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Demark-Wahnefried W, Oster RA, Smith KP, Kaur H, Frugé AD, Cole WW, Locher JL, Rocque GB, Pisu M, Bail JR, Cohen HJ, Moellering DR, Blair CK. Vegetable Gardening and Health Outcomes in Older Cancer Survivors: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2417122. [PMID: 38900426 PMCID: PMC11190797 DOI: 10.1001/jamanetworkopen.2024.17122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/16/2024] [Indexed: 06/21/2024] Open
Abstract
Importance Cancer survivors experience accelerated functional decline that threatens independence and quality of life. Previous studies have suggested that vegetable gardening may improve diet, physical activity, and physical function in this vulnerable population, which comprises more than 5% of the US population. Objective To assess whether diet, physical activity and functioning, and other outcomes improved in older cancer survivors assigned to a vegetable gardening intervention compared with a waitlist. Design, Setting, and Participants From May 11, 2016, to May 2, 2022, a 2-arm, assessor-blinded, crossover-designed, intent-to-treat, randomized clinical trial was conducted at cancer survivors' homes across Alabama. Medicare-eligible survivors of cancers with 5-year survival of 60% or more were registry ascertained and screened for suboptimal vegetable and fruit consumption (<5 servings per day), physical activity (<150 moderate-to-vigorous minutes per week), and physical function (36-Item Short Form Health Survey [SF-36] subscale score ≤90). Consented participants underwent baseline assessments, were randomly assigned to intervention or waitlisted arms, and were reassessed at 1-year follow-up. Intervention One-year, home-based vegetable gardening intervention providing gardening supplies and mentorship by cooperative extension-certified master gardeners to plant and maintain spring, summer, and fall gardens. Waitlisted participants received the identical intervention after 12 months. Main Outcomes and Measures The main outcome was a composite index of improvements in self-reported vegetable and fruit consumption, physical activity, and physical function corroborated by plasma α-carotene levels, accelerometry, and physical performance assessments, respectively. Results Of 381 enrolled participants (mean [SD] age, 69.8 [6.4] years; range, 50-95 years; 263 [69.0%] female), 194 were assigned to the gardening intervention and 187 were waitlisted (attrition rates, 7.2% and 7.0%, respectively). Intent-to-treat analyses did not detect a significant improvement in the composite index of vegetable and fruit intake, moderate-vigorous physical activity, and physical function (intervention arm vs waitlisted arm, 4.5% vs 3.1%; P = .53) or between-arm differences in vegetable and fruit intake (mean difference, 0.3 [95% CI, -0.1 to 0.7] servings per day; P = .10). The intervention arm experienced a significant improvement in vegetable and fruit intake (mean increase, 0.3 [95% CI, 0.0-0.6] servings per day; P = .04). Significant improvements also were observed in the intervention arm vs waitlisted arm in physical performance (mean difference for 2-minute step test, 6.0 [95% CI, 0.8-11.2] steps; P = .03; for 30-second chair stand, 0.8 [95% CI, 0.1-1.5] repetitions; P = .02), perceived health (8.4 [95% CI, 3.0-13.9] points on a 100-point scale [higher scores indicate better health]; P = .003), and gut microbiome alpha diversity (84.1 [95% CI, 20.5-147.6] more observed species; P = .01). The COVID-19 pandemic significantly moderated effects (eg, odds of improvement in self-reported physical functioning were greater before vs during the pandemic: odds ratio, 2.17; 95% CI, 1.12-4.22; P = .02). Conclusions and Relevance In this randomized clinical trial including older cancer survivors, a vegetable gardening intervention did not significantly improve a composite index of diet, physical activity, and physical function; however, survivors assigned to the intervention had significantly increased vegetable and fruit consumption and, compared with waitlisted survivors, experienced significant improvements in perceived health and physical performance. Further study in broader populations and during pandemic-free periods is needed to determine definitive benefits. Trial Registration ClinicalTrials.gov Identifier: NCT02985411.
