Gascoyne Growers Market: a sustainable health promotion activity developed in partnership with the community

Fruit and Vegetable Purchases in Farmer's Market Stands: Analysing Survey and Sales Data

Farmers' market implementation holds promise for increasing access to healthy foods. Although rarely measured, purchase data constitute an intermediate outcome between food environment and actual consumption. In a study conducted with two seasonal Fruits and Vegetables (FV) stands in a disadvantaged area of Montréal (Canada), we analysed how accessibility, perception, and mobility-related factors were associated with FV purchase. This analysis uses a novel measure of FV purchasing practices based on sales data obtained from a mobile application. A 2016 survey collected information on markets' physical access, perceived access to FV in the neighbourhood, usual FV consumption and purchases. Multivariate models were used to analyse three purchasing practice indicators: number of FV portions, FV variety and expenditures. Average shoppers purchased 12 FV portions of three distinct varieties and spent 5$. Shoppers stopping at the market on their usual travel route spent less (p = 0.11), bought fewer portions (p = 0.03) and a lesser FV variety (p < 0.01). FV stands may complement FV dietary intake. Individuals for whom the market is on their usual travel route might make more frequent visits and, therefore, smaller purchases. The novel data collection method allowed analysis of multiple purchase variables, is precise and easy to apply at unconventional points of sales and could be transposed elsewhere.

Harnessing Knowledge for Improving Access to Fruits and Vegetables at Farmers Markets: Interactive Data Visualization to Inform Food Security Programs and Policy

High consumption of fruits and vegetables leads to decreased risk of various chronic diseases, including obesity and cardiovascular disease. Community-level barriers to access fruits and vegetables include the high cost, limited availability, and transportation. Farmers markets are a priority strategy for improving community access to fresh fruits and vegetables. The U.S. Department of Agriculture (USDA) National Farmers Market Directory is a voluntary self-reported data source on farmers markets. The objective of this investigation of the USDA farmers markets data directory was to determine how farmers markets in the United States are grouped according to (1) availability of fruits and vegetables and (2) the payment accepted. We designed and implemented interactive data visualizations in visual analytics software to understand access to fruits and vegetables at farmers markets from 8,497 entries in the USDA Farmers Market Directory. Among the 665 new or updated entries in year 2018, a subset of 641 (96%) farmers markets with availability of fresh fruits and vegetables had 16 subgroups. Additionally, a subgroup of 102 (16%) farmer markets accepted all four federal nutrition assistance benefits (SFMNP, SNAP, WIC CVVs, and WIC FMNP). The interactive data visualizations including geographic maps connected to social media resources can be useful in advocacy efforts and can inform policy improvements designed to improve physical, social, and economic access to fruits and vegetables at farmers markets.

Population-based interventions addressing food insecurity in Australia: A systematic scoping review

AIM

Food insecurity (FI) is a critical public health issue in Australia. Population-based interventions aiming to address the socio-ecological determinants of FI are critical for relieving and preventing it. This review aimed to map and summarise the characteristics of population-based interventions addressing household and/or community FI in Australia.

METHODS

A systematic scoping review was undertaken. Five databases, selected for range and relevance to FI in Australia ("CINAHL plus", "Ovid MEDLINE", "Sociological Abstracts", "Australian Public Affairs Information Service", and "Rural and Remote Health") were searched in May 2018 using the terms and relevant synonyms "FI" and "interventions". In addition a systematic grey literature search using multiple Google searches was undertaken. Data synthesis included categorisation and counting intervention type. Interventions were defined and charted by influence of at least one dimension of food security and impact on the socioeconomic, cultural and environmental conditions.

RESULTS

A total of 3565 published and grey literature records were identified, with the final 60 records describing 98 interventions. Few national interventions were identified, with approaches predominantly in Victoria, Northern Territory and Tasmania. Determinants related to living and working environments, food availability and food utilisation were most frequently addressed. Interventions addressing the key determinant of FI economic access were limited. A number of interventions did not appear to be associated with rigorous evaluation.

CONCLUSIONS

While there is evidence of population responses to FI in Australia, the effectiveness of these remains limited. Importantly there is a lack of coordinated and coherent national responses that address the range of FI determinants.

New frontiers in community initiatives to increase vegetable consumption

ISSUE ADDRESSED

Public health concerns about insufficient consumption of vegetables across all demographics in Australia have led to 20 years of behaviour change interventions ranging from social marketing to interactive small group programs, with modest results. To maximise health promotion intervention outcomes, practitioners need up-to-date information that helps them navigate the complexity of food systems and eating behaviours.

METHODS

This scoping review of Australian and international research, including peer-reviewed and grey literature, provides a picture of health promotion nutrition interventions, as well as other initiatives that may promote increased vegetable consumption. Search terms related to nutrition and vegetable consumption, type of intervention or initiative, for example, campaign; and consumer values and behaviour. A wide range of data sources were used including scholarly papers, market research reports and publicly available websites of community organisations (eg, OOOOBY). A broad food systems typology was developed to provide a framework for the review.

