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Garrity K, Krzyzanowski Guerra K, Hart H, Al-Muhanna K, Kunkler EC, Braun A, Poppe KI, Johnson K, Lazor E, Liu Y, Garner JA. Local Food System Approaches to Address Food and Nutrition Security among Low-Income Populations: A Systematic Review. Adv Nutr 2024; 15:100156. [PMID: 38616069 PMCID: PMC11031423 DOI: 10.1016/j.advnut.2023.100156] [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: 07/08/2023] [Revised: 10/20/2023] [Accepted: 11/14/2023] [Indexed: 04/16/2024] Open
Abstract
Food and nutrition insecurity disproportionately impact low-income households in the United States, contributing to higher rates of chronic diseases among this population. Addressing this challenge is complex because of various factors affecting the availability and accessibility of nutritious food. Short value chain (SVC) models, informally known as local food systems, offer a systemic approach that aims to optimize resources and align values throughout and beyond the food supply chain. Although specific SVC interventions, such as farmers markets, have been studied individually, a comprehensive review of SVC models was pursued to evaluate their relative impact on food security, fruit and vegetable intake, diet quality, health-related markers, and barriers and facilitators to participation among low-income households. Our systematic literature search identified 37 articles representing 34 studies from 2000-2020. Quantitative, qualitative, and mixed-method studies revealed that farmers market interventions had been evaluated more extensively than other SVC models (i.e., produce prescription programs, community-supported agriculture, mobile markets, food hubs, farm stands, and farm-to-school). Fruit and vegetable intake was the most measured outcome; other outcomes were less explored or not measured at all. Qualitative insights highlighted common barriers to SVC use, such as lack of program awareness, limited accessibility, and cultural incongruence, whereas facilitators included health-promoting environments, community cohesion, financial incentives, and high-quality produce. Social marketing and dynamic nutrition education appeared to yield positive program outcomes. Financial incentives were used in many studies, warranting further investigation into optimal amounts across varying environmental contexts. SVC models are increasingly germane to national goals across the agriculture, social, and health care sectors. This review advances the understanding of key knowledge gaps related to their implementation and impact; it emphasizes the need for research to analyze SVC potential comprehensively across the rural-urban continuum and among diverse communities through long-term studies of measurable health impact and mixed-method studies investigating implementation best practices. This trial was registered at PROSPERO as CRD42020206532.
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Affiliation(s)
- Katharine Garrity
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University
| | | | - Hannah Hart
- College of Public Health, The Ohio State University
| | - Khawlah Al-Muhanna
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University
| | - Emily C Kunkler
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University
| | - Ashlea Braun
- Department of Nutritional Sciences, College of Education and Human Sciences, Oklahoma State University
| | | | - Kara Johnson
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University
| | - Emma Lazor
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University
| | - Yang Liu
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University
| | - Jennifer A Garner
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University; John Glenn College of Public Affairs, The Ohio State University.
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Kershaw KN, Magnani JW, Diez Roux AV, Camacho-Rivera M, Jackson EA, Johnson AE, Magwood GS, Morgenstern LB, Salinas JJ, Sims M, Mujahid MS. Neighborhoods and Cardiovascular Health: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes 2024; 17:e000124. [PMID: 38073532 DOI: 10.1161/hcq.0000000000000124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
The neighborhoods where individuals reside shape environmental exposures, access to resources, and opportunities. The inequitable distribution of resources and opportunities across neighborhoods perpetuates and exacerbates cardiovascular health inequities. Thus, interventions that address the neighborhood environment could reduce the inequitable burden of cardiovascular disease in disenfranchised populations. The objective of this scientific statement is to provide a roadmap illustrating how current knowledge regarding the effects of neighborhoods on cardiovascular disease can be used to develop and implement effective interventions to improve cardiovascular health at the population, health system, community, and individual levels. PubMed/Medline, CINAHL, Cochrane Library reviews, and ClinicalTrials.gov were used to identify observational studies and interventions examining or targeting neighborhood conditions in relation to cardiovascular health. The scientific statement summarizes how neighborhoods have been incorporated into the actions of health care systems, interventions in community settings, and policies and interventions that involve modifying the neighborhood environment. This scientific statement presents promising findings that can be expanded and implemented more broadly and identifies methodological challenges in designing studies to evaluate important neighborhood-related policies and interventions. Last, this scientific statement offers recommendations for areas that merit further research to promote a deeper understanding of the contributions of neighborhoods to cardiovascular health and health inequities and to stimulate the development of more effective interventions.
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Gholar VM, Christian R. Effectiveness of implementation strategies to improve nutrition education interventions in adults living in rural and/or low-income communities. JBI Evid Implement 2023; 21:374-385. [PMID: 37131273 DOI: 10.1097/xeb.0000000000000371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE The objective of this project was to promote evidence-based practice and identify how to best implement nutrition education interventions for adults living in rural and/or low-income communities. INTRODUCTION Adults living in rural and/or low-income communities are at increased risk for poor nutrition and chronic health conditions. Patients are referred to the EversCare Clinic (ECC), an ambulatory clinic at an academic medical center in Mississippi, USA, to receive assistance with social needs. In addition to living in rural and/or low-income communities, over 90% of the patients seen at the ECC are food-insecure, yet nutrition education is inconsistently provided. METHODS The JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) audit and feedback tools were used. The ECC team conducted a baseline audit of 30 patient electronic health records, designed and implemented best-practice nutrition education strategies, and completed a follow-up audit of 30 patient electronic health records. Four evidence-based criteria for nutrition education in adults living in rural and/or low-income communities were audited, and various interventions were used to address multiple levels. RESULTS The baseline audit revealed patients were not receiving recommended nutrition education interventions. Following the implementation, there was a 64.2% improvement in compliance with all four best practice criteria. Involving nursing students proved to be an effective method of improving compliance. CONCLUSION Adherence to best practices regarding implementing nutrition education interventions was satisfactory, with 80% of patients receiving interventions at individual, interpersonal, community, and societal levels. Future audits are planned to ensure sustainability.
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Affiliation(s)
- Victoria M Gholar
- School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA
- The Myrlie Evers-Williams Institute for the Elimination of Health Disparities, Jackson, MS, USA
- Mississippi Centre for Evidence-Based Practice: A JBI Centre of Excellence, Jackson, MS, USA
| | - Robin Christian
- The Myrlie Evers-Williams Institute for the Elimination of Health Disparities, Jackson, MS, USA
- Mississippi Centre for Evidence-Based Practice: A JBI Centre of Excellence, Jackson, MS, USA
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Denary W, Fenelon A, Whittaker S, Esserman D, Lipska KJ, Keene DE. Rental assistance improves food security and nutrition: An analysis of National Survey Data. Prev Med 2023; 169:107453. [PMID: 36813247 PMCID: PMC10037672 DOI: 10.1016/j.ypmed.2023.107453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023]
Abstract
The U.S. is experiencing a severe housing affordability crisis, resulting in households having to make difficult trade-offs between paying for a place to live and basic health necessities such as food. Rental assistance may mitigate these strains, improving food security and nutrition. However, only one in five eligible individuals receive assistance, with an average wait time of two years. Existing waitlists create a comparable control group, allowing us to examine the causal impact of improved housing access on health and well-being. This national quasi-experimental study utilizes linked NHANES-HUD data (1999-2016) to investigate the impacts of rental assistance on food security and nutrition using cross-sectional regression. Tenants with project-based assistance were less likely to experience food insecurity (B = -0.18, p = 0.02) and rent-assisted individuals consumed 0.23 more cups of daily fruits and vegetables compared the pseudo-waitlist group. These findings suggest that the current unmet need for rental assistance and resulting long waitlists have adverse health implications, including decreased food security and fruit and vegetable consumption.