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Affiliation(s)
| | | | - Kerry P. Smith
- Alabama Cooperative Extension System, Auburn University, Auburn
| | - Harleen Kaur
- Department of Nutrition Sciences, University of Alabama at Birmingham
| | | | - W. Walker Cole
- Department of Health Behavior, University of Alabama at Birmingham
| | | | | | - Maria Pisu
- Department of Medicine, University of Alabama at Birmingham
| | | | - Harvey Jay Cohen
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | | | - Cindy K. Blair
- Department of Internal Medicine, University of New Mexico, Albuquerque
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Carroll C, Higgs J, McCray S, Utter J. Implementation and Impact of Health Care Gardens: A Systematic Scoping Review. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:431-449. [PMID: 38011751 DOI: 10.1089/jicm.2023.0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Background: In community and school settings, gardens and garden interventions have been shown to confer several psychosocial, physiological, and nutritional benefits. However, little is known about the implementation and impact of health care gardens on patients, visitors, and staff health and well-being. The primary aim of this review is to identify and describe the types of gardens and common design elements implemented in health care settings and the impact these gardens have on the health and well-being of patients, visitors, and staff. A secondary aim is to assess the quality of available evidence. Methods: PubMed, CINAHL, EMBASE, and PsycINFO were systematically searched on October 28, 2022. Primary qualitative and quantitative studies (excluding case reports and studies) were eligible for inclusion if they described the types of gardens and common design elements implemented in health care settings (hospitals, aged care, rehabilitation facilities, and medical centers) and/or assessed the impact of garden interventions on the health and well-being of patients, visitors, and staff. Review, selection, and data extraction were conducted by two independent researchers, with findings synthesized and presented in narrative form. Articles were critically appraised using the mixed methods appraisal tool (MMAT). Results: Eighteen articles were included. Eight studies provided detailed descriptions of the types of gardens implemented in health care settings (healing [n = 3], therapeutic [n = 2], sensory [n = 2], children's fairy gardens [n = 1], and enriched [n = 1] gardens). Studies examining the psychosocial impacts of gardens were most frequently reported (n = 16), followed by physical (n = 4) and nutritional (n = 2). A wide range of positive outcomes, predominantly relating to patients (n = 12), were reported, including improvements in stress, quality of life (QOL), cognitive function, physical activity, and fruit and vegetable intake. The evidence was heterogeneous and low-medium quality. Conclusions: The findings suggest that implementing gardens and garden interventions in health care settings may positively impact the health and well-being of patients, visitors, and staff. Most studies related to the impact of gardens on patients' mental health and QOL, indicating the need for further research to explore physical and nutritional outcomes, as well as health outcomes of staff and visitors. Findings also suggest the need for high-quality study designs (e.g., cluster control trials) and standardized measurement tools.
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Affiliation(s)
- Chloe Carroll
- Nutrition and Dietetics, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Jennifer Higgs
- Nutrition and Dietetics, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Sally McCray
- Nutrition and Dietetics, Mater Health, South Brisbane, Australia
| | - Jennifer Utter
- Nutrition and Dietetics, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
- Nutrition and Dietetics, Mater Health, South Brisbane, Australia
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Azhar Hilmy SH, Nordin N, Yusof MYPM, Soh TYT, Yusof N. Components in downstream health promotions to reduce sugar intake among adults: a systematic review. Nutr J 2024; 23:11. [PMID: 38233923 PMCID: PMC10792802 DOI: 10.1186/s12937-023-00884-3] [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: 01/16/2023] [Accepted: 10/19/2023] [Indexed: 01/19/2024] Open
Abstract
Excessive sugar consumption is well documented as a common risk factor for many Non-Communicable Diseases (NCDs). Thus, an adequate intervention description is important to minimise research waste and improve research usability and reproducibility. A systematic review was conducted to identify components in published evidence interventions pertaining to the health promotions on reducing sugar intake among adults. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and used the Mixed Methods Appraisal Tool (MMAT) for quality appraisal. The period for the selected study was from 2000 to 2022, and articles were retrieved from Web of Science (WOS), Medline, Scopus, and PubMed. The target population was adults aged 18 years old and above who underwent intervention to assess the changes in their sugar intake. Data sources and all human epidemiologic studies were included. Out of the 9,333 papers identified, 25 were included. The overall quality of evidence of the studies was considered moderate. Apart from the characteristics of the reviewed studies, components of interventions are including the basis of theoretical or model for the intervention, which majority use Social Cognitive Theory, followed by PRECEDE-PROCEED model, socio-ecological and process-improvement theories and Transtheoretical Model; providers, who are commercial provider, qualified nutritionist, professor of nutrigenomics and nutrigenetics, doctor, dietitian nutritionist, lifestyle coaches, and junior public health nurses; duration of the intervention and follow-up time, varies from as short as one month to as long as 24 months; material provided either softcopy or hardcopy; tailoring approach, based on the individual goals, the process of change, genotype analysis, beliefs, barriers, and sociocultural norms; delivery mechanism either face-to-face or technology-mediated; and tools to measure the sugar consumption outcome mostly used Food Frequency Questionnaire (FFQ), besides 24-h dietary recalls, and food diaries. There are various components in downstream health promotion to reduce sugar intake among adults that can be adapted according to the local health promotion and intervention context. More well-designed interventions using integration components are encouraged in further studies.
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Affiliation(s)
- Syathirah Hanim Azhar Hilmy
- Centre of Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, 47000, Malaysia
- Department of Periodontology & Community Oral Health, Faculty of Dentistry, Universiti Sains Islam Malaysia (USIM), Kuala Lumpur, 57000, Malaysia
| | - Norhasnida Nordin
- Centre of Comprehensive Care, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh 47000, Selangor, Malaysia
| | - Mohd Yusmiaidil Putera Mohd Yusof
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Sungai Buloh 47000, Selangor, Malaysia
| | - Tuan Yuswana Tuan Soh
- Centre of Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, 47000, Malaysia
| | - Norashikin Yusof
- Centre of Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, 47000, Malaysia.
