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Houghtaling B, Zhang N, Yaroch A, Milburn Atkinson C, Byker Shanks C. How does eligibility for GusNIP produce prescriptions relate to fruit and vegetable purchases and what factors shape the relationship? A protocol for a secondary analysis of nationally representative data in the USA. BMJ Open 2024; 14:e085322. [PMID: 38697763 PMCID: PMC11085977 DOI: 10.1136/bmjopen-2024-085322] [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: 02/12/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024] Open
Abstract
INTRODUCTION US Department of Agriculture (USDA) Gus Schumacher Nutrition Incentive Programme (GusNIP) produce prescription programme (PPR) 'prescriptions' provide eligible participants with low income, risk for diet-related chronic disease and food insecurity a healthcare issued incentive to purchase lower to no cost fruits and vegetables (FVs). However, GusNIP requirements specify that PPR prescriptions can only be redeemed for fresh (not frozen, canned or dried) FVs. This requirement may prevent participants from fully engaging in or benefiting from GusNIP PPR, given communities with lower healthy food access may have reduced fresh FV accessibility. METHODS AND ANALYSIS We will use the nationally representative 2012-2013 National Household Food Acquisition and Purchase Survey (FoodAPS) and complementary FoodAPS Geography Component data in a secondary data analysis to examine how household GusNIP PPR eligibility relates to the quantity and variety of fresh, frozen, canned and dried FV purchases and to what extent individual, household and food environment factors shape the relationship. FoodAPS data include household food purchasing and acquisition information across a 7 day period from 14 317 individuals among 4826 households and was collected between April 2012 and January 2013. The FoodAPS Geography Component provides information about the local community/environment relative to FoodAPS households. This study will examine the correlation or association of selected variables between different quantities and varieties of fresh, frozen, canned and dried FVs, as well as correlations among multilevel predictors. ETHICS AND DISSEMINATION We are following data integrity standards as outlined by agreements with the USDA Economic Research Service. All results of analyses will undergo a thorough disclosure review to ensure no identifiable data are shared. Results will be disseminated to research, practice and policy communities using an Open Access peer-reviewed manuscript(s), scientific and practice presentations, and a public facing report and infographic.
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Affiliation(s)
- Bailey Houghtaling
- Gretchen Swanson Center for Nutrition, Omaha, Nebraska, USA
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia, USA
| | - Nanhua Zhang
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Amy Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, Nebraska, USA
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Houghtaling B, Short E, Shanks CB, Stotz SA, Yaroch A, Seligman H, Marriott JP, Eastman J, Long CR. Implementation of Food is Medicine Programs in Healthcare Settings: A Narrative Review. J Gen Intern Med 2024:10.1007/s11606-024-08768-w. [PMID: 38662283 DOI: 10.1007/s11606-024-08768-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
Food is Medicine (FIM) programs to improve the accessibility of fruits and vegetables (FVs) or other healthy foods among patients with low income and diet-related chronic diseases are promising to improve food and nutrition security in the United States (US). However, FIM programs are relatively new and implementation guidance for healthcare settings using an implementation science lens is lacking. We used a narrative review to describe the evidence base on barriers and facilitators to FIM program integration in US healthcare settings following the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework. Evidence surrounding the EPIS Inner Context was a focus, including constructs Leadership, Organizational Characteristics, Quality and Fidelity Monitoring and Support, Organizational Staffing Processes, and Individual Characteristics. Peer-reviewed and grey literature about barriers and facilitators to FIM programs were of interest, defined as programs that screen and refer eligible patients with diet-related chronic disease experiencing food insecurity to healthy, unprepared foods. Thirty-one sources were included in the narrative review, including 22 peer-reviewed articles, four reports, four toolkits, and one thesis. Twenty-eight sources (90%) described EPIS Inner Context facilitators and 26 sources (84%) described FIM program barriers. The most common barriers and facilitators to FIM programs were regarding Quality and Fidelity Monitoring and Support (e.g., use of electronic medical records for tracking and evaluation, strategies to support implementation) and Organizational Staffing Processes (e.g., clear delineation of staff roles and capacity); although, barriers and facilitators to FIM programs were identified among all EPIS Inner Context constructs. We synthesized barriers and facilitators to create an EPIS-informed implementation checklist for healthcare settings for use among healthcare organizations/providers, partner organizations, and technical assistance personnel. We discuss future directions to align FIM efforts with implementation science terminology and theories, models, and frameworks to improve the implementation evidence base and support FIM researchers and practitioners.
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Affiliation(s)
- Bailey Houghtaling
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA.
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA.
| | - Eliza Short
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
| | | | - Sarah A Stotz
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, USA
| | - Amy Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
| | - Hilary Seligman
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
- Division of General Internal Medicine and Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA
| | | | - Jenna Eastman
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
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Kouba I, Del Pozzo J, Lesser ML, Shahani D, Gulersen M, Bracero LA, Blitz MJ. Socioeconomic and clinical factors associated with excessive gestational weight gain. Arch Gynecol Obstet 2024; 309:1295-1303. [PMID: 36930325 PMCID: PMC10021048 DOI: 10.1007/s00404-023-07000-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 03/01/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE Excessive gestational weight gain (EGWG) is associated with adverse maternal and offspring outcomes but efforts to identify women at high risk for EGWG have been limited. The objective of this study is to identify socioeconomic and clinical factors associated with EGWG. METHODS This retrospective cohort included pregnant patients who delivered live, term, singleton newborns between January 2018 and February 2020 at seven hospitals within a large health system in New York. Patients were stratified by pre-pregnancy body mass index and then classified based on whether they exceeded the Institute of Medicine guidelines for gestational weight gain (GWG) and whether they gained more than 50 pounds in pregnancy. RESULTS A total of 44,872 subjects were included for analysis: 48% had EGWG and 17% had GWG exceeding 50 pounds. Patients with EGWG were more likely to be Black race, English speakers, overweight or obese pre-pregnancy, and have a mood disorder diagnosis. Patients who were underweight, multiparous, and those with gestational diabetes were less likely to have EGWG. CONCLUSION Sociodemographic and clinical findings associated with GWG > 50 pounds were similar but only overweight and not obese patients were at increased risk. Patients at risk for EGWG may benefit from early nutrition counseling and education on lifestyle changes.