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Affiliation(s)
- Whitney Denary
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.
| | - Andrew Fenelon
- School of Public Policy and Department of Sociology and Criminology, Penn State University, University Park, PA, USA
| | - Shannon Whittaker
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Denise Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Kasia J Lipska
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Danya E Keene
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Katre A, Raddatz B. Low-Income Families' Direct Participation in Food-Systems Innovation to Promote Healthy Food Behaviors. Nutrients 2023; 15:nu15051271. [PMID: 36904271 PMCID: PMC10005603 DOI: 10.3390/nu15051271] [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: 01/29/2023] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
Low-income families, especially those who reside in food deserts, face significant systemic barriers regarding their ability to access affordable and nutritious food. The food behaviors exhibited by low-income families are a reflection of the shortcomings of the built environment and conventional food system. Policy and public-health initiatives to improve food security have, thus far, failed to deliver interventions that simultaneously address multiple pillars of food security. Centering the voices of the marginalized and their place-based knowledge may result in the development of food-access solutions that are a much better fit for the population that they intend to serve. Community-based participatory research has emerged as a solution to better meet the needs of communities in food-systems innovation, but little is known about the extent to which direct participation improves nutritional outcomes. The purpose of this research is to answer the following question: how can food-access solutions authentically engage marginalized community members in food-system innovation, and if participation is related to changes in their food behaviors, how is it related? This action research project leveraged a mixed-methods approach to analyze nutritional outcomes and define the nature of participation for 25 low-income families who reside in a food desert. Our findings suggest that nutritional outcomes improve when major barriers to healthy food consumption are addressed, for example, time, education, and transportation. Furthermore, participation in social innovations can be characterized by the nature of involvement as either a producer or consumer, actively or inactively involved. We conclude that when marginalized communities are at the center of food-systems innovation, individuals self-select their level of participation, and when primary barriers are addressed, deeper participation in food-systems innovation is associated with positive changes in healthy food behaviors.
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Affiliation(s)
- Aparna Katre
- College of Arts Humanities and Social Sciences, University of Minnesota Duluth, 1201 Ordean Court, Duluth, MN 55812, USA
- Correspondence:
| | - Brianna Raddatz
- College of Education and Human Service Professions, University of Minnesota Duluth, 1201 Ordean Court, Duluth, MN 55812, USA
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Alghamdi MM, Burrows T, Barclay B, Baines S, Chojenta C. Culinary Nutrition Education Programs in Community-Dwelling Older Adults: A Scoping Review. J Nutr Health Aging 2023; 27:142-158. [PMID: 36806869 PMCID: PMC9872757 DOI: 10.1007/s12603-022-1876-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/04/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Culinary nutrition education programs are increasingly used as a public health intervention for older adults. These programs often integrate nutrition education in addition to interactive cooking workshops or displays to create programs suitable for older adults' needs, ability and behaviour change. Synthesising the existing literature on nutrition education and interactive cooking programs for older adults is important to guide future program development to support healthy ageing. OBJECTIVES To determine the extent of published literature and report the characteristics and outcomes of interactive culinary nutrition education programs for older adults (> 51 years). DESIGN This scoping review followed the PRISMA-ScR guidelines recommended for reporting and conducting a scoping review. METHODS Five databases were searched of relevant papers published to May 2022 using a structured search strategy. Inclusion criteria included: older adults (≥ 51 years), intervention had both an interactive culinary element and nutrition education and reported dietary outcome. Titles and abstracts were screened by two reviewers, followed by full-text retrieval. Data were charted regarding the characteristics of the program and outcomes assessed. RESULTS A total of 39 articles met the full inclusion criteria. The majority of these studies (n= 23) were inclusive of a range of age groups where older adults were the majority but did not target older adults exclusively. There were large variations in the design of the programs such as the number of classes (1 to 20), duration of programs (2 weeks to 2 years), session topics, and whether a theoretical model was used or not and which model. All programs were face-to-face (n= 39) with only two programs including alternatives or additional delivery approaches beside face-to-face settings. The most common outcomes assessed were dietary behaviour, dietary intake and anthropometrics. CONCLUSION Culinary nutrition education programs provide an environment to improve dietary habits and health literacy of older adults. However, our review found that only a small number of programs were intentionally designed for older adults. This review provides a summary to inform researchers and policy makers on current culinary nutrition education programs for older adults. It also recommends providing face-to-face alternatives that will be accessible to a wider group of older adults with fewer restrictions.
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Affiliation(s)
- M M Alghamdi
- Maryam M Alghamdi, PhD candidate, MSc, RD, School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia,
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Carroll KA, Guthrie JF, Samek A. Impact of Recipe Cards and Nutrition Tips on Produce Selection in a Food Pre-Ordering Program. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2022. [DOI: 10.1080/19320248.2022.2117004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Kathryn A. Carroll
- Department of Nutrition and Family Sciences, University of Central Arkansas, Conway, AR, USA
| | | | - Anya Samek
- Rady School of Management, University of California, San Diego, CA, USA
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Lally AE, Morina A, Vermont LN, Tirabassi JN, Leone LA. Impacts of the COVID-19 Pandemic on Mobile Produce Market Operations: Adaptations, Barriers, and Future Directions for Increasing Food Access. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11390. [PMID: 36141664 PMCID: PMC9517362 DOI: 10.3390/ijerph191811390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/26/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Mobile produce markets were increasingly recognized as an effective and accepted approach to improving access to fruits and vegetables in lower-income and at-risk communities during the first year of the COVID-19 pandemic in the United States. This study provides insights into how mobile market operations were impacted by, and evolved in response to, challenges posed by the pandemic. METHODS A survey evaluating impacts of the pandemic on mobile markets was distributed to a database of mobile market operators in the United States. Respondents were asked to describe impacts to their mobile market's operations, and what adaptations were needed to continue to effectively serve their communities during 2020. RESULTS Surveys representing 48 unique mobile markets were collected from March to July 2021. Of the respondents, 63% reported an increase in demand for mobile market services from community members. Furthermore, 65% increased the amount of produce they distributed in 2020 as compared to 2019, often through adopting low or no-cost models or participating in pandemic government programs. DISCUSSION Emergency adaptations employed by mobile markets can inform long-term operational modifications for not only mobile markets, but also other food access programs, beyond the COVID-19 pandemic.
