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Lang IM, Antonakos CL, Judd SE, Colabianchi N. Intake of Snacks and Sweets in a National Study of Built and Social Environments: the REasons for Geographic And Racial Differences in Stroke Study. J Nutr 2024; 154:2300-2314. [PMID: 38795742 DOI: 10.1016/j.tjnut.2024.05.017] [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: 11/14/2023] [Revised: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND Few national studies across the United States' rural-urban continuum examine neighborhood effects on snacks and sweets intake among adults. OBJECTIVES This study examines associations of urbanicity/rurality-tailored measures of food store availability and neighborhood socioeconomic status (NSES) with the intake of snacks and sweets in a national sample of middle and older age adults. METHODS This cross-sectional study used food frequency questionnaire data collected in the REasons for Geographic And Racial Differences in Stroke study (N = 21,204). What We Eat in America food group categorizations guided outcome classification into 1 main category (total snacks and sweets) and 4 subcategories (savory snacks and crackers; sweet bakery products; candy and desserts; nutrition bars and low-fat snacks and sweets). NSES and food store availability were determined using geographic information systems. Food store availability was characterized as geographic access to primary food stores (e.g., supermarkets, supercenters, and select food retailers) in urbanicity/rurality-tailored neighborhood-based buffers. Multiple linear regression was used to predict each outcome. RESULTS Living in neighborhoods with a high density of primary food stores was associated with 8.6%, 9.5%, and 5.8% lower intake of total snacks and sweets, sweet bakery products, and candy and desserts, respectively. Living in the highest NSES quartile was associated with 11.3%, 5.8%, and 18.9% lower intake of total snacks and sweets, savory snacks and crackers, and sweet bakery products, respectively. Depending on primary food store availability, higher household income was associated with significantly greater intake of nutrition bars and low-fat snacks and sweets. Living in a United States Department of Agriculture-defined food desert was not associated with intake. CONCLUSIONS In a geographically diverse sample of middle and older age United States adults, living in neighborhoods with no primary food stores or neighborhoods of low-SES was associated with higher intake of total snacks and sweets and subgroups of snacks and sweets.
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Affiliation(s)
- Ian-Marshall Lang
- School of Kinesiology, University of Michigan, Ann Arbor, MI, United States
| | - Cathy L Antonakos
- School of Kinesiology, University of Michigan, Ann Arbor, MI, United States
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Natalie Colabianchi
- School of Kinesiology, University of Michigan, Ann Arbor, MI, United States; Institute for Social Research, University of Michigan, Ann Arbor, MI, United States.
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Agurs-Collins T, Alvidrez J, ElShourbagy Ferreira S, Evans M, Gibbs K, Kowtha B, Pratt C, Reedy J, Shams-White M, Brown AG. Perspective: Nutrition Health Disparities Framework: A Model to Advance Health Equity. Adv Nutr 2024; 15:100194. [PMID: 38616067 PMCID: PMC11031378 DOI: 10.1016/j.advnut.2024.100194] [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: 09/14/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 04/16/2024] Open
Abstract
Disparities in nutrition, such as poor diet quality and inadequate nutrient intake, arise from multiple factors and are related to adverse health outcomes such as obesity, diabetes, cardiovascular disease, and some cancers. The aim of the current perspective is to present a nutrition-centric socioecological framework that delineates determinants and factors that contribute to diet and nutrition-related disparities among disadvantaged populations. The Nutrition Health Disparities Framework (NHDF) describes the domains (biological, behavioral, physical/built environment, sociocultural environment, and healthcare system) that influence nutrition-related health disparities through the lens of each level of influence (that is, individual, interpersonal, community, and societal). On the basis of the scientific literature, the authors engaged in consensus decision making in selecting nutrition-related determinants of health within each domain and socioecological level when creating the NHDF. The framework identifies how neighborhood food availability and access (individual/built environment) intersect with cultural norms and practices (interpersonal/sociocultural environment) to influence dietary behaviors, exposures, and risk of diet-related diseases. In addition, the NHDF shows how factors such as genetic predisposition (individual/biology), family dietary practices (interpersonal/behavioral), and food marketing policies (societal) may impact the consumption of unhealthy foods and beverages and increase chronic disease risk. Family and peer norms (interpersonal/behavior) related to breastfeeding and early childhood nutrition interact with resource-poor environments such as lack of access to preventive healthcare settings (societal/healthcare system) and low usage of federal nutrition programs (societal/behavioral), which may increase risk of poor nutrition during childhood and food insecurity. The NHDF describes the synergistic interrelationships among factors at different levels of the socioecological model that influence nutrition-related outcomes and exacerbate health disparities. The framework is a useful resource for nutrition researchers, practitioners, food industry leaders, and policymakers interested in improving diet-related health outcomes and promoting health equity in diverse populations.
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Affiliation(s)
- Tanya Agurs-Collins
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States.
| | | | - Sanae ElShourbagy Ferreira
- National Center for Advancing Translational Sciences, Division of Clinical Innovation, Bethesda, MD, United States
| | - Mary Evans
- National Institute of Diabetes and Digestive and Kidney Diseases, Division of Digestive Diseases and Nutrition, Bethesda, MD, United States
| | - Kimberlea Gibbs
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Extramural Research, Pediatric Growth and Nutrition Branch, Bethesda, MD, United States
| | | | - Charlotte Pratt
- National Heart, Lung, and Blood Institute, Division of Cardiovascular Sciences, Bethesda, MD, United States
| | - Jill Reedy
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States
| | - Marissa Shams-White
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States
| | - Alison Gm Brown
- National Heart, Lung, and Blood Institute, Division of Cardiovascular Sciences, Bethesda, MD, United States
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Murray S, Gale F, Adams D, Dalton L. Evolution of Food and Nutrition Policy: A Tasmanian Case Study from 1994 to 2023. Nutrients 2024; 16:918. [PMID: 38612952 PMCID: PMC11013732 DOI: 10.3390/nu16070918] [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: 01/30/2024] [Revised: 03/08/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024] Open
Abstract
Food security is a concept with evolving definitions and meanings, shaped by contested knowledge and changing contexts. The way in which food security is understood by governments impacts how it is addressed in public policy. This research investigates the evolution of discourses and practices in Tasmanian food and nutrition policies from 1994 to 2023. Four foundational documents were analysed using qualitative document analysis, revealing persistent food insecurity issues over three decades. The analysis identified a duality in addressing the persistent policy challenges of nutrition-related health issues and food insecurity: the balancing act between advancing public health improvements and safeguarding Tasmania's economy. The research revealed that from 1994 to 2023, Tasmania's food and nutrition policies and strategies have been characterised by various transitions and tensions. Traditional approaches, predominantly emphasising food availability and, to a limited extent, access, have persisted for over thirty years. The transition towards a more contemporary approach to food security, incorporating dimensions of utilisation, stability, sustainability, and agency, has been markedly slow, indicating systemic inertia. This points to an opportunity for future policy evolution, to move towards a dynamic and comprehensive approach. Such an approach would move beyond the narrow focus of food availability to address the complex multi-dimensional nature of food security.
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Affiliation(s)
- Sandra Murray
- School of Health Science, University of Tasmania, Launceston, TAS 7250, Australia
| | - Fred Gale
- School of Social Sciences, University of Tasmania, Launceston, TAS 7250, Australia;
| | - David Adams
- Tasmanian School of Business and Economics, University of Tasmania, Launceston, TAS 7250, Australia;
| | - Lisa Dalton
- School of Health Science, University of Tasmania, New Norfolk, TAS 7140, Australia;
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Mudd AL, Bal M, Verra SE, Poelman MP, de Wit J, Kamphuis CBM. The current state of complex systems research on socioeconomic inequalities in health and health behavior-a systematic scoping review. Int J Behav Nutr Phys Act 2024; 21:13. [PMID: 38317165 PMCID: PMC10845451 DOI: 10.1186/s12966-024-01562-1] [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] [Received: 09/13/2023] [Accepted: 01/14/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Interest in applying a complex systems approach to understanding socioeconomic inequalities in health is growing, but an overview of existing research on this topic is lacking. In this systematic scoping review, we summarize the current state of the literature, identify shared drivers of multiple health and health behavior outcomes, and highlight areas ripe for future research. METHODS SCOPUS, Web of Science, and PubMed databases were searched in April 2023 for peer-reviewed, English-language studies in high-income OECD countries containing a conceptual systems model or simulation model of socioeconomic inequalities in health or health behavior in the adult general population. Two independent reviewers screened abstracts and full texts. Data on study aim, type of model, all model elements, and all relationships were extracted. Model elements were categorized based on the Commission on Social Determinants of Health framework, and relationships between grouped elements were visualized in a summary conceptual systems map. RESULTS A total of 42 publications were included; 18 only contained a simulation model, 20 only contained a conceptual model, and 4 contained both types of models. General health outcomes (e.g., health status, well-being) were modeled more often than specific outcomes like obesity. Dietary behavior and physical activity were by far the most commonly modeled health behaviors. Intermediary determinants of health (e.g., material circumstances, social cohesion) were included in nearly all models, whereas structural determinants (e.g., policies, societal values) were included in about a third of models. Using the summary conceptual systems map, we identified 15 shared drivers of socioeconomic inequalities in multiple health and health behavior outcomes. CONCLUSIONS The interconnectedness of socioeconomic position, multiple health and health behavior outcomes, and determinants of socioeconomic inequalities in health is clear from this review. Factors central to the complex system as it is currently understood in the literature (e.g., financial strain) may be both efficient and effective policy levers, and factors less well represented in the literature (e.g., sleep, structural determinants) may warrant more research. Our systematic, comprehensive synthesis of the literature may serve as a basis for, among other things, a complex systems framework for socioeconomic inequalities in health.
