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Garrity K, Krzyzanowski Guerra K, Hart H, Al-Muhanna K, Kunkler EC, Braun A, Poppe KI, Johnson K, Lazor E, Liu Y, Garner JA. Local Food System Approaches to Address Food and Nutrition Security among Low-Income Populations: A Systematic Review. Adv Nutr 2024; 15:100156. [PMID: 38616069 PMCID: PMC11031423 DOI: 10.1016/j.advnut.2023.100156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/20/2023] [Accepted: 11/14/2023] [Indexed: 04/16/2024] Open
Abstract
Food and nutrition insecurity disproportionately impact low-income households in the United States, contributing to higher rates of chronic diseases among this population. Addressing this challenge is complex because of various factors affecting the availability and accessibility of nutritious food. Short value chain (SVC) models, informally known as local food systems, offer a systemic approach that aims to optimize resources and align values throughout and beyond the food supply chain. Although specific SVC interventions, such as farmers markets, have been studied individually, a comprehensive review of SVC models was pursued to evaluate their relative impact on food security, fruit and vegetable intake, diet quality, health-related markers, and barriers and facilitators to participation among low-income households. Our systematic literature search identified 37 articles representing 34 studies from 2000-2020. Quantitative, qualitative, and mixed-method studies revealed that farmers market interventions had been evaluated more extensively than other SVC models (i.e., produce prescription programs, community-supported agriculture, mobile markets, food hubs, farm stands, and farm-to-school). Fruit and vegetable intake was the most measured outcome; other outcomes were less explored or not measured at all. Qualitative insights highlighted common barriers to SVC use, such as lack of program awareness, limited accessibility, and cultural incongruence, whereas facilitators included health-promoting environments, community cohesion, financial incentives, and high-quality produce. Social marketing and dynamic nutrition education appeared to yield positive program outcomes. Financial incentives were used in many studies, warranting further investigation into optimal amounts across varying environmental contexts. SVC models are increasingly germane to national goals across the agriculture, social, and health care sectors. This review advances the understanding of key knowledge gaps related to their implementation and impact; it emphasizes the need for research to analyze SVC potential comprehensively across the rural-urban continuum and among diverse communities through long-term studies of measurable health impact and mixed-method studies investigating implementation best practices. This trial was registered at PROSPERO as CRD42020206532.
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Affiliation(s)
- Katharine Garrity
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University
| | | | - Hannah Hart
- College of Public Health, The Ohio State University
| | - Khawlah Al-Muhanna
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University
| | - Emily C Kunkler
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University
| | - Ashlea Braun
- Department of Nutritional Sciences, College of Education and Human Sciences, Oklahoma State University
| | | | - Kara Johnson
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University
| | - Emma Lazor
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University
| | - Yang Liu
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University
| | - Jennifer A Garner
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University; John Glenn College of Public Affairs, The Ohio State University.
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2
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Matos MS, Suzuki S, White N. Addressing Barriers to Healthy Eating Through Food as Medicine Initiatives. Am J Lifestyle Med 2023; 17:750-753. [PMID: 38511117 PMCID: PMC10948924 DOI: 10.1177/15598276231188645] [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: 03/22/2024] Open
Abstract
Poor diet is the number one risk factor for death globally; yet, few adults meet the dietary guidelines for optimal health. Food is medicine initiatives including food pharmacies, produce prescriptions, and medically tailored meals are emerging models to improve diet and reduce diet-related disease. These initiatives target barriers to healthy eating, including access, nutrition knowledge, culinary skill, motivation, and support. The following will discuss significant barriers to healthy eating and describe the strategies employed within these initiatives to overcome such barriers.
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Affiliation(s)
- Marietta Sotomayor Matos
- Department of Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA
| | - Shaye Suzuki
- Department of Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA
| | - Nicole White
- Department of Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA
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3
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Loofbourrow BM, Scherr RE. Food Insecurity in Higher Education: A Contemporary Review of Impacts and Explorations of Solutions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105884. [PMID: 37239614 DOI: 10.3390/ijerph20105884] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
Food insecurity is a global phenomenon which impacts a variety of social, economic, and life-stage groups. One such group affected by food insecurity is college students, who tend to experience food insecurity at a prevalence which exceeds the average of their local communities. The impacts of food insecurity in this population are multifaceted and have implications for their college experience and beyond. Food insecurity has been observed to have negative effects on college student academic performance, physical health, and mental health. This review explores the impacts of and solutions for food insecurity in this population globally, with particular emphasis on the United States, and specifically California.
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Affiliation(s)
| | - Rachel E Scherr
- Family, Interiors, Nutrition and Apparel, San Francisco State University, San Francisco, CA 94132, USA
- Scherr Nutrition Science Consulting, San Francisco, CA 94115, USA
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4
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Varela EG, McVay MA, Shelnutt KP, Mobley AR. The Determinants of Food Insecurity Among Hispanic/Latinx Households With Young Children: A Narrative Review. Adv Nutr 2023; 14:190-210. [PMID: 36811589 PMCID: PMC10103006 DOI: 10.1016/j.advnut.2022.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 12/01/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022] Open
Abstract
Food insecurity has disproportionately impacted Hispanic/Latinx households in the United States, specifically those with young children. Although the literature provides evidence of an association between food insecurity and adverse health outcomes in young children, minimal research has addressed the social determinants and related risk factors associated with food insecurity among Hispanic/Latinx households with children under three, a highly vulnerable population. Using the Socio-Ecological Model (SEM) as a framework, this narrative review identified factors associated with food insecurity among Hispanic/Latinx households with children under three. A literature search was conducted using PubMed and four additional search engines. Inclusion criteria consisted of articles published in English from November 1996 to May 2022 that examined food insecurity among Hispanic/Latinx households with children under three. Articles were excluded if conducted in settings other than the US and/or focused on refugees and temporary migrant workers. Data were extracted (i.e., objective, setting, population, study design, measures of food insecurity, results) from the final articles (n = 27). The strength of each article's evidence was also evaluated. Results identified individual factors (i.e., intergenerational poverty, education, acculturation, language, etc.), interpersonal factors (i.e., household composition, social support, cultural customs), organizational factors (i.e., interagency collaboration, organizational rules), community factors (i.e., food environment, stigma, etc.), and public policy/societal factors (i.e., nutrition assistance programs, benefit cliffs, etc.) associated with a food security status of this population. Overall, most articles were classified as "medium" or higher quality for the strength of evidence, and more frequently focused on individual or policy factors. Findings indicate the need for more research to include a focus on public policy/society factors, as well as on multiple levels of the SEM with considerations of how individual and policy levels intersect and to create or adapt nutrition-related and culturally appropriate interventions to improve food security of Hispanic/Latinx households with young children.
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Affiliation(s)
- Elder Garcia Varela
- Graduate Research and Teaching Assistant, Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
| | - Megan A McVay
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
| | - Karla P Shelnutt
- Department of Family, Youth & Community Sciences, University of Florida, Gainesville, FL, USA
| | - Amy R Mobley
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA.
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5
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Leone LA, Kasprzak C, Lally A, Haynes-Maslow L, Vermont LN, Horrigan-Maurer C, Tumiel-Berhalter L, Ammerman A, Raja S. A Novel Process to Recruit and Select Community Partners for a Hybrid Implementation-Effectiveness Study. Prog Community Health Partnersh 2023; 17:159-171. [PMID: 37462585 PMCID: PMC10569409 DOI: 10.1353/cpr.2023.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND Creating strong partnerships with community organizations is essential to test implementation of evidence-based interventions. However, partners are often chosen based on convenience rather than capacity or diversity. Streamlined processes are needed to identify qualified, diverse, and invested partners to conduct community-based research. OBJECTIVES There is a gap in the literature on effective and efficient processes for recruiting partners. This paper aims to fill that gap by describing a novel approach for identifying a diverse group of community organizations to participate in research. METHODS We used a Request for Partners (RFP) approach to recruit partners to participate in a hybrid implementation-effectiveness study of the Veggie Van mobile market model. The process included formative work to inform RFP development, creation of an external advisory committee, an intent-to-apply round, a full application round, and an inperson training and selection process. Data was collected to characterize applicant size, location, and experience; pre-post surveys were conducted to understand the training's utility. RESULTS We received 59 intent-to-apply submissions and invited 28 organizations to apply: 17 submitted applications and 12 organizations were chosen as finalists. The process took approximately 8 months to recruit 9 organizations and 32 community sites across 5 states and increased understanding of the intervention and partner responsibilities. CONCLUSIONS An RFP process is familiar to many community organizations that compete for grant funding but may not have prior research experience. This process streamlined recruitment timelines, increased diversity, and cultivated community among organizations. It may also improve research transparency, study completion, and intervention fidelity.