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Affiliation(s)
- Anne E. Lally
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
- Department of Anthropology, The College of Arts and Sciences, University at Buffalo, Buffalo, NY 14261, USA
| | - Alban Morina
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Leah N. Vermont
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Jill N. Tirabassi
- Department of Family Medicine, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA
| | - Lucia A. Leone
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
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Hollis-Hansen K, Janda KM, Tiscareño M, Filipowicz C, van den Berg A. Objective and perceived barriers and facilitators of daily fruit and vegetable consumption among under-resourced communities in Central Texas. Appetite 2022; 176:106130. [PMID: 35700839 PMCID: PMC9392474 DOI: 10.1016/j.appet.2022.106130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Fruit and vegetable consumption (FVC) continues to be low, particularly among people living in under-resourced communities. Identifying barriers and facilitators of FVC and whether those barriers and facilitators differ for racially and ethnically minoritized people is imperative for developing effective and equitable public health policies and interventions. METHODS A baseline cohort of 390 participants from Central Texas communities historically lacking healthy food retailers completed a survey including FVC, 7 psychosocial barriers and facilitators of FVC, distance to a grocery retailer, participation in government assistance programs, and race/ethnicity. RESULTS Not having time to prepare fruits and vegetables was the only significant psychosocial barrier identified (B = -.11, t(390) = 2.04, P = .04), but was not significant after accounting for sociodemographic variables. Significant facilitators of daily FVC were liking F&V (B=.31, t(390) = 6.40, P<.001), participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (B=.14, t(390) = 2.81, P = .005), and Hispanic/Latino(a) ethnicity (B = -.21, t(390) = 4.30, P<.001). The final model accounted for 17% of the variance in daily FVC (R2=.17, F(4, 375) = 7.69, P < .001). Black, white and Other race participants were more likely to report having difficulty using F&V before spoiling than Hispanic/Latino(a) participants (P = .003). White and Other race participants were more likely to report that F&V were hard to prepare (P = .006) and that they didn't have time to prepare F&V (P = .005). DISCUSSION When designing public health policy and interventions to increase FVC, researchers could prioritize identifying ways to alleviate time constraints, increase F&V liking, and help eligible participants to enroll in WIC. Strategies that reduce the risk of F&V spoiling and make F&V easier to prepare may also benefit some groups.
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Affiliation(s)
| | - Kathryn M Janda
- UTHealth School of Public Health in Austin, USA; Michael and Susan Dell Center for Healthy Living, USA.
| | | | - Claire Filipowicz
- UT Southwestern Medical Center, Peter O'Donnell Jr. School of Public Health, USA
| | - Alexandra van den Berg
- UTHealth School of Public Health in Austin, USA; Michael and Susan Dell Center for Healthy Living, USA
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Vermont LN, Kasprzak C, Lally A, Claudio A, Tumiel-Berhalter L, Haynes-Maslow L, Ammerman A, Raja S, Leone LA. A Randomized Controlled Trial of a Research-Tested Mobile Produce Market Model Designed to Improve Diet in Under-Resourced Communities: Rationale and Design for the Veggie Van Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9832. [PMID: 36011468 PMCID: PMC9408281 DOI: 10.3390/ijerph19169832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
Mobile produce markets are increasingly popular retail vendors used for providing access to fresh fruits and vegetables (F&V) in under-resourced communities; however, evaluation is limited due to design and implementation challenges. This protocol presents the original design of a randomized control trial aimed at assessing the effectiveness of the evidence-based Veggie Van (VV) mobile market model. Nine US community partner organizations were asked to partner with four community sites serving lower-income areas. Sites are randomized to either intervention or control. Intervention sites will host a mobile market for one year while the control sites will host planning events, with the goal to open a market afterward. Eligible participants are aged ≥ 18, the primary household shopper, live nearby/regularly frequent the site, and have expressed interest in learning about a mobile market. The primary outcome, F&V consumption, will be assessed via dietary recall at baseline and 12 months and compared between the intervention and control sites. This research advances work on the VV model and methods for mobile market evaluation with the addition of more robust measures and the study design. Determining the effectiveness of the VV model is imperative to justify taking it to scale to enhance the impact of mobile markets.
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Affiliation(s)
- Leah N. Vermont
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Christina Kasprzak
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Anne Lally
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Alicia Claudio
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Laurene Tumiel-Berhalter
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA
| | - Lindsey Haynes-Maslow
- Department of Agricultural and Human Sciences, North Carolina State University, Raleigh, NC 27695, USA
| | - Alice Ammerman
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Samina Raja
- Department of Urban and Regional Planning, School of Architecture and Planning, University at Buffalo, Buffalo, NY 14214, USA
| | - Lucia A. Leone
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
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Suggested explanations for the (in)effectiveness of nutrition information interventions among adults with a low socioeconomic status: a scoping review. J Nutr Sci 2022; 11:e50. [PMID: 35836699 PMCID: PMC9241061 DOI: 10.1017/jns.2022.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/15/2022] Open
Abstract
Unhealthy diets are a major threat to population health and are especially prevalent among those with a low socioeconomic status (SES). Health promotion initiatives often rely on nutrition information interventions (NIIs), but are usually less effective among adults with a low SES than in their high-SES counterparts. Explanations for this lower effectiveness are set out in extant studies. These have been conducted across a wide range of disciplines and subject fields and using a variety of methodological approaches. We have therefore conducted a scoping review to identify and synthesise the following: (1) explanations suggested in studies carried out in high-income countries for why NIIs are (in)effective among adults with a low SES and (2) whether these suggested explanations were studied empirically. Eight databases were searched for relevant studies published since 2009 across various disciplines. This identified 4951 papers, 27 of which were included in our review after screening. Only fifteen of these proposed an explanation for the (in)effectiveness of NIIs among adults with a low SES. The following four main themes were uncovered: health literacy, economic resources, social resources and convenience. Ten studies tested their explanations empirically, but the results were inconsistent. The reasons why NIIs are (in)effective among low-SES adults are therefore still largely unclear. Also, current literature predominantly relies on individualistic explanations, most notably focusing on psychological and economic attributes. Consequently, if the effectiveness of NIIs among low-SES populations is to be improved, future studies should examine a wider range of explanations and test them systematically and empirically.
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Ziso D, Chun OK, Puglisi MJ. Increasing Access to Healthy Foods through Improving Food Environment: A Review of Mixed Methods Intervention Studies with Residents of Low-Income Communities. Nutrients 2022; 14:nu14112278. [PMID: 35684077 PMCID: PMC9182982 DOI: 10.3390/nu14112278] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/22/2022] [Accepted: 05/27/2022] [Indexed: 12/22/2022] Open
Abstract
Food insecurity is a broad and serious public health issue in the United States, where many people are reporting lack of access to healthy foods. The reduced availability of healthy, affordable foods has led to increased consumption of energy-dense and nutrient-poor foods, resulting in increasing the risk for many chronic diseases such as obesity, cardiovascular diseases, and type 2 diabetes mellitus. Thus, identifying promising approaches to increase access to healthy foods through improving the food environment is of importance. The purpose of this review article is to highlight how the food environment affects directly a person’s food choices, and how to increase access to healthy foods through improving environmental approaches. The literature search was focused on finding different approaches to improve food security, primarily those with an impact on food environment. Overall, potential solutions were gathered through multilevel environmental approaches, including nutrition education and peer education, community-based participatory research, and policy changes in supplemental nutrition programs. A recommendation to reduce food insecurity is learning to create meals with a variety of seasonal fruits and vegetables purchased from affordable farmers’ markets.
