Impact of personal preference and motivation on fruit and vegetable consumption of WIC-participating mothers and children in Atlanta, GA

Objective and perceived barriers and facilitators of daily fruit and vegetable consumption among under-resourced communities in Central Texas

INTRODUCTION

Fruit and vegetable consumption (FVC) continues to be low, particularly among people living in under-resourced communities. Identifying barriers and facilitators of FVC and whether those barriers and facilitators differ for racially and ethnically minoritized people is imperative for developing effective and equitable public health policies and interventions.

METHODS

A baseline cohort of 390 participants from Central Texas communities historically lacking healthy food retailers completed a survey including FVC, 7 psychosocial barriers and facilitators of FVC, distance to a grocery retailer, participation in government assistance programs, and race/ethnicity.

RESULTS

Not having time to prepare fruits and vegetables was the only significant psychosocial barrier identified (B = -.11, t(390) = 2.04, P = .04), but was not significant after accounting for sociodemographic variables. Significant facilitators of daily FVC were liking F&V (B=.31, t(390) = 6.40, P<.001), participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (B=.14, t(390) = 2.81, P = .005), and Hispanic/Latino(a) ethnicity (B = -.21, t(390) = 4.30, P<.001). The final model accounted for 17% of the variance in daily FVC (R2=.17, F(4, 375) = 7.69, P < .001). Black, white and Other race participants were more likely to report having difficulty using F&V before spoiling than Hispanic/Latino(a) participants (P = .003). White and Other race participants were more likely to report that F&V were hard to prepare (P = .006) and that they didn't have time to prepare F&V (P = .005).

DISCUSSION

When designing public health policy and interventions to increase FVC, researchers could prioritize identifying ways to alleviate time constraints, increase F&V liking, and help eligible participants to enroll in WIC. Strategies that reduce the risk of F&V spoiling and make F&V easier to prepare may also benefit some groups.

Food Choice Behaviors of Lactating Women: Association with Body Mass Index and Fruits and Vegetables Intake in Central Amhara Region, Ethiopia-An Observational Study

BACKGROUND

What food people choose to eat is embraced by circumstances that are essentially influenced by the underlying motives of food choices which are important to a healthful dietary change. Therefore, this study aimed to explore food choice behaviors associated with nutritional status and FVs intake in women during lactation from central Amhara.

METHODS

A multistage sampling technique was applied to select study participants. A study was conducted among 423 randomly selected lactating women using a face-to-face interview of the questionnaire. A community-based cross-sectional, quantitative study with descriptive and analytical components was done. Anthropometrics measurements such as weight, height, waist, and hip circumference were taken from all participants. Body mass index was calculated to determine the nutritional status of women. Data were analyzed using SPSS version 20 computer software program. Association between dependent and independent variables was identified by logistic regression analysis, and a P-value< 0.05 was taken as statistically significant.

RESULTS

About 21.7% of women were underweight. Approximately 37.4% of women had good consumption trends to fruits and vegetables. Healthy meal eating motivation, price-consciousness, and mood concern were identified as the most significant behaviors of food choice, influencing the nutritional status of women with AOR (95% CI) of 2.1 (1.21-3.62), 3.01 (1.32-6.9), and 0.5 (0.30-0.95), respectively. Natural content (AOR (95%): 2.37 (1.39-4.06)), mood concern (AOR (95%): 2.29 (1.15-4.56)), religion concern (AOR (95%): 2.45 (1.37-4.4)), husband encouragement (AOR (95%): 2.26 (1.04-4.89)), and availability of milk and milk products (AOR (95%): 1.6 (1.39-2.74)) and fruits and vegetables (AOR (95%): 1.66 (1.16-3.48)) in home were associated significantly with a good intake of fruit and vegetables.

CONCLUSIONS

This finding provides a useful insight into the food choice motivations of a group of women with preference for natural foods, mood concern, religion concern, and husband support with good fruit and vegetable intake. This can help practitioners make recommendations for health promotion strategies. Emphasis on assisting women with healthy meal eating and avoiding psychological stress is important. Nutrition education about healthy food choice is recommended for communities.

Fruit and Vegetable Purchases and Consumption among WIC Participants after the 2009 WIC Food Package Revision: A Systematic Review

To promote fruit and vegetable (FV) intake among participants, the USDA Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) implemented a comprehensive food package revision in 2009. However, to our knowledge, no studies have systematically explored the factors related to FV purchases and/or consumption among WIC participants in the post-2009 revision era. To fill this knowledge gap, we conducted a systematic literature review using PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials, and Web of Science using key search terms. Studies published from January 1, 2007, through February 28, 2019, were included, since an interim rule for the WIC food package revision was issued in 2007. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses format. The articles were grouped based on main themes or factors, settings, design, study years, and sample size. Thirty-nine articles met the inclusion criteria. Seven main themes or factors related to FV purchases and/or consumption in WIC participants were identified in these articles. The 2009 WIC food package revision was the most-studied factor (n = 9). National and state-level studies showed a consistently positive relation between the 2009 revision and FV purchases and/or consumption. However, some studies did not find a positive relation. State-level policy variations can be exploited as natural experiments to assess the causality of state-level factors in WIC participants' FV purchases or consumption. The majority of the included studies were limited in being local (n = 26, 66.7%), cross-sectional (n = 29, 74.4%), or having sample sizes <1000 (n = 25, 64.1%), which could explain the diverse results regarding the relation between FV purchases and/or consumption and various factors, including individual, store, and program characteristics.

