How Livelihood Change Affects Food Choice Behaviors in Low- and Middle-Income Countries: A Scoping Review.

Livelihoods have changed dramatically over the past decade in low- and middle-income countries (LMIC). These shifts are happening in tandem with shifts in individual and household food choice behaviors. This scoping review aimed to identify and characterize mechanisms through which livelihood changes could affect food choice behaviors in LMIC, including behaviors relating to food production, acquisition, preparation, distribution, and consumption. A literature search was conducted using 4 databases: PubMed, PsycInfo, AGRICOLA, and Embase. The search was further enhanced by expert solicitations. Studies were included if they measured or focused on a livelihood change, described or assessed a change in ≥1 food choice behavior, and focused on LMIC. Studies were excluded if they focused on migration from LMIC to a high-income country. Of the 433 articles that were identified, 53 met the inclusion criteria. Five mechanisms of how livelihood change can affect food choice were identified: occupation, locality, time, income, and social relations. Changes in occupation altered the balance of the availability and affordability of foods in local food environments compared with individual food production. Changes in location, time use, and income influenced where food was purchased, what types of foods were acquired, and how or where foods were prepared. Additionally, changes in social relationships and norms led to expanded food preferences, particularly among urban populations. Time limitations and higher discretionary income were associated with consumption of ultraprocessed foods. Understanding the relationships between the changes in livelihood occuring in LMIC and food choices of households in these countries can inform the development of policies, programs, and other actions to promote sustainable healthy diets and planetary health.

Understanding differential reductions in undernutrition among districts in Rwanda through the perspectives of mid-level and community actors on policy commitment and policy coherence.

Understanding the drivers of improvements in child undernutrition at only the national level can mask subnational differences. This paper aimed to understand the contributions of factors in the enabling environment to observed differences in stunting reduction between districts in Rwanda. In 2017, we conducted 58 semi-structured interviews with mid-level actors (n = 38) and frontline workers (n = 20) implementing Rwanda's multi-sectoral nutrition policy in five districts in which stunting decreased (reduced districts) and five where it increased or stagnated (non-reduced districts) based on Rwanda's 2010 and 2014/15 Demographic and Health Surveys. Mid-level actors are government officials and service providers at the subnational level who represent the frontline of government policy. Interviews focused on political commitment to and policy coherence in nutrition, and contributors to nutrition changes. Responses were coded to capture themes on the changes and challenges of these topics and compared between reduced and non-reduced districts. Descriptive statistics described district characteristics. Political commitment to nutrition was high in both reduced and non-reduced districts. Respondents from reduced districts were more likely to define commitment to nutrition as an optimal implementation of policy, whereas those from non-reduced districts focused more on financial commitment. Regarding coherence, respondents from reduced compared to non-reduced districts were more likely to report the optimal implementation of multi-sectoral nutrition planning meetings, using data to assess plans and progress in nutrition outcomes and integration of nutrition into the agriculture sector. In contrast, respondents from non-reduced districts more often reported challenges in their relationships with national-level stakeholders and nutrition and/or monitoring and evaluation capacities. Enhancing the integration of nutrition in different sectors and improving mid-level actors' capacity to plan and advocate for nutrition programming may contribute to reductions in stunting.

Ulcerative Colitis Is Associated With Diet-related Inflammation and Physical Activity in the IBD Partners E-cohort.

