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Chacón V, Chung M, Folta SC, Hennessy E, Macfarlane H, Roberto CA, Tovar A, Wilson NLW, Economos CD. The longitudinal association between caregivers' perceived competence and autonomy and children's dietary consumption before and 10 months into the COVID-19 pandemic. Appetite 2024; 195:107205. [PMID: 38242361 DOI: 10.1016/j.appet.2024.107205] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/21/2024]
Abstract
The COVID-19 pandemic has been stressful, potentially affecting caregivers' feeding choices. Caregivers play a role in shaping children's diets, yet few studies have explored how their competence and autonomy, defined by the Self-Determination Theory, impact children's diets. We examined the relationship between caregivers' autonomy and competence and their feeding practices before and during the first year of the pandemic. A national convenience sample of caregivers with 3-12-year-old children completed an online survey during two time-periods. Questions adapted from the Intrinsic Motivation Inventory measured perceived competence and autonomy for feeding fruits and vegetables (F/V) and limiting sugar-sweetened beverages (SSBs) and desserts. National Health and Nutrition Examination Survey Dietary Screener questions measured children's consumption of F/V, SSBs, and desserts. Paired t-tests examined how child consumption and caregiver's perceived competence and autonomy changed, and logistic regressions examined whether caregivers' competence and autonomy predicted the change in child consumption and if changes in competence and autonomy were associated with changes in child consumption. Caregivers (n = 597) were mostly Black/African American (33.0%) or Latina/o/x (42.7%) and older than 30 years (84.1%). Children's consumption did not change overall, but caregivers' competence for feeding F/V increased, and their competence for limiting SSBs and desserts decreased. Caregiver competence and autonomy before COVID-19 did not predict child dietary consumption during the pandemic. However, change in competence was a significant predictor of the change in child consumption of F/V [OR (95%CI): 0.70 (0.57, 0.86)]. The association between caregiver's perceived competence for feeding F/V and child consumption remained positive and significant in both periods [OR (95%CI) pre and during COVID: 2.09 (1.69, 2.57) - 2.40 (1.88, 3.06)]. This study can inform behavioral interventions supporting caregivers' competence and autonomy around feeding choices.
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Affiliation(s)
- Violeta Chacón
- ChildObesity180, Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA.
| | - Mei Chung
- Division of Nutrition Epidemiology and Data Science, Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA
| | - Sara C Folta
- ChildObesity180, Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA
| | - Erin Hennessy
- ChildObesity180, Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA
| | - Hannah Macfarlane
- ChildObesity180, Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA
| | - Christina A Roberto
- Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive Blockley Hall, Philadelphia, PA, 19104-4884, USA
| | - Alison Tovar
- Department of Behavioral and Social Sciences, Center for Health Promotion and Health Equity, Brown School of Public Health, Brown University, Providence, RI 02912 USA
| | - Norbert L W Wilson
- Duke Divinity School, Sanford School of Public Policy, and Director of the World Food Policy Center, Duke University, Durham, NC, 27708, USA
| | - Christina D Economos
- ChildObesity180, Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA
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Li Z, Zhang FF, Cash SB, Hager K, Trevino L, Folta SC. Caregiver perceptions of a pediatric produce prescription program during the COVID-19 pandemic. Front Nutr 2024; 11:1304519. [PMID: 38577157 PMCID: PMC10991727 DOI: 10.3389/fnut.2024.1304519] [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: 09/29/2023] [Accepted: 03/07/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction Produce prescription programs are rapidly expanding as a type of Food is Medicine intervention with prospects for mitigating food insecurity and reducing diet-related health disparities. Gaining insight into participant perspectives on program logistics and perceived impacts is crucial to program success and improvements. Methods Between May and June 2021, we conducted individual and small group interviews with 23 caregivers with children aged 1-5 years who participated in a produce prescription program from 2020 to 2021 in Texas, U.S. They were provided with a gift card to a major national grocery retailer to purchase fresh produce. The card was reloaded $60 monthly for 8 months with automatic roll-over of unused funds to the next month. Participants also received nutrition education in the form of two videos. A deductive analysis approach was employed, and NVivo qualitative data analysis software was used to perform coding and to assist with subsequent analyses. Results All 23 participants were female, with an average age of 37.5 years, and the majority identified as Hispanic/Latino (83%). About 43% of the families had three or more children. Six themes were generated from interviews. Three of these themes were related to program logistics: (1) ease of program use; (2) participant satisfaction with the incentive; and (3) desire for additional store options. The remaining main themes pertained to program impact: (1) the enhanced ability to purchase produce; (2) the usefulness of the nutrition education; and (3) persistent challenges encountered when preparing the produce for picky eaters and young children. Conclusion A pediatric produce prescription program was perceived as logistically easy and a helpful source of financial support for accessing fresh produce. Program features such as card-based incentive system and partnership with major grocery retailer were favored by participants. For future program design, it may be beneficial to consider collaborating with multiple grocery outlets and enhancing the intensity and targeting of nutrition education.
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Affiliation(s)
- Zhongyu Li
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Kurt Hager
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Leo Trevino
- Amistad Community Health Center, Corpus Christi, TX, United States
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
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Chacón V, Folta SC, Hennessy E, Leak TM, Macfarlane H, Roberto CA, Tovar A, Wilson N, Economos CD. Are Caregivers' Feeding Competence and Autonomy Associated with Healthier Restaurant Food Purchases for Their Child at Fast Food or Counter Service Restaurants? A Cross-Sectional Study in a Diverse Sample of U.S. Caregivers. Nutrients 2024; 16:479. [PMID: 38398803 PMCID: PMC10892913 DOI: 10.3390/nu16040479] [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: 12/30/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
This study examined the cross-sectional relationship between caregivers' perceived competence and autonomy (as defined by the Self-Determination Theory) and their fast food or counter service restaurant food purchases (side dishes, beverage, and dessert) for their child. A U.S. national convenience sample of caregivers with at least one 3-12-year-old child completed an online survey with questions adapted from the Intrinsic Motivation Inventory that measured perceived competence and autonomy for feeding fruits and vegetables and limiting sugar-sweetened beverages (SSBs) and desserts. The survey included four questions asking about their fast food or counter service restaurant food purchases (side dish, beverage, and dessert). We applied logistic and multinomial logistic regression models to examine the associations between competence or autonomy and restaurant orders. Competence and autonomy were associated with ordering fruits and vegetables as side dishes (OR [95% CI], 1.14 [1.06, 1.24] and 1.09 [1.03, 1.14], respectively). However, higher competence was also associated with ordering desserts at restaurants and higher autonomy was associated with lower odds of ordering water. These findings will inform interventions and programs that aim to support caregivers' psychological needs, like competence and autonomy, to promote supportive environments and healthier restaurant purchases for their children.
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Affiliation(s)
- Violeta Chacón
- ChildObesity180, Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, USA
| | - Sara C Folta
- ChildObesity180, Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, USA
| | - Erin Hennessy
- ChildObesity180, Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, USA
| | - Tashara M Leak
- Division of Nutritional Sciences, Cornell University, Reservoir Ave, Ithaca, NY 14850, USA
- Division of General Internal Medicine, Weill Cornell Medicine, 530 East 70th Street, M-522, New York, NY 10021, USA
| | - Hannah Macfarlane
- ChildObesity180, Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, USA
| | - Christina A Roberto
- Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive Blockley Hall, Philadelphia, PA 19104-4884, USA
| | - Alison Tovar
- Department of Behavioral and Social Sciences, Center for Health Promotion and Health Equity, Brown School of Public Health, Brown University, Providence, RI 02912, USA
| | - Norbert Wilson
- Duke Divinity School, Duke University, Durham, NC 27708, USA
- World Food Policy Center, Sandford School of Public Policy, Duke University, Durham, NC 27708, USA
| | - Christina D Economos
- ChildObesity180, Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, USA
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MacMillan Uribe AL, Demment M, Graham ML, Szeszulski J, Rethorst CD, Githinji P, Nelson ME, Strogatz D, Folta SC, Bailey RL, Davis JN, Seguin-Fowler RA. Improvements in dietary intake, behaviors, and psychosocial measures in a community-randomized cardiovascular disease risk reduction intervention: Strong Hearts, Healthy Communities 2.0. Am J Clin Nutr 2023; 118:1055-1066. [PMID: 37717638 PMCID: PMC10636233 DOI: 10.1016/j.ajcnut.2023.09.003] [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: 11/02/2022] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) prevalence has disproportionately risen among midlife and older female adults of rural communities, partly due to poor diet and diet-related behaviors and psychosocial factors that impede healthy eating. OBJECTIVES This study aimed to evaluate the impact of Strong Hearts Healthy Communities 2.0 (SHHC-2.0) on secondary diet-related outcomes between intervention and control participants that align with the dietary goal and behavioral aims of the SHHC-2.0, a CVD risk reduction program. METHODS A community-randomized controlled trial was conducted in rural, medically underserved communities. Participants were female adults ≥40 y who were classified as obese or both overweight and sedentary. Communities were randomized to SHHC-2.0 intervention (n = 5 communities; n = 87 participants) or control (with delayed intervention) (n = 6 communities; n = 95 participants). SHHC-2.0 consisted of 24 wk of twice-weekly experiential nutrition education and group-based physical activity classes led by local health educators. Changes between baseline and end point (24 wk) in dietary intake (24-h recalls), dietary behaviors (e.g., Rapid Eating Assessment for Participants-Short Version [REAP-S] scores) and diet-related psychosocial measures (e.g., Three Factor Eating questionnaire) between groups were analyzed using linear mixed-effects multilevel models. RESULTS At 24 wk, participants from the 5 intervention communities, compared with controls, consumed fewer calories (mean difference [MD]= -211 kcal, 95% CI: -412, -110, P = 0.039), improved overall dietary patterns measured by REAP-S scores (MD: 3.9; 95% CI: 2.26, 5.6; P < 0.001), and improved psychosocial measures (healthy eating attitudes, uncontrolled eating, cognitive restraint, and emotional eating). CONCLUSIONS SHHC-2.0 has strong potential to improve diet patterns and diet-related psychosocial wellbeing consistent with improved cardiovascular health. This trial was registered at www. CLINICALTRIALS gov as NCT03059472.
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Affiliation(s)
| | - Margaret Demment
- Texas A&M Institute for Advancing Health Through Agriculture, Dallas, TX, United States
| | - Meredith L Graham
- Texas A&M Institute for Advancing Health Through Agriculture, Dallas, TX, United States
| | - Jacob Szeszulski
- Texas A&M Institute for Advancing Health Through Agriculture, Dallas, TX, United States
| | - Chad D Rethorst
- Texas A&M Institute for Advancing Health Through Agriculture, Dallas, TX, United States
| | - Phrashiah Githinji
- Texas A&M Institute for Advancing Health Through Agriculture, Dallas, TX, United States
| | - Miriam E Nelson
- Tufts University, Friedman School of Nutrition, Boston, MA, United States
| | - David Strogatz
- Bassett Research Institute, Cooperstown, NY, United States
| | - Sara C Folta
- Tufts University, Friedman School of Nutrition, Boston, MA, United States
| | - Regan L Bailey
- Texas A&M Institute for Advancing Health Through Agriculture, Dallas, TX, United States
| | - Jaimie N Davis
- Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, United States
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Folta SC, Li Z, Cash SB, Hager K, Zhang FF. Adoption and implementation of produce prescription programs for under-resourced populations: clinic staff perspectives. Front Nutr 2023; 10:1221785. [PMID: 37964933 PMCID: PMC10641783 DOI: 10.3389/fnut.2023.1221785] [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: 05/12/2023] [Accepted: 10/13/2023] [Indexed: 11/16/2023] Open
Abstract
Background Produce prescription programs represent a promising intervention strategy in the healthcare setting to address disparities in diet quality and diet-related chronic disease. The objective of this study was to understand adoption and implementation factors related to these programs that are common across contexts and those that are context-specific. Methods In this qualitative case comparison study, we conducted qualitative interviews with eight clinic staff from five primary care "safety net" clinics, identified by a partnering non-profit organization that operated the programs, in April-July 2021. Results Across clinics, the ability to provide a tangible benefit to patients was a key factor in adoption. Flexibility in integrating into clinic workflows was a facilitator of implementation. Fit with usual operations varied across clinics. Common challenges were the need for changes to the workflow and extra staff time. Clinic staff were skeptical about the sustainability of both the benefits to patients and the ability to continue the program at their clinics. Discussion This study adds to a growing body of knowledge on the adoption and implementation of produce prescription programs. Future research will further this understanding, providing the evidence necessary to guide adopting clinics and to make informed policy decisions to best promote the growth and financial sustainability of these programs.
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Affiliation(s)
- Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
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Skeer MR, Eliasziw M, Sonneville KR, Folta SC. A new tool to capture dimensions of family dinners in relation to adolescent health and risk-related outcomes: The 'Family Dinner Index'. Prev Med Rep 2023; 35:102318. [PMID: 37519439 PMCID: PMC10382666 DOI: 10.1016/j.pmedr.2023.102318] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/30/2023] [Accepted: 07/09/2023] [Indexed: 08/01/2023] Open
Abstract
There is a strong association between family meals and child and adolescent health. To systematically understand the associations between family meals with a variety of health and risk outcomes, we developed and conducted a validation study of child- and parent-versions of the Family Dinner Index (FDI; FDI-C/FDI-P). We validated the measures with a national sample of 2,090 parent-child dyads. Using factor analysis, we reduced the initial FDIs each to eight items representing communication, enjoyment, and digital distractions; the FDI-C also included meal logistics and the FDI-P, family bonding. Using multivariable log-binomial regression models, we examined the relationships between FDI scores and substance use, violence, weight perception, weight control intention, and health indicators. Children who scored ≥21 on the FDI-C had a significantly lower average prevalence of a 'negative outcome' composite, as well as a lower prevalence of each of the individual behaviors. Children of parents who scored ≥24 on the FDI-P had a significantly lower average prevalence of the 'negative outcome' composite, as well as a lower prevalence of substance use indicators, negative weight perception and intentions to lose weight, less than daily fruit and vegetable consumption, and not meeting guidelines for physical activity. The FDI measures provide support for face and content validity, as well as concurrent criterion validity and construct validity. Further validation with these measures using a longitudinal design will allow for the establishment of predictive validity. Currently, the FDI measures may help researchers and practitioners identify points of emphasis for tailoring family-based prevention programs accordingly.
