Fruit and vegetable assessment: performance of 2 new short instruments and a food frequency questionnaire

MALAMA: Cultivating Food Sovereignty through Backyard Aquaponics with Native Hawaiian Families

Native Hawaiians were a healthy and robust population who developed a sophisticated food system that was dismantled by colonization. Currently, Native Hawaiians face pervasive health disparities due to the limited access to healthy foods and lifestyles. This study pilot tested a family-based community-driven intervention called MALAMA, which teaches families to build and use a backyard aquaponics system to grow their own food. A total of 21 participants from 10 families completed a three-month curriculum that included a series of hands-on workshops. Participant attendance was recorded and participants completed a behavioral health questionnaire as well as provided clinical indicators at three time points. They also attended a focus group at the end of the curriculum. There was a high level of engagement and no participant attrition. Fruit consumption among all participants significantly increased and there were favorable trends in blood pressure and fish and vegetable consumption. No significant differences were found in the other clinical indicators. Participants found MALAMA to be highly culturally acceptable and identified multiple benefits. Community-driven solutions, such as MALAMA, may be a promising approach to addressing pervasive health disparities and promoting health equity in minority and Indigenous communities.

Assessing and Monitoring Nutrition Security in the United States: A Narrative Review of Current Measures and Instruments

PURPOSE OF REVIEW

Because nutrition plays a crucial role in the development of chronic diseases, ensuring nutrition security is important for promoting population health. Nutrition security is defined as having consistent and equitable access to healthy, safe, affordable foods essential to optimal health and well-being. Distinguished from food security, nutrition security consists of two constructs: healthy diets and nutritional status. The study aimed to identify population measures that reflect the important constructs of nutrition security (i.e., healthy diets and nutritional status) to inform U.S. nutrition security assessment and monitoring.

RECENT FINDINGS

Through a narrative review conducted across multiple databases, associations between subconstructs of healthy diets and nutritional status were identified. Of the six subconstructs that constitute healthy diets, nutrient adequacy and moderation were most often used to assess and monitor healthfulness of U.S. population diets and were associated with health outcomes. There is little evidence of an association between health outcomes and macronutrient balance or diversity in the U.S. Thirteen instruments were identified as potentially suitable for measuring at least one subconstruct of healthy diet in the population. This review highlights the importance of nutrition security in addressing population health challenges. It emphasizes the potential use of multiple instruments and measures to comprehensively monitor population nutrition security and inform intervention strategies. Identifying feasible and practical measures for assessing and monitoring nutrition security is imperative for advancing population health and mitigating the burden of chronic diseases.

Development and validity of the 'Modified Mediterranean Prime Screen' to assess dietary intake among women of reproductive age in Lebanon

The Mediterranean Region registers an increasing prevalence of obesity. The region lacks a diet screener to assess obesogenic nutrients. This study aimed to evaluate the reproducibility and validity of the Modified Mediterranean Prime Screen (MMPS) in estimating obesogenic nutrients' intake among women of reproductive age, as compared with a culturally validated Food Frequency Questionnaire (FFQ), in Lebanon. We developed the MMPS consisting of thirty-two food/beverage items specific to the Lebanese Mediterranean culture. The MMPS and FFQ were administered in two visits (2 weeks-6 months apart), face to face and via telephone during the coronavirus disease 2019 pandemic. The reproducibility and validity of the MMPS were assessed using intraclass correlation coefficients (ICC) and Pearson's correlations, respectively. The study included 143 women, aged 31·5 (sd 4·6) years, BMI 24·2 (sd 4·0) kg/m2, 87 % with university education and 91 % food secure. The reproducibility of the MMPS was moderate for energy and all assessed nutrients except for SFA (ICC = 0·428). The agreement of the MMPS with the reference FFQ was adequate for energy and obesogenic nutrients. Yet, the Pearson correlations for energy-adjusted nutrient intake were low for trans-fatty acids (0·294) and PUFA (0·377). The MMPS can be a time-efficient tool for dietary assessment of energy and many obesogenic nutrients. Future studies should validate the MMPS across the lifespan and re-evaluate it after updating the fatty acid profiles in the culturally specific food composition tables.

Cook and Move for Your Life, an eHealth intervention for women with breast cancer

We tested the feasibility and preliminary efficacy of an online diet and physical activity program for women with early-stage breast cancer who had completed surgery, chemotherapy, and radiation therapy (ongoing endocrine therapy allowed). Participants with low fruit and vegetable (F/V) consumption and/or low moderate-to-vigorous physical activity (MVPA) levels were randomized to one of two doses - low (one Zoom group session) or high (12 Zoom group sessions) - of an online lifestyle program with the goal of improving F/V intake and MVPA. All participants received eHealth communications (text messages, study website access), a Fitbit, and a WiFi-enabled scale. Primary objectives evaluated feasibility. Secondary objectives compared the 6-month change in F/V intake and MVPA between the two dose groups. Seventy-four women (mean age = 58.4 years; 87% non-Hispanic White; mean time since diagnosis = 4.6 years) were accrued. Among women in the low dose group, 94% attended the single session; among women in the high dose group, 84% attended at least 8 of the 12 sessions. Retention at 6 months was 93%. High relative to low dose participants consumed 1.5 more servings/day of F/V at 6 months (P = 0.007) but MVPA levels did not differ between groups. We successfully implemented an online lifestyle program for early-stage breast cancer survivors. The high dose intervention demonstrated preliminary efficacy in improving F/V consumption in early-stage breast cancer survivors. Future trials can test the intervention in a larger and more diverse population of breast cancer survivors.

Local Food System Approaches to Address Food and Nutrition Security among Low-Income Populations: A Systematic Review

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.

The influence of diet quality on health-related quality of life in undergraduates

Objective: Explore the relationship between fruit and vegetable (FV) intake and health-related quality of life (HRQOL) in undergraduates. Participants: Undergraduates (N = 655). Methods: Using the Centers for Disease Control's Healthy Days Core Module and National Cancer Institute's (NCI) FV screener, differences in HRQOL between students who had consumed above the sample's average FV intake and their counterparts were evaluated. Multiple regression analyses assessed behaviors that predicted HRQOL. Results: Differences existed between HRQOL of students who consumed above average FV (M = 2.2 1.3) and peers, F(9,602) = 509, p < 0.001, Wilk's Δ = 0.116, partial n2 = 0.884. Predictors explained 30.0% of the variance in days per month feeling healthy (r2 = 0.29, F(4, 549) = 58.6, p < 0.001): perceived stress (β = 0.46, p < 0.001), body mass index (BMI) (β = 0.11, p < 0.01), FV intake (β = 0.16, p < 0.001), and sleep duration (β = 0.08, p < 0.05). Conclusions: FV intake and modifiable behaviors influenced HRQOL, suggesting that multifaceted interventions could improve HRQOL in this population.

Food insecurity, fruit and vegetable consumption, and use of the Supplemental Nutrition Assistance Program (SNAP) in Appalachian Ohio

Food insecurity and inadequate nutrition are two major challenges that contribute to poor health conditions among U.S. households. Ohioans continue to face food insecurity, and rates of food insecurity in rural Southeast Ohio are higher than the state average. The main purpose of this project is to evaluate the associations between Supplemental Nutrition Assistance Program (SNAP) participation and food security in rural Ohio, and to explore the association between SNAP participation and fruit/vegetable consumption. We control for food shopping patterns, such as shopping frequency, because previous research reports a significant relationship between shopping patterns and food security. To achieve our purpose, we use novel household-level data on food insecurity and SNAP participation in rural Southeast Ohio, collected during the COVID-19 pandemic. We find that people who experience higher levels of food insecurity than others are more likely to participate in SNAP, though this is likely a function of selection bias. To correct for the bias, we employ the nearest neighbor matching method to match treated (SNAP participant) and untreated (similar SNAP nonparticipant) groups. We find that participating in SNAP increases the probability of being food secure by around 26 percentage points after controlling for primary food shopping patterns. We do not find any significant association between SNAP participation and estimated intake of fruits and vegetables. This study provides policymakers with suggestive evidence that SNAP is associated with food security in rural Southeast Ohio during the pandemic, and what additional factors may mediate these relationships.

Evaluation of a Distribution Model to Increase Access to Affordable Fruits and Vegetables

Introduction

Identifying effective, sustainable strategies to increase fruit and vegetable consumption is critical to addressing chronic disease risk. Models that provide incentives for produce purchases through reduced-cost or no-cost produce shares are promising. The purpose of our study was to examine the impact on fruit and vegetable intake of Good Food for All, a community-based program to distribute no-cost produce boxes to participants with low incomes. We also assessed program satisfaction and future interest in purchasing an affordable produce box.

Methods

The Good Food for All program was implemented in 22 US cities. Surveys were administered at baseline and postintervention. An online research panel was used as a comparison group and weighted to be demographically comparable to the intervention group. Descriptive statistics and adjusted difference-in-difference (ADID) models were used to examine differences in outcomes between groups.

