Betty T. Izumi

ASSOCIATIONS BETWEEN NEIGHBORHOOD AVAILABILITY AND INDIVIDUAL CONSUMPTION OF DARK-GREEN AND ORANGE VEGETABLES AMONG ETHNICALLY DIVERSE ADULTS IN DETROIT

Diets rich in dark-green and orange vegetables have been associated with a reduction in chronic diseases. However, most Americans do not consume the number of daily servings recommended by the 2005 Dietary Guidelines for Americans. An increasing number of studies suggest that changes to the neighborhood food environment may be critical to achieving population-wide improvements in eating. The objective of this study was to examine the relationship between observed neighborhood availability and individual consumption of dark-green and orange vegetables among low- to moderate-income and ethnically diverse adults in Detroit. This study used a cross-sectional design that drew upon a 2002-2003 community survey and 2002 in-person audit of food stores. A total of 919 adults (mean age 46.3 years, 52.2% female) including African Americans (56.7 %), Latinos (22.2%), and whites (18.7%) residing in three Detroit communities participated in the survey. Two-level weighted, hierarchical linear regression was used to analyze the data. On average, survey respondents ate 0.61 daily servings of dark-green and orange vegetables. Residents of neighborhoods with no stores carrying five or more varieties of dark-green and orange vegetables were associated with an average of 0.17 fewer daily servings of these foods compared with residents of neighborhoods with two stores carrying five or more varieties of dark-green and orange vegetables (P=0.047). These findings suggest that living in a neighborhood with multiple opportunities to purchase dark-green and orange vegetables may make an important contribution toward meeting recommended intakes.

The one-pager: a practical policy advocacy tool for translating community-based participatory research into action.

The multiple and diverse perspectives, skills, and experiences inherent in community–academic partnerships make them uniquely positioned to educate policy makers and advocate for health equity. Effective communication tools are critical to successfully engage in the policy-making process. Yet few resources emphasize the development and use of practical tools for translating community-based participatory research (CBPR) findings into action. The purpose of this article is to describe a CBPR process for developing and using a one-page summary, or “one-pager,” of research findings and their policy implications. This article draws on the experience of the Healthy Environments Partnership (HEP), a community–academic partnership in Detroit, Michigan. In addition to describing these processes, this article includes a template for a one-pager and an example of a one-pager that was written for and presented to federal policy makers.

Neighborhood food environment role in modifying psychosocial stress–diet relationships ☆

Exposure to highly palatable foods may increase eating in response to stress, but this behavioral response has not been examined in relation to the neighborhood food environment. This study examined whether the neighborhood food environment modified relationships between psychosocial stress and dietary behaviors. Probability-sample survey (n=460) and in-person food environment audit data were used. Dietary behaviors were measured using 17 snack food items and a single eating-out-of-home item. Chronic stress was derived from five subscales; major life events was a count of nine items. The neighborhood food environment was measured as availability of large grocery stores, small grocery stores, and convenience stores, as well as proportion of restaurants that were fast food. Two-level hierarchical regression models were estimated. Snack food intake was positively associated with convenience store availability and negatively associated with large grocery store availability. The measures of chronic stress and major life events were generally not associated with either dietary behavior overall, although Latinos were less likely to eat out at high levels of major life events than African Americans. Stress-neighborhood food environment interactions were not statistically significant. Important questions remain regarding the role of the neighborhood food environment in the stress-diet relationship that warrant further investigation.

Sustainable School Food Procurement in Large K–12 Districts: Prospects for Value Chain Partnerships

Many scholars and activists are interested in the potential for school-based childhood nutrition programs to positively impact the U.S. agri-food system. This paper explores efforts of a national K-12 school food collaborative to procure more sustainably grown and healthful food products. After a review of literature on transaction cost theory and school food procurement, the paper examines the potential of strategic partnerships in a value chain framework to meet procurement change goals. Results from a qualitative study of two participating school districts suggest that partnerships can offer potential solutions to recurring procurement barriers found in previous research.