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Leng KH, Yaroch AL, Nugent NB, Stotz SA, Krieger J. How Does the Gus Schumacher Nutrition Incentive Program Work? A Theory of Change. Nutrients 2022; 14:nu14102018. [PMID: 35631159 PMCID: PMC9146513 DOI: 10.3390/nu14102018] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/30/2022] [Accepted: 05/05/2022] [Indexed: 12/27/2022] Open
Abstract
Increased fruit and vegetable (FV) intake is associated with decreased risk of nutrition-related chronic diseases. Sociodemographic disparities in FV intake indicate the need for strategies that promote equitable access to FVs. The United States Department of Agriculture’s Gus Schumacher Nutrition Incentive Program (GusNIP) supports state and local programs that offer nutrition incentives (NIs) that subsidize purchase of FVs for people participating in the Supplemental Nutrition Assistance Program (SNAP). While a growing body of research indicates NIs are effective, the pathways through which GusNIP achieves its results have not been adequately described. We used an equity-focused, participatory process to develop a retrospective Theory of Change (TOC) to address this gap. We reviewed key program documents; conducted a targeted NI literature review; and engaged GusNIP partners, practitioners, and participants through interviews, workshops, and focus groups in TOC development. The resulting TOC describes how GusNIP achieves its long-term outcomes of increased participant FV purchases and intake and food security and community economic benefits. GusNIP provides NIs and promotes their use, helps local food retailers develop the capacity to sell FVs and accept NIs in accessible and welcoming venues, and supports local farmers to supply FVs to food retailers. The TOC is a framework for understanding how GusNIP works and a tool for improving and expanding the program.
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Affiliation(s)
- Kirsten H. Leng
- Healthy Food America, Seattle, WA 98122, USA;
- Correspondence: ; Tel.: +1-206-412-0997
| | - Amy L. Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, NE 68154, USA; (A.L.Y.); (N.B.N.)
| | - Nadine Budd Nugent
- Gretchen Swanson Center for Nutrition, Omaha, NE 68154, USA; (A.L.Y.); (N.B.N.)
| | - Sarah A. Stotz
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - James Krieger
- Healthy Food America, Seattle, WA 98122, USA;
- School of Public Health, University of Washington, Seattle, WA 98195, USA
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14
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Thorndike AN, Gardner CD, Kendrick KB, Seligman HK, Yaroch AL, Gomes AV, Ivy KN, Scarmo S, Cotwright CJ, Schwartz MB. Strengthening US Food Policies and Programs to Promote Equity in Nutrition Security: A Policy Statement From the American Heart Association. Circulation 2022; 145:e1077-e1093. [PMID: 35535604 DOI: 10.1161/cir.0000000000001072] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nutritionally inadequate dietary intake is a leading contributor to chronic cardiometabolic diseases. Differences in dietary quality contribute to socioeconomic and racial and ethnic health disparities. Food insecurity, a household-level social or economic condition of limited access to sufficient food, is a common cause of inadequate dietary intake. Although US food assistance policies and programs are designed to improve food security, there is growing consensus that they should have a broader focus on nutrition security. In this policy statement, we define nutrition security as an individual or household condition of having equitable and stable availability, access, affordability, and utilization of foods and beverages that promote well-being and prevent and treat disease. Despite existing policies and programs, significant gaps remain for achieving equity in nutrition security across the life span. We provide recommendations for expanding and improving current food assistance policies and programs to achieve nutrition security. These recommendations are guided by several overarching principles: emphasizing nutritional quality, improving reach, ensuring optimal utilization, improving coordination across programs, ensuring stability of access to programs across the life course, and ensuring equity and dignity for access and utilization. We suggest a critical next step will be to develop and implement national measures of nutrition security that can be added to the current US food security measures. Achieving equity in nutrition security will require coordinated and sustained efforts at the federal, state, and local levels. Future advocacy, innovation, and research will be needed to expand existing food assistance policies and programs and to develop and implement new policies and programs that will improve cardiovascular health and reduce disparities in chronic disease.
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15
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Kasprzak CM, Lally AE, Schoonover JJ, Gallicchio D, Haynes-Maslow L, Vermont LN, Ammerman AS, Raja S, Tumiel-Berhalter L, Tirabassi JN, Leone LA. Operational challenges that may affect implementation of evidence-based mobile market interventions. BMC Public Health 2022; 22:776. [PMID: 35429973 PMCID: PMC9013179 DOI: 10.1186/s12889-022-13207-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/06/2022] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Mobile produce markets are becoming an increasingly prevalent, accepted, and effective strategy for improving fruit and vegetable (F&V) access and consumption across underserved and lower-income communities. However, there is limited published research on mobile market operations. The goal of this research is to identify the challenges mobile markets face and ways to potentially mitigate those challenges. We will also discuss implications of our findings for future implementation of evidence-based food access interventions. METHODS We conducted 21 semi-structured key informant (KI) interviews to assess common practices of mobile market organizations that had been operating for 2 + years. We asked KIs about their organizational structure, operations, procurement and logistics, evaluation efforts, marketing and community engagement, success and challenges. A primary qualitative analysis involved deductive coding using qualitative software. A secondary qualitative analysis identified subthemes related to common challenges and remedial practices. A deductive coding process was applied to match identified challenges to the appropriate Consolidated Framework for Implementation Research (CFIR). RESULTS The leading challenges cited by KIs correspond to the CFIR domains of inner setting (e.g., funding and resources), outer setting (e.g., navigating regulations), and process (e.g., engaging community partnership). Practices that may mitigate challenges include maximizing ancillary services, adopting innovative volunteer and staffing structures, and formalizing agreements with community partners. CONCLUSION Common and persistent challenges ought to be addressed to ensure and enhance the positive public health impacts of mobile produce markets. Contextual factors, particularly organizational factors, that impact implementation should also be considered when implementing an evidence-based intervention at a mobile market. Further research is needed to determine which innovative solutions are the most effective in mitigating challenges, improving implementation, and enhancing sustainability of mobile markets.
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Affiliation(s)
- Christina M Kasprzak
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA.
| | - Anne E Lally
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
- Department of Anthropology, The College of Arts and Sciences, University at Buffalo, Buffalo, USA
| | - Julia J Schoonover
- Department of Sociology, The College of Arts and Sciences, University at Buffalo, Buffalo, USA
| | - Deanna Gallicchio
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professionals, University at Buffalo, Buffalo, USA
| | - Lindsey Haynes-Maslow
- Department of Agricultural and Human Sciences, North Carolina State University, Raleigh, USA
| | - Leah N Vermont
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Alice S Ammerman
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Samina Raja
- Department of Urban and Regional Planning, School of Architecture and Planning, University at Buffalo, Buffalo, USA
| | - Laurene Tumiel-Berhalter
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, USA
| | - Jill N Tirabassi
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, USA
| | - Lucia A Leone
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
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16
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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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17
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Ezekekwu E, Salunkhe SS, Jennings JC, Kelly Pryor BN. Community-Based and System-Level Interventions for Improving Food Security and Nutritious Food Consumption: A Systematic Review. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2021. [DOI: 10.1080/19320248.2021.2021120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Emmanuel Ezekekwu
- Department of Health Management and Systems Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Sonali S. Salunkhe
- Department of Health Management and Systems Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky, USA
| | - J’Aime C. Jennings
- Department of Health Management and Systems Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Brandy N. Kelly Pryor
- Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky, USA
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18
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Ng MK, Lee JS, Sanville LM, Cotta‐Rivera E, Dallas J, Pencek A, Powell A, Williams B, Moore CJ, Cox GO. Sensory evaluation of new recipes for Supplemental Nutrition Assistance Program Education (
SNAP‐Ed
) informs consumer acceptance and recipe development needs. J SENS STUD 2021. [DOI: 10.1111/joss.12730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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19
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Hernandez DC, Daundasekara SS, Walton QL, Eigege CY, Marshall AN. Feasibility of Delivering an on-Campus Food Distribution Program in a Community College Setting: A Mixed Methods Sequential Explanatory Investigation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12106. [PMID: 34831861 PMCID: PMC8619067 DOI: 10.3390/ijerph182212106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022]
Abstract
Despite community college students experiencing food insecurity there has been a dearth of research conducted on the feasibility of providing a program designed to increase access to fruits and vegetables among community colleges. This study used a mixed methods sequential explanatory design to examine the feasibility of delivering an on-campus food distribution program (FDP) to community college students and to examine the association between FDP and food insecurity and dietary intake. The study also explored the student's experiences related to barriers and facilitators of program utilization. In phase one, the FDP occurred for eight months and students could attend twice per month, receiving up to 60 pounds of food per visit. Online questionnaires were used to collect students' food security and dietary intake. Among the 1000 students offered the FDP, 495 students enrolled, with 329 students (66.5%) attending ≥ 1. Average attendance = 3.27 (SD = 3.08) [Range = 1-16] distributions. The FDP did not reduce food insecurity nor improve dietary intake. In phase two, a subsample of students (n = 36) discussed their FDP experiences through focus groups revealing three barriers limiting program utilization: program design and organization, personal schedule and transportation, and program abuse by other attendees. Facilitators to greater program utilization included: the type of food distributed and welcoming environment, along with allowing another designated individual to collect food. To maximize program use, it is suggested that reported barriers be addressed, which might positively influence food insecurity and dietary intake.
