'Nutrition is out of our control': soldiers' perceptions of their local food environment.

OBJECTIVE: To explore the perceptions of soldiers participating in a US Army Office of The Surgeon General's worksite health promotion programme (WHPP) on the local food environment within their campus-style workplace. DESIGN: Focus groups were conducted to evaluate the perceived effectiveness of the WHPP implementation. Further exploration of focus group data through thematic analysis focused on perceived contributions of the military campus-style food environment to soldiers' nutrition behaviours. SETTING: Three US Army installations located in the continental USA. PARTICIPANTS: Active duty soldiers (n 366) participating in one of the fifty-eight focus groups. RESULTS: Soldiers shared a common belief of self-discipline and personal responsibility as the foothold to nutrition behaviour change. Soldiers described aspects of the military campus-style food environment as factors impeding achievement of optimal nutrition. Collectively, soldiers perceived the proximity and density of fast-food restaurants, lack of healthy alternatives on the installation and the cost of healthy food as inhibitors to choosing healthy foods. Overwhelmingly, soldiers also perceived time constraints as a factor contributing to unhealthy food choices. CONCLUSIONS: Although nutrition behaviour is individually driven, soldiers perceived the military campus-style food environment inhibits healthy decision making. Nutrition programming in military WHPP must integrate food environment changes to improve soldiers' nutrition behaviour outcomes. Applicable to the military, food choice behaviour studies suggest environmental changes must be appealing to young adults. Considerations for environmental changes should include an increased portion size for healthy options, broadened use of soldiers' daily food allowances on local produce and increased availability of grab-and-go options.

Assessing and understanding sedentary behaviour in office-based working adults: a mixed-method approach.

BACKGROUND: Sedentary behaviours (SB) can be characterized by low energy expenditure in a reclining position (e.g., sitting) often associated with work and transport. Prolonged SB is associated with increased risk for chronic conditions, and due to technological advances, the working population is in office settings with high occupational exposure to SB. This study aims to assess SB among office workers, as well as barriers and strategies towards reducing SB in the work setting. METHODS: Using a mixed-methods approach guided by the socio-ecological framework, non-academic office workers from a professional school in a large public university were recruited. Of 180 eligible office workers, 40 enrolled and completed all assessments. Self-reported and objectively measured SB and activity levels were captured. Focus group discussion (FGD) were conducted to further understand perceptions, barriers, and strategies to reducing workplace SB. Environmental factors were systematically evaluated by trained research staff using an adapted version of the Checklist for Health Promotion Environments at Worksites (CHEW). Thematic analysis of FGD was conducted and descriptive analysis of quantitative data was performed. RESULTS: The sample was mostly Chinese (n = 33, 80 %) with a total of 24 (60 %) female participants. Most participants worked five days a week for about 9.5(0.5) hrs/day. Accelerometer data show that participants spend the majority of their days in sedentary activities both on workdays (76.9 %) and non-workdays (69.5 %). Self-report data confirm these findings with median sitting time of 420(180) minutes at work. From qualitative analyses, major barriers to reducing SB emerged, including the following themes: workplace social and cultural norms, personal factors, job scope, and physical building/office infrastructure. CHEW results confirm a lack of support from the physical infrastructure and information environment to reducing SB. CONCLUSIONS: There is high SB among office workers in this sample. We identified multiple levels of influence for prolonged occupational SB, with a particular emphasis on workplace norms and infrastructure as important barriers to reducing SB and increasing PA. A larger, representative sample of the Singaporean population is needed to confirm our findings but it seems that any intervention aimed at reducing SB in the workplace should target individual, environmental, and organizational levels.

Do the Features, Amenities, and Quality of Physical Activity Resources Differ Between City and County Areas of a Large Rural Region?

The goal of this work was to provide a community-academic partnership with actionable information for physical activity (PA) for a rural health-disparate region. Identified PA outlets were audited and combined with survey data for 813 residents in the region. Less than a third of sampled residents (28%) met PA recommendations, with low perceptions of safety for PA. PA resource outlets in rural areas had higher numbers of incivilities. On the basis of our findings, 4 actionable strategies are recommended: shared-use agreements, reducing incivilities, addressing issues related to safety from traffic, and increasing the number of PA resources in rural areas.

Lack of healthy food options on children's menus of restaurants in the health-disparate Dan River region of Virginia and North Carolina, 2013.

