facilitators included accessibility (eg, convenient location and timing), program experience (eg, positive volunteer interactions), and characteristics of goods and services (eg, acceptable variety of produce). Barriers fell under similar themes and included transportation challenges, poor weather, and insufficient quantity of produce for larger households. Participants perceived the market as improving diet and finances and offered suggestions for improvement: distributing nonproduce foods (eg, meat) or nonfood items (eg, toiletries) and augmenting existing initiatives aimed to help attendees make use of the produce (eg, handing out recipe cards). CONCLUSIONS AND IMPLICATIONS The produce market was widely accepted, and targeted areas for improvement were identified. Findings may improve existing and future charitable produce markets among diverse populations.
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Affiliation(s)
- Caroline G Dunn
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA.
| | - Kelsey A Vercammen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
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Jung SE, Shin YH, Kim S, Hermann J, Dougherty Henry R. Habit is the Bridge between Intention and Behavior: A Look at Fruit and Vegetable Consumption among Low-Income Older Adults. J Nutr Gerontol Geriatr 2021; 40:215-231. [PMID: 34170212 DOI: 10.1080/21551197.2021.1944423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the influence of habit and theory of planned behavior (TPB) variables in predicting low-income older adults' fruit and vegetable (F&V) consumption. DESIGN Cross-sectional study. SETTING A city in the southeast United States. PARTICIPANTS A total of 372 low-income older adults participated in this study. RESULTS Participants completed a validated survey measuring TPB variables (attitude, subjective norm, perceived behavioral control, and intention), F&V intake using the Block Dietary Fruit-Vegetable Screener, and self-reported habit index to measure F&V consumption. Perceived behavioral control was the largest factor influencing intention to consume F&V, followed by attitude and subjective norm. In addition, there was a significant interaction between habit strength and intention, such that intention influenced F&V consumption only among individuals with average or higher habit strength. CONCLUSIONS Findings from this study suggest health promotion programs aimed at increasing F&V intake among low-income older adults should focus on establishing F&V intake as a habit so that an individual's intentions to consume F&V can be transformed into actual F&V intake. Also, emphasizing how to overcome potential barriers would improve low-income older adults' actual F&V intake by increasing their sense of control over consuming F&V.
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Affiliation(s)
- Seung Eun Jung
- Department of Human Nutrition and Hospitality Management, The University of Alabama, Tuscaloosa, AL, USA
| | - Yeon Ho Shin
- Department of Human Nutrition and Hospitality Management, The University of Alabama, Tuscaloosa, AL, USA
| | - Seoyoun Kim
- Department of Sociology, Texas State University, San Marcos, TX, USA
| | - Janice Hermann
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, USA
| | - Regan Dougherty Henry
- Department of Human Nutrition and Hospitality Management, The University of Alabama, Tuscaloosa, AL, USA
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Horning ML, Alver B, Porter L, Lenarz-Coy S, Kamdar N. Food insecurity, food-related characteristics and behaviors, and fruit and vegetable intake in mobile market customers. Appetite 2021; 166:105466. [PMID: 34139297 DOI: 10.1016/j.appet.2021.105466] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 04/20/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
Mobile markets (MM) bring affordable, quality, healthy foods to high-need, low-food access communities. However, little is known about food insecurity of MM customers. This manuscript evaluates food insecurity prevalence in MM customers and assesses associations between food insecurity and MM use, food-related characteristics and behaviors, and fruit and vegetable (FV) intake. Customers (N = 302) completed cross-sectional surveys in summer 2019 that assessed: food security, food availability, cooking attitude, self-efficacy for healthy cooking, self-efficacy for cooking and eating FV, social connectedness, and FV intake. Descriptive and multivariate analyses were used to describe and assess associations with food insecurity and FV intake. Results show most MM customers were food insecure (85%). In logistic regression models adjusted for sociodemographic characteristics, long-term MM use (OR = 0.77, CI = 0.60-0.997), access to affordable, quality foods (OR = 0.81, CI = 0.71-0.93), and self-efficacy for both cooking healthy foods (OR = 0.88, CI = 0.80-0.97) and cooking and eating FV (OR = 0.90, CI = 0.82-0.98) were associated with lower odds of food insecurity; negative cooking attitudes (OR = 1.12, CI = 1.02-1.24) were associated with higher odds of food insecurity. Being food insecure (β = -1.37, SE=0.43, p < 0.01) was associated with poorer FV intake; this association attenuated slightly (β = -1.22, SE=0.43, p < 0.01) when length of MM use was added to the general linear model, which was also associated with higher fruit and vegetable intake (β = 0.26, SE=0.10, p = 0.01). Results suggest the MM reaches customers experiencing high levels of food insecurity and long-term MM use is associated with lower food insecurity and higher FV intake. Relationships between food insecurity and several food characteristics/behaviors provide insight for potential targets for wrap-around interventions to address food insecurity among customers. Findings suggest longitudinal evaluation of the MM's impact on food security and other food-related characteristics/behaviors is warranted.
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Affiliation(s)
- Melissa L Horning
- School of Nursing, University of Minnesota, 5-140 Weaver Densford Hall, 308 Harvard St SE, Minneapolis, MN, 55414, USA.
| | - Bonnie Alver
- School of Nursing, University of Minnesota, 5-140 Weaver Densford Hall, 308 Harvard St SE, Minneapolis, MN, 55414, USA.
| | | | | | - Nipa Kamdar
- VA Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety (CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, TX, USA.
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An exploration of key barriers to healthcare providers' use of food prescription (FRx) interventions in the rural South. Public Health Nutr 2021; 24:1095-1103. [PMID: 33423706 DOI: 10.1017/s1368980020005376] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The purpose of this exploratory study was to examine the attitude towards food prescriptions (FRx) interventions among clinicians and identify potential barriers to their use in clinical practice. DESIGN The current study employed an exploratory research design using in-depth semi-structured interviews. Research participants were selected from primary care facilities, family practice offices and obesity clinics located in Mississippi and Louisiana. SETTING Providers selected for participation in the current study serve predominantly rural, low-income communities in the US South. PARTICIPANTS From an original population of fifty healthcare providers that included physicians, registered dieticians and nurse practitioners, from Oxford, Tupelo, Batesville, Jackson, and Charleston, MS and New Orleans, LA. Fifteen healthcare providers agreed to participate, including three physicians, four registered dieticians, three nurses and three nurse practitioners. RESULTS The current study found that while healthcare providers expressed a desire to use FRx interventions, there was a universal lack of understanding by healthcare providers of what FRx interventions were, how they were implemented and what outcomes they were likely to influence. CONCLUSIONS The current study identified key bottlenecks in the use of FRx interventions at the clinic level and data provided evidence for two key recommendations: (1) development and validation of a screening tool to be used by clinicians for enrolling patients in such interventions and (2) implementation of nutrition education in primary professional training, as well as in continuing education.
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Yoder AD, Proaño GV, Handu D. Retail Nutrition Programs and Outcomes: An Evidence Analysis Center Scoping Review. J Acad Nutr Diet 2020; 121:1866-1880.e4. [PMID: 33229206 DOI: 10.1016/j.jand.2020.08.080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/05/2020] [Accepted: 08/18/2020] [Indexed: 02/06/2023]
Abstract
As nutrition-related diseases contribute to rising health care costs, food retail settings are providing a unique opportunity for registered dietitian nutritionists (RDNs) to address the nutritional needs of consumers. Food as Medicine interventions play a role in preventing and/or managing many chronic conditions that drive health care costs. The objective of this scoping review was to identify and characterize literature examining Food as Medicine interventions within food retail settings and across consumer demographics. An electronic literature search of 8 databases identified 11,404 relevant articles. Results from the searches were screened against inclusion criteria, and intervention effectiveness was assessed for the following outcomes: improvement in health outcomes and cost-effectiveness. One-hundred and eighty-six papers and 25 systematic reviews met inclusion criteria. Five categories surfaced as single interventions: prescription programs, incentive programs, medically tailored nutrition, path-to-purchase marketing, and personalized nutrition education. Multiple combinations of intervention categories, reporting of health outcomes (nutritional quality of shopping purchases, eating habits, biometric measures), and cost-effectiveness (store sales, health care dollar savings) also emerged. The intervention categories that produced both improved health outcomes and cost-effectiveness included a combination of incentive programs, personalized nutrition education, and path-to-purchase marketing. Food as Medicine interventions in the food retail setting can aid consumers in navigating health through diet and nutrition by encompassing the following strategic focus areas: promotion of health and well-being, managing chronic disease, and improving food security. Food retailers should consider the target population and desired focus areas and should engage registered dietitian nutritionists when developing Food as Medicine interventions.