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Application of the Updated WCRF/AICR Cancer Prevention Score as an Outcome for Cancer Survivors Participating in a Tailored and Intensive Dietary and Physical Activity Intervention. Nutrients 2022; 14:nu14224751. [PMID: 36432442 PMCID: PMC9699073 DOI: 10.3390/nu14224751] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/12/2022] Open
Abstract
The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) has defined evidence-based guidelines for cancer prevention. These recommendations have been operationalized into a quantitative index for individual assessment. Survivors of cancer are increasingly desiring guidance for diet and lifestyle, and in the absence of research in survivors, are often instructed to follow cancer prevention and public health guidelines. In this study, we examine the utility of the quantitative updated WCRF/AICR scoring criteria to assess change among cancer survivors with overweight/obesity (OW/OB) following an intensive behavioral intervention. We applied the WCRF/AICR scoring criteria (range 0−7) to examine changes over the duration of the study by paired t-tests. Two cancer survivor cohorts with OW/OB (n = 91) completed a six-month phase II clinical trial designed to improve dietary and physical activity patterns. At enrollment and post-intervention, participants completed assessments including anthropometrics, food frequency questionnaires, and objective evaluation of physical activity. Participants improved adherence to all scored recommendations, with a significant increase in mean score from enrollment (3.22 ± 1.06) to post-intervention (4.28 ± 1.04) (p < 0.001). Mean BMI and waist circumference improved (both p < 0.001). The greatest improvements were noted for fruit and non-starchy vegetable intakes (+39%, p < 0.001); the greatest decreases were observed for processed meat consumption (−70%, p < 0.001). The updated WCRF/AICR Score can be applied to cancer survivor intervention studies and provides a tool to compare trials in regard to the baseline status of populations enrolled and the success of the intervention. Future interventions incorporating standardized assessments will help guide effective strategies to improve the health and quality of life for cancer survivors.
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Bail JR, Blair CK, Smith KP, Oster RA, Kaur H, Locher JL, Frugé AD, Rocque G, Pisu M, Cohen HJ, Demark-Wahnefried W. Harvest for Health, a Randomized Controlled Trial Testing a Home-Based, Vegetable Gardening Intervention Among Older Cancer Survivors Across Alabama: An Analysis of Accrual and Modifications Made in Intervention Delivery and Assessment During COVID-19. J Acad Nutr Diet 2022; 122:1629-1643. [PMID: 35533876 PMCID: PMC10656755 DOI: 10.1016/j.jand.2022.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/25/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Accelerated functional decline is a concern among older cancer survivors that threatens independence and quality of life. Pilot studies suggest that vegetable gardening interventions ameliorate functional decline through improved diet and physical activity. OBJECTIVE The aim of this article was to describe the rationale, recruitment challenges, and enrollment for the Harvest for Health randomized controlled trial (RCT), which will test the impact of a home-based, vegetable gardening intervention on vegetable and fruit consumption, physical activity, and physical functioning among older cancer survivors. Modifications made to the intervention and assessments to assure safety and continuity of the RCT throughout the COVID-19 pandemic also are reported. DESIGN Harvest for Health is a 2-year, 2-arm, single-blinded, wait-list controlled RCT with cross-over. PARTICIPANTS/SETTING Medicare-eligible survivors of cancers with ≥60% 5-year survival were recruited across Alabama from October 1, 2016 to February 8, 2021. INTERVENTION Participants were randomly assigned to a wait-list control or a 1-year home-based gardening intervention and individually mentored by extension-certified master gardeners to cultivate spring, summer, and fall vegetable gardens. MAIN OUTCOME MEASURES Although the RCT's primary end point was a composite measure of vegetable and fruit consumption, physical activity, and physical functioning, this article focuses on recruitment and modifications made to the intervention and assessments during COVID-19. STATISTICAL ANALYSES PERFORMED χ2 and t tests (α < .05) were used to compare enrolled vs unenrolled populations. RESULTS Older cancer survivors (n = 9,708) were contacted via mail and telephone; 1,460 indicated interest (15% response rate), 473 were screened eligible and consented, and 381 completed baseline assessments and were randomized. Enrollees did not differ from nonrespondents/refusals by race and ethnicity, or rural-urban status, but comprised significantly higher numbers of comparatively younger survivors, those who were female, and survivors of breast cancer (P < .001). Although COVID-19 delayed trial completion, protocol modifications overcame this barrier and study completion is anticipated by June 2022. CONCLUSIONS This RCT will provide evidence on the effects of a mentored vegetable gardening program among older cancer survivors. If efficacious, Harvest for Health represents a novel, multifaceted approach to improve lifestyle behaviors and health outcomes among cancer survivors-one with capacity for sustainability and widespread dissemination.
