Incentivizing Healthy Snacks During Out-of-School Time Through Grocery Store Partnerships.

CONTEXT: Volunteer-led out-of-school-time (OST) programs, such as 4-H, scouting, and youth sports, reach a large population of children and are positioned to offer opportunities for healthy eating. However, cost is a barrier to providing healthy snacks such as fruits and vegetables (FVs) during OST. OBJECTIVE: Offering discounts through grocery store partnerships has shown promise in addressing this barrier in structured, staff-led after-school programs. We tested this model in volunteer-led OST programs and evaluated it using mixed methods. DESIGN/SETTING: The Snack It Up (SIU) intervention was designed to promote FV snacks to volunteer-led OST programs through weekly $5 grocery store discounts. Participation was limited to 1 leader per program. PARTICIPANTS: Thirty-five of 36 recruited OST program leaders completed the study; 16 were enrolled in SIU and 19 in a comparison group. MAIN OUTCOME MEASURES: We assessed the following: (1) discount redemption among SIU leaders; (2) snacks served by SIU and comparison group leaders via photographs from 3 to 4 OST program sessions during SIU implementation; and (3) SIU leader perspectives using key informant interviews before and after implementation. RESULTS: SIU leaders saved an average of $48.75 on FV snacks throughout the intervention ($2.90 per week, more than one-fifth of typical self-reported spending on snacks). SIU leaders also served a greater frequency (100% of sessions vs 75%, P < .001) and variety of FVs (an average of 3.5 types per session vs 1.3, P < .001) and fewer salty/sweet snacks (0.0 vs 1.3 types per session, P < .001) than those in the comparison group and expressed positive impressions of SIU. CONCLUSIONS: Partnerships between OST programs and grocery stores are a promising avenue for promoting healthier snacks during OST.

Written Nutrition Guidelines, Client Choice Distribution, and Adequate Refrigerator Storage Are Positively Associated with Increased Offerings of Feeding America's Detailed Foods to Encourage (F2E) in a Large Sample of Arkansas Food Pantries.

BACKGROUND: Millions of food-insecure households in the United States obtain food from food pantries each year. These foods are often of insufficient nutritional quality. OBJECTIVE: Our aim was to describe the frequency with which Arkansas food pantries offer foods included in Feeding America's Detailed Foods to Encourage (F2E) framework, and examine food pantry characteristics associated with increased frequency of offering F2E and other foods. DESIGN: This was a 27-item cross-sectional online survey that assessed food pantries' characteristics (eg, storage capacities, number of clients served) and typical food offerings. PARTICIPANTS/SETTING: Partnering with five of Arkansas's six food banks, 764 e-mail invitations were sent to food agency managers across the state. A final sample of 357 food pantries was included in the analyses. MAIN OUTCOME MEASURES: The primary outcomes of interest were the frequencies of offering specific F2E and F2E in general. The F2E framework was developed by Feeding America to more accurately assess food banks' inventories, and its categories (Fruits and Vegetables; Protein; Dairy; and Grains) are generally consistent with MyPlate. STATISTICAL ANALYSES PERFORMED: Descriptive statistics were computed for all food pantry characteristics and frequency of foods offered. Associations between food pantry characteristics and the frequency of offering F2E were examined via multiple linear regression and path analysis. RESULTS: Only 18.5% of food pantries had written nutrition guidelines, and only 19.3% offered client choice distribution. The F2E most commonly offered were meat/poultry/seafood without breading and not fried (59.6%) and peanut butter (58.2%). The least commonly offered F2E were nuts/seeds with nothing added (3.8%) and low-fat/1%/skim cheese (8.2%). Written nutrition guidelines (P<0.001), client choice distribution (P=0.003), and adequate refrigerator storage (P=0.010) were associated with more frequently offering F2E. CONCLUSIONS: This study fills a gap in knowledge by documenting food pantry characteristics that are associated with the frequencies of offering specific types of healthy foods.