Watching TV Cooking Programs: Effects on Actual Food Intake Among Children

OBJECTIVE

To test the effects of a cooking program on healthy food decisions.

DESIGN

An experimental between-subjects design with 3 conditions: healthy, unhealthy, and control.

SETTING

Class settings in 5 different schools.

PARTICIPANTS

One hundred twenty-five children between 10 and 12 years of age.

INTERVENTIONS

Video clips of cooking program containing healthy foods versus cooking program containing unhealthy foods versus control program.

MAIN OUTCOME MEASURES

Healthy versus unhealthy food choice.

ANALYSIS

Logistic regression analysis, with the control condition as a reference in the first contrast test and the unhealthy food condition as a reference in the second contrast, to examine effects on food choice between conditions.

RESULTS

Children who watched the cooking program with healthy foods had a higher probability of selecting healthy food than children who watched the cooking program with unhealthy foods (P = .027), or with the control condition (P = .039).

CONCLUSIONS AND IMPLICATIONS

These findings indicated a priming effect of the foods the children were exposed to, showing that nutrition education guided by reactivity theory can be promising. Cooking programs may affect the food choices of children and could be an effective method in combination with other methods to improve their dietary intake.

Exploring Healthy Eating and Exercise Behaviors Among Low-Income Breastfeeding Mothers

BACKGROUND:

Postpartum weight retention is often a significant contributor to overweight and obesity. Lactation is typically not sufficient for mothers to return to pre-pregnancy weight. Modifiable health behaviors (e.g., healthy eating and exercise) are important for postpartum weight loss; however, engagement among mothers, especially those who are resource-limited, is low. A deeper understanding of low-income breastfeeding mothers' healthy-eating and exercise experience, a population that may have unique motivators for health-behavior change, may facilitate creation of effective intervention strategies for these women.

RESEARCH AIM:

To describe the healthy-eating and exercise experiences of low-income postpartum women who choose to breastfeed.

METHODS:

Focus group discussions were conducted with low-income mothers ( N = 21) who breastfed and had a child who was 3 years old or younger. Transcript analysis employed integrated grounded analysis using both a priori codes informed by the theory of planned behavior and grounded codes.

RESULTS:

Three major themes were identified from five focus groups: (a) Mothers were unable to focus on their own diet and exercise due to preoccupation with infant needs and more perceived barriers than facilitators; (b) mothers became motivated to eat healthfully if it benefited the infant; and (c) mothers did not seek out information on maternal nutrition or exercise but used the Internet for infant-health information and health professionals for breastfeeding information.

CONCLUSION:

Low-income breastfeeding mothers may be more receptive to nutrition education or interventions that focus on the mother-infant dyad rather than solely on maternal health.

Barriers and Strategies for Healthy Food Choices among American Indian Tribal College Students: A Qualitative Analysis

BACKGROUND

American Indian and Alaskan Native individuals experience disproportionate levels of chronic health conditions such as type 2 diabetes and overweight and obesity that are influenced by dietary patterns and food choices. Understanding factors that influence healthy food choices among tribal college students can enrich education and programs that target dietary intake.

OBJECTIVE

To build an understanding of factors that influence healthy food choices among tribal college students at increased risk for college attrition.

DESIGN

A nonexperimental cohort design was used for qualitative descriptive analysis.

PARTICIPANTS/SETTING

Participants (N=20) were purposively sampled, newly enrolled, academically underprepared tribal college students enrolled in a culturally relevant life skills course at an upper Midwest tribal college between September 2013 and May 2015. Participant demographic characteristics included various tribal affiliations, ages, and number of dependents.

MAIN OUTCOME MEASURES

Participant responses to qualitative research questions about dietary intake, food choices, self-efficacy for healthy food choices, psychosocial determinants, and barriers to healthy food choices during telephone interviews were used as measures.

ANALYSIS

Qualitative analysis included prestudy identification of researcher bias/assumptions, audiorecording and transcription, initial analysis (coding), secondary analysis (sorting and identifying meaning), and verification (comparative pattern analysis).

RESULTS

Qualitative analysis revealed a variety of themes and subthemes about healthy food choices. Main themes related to barriers included taste, food gathering and preparation, and difficulty clarifying healthy food choices. Main themes related to strategies included taste, cultural traditions and practices, and personal motivation factors.

