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Miller S, Shier V, Wong E, Datar A. A natural experiment: The opening of a supermarket in a public housing community and impacts on children's dietary patterns. Prev Med Rep 2024; 39:102664. [PMID: 38426038 PMCID: PMC10901910 DOI: 10.1016/j.pmedr.2024.102664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
Objective The aim of the present study is to utilize a natural experiment and examine changes in dietary patterns of predominantly low-income, racial and ethnic minority children who live in a public housing community following the opening of a new supermarket. Methods Data comes from the Watts Neighborhood Health Study (WNHS), an ongoing study in South Los Angeles, United States, that follows residents of Jordan Downs, a public housing community undergoing redevelopment. Surveys were administered to children aged 9-17 years (n = 297), as well as an adult in the household. The second baseline data collection was conducted June-December 2019, and follow-up was conducted June 2020-April 2021, shortly after the introduction of the new supermarket in January 2020. ANCOVA linear regression models were estimated to examine the association between children's proximity to the new supermarket with dietary outcomes at follow-up. Interactions with barriers to food access were also explored. Results Living close to the new supermarket was not significantly associated with dietary outcomes at follow-up. However, for children who lived in households with no vehicle access, living close to the new supermarket was associated with increased fruit and vegetable consumption, compared to children in the comparison group. Conclusion Proximity to the new supermarket was not associated with improved dietary outcomes among children unless they had transportation barriers. This adds to the growing body of literature that suggests that the effects of neighborhood food environments may be modified by individuals' mobility, and that comprehensive interventions are needed.
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Affiliation(s)
- Sydney Miller
- Dornsife School of Public Health, Drexel University, United States
- Keck School of Medicine, University of Southern California, United States
| | - Victoria Shier
- Price School of Public Policy, Schaeffer Center for Health Policy and Economics, University of Southern California, United States
| | - Elizabeth Wong
- Center for Economic and Social Research, University of Southern California, United States
| | - Ashlesha Datar
- Center for Economic and Social Research, University of Southern California, United States
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2
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Paisi M, Allen Z, Shawe J. New Home, New You: A retrospective mixed-methods evaluation of a health-related behavioural intervention programme supporting social housing tenants. Health Expect 2023; 26:752-764. [PMID: 36628614 PMCID: PMC10010073 DOI: 10.1111/hex.13700] [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: 03/06/2022] [Revised: 11/15/2022] [Accepted: 12/22/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Social housing tenants are at greater risk of engaging in unhealthy behaviours than the general population. Housing association employees are in an ideal position to contribute positively to their tenants' health. 'New Home, New You' (NHNY) is a joint venture between a social housing association, a city council and a community healthcare provider in the South West of England. It was designed with the aim of improving the health and well-being of social housing tenants. OBJECTIVES The aim of this retrospective evaluation was to establish whether social housing tenants were benefiting from this health-related behavioural intervention in terms of their mental well-being and health-related behaviours. METHODS This was a mixed-methods evaluation. The outcome evaluation was a secondary analysis of quantitative data collected during the NHNY project. The process of delivering and receiving the intervention was evaluated using qualitative, semi-structured interviews with housing officers and tenants who had participated in the programme. The development of the intervention was evaluated through a focus group and additional semistructured interviews with key stakeholders. Quantitative data were analysed using the Statistical Package for the Social Sciences. Qualitative interviews were analysed using thematic analysis. RESULTS Six key stakeholders and a total of seven housing officers from several teams and seven tenants were interviewed. Of the 1016 tenants who were invited to participate in NHNY, 226 enroled in the programme. For participating tenants, the scope for health-related behaviour change was greatest in relation to eating and smoking. Small positive statistically significant changes in mental health were found between the 6- and 12-month mean score and between the baseline and the 12-month score. CONCLUSIONS The findings indicate that NHNY may have been beneficial for some participating tenants. Housing officers can have a significant role in promoting health messages and embedding behaviour change among their tenants. Although the programme was implemented as a service improvement rather than a controlled trial and focused on a particular intervention and geographical area, other housing associations may find this evaluation useful for considering whether to adopt some of the principles applied in NHNY in other settings. PATIENT OR PUBLIC CONTRIBUTION A social housing tenant representative provided input on the methodology and methods used to evaluate NHNY, as well as the information sheet.
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Affiliation(s)
- Martha Paisi
- School of Nursing and Midwifery, University of Plymouth, Plymouth, Devon, UK.,Peninsula Dental School, University of Plymouth, Plymouth, Devon, UK
| | - Zoe Allen
- Peninsula Dental School, University of Plymouth, Plymouth, Devon, UK
| | - Jill Shawe
- School of Nursing and Midwifery, University of Plymouth, Plymouth, Devon, UK
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Sanz-Remacha M, García-González L, Sevil Serrano J, Aibar Solana A. A Qualitative Evaluation of a Community-Based Intervention on Health-Related Behaviors in Disadvantaged Women. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2023; 94:272-282. [PMID: 35025722 DOI: 10.1080/02701367.2021.1971149] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/13/2021] [Indexed: 06/14/2023]
Abstract
Purpose: Grounded in social ecological model and self-determination theory, the aim of this study was to qualitatively evaluate the first and second year follow-ups of a community-based healthy lifestyle programme on health-related behaviors, and outcomes in disadvantaged adult women. Methods: Eleven disadvantaged adult women (M = 37.72; SD = 8.34) (seven of them from the Roma population) participated in this community-based participatory action research. Discussion groups, semi-structured interviews, and field notes were used to assess the effects of the intervention programme on health-related behaviors and health outcomes through thematic analysis. Results: Women perceived improvements in PA-related variables, healthy eating, and other health-related outcomes throughout two years. Most women mentioned these behavior changes in the first year, while others perceived them in the second year. Conclusions: These findings highlight the importance of developing contextual and culturally tailored interventions that address the specific problems and needs that emerge from ethnic groups. Given that some of these behavior changes were only mentioned by most of these women in the second year, long-term interventions seem to be ideally required in this population.
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Shier V, Miller S, Datar A. Heterogeneity in grocery shopping patterns among low-income minority women in public housing. BMC Public Health 2022; 22:1612. [PMID: 36002848 PMCID: PMC9404610 DOI: 10.1186/s12889-022-14003-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Public housing residents, who tend to be predominantly female and racial/ethnic minorities, are at a particularly high risk for chronic health conditions. Prior studies have suggested that a lack of access to healthy and affordable food may be an important barrier in public housing communities, but evidence is mixed on the association between the neighborhood food environment and dietary quality, suggesting the need to examine food access patterns in low-income, minority communities more deeply. The purpose of this study was to examine the variability in grocery shopping patterns, and the factors that predict them, among low-income minority women in public housing. METHODS Interviewer-administered surveys and body composition measurements were collected in the Watts Neighborhood Health Study, an ongoing longitudinal cohort study of low-income urban public housing residents located in South Los Angeles. Descriptive analyses were conducted to understand the variation in grocery shopping patterns among women. Logistic and ordered logistic regression models were estimated to examine the association between resident characteristics and grocery shopping patterns. RESULTS There was considerable variability in grocery shopping patterns, including the types of grocery stores accessed, distance travelled, frequency of shopping, and reasons behind grocery store choice. Grocery shopping patterns were associated with several participant characteristics, including race/ethnicity, working status, access to a car, income, and education. Hispanic participants were less likely to shop at a supermarket, travel further distances to shop, shop more frequently, and were more likely to prioritize price in their choice of primary grocery store than non-Hispanic Black women participants. CONCLUSIONS There was considerable variability in grocery shopping patterns, even within this low-income, minority community despite access to the same neighborhood food environment. Convenience and quality, in addition to price, were priorities for choice of primary grocery store, and differences by race/ethnicity suggest that initiatives to improve the neighborhood food environment should consider quality of food, cultural factors, and availability of foods desired by the surrounding community, in addition to price and proximity of grocery stores.