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Full-Service Twin Cities Mobile Market Impact: Qualitative Findings From Focus Groups With Customers. J Acad Nutr Diet 2020; 120:1548-1556.e1. [DOI: 10.1016/j.jand.2020.02.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/25/2020] [Indexed: 01/23/2023]
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Robitaille É, Paquette MC. Development of a Method to Locate Deserts and Food Swamps Following the Experience of a Region in Quebec, Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3359. [PMID: 32408608 PMCID: PMC7277603 DOI: 10.3390/ijerph17103359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 01/12/2023]
Abstract
Unhealthy eating and food insecurity are recognized risk factors for chronic diseases. Collective and environmental factors, such as geographic access to food condition food choices. The objective of this study was to map food deserts and food swamps in Gaspesie, a region of Quebec (Canada), using geographical information systems (GIS) and field validation. Eleven sectors (5 rural and 6 urban) where 5% of the Gaspesie population lives were considered food deserts. Eight sectors (all rural) constituting 4.5% of the population were considered food swamps. Nearly 88% (3/8) of food swamps were located in disadvantaged and very disadvantaged areas. The Gaspesie region is already actively involved in changing environments to make them conducive to healthy eating for all. The mapping of food deserts can support intersectoral collaboration on food security. Food swamp mapping will make it possible to more accurately characterize the existing food environment in the region. Both indicators will be useful in raising awareness and mobilizing partners for a comprehensive strategy to improve the food environment that is not only based on the food desert indicator alone but also takes into account the presence of food swamps.
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Affiliation(s)
- Éric Robitaille
- Institut National de Santé Publique du Québec, Montréal, QC H2P 1E2, Canada;
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Montréal, Montréal, QC H3C 3J7, Canada
| | - Marie-Claude Paquette
- Institut National de Santé Publique du Québec, Montréal, QC H2P 1E2, Canada;
- Department of Nutrition, University of Montréal, Montréal, QC H3C 3J7, Canada
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15
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Sharpe PA, Bell BA, Liese AD, Wilcox S, Stucker J, Hutto BE. Effects of a food hub initiative in a disadvantaged community: A quasi-experimental evaluation. Health Place 2020; 63:102341. [PMID: 32543428 PMCID: PMC7357735 DOI: 10.1016/j.healthplace.2020.102341] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 04/02/2020] [Accepted: 04/08/2020] [Indexed: 11/16/2022]
Abstract
A quasi-experiment evaluated a food hub's (FH) impact in a low-income/low-access (food desert) setting on fruit and vegetable (F&V) intake, diet quality, kilocalories, perceived food environment, BMI, and farmers' market shopping versus a matched community (n = 265 FH, n = 262 Comparison). Comparison shoppers had better baseline perceptions of their food environment, but FH shoppers improved significantly more than Comparison shoppers. Comparison shoppers significantly increased F&V intake versus FH shoppers. Effects were not significant for other diet outcomes, BMI, or farmers' market shopping. Factors besides spacial access to healthy food need consideration to address dietary intake and obesity in disadvantaged communities.
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Affiliation(s)
- Patricia A Sharpe
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC, 29208, United States.
| | - Bethany A Bell
- College of Social Work, University of South Carolina, 1512 Pendelton Street, Columbia, SC, 29208, United States.
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States.
| | - Sara Wilcox
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC, 29208, United States; Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC, 29208, United States.
| | - Jessica Stucker
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC, 29208, United States.
| | - Brent E Hutto
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC, 29208, United States.
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16
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Wolfson MD, Greeno C. Savoring surplus: effects of food rescue on recipients. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2020. [DOI: 10.1080/19320248.2018.1512921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Megan D. Wolfson
- University of Pittsburgh, School of Social Work, Cathedral of Learning, Pittsburgh
| | - Catherine Greeno
- University of Pittsburgh, School of Social Work, Cathedral of Learning, Pittsburgh
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17
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Rebouillat P, Bonin S, Kestens Y, Chaput S, Drouin L, Mercille G. Fruit and Vegetable Purchases in Farmer's Market Stands: Analysing Survey and Sales Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010088. [PMID: 31877682 PMCID: PMC6981572 DOI: 10.3390/ijerph17010088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 12/06/2019] [Accepted: 12/15/2019] [Indexed: 11/16/2022]
Abstract
Farmers' market implementation holds promise for increasing access to healthy foods. Although rarely measured, purchase data constitute an intermediate outcome between food environment and actual consumption. In a study conducted with two seasonal Fruits and Vegetables (FV) stands in a disadvantaged area of Montréal (Canada), we analysed how accessibility, perception, and mobility-related factors were associated with FV purchase. This analysis uses a novel measure of FV purchasing practices based on sales data obtained from a mobile application. A 2016 survey collected information on markets' physical access, perceived access to FV in the neighbourhood, usual FV consumption and purchases. Multivariate models were used to analyse three purchasing practice indicators: number of FV portions, FV variety and expenditures. Average shoppers purchased 12 FV portions of three distinct varieties and spent 5$. Shoppers stopping at the market on their usual travel route spent less (p = 0.11), bought fewer portions (p = 0.03) and a lesser FV variety (p < 0.01). FV stands may complement FV dietary intake. Individuals for whom the market is on their usual travel route might make more frequent visits and, therefore, smaller purchases. The novel data collection method allowed analysis of multiple purchase variables, is precise and easy to apply at unconventional points of sales and could be transposed elsewhere.
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Affiliation(s)
- Pauline Rebouillat
- Institut de Santé Publique d’Épidémiologie et de Développement (ISPED), Université de Bordeaux, 33000 Bordeaux, France
- Centre de recherche du Centre hospitalier de l’Université de Montréal, 850 St-Denis, Montréal, QC H2X 0A9, Canada
| | - Sarah Bonin
- Département de médecine sociale et préventive, École de Santé Publique de l’Université de Montréal, 7101 Avenue du Parc, Montréal, QC H3N 1X9, Canada
| | - Yan Kestens
- Centre de recherche du Centre hospitalier de l’Université de Montréal, 850 St-Denis, Montréal, QC H2X 0A9, Canada
- Département de médecine sociale et préventive, École de Santé Publique de l’Université de Montréal, 7101 Avenue du Parc, Montréal, QC H3N 1X9, Canada
| | - Sarah Chaput
- Centre de recherche du Centre hospitalier de l’Université de Montréal, 850 St-Denis, Montréal, QC H2X 0A9, Canada
- Département de médecine sociale et préventive, École de Santé Publique de l’Université de Montréal, 7101 Avenue du Parc, Montréal, QC H3N 1X9, Canada
| | - Louis Drouin
- Direction régionale de santé publique, Centre intégré universitaire de santé et services sociaux du Centre-Sud-de-l’Ile-de-Montréal, Montréal, QC H2L 1M3, Canada
| | - Geneviève Mercille
- Département de nutrition, Université de Montréal, 2450 Chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1A8, Canada
- Centre de recherche en santé publique, 1301 Sherbrooke Est, Montréal, QC H2L 1M3, Canada
- Correspondence:
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18
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Hollis-Hansen K, Vermont L, Zafron ML, Seidman J, Leone L. The introduction of new food retail opportunities in lower-income communities and the impact on fruit and vegetable intake: a systematic review. Transl Behav Med 2019; 9:837-846. [PMID: 31570930 PMCID: PMC8679116 DOI: 10.1093/tbm/ibz094] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023] Open
Abstract
A lack of access to fresh fruits and vegetables (F&Vs) is associated with consumption of fewer F&Vs and higher risk of obesity, especially for lower-income individuals. It is widely believed that the addition of new food retail opportunities could improve F&V consumption and subsequently reduce the chronic disease burden. Observational studies provide some support for these hypotheses, but contradictions exist. In this study we sought to examine if the introduction of a food retailer affects F&V consumption in lower-income communities. We used a systematic PRISMA approach to conduct this study. We searched PubMed, EMBASE, and ProQuest Dissertations & Theses for academic journal references and gray literature published before August 2018. Included studies were those looking at the effect of the introduction of a new food retailer on F&V consumption. Studies were also categorized based on which dimensions of food access were targeted by the food retailer. We identified 15 studies meeting inclusion criteria: 11 studies reported a positive increase in F&V consumption attributable to the introduction of a new food retailer, of which 6 were statistically significant. The remaining 4 studies, all of which examined the impact of introducing a new retail supermarket, showed no change or a decrease in F&V intake. Results from studies which change the food environment generally support the idea that increased access to healthy food improves diet, but more studies are needed in order to assess the differences between the various types of retailers, and to identify strategies for improving impact. Understanding which types of new food retail programs are most likely to impact diet has implications for policies which incentivize new food retail.
