Chery Smith

Factors affecting low-income women's food choices and the perceived impact of dietary intake and socioeconomic status on their health and weight.

OBJECTIVE To investigate factors affecting food choice and health beliefs among low-income women in the context of their weight and socioeconomic status. DESIGN Two researchers conducted 14 90-minute focus groups, which were audiotaped. SETTING Libraries, homeless shelters, and a community center. PARTICIPANTS Ninety-two low-income women (18-65 years) with at least 1 child aged 9-13 years in the household. MAIN OUTCOME MEASURES Food choice and health beliefs of low-income women. ANALYSIS Transcripts were coded and reconciled; common themes and subthemes were identified. RESULTS Over 75% of participants were overweight/obese (body mass index [BMI] > or = 25), and most were in charge of purchasing and preparing food for their families. Health concerns included diabetes, hypertension, and overweight/obesity, and most felt their health status had genetic or metabolic origins. Although many would like to regularly consume healthful food (eg, fresh fruits and vegetables), such food was perceived as unaffordable. CONCLUSIONS AND IMPLICATIONS A disconnect between diet and health among low-income women calls for nutrition interventions that educate low-income families on inexpensive, healthful eating in a structured environment, and diet-disease relationships. Changes at a policy level should be considered to increase affordability and accessibility of healthful food in low-income neighborhoods and through federal food assistance programs.

Rural food deserts: low-income perspectives on food access in Minnesota and Iowa.

OBJECTIVE To investigate how low-income rural residents living in food deserts access the normal food system and food safety net services within their communities, and explore how social, personal, and environment drives food access and food choice. DESIGN Seven focus groups (90 minutes each) were conducted with 2 moderators present and were audiotaped. SETTING Food deserts in rural Minnesota and Iowa. PARTICIPANTS Fifty-seven residents (Minnesota: 13 females and 8 males; Iowa: 24 females and 12 males). Most participants were white and had not completed high school or higher education. PHENOMENON OF INTEREST Food choice and food access among rural residents. ANALYSIS Transcripts were evaluated for consistency and coded for themes and subthemes. RESULTS Three dominant themes influence food access and choice and were identified as: (a) personal and household determinants of food; (b) social and cultural environment; and (c) structure of place or the external environment. CONCLUSIONS AND IMPLICATIONS Personal, environmental, and dietary behavioral factors are all interconnected; each plays a major role in influencing dietary behavior and the resulting health outcomes in rural Minnesotans and Iowans living in food deserts. However, although personal factors impact eating behavior for rural people, it is the physical and social environments that place constraints on food access, even in civically engaged communities. Food access may be improved in communities where civic engagement is strong, and where local organizations join in providing solutions to decrease barriers of food access by increasing access to the normal and food safety net systems and by creating informal alternatives, such as community gardens and informal transportation networks, or enhancing federal programs through greater volunteer involvement.

Understanding gardening and dietary habits among youth garden program participants using the Theory of Planned Behavior

Sedentary lifestyles, along with diets low in fruits, vegetables, and complex carbohydrates, and high in fat and total energy are increasing among youth. These unhealthy behaviors contribute to an increase in childhood overweight, which is associated with type 2 diabetes, hypertension, and heart disease. Healthful dietary behaviors, such as eating a balanced and varied diet may be addressed in garden-based programs for youth. Therefore, this project assessed the influence of a garden program, with a newly developed nutrition curriculum, on youths eating and gardening behavior using the Theory of Planned Behavior. The model included the constructs of attitude, subjective norm, and perceived behavioral control (PBC). Youth (age 8-15 years) involved in a garden program in Minneapolis/St. Paul, Minnesota completed a pre- (n=96) and a post-survey (n=66) assessing the theorys constructs with regard to eating and gardening behaviors. Fruit and vegetable consumption were assessed using survey questions and a 24-h recall. In addition to finding gender differences regarding associations between intention and behavior and the constructs correlated with behavior, results indicated that attitude was most predictive of intention at both pre- and post-survey for both boys and girls with behavior associated to PBC in girls, but not for boys. A high level of intention for boys pre-survey marginally predicted some behavioral change post-survey, but girls with high levels of intention at pre-survey did not show positive behavioral changes at post-survey. Additionally, the garden program positively impacted youth fruit and vegetable consumption, as determined from a mean computed from the responses to the fruit and vegetable behavior survey questions and the 24-h recall food group data. Because youth in the garden program consumed more fruit and vegetables at post-survey compared to pre-survey, we conclude that garden programs may be a viable way to assist youth in making healthy lifestyle changes.