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Affiliation(s)
- Margie R. Skeer
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Misha Eliasziw
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Kendrin R. Sonneville
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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Hager K, Du M, Li Z, Mozaffarian D, Chui K, Shi P, Ling B, Cash SB, Folta SC, Zhang FF. Impact of Produce Prescriptions on Diet, Food Security, and Cardiometabolic Health Outcomes: A Multisite Evaluation of 9 Produce Prescription Programs in the United States. Circ Cardiovasc Qual Outcomes 2023; 16:e009520. [PMID: 37641928 PMCID: PMC10529680 DOI: 10.1161/circoutcomes.122.009520] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 06/14/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Produce prescriptions may improve cardiometabolic health by increasing fruit and vegetable (F&V) consumption and food insecurity yet impacts on clinical outcomes and health status have not been evaluated in large, multisite evaluations. METHODS This multisite, pre- and post-evaluation used individual-level data from 22 produce prescription locations in 12 US states from 2014 to 2020. No programs were previously evaluated. The study included 3881 individuals (2064 adults aged 18+ years and 1817 children aged 2-17 years) with, or at risk for, poor cardiometabolic health recruited from clinics serving low-income neighborhoods. Programs provided financial incentives to purchase F&V at grocery stores or farmers markets (median, $63/months; duration, 4-10 months). Surveys assessed F&V intake, food security, and self-reported health; glycated hemoglobin, blood pressure, body mass index (BMI), and BMI z-score were measured at clinics. Adjusted, multilevel mixed models accounted for clustering by program. RESULTS After a median participation of 6.0 months, F&V intake increased by 0.85 (95% CI, 0.68-1.02) and 0.26 (95% CI, 0.06-0.45) cups per day among adults and children, respectively. The odds of being food insecure dropped by one-third (odds ratio, 0.63 [0.52-0.76]) and odds of improving 1 level in self-reported health status increased for adults (odds ratio, 1.62 [1.30-2.02]) and children (odds ratio, 2.37 [1.70-3.31]). Among adults with glycated hemoglobin ≥6.5%, glycated hemoglobin declined by -0.29% age points (-0.42 to -0.16); among adults with hypertension, systolic and diastolic blood pressures declined by -8.38 mm Hg (-10.13 to -6.62) and -4.94 mm Hg (-5.96 to -3.92); and among adults with overweight or obesity, BMI decreased by -0.36 kg/m2 (-0.64 to -0.09). Child BMI z-score did not change -0.01 (-0.06 to 0.04). CONCLUSIONS In this large, multisite evaluation, produce prescriptions were associated with significant improvements in F&V intake, food security, and health status for adults and children, and clinically relevant improvements in glycated hemoglobin, blood pressure, and BMI for adults with poor cardiometabolic health.
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Affiliation(s)
- Kurt Hager
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Mengxi Du
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Zhongyu Li
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
- Tufts University School of Medicine, Boston, MA
- Division of Cardiology at Tufts Medical Center, Boston, MA
| | - Kenneth Chui
- Division of Cardiology at Tufts Medical Center, Boston, MA
| | - Peilin Shi
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | | | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
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Hershey MS, Chang CR, Sotos-Prieto M, Fernandez-Montero A, Cash SB, Christophi CA, Folta SC, Muegge C, Kleinschmidt V, Moffatt S, Mozaffarian D, Kales SN. Effect of a Nutrition Intervention on Mediterranean Diet Adherence Among Firefighters: A Cluster Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2329147. [PMID: 37589978 PMCID: PMC10436136 DOI: 10.1001/jamanetworkopen.2023.29147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/09/2023] [Indexed: 08/18/2023] Open
Abstract
Importance US firefighters are a working population at risk of chronic diseases, including obesity, cardiovascular disease, and cancer. This risk may be mitigated by a healthy diet. Objective To evaluate the effect of a Mediterranean nutrition intervention using a behavioral/environmental approach (firefighter/fire station/home) at the individual participant level. Design, Setting, and Participants This 12-month cluster randomized clinical trial included US career firefighters from fire stations and homes within 2 Indiana fire departments. Participants were randomized by fire station to either Mediterranean diet or control (usual care). The study was conducted from October 2016 to December 2019, and data were analyzed in November 2022. Intervention For the first 12 months of the study, firefighters located at fire stations randomized to the intervention group were provided with access to supermarket discounts and free samples of Mediterranean diet foods, online nutrition education platforms, email announcements and reminders, family and peer education and support, and chef demonstrations. Firefighters in fire stations allocated to the control group received no intervention and were instructed to follow their usual diet. Main Outcomes and Measures Change in dietary habits at 12 months as measured by a modified Mediterranean diet score (range, 0 to 51 points) at baseline and 6-month and 12-month follow-up. Cardiometabolic parameters were secondary outcomes. Results Of 485 included firefighters, 458 (94.4%) were male, and the mean (SD) age was 47 (7.5) years. A total of 241 firefighters (27 fire stations) were randomized to the Mediterranean nutrition intervention, and 244 (25 fire stations) were randomized to usual diet. Outcomes were analyzed using generalized linear mixed models for modified Mediterranean diet score at 6 months (n = 336) and 12 months (n = 260), adjusting for baseline age, sex, race and ethnicity, fire department, physical activity, and waist circumference. In the intervention group compared with the control group, the modified Mediterranean diet score significantly increased by 2.01 points (95% CI, 0.62-3.40; P = .005) at 6 months and by 2.67 points (95% CI, 1.14-4.20; P = .001) at 12 months. Among secondary outcomes, changes in cardiometabolic risk factors were not statistically significant at 1 year. Results from analyses with multilevel multiple imputation for missingness were similar. Conclusions and Relevance In this Mediterranean nutrition intervention of multicomponent behavioral/environmental changes, career firefighters had increased adherence to a Mediterranean diet. Trial Registration ClinicalTrials.gov Identifier: NCT02941757.
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Affiliation(s)
- Maria Soledad Hershey
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Chia-Rui Chang
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Mercedes Sotos-Prieto
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain
- Campus of International Excellence (CEI) Universidad Autónoma de Madrid (UAM), Spanish National Research Council (CSIC), Madrid, Spain
| | - Alejandro Fernandez-Montero
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Occupational Medicine, University of Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Costas A. Christophi
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Lemesos, Cyprus
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Carolyn Muegge
- National Institute for Public Safety Health, Indianapolis, Indiana
| | | | - Steven Moffatt
- National Institute for Public Safety Health, Indianapolis, Indiana
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Stefanos N. Kales
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Occupational Medicine, Cambridge Hospital, Harvard Medical School, Cambridge, Massachusetts
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Seguin-Fowler RA, Demment M, Folta SC, Graham M, Hanson K, Maddock JE, Patterson MS. Recruiting experiences of NIH-funded principal investigators for community-based health behavior interventions during the COVID-19 pandemic. Contemp Clin Trials 2023; 131:107271. [PMID: 37354992 PMCID: PMC10286519 DOI: 10.1016/j.cct.2023.107271] [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: 02/10/2023] [Revised: 06/08/2023] [Accepted: 06/20/2023] [Indexed: 06/26/2023]
Abstract
Successful recruitment into randomized trials and interventions is essential to advance scientific knowledge to improve health. This rapid assessment study explored how the COVID-19 pandemic affected participant recruitment overall, identified how it exacerbated existing challenges to recruit hard-to-reach populations, and described how NIH-funded Principal Investigators (PIs) responded to COVID-era recruitment challenges. A cross-sectional survey of NIH-funded PIs conducting interventions and trials related to health behaviors was conducted in 2022. The survey was completed by 52 PIs, most of whom were highly experienced in this type of research. Eighteen PIs reported it was very difficult to recruit participants now (39.1%) compared to before COVID-19 when only one did (2.2%). PIs reported changing recruitment and data collection methods (29.4%), increasing staff dedicated to recruitment (29.4%), and increasing participant compensation (23.5%). Recruitment methods shifted from in-person activities to social media and other electronic communications. Barriers to recruitment included reluctance to participate in research, COVID-19 protocols and precautions, overwhelmed community partners, staff burnout and turnover, and limited access to technology for some populations that were already hard to reach. Facilitators to recruitment consisted of increased access and ability to use remote technologies, use of social media, strong community ties, and wanting to be part of something positive. PIs perceived recruitment as much more difficult after the onset of COVID-19, though research teams were able to pivot to more online and remote options. These tools may have a lasting impact in modernizing recruitment, data collection, and intervention techniques in future trials.
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Affiliation(s)
- Rebecca A Seguin-Fowler
- Institute for Advancing Health through Agriculture (IHA), Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University System, 1500 Research Parkway, Centeq Building B, College Station, TX 77845, United States of America.
| | - Margaret Demment
- Texas A&M AgriLife Research and Extension Center, 17360 Coit Rd, Dallas, TX 75252, United States of America.
| | - Sara C Folta
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, United States of America.
| | - Meredith Graham
- Texas A&M AgriLife Research and Extension Center, 17360 Coit Rd, Dallas, TX 75252, United States of America.
| | - Karla Hanson
- Department of Public & Ecosystem Health, Cornell University, Ithaca, NY 4853, United States of America.
| | - Jay E Maddock
- Department of Environmental and Occupational Health, Texas A&M University, College Station, TX 77843, United States of America.
| | - Megan S Patterson
- Department of Health Behavior, Texas A&M University, 1266 TAMU, College Station, TX 77843, United States of America.
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10
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Adkins JR, Mulé CM, Linder DE, Must A, Cash SB, Folta SC. Exploring health behaviors and the role of pet dogs in households with autistic children: the DANE study. Front Pediatr 2023; 11:1153124. [PMID: 37520050 PMCID: PMC10376699 DOI: 10.3389/fped.2023.1153124] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Autism spectrum disorder (ASD) often presents a unique set of risk factors that impact healthy eating and physical activity. Animal-assisted interventions (AAI) are a promising approach for autistic children. There is growing evidence for the positive impact of AAIs on self-regulation, which is necessary for initiating and maintaining behavioral changes. Pet dogs offer several potential advantages as a vehicle for an AAI focused on health behaviors. However, little is known about the experiences of autistic children and their families with respect to dog ownership and the mechanisms through which such an AAI might operate. Methods We conducted interviews with ten parent-child dyads to explore the role of pet dogs in the lives and lifestyle habits of families with an autistic child. Interview guides were designed to explore the relationship between the autistic child and the pet dog and the role of the dog in family life; attitudes and practices related to physical activity and nutrition; and thoughts about intervention strategies. We used a directed qualitative content analysis approach for analysis. Results Themes indicate a strong bond between the child and the dog, the child's enjoyment in caring for their dog, and successful integration of dogs within family routines. In contrast, minor themes emerged around the challenges that owning a pet dog posed for families with an autistic child. In terms of nutrition and physical activity, a major theme among children was that healthy eating and exercise were important for both them and their dogs. However, minor themes suggest challenges with healthy eating and exercise and room for improvement for these behaviors. Parents held favorable views toward an intervention that would incorporate the family dog to teach children about nutrition and physical activity, although they expressed some concerns about feasibility. Discussion This exploratory work suggests that AAIs to improve nutrition and physical activity could build on the strong bond that children have with their pet dogs, but should consider the specific needs of each family, including the needs of the pet dog.
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Affiliation(s)
- Janna R. Adkins
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Christina M. Mulé
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Tufts University School of Medicine, Boston, MA, United States
| | - Deborah E. Linder
- Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, United States
| | - Aviva Must
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
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11
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Maafs-Rodríguez A, Folta SC. Effectiveness of Theory-Based Physical Activity and Nutrition Interventions in Aging Latino Adults: A Scoping Review. Nutrients 2023; 15:2792. [PMID: 37375696 DOI: 10.3390/nu15122792] [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: 05/12/2023] [Revised: 06/04/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
In the United States (US), Latino individuals older than 50 years face health disparities compared to their White counterparts. Considering the rising life expectancy and the projected increase of older Latino adults in the US, this scoping review aimed to determine the effectiveness of theory-based and culturally relevant strategies that promote healthy aging in Latinos. Web of Science and PubMed databases were searched between December 2022 and February 2023 for peer-reviewed articles assessing healthy aging interventions tailored to community-dwelling aging Latino adults. We included nine studies describing the effects of seven interventions on physical activity- or nutrition-related outcomes. Although not always statistically significant, interventions had a beneficial impact on well-being indicators. The most commonly used behavioral theories were Social Cognitive Theory and Attribution Theory. Latino cultural elements in these studies included partnering with community organizations that serve Latinos (such as Catholic churches), delivery of in-person bilingual group sessions by trusted community members (such as promotoras or Latino dance instructors), and incorporating values such as family and religion into the health curriculum, among others. Future strategies that promote healthy aging in Latino adults should proactively culturally adapt the theoretical foundations and the design, recruitment, and implementation processes to ensure their relevance and effectiveness.
