Reducing food insecurity and improving fruit and vegetable intake through a nutrition incentive program in Michigan, USA.

BACKGROUND: Nutrition incentive (NI) programs increase the purchase of fruits and vegetables (FVs) among low-income participants. Double Up Food Bucks (DUFB) is a robust statewide NI program in the United States. The purpose of this paper is to report findings from DUFB in Michigan describing the factors related to FV intake (FVI) and food insecurity among participants in a NI program. METHODS: We administered a repeated cross-sectional survey with a convenience sample of DUFB participants at farmers markets and grocery stores (over the 2016, 2017, 2018 seasons). The survey was conducted online via paper-pencil. Descriptive statistics were calculated for all variables. A logistic regression model estimated household food insecurity and a linear regression estimated FVI with DUFB use/perceptions, sociodemographics, and health status as independent variables (significance level = p < 0.05). RESULTS: Descriptive results revealed that participants that completed surveys at grocery stores tended to be more racially-ethnically diverse and younger than participants that completed surveys at farmers markets. Participants with lower length of time participating in DUFB (i.e., lower dose) (p < 0.001), greater FV purchases (p < 0.05), and lower perceived health status (p < 0.001) tended to report being food insecure more frequently. Participants with increased length of time participating in DUFB (p < 0.05), greater FV purchases (p < 0.001), being male (p < 0.01), and greater perceived health status (p < 0.001) tended to report higher levels of FVI more frequently. CONCLUSIONS: Longer participation in DUFB leads to improved outcomes with FVI and food security, suggesting that NI programs do have the intended positive impact they were designed to achieve.

Refinement of measures to assess psychosocial constructs associated with skin cancer risk and protective behaviors of young adults.

The study's purpose was to select/refine measures assessing psychosocial constructs associated with skin cancer risk/protective behaviors. Cognitive interviewing was conducted with twenty participants locally, and a survey was conducted with 965 adults aged 18-25 years at moderate to high risk of developing skin cancer, recruited nationally online. Psychosocial measures assessed variables from the Integrative Model of Behavior Prediction. As a result of expert review and cognitive interviewing, items were removed, added, and/or made simpler, more personal, consistent, and less ambiguous. A factor analysis resulted in 14 scales and adequate model fit. Internal reliability and test-retest reliability was acceptable to good. Correlations among the psychosocial and behavioral variables were generally significant and in expected directions, demonstrating convergent validity. We have refined measures that assess important psychosocial constructs associated with skin cancer-related behaviors, that research participants can understand and complete successfully, and that are reliable and demonstrate evidence for validity.

An integrative literature review of small food store research across urban and rural communities in the U.S.

OBJECTIVE: The purpose of this review was to identify how rural and urban food access differs across small food stores as well as the types of research strategies and methodologies that have been applied in each setting in the U.S. METHODS: Manuscripts were included in the review if they were published in English over the past ten years, with a clear delineation between urban and/or rural, conducted in the U.S., and reported data from small food store research. RESULTS: After elimination, 19 manuscripts representing rural (n = 5) and urban (n = 14) settings were included in the final review. The review was conducted in Nebraska between January 2015 and May 2015. Findings from the reviewed manuscripts revealed that rural communities might face different challenges with healthy food access in small food stores when compared to urban settings. In particular, small food stores in rural areas lacked healthy food options largely because storeowners perceived that their customers would not purchase healthier items and due to challenges with distribution. Conversely, studies reporting on small food stores in urban areas suggest challenges with transportation and safety concerns. CONCLUSION: Research on small food stores is nascent and further research, especially intervention studies, is needed. Further, less evidence exists on healthy food access, in particular intervention testing on small food store research in rural areas.

Measurement of tanning dependence.

BACKGROUND: Indoor tanning has been found to be addictive. However, the most commonly used tanning dependence measures have not been well validated. OBJECTIVE: The study's purpose was to explore the psychometric characteristics of and compare the modified Cut-down, Annoyed, Guilty, Eye-opener Scale (mCAGE), modified Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition - Text Revised (mDSM-IV-TR) and Tanning Pathology Scale (TAPS) measures of tanning dependence and provide recommendations for research and practice. METHODS: This study was a cross-sectional online survey with 18- to 25-year-old female university students. The main outcome variable was tanning dependence measured by the mCAGE, mDSM-IV-TR and TAPS. RESULTS: Internal consistency of the TAPS subscales was good but was poor for the mCAGE and mDSM-IV-TR, except when their items were combined. Agreement between the mCAGE and mDSM-IV-TR was fair. Factor analysis of the TAPS confirmed the current four-factor structure. All of the tanning dependence scales were significantly correlated with one another. Likewise, most of the tanning dependence scales were significantly correlated with other measures of tanning attitudes and behaviours. However, the tolerance to tanning TAPS subscale was not significantly correlated with any measure of tanning attitudes or behaviours and had the lowest subscale internal reliability and eigenvalues. CONCLUSION: Based on the data and existing literature, we make recommendations for the continued use of tanning dependence measures. Intervention may be needed for the approximately 5% of college women who tend to be classified as tanning dependent across measures. Monitoring of individuals reporting tanning dependence symptoms is warranted.