Harvest for Healthy Kids Pilot Study: Associations between Exposure to a Farm-to-Preschool Intervention and Willingness to Try and Liking of Target Fruits and Vegetables among Low-Income Children in Head Start

BACKGROUND Most US children do not meet recommendations for daily fruit and vegetable intake. OBJECTIVE Our aim was to evaluate the hypothesis that at post-intervention, children exposed to the Harvest for Healthy Kids pilot study will have greater willingness to try and liking of target foods vs children in the comparison group, controlling for baseline differences. DESIGN We conducted a quasi-experimental pilot study with comparison, low-intervention, and high-intervention groups. Pre- and post-intervention survey data were collected. PARTICIPANTS/SETTING The intervention period was October 2012 to May 2013. The analysis sample was 226 children within the higher-level unit sample of five participating Head Start centers (Portland, OR); 231 children dropped out of or enrolled in Head Start mid-year, were absent during or refused to participate in the assessments, or were missing covariates. INTERVENTION The comparison group received no intervention components; the low-intervention group received foodservice modifications; the high-intervention group received foodservice modifications and nutrition education. MAIN OUTCOME MEASURES Willingness to try and liking of target foods were tested and analyzed as binary variables. STATISTICAL ANALYSES PERFORMED McNemars tests were used to assess differences between pre- and post-intervention scores by intervention group. Fixed slope, random intercept multilevel logistic models were used to assess associations between intervention group and post-intervention scores controlling for covariates, adjusting for baseline values, and accounting for center level clustering. RESULTS The difference between pre- and post-intervention willingness to try and liking of target foods was statistically significant for a variety of foods; for example, 44.2% of children liked rutabaga pre-intervention compared with 78.1% post-intervention (P=0.004). Multilevel modeling indicated similar associations. CONCLUSIONS The Harvest for Healthy Kids pilot study suggests a positive association between the intervention and willingness to try and liking for target foods among study participants. Additional research is needed to assess the impact of the program on fruit and vegetable intake.

Inter-rater reliability of the food environment audit for diverse neighborhoods (FEAD-N).

Studies have shown that neighborhood food environments are important influences on dietary intake and may contribute to health disparities. While instruments with high reliability have been developed to assess food availability, price, and quality, few measures to assess items associated with the physical and social features of food stores have been developed. Yet, recent qualitative studies have documented aspects associated with such features of urban food stores that are barriers to food acquisition. We assessed the reliability of measures to assess multiple components of the food environment—including physical and social store features—in three geographically distinct and diverse communities in Detroit, Michigan, using the Food Environment Audit for Diverse Neighborhoods (FEAD-N). Using the FEAD-N, four trained observers conducted observations of 167 food stores over a 10-week period between October and December 2008. To assess inter-rater reliability, two trained observers independently visited, on the same day, a random subset of 44 food stores. Kappa statistics and percent agreement were used to evaluate inter-rater reliability. Overall, the instrument had mostly high inter-rater reliability with more than 75% of items with kappa scores between 0.80 and 1.00, indicating almost perfect reliability. More than half of the physical store features and 47% of the social store features had almost perfect reliability and about 37% and 47%, respectively, had substantial reliability. Measuring factors associated with the physical and social environment of food stores with mostly high reliability is feasible. Systematic documentation of the physical and social features of food stores using objective measures may promote a more comprehensive understanding of how neighborhood food environments influence health.

A community-based participatory research approach to developing the Harvest for Healthy Kids curriculum.

Background: A diet rich in fruits and vegetables is associated with reduced risk of diet-related chronic diseases. However, fewer than half of children in the United States consume the recommended amount. Objectives: This article describes the community-based participatory research (CBPR) process used to develop the Harvest for Healthy Kids curriculum. Methods: Harvest for Healthy Kids is a intervention research project designed to increase access to and intake of fruits and vegetables among preschoolers enrolled in Head Start. The curriculum is composed of eight kits, each focusing on a different fruit or vegetable. Results: The Harvest for Healthy Kids curriculum was developed through an iterative process in which Head Start teachers were highly involved. The final product reflects the teachers’ experiences using the curriculum and their suggestions for improving. Conclusions: The CBPR process used to develop the Harvest for Healthy Kids curriculum led to a product that is grounded in theory and practice.