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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
| | - Christina Kasprzak
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo
| | - Anne Lally
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo
| | | | - Leah N. Vermont
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo
| | - Caroline Horrigan-Maurer
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
| | - Laurene Tumiel-Berhalter
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo
| | - Alice Ammerman
- Department of Nutrition, University of North Carolina at Chapel Hill, Center for Health Promotion and Disease Prevention
| | - Samina Raja
- Department of Urban and Regional Planning, School of Architecture and Planning, University at Buffalo
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Esquivel M, Higa A, Guidry A, Shelton C, Okihiro M. A Qualitative Study on the Motivators, Barriers and Supports to Participation in a Pediatric Produce Prescription Program in Hawai'i. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16682. [PMID: 36554563 PMCID: PMC9778988 DOI: 10.3390/ijerph192416682] [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: 10/18/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
Produce prescriptions that provide vouchers to individuals to purchase fresh FVs at a specified retail outlet have the potential to positively impact food security status, diet, and chronic disease risk. However, maximizing program participation is vital to ensuring program success. This research describes motivators, barriers, and support for participation in a child produce prescription program among a population of Native Hawaiian and Other Pacific Islanders, who are underrepresented in this field of research. This qualitative grounded theory study was nestled within a quasi-experimental pilot intervention trial and included semi-structured interviews with pediatric program participants. Twenty-five interviews were conducted, which represented one-third of program participants. The top support factors for program participation included: ease of voucher use, program convenience, health center/pediatrician endorsement and positive communications with farmers' market vendors. Key motivators for program participation were produce enjoyment, child support, financial support, and positive impacts on family. Three themes emerged consistently as barriers to participation amongst participants, (1) difficult use of vouchers, (2) conflicting schedules, and (3) online market concerns. (4) Conclusions: This research offers insight into policy implications as the number of produce prescription programs has grown. These findings suggest that key program design characteristics can enhance and support program participation.
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Affiliation(s)
- Monica Esquivel
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, Honolulu, HI 96822, USA
| | - Alicia Higa
- Elepaio Social Services, Waianae, HI 96792, USA
| | - Andrea Guidry
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, Honolulu, HI 96822, USA
| | | | - May Okihiro
- Waianae Coast Comprehensive Health Center, Waianae, HI 96792, USA
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7
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Wu JH, Trieu K, Coyle D, Huang L, Wijesuriya N, Nallaiah K, Lung T, Di Tanna GL, Zheng M, Mozaffarian D, MacMillan F, Simmons D, Wu T, Twigg S, Gauld A, Constantino M, McGill M, Wong J, Neal B. Testing the Feasibility and Dietary Impact of a "Produce Prescription" Program for Adults with Undermanaged Type 2 Diabetes and Food Insecurity in Australia. J Nutr 2022; 152:2409-2418. [PMID: 36774107 DOI: 10.1093/jn/nxac152] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/06/2022] [Accepted: 07/06/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND There is growing interest in Food is Medicine programs that incorporate food-based interventions into health care for patients with diet-related conditions. OBJECTIVES We aimed to test the feasibility of a "produce prescription" program and its impact on diet quality for people with type 2 diabetes (T2D) experiencing food insecurity in Australia. METHODS We conducted a pre-post intervention study in n = 50 adults experiencing food insecurity with T2D and glycated hemoglobin (HbA1c) ≥8%. Once enrolled, participants received healthy food boxes weekly free of charge, with the contents sufficient to create 2 meals/d, 5 d/wk for the entire household, over 12 wk. Participants were also provided with tailored recipes and behavioral change support. The primary outcome was change in diet quality assessed by 24-h diet recalls. Secondary outcomes included differences in cardiovascular disease risk factors; blood micronutrients; and feasibility indicators. Differences in the baseline and 12-wk mean primary and secondary outcomes were assessed by paired t tests. RESULTS Participants were older adults with mean ± SD age 63 ± 9 y (range: 40-87 y), HbA1c 9.8% ± 1.5%, and 46% were female. Overall, 92% completed the final study follow-up for the primary outcome. Compared with baseline, diet quality improved at week 12, with an increase in the mean overall diet quality (Alternate Healthy Eating Index score) of 12.9 (95% CI: 8.7, 17.1; P < 0.001), driven by significant improvements in vegetables, fruits, whole grains, red/processed meat, trans fat, sodium, and alcohol consumption. Blood lipids also improved (total:HDL cholesterol: -0.48; 95% CI: -0.72, -0.24; P < 0.001), and there was significant weight loss (-1.74 kg; 95% CI: -2.80, -0.68 kg, P = 0.002), but no changes in other clinical outcomes. Participants reported high levels of satisfaction with the program. CONCLUSIONS These findings provide strong support for an adequately powered randomized trial to assess effects of produce prescription as an innovative approach to improve clinical management among individuals with T2D experiencing food insecurity. This trial was registered at https://anzctr.org.au/ as ACTRN12621000404820.
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Affiliation(s)
- Jason Hy Wu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
| | - Kathy Trieu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Daisy Coyle
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Liping Huang
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Nirupama Wijesuriya
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Kellie Nallaiah
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas Lung
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Gian L Di Tanna
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Miaobing Zheng
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Freya MacMillan
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia; Diabetes, Obesity and Metabolism Translational Research Unit (DOMTRU), School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia; Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - David Simmons
- Diabetes, Obesity and Metabolism Translational Research Unit (DOMTRU), School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia; Macarthur Diabetes Service, Camden and Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - Ted Wu
- Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Royal Prince Alfred Clinic, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Stephen Twigg
- Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Royal Prince Alfred Clinic, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Amanda Gauld
- Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Royal Prince Alfred Clinic, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Maria Constantino
- Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Royal Prince Alfred Clinic, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Margaret McGill
- Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Royal Prince Alfred Clinic, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jencia Wong
- Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Royal Prince Alfred Clinic, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Bruce Neal
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Imperial College London, School of Public Health, London, United Kingdom
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Vedovato GM, Ali SH, Lowery CM, Trude ACB. Giving Families a Voice for Equitable Healthy Food Access in the Wake of Online Grocery Shopping. Nutrients 2022; 14:4377. [PMID: 36297061 PMCID: PMC9609455 DOI: 10.3390/nu14204377] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 11/23/2022] Open
Abstract
Understanding the views of families from low-income backgrounds about inequities in healthy food access and grocery purchase is critical to food access policies. This study explored perspectives of families eligible for the Supplemental Nutrition Assistance Program (SNAP) on healthy food access in physical and online grocery environments. The qualitative design used purposive sampling of 44 primary household food purchasers with children (aged ≤ 8), between November 2020-March 2021, through 11 online focus groups and 5 in-depth interviews. Grounded theory was used to identify community-level perceived inequities, including influences of COVID-19 pandemic, SNAP and online grocery services. The most salient perceived causes of inequitable food access were neighborhood resource deficiencies and public transportation limitations. Rural communities, people with disabilities, older adults, racially and ethnically diverse groups were perceived to be disproportionately impacted by food inequities, which were exacerbated by the pandemic. The ability to use SNAP benefits to buy foods online facilitated healthy food access. Delivery fees and lack of control over food selection were barriers. Barriers to healthy food access aggravated by SNAP included social stigma, inability to acquire cooked meals, and inadequate amount of monthly funds. Findings provide a foundation for policy redesign to promote equitable healthy food systems.
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Affiliation(s)
- Gabriela M. Vedovato
- Institute of Health and Society, Federal University of São Paulo, Santos 11015-021, SP, Brazil
| | - Shahmir H. Ali
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
| | - Caitlin M. Lowery
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Angela C. B. Trude
- Department of Nutrition and Food Studies, New York University Steinhardt School of Culture, Education, and Human Development, New York, NY 10003, USA
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9
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Kasprzak CM, Lally AE, Schoonover JJ, Gallicchio D, Haynes-Maslow L, Vermont LN, Ammerman AS, Raja S, Tumiel-Berhalter L, Tirabassi JN, Leone LA. Operational challenges that may affect implementation of evidence-based mobile market interventions. BMC Public Health 2022; 22:776. [PMID: 35429973 PMCID: PMC9013179 DOI: 10.1186/s12889-022-13207-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/06/2022] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Mobile produce markets are becoming an increasingly prevalent, accepted, and effective strategy for improving fruit and vegetable (F&V) access and consumption across underserved and lower-income communities. However, there is limited published research on mobile market operations. The goal of this research is to identify the challenges mobile markets face and ways to potentially mitigate those challenges. We will also discuss implications of our findings for future implementation of evidence-based food access interventions. METHODS We conducted 21 semi-structured key informant (KI) interviews to assess common practices of mobile market organizations that had been operating for 2 + years. We asked KIs about their organizational structure, operations, procurement and logistics, evaluation efforts, marketing and community engagement, success and challenges. A primary qualitative analysis involved deductive coding using qualitative software. A secondary qualitative analysis identified subthemes related to common challenges and remedial practices. A deductive coding process was applied to match identified challenges to the appropriate Consolidated Framework for Implementation Research (CFIR). RESULTS The leading challenges cited by KIs correspond to the CFIR domains of inner setting (e.g., funding and resources), outer setting (e.g., navigating regulations), and process (e.g., engaging community partnership). Practices that may mitigate challenges include maximizing ancillary services, adopting innovative volunteer and staffing structures, and formalizing agreements with community partners. CONCLUSION Common and persistent challenges ought to be addressed to ensure and enhance the positive public health impacts of mobile produce markets. Contextual factors, particularly organizational factors, that impact implementation should also be considered when implementing an evidence-based intervention at a mobile market. Further research is needed to determine which innovative solutions are the most effective in mitigating challenges, improving implementation, and enhancing sustainability of mobile markets.