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Affiliation(s)
- Andrea L Mudd
- Department of Interdisciplinary Social Science- Public Health, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands.
| | - Michèlle Bal
- Department of Interdisciplinary Social Science- Public Health, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
| | - Sanne E Verra
- Department of Interdisciplinary Social Science- Public Health, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
| | - Maartje P Poelman
- Chair Group Consumption and Healthy Lifestyles, Wageningen University & Research, Hollandseweg 1, 6706 KN, Wageningen, the Netherlands
| | - John de Wit
- Department of Interdisciplinary Social Science- Public Health, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
| | - Carlijn B M Kamphuis
- Department of Interdisciplinary Social Science- Public Health, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
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Frank SM, Jaacks LM, Avery CL, Adair LS, Meyer K, Rose D, Taillie LS. Dietary quality and cardiometabolic indicators in the USA: A comparison of the Planetary Health Diet Index, Healthy Eating Index-2015, and Dietary Approaches to Stop Hypertension. PLoS One 2024; 19:e0296069. [PMID: 38198440 PMCID: PMC10781024 DOI: 10.1371/journal.pone.0296069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 12/05/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The Planetary Health Diet Index (PHDI) measures adherence to the sustainable dietary guidance proposed by the EAT-Lancet Commission on Food, Planet, Health. To justify incorporating sustainable dietary guidance such as the PHDI in the US, the index needs to be compared to health-focused dietary recommendations already in use. The objectives of this study were to compare the how the Planetary Health Diet Index (PHDI), the Healthy Eating Index-2015 (HEI-2015) and Dietary Approaches to Stop Hypertension (DASH) relate to cardiometabolic risk factors. METHODS AND FINDINGS Participants from the National Health and Nutrition Examination Survey (2015-2018) were assigned a score for each dietary index. We examined disparities in dietary quality for each index. We used linear and logistic regression to assess the association of standardized dietary index values with waist circumference, blood pressure, HDL-C, fasting plasma glucose (FPG) and triglycerides (TG). We also dichotomized the cardiometabolic indicators using the cutoffs for the Metabolic Syndrome and used logistic regression to assess the relationship of the standardized dietary index values with binary cardiometabolic risk factors. We observed diet quality disparities for populations that were Black, Hispanic, low-income, and low-education. Higher diet quality was associated with improved continuous and binary cardiometabolic risk factors, although higher PHDI was not associated with high FPG and was the only index associated with lower TG. These patterns remained consistent in sensitivity analyses. CONCLUSIONS Sustainability-focused dietary recommendations such as the PHDI have similar cross-sectional associations with cardiometabolic risk as HEI-2015 or DASH. Health-focused dietary guidelines such as the forthcoming 2025-2030 Dietary Guidelines for Americans can consider the environmental impact of diet and still promote cardiometabolic health.
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Affiliation(s)
- Sarah M. Frank
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Midlothian, United Kingdom
| | - Lindsay M. Jaacks
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Midlothian, United Kingdom
| | - Christy L. Avery
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Linda S. Adair
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Katie Meyer
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, North Carolina, United States of America
| | - Donald Rose
- Tulane Nutrition, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Los Angeles, United States of America
| | - Lindsey Smith Taillie
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Gorin SS, Hirko K. Primary Prevention of Cancer: A Multilevel Approach to Behavioral Risk Factor Reduction in Racially and Ethnically Minoritized Groups. Cancer J 2023; 29:354-361. [PMID: 37963370 DOI: 10.1097/ppo.0000000000000686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
ABSTRACT Cancer continues to be the second most common cause of death in the United States. Racially and ethnically minoritized populations continue to experience disparities in cancer prevention compared with majority populations. Multilevel interventions-from policy, communities, health care institutions, clinical teams, families, and individuals-may be uniquely suited to reducing health disparities through behavioral risk factor modification in these populations. The aim of this article is to provide a brief overview of the evidence for primary prevention among racially and ethnically minoritized subpopulations in the United States. We focus on the epidemiology of tobacco use, obesity, diet and physical activity, alcohol use, sun exposure, and smoking, as well as increasing uptake of the Human Papillomavirus Vaccine (HPV), as mutable behavioral risk factors. We describe interventions at the policy level, including raising excise taxes on tobacco products; within communities and with community partners, for safe greenways and parks, and local healthful food; health care institutions, with reminder systems for HPV vaccinations; among clinicians, by screening for alcohol use and providing tailored weight reduction approaches; families, with HPV education; and among individuals, routinely using sun protection. A multilevel approach to primary prevention of cancer can modify many of the risk factors in racially and ethnically minoritized populations for whom cancer is already a burden.
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Affiliation(s)
- Sherri Sheinfeld Gorin
- From the Department of Family Medicine, The School of Medicine, and the School of Public Health, The University of Michigan, Ann Arbor, MI
| | - Kelly Hirko
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI
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Patel L, Rudolph L. Supporting Climate, Health, and Equity under the Farm Bill. N Engl J Med 2023; 389:1541-1543. [PMID: 37870926 DOI: 10.1056/nejmp2307507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Affiliation(s)
- Lisa Patel
- From the Medical Society Consortium on Climate and Health, Fairfax, VA (L.P., L.R.); and the Department of Pediatrics, Stanford University School of Medicine, Palo Alto (L.P.), and the Public Health Institute, Oakland (L.R.) - both in California
| | - Linda Rudolph
- From the Medical Society Consortium on Climate and Health, Fairfax, VA (L.P., L.R.); and the Department of Pediatrics, Stanford University School of Medicine, Palo Alto (L.P.), and the Public Health Institute, Oakland (L.R.) - both in California
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Mbae-Mugambi UK, Onyango AC, Okeyo DO. Food price perception, food and beverage marketing and the nutritional status of children 6-24 months in Obunga slums, Kisumu Kenya: a cross-sectional study. BMC Nutr 2023; 9:114. [PMID: 37803463 PMCID: PMC10559538 DOI: 10.1186/s40795-023-00772-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 09/29/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Malnutrition is a significant problem in Africa. In Kenya, 26% of under-fives are stunted; slums are the hardest hit. Obunga slum has the highest prevalence at 40%. METHODS A cross-sectional study was adopted; simple random sampling techniques were used to identify 189 eligible households in the Obunga slum with children between 6-24 months. An interviewer-administered questionnaire collected data on food price perceptions and food and beverage marketing. An anthropometric data collection form gathered information on the children's height, weight and age. Scores for stunting, wasting and underweight were generated based on WHO Z-Score cut-off points. Binary logistic regression identified the relationship between food price perceptions, food and beverage marketing and the nutritional status of children between 6-24 months in Obunga slums. RESULTS Prevalence of wasting was 3.2%, stunting was 27.0%, underweight was at 7.4%, while overweight was at 13%. Food price perceptions: An increase in fruits prices was significantly associated with wasting (Adjusted O.R. = 10. 82, C.I. = 1.10-106.77, P < 0.05) and underweight (Adjusted O.R. = 5.44, C.I. = 1.35-21.61, P < 0.05). Food & Beverage Marketing: Feeding children on commercially produced complementary food products and commercially produced food was significantly associated with wasting at an (Adjusted O.R. = 7.82, C.I. = 1.29-47.46, p < 0.05, and adjusted O.R. = 5.96, C.I. = 1.06-33.60, p < 0.05) respectively. Stunting was significantly associated with listening/reading or watching advertisements on commercial food products (Crude O.R. = 0.49, C.I. = 0.24-0.998, p < 0.05.). Watching food-related adverts on television (Adjusted O.R. = 0.38 C.I. = 0.146- 0.10) and watching marketing on commercial foods (Adjusted O.R. = 0.21, C.I. = 0.07-0.61) and watching television (Adjusted O.R. = 9.30, C.I. = 2.31-37.40). While watching food-related adverts on television was associated with being underweight (Adjusted O.R. = 18.68 and at C.I. = 1.22-286.89). CONCLUSION The price perceptions of fruits, feeding children commercially produced food products and complementary foods, and Watching food-related adverts on television; had an impact on the nutritional status of children. Thus, a longitudinal study would be needed to understand the long-term effect of food prices and food and beverage marketing on nutritional status.
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Affiliation(s)
- Umotho Kinya Mbae-Mugambi
- School of Public Health & Community Development, Maseno University, Kisumu City, Kenya.
- Kenya Nutritionists and Dieticians Institute, Nairobi City, Kenya.
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Garner JA, Hanson KL, Jilcott Pitts SB, Kolodinsky J, Sitaker MH, Ammerman AS, Kenkel D, Seguin-Fowler RA. Cost analysis and cost effectiveness of a subsidized community supported agriculture intervention for low-income families. Int J Behav Nutr Phys Act 2023; 20:84. [PMID: 37430305 DOI: 10.1186/s12966-023-01481-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/20/2023] [Indexed: 07/12/2023] Open
Abstract
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 .
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Affiliation(s)
- Jennifer A Garner
- School of Health & Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA
- John Glenn College of Public Affairs, The Ohio State University, Columbus, OH, USA
| | - Karla L Hanson
- Master of Public Health Program, Cornell University, Ithaca, NY, USA
| | - Stephanie B Jilcott Pitts
- Brody School of Medicine, Department of Public Health, East Carolina University, Greenville, NC, USA
| | - Jane Kolodinsky
- Department of Community Development and Applied Economics, University of Vermont, Burlington, VT, USA
| | - Marilyn H Sitaker
- Ecological Agriculture and Food Systems, The Evergreen State College, Olympia, WA, USA
| | - Alice S Ammerman
- Gillings School of Global Public Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donald Kenkel
- Cornell Brooks School of Public Policy, Cornell University, Ithaca, NY, USA
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Cran S, Cihon TM, Borba A, Kazaoka K, Smith M. A Pilot Study Exploring Practices that Support the Longevity of Community Gardens Supported by Religious Organizations. BEHAVIOR AND SOCIAL ISSUES 2023; 32:1-37. [PMID: 38625135 PMCID: PMC10177712 DOI: 10.1007/s42822-023-00124-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 04/17/2024]
Abstract
Current food production methods in the United States (US) contribute to environmental degradation as well as food insecurity. Food production by means of community gardens has the potential to reduce the deleterious effects of current production methods. However, many community gardens face challenges that hinder their longevity, thereby reducing the likelihood of the support they might provide for environmentally sustainable food production and decreased food insecurity for community members. Researchers conducted a literature review regarding best practices for community gardens, and used ethnographic research methods to inform a culturo-behavioral systems analysis using the Total Performance System and matrix (systems interdependency) analysis to better understand the cultural practices of two established community gardens in the southwest region of the US. The results of the analyses are presented in terms of recommendations to support each community garden's sustainability. Recommendations regarding future research include environmental manipulations to identify functional relations and potential outcome measures for improving the longevity of community gardens. Supplementary Information The online version contains supplementary material available at 10.1007/s42822-023-00124-7.
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DeNunzio M, Miller M, Chase M, Kraak V, Serrano E, Misyak S. A Scoping Review of the Community Health Worker Model Used for Food Systems Interventions Within the United States. Am J Health Promot 2023; 37:401-419. [PMID: 36112805 DOI: 10.1177/08901171221125451] [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: 11/17/2022]
Abstract
OBJECTIVE To document and analyze the food systems interventions delivered by community health workers (CHW) serving as educators within the United States (U.S.). DATA SOURCE Ten databases (ie, Agricola, CAB Abstracts, CINAHL, ERIC, Proquest Social Science and Education, Proquest Theses and Dissertations, PubMed, Scopus, SocIndex, Web of Science) and gray-literature repositories were searched for publications between 2005-2020. STUDY INCLUSION AND EXCLUSION CRITERIA English-language and U.S. studies included with CHW as educators or facilitators for food systems interventions. Food systems defined as processes of production, processing, distribution, marketing, access, preparation, consumption, and disposal of food products. Studies excluded for clinical settings; non-adult CHWs; CHWs with medical or public health credentials; and programming guides, reviews, and commentaries. DATA EXTRACTION Variables included CHW and intervention description, priority population, food system processes, and targeted and unexpected outcomes. DATA SYNTHESIS Data were analyzed by the lead investigator and described narratively. RESULTS Of 43 records, CHWs educated for consumption (n = 38), preparation (n = 33), and food access (n = 22) to improve health of priority populations. Community health workers educated for the highest number of food system processes in garden-based interventions. Programs reached many underserved racial and socioeconomic populations. CONCLUSIONS The CHW model has been used to educate in interventions for all food systems processes and reached many diverse underserved audiences. Future work must explore garden-based food systems education and CHWs as community change agents.