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Affiliation(s)
- Ana Maafs-Rodríguez
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
| | - Sara C Folta
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
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12
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Hager K, Shi P, Li Z, Chui K, Berkowitz SA, Mozaffarian D, Chhabra J, Wilken J, Vergara C, Becker E, Small S, Ling B, Cash SB, Folta SC, Zhang FF. Evaluation of a Produce Prescription Program for Patients With Diabetes: A Longitudinal Analysis of Glycemic Control. Diabetes Care 2023; 46:1169-1176. [PMID: 36812470 PMCID: PMC10234740 DOI: 10.2337/dc22-1645] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/27/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Produce prescriptions have shown promise in improving diabetes care, although most studies have used small samples or lacked controls. Our objective was to evaluate the impacts of a produce prescription program on glycemic control for patients with diabetes. RESEARCH DESIGN AND METHODS Participants included a nonrandom enrollment of 252 patients with diabetes who received a produce prescription and 534 similar control participants from two clinics in Hartford, Connecticut. The start of the COVID-19 pandemic in March 2020 coincided with program implementation. Produce prescription enrollees received vouchers ($60 per month) for 6 months to purchase produce at grocery retail. Controls received usual care. The primary outcome was change in glycated hemoglobin (HbA1c) between treatment and control at 6 months. Secondary outcomes included 6-month changes in systolic (SBP) and diastolic blood pressure (DBP), BMI, hospitalizations, and emergency department admissions. Longitudinal generalized estimating equation models, weighted with propensity score overlap weights, assessed changes in outcomes over time. RESULTS At 6 months, there was no significant difference in change in HbA1c between treatment and control groups, with a difference of 0.13 percentage points (95% CI -0.05, 0.32). No significant difference was observed for change in SBP (3.85 mmHg; -0.12, 7.82), DBP (-0.82 mmHg; -2.42, 0.79), or BMI (-0.22 kg/m2; -1.83, 1.38). Incidence rate ratios for hospitalizations and emergency department visits were 0.54 (0.14, 1.95) and 0.53 (0.06, 4.72), respectively. CONCLUSIONS A 6-month produce prescription program for patients with diabetes, implemented during the onset of the COVID-19 pandemic, was not associated with improved glycemic control.
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Affiliation(s)
- Kurt Hager
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Peilin Shi
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Zhongyu Li
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Kenneth Chui
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA
| | - Seth A. Berkowitz
- Division of General Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
- Tufts University School of Medicine, Boston, MA
- Division of Cardiology, Tufts Medical Center, Boston, MA
| | | | | | - Cunegundo Vergara
- Hartford Healthcare, Hartford, CT
- University of Connecticut (UConn) Internal Medicine Residency Program, UConn Health Center, Farmington, CT
| | | | | | | | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
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13
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Anyanwu OA, Folta SC, Zhang FF, Chui K, Chomitz VR, Kartasurya MI, Naumova EN. Fish-To Eat or Not to Eat? A Mixed-Methods Investigation of the Conundrum of Fish Consumption in the Context of Marine Pollution in Indonesia. Int J Environ Res Public Health 2023; 20:ijerph20085582. [PMID: 37107864 PMCID: PMC10138686 DOI: 10.3390/ijerph20085582] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 05/11/2023]
Abstract
Background: The Indonesian government faces a dilemma of promoting fish consumption for its health benefits and to ease food insecurity, while at the same time seeking effective approaches to reduce the high levels of marine pollution. However, the factors associated with fish consumption in the face of persistent high levels of marine pollution are not well elucidated in the literature. Objectives: This was an explorative study to investigate the sociodemographic factors related to fish consumption and to understand the perspectives of expert informants on marine pollution and its impact on fish quality and availability in Indonesia. Methods: We characterized fish consumption among respondents aged 15 years and older in the fifth wave of the Indonesian Family Life Survey (n = 31,032), based on their sociodemographic profiles, and developed multinomial regression models to assess the relationship between respondents' sociodemographic profiles and quintiles of fish consumption. We also conducted in-depth interviews on fish consumption and marine pollution with key informants from Indonesia (n = 27). We then used a convergent mixed-methods design to synthesize the results of both datasets. Results: Fish was the most frequently consumed animal-source food reported by survey respondents: 2.8 (±2.6) days/week. More younger respondents (15-19 years) reported relatively lower consumption of fish (9.3% in Q1 versus 5.9% in Q5) compared to respondents 50 years and older (37% in Q1 versus 39.9% in Q5; p < 0.01). When classified by region, more respondents from the Java region reported lower consumption of fish (86.5% in Q1 versus 53% in Q5; p < 0.01). Key-informants' perspectives corroborated the survey results by indicating that the younger generation tends not to want to consume fish; informants expanded the survey results by suggesting that fish is scarce in the Java region due to high levels of marine pollution. Informants further implied that there is low awareness about the impact of marine pollution on fish quality among most of the Indonesian population. Conclusion: Evidence from both data sources converge on differential preference for fish consumption by age group. Informants' perspectives also link marine pollution to fish scarcity, which poses a threat to food security among low-income Indonesians and to human health globally. More studies are needed to corroborate our findings and inform policy guidelines to reduce marine pollution while promoting fish consumption in Indonesia.
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Affiliation(s)
- Oyedolapo A. Anyanwu
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, USA
- Correspondence:
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, USA
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, USA
| | - Kenneth Chui
- Public Health & Community Medicine, School of Medicine, Tufts University, 136 Harrison Ave, Boston, MA 02111, USA
| | - Virginia R. Chomitz
- Public Health & Community Medicine, School of Medicine, Tufts University, 136 Harrison Ave, Boston, MA 02111, USA
| | - Martha I. Kartasurya
- Department of Public Health Nutrition, Diponegoro University, Semarang 50275, Jawa Tengah, Indonesia;
| | - Elena N. Naumova
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, USA
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14
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Zytnick D, Folta SC, Reid KF, Chomitz VR. Better Understanding Wearable Activity Monitor Use and Non-Use Among Older Adults: A Qualitative Study. J Appl Gerontol 2023; 42:447-455. [PMID: 36314597 DOI: 10.1177/07334648221137057] [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] [Indexed: 02/18/2023] Open
Abstract
We used qualitative methods to better understand wearable activity monitor (WAM) use and its relationship with physical activity (PA) among older adults. Four focus groups, stratified by current/past ("ever") WAM users and "never" WAM users, were conducted with 57 participants aged ≥60 years. Data were coded with deductive and inductive approaches. Among ever WAM users, those with low pre-WAM PA levels reported higher PA related to WAM use while those with high pre-WAM PA levels reported they used WAM for tracking and monitoring their activity. Ever WAM users were motivated to increase PA through rewards and social support. Many never WAM users reported that WAM was unnecessary. WAM may be helpful for some older adults to increase their PA, particularly those who are motivated by setting and achieving PA goals. The results could help develop strategies to overcome barriers to WAM adoption and promote WAM use among older adults.
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Affiliation(s)
- Deena Zytnick
- Department of Public Health and Community Medicine, School of Medicine, 1810Tufts University, Boston, MA, USA
| | - Sara C Folta
- Friedman School of Nutrition Science and Policy, 1810Tufts University, Boston, MA, USA
| | - Kieran F Reid
- Laboratory of Exercise Physiology and Physical Performance, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Virginia R Chomitz
- Department of Public Health and Community Medicine, School of Medicine, 1810Tufts University, Boston, MA, USA
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15
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Seguin-Fowler RA, Eldridge GD, Graham M, Folta SC, Hanson KL, Maddock JE. COVID-19 Related Protocol Considerations and Modifications within a Rural, Community-Engaged Health Promotion Randomized Trial. Methods Protoc 2023; 6:mps6010005. [PMID: 36648954 PMCID: PMC9844482 DOI: 10.3390/mps6010005] [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: 11/19/2022] [Revised: 12/22/2022] [Accepted: 12/24/2022] [Indexed: 01/06/2023] Open
Abstract
Rural communities are at higher risk for physical inactivity, poor dietary behaviors, and related chronic diseases and obesity. These disparities are largely driven by built environment, socioeconomic, and social factors. A community-based cluster randomized controlled trial of an intervention, the Change Club, aims to address some of these disparities via civic engagement for built environment change. Baseline data collection began in February 2020, only to be paused by the COVID-19 pandemic. In this context, the investigators evaluated multiple approaches for collecting data when the study resumed, focusing on Life’s Simple 7, and additional anthropometric, physiologic, and behavioral outcomes in rural and micropolitan (<50,000 population) communities in Texas and New York. Life’s Simple 7 includes fasting blood glucose, total cholesterol, blood pressure, weight, physical activity, diet, and smoking. Rigor and feasibility were considered across a variety of in-person versus at-home measurement options. After a comprehensive input from participants, partners, staff, researchers, and the funding liaison, the study team chose self-measurement and use of validated questionnaires/surveys to measure the Life’s Simple 7 components. This case provides an example of how a study team might adjust data collection protocol during unexpected and acute events while giving consideration to rigor, feasibility, stakeholder views, and participants’ health and safety.
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Affiliation(s)
- Rebecca A. Seguin-Fowler
- Institute for Advancing Health through Agriculture, Texas A&M AgriLife, College Station, TX 77845, USA
- Correspondence: ; Tel.:+1-979-314-3398
| | - Galen D. Eldridge
- Texas A&M AgriLife Research and Extension Center, Dallas, TX 75252, USA
| | - Meredith Graham
- Texas A&M AgriLife Research and Extension Center, Dallas, TX 75252, USA
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA 02155, USA
| | - Karla L. Hanson
- Department of Public and Ecosystem Health, Cornell University, Ithaca, NY 14853, USA
| | - Jay E. Maddock
- School of Public Health, Texas A&M University, College Station, TX 77843, USA
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16
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Anyanwu OA, Naumova EN, Chomitz VR, Zhang FF, Chui K, Kartasurya MI, Folta SC. The Socio-Ecological Context of the Nutrition Transition in Indonesia: A Qualitative Investigation of Perspectives from Multi-Disciplinary Stakeholders. Nutrients 2022; 15:nu15010025. [PMID: 36615684 PMCID: PMC9823366 DOI: 10.3390/nu15010025] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/09/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Indonesia is undergoing a rapid nutrition transition—a shift in food consumption related to globalization, modernization, urbanization, and economic development—with potentially adverse impacts on diets, health, and the environment. This study sought to understand the perspectives of a multi-disciplinary group of experts on the effects of the nutrition transition on dietary behaviors, cardiovascular disease (CVD) risk factors, and the food environment in Indonesia. Methods: In-depth interviews were conducted online with 27 Indonesian experts, who are either healthcare providers, nutrition researchers, or environmental researchers. Interview question guides were developed based on a socio-ecological framework. We analyzed the data using deductive and inductive approaches. Results: Experts described a disconnect between awareness about and adherence to healthy diets among Indonesians. They highlighted a marked generational divide in food preferences between the younger population (<40y) and older population (40y+), due to the nutrition transition. Experts perceived that the nutrition transition has also resulted in more eating out, which promotes obesity, through the unhealthy menu offerings from restaurants. Experts also implied that traditional diets are no better than modern diets, due to unhealthy cooking practices, especially frying; suggesting that the combination of higher consumption of fast foods and unhealthy cooking practices may have worsened CVD risk factors in the population. Conclusion: Multi-disciplinary experts indicated that the nutrition transition has negatively impacted diets, health, and food environment in Indonesia. Our findings offer potential hypotheses that can be tested using quantitative approaches, to inform policy and the design of programs to reduce the adverse impacts of the nutrition transition in Indonesia.
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Affiliation(s)
- Oyedolapo A. Anyanwu
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, USA
- Correspondence:
| | - Elena N. Naumova
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, USA
| | - Virginia R. Chomitz
- Public Health & Community Medicine, School of Medicine, Tufts University, 136 Harrison Ave, Boston, MA 02111, USA
| | - Fang-Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, USA
| | - Kenneth Chui
- Public Health & Community Medicine, School of Medicine, Tufts University, 136 Harrison Ave, Boston, MA 02111, USA
| | - Martha I. Kartasurya
- Department of Public Health Nutrition, Universitas Diponegoro, Semarang 50275, Jawa Tengah, Indonesia
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, USA
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17
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Seguin-Fowler RA, Eldridge GD, Rethorst CD, Graham ML, Demment M, Strogatz D, Folta SC, Maddock JE, Nelson ME, Ha S. Improvements and Maintenance of Clinical and Functional Measures Among Rural Women: Strong Hearts, Healthy Communities-2. 0 Cluster Randomized Trial. Circ Cardiovasc Qual Outcomes 2022; 15:e009333. [PMID: 36378768 PMCID: PMC9665948 DOI: 10.1161/circoutcomes.122.009333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of death in the United States; however, women and rural residents face notable health disparities compared with male and urban counterparts. Community-engaged programs hold promise to help address disparities through health behavior change and maintenance, the latter of which is critical to achieving clinical improvements and public health impact. METHODS A cluster-randomized controlled trial of Strong Hearts, Healthy Communities-2.0 conducted in medically underserved rural communities examined health outcomes and maintenance among women aged ≥40 years, who had a body mass index >30 or body mass index 25 to 30 and also sedentary. The multilevel intervention provided 24 weeks of twice-weekly classes with strength training, aerobic exercise, and skill-based nutrition education (individual and social levels), and civic engagement components related to healthy food and physical activity environments (community, environment, and policy levels). The primary outcome was change in weight; additional clinical and functional fitness measures were secondary outcomes. Mixed linear models were used to compare between-group changes at intervention end (24 weeks); subgroup analyses among women aged ≥60 years were also conducted. Following a 24-week no-contact period, data were collected among intervention participants only to evaluate maintenance. RESULTS Five communities were randomized to the intervention and 6 to the control (87 and 95 women, respectively). Significant improvements were observed for intervention versus controls in body weight (mean difference: -3.15 kg [95% CI, -4.98 to -1.32]; P=0.008) and several secondary clinical (eg, waist circumference: -3.02 cm [-5.31 to -0.73], P=0.010; systolic blood pressure: -6.64 mmHg [-12.67 to -0.62], P=0.031; percent body fat: -2.32% [-3.40 to -1.24]; P<0.001) and functional fitness outcomes; results were similar for women aged ≥60 years. The within-group analysis strongly suggests maintenance or further improvement in outcomes at 48 weeks. CONCLUSIONS This cardiovascular disease prevention intervention demonstrated significant, clinically meaningful improvements and maintenance among rural, at-risk older women. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03059472.