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Affiliation(s)
- Victoria Shier
- Price School of Public Policy, Schaeffer Center for Health Policy and Economics, University of Southern California, 635 Downey Way, Los Angeles, CA, 90089, USA.
| | - Sydney Miller
- Department of Population and Public Health Sciences, University of Southern California, 2001 N Soto St, Los Angeles, CA, 90033, USA
| | - Ashlesha Datar
- Center for Economic and Social Research, University of Southern California, 635 Downey Way, Los Angeles, CA, 90089, USA
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5
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de Albuquerque FM, Pessoa MC, De Santis Filgueiras M, Gardone DS, de Novaes JF. Retail food outlets and metabolic syndrome: a systematic review of longitudinal studies. Nutr Rev 2022; 80:1599-1618. [PMID: 35182145 DOI: 10.1093/nutrit/nuab111] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
CONTEXT The community food environment covers the type, quantity, density, location, and access to retail food outlets, and its influence on eating behavior, obesity, and metabolic syndrome has been investigated. OBJECTIVE To evaluate the evidence on longitudinal associations between objectively measured retail food outlets and metabolic syndrome components in children, adolescents, and adults. DATA EXTRACTION This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality and risk of bias were assessed with the Newcastle-Ottawa Scale. DATA SOURCES The Scopus, Embase, Web of Science, Scielo, PubMed, MEDLINE, and Lilacs databases were searched without any restriction on publication dates. DATA ANALYSIS Of the 18 longitudinal studies included, significant associations were reported in 9 between retail food outlets and metabolic syndrome components in adults (6 positive associations, 2 negative, and 1 both positive and negative), and in 3 studies of children and adolescents (2 negative associations and 1 both positive and negative). Six studies with adults found no association. CONCLUSION Limited evidence was found for longitudinal associations between retail food outlets and metabolic syndrome components. In future studies, researchers should consider the use of standardized retail food outlet measurements and accurate analysis to better understand the influence of the community food environment on metabolic syndrome. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no: CRD42020177137.
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Affiliation(s)
| | - Milene Cristine Pessoa
- Department of Nutrition, Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Danielle Soares Gardone
- Department of Nutrition, Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Juliana Farias de Novaes
- Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
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Jelalian E, Evans W, Darling KE, Seifer R, Vivier P, Goldberg J, Wright C, Tanskey L, Warnick J, Hayes J, Shepard D, Tuttle H, Elwy AR. Protocol for the Rhode Island CORD 3.0 Study: Adapting, Testing, and Packaging the JOIN for ME Family-Based Childhood Obesity Program in Low-Income Communities. Child Obes 2021; 17:S11-S21. [PMID: 34569839 PMCID: PMC8575054 DOI: 10.1089/chi.2021.0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Overweight and obesity in children is a public health crisis in the United States. Although evidence-based interventions have been developed, such programs are difficult to access. Dissemination of evidence-based pediatric weight management interventions (PWMIs) to families from diverse low-income communities is the primary objective of the CDC Childhood Obesity Research Demonstration (CORD) projects. Methods: The goal of the Rhode Island CORD 3.0 project is to adapt the evidence-based PWMI, JOIN for ME, for delivery among diverse families from low-income backgrounds and to test it in a hybrid effectiveness-implementation trial design in which the aims are to examine implementation and patient-centered outcomes. Children between the ages of 6 and 12 years with BMI ≥85th percentile and a caregiver will be recruited through two settings, a federally qualified health center, which serves as a patient-centered medical home, or low-income housing. Dyads will receive a remotely delivered group-based intervention that is 10 months in duration and includes 16 weekly sessions, followed by 4 biweekly and 4 monthly meetings. Assessments of child and caregiver weight status and child health-related quality of life will be conducted at baseline, and at 4 and 10 months after the start of intervention. Implementation outcomes assessing intervention acceptability, adoption, feasibility, fidelity, and penetration/reach will be collected to inform subsequent dissemination. Conclusions: If the adapted version of the JOIN for ME intervention can be successfully implemented and is shown to be effective, this project will provide a model for a scalable PWMI for families from low-income backgrounds. ClinicalTrials.gov no. NCT04647760.
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Affiliation(s)
- Elissa Jelalian
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA.,Address correspondence to: Elissa Jelalian, PhD, Weight Control and Diabetes Research Center, 196 Richmond Street, Providence, RI 02903, USA.
| | - Whitney Evans
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | - Katherine E. Darling
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | - Ronald Seifer
- Frank Porter Graham Child Development Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Patrick Vivier
- School of Public Health, Brown University, Providence, RI, USA
| | - Jeanne Goldberg
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
| | - Catherine Wright
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
| | | | - Jennifer Warnick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Jacqueline Hayes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | - Donald Shepard
- Heller School of Social Policy and Management, Brandeis University, Waltham, MA, USA
| | | | - A. Rani Elwy
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
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Marshall GL, Kahana E, Gallo WT, Stansbury KL, Thielke S. The price of mental well-being in later life: the role of financial hardship and debt. Aging Ment Health 2021; 25:1338-1344. [PMID: 32426995 DOI: 10.1080/13607863.2020.1758902] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study investigated the associations between various financial hardship and debt indicators and mental health status among older adults. METHODS Using data from the Health and Retirement Study (HRS), we considered the association between different forms of financial hardship and debt of those who were identified as having high levels of depressive symptoms (N = 7678) and anxiety (N = 8079). Financial hardship indicators: difficulty paying bills, food insecurity, and medication need; debt indicators: credit card and medical debt. Associations were tested using multiple logistic regression analyses and are reported as relative risk (RR) ratios and 95% confidence intervals (CIs). RESULTS Participants who had difficulty paying bills were more likely to have high levels of depressive symptoms (RR = 2.06, CI = 1.75-2.42, p < 0.001) and anxiety (RR = 1.46, CI = 1.02-2.05, p < 0.001) compared to those who did not have financial difficulty. Similarly, medical debt was associated with depressive symptoms (RR = 1.43, CI = 1.14-1.74, p < 0.01) and anxiety (RR = 1.20, CI = 0.96-1.50, p < 0.01). Credit card debt was not significantly associated with either mental health outcome. CONCLUSION Indicators of financial hardship and medical debt were associated with depressive symptoms and anxiety in a cohort of older adults. In contrast, the influence of credit card debt appeared to be more complex and vary by individual. These findings indicate that doing without meeting personal salient needs has a particularly adverse effect on psychological well-being.
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Affiliation(s)
| | - Eva Kahana
- Department of Sociology, Case Western Reserve University, Cleveland, OH, USA
| | - William T Gallo
- Department of Health Policy and Management, City University of New York, New York, NY, USA
| | - Kim L Stansbury
- Department of Social Work, North Carolina State University, Raleigh, NC, USA
| | - Stephen Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Geriatric Research, Education, and Clinical Center, Seattle VA Medical Center, Seattle, WA, USA
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8
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Pilot testing an intervention to educate and promote nutritious choices at food pantries. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01570-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Abstract
Aim
This study aimed to assess the impact of the Supporting Wellness at Pantries (SWAP) system on client food selections at a food pantry.
