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Hao SB, Jilcott Pitts SB, Iasiello J, Mejia C, Quinn AW, Popowicz P, Mitsakos A, Parikh AA, Snyder RA. A Mixed-Methods Study to Evaluate the Feasibility and Acceptability of Implementing an Electronic Health Record Social Determinants of Health Screening Instrument into Routine Clinical Oncology Practice. Ann Surg Oncol 2023; 30:7299-7308. [PMID: 37606839 DOI: 10.1245/s10434-023-14124-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/24/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Routine screening for social determinants of health (SDOH) in the outpatient oncology setting is uncommon. The primary goal of this study was to prospectively evaluate the feasibility and acceptability of implementing an electronic health record (EHR) SDOH screening instrument into routine, clinical, oncology practice. METHODS Adult patients with newly diagnosed gastrointestinal cancer presenting to a regional cancer center (November 2020 to July 2021) were eligible. Based on the consolidated framework for implementation research, feasibility measures included screening completion, median clinic visit time, and acceptability by the inter-professional care team and patients as measured by semistructured, qualitative interviews and surveys. Secondary outcomes included SDOH needs identified. RESULTS Of 137 eligible patients, 112 (81.8%) were screened for SDOH. Demographics of the cohort included: 41.1% black (n = 46), 48.2% rural (n = 54), 4.5% uninsured (n = 5), and 6.3% Medicaid-insured (n = 7) patients. Median visit time was 97 min (95% CI 70-107 min) before and 100 min after implementation (95% CI 75-119 min; p = 0.95). In total, 95.5% (n = 107) reported at least one SDOH need. Clinicians (7/10) reported that SDOH screening was not disruptive and were supportive of ongoing use. Patients (10/10) found the screening acceptable. Screening staff (5/5) reported workflow barriers. Patients and staff also recommended revision of specific instrument questions. CONCLUSIONS Routine collection of SDOH in an outpatient oncology setting using an EHR instrument is feasible and does not result in increased visit time for patients or clinicians. However, staff perceptions of clinic workflow disruption were reported. Further investigation to determine whether standardized SDOH assessment can improve cancer care delivery and outcomes is ongoing.
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Affiliation(s)
- Scarlett B Hao
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | | | - John Iasiello
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Christopher Mejia
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Ashley W Quinn
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Patrycja Popowicz
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Anastasios Mitsakos
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Alexander A Parikh
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA
- Division of Surgical Oncology, Department of Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Rebecca A Snyder
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
- Department of Public Health, East Carolina University, Greenville, NC, USA.
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Hao SB, Jilcott Pitts SB, Iasiello J, Mejia C, Quinn AW, Popowicz P, Mitsakos A, Parikh AA, Snyder RA. ASO Visual Abstract: A Mixed-Methods Study to Evaluate the Feasibility and Acceptability of Implementing an Electronic Health Record Social Determinants of Health Screening Instrument into Routine Clinical Oncology Practice. Ann Surg Oncol 2023; 30:7329. [PMID: 37635190 DOI: 10.1245/s10434-023-14173-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- Scarlett B Hao
- Department of Surgery, Brody School of Medicine at East, Carolina University, Greenville, NC, USA
| | - Stephanie B Jilcott Pitts
- Department of Public Health, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - John Iasiello
- Department of Surgery, Brody School of Medicine at East, Carolina University, Greenville, NC, USA
| | - Christopher Mejia
- Department of Surgery, Brody School of Medicine at East, Carolina University, Greenville, NC, USA
| | - Ashley W Quinn
- Department of Surgery, Brody School of Medicine at East, Carolina University, Greenville, NC, USA
| | - Patrycja Popowicz
- Department of Surgery, Brody School of Medicine at East, Carolina University, Greenville, NC, USA
| | - Anastasios Mitsakos
- Department of Surgery, Brody School of Medicine at East, Carolina University, Greenville, NC, USA
| | - Alexander A Parikh
- Department of Surgery, Brody School of Medicine at East, Carolina University, Greenville, NC, USA
- Division of Surgical Oncology, Department of Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Rebecca A Snyder
- Department of Surgery, Brody School of Medicine at East, Carolina University, Greenville, NC, USA.
- Department of Public Health, Brody School of Medicine at East Carolina University, Greenville, NC, USA.
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Jilcott Pitts SB, Wu Q, Moran NE, Laska MN, Harnack L. Examining Potential Modifiers of Human Skin and Plasma Carotenoid Responses in a Randomized Trial of a Carotenoid-Containing Juice Intervention. J Nutr 2023; 153:3287-3294. [PMID: 37742797 PMCID: PMC10687613 DOI: 10.1016/j.tjnut.2023.09.014] [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: 06/16/2023] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Skin carotenoid measurements are emerging as a valid and reliable indicator of fruit and vegetable intake and carotenoid intake. However, little is known about the extent to which skin carotenoid responsivity to dietary changes differs based on demographic and physiologic characteristics. OBJECTIVES This study examined potential effect modifiers of skin carotenoid and plasma carotenoid responses to a carotenoid-rich juice intervention. METHODS We leveraged data from 2 arms of a 3-site randomized controlled trial of a carotenoid-containing juice intervention (moderate dose = 6 ounces juice, 4 mg total carotenoids/d, high dose = 12 ounces juice, 8 mg total carotenoids/d) (n = 106) to examine effect modification by age, self-categorized race/ethnicity, biological sex, baseline body fat, body mass index, skin melanin, skin hemoglobin, skin hemoglobin saturation, skin coloration, sun exposure, and baseline intake of carotenoids from foods. Skin carotenoid concentrations were assessed using pressure-mediated reflection spectroscopy (Veggie Meter), and plasma carotenoid concentrations were measured using high-performance liquid chromatography. RESULTS In bivariate analyses, among the high-dose group (8 mg/d), those of older age had lower skin carotenoid responsiveness than their younger counterparts, and those with greater hemoglobin saturation and lighter skin had higher skin carotenoid score responsiveness. In the moderate-dose group (4 mg/d), participants from one site had greater plasma carotenoid responsiveness than those from other sites. In multivariate analyses, participants with higher baseline skin carotenoids had smaller skin carotenoid responses to both moderate and high doses. CONCLUSIONS Changes in skin carotenoid scores in response to interventions to increase fruit and vegetable intake should be interpreted in the context of baseline skin carotenoid scores, but other variables (e.g., self-categorized race/ethnicity, biological sex, baseline body fat, body mass index, skin melanin, and sun exposure) do not significantly modify the effect of carotenoid intake on changes in skin carotenoid scores. This trial was registered at clinicaltrials.gov as NCT04056624.
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Affiliation(s)
- Stephanie B Jilcott Pitts
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, United States.
| | - Qiang Wu
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Nancy E Moran
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics-Nutrition, Baylor College of Medicine, Houston, TX, United States
| | - Melissa N Laska
- Healthy Weight Research Center, Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN, United States
| | - Lisa Harnack
- Nutrition Coordinating Center, Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, United States
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Jilcott Pitts SB, Moran NE, Wu Q, Harnack L, Craft NE, Hanchard N, Bell R, Moe SG, Johnson N, Obasohan J, Carr-Manthe PL, Laska MN. Corrigendum to 'Pressure-Mediated Reflection Spectroscopy Criterion Validity as a Biomarker of Fruit and Vegetable Intake: A 2-Site Cross-Sectional Study of 4 Racial or Ethnic Groups' [J Nutr 2022;152:107-116]. J Nutr 2023; 153:3345. [PMID: 37806321 DOI: 10.1016/j.tjnut.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Affiliation(s)
| | - Nancy E Moran
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Qiang Wu
- Department of Biostatistics, East Carolina University, Greenville, NC, USA
| | - Lisa Harnack
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Neil Hanchard
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Ronny Bell
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stacey G Moe
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Nevin Johnson
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Justice Obasohan
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Pamela L Carr-Manthe
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Melissa N Laska
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
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Marshall GA, Garner JA, Hanson KL, Ammerman AS, Jilcott Pitts SB, Kolodinsky J, Sitaker M, Seguin-Fowler RA. Fruit and Vegetable Preparation Changes During and After Cost-Offset Community-Supported Agriculture Plus Nutrition Education. J Nutr Educ Behav 2023; 55:575-584. [PMID: 37389499 DOI: 10.1016/j.jneb.2023.05.002] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 04/27/2023] [Accepted: 05/08/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE Inadequate consumption of fruits and vegetables (FV) can negatively impact health. Cost-offset, or subsidized, community-supported agriculture (CO-CSA) may change FV preparation behaviors among caregivers in low-income households. We assessed changes in FV preparation frequency and methods during and after participation in a CO-CSA plus tailored nutrition education intervention. DESIGN Longitudinal comparison of outcomes at baseline, end of CO-CSA season, and 1 year later. PARTICIPANTS Caregivers of children aged 2-12 years from households with low income in rural areas of 4 US states (n = 148). INTERVENTION Summer season, half-price CO-CSA share plus tailored nutrition education classes. Comparison to a control group not included in this analysis. VARIABLES MEASURED Monthly frequency of preparing 9 FV for children's snacks and 5 vegetables for dinner; use of healthy preparation methods for dinner. ANALYSIS Repeated measures ANCOVA including state with Bonferroni correction and 95% confidence. RESULTS At baseline, caregivers prepared fruit for children's snacks and vegetables for dinner almost daily and vegetables for children's snacks every other day. The frequency of total FV preparation and most vegetable varieties increased during the intervention. Increases in total vegetables for snacks, dinner, and leafy greens were maintained 1 year later (n = 107). CONCLUSIONS AND IMPLICATIONS Community-supported agriculture plus education is a promising approach to sustained increases in vegetable preparation for children's snacks and dinner meals.
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Affiliation(s)
- Grace A Marshall
- Department of Public and Ecosystem Health, Cornell University, Ithaca, NY.
| | - Jennifer A Garner
- John Glenn College of Public Affairs, The Ohio State University, Columbus, OH; Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH
| | - Karla L Hanson
- Department of Public and Ecosystem Health, Cornell University, Ithaca, NY
| | - Alice S Ammerman
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Jane Kolodinsky
- Department of Community Development and Applied Economics, University of Vermont, Burlington, VT
| | - Marilyn Sitaker
- Extension Agriculture and Natural Resources, Washington State University, Olympia, WA
| | - Rebecca A Seguin-Fowler
- Institute for Advancing Health Through Agriculture, Texas A&M University System, College Station, TX
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Garner JA, Hanson KL, Jilcott Pitts SB, Kolodinsky J, Sitaker MH, Ammerman AS, Kenkel D, Seguin-Fowler RA. Cost analysis and cost effectiveness of a subsidized community supported agriculture intervention for low-income families. Int J Behav Nutr Phys Act 2023; 20:84. [PMID: 37430305 DOI: 10.1186/s12966-023-01481-7] [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] [Received: 03/08/2023] [Accepted: 06/20/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND The food system has a dynamic influence on disparities in food security and diet-related chronic disease. Community supported agriculture (CSA) programs, in which households receive weekly shares of produce from a local farmer during the growing season, have been examined as a possible food systems-based approach for improving diet and health outcomes. The purpose of this study was to estimate the cost of implementing and participating in a multi-component subsidized community supported agriculture intervention and calculate cost-effectiveness based on diet and food security impacts. METHODS Using data from the Farm Fresh Foods for Healthy Kids (F3HK) randomized controlled trial in New York, North Carolina, Vermont, and Washington (n = 305; 2016-2018), we estimated programmatic and participant costs and calculated incremental cost-effectiveness ratios (ICERs) for caregivers' daily fruit and vegetable (FV) intake, skin carotenoids, and household food security from program and societal perspectives. RESULTS F3HK cost $2,439 per household annually ($1,884 in implementation-related expenses and $555 in participant-incurred costs). ICERs ranged from $1,507 to $2,439 per cup increase in caregiver's FV intake (depending on perspective, setting, and inclusion of juice); from $502 to $739 per one thousand unit increase in skin carotenoid score; and from $2,271 to $3,137 per household shifted out of food insecurity. CONCLUSIONS Given the known public health, healthcare, and economic consequences of insufficient FV intake and living in a food insecure household, the costs incurred to support these positive shifts in individual- and household-level outcomes via a F3HK-like intervention may be deemed by stakeholders as a reasonable investment. This work helps to advance a critical body of literature on the cost-effectiveness of subsidized CSAs and other economic and food system interventions for the sake of evidence-based allocation of public health resources. TRIAL REGISTRATION ClinicalTrials.gov. NCT02770196. Registered 5 April 2016. Retrospectively registered. https://www. CLINICALTRIALS gov/ct2/show/NCT02770196 .
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Affiliation(s)
- Jennifer A Garner
- School of Health & Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA
- John Glenn College of Public Affairs, The Ohio State University, Columbus, OH, USA
| | - Karla L Hanson
- Master of Public Health Program, Cornell University, Ithaca, NY, USA
| | - Stephanie B Jilcott Pitts
- Brody School of Medicine, Department of Public Health, East Carolina University, Greenville, NC, USA
| | - Jane Kolodinsky
- Department of Community Development and Applied Economics, University of Vermont, Burlington, VT, USA
| | - Marilyn H Sitaker
- Ecological Agriculture and Food Systems, The Evergreen State College, Olympia, WA, USA
| | - Alice S Ammerman
- Gillings School of Global Public Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donald Kenkel
- Cornell Brooks School of Public Policy, Cornell University, Ithaca, NY, USA
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Hanson KL, Xu L, Marshall GA, Sitaker M, Jilcott Pitts SB, Kolodinsky J, Bennett A, Carriker S, Smith D, Ammerman AS, Seguin-Fowler RA. Participation in Cost-offset Community Supported Agriculture by Low-income Households in the U.S. is Associated with Community Characteristics and Operational Practices. Public Health Nutr 2022; 25:1-25. [PMID: 35416140 PMCID: PMC9991818 DOI: 10.1017/s1368980022000908] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/31/2022] [Accepted: 04/04/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Subsidized or cost-offset community supported agriculture (CO-CSA) connects farms directly to low-income households and can improve fruit and vegetable intake. This analysis identifies factors associated with participation in CO-CSA. DESIGN Farm Fresh Foods for Healthy Kids (F3HK) provided a half-price, summer CO-CSA plus healthy eating classes to low-income households with children. Community characteristics (population, socio-demographics, health statistics) and CO-CSA operational practices (share sizes, pick-up sites, payment options, produce selection) are described and associations with participation levels examined. SETTING Ten communities in New York (NY), North Carolina (NC), Vermont, and Washington states in USA. PARTICIPANTS Caregiver-child dyads enrolled in spring 2016 or 2017. RESULTS Residents of micropolitan communities had more education and less poverty than in small towns. The one rural location (NC2) had the fewest college graduates (10%) and most poverty (23%), and poor health statistics. Most F3HK participants were white, except in NC where 45.2% were African American. CO-CSA participation varied significantly across communities from 33% (NC2) to 89% (NY1) of weeks picked-up. Most CO-CSAs offered multiple share sizes (69.2%) and participation was higher than when not offered (76.8% vs. 57.7% of weeks); whereas 53.8% offered a community pick-up location, and participation in these communities was lower than elsewhere (64.7% vs. 78.2% of weeks). CONCLUSION CO-CSAs should consider offering choice of share size and innovate to address potential barriers such as rural location and limited education and income among residents. Future research is needed to better understand barriers to participation, particularly among participants utilizing community pick-up locations.