High Occurrence Rate and Contamination Level of Bacillus cereus in Organic Vegetables on Sale in Retail Markets.

Organic foods have risen in popularity recently. However, the increased risk of bacterial contamination of organic foods has not been fully evaluated. In this study, 100 samples each of organic and conventional fresh vegetables (55 lettuce samples and 45 sprout samples) sold in South Korea were analyzed for aerobic bacteria, coliforms, Escherichia coli, and Bacillus cereus. Although the aerobic bacteria and coliform counts were not significantly different between the two farming types (p > 0.05), the occurrence rate of B. cereus was higher in organically cultivated vegetables compared with those grown conventionally (70% vs. 30%, respectively). The mean contamination level of B. cereus-positive organic samples was also significantly higher (1.86 log colony-forming unit [CFU]/g vs. 0.69 log CFU/g, respectively) (p < 0.05). In addition, six samples of organic vegetables were found to be contaminated with B. cereus at over 4 log CFU/g categorized as unsatisfactory according to Health Protection Agency guideline. The relatively higher occurrence rate of B. cereus in organic vegetables emphasizes the importance of implementing control measures in organic vegetable production and postharvest processing to reduce the risk of food poisoning.

Oral bioaccessibility and human exposure assessment of cadmium and lead in market vegetables in the Pearl River Delta, South China.

A systematic investigation into cadmium (Cd) and lead (Pb) concentrations and their oral bioaccessibility in market vegetables in the Pearl River Delta region were carried out to assess their potential health risks to local residents. The average concentrations of Cd and Pb in six species of fresh vegetables varied within 0.09-37.7 and 2.3-43.4 µg kg-1, respectively. Cadmium and Pb bioaccessibility were 35-66 % and 20-51 % in the raw vegetables, respectively, and found to be significantly higher than the cooked vegetables with 34-64 % for Cd and 11-48 % for Pb. The results indicated that Cd bioaccessibility was higher in the gastric phase and Pb bioaccessibility was higher in the small intestinal phase (except for fruit vegetables). Cooking slightly reduced the total concentrations and bioaccessibility of Cd and Pb in all vegetables. The bioaccessible estimated daily intakes of Cd and Pb from vegetables were far below the tolerable limits.

Heavy metals in vegetables sold in the local market in Jordan.

Heavy metals (As, Cd, Co, Cr, Cu, Mn, Ni, Pb and Zn) in various vegetables (cabbage, green onion, lettuce, parsley, rocket, spinach, carrot, onion, potato and cauliflower) from the market in Jordan were measured using inductively coupled plasma-mass spectrometry. As, Cd, Co, Cr, Cu, Mn, Ni, Pb and Zn ranged from 0.009-0.275 mg kg(-1) wet weight, 0.004-0.060 mg kg(-1), 0.003-0.401 mg kg(-1), 0.105-3.51 mg kg(-1), 0.15-1.15 mg kg(-1), 0.93-14.39 mg kg(-1), 0.044-0.702 mg kg(-1), 0.072-0.289 mg kg(-1) and 2.23-6.65 mg kg(-1), respectively. Parsley, followed by spinach, contained the highest concentration of heavy metals. Onion contained high levels of toxic heavy metals. The content of Cu in parsley and spinach and Pb in onion exceeded the Codex limits. However, the daily intake of heavy metals from the tested vegetables was lower than the maximum limits for allowable intake.

Availability, Price, and Quality of Fruits and Vegetables in 12 Rural Montana Counties, 2014.

We assessed the consumer food environment in rural areas by using the Nutrition Environment Measures Survey for Stores (NEMS-S) to measure the availability, price, and quality of fruits and vegetables. We randomly selected 20 grocery stores (17 rural, 3 urban) in 12 Montana counties using the 2013 US Department of Agriculture's rural-urban continuum codes. We found significant differences in NEMS-S scores for quality of fruits and vegetables; of 6 possible points, the mean quality score was 4.5; of rural stores, the least rural stores had the highest mean quality scores (6.0). Intervention strategies should aim to increase fruit and vegetable quality in rural areas.