Subject and methods
In a pre–post comparison study design, a client-choice food pantry implemented SWAP by reorganizing its inventory to promote healthy options. Each product was ranked as “choose often” (green), “sometimes” (yellow), or “rarely” (red) based on saturated fat, sodium, and sugar. Signage was added to indicate each item’s SWAP rank and healthier foods were placed at eye level. Client food baskets were assessed at time 1 (n = 121) and time 2 (n = 101). The proportions of green and red foods selected were compared using regression analyses.
Results
The regression analyses showed that the proportion of green foods selected by clients increased by 11% (p < 0.001) and the proportion of red foods selected decreased by 7% (p < 0.001) after SWAP was implemented (n = 222).
Conclusions
SWAP has the potential to positively shift client choices among the items available in a food pantry setting. SWAP is one component of a suite of changes to the charitable food system that have the potential to alleviate food insecurity, improve diet quality, and assist clients in managing diet-related diseases.
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Evans EW, Lyerly R, Gans KM, Alexander Scott N, Cohen ED, Lawson E, Nunn A. Translating Research-Funded Mobile Produce Market Trials Into Sustained Public Health Programs : Food on the Move. Public Health Rep 2021; 137:425-430. [PMID: 33940983 PMCID: PMC9109519 DOI: 10.1177/00333549211012409] [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: 01/31/2023] Open
Abstract
Food on the Move is an ongoing mobile produce market program in Rhode Island whose operations evolved from previous mobile market programs evaluated by 2 research studies: (1) one on Fresh to You, a prospective cohort study evaluating markets at community sites serving low-income families; and (2) one on Live Well, Viva Bien, a cluster randomized controlled trial evaluating markets and complementary nutrition interventions at public housing sites. The 2 studies spanned more than a decade and demonstrated the effect of mobile produce markets on access to, affordability of, and consumption of fruit and vegetables in low-income communities in Rhode Island. When grant funding ended in 2016, academic and community partners continued the mobile market program as Food on the Move. The Rhode Island Public Health Institute adopted the program model and developed a business plan to maximize market efficiency. To address price as a barrier to buying fruit and vegetables, the Institute implemented an innovative incentive program for purchases made with Supplemental Nutrition Assistance Program (SNAP) benefits, funded by a federal Food Insecurity Nutrition Incentive grant program. In 2018, Food on the Move sold more than $160 000 in produce at 335 markets, more than $50 000 of which came from these SNAP incentive programs. For sustained change in communities, researchers and community partners need examples of how to translate findings from research trials into public health practice. Food on the Move serves as a case study for the successful transition of community-focused research into a sustainable and scalable evidence-based program.
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Affiliation(s)
- E. Whitney Evans
- The Weight Control and Diabetes Research Center, The Miriam
Hospital, Providence, RI, USA, Department of Psychiatry and Human Behavior, Alpert Medical
School, Brown University, Providence, RI, USA
| | - Reece Lyerly
- Rhode Island Public Health Institute, Providence, RI, USA, Gerald J. and Dorothy R. Friedman School of Nutrition Science
and Policy, Tufts University, Boston, MA, USA
| | - Kim M. Gans
- Center for Health Promotion and Health Equity, School of Public
Health, Brown University, Providence, RI, USA,Institute for Collaboration on Health, Interventions, and Policy,
University of Connecticut, Storrs, CT, USA
| | | | | | - Eliza Lawson
- Rhode Island Public Health Institute, Providence, RI, USA
| | - Amy Nunn
- Rhode Island Public Health Institute, Providence, RI, USA, Center for Health Promotion and Health Equity, School of Public
Health, Brown University, Providence, RI, USA,Amy Nunn, ScD, Rhode Island Public Health
Institute, 7 Central St, Providence, RI 02903, USA;
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10
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Dulin A, Mealy R, Whittaker S, Cardel M, Wang J, Risica PM, Gans K. Identifying Barriers to and Facilitators of Using a Mobile Fruit and Vegetable Market Intervention Delivered to Low-Income Housing Sites: A Concept Mapping Study. HEALTH EDUCATION & BEHAVIOR 2021; 49:159-168. [PMID: 33729024 DOI: 10.1177/1090198121998287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mobile fruit and vegetable (F&V) markets may be a promising strategy to improve F&V intake among low-income and racial/ethnic minority groups. However, challenges remain in terms of maximizing the reach and utilization of such markets. Therefore, this study identifies perceived barriers to and facilitators of utilizing a mobile F&V market among residents who lived in low-income housing that received the markets. Specifically, this article reports the results of the follow-up acceptability study of the "Live Well, Viva Bien" (LWVB) intervention. METHOD We conducted concept mapping with residents in housing communities that received the Fresh to You (FTY) markets. Participants generated, sorted, and rated statements concerning barriers to and facilitators of market use. We compared the rating data by residents' level of market utilization and created a map representing how statements clustered into conceptual themes. RESULTS We retained 66 unique participant-generated statements. Eight thematic clusters emerged; four pertained to barriers: financial/promotion, produce-related, scheduling/knowledge, and logistic/awareness barriers, and four related to facilitators: produce/staffing, promotion, accessibility, and multilevel market facilitators. There was a strong correlation in ratings between participants who more frequently versus less frequently shopped at the markets (r = 0.94). CONCLUSIONS Participants identified financial barriers, market promotion, ease of market accessibility, produce variety and quality, and staffing as key factors influencing FTY market use. This study highlights the importance of identifying the perceived barriers to and facilitators of mobile F&V market use among target populations to inform future efforts to scale up such approaches.
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Affiliation(s)
| | | | | | | | | | | | - Kim Gans
- University of Connecticut, Storrs, CT, USA
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11
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Rummo PE, Lyerly R, Rose J, Malyuta Y, Cohen ED, Nunn A. The impact of financial incentives on SNAP transactions at mobile produce markets. Int J Behav Nutr Phys Act 2021; 18:26. [PMID: 33557852 PMCID: PMC7871404 DOI: 10.1186/s12966-021-01093-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 01/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Offering financial incentives promotes increases in fruit and vegetable purchases in farmers' markets and supermarkets. Yet, little is understood about whether food-insecure adults purchase more fruits and vegetables as a result of receiving financial incentives in mobile produce market settings. METHODS In 2018-2019, Food on the Move provided a 50% discount to customers using Supplemental Nutrition Assistance Program (SNAP) benefits to purchase fruit and vegetables from 16 market locations in Rhode Island (n = 412 market occasions). We used mixed multivariable linear regression to estimate the difference in total dollar sales per transaction per month between SNAP transactions and non-SNAP transactions. We also estimated the difference in out-of-pocket dollar sales per transaction per month between SNAP and non-SNAP transactions, less the 50% discount. This reflects the actual amount spent on fresh fruits and vegetables purchased per visit. In both models, we controlled for the number of market sites per month, with fixed effects for quarter and year. We estimated random intercept variance for date of transaction and market site to adjust for clustering. RESULTS In 2018-2019, the majority of market transactions (total n = 13,165) were SNAP transactions [n = 7.988 (63.0%)]. On average, customers spent $17.38 (SD = 16.69) on fruits and vegetables per transaction per month. However, customers using SNAP benefits spent significantly more on FVs per transaction per month [$22.01 (SD = 17.97)] compared to those who did not use SNAP benefits [9.81 (SD = 10.68)] (β = $10.88; 95% CI: 10.18, 11.58). Similarly, out-of-pocket dollar sales per SNAP transaction per month (i.e., less the 50% discount) were significantly higher [$11.42 (SD = 9.44)] relative to non-SNAP transactions [$9.40 (SD = 9.33)] (β = $1.85; 95% CI: 1.44, 2.27). CONCLUSIONS Financial incentives contributed to higher fruit and vegetable purchases among low-income customers who shop at mobile produce markets by making produce more affordable. Higher spending on fruits and vegetables may promote healthy diet behaviors and reduce chronic disease risk among food-insecure adults.