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Affiliation(s)
- Karla L Hanson
- Department of Public and Ecosystem Health, Shurman Hall, Cornell University, Ithaca, NY14853, USA
| | - Lynn Xu
- Department of Public and Ecosystem Health, Shurman Hall, Cornell University, Ithaca, NY14853, USA
| | - Grace A Marshall
- Department of Public and Ecosystem Health, Shurman Hall, Cornell University, Ithaca, NY14853, USA
| | | | | | - Jane Kolodinsky
- Center for Rural Studies, University of Vermont, Burlington, VT, USA
| | - April Bennett
- Cornell Cooperative Extension of Jefferson County, Watertown, NY, USA
| | - Salem Carriker
- University of South Carolina, School of Medicine, Columbia, SC, USA
| | - Diane Smith
- Washington State University, Extension of Skagit County, Burlington, WA, USA
| | - Alice S Ammerman
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Belarmino EH, Kolodinsky J, Ammerman AS, Connor Volpe L, Brown C, Jilcott Pitts SB, Hanson KL, Sitaker M, Wang W, McGuirt JT, Carfagno M, Hunsinger E, Seguin-Fowler RA. Growing Opportunities for Equitable, Interdisciplinary Undergraduate Food Systems Education: A Review of Food Systems Education at Land-Grant Institutions and Development of Open-Access Materials. Front Sustain Food Syst 2022. [DOI: 10.3389/fsufs.2021.756584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Post-secondary coursework related to agriculture and the food supply has been at the core of the United States' land-grant system for more than 150 years. However, as the complexity of food systems has grown, so too have critiques that the education provided in these programs is too narrow to adequately prepare graduates to address pressing food systems issues. In response, some higher education institutions have developed degrees in food systems. To support development of this burgeoning field, we created, tested, and refined four evidence-informed, interdisciplinary, equity-oriented, open-access teaching modules. These modules are based on our experience conducting a multi-site, multi-year transdisciplinary investigation of subsidized, or “cost-offset”, community supported agriculture and a survey asking instructors at land-grant institutions (n = 66) about topic offerings and current unmet needs for instructional materials. Our collaboration illuminated the potential and challenges of food systems research; underscored the value of transdisciplinary research teams; and identified several equity-oriented topics related to the design, implementation, and evaluation of local food initiatives suitable for advancing sustainable foods systems education. Instructors reported that the most helpful teaching aids would be case studies, lesson plans with active learning components, and reference lists with relevant peer-reviewed publications. The final modules seek to shed light on the complexity of food systems projects and build knowledge, vocabularies, and skills across disciplines engaged with food systems. Per instructor-defined needs, each module features a case study, active-learning activities, and references. We anticipate that the adaptable modules will be suitable for a wide range of students and courses.
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Seguin-Fowler RA, Hanson KL, Jilcott Pitts SB, Kolodinsky J, Sitaker M, Ammerman AS, Marshall GA, Belarmino EH, Garner JA, Wang W. Community supported agriculture plus nutrition education improves skills, self-efficacy, and eating behaviors among low-income caregivers but not their children: a randomized controlled trial. Int J Behav Nutr Phys Act 2021; 18:112. [PMID: 34461931 PMCID: PMC8406558 DOI: 10.1186/s12966-021-01168-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 07/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background Adults and children in the U.S. consume inadequate quantities of fruit and vegetables (FV), in part, due to poor access among households with lower socioeconomic status. One approach to improving access to FV is community supported agriculture (CSA) in which households purchase a ‘share’ of local farm produce throughout the growing season. This study examined the effects of cost-offset (half-price) CSA plus tailored nutrition education for low-income households with children. Methods The Farm Fresh Foods for Healthy Kids (F3HK) randomized controlled trial in New York, North Carolina, Vermont, and Washington (2016–2018) assigned caregiver-child dyads (n = 305) into cost-offset CSA plus education intervention or control (delayed intervention) groups. Following one growing season of CSA participation, changes in children’s diet quality, body mass index (BMI), and physical activity; caregivers’ nutrition knowledge, attitudes, behaviors, and diet quality; and household food access and security were examined using multiple linear or logistic regression, with adjustment for baseline value within an intent-to-treat (ITT) framework in which missing data were multiply imputed. Results No significant net effects on children’s dietary intake, BMI, or physical activity were observed. Statistically significant net improvements were observed after one growing season for caregivers’ cooking attitudes, skills, and self-efficacy; FV intake and skin carotenoid levels; and household food security. Changes in attitudes and self-efficacy remained one-year after baseline, but improvements in caregiver diet and household food security did not. The number of weeks that participants picked up a CSA share (but not number of education sessions attended) was associated with improvements in caregiver FV intake and household food security. Conclusions Cost-offset CSA plus tailored nutrition education for low-income households improved important caregiver and household outcomes within just one season of participation; most notably, both self-reported and objectively measured caregiver FV intake and household food security improved. Households that picked up more shares also reported larger improvements. However, these changes were not maintained after the CSA season ended. These results suggest that cost-offset CSA is a viable approach to improving adult, but not child, FV intake and household food security for low-income families, but the seasonality of most CSAs may limit their potential to improve year-round dietary behavior and food security. Trial registration ClinicalTrials.gov. NCT02770196. Registered 5 April 2016. Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01168-x.
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Affiliation(s)
- Rebecca A Seguin-Fowler
- Texas A&M AgriLife Research, 600 John Kimbrough Boulevard, Suite 512, College Station, TX, 77843, USA.
| | - Karla L Hanson
- Department of Population Medicine and Diagnostic Sciences, Master of Public Health Program, Cornell University, S2064 Schurman Hall, Ithaca, NY, 14853, USA
| | - Stephanie B Jilcott Pitts
- Department of Public Health, East Carolina University, 600 Moye Blvd, Lakeside Annex Modular 7, Greenville, NC, 27834, USA
| | - Jane Kolodinsky
- Department of Community Development and Applied Economics, University of Vermont, 202 Morrill Hall, Burlington, VT, 05405, USA
| | - Marilyn Sitaker
- Ecological Agriculture and Food Systems, The Evergreen State College, 2700 Evergreen Parkway NW, Olympia, WA, 98505, USA
| | - Alice S Ammerman
- Department of Nutrition, Gillings School of Global Public Health, Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Boulevard, CB#7426, Chapel Hill, NC, 27599, USA
| | - Grace A Marshall
- Master of Public Health Program, Cornell University, S2074 Schurman Hall, Ithaca, NY, 14853, USA
| | - Emily H Belarmino
- Department of Nutrition and Food Sciences, University of Vermont, 225 B Marsh Life Science, Burlington, VT, 05405, USA
| | - Jennifer A Garner
- School of Health and Rehabilitation Sciences, College of Medicine, John Glenn College of Public Affairs, The Ohio State University, 210N Page Hall, Columbus, OH, 43210, USA
| | - Weiwei Wang
- Center for Rural Studies, University of Vermont, 206 Morrill Hall, 146 University Place, Burlington, VT, 05405, USA
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Garner JA, Jilcott Pitts SB, Hanson KL, Ammerman AS, Kolodinsky J, Sitaker MH, Seguin-Fowler RA. Making community-supported agriculture accessible to low-income families: findings from the Farm Fresh Foods for Healthy Kids process evaluation. Transl Behav Med 2021; 11:754-763. [PMID: 32930794 DOI: 10.1093/tbm/ibaa080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/21/2022] Open
Abstract
A randomized trial of Farm Fresh Foods for Healthy Kids (F3HK) was initiated across 4 states and 12 farms to test whether cost-offset community-supported agriculture (CO-CSA) could improve diet quality among children in low-income families. Intervention households purchased a 50% subsidized share of local produce and were invited to nine complimentary nutrition classes. The purpose of this study was to assess F3HK reach, dose, and fidelity via a mixed methods process evaluation. Screening and enrollment records indicated reach; study records and postlesson educator surveys tracked dose delivered; CSA pickup logs, lesson sign-in sheets, postseason participant surveys, and postlesson caregiver surveys assessed dose received; and coordinator audits and educator surveys tracked fidelity. Educator interviews contextualized findings. The results of this study were as follows. Reach: enrolled caregivers (n = 305) were older (p = .005) than eligible nonenrollees (n = 243) and more likely to be female (p < .001). Dose: mean CSA season was 21 weeks (interquartile range [IQR]: 19-23). Median CSA pickup was 88% of the weeks (IQR: 40-100). All sites offered each class at least once. Most adults (77%) and children (54%) attended at least one class; few attended all. Eighty-two percent of caregivers indicated that their household consumed most or all produce. Median lesson activity ratings were 5/5 ("very useful"). Fidelity: CSA locations functioned with integrity to project standards. Educators taught 92% of activities but frequently modified lesson order. This study demonstrates the feasibility of pairing a CO-CSA intervention with nutrition education across geographically dispersed sites. Greater integration of intervention elements and clearer allowance for site-level modifications, particularly for educational elements, may improve intervention dose and, ultimately, impact.
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Affiliation(s)
- Jennifer A Garner
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA.,John Glenn College of Public Affairs, The Ohio State University, Columbus, OH, USA
| | - Stephanie B Jilcott Pitts
- Brody School of Medicine, Department of Public Health, East Carolina University, Greenville, NC, USA
| | - Karla L Hanson
- Master of Public Health Program, Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA
| | - Alice S Ammerman
- Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jane Kolodinsky
- Department of Community Development and Applied Economics, University of Vermont, Burlington, VT, USA
| | - Marilyn H Sitaker
- Ecological Agriculture and Food Systems, The Evergreen State College, Olympia, WA, USA
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Haynes-Maslow L, Jilcott Pitts SB, Boys KA, McGuirt JT, Fleischhacker S, Ammerman AS, Johnson N, Kelley C, Donadio VE, Bell RA, Laska MN. Qualitative perspectives of the North Carolina healthy food small retailer program among customers in participating stores located in food deserts. BMC Public Health 2021; 21:1459. [PMID: 34315470 PMCID: PMC8317385 DOI: 10.1186/s12889-021-11509-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/10/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The North Carolina Healthy Food Small Retailer Program (NC HFSRP) was established through a policy passed by the state legislature to provide funding for small food retailers located in food deserts with the goal of increasing access to and sales of healthy foods and beverages among local residents. The purpose of this study was to qualitatively examine perceptions of the NC HFSRP among store customers. METHODS Qualitative interviews were conducted with 29 customers from five NC HFSRP stores in food deserts across eastern NC. Interview questions were related to shoppers' food and beverage purchases at NC HFSRP stores, whether they had noticed any in-store efforts to promote healthier foods and beverages, their suggestions for promoting healthier foods and beverages, their familiarity with and support of the NC HFSRP, and how their shopping and consumption habits had changed since implementation of the NC HFSRP. A codebook was developed based on deductive (from the interview guide questions) and inductive (emerged from the data) codes and operational definitions. Verbatim transcripts were double-coded and a thematic analysis was conducted based on code frequency, and depth of participant responses for each code. RESULTS Although very few participants were aware of the NC HFSRP legislation, they recognized changes within the store. Customers noted that the provision of healthier foods and beverages in the store had encouraged them to make healthier purchase and consumption choices. When a description of the NC HFSRP was provided to them, all participants were supportive of the state-funded program. Participants discussed program benefits including improving food access in low-income and/or rural areas and making healthy choices easier for youth and for those most at risk of diet-related chronic diseases. CONCLUSIONS Findings can inform future healthy corner store initiatives in terms of framing a rationale for funding or policies by focusing on increased food access among vulnerable populations.
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Affiliation(s)
- Lindsey Haynes-Maslow
- Department of Agricultural & Human Sciences, NC State University, 512 Brickhaven Drive, Room 240c, Raleigh, NC, 27695, USA.
| | - Stephanie B Jilcott Pitts
- Department of Public Health, East Carolina University, 115 Heart Drive, Room #2239, Greenville, NC, 27834, USA
| | - Kathryn A Boys
- Department of Agricultural and Resource Economics, North Carolina State University, 4306 Nelson Hall, Raleigh, NC, 27695-8109, USA
| | - Jared T McGuirt
- Department of Nutrition, University of North Carolina Greensboro, 319 Colllege Avenue, 318 Stone Building, Greensboro, NC, 27412, USA
| | | | - Alice S Ammerman
- Department of Nutrition, University of North Carolina at Chapel Hill, CB# 7426, 1700 MLK Jr. Blvd, Room 239, Chapel Hill, NC, 27599-7426, USA
| | - Nevin Johnson
- Department of Public Health, East Carolina University, 115 Heart Drive, Room #2239, Greenville, NC, 27834, USA
| | - Casey Kelley
- University of North Carolina at Chapel Hill, School of Medicine, Division of Geriatric Medicine, Center for Aging and Health, 5003 Old Clinic CB#7550, Chapel Hill, NC, 27599, USA
| | - Victoria E Donadio
- Department of Public Health, East Carolina University, 115 Heart Drive, Room #2239, Greenville, NC, 27834, USA
| | - Ronny A Bell
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Melissa N Laska
- Epidemiology & Community Health, University of Minnesota, 1300 South 2nd Street, WBOB Suite 300, Minneapolis, MN, 55454-1015, USA
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12
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Jilcott Pitts SB, Johnson NS, Wu Q, Firnhaber GC, Preet Kaur A, Obasohan J. A meta-analysis of studies examining associations between resonance Raman spectroscopy-assessed skin carotenoids and plasma carotenoids among adults and children. Nutr Rev 2021; 80:230-241. [PMID: 33822186 PMCID: PMC8754254 DOI: 10.1093/nutrit/nuab016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/25/2021] [Accepted: 02/23/2021] [Indexed: 12/20/2022] Open
Abstract
CONTEXT No meta-analyses appeared to have been conducted to examine overall correlations between resonance Raman spectroscopy (RRS)-assessed skin carotenoids and plasma/serum carotenoids. OBJECTIVE To review the available literature and quantify the association between RRS-assessed skin carotenoids and plasma/serum carotenoids via a meta-analysis of observational studies. DATA SOURCES To identify relevant publications, we searched the PubMed, Embase, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, ProQuest, and Scopus databases in April 2020 for items combining 3 concepts: Raman spectroscopy, skin, and plasma or serum. DATA EXTRACTION Criteria for inclusion were publication in a peer-reviewed journal between 1990 and 2020, available in English language, and results reported as a baseline Pearson correlation coefficient. In teams of 2, the researchers independently reviewed titles and abstracts of 2212 nonduplicate papers with initial screening yielding 62 papers for full-text review, of which 15 were deemed eligible for inclusion. DATA ANALYSIS A random-effects model in R (version 4.0.0) "meta" package was used to analyze the correlation between RRS-assessed skin and plasma/serum carotenoids. A subgroup analysis was conducted for studies involving adults and children, respectively. CONCLUSIONS The 15 studies included 1155 individuals: 963 adults and 192 children. One study included children and adults. The random-effects model yielded an overall correlation of 0.68 (95%CI, 0.61-0.74; I2 = 74%; P < 0.01). The results were similar when grouped by adults and children. Among 963 adults, the correlation in the random-effects model was 0.69 (95%CI, 0.61-0.75; I2 = 78%; P < 0.01). Among 192 children, the correlation in the random-effects model was 0.66 (95%CI, 0.52- 0.77; I2 = 55%; P = 0.06). Overall, there was a positive, statistically significant correlation between RRS-assessed skin carotenoids and plasma/serum carotenoids in a pooled meta-analysis of 15 studies. SYSTEMATIC REVIEW REGISTRATION PROSPERO (record number 178835).
