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Long CR, Narcisse MR, Selig JP, Willis DE, Gannon M, Rowland B, English ES, McElfish PA. Prevalence and associations between food insecurity and overweight/obesity among native Hawaiian and Pacific Islander adolescents. Public Health Nutr 2023; 26:1338-1344. [PMID: 37069046 PMCID: PMC10346012 DOI: 10.1017/s1368980023000769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/20/2023] [Accepted: 04/01/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE This study estimates the prevalence of, and associations between, family food insecurity and overweight/obesity among Native Hawaiian and Pacific Islander (NHPI) adolescents and explores socio-demographic factors which might have a moderation effect on the association. DESIGN Cross-sectional study using 2014 NHPI-National Health Interview Survey data reported by a parent or guardian. Family-level food security was assessed by the US Department of Agriculture 10-item questionnaire. BMI for age and sex ≥ 85th and 95th percentiles defined overweight and obesity, respectively, according to US Centers for Disease Control and Prevention criteria. SETTING The USA, including all 50 states and the District of Columbia. PARTICIPANTS 383 NHPI adolescents aged 12-17 in the USA. RESULTS A third (33·5 %) of NHPI adolescents aged 12-17 were overweight (19·1 %) or obese (14·4 %); 8·1 % had low food security; and 8·5 % had very low food security. Mean family food security score was 1·06, which corresponds to marginal food security. We found no association between family food insecurity and adolescent overweight/obesity or between any other covariates and overweight/obesity, except for family Supplemental Nutrition Assistance Program (SNAP) participation. Odds of being overweight/obese were 77 % lower for adolescents in families participating in SNAP (OR: 0·23, 95 % CI: 0·08, 0·64, P = 0·007). The association between SNAP participation and lower odds of overweight/obesity was particularly pronounced for adolescent girls in food-insecure families. CONCLUSIONS The association between SNAP participation and lower odds of overweight/obesity suggests potential benefit of research to determine whether interventions to increase SNAP enrollment would improve NHPI adolescents' health outcomes.
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Affiliation(s)
- Christopher R Long
- University of Arkansas for Medical Sciences Northwest, College of Medicine, Fayetteville, AR72703, USA
| | - Marie-Rachelle Narcisse
- University of Arkansas for Medical Sciences Northwest, College of Medicine, Fayetteville, AR72703, USA
| | - James P Selig
- University of Arkansas for Medical Sciences Northwest, Fay W. Boozman College of Public Health, Fayetteville, AR, USA
| | - Don E Willis
- University of Arkansas for Medical Sciences Northwest, College of Medicine, Fayetteville, AR72703, USA
| | - Matthew Gannon
- University of Arkansas for Medical Sciences Northwest, Office of Community Health and Research, Fayetteville, AR, USA
| | - Brett Rowland
- University of Arkansas for Medical Sciences Northwest, Office of Community Health and Research, Fayetteville, AR, USA
| | - Emily S English
- University of Arkansas for Medical Sciences Northwest, College of Medicine, Fayetteville, AR72703, USA
| | - Pearl A McElfish
- University of Arkansas for Medical Sciences Northwest, College of Medicine, Fayetteville, AR72703, USA
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Short E, Gannon MA, Bounds K, Faitak B, Martin P, Moore S, Shannon D, Selig JP, English ES, Felix HC, Haggard-Duff L, Mejia-Otero J, McElfish PA, Long CR. An integrated approach to address diabetes in the context of food insecurity: Delivering health study protocol. Contemp Clin Trials Commun 2023; 33:101139. [PMID: 37215390 PMCID: PMC10195850 DOI: 10.1016/j.conctc.2023.101139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 05/24/2023] Open
Abstract
Background Diabetes self-management education and support (DSMES) interventions among food insecure individuals with type 2 diabetes (T2D) have found modest improvements in nutrition and health outcomes but are limited by barriers to attendance and retention. This study applies a community-based participatory research approach, engaging community members at all levels of intervention planning, development, implementation, and dissemination, to deliver a plain-language DSMES curriculum to food insecure community members with T2D. Methods This is a single-arm, pre-post design assessing the efficacy of a 12-week home-delivered DSMES curriculum and T2D-appropriate food box intervention to improve the nutrition and health outcomes of food insecure individuals with T2D. The intervention consists of a weekly food box delivery and handout with video links on key DSMES topics, developed and refined using community advisor feedback. Up to 100 English-, Spanish-, or Marshallese-speaking adult participants with T2D (HbA1c ≥ 7%) and food insecurity are being recruited from food pantries in northwest Arkansas. Data is collected at pre-intervention and immediately post-intervention. The primary study outcome is change in HbA1c. Secondary measures include diet quality (Healthy Eating Index-2015, calculated from 3 24-h dietary recall interviews via phone), body mass index, blood pressure, skin carotenoids, food security, T2D self-management behaviors, T2D self-efficacy, and T2D-related distress. Results Recruitment began in August 2021 and enrollment is anticipated to be complete in March 2023. Conclusion Findings from this study will provide a rich understanding of diabetes-related health outcomes and dietary patterns of individuals with food insecurity and T2D and inform future food-focused DSMES interventions in this setting.
