Marilyn Sitaker

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.

The Ecology of Intimate Partner Violence: Theorized Impacts on Women's Use of Violence

SUMMARY The aim of this paper is to describe the multiple factors associated with intimate partner violence (IPV) using the social-ecological framework developed by Heise (1998). This framework is used to categorize research findings from multiple disciplines according to the level of social organization at which they operate. Evidence-based strategies are then reviewed according to the sphere of influence in the social ecological model, as well as their place on the prevention continuum. Along the way, possible effects on womens use of IPV, and battered womens use of violence in particular, will be noted.

Advancing Nutrition and Obesity Policy through Cross-Sector Collaboration: The Local Farms – Healthy Kids Initiative in Washington State

Nutrition policy advocates have identified many evidence-based strategies that could improve the nutritional health of populations, but progress toward policy enactment is limited. Cross-sector collaboration is a time-tested way to advance the policy process. A group of advocates, practitioners, and researchers examined policy interests across nutrition, agriculture, and environmental sectors. The group then examined how these factors played out in the Local Farms–Healthy Kids legislation in Washington State. Cross-sector advocacy based on shared values regarding healthy food access and mutual interests in production, sales, and consumption of healthy local food strengthened the policy development process.

Adults and children in low-income households that participate in cost-offset community supported agriculture have high fruit and vegetable consumption

This paper examines fruit and vegetable intake (FVI) in low-income households that participated in a cost-offset (CO), or 50% subsidized, community-supported agriculture (CSA) program. CSA customers paid farms upfront for a share of the harvest, and received produce weekly throughout the growing season. A cohort of adults and children 2–12 y in a summer CO-CSA were surveyed online twice: August 2015 (n = 41) and February 2016 (n = 23). FVI was measured by the National Cancer Institute’s (NCI) Fruit and Vegetable Screener (FVS) and an inventory of locally grown fruits and vegetables. FVI relative to United States (US) recommendations and averages, and across seasons, were tested with non-parametric tests and paired t-tests (p < 0.05). Both adults and children in the CO-CSA had higher FVI than the US averages, and more often met recommendations for vegetables. Some summer fruits and vegetables were more often eaten when locally in-season. The CO-CSA model warrants further examination as an avenue for improving vegetable consumption among adults and children in low-income households. However, causality between CO-CSA participation and FVI cannot be inferred, as CO-CSA participants may be positive deviants with respect to FVI. A multi-state randomized controlled trial is currently underway to evaluate impacts of CO-CSAs on FVI and related outcomes.

Over-representation of people of color as intimate partner violence perpetrators : The case for examining multiple points-of-contact

ABSTRACT This article presents gender, age, and race comparisons of perpetrators of adult intimate partner violence (IPV) obtained from: (a) a mid-size metropolitan police department, (b) a victim advocacy agency located in the same city, and (c) a batterer intervention program also in the same city. Results showed found that: (a) the overwhelming majority of IPV perpetrators were male, (b) perpetrators were likely to be between the ages of 20–39, (c) racial demographics varied with the type of IPV intervention agency, and (d) People of Color were over-represented in police calls. This effort confirms the importance of obtaining information from varied community sources in order to provide a more complete picture of local IPV perpetrator demographics, especially racial characteristics.

Capacity Building for and Implementation of Policy, Systems, and Environmental Change: Results from a Survey of the National Comprehensive Cancer Control Program

Policy, systems, and environmental (PSE) approaches are commonly used to improve population health. Cancer-related examples include providing data and education to stakeholders about policies that support healthy living, or health systems changes such as universal reminders about recommended cancer screening. The National Comprehensive Cancer Control Program (NCCCP) funds health departments to form cancer coalitions that develop and implement cancer plans. NCCCP initiated a demonstration program in 13 of 65 funded grantees to determine whether skilled, dedicated staffing and using a strategic process to examine data, form a workgroup, and develop an agenda would enhance their capacity to implement PSE approaches, recruit new partners, and provide data and education to stakeholders. The objective of this study was to compare demonstration program grantees to other NCCCP grantees on their ability to develop and implement PSE strategies, and the short-term results that were achieved. Program directors (PDs) from each NCCCP-funded jurisdiction completed web surveys at 2 time points during implementation to assess changes in their capacity for PSE approaches, identify implementation activities, and document short-term outcomes. Responses from demonstration program PDs and other PDs at both time points were compared in a descriptive analysis. Demonstration program grantees experienced greater increases in skills and capacity to address PSE approaches, engaged in necessary implementation activities more often, and achieved greater improvements in stakeholder and decision maker awareness and support for PSE strategies, compared to nonparticipating NCCCP grantees. These findings support continued implementation of PSE approaches for sustainable cancer prevention and control.

Fruit and Vegetable Preferences and Practices May Hinder Participation in Community-Supported Agriculture Among Low-Income Rural Families

Objective Describe fruit and vegetable (FV) preferences and other factors that may influence participation in community‐supported agriculture (CSA). Design In‐depth, semi‐structured interviews. Setting Eight rural/micropolitan communities in 4 US states. Participants There were 41 caregivers and 20 children (8–12 years of age) from low‐income, English‐speaking households. Phenomena of Interest Knowledge, attitudes, and behaviors regarding FVs; perceived barriers to CSA participation. Analysis Transcribed verbatim and iteratively coded. Results Caregivers and children believed FVs were important to health, yet FVs were not featured in dinners or snacks and consumption was challenged by limited preferences and neophobia. Few caregivers and children knew about the seasonality of FV. Most caregivers were unfamiliar with CSA and had concerns about CSA cost, accessibility, produce quality, and selection. Conclusions and Implications These qualitative data support improvements in: 1) CSA distribution practices to offer flexible payment and pick‐up options, more fruits, and self‐selection of FV; 2) public awareness of produce seasonality and the CSA distribution model as necessary precursors to participation, and lower cost for low‐income families who highlighted this barrier; and 3) capacity to prepare FV by enhancing skills and providing time‐saving kitchen tools. Approaches to aligning CSA practices with the needs and preferences of low‐income families warrant further research.