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Affiliation(s)
- Maria DeNunzio
- Department of Human Nutrition, Foods, and Exercise, 1757Virginia Tech, Blacksburg, VA, USA
| | - Makenzie Miller
- 4366Louisiana State University AgCenter, Baton Rouge, LA, USA
| | - Melissa Chase
- Department of Food Science and Technology, 118724Virginia Tech, Blacksburg, VA, USA
| | - Vivica Kraak
- Department of Human Nutrition, Foods, and Exercise, 1757Virginia Tech, Blacksburg, VA, USA
| | - Elena Serrano
- Department of Human Nutrition, Foods, and Exercise, 1757Virginia Tech, Blacksburg, VA, USA
| | - Sarah Misyak
- Department of Human Nutrition, Foods, and Exercise, 1757Virginia Tech, Blacksburg, VA, USA
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Pinho-Gomes AC, Booth L, Pettigrew S. Public perceptions of responsibility for recommended food policies in seven countries. Eur J Public Health 2023; 33:299-304. [PMID: 36763587 PMCID: PMC10066496 DOI: 10.1093/eurpub/ckad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Food policy is important to promote healthy and sustainable diets. However, who is responsible for developing and implementing food policy remains contentious. Therefore, this study aimed to investigate how the public attributes responsibility for food policy to governments, individuals and the private sector. METHODS A total of 7559 respondents from seven countries [Australia (n = 1033), Canada (n = 1079), China (n = 1099), India (n = 1086), New Zealand (n = 1090), the UK (n = 1079) and the USA (n = 1093)] completed an online survey assessing perceived responsibility for 11 recommended food policies. RESULTS Overall, preferred responsibility for the assessed food policies was primarily attributed to governments (62%), followed by the private sector (49%) and individuals (31%). Respondents from New Zealand expressed the highest support for government responsibility (70%) and those from the USA the lowest (50%). Respondents from the USA and India were most likely to nominate individuals as responsible (both 37%), while those from China were least likely (23%). The private sector had the highest attributed responsibility in New Zealand (55%) and the lowest in China and the USA (both 47%). Support for government responsibility declined with age and was higher among those on higher incomes, with a university degree, and who perceived themselves to consume a healthy diet or be in poor health. CONCLUSIONS Across seven diverse countries, results indicate the public considers government should take primary responsibility for the assessed food policies, with modest contribution from the private sector and minority support for individual responsibility.
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Affiliation(s)
- Ana-Catarina Pinho-Gomes
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK.,Institute of Health Informatics, University College London, London, UK
| | - Leon Booth
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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13
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Lombardo J, Schmucker AM, Keith SW, Ronghe A, Smith A, Ali AS, Niazi M, Denton M, Swartz K, Chapman A, Simone NL. Markers and associations of nutrition identified in a senior adult oncology clinic. J Geriatr Oncol 2023; 14:101388. [PMID: 36253248 DOI: 10.1016/j.jgo.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/01/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Joseph Lombardo
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Abigail M Schmucker
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Scott W Keith
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Ashwini Ronghe
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexandria Smith
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Ayesha S Ali
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Muneeb Niazi
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Melissa Denton
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kristine Swartz
- Jefferson Senior Adult Oncology Center, Sidney Kimmel Cancer Center, Jefferson Health, Philadelphia, PA, USA
| | - Andrew Chapman
- Jefferson Senior Adult Oncology Center, Sidney Kimmel Cancer Center, Jefferson Health, Philadelphia, PA, USA
| | - Nicole L Simone
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
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14
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Chudasama YV, Khunti K. Healthy lifestyle choices and microvascular complications: New insights into diabetes management. PLoS Med 2023; 20:e1004152. [PMID: 36626355 PMCID: PMC9831294 DOI: 10.1371/journal.pmed.1004152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Yogini Chudasama and Kamlesh Khunti discuss new evidence, published in PLOS Medicine, highlighting the importance of healthy lifestyle behaviours in diabetes management.
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Affiliation(s)
- Yogini V. Chudasama
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom
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15
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Reid BM, Sokol N, Aubuchon-Endsley NL, Stroud LR. Maternal prenatal cortisol and the interaction of income and pre-pregnancy body mass index are independently associated with newborn cortisol. Dev Psychobiol 2023; 65:e22354. [PMID: 36567656 PMCID: PMC9940703 DOI: 10.1002/dev.22354] [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] [Received: 01/24/2022] [Revised: 09/21/2022] [Accepted: 10/30/2022] [Indexed: 12/14/2022]
Abstract
While extensive research has supported the developmental programming hypothesis regarding contributions of prenatal psychosocial or nutritional adversity to offspring stress physiology, fewer studies consider both exposures together with maternal stress physiology. This study examined newborn cortisol output during a stressor as a function of maternal pre-pregnancy health status and nutritional history (pre-pregnancy body mass index [PPBMI]), economic resources (household income), and maternal cortisol awakening response (mCAR) in late pregnancy. Participants were 102 mother-infant pairs from an economically and racial/ethnically diverse sample. Offspring salivary cortisol response to a neurobehavioral exam was assessed at 1 month. Income and maternal PPBMI were positively associated with mCAR in late pregnancy. mCAR was positively related to 1-month newborn cortisol response. The interaction of income and PPBMI was positively associated with newborn cortisol output during an exam at 1-month. Mothers with the highest PPBMI and lowest income had offspring with higher cortisol responses than offspring of mothers with higher income and lower PPBMI. There was no evidence of indirect mediation effects of predictors (PPBMI, income, and interaction) on infant cortisol via mCAR. The differential effects of the interaction of PPBMI and income suggest that these exposures influence infant cortisol output in the context of one another, independent of maternal pregnancy cortisol.
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Affiliation(s)
- Brie M. Reid
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | - Natasha Sokol
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | | | - Laura R. Stroud
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
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16
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Collier-Meek MA, Kratochwill TR, Luh HJ, Sanetti LMH, Susilo A. Reflections on Consultation: Applying a DisCrit and Equitable Implementation Lens to Help School Psychologists Disrupt Disparities. JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 2022. [DOI: 10.1080/10474412.2022.2131558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
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17
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Ambikapathi R, Schneider KR, Davis B, Herrero M, Winters P, Fanzo JC. Global food systems transitions have enabled affordable diets but had less favourable outcomes for nutrition, environmental health, inclusion and equity. NATURE FOOD 2022; 3:764-779. [PMID: 37118149 DOI: 10.1038/s43016-022-00588-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 08/11/2022] [Indexed: 11/09/2022]
Abstract
AbstractOver the past 50 years, food systems worldwide have shifted from predominantly rural to industrialized and consolidated systems, with impacts on diets, nutrition and health, livelihoods, and environmental sustainability. We explore the potential for sustainable and equitable food system transformation (ideal state of change) by comparing countries at different stages of food system transition (changes) using food system typologies. Historically, incomes have risen faster than food prices as countries have industrialized, enabling a simultaneous increase in the supply and affordability of many nutritious foods. These shifts are illustrated across five food system typologies, from rural and traditional to industrial and consolidated. Evolving rural economies, urbanization and changes in food value chains have accompanied these transitions, leading to changes in land distribution, a smaller share of agri-food system workers in the economy and changes in diets. We show that the affordability of a recommended diet has improved over time, but food systems of all types are falling short of delivering optimal nutrition and health outcomes, environmental sustainability, and inclusion and equity for all. Six ‘outlier’ case studies (Tajikistan, Egypt, Albania, Ecuador, Bolivia and the United States of America) illustrate broad trends, trade-offs and deviations. With the integrated view afforded by typologies, we consider how sustainable transitions can be achieved going forward.
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18
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Pradyumna A, Mishra A, Utzinger J, Winkler MS. Health in Food Systems Policies in India: A Document Review. Int J Health Policy Manag 2022; 11:1158-1171. [PMID: 33904697 PMCID: PMC9808200 DOI: 10.34172/ijhpm.2021.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 02/23/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Food systems affect nutritional and other health outcomes. Recent literature from India has described policy aspects addressing nutritional implications of specific foods (eg, fruits, vegetables, and trans-fats), and identified opportunities to tackle the double burden of malnutrition. This paper attempts to deepen the understanding on how health concerns and the role of the health sector are addressed across food systems policies in India. METHODS This qualitative study used two approaches; namely (i) the framework method and (ii) manifest content analysis, to investigate national-level policy documents from relevant sectors (ie, food security, agriculture, biodiversity, food processing, trade, and waste management, besides health and nutrition). The documents were selected purposively. The textual data were coded and compared, from which themes were identified, described, and interpreted. Additionally, mentions of various health concerns and of the health ministry in the included documents were recorded and collated. RESULTS A total of 35 policy documents were included in the analysis. A variety of health concerns spanning nutritional, communicable and non-communicable diseases (NCDs) were mentioned. Undernutrition received specific attention even beyond nutrition policies. Only few policies mentioned NCDs, infectious diseases, and injuries. Governing and advisory bodies were instituted by 17 of the analysed policies (eg, food safety, agriculture, and food processing), and often included representation from the health ministry (9 of the 17 identified inter-ministerial bodies). CONCLUSION We found some evidence of concern for health, and inclusion of health ministry in food policy documents in India. The ongoing and planned intersectoral coordination to tackle undernutrition could inform actions to address other relevant but currently underappreciated concerns such as NCDs. Our study demonstrated a method for analysis of health consideration and intersectoral coordination in food policy documents, which could be applied to studies in other settings and policy domains.