Results

Respondents (intervention n = 632; comparison n = 1,153) were primarily White, non-Hispanic, and female. Intervention participants had a greater increase in total fruit consumption frequency (ADID: 0.43 times/d; 95% CI, 0.21-0.64; P < .001), total vegetable consumption frequency (ADID: 0.52 times/d; 95% CI, 0.12-0.91; P = .01), and total fruit and vegetable consumption frequency (ADID: 1.03 times/d; 95% CI, 0.49-1.56; P < .001) than comparison respondents. Most intervention participants reported boxes contained the right amount of food (71.9%) and high-quality produce (68.4%) and were willing to purchase a future produce box (85.0%).

Conclusion

Findings indicate that a produce box distribution model increased fruit and vegetable consumption, had high satisfaction among participants, and generated interest in purchasing affordable produce boxes. Future studies should explore feasibility of offering low-cost produce boxes at grocery stores and determine appropriate pricing models to enhance access and sustainability.

Twelve Month Efficacy of Computer-Tailored Communication in Boosting Fruit and Vegetable Consumption Among Adults Aged Forty and over: A Three-Level Meta-Analysis and Systematic Review of Randomized Controlled Trials

Computer-tailored health communication (CTC) can enhance fruit and vegetable (F&V) intake and, consequently, health by providing personalized feedback. However, few studies have examined the long-term effects of such interventions in middle-aged and older adults. This research aimed to assess the 12-mo efficacy of CTC in promoting F&V consumption and potentially identify who among middle-aged and older adults changed their diet after the intervention. The protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) on 2021-12-09, code CRD42022330491. The research was performed without external funding. We searched 6 databases (MEDLINE via PubMed, EMBASE, Scopus, Web of Science Core Collection, Cochrane Library, and PsycINFO) for randomized controlled trials (RCTs) comparing CTC interventions for increasing F&V intake with usual care/no intervention control in adults aged ≥40, measured 12 mo after the pretest. The search covered the period from 1 January 1990 to 1 January 2022. We selected 16 RCTs with 25,496 baseline participants for the review systematic literature reviews (SLR) and 11 RCTs with 19 measurements for the meta-analysis (MA). We assessed risk of bias with the JBI Critical Appraisal Checklist. The SLR revealed that at 1-y postCTC intervention, most of the treatment groups increased F&V intake more than the control groups. The overall bias in the data set was not high. The MA model on 11 RCTs revealed a significant effect size for F&V consumption in intervention groups compared with control, standardized mean difference of 0.21 (confidence interval [CI]: 0.12, 0.30), P = 0.0004. The evidence suggests that CTC is a suitable strategy for public interventions aiming to increase F&V intake in adults aged ≥40. The design of CTC for public interventions should consider the process of change and stages of change addressing awareness, attitudes, self-efficacy, and social influence as promising concepts for influencing behavior change.

Healthy Lifestyle and Quality of Life in Post-Operative Colorectal Cancer Patients: A Five-Month Observational Study

Health-related quality of life (HRQOL) is an important indicator of treatment effectiveness. An unhealthy lifestyle can have a negative impact on quality of life. This study aimed to investigate changes in health-related lifestyle over time after surgery for colorectal cancer and their impact on HRQOL. Healthy lifestyle habits examined in this study included physical activity, smoking, alcohol consumption, fruit and vegetable intake, sleep, and obesity levels. An observational study design was used. A total of 75 post-operative colorectal cancer patients were recruited from two medical centers in Taiwan. Data were collected through structured questionnaires. Mean HRQOL scores at 1, 3, and 5 months after discharge were 102.5 (SD = 18.8), 102.9 (SD = 20.1), and 103.0 (SD = 18.9), respectively. A generalized estimating equation analysis showed that alcohol consumption (p = 0.009), fruit and vegetable intake (p = 0.020), physical activity (p = 0.023), sleep quality (p < 0.001), and obesity (p = 0.035) were important predictors of post-operative quality of life in patients with colorectal cancer. The impact of smoking on HRQOL did not reach statistical significance. Colorectal cancer patients tend to have better HRQOL after surgery if they stay physically active, eat enough fruits and vegetables, and sleep well.

Effects of Episodic Food Insecurity on Psychological and Physiological Responses in African American Women With Obesity (RESPONSES): Protocol for a Longitudinal Observational Cohort Study

BACKGROUND

Food insecurity is a risk factor for multiple chronic diseases, including obesity. Importantly, both food insecurity and obesity are more prevalent in African American women than in other groups. Furthermore, food insecurity is considered a cyclic phenomenon, with episodes of food adequacy (ie, enough food to eat) and food shortage (ie, not enough food to eat). More research is needed to better understand why food insecurity is linked to obesity, including acknowledging the episodic nature of food insecurity as a stressor and identifying underlying mechanisms.

OBJECTIVE

The objective of this study is to investigate the episodic nature of food insecurity as a stressor via responses in body weight and psychological and physiological parameters longitudinally and do so in a health-disparate population-African American women.

METHODS

We enrolled 60 African American women (food-insecure cohort: n=30, 50%; food-secure cohort: n=30, 50%) aged 18-65 years with obesity (BMI 30-50 kg/m2) to measure (1) daily body weight remotely over 22 weeks and (2) psychological and physiological parameters via clinic assessments at the beginning and end of the 22-week study. Furthermore, we are assessing episodes of food insecurity, stress, hedonic eating, and appetite on a weekly basis. We hypothesize that food-insecure African American women with obesity will demonstrate increased body weight and changes in psychological and physiological end points, whereas food-secure African American women with obesity will not. We are also examining associations between changes in psychological and physiological parameters and changes in body weight and performing a mediation analysis on the psychological parameters assessed at the study midpoint. Psychological questionnaires are used to assess stress; executive function, decision-making, and motivation; and affect and nonhomeostatic eating. Physiological measurements are used to evaluate the levels of cortisol, dehydroepiandrosterone-sulfate (DHEA-S), C-reactive protein, thyroid hormones, blood glucose, glycated hemoglobin, and insulin, as well as allostatic load.

RESULTS

This study has completed participant recruitment (n=60). At the time of study enrollment, the mean age of the participants was almost 47 (SD 10.8) years, and they had a mean BMI of 39.6 (SD 5.31) kg/m2. All data are anticipated to be collected by the end of 2023.

CONCLUSIONS

We believe that this is the first study to examine changes in body weight and psychological and physiological factors in food-insecure African American women with obesity. This study has significant public health implications because it addresses the cyclic nature of food insecurity to identify underlying mechanisms that can be targeted to mitigate the adverse relationship between food insecurity and obesity and reduce health disparities in minority populations.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05076487; https://clinicaltrials.gov/study/NCT05076487.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/52193.

RJ. Evaluating a Washington DC Community-based meal-kit service aimed at mitigating dietary disparities: Results from the SouthEats pilot study

Background

Vegetable consumption is known to reduce the risk of various chronic health conditions. Yet a small percentage of US adults consume enough vegetables to meet national dietary guidelines. The SouthEats community-led meal-kit service was developed in Washington DC to address known barriers to healthy eating and vegetable consumption among middle- and low-income households.

Methods

Using a series of online surveys, we conducted a pilot study to provide preliminary information on the influence of SouthEats on vegetable consumption and factors known to influence vegetable consumption. Wilcoxon matched-pair sign ranked tests were used to examine changes in key outcomes between baseline, midpoint and endpoint surveys.

Results

Among SouthEats customers who completed all pilot study surveys (n = 23) there was a significant decrease in the median amount of time spent on meal prep between baseline and midpoint. Between baseline and endpoint, participants also indicated increased feelings that they had enough time to meet their needs including cooking healthfully. Overall vegetable and fruit and vegetable consumption increased between the baseline and midpoint but then decreased between the midpoint and endpoint survey periods. However, there were no statistically significant changes in the outcomes of home eating behaviors, perceptions of neighborhood healthy food access, vegetable self-efficacy, or vegetable consumption.

Conclusion

Our results provide some preliminary evidence suggesting that the SouthEats meal-kit service could help reduce the amount of time spent on cooking, reduce feelings of time scarcity, and increase vegetable consumption in the short-term. Further research exploring this topic will require a larger study sample.

Design and protocol of a clinic-based comparative effectiveness randomized controlled trial to determine the feasibility and effectiveness of food prescription program strategies in at-risk pediatric populations

BACKGROUND

Produce prescription programs are gaining traction in the U.S.; however, data on the impact of such approaches in pediatric populations are limited. The purpose of our clinic-based comparative effectiveness randomized controlled trial (CE RCT) is to evaluate the preliminary effectiveness of two produce prescription strategies (at-home delivery and grocery store vouchers) implemented by the Brighter Bites non-profit organization in improving obesity-related health outcomes and dietary behaviors among low-income 5-12-year-olds in Houston, Texas. This paper presents the study design, intervention components, and the study measures.

