Deborah John

Food insecurity and physical activity insecurity among rural Oregon families

Among rural families, rates of both child obesity and household food insecurity (FI) are higher compared to non-rural families. These disparities result from a complex interplay of social and environmental conditions that influence behavior. The Transtheoretical Model suggests individual readiness to change underlies success in modifying obesity-preventing behaviors; however, whether an association between readiness to change obesity-related behaviors and FI status among rural families exists is unknown. We examined the association between readiness to change family-level nutrition and physical activity (PA) behaviors that predict child obesity and family FI status within a sample of rural families to better understand these relationships. Families (n = 144) were recruited from six rural Oregon communities in 2013. Families completed a FI screener and the Family Stage of Change Survey (FSOC), a measure of readiness to change family-level nutrition and PA behaviors associated with obesity. Demographic differences by FI status were explored, and regression was applied to examine relationships between FI and FSOC scores, adjusting for relevant covariates. Among FI families (40.2%), more were non-white (77.8% vs. 22.2%; p = 0.036) and had lower adult education (30.4% vs. 11.8% with > high school degree; p = 0.015) compared to non-FI families. After adjusting for education, race, ethnicity, and eligibility for federal meal programs, readiness to provide opportunities for PA was lower among FI families (p = 0.002). These data highlight a need to further investigate how food insecurity and low readiness to provide PA opportunities, i.e. “physical activity insecurity” may be contributing to the higher obesity rates observed among rural children and families.

The Family-Home Nutrition Environment and Dietary Intake in Rural Children.

Obesity and food insecurity rates are higher among rural compared to non-rural populations. Little is known, however, about how family-home environments influence childhood obesity-related behaviors, particularly in rural settings. This study examined associations between the family-home nutrition (FN) environment, food insecurity, and dietary intake (fruits, vegetables, whole grains, dairy, protein foods, and added sugars) in rural elementary school-age children (grades K-5/6; n = 102). Parents/caregivers completed surveys on FN, food insecurity, and the Block Kids Food Screener (BKFS). Body mass index (BMI, kg/m2) was calculated from measured height and weight. Approximately 33% of children were classified as overweight/obese and 28% of families were at-risk for food insecurity. Multivariable linear regression analyses examined associations between dietary intakes with FN and food insecurity. More favorable FN scores were associated with lower added sugar intake (B = −1.38, p = 0.04) and higher vegetable (B = 0.15, p < 0.001), fruit (B = 0.71, p = 0.01), and dairy (B = 0.31, p < 0.001) intakes. No significant associations were found between food insecurity and dietary intake. Given the association between higher FN scores and more favorable dietary intake, promoting healthy FN environments among rural children is warranted.

Physical activity levels and obesity status of Oregon Rural Elementary School children

Objective To evaluate the relationship between physical activity (PA, min/school-day) at school and body mass index (BMI, kg/m2) among rural elementary-aged children. Methods Height (cm), weight (kg), and PA were measured for 1767 children (5–12 years) enrolled in six rural Oregon elementary schools in fall, 2013. PA at school was measured over four days using Walk4Life pedometers. Children with ≥ 3 valid monitoring days (n = 1482) were included in analyses. Means (min/d) were calculated for wear time, total PA (TPA: combined light, moderate, vigorous PA), and moderate to vigorous PA (MVPA: step count > 120/min). BMI z-scores were calculated and regression models were run to examine the relationship between PA and BMI z-scores, adjusting for wear time, sex, and grade. Results Overweight (38.1%: BMI ≥ 85th percentile for age and sex) and obesity (19.4%: BMI ≥ 95th percentile) prevalence was similar for boys (n = 782) and girls (n = 700). More MVPA was associated with lower BMI (P < 0.001), independent of sex, wear time or grade. Mean MVPA was 18.9 +/− 8 min/d, versus 15.2 +/− 6.7 min/d for healthy-weight and obese children, respectively. Conclusions Children are not meeting minimum MVPA recommendations (60 min/d) during school hours. Efforts to promote PA for obesity prevention in rural elementary schools should focus on increasing opportunities for MVPA.

engAGE in Community: Using Mixed Methods to Mobilize Older People to Elucidate the Age-Friendly Attributes of Urban and Rural Places.

The growing numbers of older adults in the United States will have a significant impact on community resources, which will affect the ability of residents to live and thrive in their local community regardless of age. For this study, we applied explanatory sequential mixed methods and community-based participatory research (CBPR) to discover how attributes of the physical, social, and service environments determine residents’ perceptions of community age-friendliness and conditions for aging-in-place. A population survey measuring county residents’ (n = 387) perceptions and importance of community resources that support community livability are explained by thematic results of the CBPR, that is, emergent proximal and distal age-friendly factors. Our qualitative approach engaged local people (n = 237) in participatory processes to study and share perceptions of environmental attributes in six communities in one Oregon county. Findings are integrated to explain similarities and differences in older residents’ lived experience of rural and urban settings with regard to age-friendly foci.