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Affiliation(s)
- Insaf Kouba
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Division of Maternal-Fetal Medicine, South Shore University Hospital, 376 E Main St, Suite 202, Bay Shore, NY, 11706, USA.
| | - Jaclyn Del Pozzo
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Martin L Lesser
- Biostatistics Unit, Office of Academic Affairs, New Hyde Park, NY, USA
| | - Disha Shahani
- Biostatistics Unit, Office of Academic Affairs, New Hyde Park, NY, USA
| | - Moti Gulersen
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Luis A Bracero
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Matthew J Blitz
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
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4
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Ghazaryan A, Park S, Onufrak SJ, Carlson AC, Rhone A, Roy K. Characteristics Associated With Purchasing Sugar-Sweetened Beverages and Bottled Water Among US Households, 2015. J Acad Nutr Diet 2024; 124:28-41. [PMID: 37648023 PMCID: PMC10840658 DOI: 10.1016/j.jand.2023.08.128] [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: 12/19/2022] [Revised: 07/18/2023] [Accepted: 08/24/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Frequent intake of sugar-sweetened beverages (SSBs) among US adults is a public health concern because it has been associated with increased risks for adverse health outcomes such as obesity, type 2 diabetes, and cardiovascular disease. In contrast, drinking plain water (such as tap, bottled, or unsweetened sparkling water) instead of drinking SSBs might provide health benefits by improving diet quality and helping prevent chronic diseases. However, there is limited information on estimated expenditures on SSBs or bottled water among US households. OBJECTIVE This study examined differences in SSB and bottled water purchasing according to household and geographic area characteristics and estimated costs spent on purchasing SSB and bottled water from retail stores among a nationally representative sample of US households. DESIGN This study is a secondary analysis of the 2015 Circana (formerly Information Resources Inc) Consumer Network Panel data, which were merged with the US Department of Agriculture nutrition data using the US Department of Agriculture Purchase-to-Plate Crosswalk-2015 dataset (the latest available version of the Purchase-to-Plate Crosswalk at the time the study began), and the Child Opportunity Index 2.0 data. PARTICIPANTS/SETTINGS A total of 63,610 households, representative of the contiguous US population, consistently provided food and beverage purchase scanner data from retail stores throughout 2015. EXPLANATORY VARIABLES The included demographic and socioeconomic variables were household head's age, marital status, highest education level, race and ethnicity of the primary shopper in the household, family income relative to the federal poverty level, and presence of children in the household. In addition, descriptors of households' residential areas were included, such as the county-level poverty prevalence, urbanization, census region, and census tract level Child Opportunity Index. MAIN OUTCOME MEASURES Annual per capita spending on SSB and bottled water and daily per capita SSB calories purchased. STATISTICAL ANALYSIS Unadjusted and multivariable adjusted mean values of the main outcome measures were compared by household demographic, socioeconomic, and geographic characteristics using linear regression analysis including Circana's household projection factors. RESULTS Nearly all households reported purchasing SSBs at least once during 2015 and spent on average $47 (interquartile range = $20) per person per year on SSBs, which corresponded to 211 kcal (interquartile range = 125 kcal) of SSBs per person per day. About seven in 10 households reported purchasing bottled water at least once during 2015 and spent $11 (interquartile range = $5) per person on bottled water per year. Both annual per capita SSB and bottled water spending, and daily per capita SSB calories purchased was highest for households whose heads were between 40 and 59 years of age, had low household income, or lived in poor counties, or counties with a low Child Opportunity Index. Annual per capita spending was also higher for households with never married/widowed/divorced head, or at least 1 non-Hispanic Black head, and households without children, or those living in the South. Daily per capita SSB calorie purchases were highest for households where at least 1 head had less than a high school degree, households with at least 1 Hispanic or married head, and households with children or those living in the Midwest. CONCLUSIONS These findings suggest that households that had lower socioeconomic status had higher annual per capita spending on SSBs and bottled water and higher daily per capita total SSB calories purchased than households with higher socioeconomic status.
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Affiliation(s)
- Armen Ghazaryan
- Office of the Director, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Sohyun Park
- Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephen J Onufrak
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea C Carlson
- Food Economics Division, Economic Research Service, US Department of Agriculture, Washington, DC
| | - Alana Rhone
- Food Economics Division, Economic Research Service, US Department of Agriculture, Washington, DC
| | - Kakoli Roy
- Office of the Director, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Singleton CR, Wright LA, McDonald M, Archer IG, Bell CN, McLoughlin GM, Houghtaling B, Cooksey Stowers K, Anderson Steeves E. Structural racism and geographic access to food retailers in the United States: A scoping review. Health Place 2023; 83:103089. [PMID: 37557002 DOI: 10.1016/j.healthplace.2023.103089] [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] [Received: 01/31/2023] [Revised: 05/16/2023] [Accepted: 07/17/2023] [Indexed: 08/11/2023]
Abstract
This scoping review summarized findings and key measures from U.S.-based studies that 1) examined associations between geographic indicators of structural racism (e.g., redlining, racial segregation) and access to food retailers (e.g., supermarkets, convenience stores) or 2) documented disparities in access by neighborhood racial/ethnic composition. In 2022, relevant scientific literature was reviewed using Covidence software. Independent reviewers examined 13,069 citations; 163 citations advanced to the full-text review stage and 70 were selected for inclusion. Twenty-one studies (30%) linked one or more indicator of structural racism to food retailer access while 49 (70%) solely examined differences in access by neighborhood racial/ethnic composition. All studies featuring indicators of structural racism reported significant findings; however, indicators varied across studies making it difficult to make direct comparisons. Key indicators of structural racism in the food access literature included redlining (n = 3), gentrification (n = 3), and racial segregation (n = 4). Many U.S.-based studies have evaluated food retailer access by neighborhood racial/ethnic composition. Moving forward, studies should model indicators of structural racism and determine their influence on geographic access to large and small food retailers.