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Affiliation(s)
- Kelseanna Hollis-Hansen
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Leah Vermont
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
| | | | - Jennifer Seidman
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Lucia Leone
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
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19
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Horning ML, Porter L. Twin Cities Mobile Market Food Delivery Model: A Preliminary Study Describing Results of A Customer Intercept Survey and Point of Sale Data for 2016. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2019. [DOI: 10.1080/19320248.2019.1654426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Leah Porter
- Twin Cities Mobile Market, Amherst Wilder Foundation, Saint Paul, MN, USA
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20
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Depa J, Wolf A, Rössler V, Weiffenbach J, Hilzendegen C, Stroebele-Benschop N. The impact of providing fruits and vegetables to socially disadvantaged men. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2019. [DOI: 10.1080/19320248.2018.1464999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Julia Depa
- Department of Molecular and Applied Nutritional Psychology, University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany
- Department of Nutritional, Food and Consumer Sciences, University of Applied Sciences Fulda, Fulda, Germany
| | - Amelie Wolf
- Department of Molecular and Applied Nutritional Psychology, University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany
| | - Valeska Rössler
- Department of Molecular and Applied Nutritional Psychology, University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany
| | - Jana Weiffenbach
- Department of Molecular and Applied Nutritional Psychology, University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany
| | - Carolin Hilzendegen
- Department of Molecular and Applied Nutritional Psychology, University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany
| | - Nanette Stroebele-Benschop
- Department of Molecular and Applied Nutritional Psychology, University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany
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21
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Orsega-Smith E, Slesinger N, Cotugna N. Local Pediatricians Partner with Food Bank to Provide Produce Prescription Program. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2019. [DOI: 10.1080/19320248.2019.1592051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Nicole Slesinger
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
| | - Nancy Cotugna
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
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22
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Ylitalo KR, During C, Thomas K, Ezell K, Lillard P, Scott J. The Veggie Van: Customer characteristics, fruit and vegetable consumption, and barriers to healthy eating among shoppers at a mobile farmers market in the United States. Appetite 2019; 133:279-285. [DOI: 10.1016/j.appet.2018.11.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 09/04/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
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23
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Hsiao BS, Sibeko L, Troy LM. A Systematic Review of Mobile Produce Markets: Facilitators and Barriers to Use, and Associations with Reported Fruit and Vegetable Intake. J Acad Nutr Diet 2019; 119:76-97.e1. [DOI: 10.1016/j.jand.2018.02.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 02/27/2018] [Indexed: 11/28/2022]
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24
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Gary-Webb TL, Bear TM, Mendez DD, Schiff MD, Keenan E, Fabio A. Evaluation of a Mobile Farmer's Market Aimed at Increasing Fruit and Vegetable Consumption in Food Deserts: A Pilot Study to Determine Evaluation Feasibility. Health Equity 2018; 2:375-383. [PMID: 30582097 PMCID: PMC6301430 DOI: 10.1089/heq.2018.0003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: In November 2015, Greater Pittsburgh Community Food Bank implemented a pilot phase of the Green Grocer mobile market, a program aimed at improving access to locally sourced fresh foods in low-resource neighborhoods. We conducted an evaluation of this pilot phase. Methods: We conducted baseline surveys of residents in six neighborhoods that received Green Grocer in the pilot phase to understand the food environment, including perceptions of fresh food availability, and another survey of Green Grocer consumers to evaluate their experiences and satisfaction. We measured respondent intake of fruit and vegetable in the terms of days per week and servings per day. We used Poisson regression with cluster-robust standard errors to model the average change in produce consumption pre-post intervention. Results: Residents of select communities observed meaningful improvements in intake. After covariate adjustment, Homewood residents observed an average 13% increase in vegetable intake (days/week) rates post-Green Grocer (p=0.04). Clairton residents also showed marked increases, with an average 20% increase in vegetable intake (servings/day) (p=0.049). After 6 months, declines in produce purchase from discount stores and supercenters were observed alongside increases in procurement from Green Grocer, farmer's markets, gardens, and other sources. Conclusion: Our preliminary work provides support that this mobile market serving under-resourced areas was valued by consumers and showed increases in vegetable consumption in several neighborhoods. When scaled-up, this program had the potential to reduce geographically-based food and health disparities.
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Affiliation(s)
- Tiffany L Gary-Webb
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Todd M Bear
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Dara D Mendez
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Mary D Schiff
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Ehrrin Keenan
- Greater Pittsburgh Community Food Bank, Pittsburgh, Pennsylvania
| | - Anthony Fabio
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
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25
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Local Food Sources to Promote Community Nutrition and Health: Storefront Businesses, Farmers' Markets, and a Case for Mobile Food Vending. J Acad Nutr Diet 2018; 119:39-44. [PMID: 30447973 DOI: 10.1016/j.jand.2018.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/23/2018] [Accepted: 09/10/2018] [Indexed: 11/23/2022]
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26
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Epps F, Weeks G, Graham E, Luster D. Challenges to aging in place for African American older adults living with dementia and their families. Geriatr Nurs 2018; 39:646-652. [DOI: 10.1016/j.gerinurse.2018.04.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 04/27/2018] [Indexed: 11/25/2022]
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27
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Tani Y, Suzuki N, Fujiwara T, Hanazato M, Kondo N, Miyaguni Y, Kondo K. Neighborhood food environment and mortality among older Japanese adults: results from the JAGES cohort study. Int J Behav Nutr Phys Act 2018; 15:101. [PMID: 30340494 PMCID: PMC6194719 DOI: 10.1186/s12966-018-0732-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 10/09/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Previous research has linked lower availability of food stores selling fruits and vegetables to unhealthy diet. However, the longitudinal association between the availability of healthy food stores and mortality is unknown. This study examined the association between neighborhood availability of food stores and mortality by driving status among older adults. METHODS This study drew upon a three-year follow up of participants in the Japan Gerontological Evaluation Study, a population-based cohort study of Japanese adults aged 65 years or older. Mortality from 2010 to 2013 was analyzed for 49,511 respondents. Neighborhood availability of food stores was defined as the number of food stores selling fruits and vegetables within a 500-m or 1-km radius of a person's residence. Both subjective (participant-reported) and objective (geographic information system-based) measurements were used to assess this variable. Cox regression models were used to estimate hazard ratios (HR) for mortality. RESULTS A total of 2049 deaths occurred during the follow up. Lower subjective availability of food stores was significantly associated with increased mortality. Compared with participants reporting the highest availability, the age- and sex-adjusted HR for those reporting the lowest availability was 1.28 (95% CI: 1.04-1.58; p = 0.02). The association remained significant after adjustment for sociodemographic (education, income, cohabitation, marital status, and employment status) and environmental (driving status, use of public transportation, and study site) status (HR = 1.24, 95% CI: 1.01-1.53, p = 0.04). This association was stronger among non-car users, among whom the HR for those reporting the lowest availability of food stores was 1.61 (95% CI: 1.08-2.41, p = 0.02). In contrast, no significant association was seen between objective availability and mortality. CONCLUSIONS Lower availability of healthy food stores measured subjectively, but not objectively, was associated with mortality, especially among non-car users. Considering the decline in mobility with age, living in a neighborhood with many options for procuring fruits and vegetables within walking distance may be important for healthy aging.
