Jamie Dollahite

Shopping for fruits and vegetables. Food and retail qualities of importance to low-income households at the grocery store

Purchasing fruits and vegetables is an integral part of managing food consumption and dietary quality. This study examined how low-income adults who had primary responsibility for household food purchases considered retail produce decisions. We used a qualitative research approach based on grounded theory and an ecological conceptual framework. Twenty-eight low-income rural, village, and inner city heads of households in upstate New York, USA, were selected by purposive and theoretical sampling and interviewed about fruit and vegetable shopping habits, attitudes toward local food stores, and where and how they would prefer to buy produce. Analyses revealed their concerns were organized around five themes: store venue; internal store environment; product quality; product price; relationships with the stores. An unanticipated finding was the differing social relations that appear to exist between participant consumers, store employees and management, and the store itself as a representation of the larger retail food system. Attitudes toward retail food stores in this study are described as passive or fatalistic indifference, supportive, opportunistic, and confrontational (change agents). These attitudes are related to how shoppers considered retail fruit and vegetable choice, access, and availability. These findings suggest ways to individualize nutrition education and consumer education messages.

Readability of printed sources of diet and health information

This study surveyed nutrition education materials which are low in cost, brief and the type most used in patient education to determine which might be useful with low literacy clients. Readability of 209 pamphlets from professional health organizations, commercial organizations, government agencies, and educational institutions was assessed using three different tests. Using the Flesch and Raygor tests, materials from educational institutions had significantly lower reading levels than materials from professional organizations and government agencies. No significant differences were seen among the sources using the Fry test. Sixty-eight percent (142) of the publications were written at ninth grade level or higher. Eleven percent (24) scored at sixth grade or below on either the Fry or Raygor scale. Only two publications were written at the third grade level. Many of the publications reviewed can be read and understood by many Americans, but there were few for the millions that have limited literacy skills.

Online Course Increases Nutrition Professionals' Knowledge, Skills, and Self-Efficacy in Using an Ecological Approach to Prevent Childhood Obesity.

OBJECTIVE To assess the impact of an online continuing education course on the knowledge, skills, and self-efficacy of nutrition professionals to use an ecological approach to prevent childhood obesity. DESIGN Quasi-experimental design using intervention and delayed intervention comparison groups with pre/post-course assessments. SETTING Online continuing education course. PARTICIPANTS Nutrition and health professionals in an online course (n = 105) and a delayed intervention comparison group (n = 37). INTERVENTION A 6-week, facilitated online course titled, Preventing Childhood Obesity: An Ecological Approach. MAIN OUTCOME MEASURES Changes in knowledge, skills, and self-efficacy in using an ecological approach to address childhood obesity. ANALYSIS Paired and independent sample t tests, factor analysis, regression analysis. RESULTS In contrast to a comparison group, nutrition and health professionals who participated in a 6-week online course had statistically significant increases (P < .01) in their knowledge, skills, and self-efficacy related to using an ecological approach to prevent childhood obesity. CONCLUSIONS AND IMPLICATIONS A facilitated online course can be effective at increasing the knowledge, skills, and self-efficacy of community-based nutrition and health professionals in using an ecological approach to prevent childhood obesity in their communities.

The Impact of Nutrition Education on Food Insecurity among Low-Income Participants in EFNEP.

The impact of nutrition education on food security status was assessed in a multiethnic, low-income population using a pretest-posttest comparison group design. Data were collected over 3 years from participants (N = 16,146) in the Expanded Food and Nutrition Education Program (EFNEP) in New York State who either graduated or terminated involvement prior to graduation. Both groups had a significant decrease in food insecurity score (p < .05) from pre-to post education. The difference between the graduated and terminated groups approached statistical significance using a t-test comparison (p = .055). A multiple regression analysis indicated that food insecurity score decreased significantly more in graduates (p < .001). A dose response relationship was seen between the number of lessons received and decreases in food insecurity. Programs that educate low-income families in food selection and resource management skills can decrease the risk of food insecurity, although effects vary by socio demographic characteristics of participants and program delivery methods.

Problems Encountered in Meeting the Recommended Dietary Allowances for Menus Designed According to the Dietary Guidelines for Americans

Forty-three menus that were to be used in a diet manual were designed to meet the requirements of a specific diet; provide 2,200 to 2,400 kcal, unless energy-restricted; meet the 1990 Dietary Guidelines for Americans; meet current recommendations for sodium (2g to 3 g/day), cholesterol (< or = 300 mg/day), and fiber (20g to 30 g/day); and meet or exceed the highest level for adults in the 1989 Recommended Dietary Allowances (RDAs). In addition, regular and low-fat, low-cholesterol menus for 1 week were collected from 11 hospitals throughout Arkansas. Menus were analyzed for energy, cholesterol, and 18 nutrients. Only 11% of the menus met the RDA for zinc. Half of the menus did not meet the RDA for vitamin B-6 and one third did not meet the RDA for iron. Zinc content of the menus was positively correlated (P < .001) with protein (r = .73) and with beef (r = .45). Vitamin B-6 was positively correlated with protein (r = .44, P < .001) and with all meat (r = .38, P < .01). Regular and low-fat, low-cholesterol hospital menus had the same nutrient inadequacies because they did not differ in total servings from any food group. These data indicate that the public may have difficulty choosing a diet that meets both the Dietary Guidelines and the RDAs.