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Affiliation(s)
- Eliza Short
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Matthew A. Gannon
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Kelsey Bounds
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Bonnie Faitak
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Pam Martin
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Sarah Moore
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - DeAnna Shannon
- Samaritan Community Center, 1211 W. Hudson Rd., Rogers, AR, 72756, USA
| | - James P. Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA
| | - Emily S. English
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Holly C. Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA
| | - Lauren Haggard-Duff
- College of Nursing, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Juan Mejia-Otero
- Department of Pediatric Endocrinology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Christopher R. Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
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Silva R, Gannon MA, Presley JH, Long CR, Medrano R, Vaughan JA, English ES, McElfish PA. Experiences of Farmers Market Vendors in a Healthy Food Incentive Program. Health Promot Pract 2023; 24:116S-124S. [PMID: 36999503 DOI: 10.1177/15248399221115690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
Healthy food incentive programs for Supplemental Nutrition Assistance Program participants, often implemented in farmers markets, have shown promise in improving the purchase and consumption of fruits and vegetables. However, variation in program context, program strategies, and participant populations has produced gaps in knowledge about which healthy food incentive program implementation strategies are most effective, and few studies have focused on farmers market vendors' experiences. This study evaluated experiences of farmers market vendors who participated in the Northwest Arkansas Double Your Dollars (NWA DYD) healthy food incentive program intended to increase access to healthy foods for local Hispanic/Latino and Marshallese community members with low incomes. Data were collected from a convenience sample of vendors participating in NWA DYD at the three largest participating markets on the last Saturday in October 2021. Program staff collected quantitative, categorical, and open-ended data through face-to-face surveys. Forty-one vendors completed the survey. Vendors believed NWA DYD was beneficial and easy to use, expanded their customer base, and increased participation of Hispanic/Latino and Marshallese shoppers. Vendors also identified challenges in participation related to administrative burdens and delayed reimbursements. Vendors did not identify NWA DYD as a driver for expanded production for the upcoming growing season. Vendors' experiences at NWA DYD provide implications for others interested in implementing effective healthy food incentive programs. Improving access to farmers markets through effective healthy food incentive programs is an important step toward increasing consumption of fresh, healthy foods among communities with low incomes facing elevated prevalence of chronic disease.
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Affiliation(s)
- Rosario Silva
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Matthew A Gannon
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Jessica H Presley
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Christopher R Long
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Rosalinda Medrano
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Jenni A Vaughan
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Emily S English
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Pearl A McElfish
- University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
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Long CR, Rowland B, Gannon M, Faitak B, Smith G, Clampitt J, Langston K, Presley JH, English ES, McElfish PA. Reducing Sodium Content of Foods Served in Arkansas's Largest School District: Evaluation of the Sodium Reduction in Communities Program. Prev Chronic Dis 2022; 19:E55. [PMID: 36048736 PMCID: PMC9480841 DOI: 10.5888/pcd19.220051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Purpose and Objectives The Centers for Disease Control and Prevention’s Sodium Reduction in Communities Program aims to reduce dietary sodium intake through policy, systems, and environmental approaches. The objective of our study was to evaluate changes in sodium levels over 5 years (2016–2021) in food served in school lunches as an outcome of a Sodium Reduction in Communities program in Arkansas’s largest school district. Intervention Approach We collaborated with Springdale Public Schools (SPS) to reduce dietary sodium intake in school lunches through increased implementation of 1) food service guidelines, 2) procurement practices, 3) food preparation practices, and 4) environmental strategies. These activities were maintained from year 1 through year 5. Implementation priorities were informed each year by evaluation findings from the preceding year. Evaluation Methods We collected lunch service records and information on nutritional content of menu items for the 30 schools under the direction of SPS’s Child Nutrition Department. We used a pretest–posttest quantitative evaluation design to analyze annual changes in the sodium content of meals, from baseline through year 5. Results From baseline through year 1, SPS reduced sodium served per diner, per entrée offered, and per entrée served. These reductions were maintained from baseline through 5 years of follow-up. Mean sodium per 1,000 kcal per diner served was 1,740 mg at baseline and was lower in each of the 5 follow-up years: 1,488 mg (14% decrease) in year 1; 1,495 mg (14% decrease) in year 2; 1,612 mg (7% decrease) in year 3; 1,560 mg (10% decrease) in year 4; and 1,532 mg (12% decrease) in year 5. Energy served per diner remained stable. Implications for Public Health Our study provides evidence for sustained sodium reduction strategies in a large ethnically and socioeconomically diverse school district, pointing to the potential benefit of implementing similar strategies in other school districts. The study also shows how program evaluation can be used to support sustainability.