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Affiliation(s)
- Daphne C. Hernandez
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (S.S.D.); (A.N.M.)
| | - Sajeevika S. Daundasekara
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (S.S.D.); (A.N.M.)
| | - Quenette L. Walton
- Graduate College of Social Work, University of Houston, Houston, TX 77004, USA; (Q.L.W.); (C.Y.E.)
| | - Chinyere Y. Eigege
- Graduate College of Social Work, University of Houston, Houston, TX 77004, USA; (Q.L.W.); (C.Y.E.)
| | - Allison N. Marshall
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (S.S.D.); (A.N.M.)
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20
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Kasprzak CM, Schoonover JJ, Gallicchio D, Haynes-Maslow L, Vermont LN, Ammerman A, Raja S, Tumiel-Berhalter L, Leone LA. Using common practices to establish a framework for mobile produce markets in the United States. JOURNAL OF AGRICULTURE, FOOD SYSTEMS, AND COMMUNITY DEVELOPMENT 2021; 10:73-84. [PMID: 35548369 PMCID: PMC9090202 DOI: 10.5304/jafscd.2021.104.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Access to affordable fruit and vegetables (F&V) remains a challenge within underserved communities across the United States. Mobile produce markets (mobile markets) are a well-accepted and effective strategy for increasing F&V consumption in these communities. Mobile market organizations share similar missions that focus on food, health, and empowerment, participate in incentive programs, offer nutrition education, utilize grassroots-based marketing strategies, prioritize local produce, and sell competitively priced produce through a market style. While mobile markets have become increasingly prevalent, models vary widely. Establishing standardized practices is essential for ensuring the effectiveness and sustainability of this important food access program. This research seeks to identify common practices of established mobile markets and describe the resources they rely on.
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Affiliation(s)
- Christina M. Kasprzak
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo; 329 Kimball Tower; Buffalo, NY 14214 USA
| | - Julia J. Schoonover
- Department of Sociology, The College of Arts and Sciences, University at Buffalo
| | - Deanna Gallicchio
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professionals, University at Buffalo
| | | | - Leah N. Vermont
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo
| | - Alice Ammerman
- Department of Nutrition, Gilling School of Public Health, University of North Carolina at Chapel Hill
| | - Samina Raja
- Department of Urban and Regional Planning, School of Architecture and Planning, University at Buffalo
| | - Laurene Tumiel-Berhalter
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
| | - Lucia A. Leone
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo
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21
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Dunn CG, Vercammen KA, Bleich SN, Mulugeta W, Granick J, Carney C, Zack RM. Participant Perceptions of a Free Fresh Produce Market at a Health Center. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:573-582. [PMID: 34246412 DOI: 10.1016/j.jneb.2021.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/18/2021] [Accepted: 03/25/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To examine participant perceptions of a free, monthly produce market at a health center in Massachusetts. DESIGN Participants were recruited at a produce market between June 2019 and January 2020 and engaged in a 30-65-minute focus group (n = 3 English language; n = 2 Spanish; n = 2 Arabic) conducted by trained facilitators using a semistructured guide. PARTICIPANTS Adults (n = 49) who had attended the market at least twice in the previous 6 months. MAIN OUTCOME MEASURES Participant-reported facilitators, barriers, perceived benefits, and opportunities for improvement. ANALYSIS Conventional content analysis. RESULTS Reported facilitators included accessibility (eg, convenient location and timing), program experience (eg, positive volunteer interactions), and characteristics of goods and services (eg, acceptable variety of produce). Barriers fell under similar themes and included transportation challenges, poor weather, and insufficient quantity of produce for larger households. Participants perceived the market as improving diet and finances and offered suggestions for improvement: distributing nonproduce foods (eg, meat) or nonfood items (eg, toiletries) and augmenting existing initiatives aimed to help attendees make use of the produce (eg, handing out recipe cards). CONCLUSIONS AND IMPLICATIONS The produce market was widely accepted, and targeted areas for improvement were identified. Findings may improve existing and future charitable produce markets among diverse populations.
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Affiliation(s)
- Caroline G Dunn
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA.
| | - Kelsey A Vercammen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
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22
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Horning ML, Alver B, Porter L, Lenarz-Coy S, Kamdar N. Food insecurity, food-related characteristics and behaviors, and fruit and vegetable intake in mobile market customers. Appetite 2021; 166:105466. [PMID: 34139297 DOI: 10.1016/j.appet.2021.105466] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 04/20/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
Mobile markets (MM) bring affordable, quality, healthy foods to high-need, low-food access communities. However, little is known about food insecurity of MM customers. This manuscript evaluates food insecurity prevalence in MM customers and assesses associations between food insecurity and MM use, food-related characteristics and behaviors, and fruit and vegetable (FV) intake. Customers (N = 302) completed cross-sectional surveys in summer 2019 that assessed: food security, food availability, cooking attitude, self-efficacy for healthy cooking, self-efficacy for cooking and eating FV, social connectedness, and FV intake. Descriptive and multivariate analyses were used to describe and assess associations with food insecurity and FV intake. Results show most MM customers were food insecure (85%). In logistic regression models adjusted for sociodemographic characteristics, long-term MM use (OR = 0.77, CI = 0.60-0.997), access to affordable, quality foods (OR = 0.81, CI = 0.71-0.93), and self-efficacy for both cooking healthy foods (OR = 0.88, CI = 0.80-0.97) and cooking and eating FV (OR = 0.90, CI = 0.82-0.98) were associated with lower odds of food insecurity; negative cooking attitudes (OR = 1.12, CI = 1.02-1.24) were associated with higher odds of food insecurity. Being food insecure (β = -1.37, SE=0.43, p < 0.01) was associated with poorer FV intake; this association attenuated slightly (β = -1.22, SE=0.43, p < 0.01) when length of MM use was added to the general linear model, which was also associated with higher fruit and vegetable intake (β = 0.26, SE=0.10, p = 0.01). Results suggest the MM reaches customers experiencing high levels of food insecurity and long-term MM use is associated with lower food insecurity and higher FV intake. Relationships between food insecurity and several food characteristics/behaviors provide insight for potential targets for wrap-around interventions to address food insecurity among customers. Findings suggest longitudinal evaluation of the MM's impact on food security and other food-related characteristics/behaviors is warranted.