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Affiliation(s)
- Stephanie B Jilcott Pitts
- S.B. Jilcott Pitts, N.S. Johnson, and A.P. Kaur are with the Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA. Q. Wu is with the Department of Biostatistics, East Carolina University, East Carolina Heart Institute, Greenville, North Carolina, USA. G. Cahoon Firnhaber is with the Nurse Anesthesia Program, East Carolina University College of Nursing, Greenville, North Carolina, USA. J. Obasohan is with the National Human Genome Research Institute, National Institutes of Health, 10 Center Drive, Bethesda, Maryland, USA
| | - Nevin S Johnson
- S.B. Jilcott Pitts, N.S. Johnson, and A.P. Kaur are with the Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA. Q. Wu is with the Department of Biostatistics, East Carolina University, East Carolina Heart Institute, Greenville, North Carolina, USA. G. Cahoon Firnhaber is with the Nurse Anesthesia Program, East Carolina University College of Nursing, Greenville, North Carolina, USA. J. Obasohan is with the National Human Genome Research Institute, National Institutes of Health, 10 Center Drive, Bethesda, Maryland, USA
| | - Qiang Wu
- S.B. Jilcott Pitts, N.S. Johnson, and A.P. Kaur are with the Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA. Q. Wu is with the Department of Biostatistics, East Carolina University, East Carolina Heart Institute, Greenville, North Carolina, USA. G. Cahoon Firnhaber is with the Nurse Anesthesia Program, East Carolina University College of Nursing, Greenville, North Carolina, USA. J. Obasohan is with the National Human Genome Research Institute, National Institutes of Health, 10 Center Drive, Bethesda, Maryland, USA
| | - Gina C Firnhaber
- S.B. Jilcott Pitts, N.S. Johnson, and A.P. Kaur are with the Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA. Q. Wu is with the Department of Biostatistics, East Carolina University, East Carolina Heart Institute, Greenville, North Carolina, USA. G. Cahoon Firnhaber is with the Nurse Anesthesia Program, East Carolina University College of Nursing, Greenville, North Carolina, USA. J. Obasohan is with the National Human Genome Research Institute, National Institutes of Health, 10 Center Drive, Bethesda, Maryland, USA
| | - Archana Preet Kaur
- S.B. Jilcott Pitts, N.S. Johnson, and A.P. Kaur are with the Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA. Q. Wu is with the Department of Biostatistics, East Carolina University, East Carolina Heart Institute, Greenville, North Carolina, USA. G. Cahoon Firnhaber is with the Nurse Anesthesia Program, East Carolina University College of Nursing, Greenville, North Carolina, USA. J. Obasohan is with the National Human Genome Research Institute, National Institutes of Health, 10 Center Drive, Bethesda, Maryland, USA
| | - Justice Obasohan
- S.B. Jilcott Pitts, N.S. Johnson, and A.P. Kaur are with the Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA. Q. Wu is with the Department of Biostatistics, East Carolina University, East Carolina Heart Institute, Greenville, North Carolina, USA. G. Cahoon Firnhaber is with the Nurse Anesthesia Program, East Carolina University College of Nursing, Greenville, North Carolina, USA. J. Obasohan is with the National Human Genome Research Institute, National Institutes of Health, 10 Center Drive, Bethesda, Maryland, USA
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Jilcott Pitts SB, Wu Q, Truesdale KP, Rafferty AP, Haynes-Maslow L, Boys KA, McGuirt JT, Fleischhacker S, Johnson N, Kaur AP, Bell RA, Ammerman AS, Laska MN. A four-year observational study to examine the dietary impact of the North Carolina Healthy Food Small Retailer Program, 2017-2020. Int J Behav Nutr Phys Act 2021; 18:44. [PMID: 33761952 PMCID: PMC7990380 DOI: 10.1186/s12966-021-01109-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The North Carolina (NC) Healthy Food Small Retailer Program (HFSRP) was passed into law with a $250,000 appropriation (2016-2018) providing up to $25,000 in funding to small food stores for equipment to stock healthier foods and beverages. This paper describes an observational natural experiment documenting the impact of the HFSRP on store food environments, customers' purchases and diets. METHODS Using store observations and intercept surveys from cross-sectional, convenience customer samples (1261 customers in 22 stores, 2017-2020; 499 customers in 7 HFSRP stores, and 762 customers in 15 Comparison stores), we examined differences between HFSRP and comparison stores regarding: (1) change in store-level availability, quality, and price of healthy foods/beverages; (2) change in healthfulness of observed food and beverage purchases ("bag checks"); and, (3) change in self-reported and objectively-measured (Veggie Meter®-assessed skin carotenoids) customer dietary behaviors. Differences (HFSRP vs. comparison stores) in store-level Healthy Food Supply (HFS) and Healthy Eating Index-2010 scores were assessed using repeated measure ANOVA. Intervention effects on diet were assessed using difference-in-difference models including propensity scores. RESULTS There were improvements in store-level supply of healthier foods/beverages within 1 year of program implementation (0 vs. 1-12 month HFS scores; p = 0.055) among HFSRP stores only. Comparing 2019 to 2017 (baseline), HFSRP stores' HFS increased, but decreased in comparison stores (p = 0.031). Findings indicated a borderline significant effect of the intervention on self-reported fruit and vegetable intake (servings/day), though in the opposite direction expected, such that fruit and vegetable intake increased more among comparison store than HFSRP store customers (p = 0.05). There was no significant change in Veggie Meter®-assessed fruit and vegetable intake by customers shopping at the intervention versus comparison stores. CONCLUSIONS Despite improvement in healthy food availability, there was a lack of apparent impact on dietary behaviors related to the HFSRP, which could be due to intervention dose or inadequate statistical power due to the serial cross-sectional study design. It may also be that individuals buy most of their food at larger stores; thus, small store interventions may have limited impact on overall eating patterns. Future healthy retail policies should consider how to increase intervention dose to include more product marketing, consumer messaging, and technical assistance for store owners.
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Affiliation(s)
- Stephanie B. Jilcott Pitts
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834 USA
| | - Qiang Wu
- Department of Biostatistics, East Carolina University, Greenville, NC 27834 USA
| | - Kimberly P. Truesdale
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
- Healthy Weight Research Center, University of Minnesota School of Public Health, Minneapolis, MN 55454 USA
| | - Ann P. Rafferty
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834 USA
| | - Lindsey Haynes-Maslow
- Department of Agricultural & Human Sciences, North Carolina State University, Raleigh, 27695 USA
| | - Kathryn A. Boys
- Department of Agricultural & Resource Economics, North Carolina State University, Raleigh, 27695 USA
| | - Jared T. McGuirt
- Department of Nutrition, University of North Carolina at Greensboro, Greensboro, 27412 NC USA
| | | | - Nevin Johnson
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834 USA
| | - Archana P. Kaur
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834 USA
| | - Ronny A. Bell
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, 27157 USA
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC 27157 USA
| | - Alice S. Ammerman
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Melissa N. Laska
- Healthy Weight Research Center, University of Minnesota School of Public Health, Minneapolis, MN 55454 USA
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Seguin-Fowler RA, Hanson KL, Marshall GA, Belarmino EH, Jilcott Pitts SB, Kolodinsky J, Sitaker M, Ammerman A. Fruit and Vegetable Intake Assessed by Repeat 24 h Recalls, but Not by A Dietary Screener, Is Associated with Skin Carotenoid Measurements in Children. Nutrients 2021; 13:nu13030980. [PMID: 33803576 PMCID: PMC8003042 DOI: 10.3390/nu13030980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 01/09/2023] Open
Abstract
Accurate measurement of fruit and vegetable (FV) intake is important for nutrition surveillance and evaluation of dietary interventions. We compared two tools for reporting FV intake to objective measurement of skin carotenoids among children. FV cups/day was assessed by repeated 24 h dietary recalls (24H FV) and the National Cancer Institute’s All-Day Fruit and Vegetable Screener (NCI FV). Skin carotenoids were measured by repeated resonance Raman spectroscopy (RRS) of the palm. FV cups were regressed on RRS scores in unadjusted, field-based, and research-setting models with covariates feasible in each scenario. Data were baseline values from children aged 2–12 years in low-income households enrolled in a healthy eating randomized trial in four U.S. states (n = 177). Twenty-four-hour FV cups were associated with skin carotenoids in all models (p < 0.001) but NCI FV cups were not. Predicted RRS scores for discrete 24H FV cups provide a guide to interpretation of RRS in children (2 cups FV intake ~36,000 RRS units), with the research-setting scenario generally providing the narrowest prediction range (+/−1924). When self-reported data are required, 24 h recalls are more accurate than NCI FV screener data; and, when limited time, resources, or literacy must be considered, RRS scores can be quickly obtained and easily interpreted.
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Affiliation(s)
- Rebecca A. Seguin-Fowler
- Texas A&M AgriLife Research and the Department of Nutrition, Texas A&M University System, College Station, TX 77843, USA
- Correspondence: ; Tel.: +1-(979)-845-8486
| | - Karla L. Hanson
- Master of Public Health Program and the Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853, USA; (K.L.H.); (G.A.M.)
| | - Grace A. Marshall
- Master of Public Health Program and the Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY 14853, USA; (K.L.H.); (G.A.M.)
| | - Emily H. Belarmino
- Department of Nutrition and Food Science, University of Vermont, Burlington, VT 05405, USA;
| | | | - Jane Kolodinsky
- Community Development and Applied Economics Department, University of Vermont, Burlington, VT 05405, USA;
| | | | - Alice Ammerman
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
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15
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McGuirt JT, Wu Q, Laska MN, Truesdale KP, Rafferty AP, Bell RA, Ammerman AS, Jilcott Pitts SB. Associations between shopping patterns, dietary behaviours and geographic information system-assessed store accessibility among small food store customers. Public Health Nutr 2020; 25:1-10. [PMID: 33317649 PMCID: PMC9991690 DOI: 10.1017/s1368980020005017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 04/03/2020] [Revised: 10/12/2020] [Accepted: 10/26/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To examine associations between geographic information systems (GIS)-assessed accessibility to small food stores, shopping patterns and dietary behaviours among small food store customers. DESIGN Residential addresses and customer shopping patterns (frequency of shopping, and previous purchase of fruits and vegetables) were gathered through customer intercept surveys. Addresses were geocoded, and GIS-assessed distance and driving time from the participants' residence to the store were calculated. Dietary status and behaviours were assessed using an objective non-invasive measure of skin carotenoids, the National Cancer Institute Fruit and Vegetable Screener, and items to assess sugary beverage intake. Associations between distance and driving time, demographics, shopping frequency, prior reported purchase of fruits and vegetables at the store and dietary behaviours were examined. SETTING Small food stores (n 22) across North Carolina. PARTICIPANTS Cross-sectional convenience samples of English-speaking customers aged 18 years or older (n 692). RESULTS Participants living closer to the small store had lower income and formal education, were more likely to be Black, more likely to have previously bought fruits and vegetables at the store and more frequently shopped at the store. In adjusted models, skin carotenoids (n 644) were positively associated with distance to the store from home in miles (P = 0·01). CONCLUSIONS Customers who lived closer to the stores were more frequent shoppers and more likely to have previously purchased fruits and vegetables at the store yet had lower skin carotenoids. These results support continued efforts to examine how to increase the availability and promotion of healthful foods at small food retail stores.
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Affiliation(s)
- Jared T McGuirt
- Department of Nutrition, University of North Carolina Greensboro, 319 College Avenue, 318 Stone Building, Greensboro, NC27412, USA
| | - Qiang Wu
- Department of Biostatistics, East Carolina University, Greenville, NC, USA
| | - Melissa N Laska
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Kimberly P Truesdale
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ann P Rafferty
- Department of Public Health, East Carolina University, Greenville, NC, USA
| | - Ronny A Bell
- Department of Public Health, East Carolina University, Greenville, NC, USA
| | - Alice S Ammerman
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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McGuirt JT, Huebner G, Ward R, Jilcott Pitts SB. Food and Beverage Options at Highway Rest Areas in North Carolina: A Mixed-Methods Audit and Geospatial Approach. Prev Chronic Dis 2019; 16:E142. [PMID: 31625869 PMCID: PMC6824145 DOI: 10.5888/pcd16.190129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Each year, millions of people purchase food at highway rest areas. Rest areas are potential sites for health promotion because they are operated by the public sector; they are frequently visited by professional truck drivers, who have a disproportionate burden of chronic disease; and they are easily accessible. To our knowledge, no research has systematically examined the healthfulness of food offerings at rest areas. The objective of this study was to determine the accessibility and healthfulness of food and beverages offered at highway rest areas in North Carolina using a mixed-methods audit and geospatial approach. METHODS We conducted a cross-sectional audit of all rest areas offering foods and beverages in North Carolina (N = 30) in summer 2018. We used the Nutrition Environment Measures Survey-Vending (NEMS-V) to record the 1) type, price, and size of all foods and beverages and 2) healthfulness of items offered (based on NEMS-V categorization). Two researchers independently double coded NEMS-V data. We used geospatial analysis to examine proximity of rest areas to food stores. We analyzed data by using univariate and bivariate analysis. RESULTS The mean number of vending machines per site was 8.0 (range, 2-12, standard deviation, 2.8). The healthfulness of offerings varied across sites. Most food items (88.1%; 2,922 of 3,315) and beverage items (63.7%; 1,567 of 2,459) were classified as least healthful. Cold beverage machines had a greater percentage of healthful items (38.2%; 778 of 2,036) than snack machines (11.4%; 374 of 3,270) (P < .001), mainly because of water and diet soda in beverage machines. CONCLUSION Policy changes are needed to increase the number and presentation of healthful food options at highway rest areas. Policy changes could provide travelers with more healthful options conveniently located along their travel route.