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Grants
- 16K16295 and 16J11423 Japan Society for the Promotion of Science
- 22330172, 22390400, 23243070, 23590786, 23790710, 24390469, 24530698, 24683018, 25253052, 25870573, 25870881, 26285138, 26882010, 15H01972 Japan Society for the Promotion of Science
- Numbers H22-Choju-Shitei-008, H24-Junkanki[Seishu]-Ippan-007, H24-Chikyukibo-Ippan-009, H24-Choju-Wakate-009, H25-Kenki-Wakate-015, H25-Choju-Ippan-003, H26-Irryo-Shitei-003[Fukkou], H26-Choju-Ippan-006, H27-Ninchisyou-Ippan-001, H28-Choju-Ippan-002 Health Labour Sciences Research Grants
- 24-17 and 24-23 Research Funding for Longevity Sciences from the National Center for Geriatrics and Gerontology
- Ministry of Education, Culture, Sports, Science and Technology, Japan
- a Lotte Research Promotion Grant
- Japan Agency for Medical Research and Development
- the Japan Foundation for Aging and Health
- World Health Organization Centre for Health Development
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Affiliation(s)
- Yukako Tani
- Department of Global Health Promotion, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519 Japan
- Japan Society for the Promotion of Science, 5-3-1, Kojimachi, Chiyoda-ku, Tokyo, 102-0083 Japan
| | - Norimichi Suzuki
- Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoicho, Inage-ku, Chiba-shi, Chiba, 263-8522 Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519 Japan
| | - Masamichi Hanazato
- Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoicho, Inage-ku, Chiba-shi, Chiba, 263-8522 Japan
| | - Naoki Kondo
- Department of Health Education and Health Sociology, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Yasuhiro Miyaguni
- Department of Gerontological Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morikoka-cho, Obu-shi, Aichi 474-8511 Japan
| | - Katsunori Kondo
- Department of Gerontological Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morikoka-cho, Obu-shi, Aichi 474-8511 Japan
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8672 Japan
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28
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Gans KM, Risica PM, Keita AD, Dionne L, Mello J, Stowers KC, Papandonatos G, Whittaker S, Gorham G. Multilevel approaches to increase fruit and vegetable intake in low-income housing communities: final results of the 'Live Well, Viva Bien' cluster-randomized trial. Int J Behav Nutr Phys Act 2018; 15:80. [PMID: 30126463 PMCID: PMC6102886 DOI: 10.1186/s12966-018-0704-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 07/20/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Fruit and vegetable (F&V) intake can reduce risks for chronic disease, but is much lower than recommended amounts in most Western populations, especially for those with low income levels. Rigorous research is needed on practical, cost-effective interventions that address environmental as well as personal determinants of F&V intake. This paper presents the results of a cluster randomized controlled trial evaluating the efficacy of 'Live Well, Viva Bien' (LWVB), a multicomponent intervention that included discount, mobile fresh F&V markets in conjunction with nutrition education. METHODS Fifteen subsidized housing sites in Providence County, Rhode Island (8 intervention and 7 control sites) were randomized using a random number generator. Of these, nine housed elderly and/or disabled residents and six housed families. A total of 1597 adult housing site residents (treatment n = 837; control n = 760) were enrolled (73% women, 54% Hispanic, 17% black, Mean age 54 years). A year-long multicomponent intervention including mobile F&V markets plus nutrition education (e.g. campaigns, DVDs, newsletters, recipes, and chef demonstrations) was implemented at intervention sites. Physical activity and stress interventions were implemented at control sites. Follow-up occurred at 6 and 12 months. The main outcome measure was F&V consumption measured by National Cancer Institute's 'Eating at America's Table All Day Screener'. RESULTS From baseline to 12 months, the intervention group increased total F&V intake by 0.44 cups with the control group decreasing intake by 0.08 cups (p < .02). Results also showed an increased frequency of F&V eating behaviors compared to the control group (p < .01). There was a clear dose response effect of the F&V markets with participants who reported attending all or most of the markets increasing F&V intake by 2.1 cups and 0.86 cups, respectively compared with less than half cup increases for lower levels of market attendance (p < .05). Use of the DVDs, recipes and taste-testings was also associated with greater increases in F&V intake; however, use of other educational components was not. CONCLUSIONS LWVB is the first cluster, randomized controlled trial to demonstrate the efficacy of year-round F&V markets on improving F&V intake for low-income adults, which provides an evidence-base to bolster the mission of mobile produce markets. Further, the results more broadly support investment in environmental changes to alleviate disparities in F&V consumption and diet-related health inequities. TRIAL REGISTRATION NUMBER Clinicatrials.gov registration number: NCT02669472.
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Affiliation(s)
- Kim M. Gans
- Department of Human Development and Family Studies, University of Connecticut, Storrs, USA
- University of Connecticut Intitute for Collaboration in Health, Interventions and Policy, Storrs, USA
- Center for Health Equity Research, Brown University School of Public Health, Providence, USA
- Deartment of Behavioral and Social Science, Brown University School of Public Health, Providence, USA
| | - Patricia Markham Risica
- Center for Health Equity Research, Brown University School of Public Health, Providence, USA
- Deartment of Behavioral and Social Science, Brown University School of Public Health, Providence, USA
| | - Akilah Dulin Keita
- Center for Health Equity Research, Brown University School of Public Health, Providence, USA
- Deartment of Behavioral and Social Science, Brown University School of Public Health, Providence, USA
| | - Laura Dionne
- Center for Health Equity Research, Brown University School of Public Health, Providence, USA
| | - Jennifer Mello
- Center for Health Equity Research, Brown University School of Public Health, Providence, USA
| | - Kristen Cooksey Stowers
- University of Connecticut Intitute for Collaboration in Health, Interventions and Policy, Storrs, USA
- University of Connecticut Rudd Center for Food Policy and Obesity, Hartford, USA
| | - George Papandonatos
- Department of Statistical Scieces, Brown University School of Public Health, Providence, USA
| | | | - Gemma Gorham
- Department of Human Development and Family Studies, University of Connecticut, Storrs, USA
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29
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Promoting access to fresh fruits and vegetables through a local market intervention at a subway station. Public Health Nutr 2018; 21:3258-3270. [PMID: 30101730 DOI: 10.1017/s1368980018001921] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Alternative food sources (AFS) such as local markets in disadvantaged areas are promising strategies for preventing chronic disease and reducing health inequalities. The present study assessed how sociodemographic characteristics, physical access and fruit and vegetable (F&V) consumption are associated with market use in a newly opened F&V market next to a subway station in a disadvantaged neighbourhood. DESIGN Two cross-sectional surveys were conducted among adults: (i) on-site, among shoppers who had just bought F&V and (ii) a telephone-based population survey among residents living within 1 km distance from the market. SETTING One neighbourhood in Montreal (Canada) with previously limited F&V offerings. SUBJECTS Respectively, 218 shoppers and 335 residents completed the on-site and telephone-based population surveys. RESULTS Among shoppers, 23 % were low-income, 56 % did not consume enough F&V and 54 % did not have access to a car. Among all participants living 1 km from the market (n 472), market usage was associated (OR; 95 % CI) with adequate F&V consumption (1·86; 1·10, 3·16), living closer to the market (for distance: 0·86; 0·76, 0·97), having the market on the commute route (2·77; 1·61, 4·75) and not having access to a car (2·96; 1·67, 5·26). CONCLUSIONS When implemented in strategic locations such as transport hubs, AFS like F&V markets offer a promising strategy to improve F&V access among populations that may be constrained in their food acquisition practices, including low-income populations and those relying on public transportation.
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Bradford VA, Quinn EL, Walkinshaw LP, Rocha A, Chan NL, Saelens BE, Johnson DB. Fruit and vegetable access programs and consumption in low-income communities. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2018. [DOI: 10.1080/19320248.2018.1498819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Victoria A. Bradford
- University of Washington Department of Health Services, Center for Public Health Nutrition, University of Washington, Seattle, Washington, USA
| | - Emilee L. Quinn
- University of Washington Department of Health Services, Center for Public Health Nutrition, University of Washington, Seattle, Washington, USA
| | - Lina P. Walkinshaw
- University of Washington Department of Health Services, Center for Public Health Nutrition, University of Washington, Seattle, Washington, USA
| | - Anita Rocha
- Data Manager and Research Analyst, SSW: West Coast Poverty Center, University of Washington, Seattle, Washington, USA
| | - Nadine L. Chan
- Assessment, Policy Development, and Evaluation Unit Public Health, Seattle, King County, Washington, USA
- Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, Washington, USA
| | - Brian E. Saelens
- Pediatrics and Psychiatry & Behavioral Sciences, University of Washington and Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Donna B. Johnson
- University of Washington School of Public Health, Nutritional Sciences Program, Center for Public Health Nutrition, University of Washington, Seattle, Washington, USA
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Leone LA, Tripicchio GL, Haynes-Maslow L, McGuirt J, Grady Smith JS, Armstrong-Brown J, Kowitt SD, Gizlice Z, Ammerman AS. A Cluster-Randomized Trial of a Mobile Produce Market Program in 12 Communities in North Carolina: Program Development, Methods, and Baseline Characteristics. J Acad Nutr Diet 2018; 119:57-68. [PMID: 29945851 DOI: 10.1016/j.jand.2018.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 04/15/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mobile markets are an increasingly popular method for providing access to fresh fruits and vegetables (F/V) in underserved communities; however, evaluation of these programs is limited, as are descriptions of their development, study designs, and needs of the populations they serve. OBJECTIVE Our aim was to describe the development and theoretical basis for Veggie Van (VV), a mobile produce market intervention, the study design for the VV evaluation, and baseline characteristics of the study population. DESIGN The protocol and sample for a cluster-randomized controlled trial with 12 sites are described. PARTICIPANTS/SETTING Community partner organizations in the Triangle region of North Carolina that primarily served lower-income families or were located in areas that had limited access to fresh produce were recruited. Eligible individuals at each site (older than 18 years of age, self-identified as the main shoppers for their household, and expressed interest in using a mobile market) were targeted for enrollment. A total of 201 participants at 12 sites participated in the VV program and evaluation, which was implemented from November 2013 to March 2016. MAIN OUTCOME MEASURES Change in F/V intake (cups/day), derived from self-reported responses to the National Cancer Institute F/V screener, was the main outcome measure. STATISTICAL ANALYSES PERFORMED We performed a descriptive analysis of baseline sample characteristics. RESULTS Mean reported F/V intake was 3.4 cups/day. Participants reported generally having some access to fresh F/V, and 57.7% agreed they could afford enough F/V to feed their family. The most frequently cited barriers were cost (55.7%) and time to prepare F/V (20.4%). Self-efficacy was lowest for buying more F/V than usual and trying new vegetables. CONCLUSIONS By addressing cost and convenience and building skills for purchasing and preparing F/V, the VV has the potential to improve F/V consumption in underserved communities.
