Courtney A. Pinard

Developing an agenda for research about policies to improve access to healthy foods in rural communities: a concept mapping study

BackgroundPolicies that improve access to healthy, affordable foods may improve population health and reduce health disparities. In the United States most food access policy research focuses on urban communities even though residents of rural communities face disproportionately higher risk for nutrition-related chronic diseases compared to residents of urban communities. The purpose of this study was to (1) identify the factors associated with access to healthy, affordable food in rural communities in the United States; and (2) prioritize a meaningful and feasible rural food policy research agenda.MethodsThis study was conducted by the Rural Food Access Workgroup (RFAWG), a workgroup facilitated by the Nutrition and Obesity Policy Research and Evaluation Network. A national sample of academic and non-academic researchers, public health and cooperative extension practitioners, and other experts who focus on rural food access and economic development was invited to complete a concept mapping process that included brainstorming the factors that are associated with rural food access, sorting and organizing the factors into similar domains, and rating the importance of policies and research to address these factors. As a last step, RFAWG members convened to interpret the data and establish research recommendations.ResultsSeventy-five participants in the brainstorming exercise represented the following sectors: non-extension research (n = 27), non-extension program administration (n = 18), “other” (n = 14), policy advocacy (n = 10), and cooperative extension service (n = 6). The brainstorming exercise generated 90 distinct statements about factors associated with rural food access in the United States; these were sorted into 5 clusters. Go Zones were established for the factors that were rated highly as both a priority policy target and a priority for research. The highest ranked policy and research priorities include strategies designed to build economic viability in rural communities, improve access to federal food and nutrition assistance programs, improve food retail systems, and increase the personal food production capacity of rural residents. Respondents also prioritized the development of valid and reliable research methodologies to measure variables associated with rural food access.ConclusionsThis collaborative, trans-disciplinary, participatory process, created a map to guide and prioritize research about polices to improve healthy, affordable food access in rural communities.

Smart Choices for Healthy Families: A Pilot Study for the Treatment of Childhood Obesity in Low-Income Families.

This pre–post study used a mixed-methods approach to examine the impact of a family-based weight management program among a low-income population. Smart Choices for Healthy Families was developed through an integrated research–practice partnership and piloted with 26 children and parents (50% boys; mean age = 10.5 years; 54% Black) who were referred by their pediatrician. Smart Choices included six biweekly group sessions and six automated telephone-counseling calls over 3 months. Children displayed reduced body mass index z-scores (p < .05), increased lean muscle mass (p < .001), and increased quality of life (p < .0001). Follow-up interviews indicated that physicians valued the lay leaders’ ability to provide lifestyle education, whereas lay leaders extended their reach to more community members. Parents wanted to become positive role models and found that the calls maintained focus on goals. Smart Choices shows promise to initiate weight management for children in low-income families.

The validity and reliability of the Comprehensive Home Environment Survey (CHES)

Few comprehensive measures exist to assess contributors to childhood obesity within the home, specifically among low-income populations. The current study describes the modification and psychometric testing of the Comprehensive Home Environment Survey (CHES), an inclusive measure of the home food, physical activity, and media environment related to childhood obesity. The items were tested for content relevance by an expert panel and piloted in the priority population. The CHES was administered to low-income parents of children 5 to 17 years (N = 150), including a subsample of parents a second time and additional caregivers to establish test–retest and interrater reliabilities. Children older than 9 years (n = 95), as well as parents (N = 150) completed concurrent assessments of diet and physical activity behaviors (predictive validity). Analyses and item trimming resulted in 18 subscales and a total score, which displayed adequate internal consistency (α = .74-.92) and high test–retest reliability (r ≥ .73, ps < .01) and interrater reliability (r ≥ .42, ps < .01). The CHES score and a validated screener for the home environment were correlated (r = .37, p < .01; concurrent validity). CHES subscales were significantly correlated with behavioral measures (r = −.20-.55, p < .05; predictive validity). The CHES shows promise as a valid/reliable assessment of the home environment related to childhood obesity, including healthy diet and physical activity.