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Affiliation(s)
- Jared T McGuirt
- Department of Nutrition, University of North Carolina at Greensboro, Greensboro, North Carolina
- The University of North Carolina at Greensboro, 319 College Ave, 318 Stone Building, Greensboro, NC 27412.
| | - Grace Huebner
- Department of Nutrition, University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Rachel Ward
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee
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Purnell TS, Fakunle DO, Bone LR, Johnson TP, Hemberger N, Jilcott Pitts SB, Bowie JV, Oakley K, Thompson B, Paskett ED, Cooper LA. Overcoming Barriers to Sustaining Health Equity Interventions: Insights from the National Institutes of Health Centers for Population Health and Health Disparities. J Health Care Poor Underserved 2019; 30:1212-1236. [PMID: 31422998 DOI: 10.1353/hpu.2019.0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We conducted qualitative semi-structured telephone interviews with the directors of the 10 National Institutes of Health Centers for Population Health and Health Disparities (NIH/CPHHD) to identify factors that were associated with the sustainability of 19 interventions developed to address cancer disparities and 17 interventions developed to address cardiovascular disease disparities in the United States. Interview transcripts were analyzed using the constant comparative method of analysis to identify key themes and synthesize findings. Directors at NIH/CPHHD reported that barriers to sustainability included uncertainty about future funding and insufficient resources to build and maintain diverse stakeholder partnerships. Strategies that helped to overcome these barriers included developing and engaging community partnerships with health care systems; early pursuit of multiple funding sources; and investments in infrastructure to address the social determinants of health. Sustainability planning should be incorporated during the early stages of intervention development to facilitate maintenance of successful programs that address health disparities.
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Hanson KL, Volpe LC, Kolodinsky J, Hwang G, Wang W, Jilcott Pitts SB, Sitaker M, Ammerman AS, Seguin RA. Knowledge, Attitudes, Beliefs and Behaviors regarding Fruits and Vegetables among Cost-offset Community-Supported Agriculture (CSA) Applicants, Purchasers, and a Comparison Sample. Nutrients 2019; 11:nu11061320. [PMID: 31212869 PMCID: PMC6627932 DOI: 10.3390/nu11061320] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 11/16/2022] Open
Abstract
Community-supported agriculture (CSA) participation has been associated with high fruit and vegetable (FV) consumption, which may be due to better access to FV for CSA purchasers, or to positive knowledge, attitudes, and beliefs (KAB) regarding healthy eating among CSA applicants. The objective of this study was to examine KAB and consumption, in association with application to a cost-offset CSA (CO-CSA) program, and with CO-CSA purchase among applicants. We conducted a cross-sectional survey of CO-CSA applicants and a comparison sample in August 2017. All respondents were English-reading adults with a child 2–12 years old and household income of ≤185% of the federal poverty level. Among CO-CSA applicants, some were CO-CSA purchasers (n = 46) and some were not (n = 18). An online comparison sample met equivalent eligibility criteria, but had not participated in CSA for three years (n = 105). We compared CO-CSA applicants to the comparison sample, and compared purchasers and non-purchaser sub-groups, using Mann-Whitney U tests and chi-square analysis. CO-CSA applicants reported better knowledge, self-efficacy, home habits, and diet than the comparison sample. Among applicants, CO-CSA purchasers and non-purchasers had equivalent KAB, but children in purchaser households had higher FV consumption than in non-purchaser households (4.14 vs. 1.83 cups, p = 0.001). Future research should explore associations between CO-CSA participation and diet using experimental methods.
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Affiliation(s)
- Karla L Hanson
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA.
| | - Leah C Volpe
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA.
| | - Jane Kolodinsky
- Department of Community Development and Applied Economics, University of Vermont, Burlington, VT 05405, USA.
| | - Grace Hwang
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA.
| | - Weiwei Wang
- Department of Community Development and Applied Economics, University of Vermont, Burlington, VT 05405, USA.
| | - Stephanie B Jilcott Pitts
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
| | - Marilyn Sitaker
- The Evergreen State College, Ecological Agriculture and Food System, Olympia, WA 98505, USA.
| | - Alice S Ammerman
- Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Rebecca A Seguin
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA.
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Gustafson A, Jilcott Pitts SB, McQuerry K, Babtunde O, Mullins J. A Mentor-Led Text-Messaging Intervention Increases Intake of Fruits and Vegetables and Goal Setting for Healthier Dietary Consumption among Rural Adolescents in Kentucky and North Carolina, 2017. Nutrients 2019; 11:nu11030593. [PMID: 30862118 PMCID: PMC6471255 DOI: 10.3390/nu11030593] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 01/23/2023] Open
Abstract
Introduction—Text-messaging interventions hold promise for successful weight loss interventions. However, there is limited research on text-messaging interventions to improve dietary intake among rural adolescents, who are at greater risk for obesity and related risk factors. The goal of this study was to test an eight-week, mentor-led text-messaging intervention among 14–16-year-old rural adolescents: the “Go Big and Bring It Home” Project to improve fruit and vegetable and healthy beverage intake. Methods and Materials—Eight rural high schools in eastern Kentucky and eastern North Carolina participated (n = 4 were randomized as intervention schools and n = 4 were randomized as control schools). Adolescents were recruited to participate in the eight-week text-messaging intervention. The text messages were primarily affective messages, and included a weekly challenge related to consuming fruits, vegetables, or healthy/low-calorie beverages. Undergraduate nutrition students sent text messages on Tuesday and Saturday every week over the eight-week period via the “Group Me” mobile application. Delayed controls received no information or text messages during the eight-week intervention. Fruit and vegetable intake was measured with the National Cancer Institute Fruit and Vegetable screener and beverage intake was assessed using the Beverage Questionnaire-10 (BEVQ-10). Intention-to-treat analyses were conducted among all those that completed the baseline and post-intervention survey (n = 277 intervention students and n = 134 delayed control students). All linear regression models were adjusted for race and were clustered on school to control for intraclass correlation. Results—In adjusted analyses, there was a statistically significant positive intervention effect on the primary outcome of fruit and vegetable servings/day with a mean difference between intervention and control participants of 1.28 servings/day (95% Confidence Interval 1.11, 1.48). There was no intervention effect on beverage intake. There was a statistically significant increase in the odds of goal setting for healthier dietary behaviors among intervention participants relative to controls. Conclusion—An eight-week text-messaging intervention led to increases in self-reported fruit and vegetable intake and improvements in goal setting for healthier dietary behaviors. Due to the use of undergraduate students to deliver the messages, and use of an existing web application, this text-messaging intervention can be sustained in underserved, rural environments. Thus there is potential for significant reach and public health impact to improve dietary patterns.
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Affiliation(s)
- Alison Gustafson
- Department of Dietetics and Human Nutrition, University of Kentucky, 206G Funkhouser Building, Lexington, KY 40506, USA.
| | - Stephanie B Jilcott Pitts
- Department of Public Health, Brody School of Medicine, East Carolina University, 115 Heart Drive, Mailstop 660, Room 2239, Greenville, NC 27834, USA.
| | - Kristen McQuerry
- Applied Statistics Lab, University of Kentucky, 305B MDS Building, Lexington, KY 40506, USA.
| | - Oyinlola Babtunde
- Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Health Sciences Bldg. Rm. 2437, MailStop #668, 600 Moye Blvd., Greenville, NC 27834, USA.
| | - Janet Mullins
- Department of Dietetics and Human Nutrition, University of Kentucky, 206J Funkhouser Building, Lexington, KY 40506, USA.
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Hanson KL, Garner J, Connor LM, Jilcott Pitts SB, McGuirt J, Harris R, Kolodinsky J, Wang W, Sitaker M, Ammerman A, Seguin RA. Fruit and Vegetable Preferences and Practices May Hinder Participation in Community-Supported Agriculture Among Low-Income Rural Families. J Nutr Educ Behav 2019; 51:57-67. [PMID: 30301601 PMCID: PMC6467078 DOI: 10.1016/j.jneb.2018.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 07/23/2018] [Accepted: 08/10/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Describe fruit and vegetable (FV) preferences and other factors that may influence participation in community-supported agriculture (CSA). DESIGN In-depth, semi-structured interviews. SETTING Eight rural/micropolitan communities in 4 US states. PARTICIPANTS There were 41 caregivers and 20 children (8-12 years of age) from low-income, English-speaking households. PHENOMENA OF INTEREST Knowledge, attitudes, and behaviors regarding FVs; perceived barriers to CSA participation. ANALYSIS Transcribed verbatim and iteratively coded. RESULTS Caregivers and children believed FVs were important to health, yet FVs were not featured in dinners or snacks and consumption was challenged by limited preferences and neophobia. Few caregivers and children knew about the seasonality of FV. Most caregivers were unfamiliar with CSA and had concerns about CSA cost, accessibility, produce quality, and selection. CONCLUSIONS AND IMPLICATIONS These qualitative data support improvements in: 1) CSA distribution practices to offer flexible payment and pick-up options, more fruits, and self-selection of FV; 2) public awareness of produce seasonality and the CSA distribution model as necessary precursors to participation, and lower cost for low-income families who highlighted this barrier; and 3) capacity to prepare FV by enhancing skills and providing time-saving kitchen tools. Approaches to aligning CSA practices with the needs and preferences of low-income families warrant further research.
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Affiliation(s)
- Karla L Hanson
- Division of Nutritional Sciences, Cornell University, Ithaca, NY.
| | - Jennifer Garner
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | - Leah M Connor
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | | | - Jared McGuirt
- Department of Nutrition, University of North Carolina-Greensboro, Greensboro, NC
| | - Raiven Harris
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | - Jane Kolodinsky
- Department of Community Development and Applied Economics, University of Vermont, Burlington, VT
| | - Weiwei Wang
- Department of Community Development and Applied Economics, University of Vermont, Burlington, VT
| | - Marilyn Sitaker
- The Evergreen State College, Ecological Agriculture and Food System, Olympia, WA
| | - Alice Ammerman
- Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Rebecca A Seguin
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
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McGuirt JT, Jilcott Pitts SB, Gustafson A. Association between Spatial Access to Food Outlets, Frequency of Grocery Shopping, and Objectively-Assessed and Self-Reported Fruit and Vegetable Consumption. Nutrients 2018; 10:E1974. [PMID: 30551652 PMCID: PMC6316649 DOI: 10.3390/nu10121974] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/04/2018] [Accepted: 12/11/2018] [Indexed: 12/30/2022] Open
Abstract
Because supermarkets are a critical part of the community food environment, the purpose of this paper is to examine the association between accessibility to the supermarket where participants were surveyed, frequency of shopping at the supermarket, and self-reported and objectively-assessed fruit and vegetable consumption. Accessibility was assessed using Geographic Information Systems (GIS) measured distance and multiple versions of the modified Retail Food Environment Index (mRFEI), including a localized road network buffer version. Frequency of shopping was assessed using self-report. The National Cancer Institute Fruit and Vegetable screener was used to calculate daily servings of fruits and vegetables. Skin carotenoids were assessed using the "Veggie Meter™" which utilizes reflection spectroscopy to non-invasively assess skin carotenoids as an objective measure of fruit and vegetable consumption. Bivariate and multivariable statistics were used to examine the associations in RStudio. There was a positive association between skin carotenoids and the Special Supplemental Nutrition Program for Women Infants and Children (WIC) and mRFEI scores, suggesting that WIC participation and a healthier food environment were associated with objectively-assessed fruit and vegetable consumption (skin carotenoids). Future research should examine these associations using longitudinal study designs and larger sample sizes.
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Affiliation(s)
- Jared T McGuirt
- Department of Nutrition, School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, NC 27412, USA.
| | - Stephanie B Jilcott Pitts
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
| | - Alison Gustafson
- Department of Dietetics and Human Nutrition, School of Human Environmental Sciences, University of Kentucky, Lexington, KY 40506, USA.
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Seguin RA, McGuirt JT, Jilcott Pitts SB, Garner J, Hanson KL, Kolodinsky J, Sitaker M. Knowledge and Experience Related to Community Supported Agriculture and Local Foods among Nutrition Educators. Journal of Hunger & Environmental Nutrition 2018. [DOI: 10.1080/19320248.2018.1549520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Rebecca A. Seguin
- Department of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Jared T. McGuirt
- Department of Health Behavior, University of North Carolina, Greensboro, NC, USA
| | | | - Jennifer Garner
- Department of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Karla L. Hanson
- Department of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Jane Kolodinsky
- Department Community Development and Applied Economics, University of Vermont, Burlington, VT, USA
| | - Marilyn Sitaker
- Department of Ecological Agriculture and Food Systems, The Evergreen State College, Olympia, WA, USA
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Jilcott Pitts SB, Wu Q, Truesdale KP, Haynes-Maslow L, McGuirt JT, Ammerman A, Bell R, Laska MN. One-Year Follow-Up Examination of the Impact of the North Carolina Healthy Food Small Retailer Program on Healthy Food Availability, Purchases, and Consumption. Int J Environ Res Public Health 2018; 15:E2681. [PMID: 30487427 PMCID: PMC6313329 DOI: 10.3390/ijerph15122681] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/17/2018] [Accepted: 11/26/2018] [Indexed: 02/07/2023]
Abstract
We examined the short-term impact of the North Carolina Healthy Food Small Retailer Program (HFSRP), a legislatively appropriated bill providing funding up to $25,000 to small food retailers for equipment to stock and promote healthier foods, on store-level availability and purchase of healthy foods and beverages, as well as customer dietary patterns, one year post-policy implementation. We evaluated healthy food availability using a validated audit tool, purchases using customer bag-checks, and diet using self-reported questionnaires and skin carotenoid levels, assessed via Veggie Meter™, a non-invasive tool to objectively measure fruit and vegetable consumption. Difference-in-difference analyses were used to examine changes in HFSRP stores versus control stores after 1 year. There were statistically significant improvements in healthy food supply scores (availability), with the Healthy Food Supply HFS score being -0.44 points lower in control stores and 3.13 points higher in HFSRP stores pre/post HFSRP (p = 0.04). However, there were no statistically significant changes in purchases or self-reported consumption or skin carotenoids among customers in HFSRP versus control stores. Additional time or other supports for retailers (e.g., marketing and promotional materials) may be needed for HFSRP implementation to influence purchase and consumption.
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Affiliation(s)
- Stephanie B Jilcott Pitts
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
| | - Qiang Wu
- Department of Biostatistics, College of Allied Health Sciences, East Carolina University, Greenville, NC 27834, USA.
| | - Kimberly P Truesdale
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Lindsey Haynes-Maslow
- Department of Agricultural and Human Sciences, North Carolina State University, Raleigh, NC 27695, USA.
| | - Jared T McGuirt
- Department of Nutrition, University of North Carolina at Greensboro, Greensboro, NC 27412, USA.
| | - Alice Ammerman
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Ronny Bell
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
| | - Melissa N Laska
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454, USA.