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Affiliation(s)
- Adithya Pradyumna
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Azim Premji University, Bengaluru, India
| | | | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Mirko S. Winkler
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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19
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Análisis bibliométrico y revision temática de estudios en consumo infantil de 1974 a 2019. ACTA COLOMBIANA DE PSICOLOGIA 2022. [DOI: 10.14718/acp.2022.25.2.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
El papel de los niños como consumidores ha generado un gran interés en el marketing social, especialmente en los aspectos relacionados con la alimentación; sin embargo, hay campos como la regulación de la publicidad, el comportamiento digital y las actitudes de los niños hacia los productos, que hasta ahora no están completamente estudiados. Para apoyar las futuras investigaciones de la comunidad científica del marketing social sobre este tema, el presente estudio bibliométrico tuvo como objetivo investigar y describir las líneas y áreas de investigación en psicología, comportamiento y marketing social, en relación con el consumo infantil, para responder a la siguiente pregunta de investigación: ¿Cuáles son las publicaciones, autores y tendencias más importantes en la investigación sobre el consumo infantil en los últimos 45 años? Para ello, se analizaron 1375 artículos de 703 revistas con los paquetes Bibliometrix (R Studio), utilizando una metodología exploratoria y descriptiva, analizando 2588 palabras clave de autor y 1265 palabras clave adicionales con 2597 autores en la base de datos Scopus. Los indicadores cienciométricos muestran la existencia de cinco grupos temáticos relacionados con el consumo infantil. Se concluye que la producción científica sobre el consumo de niños y niñas debe abordar cuestiones de protección y regulación orientadas a la responsabilidad social, especialmente en las comunicaciones integradas de marketing y publicidad de las marcas alimentarias, con mayor y especial cuidado en el entorno digital, debido a la actual inmersión de la población infantil mundial y su creciente autonomía en la elección de contenidos, productos y marcas digitales.
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20
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Doan N, Olstad DL, Vanderlee L, Hammond D, Wallace M, Kirkpatrick SI. Investigating the Intersections of Racial Identity and Perceived Income Adequacy in Relation to Dietary Quality Among Adults in Canada. J Nutr 2022; 152:67S-75S. [PMID: 35544238 PMCID: PMC9188862 DOI: 10.1093/jn/nxac076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/16/2022] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Structural racism and economic marginalization shape dietary patterns in complex ways. Most research examining race and income inequities discount their interactions in shaping dietary intakes. An intersectional approach is needed to identify interconnected sources of social inequities and to more precisely locate dietary inequities. OBJECTIVES We examined whether racial identity and perceived income adequacy independently and jointly shape dietary quality, defined using the Healthy Eating Index (HEI) 2015, among a large sample of adults in Canada. METHODS Cross-sectional data from 2540 adults (≥18 years of age) in Canada who participated in the 2019 International Food Policy Study were analyzed. Multivariable linear regression models were executed to test the independent associations and interactions between racial identity and perceived income adequacy with HEI-2015 scores. Models were constructed to examine HEI-2015 total and component scores, adjusting for age, gender, and education. RESULTS Perceived income adequacy, but not racial identity, was independently associated with HEI-2015 total scores. The interaction between racial identity and perceived income adequacy was significantly associated with HEI-2015 scores. Compared to the reference group (individuals identifying as White and reporting income adequacy), those identifying as Black and reporting income adequacy were associated with lower HEI-2015 scores (β, -7.30; 95% CI, -13.07 to -1.54) and those identifying as Black and reporting income inadequacy were associated with lower HEI-2015 scores (β, -6.37; 95% CI, -12.13 to -0.60). Individuals who identified as indigenous and reported neither income adequacy nor inadequacy had lower HEI-2015 scores (β, -8.50; 95% CI, -13.82 to -3.18) compared to the reference group. CONCLUSIONS Findings suggest that racial identity and perceived income adequacy jointly shape dietary quality. Inequities in dietary quality may be missed when intersecting racial identities and socioeconomic positions are not explicitly investigated. To support healthier dietary patterns, strategies must reduce socioeconomic barriers that impose dietary constraints on some racialized groups.
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Affiliation(s)
| | - Dana Lee Olstad
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Lana Vanderlee
- École de Nutrition, Centre Nutrition, santé et société (Centre NUTRISS), and Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Michael Wallace
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Canada
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21
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Freedman DA, Clark JK, Lounsbury DW, Boswell L, Burns M, Jackson MB, Mikelbank K, Donley G, Worley-Bell LQ, Mitchell J, Ciesielski TH, Embaye M, Lee EK, Roche A, Gill I, Yamoah O. Food system dynamics structuring nutrition equity in racialized urban neighborhoods. Am J Clin Nutr 2022; 115:1027-1038. [PMID: 34792095 DOI: 10.1093/ajcn/nqab380] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/15/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The food system is a social determinant of health and a leverage point for reducing diet-related racial inequities. Yet, food system interventions have not resulted in sustained improvement in dietary outcomes for underrepresented minorities living in neighborhoods with a history of disinvestment. Research is needed to illuminate the dynamics structuring food systems in racialized neighborhoods to inform intervention development. OBJECTIVES To conduct participatory research examining the complexity and inequity of food systems in historically redlined neighborhoods to identify feedback mechanisms to leverage in efforts to transform system outcomes for racial equity. METHODS We conducted a mixed-methods study in Cleveland, Ohio, USA from 2018 to 2021 using participatory system dynamic modeling with 30 academic and community partners, in-depth qualitative interviews with 22 key stakeholders, and public convenings with 250 local food policy council affiliates. Data were synthesized into causal loop diagrams depicting feedback mechanisms reinforcing or balancing neighborhood-level food system dynamics. RESULTS We identified 10 feedback mechanisms structuring nutrition equity, which was identified as a meta-goal for food systems in racialized neighborhoods. Feedback mechanisms were organized in 3 domains: 1) meeting basic food needs with dignity (i.e., side hustle, government benefits, emergency food assistance, stigma, and stereotypes); 2) local food supply and demand dynamics (i.e., healthy food retail, job security, food culture, and norms); and 3) community empowerment and food sovereignty (i.e., community power, urban agriculture, risk of gentrification). Five exogenous factors moderate feedback dynamics: neighborhood crisis, neighborhood investments, household costs, government benefit funding, and voter participation. CONCLUSIONS We identified nutrition equity as an overarching goal for local food systems, which reflects a state of having freedom, agency, and dignity in food traditions resulting in people and communities healthy in body, mind, and spirit. It is a transformative goal designed to spur system-level interventions that further racial equity through improved local food system dynamics.
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Affiliation(s)
- Darcy A Freedman
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Jill K Clark
- Department of Geography, John Glenn College of Public Affairs, The Ohio State University, Columbus, OH, USA
| | - David W Lounsbury
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | | | - Marilyn Burns
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA.,Community Leader, Cleveland, OH, USA
| | - Michelle B Jackson
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA.,Activist and Community Organizer, Cleveland, OH, USA
| | | | - Gwendolyn Donley
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | | | | | - Timothy H Ciesielski
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Milen Embaye
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Eun Kyung Lee
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Abigail Roche
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - India Gill
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Owusua Yamoah
- Mary Ann Swetland Center for Environmental Health, Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
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22
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Shroba J, Das R, Bilaver L, Vincent E, Brown E, Polk B, Ramos A, Russell AF, Bird JA, Ciaccio CE, Lanser BJ, Mudd K, Sood A, Vickery BP, Gupta R. Food Insecurity in the Food Allergic Population: A Work Group Report of the AAAAI Adverse Reactions to Foods Committee. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:81-90. [PMID: 34862158 DOI: 10.1016/j.jaip.2021.10.058] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 12/13/2022]
Abstract
Food allergies affect 32 million Americans. Restricted diets due to food allergies can be difficult to maintain especially when the household is food insecure. Food insecurity is defined as the inability to acquire food for household members due to insufficient money or resources for food. The COVID-19 pandemic has caused many people to face food insecurity for the first time with Latinx, Native American, and Black communities disproportionately affected. Because of the increase in food insecurity, this work group developed a survey regarding food insecurity screening. This survey was sent out to a random sample of American Academy of Allergy Asthma & Immunology members to assess food insecurity knowledge and practices. The majority of survey participants did not routinely screen their patients for food insecurity. The biggest barrier identified to screening was lack of knowledge of how to perform a screen and resources available when a patient screened positive. This work group report provides guidance on how to implement and perform a food insecurity screen, including federal resources and assistance programs.
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Affiliation(s)
- Jodi Shroba
- Division of Allergy and Immunology, Children's Mercy Hospital, Kansas City, Mo.
| | - Rajeshree Das
- Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Lucy Bilaver
- Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Eileen Vincent
- Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | | | - Brooke Polk
- Division of Allergy, Imunology and Pulmonary Medicine, Washington University, St Louis, Mo
| | - Ashley Ramos
- Division of Allergy and Immunology, Children's National Health System, Washington, DC
| | - Anne F Russell
- Spring Arbor University School of Nursing and Health Sciences Spring Arbor, Mich
| | - J Andrew Bird
- Southwestern Medical Center, University of Texas, Dallas, Texas
| | | | - Bruce J Lanser
- National Jewish Health Division of Pediatric Allergy and Clinical Immunology, Denver, Colo
| | - Kim Mudd
- Division of Pediatric Allergy and Immunology, Johns Hopkins, Baltimore, Md
| | - Amika Sood
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Brian P Vickery
- Emory University and Children's Healthcare of Atlanta, Atlanta, Ga
| | - Ruchi Gupta
- Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Ill
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23
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Taghizadeh S, Farhangi MA, Khodayari-Zarnaq R. Stakeholders perspectives of barriers and facilitators of childhood obesity prevention policies in Iran: A Delphi method study. BMC Public Health 2021; 21:2260. [PMID: 34895191 PMCID: PMC8665716 DOI: 10.1186/s12889-021-12282-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 11/22/2021] [Indexed: 12/03/2022] Open
Abstract
Background The prevalence of obesity among children and adolescents is one of the most important health challenges of the present century. Many factors affect the prevention policies related to this health problem and make their implementation difficult. This study examined perceived barriers and facilitators of childhood obesity prevention policies by stakeholders. Methods A qualitative descriptive research design based on Delphi method was conducted. In addition, semi-structured one-to-one interviews were conducted with childhood obesity prevention policy stakeholders (n=39) and initial identification of barriers and facilitators in this area. Interviews were digitally recorded, transcribed verbatim, and finally analyzed, followed by using thematic analysis. Subsequently, two-round Delphi panel was done by sending e-mails to stakeholders (21 stakeholders participated in the first round and 15 stakeholders in the second round) for the final selection of barriers and facilitators of obesity prevention policies among children and adolescents in Iran. Results The identified barriers and facilitators were divided into three levels: individual, executive, and structural. Barriers and facilitators of the structural level showed a high score and priority regarding obesity prevention policies among children and adolescents. Conclusion The existence of significant barriers at all three levels and especially at the structural level were among the concerns of stakeholders. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12282-7.
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Affiliation(s)
- Shahnaz Taghizadeh
- Department of Community Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Rahim Khodayari-Zarnaq
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, 14711, Tabriz, 5166614711, Iran.