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Affiliation(s)
- Melissa L Horning
- School of Nursing, University of Minnesota, 5-140 Weaver Densford Hall, 308 Harvard St SE, Minneapolis, MN, 55414, USA.
| | - Bonnie Alver
- School of Nursing, University of Minnesota, 5-140 Weaver Densford Hall, 308 Harvard St SE, Minneapolis, MN, 55414, USA.
| | | | | | - Nipa Kamdar
- VA Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety (CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, TX, USA.
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23
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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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24
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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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25
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Quintiliani LM, Whiteley JA, Murillo J, Lara R, Jean C, Quinn EK, Kane J, Crouter SE, Heeren TC, Bowen DJ. Community health worker-delivered weight management intervention among public housing residents: A feasibility study. Prev Med Rep 2021; 22:101360. [PMID: 33816090 PMCID: PMC8008178 DOI: 10.1016/j.pmedr.2021.101360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 02/27/2021] [Accepted: 03/04/2021] [Indexed: 01/22/2023] Open
Abstract
Community health worker-led interventions may be an optimal approach to promote behavior change among populations with low incomes due to the community health workers’ unique insights into participants’ social and environmental contexts and potential ability to deliver interventions widely. The objective was to determine the feasibility (implementation, acceptability, preliminary efficacy) of a weight management intervention for adults living in public housing developments. In 2016–2018, in Boston Massachusetts, we conducted a 3-month, two-group randomized trial comparing participants who received a tailored feedback report (control group) to participants who received the same report plus behavioral counseling. Community health workers provided up to 12 motivational interviewing-based counseling sessions in English or Spanish for diet and physical activity behaviors using a website designed to guide standardized content delivery. 102 participants enrolled; 8 (7.8%) were lost at 3-month follow up. Mean age was 46.5 (SD = 11.9) years; the majority were women (88%), Hispanic (67%), with ≤ high school degree (62%). For implementation, among intervention group participants (n = 50), 5 completed 0 sessions and 45 completed a mean of 4.6 (SD = 3.1) sessions. For acceptability, most indicated they would be very likely (79%) to participate again. For preliminary efficacy, adjusted linear regression models showed mean changes in weight (-0.94 kg, p = 0.31), moderate-to-vigorous physical activity (+11.7 min/day, p = 0.14), and fruit/vegetable intake (+2.30 servings/day, p < 0.0001) in the intervention vs. control group. Findings indicate a low-income public housing population was reached through a community health worker-led intervention with sufficient implementation and acceptability and promising beneficial changes in weight, nutrition, and physical activity outcomes.
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Affiliation(s)
- Lisa M Quintiliani
- Boston University, Department of Medicine, Section of General Internal Medicine, Boston Medical Center, United States
| | - Jessica A Whiteley
- University of Massachusetts Boston, College of Nursing and Health Sciences, Department of Exercise and Health Sciences, United States
| | - Jennifer Murillo
- Section of General Internal Medicine, Boston Medical Center, United States
| | - Ramona Lara
- Section of General Internal Medicine, Boston Medical Center, United States
| | - Cheryl Jean
- Section of General Internal Medicine, Boston Medical Center, United States
| | - Emily K Quinn
- Boston University, School of Public Health, Biostatics and Epidemiology Data Analytics Center, United States
| | - John Kane
- Boston Housing Authority, United States
| | - Scott E Crouter
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, Knoxville, United States
| | - Timothy C Heeren
- Department of Biostatistics, Boston University, School of Public Health, United States
| | - Deborah J Bowen
- Department of Bioethics and Humanities, University of Washington, United States
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26
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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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Farrell P, Thow AM, Rimon M, Roosen A, Vizintin P, Negin J. An Analysis of Healthy Food Access Amongst Women in Peri-urban Honiara. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2021; 80:33-40. [PMID: 33575663 PMCID: PMC7871453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Highly processed and energy-dense foods are contributing to the high and rising rates of non-communicable diseases and nutrient deficiencies in Solomon Islands. Non-communicable diseases currently cause 69% of deaths in Solomon Islands, and the rate is rising, fuelled in part by limited health system capacity to treat these conditions. Solomon Islands also has the highest reported undernourishment rate in the Pacific. Recent decades have seen several factors change the food and economic environment in Solomon Islands. Importantly, rural-to-urban migration has caused a disconnect between urban residents and access to land and home gardens. This study aimed to examine the complexities of nutritious food access in urban Solomon Islands. Data were collected from 32 women in Honiara, the islands' capital, using a novel survey instrument. There were 3 important findings: (1) the dominant influencers of the diet patterns described by participants in this study were food affordability and access to land on which to grow it, (2) all participants experienced food insecurity, and (3) reported diet patterns reflected unhealthy diets which were particularly high in processed and sugary foods. These findings suggest a need for improvements in the food environment in Honiara.
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Affiliation(s)
- Penny Farrell
- Sydney School of Public Health, Edward Ford Building A27, The University of Sydney, NSW, 2006, Australia (PF, PV, JN)
| | - Anne Marie Thow
- Menzies Centre for Health Policy, Charles Perkins Centre D17, The University of Sydney, NSW, 2006, Australia (AMT)
| | - Mia Rimon
- Pacific Community (SPC). Port Vila, Vanuatu and Honiara, Solomon Islands (MR)
| | - Andy Roosen
- Synergies Ltd, Ngossi Ridge, Honiara, Solomon Islands (AR)
| | - Pavle Vizintin
- Sydney School of Public Health, Edward Ford Building A27, The University of Sydney, NSW, 2006, Australia (PF, PV, JN)
| | - Joel Negin
- Sydney School of Public Health, Edward Ford Building A27, The University of Sydney, NSW, 2006, Australia (PF, PV, JN)
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Colabianchi N, Antonakos CL, Coulton CJ, Kaestner R, Lauria M, Porter DE. The role of the built environment, food prices and neighborhood poverty in fruit and vegetable consumption: An instrumental variable analysis of the moving to opportunity experiment. Health Place 2021; 67:102491. [PMID: 33348282 PMCID: PMC8123939 DOI: 10.1016/j.healthplace.2020.102491] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 08/17/2020] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
The food environment has been associated with fruit and vegetable consumption, however many studies utilize cross-sectional research designs. This study examined 3,473 participants in the Moving to Opportunity experiment, who were randomized into groups that affected where they lived. The relationship between the built environment, food prices and neighborhood poverty, assessed over four to seven years, on fruit or vegetable consumption was examined using instrumental variable analysis. Higher food prices and neighborhood poverty were associated with lower fruit or vegetable consumption. Policies and programs that address food prices should be implemented and evaluated for their effects on fruit and vegetable consumption.