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White MJ, Jilcott Pitts SB, McGuirt JT, Hanson KL, Morgan EH, Kolodinsky J, Wang W, Sitaker M, Ammerman AS, Seguin RA. The perceived influence of cost-offset community-supported agriculture on food access among low-income families. Public Health Nutr 2018; 21:2866-2874. [PMID: 29991375 PMCID: PMC10260852 DOI: 10.1017/s1368980018001751] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 02/17/2018] [Revised: 05/18/2018] [Accepted: 06/04/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To examine perspectives on food access among low-income families participating in a cost-offset community-supported agriculture (CO-CSA) programme. DESIGN Farm Fresh Foods for Healthy Kids (F3HK) is a multicentre randomized intervention trial assessing the effect of CO-CSA on dietary intake and quality among children from low-income families. Focus groups were conducted at the end of the first CO-CSA season. Participants were interviewed about programme experiences, framed by five dimensions of food access: availability, accessibility, affordability, acceptability and accommodation. Transcribed data were coded on these dimensions plus emergent themes. SETTING Nine communities in the US states of New York, North Carolina, Washington and Vermont. SUBJECTS Fifty-three F3HK adults with children. RESULTS CSA models were structured by partner farms. Produce quantity was abundant; however, availability was enhanced for participants who were able to select their own produce items. Flexible CSA pick-up times and locations made produce pick-up more accessible. Despite being affordable to most, payment timing was a barrier for some. Unfamiliar foods and quick spoilage hindered acceptability through challenging meal planning, despite accommodations that included preparation advice. CONCLUSIONS Although CO-CSA may facilitate increased access to fruits and vegetables for low-income families, perceptions of positive diet change may be limited by the ability to incorporate share pick-up into regular travel patterns and meal planning. Food waste concerns may be particularly acute for families with constrained resources. Future research should examine whether CO-CSA with flexible logistics and produce self-selection are sustainable for low-income families and CSA farms.
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Affiliation(s)
- Michelle J White
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, 231 MacNider, CB#7225, Chapel Hill, NC 27599-7225, USA
| | | | - Jared T McGuirt
- Department of Nutrition, The University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Karla L Hanson
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Emily H Morgan
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Jane Kolodinsky
- Department of Community Development and Applied Economics, University of Vermont, Burlington, VT, USA
| | - Weiwei Wang
- Department of Community Development and Applied Economics, University of Vermont, Burlington, VT, USA
| | - Marilyn Sitaker
- Ecological Agriculture and Food Systems, The Evergreen State College, Olympia, WA, USA
| | - Alice S Ammerman
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca A Seguin
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
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Haynes-Maslow L, Osborne I, Jilcott Pitts SB. Best Practices and Innovative Solutions to Overcome Barriers to Delivering Policy, Systems and Environmental Changes in Rural Communities. Nutrients 2018; 10:nu10081012. [PMID: 30081482 PMCID: PMC6116016 DOI: 10.3390/nu10081012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 07/25/2018] [Accepted: 07/30/2018] [Indexed: 11/16/2022] Open
Abstract
To better understand the barriers to implementing policy; systems; and environmental (PSE) change initiatives within Supplemental Nutrition Assistance Program-Education (SNAP-Ed) programming in U.S. rural communities; as well as strategies to overcome these barriers, this study identifies: (1) the types of nutrition-related PSE SNAP-Ed programming currently being implemented in rural communities; (2) barriers to implementing PSE in rural communities; and (3) common best practices and innovative solutions to overcoming SNAP-Ed PSE implementation barriers. This mixed-methods study included online surveys and interviews across fifteen states. Participants were eligible if they: (1) were SNAP-Ed staff that were intimately aware of facilitators and barriers to implementing programs, (2) implemented at least 50% of their programming in rural communities, and (3) worked in their role for at least 12 months. Sixty-five staff completed the online survey and 27 participated in interviews. Barriers to PSE included obtaining community buy-in, the need for relationship building, and PSE education. Facilitators included finding community champions; identifying early "wins" so that community members could easily see PSE benefits. Partnerships between SNAP-Ed programs and non-SNAP-Ed organizations are essential to implementing PSE. SNAP-Ed staff should get buy-in from local leaders before implementing PSE. Technical assistance for rural SNAP-Ed programs would be helpful in promoting PSE.
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Affiliation(s)
- Lindsey Haynes-Maslow
- Department of Agricultural and Human Sciences, North Carolina State University, Raleigh, NC 27695, USA.
| | - Isabel Osborne
- Department of Global Studies, University of North Carolina, Chapel Hill, NC 27514, USA.
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Jilcott Pitts SB, Wu Q, Truesdale KP, Laska MN, Grinchak T, McGuirt JT, Haynes-Maslow L, Bell RA, Ammerman AS. Baseline Assessment of a Healthy Corner Store Initiative: Associations between Food Store Environments, Shopping Patterns, Customer Purchases, and Dietary Intake in Eastern North Carolina. Int J Environ Res Public Health 2017; 14:E1189. [PMID: 28991156 PMCID: PMC5664690 DOI: 10.3390/ijerph14101189] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 11/30/2022]
Abstract
In 2016, the North Carolina (NC) Legislature allocated $250,000 to the NC Department of Agriculture, to identify and equip small food retailers to stock healthier foods and beverages in eastern NC food deserts (the NC Healthy Food Small Retailer Program, HFSRP). The purpose of this study was to examine associations between food store environments, shopping patterns, customer purchases, and dietary consumption among corner store customers. We surveyed 479 customers in 16 corner stores regarding demographics, food purchased, shopping patterns, and self-reported fruit, vegetable, and soda consumption. We objectively assessed fruit and vegetable consumption using a non-invasive reflection spectroscopy device to measure skin carotenoids. We examined associations between variables of interest, using Pearson's correlation coefficients and adjusted linear regression analyses. A majority (66%) of participants were African American, with a mean age of 43 years, and a mean body mass index (BMI) of 30.0 kg/m². There were no significant associations between the healthfulness of food store offerings, customer purchases, or dietary consumption. Participants who said they had purchased fruits and vegetables at the store previously reported higher produce intake (5.70 (4.29) vs. 4.60 (3.28) servings per day, p = 0.021) versus those who had not previously purchased fresh produce. The NC Legislature has allocated another $250,000 to the HFSRP for the 2018 fiscal year. Thus, evaluation results will be important to inform future healthy corner store policies and initiatives.
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Affiliation(s)
- Stephanie B Jilcott Pitts
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
| | - Qiang Wu
- Department of Biostatistics, College of Allied Health, East Carolina University, Greenville, NC 27834, USA.
| | - Kimberly P Truesdale
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA.
| | - Melissa N Laska
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Taras Grinchak
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
| | - Jared T McGuirt
- Department of Nutrition, University of North Carolina at Greensboro, Greensboro, NC 27413, USA.
| | - Lindsey Haynes-Maslow
- Department of Agricultural and Human Sciences, North Carolina State University, Raleigh, NC 27695, USA.
| | - Ronny A Bell
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
| | - Alice S Ammerman
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA.
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Jilcott Pitts SB, Keyserling TC, Johnston LF, Evenson KR, McGuirt JT, Gizlice Z, Whitt OR, Ammerman AS. Examining the Association between Intervention-Related Changes in Diet, Physical Activity, and Weight as Moderated by the Food and Physical Activity Environments among Rural, Southern Adults. J Acad Nutr Diet 2017; 117:1618-1627. [PMID: 28606554 PMCID: PMC5623155 DOI: 10.1016/j.jand.2017.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Few studies have been conducted in rural areas assessing the influence of community-level environmental factors on residents' success improving lifestyle behaviors. OBJECTIVE Our aim was to examine whether 6-month changes in diet, physical activity, and weight were moderated by the food and physical activity environment in a rural adult population receiving an intervention designed to improve diet and physical activity. DESIGN We examined associations between self-reported and objectively measured changes in diet, physical activity, and weight, and perceived and objectively measured food and physical activity environments. Participants were followed for 6 months. PARTICIPANTS/SETTING Participants were enrolled in the Heart Healthy Lenoir Project, a lifestyle intervention study conducted in Lenoir County, located in rural southeastern North Carolina. Sample sizes ranged from 132 to 249, depending on the availability of the data. INTERVENTION Participants received four counseling sessions that focused on healthy eating (adapted Mediterranean diet pattern) and increasing physical activity. POTENTIAL MODERATING FACTORS Density of and distance to food and physical activity venues, modified food environment index, Walk Score, crime, and perceived nutrition and physical activity neighborhood barriers were the potential mediating factors. OUTCOME MEASURES Diet quality, physical activity, and weight loss were the outcomes measured. STATISTICAL ANALYSES Statistical analyses included correlation and linear regression and controlling for potential confounders (baseline values of the dependent variables, age, race, education, and sex). RESULTS In adjusted analysis, there was an inverse association between weight change and the food environment, suggesting that participants who lived in a less-healthy food environment lost more weight during the 6-month intervention period (P=0.01). Also, there was a positive association between self-reported physical activity and distance to private gyms (P=0.04) and an inverse association between private gym density and pedometer-measured steps (P=0.03), indicating that those who lived farther from gyms and in areas with lower density of gyms had greater increases in physical activity and steps, respectively. CONCLUSIONS Contrary to our hypotheses, results indicated that those living in less-favorable food and physical activity environments had greater improvements in diet, physical activity, and weight, compared to those living in more favorable environments. Additional research should be undertaken to address these paradoxical findings and, if confirmed, to better understand them.
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Seguin RA, Morgan EH, Hanson KL, Ammerman AS, Jilcott Pitts SB, Kolodinsky J, Sitaker M, Becot FA, Connor LM, Garner JA, McGuirt JT. Farm Fresh Foods for Healthy Kids (F3HK): An innovative community supported agriculture intervention to prevent childhood obesity in low-income families and strengthen local agricultural economies. BMC Public Health 2017; 17:306. [PMID: 28390403 PMCID: PMC5385092 DOI: 10.1186/s12889-017-4202-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 03/25/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Childhood obesity persists in the United States and is associated with serious health problems. Higher rates of obesity among children from disadvantaged households may be, in part, attributable to disparities in access to healthy foods such as fruits and vegetables. Community supported agriculture can improve access to and consumption of fresh produce, but the upfront payment structure, logistical barriers, and unfamiliarity with produce items may inhibit participation by low-income families. The aim of this project is to assess the impact of subsidized, or "cost-offset," community supported agriculture participation coupled with tailored nutrition education for low-income families with children. METHODS/DESIGN The Farm Fresh Foods for Healthy Kids community-based, randomized intervention trial will build on formative and longitudinal research to examine the impact of cost-offset community supported agriculture on diet and other health behaviors as well as the economic impacts on local economies. The intervention will involve reduced-price community supported agriculture shares which can be paid for on a weekly basis, nine skill-based and seasonally-tailored healthy eating classes, and the provision of basic kitchen tools. Low income families with at least one child aged 2-12 years will be recruited to join existing community supported agriculture programs in New York, North Carolina, Vermont, and Washington. In each program, families will be randomized 1:1 to intervention or delayed intervention groups. Data will be collected at baseline, and in the fall and spring for 3 years. The primary outcomes are children's intake of fruits and vegetables and foods high in sugar and/or (solid) fat, as well as diet quality; secondary outcomes include physical, behavioral, psychosocial, and environmental variables. Cost-effectiveness and economic impact at the farm and community levels also will be assessed. DISCUSSION This integrated project will provide important information and contribute to the evidence base regarding the use of local agricultural interventions to improve children's dietary behaviors and weight maintenance. Findings also will inform the development of a toolkit for farmers and education modules related to local food system innovations for undergraduate and graduate students. TRIAL REGISTRATION ClinicalTrials.gov NCT02770196 . Registered 5 April 2016.
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Affiliation(s)
- Rebecca A. Seguin
- Division of Nutritional Sciences, Cornell University, Savage Hall, Ithaca, NY 14853 USA
| | - Emily H. Morgan
- Division of Nutritional Sciences, Cornell University, Savage Hall, Ithaca, NY 14853 USA
| | - Karla L. Hanson
- Division of Nutritional Sciences, Cornell University, Savage Hall, Ithaca, NY 14853 USA
| | - Alice S. Ammerman
- Department of Nutrition, Gillings School of Global Public Health & School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8140 USA
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8140 USA
| | - Stephanie B. Jilcott Pitts
- Brody School of Medicine, East Carolina University, Lakeside Annex 8, Room 126, 600 Moye Boulevard, Greenville, NC 27834 USA
| | - Jane Kolodinsky
- Center for Rural Studies, University of Vermont, 206 Morrill Hall, Burlington, VT 05405 USA
- Department of Community Development and Applied Economics, University of Vermont, Morrill Hall, Burlington, VT 05405 USA
| | - Marilyn Sitaker
- The Evergreen State College, 2700 Evergreen Pkwy NW, Olympia, WA 98505 USA
| | - Florence A. Becot
- Center for Rural Studies, University of Vermont, 206 Morrill Hall, Burlington, VT 05405 USA
| | - Leah M. Connor
- Division of Nutritional Sciences, Cornell University, Savage Hall, Ithaca, NY 14853 USA
| | - Jennifer A. Garner
- Division of Nutritional Sciences, Cornell University, Savage Hall, Ithaca, NY 14853 USA
| | - Jared T. McGuirt
- Department of Nutrition, Gillings School of Global Public Health & School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8140 USA
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8140 USA
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Jilcott Pitts SB, Hinkley J, Wu Q, McGuirt JT, Lyonnais MJ, Rafferty AP, Whitt OR, Winterbauer N, Phillips L. A possible dose-response association between distance to farmers' markets and roadside produce stands, frequency of shopping, fruit and vegetable consumption, and body mass index among customers in the Southern United States. BMC Public Health 2017; 17:65. [PMID: 28077113 PMCID: PMC5225609 DOI: 10.1186/s12889-016-3943-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 12/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The association between farmers' market characteristics and consumer shopping habits remains unclear. Our objective was to examine associations among distance to farmers' markets, amenities within farmers' markets, frequency of farmers' market shopping, fruit and vegetable consumption, and body mass index (BMI). We hypothesized that the relationship between frequency of farmers' market shopping and BMI would be mediated by fruit and vegetable consumption. METHODS In 15 farmers' markets in northeastern North Carolina, July-September 2015, we conducted a cross-sectional survey among 263 farmers' market customers (199 provided complete address data) and conducted farmers' market audits. To participate, customers had to be over 18 years of age, and English speaking. Dependent variables included farmers' market shopping frequency, fruit and vegetable consumption, and BMI. Analysis of variance, adjusted multinomial logistic regression, Poisson regression, and linear regression models, adjusted for age, race, sex, and education, were used to examine associations between distance to farmers' markets, amenities within farmers' markets, frequency of farmers' market shopping, fruit and vegetable consumption, and BMI. RESULTS Those who reported shopping at farmers' markets a few times per year or less reported consuming 4.4 (standard deviation = 1.7) daily servings of fruits and vegetables, and those who reported shopping 2 or more times per week reported consuming 5.5 (2.2) daily servings. There was no association between farmers' market amenities, and shopping frequency or fruit and vegetable consumption. Those who shopped 2 or more times per week had a statistically significantly lower BMI than those who shopped less frequently. There was no evidence of mediation of the relationship between frequency of shopping and BMI by fruit and vegetable consumption. CONCLUSIONS More work should be done to understand factors within farmers' markets that encourage fruit and vegetable purchases.