BACKGROUND: Individuals with ulcerative colitis (UC) seek complementary treatment methods, including diet and physical activity, to manage the burden of living with UC. This study examined associations between diet-associated inflammation, physical activity (PA), and UC-related health outcomes. METHODS: Data were obtained from 2052 IBD Partners e-cohort participants with UC. To quantify the inflammatory potential of food intake, dietary data were converted into Dietary Inflammatory Index (DII) and energy adjusted (E-DII) scores. Physical activity data were collected using the Godin-Shephard Leisure Time Activity Index. Outcome variables included the Simple Clinical Colitis Activity Index, Short Inflammatory Bowel Disease Questionnaire, and psychosocial PROMIS domains. RESULTS: Higher E-DII scores, as indicator of increased dietary inflammatory potential, were associated with increased disease activity (ß = 0.166; P < .001), anxiety (ß = 0.342; P = .006), depression (ß = 0.408; P = .004), fatigue (ß = 0.386; P = .005), sleep disturbance (ß = 0.339; P = .003), and decreased social satisfaction (ß = -0.370; P = .004) and quality of life (ß = -0.056; P < .001). Physical activity was inversely associated with disease activity (ß = -0.108; P < .001), anxiety (ß = -0.025; P = .001), depression (ß = -0.025; P = .001), fatigue (ß = -0.058; P < .001), and sleep disturbance (ß = -0.019; P = .008), while positively associated with social satisfaction (ß = 0.063; P < .001) and quality of life (ß = 0.005; P < .001). Beneficial effects were generally greater for strenuous PA intensity. CONCLUSIONS: An anti-inflammatory diet and increased PA are associated with decreased disease activity, anxiety symptoms, depression symptoms, and fatigue, and associated with improved quality of life, sleep, and social satisfaction for patients with UC. Such modalities may reduce the daily burden of illness and aid in managing systemic and localized inflammation associated with UC.

Understanding Commitment of Local Food Banks, Faith-Based Organizations, and Schools to Provide Nongovernment Food Programs.

Background: Nongovernment food assistance is typically provided to families by faith-based organizations, schools, and food banks. Community organizations appear to be strongly committed to these programs, but little is known about the basis for this commitment. Objectives: The aim of this study was to examine the values and identities of community organizations to understand the reasons for their commitment to providing nongovernment food assistance. Methods: Thirty-three in-depth interviews were conducted with 36 leaders at faith-based organizations (19 participants), schools (14 participants), and a local food bank (3 participants) in South Carolina. Observations were made, and informational documents (e.g., flyers and pamphlets) were reviewed. Thematic coding using the constant comparative method was guided by the policy concepts of organizational perspectives, values, and identities. Results: Nongovernment food programs offered participants volunteering opportunities to become involved with community organizations, which in turn increased financial support for the sustainability of these programs. School participants regarded themselves as a mechanism through which food programs were provided because of their commitment to students and believed they have limited capacity to make proposals to influence the food programs. Seeking to improve the well-being of the community by ending hunger was not the primary value on which organizations focused; instead, it was the process of fulfilling other values (e.g., forming or maintaining relationships within the community), maintaining identity, and appealing to their participants that strengthened their commitment to nongovernment food programs. Conclusion: Nongovernment programs are meant to be a solution to food insecurity complementary to government programs. Commitment to nongovernment programs fulfills organizational identities, wants, and assumptions, but a consequence of commitment to food programs, derived from fulfilling other values, is that the roots of hunger in a community become obscured and alternative solutions are ignored or rejected.

Basic human values drive food choice decision-making in different food environments of Kenya and Tanzania.

Increased access to a variety of foods in low-and-middle-income countries (LMICs) has led to greater autonomy in food choice decision-making. Autonomy allows individuals to make decisions through negotiation of considerations in ways that are consistent with basic values. The aim of this study was to identify and describe how basic human values drive food choice in two diverse populations with transitioning food environments living in the neighboring East African countries of Kenya and Tanzania. Secondary data analysis was carried out on focus group discussions conducted with men and women in Kenya (n = 28) and Tanzania (n = 28) as part of prior studies on food choice. A priori coding based on Schwartz's theory of basic human values was conducted, followed by a narrative comparative analysis, which included review by original principal investigators. Values of conservation (security, conformity, tradition), openness to change (self-directed thought and action, stimulation, indulgence), self-enhancement (achievement, power, face), and self-transcendence (benevolence-dependability and -caring) were prominent drivers of food choice in both settings. Participants described how values were negotiated and highlighted existing tensions. For example, the value of tradition was cited as important in both settings but changing food contexts (e.g., new foods, diverse neighborhoods) increased prioritization of values like stimulation, indulgence, and self-directed thought and action. The application of a basic values framework was useful for understanding food choice in both settings. A focused understanding of how values drive food choice decision-making in the context of changing food availability in LMICs is essential for the promotion of sustainable healthy diets.