Acculturation and environmental change impacts dietary habits among adult Hmong.

Focus groups (n=65) were conducted with Hmong adults in St. Paul/Minneapolis, MN to determine how environmental factors, acculturation, and food insecurity influence dietary behavior, body mass index (BMI), and health. Acculturation was assessed by examining linguistic, social, and eating behavior, length of time in the US, and BMI for B-TL(1) (born in Thailand/Laos and in US < or =5 years), B-TL(2) (in Thailand/Laos through adolescence, had food memories, and in US >5 years), and B-US (born in US or in Thailand/Laos less than 8 years and no food memories from there). Acculturation was associated with years lived in the US, household size and income, and food assistance usage. Years lived in the US was correlated with food assistance usage, education, household size and income, and perception of diet. B-TL(1) and B-TL(2) were on average overweight (BMI> or =25<30), US men were obese (mean BMI=32.4+/-7.4), and women were overweight (mean BMI=29.1+/-6.8). Themes identified were cultural values impact eating and lifestyle behaviors, food insecurity history influences post-migration behavior, acculturation impacts BMI through diet and exercise, and health status is influenced by changed environments. Environmental changes and increased acculturation have negatively impacted the weight and health of Hmong adults.

Dietary intake, overweight status, and perceptions of food insecurity among homeless Minnesotan youth

Youth, 9–18 years (n = 202), living in homeless shelters in Minneapolis, Minnesota, were assessed for height, weight, dietary intake, and perceptions of food insecurity. Perceptions of food security were measured by asking youth to respond to the statements (1) “There are times when we do not have enough food in the house,” (2) “I go to bed hungry at night,” (3) “I do not get enough to eat at home,” and (4) “Have you ever had to miss a meal (or not been able to eat) because there was no food at home?” Additionally, questions evaluated coping mechanisms used by children to ward off hunger. Fifty‐five percent of the children reported not enough food in the house and 25% reported going to bed hungry. Youth had inadequate intakes of vitamin D, calcium, and potassium and the majority consumed less than the estimated average requirements (EAR) for vitamins A, C, and E, phosphorus, folate, and zinc. Fruits, vegetables, and dairy were also consumed below recommended levels. Forty‐five percent of boys and 50% of girls were at risk‐for‐overweight or were overweight. Overeating, eating anything, eating disliked foods, and eating at the homes of family and friends were identified as strategies to cope with food insecurity. Overeating when food is available may explain why we see a hunger‐obesity paradigm to the magnitude that we do among the poorest Americans. These strategies protect children from the immediate negative associations of poverty and hunger, but they may contribute to long‐term weight problems currently found in the US. Am. J. Hum. Biol., 2008.

Food choice, eating behavior, and food liking differs between lean/normal and overweight/obese, low-income women

The higher rate of obesity among low-income women has widely been attributed to environmental barriers; however, many low-income women are still able to maintain a healthy weight despite obesogenic environments. To better understand personal and behavioral attributes related to food choice and weight, overweight/obese women and lean/normal weight women living in similar low-income environments, participated in focus groups, and taste testing sessions to investigate food liking (n=83). During focus groups, lean/normal weight participants reported that health was influential in food choice, while overweight/obese participants expressed cost as being more of a factor. Both BMI (kg/m(2)) groups reported that taste was of greatest importance. Personal factors, like emotional eating, and overeating were also discussed with differences noted between BMI (kg/m(2)) groups. Quantitative data also showed cost to be more important for overweight/obese women. Taste testing results revealed that overweight/obese participants had a higher overall liking for both healthy and less healthy foods, as well as other food categories. Additionally, these women had a higher liking of fat in the context of spreadable fats. Our results show that a variety of complex factors interact to influence eating behavior and present weight status of women living in similarly impoverished environments. However, findings from this exploratory study should be confirmed through further research.