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24
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Benninger E, Donley G, Schmidt-Sane M, Clark JK, Lounsbury DW, Rose D, Freedman D. Fixes that Fail: A system archetype for examining racialized structures within the food system. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 68:455-470. [PMID: 34333787 DOI: 10.1002/ajcp.12534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Access to fresh and healthy food within a neighborhood has been identified as a social mechanism contributing to community health. Grounded in the understanding that challenges related to equity within a food system are both structural and systemic, our research demonstrates how systems thinking can further understandings of food system complexity. Within systems thinking, we provide an illustration of how system archetypes offer an analytic tool for examining complex community issues. We map semi-structured interview data from community stakeholders (N = 22) to the "Fixes that Fail" system archetype to illuminate systemic challenges, such as incarceration and poverty, that structure food system inequity in urban communities. Within our research, the "Fixes that Fail" archetype provided a narrative interpretive tool for unveiling complexity within the food system and interdependencies with racialized systems such as criminal justice and labor markets. This system archetype provided an accessible approach for generating narratives about systemic complexity, the production of inequity through racialized forces, and opportunities for transformation.
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Affiliation(s)
| | | | | | - Jill K Clark
- John Glenn College of Public Affairs, Ohio State University, Columbus, OH, USA
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25
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Vaudin A, Wambogo E, Moshfegh AJ, Sahyoun NR. Sodium and Potassium Intake, the Sodium to Potassium Ratio, and Associated Characteristics in Older Adults, NHANES 2011-2016. J Acad Nutr Diet 2021; 122:64-77. [PMID: 34303635 DOI: 10.1016/j.jand.2021.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 06/04/2021] [Accepted: 06/10/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Sodium, potassium, and the balance between these 2 nutrients are associated with hypertension and cardiovascular disease, and prevalence of these conditions increases with age. However, limited information is available on these intakes among older adults. OBJECTIVE Our aim was to explore the socioeconomic and health factors associated with usual sodium and potassium intakes and the sodium to potassium (Na:K) ratio of older adults. DESIGN This was a cross-sectional, secondary analysis of the 2011-2012, 2013-2014, and 2015-2016 National Health and Nutrition Examination Survey. PARTICIPANTS/SETTING This study included the data of 5,104 adults 50 years and older, with at least one reliable 24-hour dietary recall and an estimated glomerular filtration rate ≥60 mL/min/1.73 m2. MAIN OUTCOME MEASURES Sodium and potassium intake, as absolute intake, density (per 1,000 kcal) and ratio of Na:K intake. STATISTICAL ANALYSES We used t tests and χ2 tests to examine significant differences in intakes on a given day by characteristics. Linear and logistic regression models were used to assess associations of socioeconomic and health characteristics with usual sodium and potassium intakes, determined using the National Cancer Institute method. RESULTS Only 26.2% of participants consumed <2,300 mg sodium (16.2% of men and 35.2% of women) and 36.0% of men and 38.1% of women consumed at least 3,400 mg and 2,600 mg of potassium, respectively. Fewer than one-third of participants consumed a Na:K ratio of <1.0. Women, those with lower blood pressure, and those with a lower body mass index were more likely to have a ratio <1.0. CONCLUSIONS Participants consumed too much sodium and not enough potassium, based on current recommendations. A higher Na:K ratio was significantly associated with established risk factors for cardiovascular disease. The study findings suggest that more research on cardiovascular health should include both sodium and potassium, as well as balance between these nutrients.
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Beltrán S, Pharel M, Montgomery CT, López-Hinojosa IJ, Arenas DJ, DeLisser HM. Food insecurity and hypertension: A systematic review and meta-analysis. PLoS One 2020; 15:e0241628. [PMID: 33201873 PMCID: PMC7671545 DOI: 10.1371/journal.pone.0241628] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/17/2020] [Indexed: 12/26/2022] Open
Abstract
Background Food insecurity (FIS) is an important public health issue associated with cardiovascular risk. Given the association of FIS with diets of poorer nutritional quality and higher salt intake as well as chronic stress, numerous studies have explored the link between FIS and hypertension. However, no systematic review or meta-analysis has yet to integrate or analyze the existing literature. Methods We performed a wide and inclusive search of peer-reviewed quantitative data exploring FIS and hypertension. A broad-terms, systematic search of the literature was conducted in PubMed, Embase, Scopus, and Web of Science for all English-language, human studies containing primary data on the relationship between FIS and hypertension. Patient population characteristics, study size, and method to explore hypertension were extracted from each study. Effect sizes including odds ratios and standardized mean differences were extracted or calculated based on studies’ primary data. Comparable studies were combined by the random effects model for meta-analyses along with assessment of heterogeneity and publication bias. Results A total of 36 studies were included in the final analyses. The studies were combined into different subgroups for meta-analyses as there were important differences in patient population characteristics, methodology to assess hypertension, and choice of effect size reporting (or calculability from primary data). For adults, there were no significantly increased odds of elevated blood pressures for food insecure individuals in studies where researchers measured the blood pressures: OR = 0.91 [95%CI: 0.79, 1.04; n = 29,781; Q(df = 6) = 7.6; I2 = 21%]. This remained true upon analysis of studies which adjusted for subject BMI. Similarly, in studies for which the standardized mean difference was calculable, there was no significant difference in measured blood pressures between food secure and FIS individuals: g = 0.00 [95%CI: -0.04, 0.05; n = 12,122; Q(df = 4) = 3.6; I2 = 0%]. As for retrospective studies that inspected medical records for diagnosis of hypertension, there were no significantly increased odds of hypertension in food insecure adults: OR = 1.11 [95%CI: 0.86, 1.42; n = 2,887; Q(df = 2) = 0.7; I2 = 0%]. In contrast, there was a significant association between food insecurity and self-reports of previous diagnoses of hypertension: 1.46 [95%CI: 1.13, 1.88; n = 127,467; Q(df = 7) = 235; I2 = 97%]. Only five pediatric studies were identified which together showed a significant association between FIS and hypertension: OR = 1.44 [95%CI: 1.16, 1.79; n = 19,038; Q(df = 4) = 5.7; I2 = 30%]. However, the small number of pediatric studies were not sufficient for subgroup meta-analyses based on individual study methodologies. Discussion In this systematic review and meta-analysis, an association was found between adult FIS and self-reported hypertension, but not with hypertension determined by blood pressure measurement or chart review. Further, while there is evidence of an association between FIS and hypertension among pediatric subjects, the limited number of studies precluded a deeper analysis of this association. These data highlight the need for more rigorous and longitudinal investigations of the relationship between FIS and hypertension in adult and pediatric populations.
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Affiliation(s)
- Sourik Beltrán
- Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Marissa Pharel
- Rush Medical College, Rush University, Chicago, Illinois, United States of America
| | - Canada T. Montgomery
- Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Itzel J. López-Hinojosa
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Daniel J. Arenas
- Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Horace M. DeLisser
- Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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Patterson GT, Thomas LF, Coyne LA, Rushton J. Moving health to the heart of agri-food policies; mitigating risk from our food systems. GLOBAL FOOD SECURITY 2020; 26:100424. [PMID: 32904586 PMCID: PMC7456577 DOI: 10.1016/j.gfs.2020.100424] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/09/2020] [Accepted: 08/15/2020] [Indexed: 01/15/2023]
Abstract
Our food systems are progressively more industrialized and consolidated with many modern food value chains involving multiple countries and continents, and as such being associated with changes in risk profile and impacts of emerging and re-emerging diseases. Disease outbreaks that sweep through a single region can have massive impacts on food supply, while severe outbreaks of human pathogens can disrupt agricultural labor supply or demand for products perceived as 'unsafe'. Market pressures have generally rewarded production of cash crops for fuel and energy dense, low nutrient processed foods over production of fruits and vegetables for local consumption. Climbing rates of food-related NCDs and pre-existing conditions leave the population increasingly susceptible to infectious diseases that are often driven by or arise from the food system. Therefore disease and diet from our food systems cause impacts on human health, and human health issues can impact on the functioning of the food system. The COVID-19 outbreak is the most recent example of food system driven disease emergence and of massive supply and demand shocks in the food system, experienced as a direct and indirect result of this disease. The effects of the food system on disease spread (and vice versa) must be addressed in future plans to prevent and mitigate large scale outbreaks. Health policies must acknowledge the food system as the base of our health system, as must agri-food policy recognize the pre-eminence of human health (directly and indirectly) in decision making.
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Affiliation(s)
- Grace T Patterson
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Lian F Thomas
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- International Livestock Research Institute, PO Box 30709, Nairobi, 00100, UK
| | - Lucy A Coyne
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Jonathan Rushton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
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Ahmed S, Dupuis V, Tyron M, Running Crane M, Garvin T, Pierre M, Byker Shanks C. Intended and Unintended Consequences of a Community-Based Fresh Fruit and Vegetable Dietary Intervention on the Flathead Reservation of the Confederated Salish and Kootenai Tribes. Front Public Health 2020; 8:331. [PMID: 32850578 PMCID: PMC7426441 DOI: 10.3389/fpubh.2020.00331] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 06/15/2020] [Indexed: 11/13/2022] Open
Abstract
Tribal communities in the United States face disparities to accessing healthy foods including high-quality produce. A six-week fresh fruit and vegetable (FV) dietary intervention, Eat Fresh, was co-designed with a Community Advisory Board of local food and nutrition stakeholders on the Flathead Reservation of the Confederated Salish and Kootenai Tribes in Montana. Eat Fresh was implemented as a pilot study with low-income participants (n = 19) enrolled in the Food Distribution Program on Indian Reservations toward improving dietary quality and perceptions of well-being. We evaluated Eat Fresh at pre- and post-intervention on the basis on food procurement practices, dietary quality using the Healthy Eating Index (HEI), Body Mass Index (BMI), blood pressure, and participant perceptions of health. Participants reported consuming a greater number of types of FVs daily during the intervention (p < 0.005 for fruits and p > 0.19 for vegetables). Overall, participants found Eat Fresh moderately challenging to adhere to with the main barriers being access to ingredients in recipes (39.51% of responses), time constraints to cook (35.80%), and lack of financial resources (33.33%). Dietary quality improved during the intervention from a mean HEI score of 48.82 (± 11.88) out of 100-56.92 (± 11.88; (p > 0.12). HEI scores for fruit consumption significantly increased (p < 0.05) from 1.69 (out of 5 points) during the pre-intervention to 2.96 during the post-intervention. BMI and blood pressure increased for several participants, highlighting an unintended consequence. Most participants responded that FV consumption made them feel either very good (51.16%) or good about their health (43.02%) with the majority (83%) perceiving an improvement in energy. Findings of this pilot study highlight both intended and unintended consequences of a dietary intervention that provide lessons in co-designing community-based programs.