METHODS

Participants (n = 150) are being recruited from two pediatric clinics in Houston, Texas. Child eligibility criteria are aged 5-12 years, Medicaid recipients, body-mass index (BMI) percentile ≥85 and living within 10 miles of a Brighter Bites distribution site. Following consent and baseline measures, children are randomized into one of three arms: (1) Bi-weekly $25 vouchers redeemable for produce at stores (n = 50), (2) Bi-weekly produce delivery to participants' homes through DoorDash (n = 50), and (3) wait-list usual care controls (n = 50). Intervention participants also receive Brighter Bites nutrition education materials. Main child outcome measures are BMI z-scores, blood pressure, hemoglobin A1c, liver panels, and lipid panels. Other outcomes including household food insecurity, child diet quality, and home nutrition environment will be collected through parent surveys. Outcome measures are collected at baseline and post-intervention. Process evaluation will measure program dosage, reach, acceptability, and feasibility.

CONCLUSIONS

Our paper presents the design and next steps to ensure the successful implementation of a produce prescription program in a pediatric clinic setting.

The Tech4Rest Randomized Controlled Trial: Applying the Hierarchy of Controls to Advance the Sleep, Health, and Well-being of Team Truck Drivers

OBJECTIVE

The aim of the study was to evaluate the effectiveness of interventions to improve sleep, reduce fatigue, and advance the well-being of team truck drivers.

METHODS

In a randomized controlled trial ( k = 24 teams; N = 49 drivers; 61.3% of planned sample), intervention teams were exposed to baseline (3-4 weeks), cab enhancements (active suspension seat, therapeutic mattress; 3-4 weeks), and cab enhancements plus a behavioral sleep-health program (1-2 months). Control teams worked as usual during the same period.

RESULTS

Trends in sleep-related outcomes favored the intervention. Large and statistically significant intervention effects were observed for objectively measured physical activity (a behavioral program target). The discussion of results addresses effect sizes, statistical power, intervention exposure, and work organization.

CONCLUSIONS

Trends, effect sizes, and significant findings in this rare trial provide valuable guidance for future efforts to improve working conditions and outcomes for team drivers.

The CENTS program: promoting healthy eating by addressing perceived barriers

OBJECTIVE

Nutrition interventions addressing barriers to healthy eating can mitigate concerns regarding poor diet and obesity among college students. Aimed at reducing healthy eating perceived barriers, this investigation employed two mindset change intervention studies.

DESIGN

First, a nutrition improvement program called CENTS (Cost of Eating Nutritiously during Time as a Student) that disseminated specific information and utilized experiential activities for mindset change was developed and pilot tested using a pre/post study design. Second, using a similar pre/post method, the CENTS program was evaluated in a quasi-experimental design.

MAIN OUTCOME MEASURES

We examined perceived barriers to healthy eating (e.g. too costly, too much time), fruit and vegetable consumption, and other variables related to healthy eating (e.g. cost estimates, diet attitudes, self-efficacy, sugary foods consumption).

RESULTS

Results demonstrated some improvement in many outcomes between the two studies. Most noteworthy, the two major perceived barriers of healthy eating (i.e. too expensive, too much time to prepare) dramatically reduced and cost appraisal accuracy improved. Moreover, some attitudes to eat healthy improved and some unhealthy dietary behaviors reduced.

CONCLUSION

Using mindset change techniques to address perceived barriers to healthy eating, interventions can promote healthy eating and discourage unhealthy dietary habits among college students.

Cost analysis and cost effectiveness of a subsidized community supported agriculture intervention for low-income families

BACKGROUND

The food system has a dynamic influence on disparities in food security and diet-related chronic disease. Community supported agriculture (CSA) programs, in which households receive weekly shares of produce from a local farmer during the growing season, have been examined as a possible food systems-based approach for improving diet and health outcomes. The purpose of this study was to estimate the cost of implementing and participating in a multi-component subsidized community supported agriculture intervention and calculate cost-effectiveness based on diet and food security impacts.

METHODS

Using data from the Farm Fresh Foods for Healthy Kids (F3HK) randomized controlled trial in New York, North Carolina, Vermont, and Washington (n = 305; 2016-2018), we estimated programmatic and participant costs and calculated incremental cost-effectiveness ratios (ICERs) for caregivers' daily fruit and vegetable (FV) intake, skin carotenoids, and household food security from program and societal perspectives.

RESULTS

F3HK cost $2,439 per household annually ($1,884 in implementation-related expenses and $555 in participant-incurred costs). ICERs ranged from $1,507 to $2,439 per cup increase in caregiver's FV intake (depending on perspective, setting, and inclusion of juice); from $502 to $739 per one thousand unit increase in skin carotenoid score; and from $2,271 to $3,137 per household shifted out of food insecurity.

CONCLUSIONS

Given the known public health, healthcare, and economic consequences of insufficient FV intake and living in a food insecure household, the costs incurred to support these positive shifts in individual- and household-level outcomes via a F3HK-like intervention may be deemed by stakeholders as a reasonable investment. This work helps to advance a critical body of literature on the cost-effectiveness of subsidized CSAs and other economic and food system interventions for the sake of evidence-based allocation of public health resources.

TRIAL REGISTRATION

ClinicalTrials.gov. NCT02770196. Registered 5 April 2016. Retrospectively registered. https://www.

CLINICALTRIALS

gov/ct2/show/NCT02770196 .

Building on Community Research Partnerships and Training Students in a Multi-Phase Community-Based Participatory Research Study With Young Women of Cambodian Heritage in Massachusetts

Refugees bring significant economic and cultural benefits to communities and yet face elevated risk of chronic disease and barriers to good health in the U.S. Community-based participatory research (CBPR) can benefit refugee communities and provide training/mentoring opportunities for students. The Cambodian Women's Health Study was a four-phase, multi-year CBPR university-community collaboration with the Massachusetts Cambodian community that focused on health, nutrition, pregnancy, and food security among primarily young women of Cambodian heritage ages 15-30 years old. Phase 1 was a focus group discussion (FGD, n = 4) and cross-sectional survey (n = 56) with pregnant women. Phase 2 was a cross-sectional survey (n = 107) with nonpregnant women. Phase 3 was a series of FGD (seven FGD, n = 38) with women. Phase 4 was a student-led translational nutrition intervention (three classes) with women (n = 11) and men (n = 10). The study design included compensation and support for the community partner and included structured mentoring of students (six graduates, eight undergraduates) in CBPR methods, adult learning, and cultural humility. Benefits to the community agency included enhanced research capacity, including supervising student research assistants, and robust compensation. Benefits to students included intensive mentoring and training. Successes included cost-effectiveness and strong recruitment and experiences with participants. Challenges included issues with student-led recruitment and organization that required additional mentoring and reflection. To work toward socially just and equitable research and interventions, CBPR collaborative efforts should include intentional meaningful compensation and community capacity-building as well as structured mentoring and training for student researchers and should build on existing work and relationships within communities.

The prevalence of obesity and lifestyle behaviors of parents of youth with intellectual and developmental disabilities

BACKGROUND

Parents of youth with intellectual and developmental disabilities (IDD) may have a higher prevalence of overweight and obesity and poorer weight management behaviors compared to the general population.

OBJECTIVE

To describe the prevalence of overweight/obesity and related socioeconomic and lifestyle factors including diet quality, physical activity, and reported health habits in parents of youth with IDD.

METHODS

We assessed: BMI (kg/m2), moderate-to-vigorous physical activity (MVPA), fruit and vegetable intake (FVI), parental diet and physical activity habits, and socioeconomic characteristics. Associations of BMI on MVPA and FVI were assessed with Spearman's correlation; differences in BMI by parental diet and physical activity habits were assessed with Kruskall-Wallis tests; and the relationships of BMI to household income, race, and education were assessed with Kendall Tau-b and Mann Whitney U tests.

RESULTS

Data was obtained from 110 parents (97.3% female) who were study partners for their adolescents/young adults with IDD participating in a weight loss clinical trial. Approximately 81% of parents were overweight or obese (25.7% overweight, 55.1% obese), with 46.3% and 20% meeting the recommended U.S. guidelines for MVPA and FVI, respectively. Higher FVI and higher income were significantly associated with lower parent BMI. BMI was significantly lower in parents who reported to be physically active and choose healthy food.

CONCLUSION

We observed a high prevalence of overweight/obesity, low FVI and low levels of MVPA in parents of adolescents with IDD. These observations suggest that interventions designed to address these factors have the potential to improve the health and wellbeing of both parents and adolescents with IDD.

CLINICAL TRIALS NUMBER

NCT02561754.

Development and Evaluation of the Delivery-Based HEALED Produce Rx Program for Uninsured Patients With Diabetes in Rural Eastern North Carolina

Produce prescription (PRx) programs have emerged as a preventive treatment to subsidize the cost of fruits and vegetables for people with lower income and have shown promise in improving diet quality and diabetes-related health outcomes (eg, glycated hemoglobin A_1c). Researchers from the Department of Nutrition Science at East Carolina University worked with the Wayne Action Teams for Community Health (WATCH) Clinic, a safety-net clinic in rural Eastern North Carolina, and a local research farm to develop a PRx program for rural patients with type 2 diabetes and no health insurance. Preliminary patient surveys identified high levels of interest in a PRx program and a desire for recipes to accompany the produce. Formative evaluation results via telephone interviews with eligible patients identified transportation barriers to participation and the desire for complementary nutrition education and culinary resources. These results led to a delivery-based PRx program implemented from June through November 2021. Patients received weekly home delivery of an average of 4.7 pounds of fruits and vegetables and complementary nutrition and health education materials and culinary resources (cookbook, recipes). The level of patient satisfaction with the program was high; the reported level of consumption of produce, including unfamiliar produce, was high; educational resources were associated with increased knowledge and motivation to make healthful lifestyle changes, and glycemic control significantly improved. Ensuring that patients have a voice in the design and implementation of PRx programs is crucial to success. Ongoing use of rigorous formative and process evaluations can ensure appropriateness, use, and a positive effect of PRx programs, and they are needed to establish best practices for implementation.