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Affiliation(s)
- Pasquale E Rummo
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Reece Lyerly
- Rhode Island Public Health Institute, Providence, RI, USA.,Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | | | - Yelena Malyuta
- Rhode Island Public Health Institute, Providence, RI, USA
| | | | - Amy Nunn
- Rhode Island Public Health Institute, Providence, RI, USA. .,Center for Health Promotion and Health Equity, School of Public Health, Brown University, Providence, RI, USA.
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12
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Effectiveness of mobile produce markets in increasing access and affordability of fruits and vegetables among low-income seniors. Public Health Nutr 2020; 23:3226-3235. [PMID: 32886057 DOI: 10.1017/s1368980020002931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Mobile produce markets (MPM) offering Supplemental Nutrition Assistance Program (SNAP) incentive programmes have the potential to provide accessible and affordable fruits and vegetables (FV) to populations at risk of food insecurity. The objective of this study is to characterise the customer base of an MPM and describe their participation at twelve market sites serving low-income seniors. DESIGN In 2018, customers from an MPM in Rhode Island (RI) participated in a cross-sectional survey (n 330; 68 % response rate), which measured dietary patterns, food security and food shopping behaviours. We compared the shopping habits and market experiences of customers who currently received SNAP benefits with those who did not currently receive SNAP benefits. SETTING An MPM in RI which offers a 50 % discount for FV purchased with SNAP benefits. PARTICIPANTS This study describes current market customers at twelve market sites serving low-income seniors. RESULTS Market customers were mostly low-income, female, over the age of 50 years and Hispanic/Latino. Most customers received SNAP benefits, and almost half were food insecure. In addition, three quarters of SNAP customers reported their SNAP benefits last longer since shopping at the markets. Mixed logistic regression models indicated that SNAP customers were more likely to report buying and eating more FV than non-SNAP customers. CONCLUSIONS MPM are critical resources of affordable produce and have been successful in improving access to FV among individuals of low socio-economic status in RI. This case study can inform policy and programme recommendations for MPM and SNAP incentive programmes.
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13
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Russo R, Li Y, Chong S, Siscovick D, Trinh-Shevrin C, Yi S. Dietary policies and programs in the United States: A narrative review. Prev Med Rep 2020; 19:101135. [PMID: 32551216 PMCID: PMC7289763 DOI: 10.1016/j.pmedr.2020.101135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/14/2020] [Accepted: 05/23/2020] [Indexed: 01/18/2023] Open
Abstract
School-based and youth targeted programs and policies were most frequently studied. Research has rather neglected older adult, Asian, Native Hawaiian and American Indian populations. Despite existing research indicating effectiveness, faith-based were understudied.
Prior reviews describing approach, methodological quality and effectiveness of dietary policies and programs may be limited in use for practitioners seeking to introduce innovative programming, or academic researchers hoping to understand and address gaps in the current literature. This review is novel, assessing the “where, who, and in whom” of dietary policies and programs research in the United States over the past decade – with results intended to serve as a practical guide and foundation for innovation. This study was conducted from October 2018 to March 2019. Papers were selected through a tailored search strategy on PubMed as well as citation searches, to identify grey literature. A total of 489 papers were relevant to our research objective. The largest proportion of papers described school-based strategies (31%) or included economic incentives (19%). In papers that specified demographics, the study populations most often included children, adults and adolescents (54%, 46%, and 42% respectively); and White, Black and Hispanic populations (77%, 76% and 70%, respectively). Results highlight opportunities for future research within workplace and faith-based settings, among racial/ethnic minorities, and older adults.
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Affiliation(s)
- Rienna Russo
- NYU School of Medicine, Department of Population Health, New York, NY, United States
| | - Yan Li
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Medicine, New York, NY, United States
| | - Stella Chong
- NYU School of Medicine, Department of Population Health, New York, NY, United States
| | - David Siscovick
- New York Academy of Medicine, Center for Health Innovation, New York, NY, United States
| | - Chau Trinh-Shevrin
- NYU School of Medicine, Department of Population Health, New York, NY, United States
| | - Stella Yi
- NYU School of Medicine, Department of Population Health, New York, NY, United States
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Aktary ML, Caron-Roy S, Sajobi T, O'Hara H, Leblanc P, Dunn S, McCormack GR, Timmins D, Ball K, Downs S, Minaker LM, Nykiforuk CI, Godley J, Milaney K, Lashewicz B, Fournier B, Elliott C, Raine KD, Prowse RJ, Olstad DL. Impact of a farmers' market nutrition coupon programme on diet quality and psychosocial well-being among low-income adults: protocol for a randomised controlled trial and a longitudinal qualitative investigation. BMJ Open 2020; 10:e035143. [PMID: 32371514 PMCID: PMC7228519 DOI: 10.1136/bmjopen-2019-035143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/19/2020] [Accepted: 04/02/2020] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Low-income populations have poorer diet quality and lower psychosocial well-being than their higher-income counterparts. These inequities increase the burden of chronic disease in low-income populations. Farmers' market subsidies may improve diet quality and psychosocial well-being among low-income populations. In Canada, the British Columbia (BC) Farmers' Market Nutrition Coupon Programme (FMNCP) aims to improve dietary patterns and health among low-income participants by providing coupons to purchase healthy foods from farmers' markets. This study will assess the impact of the BC FMNCP on the diet quality and psychosocial well-being of low-income adults and explore mechanisms of programme impacts. METHODS AND ANALYSIS In a parallel group randomised controlled trial, low-income adults will be randomised to an FMNCP intervention (n=132) or a no-intervention control group (n=132). The FMNCP group will receive 16 coupon sheets valued at CAD$21/sheet over 10-15 weeks to purchase fruits, vegetables, dairy, meat/poultry/fish, eggs, nuts and herbs at farmers' markets and will be invited to participate in nutrition skill-building activities. Overall diet quality (primary outcome), diet quality subscores, mental well-being, sense of community, food insecurity and malnutrition risk (secondary outcomes) will be assessed at baseline, immediately post-intervention and 16 weeks post-intervention. Dietary intake will be assessed using the Automated Self-Administered 24-hour Dietary Recall. Diet quality will be calculated using the Healthy Eating Index-2015. Repeated measures mixed-effect regression will assess differences in outcomes between groups from baseline to 16 weeks post-intervention. Furthermore, 25-30 participants will partake in semi-structured interviews during and 5 weeks after programme completion to explore participants' experiences with and perceived outcomes from the programme. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Calgary Conjoint Health Research Ethics Board, Rutgers University Ethics and Compliance, and University of Waterloo Office of Research Ethics. Findings will be disseminated through policy briefs, conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT03952338.