Strategies elementary school children use to influence mothers' food purchasing decisions.

This study aimed to understand the strategies elementary-school-aged children used to influence mothers' food purchasing decisions. Semi-structured qualitative interviews were conducted with 40 children aged 6-11 years and their mothers living in South Carolina. Strategies to influence mothers' food purchases were collected from children and their mothers separately. The interviews were audio-recorded, transcribed verbatim, and open-coded. The constant comparative method was used for data analysis. Coding matrices were used to compare children's and mothers' responses on the children's strategies. Children reported 157 instances of 25 distinct strategies to influence mothers' purchasing decisions. Mothers had concordance with 83 instances of these strategies. Mothers were more concordant with sons than daughters. The most common and successful strategies reported by children and mothers were repeated polite requests, reasoned requests and referencing friends. Other strategies included offers to contribute money or service, using other family members to pursue mothers for the item, writing a list and grabbing desired items. Mothers perceived that children had a large influence on food purchasing decisions. Children were aware of the strategies that would get positive reactions from mothers. They (children) could get their desired items a lot of times, often, or several times in a month from their mothers irrespective of the healthfulness of the items. Children's influence can be used as a change agent for improving mothers' food purchases if children prefer healthy foods. Efforts are needed for mothers and children to help address children's strategies to influence mothers to purchase unhealthy foods and make healthy foods more appealing to children.

Why understanding food choice is crucial to transform food systems for human and planetary health.

What, how and why people eat has long been understood to be important for human health, but until recently, has not been recognised as an essential facet of climate change and its effects on planetary health. The global climate change and diet-related health crises occurring are connected to food systems, food environments and consumer food choices. Calls to transform food systems for human and planetary health highlight the importance of understanding individual food choice. Understanding what, how and why people eat the way they do is crucial to successful food systems transformations that achieve both human and planetary health goals. Little is known about how food choice relates to climate. To clarify potential paths for action, we propose that individual food choice relates to climate change through three key mechanisms. First, the sum of individual food choices influences the supply and demand of foods produced and sold in the marketplace. Second, individual food decisions affect type and quantity of food waste at the retail and household level. Third, individual food choices serve as a symbolic expression of concern for human and planetary health, which can individually and collectively stimulate social movements and behaviour change. To meet the dietary needs of the 2050 global population projection of 10 billion, food systems must transform. Understanding what, how and why people eat the way they do, as well as the mechanisms by which these choices affect climate change, is essential for designing actions conducive to the protection of both human and planetary health.

How Perspectives on Food Safety of Vendors and Consumers Translate into Food-Choice Behaviors in 6 African and Asian Countries.

Background: Consumption of unsafe foods increases morbidity and mortality and is currently an issue, particularly in low- and middle-income countries. Policy actions to ensure food safety are dominated by mitigation of biological and chemical hazards through supply-side risk management, lessening the degree to which consumer perspectives of food safety are considered. Objectives: This study aimed to provide an in-depth understanding, from vendor and consumer perspectives, of how food-safety concerns of consumers translate into their subsequent food-choice behaviors in 6 diverse low- and middle-income countries. Methods: Six Drivers of Food Choice projects (2016-2022) provided transcripts from 17 focus group discussions and 343 interviews conducted in Ghana, Guinea, India, Kenya, Tanzania, and Vietnam. Qualitative thematic analysis was used to identify emerging themes important to food safety. Results: The analysis suggests that consumers constructed meaning about food safety through personal lived experience and social influences. Community and family members contributed knowledge about food safety. Concerns about food safety were influenced by reputations of and relationships with food vendors. Consumers' mistrust of food vendors was amplified by purposeful adulteration or unsafe selling practices and new methods used to produce food. Moreover, consumers were reassured of food safety by positive relationships with vendors; meals cooked at home; implementation of policies and following regulations; vendor adherence to environmental sanitation and food-hygiene practices; cleanliness of vendors' appearance; and vendors' or producers' agency to use risk mitigation strategies in production, processing, and distribution of food. Conclusions: Consumers integrated their meanings, knowledge, and concerns about food safety to achieve assurance about the safety of their foods when making food-choice decisions. The success of food-safety policies hinges on consideration of consumers' food-safety concerns in their design and implementation, alongside actions to reduce risk in food supply.