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Affiliation(s)
- Chelsea R Singleton
- Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health & Tropical Medicine, New Orleans, LA, USA.
| | - Laura A Wright
- Rudolph Matas Library of the Health Sciences, Tulane University, New Orleans, LA, USA
| | - Meredith McDonald
- Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Isabel G Archer
- Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Caryn N Bell
- Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Gabriella M McLoughlin
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA; Implementation Science Center for Cancer Control, Washington University in St. Louis, St. Louis, MO, USA
| | - Bailey Houghtaling
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA; Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - Kristen Cooksey Stowers
- Department of Allied Health Sciences, College of Agriculture, Health, And Natural Resources, University of Connecticut, Storrs, CT, USA
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6
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Baldeon AD, McDonald D, Gonzalez A, Knight R, Holscher HD. Diet Quality and the Fecal Microbiota in Adults in the American Gut Project. J Nutr 2023; 153:2004-2015. [PMID: 36828255 DOI: 10.1016/j.tjnut.2023.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 01/18/2023] [Accepted: 02/13/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND The Dietary Guidelines for Americans advises on dietary intake to meet nutritional needs, promote health, and prevent diseases. Diet affects the intestinal microbiota and is increasingly linked to health. It is vital to investigate the relationships between diet quality and the microbiota to better understand the impact of nutrition on human health. OBJECTIVES This study aimed to investigate the differences in fecal microbiota composition in adults from the American Gut Project based on their adherence to the Dietary Guidelines for Americans. METHODS This study was a cross-sectional analysis of the 16S sequencing and food frequency data of a subset of adults (n = 432; age = 18-60 y; 65% female, 89% white) participating in the crowdsourced American Gut Project. The Healthy Eating Index-2015 assessed the compliance with Dietary Guideline recommendations. The cohort was divided into tertiles based on Healthy Eating Index-2015 scores, and differences in taxonomic abundances and diversity were compared between high and low scorers. RESULTS The mean Total Score for low-scoring adults (58.1 ± 5.4) was comparable with the reported score of the average American adult (56.7). High scorers for the Total Score and components related to vegetables, grains, and dairy had greater alpha diversity than low scorers. High scorers in the fatty acid component had a lower alpha diversity than low scorers (95% CI: 0.35, 1.85). A positive log-fold difference in abundance of plant carbohydrate-metabolizing taxa in the families Lachnospiraceae and Ruminococcaceae was observed in high-scoring tertiles for Total Score, vegetable, fruit, and grain components (Benjamini-Hochberg; q < 0.05). CONCLUSIONS Adults with greater compliance to the Dietary Guidelines demonstrated higher diversity in their fecal microbiota and greater abundance of bacteria capable of metabolizing complex carbohydrates, providing evidence on how Dietary Guidelines support the gut microbiota.
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Affiliation(s)
- Alexis D Baldeon
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Daniel McDonald
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
| | - Antonio Gonzalez
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
| | - Rob Knight
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA; Center for Microbiome Innovation, University of California San Diego, La Jolla, California, USA; Department of Bioengineering, University of California San Diego, La Jolla, California, USA; Department of Computer Science and Engineering, University of California San Diego, La Jolla, California, USA
| | - Hannah D Holscher
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA; Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA.
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7
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Tripathy K, Bhasin R, McKinzie R, Sackett A, Storrs ME, Janda KM. Food insecurity disparities and impact on academic and social experiences among college students at a large public university. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-8. [PMID: 36996426 PMCID: PMC10544684 DOI: 10.1080/07448481.2023.2194435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 01/18/2023] [Accepted: 03/14/2023] [Indexed: 05/24/2023]
Abstract
Objective: This research seeks to understand food insecurity experiences among students at a large public university in the southern United States. Participants: Participants consented and completed an online survey disseminated on campus in April-May 2021 (N = 418). The participants sampled were predominantly undergraduate (78.2%), females (72.4%), who lived off campus (54.1%), and were racially/ethnically diverse. Methods: Descriptive statistics, multivariable logistic regression, and chi-squared tests were used to examine the differences and association between demographic characteristics and behaviors and food insecurity status. Results: About 32% students surveyed had experienced food insecurity in the last year, which resembles national trends. There were significant differences in students' food insecurity status by race, sexual orientation, first-generation status, residential category, and main mode of transportation. Food insecurity impacted academic and socioeconomic student behaviors. Conclusions: This research has implications for improving the academic, physical, and psychological wellbeing of university students and should inform future programs and policies.