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Affiliation(s)
- Jennifer R Bail
- College of Nursing, University of Alabama in Huntsville, Huntsville, AL; Department of Nutrition Sciences, University of Alabama, Birmingham, AL
| | - Cindy K Blair
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM
| | - Kerry P Smith
- Alabama Cooperative Extension System, Auburn University, Auburn, AL
| | - Robert A Oster
- Division of Preventive Medicine, Department of Medicine, University of Alabama, Birmingham, AL
| | - Harleen Kaur
- Department of Nutrition Sciences, University of Alabama, Birmingham, AL
| | - Julie L Locher
- Division of Geriatrics, Department of Medicine, University of Alabama, Birmingham, AL
| | - Andrew D Frugé
- Department of Nutrition Sciences, University of Alabama, Birmingham, AL; Department of Nutrition, Dietetics & Hospitality Management, Auburn University, Auburn, AL
| | | | - Maria Pisu
- Division of Preventive Medicine, Department of Medicine, University of Alabama, Birmingham, AL
| | - Harvey Jay Cohen
- Department of Medicine, Duke University Medical Center, Durham, NC
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Hume C, Grieger JA, Kalamkarian A, D'Onise K, Smithers LG. Community gardens and their effects on diet, health, psychosocial and community outcomes: a systematic review. BMC Public Health 2022; 22:1247. [PMID: 35739494 PMCID: PMC9229094 DOI: 10.1186/s12889-022-13591-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 03/15/2022] [Indexed: 11/26/2022] Open
Abstract
Background We systematically reviewed the effects of community gardens on physical and psychosocial health, health behaviors and community outcomes. Methods Quantitative studies that examined associations of health, psychosocial or community outcomes with community gardens were included in the review. Studies up to December 2020 were captured from searches of Medline, Web of Science, PsycInfo, EBSCOHost and CAB Abstracts. Data were extracted and study quality including risk of bias was examined. Results There were 53 studies that met the inclusion criteria. Studies examining associations between community gardens and nutrition or food security were most frequently reported (k = 23). Other factors examined for associations with community gardens were health (k = 16), psychosocial (k = 16) and community outcomes (k = 7). Effects appeared positive for fruit and vegetable intake, some psychosocial and community outcomes, but mixed for physical health outcomes. Evidence quality overall was low. Conclusions Community gardening was associated with higher fruit and vegetable intake, positive psychosocial and community outcomes, but poor evidence quality suggests the effects of community gardening may be overestimated. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13591-1.
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Affiliation(s)
- Clare Hume
- School of Public Health, University of Adelaide, Adelaide, 5000, Australia.
| | - Jessica A Grieger
- Adelaide Medical School, North Terrace, University of Adelaide, Adelaide, SA, 5000, Australia.,Robinson Research Institute, University of Adelaide, North Adelaide, SA, 5006, Australia
| | - Anna Kalamkarian
- School of Public Health, University of Adelaide, Adelaide, 5000, Australia
| | - Katina D'Onise
- School of Public Health, University of Adelaide, Adelaide, 5000, Australia.,Wellbeing SA, Citicentre, Hindmarsh Square, Adelaide, SA, 5000, Australia
| | - Lisa G Smithers
- School of Public Health, University of Adelaide, Adelaide, 5000, Australia.,Robinson Research Institute, University of Adelaide, North Adelaide, SA, 5006, Australia.,School of Health and Society, University of Wollongong, Wollongong, NSW, 2522, Australia
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Ronto R, Saberi G, Leila Robbers GM, Godrich S, Lawrence M, Somerset S, Fanzo J, Chau JY. Identifying effective interventions to promote consumption of protein-rich foods from lower ecological footprint sources: A systematic literature review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000209. [PMID: 36962370 PMCID: PMC10021177 DOI: 10.1371/journal.pgph.0000209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/23/2022] [Indexed: 11/18/2022]
Abstract
Addressing overconsumption of protein-rich foods from high ecological footprint sources can have positive impacts on health such as reduction of non-communicable disease risk and protecting the natural environment. With the increased attention towards development of ecologically sustainable diets, this systematic review aimed to critically review literature on effectiveness of those interventions aiming to promote protein-rich foods from lower ecological footprint sources. Five electronic databases (Medline, Web of Science, Scopus, Embase and Global Health) were searched for articles published up to January 2021. Quantitative studies were eligible for inclusion if they reported on actual or intended consumption of protein-rich animal-derived and/or plant-based foods; purchase, or selection of meat/plant-based diet in real or virtual environments. We assessed 140 full-text articles for eligibility of which 51 were included in this review. The results were narratively synthesised. Included studies were categorised into individual level behaviour change interventions (n = 33) which included education, counselling and self-monitoring, and micro-environmental/structural behaviour change interventions (n = 18) which included menu manipulation, choice architecture and multicomponent approaches. Half of individual level interventions (52%) aimed to reduce red/processed meat intake among people with current/past chronic conditions which reduced meat intake in the short term. The majority of micro-environmental studies focused on increasing plant-based diet in dining facilities, leading to positive dietary changes. These findings point to a clear gap in the current evidence base for interventions that promote plant-based diet in the general population.