Native opportunities to stop hypertension: study protocol for a randomized controlled trial among urban American Indian and Alaska Native adults with hypertension

Introduction

American Indian and Alaska Native (AI/AN) adults experience disproportionate cardiovascular disease (CVD) morbidity and mortality compared to other races, which may be partly attributable to higher burden of hypertension (HTN). Dietary Approaches to Stop Hypertension (DASH) is a high-impact therapeutic dietary intervention for primary and secondary prevention of CVD that can contribute to significant decreases in systolic blood pressure (BP). However, DASH-based interventions have not been tested with AI/AN adults, and unique social determinants of health warrant independent trials. This study will assess the effectiveness of a DASH-based intervention, called Native Opportunities to Stop Hypertension (NOSH), on systolic BP among AI/AN adults in three urban clinics.

Methods

NOSH is a randomized controlled trial to test the effectiveness of an adapted DASH intervention compared to a control condition. Participants will be aged ≥18 years old, self-identify as AI/AN, have physician-diagnosed HTN, and have elevated systolic BP (≥ 130 mmHg). The intervention includes eight weekly, tailored telenutrition counseling sessions with a registered dietitian on DASH eating goals. Intervention participants will be provided $30 weekly and will be encouraged to purchase DASH-aligned foods. Participants in the control group will receive printed educational materials with general information about a low-sodium diet and eight weekly $30 grocery orders. All participants will complete assessments at baseline, after the 8-week intervention, and again 12 weeks post-baseline. A sub-sample of intervention participants will complete an extended support pilot study with assessments at 6- and 9-months post-baseline. The primary outcome is systolic BP. Secondary outcomes include modifiable CVD risk factors, heart disease and stroke risk scores, and dietary intake.

Discussion

NOSH is among the first randomized controlled trials to test the impact of a diet-based intervention on HTN among urban AI/AN adults. If effective, NOSH has the potential to inform clinical strategies to reduce BP among AI/AN adults.

Clinical trials registration

https://clinicaltrials.gov/ct2/show/NCT02796313, Identifier NCT02796313.

Association Between VACS Index and Health-Related Quality of Life in Persons with HIV: Moderating Role of Fruit and Vegetable Consumption

BACKGROUND

The health status of people with HIV (PWH) influences their health-related quality of life (HRQOL). Modifiable lifestyle factors may improve HRQOL. This study (1) explores the association between modifiable lifestyle factors (physical activity and nutrition) and HRQOL and (2) examines if these lifestyle factors moderate the association health status and HRQOL.

METHODS

Participants included 91 community dwelling PWH (age 36-65 years) from the university lab. Participants reported mental and physical HRQOL via the Medical Outcome Study 36-Item Short-Form (SF-36). Physical activity was examined via the International Physical Activity Questionnaire and nutrition (i.e., fruit and vegetable consumption) was assessed with the By-Meal Screener. Health status was ascertained via the Veterans Aging Cohort Study (VACS) Index.

RESULTS

Aim 1 analyses indicated that neither physical activity nor nutrition was related to mental HRQOL (p's > .05). However, greater physical activity (β = .33, p < .01) and nutrition (β = .23, p = .03) were each independently related to better physical HRQOL and remained significant after accounting for co-occurring medical conditions. For aim 2, the interaction between health status and nutrition was statistically significant (β = .24, p = .02), such that the association between worse health status and worse physical HRQOL was weaker with better nutrition. There was not a statistically significant interaction between physical activity and health status on physical HRQOL (p > .05).

CONCLUSION

Physical HRQOL is related to self-reported physical activity and nutrition, with nutrition showing a moderating effect on the association between health status and physical HRQOL. Thus, future interventional studies designed to improve physical HRQOL should target both physical activity and nutrition.

Body weight and fat trajectories of Black and White women in the first postpartum year

OBJECTIVE

The aim of this study was to examine changes in body weight and fat in Black and White women during the first postpartum year and to determine whether there is preferential retention of fat mass and abdominal fat.

METHODS

Body composition was quantified by dual-energy x-ray absorptiometry in Black (n = 49) and White (n = 85) women at 6 to 8 weeks, 6 months, and 12 months after delivery of a singleton infant.

RESULTS

Weight, fat mass, percent body fat, and fat in the trunk, android, gynoid, and limb regions decreased from 6 to 8 weeks to 12 months in White women, but not in Black women (fat mass, adjusted mean [SE]: 29.6 [1.3] to 26.9 [1.3] kg in White women and 34.5 [1.5] to 36.8 [1.8] kg in Black women). In the entire sample, fat mass was higher at 6 months than at 6 to 8 weeks, independent of weight change; visceral fat was higher at 12 months (686 [45] g) than at 6 to 8 weeks (611 [42] g) and 6 months (626 [43] g); and android fat was higher at 12 months than at 6 months, independent of fat change.

CONCLUSIONS

Black women were less likely than White women to lose weight and fat in the postpartum period. There was preferential retention of fat in the abdominal area.

Healthier Energy Balance Behaviors Most Important for Health-Related Quality of Life in Rural Cancer Survivors in Central Pennsylvania

BACKGROUND

Rural cancer survivors face a greater number of health disparities, including poorer health-related quality of life (HRQoL), than urban cancer survivors. Engagement in healthy lifestyle behaviors also varies between rural and urban cancer survivors. Lifestyle behaviors can improve HRQoL; however, the combination of behaviors most important for HRQoL in rural survivors is unclear. This study examined clusters of lifestyle behaviors in rural cancer survivors, and differences in HRQoL between behavioral clusters.

METHODS

Rural cancer survivors in the United States (N = 219) completed a cross-sectional survey. Lifestyle behaviors were classified into unhealthy/healthy binary categories (inactive/active, longer/shorter sedentary time, excessive/acceptable fat intake, very low/higher fruit and vegetable intake, some/no alcohol consumption, and poor/good sleep quality). Behavioral clusters were identified by latent class analysis. HRQoL differences between behavioral clusters were assessed by ordinary least squares regression.

RESULTS

The 2-class model demonstrated the best fit and interpretability. The "mostly unhealthy behaviors" class (38.5% of sample) had higher probabilities of all unhealthy behaviors, except alcohol consumption. The "healthier energy balance" class (61.5% of sample) had higher probabilities of active, shorter sedentary, higher fruit and vegetable consumption, excessive fat intake, some alcohol consumption, and poor sleep categories, and reported better HRQoL.

CONCLUSIONS

Healthier energy balance behaviors were particularly relevant for HRQoL in rural cancer survivors. Multiple behavior change interventions to improve HRQoL in rural cancer survivors should focus on supporting energy balance behaviors. Many rural cancer survivors may lead very unhealthy lifestyles, placing them at high risk of adverse outcomes. This subpopulation should be prioritized to help alleviate cancer health disparities.

Primary Prevention of Weight Gain Among New Bus Operators: Results of the "Success & Health Impacts For Transit operators during Onboarding" (SHIFT Onboard) Pilot Study

OBJECTIVE

This study aimed to test the feasibility and efficacy of an enhanced onboarding intervention to prevent weight gain and support the early job success of new bus operators.

METHODS

Control participants ( n = 9) completed usual practice new employee training and onboarding. Intervention participants ( n = 14) completed five supplemental trainings and four online challenges during their first year. Primary outcomes were body weight, dietary behaviors, physical activity, and sleep duration/quality. Early job success was evaluated with measures of newcomer adjustment.

RESULTS

The difference between intervention and control participants in body weight change at 12-month was -6.71 lb (Cohen's d = -1.35). Differences in health behavior changes were mixed, but newcomer adjustment changes favored the intervention group.

CONCLUSIONS

Results support the feasibility of enhanced onboarding for bus operators to prevent worsening health while simultaneously advancing their success as new employees.

Personality traits and meat consumption: The mediating role of animal-related ethical concerns

Prior research suggests that personality traits are associated with meat consumption. However, this association is not uniform across all types of meat. For instance, Big Five personality traits such as openness and agreeableness are negatively associated with red meat consumption but positively associated with fish. Using a large sample of Chilean university students (N = 1,149), we examined whether these differential meat consumption patterns can be explained by an intermediary variable of animal-related ethical values. Structural equation modeling was employed to test the hypothesized associations. The results suggest that animal-related ethical values mediate the effect of certain personality traits on the consumption of beef and poultry.