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Affiliation(s)
- Michelle L Aktary
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Tolulope Sajobi
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Heather O'Hara
- British Columbia Association of Farmers' Markets, Vancouver, British Columbia, Canada
| | - Peter Leblanc
- British Columbia Association of Farmers' Markets, Vancouver, British Columbia, Canada
| | - Sharlette Dunn
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Gavin R McCormack
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
- School of Architecture, Planning and Landscape, University of Calgary, Calgary, Alberta, Canada
| | - Dianne Timmins
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kylie Ball
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, Victoria, Australia
| | - Shauna Downs
- School of Public Health, Rutgers University, Newark, New Jersey, USA
| | - Leia M Minaker
- School of Planning, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Jenny Godley
- Department of Sociology, University of Calgary, Calgary, Alberta, Canada
| | - Katrina Milaney
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Bonnie Lashewicz
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Bonnie Fournier
- School of Nursing, Thompson Rivers University, Kamloops, British Columbia, Canada
| | - Charlene Elliott
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Communication Media and Film, University of Calgary, Calgary, Alberta, Canada
| | - Kim D Raine
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Rachel Jl Prowse
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Dana Lee Olstad
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
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15
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Hernández D. Housing-Based Health Interventions: Harnessing the Social Utility of Housing to Promote Health. Am J Public Health 2019; 109:S135-S136. [PMID: 30785797 DOI: 10.2105/ajph.2018.304914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Diana Hernández
- Diana Hernández is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
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16
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Hsiao BS, Sibeko L, Troy LM. A Systematic Review of Mobile Produce Markets: Facilitators and Barriers to Use, and Associations with Reported Fruit and Vegetable Intake. J Acad Nutr Diet 2019; 119:76-97.e1. [DOI: 10.1016/j.jand.2018.02.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 02/27/2018] [Indexed: 11/28/2022]
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Gans KM, Risica PM, Keita AD, Dionne L, Mello J, Stowers KC, Papandonatos G, Whittaker S, Gorham G. Multilevel approaches to increase fruit and vegetable intake in low-income housing communities: final results of the 'Live Well, Viva Bien' cluster-randomized trial. Int J Behav Nutr Phys Act 2018; 15:80. [PMID: 30126463 PMCID: PMC6102886 DOI: 10.1186/s12966-018-0704-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 07/20/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Fruit and vegetable (F&V) intake can reduce risks for chronic disease, but is much lower than recommended amounts in most Western populations, especially for those with low income levels. Rigorous research is needed on practical, cost-effective interventions that address environmental as well as personal determinants of F&V intake. This paper presents the results of a cluster randomized controlled trial evaluating the efficacy of 'Live Well, Viva Bien' (LWVB), a multicomponent intervention that included discount, mobile fresh F&V markets in conjunction with nutrition education. METHODS Fifteen subsidized housing sites in Providence County, Rhode Island (8 intervention and 7 control sites) were randomized using a random number generator. Of these, nine housed elderly and/or disabled residents and six housed families. A total of 1597 adult housing site residents (treatment n = 837; control n = 760) were enrolled (73% women, 54% Hispanic, 17% black, Mean age 54 years). A year-long multicomponent intervention including mobile F&V markets plus nutrition education (e.g. campaigns, DVDs, newsletters, recipes, and chef demonstrations) was implemented at intervention sites. Physical activity and stress interventions were implemented at control sites. Follow-up occurred at 6 and 12 months. The main outcome measure was F&V consumption measured by National Cancer Institute's 'Eating at America's Table All Day Screener'. RESULTS From baseline to 12 months, the intervention group increased total F&V intake by 0.44 cups with the control group decreasing intake by 0.08 cups (p < .02). Results also showed an increased frequency of F&V eating behaviors compared to the control group (p < .01). There was a clear dose response effect of the F&V markets with participants who reported attending all or most of the markets increasing F&V intake by 2.1 cups and 0.86 cups, respectively compared with less than half cup increases for lower levels of market attendance (p < .05). Use of the DVDs, recipes and taste-testings was also associated with greater increases in F&V intake; however, use of other educational components was not. CONCLUSIONS LWVB is the first cluster, randomized controlled trial to demonstrate the efficacy of year-round F&V markets on improving F&V intake for low-income adults, which provides an evidence-base to bolster the mission of mobile produce markets. Further, the results more broadly support investment in environmental changes to alleviate disparities in F&V consumption and diet-related health inequities. TRIAL REGISTRATION NUMBER Clinicatrials.gov registration number: NCT02669472.
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Affiliation(s)
- Kim M. Gans
- Department of Human Development and Family Studies, University of Connecticut, Storrs, USA
- University of Connecticut Intitute for Collaboration in Health, Interventions and Policy, Storrs, USA
- Center for Health Equity Research, Brown University School of Public Health, Providence, USA
- Deartment of Behavioral and Social Science, Brown University School of Public Health, Providence, USA
| | - Patricia Markham Risica
- Center for Health Equity Research, Brown University School of Public Health, Providence, USA
- Deartment of Behavioral and Social Science, Brown University School of Public Health, Providence, USA
| | - Akilah Dulin Keita
- Center for Health Equity Research, Brown University School of Public Health, Providence, USA
- Deartment of Behavioral and Social Science, Brown University School of Public Health, Providence, USA
| | - Laura Dionne
- Center for Health Equity Research, Brown University School of Public Health, Providence, USA
| | - Jennifer Mello
- Center for Health Equity Research, Brown University School of Public Health, Providence, USA
| | - Kristen Cooksey Stowers
- University of Connecticut Intitute for Collaboration in Health, Interventions and Policy, Storrs, USA
- University of Connecticut Rudd Center for Food Policy and Obesity, Hartford, USA
| | - George Papandonatos
- Department of Statistical Scieces, Brown University School of Public Health, Providence, USA
| | | | - Gemma Gorham
- Department of Human Development and Family Studies, University of Connecticut, Storrs, USA
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18
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Vadiveloo M, Principato L, Morwitz V, Mattei J. Sensory variety in shape and color influences fruit and vegetable intake, liking, and purchase intentions in some subsets of adults: a randomized pilot experiment. Food Qual Prefer 2018; 71:301-310. [PMID: 31105386 DOI: 10.1016/j.foodqual.2018.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Dietary variety increases food intake, but it is unclear if sensory differences elicit increases in eating-related behaviors. Using a 4×3 between-subject pilot experiment, we examined if increasing sensory variety (control, color, shape, both color and shape) and priming individuals to notice differences or similarities in the foods (positive, neutral, negative) influenced ad libitum proximal intake, liking, and willingness to purchase pears and peppers among 164 Greater Boston adults >18y/o. MANOVA was used to examine associations between sensory variety (independent variable) and six dependent measures. We tested for interactions between sensory variety condition and individual-level factors that may influence food intake. There was no main effect of sensory variety condition for any dependent measure. However, interactions between sensory variety condition and age, overweight status, and prime were detected. Adults with overweight (vs. adults of normal weight) ate more pear with color variety (7.2 vs. 4.4 oz, p=0.01). Pear intake was also higher among adults with overweight in the color variety (7.2 oz) vs. combination variety (4.4 oz) condition. Adults ≥36y/o ate more peppers (3.5 oz) in the color variety condition versus other conditions (2.1-2.2 oz, p=0.04). Participants primed to notice differences were more willing to purchase pears in the color variety (5.0 ± 0.5) versus control (3.7 ± 0.5) condition. Color variety may modestly increase proximal intake, liking, and purchase intentions for fruits and vegetables in some subsets of adults. Our preliminary findings encourage more research to determine if color variety can be used to improve diet quality of targeted populations.