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Affiliation(s)
- Christina M Kasprzak
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA.
| | - Anne E Lally
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
- Department of Anthropology, The College of Arts and Sciences, University at Buffalo, Buffalo, USA
| | - Julia J Schoonover
- Department of Sociology, The College of Arts and Sciences, University at Buffalo, Buffalo, USA
| | - Deanna Gallicchio
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professionals, University at Buffalo, Buffalo, USA
| | - Lindsey Haynes-Maslow
- Department of Agricultural and Human Sciences, North Carolina State University, Raleigh, USA
| | - Leah N Vermont
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Alice S Ammerman
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Samina Raja
- Department of Urban and Regional Planning, School of Architecture and Planning, University at Buffalo, Buffalo, USA
| | - Laurene Tumiel-Berhalter
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, USA
| | - Jill N Tirabassi
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, USA
| | - Lucia A Leone
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
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10
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Abstract
Since the mid-1990s, there has been a growing interest among consumers and producers in downscaling to a local level the length of the agri-food chains as a solution for fairer and more sustainable food production systems. From the point of view of consumption, the attribute “local” is assuming an important role in defining food purchasing preferences, both in terms of expectations of product quality and in terms of its perceived relevance in determining the supply chain sustainability. This research aims to define how individuals’ perception of local production influences the definition of “local” among consumers based on a survey submitted to a sample of 500 consumers in North-Western Italy. The paper provides: (i) a semantic map built on keywords adopted by the respondents to describe local production; (ii) a categorization of food consumers divided in clusters on the basis of their eating styles; and (iii) a characterization of consumers clusters according to the preferences and knowledge expressed towards local production. The results show that consumers’ awareness and attitudes towards the concept of the “local” are influenced by the joint effect of their socio-demographic profile and their food consumption style, with some unexpected evidences that would deserve to be deepen with further research. However, given this uncertainty, three main traits seem to characterize the consumers attitude towards the “local”: a positive relation among the dimensions of environment, local development and product quality and the strength of the link between local production and the reduction of the length of the supply chain. Ultimately, territoriality is perceived as an index of higher product quality (seasonal, therefore fresh and genuine).
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11
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Howse E, Cullerton K, Grunseit A, Bohn-Goldbaum E, Bauman A, Freeman B. Measuring public opinion and acceptability of prevention policies: an integrative review and narrative synthesis of methods. Health Res Policy Syst 2022; 20:26. [PMID: 35246170 PMCID: PMC8895540 DOI: 10.1186/s12961-022-00829-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 02/15/2022] [Indexed: 11/21/2022] Open
Abstract
Acceptability of and public support for prevention are an important part of facilitating policy implementation. This review aims to identify, summarize and synthesize the methods and study designs used to measure and understand public opinion, community attitudes and acceptability of strategies to prevent chronic noncommunicable disease (NCDs) in order to allow for examination of imbalances in methodological approaches and gaps in content areas. We searched four scientific databases (CINAHL, Embase, Ovid/MEDLINE and Scopus) for peer-reviewed, English-language studies published between January 2011 and March 2020 in high-income, democratic countries across North America, Europe and the Asia–Pacific region. Studies were included if they focused on opinions, attitudes and acceptability of primary prevention strategies and interventions addressing the key NCD risk factors of alcohol use, unhealthy diet, overweight/obesity, tobacco use and smoking, and physical inactivity. A total of 293 studies were included. Two thirds of studies (n = 194, 66%) used quantitative methods such as cross-sectional studies involving surveys of representative (n = 129, 44%) or convenience (n = 42, 14%) samples. A smaller number of studies used qualitative methods (n = 60, 20%) such as focus groups (n = 21, 7%) and interviews (n = 21, 7%). Thirty-nine studies (13%) used mixed methods such as content analysis of news media (n = 17, 6%). Tobacco control remains the dominant topic of public opinion literature about prevention (n = 124, 42%). Few studies looked solely at physical inactivity (n = 17, 6%). The results of this review suggest that public opinion and acceptability of prevention in the peer-reviewed literature is investigated primarily through cross-sectional surveys. Qualitative and mixed methods may provide more nuanced insights which can be used to facilitate policy implementation of more upstream strategies and policies to prevent NCDs.
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Affiliation(s)
- Eloise Howse
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia. .,Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Katherine Cullerton
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia.,School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Anne Grunseit
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia.,Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Erika Bohn-Goldbaum
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia.,Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Adrian Bauman
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia.,Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Becky Freeman
- Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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12
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Hernandez DC, Daundasekara SS, Walton QL, Eigege CY, Marshall AN. Feasibility of Delivering an on-Campus Food Distribution Program in a Community College Setting: A Mixed Methods Sequential Explanatory Investigation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12106. [PMID: 34831861 PMCID: PMC8619067 DOI: 10.3390/ijerph182212106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022]
Abstract
Despite community college students experiencing food insecurity there has been a dearth of research conducted on the feasibility of providing a program designed to increase access to fruits and vegetables among community colleges. This study used a mixed methods sequential explanatory design to examine the feasibility of delivering an on-campus food distribution program (FDP) to community college students and to examine the association between FDP and food insecurity and dietary intake. The study also explored the student's experiences related to barriers and facilitators of program utilization. In phase one, the FDP occurred for eight months and students could attend twice per month, receiving up to 60 pounds of food per visit. Online questionnaires were used to collect students' food security and dietary intake. Among the 1000 students offered the FDP, 495 students enrolled, with 329 students (66.5%) attending ≥ 1. Average attendance = 3.27 (SD = 3.08) [Range = 1-16] distributions. The FDP did not reduce food insecurity nor improve dietary intake. In phase two, a subsample of students (n = 36) discussed their FDP experiences through focus groups revealing three barriers limiting program utilization: program design and organization, personal schedule and transportation, and program abuse by other attendees. Facilitators to greater program utilization included: the type of food distributed and welcoming environment, along with allowing another designated individual to collect food. To maximize program use, it is suggested that reported barriers be addressed, which might positively influence food insecurity and dietary intake.
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Affiliation(s)
- Daphne C. Hernandez
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (S.S.D.); (A.N.M.)
| | - Sajeevika S. Daundasekara
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (S.S.D.); (A.N.M.)
| | - Quenette L. Walton
- Graduate College of Social Work, University of Houston, Houston, TX 77004, USA; (Q.L.W.); (C.Y.E.)
| | - Chinyere Y. Eigege
- Graduate College of Social Work, University of Houston, Houston, TX 77004, USA; (Q.L.W.); (C.Y.E.)
| | - Allison N. Marshall
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (S.S.D.); (A.N.M.)
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13
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What Are the Relationships between Psychosocial Community Characteristics and Dietary Behaviors in a Racially/Ethnically Diverse Urban Population in Los Angeles County? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189868. [PMID: 34574791 PMCID: PMC8468734 DOI: 10.3390/ijerph18189868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/22/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022]
Abstract
To address existing gaps in public health practice, we used data from a 2014 internet panel survey of 954 Los Angeles County adults to investigate the relationships between psychosocial community characteristics (PCCs) and two key chronic disease-related dietary behaviors: fruit and vegetable (F+V) and soda consumption. Negative binomial regression models estimated the associations between 'neighborhood risks and resources' and 'sense of community' factors for each dietary outcome of interest. While high perceived neighborhood violence (p < 0.001) and perceived community-level collective efficacy (p < 0.001) were associated with higher F+V consumption, no PCCs were directly associated with soda consumption overall. However, moderation analyses by race/ethnicity showed a more varied pattern. High perceived violence was associated with lower F+V consumption among White and Asian/Native Hawaiian/Other Pacific Islander (ANHOPI) groups (p < 0.01). Inadequate park access and walking as the primary mode of transportation to the grocery store were associated with higher soda consumption among the ANHOPI group only (p < 0.05). Study findings suggest that current and future chronic disease prevention efforts should consider how social and psychological dynamics of communities influence dietary behaviors, especially among racially/ethnically diverse groups in urban settings. Intervention design and implementation planning could benefit from and be optimized based on these considerations.
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14
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Kasprzak CM, Schoonover JJ, Gallicchio D, Haynes-Maslow L, Vermont LN, Ammerman A, Raja S, Tumiel-Berhalter L, Leone LA. Using common practices to establish a framework for mobile produce markets in the United States. JOURNAL OF AGRICULTURE, FOOD SYSTEMS, AND COMMUNITY DEVELOPMENT 2021; 10:73-84. [PMID: 35548369 PMCID: PMC9090202 DOI: 10.5304/jafscd.2021.104.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Access to affordable fruit and vegetables (F&V) remains a challenge within underserved communities across the United States. Mobile produce markets (mobile markets) are a well-accepted and effective strategy for increasing F&V consumption in these communities. Mobile market organizations share similar missions that focus on food, health, and empowerment, participate in incentive programs, offer nutrition education, utilize grassroots-based marketing strategies, prioritize local produce, and sell competitively priced produce through a market style. While mobile markets have become increasingly prevalent, models vary widely. Establishing standardized practices is essential for ensuring the effectiveness and sustainability of this important food access program. This research seeks to identify common practices of established mobile markets and describe the resources they rely on.