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Affiliation(s)
- Rebecca A. Seguin-Fowler
- Institute for Advancing Health through Agriculture, Texas A&M AgriLife, College Station (R.A.S-F.)
| | - Galen D. Eldridge
- Texas A&M AgriLife Research and Extension Center, Dallas (G.D.E., C.D.R., M.L.G., M.D.)
| | - Chad D. Rethorst
- Texas A&M AgriLife Research and Extension Center, Dallas (G.D.E., C.D.R., M.L.G., M.D.)
| | - Meredith L. Graham
- Texas A&M AgriLife Research and Extension Center, Dallas (G.D.E., C.D.R., M.L.G., M.D.)
| | - Margaret Demment
- Texas A&M AgriLife Research and Extension Center, Dallas (G.D.E., C.D.R., M.L.G., M.D.)
| | | | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston (S.C.F., M.E.N.).,Texas A&M University, College Station (S.C.F., M.E.N.)
| | - Jay E. Maddock
- Statistical Collaboration Center, Texas A&M University, College Station (J.E.M., S.H.)
| | - Miriam E. Nelson
- Friedman School of Nutrition Science and Policy, Tufts University, Boston (S.C.F., M.E.N.).,Texas A&M University, College Station (S.C.F., M.E.N.)
| | - Seungyeon Ha
- Statistical Collaboration Center, Texas A&M University, College Station (J.E.M., S.H.)
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18
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Anyanwu OA, Naumova EN, Chomitz VR, Zhang FF, Chui K, Kartasurya MI, Folta SC. The Effects of the COVID-19 Pandemic on Nutrition, Health and Environment in Indonesia: A Qualitative Investigation of Perspectives from Multi-Disciplinary Experts. Int J Environ Res Public Health 2022; 19:ijerph191811575. [PMID: 36141848 PMCID: PMC9517566 DOI: 10.3390/ijerph191811575] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 07/29/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 05/25/2023]
Abstract
OBJECTIVES The COVID-19 pandemic impacted food systems, health systems and the environment globally, with potentially greater negative effects in many lower-middle income countries (LMICs) including Indonesia. The purpose of this qualitative study was to investigate the potential impacts of the COVID-19 pandemic on diets, health and the marine environment in Indonesia, based on the perspectives of a multidisciplinary group of informants. METHODS We conducted remote in-depth interviews with 27 key informants from many regions of Indonesia, who are either healthcare providers, nutrition researchers or environmental researchers. Interview question guides were developed based on a socio-ecological framework. We analyzed the data using a qualitative content analysis approach. RESULTS Informants suggested that while the COVID-19 brought increased awareness about and adherence to good nutrition and health behaviors, the impact was transitory. Informants indicated that healthy food options became less affordable, due to job losses and reduced income, suggesting a likely increase in food insecurity and obesity. Environmental researchers described higher levels of marine pollution from increase in hygienic wastes as well as from plastic packaging from food orders. CONCLUSIONS Our findings reveal perceptions by informants that the increased awareness and adherence to health behaviors observed during the pandemic was not sustained. Our results also suggest that the pandemic may have exacerbated the double-burden paradox and marine pollution in Indonesia. This study offers information for generating hypotheses for quantitative studies to corroborate our findings and inform policies and programs to mitigate the long-term impacts of the COVID-19 on diets, health, and the marine environment in Indonesia.
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Affiliation(s)
- Oyedolapo A. Anyanwu
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 20111, USA
| | - Elena N. Naumova
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 20111, USA
| | - Virginia R. Chomitz
- Public Health & Community Medicine, School of Medicine, Tufts University, 136 Harrison Ave, Boston, MA 20111, USA
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 20111, USA
| | - Kenneth Chui
- Public Health & Community Medicine, School of Medicine, Tufts University, 136 Harrison Ave, Boston, MA 20111, USA
| | - Martha I. Kartasurya
- Department of Public Health Nutrition, Faculty of Public Health, Universitas Diponegoro, Semarang 50275, Jawa Tengah, Indonesia
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 20111, USA
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19
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Seguin-Fowler RA, Hanson KL, Villarreal D, Rethorst CD, Ayine P, Folta SC, Maddock JE, Patterson MS, Marshall GA, Volpe LC, Eldridge GD, Kershaw M, Luong V, Wang H, Kenkel D. Evaluation of a civic engagement approach to catalyze built environment change and promote healthy eating and physical activity among rural residents: a cluster (community) randomized controlled trial. BMC Public Health 2022; 22:1674. [PMID: 36058913 PMCID: PMC9441047 DOI: 10.1186/s12889-022-13653-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prior studies demonstrate associations between risk factors for obesity and related chronic diseases (e.g., cardiovascular disease) and features of the built environment. This is particularly true for rural populations, who have higher rates of obesity, cancer, and other chronic diseases than urban residents. There is also evidence linking health behaviors and outcomes to social factors such as social support, opposition, and norms. Thus, overlapping social networks that have a high degree of social capital and community cohesion, such as those found in rural communities, may be effective targets for introducing and maintaining healthy behaviors. METHODS This study will evaluate the effectiveness of the Change Club (CC) intervention, a civic engagement intervention for built environment change to improve health behaviors and outcomes for residents of rural communities. The CC intervention provides small groups of community residents (approximately 10-14 people) with nutrition and physical activity lessons and stepwise built environment change planning workshops delivered by trained extension educators via in-person, virtual, or hybrid methods. We will conduct process, multilevel outcome, and cost evaluations of implementation of the CC intervention in a cluster randomized controlled trial in 10 communities across two states using a two-arm parallel design. Change in the primary outcome, American Heart Association's Life's Simple 7 composite cardiovascular health score, will be evaluated among CC members, their friends and family members, and other community residents and compared to comparable samples in control communities. We will also evaluate changes at the social/collective level (e.g., social cohesion, social trust) and examine costs as well as barriers and facilitators to implementation. DISCUSSION Our central hypothesis is the CC intervention will improve health behaviors and outcomes among engaged citizens and their family and friends within 24 months. Furthermore, we hypothesize that positive changes will catalyze critical steps in the pathway to improving longer-term health among community residents through improved healthy eating and physical activity opportunities. This study also represents a unique opportunity to evaluate process and cost-related data, which will provide key insights into the viability of this approach for widespread dissemination. TRIAL REGISTRATION ClinicalTrials.gov: NCT05002660 , Registered 12 August 2021.
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Affiliation(s)
- Rebecca A. Seguin-Fowler
- Institute for Advancing Health Through Agriculture, Texas A&M AgriLife, College Station, TX 77843 USA
| | - Karla L. Hanson
- grid.5386.8000000041936877XDepartment of Public and Ecosystem Health, Cornell University, Ithaca, NY 14853 USA
| | - Deyaun Villarreal
- Institute for Advancing Health Through Agriculture, Texas A&M AgriLife Dallas Center, Dallas, TX 75252 USA
| | - Chad D. Rethorst
- Institute for Advancing Health Through Agriculture, Texas A&M AgriLife Dallas Center, Dallas, TX 75252 USA
| | - Priscilla Ayine
- Institute for Advancing Health Through Agriculture, Texas A&M AgriLife Dallas Center, Dallas, TX 75252 USA
| | - Sara C. Folta
- grid.429997.80000 0004 1936 7531Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02155 USA
| | - Jay E. Maddock
- grid.264756.40000 0004 4687 2082School of Public Health, Texas A&M University, College Station, TX 77843 USA
| | - Megan S. Patterson
- grid.264756.40000 0004 4687 2082School of Public Health, Texas A&M University, College Station, TX 77843 USA
| | - Grace A. Marshall
- grid.5386.8000000041936877XDepartment of Public and Ecosystem Health, Cornell University, Ithaca, NY 14853 USA
| | - Leah C. Volpe
- grid.5386.8000000041936877XDepartment of Public and Ecosystem Health, Cornell University, Ithaca, NY 14853 USA
| | - Galen D. Eldridge
- Institute for Advancing Health Through Agriculture, Texas A&M AgriLife Dallas Center, Dallas, TX 75252 USA
| | - Meghan Kershaw
- Institute for Advancing Health Through Agriculture, Texas A&M AgriLife Dallas Center, Dallas, TX 75252 USA
| | - Vi Luong
- Institute for Advancing Health Through Agriculture, Texas A&M AgriLife Dallas Center, Dallas, TX 75252 USA
| | - Hua Wang
- grid.5386.8000000041936877XJeb E. Brooks School of Public Policy, Cornell University, Ithaca, NY 14853 USA
| | - Don Kenkel
- grid.5386.8000000041936877XJeb E. Brooks School of Public Policy, Cornell University, Ithaca, NY 14853 USA
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20
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Gerber S, Folta SC. You Are What You Eat… But Do You Eat What You Are? The Role of Identity in Eating Behaviors—A Scoping Review. Nutrients 2022; 14:nu14173456. [PMID: 36079713 PMCID: PMC9458161 DOI: 10.3390/nu14173456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Identity is a major construct in the fields of psychology and anthropology that can relate to both the maintenance of eating behaviors and cultural sensitivity. However, there has not been any systematic effort to understand the role of identity in eating behaviors and the maintenance of eating behaviors, or to address multiple aspects of identity within an individual across scientific disciplines. This scoping review aims to understand and describe existing research relating identity to eating behaviors and to detail the measurement of identity. Methods: We conducted a systematic search of Ovid, PsychINFO, Embase, and Web of Science for articles on identity and eating behaviors published between January 1946 and March 2022. We utilized the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist, and search methods were developed with the assistance of a research librarian. We rated articles from 1 to 5 based on the depth, complexity, and multi-dimensionality of the identity measurement conducted. Scoring criteria included a review of the number of items directly querying or evaluating identity and the extent of measurement of identity domains. Results: In total, 100 articles were included, examining 10 different identities, 8 identity constructs, 11 eating behaviors, and construct contributions from 26 theories. The mean score of all articles was 2.9 on the scale from 1 to 5. A total of 10 studies scored a “1”; 30 scored a “2”, indicating the use of 1–2 basic questions about identity; 31 received a “3” for use of a common but non-complex identity instrument; 19 received a “4”, meaning they contained strong evaluation and included multiple types of identity but were lacking in terms of depth of measure and/or the comparison of identity effects to constructs; and 10 scored a “5” for their strong, in-depth measure of identity and inclusion of multiple types. Identity was found to be significantly related to eating behaviors in all but one study. Conclusion: Identity measurements seldom accounted for complexities such as multiple identities and identity shifting over time. Nonetheless, our findings indicate that multiple aspects of identity reciprocally reinforce behavior and that change maintenance is associated with identity salience and centrality. Identity is underutilized and heterogeneously applied in eating behavior research. The inclusion of identity assessments may lead to better outcomes being obtained within differing cultural, normative, and environmental scenarios.
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Affiliation(s)
- Suzannah Gerber
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
- Betty and Guy Beatty Liver and Obesity Research Program, Inova Medical System, Falls Church, VA 22043, USA
- Correspondence:
| | - Sara C. Folta
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
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21
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Anyanwu OA, Folta SC, Zhang FF, Chui K, Chomitz VR, Kartasurya MI, Naumova EN. A Cross-Sectional Assessment of Dietary Patterns and Their Relationship to Hypertension and Obesity in Indonesia. Curr Dev Nutr 2022; 6:nzac091. [PMID: 35769449 PMCID: PMC9233620 DOI: 10.1093/cdn/nzac091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/11/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background There is a marked increase in the intake of foods associated with higher risks for hypertension and obesity in Indonesia. However, studies assessing the relationship between dietary patterns and health outcomes are few. Objective The purpose of this study was to characterize dietary patterns and investigate their relationship with hypertension and obesity in Indonesia. Methods Exploratory factor analysis was used to derive dietary patterns from a brief food scanner filled by 31,160 respondents aged 15 y and older in the Indonesian Family Life Survey wave 5 (IFLS 5). Age- and gender-specific quintiles of consumption were created for each pattern and the association between quintiles of each dietary pattern and the odds for hypertension and obesity were assessed using multivariate logistic regression analyses. Results Two dietary patterns were identified: a modern dietary pattern characterized by fast foods, soft drinks, sweet snacks, and salty snacks and a traditional pattern characterized by fish, vegetables, and fruits. Younger age and being male were significantly correlated with higher consumption of the modern pattern (P < 0.0001 and P = 0.03, respectively). Analyses showed no association between hypertension and the modern pattern. However, the traditional pattern revealed lower odds for hypertension among those in the highest quintile compared with the lowest quintile (OR: 0.84; 95% CI: 0.74, 0.95; P-trend < 0.05). Individuals in the highest quintile of each dietary pattern had higher odds of obesity compared with those in the lowest quintile (modern pattern-OR: 1.31; 95% CI: 1.15, 1.49; P-trend < 0.00; traditional pattern-OR: 1.25; 95% CI: 1.10, 1.42; P-trend < 0.01). Conclusions More studies using gold-standard measures of dietary intake are needed to better understand the relationship between the modern dietary pattern and hypertension in Indonesia. Also, both modern and traditional dietary patterns in Indonesia may be energy dense, leading to higher risk for obesity.
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Affiliation(s)
- Oyedolapo A Anyanwu
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Sara C Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Kenneth Chui
- Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA, USA
| | - Virginia R Chomitz
- Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA, USA
| | - Martha I Kartasurya
- Department of Public Health Nutrition, Diponegoro University, Semarang, Indonesia
| | - Elena N Naumova
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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22
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Wilson NLW, Calancie L, Adkins J, Folta SC. Understanding Micro-pantries as an Emergency Food Source During the COVID-19 Pandemic. J Nutr Educ Behav 2022; 54:299-310. [PMID: 35039234 PMCID: PMC8758996 DOI: 10.1016/j.jneb.2021.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/01/2021] [Accepted: 11/05/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore the role of micro-pantries in addressing food insecurity during the coronavirus disease 2019 (COVID-19) pandemic. DESIGN Qualitative interviews with 20 micro-pantry users and 10 stakeholders during April and May, 2020. SETTING Six US states. PARTICIPANTS Users, aged ≥ 18 years, had obtained food from a micro-pantry in the past 2 weeks; stakeholders, aged ≥ 18 years, played a role in organizing micro-pantries at the community, regional, or national levels. PHENOMENA OF INTEREST Impact of COVID-19 on food insecurity and use of micro-pantries to mitigate it; benefits of, suggested improvements to, and adoption and administration of micro-pantries. ANALYSIS We transcribed the data verbatim and performed deductive qualitative content analysis. RESULTS Micro-pantry users had increased their use of both micro-pantries and regular food pantries during the pandemic. Micro-pantries helped stretch resources. Users appreciated the anonymity and choice; the mutual aid aspects reduced stigma. Stakeholders described micro-pantries as providing a direct way for neighbors to help neighbors during the pandemic. They described a decentralized and informal system of administration. CONCLUSIONS AND IMPLICATIONS Findings suggest that micro-pantries provided a supplemental food source that supported the resilience of communities during the COVID-19 pandemic.