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Affiliation(s)
- Krisha Tripathy
- Food Insecurity Action Team, University of Texas at Austin, Austin, Texas, USA
| | - Ria Bhasin
- Food Insecurity Action Team, University of Texas at Austin, Austin, Texas, USA
| | - Riley McKinzie
- Food Insecurity Action Team, University of Texas at Austin, Austin, Texas, USA
| | - Abigail Sackett
- Food Insecurity Action Team, University of Texas at Austin, Austin, Texas, USA
| | - Martha-Ellen Storrs
- Food Insecurity Action Team, University of Texas at Austin, Austin, Texas, USA
| | - Kathryn M. Janda
- Baylor University, Robbins College of Health and Human Sciences, Department of Public Health, Waco, Texas, USA
- UTHealth Science Center School of Public Health – Austin Campus, Austin, Texas, USA
- Michael and Susan Dell Center for Healthy Living, Austin, Texas, USA
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Zsichla L, Müller V. Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors. Viruses 2023; 15:175. [PMID: 36680215 PMCID: PMC9863423 DOI: 10.3390/v15010175] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
The clinical course and outcome of COVID-19 are highly variable, ranging from asymptomatic infections to severe disease and death. Understanding the risk factors of severe COVID-19 is relevant both in the clinical setting and at the epidemiological level. Here, we provide an overview of host, viral and environmental factors that have been shown or (in some cases) hypothesized to be associated with severe clinical outcomes. The factors considered in detail include the age and frailty, genetic polymorphisms, biological sex (and pregnancy), co- and superinfections, non-communicable comorbidities, immunological history, microbiota, and lifestyle of the patient; viral genetic variation and infecting dose; socioeconomic factors; and air pollution. For each category, we compile (sometimes conflicting) evidence for the association of the factor with COVID-19 outcomes (including the strength of the effect) and outline possible action mechanisms. We also discuss the complex interactions between the various risk factors.
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Affiliation(s)
- Levente Zsichla
- Institute of Biology, Eötvös Loránd University, 1117 Budapest, Hungary
- National Laboratory for Health Security, Eötvös Loránd University, 1117 Budapest, Hungary
| | - Viktor Müller
- Institute of Biology, Eötvös Loránd University, 1117 Budapest, Hungary
- National Laboratory for Health Security, Eötvös Loránd University, 1117 Budapest, Hungary
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Janda KM, Ranjit N, Salvo D, Nielsen A, Kaliszewski C, Hoelscher DM, van den Berg AE. Association between Fresh Fruit and Vegetable Consumption and Purchasing Behaviors, Food Insecurity Status and Geographic Food Access among a Lower-Income, Racially/Ethnically Diverse Cohort in Central Texas. Nutrients 2022; 14:5149. [PMID: 36501179 PMCID: PMC9738536 DOI: 10.3390/nu14235149] [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: 11/05/2022] [Revised: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 12/10/2022] Open
Abstract
The aims of this study were to determine if fresh fruit and vegetable consumption and purchasing behaviors were associated with geographic food access and/or food insecurity status, and to explore the role of sociodemographic characteristics among participants of a lower-income, racially/ethnically diverse cohort. This study used a cross-sectional design and baseline survey data from the FRESH-Austin study (N = 393). Associations between fresh produce consumption/purchasing and food insecurity status and geographic access to food were assessed utilizing univariate, bivariate, and multivariate linear regression methods and potential interactions were examined. The sample 40% reported being food insecure and the majority identified as Hispanic. Geographic food access was directly associated with fresh produce consumption (β = 0.46, p = 0.02); however, the directionality of the relationship between food insecurity and fresh produce consumption varied due to a significant interaction with race/ethnicity. Only utilizing food assistance was associated with purchasing fewer fresh produce (β= -1.83, p = 0.03). Findings suggest that communities experience food insecurity and limited healthy food access in different ways, and in some situations, are associated with fresh produce consumption and purchasing behaviors. Future research adopting an intersectionality-sensitive approach to better understand how to best support communities at risk is needed.
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Affiliation(s)
- Kathryn M. Janda
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76798, USA
- Department of Health Promotion and Behavioral Science, School of Public Health in Austin, University of Texas Health Science Center in Houston in Austin, Austin, TX 78701, USA
- Michael and Susan Dell Center for Healthy Living, Austin, TX 78701, USA
| | - Nalini Ranjit
- Department of Health Promotion and Behavioral Science, School of Public Health in Austin, University of Texas Health Science Center in Houston in Austin, Austin, TX 78701, USA
- Michael and Susan Dell Center for Healthy Living, Austin, TX 78701, USA
| | - Deborah Salvo
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX 78712, USA
| | - Aida Nielsen
- Department of Health Promotion and Behavioral Science, School of Public Health in Austin, University of Texas Health Science Center in Houston in Austin, Austin, TX 78701, USA
- Michael and Susan Dell Center for Healthy Living, Austin, TX 78701, USA
| | - Catherine Kaliszewski
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76798, USA
| | - Deanna M. Hoelscher
- Department of Health Promotion and Behavioral Science, School of Public Health in Austin, University of Texas Health Science Center in Houston in Austin, Austin, TX 78701, USA
- Michael and Susan Dell Center for Healthy Living, Austin, TX 78701, USA
| | - Alexandra E. van den Berg
- Department of Health Promotion and Behavioral Science, School of Public Health in Austin, University of Texas Health Science Center in Houston in Austin, Austin, TX 78701, USA
- Michael and Susan Dell Center for Healthy Living, Austin, TX 78701, USA
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10
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Janda KM, Salvo D, Ranjit N, Hoelscher DM, Nielsen A, Lemoine P, Casnovsky J, van den Berg A. Who shops at their nearest grocery store? A cross-sectional exploration of disparities in geographic food access among a low-income, racially/ethnically diverse cohort in Central Texas. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2022; 19:355-375. [PMID: 38800668 PMCID: PMC11114093 DOI: 10.1080/19320248.2022.2128962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Abstract
We examined whether Central Texans shop at their nearest supermarket, how far they travel for groceries, and explored differences by race/ethnicity, urbanicity, motivations for store selection and other demographic characteristics. Using cross-sectional data and GIS, continuous network distances from participants' homes to nearest and usual supermarkets were calculated and multivariate linear regression assessed differences. <19% shopped at their nearest supermarket. Regression models found that urbanicity played a large role in distance traveled to preferred supermarket, but other factors varied by race/ethnicity. Our findings demonstrate racial/ethnic and urbanicity disparities in food access and multiple domains of food access need greater consideration.