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Mobile produce market influences access to fruits and vegetables in an urban environment. Public Health Nutr 2018; 21:1332-1344. [DOI: 10.1017/s1368980017003755] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveTo assess the influence of a mobile produce market (MPM) on fruit and vegetable access.DesignNovel application of a structured assessment (five dimensions of access framework) to examine fruit and vegetable access through self-administered surveys on shopping behaviours, and perceptions and experiences of shopping at the MPM.SettingLow-income neighbourhoods with limited access to fruits and vegetables.SubjectsOlder (≥60 years) and younger (18–59·9 years) shoppers.ResultsParticipants were more likely to be women and non-White, one-third lived alone and nearly half were older adults. Compared with younger, older participants had different shopping behaviours: tended to purchase food for one person (P < 0·001), be long-term shoppers (P=0·002) and use electronic benefit transfer (EBT) cards (P=0·012). Older adults were more likely to like the market location (P=0·03), while younger adults were more likely to want changes in location (P=0·04), more activities (P=0·04), taste sampling (P=0·05) and nutritional counselling (P=0·01). The MPM captured all dimensions of access: availability, indicated by satisfaction with the produce variety for nearly one-third of all participants; accessibility, indicated by participants travelling <1 mile (<1·6 km; 72·2 %) and appreciation of location (72·7 %); affordability, indicated by satisfaction with price (47·6 %); acceptability, indicated by appreciation of produce quality (46·2 %); and accommodation, indicated by satisfaction with safety of location (30·1 %) and high EBT use among older adults (41·8 %).ConclusionsMPM may influence fruit and vegetable access in low-income urban neighbourhoods by facilitating the five dimensions of access and may especially benefit older adults and individuals living alone.
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Leone LA, Tripicchio GL, Haynes-Maslow L, McGuirt J, Grady Smith JS, Armstrong-Brown J, Gizlice Z, Ammerman A. Cluster randomized controlled trial of a mobile market intervention to increase fruit and vegetable intake among adults in lower-income communities in North Carolina. Int J Behav Nutr Phys Act 2018; 15:2. [PMID: 29304862 PMCID: PMC5756418 DOI: 10.1186/s12966-017-0637-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 12/18/2017] [Indexed: 11/15/2022] Open
Abstract
Background Poorer diets and subsequent higher rates of chronic disease among lower-income individuals may be partially attributed to reduced access to fresh fruits and vegetables (F&V) and other healthy foods. Mobile markets are an increasingly popular method for providing access to F&V in underserved communities, but evaluation efforts are limited. The purpose of this study was to determine the impact of Veggie Van (VV), a mobile produce market, on F&V intake in lower-income communities using a group randomized controlled trial. Methods VV is a mobile produce market that sells reduced-cost locally grown produce and offers nutrition and cooking education. We recruited 12 sites in lower-income communities in North Carolina (USA) to host VV, randomizing them to receive VV immediately (intervention) or after the 6-month study period (delayed intervention control). Participants at each site completed baseline and follow-up surveys including F&V intake, perceived access to fresh F&V and self-efficacy for purchasing, preparing and eating F&V. We used multiple linear regression to calculate adjusted differences in outcomes while controlling for baseline values, education and clustering within site. Results Among 142 participants who completed the follow-up, baseline F&V intake was 3.48 cups/day for control and 3.33 for intervention. At follow-up, adjusted change in F&V consumption was 0.95 cups/day greater for intervention participants (p = 0.005), but was attenuated to 0.51 cups per day (p = 0.11) after removing extreme values. VV customers increased their F&V consumption by 0.41 cups/day (n = 30) compared to a 0.25 cups/day decrease for 111 non-customers (p = 0.04). Intervention participants did not show significant improvements in perceived access to fresh F&V, but increased their self-efficacy for working more F&V into snacks (p = 0.02), making up a vegetable dish with what they had on hand (p = 0.03), and cooking vegetables in a way that is appealing to their family (p = 0.048). Conclusions Mobile markets may help improve F&V intake in lower-income communities. Trial registration Clinicaltrials.gov ID# NCT03026608 retrospectively registered January 2, 2017. Electronic supplementary material The online version of this article (10.1186/s12966-017-0637-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lucia A Leone
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA.
| | - Gina L Tripicchio
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lindsey Haynes-Maslow
- Department of Agricultural and Human Sciences, North Carolina State University, Raleigh, NC, USA
| | - Jared McGuirt
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jacqueline S Grady Smith
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Ziya Gizlice
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alice Ammerman
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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The dietary impact of introducing new retailers of fruits and vegetables into a community: results from a systematic review. Public Health Nutr 2017; 21:981-991. [PMID: 29284549 DOI: 10.1017/s1368980017003226] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the potential dietary impact of the opening of new retailers of healthy foods. DESIGN Systematic review of the peer-reviewed research literature. SETTING References published before November 2015 were retrieved from MEDLINE, EMBASE and Web of Science databases using keyword searches. SUBJECTS The outcome of the review was change in fruit and vegetable consumption among adults. RESULTS Of 3514 references retrieved, ninety-two articles were reviewed in full text, and twenty-three articles representing fifteen studies were included. Studies used post-test only (n 4), repeated cross-sectional (n 4) and repeated measures designs (n 7) to evaluate the dietary impact of supermarket (n 7), farmers' market (n 4), produce stand (n 2) or mobile market (n 2) openings. Evidence of increased fruit and vegetable consumption was most consistent among adults who began shopping at the new retailer. Three of four repeated measures studies found modest, albeit not always statistically significant, increases in fruit and vegetable consumption (range 0·23-0·54 servings/d) at 6-12 months after baseline. Dietary change among residents of the broader community where the new retailer opened was less consistent. CONCLUSIONS The methodological quality of studies, including research designs, sampling methods, follow-up intervals and outcome measures, ranged widely. Future research should align methodologically with previous work to facilitate meta-analytic synthesis of results. Opening a new retailer may result in modest short-term increases in fruit and vegetable consumption among adults who choose to shop there, but the potential longer-term dietary impact on customers and its impact on the broader community remain unclear.
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Bryce R, Guajardo C, Ilarraza D, Milgrom N, Pike D, Savoie K, Valbuena F, Miller-Matero LR. Participation in a farmers' market fruit and vegetable prescription program at a federally qualified health center improves hemoglobin A1C in low income uncontrolled diabetics. Prev Med Rep 2017; 7:176-179. [PMID: 28702315 PMCID: PMC5496208 DOI: 10.1016/j.pmedr.2017.06.006] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 06/12/2017] [Accepted: 06/18/2017] [Indexed: 11/25/2022] Open
Abstract
Fruit and vegetable prescription programs have been shown to increase consumption of fresh produce, but whether they have an impact on medical outcomes is unknown. The purpose of this study was to examine the role of participation in a farmers' market and fruit and vegetable prescription program on changes in hemoglobin A1C (HbA1C), blood pressure (BP) and weight in patients with uncontrolled type 2 diabetes at a federally qualified health center (FQHC) in Detroit, MI. The 13-week Fresh Prescription program (June 2015-October 2015) was designed to improve access and consumption of produce among low-income patients with uncontrolled type 2 diabetes. The program allotted up to $40 ($10 per week for up to four weeks) for purchase of produce from a FQHC located farmers' market. Adult, non-pregnant patients with a history of type 2 diabetes that had an elevated HbA1C > 6.5 within three months before Fresh Prescription program were eligible to participate. HgA1c, BP and weight were collected within three months of program start and within three months of completion. There were 65 eligible participants with complete biometric data. A statistically significant (p = 0.001) decrease in HbA1C was found (9.54% to 8.83%). However, weight (208.3 lbs. to 209.0 lbs.) and BP (135.1/79.3 mm Hg to 135.8/77.6 mm Hg) did not change from pre- to post-study (p > 0.05). Access to a fruit and vegetable prescription program over a 13-week period led to decreased HbA1C concentrations in uncontrolled type 2 diabetic patients living in an urban area of predominately-lower socioeconomic status.