Badge It! Using Digital Badges to Certify Information Literacy Skills within Disciplinary Curriculum

Purpose – The purpose of this article is to discuss the collaborative learning outcomes-based approach taken by a librarian and disciplinary faculty members to improve information literacy (IL) curriculum within disciplinary courses. To this end, the team aimed to award badges to certify IL skills. Design/methodology/approach – This article considers relevant literature on competency-based curriculum, technological innovation in higher education, collaboration between library and disciplinary faculty and badges. This literature is used to frame the approach to plan a successful and sustainable project to embed IL in disciplinary curriculum using digital badges. The approach includes mapping learning outcomes and engaging in instructional design tasks – including planning for content delivery and student assessment. Findings – An approach to technological innovation for instructional projects based on the principles of pedagogical design can result in improvements to IL pedagogy and collaboration between librarians and disciplinary faculty, whether or not a technological implementation is successful. Practical implications – Librarians and disciplinary faculty can take a pedagogical and learning outcomes-based approach to embedding IL into disciplinary curricula. Further, despite administrative push for technological innovation, projects can succeed when focused on improvements to pedagogy rather than solely on the implementation of new technologies. Originality/value – Planning for and implementing badges for IL curriculum is in an incipient phase in higher education. This paper uniquely addresses a collaborative approach to be used by librarians to plan and implement embedded library instruction in disciplinary courses, with or without the use of badging technology.

Effects of Particulate Matter and Antioxidant Dietary Intake on Blood Pressure

OBJECTIVES We assessed 2 pathways through which dietary antioxidants may counter adverse effects of exposure to particulate matter less than 2.5 micrometers in diameter (PM2.5) on blood pressure (BP): main (compensatory) and modifying (protective) models. METHODS We used 2002 to 2003 data from the Detroit Healthy Environments Partnership community survey conducted with a multiethnic sample of adults (n = 347) in low- to moderate-income, predominantly Hispanic and non-Hispanic Black neighborhoods in Detroit, Michigan. We used generalized estimating equations to test the effects of ambient exposure to PM2.5 and dietary antioxidant intake on BP, with adjustment for multiple confounders. RESULTS Dietary antioxidant intake was inversely associated with systolic BP (b = -0.5; P < .05) and pulse pressure (b  = -0.6; P < .05) in neighborhoods closest to major sources of air pollutants. Adverse effects of PM2.5 remained significant after accounting for antioxidant intakes. Exploratory analyses suggested potential modifying effects of antioxidant intake on associations between ambient PM2.5 exposure and BP. CONCLUSIONS Interventions to improve access to antioxidant-rich foods in polluted urban areas may be protective of cardiovascular health. However, efforts to reduce PM2.5 exposure remain critical for cardiovascular health promotion.

Leader Behaviors, Group Cohesion, and Participation in a Walking Group Program

INTRODUCTION Less than half of all U.S. adults meet the 2008 Physical Activity Guidelines. Leader behaviors and group cohesion have been associated with increased participation or adherence in sports team and exercise class settings. Physical activity interventions in community settings that encompass these factors may enhance intervention adherence. The purpose of this study is to examine the impact of Community Health Promoter leader behaviors and group cohesion on participation in a walking group intervention among racially/ethnically diverse adults in low to moderate-income communities in Detroit, Michigan. DESIGN Data for the current study were drawn from the Walk Your Heart to Health (WYHH) data set. WYHH was a multisite cluster RCT with a lagged intervention and outcome measurements at baseline and 4, 8, and 32 weeks. Pooled survey data from both intervention arms were used for the current study. Data were analyzed between August 2013 and October 2014. SETTING/PARTICIPANTS A total of 603 non-Hispanic black, non-Hispanic white, and Hispanic adults across five cohorts that began the 32-week WYHH intervention between March 2009 and October 2011. INTERVENTION The intervention was a 32-week walking group program hosted by community- and faith-based organizations and facilitated by Community Health Promoters. Walking groups met three times per week for 90 minutes per session. To promote participation in or adherence to WYHH, Community Health Promoters used evidence-based strategies to facilitate group cohesion. Group members assumed increasing leadership responsibility for facilitating sessions over time. MAIN OUTCOME MEASURES Participation in WYHH as measured by consistency of attendance. RESULTS Community Health Promoter leader behaviors were positively associated with participation in WYHH. Social but not task cohesion was significantly associated with consistent participation. Social cohesion may mediate the relationship between leader behaviors and walking group participation. CONCLUSIONS Providing leaders with training to build socially cohesive groups may help motivate individuals to continue participation in community-based physical activity programs.