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Affiliation(s)
- Kathryn M. Janda
- UTHealth School of Public Health in Austin, 1616 Guadalupe Street, Suite 6.300, Austin, Texas, 78701, USA
- Michael and Susan Dell Center for Healthy Living 1616 Guadalupe Street, Suite 6.300, Austin, Texas, 78701, USA
- Baylor University, Department of Public Health, Robbins College of Health and Human Sciences, One Bear Place #97343, Waco, TX, 76798, USA
| | - Deborah Salvo
- Department of Kinesiology and Health Education, College of Education, The University of Texas at Austin, 1212 Speedway Stop D5000, Austin, Texas 78712
| | - Nalini Ranjit
- UTHealth School of Public Health in Austin, 1616 Guadalupe Street, Suite 6.300, Austin, Texas, 78701, USA
- Michael and Susan Dell Center for Healthy Living 1616 Guadalupe Street, Suite 6.300, Austin, Texas, 78701, USA
| | - Deanna M. Hoelscher
- UTHealth School of Public Health in Austin, 1616 Guadalupe Street, Suite 6.300, Austin, Texas, 78701, USA
- Michael and Susan Dell Center for Healthy Living 1616 Guadalupe Street, Suite 6.300, Austin, Texas, 78701, USA
| | - Aida Nielsen
- UTHealth School of Public Health in Austin, 1616 Guadalupe Street, Suite 6.300, Austin, Texas, 78701, USA
- Michael and Susan Dell Center for Healthy Living 1616 Guadalupe Street, Suite 6.300, Austin, Texas, 78701, USA
| | - Pablo Lemoine
- Centro Nacional de Consultoría, Calle 82 651 Bogotá, D.C., 801, Colombia
| | - Joy Casnovsky
- Sustainable Food Center, 2921 E. 17 Street, Building C, Austin, Texas, 78702, USA
| | - Alexandra van den Berg
- UTHealth School of Public Health in Austin, 1616 Guadalupe Street, Suite 6.300, Austin, Texas, 78701, USA
- Michael and Susan Dell Center for Healthy Living 1616 Guadalupe Street, Suite 6.300, Austin, Texas, 78701, USA
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Houghtaling B, Greene M, Parab KV, Singleton CR. Improving Fruit and Vegetable Accessibility, Purchasing, and Consumption to Advance Nutrition Security and Health Equity in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11220. [PMID: 36141494 PMCID: PMC9517087 DOI: 10.3390/ijerph191811220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/01/2022] [Accepted: 09/03/2022] [Indexed: 06/16/2023]
Abstract
In recent years, national and local efforts to improve diet and health in the United States have stressed the importance of nutrition security, which emphasizes consistent access to foods and beverages that promote health and prevent disease among all individuals. At the core of this endeavor is fruit and vegetable (FV) consumption, a dietary practice that is integral to attaining and sustaining a healthy diet. Unfortunately, significant inequities in FV accessibility, purchasing, and consumption exist, particularly among populations that are socially and economically disadvantaged. To achieve nutrition and health equity in the United States, the field must center the goal of nutrition security and initiatives that aim to increase FV consumption, specifically, in future work. The International Journal of Environmental Research and Public Health (IJERPH) Special Issue titled "Nutrition and Health Equity: Revisiting the Importance of Fruit and Vegetable Availability, Purchasing, and Consumption" features several scholarly publications from experts conducting timely research on these topics. In this commentary, we (1) summarize the U.S.-based literature on inequities in FV accessibility, purchasing, and consumption, (2) describe how the contributions to this IJERPH special issue can advance nutrition security and health equity, and (3) outline future research questions from our perspective.
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Affiliation(s)
- Bailey Houghtaling
- Gretchen Swanson Center for Nutrition, Omaha, NE 68514, USA
- School of Nutrition and Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA 70803, USA
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA 24061, USA
| | - Matthew Greene
- School of Nutrition and Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA 70803, USA
| | - Kaustubh V. Parab
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA
| | - Chelsea R. Singleton
- Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112, 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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Janda KM, Ranjit N, Salvo D, Hoelscher DM, Nielsen A, Casnovsky J, van den Berg A. Examining Geographic Food Access, Food Insecurity, and Urbanicity among Diverse, Low-Income Participants in Austin, Texas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095108. [PMID: 35564504 PMCID: PMC9104388 DOI: 10.3390/ijerph19095108] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 12/10/2022]
Abstract
The purpose of this study was to explore the association between geographic food access and food insecurity and the potential role of race/ethnicity, income, and urbanicity among a low-income, diverse sample in Central Texas. Utilizing a cross-sectional study design, secondary data analysis of an existing cohort was used to examine the association between food insecurity; geographic food access; and sociodemographic factors of race/ethnicity, income, urbanicity, and additional covariates using binomial logistic regression models. The existing cohort was recruited from lower-income communities in Travis County, Texas. The sample (N = 393) was predominantly Hispanic, lived in urban areas, and nearly 40% were food insecure. Geographic food access was not found to be significantly associated with food insecurity. However, rural residents had greater odds of being food insecure than urban residents. Also, participants who earned USD 45,000-64,999 and over USD 65,000 had lower odds of being food insecure than participants who earned under USD 25,000. These findings add to the inconsistent literature about the association between geographic food access and food insecurity and contribute to urbanicity and income disparities in food-insecurity literature. Future work should consider urbanicity, income, and utilize community-specific data to gain greater understanding of the association between geographic food access and food insecurity.
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Affiliation(s)
- Kathryn M. Janda
- UTHealth School of Public Health, Austin, TX 78701, USA; (N.R.); (D.M.H.); (A.N.); (A.v.d.B.)