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Affiliation(s)
- Christina M. Kasprzak
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo; 329 Kimball Tower; Buffalo, NY 14214 USA
| | - Julia J. Schoonover
- Department of Sociology, The College of Arts and Sciences, University at Buffalo
| | - Deanna Gallicchio
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professionals, University at Buffalo
| | | | - Leah N. Vermont
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo
| | - Alice Ammerman
- Department of Nutrition, Gilling School of Public Health, University of North Carolina at Chapel Hill
| | - Samina Raja
- Department of Urban and Regional Planning, School of Architecture and Planning, University at Buffalo
| | - Laurene Tumiel-Berhalter
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
| | - Lucia A. Leone
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo
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15
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McManus KE, Bertrand A, Snelling AM, Cotter EW. In Their Own Words: Parents and Key Informants' Views on Nutrition Education and Family Health Behaviors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8155. [PMID: 34360448 PMCID: PMC8346135 DOI: 10.3390/ijerph18158155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022]
Abstract
Parents, health professionals, and communities are integral in the development of nutrition behaviors that reduce children's risk for high body mass index (BMI) and chronic disease. The aim of this study was to conduct formative evaluations with key health informants and parents to understand the specific strategies that families use at mealtimes to promote their family's health, along with the barriers they face in attending current nutrition education programming. Focus groups (in English and Spanish) were conducted with parents (n = 22; 63.64% Black/African American, 13.64% Black but not African American, 18.18% Hispanic/Latinx) whose household was located in a community where 50% of residents' gross income was ≤185% of the federal poverty level. Semi-structured interviews were conducted with six key informants with expertise in family health and nutrition. Inductive thematic analysis was used to identify themes across interviews. Six general themes emerged from the interviews including perceptions of health, relationships, health behaviors, facilitators, barriers, and desired changes. Across the six themes, participants responded with suggestions for community-based health promotion programs such as incorporating a broader definition of health to better address the individual and systemic barriers that perpetuate health inequities and make healthy eating difficult. Participants identified stress reduction, health literacy, and cooking knowledge as areas of interest for future programming.
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Affiliation(s)
| | - Adrian Bertrand
- Department of Health Studies, American University, Washington, DC 20016, USA; (A.B.); (A.M.S.); (E.W.C.)
| | - Anastasia M. Snelling
- Department of Health Studies, American University, Washington, DC 20016, USA; (A.B.); (A.M.S.); (E.W.C.)
| | - Elizabeth W. Cotter
- Department of Health Studies, American University, Washington, DC 20016, USA; (A.B.); (A.M.S.); (E.W.C.)
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16
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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: 11] [Impact Index Per Article: 3.7] [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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17
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Stotz SA, Thompson JJ, Bhargava V, Scarrow A, Cheek H, Harvey D, Lee JS. Feasibility of eLearning Nutrition Education and Supplemental Locally-Grown Produce Dissemination Model: Perspectives from Key Stakeholders. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2021. [DOI: 10.1080/19320248.2020.1768998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Sarah A. Stotz
- Colorado School of Public Health, Centers for American Indian and Alaska Native Health, University of Colorado, Aurora, Colorado, USA
| | | | - Vibha Bhargava
- Department of Foods and Nutrition, University of Georgia, Athens, GA, USA
| | - Andrea Scarrow
- University of Georgia Cooperative Extension, Tifton, GA, USA
| | | | | | - Jung Sun Lee
- Department of Foods and Nutrition, University of Georgia, Athens, GA, USA
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18
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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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19
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Malberg Dyg P, Christensen S, Peterson CJ. Community gardens and wellbeing amongst vulnerable populations: a thematic review. Health Promot Int 2021; 35:790-803. [PMID: 31369084 DOI: 10.1093/heapro/daz067] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The aim of the thematic review is to document the effects of community gardens on wellbeing amongst vulnerable populations. We searched for articles published between 1980 and 2017 in major databases resulting in the inclusion of 51 articles. Vulnerable populations included, amongst others, ethnic minorities and refugees, socioeconomically disadvantaged neighbourhoods or low-income or food insecure families. Our findings suggest that community garden participation may have a positive impact on physical health, such as reducing body weight and hypertension, and increasing physical activity and food knowledge. However, findings relating to community gardens and their potential to enhance food security were inconsistent. Furthermore we found that community gardens can have a positive influence both at the individual level (i.e. self-esteem, independence, personal control, etc.), particularly for refugees; the relational and social level (i.e. relationships, social connections, community and neighbourhood). Community garden participation have the potential to enhance wellbeing amongst vulnerable populations. However, two articles in our review presented potential food safety concerns related to community gardens, indicating that, particularly in urban settings, attention must be given to minimizing potential food safety concerns, e.g. by using raised garden beds. Based on this review, we recommend that further research and evaluation on non-US-based community gardens is carried out, as community gardens are practiced globally but there is little research to document the effects of community gardens on wellbeing amongst vulnerable populations outside of the USA.
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Affiliation(s)
- Pernille Malberg Dyg
- University College Copenhagen, Department of Nursing and Nutrition, 2200 Copenhagen, Denmark
| | - Søren Christensen
- Roskilde University, Institute for People and Technology, 4000 Roskilde, Denmark
| | - Corissa Jade Peterson
- University College Copenhagen, Department of Nursing and Nutrition, 2200 Copenhagen, Denmark
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20
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Dulin A, Mealy R, Whittaker S, Cardel M, Wang J, Risica PM, Gans K. Identifying Barriers to and Facilitators of Using a Mobile Fruit and Vegetable Market Intervention Delivered to Low-Income Housing Sites: A Concept Mapping Study. HEALTH EDUCATION & BEHAVIOR 2021; 49:159-168. [PMID: 33729024 DOI: 10.1177/1090198121998287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mobile fruit and vegetable (F&V) markets may be a promising strategy to improve F&V intake among low-income and racial/ethnic minority groups. However, challenges remain in terms of maximizing the reach and utilization of such markets. Therefore, this study identifies perceived barriers to and facilitators of utilizing a mobile F&V market among residents who lived in low-income housing that received the markets. Specifically, this article reports the results of the follow-up acceptability study of the "Live Well, Viva Bien" (LWVB) intervention. METHOD We conducted concept mapping with residents in housing communities that received the Fresh to You (FTY) markets. Participants generated, sorted, and rated statements concerning barriers to and facilitators of market use. We compared the rating data by residents' level of market utilization and created a map representing how statements clustered into conceptual themes. RESULTS We retained 66 unique participant-generated statements. Eight thematic clusters emerged; four pertained to barriers: financial/promotion, produce-related, scheduling/knowledge, and logistic/awareness barriers, and four related to facilitators: produce/staffing, promotion, accessibility, and multilevel market facilitators. There was a strong correlation in ratings between participants who more frequently versus less frequently shopped at the markets (r = 0.94). CONCLUSIONS Participants identified financial barriers, market promotion, ease of market accessibility, produce variety and quality, and staffing as key factors influencing FTY market use. This study highlights the importance of identifying the perceived barriers to and facilitators of mobile F&V market use among target populations to inform future efforts to scale up such approaches.
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Affiliation(s)
| | | | | | | | | | | | - Kim Gans
- University of Connecticut, Storrs, CT, USA
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21
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A Model Depicting the Retail Food Environment and Customer Interactions: Components, Outcomes, and Future Directions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207591. [PMID: 33086537 PMCID: PMC7589434 DOI: 10.3390/ijerph17207591] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/06/2020] [Accepted: 10/16/2020] [Indexed: 12/26/2022]
Abstract
The retail food environment (RFE) has important implications for dietary intake and health, and dramatic changes in RFEs have been observed over the past few decades and years. Prior conceptual models of the RFE and its relationships with health and behavior have played an important role in guiding research; yet, the convergence of RFE changes and scientific advances in the field suggest the time is ripe to revisit this conceptualization. In this paper, we propose the Retail Food Environment and Customer Interaction Model to convey the evolving variety of factors and relationships that convene to influence food choice at the point of purchase. The model details specific components of the RFE, including business approaches, actors, sources, and the customer retail experience; describes individual, interpersonal, and household characteristics that affect customer purchasing; highlights the macro-level contexts (e.g., communities and nations) in which the RFE and customers behave; and addresses the wide-ranging outcomes produced by RFEs and customers, including: population health, food security, food justice, environmental sustainability, and business sustainability. We believe the proposed conceptualization helps to (1) provide broad implications for future research and (2) further highlight the need for transdisciplinary collaborations to ultimately improve a range of critical population outcomes.
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22
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DeWit EL, Meissen-Sebelius EM, Shook RP, Pina KA, De Miranda ED, Summar MJ, Hurley EA. Beyond clinical food prescriptions and mobile markets: parent views on the role of a healthcare institution in increasing healthy eating in food insecure families. Nutr J 2020; 19:94. [PMID: 32907620 PMCID: PMC7487727 DOI: 10.1186/s12937-020-00616-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/26/2020] [Indexed: 11/18/2022] Open
Abstract
Background Children in food-insecure families face increased barriers to meeting recommendations for fruit and vegetable consumption. Hospitals and pediatric healthcare institutions have attempted to alleviate food-insecurity through various internal programs like food prescriptions, yet little evidence for these programs exist. Consistent with a patient-centered perspective, we sought to develop a comprehensive understanding of barriers to fruit and vegetable consumption and a parent-driven agenda for healthcare system action. Methods We conducted six qualitative focus group discussions (four in English, two in Spanish) with 29 parents and caregivers of patients who had screened positive for food-insecurity during visits to a large pediatric healthcare system in a midwestern U.S. city. Our iterative analysis process consisted of audio-recording, transcribing and coding discussions, aiming to produce a) a conceptual framework of barriers to fruit and vegetable consumption and b) a synthesis of participant programmatic suggestions for their healthcare system. Results Participants were 90% female, 38% Black/African American and 41% Hispanic/Latino. Barriers to fruit and vegetable consumption in their families fell into three intersecting themes: affordability, accessibility and desirability. Participant-generated intervention recommendations were multilevel, suggesting healthcare systems focus not only on clinic and community-based action, but also advocacy for broader policies that alleviate barriers to acquiring healthy foods. Conclusion Parents envision an expanded role for healthcare systems in ensuring their children benefit from a healthy diet. Findings offer critical insight on why clinic-driven programs aimed to address healthy eating may have failed and healthcare organizations may more effectively intervene by adopting a multilevel strategy.