Attributes of parenting identities and food practices among parents in Nairobi, Kenya.

Dramatic changes in daily life are leading to increased rates of obesity and non-communicable diseases (NCD) in Kenya, including among children. Parenting plays a vital role in helping children establish healthy eating habits to prevent obesity and NCDs. The objective of this study was to describe parenting identity and how attributes of parenting influence food parenting practices in an urban Kenyan context. A qualitative study design was employed with 18 participants recruited using quota sampling to include parents who were born in (n = 8) or migrated to Nairobi in the last five years (n = 10). In-depth qualitative interviews were conducted by an experienced ethnographic interviewer that inquired about parenting identity and food parenting practices. Transcripts were analyzed using thematic coding in a multi-step and emergent process. Parents described their parenting identities as an integration of tradition and personal experiences during their upbringing with the modern realities of daily life. Their own experiences with discipline, modern urban lifestyles, and social pressures were dominant influences on their identities. Parenting identities included four distinct but related attributes: good disciplinarian, trustworthy, protective, and balanced provider and nurturer. Food parenting practices were described as expressions of parenting identity and included the goals: children becoming better eaters; nourishing through food; impart joy; and bonding. The study findings illustrate the influence of modern urban lifestyles on food parenting identities and practices. Understanding emerging identities and practices in rapidly changing low- and middle-income countries (LMIC) contexts is essential for health promoting policies and programs.

Alternative caregivers` role in food choices for young children in semi-urban and urban Mexico.

Alternative caregivers (i.e., someone besides the primary caregiver who also takes care of children) make food choices for children. This study investigated what alternative caregivers consider when making food choices for children and their perspectives on their role in making food choices to feed children. In-depth interviews were conducted with 16 alternative caregivers of children aged 1-5 years old in semi-urban and urban areas of the State of Mexico in Mexico. Interviews were recorded, transcribed, coded, and analyzed using constant comparative method. Alternative caregivers described spaces and situations that exposed children to food while under their care. Alternative caregivers who spent longer periods of time with the child described more involvement in what the child ate. Healthy or nutritious food, cost of food and affection for children were important considerations for alternative caregivers when deciding what to feed the child. Alternative caregivers had a substantial role in child feeding, decisions about cooking, and advising mothers on how to feed their children. Efforts to promote healthy food choices for children should include targeting of alternative caregivers.

Sustaining Agriculture and Nutrition Interventions: Continued Engagement of Village Model Farmers in Nepal.

BACKGROUND: In homestead food production (HFP) programs, village model farmers (VMFs), after training, implement agriculture and nutrition activities to improve household knowledge and practices. Little evidence exists on what enables VMFs to remain actively engaged and for impacts to be sustained. OBJECTIVE: To examine variables explaining active engagement of VMFs, at least 4 years post-training, in an HFP program in Nepal. METHODS: We used cross-sectional data, collected from 2018 to 2019, among 4750 VMFs of Suaahara, a multisectoral nutrition program. We assessed whether respondents registered their HFP group with the local government, conducted regular group meetings, discussed vegetable growing and chicken rearing practices with group members, or engaged in saving and credit activities in their HFP group. Outcome variable was a count of these 4 activities in which the VMF engaged. Socioeconomic, demographic, and programmatic explanatory variables were identified a priori and by bivariate analysis and were adjusted in ordinal regression models accounting for clusters. RESULTS: On average, VMFs engaged in 1.4 activities. Having attended primary or secondary school (adjusted odds ratios [AOR] = 1.39), being a female community health volunteer (AOR = 1.27), being from an advantaged caste/ethnic group (AOR = 1.34), receiving additional trainings (AOR = 1.56) and inputs (AOR = 1.31) were associated with more active engagement of VMFs. CONCLUSION: Village model farmers receiving more training and inputs were more likely to remain actively engaged. Female community health workers, people from higher caste/ethnic groups, and those with primary or secondary education were more likely to remain active VMFs and could be targeted for this role in HFP programs leading to sustained impact.