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Affiliation(s)
| | - Cathy L Antonakos
- 1402 Washington Heights, Ann Arbor, MI, 48109, University of Michigan, USA.
| | - Claudia J Coulton
- 11402 Bellflower Road, Cleveland, OH, 44106-7167, Case Western Reserve University, USA.
| | - Robert Kaestner
- 1307 East 60th Street, University of Chicago, Chicago, IL, 60637, USA.
| | - Mickey Lauria
- 323 Fernow St, Clemson University, Clemson, SC, 29634, USA.
| | - Dwayne E Porter
- 915 Greene Street, University of South Carolina, Columbia, SC, 29201, USA.
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Yoder AD, Proaño GV, Handu D. Retail Nutrition Programs and Outcomes: An Evidence Analysis Center Scoping Review. J Acad Nutr Diet 2020; 121:1866-1880.e4. [PMID: 33229206 DOI: 10.1016/j.jand.2020.08.080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/05/2020] [Accepted: 08/18/2020] [Indexed: 02/06/2023]
Abstract
As nutrition-related diseases contribute to rising health care costs, food retail settings are providing a unique opportunity for registered dietitian nutritionists (RDNs) to address the nutritional needs of consumers. Food as Medicine interventions play a role in preventing and/or managing many chronic conditions that drive health care costs. The objective of this scoping review was to identify and characterize literature examining Food as Medicine interventions within food retail settings and across consumer demographics. An electronic literature search of 8 databases identified 11,404 relevant articles. Results from the searches were screened against inclusion criteria, and intervention effectiveness was assessed for the following outcomes: improvement in health outcomes and cost-effectiveness. One-hundred and eighty-six papers and 25 systematic reviews met inclusion criteria. Five categories surfaced as single interventions: prescription programs, incentive programs, medically tailored nutrition, path-to-purchase marketing, and personalized nutrition education. Multiple combinations of intervention categories, reporting of health outcomes (nutritional quality of shopping purchases, eating habits, biometric measures), and cost-effectiveness (store sales, health care dollar savings) also emerged. The intervention categories that produced both improved health outcomes and cost-effectiveness included a combination of incentive programs, personalized nutrition education, and path-to-purchase marketing. Food as Medicine interventions in the food retail setting can aid consumers in navigating health through diet and nutrition by encompassing the following strategic focus areas: promotion of health and well-being, managing chronic disease, and improving food security. Food retailers should consider the target population and desired focus areas and should engage registered dietitian nutritionists when developing Food as Medicine interventions.
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Nickel S, von dem Knesebeck O. Do multiple community-based interventions on health promotion tackle health inequalities? Int J Equity Health 2020; 19:157. [PMID: 32912257 PMCID: PMC7488049 DOI: 10.1186/s12939-020-01271-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 08/25/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Previous systematic reviews of the impact of multi-component community-based health promotion interventions on reducing health inequalities by socio-economic status (SES) were restricted to physical activity and smoking behavior, and revealed limited and rather disillusioning evidence. Therefore, we conducted a comprehensive review worldwide to close this gap, including a wide range of health outcomes. METHODS The Pubmed and PsycINFO databases were screened for relevant articles published between January 1999 and August 2019, revealing 87 potentially eligible publications out of 2876 hits. In addition, three studies out of a prior review on the effectiveness of community-based interventions were reanalyzed under the new research question. After a systematic review process, 23 papers met the inclusion criteria and were included in the synthesis. RESULTS More than half (56.5%) of the studies reported improvements of socially disadvantaged communities overall (i.e. reduced inequalities at the area level) in at least one health behavior and/or health status outcome. Amongst the remaining studies we found some beneficial effects in the most deprived sub-groups of residents (8.2%) and studies with no differences between intervention and control areas (34.8%). There was no evidence that any program under review resulted in an increase in health disparity. CONCLUSIONS Our results confirm that community-based interventions may be reducing absolute health inequalities of deprived and disadvantaged populations, but their potential so far is not fully realized. For the future, greater attention should be paid to inequalities between sub-groups within communities when analyzing changes in health inequality over time.
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Affiliation(s)
- Stefan Nickel
- University Medical Center Hamburg-Eppendorf, Institute of Medical Sociology, Martinistraße 52, D-20246, Hamburg, Germany.
| | - Olaf von dem Knesebeck
- University Medical Center Hamburg-Eppendorf, Institute of Medical Sociology, Martinistraße 52, D-20246, Hamburg, Germany
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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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Full-Service Twin Cities Mobile Market Impact: Qualitative Findings From Focus Groups With Customers. J Acad Nutr Diet 2020; 120:1548-1556.e1. [DOI: 10.1016/j.jand.2020.02.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/25/2020] [Indexed: 01/23/2023]
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The provision of recipes and single-use herb/spice packets to increase egg and protein intake in community-dwelling older adults: a randomised controlled trial. Public Health Nutr 2020; 24:2109-2122. [PMID: 32867875 PMCID: PMC8145475 DOI: 10.1017/s1368980020002712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study investigated the impact of recipe and single-use herb/spice packet provision on egg intake and protein intake in community-dwelling individuals aged over 55 years. DESIGN Using a randomised-controlled intervention design, 100 older adults were randomised to receive (n 53) or not receive (n 47) high-protein egg-based recipes and herb/spice packets through the post for 12 weeks, from June to December 2016. Egg intake, protein intake, adverse events, lean body mass and functional measures of lean body mass were measured at baseline, after the 12 weeks and after a further 12 weeks. SETTING Bournemouth, UK. PARTICIPANTS Community-dwelling older adults. RESULTS Intention-to-treat data were analysed using regression, controlling for various demographic and lifestyle characteristics. Ninety-three individuals (intervention, n 50; control, n 43) completed assessments at all three time points. Egg intakes increased by end of intervention in both groups (mean: 4-5 eggs/month). After a further 12 weeks, higher egg intakes were sustained in the intervention group, while egg intakes in the control group returned to baseline levels (between-group difference: β = -0·124, P = 0·047). No differences were found in other measures (largest β = -0·106, P = 0·12). CONCLUSIONS The provision of high-protein egg-based recipes and single-use herb/spice packets over 12 weeks increased egg intakes up to 12 weeks after end of intervention. Other factors may explain increased egg intakes during the intervention, but the sustained effects most plausibly result directly from recipe provision. Limited effects in other measures suggest that the recipes may have replaced as opposed to added to existing protein intakes.
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Patel N, Lakshminarayanan S, Olickal JJ. Effectiveness of nutrition education in improving fruit and vegetable consumption among selected college students in urban Puducherry, South India. A pre-post intervention study. Int J Adolesc Med Health 2020; 34:243-248. [PMID: 32845862 DOI: 10.1515/ijamh-2020-0077] [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] [Received: 04/18/2020] [Accepted: 06/28/2020] [Indexed: 11/15/2022]
Abstract
Objectives World Health Organization (WHO) suggests intake of five servings (400 g) of fruits and vegetables (F&V) per day to ensure an adequate dietary fibre and to reduce the risk of non-communicable diseases. Risk factor survey of Non-Communicable Diseases (2007-08), reports that only 1% population in Tamil Nadu, South India consumed more than five servings a day. So we aimed to assess the effectiveness of nutrition education in improving the daily intake of fruit and vegetable servings and stage of behaviour change among college students. Methods A pre-post intervention study was conducted among undergraduate students from two selected women's colleges in urban Puducherry, South India during September-October 2019. The two English departments were randomly allocated into intervention group (IG), control group (CG) and 75 students in each group were chosen by systematic random sampling. IG received 30 min of nutrition education programme; which includes importance and minimum daily intake of fruits & vegetables, local availability, cost and awareness about myths and misconceptions. CG received pamphlets regarding healthy dietary intake. Knowledge regarding portion sizes, average daily servings of fruit & vegetable intake and stage of behaviour change were assessed at baseline and after one month of intervention. Results There was a significant increase in knowledge regarding portion sizes (28- 64%) after intervention in IG (p<0.001) compared to CG (24- 40%). The knowledge regarding the required number of servings of fruits (27-56%) and vegetables (15-58%) also increased significantly (p<0.001) in the IG. Intake of fruits, vegetables and juices in the last 24 h were significantly increased in IG compared to CG (p<0.001). There was a significant increase (p=0.002) in contemplation and preparation stage (13-34%) in IG after intervention. Conclusions A well designed nutrition education programme is an effective tool in promoting healthy eating habits among adolescents. It enabled a significant increase in knowledge regarding portion sizes of F&V and daily intake of fruits and vegetables.