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Affiliation(s)
- Emily L DeWit
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Emily M Meissen-Sebelius
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Robin P Shook
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA.,Department of Pediatrics, University of Missouri Kansas City- School of Medicine, Kansas City, MO, USA
| | - Kimberly A Pina
- Health Services and Health Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA.
| | - Evelyn Donis De Miranda
- Health Services and Health Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Michelle J Summar
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Emily A Hurley
- Health Services and Health Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA.,Department of Pediatrics, University of Missouri Kansas City- School of Medicine, Kansas City, MO, USA
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23
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Haynes-Maslow L, Hardison-Moody A, Patton-Lopez M, Prewitt TE, Byker Shanks C, Andress L, Osborne I, Jilcott Pitts S. Examining Rural Food-Insecure Families' Perceptions of the Supplemental Nutrition Assistance Program: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176390. [PMID: 32887328 PMCID: PMC7504226 DOI: 10.3390/ijerph17176390] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/13/2020] [Accepted: 08/22/2020] [Indexed: 11/16/2022]
Abstract
The Supplemental Nutrition Assistance Program (SNAP) is a critical program that helps reduce the risk of food insecurity, yet little is known about how SNAP addresses the needs of rural, food-insecure residents in the United States (U.S.). This study examines how rural, food-insecure residents perceive SNAP. Semi-structured interviews were conducted with 153 individuals living in six diverse rural regions of Arkansas, Montana, North Carolina, Oregon, Texas, and West Virginia. SNAP was described as a crucial stop-gap program, keeping families from experiencing persistent food insecurity, making food dollars stretch when the family budget is tight, and helping them purchase healthier foods. For many rural residents interviewed, SNAP was viewed in a largely positive light. In efforts to continue improving SNAP, particularly in light of its relevance during and post-coronavirus (COVID-19) pandemic, policymakers must be aware of rural families' perceptions of SNAP. Specific improvements may include increased transparency regarding funding formulas, budgeting and nutrition education for recipients, effective training to improve customer service, connections among social service agencies within a community, and increased availability of automation to streamline application processes.
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Affiliation(s)
- Lindsey Haynes-Maslow
- Department of Agricultural & Human Sciences, North Carolina State University, Raleigh, NC 27659, USA;
- Correspondence: ; Tel.: +1-919-515-9125
| | - Annie Hardison-Moody
- Department of Agricultural & Human Sciences, North Carolina State University, Raleigh, NC 27659, USA;
| | - Megan Patton-Lopez
- Division of Health & Exercise Science, Western Oregon University, Monmouth, OR 97361, USA;
| | - T. Elaine Prewitt
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
| | - Carmen Byker Shanks
- Food and Health Lab, Department of Health & Human Development, Montana State University, Bozeman, MT 59718, USA;
| | - Lauri Andress
- Department of Health Policy, Management, and Leadership, West Virginia University School of Public Health, Morgantown, WV 26505, USA;
| | - Isabel Osborne
- Department of Global Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA;
| | - Stephanie Jilcott Pitts
- Department of Public Health, East Carolina University, 115 Heart Drive, Greenville, NC 27834, USA;
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Kasprzak CM, Sauer HA, Schoonover JJ, Lapp MM, Leone LA. Barriers and Facilitators to Fruit and Vegetable Consumption among Lower-Income Families: Matching Preferences with Stakeholder Resources. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2020. [DOI: 10.1080/19320248.2020.1802383] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Christina M. Kasprzak
- Community Health and Health Behavior, School of Public Health and Health Professions, Buffalo, New York, United States
| | - Halle A. Sauer
- Rehabilitation Science, School of Public Health and Health Professions, Buffalo, New York, United States
| | - Julia J. Schoonover
- Department of Sociology, The College of Arts and Sciences, Buffalo, New York, United States
| | - Margaret M. Lapp
- Community Health and Health Behavior, School of Public Health and Health Professions, Buffalo, New York, United States
| | - Lucia A. Leone
- Community Health and Health Behavior, School of Public Health and Health Professions, Buffalo, New York, United States
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Barriers to Preparing and Cooking Vegetables Are Associated with Decreased Home Availability of Vegetables in Low-Income Households. Nutrients 2020; 12:nu12061823. [PMID: 32570923 PMCID: PMC7353206 DOI: 10.3390/nu12061823] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/06/2020] [Accepted: 06/16/2020] [Indexed: 11/16/2022] Open
Abstract
Knowing which barriers to buying and preparing/cooking vegetables at home are linked with the home availability of vegetables and how food-security status impacts this relationship will facilitate the tailoring of future public health interventions. Baseline data were used from an elementary-school-based intervention. Data on household food-security status, availability of vegetables at home, and barriers to buying and preparing/cooking vegetables were collected from 1942 parents. Differences between food-secure and food-insecure households were examined for barriers to buying and preparing/cooking vegetables. Mixed-effects linear regression was used to estimate the associations between barriers to buying and preparing/cooking vegetables and food-security status on the home availability of vegetables. Food insecurity was reported in 27% of households. Food-insecure households were significantly more likely to report barriers to buying and preparing/cooking vegetables. The barriers to purchasing/cooking vegetables score was associated with a decrease in the home availability of vegetables score (β = −0.77; 95% CI: −0.88, −0.65; p < 0.001). Compared to food-secure households, food-insecure households were 15% less likely to have home vegetable availability (β = −1.18; 95% CI: −1.45, −0.92; p < 0.001). Although home availability of vegetables does not guarantee consumption, this study identified specific barriers that were associated with availability that can be targeted in future interventions seeking to improve vegetable consumption in the homes of low-income families.
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Esquivel MK, Higa A, Hitchens M, Shelton C, Okihiro M. Keiki Produce Prescription (KPRx) Program Feasibility Study to Reduce Food Insecurity and Obesity Risk. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2020; 79:44-49. [PMID: 32490385 PMCID: PMC7260871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
One in 6 US children experience food insecurity, signifying that at some time during the last year their household did not have sufficient food, money, or resources to feed their family. These children experience little intake of fresh fruits and vegetables (FV), a risk factor for chronic disease, including obesity. Produce prescription programs provide vouchers to purchase fresh FV at participating retailers. The Keiki Produce Prescription (KPRx) Program feasibility study was conducted through a partnership between the Waianae Coast Comprehensive Health Center's Pediatrics and Health Promotion Department's Farmers'Market and the University of Hawai'i nutrition faculty. Pediatricians provided patients with a prescription (Rx) to purchase FV from the Farmers' Market ($24 per month for three months). Of the 193 Rx distributed, 125 patients participated in part of the program, while 34 completed the full program. Parents, pediatricians, clinic staff, and community members expressed overwhelming support of the program. Parents of participating children completed an exit interview that identified themes surrounding motivation to participate, benefits to child and family, and future recommendations. It identified the need to improve program retention efforts. Participants reported lifestyle benefits for both the child and family and recommended educational resources. Aresearch protocol was developed to address the following objectives: (1) streamline referrals, (2) enhance retention, (3) quantify program impact, and (4) identify barriers to participation. Subsidies have the potential to increase FV consumption, improve overall health, reduce chronic diseases in adulthood, and result in substantial healthcare cost savings.
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Affiliation(s)
- Monica K. Esquivel
- Department of Human Nutrition, Food and Animal Sciences College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, Honolulu, HI (MKE, CS)
| | - Alicia Higa
- Wai‘anae Coast Comprehensive Health Center, Wai‘anae HI (AH, MH, MO)
| | - Moulika Hitchens
- Wai‘anae Coast Comprehensive Health Center, Wai‘anae HI (AH, MH, MO)
| | - Cherese Shelton
- Department of Human Nutrition, Food and Animal Sciences College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, Honolulu, HI (MKE, CS)
| | - May Okihiro
- Wai‘anae Coast Comprehensive Health Center, Wai‘anae HI (AH, MH, MO)
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López-Cepero A, Frisard C, Bey G, Lemon SC, Rosal MC. Association between food insecurity and emotional eating in Latinos and the mediating role of perceived stress. Public Health Nutr 2020; 23:642-648. [PMID: 31718732 PMCID: PMC7060105 DOI: 10.1017/s1368980019002878] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 06/06/2019] [Accepted: 06/24/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To examine the association between food insecurity and emotional eating (EE) in US Latinxs and explore the mediating role of perceived stress. DESIGN Cross-sectional analysis. Food insecurity was measured with the six-item US Department of Agriculture Household Food Security Scale; EE with the Three-Factor Eating Questionnaire R18-V2; and perceived stress with Cohen's Perceived Stress Scale-10. Covariates included age, sex, education, marital status, household size and country of birth. Mediation was tested using the Baron and Kenny method and the mediated proportion was calculated. Analyses included multivariable linear regression and multinomial logistic regression. SETTING A largely Latinx city in Massachusetts, USA. Participants were recruited from a community health centre serving a large portion of this Latinx community. PARTICIPANTS Latinx individuals (n 580), aged 21-84 years. RESULTS Overall, 34·4 % were food insecure and 33·8 % experienced High EE. Food insecurity was associated (adjusted OR; 95 % CI) with higher odds of High EE (1·96; 1·28, 3·02) but not Low EE (1·27; 0·82, 1·99). Food insecurity was associated (β; 95 % CI) with higher perceived stress (5·69; 4·20, 7·19). Perceived stress was associated (adjusted OR; 95 % CI) with High EE (1·09; 1·06, 1·12) but not Low EE (1·00; CI 0·97, 1·02). When perceived stress was added in the main effects model, food insecurity was no longer associated (OR; 95 % CI) with High EE (1·31; 0·83, 2·07) and explained 69·9 % of the association between food insecurity and High EE. CONCLUSIONS The association between food insecurity and high EE among Latinxs may be largely mediated by perceived stress. Longitudinal studies are needed.