Experiences and Situations of Shame among Food-insecure Adolescents in South Carolina and Oregon.

Shame experienced with food insecurity and participating in food assistance may affect adolescents. We investigated adolescents' experiences of shame related to food insecurity and situations for these experiences in an ethnically diverse sample of 40 adolescents aged 9-15 years from South Carolina and Oregon. In-depth interviews were recorded, transcribed, coded, and analyzed. Participants described feelings of sadness, anger, and internalized shame with food insecurity. Salient situations were participating in food assistance, seeking food assistance from others or community services, and social encounters at school among peers. Adolescents felt shame knowing that peers were aware of their food insecurity and about them participating in food assistance through school.

Functions of social networks in maternal food choice for children in Mexico.

Food choice for children has important implications in establishing early-life dietary habits and preferences. Food choice for children has been studied as parent-child dyad dynamics, but little is known about the extended system of relationships in maternal food choice for children. The objective of this study was to understand the functions of mothers' social networks in the food choices that mothers make for their children ages 1 to 5 years old in rural Mexico. In-depth interviews were conducted with 46 participants in three rural communities. The interviews inquired about participants' child-feeding practices, personal and local beliefs about child feeding and the individuals with whom they had conversations about food and child feeding. All interviews were conducted in Spanish, audio-recorded, transcribed verbatim, verified for quality and analysed using the constant comparative method. Five interconnected networks emerged, consisting of household family, non-household family, community, children's initial school and health and nutritional programme personnel. Each network had functions in food choice that ranged from shared food decision-making in the household family network to imparting formal dietary guidance in the health and nutritional programme personnel network. Across the networks, professionals, participants' mothers and mothers-in-law, community senior women and other women with children emerged as prominent figures whom participants would turn to for child-feeding advice. These findings provide empirical evidence that social networks, as an organized system of interconnected relationships, have vital functions in establishing social norms for food choices made for children that can be leveraged to promote healthy food choices.

Experiences of midlife and older African American men living with type 2 diabetes.

OBJECTIVE: Type 2 Diabetes Mellitus (T2DM) is a complicated disease that disproportionately affects African American men. Understanding the experiences of African American men living with T2DM is important for developing effective, culturally sensitive interventions. The purpose of this study was to describe how African American men view their T2DM and describe their perspectives on living with and self-managing T2DM. DESIGN: In-depth semi-structured qualitative interviews were conducted with 22 African American men aged 40-85 years diagnosed with T2DM. Interviews were transcribed and analyzed using NVivo 10 with thematic analysis. RESULTS: Disbelief, shock, and denial were commonly experienced reactions at initial diagnosis. Many participants defined diabetes using words such as 'sugar' or 'glucose' and reported an awareness of health complications caused by diabetes, such as amputations and diabetic comas. Participants expressed various perspectives and attitudes towards having diabetes, including avoidance/apathy, fatalism, guilt and shame, fear and concern, and self-mastery. The majority of men described efforts to self-manage diabetes via glucose monitoring, changing dietary habits, and exercise. Many participants expressed concern over the financial burden associated with managing diabetes and reported that high costs can hinder a patient's ability to maintain active self-monitoring and deter patients from attending needed doctor's visits. Many participants expressed confidence in their healthcare providers, although a few expressed feelings of distrust and being uninformed. Participants tended to most appreciate physicians who spent time discussing their condition and who made an effort to engage in open patient-provider communication. CONCLUSION: Living with diabetes can be emotionally, physically, and mentally challenging. Efforts to improve adoption and maintenance of self-management behaviors may benefit from sensitivity to the patient's attitude and perspectives towards diabetes self-management, assistance overcoming the financial burden of managing diabetes, and open patient-provider communication.

