Dyadic Peer Support to Improve Diet and Physical Activity Among African American Church Members: An Exploratory Study.

This study examined how African American church members communicated and cooperated as dyads to attain health goals. Participants completed nine weeks of group classes then worked as dyads for nine weeks. Communication logs and interviews were used to assess: (1) dyad communication and (2) dyad cooperation. Thirty-two dyads from three churches completed the study. Dyads communicated an average of two times per week. Dyads experienced challenges and provided encouragement. Findings indicate African American church members cooperate and communicate as family, friend, and acquaintance dyads to achieve health goals.

Food Insecurity in the Rural United States: An Examination of Struggles and Coping Mechanisms to Feed a Family among Households with a Low-Income.

Households with a low-income in rural places experience disproportionate levels of food insecurity. Further research is needed about the nuances in strategies that households with a low-income in rural areas apply to support food security nationally. This study aimed to understand the barriers and strategies that households with a low-income in rural areas experience to obtain a meal and support food security in the United States. We conducted a qualitative study with semi-structured interviews among 153 primary grocery shoppers with a low-income residing in rural counties. A majority of family's ideal meals included animal-based protein, grains, and vegetables. Main themes included struggles to secure food and coping mechanisms. Ten categories included affordability, adequacy, accommodation, appetite, time, food source coordinating, food resource management, reduced quality, rationing for food, and exceptional desperation. These results can inform public health professionals' efforts when partnering to alleviate food insecurity in rural areas.

Disparities in dietary practices during the COVID-19 pandemic by food security status.

Little is known about the differences in dietary practices among food secure and food insecure populations during the early COVID-19 pandemic restrictions. The purpose of this study was to examine differences in dietary practices the early COVID-19 pandemic restrictions between adults reporting food security versus food insecurity. An online cross-sectional survey using validated measures was administered between April and September 2020 to explore both dietary patterns and practices and food security status among persons residing in five U.S. states from different regions of the country during the COVID-19 pandemic. Between-group differences (food secure versus food insecure) were examined for dietary practice outcomes using Pearson's Chi-Square test statistic, with Fisher's Exact test for cell counts less than five. There were 3,213 adult respondents. Food insecurity increased among the survey sample from 15.9% before the COVID-19 pandemic to 23.1% during the onset of the COVID-19 pandemic (p < 0.01). Compared to food secure respondents, those experiencing food insecurity reported more group gatherings for meals during the pandemic, decreased fruit and vegetable intake, and a need for more nutrition support resources than food secure respondents (p < 0.05). Food secure individuals reported increasing alcohol consumption, more frequent take-out or delivery ordering from fast food or restaurants, and more interest in supporting the local food system (p < 0.05). Results indicate a clear risk of disparities in dietary practices based on food security status during the early COVID-19 pandemic restrictions. Public health research, practice, and policy efforts should tailor specific efforts towards both food secure and food insecure groups.

Religious social capital and minority health: A concept analysis.

OBJECTIVE: Optimizing resources within environments where people live, work, and pray can aid nurses in improving public health. Religion and social capital significantly influence the health of individuals and communities, particularly among racial and ethnic minorities in the United States. A concept analysis of religious social capital was conducted to clarify how this resource is used in the context of health. DESIGN AND SAMPLE: Rodgers' evolutionary concept analysis method guided this analysis. A search of PubMed, CINAHL, and PsycINFO, using keywords "religious social capital" and "health" yielded 152 publications. RESULTS: Antecedents were "defined religious social network," "voluntary membership," "shared values," and "trust." Attributes were "relationships (bonding bridging, and linking)," "information exchange and resource sharing," and "reciprocal participation." Consequences were "increased productivity," "increased resources," "better personal and community health," and "trust." A model case of African American women and HIV prevention was included to illustrate how religious social capital can be developed and optimized to promote health. CONCLUSION: Religious social capital is defined as increased individual and collective capabilities that result from voluntary and reciprocal participation in bonding, bridging, or linking social network relationships and activities. Religious social capital is an accessible resource that can be leveraged to improve minority health.