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Affiliation(s)
- Namita Patel
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Subitha Lakshminarayanan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Jeby Jose Olickal
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Rural SNAP Participants and Food Insecurity: How Can Communities Leverage Resources to Meet the Growing Food Insecurity Status of Rural and Low-Income Residents? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176037. [PMID: 32825144 PMCID: PMC7504289 DOI: 10.3390/ijerph17176037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/30/2020] [Accepted: 08/16/2020] [Indexed: 12/11/2022]
Abstract
The burden of obesity disproportionately influences poor health outcomes in rural communities in the United States. Various social and environmental factors contribute to inadequate food access and availability in rural areas, influencing dietary intakes and food insecurity rates. This study aims to identify patterns related to food insecurity and fruit and vegetable consumption within a SNAP-eligible and low-income, highly obese rural Appalachian community. A prospective cohort was implemented to identify gaps in resources addressing obesity and food insecurity challenges. SAS 9.4 software was used to examine differences in dietary intakes and shopping practices among SNAP participants. Among participants (n = 152), most reported an annual household income less than USD 20,000 (n = 90, 60.4%), 29.1% reported food insecurity, and 39.5% reported receiving SNAP benefits within the last month. The overall mean FV intake was 3.46 daily servings (95% CI: 3.06–3.91) among all participants. SNAP participation was associated with food insecurity (p = 0.007) and those participating in SNAP were two times more likely to report being food insecure (OR = 2.707, 95% CI: 1.317, 5.563), relative to non-participants. These findings further depict the need for intervention, as the burden of food insecurity persists. Tailoring health-promoting initiatives to consider rurality and SNAP participation is vital for sustainable success among these populations.
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Gray VB, Hardman AM, Byrd SH. Qualitative Evaluation of Drivers of Eating Decisions among SNAP Participants in Mississippi. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:775-787. [PMID: 32507480 DOI: 10.1016/j.jneb.2020.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 04/03/2020] [Accepted: 04/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To explore food-related decision patterns among Supplemental Nutrition Assistance Program (SNAP) recipients in Mississippi. DESIGN A qualitative design was used to conduct focus groups (n = 18) based on the Health Belief Model with low-income female caregivers of children aged under 13 years. SETTING Mississippi. PARTICIPANTS Cluster sampling was used to recruit participants (n = 126) from the 4 regional divisions of Mississippi State University Extension. PHENOMENON OF INTEREST Drivers of eating decisions among SNAP participants. ANALYSIS Focus groups were recorded, transcribed, and coded by 2 independent coders using thematic analysis. RESULTS Drivers of food selection often overlapped with barriers to healthy eating. Participants used many strategies to manage costs and viewed healthy foods as out of reach and quick to perish. Cost, taste preferences, habits, and family factors were primary drivers of food selection and preparation; each of these presented barriers to healthier eating. Health was most often shared as a driver of food selection once disease was established. Participants reported a variety of strategies used in striving for healthier eating. CONCLUSIONS AND IMPLICATIONS Focusing on ways to manage the costs of healthy foods, honor taste preferences, and work within habits/families may enhance efforts to support healthy eating among SNAP participants.
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Affiliation(s)
- Virginia B Gray
- Department of Family and Consumer Sciences, California State University Long Beach, Long Beach, CA.
| | - Alisha M Hardman
- School of Human Sciences, Mississippi State University, Mississippi State, MS
| | - Sylvia H Byrd
- Office of Nutrition Education, Mississippi State University Extension Service, Mississippi State, MS
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Food Co-Operatives: A Potential Community-Based Strategy to Improve Fruit and Vegetable Intake in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114154. [PMID: 32532100 PMCID: PMC7312496 DOI: 10.3390/ijerph17114154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 12/22/2022]
Abstract
Only 5% of Australian children and adults eat enough fruit and vegetables. Two common barriers are high cost and limited access. Food co-operatives (‘co-ops’) may have the potential to reduce these barriers. We conducted a scoping analysis of food co-ops in the Sydney region to describe their characteristics and objectives. We also conducted a survey of members and non-members of co-ops to assess their fruit and vegetable intake using validated questions. Fifteen food co-ops were identified in the Sydney region and the most common objective was to provide cheap affordable produce. Most co-ops (61%) were in areas of high socio-economic status (SES). Members of food co-ops had a higher vegetable intake than non-members [mean difference (MD) = 0.54 serves/daily; 95% confidence interval (CI) of 0.15 to 0.93] and were also more likely to meet the recommendations for fruit and vegetable intake [odds ratio (OR) = 4.77 (95% CI = 1.15, 19.86)]. Implications of this study are that if food co-ops can be implemented on a wider scale, they hold potential for improving fruit and vegetable intakes.
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Hollis-Hansen K, Vermont L, Zafron ML, Seidman J, Leone L. The introduction of new food retail opportunities in lower-income communities and the impact on fruit and vegetable intake: a systematic review. Transl Behav Med 2019; 9:837-846. [PMID: 31570930 PMCID: PMC8679116 DOI: 10.1093/tbm/ibz094] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023] Open
Abstract
A lack of access to fresh fruits and vegetables (F&Vs) is associated with consumption of fewer F&Vs and higher risk of obesity, especially for lower-income individuals. It is widely believed that the addition of new food retail opportunities could improve F&V consumption and subsequently reduce the chronic disease burden. Observational studies provide some support for these hypotheses, but contradictions exist. In this study we sought to examine if the introduction of a food retailer affects F&V consumption in lower-income communities. We used a systematic PRISMA approach to conduct this study. We searched PubMed, EMBASE, and ProQuest Dissertations & Theses for academic journal references and gray literature published before August 2018. Included studies were those looking at the effect of the introduction of a new food retailer on F&V consumption. Studies were also categorized based on which dimensions of food access were targeted by the food retailer. We identified 15 studies meeting inclusion criteria: 11 studies reported a positive increase in F&V consumption attributable to the introduction of a new food retailer, of which 6 were statistically significant. The remaining 4 studies, all of which examined the impact of introducing a new retail supermarket, showed no change or a decrease in F&V intake. Results from studies which change the food environment generally support the idea that increased access to healthy food improves diet, but more studies are needed in order to assess the differences between the various types of retailers, and to identify strategies for improving impact. Understanding which types of new food retail programs are most likely to impact diet has implications for policies which incentivize new food retail.
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Affiliation(s)
- Kelseanna Hollis-Hansen
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Leah Vermont
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
| | | | - Jennifer Seidman
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Lucia Leone
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
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