Drivers of Food Choice among Children and Caregivers in Post-earthquake Nepal.

Food systems in many countries are experiencing a shift from traditional foods toward processed foods high in sugar, fat and salt, but low in dietary fiber and micronutrients. There is an urgent need to better understand drivers of changing food behavior, particularly for lower-income countries. This study analyzes drivers of food choice among children and parents in rural Nepal. It uses qualitative data collected through key informant interviews and focus group discussions with school children, parents and teachers. The study reveals substantial changes in food behavior during the past decade with increased consumption of rice, meat, and highly processed snack foods while an increased consumption of fruit and vegetables is not evident. It identifies cash availability is the main driver of increased rice, meat and snack food consumption. The second driver is the 2015 Nepal earthquake, which accelerated the transition from homegrown food to purchased food as people got habituated to eating more meat and snack foods while reconstruction tripled local wages and changed the food environment. This shows how humanitarian assistance in the wake of extreme shocks can unintentionally contribute to unhealthy eating habits. An integrated school and home garden intervention appears to contribute to healthier diets.

Occasions, purposes, and contexts for offering snacks to preschool-aged children: Schemas of caregivers with low-income backgrounds.

OBJECTIVE: Snacking among preschool aged children is nearly universal and has been associated with overconsumed nutrients, particularly solid fats and added sugars (SoFAS). This research examined caregivers' schemas, or cognitive frameworks, for offering snacks to preschool-aged children. METHODS: A qualitative design utilizing card sort methods was employed. Participants were 59 Black, Hispanic, and White caregivers of children aged 3-5 years with low-income backgrounds. Caregivers sorted 63 cards with images of commonly consumed foods/beverages by preschool-aged children in three separate card sorts to characterize snacking occasions, purposes, and contexts. The mean SoFAS content (kcal/100 g) of foods/beverages was evaluated by snacking occasions (snacks vs. not-snacks), purposes, and contexts. RESULTS: Just under two-thirds (38/63 food cards) of foods/beverages were classified as snacks with moderate to high agreement. Snacks were offered for non-nutritive (e.g., requests, rewards) and nutritive (e.g., hunger/thirst) purposes in routine (e.g., home, school) and social contexts (e.g., with grandparents). Snacks offered for non-nutritive purposes and in social contexts were higher in SoFAS than those offered for nutritive reasons and in routine contexts. CONCLUSIONS: Caregivers of young children offered various types of foods/beverages as snacks, with higher SoFAS snacks given for non-nutritive purposes and in social contexts. Understanding of caregivers' schemas for offering snacks to young children may inform targets for obesity prevention and anticipatory guidance to promote the development of healthful eating behaviors.

Gendered Intrahousehold Bargaining Power is Associated with Child Nutritional Status in Nepal.

BACKGROUND: Women's intrahousehold bargaining power is an important determinant of child nutrition in Nepal, but a better understanding is needed on how men's bargaining power is related to child nutrition. OBJECTIVES: We examined the relation of women's and men's household bargaining power with child height-for-age z score (HAZ). METHODS: We analyzed cross-sectional data from 2012, collected as an impact evaluation baseline of the Suaahara 1 program. A subsample of households with data on women's and men's intrahousehold bargaining power (n = 2170) with children aged 0-59 mo across Nepal was considered for this analysis. Intrahousehold bargaining power consisted of 4 domains: 1) ownership and control of assets, 2) social participation, 3) time allocation to work activities (workload), and 4) household decision-making control. Using multilevel methods, we analyzed associations between HAZ and 1) women's bargaining power, 2) men's bargaining power, and 3) women's and men's bargaining power, adjusted for individual- and household-level confounding factors and clustering. RESULTS: Women's ownership and control of assets was positively associated with HAZ when women's and men's domains were modeled together (ß: 0.0597, P = 0.026). Men's social participation was positively associated with HAZ in the men's model (ß: 0.233, P < 0.001) and the model with women's and men's domains (ß: 0.188, P = 0.001). Women's workload was negatively associated with HAZ in the women's model (ß: -0.0503, P = 0.014) and in the model with women's and men's domains (ß: -0.056, P = 0.008). Household decision making for women (ß: -0.0631, P = 0.007) and for men (ß: -0.0546, P = 0.017) were negatively associated with HAZ in the gender-specific models. Women's social participation, men's ownership and control of assets, and men's workload were not associated with HAZ. CONCLUSIONS: Women's workload and ownership and control of assets and men's social participation may be important in improving child HAZ in Nepal. Nutrition interventions should address women's intrahousehold bargaining power and promote men's social engagement.