Development and Implementation of the National Cancer Institute’s Food Attitudes and Behaviors Survey to Assess Correlates of Fruit and Vegetable Intake in Adults

Background Low fruit and vegetable (FV) intake is a leading risk factor for chronic disease globally as well as in the United States. Much of the population does not consume the recommended servings of FV daily. This paper describes the development of psychosocial measures of FV intake for inclusion in the U.S. National Cancer Institute’s 2007 Food Attitudes and Behaviors Survey. Methods This was a cross-sectional study among 3,397 adults from the United States. Scales included conventional constructs shown to be correlated with fruit and vegetable intake (FVI) in prior studies (e.g., self-efficacy, social support), and novel constructs that have been measured in few- to- no studies (e.g., views on vegetarianism, neophobia). FVI was assessed with an eight-item screener. Exploratory factor analysis, Cronbach’s alpha, and regression analyses were conducted. Results Psychosocial scales with Cronbach’s alpha ≥0.68 were self-efficacy, social support, perceived barriers and benefits of eating FVs, views on vegetarianism, autonomous and controlled motivation, and preference for FVs. Conventional scales that were associated (p<0.05) with FVI were self-efficacy, social support, and perceived barriers to eating FVs. Novel scales that were associated (p<0.05) with FVI were autonomous motivation, and preference for vegetables. Other single items that were associated (p<0.05) with FVI included knowledge of FV recommendations, FVI “while growing up”, and daily water consumption. Conclusion These findings may inform future behavioral interventions as well as further exploration of other potential factors to promote and support FVI.

Development and testing of a revised cooking matters for adults survey

OBJECTIVES The purpose of this study was to: (1) develop and psychometrically test a survey designed to assess Cooking Matters for Adults (CMA); and (2) assess changes in outcomes from pre- to post-pilot testing in English-speaking CMA classes to support the construct validity of the survey. METHODS Cognitive interviewing participants were drawn from a low-income convenience sample in Omaha, Nebraska (N = 21). The survey included items to assess dietary patterns and choices, sociodemographics, and psychosocial correlates. Analyses were conducted with SPSS and included descriptive statistics, exploratory factor analysis, Cronbachs alpha, and paired sample t-tests. RESULTS Cognitive interviewing resulted in changes to survey layout and wording. Factor analysis revealed 4 actors with Cronbach alphas supporting internal consistency. Between pretest and posttest, fruit intake increased (p < .05) and non-fried potatoes decreased (p < .05). Selection of healthy dietary options (low-fat dairy and milk, sodium, lean meats; ps < .05), healthy food preparation (p < .001), and cooking confidence (p < .001) increased and perceived barriers to cooking (p < .01) decreased. CONCLUSIONS The CMA Survey includes psychometrically sound items and positive self-reported changes. This survey can be a valuable resource for other similar programs.

Using Secondary 24-Hour Dietary Recall Data to Estimate Daily Dietary Factor Intake From the FLASHE Study Dietary Screener