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Affiliation(s)
- Selena Ahmed
- Food and Health Lab, Sustainable Food Systems Program, Department of Health and Human Development, Montana State University, Bozeman, MT, United States
| | - Virgil Dupuis
- Extension, Salish Kootenai College, Pablo, MT, United States
| | - Michael Tyron
- Extension, Salish Kootenai College, Pablo, MT, United States
| | | | - Teresa Garvin
- Gretchen Swanson Center for Nutrition, Omaha, NE, United States
| | - Michael Pierre
- Flathead Food Distribution Program on Indian Reservations, Pablo, MT, United States
| | - Carmen Byker Shanks
- Food and Health Lab, Sustainable Food Systems Program, Department of Health and Human Development, Montana State University, Bozeman, MT, United States
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Hurtado-Bermúdez LJ, Vélez-Torres I, Méndez F. No land for food: prevalence of food insecurity in ethnic communities enclosed by sugarcane monocrop in Colombia. Int J Public Health 2020; 65:1087-1096. [PMID: 32712693 DOI: 10.1007/s00038-020-01421-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/06/2020] [Accepted: 06/25/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To evaluate how the food systems in areas close to sugarcane monocrops influence the prevalence of food insecurity (FI) among three ethnic communities in the upper Cauca River basin of Colombia. METHODS We developed a mixed methodology study at three rural zones located in the departments of Cauca and Valle del Cauca, Colombia, using a household survey to establish the level of FI, and semi-structured interviews with key community actors. RESULTS These three ethnic communities have a high prevalence of FI (> 70%) that was found to be associated with economic income, social security, gender, the presence of minors in the home, refrigerator in operation and ownership of the land. Loss of food sovereignty was associated with the sale and rental of land. CONCLUSIONS The sugarcane monocrop has contributed to environmental crises, spatial confinement and sociocultural disruption in ethnic territories; by renting, selling or leasing their land to the industrial production of sugarcane, traditional practices of food production and self-consumption have been profoundly transformed. Ethnic cultures are endangered, while food security and sovereignty of indigenous and black communities have been negatively affected.
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Affiliation(s)
| | - Irene Vélez-Torres
- Escuela de Ingeniería de los Recursos Naturales y del Ambiente, Universidad del Valle, Cali, Colombia
| | - Fabián Méndez
- Escuela de Salud Pública, Universidad del Valle, Cali, Colombia.
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Lourival I, Rose N. From Nar Nar Goon to Koo Wee Rup: Can Participatory Food Policy Making Processes Contribute to Healthier and Fairer Food Systems in the Australian Municipal Context? A Case Study from Cardinia Shire, Melbourne. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2020. [DOI: 10.1080/19320248.2020.1782797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Izo Lourival
- Faculty of Higher Education, William Angliss Institute, Melbourne, Australia
| | - Nick Rose
- Faculty of Higher Education, William Angliss Institute, Melbourne, Australia
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Higher ultra-processed food intake is associated with higher DNA damage in healthy adolescents. Br J Nutr 2020; 125:568-576. [DOI: 10.1017/s0007114520001981] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AbstractUltra-processed food is one of the main contributors to energy supply and consumption in food systems worldwide, and evidence of their detrimental health outcomes in humans is emerging. This study aimed to assess ultra-processed food intake and its association with urinary levels of 8-hydroxy-2′-deoxyguanosine (8-OHdG), a biomarker of DNA oxidative damage, in 139 healthy adolescents in Karaj City in Iran. Usual dietary intake was measured using a 168-item validated FFQ. The daily intake of ultra-processed food consumption was determined through the classification of NOVA, and general linear models were used to compare the urinary levels of 8-OHdG/creatinine (ng/mg creatinine) within tertiles of ultra-processed food intake. Adolescents in the higher tertile of ultra-processed food consumption had a significantly higher mean level of urinary 8-OHdG/creatinine in comparison with the lower tertiles in the crude model (Pfor trend: 0·003) and after adjustment for confounding variables, including total energy intake, sex, age, BMI for age Z-score, obesity and physical activity (Pfor trend: 0·004). This association was still significant after adjusting for dietary intake of whole grains, nuts, legumes, the ratio of MUFA:SFA (g/d) and Mediterranean dietary score (Pfor trend: 0·002). More studies are needed to explore the determinants of ultra-processed food supply, demand, consumption and health effects; such studies should be applied to develop evidence-informed policies and regulatory mechanisms to improve children’s and adolescents’ food environment policymaking and legislation with special attention to ultra-processed food.
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Eng S, Donoghue C, Khun T, Szmodis W. Critical Consciousness of Food Systems as a Potential Lifestyle Intervention on Health Issues. Am J Lifestyle Med 2020; 14:258-263. [PMID: 32477023 PMCID: PMC7232891 DOI: 10.1177/1559827620907833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
When examining food systems in contemporary, industrialized, and globalized nations such as the United States, there is a quantity over quality cultural mind-set driven by capitalism. This creates an environment in which consumer desires for convenient lifestyles run high, mainly focused on the production of food and individual financial gain rather than the food systems as a whole. This approach neglects the overall outcomes in health, wellness, health disparities, and the sustainability footprint associated with consumption. Food is more than just food. It involves a network of different levels and elements that creates a multidimensional framework in which food systems, and the choices produced within those systems, can either positively or negatively affect consumers' lifestyles and health. This article discusses the importance of food systems and the ways in which they can be incorporated into a lifestyle intervention for general food consumers as well as those suffering from dietary-related diseases. With a critical understanding that structural barriers associated with current food systems are partly responsible for dietary-related diseases, individuals' self-blame and guilt can be alleviated and liberated, thus enhancing overall emotional and physical health. Drawing on social cognitive theory, food systems are conceptualized into triadic, dynamic interaction of environment (eg, food production, processing, packaging, transporting, marketing, disposing), cognition (eg, learned experience, and knowledge of food, nutrition, and wellness), and behavior (eg, food purchasing, preparation, and consumption).
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Affiliation(s)
- Sothy Eng
- Sothy Eng, PhD, University of Hawaii at Manoa, 2515 Campus Road, Honolulu, HI 96822; e-mail:
| | - Carli Donoghue
- University of Hawaii at Manoa, Honolulu, Hawaii (SE, CD, TK)
- Lehigh University, Bethlehem, Pennsylvania (WS)
| | - Tricia Khun
- University of Hawaii at Manoa, Honolulu, Hawaii (SE, CD, TK)
- Lehigh University, Bethlehem, Pennsylvania (WS)
| | - Whitney Szmodis
- University of Hawaii at Manoa, Honolulu, Hawaii (SE, CD, TK)
- Lehigh University, Bethlehem, Pennsylvania (WS)
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Sanderson J, Martin KS, Colantonio AG, Wu R. An Outcome Evaluation of Food Pantries Implementing the More than Food Framework. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2020. [DOI: 10.1080/19320248.2020.1748782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Katie S. Martin
- Foodshare, Institute for Hunger Research & Solutions, Bloomfield, CT, USA
| | | | - Rong Wu
- University of Connecticut Health Center, Biostatistics Center, Farmington, CT, USA
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The relationship between joining a US free trade agreement and processed food sales, 2002-2016: a comparative interrupted time-series analysis. Public Health Nutr 2020; 23:1609-1617. [PMID: 32188524 DOI: 10.1017/s1368980019003999] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine changes in sales of highly processed foods, including infant formulas, in countries joining free trade agreements (FTAs) with the US. DESIGN Annual country-level data for food and beverage sales come from Euromonitor International. Analyses are conducted in a comparative interrupted time-series (CITS) framework using multivariate random-effects linear models, adjusted for key confounders: gross domestic product (GDP) per capita, percent of the population living in urban areas and female labor force participation rate. Memberships in other FTAs and investment treaties are also explored as possible confounders. SETTING Changes are assessed between 2002 and 2016. PARTICIPANTS Ten countries joining US FTAs are compared with eleven countries without US FTAs in force; countries are matched on national income level, world region and World Trade Organization membership. RESULTS After countries join a US FTA, sales are estimated to increase by: 0·89 (95 % CI 0·16, 1·6; P = 0·016) kg per capita per annum for ultra-processed products, 0·81 (95 % CI 0·47, 1·1; P < 0·001) kg per capita per annum for processed culinary ingredients and 0·17 (95 % CI 0·052, 0·29; P = 0·005) kg per capita under age 5 per annum for baby food. No significant change is estimated for minimally processed foods. In statistical models, large unexplained variations in country-specific trends suggest additional unmeasured country-level factors also impact sales trends following entry into US FTAs. CONCLUSIONS These findings strongly support the conclusion that joining US FTAs can contribute to detrimental changes in national dietary consumption that increase population risk of non-communicable diseases.
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D'Alonzo KT, Vilaró FM, Joseph ME, Oyeneye V, Garsman L, Rosas SR, Castañeda M, Vivar M. Using Concept Mapping within a Community-Academic Partnership to Examine Obesity among Mexican Immigrants. Prog Community Health Partnersh 2020; 14:173-185. [PMID: 33414692 PMCID: PMC7787540 DOI: 10.1353/cpr.2020.0016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Weight gain is common following migration to a new country. Mexican immigrants have a disparate prevalence of overweight/obesity and food insecurity. Social stressors, such as unemployment, discrimination, and the threat of deportation, may fuel both food insecurity and weight gain in this population. Objectives We sought to (1) examine community-defined causes and correlates of obesity among Mexican-Americans; (2) determine how current social stressors, policies, and programs impact food insecurity and obesity; and (3) identify community-defined priorities for preventive interventions. Methods Group concept mapping (GCM) was used in a community-academic partnership (CAP) to describe the factors contributing to weight gain and obesity among Mexican immigrant families. Activities included community brainstorming, sorting and rating, multivariate statistical analysis, and community interpretation of results. Results Eighty statements were generated in the brainstorming sessions. These statements were sorted into nine clusters, which were organized into three regions: (1) intrapersonal factors; (2) community-level factors; and (3) social policy-related barriers. Statements reflecting the impact of immigration-related stressors were found in all three regions, addressing participants' fears of deportation, and the prioritization of resources away from healthy eating, resulting in food insecurity. Community members identified five priority areas for intervention planning: (1) lack of exercise; (2) lack of knowledge of a healthy diet; (3) expense of healthy foods; (4) "junk" food; and (5) stress management. Conclusions Results suggest high levels of social stress are contributing to food insecurity and obesity among Mexican immigrant families. Areas identified for intervention planning reflect the need for a multifaceted approach toward obesity prevention.