Food ingestion factors of the Korean exposure factors handbook.

The purpose of this study was to establish food ingestion factors needed to assess exposure to contaminants through food ingestion. The study reclassified the raw data of the Korean National Health and Nutrition Examination Survey in 2001 into 12 subcategories including grain products, meat products, fish and shellfish, and vegetables for international comparability of exposure evaluation. The criteria for food intake calculation were unified according to the characteristics of food groups, and recommended values for food ingestion factors were calculated through moisture correction and recategorization of cooked, processed, and mixed foods for each group. The average intake rate for grain and grain products was 6.25 g/kg-d per capita and the men's intake rate was approximately 8% higher than that of the women. The average intake rate of meat and meat products was 1.62 g/kg-d per capita and the men's intake rate was 30% higher than that of the women, on average. The average intake rate of fish and shellfish was 1.53 g/kg-d per capita, and the age groups of 1 to 2 and 3 to 6 recorded higher capita intake rates than other age groups, 2.62 g/kg-d and 2.25 g/kg-d, respectively. The average intake rate of vegetables was 6.47 g/kg-d per capita, with the age group of 1 to 2 recording the highest per capita intake rate of 9.79 g/kg-d and that of 13 to 19 recording the lowest mean. The study also offers recommended values for food ingestion factors of other food groups by gender, age, and region. The food ingestion exposure factors will need future updates in consideration of ongoing changes in food consumption behavior.

Family support is associated with behavioral strategies for healthy eating among Latinas.

BACKGROUND: Healthy eating is important for obesity control. Dietary interventions target the adoption of behavioral strategies to increase fiber and decrease fat consumption. However, little is known about the contributions of psychosocial factors to the use of these strategies. PURPOSE: This study examined psychosocial correlates of behavioral strategies for healthy eating among Latinas. METHOD: Participants included 361 Latino mothers living along the U.S.-Mexico border in California. Data included measures of sociodemographics, acculturation, and psychosocial determinants of healthy eating. A 30-item dietary behavioral strategies scale assessed strategies to increase fiber and decrease fat consumption. RESULTS: Family interactions regarding dietary habits (ß = .224, p < .001) and financial status (ß = .148, p = .029) were associated with the use of strategies to decrease fat consumption. Positive family interactions regarding dietary habits (ß = .226, p < .001), fewer barriers to obtaining fruits and vegetables (ß = -.207, p < .001), and more family support for vegetable purchasing (ß = .070, p = .047) were associated with use of strategies to increase fiber consumption. CONCLUSIONS: Future interventions would benefit from improving family systems associated with healthy eating.

Evaluation of the food store environment on and near the campus of 15 postsecondary institutions.

PURPOSE: This study evaluated the food stores on and near postsecondary campuses varying in institutional size. DESIGN: The design of the study is an environmental audit survey. SETTING: Fifteen U.S. postsecondary education institutions participated in this study between 2009-2011. SUBJECTS: Eighty-one stores (44% grocery, 17% campus, and 39% convenience/drug) were evaluated. MEASURES: The Nutrition Environment Measures Survey for Stores was modified to evaluate food stores. Analysis. Analysis of variance with post hoc Tukey B and t-tests assessed differences between store types and by institutional size. RESULTS: Grocery stores had significantly higher scores than campus/convenience stores for healthy foods (19.5 ± 3.8 vs. 2.4 ± 1.7), and for the availability (19.5 ± 3.8 vs. 2.4 ± 1.7) and quality (5.9 ± 0.5 vs. 1.8 ± 2.2) of fruits/vegetables (p < .001). Healthy foods and beverages were significantly more expensive (-0.6 ± 3.4 vs. 0.9 ± 2.0; p < .031) than their less healthful alternatives in grocery stores, but not in convenience stores. There were no differences by institutional size for grocery stores; however, smaller institutions' convenience stores had significantly lower availability and quality of fruits/vegetables and total food store environment scores. CONCLUSION: A college campus provides a food environment with an array of shopping venues, most of which are not consistent with dietary recommendations for obesity prevention. The limited quality of healthy food in on-campus and convenience stores and the exacerbated deficiencies for small postsecondary institutions provide evidence to support environmental and policy initiatives to improve the quality of campus food store environments.