CONCLUSIONS

Qualitative analysis identified barrier and strategy themes that may assist nutrition and dietetics practitioners working with tribal/indigenous communities, tribal college educators and health specialists, and tribal community health workers who target health and dietary intake of American Indian and Alaskan Native students.

Fruit and vegetable intake among participants in a District of Columbia farmers’ market incentive programme

Objective

Limited research is available on whether participation in healthy food incentive programmes is associated with higher fruit and vegetable intake. The objective of the present study was to determine fruit and vegetable intake among participants in the Produce Plus Program, a farmers’ market-based healthy food incentive programme in Washington, DC, and identify demographic and behavioural factors associated with higher fruit and vegetable intake.

Design

Using a cross-sectional survey, programme participants were interviewed at markets across DC between June and September 2015. Questions included the Behavioral Risk Factor Surveillance System (BRFSS) fruit and vegetable module. Fruit and vegetable intake among 2013 DC BRFSS participants reporting annual household incomes of ≤$US 35 000 was calculated for context.

Setting

Washington, DC, USA.

Subjects

Participants (n 288) in the Produce Plus Program.

Results

On average, participants reported consuming both fruits (interquartile range: 1·0–3·0) and vegetables (interquartile range: 1·3–3·5) two times/d. Participants who reported eating home-cooked meals ≥3 times/week also reported higher median fruit (2·0 v. 0·8) and vegetable (2·3 v. 1·3) intake compared with those eating home-cooked meals less frequently. No statistically significant differences in reported median fruit or vegetable intake were observed over the course of the farmers’ market (June v. August/September) season.

Conclusions

Produce Plus Program participants reported higher median fruit and vegetable intake compared with DC BRFSS respondents with similar incomes, but still below recommended levels. More frequent home-cooked meals were associated with higher fruit and vegetable intake. Thus, efforts to increase home cooking may represent an opportunity to increase fruit and vegetable intake among healthy food incentive participants.

A realist review to explore how low-income pregnant women use food vouchers from the UK's Healthy Start programme

OBJECTIVES

To explore how low-income pregnant women use Healthy Start food vouchers, the potential impacts of the programme, and which women might experience these impacts and why.

DESIGN

A realist review.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Primary or empirical studies (of any design) were included if they contributed relevant evidence or insights about how low-income women use food vouchers from the Healthy Start (UK) or the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) programmes. The assessment of 'relevance' was deliberately broad to ensure that reviewers remained open to new ideas from a variety of sources of evidence.

ANALYSIS

A combination of evidence synthesis and realist analysis techniques was used to modify, refine and substantiate programme theories, which were constructed as explanatory 'context-mechanism-outcome'-configurations.

RESULTS

38 primary studies were included in this review: four studies on Healthy Start and 34 studies on WIC. Two main outcome strands were identified: dietary improvements (intended) and financial assistance (unintended). Three evidence-informed programme theories were proposed to explain how aspects of context (and mechanisms) may generate these outcomes: the 'relative value' of healthy eating (prioritisation of resources); retailer discretion (pressure to 'bend the rules'); the influence of other family members (disempowerment).

CONCLUSIONS

This realist review suggests that some low-income pregnant women may use Healthy Start vouchers to increase their consumption of fruits and vegetables and plain cow's milk, whereas others may use them to reduce food expenditure and save money for other things.

Impact of cooking and home food preparation interventions among adults: outcomes and implications for future programs

OBJECTIVE

Cooking programs are growing in popularity; however, an extensive review has not examined their overall impact. Therefore, this study reviewed previous research on cooking/home food preparation interventions and diet and health-related outcomes among adults and identified implications for practice and research.

DESIGN

Literature review and descriptive summative method.

MAIN OUTCOME MEASURES

Dietary intake, knowledge/skills, cooking attitudes and self-efficacy/confidence, health outcomes.

ANALYSIS

Articles evaluating the effectiveness of interventions that included cooking/home food preparation as the primary aim (January, 1980 through December, 2011) were identified via Ovid MEDLINE, Agricola, and Web of Science databases. Studies grouped according to design and outcomes were reviewed for validity using an established coding system. Results were summarized for several outcome categories.

RESULTS

Of 28 studies identified, 12 included a control group with 6 as nonrandomized and 6 as randomized controlled trials. Evaluation was done postintervention for 5 studies, pre- and postintervention for 23, and beyond postintervention for 15. Qualitative and quantitative measures suggested a positive influence on main outcomes. However, nonrigorous study designs, varying study populations, and the use of nonvalidated assessment tools limited stronger conclusions.

CONCLUSIONS AND IMPLICATIONS

Well-designed studies are needed that rigorously evaluate long-term impact on cooking behavior, dietary intake, obesity and other health outcomes.