INTRODUCTION The National Cancer Institutes 2014 Family Life, Activity, Sun, Health, and Eating Study utilized a 27-item Dietary Screener tailored to adolescent eating patterns that assessed the frequency of intake of several foods and beverages in parent-adolescent dyads. This study estimated intake of fruits and vegetables (FVs), dairy, added sugars, and whole grains for screener respondents using existing, nationally representative, 24-hour dietary recall data. METHODS Dietary Screener items were converted from frequency responses to daily intake. Intake (dependent variable) was estimated using regression coefficients and portion sizes of foods and beverages (independent variables) generated from the 2003-2006 National Health and Nutrition Examination Survey 2-day 24-hour recall data set. Means (SDs) were used to examine daily dietary factor intake among parent and adolescents. Analysis was conducted in 2015-2016. The analytic sample consisted of 1,732 parents (aged ≥18 years) and their adolescent aged 12-17 years (n=1,632). RESULTS Male parents consumed 3.6 cups of FVs, 1.8 cups of dairy, 22.6 teaspoons of added sugars, and 2.1 ounces of whole grains daily; female parents consumed 2.8 cups of FVs, 1.3 cups of dairy, 14.8 teaspoons of added sugars, and 1.4 ounces of whole grains daily. Male adolescents consumed 2.2 cups of FVs, 1.9 cups of dairy, 17.9 teaspoons of added sugars, and 1.0 ounces of whole grains daily; female adolescents consumed 2.2 cups FVs, 1.6 cups of dairy, 14.2 teaspoons of added sugars, and 0.8 ounces of whole grains daily. CONCLUSIONS Utilizing a dietary screener tailored to adolescent eating patterns in parent-adolescent dyads provided estimated dietary factor intake, underscoring existing 24-hour dietary recall data can be used to calibrate dietary habits.

Auxiliary measures to assess factors related to food insecurity: Preliminary testing and baseline characteristics of newly designed hunger-coping scales.

The objective of this paper is to describe the development and preliminary testing of new scales to assess hunger-coping behaviors in a very low-income population. Very low-income adults (≥ 19 years), caregivers to at least one child (n = 306) completed a survey in a community setting (e.g., libraries). The survey included novel items assessing hunger-coping behaviors (e.g., trade-offs to purchase food, strategies to stretch and obtain food), food insecurity status, and physiological hunger. Internal consistency of hunger-coping scales, one-way ANOVAs, post-hoc analyses, Spearmans correlations among variables. Respondents were 75% female, 51% African American, 34% White, and 15% Hispanic, and 73% earned <

An Examination of Organizational and Statewide Needs to Increase Supplemental Nutrition Assistance Program (SNAP) Participation

20,000/year. Four scales emerged: hunger-coping trade-offs, financial coping strategies, rationing coping strategies, and physiological adult hunger symptoms. All scales demonstrated acceptable internal consistency (α/KR-20 = 0.70–0.90). Predictive, construct, and content validity were demonstrated by correlations between hunger-coping scales and food insecurity (FI), measured with the USDA 6-item HFSSM (rs = 0.42–0.68, ps < 0.001). Higher levels of hunger-coping trade-offs (F(2,297) = 42.54, p < 0.001), financial coping strategies (F(2,287) = 70.77, p < 0.001), and rationing coping strategies (F(2,284) = 69.19, p < 0.001), corresponded with increasing levels of FI. These preliminary results support use of newly developed hunger-coping scales in a very low-income population and can compliment traditional food security measures to inform hunger prevention policy and programming.

The food and water system: Impacts on obesity

This study examined Supplemental Nutrition Assistance Program (SNAP) outreach efforts among representatives of community organizations, as well as local and statewide needs for increasing SNAP participation. We conducted qualitative interviews with 34 SNAP outreach workers across 27 states; participants reported working at food banks, social services agencies, antihunger nonprofits, legal aid agencies, faith-based nonprofits, and health clinics. Four major needs emerged as themes for community-level organizations: increased personnel, increased funding, improved application process, and increased community awareness. For broader, statewide needs, 3 themes emerged: increased staffing of state caseworkers, decreased stigma and negative perceptions, and improved application processing capacity and infrastructure. The findings of this qualitative study suggest that community organizations and state SNAP-administering offices should work together more closely to share best practices, improve SNAP application-related technology, and develop tailored outreach plans.

Factors Associated With Supplemental Nutrition Assistance Program Participation Among the Working Poor: Findings From 2012 American Community Survey

The Weight of the Nation™ (WON) conference was held in Washington, D.C. This article presents the issues and topics presented and discussed within the Food and Water System: Agriculture, Access and Sustainability track. Areas for opportunity are outlined in this article.