INTRODUCTION: Interest has increased in understanding the types and healthfulness of restaurant foods for children, particularly in disadvantaged areas. The purpose of this community-based participatory research study was to describe the quality of restaurant food offered to children in a health-disparate region in Virginia and North Carolina and to determine if the availability of healthy foods differed by location (rural, urban) or by the predominant race (black, white, mixed race) of an area's population. METHODS: Restaurants offering a children's menu in the 3 counties in Virginia and North Carolina that make up the Dan River Region were identified by using state health department records. Research assistants reviewed menus using the Children's Menu Assessment (CMA), a tool consisting of 29 scored items (possible score range, -4 to 21). Scores were calculated for each restaurant. We obtained information on the predominant race of the population at the block group level for all counties from 2010 US Census data. RESULTS: For the 137 restaurants studied, mean CMA scores were low (mean, 1.6; standard deviation [SD], 2.7), ranging from -4 to 9 of 21 possible points. Scores were lowest for restaurants in the predominantly black block groups (mean, 0.2; SD, 0.4) and significantly different from the scores for restaurants in the predominantly white (mean, 1.4; SD, 1.6) and mixed-race block groups (mean, 2.6; SD, 2.4) (F = 4.3; P < .05). CONCLUSION: Children's menus available in the Dan River Region lack healthy food options, particularly in predominantly black block groups. These study findings can contribute to regional efforts in policy development or environmental interventions for children's food quality by the community-based participatory research partnership and help local stakeholders to determine possible strategies and solutions for improving local food options for children.

Understanding physical activity and sedentary behaviour among preschool-aged children in Singapore: a mixed-methods approach.

OBJECTIVES: This study investigated physical activity (PA) and sedentary behaviour (SB) among preschool-aged children in Singapore and potential correlates at multiple levels of the socioecological model from in-school and out-of-school settings. DESIGN: A cross-sectional study using a mixed-methods approach. PARTICIPANTS: Parent-child dyads from six preschools in Singapore. METHODS: PA and SB of children (n=72) were quantified using wrist-worn accelerometers for seven consecutive days. Three focus group discussions (FGDs) among 12 teachers explored diverse influences on children's activities, and System for Observing Play and Leisure Activity in Youth (SOPLAY) assessed PA environment and children's activity levels at preschools. Seventy-three parents completed questionnaires on home and neighbourhood factors influencing children's PA and SB. Descriptive analyses of quantitative data and thematic analysis of FGDs were performed. RESULTS: Based on accelerometry, children (4.4±1.1 years) spent a median of 7.8 (IQR 6.4-9.0) hours/day in SB, and 0.5 (0.3-0.8) hours/day in moderate-to-vigorous physical activity (MVPA). MVPA was similar throughout the week, and SB was slightly higher on non-school days. In preschools, SOPLAY showed more children engaging in MVPA outdoors (34.0%) than indoors (7.7%), and absence of portable active play equipment. FGDs revealed issues that could restrict active time at preschool, including academic requirements of the central curriculum and its local implementation. The teachers had varying knowledge about PA guidelines and perceived that the children were sufficiently active. In out-of-school settings, parents reported that their children rarely used outdoor facilities for active play and spent little time in active travel. Few children (23.5%) participated in extracurricular sports, but most (94.5%) reported watching screens for 1.5 (0.5-3.0) hours/day. CONCLUSION: MVPA was low and SB was high in preschool-aged children in an urban Asian setting. We identified diverse in-school and out-of-school correlates of PA and SB that should be taken into account in health promotion strategies.

Associations among chronic disease status, participation in federal nutrition programs, food insecurity, and sugar-sweetened beverage and water intake among residents of a health-disparate region.

OBJECTIVE: To determine whether sociodemographic characteristics, food security status, participation in federal nutrition programs (Supplemental Nutrition Assistance Program [SNAP] or Special Supplemental Nutrition Program for Women, Infants, and Children [WIC]), and chronic disease status were associated with adherence to water and sugar-sweetened beverage (SSB) intake recommendations. DESIGN: Cross-sectional, random-digit phone survey with questions from the Behavioral Risk Factor Surveillance System and beverage intake questionnaire. PARTICIPANTS: Residents of a medically underserved, rural area. MAIN OUTCOME MEASURES: Water and SSB intake. ANALYSIS: Descriptive statistics, chi-square and 1-way ANOVA, and linear and logistic regression. RESULTS: The sample consisted of 930 respondents (aged 56 ± 17 years; 35% non-white); reported food insecurity and SNAP and WIC participation were 37%, 29%, and 8%, respectively. Prevalent health conditions included overweight/obesity (69%), diabetes (19%), and hypertension (45%). Water recommendations were more likely to be met (72%; mean intake, 31 ± 19 fluid oz) than SSB (41%; mean intake, 246 ± 297 kcal). Food insecurity and SNAP/WIC participation were not associated with meeting recommendations, but those reporting ≥ 1 chronic disease were more likely to meet SSB recommendations (odds ratio, 2.42; P = .02). CONCLUSIONS AND IMPLICATIONS: Odds of achieving SSB but not water recommendations were greater among individuals with a chronic disease. Efforts to communicate beverage recommendations to at-risk groups are needed.