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Affiliation(s)
- Rimante Ronto
- Department of Health Sciences, Macquarie University, Sydney, Australia
| | - Golsa Saberi
- Department of Health Sciences, Macquarie University, Sydney, Australia
| | | | - Stephanie Godrich
- School of Medicine and Health Sciences, Edith Cowan University, Perth, Australia
| | - Mark Lawrence
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - Shawn Somerset
- Faculty of Health, University of Canberra, Canberra, Australia
| | - Jessica Fanzo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Josephine Y. Chau
- Department of Health Sciences, Macquarie University, Sydney, Australia
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Improving Food Literacy and Access Among Young Adult Cancer Survivors: A Cross-Sectional Descriptive Study. Cancer Nurs 2021; 45:161-166. [PMID: 34507337 DOI: 10.1097/ncc.0000000000000992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The links between nutrition and chronic disease are well established, but consumption of fruits and vegetables is low among young adult childhood cancer survivors (YACS) worldwide. Ensuring equitable access to fresh produce is a significant, persistent public health challenge. OBJECTIVE The purposes of this report are to describe patterns of access to fresh produce, daily intake of fruits/vegetables, and nutrition education preferences among a sample of YACS and to highlight early development of a mentored gardening intervention. METHODS A cross-sectional descriptive study design was used to assess dietary intake, access to fruits/vegetables, and preferences for nutrition education among 124 YACS through a comprehensive cancer survivorship program in a large pediatric cancer center. RESULTS Most participants (71.8%) live more than 10 minutes' walking distance from a supermarket, and 88.7% do not meet the recommended daily intake of 5 or more servings of fruit and vegetables. A total of 91% of participants express that nutrition is important, and 81.5% desire dietary improvement. Most (78.2%) are likely to use either their computer or cell phone for nutrition content. To establish healthy nutrition habits, many seek the support of a nutritionist (63.7%) or another survivor (41.9%). CONCLUSIONS Study findings underscore the need for advocacy to support equitable access to fresh produce and technology-enhanced nutrition education among YACS. IMPLICATIONS FOR PRACTICE To improve access to fresh produce and food literacy among YACS, providers can collaborate with community stakeholders to build capacity for sustainable, technology-enhanced, and mentored gardening interventions at the individual, family, and community level.
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Pratt KJ, Hill EB, Kiser HM, VanFossen CE, Braun A, Taylor CA, Spees C. Changes in Parent and Child Skin Carotenoids, Weight, and Dietary Behaviors over Parental Weight Management. Nutrients 2021; 13:2227. [PMID: 34209574 PMCID: PMC8308330 DOI: 10.3390/nu13072227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 06/25/2021] [Accepted: 06/27/2021] [Indexed: 11/17/2022] Open
Abstract
(1) The objective was to determine changes in parent-child (ages 7-18) dyad skin carotenoids spanning parental participation in a medical weight management program (WMP), and associations with parent BMI, child BMIz, fruit/vegetable intake, and family meals and patterns. (2) The study design was a longitudinal dyadic observational study with assessment at WMP initiation, mid-point (3-months), and conclusion (6-months). Twenty-three dyads initiated the study, 16 provided assessments at 3 months, and 11 at program conclusion. Associations between parent and child carotenoids (dependent variables) and parent BMI, child BMIz, increases in fruit/vegetable intake, and family meals and patterns were analyzed using Pearson's correlations and independent samples t-tests. Repeated measures ANOVA assessed changes in weight status and carotenoids. (3) Parents experienced significant declines in BMI and skin carotenoid levels over 6 months. Parent and child carotenoids were correlated at each assessment. At initiation, parent BMI and carotenoids were inversely correlated, child carotenoids were associated with increased family meals, and never consuming an evening fast food or restaurant meal were associated with increased parent and child carotenoids. (4) Results demonstrate skin carotenoids are strongly correlated within dyads and may be associated with lower parental BMI and positive family meal practices.
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Affiliation(s)
- Keeley J. Pratt
- Human Development and Family Science Program, Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH 43210, USA; (H.M.K.); (C.E.V.)
- The Ohio State Wexner Medical Center, Department of Surgery, Columbus, OH 43210, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH 43210, USA
| | - Emily B. Hill
- Divison of Medical Dietetics, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH 43210, USA; (E.B.H.); (A.B.); (C.A.T.); (C.S.)
| | - Haley M. Kiser
- Human Development and Family Science Program, Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH 43210, USA; (H.M.K.); (C.E.V.)
| | - Catherine E. VanFossen
- Human Development and Family Science Program, Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH 43210, USA; (H.M.K.); (C.E.V.)
| | - Ashlea Braun
- Divison of Medical Dietetics, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH 43210, USA; (E.B.H.); (A.B.); (C.A.T.); (C.S.)
| | - Christopher A. Taylor
- Divison of Medical Dietetics, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH 43210, USA; (E.B.H.); (A.B.); (C.A.T.); (C.S.)
| | - Colleen Spees
- Divison of Medical Dietetics, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH 43210, USA; (E.B.H.); (A.B.); (C.A.T.); (C.S.)