Development of a modified picture-sort food frequency questionnaire administered to low-income, overweight, African-American adolescent girls.

There is essentially no ideal method of dietary assessment. Physiologic methods (i.e., doubly labeled water) probably come closest, but high cost, participant burden, and limited information limit their use. Furthermore, most dietary assessment methods have been designed for and tested in white adults. Very few have been designed for and tested in African-American adolescents. This study examined validity and reliability of a modified picture-sort food frequency questionnaire (FFQ) administered to 22 low-income, overweight, African-American adolescent girls, aged 11 to 17 years. The FFQ was administered to subjects twice during a 2-week period, and evaluated using the mean values of three 24-hour recalls. The natural log-transformed energy-adjusted, deattenuated correlation coefficients between the second FFQ and the mean from 3 recalls exceeded 0.50 for most nutrients, ranging from 0.32 (protein) to 0.87 (saturated fat). The energy and nutrient values from the first FFQ were greater than those from the second FFQ. Most correlation coefficients for the test-retest reliability of the FFQ were not significant. We conclude that although larger samples are needed to generalize results, the picture-sort dietary assessment method appears to be promising and merits further research.

GO GIRLS!: results from a nutrition and physical activity program for low-income, overweight African American adolescent females.

This article describes the development, implementation, and results of an intervention designed for inner-city, overweight African American adolescent women. Fifty-seven participants were recruited from four public housing developments. Participants were administered physiologic, dietary, and cognitive assessments at baseline and immediately postintervention. Each session comprised three elements: (1) an educational/behavioral activity, (2) 30 to 60 minutes of physical activity, and (3) preparation and tasting of low-fat meals. In the absence of a control group, results were compared for high and low attenders, the former defined as attending at least 50% of the sessions. High attenders (n = 26) showed more favorable 6-month posttest values for most outcomes compared with low attenders (n = 31). These effects achieved statistical significance for nutrition knowledge, low-fat practices, perceived changes in low-fat practices, and social support.

Methods, results, and lessons learned from process evaluation of the high 5 school-based nutrition intervention.

This article describes the process evaluation of High 5, a school-based intervention targeting fruit and vegetable consumption among fourth graders and their families. The outcome evaluation involved 28 schools randomized to intervention or control conditions. The intervention included classroom, family, and cafeteria components. Process evaluation was completed on each of these components by using observations, self-report checklists, surveys, and other measures. Results indicated high implementation rates on the classroom activities. Moderate family involvement was attained, perhaps diminishing intervention effects on parent consumption. Cafeterias provided environmental cues, and fruit and vegetable offerings as directed by the program. A lower dose of the intervention was delivered to schools with larger African American enrollments and lower-income families. This article provides insights into the effective elements of a school-based dietary intervention and provides suggestions for process evaluation in similar studies.

Validity and reliability of a modified qualitative dietary fat index in low-income, overweight, African American adolescent girls.

This study evaluated the validity and reliability of a modified qualitative dietary fat index questionnaire (QFQ) in an adolescent minority population. The QFQ was administered to study participants twice over a 2-week period, and data were compared with mean values from three 24-hour recalls. Fifty-seven low-income, overweight, African American adolescent girls, aged 11 to 17 years, were recruited from 7 public housing developments in Atlanta, Georgia. To determine validity, the total QFQ score was compared with the mean values of total fat, percentage of energy from fat, and total energy from three 24-hour recalls within 2 weeks of first administration of the QFQ. Reliability was tested in a subsample (n = 22) by comparing total QFQ scores administered 2 weeks apart. Total fat was significantly correlated (r = 0.31, P < .05) with the QFQ score. Total energy (r = 20.23) and percentage of energy from fat (r = -0.23) were not significantly correlated with the QFQ score. The test-retest QFQ scores were significantly correlated (r = 0.54, P < .01). The data suggest that additional modifications are needed to make the QFQ more appropriate for low-income, over-weight, African American adolescent girls.