Healthy Eating, Physical Activity, and Learning Behaviors

Approximately 17% of US youth aged 2-19 years are obese, a state defined as a body mass index (BMI) at or above the 95th percentile on the BMI-for-age growth charts.1 Obese children are at increased risk for chronic physical, social, and psychological health problems,2-4 and are more likely to become obese adults.3 In addition to health consequences, childhood obesity has been associated with school performance.5 Although the causal path remains unclear, several studies provide support for an inverse relationship between overweight status and academic achievement.6-8 Other studies indicate that weight-related health behaviors, including physical activity and healthy eating habits, are positively associated with learning.9-17 Together, these findings suggest that the establishment of healthy eating and activity practices at a young age may enhance child development related to both health and education. According to one published review,18 the interrelationships among health behaviors, including nutrition and physical activity, and academic achievement may have longterm implications for youth, adults, and society. An ecological perspective of human development considers the reciprocal determinants of human behavior.19 Examination of the relationships among personal, organizational, and environmental levels is consistent with multiple theories of health behavior and learning.20-22 For example, school and home environments are considered key behavioral settings that influence risk for childhood obesity.23,24 Whereas emphasis has been placed on creating school environments that support student health and learning,25,26 our review of the literature found no previous studies that have examined the relationship between the home nutrition and physical activity environment and school performance. Multiple studies27-33 suggest that home contextual

The Family Home Environment, Food Insecurity, and Body Mass Index in Rural Children.

Background. Family homes are a key setting for developing lifelong eating and physical activity habits, yet little is known about how family home nutrition and physical activity (FNPA) environments influence food insecurity (FI) and childhood obesity, particularly in rural settings. Aims. This study examined associations among FNPA, FI, and body mass index (BMI) in rural children. Method. Parents of 186 elementary school–age children completed FNPA and FI surveys. Child anthropometrics were directly measured. Logistic and linear regressions were used to examine associations. Results. Approximately 37% of children were overweight/obese; 43% of families were at risk for FI. Children whose families limited watching TV while eating were less likely to be obese (odds ratio [OR] = 0.56, p = .03) as were children whose families monitored intake of chips, cookies, and candy (OR = 0.54, p = .01). FI was higher in obese than normal weight children (OR = 11.00, p = .003) but only among families not eligible to receive free/reduced-cost school meals. Among eligible families, lower odds of FI were found for those who ate meals together often (OR = 0.31, p = .04) and for those with children frequently enrolled in organized sports/activities (OR = 0.65, p = .04). Findings were not significant after adjusting for multiple comparisons. Discussion. Results suggest that favorable FNPA factors were associated with healthier BMI and lower odds of FI. Conclusion. Opportunities for healthy eating at home may support rural children’s weight health. Additional resources may be necessary to promote food security among low-income families. Future research is warranted to better understand FNPA in relationship to the disproportionate rates of obesity and FI in rural populations.

Community-Engaged Attribute Mapping: Exploring Resources and Readiness to Change the Rural Context for Obesity Prevention

Abstract:Background: Individual risk factors for obesity are well-known, but environmental characteristics that influence individual risk, especially in rural communities, are not confirmed. Rural communities face unique challenges to implementing environmental strategies, such as walkability, aimed at supporting weight healthy lifestyles. Cooperative Extension, a community-embedded weight health partner, convened and engaged community members in self-exploration of local resources and readiness to change environmental characteristics perceived to promote unhealthy eating and inactivity. This approach leveraged Extensions mission, which includes connecting rural communities with land-grant university resources.Objectives: HEAL MAPPS™ (Healthy Eating Active Living Mapping Attributes using Participatory Photographic Surveys) was developed as a participatory action research methodology. Adopted by Extension community partners, HEAL MAPPS™ involved residents in photomapping, characterizing, and communicating lived experiences of their rural community, and prioritizing interventions to change the obesogenic context.Methods: Extension educators serving rural communities in six Western U.S. states were trained to implement HEAL MAPPS™. Extension engaged community members who mapped and evaluated their encounters with environmental attributes that shape their dietary and activity patterns. The method partnered residents with decision makers in identifying issues, assessing resources and readiness, and prioritizing locally relevant environmental strategies to reduce access disparities for rural populations with high obesity risk.Conclusions: HEAL MAPPS™ revealed differences in resource availability, accessibility, and affordability within and among rural communities, as well as in readiness to address the obesogenic context. Extension functioned successfully as the backbone organization, and local community health partner, cooperatively implementing HEAL MAPPS™ and engaging constituents in shaping weight healthy environments.