A qualitative study of perceived barriers to fruit and vegetable consumption among low-income populations, North Carolina, 2011.

INTRODUCTION: Obesity is the leading preventable cause of illness and a major contributor to chronic disease. Eating fresh fruits and vegetables can help manage and prevent weight gain and reduce the risk of chronic diseases. Low-income communities often lack stores that sell fresh fruit and vegetables and have instead stores that sell foods low in nutritional value. The objective of this study was to understand perceived community-level barriers to fruit and vegetable consumption among low-income people. METHODS: We conducted 8 focus groups involving 68 low-income participants in 2 North Carolina counties, from May 2011 through August 2011. The socioecological model of health guided data analysis, and 2 trained researchers coded transcripts and summarized findings. Four focus groups were conducted in each county; 1 was all male, 5 all female, and 2 mixed sexes. Most participants were black (68%), most were women (69.1%), and most had a high school education or less (61.8%). Almost half received support from either the Supplemental Nutrition Assistance Program or another government assistance program. RESULTS: We identified 6 major community-level barriers to access to fruits and vegetables: cost, transportation, quality, variety, changing food environment, and changing societal norms on food. CONCLUSION: Policymakers should consider supporting programs that decrease the cost and increase the supply of high-quality fruits and vegetables in low-income communities.

Short-term temporal stability in observed retail food characteristics.

OBJECTIVE: Use of direct observation to characterize neighborhood retail food environments is increasing, but to date most studies have relied on a single observation. If food availability, prices, and quality vary over short time periods, repeated measures may be needed to portray these food characteristics. This study evaluated short-term (2-week), within-season temporal stability in retail food availability, prices, and quality. DESIGN: In-person observations of retail food stores at 2 time points, 2 weeks apart. SETTING: Southwest Chicago, IL. SAMPLE: 157 food stores. MAIN OUTCOME MEASURES: Availability and prices of food items selected from the following food groups: fruit, vegetables, grains, meats and beans, and dairy, as well as fresh produce quality. ANALYSIS: Temporal stability was tested for availability using a McNemar test and for price and quality using a Wilcoxon signed-rank test. RESULTS: Measures of food availability and prices as well as fresh produce quality at stores were generally stable at the 2 time points. CONCLUSIONS AND IMPLICATIONS: This study suggests that a single observation may be sufficient to accurately characterize within-season food availability, food prices, and fresh produce quality.

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.

Dietitians' attitudes, perceptions, and usage patterns for fresh-cut fruit and vegetables.

PURPOSE: New fresh-cut fruit and vegetable products are being developed worldwide. Nutrition educators' perceptions of these products were studied. METHODS: Professional dietitians in Nova Scotia were asked to complete a questionnaire on their use of fresh-cut produce. The questionnaire also elicited their attitudes and perceptions about the convenience, taste/quality, nutrition/health benefits, cost, and safety of fresh-cut fruit and vegetables. RESULTS: Sixty-three percent of respondents reported eating five to six servings of fruit and vegetables a day. This group most frequently consumed fresh-cut fruit as snacks or dessert, and vegetables in stir-fry dishes or salads or cooked with meals. In general, fresh-cut fruit and vegetables were perceived as convenient, safe, and nutritious. While approximately 50% of participants felt fresh-cut produce did not differ in taste from whole fresh produce, almost the same number considered whole fresh produce superior in taste. CONCLUSIONS: Dietitians have a generally positive perception of fresh-cut products; however, there is uncertainty about the nutritional value, cost/benefit, and use of the products. Dietitians require more information on the nutrient value of these products and on suggested alternative uses. Attention should be paid to developing fresh-cut products that have good sensory quality.