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Affiliation(s)
- Richard Bryce
- Community Health and Social Services (CHASS) Center, 5635 W. Fort St, Detroit, MI 48209, United States
- Henry Ford Health System, 2799 W. Grand Blvd., Detroit, MI 48202, United States
| | - Claudia Guajardo
- Community Health and Social Services (CHASS) Center, 5635 W. Fort St, Detroit, MI 48209, United States
| | - Deliana Ilarraza
- Community Health and Social Services (CHASS) Center, 5635 W. Fort St, Detroit, MI 48209, United States
| | - Nicki Milgrom
- Ecology Center, 339 E. Liberty St., Suite 300, Ann Arbor, MI 48104, United States
| | - Denise Pike
- Community Health and Social Services (CHASS) Center, 5635 W. Fort St, Detroit, MI 48209, United States
| | - Kathryn Savoie
- Ecology Center, 339 E. Liberty St., Suite 300, Ann Arbor, MI 48104, United States
| | - Felix Valbuena
- Community Health and Social Services (CHASS) Center, 5635 W. Fort St, Detroit, MI 48209, United States
- Henry Ford Health System, 2799 W. Grand Blvd., Detroit, MI 48202, United States
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Jiang Q, Cohen NL, Marra MV, Woolf K, Gilbride J, Francis SL. Community Priorities for Healthy Eating in Older Adults. J Nutr Gerontol Geriatr 2017; 36:75-91. [PMID: 29048239 DOI: 10.1080/21551197.2017.1365039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Community planners such as policymakers and health care and nutrition service providers can create an "age-friendly" environment to support healthy eating in older residents by addressing the highest priorities that enable older adults to improve their dietary intake through different food-related community settings. To identify and prioritize these factors that facilitate behavioral change (enablers) and behavioral settings important for older adult nutrition based on the social ecological model, nutrition and aging professionals (n = 30) from two rural (West Virginia, Iowa) and two urban (Massachusetts, New York) city/county regions (communities) participated in an online or live focus group discussion and completed an analytic hierarchy process survey online. Overall, the most important perceived enablers were accessibility and cost, followed by transportation and social support, but their relative importance varied by community. Participants from all communities considered congregate meal sites and food banks among the most important behavioral settings. Participants from most communities considered food stores to be important and also highlighted other settings unique to the area, such as senior housing, neighborhood, and farmers' markets. By targeting interventions to address the most notable enablers and behavioral settings specific to their community, planning groups can enhance their older residents' ability to achieve optimal nutritional health.
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Affiliation(s)
- Qianzhi Jiang
- a Department of Nutrition , The University of Massachusetts Amherst , Amherst , MA , USA
| | - Nancy L Cohen
- a Department of Nutrition , The University of Massachusetts Amherst , Amherst , MA , USA
| | - Melissa Ventura Marra
- b Department of Human Nutrition and Foods , West Virginia University , Morgantown , WV , USA
| | - Kathleen Woolf
- c Department of Nutrition and Food Studies, and Public Health , New York University , New York , NY , USA
| | - Judith Gilbride
- c Department of Nutrition and Food Studies, and Public Health , New York University , New York , NY , USA
| | - Sarah L Francis
- d Department of Food Science and Human Nutrition , Iowa State University , Ames , IA , USA
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Hazavehei SMM, Afshari M. The role of nutritional interventions in increasing fruit and vegetable intake in the elderlies: a systematic review. Aging Clin Exp Res 2016; 28:583-98. [PMID: 26423564 DOI: 10.1007/s40520-015-0454-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/11/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND The consumption of fruit and vegetables in old ages is particularly important, so that the appropriate consumption amount leads to reduction in the risk of chronic diseases. To increase consumption of fruit and vegetables and modify consumption pattern in the elderlies, training programs and appropriate intervention can be designed and implemented. AIMS The study was done to assess and compare nutritional intervention-based training methods and education using theories and health education models for the consumption of fruits and vegetables in the elderlies. METHODS Electronic search using keywords of Country Review Information Bank (Magiran), Scientific Information Database, Pub Med, Science direct, Science, Biomed central from the beginning of March 2014 to end of April 2015 was performed. RESULTS Ten interventional studies were assessed in this systematic study. The interventions were divided into two groups of studies, a total of five studies, theories and health education models were the basis of training intervention and the other five studies that include their interventions without the use of theories and health education models was carried out. Of ten interventional studies, three studies as before and after and seven studies as the intervention and control was performed. DISCUSSION The results showed that education-based theory and health education models have a greater impact on the consumption of fruit and vegetables in the elderlies. CONCLUSIONS The duration and interventions performing method, environmental factors and educational programs using appropriate models and theories are important on the effectiveness of interventions to increase consumption of fruit and vegetables in the elderliness.
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Affiliation(s)
- Seyed Mohammad Mehdi Hazavehei
- Research Center for Health Science and Department of Public Health, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Afshari
- School of Public Health, Student Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
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Gans KM, Gorham G, Risica PM, Dulin-Keita A, Dionne L, Gao T, Peters S, Principato L. A multi-level intervention in subsidized housing sites to increase fruit and vegetable access and intake: Rationale, design and methods of the 'Live Well, Viva Bien' cluster randomized trial. BMC Public Health 2016; 16:521. [PMID: 27353149 PMCID: PMC4924350 DOI: 10.1186/s12889-016-3141-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/19/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adequate fruit and vegetable (F&V) intake is important for disease prevention. Yet, most Americans, especially low-income and racial/ethnic minorities, do not eat adequate amounts. These disparities are partly attributable to food environments in low-income neighborhoods where residents often have limited access to affordable, healthful food and easy access to inexpensive, unhealthful foods. Increasing access to affordable healthful food in underserved neighborhoods through mobile markets is a promising, year-round strategy for improving dietary behaviors and reducing F&V intake disparities. However, to date, there have been no randomized controlled trials studying their effectiveness. The objective of the 'Live Well, Viva Bien' (LWVB) cluster randomized controlled trial is to evaluate the efficacy of a multicomponent mobile market intervention at increasing F&V intake among residents of subsidized housing complexes. METHODS/DESIGN One housing complex served as a pilot site for the intervention group and the remaining 14 demographically-matched sites were randomized into either the intervention or control group. The intervention group received bimonthly, discount, mobile, fresh F&V markets in conjunction with a nutrition education intervention (two F&V campaigns, newsletters, DVDs and cooking demonstrations) for 12 months. The control group received physical activity and stress reduction interventions. Outcome measures include F&V intake (measured by two validated F&V screeners at baseline, six-month and twelve-months) along with potential psychosocial mediating variables. Extensive quantitative and qualitative process evaluation was also conducted throughout the study. DISCUSSION Modifying neighborhood food environments in ways that increase access to affordable, healthful food is a promising strategy for improving dietary behaviors among low-income, racial and ethnic minority groups at increased risk for obesity and other food-related chronic diseases. Discount, mobile F&V markets address all the major barriers to eating more F&V (high cost, poor quality, limited access and limited time to shop and cook) and provide a year-round solution to limited access to healthful food in low-income neighborhoods. LWVB is the first randomized controlled trial evaluating the effectiveness of mobile markets at increasing F&V intake. If proven efficacious at increasing F&V consumption, LWVB could be disseminated widely to neighborhoods that have low access to fresh F&V. TRIALS REGISTRATION Clinicatrials.gov registration number: NCT02669472 First Received: January 19, 2016.
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Affiliation(s)
- Kim M Gans
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI, 02912, USA.
- Department of Human Development and Family Studies and Center for Health Interventions and Prevention, University of Connecticut, Storrs, CT, 06269, USA.
| | - Gemma Gorham
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI, 02912, USA
| | - Patricia M Risica
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI, 02912, USA
| | - Akilah Dulin-Keita
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI, 02912, USA
| | - Laura Dionne
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI, 02912, USA
| | - Tina Gao
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI, 02912, USA
| | - Sarah Peters
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI, 02912, USA
| | - Ludovica Principato
- Department of Management, Sapienza University of Rome, Sapienza University, Rome, Italy
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Leone LA, Haynes-Maslow L, Ammerman AS. Veggie Van Pilot Study: Impact of a Mobile Produce Market for Underserved Communities on Fruit and Vegetable Access and Intake. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2016; 12:89-100. [PMID: 28529669 DOI: 10.1080/19320248.2016.1175399] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We conducted a pilot evaluation of the Veggie Van, a mobile produce market that brings weekly boxes of reduced-cost locally grown fruits and vegetables (F&V) to lower-income communities and offers cooking and nutrition education to customers. We conducted surveys just prior to starting Veggie Van at each of 3 sites and again at 2-3 months. F&V intake was measured with a 2-question item and a 10-item food frequency questionnaire (FFQ) in a subset of participants. At baseline, average servings/day of F&V was 4.9 (SD = 2.6, n = 60). At follow-up, individuals who reported shopping at Veggie Van frequently (n = 32) increased their F&V consumption by 0.41 servings/day compared with a decrease of -1.19 for those who rarely/never used Veggie Van (n = 27), a total difference of 1.6 servings/day (P = .01). There were no statistically significant differences in F&V consumption between groups based on the FFQ measure. Frequent shoppers reported additional health improvements and increases in their ability to buy enough F&V. We conclude that offering weekly boxes of affordable F&V paired with education in underserved communities may improve F&V consumption for frequent program users.