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Affiliation(s)
- Andrea López-Cepero
- Division of Preventive and Behavioral Medicine, Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Christine Frisard
- Division of Preventive and Behavioral Medicine, Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Ganga Bey
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Stephenie C Lemon
- Division of Preventive and Behavioral Medicine, Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Milagros C Rosal
- Division of Preventive and Behavioral Medicine, Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA
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Swindle T, Curran GM, Johnson SL. Implementation Science and Nutrition Education and Behavior: Opportunities for Integration. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:763-774.e1. [PMID: 30982567 PMCID: PMC6904925 DOI: 10.1016/j.jneb.2019.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/27/2019] [Accepted: 03/01/2019] [Indexed: 05/05/2023]
Abstract
Implementation science (IS) is the study of approaches designed to increase adoption and sustainability of research evidence into routine practice. This article provides an overview of IS and ideas for its integration with nutrition education and behavior practice and research. Implementation science application in nutrition education and behavior practice can inform real-word implementation efforts. Research opportunities include advancing common approaches to implementation measurement. In addition, the article provides suggestions for future studies (eg, comparative effectiveness trials comparing implementation strategies) to advance the knowledge base of both fields. An example from ongoing research is included to illustrate concepts and methods of IS.
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Affiliation(s)
- Taren Swindle
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Geoff M Curran
- Department of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Susan L Johnson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
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Herran OF, Patiño GA, Gamboa EM. Socioeconomic inequalities in the consumption of fruits and vegetables: Colombian National Nutrition Survey, 2010. CAD SAUDE PUBLICA 2019; 35:e00031418. [PMID: 30892423 DOI: 10.1590/0102-311x00031418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 09/20/2018] [Indexed: 11/21/2022] Open
Abstract
The objective of this study was to estimate inequalities in the consumption of fruits and vegetables. A multilevel study was performed based on cross-sectional data of adults from 18 to 64 years of age (n = 5,217) and in geodemographic units (n = 33). The consumption of fruits and vegetables was estimated with a food frequency questionnaire administered as part of the 2010 Colombian National Nutrition Survey (ENSIN). Inequality indices for the consumption of whole fruits and fruit juice and for raw and cooked vegetables were estimated using data on wealth, food security, geographical area and monetary poverty. The prevalence of the consumption of cooked vegetables was 64.8% (95%CI: 59.2-70.4) among men and the prevalence of the consumption of fruit juice was 86.1% (95%CI: 82.4-89.8) among women. The frequency of the consumption of fruit juice was 1.03 times/day (95%CI: 0.93-1.14) among women. The prevalence and frequency fruits and vegetables consumption per day for the three socioeconomic variables considered in this study are higher according to the higher socioeconomic level (p < 0.05), except for the consumption frequency of whole fruits/day (p = 0.24). At the individual level, the Gini coefficient for frequency/day ranged from 0.51 to 0.62. At the ecological level, the Gini index for prevalence ranged from 0.04 to 0.14; and for frequency/day ranged from 0.03 to 0.11. The Colombian population does not meet fruits and vegetables consumption recommendations. Men and women favor the consumption of fruit juice over whole fruits. The inequality in vegetable consumption is clear, with men at a disadvantage. The poor eat fewer fruits and vegetables.
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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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Haynes-Maslow L, Osborne I, Pitts SJ. Examining Barriers and Facilitators to Delivering SNAP-Ed Direct Nutrition Education in Rural Communities. Am J Health Promot 2019; 33:736-744. [DOI: 10.1177/0890117118821845] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To better understand the barriers to implementing Supplemental Nutrition Assistance Program Education (SNAP-Ed) direct education programming in rural communities, as well as strategies to overcome these barriers. This includes (1) barriers to implementing direct education in rural communities, and (2) facilitators to overcoming direct-education barriers in rural communities. Design: This was a qualitative study that included in-depth interviews. Setting: Fifteen states across all 7 SNAP-Ed regions. Participants: Participants were eligible if they (1) were SNAP-Ed staff who were involved with implementing programs; (2) implemented at least 50% of their programming in rural communities, and (3) worked in their role for at least 12 months. Twenty-seven (n = 27) staff participated in interviews. Measures: Online surveys ascertained if participants were interested in participating in a 60-minute interview about implementing SNAP-Ed in rural communities. Interviews were semistructured and focused on the barriers and facilitators to implementing SNAP-Ed direct-education nutrition programming in rural areas. Analysis: Qualitative interviews were analyzed using content analysis in Atlas.ti. Results: Barriers to implementing direct education in rural communities included lack of healthy food and physical activity infrastructure to reinforce messages taught in class, funding restrictions, transportation for SNAP-Ed staff and the perception that this was also a problem for participants, and SNAP-Ed staff being seen as “outsiders” (not from the community). Facilitators included partnering with other organizations to increase recruitment and retention of SNAP-Ed participants, buy-in from local leaders, and SNAP-Ed staff being from the community. Conclusion: Partnerships between SNAP-Ed programs and non-SNAP-Ed organizations were essential in helping to recruit and retain participants. The SNAP-Ed staff should get buy-in from local leaders before starting direct-education programming. The SNAP-Ed programs should explore innovative delivery modalities including online and text messaging due to transportation issues in widespread rural geographies. Lastly, more work should be done to complement SNAP-Ed direct education with policy, systems, and environmental change initiatives.
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Affiliation(s)
- Lindsey Haynes-Maslow
- Department of Agricultural and Human Sciences, NC State University, Raleigh, NC, USA
| | - Isabel Osborne
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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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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Monteban MF, Bess KD, Walsh CC, Baily H, Flocke SA, Borawski EA, Freedman DA. People and places shaping food procurement among recipients of Supplemental Nutrition Assistance Program (SNAP). Health Place 2018; 53:155-163. [PMID: 30142499 DOI: 10.1016/j.healthplace.2018.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/30/2018] [Accepted: 08/03/2018] [Indexed: 01/18/2023]
Abstract
A key gap in existing food environment research is a more complex understanding of the interplay between physical and social contexts, including the influence of social networks on food habits. This mixed methods research examined the nature of social connections at food procurement places among a sample of 30 people receiving Supplemental Nutrition Assistance Program (SNAP) benefits in an urban setting. Results highlight the significance of social connections as motivators to use food places, the value of access to information and other resources at food places, and the role of weak ties with actors within food places to facilitate utilization and interaction. Social connections at the varied places individuals procure food may be leveraged to disseminate information and resources to further healthy food access.
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Affiliation(s)
- Madalena F Monteban
- Case Western Reserve University, School of Medicine, Prevention Research Center for Healthy Neighborhoods, BioEnterprise Building, Room 443, 11000 Cedar Avenue, Cleveland, OH 44106, USA.
| | - Kimberly D Bess
- Vanderbilt University, Department of Human and Organizational Development, Peabody #90, 230 Appleton Place, Nashville, TN 37203-5721, USA
| | - Colleen C Walsh
- Cleveland State University, School of Health Sciences, 2121 Euclid Ave. IM 115, Cleveland, OH 44115, USA
| | - Heather Baily
- Case Western Reserve University, Department of Anthropology, Mather Memorial Room 238, 11220 Bellflower Road, Cleveland, OH 44106-7125, USA
| | - Susan A Flocke
- Case Western Reserve University, School of Medicine, Prevention Research Center for Healthy Neighborhoods, BioEnterprise Building, Room 443, 11000 Cedar Avenue, Cleveland, OH 44106, USA
| | - Elaine A Borawski
- Case Western Reserve University, School of Medicine, Prevention Research Center for Healthy Neighborhoods, BioEnterprise Building, Room 443, 11000 Cedar Avenue, Cleveland, OH 44106, USA
| | - Darcy A Freedman
- Case Western Reserve University, School of Medicine, Prevention Research Center for Healthy Neighborhoods, BioEnterprise Building, Room 443, 11000 Cedar Avenue, Cleveland, OH 44106, USA
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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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Freedman DA, Lee E, Ohri-Vachaspati P, Trapl E, Borawski E, Bess K, Flocke S. Predictors of Farmers' Market Shopping among People Receiving Supplemental Nutrition Assistance Program Benefits. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 61:488-499. [PMID: 29659024 DOI: 10.1002/ajcp.12245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Promoting use of farmers' markets (FMs) is a promising community-level strategy to increase access to nutritious foods such as fruits and vegetables. Yet, FM shopping among people with Supplemental Nutrition Assistance Program (SNAP) benefits remains low. This research examined predictors of FM shopping among SNAP recipients living within 1 mile of a FM. A cross-sectional survey of SNAP participants (N = 270) was conducted in 2015 in Cleveland and East Cleveland, OH, USA. Multinomial regression and zero-truncated Poisson regression analyses were conducted to examine factors associated with FM shopping. Results indicate 48% reported shopping at a FM at least once in the past year, 26% had shopped at a FM before, but not in the last year, and 26% had never shopped at a FM. The multivariable analyses found awareness of FMs and a healthy food incentive program, and four dimensions of healthy food access are significantly associated with FM shopping among SNAP recipients. The food access dimensions included service delivery, spatial-temporal, personal, and social access. Findings highlight modifiable leverage points for improving the reach of FMs among low-income populations.