Assessing body image issues and body satisfaction/dissatisfaction among Hmong American children 9-18 years of age using mixed methodology

This study investigated body image issues and the usefulness of self-reported measurements among Hmong American children, 9-18 years using mixed methodology. Twelve focus groups were conducted (n=68) and a silhouette drawing instrument and six questions pertaining to body image were administered (n=335). About 50% of the children were either overweight or obese and 23% were short statured relative to US norms. About 70% of the girls and 53% of the boys selected smaller body ideals than their perceived body sizes. Further, 21% of the girls and 31% of the boys were satisfied with their bodies. Children underestimated their weights and overestimated their heights. During focus groups children reported that parents, peers, and media influenced their body image perceptions. Our results indicate that the majority of Hmong children are dissatisfied with their bodies and tend to endorse American ideals of beauty and attractiveness rather than the heavier, traditional Hmong body ideals supported by their parents.

Differences in stature, BMI, and dietary practices between US born and newly immigrated Hmong children

This study investigated how acculturation influences diet, cultural practices related to cooking and food preparation knowledge, and stature and body mass index (BMI) of Hmong children. Focus groups (n=12) were conducted during the spring of 2008 in St. Paul/Minneapolis, Minnesota with those born in the US and 9-13 years old (n=22), those born in the US and 14-18 years old (n=25), and those born in Thailand or Laos, who had lived in the US< or =5 years, and 14-18 years old (n=21). Respondents also completed a survey instrument to assess acculturation level which was evaluated by questions about social connections, language use, and dietary habits. Compared to those born in the US, those born in Thailand or Laos were significantly shorter and leaner. Those born in the US also showed elevated acculturation levels in language use, social connections, and gender-oriented tasks compared to those born in Thailand or Laos. Themes from focus group discussions were mealtime patterns, determinants of food health, future health concerns, and changing cultural traditions. Acculturation, years lived in the US, and birth place may play an important role in stature and BMI, food and physical activity habits, cooking and food preparation knowledge, and perceptions of health.

Military experience strongly influences post-service eating behavior and BMI status in American veterans.

In-depth interviews were conducted with veterans (n=64) with an average age of 57 years to investigate eating behavior and food insecurity during military service and examine if it affects post-war eating behavior, and if this contributes to the high incidence of obesity found in veterans. About half of the subjects served during the Vietnam War, while smaller numbers served in WWII, the Korean War, Desert Storm, or other conflicts. The mean BMI was 30.5+/-6.7 kg/m(2). Only 12.5% of participants were classified as normal weight, while 37.5% were overweight, 46.9% were obese, and 3.1% were classified as excessively obese. Five major themes were identified including, (a) military service impacts soldiers food environment, (b) food insecurity influences eating behavior and food choices, (c) military impacts weight status during and post-service, (d) military service has health consequences, and (e) post-service re-adjustment solutions are needed to ease re-entry into civilian life.

Food-related environmental, behavioral, and personal factors associated with body mass index among urban, low-income African-American, American Indian, and Caucasian women

Purpose. To examine racial/ethnic differences in relationships between food-related environmental, behavioral and personal factors and low-income womens weight status using Social Cognitive Theory (SCT) as a framework. Design. Cross-sectional survey. Setting. Community sites and low-income housing developments in the Twin Cities metropolitan area. Subjects. Low-income African-American, American Indian, and Caucasian women ≥ 18 years old (n = 367). Measures. Participants completed a survey including demographic, food security, and theoretically based questions. Heights and weights were measured to determine body mass index (BAI). Analysis. Data were split by race/ethnicity and reduced by examining Pearson coefficients for SCT survey questions significantly correlated with BMI (p < .05). Separate environmental, behavioral, and personal multiple linear regression models for each racial/ethnic group were run to explore the proportion of variance in BMI explained by each SCT construct and which questions were significant predictors. Results. All regression models were statistically significant, although the personal regression models predicted the greatest proportion of the variance in BMI for African-American (15% of the variance), American Indian (22% of the variance), and Caucasian women (37% of the variance). Conclusion. Effective nutrition education and intervention efforts to control the obesity epidemic among urban, low-income women may call for a tailored approach with noted consideration of their racial/ethnic identity. Although broader changes to the food environment are necessary, the importance of addressing personal factors such as nutrition knowledge, self-efficacy, and emotional coping responses to stress, in the context of income constraints, food insecurity, and health beliefs, is also implicated.