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Veldheer S, Scartozzi C, Knehans A, Oser T, Sood N, George DR, Smith A, Cohen A, Winkels RM. A Systematic Scoping Review of How Healthcare Organizations Are Facilitating Access to Fruits and Vegetables in Their Patient Populations. J Nutr 2020; 150:2859-2873. [PMID: 32856074 DOI: 10.1093/jn/nxaa209] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/18/2020] [Accepted: 06/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is compelling evidence on the impact of diet as preventative medicine, and with rising health care costs healthcare organizations are attempting to identify interventions to improve patient health outcomes. OBJECTIVES The purpose of this systematic scoping review was to characterize existing healthcare organization-based interventions to improve access to fruits and vegetables (F&V) for their patient populations. In addition, we aimed to review the impact of identified interventions on dietary intake and health outcomes. METHODS Titles and abstracts were searched in PubMed® (MEDLINE®), Embase®, CINAHL®, and the Cochrane Library® from 1 January 1990 to 31 December 2019. To be selected for inclusion, original studies must have included a healthcare organization and have had a programmatic focus on increasing access to or providing fresh F&V to patients in an outpatient, naturalistic setting. The Effective Public Health Practice Project tool was used to assess study quality in 6 domains (selection bias, study design, confounders, blinding, data collection methods, and withdrawals and dropouts). RESULTS A total of 8876 abstracts were screened, yielding 44 manuscripts or abstracts from 27 programs. Six program models were identified: 1) a cash-back rebate program, 2) F&V voucher programs, 3) garden-based programs, 4) subsidized food box programs, 5) home-delivery meal programs, and 6) collaborative food pantry-clinical programs. Only 6 of 27 studies included a control group. The overall quality of the studies was weak due to participant selection bias and incomplete reporting on data collection tools, confounders, and dropouts. Given the heterogeneity of outcomes measured and weak study quality, conclusions regarding dietary and health-related outcomes were limited. CONCLUSIONS Healthcare-based initiatives to improve patient access to F&V are novel and have promise. However, future studies will need rigorous study designs and validated data collection tools, particularly related to dietary intake, to better determine the effect of these interventions on health-related outcomes.
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Affiliation(s)
- Susan Veldheer
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA.,Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Christina Scartozzi
- Penn State Health, St. Joseph's Family and Community Medicine Residency Program, Hershey, PA, USA
| | - Amy Knehans
- Penn State College of Medicine, Harrell Library, Hershey, PA, USA
| | - Tamara Oser
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA.,Department of Family Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO, USA
| | - Natasha Sood
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Daniel R George
- Department of Humanities, Penn State College of Medicine, Hershey, PA, USA
| | | | - Alicia Cohen
- Departments of Family Medicine and Health Services, Policy, and Practice, Providence VA Medical Center and Brown University, Providence, RI, USA
| | - Renate M Winkels
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.,Wageningen University, Division of Human Nutrition and Health, Wageningen, Netherlands
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11
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Veldheer S, Winkels RM, Cooper J, Groff C, Lepley J, Bordner C, Wagner A, George DR, Sciamanna C. Growing Healthy Hearts: Gardening Program Feasibility in a Hospital-Based Community Garden. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:958-963. [PMID: 33039024 DOI: 10.1016/j.jneb.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To assess feasibility in terms of acceptability, demand, and participant willingness to engage in gardening activities during an intervention delivered at a hospital-based community garden for patients at risk for cardiovascular disease (CVD). METHODS In a pre-post study design, 15 adults with ≥1 CVD risk factor attended 5 education sessions over 12 weeks, tended garden beds, and completed questionnaires related to program acceptability and future gardening intentions. Interviews were used to identify areas for programmatic improvement. RESULTS Most participants rated the intervention as good or excellent (93%), and 73% indicated that it was likely that they would garden next season. Areas for programmatic improvement included creating opportunities for group discussion, providing online materials, and offering more cooking and gardening content. CONCLUSIONS AND IMPLICATIONS Gardening as an intervention for adult patients with CVD risk factors is feasible. Assessment of the effect of gardening on health outcomes and dietary intake is warranted.
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Affiliation(s)
- Susan Veldheer
- Department of Family and Community Medicine, Pennsylvania State University, College of Medicine, Hershey, PA; Department of Public Health Sciences, Pennsylvania State University, College of Medicine, Hershey, PA.