Impact of a School-based Community Intervention Program on Nutrition Knowledge and Food Choices in Elementary School Children in the Rural Arkansas Delta

Abstract The purpose of this study was to provide nutrition education to school children (grades K–5; n = 548) and their parents in a low-income rural community via the school; the Supplemental Nutrition Program for Women, Infants, and Children; the Food Stamp program; and the Expanded Food and Nutrition Education Program. A community consortium was developed to guide project interventions including a school-based nutrition curriculum, revised lunch menus with nutrition messages in the cafeteria, parent attendance at lunch, development and dissemination of nutrition messages to parents, and community activities. Outcome results were compared in a pre-/postintervention design with results from students (n = 232) and parents in a neighboring community. Significant improvements in knowledge, behavioral intent, and behavior were seen in fourth and fifth graders at the intervention school. In second and third graders, significant knowledge gain was seen by one measure, but no other significant changes were noted. No significant changes were seen in knowledge or diet-related beliefs in parents. A slight but significant improvement was seen in parents’ food choice behavior. No effect of multiple messages was seen for children or parents, possibly due to lack of optimal coordination and exposure time.

Attitudes and Behaviors of Low-Income Food Heads of Households Toward Sustainable Food Systems Concepts

ABSTRACT To what extent do attitudes of low-income food heads of households correspond to beliefs held by mainstream local food movement members regarding food systems? For this qualitative study, 28 households (≤185% US poverty) in rural, village, and inner-city areas were purposively selected and interviewed about acquiring fruits and vegetables. Data analysis revealed 5 themes showing relationships between: household health and food production methods; economic development; food quality and point of origin; local food systems and civic-mindedness; self-respect, self-reliance, and informal food systems; and geographic and economic justice. Physical, economic, and knowledge barriers remain obstacles to greater support of local food systems.

Developing a Measure of Behavior Change in a Program to Help Low-Income Parents Prevent Unhealthful Weight Gain in Children

OBJECTIVE To develop and test a brief measure of changes in eating, active play, and parenting practices after an intervention to help parents shape childrens choices and home environments. DESIGN Sequential phases of development and testing: expert panel review, cognitive testing interviews, field testing, test-retest study, and assessment of convergence with detailed previously validated instruments. SETTING AND PARTICIPANTS Expanded Food and Nutrition Education Program (EFNEP), New York State. Low-income parents of 3- to 11-year-old children; Cooperative Extension nutrition and parenting educators. MAIN OUTCOME MEASURES Questionnaire reliability, validity, respondent comprehension, and feasibility of use in program contexts. ANALYSIS Qualitative analysis of item comprehension. Correlational analysis of test-retest reliability and convergent validity. RESULTS A behavior checklist was developed to assess change in parent-reported family eating, physical activity, and parenting practices addressed by an intervention. The checklist was feasible for use in EFNEP and questions were understood as intended. Test-retest reliability was good (r = 0.83) and scores correlated significantly (range, 0.25 to -0.60; P < .05) with detailed measures of dietary habits, parental modeling, physical activity, and home environment. CONCLUSIONS AND IMPLICATIONS Development and testing in a program context produced a tool community nutritionists can use to evaluate educational interventions aimed at helping parents promote healthful eating and activity.

Outcome effectiveness of the widely adopted EFNEP curriculum Eating Smart-Being Active.

OBJECTIVE To determine the effectiveness of the Expanded Food and Nutrition Education Program (EFNEP) curriculum Eating Smart-Being Active (ESBA). DESIGN AND SETTING A quantitative, multi-state, nonequivalent comparison group pretest-posttest design was used to compare nutrition-related behavior changes in participants. ESBA was compared to previously used curricula for 3 different time periods in 5 states using the EFNEP evaluation tool. PARTICIPANTS Adults enrolled in EFNEP who completed their entry and exit paperwork during any of the 3 time points. INTERVENTION An 8-lesson adult curriculum based on the Dietary Guidelines for Americans and MyPlate. ANALYSIS Analysis of variance and covariance (with pretests scores and demographic variables as covariates) were used to analyze data with significance at P ≤ .05. RESULTS ESBA elicited a mean positive behavior change for food resource management (P < .01), food safety (P ≤ .001), nutrition (P < .001), and physical activity level in participating states (P ≤ .01). Compared with previous curricula, ESBA produced better mean outcomes in food resource management, nutrition, physical activity, and intakes of fruit and vegetables. CONCLUSION AND IMPLICATIONS ESBA is effective at eliciting positive nutrition-related behavior change. The results of this multi-state, practice-based approach suggest that ESBA is effective in multiple settings and has external validity for use in EFNEP and other community nutrition programs.

Assessment of dietitians' nutrition counselling self-efficacy and its positive relationship with reported skill usage.

BACKGROUND Previous studies on nutrition counselling self-efficacy have assessed small groups of dietitians in focused practice areas or evaluated the effectiveness of skills training on only a few skills. This descriptive study developed a comprehensive scale to examine self-efficacy in a large, cross-sectional sample of practising dietitians when performing various counselling skills that promote dietary behaviour changes. METHODS A valid and reliable instrument was developed and administered through the Internet to survey dietitians in the USA from various areas of dietetics and with varying years of experience. Items included counselling self-efficacy, skill usage and counselling-related job characteristics. Of the 612 respondents, one group (n = 486) conducted counselling for more than 50% of their work week, and the other group (n = 126) for less than 50%. Factor analysis was used for scale development. Independent samples t-tests and chi-square tests were performed for group comparisons. Correlations and multiple regression analyses further assessed the relationships among variables. RESULTS The resultant unidimensional scale contained 25 items. Dietitians reported high self-efficacy scores and frequent skill usage. Those who counsel for more than 50% of their work week were more likely to work in outpatient settings and private practice, reported higher self-efficacy scores, and held longer and repeated sessions. Self-efficacy scores were positively correlated with counselling-related job characteristics. Years of counselling experience and skill usage significantly predicted self-efficacy scores. CONCLUSIONS Dietitians perceive themselves to be highly self-efficacious in using counselling skills which may contribute positively to their professional practice. However, the relationship between counselling self-efficacy and actual performance warrants further investigation.