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Affiliation(s)
- Norbert L W Wilson
- Duke Divinity School and Sanford School of Public Policy, Duke University, Durham, NC
| | - Larissa Calancie
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Janna Adkins
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Sara C Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA.
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23
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Linder DE, Folta SC, Must A, Mulé CM, Cash SB, Halbreich ED, Colón C, Sullivan S, Sanabria E, Gibbs D, Farrell T. A Stakeholder-Engaged Approach to Development of an Animal-Assisted Intervention for Obesity Prevention Among Youth With Autism Spectrum Disorder and Their Pet Dogs. Front Vet Sci 2021; 8:735432. [PMID: 34869717 PMCID: PMC8636006 DOI: 10.3389/fvets.2021.735432] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/11/2021] [Indexed: 11/22/2022] Open
Abstract
Stakeholder involvement in research has been demonstrated to increase the effectiveness, validity, and quality of a study. This paper describes the engagement of a stakeholder panel in the development and implementation of an animal-assisted intervention (AAI) assessment and program for children diagnosed with Autism Spectrum Disorder (ASD). Canines for Autism Activity and Nutrition (CAAN) aims to promote physical activity and wellness among children diagnosed with ASD by integrating activities with their pet dog during the child's ongoing Applied Behavioral Analysis (ABA) in-home therapy sessions. Feedback from stakeholders guided program development at each stage of the research process, including this publication. Utilizing a stakeholder-informed approach was essential for the development of assessment tools, program materials, and program design. Methods that may assist others to effectively partner with stakeholders to implement an AAI among children diagnosed with ASD or related disorders are described.
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Affiliation(s)
- Deborah E. Linder
- Tufts Institute for Human-Animal Interaction, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, United States
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Aviva Must
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Christina M. Mulé
- Division of Developmental Behavioral Pediatrics, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, United States
- Division of Developmental Behavioral Pediatrics, Department of Pediatrics, Tufts University School of Medicine, Boston, MA, United States
| | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Eli D. Halbreich
- Department of Psychology, Tufts University School of Arts and Sciences, Medford, MA, United States
| | | | - Sandy Sullivan
- Massachusetts Bay Transportation Authority, Boston, MA, United States
| | | | - Debra Gibbs
- Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, United States
| | - Terri Farrell
- The Shriver Center, The University of Massachusetts Chan Medical School, Worcester, MA, United States
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24
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Lo BK, Graham ML, Folta SC, Strogatz D, Parry SA, Seguin-Fowler RA. Physical activity and healthy eating behavior changes among rural women: an exploratory mediation analysis of a randomized multilevel intervention trial. Transl Behav Med 2021; 11:1839-1848. [PMID: 33484151 PMCID: PMC8541698 DOI: 10.1093/tbm/ibaa138] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Rural women experience disproportionately higher levels of obesity in comparison to their non-rural counterparts. The present exploratory mediation analysis sought to identify mechanisms that might have contributed to rural women's physical activity and diet changes after participating in a 6-month multilevel community-randomized trial: Strong Hearts, Healthy Communities (SHHC). SHHC was conducted in 16 rural towns in Montana and New York, between 2015 and 2016; 194 overweight, sedentary midlife, and older women (mean age 59; 26.8% overweight; 73.2% obese) participated. Participants in eight towns received the SHHC intervention (n = 101), which focused on healthy behavior change at the individual level as well as creating supportive social and built environments for physical activity and healthy eating. Participants in the other eight towns received an education-only control intervention (n = 93). We investigated the direct and indirect effects of the SHHC intervention through changes to self-efficacy, social support, and built environment perception, on changes in participants' physical activity and diet. Compared to the controls, SHHC intervention participants increased their social support from friends for physical activity (p = 0.009) and healthy eating (p = 0.032). Participants' improved social support from friends marginally mediated the intervention effects for walking metabolic equivalent minutes per week, explaining 40.5% of the total effect (indirect effect = +45.24, 95% CI: -1.51, +91.99; p = 0.059). Increasing social support from friends appears to be helpful in encouraging rural women to become more active. Further investigations are needed to better understand how multilevel interventions work in rural communities.
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Affiliation(s)
- Brian K Lo
- School of Social Work, Boston College, Chestnut Hill, MA
| | - Meredith L Graham
- Texas A&M AgriLife Research, Texas A&M University System, College Station, TX
| | - Sara C Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - David Strogatz
- Center for Rural Community Health, Bassett Healthcare Network, Cooperstown, NY
| | - Stephen A Parry
- Cornell Statistical Consulting Unit, Cornell University, Ithaca, NY
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25
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Folta SC, Anyanwu O, Pustz J, Oslund J, Penkert LP, Wilson N. Food Choice With Economic Scarcity and Time Abundance: A Qualitative Study. Health Educ Behav 2021; 49:150-158. [PMID: 34636284 DOI: 10.1177/10901981211045926] [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] [Indexed: 11/15/2022]
Abstract
Consumers with low income in the United States have higher vulnerability to unhealthy diets compared with the general population. Although some literature speculates that scarcity is an explanation for this disparity, empirical evidence is lacking. We conducted a qualitative study of food choice to explore whether scarcity-related phenomena, such as tunneling and bandwidth tax, may contribute to unhealthy dietary choices. We used participant-driven photo elicitation (n = 18) to investigate the food choice behaviors of individuals living in the greater Boston area who met the federal guidelines for poverty. Participants took photos at the point of food acquisition for 1 month, after which we interviewed them using a semistructured interview guide with the photos as prompts. Thematic coding was used for analysis. Respondents had relative time abundance. Two major themes emerged: participants used a set of strategies to stretch their budgets, and they highly prioritized cost and preference when making food choices. The extreme focus on obtaining food at low cost, which required time and effort, was suggestive of tunneling. We found no evidence of the bandwidth tax. Our findings raise the hypothesis of scarcity as a continuum: when individuals experience multiple resource constraints, they experience scarcity; whereas people with very limited finances and relative time abundance may instead be in a prescarcity condition, with a hyperfocus on a scarce resource that could lead to tunneling as constraints increase. Additional studies are needed to understand whether and how tunneling and bandwidth tax emerge, independently or together, as people face different levels and types of scarcity.
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Affiliation(s)
| | | | | | | | | | - Norbert Wilson
- Tufts University, Boston, MA, USA.,Duke Divinity School and Sanford Public Policy, Durham, NC, USA
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26
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Rottapel RE, Hudson LB, Folta SC. Cardiovascular Health and African-American Women: A Qualitative Analysis. Am J Health Behav 2021; 45:735-745. [PMID: 34340740 DOI: 10.5993/ajhb.45.4.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: There are disparities in cardiovascular disease (CVD) among African-American women and culturally adapted interventions are needed for this population. The purpose of this study was to conduct qualitative research to inform a cultural adaptation of the evidence-based Strong Women - Healthy Hearts intervention for midlife and older African-American women. Methods: Eligible participants were African-American women age ≥ 40 years, BMI ≥ 25, and sedentary. The study guide explored perceptions of heart disease and prevention using a novel construct, 'abundant life'. Twenty-two participants attended focus groups (N=5). A directed qualitative content analysis approach was used. Results: Participants described an abundant life as lack of stress, good health, and supportive relationships. Facilitators of abundant life and cardiovascular health often overlapped, including healthy diet, exercise, positive family and community ties, and spirituality. Key barriers included family caregiving burdens and the enduring legacy of racism which contributed to stress, environmental barriers to healthy eating and physical activity, and discriminatory experiences in the healthcare system. Conclusion: Participant responses were provided within the context of their personal values and social identities, providing insights that may support adaption of behavioral interventions for this high-need population.
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Affiliation(s)
- Rebecca E. Rottapel
- Rebecca E. Rottapel, Project Manager, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Linda B. Hudson
- Linda B. Hudson, Assistant Professor, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Sara C. Folta
- Sara C. Folta, PhD, Associate Professor, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States;,
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27
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Tsai M, Cash SB, Anzman-Frasca S, Goldberg JP, Johnson SK, Oslund J, Folta SC. Helping parents provide vegetable snacks: Investigating price and taste as barriers. Appetite 2021; 166:105481. [PMID: 34175360 DOI: 10.1016/j.appet.2021.105481] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/19/2022]
Abstract
Snacks contribute nearly one-quarter of children's daily energy intake in the USA. Snack time therefore represents an opportunity for parents to provide foods with key nutrients. Instead, the most common snack foods are major contributors to children's consumption of added sugars and sodium. Parents face major barriers to providing healthier snacks, including perceptions of high cost and lack of child acceptance. We obtained both economic and qualitative data to inform and optimize interventions for parents to promote vegetable snacks for children. We conducted a survey with parents (n = 368) to estimate how much of a discount would influence vegetable snack purchases by estimating willingness-to-pay using the contingent valuation method, using baby-cut carrots as a sample product. We conducted three focus groups (n = 19) and 1 group interview (n = 2) with children to help understand how to increase the appeal of vegetable snacks. Most (70%) parents accepted the reference price for the vegetable snack. Among those who did not, contingent valuation analysis revealed that a mean discount of approximately 30% would shift consumers to purchasing the snack. Focus group results revealed that the appeal of vegetable snacks to children was influenced by how they were prepared and presented, and the child's familiarity with the vegetables and ability to choose among them. This study lays the groundwork for effective interventions to promote the provision of vegetable snacks by parents.
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Affiliation(s)
- Marisa Tsai
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA; Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, 1111 Franklin Street, Tenth Floor, Oakland, CA 94607, USA.
| | - Sean B Cash
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA.
| | - Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences and Center for Ingestive Behavior Research, University at Buffalo, G56 Farber Hall, South Campus, Buffalo, NY, USA.
| | - Jeanne P Goldberg
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA.
| | - Sarah K Johnson
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA.
| | - Jennifer Oslund
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA.
| | - Sara C Folta
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA.
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28
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Alsukait RF, Folta SC, Chui K, Seguin RA, Sinclair CG, Hudson LB. Healthy Hearts for an Abundant Life: Feasibility of a Culturally Adapted Cardiovascular Disease Prevention Curriculum for African American Women. Health Equity 2021; 5:398-407. [PMID: 34235364 PMCID: PMC8237101 DOI: 10.1089/heq.2021.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: This study tested the feasibility of implementing Healthy Hearts for an Abundant Life (HHAL), a cultural adaptation for African American (AA) women of the evidence-based cardiovascular disease prevention program Strong Women-Healthy Hearts (SWHH). Methods: Using a quasi-experimental pre-post study design, this 12-week program was implemented in four faith-based organizations between 2017 and 2018. Eligible participants were AA women between 40 and 65 years who had a body mass index of 25 or higher and were currently sedentary. HHAL program participants met weekly for 2-h sessions led by program leaders. The curriculum has four modules: total health; relationships, family, and networks; material security and the environment; and emotional wellness. Each class included walking for 30 min, goal-setting session, and a group dialog called "making it work" for building collective efficacy. Results: Of the 27 participants (mean age=54.2±5.9), 24 completed postassessments (93% retention rate). All outcome measures proved feasible and weekly program attendance was 73%. Findings from in-depth interviews show high satisfaction with the program and suggest extending the class time and adding cooking demonstrations. Conclusions: The culturally adapted HHAL proved feasible and was positively received by the participants. Future studies will evaluate the effectiveness of the program.
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Affiliation(s)
- Reem F. Alsukait
- Community Health Department, King Saud University, Riyadh, Saudi Arabia
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Kenneth Chui
- Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Rebecca A. Seguin
- College of Agriculture and Life Sciences, Texas A&M University, College Station, Texas, USA
| | - Christine G. Sinclair
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Linda B. Hudson
- Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
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29
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Must A, Mulé CM, Linder DE, Cash SB, Folta SC. Animal-Assisted Intervention: A Promising Approach to Obesity Prevention for Youth With Autism Spectrum Disorder. Front Vet Sci 2021; 8:646081. [PMID: 34095272 PMCID: PMC8171662 DOI: 10.3389/fvets.2021.646081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/23/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Aviva Must
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Christina M. Mulé
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Tufts University School of Medicine, Boston, MA, United States
| | - Deborah E. Linder
- Tufts Institute for Human-Animal Interaction, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, United States
| | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
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Botoseneanu A, Chen H, Ambrosius WT, Allore HG, Anton S, Folta SC, King AC, Nicklas BJ, Spring B, Strotmeyer ES, Gill TM. Metabolic syndrome and the benefit of a physical activity intervention on lower-extremity function: Results from a randomized clinical trial. Exp Gerontol 2021; 150:111343. [PMID: 33848565 DOI: 10.1016/j.exger.2021.111343] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND In older adults, increases in physical activity may prevent decline in lower-extremity function, but whether the benefit differs according to metabolic syndrome (MetS) status is uncertain. We aim to investigate whether structured physical activity is associated with less decline in lower-extremity function among older adults with versus without MetS. METHODS We used data from the multicenter Lifestyle Interventions and Independence for Elders (LIFE) study to analyze 1535 sedentary functionally-vulnerable women and men, aged 70 to 89 years old, assessed every 6 months (February 2010-December 2013) for an average of 2.7 years. Participants were randomized to a structured, moderate-intensity physical activity intervention (PA; n = 766) or health education program (HE; n = 769). MetS was defined according to the 2009 multi-agency harmonized criteria. Lower-extremity function was assessed by 400-m walking speed and the Short Physical Performance Battery (SPPB) score. RESULTS 763 (49.7%) participants met criteria for MetS at baseline. Relative to HE, PA was associated with faster 400-m walking speed among participants with MetS (P < 0.001) but not among those without MetS (P = 0.91), although the test for statistical interaction was marginally non-significant (P = 0.07). In contrast, no benefit of PA versus HE was observed on the SPPB score in either MetS subgroup. CONCLUSIONS Among older adults at high risk for mobility disability, moderate-intensity physical activity conveys significant benefits in 400-m walking speed but not SPPB in those with, but not without, MetS. The LIFE physical activity program may be an effective strategy for maintaining or improving walking speed among vulnerable older adults with MetS. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01072500.