Impact of community-driven interventions on dietary and physical activity outcomes among a cohort of adults in a rural Appalachian county in Eastern Kentucky, 2019-2022

Several environmental level factors exacerbate poor health outcomes in rural populations in the United States, such as lack of access to healthy food and locations to be physically active, which support healthy choices at the individual level. Thus, utilizing innovative place-based approaches in rural locations is essential to improve health outcomes. Leveraging community assets, like Cooperative Extension, is a novel strategy for implementing community-driven interventions. This prospective cohort study (n = 152), recruited in 2019 and surveyed again in 2020 and 2021, examined individual level changes in diet and physical activity in one rural Appalachian county. During this time, multiple community-driven interventions were implemented alongside Cooperative Extension and several community partners. Across the three-year study, the cohort indicated increases in other vegetables and water and reductions in fruits and legumes. There were also reductions in less healthy items such as French fries and sugar-sweetened beverages. The cohort also reported being less likely to engage in physical activity. Our findings suggest that key community-driven programs may have indirect effects on dietary and physical activity choices over time. Outcomes from this study are relevant for public health practitioners and community organizations working within rural Appalachian communities to address health-related behaviors.

Reaching high-risk Black adults for diabetes prevention programming during a pandemic: The design of Fit & Faithful a randomized controlled community trial

Obesity is a key risk factor for Type 2 diabetes (T2D). Alarmingly, 87% of US adults have overweight or obesity, with non-Hispanic black adults having higher obesity and T2D prevalence than non-Hispanic white. The Diabetes Prevention Program (DPP) demonstrated the clinical benefits of lifestyle intervention (LI). While the DPP LI is effective, some participants don't achieve clinically significant weight loss in the current group-based translation paradigm. Black adults have the lowest adjusted weight loss (3.2%) among all racial/ethnic groups. Early intervention nonresponse defined as ≤1% weight loss at intervention week 4 is linked to lower probability of achieving weight loss goals. This paper describes the design and methods of a cluster randomized controlled trial among black weight loss nonresponders nested in 20 community sites (primarily churches). Descriptions of the adaptations made to transition the program to virtual format during the COVID-19 pandemic are also included. Trained community health workers deliver a group-based, 6-month long DPP over 18 sessions via Zoom. Additionally, nonresponders in the enhanced group receive weekly telephone support to provide individual-level intervention to help overcome weight loss barriers. Outcomes include weight, physical activity level, blood pressure, and dietary behaviors; these are compared between nonresponders in the enhanced intervention group and nonresponders in the active control group. Cost, mediators, and moderators are explored. If found to efficacious, these enhanced strategies could be standardized as a supplement for use with DPP nonresponders.

Harvest for Health, a Randomized Controlled Trial Testing a Home-Based, Vegetable Gardening Intervention Among Older Cancer Survivors Across Alabama: An Analysis of Accrual and Modifications Made in Intervention Delivery and Assessment During COVID-19

BACKGROUND

Accelerated functional decline is a concern among older cancer survivors that threatens independence and quality of life. Pilot studies suggest that vegetable gardening interventions ameliorate functional decline through improved diet and physical activity.

OBJECTIVE

The aim of this article was to describe the rationale, recruitment challenges, and enrollment for the Harvest for Health randomized controlled trial (RCT), which will test the impact of a home-based, vegetable gardening intervention on vegetable and fruit consumption, physical activity, and physical functioning among older cancer survivors. Modifications made to the intervention and assessments to assure safety and continuity of the RCT throughout the COVID-19 pandemic also are reported.

DESIGN

Harvest for Health is a 2-year, 2-arm, single-blinded, wait-list controlled RCT with cross-over.

PARTICIPANTS/SETTING

Medicare-eligible survivors of cancers with ≥60% 5-year survival were recruited across Alabama from October 1, 2016 to February 8, 2021.

INTERVENTION

Participants were randomly assigned to a wait-list control or a 1-year home-based gardening intervention and individually mentored by extension-certified master gardeners to cultivate spring, summer, and fall vegetable gardens.

MAIN OUTCOME MEASURES

Although the RCT's primary end point was a composite measure of vegetable and fruit consumption, physical activity, and physical functioning, this article focuses on recruitment and modifications made to the intervention and assessments during COVID-19.

STATISTICAL ANALYSES PERFORMED

χ2 and t tests (α < .05) were used to compare enrolled vs unenrolled populations.

RESULTS

Older cancer survivors (n = 9,708) were contacted via mail and telephone; 1,460 indicated interest (15% response rate), 473 were screened eligible and consented, and 381 completed baseline assessments and were randomized. Enrollees did not differ from nonrespondents/refusals by race and ethnicity, or rural-urban status, but comprised significantly higher numbers of comparatively younger survivors, those who were female, and survivors of breast cancer (P < .001). Although COVID-19 delayed trial completion, protocol modifications overcame this barrier and study completion is anticipated by June 2022.

CONCLUSIONS

This RCT will provide evidence on the effects of a mentored vegetable gardening program among older cancer survivors. If efficacious, Harvest for Health represents a novel, multifaceted approach to improve lifestyle behaviors and health outcomes among cancer survivors-one with capacity for sustainability and widespread dissemination.

Associations Between Acculturation and Weight, Diet Quality, and Physical Activity Among Latina Breast Cancer Survivors: The ¡Mi Vida Saludable! Study

BACKGROUND

Among Latinos, greater acculturation to the United States (US) is associated with risk of obesity and obesity-related comorbidities. Less is known about the associations between acculturation and obesity-related modifiable risk factors, such as diet quality and physical activity (PA) among Latina breast cancer survivors.

OBJECTIVE

The aim of this study was to explore associations between acculturation and weight status, diet quality, and PA among Latina breast cancer survivors.

DESIGN

This is a cross-sectional secondary analysis of baseline data on demographic and clinical characteristics, acculturation, anthropometric measures, diet quality, and PA collected from Latina breast cancer survivors enrolled in the ¡Mi Vida Saludable! (My Healthy Life) behavioral diet and PA intervention trial.

PARTICIPANTS/SETTING

Participants were Latina women (n = 167) residing in New York City, with a medical history of stage 0 to III breast cancer, no evidence of recurrent or metastatic disease, and at least 90 days post cancer treatment who participated in the ¡Mi Vida Saludable! randomized controlled trial between July 2016 and October 2018.

MAIN OUTCOME MEASURES

Acculturation status was measured by the Short Acculturation Scale for Hispanics score, language preference, place of birth, and duration of US residence. Weight, height, and waist and hip circumferences were measured at an in-person clinic visit. Diet information was collected via 3 telephone-based 24-hour dietary recalls and PA information was collected via staff administered 7-day recalls.

STATISTICAL ANALYSES PERFORMED

Linear regression models examined associations between acculturation and weight status, diet quality, and PA.

RESULTS

Based on the Short Acculturation Scale for Hispanics acculturation score, more acculturated compared with less acculturated Latinas were younger in age, more educated, and had higher annual household incomes (all, P < .05). Compared with Spanish-speaking Latinas, English-speaking Latinas had larger waist circumference (103 vs 96.1 cm; P = .01) and poorer-quality diets (Healthy Eating Index 2015 scores, 57.3 vs 71.5; P < .001). Greater levels of acculturation were also associated with higher levels of leisure walking at a moderate-to-vigorous intensity (265.8 vs 179.0 min/wk; P =.04).

CONCLUSIONS

Greater levels of acculturation were associated with higher central obesity and poorer-quality diets. Future lifestyle modification trials tailored to the unique role of acculturation on adopting behavior change recommendations is a promising next step in this line of research.

Definitions and Assessment Methods of ‘Home Cooking’ in Studies with Dietary Variables: A Scoping Review

Home cooking is a complex idea that involves multiple skills and behaviors and can be interpreted differently. Using six databases (two of which were Japanese), this scoping review examined the definitions and methods used in studies investigating the relationship between home cooking and dietary variables. Of the 40 studies (2 in Japanese) included in this review, 8 provided definitions but did not specify the extent or level that convenience foods can be allowed in food preparation. The methods were classified into two categories, namely, perception-dependent (n = 29) if using a self-reported instrument, or perception-independent (n = 11) if based on investigators’ classification. Subsequently, indicators of home cooking were classified based on survey attributes (e.g., frequency, location). All but five studies used single indicators, primarily the preparation frequency (n = 18). Quality of analysis was also evaluated. Studies that used multiple indicators or perception-independent methods showed high or moderate overall quality. In contrast, studies that used single indicators based on perception-dependent methods tended to have a low overall quality. The consistency of the relationship between home cooking and dietary variables depended on study quality. In conclusion, the definitions of home cooking were inconsistent across studies, and lacked consensus for examining the association between dietary outcomes.

Differences in health behaviors related to overweight/obesity by race/ethnicity in a diverse urban commuter college

Objective: To examine health behaviors associated with overweight/obesity by race/ethnicity at a diverse urban college. Participants: 270 undergraduates (77.0% female; 26.7% non-Hispanic white) and median body mass index (BMI) of 23.1 kg/m². Methods: A questionnaire about health-related behaviors as part of the "Get Fruved" project was used to measure health behaviors (sugar sweetened beverage (SSB), fruit and vegetable consumption, physical activity, stress, and sleep) by race/ethnicity. Multivariable logistic regression was used to assess the adjusted odds of engaging in positive health-related behaviors. Results: Non-Hispanic black and Hispanic students were 64% and 59% less likely to consume lower amounts of SSB. Hispanic students were 83% and 81% less likely to meet vegetable and fruit recommendations. Non-Hispanic black and other (including biracial) had reduced odds of meeting vegetable recommendations (AOR = 0.18 and 0.28). Conclusions: Disparities in SSB, fruit, and vegetable consumption represent potential intervention targets to improve health behaviors among racial/ethnic minorities.