- Michael and Susan Dell Center for Healthy Living, Austin, TX 78701, USA
- Correspondence:
| | - Nalini Ranjit
- UTHealth School of Public Health, Austin, TX 78701, USA; (N.R.); (D.M.H.); (A.N.); (A.v.d.B.)
- Michael and Susan Dell Center for Healthy Living, Austin, TX 78701, USA
| | - Deborah Salvo
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA;
| | - Deanna M. Hoelscher
- UTHealth School of Public Health, Austin, TX 78701, USA; (N.R.); (D.M.H.); (A.N.); (A.v.d.B.)
- Michael and Susan Dell Center for Healthy Living, Austin, TX 78701, USA
| | - Aida Nielsen
- UTHealth School of Public Health, Austin, TX 78701, USA; (N.R.); (D.M.H.); (A.N.); (A.v.d.B.)
- Michael and Susan Dell Center for Healthy Living, Austin, TX 78701, USA
| | | | - Alexandra van den Berg
- UTHealth School of Public Health, Austin, TX 78701, USA; (N.R.); (D.M.H.); (A.N.); (A.v.d.B.)
- Michael and Susan Dell Center for Healthy Living, Austin, TX 78701, USA
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Houghtaling B, Cater M, Bryant D, Brooks A, Holston D. What is the availability, affordability, and quality of foods and beverages aligned with dietary guidance in Louisiana Supplemental Nutrition Assistance Program (SNAP) authorized stores? Prev Med Rep 2021; 24:101578. [PMID: 34976640 PMCID: PMC8683981 DOI: 10.1016/j.pmedr.2021.101578] [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: 02/11/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 11/23/2022] Open
Abstract
SNAP stores in Louisiana score low on measures of healthy food access. No differences in healthy food access were found between rural/urban SNAP stores. Independent SNAP stores scored lower on healthy food access than corporate stores. SNAP grocery and dollar stores scored higher than SNAP convenience stores. Healthy retail partnerships with independent SNAP retailers are needed in Louisiana.
Healthy food retail strategies are delivered by Cooperative Extension Services in Louisiana to improve public health among communities with lower income. To guide Cooperative Extension Services Programming, the aim of this study was to assess healthy food access among SNAP-authorized stores. This included comparing the availability, affordability, and quality of healthy foods sold in these stores by geography, ownership, and store type. Seventy-five Louisiana SNAP-authorized stores were selected for measurement. Between October 2019 and March 2020 (prior to the COVID-19 national emergency declaration), trained researchers used the Nutrition Environment Measures Survey in Stores (NEMS-S) to assess the availability, affordability, and quality of healthy versus less healthy foods and beverages in 42 SNAP-authorized stores, including: grocery (n = 12, 29%), convenience (n = 17, 41%), drug (n = 1, 2%), dollar (n = 11, 26%), and butcher/meat (n = 1, 2%). Multivariate analysis of variance (a priori, p < 0.05) determined if differences in total NEMS-S scores or subscores existed by geography (urban versus rural), ownership (corporate/chain versus independent), or store type. No urban/rural differences were identified. Corporate/chain SNAP-authorized stores scored higher on average than independent SNAP-authorized stores for the total NEMS-S score (17.2 versus 8.1; p = 0.009) and availability subscore (13.1 versus 6.1; p = 0.02). SNAP-authorized grocery stores scored higher than all other store types (total NEMS-S score 27.6), followed by SNAP-authorized dollar stores (total NEMS-S score 10.7), and SNAP-authorized convenience stores (total NEMS-S score 5) (p < 0.001). Louisiana Cooperative Extension Services should explore ways to scale healthy food retail strategies statewide with a specific emphasis on independent and smaller SNAP-authorized retailers.
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Key Words
- Beverages
- CDC, Centers for Disease Control and Prevention
- DGA, 2020–2025 Dietary Guidelines for Americans
- EFNEP, Expanded Food and Nutrition Education Program
- Food
- Food access
- Food assistance
- Food security
- NEMS-S, Nutrition Environment Measures Survey in Stores
- PSE, policy, systems, and environmental
- Public health
- RUCC, Rural-Urban Continuum Code
- SNAP, Supplemental Nutrition Assistance Program
- SNAP-Ed, Supplemental Nutrition Assistance Program Education
- WIC, Special Supplemental Nutrition Assistance Program for Women, Infants, and Children
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Affiliation(s)
- Bailey Houghtaling
- School of Nutrition and Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA 70803, USA
- Corresponding author.
| | - Melissa Cater
- Agricultural and Extension Education and Evaluation, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA 70803, USA
| | - De'Jerra Bryant
- School of Nutrition and Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA 70803, USA
| | - Allie Brooks
- School of Nutrition and Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA 70803, USA
| | - Denise Holston
- School of Nutrition and Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA 70803, USA
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15
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The Potential for Healthy Checkout Policies to Advance Nutrition Equity. Nutrients 2021; 13:nu13114181. [PMID: 34836436 PMCID: PMC8618319 DOI: 10.3390/nu13114181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND As the only place in a store where all customers must pass through and wait, the checkout lane may be particularly influential over consumer purchases. Because most foods and beverages sold at checkout are unhealthy (e.g., candy, sweets, sugar-sweetened beverages, and salty snacks), policymakers and advocates have expressed growing interest in healthy checkout policies. To understand the extent to which such policies could improve nutrition equity, we assessed the prevalence and sociodemographic correlates of purchasing items found at (i.e., from) checkout. METHODS We assessed self-reported checkout purchasing and sociodemographic characteristics in a national convenience sample of adults (n = 10,348) completing an online survey in 2021. RESULTS Over one third (36%) of participants reported purchasing foods or drinks from checkout during their last grocery shopping trip. Purchasing items from checkout was more common among men; adults < 55 years of age; low-income consumers; Hispanic, non-Hispanic American Indian or Alaska Native, and non-Hispanic Black consumers; those with a graduate or professional degree; parents; and consumers diagnosed with type 2 diabetes or pre-diabetes (p-values < 0.05). CONCLUSIONS Purchasing foods or beverages from store checkouts is common and more prevalent among low-income and Hispanic, American Indian or Alaska Native, and Black consumers. These results suggest that healthy checkout policies have the potential to improve nutrition equity.