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Affiliation(s)
- Anda Botoseneanu
- Department of Health and Human Services and Institute of Gerontology, University of Michigan, Ann Arbor and Dearborn, MI, USA.
| | - Haiying Chen
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Walter T Ambrosius
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Heather G Allore
- Department of Internal Medicine/Geriatrics, Yale School of Medicine, New Haven, CT, USA
| | - Stephen Anton
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Sara C Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Abby C King
- Department of Epidemiology & Population Health and the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Barbara J Nicklas
- J. Paul Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elsa S Strotmeyer
- Department of Epidemiology, Center for Aging and Population Health, Graduate School of Public Health, University of Pittsburgh, PA, USA
| | - Thomas M Gill
- Department of Internal Medicine/Geriatrics, Yale School of Medicine, New Haven, CT, USA.
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Hollander JB, Folta SC, Graves EM, Allen JD, Situ M. A Fitness App for Monitoring Walking Behavior and Perception (Runkeeper): Mixed Methods Pilot Study. JMIR Form Res 2021; 5:e22571. [PMID: 33646132 PMCID: PMC7961398 DOI: 10.2196/22571] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/22/2020] [Accepted: 01/17/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Physical activity has a strong positive impact on both physical and mental health, and public health interventions often encourage walking as a means to promote physical activity. Social connectivity, such as that among spouses, families, friends, and colleagues, highly influences physical activity. Although technology-based interventions have some influence on human behavior, they have not been fully implemented and evaluated for their influence on walking through social connectivity. OBJECTIVE We aimed to pilot-test the organization of neighborhood walking clubs and use of a mobile app (Runkeeper) to encourage social connectedness and neighborhood cohesion, as well as to increase physical activity. METHODS We used a convenience sampling method to recruit 46 adults from an urban location in Greater Boston, Massachusetts. We assigned participants to teams based on their geographic location and neighborhood and required them to use the app (Runkeeper). Participants completed 2 self-administered web-based surveys before and after the intervention period. The surveys included standard measures to evaluate physical activity, social connectedness, perceived social support, and neighborhood cohesion (Buckner Neighborhood Cohesion Scale) before and after the intervention. Following the intervention, we randomly selected 14 participants to participate in postintervention, in-depth phone interviews to gain an understanding of their experiences. RESULTS This study was approved by the institutional review board in June 2018 and funded in January 2018. Recruitment started in May 2019 and lasted for 2 months. Data were collected from July 2019 to January 2020. In this study, Runkeeper was of limited feasibility as an app for measuring physical activity or promoting social connectedness. Data from the app recorded sparse and uneven walking behaviors among the participants. Qualitative interviews revealed that users experienced difficulties in using the settings and features of the app. In the questionnaire, there was no change between pre-post assessments in walking minutes (b=-.79; 95% CI -4.0 to 2.4; P=.63) or miles (b=-.07; 95% CI -0.15 to 0.01; P=.09). We observed a pre-post increase in social connectedness and a decrease in neighborhood cohesion. Both quantitative and qualitative results indicated that the psychosocial aspects of walking motivated the participants and helped them relieve stress. Interview results showed that participants felt a greater virtual connection in their assigned groups and enhanced connections with friends and family members. CONCLUSIONS Our study found that Runkeeper created a virtual connection among walking group members and its data sharing and ranking motivated walking. Participants felt that walking improved their mental health, helped to relieve stress, and made them feel more connected with friends or family members. In future studies, it will be important to use an app that integrates with a wearable physical activity device. There is also a need to develop and test intervention components that might be more effective in fostering neighborhood cohesion.
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Affiliation(s)
- Justin B Hollander
- Department of Urban and Environmental Policy and Planning, School of Arts and Sciences, Tufts University, Medford, MA, United States
| | - Sara C Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, United States
| | | | - Jennifer D Allen
- Department of Community Health, Tufts University, Medford, MA, United States
| | - Minyu Situ
- Graduate Program of Community and Regional Planning, School of Architecture, University of Texas Austin, Austin, TX, United States
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Glanz K, Metcalfe JJ, Folta SC, Brown A, Fiese B. Diet and Health Benefits Associated with In-Home Eating and Sharing Meals at Home: A Systematic Review. Int J Environ Res Public Health 2021; 18:ijerph18041577. [PMID: 33562357 PMCID: PMC7915304 DOI: 10.3390/ijerph18041577] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/19/2021] [Accepted: 01/28/2021] [Indexed: 11/25/2022]
Abstract
In-home and shared meals have been hypothesized to have positive effects. This narrative review examines research on the influence of in-home eating on diet quality, health outcomes, and family relationships. A combination search approach included a search of PubMed, backward searches of previous published reviews, and studies the authors were familiar with. A search identified 118 publications; 54 original studies and 11 review studies were included in this review. Each study was reviewed and summarized. The diverse designs precluded quantitative data synthesis. Relatively strong evidence from cross-sectional research supports the association of shared family meals with favorable dietary patterns in children and adolescents, including consumption of fruits, vegetables, and healthful nutrients. Correlational evidence links shared meals with health and psychosocial outcomes in youth, including less obesity, decreased risk for eating disorders, and academic achievement. Most evidence is cross-sectional, thus, limiting attribution of causality. There is insufficient evidence to conclude that interventions improve the frequency of shared meals, improve diet, or prevent child obesity. Despite the “common wisdom”, the evidence that in-home, shared meals, per se, have positive effects on diet quality, health outcomes, psychosocial outcomes, and family relationships is limited due to weak research designs and single-item measurement of the independent variable. More research, with stronger designs, is warranted.
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Affiliation(s)
- Karen Glanz
- Perelman School of Medicine and School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA
- Correspondence: ; Tel.: +1-215-898-0613
| | - Jessica J. Metcalfe
- Department of Food Science and Human Nutrition, University of Illinois, Urbana, IL 61820, USA;
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA;
| | - Alison Brown
- National Heart, Lung and Blood Institute, NIH, Bethesda, MD 20892, USA;
| | - Barbara Fiese
- Department of Human Development and Family Studies, University of Illinois, Urbana, IL 61820, USA;
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Zytnick D, Kumar GS, Folta SC, Reid KF, Tybor D, Chomitz VR. Wearable Activity Monitor Use Is Associated With the Aerobic Physical Activity Guidelines and Walking Among Older Adults. Am J Health Promot 2021; 35:679-687. [PMID: 33406889 DOI: 10.1177/0890117120985834] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To examine wearable activity monitor (WAM) use and its association with meeting the 2008 aerobic Physical Activity Guidelines (PAG) and walking among older adults. DESIGN Cross-sectional. SETTING FallStyles 2015 national consumer panel survey. SAMPLE 1,317 U.S. adults aged ≥ 60 years. MEASURES Self-reported WAM use, meeting aerobic PAG, and walking. Covariates included age, sex, race/ethnicity, education level, marital status, annual household income, and geographic region of the country. ANALYSIS Chi-square tests to examine associations between WAM use and respondent demographic characteristics. Logistic regressions to explore associations between WAM use and meeting aerobic PAG and walking adjusted for demographics (e.g., education, income). RESULTS Among older adults, 8.0% were current WAM users and 11.3% were past WAM users. Current WAM use was most prevalent among those aged 65-74 (16.6%), females (9.4%), college graduates (13.8%), and those with incomes $75,000-$99,999 (14.8%). Current WAM users were more likely than never WAM users to report meeting aerobic PAG (OR: 3.98; 95% CI: 2.07, 7.66) and walking (OR: 3.90; 95% CI: 1.57, 9.69). Past and never WAM use were not associated with meeting aerobic PAG or walking. CONCLUSION We found current WAM use is associated with meeting the aerobic PAG and walking among older adults. Further longitudinal research is needed to understand whether WAM could promote increased PA among older adults.
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Affiliation(s)
- Deena Zytnick
- Department of Public Health and Community Medicine, 1810Tufts University School of Medicine, Boston, MA, USA
| | - Gayathri S Kumar
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sara C Folta
- Friedman School of Nutrition Science and Policy, 1810Tufts University, Boston, MA, USA
| | - Kieran F Reid
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at 1810Tufts University, Boston, MA, USA
| | - David Tybor
- Department of Public Health and Community Medicine, 1810Tufts University School of Medicine, Boston, MA, USA
| | - Virginia R Chomitz
- Department of Public Health and Community Medicine, 1810Tufts University School of Medicine, Boston, MA, USA
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Shonkoff E, Folta SC, Fitopoulos T, Ramirez CN, Bluthenthal R, Pentz MA, Chou CP, Dunton GF. A positive deviance-based qualitative study of stress, coping, and feeding practices among low-income, Hispanic mothers whose children do versus do not meet guidelines for fruit and vegetable intake. Health Educ Res 2020; 35:584-604. [PMID: 33367771 PMCID: PMC8463094 DOI: 10.1093/her/cyaa037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 09/04/2020] [Indexed: 06/12/2023]
Abstract
Less than 1% of children in the United States concurrently meet guidelines for fruit/vegetable intake, physical activity, screen time, and sugar-sweetened beverages. Prior evidence suggests that parents of this 1% potentially cope with stress differently. This qualitative study used a positive deviance-based approach to locate mothers whose children avoided negative feeding outcomes despite being 'high-risk' for obesity. Semi-structured interviews were conducted in Spanish for two groups: low-income, Hispanic mothers whose children were normal weight and met recommendations for fruits/vegetables and physical activity (n = 5); and a comparison group whose children had obesity and did not meet guidelines (n = 8). Topics included weight-related parenting practices, attitudes toward health, and stress management. Interviews were transcribed, translated, and coded using NVivo for theoretically driven thematic analysis. Results suggested that mothers viewed stress differently. Mothers of healthy weight children believed stress could be prevented, such as by paying children more attention or directing one's attention away from stressors; comparison group mothers tended to report stress about managing their child's eating and about financial worries. Future research is needed to understand the underlying sources of these differences (e.g. personality traits, coping practices) and test whether stress prevention interventions can promote healthy parental feeding practices.
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Affiliation(s)
- Eleanor Shonkoff
- School of Health Sciences, Merrimack College, North Andover, MA 01845, USA
| | - Sara C Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
| | - Theodore Fitopoulos
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
| | - Cynthia N Ramirez
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90032, USA
| | - Ricky Bluthenthal
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90032, USA
| | - Mary Ann Pentz
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90032, USA
| | - Chih-Ping Chou
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90032, USA
| | - Genevieve F Dunton
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90032, USA
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Folta SC, Curtin C, Must A, Pehrson A, Ryan K, Bandini L. Impact of Selective Eating on Social Domains Among Transition-Age Youth with Autism Spectrum Disorder: A Qualitative Study. J Autism Dev Disord 2020; 50:2902-2912. [PMID: 32034651 DOI: 10.1007/s10803-020-04397-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Food selectivity is a common feeding problem among autistic children. The objective of this qualitative study was to explore the impact of selective eating on key social domains-with family, peers, and in other social situations-of transition-age autistic youth who self-identified as being food selective. Interviews were conducted with 20 autistic youth ages 18-23 years. Data were analyzed using descriptive and thematic coding. Participants had developed a range of strategies to cope with their food selectivity, and although some expressed concerns, they did not feel that it had a major impact on social situations. A responsive approach to supporting such youth would likely involve recognizing the effort and skills that the youth have already developed around this issue.
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Affiliation(s)
- Sara C Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, 02111, USA.
| | - Carol Curtin
- E.K. Shriver Center and the Departments of Family Medicine & Community Health and Psychiatry, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Aviva Must
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Ave, Boston, MA, 02111, USA
| | - Annie Pehrson
- Department of Health Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, Boston, MA, 02215, USA
| | - Kate Ryan
- Eunice Kennedy Shriver Center, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
| | - Linda Bandini
- Department of Pediatrics, Eunice Kennedy Shriver Center, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
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Liu CK, Afezolli D, Seo J, Syeda H, Zheng S, Folta SC. Perceptions of Physical Activity in African American Older Adults on Hemodialysis: Themes From Key Informant Interviews. Arch Rehabil Res Clin Transl 2020; 2:100056. [PMID: 33543083 PMCID: PMC7853361 DOI: 10.1016/j.arrct.2020.100056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To determine key themes underlying the perceptions of older (≥65y) adults on hemodialysis regarding physical activity using qualitative methodology. DESIGN Semistructured key informant interviews. SETTING Academic medical center. PARTICIPANTS Convenience sample of older adults on hemodialysis (N=10). INTERVENTIONS None. MAIN OUTCOME MEASURES Interview transcripts were coded and analyzed using the framework method to extract themes and subthemes. Participants also answered Likert statements regarding their perceptions of physical activity, and the responses were tallied. RESULTS Ten older adults on hemodialysis participated (mean age 73±5y; 60% women); all were African American. All participants stated physical activity would make them feel better. The major themes that emerged were barriers and facilitators. Facilitators included internal motivators, family and friend support, and feasibility of incorporating physical activity into routine activities. Barriers were lack of motivation, health issues, and environmental restrictions. CONCLUSIONS Physical activity potentially could prevent the physical decline commonly seen in older adults on hemodialysis. Yet information regarding the perceptions of this population toward physical activity is sparse. Although the study is limited by selection bias, our study presents qualitative evidence that black older adults on hemodialysis desire physical activity for their health. Future interventions to increase physical activity in this population should consider leveraging existing facilitators, such as the support of family and friends, and use strategies to address barriers like minimal motivation.