Site-specific risk assessment in contaminated vegetable gardens.

A field survey was carried on in Gyöngyösoroszi, Hungary, near to an abandoned lead/zinc mine to analyse the metal contamination of flooded and non-flooded vegetable gardens, and to evaluate the health risks to local population. Contamination levels of arsenic, cadmium, lead, mercury and zinc were measured in soil and homegrown vegetable samples and bioconcentration factors and hazard indices were calculated. The high metal contents of flooded vegetable gardens were caused by floods, the results indicated significant differences between flooded and non-flooded vegetable gardens. The most accumulating vegetable was sorrel, the most mobile elements were cadmium and lead. Arsenic was not available for vegetables. The health risk was calculated for two exposure routes: ingestion of soil and ingestion of vegetables. The site-specific exposure parameters were established after a population based survey and a special equation was created to calculate the health risk due to homegrown vegetable consumption. The highest risk was associated with ingestion of vegetables, the most hazardous element being lead. The hazard index did not exceed the threshold value of one in flooded or non-flooded gardens. The analyses of health risk indicated that despite the high metal concentrations of soil the contamination of vegetable gardens does not pose an unacceptable risk to the inhabitants of the village.

Pesticide and non-dioxin-like polychlorinated biphenyls (NDL-PCBs) residues in foodstuffs from Ismailia city, Egypt.

Samples of vegetables and cereals from Egypt were screened for 113 pesticides, of which 68 were quantified, using gas chromatography-mass spectrometry (GC/MS) with limits of detection (LODs) ranging from 0.02 to 1.9 µg kg⁻¹. In addition, the residues of 17 non-dioxin-like polychlorinated biphenyls (NDL-PCBs) were measured in samples of animal origin (meat, dairy products and seafood) using high-resolution gas chromatography (HRGC)/high-resolution mass spectroscopy (HRMS). None of the cereal samples and 72.7% of the vegetables contained any detectable levels of the pesticides. Detectable residues, not exceeding the current European Union maximum residue limits (MRLs) were found in 27.3% of vegetables. The estimated daily intake for detected pesticides was well below their corresponding acceptable daily intake (ADI), with exposure ranges between 0.002% of the ADI for profenofos and 0.2% of the ADI for lambda-cyhalothrin. The sum concentration of 17 PCBs congeners varied between 2.5 and 322 ng g⁻¹ fat, corresponding to 1.7-216 ng g⁻¹ fat for the seven indicator PCBs. The highest values were measured in seafood, the lowest in dairy products. Hexa-CB 153, 138 and hepta-CB180 were the congeners with the highest contribution. PCBs congener profiles found in most of the samples were consistent with the expected profile for Aroclor 1260 and 1262. PCBs' contamination levels reported in this paper were many times lower than in developed countries, except for chicken samples. Also, the dietary intake of seven indicator PCBs due to the consumption of food of animal origin (4.84 ng kg⁻¹ body weight day⁻¹) from Ismailia city, Egypt, is several times lower than the intake in European Union countries.

Growing vegetables in developing countries for local urban populations and export markets: problems confronting small-scale producers.