Healthy Eating and Physical Activity Interventions in Faith-Based Settings: A Systematic Review Using the Reach, Effectiveness/Efficacy, Adoption, Implementation, Maintenance Framework.

CONTEXT: Faith-based health interventions may improve obesity-related health behaviors, including healthy eating and physical activity. However, the generalizability of results and comprehensiveness of reporting for critical design elements sufficient for large-scale implementation and broad public health impact are unclear. This review assesses the degree to which faith-based healthy eating and physical activity programs report intervention elements using the reach, effectiveness/efficacy, adoption, implementation, maintenance framework. EVIDENCE ACQUISITION: A systematic literature search was initiated in June 2017, and updated searches concluded in December 2019. Articles were included if they (1) were published in an English language peer-reviewed journal, (2) were conducted in the U.S., (3) were interventions, (4) included individual-level healthy eating or physical activity behavioral outcomes, (5) were conducted within an organizational setting, and (6) were faith-based. Intervention elements were extracted, and comprehensiveness of reporting for intervention elements was assessed according to reach, effectiveness/efficacy, adoption, implementation, maintenance domains. EVIDENCE SYNTHESIS: A total of 38 interventions (46 articles) met the inclusion criteria. Most were conducted at the individual/interpersonal level (66%); few included additional elements of policy or environmental change (34%). Most interventions showed favorable changes in at least 1 health behavior outcome. No intervention addressed all reach, effectiveness/efficacy, adoption, implementation, maintenance indicators. The mean level of reporting was low for all reach, effectiveness/efficacy, adoption, implementation, maintenance dimensions (reach: 2.3 of 5 [SD=1.0] indicators, efficacy/effectiveness: 2.3 of 4 [SD=0.8] indicators, adoption: 3.7 of 6 [SD=1.4] indicators, implementation: 1.3 of 3 [SD=0.6] indicators, maintenance: 0.3 of 3 [SD=0.5] indicators). CONCLUSIONS: Studies reporting outcomes of faith-based interventions to improve healthy eating/physical activity behaviors lack the information necessary to understand the potential for broad dissemination and implementation in community settings. Future studies should report on the considerations for the translation and dissemination of evidence-based programs to expand public health impact.

An interdisciplinary intensive outpatient pain program is associated with improved patient activation and key outcomes.

Aim: To examine the change in the Patient Activation Measure and physical and psychosocial outcome measures in a military interdisciplinary intensive outpatient program for persistent pain. Materials & methods: Pre- and post-intervention measures, which were also stratified by gender and baseline activation, included patient-reported outcomes and physical function assessment, obtained from 2017 to 2018 program database. Results: The majority of the participants were male (70.9%), with an average age of 29.18 years and pain duration of 4.78 years (n = 103). Patient activation, majority of the patient reported outcomes and functional assessments improved in the overall sample with fewer changes in females on the Defense and Veterans Pain Rating Scale. Conclusion: Improvements were noted on the Patient Activation Measure and majority of the other outcome measures suggesting that service members with persistent pain at any level of patient activation or baseline function, may benefit from an intensive outpatient program.