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Affiliation(s)
- Stephanie B. Jilcott Pitts
- Department of Public Health, Brody School of Medicine East Carolina University, 600 Moye Blvd, MS 660, Lakeside Annex 7, Greenville, NC 27834 USA
| | - Jedediah Hinkley
- Healthy Foods Coordinator Partnerships to Improve Community Health, Albemarle Regional Health Services, Elizabeth City, NC USA
| | - Qiang Wu
- Department of Biostatistics, East Carolina University, 2435D Health Sciences Building, Greenville, NC 27834 USA
| | - Jared T. McGuirt
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Mary Jane Lyonnais
- Department of Public Health, Brody School of Medicine East Carolina University, 600 Moye Blvd, MS 660, Lakeside Annex 7, Greenville, NC 27834 USA
| | - Ann P. Rafferty
- Department of Public Health, Brody School of Medicine East Carolina University, 600 Moye Blvd, MS 660, Lakeside Annex 7, Greenville, NC 27834 USA
| | - Olivia R. Whitt
- Department of Public Health, Brody School of Medicine East Carolina University, 600 Moye Blvd, MS 660, Lakeside Annex 7, Greenville, NC 27834 USA
| | - Nancy Winterbauer
- Department of Public Health, Brody School of Medicine East Carolina University, 600 Moye Blvd, MS 660, Lakeside Annex 7, Greenville, NC 27834 USA
| | - Lisa Phillips
- Department of Public Health, Brody School of Medicine East Carolina University, 600 Moye Blvd, MS 660, Lakeside Annex 7, Greenville, NC 27834 USA
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Jilcott Pitts SB, Wu Q, Sharpe PA, Rafferty AP, Elbel B, Ammerman AS, Payne CR, Hopping BN, McGuirt JT, Wall-Bassett ED. Preferred Healthy Food Nudges, Food Store Environments, and Customer Dietary Practices in 2 Low-Income Southern Communities. J Nutr Educ Behav 2016; 48:735-742.e1. [PMID: 27692628 DOI: 10.1016/j.jneb.2016.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 07/30/2016] [Accepted: 08/02/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To examine how food store environments can promote healthful eating, including (1) preferences for a variety of behavioral economics strategies to promote healthful food purchases, and (2) the cross-sectional association between the primary food store where participants reported shopping, dietary behaviors, and body mass index. METHODS Intercept survey participants (n = 342) from 2 midsized eastern North Carolina communities completed questionnaires regarding preferred behavioral economics strategies, the primary food store at which they shopped, and consumption of fruits, vegetables, and sugary beverages. RESULTS Frequently selected behavioral economic strategies included: (1) a token and reward system for fruit and vegetable purchases; and (2) price discounts on healthful foods and beverages. There was a significant association between the primary food store and consumption of fruits and vegetables (P = .005) and sugary beverages (P = .02). CONCLUSIONS AND IMPLICATIONS Future studies should examine associations between elements of the in-store food environment, purchases, and consumption.
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Affiliation(s)
| | - Qiang Wu
- Department of Biostatistics, East Carolina University, Greenville, NC
| | - Patricia A Sharpe
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Ann P Rafferty
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Brian Elbel
- NYU School of Medicine and NYU Wagner School of Public Service, New York, NY
| | - Alice S Ammerman
- Center for Health Promotion and Disease Prevention; Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Collin R Payne
- Marketing Department, College of Business, New Mexico State University, Las Cruces, NM
| | - Beth N Hopping
- Center for Advanced Hindsight, Social Science Research Institute, Duke University, Durham, NC
| | - Jared T McGuirt
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Elizabeth D Wall-Bassett
- Nutrition & Dietetics Program, School of Health Sciences, Western Carolina University, Cullowhee, NC
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Jilcott Pitts SB, McGuirt JT, Wu Q, Rushing J, Uslan D, Stanley KK, Bullock SL, Ward RK, Rafferty AP, Ammerman AS. Assessing Preliminary Impact of the North Carolina Community Transformation Grant Project Farmers' Market Initiatives Among Rural Residents. J Nutr Educ Behav 2016; 48:343-349.e1. [PMID: 27169642 DOI: 10.1016/j.jneb.2016.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 02/26/2016] [Accepted: 03/04/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Using the Social Determinants of Health as the study's theoretical underpinning, the authors examined the impact of the North Carolina Community Transformation Grant Project farmers' market initiatives on changes in awareness and use of farmers' markets, and fruit and vegetable consumption. METHODS During the farmers' market season, the researchers conducted a random digit-dial telephone survey among residents in 3 rural North Carolina counties to examine changes in farmers' market awareness, shopping, and fruit and vegetable consumption. They examined change over 1 year using t tests, chi-square tests, and propensity score matching. RESULTS In 1 county there were increases in farmers' market shopping and fruit and vegetable consumption, and in 1 county there were decreases in farmers' market shopping and fruit and vegetable consumption. CONCLUSIONS AND IMPLICATIONS The impact of farmers' market initiatives may be affected by county-specific socioeconomic contexts.
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Affiliation(s)
| | - Jared T McGuirt
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Qiang Wu
- Department of Biostatistics, East Carolina University, Greenville, NC
| | - Jill Rushing
- North Carolina Department of Health and Human Services, Raleigh, NC
| | - Daniella Uslan
- SNAP-Ed, Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Karen K Stanley
- Chronic Disease and Injury Section, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC
| | - Sally L Bullock
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Rachel K Ward
- Department of Community Health, East Tennessee State University, Johnson City, TN
| | - Ann P Rafferty
- Department of Public Health, East Carolina University, Greenville, NC
| | - Alice S Ammerman
- Department of Nutrition, Gillings School of Global Public Health, Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Cavallo DN, Sisneros JA, Ronay AA, Robbins CL, Jilcott Pitts SB, Keyserling TC, Ni A, Morrow J, Vu MB, Johnston LF, Samuel-Hodge CD. Assessing the Feasibility of a Web-Based Weight Loss Intervention for Low-Income Women of Reproductive Age: A Pilot Study. JMIR Res Protoc 2016; 5:e30. [PMID: 26920252 PMCID: PMC4788741 DOI: 10.2196/resprot.4865] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/04/2015] [Accepted: 11/14/2015] [Indexed: 11/20/2022] Open
Abstract
Background Low-income women of reproductive age are at increased risk for obesity and resulting increases in the risk of maternal/fetal complications and mortality and morbidity. Very few weight-loss interventions, however, have been targeted to this high-risk group. Based on the high prevalence of social media use among young and low-income individuals and previous successes using group formats for weight-loss interventions, the use of social media as a platform for weight-loss intervention delivery may benefit low-income women of reproductive age. Objective Examine the feasibility of delivering group-based weight-loss interventions to low-income women of reproductive age using face-to-face meetings and Web-based modalities including social media. Methods Participants attended a family planning clinic in eastern North Carolina and received a 5-month, group- and Web-based, face-to-face weight-loss intervention. Measures were assessed at baseline and 20 weeks. Results Forty participants enrolled, including 29 (73%) African American women. The mean body mass index of enrollees was 39 kg/m2. Among the 12 women who completed follow-up, mean weight change was -1.3 kg. Participation in the intervention was modest and retention at 5 months was 30%. Returnees suggested sending reminders to improve participation and adding activities to increase familiarity among participants. Conclusions Engagement with the intervention was limited and attrition was high. Additional formative work on the barriers and facilitators to participation may improve the intervention’s feasibility with low-income women of reproductive age.
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Affiliation(s)
- David N Cavallo
- Case Western Reserve University, Department of Nutrition, Cleveland, OH, United States.
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Bullock SL, Jilcott Pitts SB, Listenfelt B, McGuirt JT, Stanley K, Beth D, Kolbe MB, Rushing J, Wu Q, Ward RK, Mayo Acheson ML, Dortche CJM, Ammerman AS. Availability of Farmers’ Markets and Supplemental Nutrition Assistance Program/Electronic Benefit Transfer Systems and Associations With Rurality, Poverty, Race/Ethnicity, and Obesity Among North Carolina Counties. Journal of Hunger & Environmental Nutrition 2016. [DOI: 10.1080/19320248.2015.1045665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jilcott Pitts SB, Keyserling TC, Johnston LF, Smith TW, McGuirt JT, Evenson KR, Rafferty AP, Gizlice Z, Garcia BA, Ammerman AS. Associations between neighborhood-level factors related to a healthful lifestyle and dietary intake, physical activity, and support for obesity prevention polices among rural adults. J Community Health 2015; 40:276-84. [PMID: 25096764 DOI: 10.1007/s10900-014-9927-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
We examined cross-sectional associations among neighborhood- and individual-level factors related to a healthful lifestyle and dietary intake, physical activity (PA), and support for obesity prevention polices in rural eastern North Carolina adults. We examined perceived neighborhood barriers to a healthful lifestyle, and associations between neighborhood barriers to healthy eating and PA, participants' support for seven obesity prevention policies, and dependent variables of self-reported dietary and PA behaviors, and measured body mass index (BMI) (n = 366 study participants). We then used participants' residential addresses and Geographic Information Systems (GIS) software to assess neighborhood-level factors related to access to healthy food and PA opportunities. Correlational analyses and adjusted linear regression models were used to examine associations between neighborhood-level factors related to a healthful lifestyle and dietary and PA behaviors, BMI, and obesity prevention policy support. The most commonly reported neighborhood barriers (from a list of 18 potential barriers) perceived by participants included: not enough bicycle lanes and sidewalks, not enough affordable exercise places, too much crime, and no place to buy a quick, healthy meal to go. Higher diet quality was inversely related to perceived and GIS-assessed neighborhood nutrition barriers. There were no significant associations between neighborhood barriers and PA. More perceived neighborhood barriers were positively associated with BMI. Support for obesity prevention policy change was positively associated with perceptions of more neighborhood barriers. Neighborhood factors that promote a healthful lifestyle were associated with higher diet quality and lower BMI. Individuals who perceived more neighborhood-level barriers to healthy eating and PA usually supported policies to address those barriers. Future studies should examine mechanisms to garner such support for health-promoting neighborhood changes.
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Affiliation(s)
- Stephanie B Jilcott Pitts
- Department of Public Health, East Carolina University, Lakeside Annex 8, 600 Moye Blvd, MS 660, Greenville, NC, 27834, USA,
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McGuirt JT, Pitts SBJ, Ammerman A, Prelip M, Hillstrom K, Garcia RE, McCarthy WJ. A Mixed Methods Comparison of Urban and Rural Retail Corner Stores. AIMS Public Health 2015; 2:554-582. [PMID: 29546125 PMCID: PMC5690250 DOI: 10.3934/publichealth.2015.3.554] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Indexed: 11/18/2022] Open
Abstract
Efforts to transform corner stores to better meet community dietary needs have mostly occurred in urban areas but are also needed in rural areas. Given important contextual differences between urban and rural areas, it is important to increase our understanding of the elements that might translate successfully to similar interventions involving stores in more rural areas. Thus, an in-depth examination and comparison of corner stores in each setting is needed. A mixed methods approach, including windshield tours, spatial visualization with analysis of frequency distribution, and spatial regression techniques were used to compare a rural North Carolina and large urban (Los Angeles) food environment. Important similarities and differences were seen between the two settings in regards to food environment context, spatial distribution of stores, food products available, and the factors predicting corner store density. Urban stores were more likely to have fresh fruits (Pearson chi2 = 27.0423; p < 0.001) and vegetables (Pearson chi2 = 27.0423; p < 0.001). In the urban setting, corner stores in high income areas were more likely to have fresh fruit (Pearson chi2 = 6.00; p = 0.014), while in the rural setting, there was no difference between high and low income area in terms of fresh fruit availability. For the urban area, total population, no vehicle and Hispanic population were significantly positively associated (p < 0.05), and median household income (p < 0.001) and Percent Minority (p < 0.05) were significantly negatively associated with corner store count. For the rural area, total population (p < 0.05) and supermarket count were positively associated (p < 0.001), and median household income negatively associated (P < 0.001), with corner store count. Translational efforts should be informed by these findings, which might influence the success of future interventions and policies in both rural and urban contexts.
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Affiliation(s)
- Jared T McGuirt
- Department of Nutrition, Gillings School of Global Public Health, UNC Center for Health Promotion and Disease Prevention, University of North Carolina-Chapel Hill, 2200 McGavran-Greenberg Hall, Chapel Hill NC
| | | | - Alice Ammerman
- Department of Nutrition, Gillings School of Global Public Health, UNC Center for Health Promotion and Disease Prevention, University of North Carolina-Chapel Hill, 2200 McGavran-Greenberg Hall, Chapel Hill NC
| | - Michael Prelip
- UCLA Fielding School of Public Health, University of California, Los Angeles, CA
| | - Kathryn Hillstrom
- Department of Kinesiology & Nutritional Science, California State University, Los Angeles, CA
| | - Rosa Elena Garcia
- UCLA Fielding School of Public Health, University of California, Los Angeles, CA
| | - William J McCarthy
- UCLA Fielding School of Public Health, University of California, Los Angeles, CA
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Calancie L, Leeman J, Jilcott Pitts SB, Khan LK, Fleischhacker S, Evenson KR, Schreiner M, Byker C, Owens C, McGuirt J, Barnidge E, Dean W, Johnson D, Kolodinsky J, Piltch E, Pinard C, Quinn E, Whetstone L, Ammerman A. Nutrition-related policy and environmental strategies to prevent obesity in rural communities: a systematic review of the literature, 2002-2013. Prev Chronic Dis 2015; 12:E57. [PMID: 25927605 PMCID: PMC4416478 DOI: 10.5888/pcd12.140540] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Residents of rural communities in the United States are at higher risk for obesity than their urban and suburban counterparts. Policy and environmental-change strategies supporting healthier dietary intake can prevent obesity and promote health equity. Evidence in support of these strategies is based largely on urban and suburban studies; little is known about use of these strategies in rural communities. The purpose of this review was to synthesize available evidence on the adaptation, implementation, and effectiveness of policy and environmental obesity-prevention strategies in rural settings. METHODS The review was guided by a list of Centers for Disease Control and Prevention Recommended Community Strategies and Measurements to Prevent Obesity in the United States, commonly known as the "COCOMO" strategies. We searched PubMed, Cumulative Index of Nursing and Allied Health Literature, Public Affairs Information Service, and Cochrane databases for articles published from 2002 through 2013 that reported findings from research on nutrition-related policy and environmental strategies in rural communities in the United States and Canada. Two researchers independently abstracted data from each article, and resolved discrepancies by consensus. RESULTS Of the 663 articles retrieved, 33 met inclusion criteria. The interventions most commonly focused on increasing access to more nutritious foods and beverages or decreasing access to less nutritious options. Rural adaptations included accommodating distance to food sources, tailoring to local food cultures, and building community partnerships. CONCLUSIONS Findings from this literature review provide guidance on adapting and implementing policy and environmental strategies in rural communities.