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Affiliation(s)
- Lucia A Leone
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Lindsey Haynes-Maslow
- Department of Youth, Family, and Community Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Alice S Ammerman
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Best AL, Johnson JL. Alternate Food Markets, NGOs, and Health Policy: Improving Food Access and Food Security, Trust Bonds, and Social Network Ties. WORLD MEDICAL & HEALTH POLICY 2016. [DOI: 10.1002/wmh3.190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
The number of older adults living in the USA, 65 years of age and older, has been steadily increasing. Data from the National Health and Nutrition Examination Survey (NHANES), 2007-2010, indicate that more than one-third of older adults, 65 years of age and older, were obese. With the increased rate of obesity in older adults, the purpose of this paper is to present research on different methods to prevent or manage obesity in older adults, namely dietary interventions, physical activity interventions, and a combination of dietary and physical activity interventions. In addition, research on community assistance programs in the prevention of obesity with aging will be discussed. Finally, data on federal programs for older adults will also be presented.
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Affiliation(s)
- Stella Lucia Volpe
- Department of Nutrition Sciences, Drexel University, Room 381, 3rd Floor, Parkway Building, 1601 Cherry Street, Mail Stop 31030, Philadelphia, PA, 19102, USA.
| | - Deeptha Sukumar
- Department of Nutrition Sciences, Drexel University, Room 381, 3rd Floor, Parkway Building, 1601 Cherry Street, Mail Stop 31030, Philadelphia, PA, 19102, USA
| | - Brandy-Joe Milliron
- Department of Nutrition Sciences, Drexel University, Room 381, 3rd Floor, Parkway Building, 1601 Cherry Street, Mail Stop 31030, Philadelphia, PA, 19102, USA
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Freedman DA, Vaudrin N, Schneider C, Trapl E, Ohri-Vachaspati P, Taggart M, Ariel Cascio M, Walsh C, Flocke S. Systematic Review of Factors Influencing Farmers' Market Use Overall and among Low-Income Populations. J Acad Nutr Diet 2016; 116:1136-55. [PMID: 27021526 DOI: 10.1016/j.jand.2016.02.010] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 02/08/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Recent evidence indicates a widening gap in fruit and vegetable (F/V) consumption between high- and low-income Americans. This gap is related, in part, to decreased access to food retailers that sell fresh F/V in low-income communities. Farmers' markets are identified as a strategy for improving F/V consumption by increasing access to these foods. OBJECTIVES The aim of this systematic review was to examine literature published from 1994 to 2014 to identify facilitators and barriers of farmers' markets use, particularly among low-income consumers. DESIGN Peer-reviewed literature was identified in Ebsco Host (Academic Search Complete). Inclusion criteria for abstract review was primary research focused on farmers' market use identifying 87 studies for full-text review. Full-text review identified articles focused on facilitators and/or barriers of farmers' market use resulting in 49 articles. At least two reviewers completed review of all articles. RESULTS Of the 49 articles, 39% specified inclusion of low-income consumers and fewer than 15% focused on racial and ethnic minorities. Few studies were guided by theory and/or used standardized metrics. Results indicate farmers' market use is influenced by multiple economic, service delivery, spatial-temporal, social, and personal factors. Among studies that included low-income populations (n=19), key barriers to farmers' market use were perceptions that food assistance benefits were not accepted, belief that food variety at farmers' markets was limited, lack of access to transportation, lack of racial/ethnic diversity in the market space, and mismatch between markets and personal lifestyles. There is wide variation in study design and reporting standards and infrequent use of standardized measures limiting comparisons across studies. CONCLUSIONS There is a need to establish valid and reliable metrics and reporting standards for evaluating farmers' markets. Findings may inform interventions, programs, and policies to promote farmers' market use.
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Woodruff RC, Coleman AM, Hermstad AK, Honeycutt S, Munoz J, Loh L, Brown AF, Shipley R, Kegler MC. Increasing Community Access to Fresh Fruits and Vegetables: A Case Study of the Farm Fresh Market Pilot Program in Cobb County, Georgia, 2014. Prev Chronic Dis 2016; 13:E36. [PMID: 26963860 PMCID: PMC5147014 DOI: 10.5888/pcd13.150442] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Ecological models of health suggest that to effectively prevent chronic disease, community food environments must support healthy eating behaviors. However, disparities in access to healthy foods persist in the United States. Community Context The Farm Fresh Market (FFM) was a fruit and vegetable market that sold low-cost fresh produce in Cobb County, Georgia in 2014. Methods This case study describes the development of the FFM through a community engagement process and presents evaluation results from the project’s pilot implementation. Community engagement strategies included forming a community advisory board, conducting a needs assessment, and contracting with a community-based organization to implement the FFM. Outcome In the pilot year, the FFM served an average of 28.7 customers and generated an average of $140.20 in produce sales per market day. Most returning customers lived in the local community and reported a range of socioeconomic backgrounds. Most returning customers strongly agreed that the FFM made it easier (69.0%) and less expensive (79.0%) for them to buy fresh fruits and vegetables, reported that they ate more vegetables (65.0%) and fruit (55.0%) as a result of the FFM, and reported that they were very satisfied with the FFM overall (92.0%). Interpretation Results from this community case study underscore the importance of engaging communities in the development of community food environment interventions. Results also suggest that the FFM initiative was a feasible and acceptable way to respond to the community-identified public health priority of increasing access to healthy foods.
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Affiliation(s)
- Rebecca C Woodruff
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322.
| | | | - April K Hermstad
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Sally Honeycutt
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Lorna Loh
- McCleskey-East Cobb Family YMCA, Marietta, Georgia
| | | | | | - Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Increasing vegetable intakes: rationale and systematic review of published interventions. Eur J Nutr 2016; 55:869-96. [PMID: 26754302 PMCID: PMC4819941 DOI: 10.1007/s00394-015-1130-8] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 12/06/2015] [Indexed: 02/07/2023]
Abstract
Purpose
While the health benefits of a high fruit and vegetable consumption are well known and considerable work has attempted to improve intakes, increasing evidence also recognises a distinction between fruit and vegetables, both in their impacts on health and in consumption patterns. Increasing work suggests health benefits from a high consumption specifically of vegetables, yet intakes remain low, and barriers to increasing intakes are prevalent making intervention difficult. A systematic review was undertaken to identify from the published literature all studies reporting an intervention to increase intakes of vegetables as a distinct food group. Methods Databases—PubMed, PsychInfo and Medline—were searched over all years of records until April 2015 using pre-specified terms. Results Our searches identified 77 studies, detailing 140 interventions, of which 133 (81 %) interventions were conducted in children. Interventions aimed to use or change hedonic factors, such as taste, liking and familiarity (n = 72), use or change environmental factors (n = 39), use or change cognitive factors (n = 19), or a combination of strategies (n = 10). Increased vegetable acceptance, selection and/or consumption were reported to some degree in 116 (83 %) interventions, but the majority of effects seem small and inconsistent. Conclusions Greater percent success is currently found from environmental, educational and multi-component interventions, but publication bias is likely, and long-term effects and cost-effectiveness are rarely considered. A focus on long-term benefits and sustained behaviour change is required. Certain population groups are also noticeably absent from the current list of tried interventions.
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Farley SM, Sacks R, Dannefer R, Johns M, Leggat M, Lim S, Konty K, Nonas C. Evaluation of the New York City Green Carts program. AIMS Public Health 2015; 2:906-918. [PMID: 29546140 PMCID: PMC5690450 DOI: 10.3934/publichealth.2015.4.906] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 12/23/2015] [Indexed: 11/30/2022] Open
Abstract
Access to fresh fruits and vegetables is a concern, particularly among low-income populations. Mobile vending is one strategy to expand produce availability and access to increase consumption. In 2008, New York City launched a mobile vending initiative, Green Carts. We report on the evaluation. Three waves of cross-sectional observational surveys of produce availability, variety, and quality were conducted during the summers of 2008, 2009, and 2011 in a stratified random sample of stores and carts comparing establishments in Green Cart neighborhoods (n = 13) with comparison neighborhoods (n = 3). Bivariate analyses for availability, variety, and quality comparing Green Cart and comparison neighborhoods were presented across years, and logistic and negative binomial regressions were used to test whether fruit and vegetable availability, variety, and quality increased in Green Cart compared with comparison neighborhoods, adjusting for clustering and neighborhood demographics. Establishments selling fruits and vegetables in Green Cart neighborhoods increased between 2008 and 2011 (50% to 69%, p <0.0001); there was no comparable increase in comparison neighborhoods. Establishments selling more than 10 fruits and vegetables types increased from 31% to 38% (p = 0.0414) in Green Cart neighborhoods; there was no change in comparison neighborhoods. Produce quality was high among comparison establishments, with 95% and 94% meeting the quality threshold in 2008 and 2011, while declining in Green Cart neighborhood establishments from 96% to 88% (p < 0.0001). Sustained produce availability was found in Green Cart neighborhoods between 2008-2011. Green Carts are one strategy contributing to improving produce access among New Yorkers.