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Affiliation(s)
- Maya Vadiveloo
- Harvard T.H. Chan School of Public Health, Department of Nutrition, 665 Huntington Ave, Bldg 2, Boston, MA 02115, USA
| | - Ludovica Principato
- Rome Tre University, Department of Business Studies, Via Silvio D'Amico, 77, 00145 Rome, Italy
| | - Vicki Morwitz
- New York University, Stern School of Business, 40 West 4th Street, Room 807, New York, NY 10012, USA
| | - Josiemer Mattei
- Harvard T.H. Chan School of Public Health, Department of Nutrition, 665 Huntington Ave, Bldg 2, Boston, MA 02115, USA
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Bowen DJ, Quintiliani LM, Bhosrekar SG, Goodman R, Smith E. Changing the housing environment to reduce obesity in public housing residents: a cluster randomized trial. BMC Public Health 2018; 18:883. [PMID: 30012120 PMCID: PMC6048807 DOI: 10.1186/s12889-018-5777-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 06/28/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Public housing residents face significant social, economic, and physical barriers to the practice of health behaviors for prevention of chronic disease. Research shows that public housing residents are more likely to report higher rates of obesity, current smoking, disability, and insufficient physical activity compared to individuals not living in public housing. Because these behaviors and conditions may be shaped by the built and social environments in which they live, we conducted a study to test an environmental level diet and physical activity intervention targeting obesity among urban public housing developments. METHODS This study was a cluster randomized controlled trial of public housing developments, the unit of analysis and randomization. A total of 10 public housing developments were recruited and subsequently randomized to either receive the intervention package or to serve as comparison sites. The year-long intervention included components to change the dietary and physical activity-related environments of the developments. Surveys at baseline and one-year follow-up provided data on changes in behaviors and weight from participants in both intervention and control developments. RESULTS Intervention participants significantly changed their eating and activity behaviors and body weight from baseline to one-year follow-up (p's < .05) while comparison participants reported no significant changes in any study variable. CONCLUSIONS These data provide initial support for the idea that interventions targeting the environment of public housing developments can assist residents to change unhealthy behaviors and can possibly reduce the high levels of chronic disease among public housing residents.
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Affiliation(s)
- Deborah J. Bowen
- University of Washington, 1959 Pacific Street NE, Box 357120, Seattle, WA 98195 USA
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20
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Leone LA, Tripicchio GL, Haynes-Maslow L, McGuirt J, Grady Smith JS, Armstrong-Brown J, Kowitt SD, Gizlice Z, Ammerman AS. A Cluster-Randomized Trial of a Mobile Produce Market Program in 12 Communities in North Carolina: Program Development, Methods, and Baseline Characteristics. J Acad Nutr Diet 2018; 119:57-68. [PMID: 29945851 DOI: 10.1016/j.jand.2018.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 04/15/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mobile markets are an increasingly popular method for providing access to fresh fruits and vegetables (F/V) in underserved communities; however, evaluation of these programs is limited, as are descriptions of their development, study designs, and needs of the populations they serve. OBJECTIVE Our aim was to describe the development and theoretical basis for Veggie Van (VV), a mobile produce market intervention, the study design for the VV evaluation, and baseline characteristics of the study population. DESIGN The protocol and sample for a cluster-randomized controlled trial with 12 sites are described. PARTICIPANTS/SETTING Community partner organizations in the Triangle region of North Carolina that primarily served lower-income families or were located in areas that had limited access to fresh produce were recruited. Eligible individuals at each site (older than 18 years of age, self-identified as the main shoppers for their household, and expressed interest in using a mobile market) were targeted for enrollment. A total of 201 participants at 12 sites participated in the VV program and evaluation, which was implemented from November 2013 to March 2016. MAIN OUTCOME MEASURES Change in F/V intake (cups/day), derived from self-reported responses to the National Cancer Institute F/V screener, was the main outcome measure. STATISTICAL ANALYSES PERFORMED We performed a descriptive analysis of baseline sample characteristics. RESULTS Mean reported F/V intake was 3.4 cups/day. Participants reported generally having some access to fresh F/V, and 57.7% agreed they could afford enough F/V to feed their family. The most frequently cited barriers were cost (55.7%) and time to prepare F/V (20.4%). Self-efficacy was lowest for buying more F/V than usual and trying new vegetables. CONCLUSIONS By addressing cost and convenience and building skills for purchasing and preparing F/V, the VV has the potential to improve F/V consumption in underserved communities.
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Dulin A, Risica PM, Mello J, Ahmed R, Carey KB, Cardel M, Howe CJ, Nadimpalli S, Gans KM. Examining neighborhood and interpersonal norms and social support on fruit and vegetable intake in low-income communities. BMC Public Health 2018; 18:455. [PMID: 29621989 PMCID: PMC5887203 DOI: 10.1186/s12889-018-5356-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 03/22/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND We examined whether neighborhood-, friend-, and family- norms and social support for consumption and purchase of fruits and vegetables (F&V) were associated with F&V intake among low-income residents in subsidized housing communities. We examined baseline data from a study ancillary to the Live Well/Viva Bien intervention. Participants included 290 residents in four low-income subsidized housing sites who were ≥ 18 years of age, English and/or Spanish speaking, and without medical conditions that prevented consumption of F&V. METHODS Linear regression models examined associations of norms and social support with F&V intake after adjustments for sociodemographic characteristics. RESULTS In the analysis, neighborhood social support for F&V was associated with a 0.31 cup increase in F&V intake (95% CI = 0.05, 0.57). The family norm for eating F&V and family social support for eating F&V were associated with a 0.32 cup (95% CI = 0.13, 0.52) and 0.42 cup (95% CI = 0.19, 0.64) increase in F&V intake, respectively. CONCLUSIONS To our knowledge, no other studies have examined neighborhood, family, and peer norms and social support simultaneously and in relation to F&V intake. These findings may inform neighborhood interventions and community-level policies to reduce neighborhood disparities in F&V consumption.
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Affiliation(s)
- Akilah Dulin
- Behavioral and Social Sciences, Center for Health Equity Research, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA.
| | - Patricia M Risica
- Behavioral and Social Sciences, Center for Health Equity Research, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA
| | - Jennifer Mello
- Center for Health Equity Research, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA
| | - Rashid Ahmed
- Center for Health Equity Research, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA
| | - Kate B Carey
- Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-5, Providence, RI, 02912, USA
| | - Michelle Cardel
- Health Outcomes and Policy, Institute for Child Health Policy, University of Florida, 2197 Mowry Road, 132, PO Box 100177, Gainsville, FL, 32610, USA
| | - Chanelle J Howe
- Epidemiology, Brown University School of Public Health, Box G-S121-2, Providence, RI, 02912, USA
| | - Sarah Nadimpalli
- Center for Health Equity Research, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA
| | - Kim M Gans
- Human Development and Family Studies, University of Connecticut, 348 Mansfield Road, Unit 1058, Room 320, Storrs, CT, 06269, USA
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Leone LA, Tripicchio GL, Haynes-Maslow L, McGuirt J, Grady Smith JS, Armstrong-Brown J, Gizlice Z, Ammerman A. Cluster randomized controlled trial of a mobile market intervention to increase fruit and vegetable intake among adults in lower-income communities in North Carolina. Int J Behav Nutr Phys Act 2018; 15:2. [PMID: 29304862 PMCID: PMC5756418 DOI: 10.1186/s12966-017-0637-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 12/18/2017] [Indexed: 11/15/2022] Open
Abstract
Background Poorer diets and subsequent higher rates of chronic disease among lower-income individuals may be partially attributed to reduced access to fresh fruits and vegetables (F&V) and other healthy foods. Mobile markets are an increasingly popular method for providing access to F&V in underserved communities, but evaluation efforts are limited. The purpose of this study was to determine the impact of Veggie Van (VV), a mobile produce market, on F&V intake in lower-income communities using a group randomized controlled trial. Methods VV is a mobile produce market that sells reduced-cost locally grown produce and offers nutrition and cooking education. We recruited 12 sites in lower-income communities in North Carolina (USA) to host VV, randomizing them to receive VV immediately (intervention) or after the 6-month study period (delayed intervention control). Participants at each site completed baseline and follow-up surveys including F&V intake, perceived access to fresh F&V and self-efficacy for purchasing, preparing and eating F&V. We used multiple linear regression to calculate adjusted differences in outcomes while controlling for baseline values, education and clustering within site. Results Among 142 participants who completed the follow-up, baseline F&V intake was 3.48 cups/day for control and 3.33 for intervention. At follow-up, adjusted change in F&V consumption was 0.95 cups/day greater for intervention participants (p = 0.005), but was attenuated to 0.51 cups per day (p = 0.11) after removing extreme values. VV customers increased their F&V consumption by 0.41 cups/day (n = 30) compared to a 0.25 cups/day decrease for 111 non-customers (p = 0.04). Intervention participants did not show significant improvements in perceived access to fresh F&V, but increased their self-efficacy for working more F&V into snacks (p = 0.02), making up a vegetable dish with what they had on hand (p = 0.03), and cooking vegetables in a way that is appealing to their family (p = 0.048). Conclusions Mobile markets may help improve F&V intake in lower-income communities. Trial registration Clinicaltrials.gov ID# NCT03026608 retrospectively registered January 2, 2017. Electronic supplementary material The online version of this article (10.1186/s12966-017-0637-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lucia A Leone
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA.