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Affiliation(s)
- Larissa Calancie
- Department of Nutrition, University of North Carolina, Chapel Hill, Gillings School of Global Public Health, CB No 7426, 1700 MLK/Airport Rd, Room 239, Chapel Hill, NC 27599-7426. Telephone: 315-350-1689.
| | - Jennifer Leeman
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Laura Kettel Khan
- Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, Atlanta, Georgia
| | - Sheila Fleischhacker
- National Institutes of Health, Division on Nutrition Research Coordination, Bethesda, Maryland
| | - Kelly R Evenson
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michelle Schreiner
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Carmen Byker
- Montana State University, Billings, Montana; Ellen Barnidge, Saint Louis University, St. Louis, Missouri
| | - Clint Owens
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jared McGuirt
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Wesley Dean
- US Department of Agriculture Food and Nutrition Service, Washington, DC
| | | | | | | | | | | | | | - Alice Ammerman
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Crawford TW, Jilcott Pitts SB, McGuirt JT, Keyserling TC, Ammerman AS. Conceptualizing and comparing neighborhood and activity space measures for food environment research. Health Place 2014; 30:215-25. [PMID: 25306420 DOI: 10.1016/j.healthplace.2014.09.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 09/04/2014] [Accepted: 09/09/2014] [Indexed: 10/24/2022]
Abstract
Greater accessibility to geospatial technologies has led to a surge of spatialized public health research, much of which has focused on food environments. The purpose of this study was to analyze differing spatial measures of exposure to supermarkets and farmers׳ markets among women of reproductive age in eastern North Carolina. Exposure measures were derived using participant-defined neighborhoods, investigator-defined road network neighborhoods, and activity spaces incorporating participants׳ time space behaviors. Results showed that mean area for participant-defined neighborhoods (0.04 sq. miles) was much smaller than 2.0 mile road network neighborhoods (3.11 sq. miles) and activity spaces (26.36 sq. miles), and that activity spaces provided the greatest market exposure. The traditional residential neighborhood concept may not be particularly relevant for all places. Time-space approaches capturing activity space may be more relevant, particularly if integrated with mixed methods strategies.
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Affiliation(s)
- Thomas W Crawford
- Banpu Endowed Chair, 3694 West Pine Mall, Center for Sustainability, Saint Louis University, St. Louis, MO 63108, United States.
| | - Stephanie B Jilcott Pitts
- East Carolina University, Department of Public Health, 600 Moye Blvd, MS 660, Greenville, NC 27834, United States.
| | - Jared T McGuirt
- University of North Carolina at Chapel Hill, Department of Nutrition Chapel Hill, NC 27599, United States.
| | - Thomas C Keyserling
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, United States.
| | - Alice S Ammerman
- Department of Nutrition, Gillings School of Global Public Health Director, Center for Health Promotion, Disease Prevention University of North Carolina at Chapel Hill, CB# 7426, Chapel Hill, NC 27599-7426, United States.
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Johnson DB, Quinn E, Sitaker M, Ammerman A, Byker C, Dean W, Fleischhacker S, Kolodinsky J, Pinard C, Pitts SBJ, Sharkey J. Developing an agenda for research about policies to improve access to healthy foods in rural communities: a concept mapping study. BMC Public Health 2014; 14:592. [PMID: 24919425 PMCID: PMC4064519 DOI: 10.1186/1471-2458-14-592] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 06/02/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Policies that improve access to healthy, affordable foods may improve population health and reduce health disparities. In the United States most food access policy research focuses on urban communities even though residents of rural communities face disproportionately higher risk for nutrition-related chronic diseases compared to residents of urban communities. The purpose of this study was to (1) identify the factors associated with access to healthy, affordable food in rural communities in the United States; and (2) prioritize a meaningful and feasible rural food policy research agenda. METHODS This study was conducted by the Rural Food Access Workgroup (RFAWG), a workgroup facilitated by the Nutrition and Obesity Policy Research and Evaluation Network. A national sample of academic and non-academic researchers, public health and cooperative extension practitioners, and other experts who focus on rural food access and economic development was invited to complete a concept mapping process that included brainstorming the factors that are associated with rural food access, sorting and organizing the factors into similar domains, and rating the importance of policies and research to address these factors. As a last step, RFAWG members convened to interpret the data and establish research recommendations. RESULTS Seventy-five participants in the brainstorming exercise represented the following sectors: non-extension research (n = 27), non-extension program administration (n = 18), "other" (n = 14), policy advocacy (n = 10), and cooperative extension service (n = 6). The brainstorming exercise generated 90 distinct statements about factors associated with rural food access in the United States; these were sorted into 5 clusters. Go Zones were established for the factors that were rated highly as both a priority policy target and a priority for research. The highest ranked policy and research priorities include strategies designed to build economic viability in rural communities, improve access to federal food and nutrition assistance programs, improve food retail systems, and increase the personal food production capacity of rural residents. Respondents also prioritized the development of valid and reliable research methodologies to measure variables associated with rural food access. CONCLUSIONS This collaborative, trans-disciplinary, participatory process, created a map to guide and prioritize research about polices to improve healthy, affordable food access in rural communities.
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Affiliation(s)
- Donna B Johnson
- Nutritional Sciences, University of Washington, 98195, Box 353410, Seattle, WA, USA
| | - Emilee Quinn
- Center for Public Health Nutrition, University of Washington, 98195, Box 353410, Seattle, WA, USA
| | - Marilyn Sitaker
- Battelle, Health & Analytics, 1100 Dexter Avenue N., Suite 400, 98109 Seattle, WA, USA
| | - Alice Ammerman
- Department of Nutrition, Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, CB# 7426, 1700 MLK/Airport Rd, Room 239, 27599–7426, Chapel Hill, NC, USA
| | - Carmen Byker
- Department of Health and Human Development, Montana State University, 222 Romney Gym, 59717 Bozeman, MT, USA
| | - Wesley Dean
- United States Department of Agriculture Food and Nutrition Service, Office of Policy Support, Food, Nutrition and Consumer Services Headquarters, 3101 Park Center Drive, 22302 Alexandria, VA, USA
| | - Sheila Fleischhacker
- Division of Nutrition Research Coordination, National Institutes of Health, Two Democracy Plaza, Room 635 6707 Democracy Boulevard MSC 5461, 20892-5461 Bethesda, MD, USA
| | - Jane Kolodinsky
- Department of Community Development and Applied Economics, University of Vermont, 202 Morrill Hall, 05405 Burlington, VT, USA
| | - Courtney Pinard
- Gretchen Swanson Center for Nutrition, 8401 W Dodge Rd, Suite 100, 68114 Omaha, NE, USA
| | - Stephanie B Jilcott Pitts
- Department of Public Health, East Carolina University, 600 Moye Blvd., Mailstop 660 Lakeside Annex Modular Unit 8, Room 126, 27834 Greenville, NC, USA
| | - Joseph Sharkey
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, School of Public Health, MS 1266, 77843-1266 College Station, TX, USA
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Jilcott Pitts SB, Gustafson A, Wu Q, Leah Mayo M, Ward RK, McGuirt JT, Rafferty AP, Lancaster MF, Evenson KR, Keyserling TC, Ammerman AS. Farmers' market use is associated with fruit and vegetable consumption in diverse southern rural communities. Nutr J 2014; 13:1. [PMID: 24405527 PMCID: PMC3896848 DOI: 10.1186/1475-2891-13-1] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 12/23/2013] [Indexed: 11/12/2022] Open
Abstract
Background While farmers’ markets are a potential strategy to increase access to fruits and vegetables in rural areas, more information is needed regarding use of farmers’ markets among rural residents. Thus, this study’s purpose was to examine (1) socio-demographic characteristics of participants; (2) barriers and facilitators to farmers’ market shopping in southern rural communities; and (3) associations between farmers’ market use with fruit and vegetable consumption and body mass index (BMI). Methods Cross-sectional surveys were conducted with a purposive sample of farmers’ market customers and a representative sample of primary household food shoppers in eastern North Carolina (NC) and the Appalachian region of Kentucky (KY). Customers were interviewed using an intercept survey instrument at farmers’ markets. Representative samples of primary food shoppers were identified via random digit dial (RDD) cellular phone and landline methods in counties that had at least one farmers’ market. All questionnaires assessed socio-demographic characteristics, food shopping patterns, barriers to and facilitators of farmers’ market shopping, fruit and vegetable consumption and self-reported height and weight. The main outcome measures were fruit and vegetable consumption and BMI. Descriptive statistics were used to examine socio-demographic characteristics, food shopping patterns, and barriers and facilitators to farmers’ market shopping. Linear regression analyses were used to examine associations between farmers’ market use with fruit and vegetable consumption and BMI, controlling for age, race, education, and gender. Results Among farmers’ market customers, 44% and 55% (NC and KY customers, respectively) reported shopping at a farmers’ market at least weekly, compared to 16% and 18% of NC and KY RDD respondents. Frequently reported barriers to farmers’ market shopping were market days and hours, “only come when I need something”, extreme weather, and market location. Among the KY farmers’ market customers and NC and KY RDD respondents, fruit and vegetable consumption was positively associated with use of farmers’ markets. There were no associations between use of farmers’ markets and BMI. Conclusions Fruit and vegetable consumption was associated with farmers’ market shopping. Thus, farmers’ markets may be a viable method to increase population-level produce consumption.
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Affiliation(s)
- Stephanie B Jilcott Pitts
- Department of Public Health, Brody School of Medicine, East Carolina University, 600 Moye Blvd,, Mailstop 660, Lakeside Annex Modular Unit 8, Room 126, Greenville, NC 27834, USA.
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McGuirt JT, Ward R, Elliott NM, Bullock SL, Jilcott Pitts SB. Factors influencing local food procurement among women of reproductive age in rural eastern and western North Carolina, USA. J Agric Food Syst Community Dev 2014; 4:143-154. [PMID: 25664198 PMCID: PMC4317329 DOI: 10.5304/jafscd.2014.044.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Little is known about the barriers and facilitators to local food procurement among women of reproductive age (WRA). Therefore we conducted qualitative interviews with WRA in rural eastern and western NC (ENC and WNC) to learn of factors related to locally sourced food procurement. In-depth interviews were conducted among low-income White, Black, and Hispanic English-speaking WRA (N=62 (ENC: 37; WNC: 23) (18-44 years)). Independent coders used a consensus codebook to double-code all transcripts. Coders then came together to discuss and resolve coding discrepancies, and identified themes and salient quotes. Cross-cutting themes from both ENC and WNC participants included access to local food sources; acceptance of Supplemental Nutrition Assistance Program/Electronic Benefit Transfer (SNAP/EBT); freshness of produce; support for local agriculture; and the community aspect of local food sourcing. The in-depth understanding gained from this study could be used to guide tailored policy and intervention efforts aimed at promoting fruit and vegetable consumption among low-income WRA.
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Affiliation(s)
- Jared T. McGuirt
- Department of Nutrition, University of North Carolina at Chapel Hill; 2200 McGavran-Greenberg Hall; Chapel Hill, North Carolina 27599 USA; +1-910-249-2296
| | - Rachel Ward
- Department of Community Health, East Tennessee State University; Johnson City, Tennessee USA; +1-828-808-7913
| | - Nadya Majette Elliott
- Department of Public Health, East Carolina University; 600 Moye Boulevard, MS 660; Greenville, North Carolina 27834 USA; +1-252-744-4034
| | - Sally Lawrence Bullock
- Department of Nutrition, University of North Carolina at Chapel Hill; 2200 McGavran-Greenberg Hall; Chapel Hill, North Carolina 27599 USA
| | - Stephanie B. Jilcott Pitts
- Department of Public Health, East Carolina University; 600 Moye Boulevard, MS 660 Lakeside Annex 7; Greenville, North Carolina 27834 USA; +1-252-744-5572
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Sitaker M, Kolodinsky J, Jilcott Pitts SB, Seguin RA. Do entrepreneurial food systems innovations impact rural economies and health? Evidence and gaps. Am J Entrep 2014; 7:3-16. [PMID: 26613066 PMCID: PMC4657568] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A potential solution for weakened rural economies is the development of local food systems, which include affordable foods sources for consumers and economically feasible structures for producers. Local food systems are purported to promote sustainability, improve local economies, increase access to healthy foods, and improve the local diets. Four entrepreneurial food systems innovations that support local economies include farmers' markets, community supported agriculture, farm to institution programs and food hubs. We review current literature to determine whether innovations for aggregation, processing, distribution and marketing in local food systems: 1) enable producers to make a living; 2) improve local economies; 3) provide local residents with greater access to affordable, healthy food; and 4) contribute to greater consumption of healthy food among residents. While there is some evidence for each, more transdisciplinary research is needed to determine whether entrepreneurial food systems innovations provide economic and public health benefits.
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Affiliation(s)
- Marilyn Sitaker
- Battelle, Health & Analytics, 1100 Dexter Avenue N., Suite 400 Seattle, WA 98109, Phone: (206) 528-3365
| | - Jane Kolodinsky
- Community Development and Applied Economics Department, University of Vermont, Burlington, VT 05405, Phone: 802.656.4616
| | | | - Rebecca A. Seguin
- Division of Nutritional Sciences Cornell University, Ithaca, NY 14853, Phone: 607.255.8250
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McGuirt JT, Jilcott Pitts SB, Ward R, Crawford TW, Keyserling TC, Ammerman AS. Examining the Influence of price and accessibility on willingness to shop at farmers' markets among low-income eastern North Carolina women. J Nutr Educ Behav 2014; 46:26-33. [PMID: 24201077 PMCID: PMC3891513 DOI: 10.1016/j.jneb.2013.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 06/10/2013] [Accepted: 06/10/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To examine the influence of farmers' market pricing and accessibility on willingness to shop at farmers' markets, among low-income women. DESIGN Qualitative interviews using scenarios with quantitative assessment of willingness to shop at farmers' markets given certain pricing and accessibility scenarios. SETTING Eastern North Carolina. PARTICIPANTS A total of 37 low-income women of childbearing age (18-44 years) receiving family planning services at the health department. PHENOMENON OF INTEREST Willingness to shop at a farmers' market. ANALYSIS Fisher's exact test was used to examine associations between willingness to shop at farmers' markets by urban/rural residence, race, and employment status. Direct quotations relevant to participants' use of farmers' markets were extracted based on a positive deviance framework. RESULTS Participants were increasingly willing to shop at the farmers' market when price savings increased and when the market was incrementally closer to their residence. Willingness was highest when there was at least a 20% price savings. Participants seemed to be influenced more by a visual representation of a greater quantity of produce received with the price savings rather than a quantitative representation of the money saved by the reduced price. CONCLUSIONS AND IMPLICATIONS Future farmers' market interventions should take into account these consumer level preferences.