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Affiliation(s)
| | | | - Maya E Joseph
- Rutgers, The State University of New Jersey, School of Nursing
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Food democracy, health disparities and the New York City trans fat policy. Public Health Nutr 2019; 23:738-746. [PMID: 31839022 DOI: 10.1017/s1368980019003306] [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: 11/05/2022]
Abstract
OBJECTIVE To investigate food democracy and health disparities in the New York City (NYC) trans fat policy process. DESIGN Texts from semi-structured interviews, public testimony and comments on the policy were analysed using categorization and thematic coding. A priori content analysis for themes of food democracy was followed by open, axial and selective coding for sub-themes on health disparities. Data and method triangulation and respondent validation were used to establish data dependability, trustworthiness and representativeness. SETTING NYC. PARTICIPANTS Interviews from a purposive, snowballed sample of thirty-three participants included restaurateurs, scientists, health and consumer advocates, consumers and policy makers. Additionally, 261 pages of transcript from public testimony of fifty-three participants and a purposive sample of public comments on the policy from a pool of 2157 were analysed. RESULTS Principles of food democracy involving inclusive citizenship, access to information, collaborative participation and focus on collective good were well represented in the data. Additionally, sub-themes linked to health disparities included: government responsibility for fairer access to healthier foods; recognition that people made choices based on circumstances; concern for vulnerable groups; and outrage with a food industry viewed as unconcerned for public health. CONCLUSIONS Principles of food democracy present in the successful process of adoption of the 2006 NYC trans fat policy addressed nutrition-related health. Food democracy is a contemporary food system and policy approach with potential for public health benefits in reducing nutrition-related health disparities.
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Hollis-Hansen K, Vermont L, Zafron ML, Seidman J, Leone L. The introduction of new food retail opportunities in lower-income communities and the impact on fruit and vegetable intake: a systematic review. Transl Behav Med 2019; 9:837-846. [PMID: 31570930 PMCID: PMC8679116 DOI: 10.1093/tbm/ibz094] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023] Open
Abstract
A lack of access to fresh fruits and vegetables (F&Vs) is associated with consumption of fewer F&Vs and higher risk of obesity, especially for lower-income individuals. It is widely believed that the addition of new food retail opportunities could improve F&V consumption and subsequently reduce the chronic disease burden. Observational studies provide some support for these hypotheses, but contradictions exist. In this study we sought to examine if the introduction of a food retailer affects F&V consumption in lower-income communities. We used a systematic PRISMA approach to conduct this study. We searched PubMed, EMBASE, and ProQuest Dissertations & Theses for academic journal references and gray literature published before August 2018. Included studies were those looking at the effect of the introduction of a new food retailer on F&V consumption. Studies were also categorized based on which dimensions of food access were targeted by the food retailer. We identified 15 studies meeting inclusion criteria: 11 studies reported a positive increase in F&V consumption attributable to the introduction of a new food retailer, of which 6 were statistically significant. The remaining 4 studies, all of which examined the impact of introducing a new retail supermarket, showed no change or a decrease in F&V intake. Results from studies which change the food environment generally support the idea that increased access to healthy food improves diet, but more studies are needed in order to assess the differences between the various types of retailers, and to identify strategies for improving impact. Understanding which types of new food retail programs are most likely to impact diet has implications for policies which incentivize new food retail.
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Affiliation(s)
- Kelseanna Hollis-Hansen
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Leah Vermont
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
| | | | - Jennifer Seidman
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Lucia Leone
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
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Heterogeneous factors predict food insecurity among the elderly in developed countries: insights from a multi-national analysis of 48 countries. Food Secur 2019. [DOI: 10.1007/s12571-019-00934-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Karpyn AE, Riser D, Tracy T, Wang R, Shen YE. The changing landscape of food deserts. UNSCN NUTRITION 2019; 44:46-53. [PMID: 32550654 PMCID: PMC7299236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In this article, we discuss the most recent trends in food-retail access in low- and moderate-income communities in the United States of America. We begin with a review of the current literature on the number of people impacted by food deserts and then review several critical retail trends, including supercentres (such as Walmart), dollar stores, farmers markets and online food retail. We discuss the growing investment in incentive programmes, as well as new understandings of the impact of food deserts on health. In the United States of America, the number of communities without adequate access to healthy affordable food has declined, though more than 5.6 percent of the population still lives in low-access census tracts. At the same time, racial and economic disparities in food access remain a considerable concern, with around 30 percent more non-white residents facing limited access to food retail than white residents. We also provide recommendations for areas of future research.
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Affiliation(s)
- Allison E Karpyn
- Center for Research in Education and Social Policy (CRESP) and Department of Human Development and Family Sciences, University of Delaware
| | - Danielle Riser
- Department of Human Development and Family Sciences, University of Delaware
| | | | - Rui Wang
- School of Education, University of Delaware
| | - Y E Shen
- School of Education, University of Delaware
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The Experience of Food Insecurity Among Immigrants: a Scoping Review. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2018. [DOI: 10.1007/s12134-018-0613-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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McWhorter JW, Raber M, Sharma SV, Moore LS, Hoelscher DM. The Nourish Program: An Innovative Model for Cooking, Gardening, and Clinical Care Skill Enhancement for Dietetics Students. J Acad Nutr Diet 2018; 119:199-203. [PMID: 29452976 DOI: 10.1016/j.jand.2017.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Indexed: 11/16/2022]
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Wenzel AG, Brock JW, Cruze L, Newman RB, Unal ER, Wolf BJ, Somerville SE, Kucklick JR. Prevalence and predictors of phthalate exposure in pregnant women in Charleston, SC. CHEMOSPHERE 2018; 193:394-402. [PMID: 29154114 PMCID: PMC6282186 DOI: 10.1016/j.chemosphere.2017.11.019] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/29/2017] [Accepted: 11/05/2017] [Indexed: 05/21/2023]
Abstract
Phthalates are plasticizers commonly detected in human urine due to widespread exposure from PVC plastics, food packaging, and personal care products. Several phthalates are known antiandrogenic endocrine disruptors, which raises concern for prenatal exposure during critical windows of fetal development. While phthalate exposure is ubiquitous, certain demographics are subject to greater or lesser exposure. We sampled urine from 378 pregnant women during the second trimester of gestation living in Charleston, SC, and measured eight urinary phthalate metabolites as biomarkers of phthalate exposure: monobutyl phthalate (MBP), monobenzyl phthalate (MBzP), mono(2-ethylhexyl) phthalate (MEHP), mono(2-ethyl-5-oxohexyl) phthalate (MEOHP), mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), monoethyl phthalate (MEP), monoisobutyl phthalate (MiBP), and monomethyl phthalate (MMP). Demographic data was collected from questionnaires administered at the time of specimen collection. All phthalate metabolites were detected in over 93% of urine samples. On average, concentrations were highest for MEP (median = 47.0 ng/mL) and lowest for MMP (median = 1.92 ng/mL). Sociodemographic characteristics associated with elevated phthalate concentrations included being unmarried, less educated, having a low income, high body mass index (BMI), and/or being African American. After racial stratification, age, BMI, education, and income were significantly associated with phthalate concentrations in African American women. Marital status was associated with phthalate concentrations in Caucasian women only, with greater concentrations of MBP, MEHHP, MiBP, and MMP in unmarried versus married women. Results of this cross-sectional study provide evidence for significant racial and demographic variations in phthalate exposure.
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Affiliation(s)
- Abby G Wenzel
- Department of Obstetrics and Gynecology, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA; National Institute of Standards and Technology, Hollings Marine Laboratory, 331 Fort Johnson Road, Charleston, SC 29412, USA.
| | - John W Brock
- Department of Chemistry, University of North Carolina Asheville, CPO #2010, One University Heights, Asheville, NC 28804, USA
| | - Lori Cruze
- Department of Biology, Wofford College, 429 North Church Street, Spartanburg, SC 29303, USA
| | - Roger B Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Elizabeth R Unal
- Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, 415 N. 9th Street, Springfield, IL 62701, USA
| | - Bethany J Wolf
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite 303, MSC 835, Charleston, SC 29425, USA
| | - Stephen E Somerville
- Department of Obstetrics and Gynecology, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - John R Kucklick
- National Institute of Standards and Technology, Hollings Marine Laboratory, 331 Fort Johnson Road, Charleston, SC 29412, USA
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Skizim M, Sothern M, Blaha O, Tseng TS, Griffiths L, Joseph J, Nuss H. Social marketing for a farmer's market in an underserved community: A needs assessment. J Public Health Res 2017; 6:815. [PMID: 29441329 PMCID: PMC5806034 DOI: 10.4081/jphr.2017.815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 10/27/2017] [Accepted: 10/30/2017] [Indexed: 11/30/2022] Open
Abstract
The aim of the present paper is to assess local residents' awareness of utilizing Supplemental Nutrition Assistance Program (SNAP) benefits to purchase fresh produce at local farmers' markets, and to determine internet use and media preferences of study participants prior to implementation of a social marketing campaign. A needs assessment was conducted to collect baseline data in an underserved neighbourhood in New Orleans (La, USA). The study was carried out August 2014-May 2015. The assessment revealed that 73% of the respondents were unaware that the SNAP benefits could be used to purchase food in farmers' markets; 63% of low-income participants never attended a farmers' market compared to 27% of mid/high-income. Over 50% of the low-income respondents have access to the internet at least once per day. The results show the potential of raising awareness among a wide range of members in the community. This needs assessment will serve as the foundation for a social marketing intervention, which will be disseminated city-wide.
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Affiliation(s)
- Meg Skizim
- Louisiana State University Health Sciences Center, New Orleans School of Public Health, LA, USA
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Ferdinand R, Torres R, Scott J, Saeed I, Scribner R. Incentivizing Fruit and Vegetable Purchasers at Fresh Markets in Lower 9th Ward, New Orleans. Ethn Dis 2017; 27:287-294. [PMID: 29158653 PMCID: PMC5684772 DOI: 10.18865/ed.27.s1.287] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective Disparities in fruit and vegetable consumption have been observed across income and race-ethnicity and shown to be associated with both access to fresh food venues and price. This study assesses the feasibility of increasing produce consumption by incentivizing fruit and vegetable purchases at local markets. Design We conducted analyses of a cross-sectional survey of program participants and point-of-sale reports on fruit and vegetable purchases at the fresh food markets. Setting Five fresh food markets in the Lower Ninth Ward (LNW) of New Orleans, Louisiana. Participants A total of 176 participants were enrolled in the "Veggie Dollars" program (VDP). Intervention From January to July 2016, Sankofa, our community partner, recruited patrons at its markets into the VDP, a fresh food incentive program. Participants received coupons worth $4 per week for fruit and vegetables over a six-week period. Main Outcome Measures Total monthly gross, VDP, and SNAP benefit sales at the markets measured program participation. A survey (N=96) assessed the demographics and fruit and vegetable purchasing practices of participants. Results Participants were predominantly women (81%), African American (94%) and raising children at home (53%). Point-of-sales data indicated that VDP sales nearly doubled over the intervention period. Total market sales and SNAP benefit purchases also increased. The majority (63%) of VDP participants reported their produce purchases increased and 89% reported increasing their consumption of fruit and vegetables since entering the program. Conclusions Monetary incentives were associated with increased fruit and vegetable purchases at local fresh food markets in a low-income minority community.