| | - Gina L Tripicchio
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lindsey Haynes-Maslow
- Department of Agricultural and Human Sciences, North Carolina State University, Raleigh, NC, USA
| | - Jared McGuirt
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jacqueline S Grady Smith
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Ziya Gizlice
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alice Ammerman
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Ashe KM, Lapane KL. Food Insecurity and Obesity: Exploring the Role of Social Support. J Womens Health (Larchmt) 2017; 27:651-658. [PMID: 29182494 DOI: 10.1089/jwh.2017.6454] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Women are disproportionately affected by both obesity and food insecurity. Food insecurity occurs when there is limited ability to acquire adequate foods. It is unknown whether social support can reduce the effect of food insecurity on increased obesity. This study seeks to determine whether social support modifies the relationship between food insecurity and obesity. METHODS We conducted a cross-sectional study in a nationally representative sample of 4672 women aged ≥40 years using National Health and Nutrition Examination Survey (2003-2008). Individual food insecurity was assessed based on the U.S. Department of Agriculture 18-item validated household food security scale. Women were categorized as fully food secure (0 affirmative responses) or food insecure (1-10 affirmative responses). Obesity was defined as body mass index ≥30 kg/m2. Outcomes were analyzed by multivariable logistic regression. RESULTS Fourteen percent were food insecure. Women with food insecurity had 1.4 the odds of obesity as those who were fully food secure, adjusting for race/ethnicity and health status (95% confidence interval [CI] 1.22-1.62). Food-insecure women were 80% less likely to report strong social support than women who were fully food secure (95% CI 0.11-0.36). Social support as measured in this study did not modify the association between food insecurity and obesity. CONCLUSIONS Women reporting food insecurity reported lower levels of social support and were more likely to experience obesity. Interventions to reduce obesity in women who are food insecure must consider the limited resources available to these women.
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Affiliation(s)
- Karen M Ashe
- 1 Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School , Worcester, MA
| | - Kate L Lapane
- 2 Quantitative Health Sciences, University of Massachusetts Medical School , Worcester, MA
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Noonan D, Hartman AM, Briggs J, Biederman DJ. Collaborating with Public Housing Residents and Staff to Improve Health: A Mixed-Methods Analysis. J Community Health Nurs 2017; 34:203-213. [PMID: 29023160 DOI: 10.1080/07370016.2017.1369810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study described the health behaviors and barriers and facilitators of those behaviors in elderly and/or disabled residents of public housing. A mixed-methods design was used. Residents (N = 88) completed a survey with validated measures of health behaviors. A sub-sample (N = 16) participated in three focus groups. Residents scored worse than population norms on the majority of behaviors measured. Qualitative results framed in an ecological model indicated the majority of facilitators and barriers to health behaviors were perceived as occurring at the intrapersonal and interpersonal levels. Interventions to promote health should consider the unique barriers and facilitators to health behaviors among residents.
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Affiliation(s)
- Devon Noonan
- a School of Nursing, Duke University , Durham , North Carolina
| | | | - Joyce Briggs
- b Durham Housing Authority , Durham , North Carolina
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Houle J, Coulombe S, Radziszewski S, Leloup X, Saïas T, Torres J, Morin P. An intervention strategy for improving residential environment and positive mental health among public housing tenants: rationale, design and methods of Flash on my neighborhood! BMC Public Health 2017; 17:737. [PMID: 28946855 PMCID: PMC5613323 DOI: 10.1186/s12889-017-4730-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Canada, public housing programs are an important part of governmental strategies to fight poverty and public exclusion. The Flash on my neighborhood! project is a four-year multiphase community-based participatory action research strategy currently implemented in six public housing developments (n = 1009 households) across the province of Québec, Canada. The goal is to reduce the mental health disparities faced by these public housing tenants compared to the general population, while identifying which environmental and policy changes are needed to turn public housing settings into healthier environments. METHODS The protocol involves three successive, interconnected phases: 1) Strengths and needs assessment, including community outreach and recruitment of tenants to collaborate as peer researchers, an exploratory qualitative component (photovoice), a systematic neighborhood observation, and a household survey; 2) Action plan development, including a community forum and interactive capacity-building and discussion sessions; 3) Action plan implementation and monitoring. The entire intervention is evaluated using a mixed-method design, framed within a multiple case study perspective. Throughout the project and particularly in the evaluation phase, data will be collected to record a) contextual factors (tenants' previous experience of participation, history of public housing development, etc.); b) activities that took place and elements from the action plan that were implemented; and c) short- and medium-term outcomes (objective and perceived improvements in the quality of the residential setting, both physically and in terms of mental health and social capital). DISCUSSION The study will provide unprecedented evidence-based information on the key ingredients of a collective intervention process associated with the increased collective empowerment and positive mental health of public housing tenants.