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Affiliation(s)
| | - Eunlye Lee
- Case Western Reserve University, Cleveland, OH, USA
| | | | - Erika Trapl
- Case Western Reserve University, Cleveland, OH, USA
| | | | | | - Susan Flocke
- Case Western Reserve University, Cleveland, OH, USA
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Barriers to fruit and vegetable consumption among farmers’ market incentive programme users in Illinois, USA. Public Health Nutr 2018; 21:1345-1349. [DOI: 10.1017/s1368980018000101] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectivePrevious research indicates that low-income individuals often struggle to consume the recommended amount of fruits and vegetables (F&V). LINK Up Illinois is a farmers’ market incentive programme that aims to increase F&V consumption among Supplemental Nutrition Assistance Program (SNAP) recipients by improving access to and affordability of locally grown foods. The present research aimed to identify barriers to F&V consumption that exist among users of the LINK Up Illinois programme.DesignCross-sectional.SettingFarmers’ markets in Chicago, Springfield, Northbrook, Woodstock, Aurora and Urbana, IL.SubjectsIn 2016, a volunteer sample of 140 LINK Up Illinois users (mean age 42·5 years; 81·7 % female; 28·7 % African American; 44·0 % obese) completed a survey at participating farmers’ markets across the state. Information on demographics, food shopping behaviours, programme satisfaction, barriers to F&V consumption and frequency of F&V consumption was collected and examined.ResultsApproximately 23 % of survey participants reported consuming F&V ≥3 times/d. The barriers to F&V consumption most often reported by survey participants were the cost of F&V (29·5 %), spoilage (18·6 %), knowing how to cook F&V (8·7 %) and not thinking about F&V when hungry (8·6 %). Results from multivariable-adjusted logistic regression models suggested that reporting one or more barriers was associated with reduced odds of consuming vegetables ≥3 times/d, but not fruits.ConclusionsCost, spoilage and knowledge of cooking are key barriers to F&V consumption that exist among LINK Up Illinois users. Strategies are needed to mitigate these barriers and increase F&V consumption in this population.
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Alaimo K, Beavers AW, Crawford C, Snyder EH, Litt JS. Amplifying Health Through Community Gardens: A Framework for Advancing Multicomponent, Behaviorally Based Neighborhood Interventions. Curr Environ Health Rep 2018; 3:302-12. [PMID: 27379424 DOI: 10.1007/s40572-016-0105-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The article presents a framework for understanding the relationship between community garden participation, and the myriad ways gardens and participation lead to emotional, social, and health impacts. Existing empirical research relating community gardens to health behaviors, such as physical activity and diet, and longer-term chronic disease-related outcomes is summarized. The research areas discussed include the effects of community garden participation on individual, social, emotional, and environmental processes; health behaviors including diet and physical activity; and health outcomes such as self-rated health, obesity, and mental health. Other mechanisms through which community gardens may affect population health are described. Applying a multitheoretical lens to explore associations between community garden participation and health enables us to delineate key aspects of gardening that elicit positive health behaviors and multifactorial health assets that could be applied to designing other types of health interventions.
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Affiliation(s)
- Katherine Alaimo
- Department of Food Science and Human Nutrition, Michigan State University, G. Malcolm Trout Building, Room 208C, 469 Wilson Road, East Lansing, MI, 48824, USA
| | - Alyssa W Beavers
- Department of Food Science and Human Nutrition, Michigan State University, G. Malcolm Trout Building, Room 208C, 469 Wilson Road, East Lansing, MI, 48824, USA
| | | | - Elizabeth Hodges Snyder
- Department of Health Sciences, University of Alaska Anchorage, 3211 Providence Drive, DPL 405, Anchorage, AK, 99508-4614, USA
| | - Jill S Litt
- University of Colorado Boulder, 4001 Discovery Drive, Boulder, CO, 80303, USA.
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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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Mulik K, Haynes-Maslow L. The Affordability of MyPlate: An Analysis of SNAP Benefits and the Actual Cost of Eating According to the Dietary Guidelines. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2017; 49:623-631.e1. [PMID: 28889851 DOI: 10.1016/j.jneb.2017.06.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 06/09/2017] [Accepted: 06/11/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To estimate the funds required to support a MyPlate diet and to estimate the additional costs needed for Supplemental Nutrition Assistance Program recipients to adhere to the MyPlate diet. DESIGN Using the US Department of Agriculture's (USDA's) MyPlate dietary guidelines that specify recommendations for individuals based on age and gender and retail price data from the USDA, the cost of following USDA's MyPlate guidelines for consuming 3 meals daily was estimated for the following individuals: children, adolescents, female adults, male adults, female seniors, male seniors, and a 4-person family. MAIN OUTCOME MEASURES Cost of consuming a MyPlate diet, including canned, frozen, and fresh produce as part of the diet. ANALYSIS Descriptive analysis of the cost of consuming a MyPlate diet. RESULTS Consuming a MyPlate diet consisting of only fresh fruits and vegetables is the most expensive diet. The monthly additional costs on an individual basis is the largest for boys aged 12-17 years ($75/mo) because they have the largest quantity of food consumed compared with all other gender and age groups. The monthly cost for a family of 4 ranged from $1,109 to $1,249/mo. CONCLUSIONS AND IMPLICATIONS The monetary amount of Supplemental Nutrition Assistance Program benefits may be insufficient to support a healthy diet recommended by federal nutrition guidelines.
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Affiliation(s)
- Kranti Mulik
- Food and Environment Program, Union of Concerned Scientists, Washington, DC
| | - Lindsey Haynes-Maslow
- Department of Agricultural and Human Sciences, North Carolina State University, Raleigh, NC.
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DeWitt E, McGladrey M, Liu E, Peritore N, Webber K, Butterworth B, Vail A, Gustafson A. A Community-Based Marketing Campaign at Farmers Markets to Encourage Fruit and Vegetable Purchases in Rural Counties With High Rates of Obesity, Kentucky, 2015-2016. Prev Chronic Dis 2017; 14:E72. [PMID: 28858607 PMCID: PMC5580727 DOI: 10.5888/pcd14.170010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Availability of farmers markets may increase fruit and vegetable consumption among rural residents of the United States. We conducted a community-based marketing campaign, Plate it Up Kentucky Proud (PIUKP), in 6 rural communities over 2 years to determine the association between exposure to the campaign and fruit and vegetable purchases, adjusted for Supplemental Nutrition Assistance Program recipient status. Logistic regression was used to examine the odds of the PIUKP campaign influencing purchases. Awareness of the PIUKP marketing campaign was significantly associated with a willingness to prepare fruits and vegetables at home. Using marketing strategies at farmers markets may be an effective way to improve fruit and vegetable purchases in rural communities.
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Affiliation(s)
- Emily DeWitt
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, Kentucky
| | | | - Emily Liu
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, Kentucky
| | - Nicole Peritore
- Family and Consumer Sciences Extension, University of Kentucky, Lexington, Kentucky
| | - Kelly Webber
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, Kentucky
| | - Brooke Butterworth
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, Kentucky
| | - Ann Vail
- School of Human Environmental Sciences, Family and Consumer Sciences, University of Kentucky, Lexington, Kentucky
| | - Alison Gustafson
- Department of Dietetics and Human Nutrition, University of Kentucky, 206G Funkhouser Bldg, Lexington, KY 40506.
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Haynes-Maslow L, Leone LA. Examining the relationship between the food environment and adult diabetes prevalence by county economic and racial composition: an ecological study. BMC Public Health 2017; 17:648. [PMID: 28793887 PMCID: PMC5551001 DOI: 10.1186/s12889-017-4658-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 07/31/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Inequitable access to healthy food may contribute to health disparities. This study examines the relationship between the prevalence of adult diabetes and food access in the U.S. by county economic/racial composition. METHODS An ecological study from 2012 was used to estimate the relationship between diabetes and retail food outlet access. County diabetes prevalence was measured based on individual responses to the Behavioral Risk Factor Surveillance Survey question, "Have you ever been told by a doctor that you have diabetes?" If the answer was "yes" individuals were classified as having diabetes. Retail food outlets included grocery stores, supercenters, farmer's markets, full-service restaurants, fast food restaurants and convenience stores. Counties were categorized as "high-poverty" or "low-poverty". Counties were categorized as low (< 4.6%), medium (4.6%-31.0%), and high (> 31.0%) percent minority residents. Multiple linear regression models estimated the association between retail food outlets and diabetes, controlling for confounders, and testing for interactions between retail food outlets and county racial composition. Regression models were conditioned on county economic composition. Data were analyzed in 2016. RESULTS Density of retail foods outlets varied greatly by county economic and racial composition; counties with medium-minority populations had the least access to grocery stores and the highest access to fast food restaurants and convenience stores. Low poverty/low-minority population counties had the greatest access to farmer's markets and grocery stores. For low poverty/low-minority counties, grocery stores were associated with decreased of diabetes prevalence. Supercenters were associated with an increase in diabetes prevalence for high-poverty/low-minority counties. Only low poverty/medium-minority counties had a statistically significant relationship between farmer's markets and diabetes prevalence. Fast food restaurants were found to be positively associated with diabetes prevalence in all counties except high poverty/medium-minority. However, only low poverty/low-minority counties had a statistically significant relationship. Across all models, access to full service restaurants were significantly associated with lower prevalence of diabetes. Generally, access to convenience stores were associated with increased diabetes prevalence, except for high poverty/low-minority counties. CONCLUSIONS The food environment is more strongly associated with diabetes prevalence for wealthier counties with a lower proportion of minority residents. This is important given efforts to increase food access in vulnerable communities. Availability of healthier food may not be enough to change health outcomes.