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Affiliation(s)
- Shannon M Farley
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene
| | - Rachel Sacks
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene
| | - Rachel Dannefer
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene
| | - Michael Johns
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene
| | - Margaret Leggat
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene
| | - Sungwoo Lim
- Bureau of Epidemiology Services, New York City Department of Health and Mental Hygiene
| | - Kevin Konty
- Division of Epidemiology, New York City Department of Health and Mental Hygiene
| | - Cathy Nonas
- Center for Health Equity, New York City Department of Health and Mental Hygiene
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46
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Gorham G, Dulin-Keita A, Risica PM, Mello J, Papandonatos G, Nunn A, Gorham S, Roberson M, Gans KM. Effectiveness of Fresh to You, a Discount Fresh Fruit and Vegetable Market in Low-Income Neighborhoods, on Children's Fruit and Vegetable Consumption, Rhode Island, 2010-2011. Prev Chronic Dis 2015; 12:E176. [PMID: 26469949 PMCID: PMC4611858 DOI: 10.5888/pcd12.140583] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Introduction Eating fruits and vegetables is associated with lowered risk for many chronic diseases. However, most Americans, especially members of low-income and minority populations, do not eat adequate amounts. Fresh to You is a public–private partnership program that brings discount fresh produce markets into low-income neighborhoods. We conducted a mixed-methods evaluation of Fresh to You to assess the effect of the program on children’s consumption of fruits and vegetables. Methods A local produce distributor brought the Fresh to You markets to 6 community organizations serving low-income families in Rhode Island. The markets, held weekly for 5 months at each site, sold fresh produce at below-retail prices. Parents (N = 480) of children aged 3 to 13 years were recruited at the markets to participate in a 5-month cohort study. The primary outcome was change in children’s fruit and vegetable intake, measured by a validated screener. We also conducted postintervention focus groups at each site with parents and qualitative interviews with site contacts to collect feedback about Fresh to You. Results From baseline to 5 months, there was a significant increase in children’s daily fruit and vegetable consumption of 0.48 cups (t = 4.16, P < .001). Data from follow-up parent surveys, focus groups, and site contact interviews provided positive feedback about Fresh to You and recommendations for improvement. Conclusion Fresh to You was effective at increasing consumption of fruits and vegetables among racially and ethnically diverse low-income children aged 3 to 13 years whose parents shopped at the markets. The intervention could serve as a model program for replication in other cities. Refinements and a more rigorous evaluation are needed.
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Affiliation(s)
- Gemma Gorham
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, Rhode Island
| | - Akilah Dulin-Keita
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Patricia Markham Risica
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Jennifer Mello
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - George Papandonatos
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Amy Nunn
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, Rhode Island
| | - Sara Gorham
- Institute for Community Health Promotion, Brown University School of Public Health and Rhode Island Public Health Institute, Providence, Rhode Island
| | - Mya Roberson
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, Rhode Island
| | - Kim M Gans
- Institute for Community Health Promotion, Brown University School of Public Health, 121 South Main St, 8th Floor, Box G-S121-8, Providence, RI 02912. . Dr Gans is also affiliated with the Rhode Island Public Health Institute, Providence, Rhode Island, and the University of Connecticut, Department of Human Development and Family Studies, and the Center for Health Interventions and Prevention, Storrs, Connecticut
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Haynes-Maslow L, Auvergne L, Mark B, Ammerman A, Weiner BJ. Low-Income Individuals' Perceptions About Fruit and Vegetable Access Programs: A Qualitative Study. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2015; 47:317-24.e1. [PMID: 25910929 PMCID: PMC4500669 DOI: 10.1016/j.jneb.2015.03.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 02/21/2015] [Accepted: 03/14/2015] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To examine how fruit and vegetable (FV) programs address barriers to FV access and consumption as perceived by low-income individuals. DESIGN From 2011 to 2012, the researchers used 13 focus groups to better understand low-income individuals' perceptions about FV programs. SETTING Five North Carolina counties at community-serving organizations. PARTICIPANTS Low-income participants aged ≥ 18 years were included in the study. A majority were African American women with a high school education or less, and received government assistance. PHENOMENON OF INTEREST Low-income individuals' perceptions about how FV access programs can reduce barriers and increase consumption. ANALYSIS A socio-ecological framework guided data analysis, and 2 trained researchers coded transcripts, identified major themes, and summarized findings. RESULTS A total of 105 participants discussed how mobile markets could overcome barriers such as availability, convenience, transportation, and quality/variety. Some were worried about safety in higher-crime communities. Participants' opinions about how successful food assistance programs were at overcoming cost barriers were mixed. Participants agreed that community gardens could increase access to affordable, conveniently located produce but worried about feasibility and implementation issues. IMPLICATIONS FOR RESEARCH AND PRACTICE Addressing access barriers through FV programs could improve consumption. Programs have the potential to be successful if they address multiple access barriers.
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Affiliation(s)
| | - Lauriane Auvergne
- Department of Anesthesiology, University of Michigan at Ann Arbor, Ann Arbor, MI
| | - Barbara Mark
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Alice Ammerman
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Bryan J Weiner
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Johnson AE, Boulware LE, Anderson CAM, Chit-ua-aree T, Kahan K, Boyér LL, Liu Y, Crews DC. Perceived barriers and facilitators of using dietary modification for CKD prevention among African Americans of low socioeconomic status: a qualitative study. BMC Nephrol 2014; 15:194. [PMID: 25481019 PMCID: PMC4268853 DOI: 10.1186/1471-2369-15-194] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 11/20/2014] [Indexed: 02/07/2023] Open
Abstract
Background Factors influencing the use of dietary interventions for modification of CKD risk among African Americans have not been well-explored. We assessed perceived barriers and facilitators of CKD prevention through dietary modifications among African Americans with low socioeconomic status (SES) and at high risk for CKD. Methods We conducted a qualitative study involving three 90 minute focus groups of low SES (limited education, unemployed, uninsured, or income < $25,000/year) African American residents of Baltimore, Maryland (N = 17), who were aged 18-60 years, with no known history of CKD and (1) a family history of end stage renal disease and (2) self-reported diabetes, hypertension, cardiovascular disease, HIV or obesity. A trained moderator asked a series of 21 closed and open-ended questions. Group sessions were recorded, transcribed, and two independent investigators reviewed transcripts to identify common themes. Results Participants’ mean (SD) age was 39.8 (12.4) years. Most (59%) were female and earned < $5,000/year (71%). One quarter (24%) had self-reported diabetes and over half had hypertension (53%). Few (12%) perceived their CKD risk as high. Perceived barriers to CKD prevention through dietary change included the expense and unavailability of healthy foods, family member preferences, convenience of unhealthy foods, and inability to break lifelong habits. They identified vouchers for healthy foods, family-based interventions, nutritional counseling and group gatherings for persons interested in making dietary changes as acceptable facilitators of dietary CKD prevention efforts. Conclusions Low SES African Americans at high risk for CKD had limited perception of their risk but they identified multiple barriers and potential facilitators of CKD prevention via dietary modifications which can inform future studies and public health interventions. Electronic supplementary material The online version of this article (doi:10.1186/1471-2369-15-194) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | - Deidra C Crews
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
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Antentas JM, Vivas E. Impacto de la crisis en el derecho a una alimentación sana y saludable. Informe SESPAS 2014. GACETA SANITARIA 2014; 28 Suppl 1:58-61. [DOI: 10.1016/j.gaceta.2014.04.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 04/03/2014] [Accepted: 04/05/2014] [Indexed: 11/17/2022]
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50
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Overcoming challenges to effectiveness of mobile markets in US food deserts. Appetite 2014; 79:58-67. [PMID: 24727100 DOI: 10.1016/j.appet.2014.03.026] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/14/2014] [Accepted: 03/25/2014] [Indexed: 11/21/2022]
Abstract
The purpose of this research is to investigate whether mobile food markets may be effective in facilitating healthy food choices in food deserts. We investigate who does and does not use mobile food markets and why, and whether mobile markets have the potential to alter attitudes and food choices, and if so, how? We use a focus group study at four sites in the US to ask groups of mobile market shoppers and non-shoppers about their shopping, cooking, and eating attitudes and behaviors. We find that mobile market shoppers eat significantly more servings of fruits and vegetables, however, both shoppers and non-shoppers perceive fruits and vegetables as luxury items, and both groups lack knowledge about what is a serving and what is the recommended number of servings per day. Both groups identified the following needs for mobile markets to be more successful: increased awareness and advertising; affordability; improved convenience by offering more stops and hours, as well as greater variety of items for one-stop shopping; emphasis on value and service; and building trust within communities.
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