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Affiliation(s)
| | - Rosamar Torres
- Sankofa Community Development Corporation, New Orleans, Louisiana
| | - Jennifer Scott
- Louisiana State University, School of Social Work, Baton Rouge, Louisiana
| | - Imran Saeed
- Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Richard Scribner
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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Sadler RC, Lafreniere DJ. You are where you live: Methodological challenges to measuring children's exposure to hazards. ACTA ACUST UNITED AC 2017; 23:189-198. [PMID: 31929718 DOI: 10.1080/10796126.2017.1336705] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Many of the challenges that affect children living in poverty are directly related to the neighborhoods in which they live. Places that inhibit healthy living and those that expose children to environmental pollution tend to more heavily affect children in poverty. This environmental injustice is a natural concern of the fields of urban planning, geography, and children's health. Yet many decisions that affect opportunities for healthy living are made without a full understanding of how neighborhood context influences such opportunities. In this brief, we paint inequalities in child health outcomes as a spatial problem, review some of the geospatial tools used by urban planners and geographers, discuss common reasons for misclassification or misrepresentation of spatially explicit problems, and propose more suitable methods for measuring opportunities and exposures germane to the field of child poverty. Throughout, we emphasize the need for evidence-driven, spatially grounded responses to child poverty issues with a spatial dimension.
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Affiliation(s)
- Richard C Sadler
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI, USA
| | - Don J Lafreniere
- Department of Social Science, Michigan Technological University, Houghton, MI, USA
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How Latina mothers navigate a 'food swamp' to feed their children: a photovoice approach. Public Health Nutr 2017; 20:1941-1952. [PMID: 28514988 DOI: 10.1017/s1368980017000738] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To understand how mothers who recently migrated from Central America to the USA feed their children in a neighbourhood saturated with unhealthful food choices ('food swamp') and to formulate a mother-driven plan of action to facilitate their acquisition of foods. Design/Setting/Subjects We purposively sampled mothers with children (<10 years old) who were recent immigrants/refugees from Central America and lived in a 'food swamp' neighbourhood. We used the photovoice approach to elicit textual data from thirty in-depth interviews, a participatory workshop, and visual data from photographs. Analyses were guided by the Social Ecological Framework and Social Cognitive Theory to identify barriers, facilitators and strategies that support parents in feeding their children. RESULTS Mothers valued foods that they considered to be 'traditional' and 'healthful'. They navigated their food retail environment looking for these foods (of good quality and well-priced). Food values were reinforced by pre-migration food customs and culture, health professionals' advice and, in some cases, by the desire to avoid conflict with their children. The neighbourhood food environment could directly influence children's food preferences and often created conflict between what the child wanted to eat and the foods that mothers valued. Mothers in this 'food swamp' wanted to be engaged in addressing the selection of foods offered in schools and in neighbourhood food venues to reflect their own food values. CONCLUSIONS These mothers' feeding choices were influenced directly by their food values, and indirectly by the neighbourhood and school food environments via their children's preferences.
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Aoki JR, Peters C, Platero L, Headrick C. Maximizing Community Voices to Address Health Inequities: How the Law Hinders and Helps. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2017; 45:11-15. [PMID: 28661300 DOI: 10.1177/1073110517703305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This paper highlights the need to apply an equity lens when assessing the impact of preemption and related legal doctrines on community health. Community autonomy to set and pursue public health priorities is an essential part of achieving health equity. Unfortunately, the priorities of organized industry interest groups often conflict with health equity goals. These groups have a history of successfully using law to limit community autonomy to pursue public health measures, most notably through preemption and related legal doctrines. We examine this phenomenon using two examples. First, we look at dental association efforts to block the spread of dental therapists in Indian Country. Native dental therapists have been improving the oral health of native people in Alaska for over a decade; yet the national and state dental associations have sought with mixed success to leverage state and federal laws to hinder other tribal governments from utilizing these providers. We compare these efforts with a restaurant association-led movement to limit what municipal governments can do to address food-based health inequities, focusing on a "model" ALEC bill that started in Ohio. Finally, we discuss how municipalities and Tribes are fighting back and continuing to pursue health equity for their communities.
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Affiliation(s)
- Julie Ralston Aoki
- Julie Ralston Aoki, J.D., is the Director of Healthy Eating and Active Living at the Public Health Law Center. Christina Peters is the Native Dental Therapy Initiative Project Director at Northwest Portland Area Indian Health Board. Laura Platero, J.D., is the Government Affairs and Policy Director at Northwest Portland Area Indian Health Board. Carter Headrick is the Director of State and Local Obesity Policy Initiatives for Voices for Healthy Kids
| | - Christina Peters
- Julie Ralston Aoki, J.D., is the Director of Healthy Eating and Active Living at the Public Health Law Center. Christina Peters is the Native Dental Therapy Initiative Project Director at Northwest Portland Area Indian Health Board. Laura Platero, J.D., is the Government Affairs and Policy Director at Northwest Portland Area Indian Health Board. Carter Headrick is the Director of State and Local Obesity Policy Initiatives for Voices for Healthy Kids
| | - Laura Platero
- Julie Ralston Aoki, J.D., is the Director of Healthy Eating and Active Living at the Public Health Law Center. Christina Peters is the Native Dental Therapy Initiative Project Director at Northwest Portland Area Indian Health Board. Laura Platero, J.D., is the Government Affairs and Policy Director at Northwest Portland Area Indian Health Board. Carter Headrick is the Director of State and Local Obesity Policy Initiatives for Voices for Healthy Kids
| | - Carter Headrick
- Julie Ralston Aoki, J.D., is the Director of Healthy Eating and Active Living at the Public Health Law Center. Christina Peters is the Native Dental Therapy Initiative Project Director at Northwest Portland Area Indian Health Board. Laura Platero, J.D., is the Government Affairs and Policy Director at Northwest Portland Area Indian Health Board. Carter Headrick is the Director of State and Local Obesity Policy Initiatives for Voices for Healthy Kids
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Store-directed price promotions and communications strategies improve healthier food supply and demand: impact results from a randomized controlled, Baltimore City store-intervention trial. Public Health Nutr 2017; 20:3349-3359. [PMID: 28222818 PMCID: PMC5725746 DOI: 10.1017/s1368980017000064] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objective Small food store interventions show promise to increase healthy food access in under-resourced areas. However, none have tested the impact of price discounts on healthy food supply and demand. We tested the impact of store-directed price discounts and communications strategies, separately and combined, on the stocking, sales and prices of healthier foods and on storeowner psychosocial factors. Design Factorial design randomized controlled trial. Setting Twenty-four corner stores in low-income neighbourhoods of Baltimore City, MD, USA. Subjects Stores were randomized to pricing intervention, communications intervention, combined pricing and communications intervention, or control. Stores that received the pricing intervention were given a 10–30% price discount by wholesalers on selected healthier food items during the 6-month trial. Communications stores received visual and interactive materials to promote healthy items, including signage, taste tests and refrigerators. Results All interventions showed significantly increased stock of promoted foods υ. control. There was a significant treatment effect for daily unit sales of healthy snacks (β = 6·4, 95% CI 0·9, 11·9) and prices of healthy staple foods (β = −0·49, 95% CI −0·90, −0·03) for the combined group υ. control, but not for other intervention groups. There were no significant intervention effects on storeowner psychosocial factors. Conclusions All interventions led to increased stock of healthier foods. The combined intervention was effective in increasing sales of healthier snacks, even though discounts on snacks were not passed to the consumer. Experimental research in small stores is needed to understand the mechanisms by which store-directed price promotions can increase healthy food supply and demand.
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Mui Y, Gittelsohn J, Jones-Smith JC. Longitudinal Associations between Change in Neighborhood Social Disorder and Change in Food Swamps in an Urban Setting. J Urban Health 2017; 94:75-86. [PMID: 28074429 PMCID: PMC5359167 DOI: 10.1007/s11524-016-0107-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Few studies have examined how neighborhood contextual features may influence the food outlet mix. We evaluated the relationship between changes in neighborhood crime and changes in the food environment, namely the relative density of unhealthy (or intermediate) food outlets out of total food outlets, or food swamp score, in Baltimore City from 2000 to 2012, using neighborhood fixed-effects linear regression models. Comparing neighborhoods to themselves over time, each unit increase in crime rate was associated with an increase in the food swamp score (b = 0.13; 95% CI, -0.00017 to 0.25). The association with food swamp score was in the same direction for violent crime and in the inverse direction for arrests related to juvenile crimes (proxy of reduced crime), but did not reach statistical significance when examined separately. Unfavorable conditions, such as crime, may deter a critical consumer base, diminishing the capacity of a community to attract businesses that are perceived to be neighborhood enhancing. Addressing these more distal drivers may be important for policies and programs to improve these food environments.
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Affiliation(s)
- Yeeli Mui
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA. .,Global Obesity Prevention Center (GOPC) at Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Joel Gittelsohn
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.,Global Obesity Prevention Center (GOPC) at Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Jessica C Jones-Smith
- Department of Health Services & Nutrition Sciences Program, School of Public Health, University of Washington, Seattle, Seattle, WA, 98195, USA
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Sadler RC. Integrating expert knowledge in a GIS to optimize siting decisions for small-scale healthy food retail interventions. Int J Health Geogr 2016; 15:19. [PMID: 27312971 PMCID: PMC4911689 DOI: 10.1186/s12942-016-0048-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 06/04/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The availability of healthy foods in a neighborhood remains a key determinant of diet and diet-related disease in disadvantaged communities. Innovative solutions to the 'food desert' problem include the deployment of mobile markets and healthy corner store initiatives. Such initiatives, however, do not always capitalize on the principles guiding retail development and the possibilities of GIS-based data. Simultaneously, community partners are not always engaged effectively in the planning for such interventions, which limits acceptability and suitability of such work. METHODS This paper highlights the results of a participatory mapping exercise to optimize the siting of a planned healthy food retail intervention in Flint, Michigan. Potential sites are chosen by engaging experts in a three-stage mapping process that includes the analytic hierarchy process and point allocation of five key variables (including food access, socioeconomic distress, population density, access to transit, and proximity to neighborhood centers), as well as direct mapping of suitable sites. RESULTS Results suggest a discrete set of areas-primarily in the northwestern quadrant of the city-where small-scale healthy food retail interventions might be most strategically located. Areas with the most consistent overlap between directly mapped sites and very high levels of suitability align well with neighborhoods which are distant from existing grocery stores. CONCLUSIONS As a community-based strategy, this increases the opportunity for effectively improving neighborhood access to healthy foods by optimizing the potential sites for healthy food interventions. Community partners have already been active in using these results in project planning for just such an intervention.
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Affiliation(s)
- Richard Casey Sadler
- Department of Family Medicine, Michigan State University, 200 E 1st St, Flint, MI, 48502, USA.
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