Dietary behavior and urinary gallic acid concentration differences among underserved elder racial and ethnic minorities in New York City

Purpose

Diet and nutrition are important for cancer prevention. To investigate associations between dietary behavior, demographics, and risk of cancer, we assessed dietary behavior and urinary concentration of gallic acid, a polyphenol with anticancer properties found in various fruits and vegetables, in racial and ethnic minorities.

Methods

Ninety-one (91) participants were recruited from senior centers in East Harlem, New York City, a racially diverse and underserved community. A National Institute of Health (NIH)—validated dietary survey questionnaire—was used to collect dietary fruits and vegetables consumption data. Demographic and cancer information were also collected. All 91 participants completed the survey and forty-five (45) participants provided urine samples for gallic acid analysis.

Results

Gender differences were significantly associated with dietary behavior and urinary gallic acid concentration (UGAC). Female participants had a higher total daily intake of fruits and a significantly higher UGAC compared to male participants (p < 0.05). Age was negatively associated with the serving quantity of French fries/fried potatoes and white potatoes (p < 0.05), while positively associated with the daily intake frequency and daily intake of fruits (p < 0.05). Furthermore, Asian race was associated with higher daily intake frequencies of fruits and vegetable soup (p < 0.05), compared to other races. In a multivariate analysis, a significant association was observed between the serving quantities of fruits and other vegetables and UGAC (p < 0.05) after controlling for demographic characteristics.

Conclusion

The observed differences in dietary behavior and UGAC in this study provide limited information on the association between demographic differences and cancer prevalence in elder racial and ethnic minorities. Future research should investigate this association further for potential implications in cancer prevention.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10552-022-01581-y.

Lower Life Satisfaction and Inflammation in African American Adults: Body Adiposity Mediation and Sex Moderation

Both lower life satisfaction (LLS) and chronic inflammation are underlying conditions for numerous diseases. We investigated their associations in African American adults, within the context of three hypotheses: (a) perceived LLS will be positively associated with inflammation measured by serum C-reactive protein (CRP); (b) this association will be mediated by body adiposity; and (c) these associations will be moderated by sex. Participants (n = 83; >45 years; 59% women) were a subsample of a larger church-based intervention to reduce cardiovascular risks and were assessed at baseline and after 6 months. Body adiposity (BMI/hip/waist circumferences) was measured by standardized methods and CRP with ELISA. LLS was self-reported. The analyses were conducted in the structural equation modeling (SEM) framework. The direct relationship between LLS and CRP was significant for all participants but was mediated by BMI/hip/waist circumferences. Multi-group SEM analysis provided evidence for sex moderation by showing that the mediating pathway from LLS to CRP through BMI, and to a lesser extent through hip/waist circumferences, was significant only in women. In conclusion, perceived LLS was positively associated with the level of inflammation mediated by BMI/hip/waist circumference, with the association between LLS and CRP being stronger in women. These findings contribute to the current literature untangling mediation/moderation processes in which perceived LLS may contribute to adiposity-related inflammation. They also add to precision medicine development, suggesting that stress and inflammation-reducing interventions should focus on African Americans, particularly women.

Strategies and Lessons Learned from a Home Delivery Food Prescription Program for Older Adults

Food insecurity (FI) is a growing health problem, worsening during the COVID-19 pandemic. Fresh food prescription programs (FFRx) have been shown to increase healthy eating and decrease FI, but few FFRx are community-informed, or theory based. Our FFRx was a delivery program developed to alleviate FI for older adults. It was implemented in an academic medical center and guided by the Capabilities, Opportunities, Motivations, and Behaviors and Theoretical Domains Framework. We tested impacts of the program on FI, Fruit and Vegetable (FV) intake, depression, and loneliness at six-month intervals. During the FFRx, 31 people completed surveys every six months. FI decreased by an average of 2.03 points (p = <.001) while FV intake increased from a mean of 2.8 servings per day to 2.9 servings per day (p = .53). Depression and loneliness scores stayed stable. Preliminary data from this FFRx program, a partnership between an academic medical center and community partners, had positive impacts on FI.

Predicting intentions to meet fruit & vegetable recommendations among black emerging adult women

ObjectiveTo examine Black emerging adult women's (ages 18-29) intention to meet the recommended daily intake of fruits and vegetables using the Theory of Planned Behavior (TPB). Participants: Black emerging adult women (BEAW; N = 100). Methods: A cross-sectional survey design. Results: Hierarchical regression analyses revealed that in Model 1, attitudes (p<.0001) and subjective norms (p<.05) were significant predictors of intentions to meet the recommended daily intake of fruits and vegetables. In Model 2, attitudes (p=.0001) and perceived behavioral control (p<.0001) were revealed to be significant predictors of intentions. The change in R squared from Model 1 (R2=.304) and Model 2 (R2=.559), was 0.255 (F = 40.08, p<.0001) with the addition of perceived behavioral control to the second model. Conclusion: The TPB may be a suitable framework to assess factors associated with fruit and vegetable intentions among BEAW. Interventions designed to increase fruit and vegetable intake in BEAW should prioritize modifying perceived behavioral control.

The Impact of a Grocery Store Closure in One Rural Highly Obese Appalachian Community on Shopping Behavior and Dietary Intake

Research has examined how the entry of grocery stores into neighborhoods influences dietary outcomes, yet limited evidence suggests a direct correlation between opening a store and changes in dietary intake. A factor that might influence individuals’ behavior more directly is the closing of a grocery store where residents shop. This study aims to examine how a grocery closure in a rural Appalachian high poverty county is associated with dietary intake. A cohort of n = 152 individuals were recruited to participate in a longitudinal study examining purchasing habits and dietary intake. At time point two, one year later, n = 74 individuals completed the survey via phone. Results indicate those that switched from shopping at a local grocery store to a supercenter significantly increased their dietary intake of fruit (0.2 ± 0.8), fruits and vegetables (1.4 ± 2.7), alcohol (grams) (17.3 ± 54.1), and tomato sauce (0.1 ± 0.3). A local grocery store closure was associated with a change in shopping behavior and dietary intake. Community-level interventions targeting dietary behaviors must account for neighborhood food environment influences, including grocery store availability. Policy aimed at improving food access in rural communities need to consider approaches to improving a variety of food venues with affordable healthy food, while addressing the evolving grocery shopping behaviors of consumers.

We Are What We Eat: Assessing the Use of a Documentary Film as an Educational Tool to Change Students’ Nutritional Attitudes and Behaviors

Background: Identifying effective educational strategies to change lifestyle behaviors related to eating habits is imperative for health professionals providing education related to disease management and prevention. The purpose of this study is to investigate the use of mass media as a tool for improving dietary habits. Methods: 151 Undergraduate students participated in a quasi-experimental control group design at a midsize liberal arts university. The treatment group watched the film Forks Over Knives and was assessed on their dietary habits, locus of control, and current stage of change before and after viewing the film. Results: Results showed differences to current stage of change in reducing animal-based food consumption in the treatment group but did not show significant changes in increasing plant-based food. Discussion: This study provides evidence that use of the documentary Forks Over Knives affects students’ intake of animal-based foods but is not an impactful enough tool to increase intake of plant-based foods. Translation to Health Practice: Professionals who utilize the film Forks Over Knives to encourage dietary changes should do so as part of a more structured, long-term behavior change intervention program. Additional research is needed to compare Forks Over Knives with other documentary films that encourage plant-based dietary habits.

Food Insecurity, Associated Health Behaviors, and Academic Performance Among Urban University Undergraduate Students

OBJECTIVE

To explore associations between food insecurity, health behaviors, and academic performance among undergraduates at a private, urban US university.

METHODS

A cross-sectional web-based survey was conducted among a convenience sample of New York University undergraduates. Multivariable logistic regression estimated associations of food security (using the 6-item US Household Food Security Survey Module) and health behaviors (fruit/vegetable, beverage and alcohol intakes, and sleep), self-rated health, and academic performance.

RESULTS

Of the 257 students who completed the survey, 41% reported food insecurity. Food insecurity was associated with approximately 2-fold higher odds of sugar-sweetened beverage consumption (adjusted odds ratio, 1.97; 95% confidence interval, 1.14-3.41) and fair/poor health (adjusted odds ratio, 2.29; 95% confidence interval, 1.23-4.25).

CONCLUSIONS AND IMPLICATIONS

Increased awareness of food insecurity and associated health behaviors among students has implications for higher education's provision of on-campus food support programs.