RESULTS

The review finds an emerging group of community-driven initiatives within local food systems that appear to have positive impacts on vegetable consumption. These initiatives sit within a multi-faceted approach to health and well-being that is consistent with the tenets of the Ottawa Charter for Health Promotion, including community engagement, social justice and sustainability goals.

CONCLUSIONS

More research into the impact of these new frontiers is needed, but our preliminary findings point to the potential for health promotion practitioners to collaborate on local/community food system initiatives that are not motivated primarily by health goals, but have the potential to deliver multiple health and environmental outcomes. SO WHAT?: This review demonstrated community-driven initiatives around local food systems show the most promise in promoting vegetable consumption and addressing the determinants of health. Health promotion efforts to encourage food security and healthy eating could be strengthened through collaborations within these new frontiers.

The dietary impact of introducing new retailers of fruits and vegetables into a community: results from a systematic review

OBJECTIVE

To investigate the potential dietary impact of the opening of new retailers of healthy foods.

DESIGN

Systematic review of the peer-reviewed research literature.

SETTING

References published before November 2015 were retrieved from MEDLINE, EMBASE and Web of Science databases using keyword searches.

SUBJECTS

The outcome of the review was change in fruit and vegetable consumption among adults.

RESULTS

Of 3514 references retrieved, ninety-two articles were reviewed in full text, and twenty-three articles representing fifteen studies were included. Studies used post-test only (n 4), repeated cross-sectional (n 4) and repeated measures designs (n 7) to evaluate the dietary impact of supermarket (n 7), farmers' market (n 4), produce stand (n 2) or mobile market (n 2) openings. Evidence of increased fruit and vegetable consumption was most consistent among adults who began shopping at the new retailer. Three of four repeated measures studies found modest, albeit not always statistically significant, increases in fruit and vegetable consumption (range 0·23-0·54 servings/d) at 6-12 months after baseline. Dietary change among residents of the broader community where the new retailer opened was less consistent.

CONCLUSIONS

The methodological quality of studies, including research designs, sampling methods, follow-up intervals and outcome measures, ranged widely. Future research should align methodologically with previous work to facilitate meta-analytic synthesis of results. Opening a new retailer may result in modest short-term increases in fruit and vegetable consumption among adults who choose to shop there, but the potential longer-term dietary impact on customers and its impact on the broader community remain unclear.

Social capital in Japan: What characteristics do public health nurses see in their communities?

AIM

A concept of social capital that accounts for a community's cultural background and incorporates social capital into public health nursing practice are needed. This study aimed to describe the characteristics of social capital in the context of public health nursing in Japan.

METHODS

The study interviewed 11 veteran public health nurses from five municipalities across Japan and undertook a qualitative research analysis. A digital voice recorder was used to collect qualitative data by using a background data sheet and semistructured interviews. Trustworthiness in interpreting the data was ensured by conducting 13 additional interviews with residents and collating the two sets of results.

RESULTS

All the participants were female: 10 were veterans with ≥15 years' experience. Nine worked in management. The methods yielded six categories: (i) the richness of the interactions among the residents; (ii) the community residents who showed concern for those in need; (iii) community civic activities; (iv) the residents' willingness to contribute to the community; (v) the health promotion volunteers who work alongside the public health nurses; and (vi) an enriched community environment.

CONCLUSION

The results contribute to an understanding of social capital in the context of public health nursing activities and further research on social capital. It also is discussed how social capital can be incorporated into public health nursing activities in the future.

Identifying emergent social networks at a federally qualified health center-based farmers' market

Identifying potential mechanisms connecting farmers' market interventions with health, economic, and community outcomes could inform strategies for addressing health disparities. The present study used social network theory to guide the in-depth examination of naturally occurring social interactions at a farmers' market located at a federally qualified health center located in a rural, low-income community. Trained observers recorded 61 observation logs at the market over 18 weeks. Thematic analysis revealed a range of actors and nonhuman facilitators instrumental to the farmers' market context. These actors connected with one another for communication and relationship development, economic and financial exchange, education, resource sharing, community ownership of the farmers' market, and conflict resolution. These interactions provided opportunities for social networks to develop among attendees, which may have facilitated the acquisition of social supports related to improved health, economic and community outcomes. Results provide insight into the role social networks may play in mediating the relationship between a farmers' market intervention and individual benefits. Findings also contribute to defining the typology of social networks, which may further disentangle the complex relationships between social networks and health outcomes. Future research should identify strategies for purposefully targeting social networks as a way to reduce diet-related health disparities.