| | - Renate M Winkels
- Department of Public Health Sciences, Pennsylvania State University, College of Medicine, Hershey, PA; Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
| | - Joie Cooper
- Department of Family and Community Medicine, Pennsylvania State University, College of Medicine, Hershey, PA
| | - Calesta Groff
- Department of Family and Community Medicine, Pennsylvania State University, College of Medicine, Hershey, PA
| | - Jordan Lepley
- Department of Family and Community Medicine, Pennsylvania State University, College of Medicine, Hershey, PA
| | - Candace Bordner
- Department of Family and Community Medicine, Pennsylvania State University, College of Medicine, Hershey, PA; Department of Public Health Sciences, Pennsylvania State University, College of Medicine, Hershey, PA
| | - Alexandra Wagner
- Department of Family and Community Medicine, Pennsylvania State University, College of Medicine, Hershey, PA
| | - Daniel R George
- Department of Humanities, Pennsylvania State University, College of Medicine, Hershey, PA
| | - Christopher Sciamanna
- Department of Public Health Sciences, Pennsylvania State University, College of Medicine, Hershey, PA; Department of General Internal Medicine, Pennsylvania State University, College of Medicine, Hershey, PA
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12
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Raber M, Basen-Engquist K, Moran NE, Chandra J. The Healthy Cooking Index does not Predict the Carotenoid Content of Home-Cooked Meals. Nutrients 2020; 12:nu12020524. [PMID: 32092844 PMCID: PMC7071392 DOI: 10.3390/nu12020524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 12/04/2022] Open
Abstract
Home cooking programs are an increasingly popular approach to nutrition education and have the potential to promote diet quality among pediatric cancer survivors. A cornerstone of many programs is the use of fresh fruits and vegetables, which may support increased intake of many food components, including carotenoids, to improve survivor health. However, most dietary carotenoids in the United States currently come from processed vegetables, and it is unclear if the emphasis on fresh fruits and vegetables common in cooking education programs is associated with the total carotenoid content of meals. The objective of this analysis is to examine the relationship between fresh produce usage, practices commonly taught in healthy home cooking classes, and the carotenoid content of prepared meals among 40 parents with school-aged children. This is a secondary analysis of an observational study examining the quality of home cooking practices using an evidence-based index of behaviors, the Healthy Cooking Index (HCI). Nutrition-optimizing cooking practices, as quantified by the HCI, were not associated with the carotenoid content of meals (r = −0.24, p = 0.13). Further, total fruit and vegetable content of meals was not associated with total carotenoids (r = 0.14; p = 0.38), indicating heterogeneity in the carotenoid profiles of foods used by this population. High-carotenoid meals tended to use more canned and/or frozen tomato and vegetable products, and carotenoid content was associated with meals with sugar (r = 0.32; p = 0.04), and servings of refined grains (r = 0.49; p < 0.01). Our findings indicate an opportunity to educate pediatric cancer survivors and families on the incorporation of high-carotenoid food products while reducing refined grain and sweetener intake through a tailored home cooking intervention.
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Affiliation(s)
- Margaret Raber
- University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (K.B.-E.)
| | | | - Nancy E. Moran
- Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children’s Nutrition Research Center, Houston, TX 77030, USA;
| | - Joya Chandra
- University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (K.B.-E.)
- Correspondence: ; Tel.: +1-713-702-4801
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13
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Impact of a Tailored Nutrition and Lifestyle Intervention for Overweight Cancer Survivors on Dietary Patterns, Physical Activity, Quality of Life, and Cardiometabolic Profiles. JOURNAL OF ONCOLOGY 2019; 2019:1503195. [PMID: 31871455 PMCID: PMC6906801 DOI: 10.1155/2019/1503195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/09/2019] [Accepted: 10/05/2019] [Indexed: 02/06/2023]
Abstract
Survivors of cancer often experience treatment-related toxicity in addition to being at risk of cancer recurrence, second primary cancers, and greater all-cause mortality. The objective of this study was to test the safety and efficacy of an intensive evidence-based garden intervention to improve outcomes for cancer survivors after curative therapy. To do so, a clinical trial of adult overweight and obese cancer survivors within 2 years of completing curative therapy was completed. The 6-month intervention, delivered within the context of harvesting at an urban garden, combined group education with cooking demonstrations, remote motivational interviewing, and online digital resources. Data on dietary patterns, program satisfaction, and quality of life were collected via questionnaires; anthropometrics, physical activity, and clinical biomarkers were measured objectively. Of the 29 participants, 86% were white, 83% were female, and the mean age was 58 years. Compared to baseline, participants had significant improvements in Healthy Eating Index (HEI) scores (+5.2 points, p = 0.006), physical activity (+1,208 steps, p = 0.033), and quality of life (+16.07 points, p = 0.004). Significant improvements were also documented in weight (−3.9 kg), waist circumference (−5.5 cm), BMI (−1.5 kg/m2), systolic BP (−9.5 mmHg), plasma carotenoids (+35%), total cholesterol (−6%), triglycerides (−14%), hs-CRP (−28%), and IGFBP-3 (−5%) (all p < 0.010). These findings demonstrate a tailored multifaceted garden-based biobehavioral intervention for overweight and obese cancer survivors after curative therapy is safe and highly effective, warranting larger randomized controlled trials to identify program benefits, optimal maintenance strategies, program value relative to cost, and approaches for integration into a survivor's oncology management program. This trial is registered on ClinicalTrials.gov NCT02268188.
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14
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Winkels RM, Artrip R, Tupinio M, Veldheer S, Dandekar SC, George DR. Opportunities for Growth: Evaluating the Feasibility of a Community Gardening Intervention Pairing Adolescent and Young Adult Cancer Survivors with Experienced Gardeners. J Adolesc Young Adult Oncol 2019; 9:115-119. [PMID: 31580754 DOI: 10.1089/jayao.2019.0035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We evaluated the feasibility of a mentored gardening intervention for adolescent and young adult (AYA) cancer survivors in a hospital-based community garden as a way to improve diet and physical activity, using qualitative data to assess the challenges, facilitators, and areas for future programmatic improvement and replication. Over the course of growing season 2018, AYA cancer survivors tended a garden plot in a community garden under the mentorship of an experienced (master) gardener. AYA cancer survivors were successful in planting and harvesting vegetables from the garden in partnership with their mentors. Qualitative results and future directions for the project are discussed.