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Affiliation(s)
- Christine Kee Liu
- Section of Geriatrics, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Debora Afezolli
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Janet Seo
- Section of Geriatrics, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Haniya Syeda
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Shenglin Zheng
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Sara C. Folta
- Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
- Jonathan M. Tisch College of Citizenship and Public Service, Tufts University, Boston, Massachusetts
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Abstract
Objectives: In this scoping review, we examine the current state of literature on weight-related Multiple Health Behavior Change (MHBC). Specifically, we investigate: (1) MHBC versus single health behavior change (SHBC) interventions and (2) simultaneous versus sequential MHBC approaches. Secondarily, we explore (3) attributes that predict success in MHBC, and (4) the utilization of theoretical frameworks. Methods: We retrieved studies from PubMed, Web of Science, and Google Scholar within the 2000 to 2018 range. Results: MHBC interventions proved superior for long-term weight loss when compared to SHBC approaches. However, the literature is limited. Studies investigating simultaneous and sequential MHBC approaches are also limited and have mixed results. Predictive characteristics of MHBC include behavior adherence, risk level, stage of change, self-efficacy, social support, environmental barriers, and treatment approaches. Whereas evidence evaluating theory in MHBC programs remains scant, there is promising research on constructs from the Transtheoretical Model and Social Cognitive Theory. Conclusions: MHBC approaches may better support weight loss efforts. However, further research is needed to understand the effects of behavior change order and timing, predictive features of participants and interventions, and theoretical framework utilization in these weight-loss programs.
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Affiliation(s)
| | - Eleanor T. Shonkoff
- Assistant Clinical Professor, School of Health Science, Merrimack College, North Andover, MA
| | - Sara C. Folta
- Associate Professor, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
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Alsukait R, Wilde P, Bleich SN, Singh G, Folta SC. Evaluating Saudi Arabia's 50% carbonated drink excise tax: Changes in prices and volume sales. Econ Hum Biol 2020; 38:100868. [PMID: 32302767 DOI: 10.1016/j.ehb.2020.100868] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 03/01/2020] [Accepted: 03/03/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Reem Alsukait
- Friedman School of Nutrition Science and Policy, Tufts University, Address: 75 Kneeland Street, Boston, MA, 02111, United States; Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
| | - Parke Wilde
- Friedman School of Nutrition Science and Policy, Tufts University, Address: 75 Kneeland Street, Boston, MA, 02111, United States.
| | - Sara N Bleich
- Harvard Chan School of Public Health, Harvard University, Address: 677 Huntington Avenue, Boston, MA, 02115, United States.
| | - Gitanjali Singh
- Friedman School of Nutrition Science and Policy, Tufts University, Address: 75 Kneeland Street, Boston, MA, 02111, United States.
| | - Sara C Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Address: 75 Kneeland Street, Boston, MA, 02111, United States.
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Lo BK, Graham ML, Eldridge G, Donoso MR, Folta SC, Strogatz D, Nelson ME, Paul LC, Parry SA, Seguin-Fowler RA. Ripple Effects of a Community-Based Randomized Trial for Rural Women: Strong Hearts, Healthy Communities. Obesity (Silver Spring) 2020; 28:1561. [PMID: 32935534 PMCID: PMC10617540 DOI: 10.1002/oby.22959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Allen JD, Shelton RC, Kephart L, Jandorf L, Folta SC, Knott CL. Organizational characteristics conducive to the implementation of health programs among Latino churches. Implement Sci Commun 2020; 1:62. [PMID: 32885217 PMCID: PMC7427941 DOI: 10.1186/s43058-020-00052-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/20/2019] [Accepted: 06/18/2020] [Indexed: 01/16/2023] Open
Abstract
Background Faith-based organizations (FBOs) can be effective partners in the implementation of health interventions to reach underserved audiences. However, little is known about the capacity they have or need to engage in these efforts. We examined inner-setting organizational characteristics hypothesized to be important for program implementation by the Consolidated Framework for Implementation Research (CFIR). Methods This cross-sectional study involved 34 churches with predominantly Latino congregations in Massachusetts. FBO leaders completed a survey assessing inner-setting CFIR organizational characteristics, including organizational readiness, implementation climate, organizational culture, and innovation “fit” with organizational mission. Results There was limited variability in CFIR organizational characteristics, with scores on a scale from 1 to 5 skewed toward higher values, ranging from 3.27 (SD 0.94) for implementation climate to 4.58 (SD 0.54). Twenty-one percent of the FBOs had offered health programs in the prior year. Conclusions FBOs had high scores on most of the organizational factors hypothesized to be important for the implementation of health programs, although relatively few FBOs offered them. While this suggests that FBOs have favorable characteristics for health programming, prospective studies are needed to understand relative salience of inner-setting organizational characteristics versus factors external to the organization (e.g., policies, incentives), as well as the potential direction of relationships between internal organizational characteristics and health program offerings. Trial registration Clinical trials identifier number NCT01740219 (clinicaltrials.gov)
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Affiliation(s)
- Jennifer D Allen
- Department of Community Health, Tufts University, 574 Boston Avenue, Medford, MA 02155 USA
| | - Rachel C Shelton
- Department of Socio-medical Sciences, Columbia University Mailman School of Public Health, New York, NY 10032 USA
| | - Lindsay Kephart
- Massachusetts Department of Public Health, 250 Washington Street, Boston, MA 02108 USA
| | - Lina Jandorf
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029 USA
| | - Sara C Folta
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA 02111 USA
| | - Cheryl L Knott
- Department of Behavioral and Community Health, University of Maryland School of Public Health, 1234 W SPH Building, College Park, MD 20742 USA
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Lo BK, Graham ML, Eldridge G, Donoso MR, Folta SC, Strogatz D, Nelson ME, Paul LC, Parry SA, Seguin-Fowler RA. Ripple Effects of a Community-Based Randomized Trial for Rural Women: Strong Hearts, Healthy Communities. Obesity (Silver Spring) 2020; 28:1224-1234. [PMID: 32441870 PMCID: PMC7311263 DOI: 10.1002/oby.22817] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 02/28/2020] [Accepted: 03/17/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study aimed to examine (1) whether the Strong Hearts, Healthy Communities intervention (SHHC) improved social network members' (SNMs') weight, exercise, and diet and (2) whether SNMs' weight and behavioral changes were modified by their relationship closeness and/or spatial closeness with trial participants. METHODS Eight towns received the SHHC intervention, which focused on building individual healthy behaviors and creating supportive social and built environments for exercise and healthy eating. Eight towns received an education-only control intervention. SNMs (n = 487) were recruited to complete a questionnaire at baseline and at 6 months that asked about demographics, weight, height, exercise, and eating habits. RESULTS SHHC's effect on SNMs differed depending on their relationship closeness with trial participants. Among SNMs who had a very close relationship with trial participants, those associated with the intervention group lost more weight and decreased BMI more than those associated with the control group (weight [kilograms] between-group difference: Δ = -1.68; 95% CI: -3.10 to -0.25; P = 0.021; BMI between-group difference: Δ = -0.60; 95% CI: -1.16 to -0.04; P = 0.034). Spatial closeness did not modify any of SHHC's ripple effects. CONCLUSIONS Relationship closeness, rather than spatial closeness, played an important role in influencing a rural community-based intervention's ripple effects.
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Affiliation(s)
- Brian K Lo
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Meredith L Graham
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Galen Eldridge
- Texas A&M AgriLife Research, Texas A&M University, College Station, Texas, USA
| | - Maria R Donoso
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Sara C Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - David Strogatz
- Bassett Research Institute, Bassett Healthcare Network, Cooperstown, New York, USA
| | - Miriam E Nelson
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Lynn C Paul
- College of Education, Health and Human Development, Montana State University, Bozeman, Montana, USA
| | - Stephen A Parry
- Cornell Statistical Consulting Unit, Cornell University, Ithaca, New York, USA
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Seguin-Fowler RA, Strogatz D, Graham ML, Eldridge GD, Marshall GA, Folta SC, Pullyblank K, Nelson ME, Paul L. The Strong Hearts, Healthy Communities Program 2.0: An RCT Examining Effects on Simple 7. Am J Prev Med 2020; 59:32-40. [PMID: 32389532 PMCID: PMC7311302 DOI: 10.1016/j.amepre.2020.01.027] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 01/26/2020] [Accepted: 01/27/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Rural women have higher rates of cardiovascular disease than their nonrural counterparts, partially because of their social and environmental contexts. The study objective is to test a refined version of the multilevel Strong Hearts, Healthy Communities intervention, which used extensive process and outcome evaluation data from the original randomized trial to optimize effectiveness as measured by improved Simple 7 score, a composite measure of cardiovascular disease risk. STUDY DESIGN The intervention was implemented in a 6-month, delayed intervention, community-randomized trial; control participants received the program following 24-week outcome assessment. The study was conducted in 2017-2018; data analysis occurred in 2018-2019. SETTING/PARTICIPANTS The study was conducted in 11 rural, medically underserved towns in New York. Participants were women aged ≥40 years who were either (1) obese or (2) overweight and sedentary. INTERVENTION The intervention group received 24 weeks of hour-long, twice-weekly classes including strength training, aerobic exercise, and skill-based nutrition- and health-related education, as well as civic engagement activities focused on healthy food and physical activity environments. MAIN OUTCOME MEASURES Measures included weight and height; blood pressure; blood cholesterol; blood glucose; and self-reported smoking, diet, and physical activity behaviors. Individual Simple 7 components were examined, and mixed linear regression analyses were used to examine change in Simple 7 score. RESULTS A total of 182 participants were randomized. Compared with control participants, the intervention group had greater improvements in Simple 7 score (difference=1.03, 95% CI=0.44, 1.61, p<0.001) and 3 of the Simple 7 components (physical activity, healthy diet score, and BMI). CONCLUSIONS These findings highlight the importance of rigorously evaluating programs in real-world community settings and, when appropriate, revising and retesting interventions to optimize dissemination potential. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT03059472.
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Affiliation(s)
- Rebecca A Seguin-Fowler
- Texas A&M AgriLife Research, Texas A&M University System, College Station, Texas; Department of Nutrition, Texas A&M University, College Station, Texas.
| | - David Strogatz
- Center for Rural Community Health, Bassett Research Institute, Cooperstown, New York
| | - Meredith L Graham
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Galen D Eldridge
- Texas A&M AgriLife Research, Texas A&M University System, College Station, Texas
| | - Grace A Marshall
- Master of Public Health Program, Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, New York
| | - Sara C Folta
- Friedman School of Nutrition, Tufts University, Boston, Massachusetts
| | - Kristin Pullyblank
- Center for Rural Community Health, Bassett Research Institute, Cooperstown, New York
| | - Miriam E Nelson
- Friedman School of Nutrition, Tufts University, Boston, Massachusetts
| | - Lynn Paul
- Montana State University Extension, Bozeman, Montana
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Folta SC, Anzman-Frasca S, Tsai M, Johnson SK, Rossi M, Cash SB. Snack It Up for Parents: Brief Videos and Tip Sheets for Promoting Vegetable Snacks to School-Aged Children. J Nutr Educ Behav 2020; 52:565-567. [PMID: 31917130 DOI: 10.1016/j.jneb.2019.12.003] [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] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/27/2019] [Accepted: 12/05/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Sara C Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA.
| | - Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY
| | | | | | | | - Sean B Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
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Keaver L, Yiannakou I, Folta SC, Zhang FF. Perceptions of Oncology Providers and Cancer Survivors on the Role of Nutrition in Cancer Care and Their Views on the "NutriCare" Program. Nutrients 2020; 12:nu12051277. [PMID: 32365871 PMCID: PMC7282021 DOI: 10.3390/nu12051277] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 03/25/2020] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 12/17/2022] Open
Abstract
Cancer patients and survivors can experience treatment related side effects that impact nutrition status, as well as unwanted weight loss, weight gain and poor dietary quality. Therefore, they are a group that would benefit from nutrition intervention. A qualitative study was conducted online (six focus groups and two interviews) with 12 oncology providers and 12 survivors in the United States. Participants were asked about the role of nutrition in survivors' health, appropriate components of nutrition care for cancer patients, and strategies to integrate nutrition into oncology care. Feedback on a proposed program, "NutriCare", was also sought. Focus groups were recorded, transcribed verbatim, and analyzed for themes. Four main themes emerged: (1) nutrition is an important component of oncology care and source of empowerment for cancer patients; (2) in the NutriCare program, the prescription pad component was viewed as a critical aspect, and there was also a preference for dealing with patients and survivors separately; (3) for implementation, the most appropriate time for providers to talk to patients about nutrition is during the development of the treatment plan. Reinforcement of key nutrition messages by providers was also highlighted; (4) major barriers included lack of time and motivation by providers. Survivors were interested in and providers supportive of integrating nutrition into oncology care.
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Affiliation(s)
- Laura Keaver
- Department of Health and Nutritional Science, Institute of Technology Sligo, Sligo, F91 YW50, Ireland
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA; (S.C.F.); (F.F.Z.)
- Correspondence: ; Tel.: +353-71-930-5537
| | - Ioanna Yiannakou
- Department of Medicine, Boston University, Boston, MA 02215, USA;
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA; (S.C.F.); (F.F.Z.)
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA; (S.C.F.); (F.F.Z.)