Provider communication and role modeling related to patients' perceptions and use of a federally qualified health center-based farmers' market

Farmers' markets have the potential to improve the health of underserved communities, shape people's perceptions, values, and behaviors about healthy eating, and serve as a social space for both community members and vendors. This study explored the influence of health care provider communication and role modeling for diabetic patients within the context of a farmers' market located at a federally qualified health center. Although provider communication about diet decreased over time, communication strategies included: providing patients with "prescriptions" and vouchers for market purchases; educating patients about diet; and modeling healthy purchases. Data from patient interviews and provider surveys revealed that patients enjoyed social aspects of the market including interactions with their health care provider, and providers distributed prescriptions and vouchers to patients, shopped at the market, and believed that the market had potential to improve the health of staff and patients of the federally qualified health center. Provider modeling of healthy behaviors may influence patients' food-related perceptions and dietary behaviors.

Comparing the availability, price, variety and quality of fruits and vegetables across retail outlets and by area-level socio-economic position

OBJECTIVE

To explore whether area-level socio-economic position or the form of retail stream (conventional v. farmers' market) is associated with differences in the price, availability, variety and quality of a range of fresh fruit and vegetables.

DESIGN

A multi-site cross-sectional pilot study of farmers' markets, supermarkets and independent fruit and vegetable retailers. Each was surveyed to assess the price, availability, variety and quality of fifteen fruit and eighteen vegetable items.

SETTING

Retail outlets were located in south-east Queensland.

SUBJECTS

Fifteen retail outlets were surveyed (five of each retail stream).

RESULTS

Average basket prices were not significantly different across the socio-economic spectrum, but prices in low socio-economic areas were cheapest. Availability, variety and quality did not differ significantly across levels of socio-economic position; however, the areas with the most socio-economic disadvantage scored poorest for quality and variety. Supermarkets had significantly better fruit and vegetable availability than farmers' markets, although price, variety and quality scores were not different across retail streams. Results demonstrate a trend to fruit and vegetable prices being more expensive at farmers' markets, with the price of the fruit basket being significantly greater at the organic farmers' market compared with the non-organic farmers' markets.

CONCLUSIONS

Neither area-level socio-economic position nor the form of retail stream was significantly associated with differences in the availability, price, variety and quality of fruit and vegetables, except for availability which was higher in supermarkets than farmers' markets. Further research is needed to determine what role farmers' markets can play in affecting fruit and vegetable intake.

Perceived influences on physical activity and diet in low-income adults from two rural counties

BACKGROUND

Despite the increased use of ecological models in health behavior research, multilevel influences on health behaviors in rural, low-income people, an aggregate at high risk for sedentary behavior and inadequate diets, have been examined in few studies.

OBJECTIVE

The purpose of this study was to describe influences on physical activity and diet in low-income, rural adults.

METHOD

A cross-sectional survey was conducted using face-to-face interviews in a convenience sample of 137 low-income Anglo and Latino adults recruited from two rural Wisconsin counties. The survey included questions on health behaviors, self-efficacy, barriers, social support, and community environments. Self-report data on physical activity and fruit and vegetable intake were categorized into outcome variables of meets recommendation or does not meet recommendation. Latent class cluster analysis was used to identify clusters of participants with similar influences on health behaviors, and cluster membership was used as an independent variable in logistic regression of physical activity and diet outcomes.

RESULTS

Fifty-two percent of participants met a recommendation for physical activity, but only 8% met their MyPyramid recommendation for fruit and vegetable intake. Participants in the moderate self-efficacy/high safety cluster were significantly more likely than those in the low self-efficacy/moderate safety cluster to meet a recommendation for physical activity (odds ratio = 2.65). For healthy diet, participants in the low barriers cluster were significantly more likely to eat more fruits and vegetables (odds ratio = 4.13) than those in the high barriers cluster.

DISCUSSION

People with healthier behaviors were distinguished from those with less healthy behaviors by higher levels of intrapersonal, interpersonal, and community supports. Results support the importance of multilevel approaches to promoting healthy lifestyles in rural, low-income adults.

The role of tailored consultation following health-risk appraisals in employees' health behavior

OBJECTIVES

This study evaluates employees' health and lifestyle changes following health risk appraisal only and health risk appraisal with a consultation (HRAC) based on the constructs of Transtheoretical model (TTM).

METHODS

Sixty employees self-selected to an HRAC or health risk appraisal only, implemented in 6-month interval. Demographics, lifestyle behavior, and stage of change (SOC) assessments based on TTM along with weight, height, body mass index, blood pressure, blood glucose, and cholesterol were measured.

RESULTS

Second health risk appraisal showed improvements in nutrition, fitness, and overall health in both groups (P < 0.05). Significant improvements were found between HRAC group and their SOC for exercise, nutrition, and overall lifestyle. Also, group differences in SOC for exercise, amount of snack food, fruits and vegetables consumed, and physical activity (P < 0.05) were significant.

CONCLUSION

HRAC based on TTM constructs is effective in promoting behavior change in high-risk employees.