Vegetables attract high applications of pesticides, and farmers in developing countries use many acutely toxic insecticides to control pests on these crops. With the liberalisation of agricultural markets in developing countries, the number of small-scale farmers growing vegetables for both domestic and export markets is increasing. Demand for supplies of year-round and exotic fruit and vegetables has grown in industrialised countries, but with rising quality standards and traceability requirements it is difficult for small-scale farmers to benefit from this lucrative non-traditional agricultural export trade. The demand is high for vegetables in the expanding cities in developing countries, and farmers in peri-urban areas, or rural areas with good access to the cities, are in a position to find a growing market for their produce. Poor storage facilities will often mean that farmers are forced to sell at peak times when prices are low. Farmers rarely have access to training in pesticide use, and have only limited or no access to advice on the complicated management of pesticides. The Food and Agriculture Organisation of the UN is concerned about high levels of poor quality and adulterated pesticides on sale in developing countries. Surveys repeatedly show that without training, farmers are unable to make good crop decisions: recognition of pests and their predators is generally low, leading to decisions to spray to kill any insect; knowledge of product selection, application rates and timing is poor; different products are often combined in the belief that the effect will be greater; re-entry periods after spraying and essential harvest intervals are not known; and without knowledge of alternatives, farmers will often assume that the only solution to pest problems is to spray more frequently. From a consumer's point of view, few developing countries are able to monitor pesticide residues, particularly for produce grown for home consumption: most countries do not have laboratories for even simple residue testing. Changes in European Maximum Residue Limits means that export crops will be rejected if they contain residues at the Limit of Detection of pesticides not registered in Europe. Season-long field level training in Integrated Pest Management can help farmers to become better decision-makers, and to greatly reduce pesticide use while reducing risks to their own health and environment, producing safer products for consumers, maintaining yields, and increasing incomes.

Changes in beta-carotene and ascorbic acid content of fresh amaranth and fenugreek leaves during storage by low cost technique.

Leafy vegetables are highly perishable and their shelf life depends on duration and conditions of storage. A low cost storage structure was used to extend the shelf life of amaranth and fenugreek and their quality was evaluated on the basis of retention of beta-carotene, ascorbic acid and chlorophyll during storage. Losses of beta-carotene ranged from 46.5 to 85.0% for amaranth and 24.0 to 73.0% for fenugreek depending on duration and conditions of storage. Similarly ascorbic acid retention varied from 9-32% for amaranth and 23-80% for fenugreek. Results showed that the degradation of quality parameters was faster at ambient conditions and packaging of leaves in low density polyethylene bags was beneficial in improving shelf life and nutritive value. Low cost storage structure was similar to low temperature storage for retention of beta-carotene, ascorbic acid, chlorophyll content and enhancement of shelf life.

The Healthy Eating Index: design and applications.

OBJECTIVE: To develop an index of overall diet quality. DESIGN: The Healthy Eating Index (HEI) was developed based on a 10-component system of five food groups, four nutrients, and a measure of variety in food intake. Each of the 10 components has a score ranging from 0 to 10, so the total possible index score is 100. METHODS/SUBJECTS: Data from the 1989 and 1990 Continuing Survey of Food Intake by Individuals were used to analyze the HEI for a representative sample of the US population. STATISTICAL ANALYSES PERFORMED: Frequencies, correlation coefficients, means. RESULTS: The mean HEI was 63.9; most people scored neither very high nor very low. No one component of the index dominated the HEI score. People were most likely to do poorly in the fruit, saturated fat, grains, vegetable, and total fat categories. The HEI correlated positively and significantly with most nutrients; as the total HEI increased, intake for a range of nutrients also increased. DISCUSSION/CONCLUSIONS: The HEI is a useful index of overall diet quality of the consumer. The US Department of Agriculture will use the HEI to monitor changes in dietary intake over time and as the basis of nutrition promotion activities for the population.

Dietary intake of fruits and vegetables in Norway: influence of life phase and socio-economic factors.

The aim of the study was to contribute to a better understanding of factors influencing the consumption of fruits, vegetables and potatoes among consumers in Norway. It is built on data from two consumer surveys; one including 1103 persons and the other including 13,857 persons. The data indicate that a considerable proportion of the consumers had a very low frequency of consumption when compared to present recommendations of intake; 31% consumed vegetables, and 24% fruits twice a week or less. Data from multivariate analyses (logistic regression) showed that age, sex, income and household structure were important determinants for the consumption of fruits. These factors, as well as education and place of living were important determinants of the consumption of vegetables and potatoes. Consumers who were very interested in health issues, were more likely to have a high consumption of fruits and vegetables, whereas those who had a preference for quickly prepared food tended to have a low consumption of vegetables. These results are discussed in relation to the consumers own perception of important limitations for consumption of these products.