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Affiliation(s)
- Jared T McGuirt
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | | | - Rachel Ward
- Department of Community Health, East Tennessee State University, Johnson City, TN
| | | | - Thomas C Keyserling
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Alice S Ammerman
- Gillings School of Global Public Health and School of Medicine, Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Mayo ML, Pitts SBJ, Chriqui JF. Associations between county and municipality zoning ordinances and access to fruit and vegetable outlets in rural North Carolina, 2012. Prev Chronic Dis 2013; 10:E203. [PMID: 24309091 PMCID: PMC3854873 DOI: 10.5888/pcd10.130196] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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: 11/29/2022] Open
Abstract
Introduction Zoning ordinances and land-use plans may influence the community food environment by determining placement and access to food outlets, which subsequently support or hinder residents’ attempts to eat healthfully. The objective of this study was to examine associations between healthful food zoning scores as derived from information on local zoning ordinances, county demographics, and residents’ access to fruit and vegetable outlets in rural northeastern North Carolina. Methods From November 2012 through March 2013, county and municipality zoning ordinances were identified and double-coded by using the Bridging the Gap food code/policy audit form. A healthful food zoning score was derived by assigning points for the allowed use of fruit and vegetable outlets. Pearson coefficients were calculated to examine correlations between the healthful food zoning score, county demographics, and the number of fruit and vegetable outlets. In March and April 2013, qualitative interviews were conducted among county and municipal staff members knowledgeable about local zoning and planning to ascertain implementation and enforcement of zoning to support fruit and vegetable outlets. Results We found a strong positive correlation between healthful food zoning scores and the number of fruit and vegetable outlets in 13 northeastern North Carolina counties (r = 0.66, P = .01). Major themes in implementation and enforcement of zoning to support fruit and vegetable outlets included strict enforcement versus lack of enforcement of zoning regulations. Conclusion Increasing the range of permitted uses in zoning districts to include fruit and vegetable outlets may increase access to healthful fruit and vegetable outlets in rural communities.
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Affiliation(s)
- Mariel Leah Mayo
- Albemarle Regional Health Services-North Carolina, Elizabeth City, North Carolina
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Fleischhacker SE, Evenson KR, Sharkey J, Pitts SBJ, Rodriguez DA. Validity of secondary retail food outlet data: a systematic review. Am J Prev Med 2013; 45:462-73. [PMID: 24050423 PMCID: PMC3779346 DOI: 10.1016/j.amepre.2013.06.009] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 04/17/2013] [Accepted: 06/12/2013] [Indexed: 10/26/2022]
Abstract
CONTEXT Improving access to healthy foods is a promising strategy to prevent nutrition-related chronic diseases. To characterize retail food environments and identify areas with limited retail access, researchers, government programs, and community advocates have primarily used secondary retail food outlet data sources (e.g., InfoUSA or government food registries). To advance the state of the science on measuring retail food environments, this systematic review examined the evidence for validity reported for secondary retail food outlet data sources for characterizing retail food environments. EVIDENCE ACQUISITION A literature search was conducted through December 31, 2012, to identify peer-reviewed published literature that compared secondary retail food outlet data sources to primary data sources (i.e., field observations) for accuracy of identifying the type and location of retail food outlets. Data were analyzed in 2013. EVIDENCE SYNTHESIS Nineteen studies met the inclusion criteria. The evidence for validity reported varied by secondary data sources examined, primary data-gathering approaches, retail food outlets examined, and geographic and sociodemographic characteristics. More than half of the studies (53%) did not report evidence for validity by type of food outlet examined and by a particular secondary data source. CONCLUSIONS Researchers should strive to gather primary data but if relying on secondary data sources, InfoUSA and government food registries had higher levels of agreement than reported by other secondary data sources and may provide sufficient accuracy for exploring these associations in large study areas.
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Affiliation(s)
- Sheila E Fleischhacker
- Division of Nutrition Research Coordination (Fleischhacker), National Institute of Diabetes and Digestive and Kidney Diseases of NIH, Bethesda, Maryland.
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Pitts SBJ, Carr LJ, Brinkley J, Byrd JL, Crawford T, Moore JB. Associations between Neighborhood Amenity Density and Health Indicators among Rural and Urban Youth. Am J Health Promot 2013; 28:e40-3. [DOI: 10.4278/ajhp.120711-arb-342] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To examine associations between the built/social environment (neighborhood amenity density, crime) and health indicators (body mass index [BMI] percentile, cardiovascular fitness, and time spent in moderate to vigorous physical activity [MVPA]) among rural and urban youth. Design. Cross-sectional. Setting. Eastern North Carolina. Subjects. Youth (n = 296) were recruited from three middle schools. Measures. Neighborhood density was estimated using Walk Score. Crime was assessed using Regional Analysis and Information Sharing online. BMI percentiles were calculated from measured height and weight. Cardiovascular fitness was estimated using heart rate measured at the conclusion of a 3-minute step test. Time spent in MVPA was measured objectively via accelerometer. Analysis. Bivariate and multivariate statistics were used to examine associations between Walk Score, crime, BMI percentile, cardiovascular fitness (as measured via heart rate), and MVPA. Results. Walk Score was positively correlated with crime. There were positive, statistically significant associations between Walk Score and (1) BMI percentile (p = .0223) and (2) heart rate (p = .0044), and (3) inverse associations between Walk Score and MVPA (p = .0042), indicating that high neighborhood density was associated with greater BMI percentiles, lower fitness, and less MVPA among urban youth. Conclusion. These counterintuitive findings may be due to the negative effect of crime on health indicators, which may outweigh potential positive health impacts of high neighborhood amenity density.
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Pitts SBJ, Bringolf KR, Lawton KK, McGuirt JT, Wall-Bassett E, Morgan J, Laska MN, Sharkey JR. Formative evaluation for a healthy corner store initiative in Pitt County, North Carolina: assessing the rural food environment, part 1. Prev Chronic Dis 2013; 10:E121. [PMID: 23866165 PMCID: PMC3716336 DOI: 10.5888/pcd10.120318] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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: 11/29/2022] Open
Abstract
Introduction Obesity prevalence in the rural United States is higher than in urban or suburban areas, perhaps as a result of the food environment. Because rural residents live farther from supermarkets than their urban- and suburban-dwelling counterparts, they may be more reliant on smaller corner stores that offer fewer healthful food items. Methods As part of a Communities Putting Prevention to Work (CPPW) healthy corner store initiative, we reviewed audit tools in the fall of 2010 to measure the consumer food environment in eastern North Carolina and chose the NEMS-S-Rev (Nutrition Environment Measures Survey-Stores-Revised) to assess 42 food stores. During the spring and summer of 2011, 2 trained graduate assistants audited stores, achieving interrater reliability of at least 80%. NEMS-S-Rev scores of stores in rural versus urban areas were compared. Results Overall, healthful foods were less available and of lower quality in rural areas than in urban areas. NEMS-S-Rev scores indicated that healthful foods were more likely to be available and had similar pricing and quality in rural corner stores than in urban corner stores. Conclusion Food store audit data provided a baseline to implement and evaluate a CPPW healthy corner store initiative in Pitt County. This work serves as a case study, providing lessons learned for engaging community partners when conducting rural food store audits.
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Affiliation(s)
- Stephanie B Jilcott Pitts
- East Carolina University, Department of Public Health, 600 Moye Blvd, MS 660, Greenville, NC 27834. E-mail:
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Pitts SBJ, Bringolf KR, Lloyd CL, McGuirt JT, Lawton KK, Morgan J. Formative evaluation for a healthy corner store initiative in Pitt County, North Carolina: engaging stakeholders for a healthy corner store initiative, part 2. Prev Chronic Dis 2013; 10:E120. [PMID: 23866164 PMCID: PMC3716339 DOI: 10.5888/pcd10.120319] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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
Introduction We examined the feasibility of increasing access to healthful food in corner stores to inform a Communities Putting Prevention to Work (CPPW) initiative by engaging stakeholders (corner store owners and customers) in a formative evaluation. Methods Qualitative interviews were conducted with corner store owners and managers (n = 11). Customer intercept surveys (n = 179) were also conducted with customers of 9 stores. Corner stores were located in rural food deserts (municipalities without a chain supermarket) and in low-income, urban municipalities in eastern North Carolina. Interviews were transcribed verbatim and double-coded. Qualitative themes related to feasibility of increasing access to healthful foods were extracted. Shopping patterns of rural and urban customers were compared by using t tests. Results Corner store owners were willing to stock more healthful foods, but they perceived that customer demand for these foods was low. Rural customers reported more frequently shopping at corner stores than urban customers and more frequently stated that the reason they do not eat more fruits and vegetables is that the stores in which they shop do not sell them. Most customers reported they would be very or somewhat likely to purchase fresh produce at a corner store. Conclusion Corner stores may be an important source of food for rural and low-income residents and thus a good place in which to intervene. The results of this formative evaluation were used to plan and evaluate a CPPW healthy corner store initiative.
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Robbins CL, Keyserling TC, Pitts SBJ, Morrow J, Majette N, Sisneros JA, Ronay A, Farr SL, Urrutia RP, Dietz PM. Screening low-income women of reproductive age for cardiovascular disease risk factors. J Womens Health (Larchmt) 2013; 22:314-21. [PMID: 23531099 PMCID: PMC4386647 DOI: 10.1089/jwh.2012.4149] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED Abstract Background: Identifying and treating chronic diseases, their precursors, and other cardiovascular disease (CVD) risk factors during family planning visits may improve long-term health and reproductive outcomes among low-income women. A cross-sectional study design was used to describe the prevalence of chronic diseases (hypertension, high cholesterol, and diabetes), their precursors (pre-hypertension, borderline high cholesterol, and pre-diabetes), and related CVD risk factors (such as obesity, smoking, and physical inactivity) among low-income women of reproductive age. METHODS Prevalence of chronic diseases, their precursors, and related CVD risk factors were assessed for 462 out of 859 (53.8%) female family planning patients, ages 18-44 years, who attended a Title X clinic in eastern North Carolina during 2011 and 2012 and consented to participate. Data were obtained from clinical measurements, blood test results, and questionnaire. Differences in distribution of demographic and health care characteristics and CVD risk factors by presence of prehypertension and pre-diabetes were assessed by Pearson chi-square tests. RESULTS The prevalence of hypertension was 12%, high cholesterol 16%, and diabetes 3%. Nearly two-thirds of women with hypertension were newly diagnosed (62%) as were 75% of women with diabetes. The prevalence of pre-hypertension was 35%, pre-diabetes 31%, obesity 41%, smoking 32%, and physical inactivity 42%. The majority of participants (87%) had one or more chronic disease or related cardiovascular disease risk factor. CONCLUSIONS CVD screening during family planning visits can identify significant numbers of women at risk for poor pregnancy outcomes and future chronic disease and can provide prevention opportunities if effective interventions are available and acceptable to this population.
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Affiliation(s)
- Cheryl L Robbins
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Jilcott Pitts SB, Vu MB, Garcia BA, McGuirt JT, Braxton D, Hengel CE, Huff JV, Keyserling TC, Ammerman AS. A community assessment to inform a multilevel intervention to reduce cardiovascular disease risk and risk disparities in a rural community. Fam Community Health 2013; 36:135-146. [PMID: 23455684 PMCID: PMC4155752 DOI: 10.1097/fch.0b013e31828212be] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
To complete a formative evaluation to identify community-level assets and barriers to healthy lifestyle choices, we conducted qualitative interviews, community audits, and secondary data analyses. We solicited local leaders' perspectives regarding winnability of obesity prevention policy options. Participants noted that many resources were available, yet a barrier was high cost. There were more parks per capita in low-income areas, but they were of lower quality. The most winnable obesity prevention policy was incentives for use of food from local farms. Results are being used to inform an intervention to reduce cardiovascular disease risk in rural eastern North Carolina.
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Affiliation(s)
- Stephanie B. Jilcott Pitts
- East Carolina University, Department of Public Health, 600 Moye Blvd, MS 660, Greenville, 27834, ; Telephone: (252) 744-5572; Fax: (252) 744-4008
| | - Maihan B. Vu
- University of North Carolina at Chapel Hill, Center for Health Promotion and Disease Prevention, 1700 Martin Luther King Jr Blvd, Campus Box 7426, Chapel Hill, NC 27599-7426, ; Telephone: 919-966-9793; Fax: 919-966-8564
| | - Beverly A. Garcia
- UNC Center for Health Promotion and Disease Prevention, CB# 7426, 1700 MLK Jr. Blvd., Chapel Hill, NC 27599-7426, ; Telephone: 919-966-6088; Fax: 919-966-6264
| | - Jared T. McGuirt
- UNC Center for Health Promotion and Disease Prevention, CB# 7426, 1700 MLK Jr. Blvd., Chapel Hill, NC 27599-7426;
| | - Danielle Braxton
- UNC Center for Health Promotion and Disease Prevention, CB# 7426, 1700 MLK Jr. Blvd., Chapel Hill, NC 27599-7426;
| | - Constance E. Hengel
- Community Programming and Development, Lenoir Memorial Hospital, 100 Airport Road, Kinston, NC 28501, ; Telephone: (252) 522-7028
| | - Joey V. Huff
- Lenoir County Health Department, ; Telephone: (252) 526-4299
| | - Thomas C. Keyserling
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, ; Telephone: 919-966-2276; Fax: 919-966-2274
| | - Alice S. Ammerman
- Department of Nutrition, Gillings School of Global Public Health Director, Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, CB# 7426, Chapel Hill, NC 27599-7426, ; Telephone: 919 966-6082, FAX 919 966-3374
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Jilcott Pitts SB, McGuirt JT, Carr LJ, Wu Q, Keyserling TC. Associations between Body Mass Index, Shopping Behaviors, Amenity Density, and Characteristics of the Neighborhood Food Environment among Female Adult Supplemental Nutrition Assistance Program (SNAP) Participants in Eastern North Carolina. Ecol Food Nutr 2012; 51:526-41. [DOI: 10.1080/03670244.2012.705749] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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