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Affiliation(s)
- Janie Houle
- Department of Psychology, Université du Québec à Montréal, C.P. 8888, succ. Centre-ville, Montréal, Québec H3C 3P8 Canada
| | - Simon Coulombe
- Department of Psychology, Wilfrid Laurier University, Waterloo, Canada
| | - Stephanie Radziszewski
- Department of Psychology, Université du Québec à Montréal, C.P. 8888, succ. Centre-ville, Montréal, Québec H3C 3P8 Canada
| | - Xavier Leloup
- Institut national de la recherche scientifique, Centre Urbanisation Culture Société, Montreal, Canada
| | - Thomas Saïas
- Department of Psychology, Université du Québec à Montréal, C.P. 8888, succ. Centre-ville, Montréal, Québec H3C 3P8 Canada
| | - Juan Torres
- Urban planning, Université de Montréal, Montréal, Canada
| | - Paul Morin
- Social Work, Université de Sherbrooke, Sherbrooke, Canada
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Mosdøl A, Lidal IB, Straumann GH, Vist GE. Targeted mass media interventions promoting healthy behaviours to reduce risk of non-communicable diseases in adult, ethnic minorities. Cochrane Database Syst Rev 2017; 2:CD011683. [PMID: 28211056 PMCID: PMC6464363 DOI: 10.1002/14651858.cd011683.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Physical activity, a balanced diet, avoidance of tobacco exposure, and limited alcohol consumption may reduce morbidity and mortality from non-communicable diseases (NCDs). Mass media interventions are commonly used to encourage healthier behaviours in population groups. It is unclear whether targeted mass media interventions for ethnic minority groups are more or less effective in changing behaviours than those developed for the general population. OBJECTIVES To determine the effects of mass media interventions targeting adult ethnic minorities with messages about physical activity, dietary patterns, tobacco use or alcohol consumption to reduce the risk of NCDs. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, ERIC, SweMed+, and ISI Web of Science until August 2016. We also searched for grey literature in OpenGrey, Grey Literature Report, Eldis, and two relevant websites until October 2016. The searches were not restricted by language. SELECTION CRITERIA We searched for individual and cluster-randomised controlled trials, controlled before-and-after studies (CBA) and interrupted time series studies (ITS). Relevant interventions promoted healthier behaviours related to physical activity, dietary patterns, tobacco use or alcohol consumption; were disseminated via mass media channels; and targeted ethnic minority groups. The population of interest comprised adults (≥ 18 years) from ethnic minority groups in the focal countries. Primary outcomes included indicators of behavioural change, self-reported behavioural change and knowledge and attitudes towards change. Secondary outcomes were the use of health promotion services and costs related to the project. DATA COLLECTION AND ANALYSIS Two authors independently reviewed the references to identify studies for inclusion. We extracted data and assessed the risk of bias in all included studies. We did not pool the results due to heterogeneity in comparisons made, outcomes, and study designs. We describe the results narratively and present them in 'Summary of findings' tables. We judged the quality of the evidence using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology. MAIN RESULTS Six studies met the inclusion criteria, including three RCTs, two cluster-RCTs and one ITS. All were conducted in the USA and comprised targeted mass media interventions for people of African descent (four studies), Spanish-language dominant Latino immigrants (one study), and Chinese immigrants (one study). The two latter studies offered the intervention in the participants' first language (Spanish, Cantonese, or Mandarin). Three interventions targeted towards women only, one pregnant women specifically. We judged all studies as being at unclear risk of bias in at least one domain and three studies as being at high risk of bias in at least one domain.We categorised the findings into three comparisons. The first comparison examined mass media interventions targeted at ethnic minorities versus an equivalent mass media intervention intended for the general population. The one study in this category (255 participants of African decent) found little or no difference in effect on self-reported behavioural change for smoking and only small differences in attitudes to change between participants who were given a culturally specific smoking cessation booklet versus a booklet intended for the general population. We are uncertain about the effect estimates, as assessed by the GRADE methodology (very low quality evidence of effect). No study provided data for indicators of behavioural change or adverse effects.The second comparison assessed targeted mass media interventions versus no intervention. One study (154 participants of African decent) reported effects for our primary outcomes. Participants in the intervention group had access to 12 one-hour live programmes on cable TV and received print material over three months regarding nutrition and physical activity to improve health and weight control. Change in body mass index (BMI) was comparable between groups 12 months after the baseline (low quality evidence). Scores on a food habits (fat behaviours) and total leisure activity scores changed favourably for the intervention group (very low quality evidence). Two other studies exposed entire populations in geographical areas to radio advertisements targeted towards African American communities. Authors presented effects on two of our secondary outcomes, use of health promotion services and project costs. The campaign message was to call smoking quit lines. The outcome was the number of calls received. After one year, one study reported 18 calls per estimated 10,000 targeted smokers from the intervention communities (estimated target population 310,500 persons), compared to 0.2 calls per estimated 10,000 targeted smokers from the control communities (estimated target population 331,400 persons) (moderate quality evidence). The ITS study also reported an increase in the number of calls from the target population during campaigns (low quality evidence). The proportion of African American callers increased in both studies (low to very low quality evidence). No study provided data on knowledge and attitudes for change and adverse effects. Information on costs were sparse.The third comparison assessed targeted mass media interventions versus a mass media intervention plus personalised content. Findings are based on three studies (1361 participants). Participants in these comparison groups received personal feedback. Two of the studies recorded weight changes over time. Neither found significant differences between the groups (low quality evidence). Evidence on behavioural changes, and knowledge and attitudes typically found some effects in favour of receiving personalised content or no significant differences between groups (very low quality evidence). No study provided data on adverse effects. Information on costs were sparse. AUTHORS' CONCLUSIONS The available evidence is inadequate for understanding whether mass media interventions targeted toward ethnic minority populations are more effective in changing health behaviours than mass media interventions intended for the population at large. When compared to no intervention, a targeted mass media intervention may increase the number of calls to smoking quit line, but the effect on health behaviours is unclear. These studies could not distinguish the impact of different components, for instance the effect of hearing a message regarding behavioural change, the cultural adaptation to the ethnic minority group, or increase reach to the target group through more appropriate mass media channels. New studies should explore targeted interventions for ethnic minorities with a first language other than the dominant language in their resident country, as well as directly compare targeted versus general population mass media interventions.
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Affiliation(s)
- Annhild Mosdøl
- Norwegian Institute of Public HealthKnowledge Centre for the Health ServicesPO BOX 4404 NydalenOsloNorway
| | - Ingeborg B Lidal
- Norwegian Institute of Public HealthKnowledge Centre for the Health ServicesPO BOX 4404 NydalenOsloNorway
- Sunnaas Rehabilitation HospitalTRS National Resource Centre for Rare DisordersNesoddtangenNorway1450
| | - Gyri H Straumann
- Norwegian Institute of Public HealthKnowledge Centre for the Health ServicesPO BOX 4404 NydalenOsloNorway
| | - Gunn E Vist
- Norwegian Knowledge Centre for the Health ServicesPrevention, Health Promotion and Organisation UnitPO Box 7004St Olavs PlassOsloNorway0130
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Stevens J, Pratt C, Boyington J, Nelson C, Truesdale KP, Ward DS, Lytle L, Sherwood NE, Robinson TN, Moore S, Barkin S, Cheung YK, Murray DM. Multilevel Interventions Targeting Obesity: Research Recommendations for Vulnerable Populations. Am J Prev Med 2017; 52:115-124. [PMID: 28340973 PMCID: PMC5571824 DOI: 10.1016/j.amepre.2016.09.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/18/2016] [Accepted: 09/06/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The origins of obesity are complex and multifaceted. To be successful, an intervention aiming to prevent or treat obesity may need to address multiple layers of biological, social, and environmental influences. METHODS NIH recognizes the importance of identifying effective strategies to combat obesity, particularly in high-risk and disadvantaged populations with heightened susceptibility to obesity and subsequent metabolic sequelae. To move this work forward, the National Heart, Lung, and Blood Institute, in collaboration with the NIH Office of Behavioral and Social Science Research and NIH Office of Disease Prevention convened a working group to inform research on multilevel obesity interventions in vulnerable populations. The working group reviewed relevant aspects of intervention planning, recruitment, retention, implementation, evaluation, and analysis, and then made recommendations. RESULTS Recruitment and retention techniques used in multilevel research must be culturally appropriate and suited to both individuals and organizations. Adequate time and resources for preliminary work are essential. Collaborative projects can benefit from complementary areas of expertise and shared investigations rigorously pretesting specific aspects of approaches. Study designs need to accommodate the social and environmental levels under study, and include appropriate attention given to statistical power. Projects should monitor implementation in the multiple venues and include a priori estimation of the magnitude of change expected within and across levels. CONCLUSIONS The complexity and challenges of delivering interventions at several levels of the social-ecologic model require careful planning and implementation, but hold promise for successful reduction of obesity in vulnerable populations.
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Affiliation(s)
- June Stevens
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Charlotte Pratt
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Josephine Boyington
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Cheryl Nelson
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Kimberly P Truesdale
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Dianne S Ward
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Leslie Lytle
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nancy E Sherwood
- HealthPartners Institute for Education and Research, Bloomington, Minnesota
| | - Thomas N Robinson
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California; Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Shirley Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Shari Barkin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ying Kuen Cheung
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - David M Murray
- Division of Program Coordination, Planning, and Strategic Initiatives, NIH, Bethesda, Maryland
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