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Affiliation(s)
- Christopher R Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N College Ave, Fayetteville, AR 72701.
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Matthew Gannon
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Bonnie Faitak
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Gena Smith
- Child Nutrition, Springdale Public Schools, Springdale, Arkansas
| | - Jennifer Clampitt
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Krista Langston
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Jessica H Presley
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Emily S English
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
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Long CR, Bailey MM, Cascante D, Purvis R, Rowland B, Faitak B, Gittelsohn J, Caspi CE, English ES, McElfish PA. Food Pantry Clients' Needs, Preferences, and Recommendations for Food Pantries: A Qualitative Study. J Hunger Environ Nutr 2022; 18:245-260. [PMID: 37065860 PMCID: PMC10103899 DOI: 10.1080/19320248.2022.2058334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A qualitative formative approach was used to explore food pantry clients' needs, preferences, and recommendations regarding food received from food pantries. Fifty adult clients of six Arkansas food pantries were interviewed in English, Spanish, or Marshallese. Data analysis used the constant comparative qualitative methodology. In choice and minimal choice pantries, three themes emerged: clients need increased quantities of food, particularly more proteins and dairy; clients desire higher quality food, including healthy food and food not close to expiration; and clients desire familiar foods and food appropriate for their health needs. System level policy changes are needed to address clients' recommendations.
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Affiliation(s)
- Christopher R Long
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 1125 N. College Avenue, Fayetteville, 72703-5011 United States
| | - Mary M Bailey
- University of Arkansas for Medical Sciences Northwest, Office of Community Health and Research, 1125 N. College Avenue, Fayetteville, 72703-5011 United States
| | - Diana Cascante
- University of Arkansas for Medical Sciences Northwest, Office of Community Health and Research, 1125 N. College Avenue, Fayetteville, 72703-5011 United States
| | - Rachel Purvis
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 1125 N. College Avenue, Fayetteville, 72703-5011 United States
| | - Brett Rowland
- University of Arkansas for Medical Sciences Northwest, Office of Community Health and Research, 1125 N. College Avenue, Fayetteville, 72703-5011 United States
| | - Bonnie Faitak
- University of Arkansas for Medical Sciences Northwest, Office of Community Health and Research, 1125 N. College Avenue, Fayetteville, 72703-5011 United States
| | - Joel Gittelsohn
- Johns Hopkins University Bloomberg School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, 21205-2103 United States
| | - Caitlin E Caspi
- University of Connecticut, Rudd Center for Food Policy and Obesity, 1 Constitution Plaza, Storrs, 06269 United States
| | - Emily S English
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 1125 N. College Avenue, Fayetteville, 72703-5011 United States
| | - Pearl A McElfish
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 1125 N. College Avenue, Fayetteville, 72703-5011 United States
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Long CR, Narcisse MR, Rowland B, Faitak B, Bailey MM, Gittelsohn J, Caspi CE, Niemeier J, English ES, McElfish PA. Food Pantry Usage Patterns are Associated with Client Sociodemographics and Health. J Hunger Environ Nutr 2022; 17:408-424. [PMID: 35935752 PMCID: PMC9355513 DOI: 10.1080/19320248.2021.2001404] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Characterizing food pantry (FP) clients' FP usage patterns may provide opportunities to tailor health-related interventions. Respondents (n=245) at seven FPs reported their frequency and reliance on FPs and their sociodemographics, health status, and health-related trade-offs. Clients were categorized via latent class analysis. Higher FP usage was associated with being older, having a household member with heart disease, and putting off buying medicine to buy food. Lower FP usage was associated with higher levels of education and having a household member with cancer. Findings highlight the potential importance of measuring FP clients' degree of FP use.
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Affiliation(s)
- Christopher R. Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703 USA
| | - Marie-Rachelle Narcisse
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703 USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703 USA
| | - Bonnie Faitak
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703 USA
| | - Mary M. Bailey
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703 USA
| | - Joel Gittelsohn
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Caitlin E. Caspi
- University of Connecticut Rudd Center for Food Policy and Obesity, 1 Constitution Plaza, Hartford, CT 06103 USA
| | - Jill Niemeier
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703 USA
| | - Emily S. English
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703 USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703 USA
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