Effect of a pediatric fruit and vegetable prescription program on child dietary patterns, food security, and weight status: a study protocol

Background

Although nutrients in fruits and vegetables are necessary for proper development and disease prevention, most US children consume fewer servings than recommended. Prescriptions for fruits and vegetables, written by physicians to exchange for fresh produce, address access and affordability challenges while emphasizing the vital role of diet in health promotion and disease prevention. Michigan’s first fruit and vegetable prescription program (FVPP) exclusively for children was introduced in 2016 at one large pediatric clinic in Flint and expanded to a second clinic in 2018. The program provides one $15 prescription for fresh produce to all pediatric patients at every office visit. Prescriptions are redeemable at a year-round farmers’ market or a local mobile market. The current study will assess the impact of this FVPP on diet, food security, and weight status of youth.

Methods

Demographically similar pediatric patient groups with varying levels of exposure to the FVPP at baseline will be compared: high exposure (> 24 months), moderate exposure (12–24 months), and no previous exposure. Data collection will focus on youth ages 8–16 years. A total of 700 caregiver-child dyads (one caregiver and one child per household) will be enrolled in the study, with approximately 200 dyads at clinic 1 (high exposure); 200 dyads at clinic 2 (moderate exposure), and 300 dyads at clinic 3 (no previous exposure). Children with no previous exposure will be introduced to the FVPP, and changes in diet, food security, and weight status will be tracked over two years. Specific aims are to (1) compare baseline diet, food security, and weight status between pediatric patients with varying levels of exposure to the FVPP; (2) measure changes in diet, food security, and weight status before and after never-before-exposed children are introduced to the FVPP; and (3) compare mean 12- and 24-month follow-up measures of diet, food security, and weight status in the initial no exposure group to baseline measures in the high exposure group.

Discussion

Completion of study aims will provide evidence for the effectiveness of pediatric FVPPs and insights regarding the duration and intensity of exposure necessary to influence change.

Trial registration

The study was registered through clinicaltrials.gov [ID: NCT04767282] on February 23, 2021.

Rural and Urban Differences in Vegetable and Fruit Consumption Among Older Cancer Survivors in the Deep South: An Exploratory Cross-Sectional Study

BACKGROUND

Cancer survivors, especially those who are older, experience increased comorbidity and risk for secondary cancers. A varied dietary pattern, rich in vegetables and fruit (V&F) is recommended to improve health. However, V&F intake may differ by rural versus urban status.

OBJECTIVE

To assess differences in V&F consumption among older cancer survivors residing in urban- and rural-designated areas, and explore whether differences exist by sex, race, and cancer type.

DESIGN

This was a cross-sectional secondary analysis.

PARTICIPANTS/SETTING

Screening data from the Harvest for Health trial were obtained from October 2016 to November 2019 on 731 Medicare-eligible cancer survivors across Alabama.

MAIN OUTCOME MEASURES

V&F consumption was measured by 2-items from the Eating at America's Table NCI Dietary Screener. Rural and urban residence was coded at the zip-code level using the USDA's Rural-Urban Commuting Area (RUCA) coding schema using five different classifications (A-E). Sex, race and cancer-type were dichotomized as male/female, Non-Hispanic White (NHW)/Non-Hispanic Black (NHB) and gastro-intestinal/other cancers, respectively.

STATISTICAL ANALYSES

Kruskal Wallis rank sum and post-hoc tests were performed to detect differences in V&F consumption (α<0.05).

RESULTS

The study sample was largely female (66.2%), NHW (78.1%), of mean age 70 years and reported an average V&F intake of 1.47 cups/day. V&F consumption of cancer survivors living in isolated, small, rural towns was roughly half that consumed by survivors living elsewhere; thus, statistically significant rural-urban differences were found in models that accounted specifically for this subgroup, i.e., RUCA categorizations A and E.V&F consumption also was significantly lower in NHB (1.32 ± 0.98 cups/day) than NHW survivors (1.51 ± 1.10 cups/day) (p=0.0456); however, no statistically significant differences were detected by sex and cancer type.

CONCLUSION

Analyses that address the variability within "rural" designated areas are important in future studies. Moreover, a greater understanding is needed of factors that adversely affect V&F consumption of those most vulnerable, i.e., older NHB cancer survivors as well as those living in isolated, small, rural towns to best target future interventions.

Monday-focused tailored rapid interactive mobile messaging for weight management 2 (MTRIMM2): results from a randomized controlled trial

BACKGROUND

Text-messaging interventions can reach many individuals across a range of socioeconomic groups, at a low cost. Few randomized controlled trials (RCTs) of text-messaging weight loss interventions have been conducted in United States.

METHODS

From September of 2016 to September of 2018, we conducted a two-parallel group, superiority, RCT of a 16-week text-messaging, weight loss intervention in Baltimore, Maryland, in overweight and obese adults younger than 71, who were able to receive text-messages. Our objective was to assess the effect of receiving the message content only (in printed documents distributed at baseline and week 8), versus receiving messages via short messaging service (SMS) on weight loss (primary outcome), body mass index, perceived exercise benefits and barriers, self-efficacy, and physical activity (PA). The random allocation sequence was equally balanced intervention groups by gender and age groups. Participants were randomized after the baseline assessment. Then, participants and most study staff were unblinded. Follow-up assessments were conducted at 8-, 16-, and 42-week post randomization. We performed intention-to-treat analysis using mixed linear regression models.

RESULTS

Of the 155 adults randomized (printed messages =77, SMS =78), 87.1% were women, 53.5% were African Americans, and 93.5% non-Hispanic. Participants who completed at least one follow-up assessment were included in regression analyses (n=145, printed messages =74, SMS =71). Compared to baseline, at the 42-week assessment, the average percent weight loss was 1.23 for the SMS group (P=0.006) and 0.86 for the printed messages group (P=0.047). Both groups experienced small reductions in weight (printed messages: -0.96 kg, P=0.022; SMS: -1.19 kg, P=0.006), BMI (printed messages: -0.32, P=0.035; SMS: -0.52, P=0.002), and percent energy from fat consumption (printed messages: -1.43, P=0.021; SMS: -2.14, P≤0.001). No statistically significant between groups differences were detected for any of the study outcomes. SMS response rates were not statistically significantly associated with study outcomes. No adverse events were reported.

CONCLUSIONS

A semi-tailored SMS weight loss intervention among overweight and obese adults was not statistically superior in efficacy to paper-based messaging.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04506996.

A randomized controlled trial of a community-based obesity intervention utilizing motivational interviewing and community resource mobilization for low-income families: Study protocol and baseline characteristics

Low-income, racially diverse families with one parent with obesity are at high risk for child obesity. Effective approaches to promote healthy behaviors and prevent additional weight gain in family members are needed. Motivational interviewing (MI) may assist families to engage, identify motivations for change and establish goals. However, families with limited resources face other barriers to goal achievement that may be addressed through connection with community organizations. This paper describes a unique protocol combining MI and community connection. This randomized controlled trial includes low-income families with one parent with obesity and at least one child aged 6 to 12 years. Families in the intervention group receive an innovative, 12-month intervention combining health coaching using MI to promote lifestyle behavior change goals and community resource mobilization to assist with basic needs and resources to aid goals. The study protocol is modeled on community-based participatory research principles. Data is collected at baseline, 6 months, 12 months, and 18 months include questionnaires, body measurements, and accelerometer data. For adults, primary outcomes are Body Mass Index (BMI), minutes of moderate to vigorous physical activity (MVPA), and hours of sedentary time per day. For children, primary outcomes are sedentary time, MVPA, and the Family Nutrition and Physical Activity Score. From this hard-to-reach population, 236 diverse families were recruited. If the study is deemed effective, it has the potential to demonstrate that the combination of MI, resource mobilization, and utilization of existing community organizations is a sustainable model to assist families at risk for obesity.

COVID-19 pandemic and stay-at-home mandates promote weight gain in US adults

OBJECTIVE

The purpose of this study was to prospectively examine the effect of state stay-at-home mandates on weight of US adults by BMI over 3 months during COVID-19.

METHODS

US adults completed an online questionnaire containing demographics, weight, physical activity, sedentary time, fruit/vegetable intake, depressive symptoms, stress, and sleep at baseline (May 2020) and after 3 months (August 2020).

RESULTS

Participants gained 0.6 kg (76.7-77.3 kg, p = 0.002). A total of 26% of those with obesity gained > 2 kg compared with 14.8% of those with normal weight (p < 0.001). A total of 53.3% of individuals with obesity maintained weight within 2 kg compared with 72.5% of those with normal weight (p < 0.001). Greater weight gain was related to longer stay-at-home mandates (β = 0.078, p = 0.010), lower baseline minutes of physical activity per day (β = -0.107, p = 0.004), greater declines in minutes of physical activity per day (β = -0.076, p = 0.026), depressive symptoms (β = 0.098, p = 0.034), and greater increases in time preparing food (β = 0.075, p = 0.031).

CONCLUSIONS

US adults gained weight, and stay-at-home mandates were associated with atypical weight gain and greater reported weight gain in individuals with obesity over 3 months.