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Lehnerd ME, Goldberg JP, Folta SC, Cash SB, Griffin TS, Lucas R, Sacheck JM. Qualitative Exploration of Farm to School Program Adoption and Expansion in Massachusetts Schools. Journal of Hunger & Environmental Nutrition 2020. [DOI: 10.1080/19320248.2019.1610539] [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: 10/26/2022]
Affiliation(s)
- Megan E. Lehnerd
- Department of Food and Nutrition, Framingham State University, Framingham, MA, USA
| | - Jeanne P. Goldberg
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Timothy S. Griffin
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Rebecca Lucas
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Jennifer M. Sacheck
- Exercise and Nutrition Sciences Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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Miki AJ, Livingston KA, Karlsen MC, Folta SC, McKeown NM. Using Evidence Mapping to Examine Motivations for Following Plant-Based Diets. Curr Dev Nutr 2020; 4:nzaa013. [PMID: 32110769 PMCID: PMC7042611 DOI: 10.1093/cdn/nzaa013] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 08/27/2019] [Revised: 12/06/2019] [Accepted: 01/30/2020] [Indexed: 12/17/2022] Open
Abstract
Motivations to adopt plant-based diets are of great public health interest. We used evidence mapping to identify methods that capture motivations to follow plant-based diets and summarize demographic trends in dietary motivations. We identified 56 publications that described 90 samples of plant-based diet followers and their dietary motivations. We categorized the samples by type of plant-based diet: vegan (19%), vegetarian (33%), semivegetarian (24%), and other, unspecified plant-based diet followers (23%). Of 90 studies examined, 31% administered multiple-choice questions to capture motivations, followed by rate items (23%), Food Choice Questionnaire (17%), free response (9%), and rank choices (10%). Commonly reported motivations were health, sensory/taste/disgust, animal welfare, environmental concern, and weight loss. The methodological variation highlights the importance of using a structured questionnaire to investigate dietary motivations in epidemiological studies. Motivations among plant-based diet followers appear distinct, but evidence on the association between age and motivations appears limited.
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Affiliation(s)
- Akari J Miki
- Nutritional Epidemiology, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Kara A Livingston
- Nutritional Epidemiology, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | | | - Sara C Folta
- Friedman School of Nutrition Science and Policy at Tufts University, Boston, MA, USA
| | - Nicola M McKeown
- Nutritional Epidemiology, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
- Friedman School of Nutrition Science and Policy at Tufts University, Boston, MA, USA
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Folta SC, Paul L, Nelson ME, Strogatz D, Graham M, Eldridge GD, Higgins M, Wing D, Seguin-Fowler RA. Changes in diet and physical activity resulting from the Strong Hearts, Healthy Communities randomized cardiovascular disease risk reduction multilevel intervention trial. Int J Behav Nutr Phys Act 2019; 16:91. [PMID: 31653260 PMCID: PMC6815048 DOI: 10.1186/s12966-019-0852-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 09/30/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Women living in rural areas face unique challenges in achieving a heart-healthy lifestyle that are related to multiple levels of the social-ecological framework. The purpose of this study was to evaluate changes in diet and physical activity, which are secondary outcomes of a community-based, multilevel cardiovascular disease risk reduction intervention designed for women in rural communities. METHODS Strong Hearts, Healthy Communities was a six-month, community-randomized trial conducted in 16 rural towns in Montana and New York, USA. Sedentary women aged 40 and older with overweight and obesity were recruited. Intervention participants (eight towns) attended twice weekly exercise and nutrition classes for 24 weeks (48 total). Individual-level components included aerobic exercise, progressive strength training, and healthy eating practices; a civic engagement component was designed to address social and built environment factors to support healthy lifestyles. The control group (eight towns) attended didactic healthy lifestyle classes monthly (six total). Dietary and physical activity data were collected at baseline and post-intervention. Dietary data were collected using automated self-administered 24-h dietary recalls, and physical activity data were collected by accelerometry and self-report. Data were analyzed using multilevel linear regression models with town as a random effect. RESULTS At baseline, both groups fell short of meeting many recommendations for cardiovascular health. Compared to the control group, the intervention group realized significant improvements in intake of fruit and vegetables combined (difference: 0.6 cup equivalents per day, 95% CI 0.1 to 1.1, p = .026) and in vegetables alone (difference: 0.3 cup equivalents per day, 95% CI 0.1 to 0.6, p = .016). For physical activity, there were no statistically significant between-group differences based on accelerometry. By self-report, the intervention group experienced a greater increase in walking MET minutes per week (difference: 113.5 MET-minutes per week, 95% CI 12.8 to 214.2, p = .027). CONCLUSIONS Between-group differences in dietary and physical activity behaviors measured in this study were minimal. Future studies should consider how to bolster behavioral outcomes in rural settings and may also continue to explore the value of components designed to enact social and environmental change. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02499731. Registered 16 July 2015.
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Affiliation(s)
- Sara C. Folta
- Friedman School of Nutrition, Tufts University, Boston, MA 02111 USA
| | - Lynn Paul
- College of Education, Health and Human Development, Montana State University, Bozeman, MT 59717 USA
| | - Miriam E. Nelson
- Friedman School of Nutrition, Tufts University, Boston, MA 02111 USA
| | - David Strogatz
- Center for Rural Community Health, Bassett Research Institute, Cooperstown, NY 13326 USA
| | - Meredith Graham
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853 USA
| | | | - Michael Higgins
- Exercise and Physical Activity Resource Center, University of California, La Jolla, San Diego, CA 92093-0811 USA
| | - David Wing
- Exercise and Physical Activity Resource Center, University of California, La Jolla, San Diego, CA 92093-0811 USA
| | - Rebecca A. Seguin-Fowler
- Department of Nutrition and Food Science College of Agriculture and Life Sciences, Texas A&M University, College Station, Texas, TX 77843 USA
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Brown AGM, Houser RF, Mattei J, Rehm CD, Mozaffarian D, Lichtenstein AH, Folta SC. Diet quality among US-born and foreign-born non-Hispanic blacks: NHANES 2003-2012 data. Am J Clin Nutr 2019; 107:695-706. [PMID: 29722843 DOI: 10.1093/ajcn/nqy021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/24/2018] [Indexed: 02/07/2023] Open
Abstract
Background Non-Hispanic blacks in the United States are less likely to not meet national dietary recommendations than non-Hispanic whites; however, most studies do not consider nativity of US blacks. Objective With the use of the Alternative Healthy Eating Index-2010 (AHEI-2010) and the Dietary Approach to Stop Hypertension (DASH) scores, this cross-sectional study compared diet quality between US-born (n = 3,911) and foreign-born (n = 408) non-Hispanic black adults aged 22-79 y, based on pooled nationally representative data (NHANES 2003-2012) as well as by length of US residency. Design The association between nativity and diet quality was determined by using multivariable-adjusted linear regression for the continuous total diet quality scores and their components or multinomial (polytomous) logistic regression for categorical tertiles (low, medium, or high) of the total scores and their components. Results Foreign-born blacks had significantly higher AHEI-2010 (β: 9.3; 95% CI: 7.5, 11.0) and DASH (β: 3.1; 95% CI: 2.5, 3.8) scores compared with US-born blacks and more favorable intakes for many of the score components. Among foreign-born blacks, diet quality did not significantly differ by length of residency. Foreign-born blacks were more likely to be in the high than in the low tertile for vegetables [excluding starchy vegetables; relative risk ratio (RRR): 1.68; 95% CI: 1.24, 2.29], fruit [excluding and including fruit juice-RRR: 2.42 (95% CI: 1.69, 3.47) and RRR: 2.95 (95% CI: 1.90, 4.59), respectively], percentage of whole grains (RRR: 2.39; 95% CI: 1.64, 3.49), and omega-3 (ω-3) fatty acids (RRR: 2.03; 95% CI: 1.38, 2.97). Conclusions Foreign-born blacks have better diet quality than their US-born counterparts. In nutrition research and public health efforts, considering the place of birth among US blacks may improve the accuracy of characterizing dietary intakes and facilitate the development of targeted nutrition interventions to reduce diet-related diseases in the diverse black population in the United States.
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Affiliation(s)
- Alison G M Brown
- Tufts University, Friedman School of Nutrition Science and Policy, Boston, MA
| | - Robert F Houser
- Tufts University, Friedman School of Nutrition Science and Policy, Boston, MA
| | | | - Colin D Rehm
- Albert Einstein College of Medicine, New York, NY
| | - Dariush Mozaffarian
- Tufts University, Friedman School of Nutrition Science and Policy, Boston, MA
| | | | - Sara C Folta
- Tufts University, Friedman School of Nutrition Science and Policy, Boston, MA
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Seguin RA, Graham ML, Eldridge G, Nelson ME, Strogatz D, Folta SC, Paul L. Strong Hearts for New York: A multilevel community-based randomized cardiovascular disease risk reduction intervention for rural women. Contemp Clin Trials 2019; 82:17-24. [PMID: 31129372 PMCID: PMC6606389 DOI: 10.1016/j.cct.2019.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/06/2019] [Accepted: 05/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rural midlife and older women have high rates of cardiovascular disease (CVD) risk factors and lower access to healthy living resources. The Strong Hearts, Healthy Communities (SHHC) intervention, tailored to the needs of rural women, demonstrated effectiveness on many outcomes. The purpose of the Strong Hearts for New York (SHNY) study is to evaluate the efficacy of an enhanced version of the curriculum (SHHC-2.0). METHODS SHNY is a randomized controlled efficacy intervention, comparing participants receiving the SHHC-2.0 curriculum with a delayed intervention control group. SHHC, informed by formative research, includes core elements from three evidence-based programs. Changes based on extensive outcome and process evaluation data were made to create SHHC-2.0. Classes will meet twice weekly for 24 weeks and include individual, social, and environmental components. Overweight women age 40 and over will be recruited from 11 rural, medically underserved communities in New York; data will be collected at baseline and 12, 24, 36, and 48 weeks across individual, social, and environmental levels. Primary outcome is body weight. Secondary outcomes include Simple 7 (composite CVD risk score), anthropometric, physiologic, biochemical, physical activity, and dietary intake measures; healthy eating and exercise self-efficacy and attitudes; and self-efficacy of the social network of participants. DISCUSSION The aims of this study are to evaluate the efficacy of the enhanced SHHC-2.0 program for participants, changes among participants' social networks, and the difference in outcomes when participants are and are not provided with technological tools (Fitbit and body composition scale).
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Affiliation(s)
- Rebecca A Seguin
- Cornell University, Division of Nutritional Sciences, 412 Savage Hall, Ithaca, NY 14853, USA.
| | - Meredith L Graham
- Cornell University, Division of Nutritional Sciences, 413 Savage Hall, Ithaca, NY 14853, USA.
| | - Galen Eldridge
- Cornell University, Division of Nutritional Sciences, 413 Savage Hall, Ithaca, NY 14853, USA.
| | - Miriam E Nelson
- Hampshire College, 893 West St, Amherst, MA 01002, USA; Tufts University, Friedman School of Nutrition, 150 Harrison Ave, Boston, MA 02111, USA.
| | - David Strogatz
- Bassett Research Institute, One Atwell Rd, Cooperstown, NY 13326, USA.
| | - Sara C Folta
- Tufts University, Friedman School of Nutrition, 150 Harrison Ave, Boston, MA 02111, USA.
| | - Lynn Paul
- Montana State University Extension, 322 Reid Hall, Bozeman, MT 59717, USA
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Wang H, Kenkel D, Graham ML, Paul LC, Folta SC, Nelson ME, Strogatz D, Seguin RA. Cost-effectiveness of a community-based cardiovascular disease prevention intervention in medically underserved rural areas. BMC Health Serv Res 2019; 19:315. [PMID: 31096977 PMCID: PMC6524317 DOI: 10.1186/s12913-019-4117-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/20/2018] [Accepted: 04/22/2019] [Indexed: 12/25/2022] Open
Abstract
Background Rural women experience health disparities in terms of cardiovascular disease (CVD) risk compared to urban women. Cost-effective CVD-prevention programs are needed for this population. The objective of this study was to conduct cost analysis and cost-effectiveness analyses (CEAs) of the Strong Hearts, Healthy Communities (SHHC) program compared to a control program in terms of change in CVD risk factors, including body weight and quality-adjusted life years (QALYs). Methods Sixteen medically underserved rural towns in Montana and New York were randomly assigned to SHHC, a six-month twice-weekly experiential learning lifestyle program focused predominantly on diet and physical activity behaviors (n = 101), or a monthly healthy lifestyle education-only control program (n = 93). Females who were sedentary, overweight or obese, and aged 40 years or older were enrolled. The cost analysis calculated the total and per participant resource costs as well as participants’ costs for the SHHC and control programs. In the intermediate health outcomes CEAs, the incremental costs were compared to the incremental changes in the outcomes. The QALY CEA compares the incremental costs and effectiveness of a national SHHC intervention for a hypothetical cohort of 2.2 million women compared to the status quo alternative. Results The resource cost of SHHC was $775 per participant. The incremental cost-effectiveness ratios from the payer’s perspective was $360 per kg of weight loss. Over a 10-year time horizon, to avert per QALY lost SHHC is estimated to cost $238,271 from the societal perspective, but only $62,646 from the healthcare sector perspective. Probabilistic sensitivity analyses show considerable uncertainty in the estimated incremental cost-effectiveness ratios. Conclusions A national SHHC intervention is likely to be cost-effective at willingness-to-pay thresholds based on guidelines for federal regulatory impact analysis, but may not be at commonly used lower threshold values. However, it is possible that program costs in rural areas are higher than previously studied programs in more urban areas, due to a lack of staff and physical activity resources as well as availability for partnerships with existing organizations. Trial registration ClinicalTrials.gov identifier NCT02499731, registered on July 16, 2015.
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Affiliation(s)
- Hua Wang
- Cornell University, 292 Martha Van Rensselaer Hall, Ithaca, NY, 14853, USA.
| | - Donald Kenkel
- Cornell University, 2310 Martha Van Rensselaer Hall, Ithaca, NY, 14853, USA
| | | | - Lynn C Paul
- Montana State University, 322 Reid Hall, Bozeman, MT, 59717, USA
| | - Sara C Folta
- Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA
| | | | - David Strogatz
- Bassett Research Institute, One Atwell Rd, Cooperstown, NY, 13326, USA
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