Lauren Haldeman

Barriers to truck drivers’ healthy eating: Environmental influences and health promotion strategies.

This article presents an assessment of 25 trucking work settings designed to examine whether the environmental attributes of these settings influence eating patterns of truckers who are at risk for excess weight gain. Findings corroborate evidence that these work settings represent healthy food deserts. From restaurants and vending machines to the social/information environments and their surrounding communities, only meager opportunities exist for healthful eating practices. This article aims to place underserved truckers and warehousing-sector employees firmly within the discourse of workplace health promotion and calls for multistakeholder wellness strategies that encompass the intertwined risk factors linked with the transportation work environment.

What Changes When We Move? A Transnational Exploration of Dietary Acculturation

This study aimed to explore Mexican dietary acculturation patterns among immigrants using a unique transnational photographic assessment. Participants (N = 10) were Latino mother and child pairs living in Mexico (1 pair) and in the United States (4 pairs). Data were collected in 2 phases: 1) participant observation and photography in Mexico, and 2) in-depth interviewing using photographic guides in North Carolina. Environment, daily activity patterns, shopping, and dietary patterns in Mexico were all documented. Acculturation resulted in poor dietary intake due to decreased availability, food displacement, and cost. Decreases in physical activity due to environmental and social barriers were also reported.

Cultural Adaptation Resources for Nutrition and Health in New Immigrants in Central North Carolina

This paper presents results of a study that was conducted for the purposes of describing available human services resources relating to nutrition, physical health, and behavioral health for new and recent immigrants (predominantly Mexican immigrants, but groups from Southeast Asia and continental Africa as well) in Guilford County, NC. Sixty-five service providers were determined to represent cultural adaptation resources providing either direct and/or ancillary assistance to limited English proficient immigrants. Seventeen direct assistance providers specialized in food and nutrition programs, but only 2 had targeted programs for addressing food scarcity, insecurity, and nutritional deficiencies in immigrant households. Four of 15 direct physical health services providers had clinical care or specialty programs for immigrants. Finally, 5 of 16 direct behavioral health care providers offered mental health treatment and counseling services adapted specifically for targeted immigrant groups. These findings highlight the limited development of the existing human services network to increase its capacity to provide nutrition and health related services to a growing community of diverse immigrant groups. These descriptive results underscore a need for additional local level or community based resources to be directed towards increasing the community’s ability to provide essential human services to population groups not yet language proficient and acculturated to “American community standards.”

Risk Factors in Adolescent Hypertension

Hypertension is a complex and multifaceted disease, with many contributing factors. While diet and nutrition are important influences, the confounding effects of overweight and obesity, metabolic and genetic factors, racial and ethnic predispositions, socioeconomic status, cultural influences, growth rate, and pubertal stage have even more influence and make diagnosis quite challenging. The prevalence of hypertension in adolescents far exceeds the numbers who have been diagnosed; studies have found that 75% or more go undiagnosed. This literature review summarizes the challenges of blood pressure classification in adolescents, discusses the impact of these confounding influences, and identifies actions that will improve diagnosis and treatment outcomes.

Determinants of Food Security and Diet Among Rural and Urban Latino/Hispanic Immigrants

ABSTRACT Rural migration and food insecurity of Latino immigrants is high. The goal of this study was to examine food insecurity among Latino immigrants in a rural region (N = 119) in comparison to urban Latinos (N = 166). The objectives were to examine, identify, and compare determinants of food security, weight status, and diet between urban and rural Latinos. Household surveys were conducted by 2 trained bilingual/bicultural interviewers. Data on food security, body mass index, self-reported weight change since US arrival, diet, and barriers to healthy eating were collected. Rural Latinos were more likely to be overweight and have low food security than urban Latinos. Difficulty eating healthy and increased time in the United States were the primary determinants of low food security and poor diet among rural Latinos. Rurality and food insecurity pose a barrier for Latino immigrants and must be addressed further.

Changes in Meal Participation, Attendance, and Test Scores Associated with the Availability of Universal Free School Breakfasts

This study investigates student outcomes associated with changes in the availability of universal free breakfasts at elementary schools in the Guilford County Schools (GCS) in North Carolina. In 2007–8, the GCS offered universal free breakfasts in schools with high proportions of economically disadvantaged students. In 2008–9, the GCS reduced its universal free programs, with the affected schools returning to eligibility-based programs. We examine how breakfast and lunch participation, attendance, and reading, math, and science test scores changed across years at affected and unaffected schools. We find that the switch from a universal free to an eligibility-based School Breakfast Program reduced breakfast participation substantially with the largest changes occurring among students who were not eligible for free or reduced-price meals. The changes to eligibility-based provision were associated with decreases in lunch participation for paid-eligible students but not for other students. The changes to eligibility-based provision did not harm test scores or attendance.

Evaluating the Implementation of a Farmers’ Market Targeting WIC FMNP Participants

The present study planned and implemented a new farmers’ market (FM) at a WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) clinic in North Carolina, of which WIC FM Nutrition Program (FMNP) participants were the main priority population. The purpose of this FM was to provide convenience and improve access to locally grown fresh fruits and vegetables in the community and to increase the FMNP coupon redemption rate. The main objective of this study was to describe the overall process and key strategies involved in implementing a FM at a WIC clinic. A community-based participatory research design using different formative methods documented the process and key inputs in FM implementation. Local farmers, program administrators, and community advocates were involved in documenting the implementation process. Multiple formative methods included direct observation and semistructured interviews with staff and farmers (n = 13). A community partnership was key in implementing the FM. The market operated weekly over the course of 24 weeks, involved 12 WIC-approved farmers, and featured over 50 types of fresh fruits and vegetables. The FMNP coupon redemption rate at the county level increased from 51.3% to 62.9%. The results demonstrate that a FM can be successfully located near a WIC clinic with positive effects of increasing availability to fresh fruits and vegetables for a low-income population and revenue for local farmers.

Hypertension in Low-Income Adolescents

Disadvantaged adolescents are at higher risk for undiagnosed and untreated obesity and hypertension. Using nurse-measured weight, height, and blood pressure (BP) as well as self-reported age and activity/lifestyle behaviors, we assessed the prevalence of obesity and hypertension in 573 adolescent patients aged 13.0 to 17.9 years (females: n = 267, 46.6%; males: n = 306, 53.4%) from a clinic serving low-income, ethnically diverse pediatric patients. Body mass index distribution was as follows: 11, underweight (1.9%); 330, healthy weight (57.6%); 105, overweight (18.3%); and 127, obese (22.2%). The age-adjusted height percentile was normally distributed, but distribution by BP category was 326 normotensive (56.9%), 147 prehypertensive (25.7%), 60 with stage 1 hypertension (10.5%), and 40 with stage 2 hypertension (7.0%). Activity and lifestyle behaviors did not adequately explain obesity and hypertension rates. Efforts to prevent/reduce childhood overweight, obesity, and hypertension in underserved populations need to include dietary education, weight control interventions, and physical activity programs specifically tailored to overweight/obese youth and parents.