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Sawyer-Morris G, Grajeda S, Tracy T, Karpyn A. Between- and within-Group Differences in Fruit and Vegetable Purchases, Consumption, and BMI among Hispanic Farmers' Market Shoppers Who Use SNAP. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189923. [PMID: 34574846 PMCID: PMC8467110 DOI: 10.3390/ijerph18189923] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/06/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Despite considerable efforts to increase farmers' market access (FM) and improve household fruit and vegetable (FV) purchasing in low-income communities, little is known about the FV purchasing and consumption characteristics of low-income Hispanic farmers' market shoppers. (2) Methods: A secondary analysis of baseline data from a farmers' market study conducted between 2015 and 2017 (n = 2825) was performed. Participants who also received supplemental nutrition assistance program (SNAP) completed a 31-item online survey assessing demographics, health characteristics, and FV purchasing and consumption habits. Descriptive statistics and bivariate analyses were used to assess between- and within-group differences amongst Hispanic and non-Hispanic households. Regression analyses were used to examine associations among BMI, FV purchasing and consumption, and household size for Hispanic and non-Hispanic households as well as for Hispanic subgroups. (3) Results: The sample included 515 Hispanic and 2310 non-Hispanic SNAP-using FM shoppers in 13 states. Despite experiencing significantly higher food insecurity (89% vs. 81%, non-Hispanic), Hispanic shoppers consumed similar amounts of FV (3.04 cups/day) and spent less doing so. Significant subgroup differences were identified for FV purchasing. (4) Conclusions: Findings emphasize the importance of food insecurity and household size in FV interventions and underscore the capacity of Hispanic families to maintain FV consumption.
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Affiliation(s)
- Ginnie Sawyer-Morris
- Human Development & Family Sciences, University of Delaware, Newark, DE 19716, USA;
| | - Sara Grajeda
- Center for Research in Education and Social Policy, University of Delaware, Newark, DE 19716, USA; (S.G.); (T.T.)
| | - Tara Tracy
- Center for Research in Education and Social Policy, University of Delaware, Newark, DE 19716, USA; (S.G.); (T.T.)
| | - Allison Karpyn
- Center for Research in Education and Social Policy, University of Delaware, Newark, DE 19716, USA; (S.G.); (T.T.)
- Correspondence:
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17
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Petimar J, Zhang F, Rimm EB, Simon D, Cleveland LP, Gortmaker SL, Bleich SN, Polacsek M, Roberto CA, Block JP. Changes in the calorie and nutrient content of purchased fast food meals after calorie menu labeling: A natural experiment. PLoS Med 2021; 18:e1003714. [PMID: 34252088 PMCID: PMC8312920 DOI: 10.1371/journal.pmed.1003714] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 07/26/2021] [Accepted: 06/28/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Calorie menu labeling is a policy that requires food establishments to post the calories on menu offerings to encourage healthy food choice. Calorie labeling has been implemented in the United States since May 2018 per the Affordable Care Act, but to the best of our knowledge, no studies have evaluated the relationship between calorie labeling and meal purchases since nationwide implementation of this policy. Our objective was to investigate the relationship between calorie labeling and the calorie and nutrient content of purchased meals after a fast food franchise began labeling in April 2017, prior to the required nationwide implementation, and after nationwide implementation of labeling in May 2018, when all large US chain restaurants were required to label their menus. METHODS AND FINDINGS We obtained weekly aggregated sales data from 104 restaurants that are part of a fast food franchise for 3 national chains in 3 US states: Louisiana, Mississippi, and Texas. The franchise provided all sales data from April 2015 until April 2019. The franchise labeled menus in April 2017, 1 year prior to the required nationwide implementation date of May 2018 set by the US Food and Drug Administration. We obtained nutrition information for items sold (calories, fat, carbohydrates, protein, saturated fat, sugar, dietary fiber, and sodium) from Menustat, a publicly available database with nutrition information for items offered at the top revenue-generating US restaurant chains. We used an interrupted time series to find level and trend changes in mean weekly calorie and nutrient content per transaction after franchise and nationwide labeling. The analytic sample represented 331,776,445 items purchased across 67,112,342 transactions. Franchise labeling was associated with a level change of -54 calories/transaction (95% confidence interval [CI]: -67, -42, p < 0.0001) and a subsequent 3.3 calories/transaction increase per 4-week period (95% CI: 2.5, 4.1, p < 0.0001). Nationwide implementation was associated with a level decrease of -82 calories/transaction (95% CI: -88, -76, p < 0.0001) and a subsequent -2.1 calories/transaction decrease per 4-week period (95% CI: -2.9, -1.3, p < 0.0001). At the end of the study, the model-based predicted mean calories/transaction was 4.7% lower (change = -73 calories/transaction, 95% CI: -81, -65), and nutrients/transaction ranged from 1.8% lower (saturated fat) to 7.0% lower (sugar) than what we would expect had labeling not been implemented. The main limitations were potential residual time-varying confounding and lack of individual-level transaction data. CONCLUSIONS In this study, we observed that calorie labeling was associated with small decreases in mean calorie and nutrient content of fast food meals 2 years after franchise labeling and nearly 1 year after implementation of labeling nationwide. These changes imply that calorie labeling was associated with small improvements in purchased meal quality in US chain restaurants.