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Affiliation(s)
- Lindsey Haynes-Maslow
- Department of Agricultural and Human Sciences, School of Public Health and Health Professions North Carolina State University, 512 Brickhaven Drive, Suite 240, Campus Box 7606, Raleigh, NC 27695 USA
| | - Lucia A. Leone
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY USA
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Savoie Roskos MR, Wengreen H, Gast J, LeBlanc H, Durward C. Understanding the Experiences of Low-Income Individuals Receiving Farmers’ Market Incentives in the United States: A Qualitative Study. Health Promot Pract 2017; 18:869-878. [DOI: 10.1177/1524839917715438] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. The objective of this study was to identify benefits and barriers to using a farmers’ market (FM) incentive program among program participants. Design. In qualitative semistructured interviews, participants were asked about their experiences with shopping at FM, using FM incentives, barriers to fruit and vegetable (F&V) intake, and changes in dietary intake. Interviews were recorded and transcribed. Inductive content analysis was used to code, categorize, and develop themes based on the transcriptions. Setting. A FM in Northern Utah. Subjects. A convenience sample of participants ( n = 14) completed a 45- to 60-minute interview after receiving FM incentives for an 8-week intervention period. Results. FM incentives reduced barriers associated with shopping at FM such as cost and accessibility among program participants. Incentives provided participants with greater spending flexibility, allowing parents to provide children with F&V that previously did not fit into their food budget. Participants reported greater family and community involvement when shopping at FM. However, the limited hours and days of operation were factors that reduced the use of FM among participants, even when incentives were provided. Conclusions. The perceived benefits and barriers to shopping at FM and receiving FM incentives should be considered by future programmers and funding agencies.
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Freedman DA, Flocke S, Shon EJ, Matlack K, Trapl E, Ohri-Vachaspati P, Osborne A, Borawski E. Farmers' Market Use Patterns Among Supplemental Nutrition Assistance Program Recipients With High Access to Farmers' Markets. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2017; 49:397-404.e1. [PMID: 28274790 DOI: 10.1016/j.jneb.2017.01.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/13/2017] [Accepted: 01/17/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Evaluate farmers' market (FM) use patterns among Supplemental Nutrition Assistance Program (SNAP) recipients. DESIGN Cross-sectional survey administered June to August, 2015. SETTING Cleveland and East Cleveland, OH. PARTICIPANTS A total of 304 SNAP recipients with children. Participants lived within 1 mile of 1 of 17 FMs. Most were African American (82.6%) and female (88.1%), and had received SNAP for ≥5 years (65.8%). MAIN OUTCOME MEASURES Patterns of FM shopping, awareness of FM near home and of healthy food incentive program, use of SNAP to buy fruits and vegetables and to buy other foods at FMs, receipt of healthy food incentive program. ANALYSIS Two-stage cluster analysis to identify segments with similar FM use patterns. Bivariate statistics including chi-square and ANOVA to evaluate main outcomes, with significance at P ≤ .05. RESULTS A total of 42% reported FM use in the past year. Current FM shoppers (n = 129) were segmented into 4 clusters: single market, public market, multiple market, and high frequency. Clusters differed significantly in awareness of FM near home and the incentive program, use of SNAP to buy fruit and vegetables at FMs, and receipt of incentive. CONCLUSIONS AND IMPLICATIONS Findings highlight distinct types of FM use and had implications for tailoring outreach to maximize first time and repeat use of FMs among SNAP recipients.
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Affiliation(s)
- Darcy A Freedman
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH.
| | - Susan Flocke
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH
| | - En-Jung Shon
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH
| | - Kristen Matlack
- The Ohio State University, Cuyahoga County Extension, Cleveland, OH
| | - Erika Trapl
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH
| | | | - Amanda Osborne
- The Ohio State University, Cuyahoga County Extension, Cleveland, OH
| | - Elaine Borawski
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH
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Tripicchio GL, Grady Smith J, Armstrong-Brown J, McGuirt J, Haynes-Maslow L, Mardovich S, Ammerman AS, Leone L. Recruiting Community Partners for Veggie Van: Strategies and Lessons Learned From a Mobile Market Intervention in North Carolina, 2012-2015. Prev Chronic Dis 2017; 14:E36. [PMID: 28448250 PMCID: PMC5420442 DOI: 10.5888/pcd14.160475] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Food access interventions are promising strategies for improving dietary intake, which is associated with better health. However, studies examining the relationship between food access and intake are limited to observational designs, indicating a need for more rigorous approaches. The Veggie Van (VV) program was a cluster-randomized intervention designed to address the gap between food access and intake. In this article, we aim to describe the approaches involved in recruiting community partners to participate in VV. COMMUNITY CONTEXT The VV mobile market aimed to improve access to fresh fruits and vegetables by providing subsidized, high-quality, local produce in low-resource communities in North Carolina. This study describes the strategies and considerations involved in recruiting community partners and individual participants for participation in the VV program and evaluation. METHODS To recruit partners, we used various strategies, including a site screener to identify potential partners, interest forms to gauge future VV use and prioritize enrollment of a high-need population, marketing materials to promote VV, site liaisons to coordinate community outreach, and a memorandum of understanding between all invested parties. OUTCOME A total of 53 community organizations and 725 participants were approached for recruitment. Ultimately, 12 sites and 201 participants were enrolled. Enrollment took 38 months, but our approaches helped successfully recruit a low-income, low-access population. The process took longer than anticipated, and funding constraints prevented certain strategies from being implemented. INTERPRETATION Recruiting community partners and members for participation in a multi-level, community-based intervention was challenging. Strategies and lessons learned can inform future studies.
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Affiliation(s)
- Gina L Tripicchio
- Department of Nutrition, Gillings School of Global Public Health, 2224 McGavran-Greenberg Campus, Box No. 7461, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7461. .,Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jacqueline Grady Smith
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Jared McGuirt
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lindsey Haynes-Maslow
- Department of Agricultural and Human Sciences, North Carolina State University, Raleigh, North Carolina
| | - Sarah Mardovich
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alice S Ammerman
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lucia Leone
- Department of Community Health and Health Behavior, University at Buffalo-SUNY, Buffalo, New York
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Low-income adults' perceptions of farmers' markets and community-supported agriculture programmes. Public Health Nutr 2017; 20:1452-1460. [PMID: 28202100 DOI: 10.1017/s1368980017000088] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To better understand low-income adults' attitudes towards participating in farmers' markets, community-supported agriculture (CSA) and nutrition education programming. DESIGN Focus groups were held with a diverse sample of adults. Interviews were transcribed verbatim and analysed using thematic analysis. SETTING Three affordable housing communities in Washington, DC, USA. SUBJECTS Participants included twenty-eight residents of the three affordable housing communities. RESULTS Four major themes emerged across groups, along with several sub-themes within each theme. These included: (i) perceptions of farmers' markets (benefits, barriers, current participation and knowledge); (ii) perceptions of CSA (benefits, barriers and questions/concerns); (iii) need/interest in additional programming (nutrition education, non-nutrition education, qualities of programming and perceived barriers); and (iv) current health knowledge and behaviours (dietary behaviours, health recommendations and health concerns). CONCLUSION Adults living in urban, affordable housing communities desire access to healthy foods, but are limited by cost. Programmes could have a higher likelihood of success if they accept benefits like SNAP (the Supplemental Nutrition Assistance Program), are heavily marketed and incorporate culturally relevant nutrition education components.
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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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Hosler AS, Michaels IH, Buckenmeyer EM. Food Shopping Venues, Neighborhood Food Environment, and Body Mass Index Among Guyanese, Black, and White Adults in an Urban Community in the US. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2016; 48:361-368.e1. [PMID: 27085256 DOI: 10.1016/j.jneb.2016.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/25/2016] [Accepted: 03/06/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate relationships among food shopping venues, food environment, and body mass index (BMI). DESIGN Cross-sectional survey data and directly assessed food environment data were linked at the neighborhood level. SETTING Schenectady, NY. PARTICIPANTS A sample of Guyanese, black, and white adults (n = 226, 485, and 908, respectively). MAIN OUTCOME MEASURES BMI. ANALYSIS Linear regression models were constructed with 10 food shopping venues and neighborhood food environment as explanatory variables, controlling for sociodemographics, dietary behavior, physical activity, and perception of healthy food access. RESULTS On average, respondents used 3.5 different food shopping venues. Supermarkets and ethnic markets were associated with a lower BMI in Guyanese adults. Among black adults, farmers' markets were associated with a lower BMI, whereas supermarkets, wholesale clubs, and food pantries were associated with a higher BMI. Among white adults, food coops and supermarkets were associated with a lower BMI and wholesale clubs were associated with a higher BMI. Neighborhoods with less a favorable food environment (longer travel distance to a supermarket) were associated with a lower BMI in Guyanese adults. CONCLUSIONS AND IMPLICATIONS Both primary (ie, supermarkets) and secondary food shopping venues could be independent determinants of BMI. The observed variations by race and ethnicity provided insights into a culturally tailored approach to address obesity.
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Affiliation(s)
- Akiko S Hosler
- Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY.
| | - Isaac H Michaels
- Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY
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