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Affiliation(s)
| | - Rick Artrip
- Department of Penn State College of Medicine, Hershey, Pennsylvania
| | - Maegan Tupinio
- Department of Penn State College of Medicine, Hershey, Pennsylvania
| | - Susan Veldheer
- Department of Family and Community Medicine, Hershey, Pennsylvania
| | - Smita C Dandekar
- Pediatric Hematology/Oncology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
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15
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Braun A, Portner J, Grainger EM, Hill EB, Young GS, Clinton SK, Spees CK. Tele-Motivational Interviewing for Cancer Survivors: Feasibility, Preliminary Efficacy, and Lessons Learned. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2018; 50:19-32.e1. [PMID: 29325658 PMCID: PMC7333356 DOI: 10.1016/j.jneb.2017.05.352] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/07/2017] [Accepted: 05/14/2017] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Determine the feasibility, acceptability, and efficacy of tele-Motivational Interviewing (MI) for overweight cancer survivors. DESIGN Six-month nonrandomized phase 2 clinical trial. SETTING Urban garden and remote platforms. PARTICIPANTS Overweight and obese cancer survivors post active treatment. INTERVENTION Remote tele-MI from a trained registered dietitian nutritionist (RDN). MAIN OUTCOME MEASURES Feasibility, acceptability, and preliminary efficacy. ANALYSIS Groups were stratified as users and nonusers based on tele-MI use. Qualitative survey data and remote MI interaction logs were analyzed for trends. Two-sample t tests were performed to assess pre-post intervention changes in physical activity and dietary behaviors, quality of life, self-efficacy, and clinical biomarkers. RESULTS A total of 29 participants completed the intervention. There were 17 tele-MI users (59%) and 12 nonusers (41%). Users were primarily female (88%), breast cancer survivors (59%), college educated (82%), with a mean age of 58 years. Users set 50% more goals, lost more weight (4.8 vs 2.6 kg), significantly improved quality of life (P = .03), and trended more positively in clinical biomarkers (eg, cholesterol, blood pressure) than did nonusers. CONCLUSIONS AND IMPLICATIONS Findings from this study indicate that tele-MI is a feasible and acceptable intervention for overweight cancer survivors after active therapy. Larger randomized trials are needed to establish efficacy and generalizability to a variety of demographic populations.
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Affiliation(s)
- Ashlea Braun
- Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, Ohio State University College of Medicine, Columbus, OH
| | - James Portner
- Ohio State University College of Social Work, Columbus, OH
| | - Elizabeth M Grainger
- Comprehensive Cancer Center, Ohio State University College of Medicine, Columbus, OH
| | - Emily B Hill
- Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, Ohio State University College of Medicine, Columbus, OH
| | - Gregory S Young
- Center for Biostatistics, Ohio State University College of Medicine, Columbus, OH
| | - Steven K Clinton
- Comprehensive Cancer Center, Ohio State University College of Medicine, Columbus, OH; Department of Internal Medicine, Division of Medical Oncology, Ohio State University College of Medicine, Columbus, OH
| | - Colleen K Spees
- Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, Ohio State University College of Medicine, Columbus, OH; Comprehensive Cancer Center, Ohio State University College of Medicine, Columbus, OH.
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16
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Abstract
PURPOSE OF REVIEW Due to medical advances and an aging population, the number of cancer survivors continues to rise. Survivors often experience late and long-term sequelae of cancer and its treatment (e.g., fatigue, pain, fear of recurrence, and stress). As a result, some patients have utilized or expressed interest in integrative medicine (IM) modalities for prevention of recurrence, optimizing health, enhancing quality of life, and managing symptoms. The purpose of this review is to focus on research published during the past year that informs our understanding of the utility of IM for cancer survivors. RECENT FINDINGS Physical activity, diet, dietary supplements, mind-body modalities, acupuncture, and massage therapy all may play a role in the management of the physical (e.g., fatigue and pain) and emotional (e.g., anxiety and fear) issues faced by cancer survivors. SUMMARY IM therapies are appealing to and utilized by many cancer survivors and may reduce symptom burden. Clinicians who provide cancer survivorship care may improve patient care by understanding the evidence for and against their use.
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17
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Fitz E, Warner J, Braun A, Hill E, Wolf K, Spees C. Development, Implementation, and Evaluation of Evidence-Based Cooking Videos for Cancer Survivors. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2017; 49:525-526.e1. [PMID: 28442283 DOI: 10.1016/j.jneb.2017.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/16/2017] [Accepted: 03/19/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Emily Fitz
- Medical Dietetics and Health Sciences, The Ohio State University College of Medicine, Columbus, OH
| | - Jim Warner
- Food and Nutrition, Nutrition Services, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Ashlea Braun
- Medical Dietetics and Health Sciences, The Ohio State University College of Medicine, Columbus, OH
| | - Emily Hill
- Medical Dietetics and Health Sciences, The Ohio State University College of Medicine, Columbus, OH
| | - Kay Wolf
- Medical Dietetics and Health Sciences, The Ohio State University College of Medicine, Columbus, OH
| | - Colleen Spees
- Medical Dietetics and Health Sciences, The Ohio State University College of Medicine, Columbus, OH; Comprehensive Cancer Center, The Ohio State University, Columbus, OH.
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