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Affiliation(s)
- Joshua Petimar
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute & Harvard Medical School, Boston, Massachusetts, United States of America.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Fang Zhang
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Pilgrim Health Care Institute & Harvard Medical School, Boston, Massachusetts, United States of America
| | - Eric B Rimm
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Denise Simon
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute & Harvard Medical School, Boston, Massachusetts, United States of America
| | - Lauren P Cleveland
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute & Harvard Medical School, Boston, Massachusetts, United States of America
| | - Steven L Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Michele Polacsek
- Westbrook College of Health Professions, University of New England, Portland, Maine, United States of America
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Jason P Block
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute & Harvard Medical School, Boston, Massachusetts, United States of America
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Yisahak SF, Mumford SL, Grewal J, Li M, Zhang C, Grantz KL, Hinkle SN. Maternal diet patterns during early pregnancy in relation to neonatal outcomes. Am J Clin Nutr 2021; 114:358-367. [PMID: 33742192 PMCID: PMC8246623 DOI: 10.1093/ajcn/nqab019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 01/18/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Research has established that maternal diet influences fetal growth and preterm birth, but most studies only evaluate single nutrients. Relations between dietary patterns and neonatal outcomes are understudied. OBJECTIVE We evaluated associations of neonatal outcomes with maternal diet patterns derived using 3 a priori diet scores [Alternative Healthy Eating Index-2010 (AHEI-2010), alternate Mediterranean diet score (aMed), and Dietary Approaches to Stop Hypertension (DASH)] as well as principal components analysis (PCA). METHODS We studied 1948 women from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies-Singletons, a racially diverse multisite cohort of pregnant women in the USA (2009-2013). Diet in the past 3 mo was assessed using a self-administered FFQ at 8-13 weeks of gestation. Birthweight was abstracted from medical records and neonatal anthropometry measured postdelivery using standardized protocols. RESULTS All 3 a priori scores were significantly associated with increased birthweight, and aMed was also associated with reduced odds of low birthweight [quartile 4 versus 1: ORadj = 0.42; 95% CI: 0.18, 1.00 (P-trend = 0.02)]. Greater aMed and DASH scores were significantly associated with increased length [aMed: quartile 4 versus 1: 0.54 cm; 95% CI: 0.10, 0.99 (P-trend = 0.006); DASH: quartile 4 versus 1: 0.62 cm; 95% CI: 0.25, 0.99 (P-trend = 0.006)] and upper arm length. Neither diet pattern derived from PCA was significantly associated with birthweight. CONCLUSION Among mostly low-risk pregnant women, pre- and early pregnancy healthful diet quality indices, particularly the aMed score, were associated with larger neonatal size across the entire birthweight distribution. In the absence of generally accepted pregnancy-specific diet quality scores, these results provide evidence for an association between maternal diet patterns and neonatal outcomes.
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Affiliation(s)
- Samrawit F Yisahak
- Office of the Director, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Sunni L Mumford
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Jagteshwar Grewal
- Office of the Director, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Mengying Li
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Cuilin Zhang
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Katherine L Grantz
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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The Retail Food Environment: Time for a Change. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238846. [PMID: 33260704 PMCID: PMC7729811 DOI: 10.3390/ijerph17238846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 12/20/2022]
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Hecht AA, Lott MM, Arm K, Story MT, Snyder E, Wootan MG, Moran AJ. Developing a National Research Agenda to Support Healthy Food Retail. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8141. [PMID: 33158134 PMCID: PMC7663573 DOI: 10.3390/ijerph17218141] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/28/2020] [Accepted: 11/02/2020] [Indexed: 12/24/2022]
Abstract
The food retail environment is an important driver of dietary choices. This article presents a national agenda for research in food retail, with the goal of identifying policies and corporate practices that effectively promote healthy food and beverage purchases and decrease unhealthy purchases. The research agenda was developed through a multi-step process that included (1) convening a scientific advisory committee; (2) commissioned research; (3) in-person expert convening; (4) thematic analysis of meeting notes and refining research questions; (5) follow-up survey of convening participants; and (6) refining the final research agenda. Public health researchers, advocates, food and beverage retailers, and funders participated in the agenda setting process. A total of 37 research questions grouped into ten priority areas emerged. Five priority areas focus on understanding the current food retail environment and consumer behavior and five focus on assessing implementation and effectiveness of interventions and policies to attain healthier retail. Priority topics include how frequency, duration, and impact of retailer promotion practices differ by community characteristics and how to leverage federal nutrition assistance programs to support healthy eating. To improve feasibility, researchers should explore partnerships with retailers and advocacy groups, identify novel data sources, and use a variety of study designs. This agenda can serve as a guide for researchers, food retailers, funders, government agencies, and advocacy organizations.
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Affiliation(s)
- Amelie A. Hecht
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Megan M. Lott
- Healthy Eating Research, Duke Global Health Institute, Duke University, Durham, NC 27708, USA; (M.M.L.); (K.A.); (M.T.S.)
| | - Kirsten Arm
- Healthy Eating Research, Duke Global Health Institute, Duke University, Durham, NC 27708, USA; (M.M.L.); (K.A.); (M.T.S.)
| | - Mary T. Story
- Healthy Eating Research, Duke Global Health Institute, Duke University, Durham, NC 27708, USA; (M.M.L.); (K.A.); (M.T.S.)
| | - Emily Snyder
- Center for Science in the Public Interest, Washington, DC 20005, USA; (E.S.); (M.G.W.)
| | - Margo G. Wootan
- Center for Science in the Public Interest, Washington, DC 20005, USA; (E.S.); (M.G.W.)
| | - Alyssa J. Moran
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
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