Does health literacy affect fruit and vegetable consumption? An assessment of the relationship between health literacy and dietary practices among college students

Objective To explore the association between health literacy and fruit and vegetable (F&V) consumption among college students. Participants: In 2018, undergraduate students from a large, southeastern university were recruited to participate in this study. Methods: Participants (n = 436) completed an online survey assessing health literacy, F&V intake, and personal, situational, and societal and environmental determinants of health literacy. Results: There was a significant association between general health literacy, F(2, 161.54) = 6.52, p < .001; disease prevention health literacy, F(2, 214.22) = 4.788, p < .01; and health promotion health literacy, F(2, 138.35) = 5.53, p < .01 with F&V consumption. Students with excellent health literacy consumed significantly more fruits and vegetables than students with limited health literacy. Conclusions: Health literacy may play an important role in F&V consumption among college students. Future research should explore the relationship between the health literacy and dietary practice decision-making to inform intervention development among college students.

Life of a vegetarian college student: Health, lifestyle, and environmental perceptions

Objective To examine health behavior and environmental perception differences among vegetarian and nonvegetarian students. Participants: First-year university students (n = 1078) from eight United States universities. Methods: Data were obtained from base 2015 and followup 2016 assessments. Vegetarians and nonvegetarians were compared for anthropometrics, lifestyle behaviors, and campus environmental perceptions (CEPS). Results: Vegetarians had smaller waist circumference, lower systolic blood pressure, higher fruit and vegetable consumption, lower percentage of energy obtained from fat, and higher perceived stress. Vegetarians expressed a lower rating of perceptions of health policies on campus. Conclusion: A clear difference in indicators of physical health does not appear, however, vegetarian students show positive dietary patterns which can promote positive health outcomes. Further, vegetarians had lower perceptions of health policies on campus. Results can be used by administrators to ensure policies are in place to support health of students as currently vegetarian students see limitations in the environmental health policies.

Food Acquisition Practices, Body Mass Index, and Dietary Outcomes by Level of Rurality

PURPOSE

Rural residents are more likely to be obese than urban residents. Research on how people navigate their local food environments through food acquisition behaviors, such as food shopping and restaurant use, in different types of communities may help to create a deeper understanding of the multilevel determinants of obesity.

METHODS

Data are from a national sample of US adults ages 18-75. Respondents were recruited from an online survey panel in 2015 and asked about food shopping, restaurant use, diet and weight (N = 3,883). Comparisons were made by level of rurality as assessed by Rural-Urban Continuum Codes (RUCC) and self-reported rurality of the area around their home.

FINDINGS

Food acquisition behaviors varied minimally by RUCC-defined level of rurality, with the exceptions of type and distance to primary food store. Rural residents drove further and were more likely to shop at small grocery stores and supercenters than were residents of semiurban or urban counties. In contrast, all of the food acquisition behaviors varied by self-reported rurality of residential areas. Respondents living in rural areas shopped for groceries less frequently, drove further, more commonly shopped at small grocery stores and supercenters, and used restaurants less frequently. In multivariable analyses, rural, small town, and suburban areas were each significantly associated with BMI and fruit and vegetable intake, but not percent energy from fat.

CONCLUSION

Findings show that self-reported rurality of residential area is associated with food acquisition behaviors and may partly explain rural-urban differences in obesity and diet quality.

Improvements in Diet and Physical Activity-Related Psychosocial Factors Among African Americans Using a Mobile Health Lifestyle Intervention to Promote Cardiovascular Health: The FAITH! (Fostering African American Improvement in Total Health) App Pilot Study

BACKGROUND

African Americans continue to have suboptimal cardiovascular health (CVH) related to diet and physical activity (PA) behaviors compared with White people. Mobile health (mHealth) interventions are innovative platforms to improve diet and PA and have the potential to mitigate these disparities. However, these are understudied among African Americans.

OBJECTIVE

This study aims to examine whether an mHealth lifestyle intervention is associated with improved diet and PA-related psychosocial factors in African Americans and whether these changes correlate with diet and PA behavioral change.

METHODS

This study is a retrospective analysis evaluating changes in diet and PA-related self-regulation, social support, perceived barriers, and CVH behaviors (daily fruit and vegetable intake and moderate-intensity PA [MPA] per week) in 45 African American adults (mean age 48.7 years, SD 12.9 years; 33/45, 73% women) enrolled in the FAITH! (Fostering African American Improvement in Total Health) app pilot study. The intervention is a 10-week, behavioral theory-informed, community-based mHealth lifestyle intervention delivered through a mobile app platform. Participants engaged with 3 core FAITH! app features: multimedia education modules focused on CVH with self-assessments of CVH knowledge, self-monitoring of daily fruit and vegetable intake and PA, and a sharing board for social networking. Changes in self-reported diet and PA-related self-regulation, social support, perceived barriers, and CVH behaviors were assessed by electronic surveys collected at baseline and 28 weeks postintervention. Changes in diet and PA-related psychosocial factors from pre- to postintervention were assessed using paired 2-tailed t tests. The association of changes in diet and PA-related psychosocial variables with daily fruit and vegetable intake and MPA per week was assessed using Spearman correlation. Associations between baseline and 28-week postintervention changes in diet and PA-related psychosocial measures and CVH behaviors with covariates were assessed by multivariable linear regression.

RESULTS

Participants reported improvements in 2 subscales of diet self-regulation (decrease fat and calorie intake, P=.01 and nutrition tracking, P<.001), one subscale of social support for healthy diet (friend discouragement, P=.001), perceived barriers to healthy diet (P<.001), and daily fruit and vegetable intake (P<.001). Improvements in diet self-regulation (increase fruit, vegetable, and grain intake, and nutrition tracking) and social support for healthy diet (friend encouragement) had moderate positive correlations with daily fruit and vegetable intake (r=0.46, r=0.34, and r=0.43, respectively). A moderate negative correlation was observed between perceived barriers to healthy diet and daily fruit and vegetable intake (r=-0.25). Participants reported increases in PA self-regulation (P<.001). Increase in social support subscales for PA (family and friend participation) had a moderate positive correlation with MPA per week (r=0.51 and r=0.61, respectively).

CONCLUSIONS

Our findings highlight key diet and PA-related psychosocial factors to target in future mHealth lifestyle interventions aimed at promoting CVH in African Americans.

Yoga participation associated with changes in dietary patterns and stress: A pilot study in stressed adults with poor diet

BACKGROUND AND PURPOSE

Stress contributes to dietary patterns that impede health. Yoga is an integrative stress management approach associated with improved dietary patterns in burgeoning research. Yet, no research has examined change in dietary patterns, body mass index (BMI), and stress during a yoga intervention among stressed adults with poor diet.

MATERIALS AND METHODS

Objectively-measured BMI and a battery of self-report questionnaires were collected at four time points during and following a 12-week yoga intervention (N = 78, 71% women, mean BMI = 25.69 kg/m2±4.59) - pre-treatment (T1), mid-treatment (6 weeks; T2), post-treatment (12 weeks; T3), and at 3-month follow-up (24 weeks; T4).

RESULTS

T1 to T3 fruit and vegetable intake, BMI, and stress significantly declined in the overall sample. Reduction in vegetable intake was no longer significant after accounting for reductions in caloric intake, and reduction in caloric intake remained significant after accounting for reductions in stress.

CONCLUSION

Findings may be interpreted as yoga either encouraging or adversely impacting healthy dietary patterns (i.e., minimizing likelihood of future weight gain vs. decreasing vegetable intake and overall caloric intake among individuals who may not need to lose weight, respectively). Continued research is warranted, utilizing causal designs.

¡Mi Vida Saludable! A randomized, controlled, 2 × 2 factorial trial of a diet and physical activity intervention among Latina breast cancer survivors: Study design and methods

BACKGROUND

Most Latina breast cancer survivors do not meet diet and physical activity (PA) guidelines for cancer survivors and effective lifestyle interventions to adopt and maintain these recommendations are limited, especially among underserved populations. Here we describe the design, methods and enrollment of a 2 × 2 factorial-designed trial testing the separate effects of the ¡Mi Vida Saludable! (My Healthy Life!) intervention program on changes in diet and PA behaviors among Latina breast cancer survivors.

METHODS

Latinas with a history of stage 0-III breast cancer, no evidence of recurrent/metastatic disease, and > 90 days post-treatment were primarily identified via cancer registries and physician referral. Participants were randomized to four arms: 1) 4 weeks of in-person group sessions plus 11 months of eHealth communication, 2) in-person group sessions alone, 3) eHealth alone, or 4) control. All participants received a Fitbit to self-monitor PA. Assessments at baseline, 6 and 12 months include diet, PA, anthropometrics, predictors and mediators of behavior change, psychosocial and quality of life outcomes, and blood draw.

RESULTS

Of 884 women screened between January 2016 and September 2018, 27% were eligible. Primary reasons for ineligibility included not being willing/able to participate due to work/life responsibilities, health reasons, or transportation. Of 241 eligible women, 167 completed baseline assessment and enrolled.

CONCLUSIONS

We successfully enrolled a diverse group of breast cancer survivors representing more than 15 Latin American nationalities to a diet and physical activity trial. If effective, the ¡Mi Vida Saludable! program can be implemented by community groups and medical centers.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02780271, registered May 2016.