Examining the relationship between physical activity and mental health during the COVID-19 pandemic across five U.S. States.

The objectives of this paper are to investigate: 1) how the COVID-19 pandemic influenced both physical activity practices and mental health status, and 2) to assess the relationship between the two. Our mixed-methods study draws on 4,026 online survey responses collected between April - September 2020 across five states (Louisiana, Montana, North Carolina, Oregon and West Virginia). Logistic regression models were run for two outcome variables (physical activity and mental health status (measured using the Kessler Psychological Distress scale)). Researchers controlled for race/ethnicity, household income/size, gender, urbanicity, education, employment, use of government assistance and presence of chronic health conditions. Qualitative analysis was applied to open-ended survey responses to contextualize quantitative findings. Household income was significant in predicting difficulty maintaining pre-pandemic physical activity levels; pre-pandemic physical activity levels were associated with increased psychological distress levels during COVID-19; and race/ethnicity, income status and urbanicity were significantly associated with deteriorating mental health status and physical activity levels during COVID-19. Data suggests that a bi-directional, cyclical relationship between physical activity and mental health exists. Policy implications should include physical activity promotion as a protective factor against declining mental health.

Examining Rural Food-Insecure Families' Perceptions of the Supplemental Nutrition Assistance Program: A Qualitative Study.

The Supplemental Nutrition Assistance Program (SNAP) is a critical program that helps reduce the risk of food insecurity, yet little is known about how SNAP addresses the needs of rural, food-insecure residents in the United States (U.S.). This study examines how rural, food-insecure residents perceive SNAP. Semi-structured interviews were conducted with 153 individuals living in six diverse rural regions of Arkansas, Montana, North Carolina, Oregon, Texas, and West Virginia. SNAP was described as a crucial stop-gap program, keeping families from experiencing persistent food insecurity, making food dollars stretch when the family budget is tight, and helping them purchase healthier foods. For many rural residents interviewed, SNAP was viewed in a largely positive light. In efforts to continue improving SNAP, particularly in light of its relevance during and post-coronavirus (COVID-19) pandemic, policymakers must be aware of rural families' perceptions of SNAP. Specific improvements may include increased transparency regarding funding formulas, budgeting and nutrition education for recipients, effective training to improve customer service, connections among social service agencies within a community, and increased availability of automation to streamline application processes.

The Curated Food System: A Limiting Aspirational Vision of What Constitutes "Good" Food.

In an effort to elucidate an aspirational vision for the food system and explore whether the characteristics of such a system inadvertently set unattainable standards for low-wealth rural communities, we applied discourse analysis to the following qualitative datasets: (1) interviews with food experts and advocates, (2) scholarly and grey literature, (3) industry websites, and (4) email exchanges between food advocates. The analysis revealed eight aspirational food system discourses: production, distribution, and infrastructure; healthy, organic, local food; behavioral health and education; sustainability; finance and investment; hunger relief; demand-side preferences; romanticized, community led transformations. Study findings reveal that of eight discourses, only three encompass the experiences of low-wealth rural residents. This aspirational food system may aggravate the lack of autonomy and powerlessness already experienced by low-wealth rural groups, perpetuate a sense of failure by groups who will be unable to reach the aspirational food vision, silence discourses that might question those that play a role in the inequitable distribution of income while sanctioning discourses that focus on personal or community solutions, and leave out other policy-based solutions that address issues located within the food system. Further research might explore how to draw attention to silenced discourses on the needs and preferences of low-wealth rural populations to ensure that the policies and programs promoted by food system experts mitigate poor diets caused by food insecurity. Further research is needed to inform policies and programs to mitigate food insecurity in low-wealth rural populations.

Evaluation of a Policy, Systems, and Environmental-Focused Faith-Based Health Promotion Program.

OBJECTIVE: This study assessed the impact and lessons learned from implementing policy, systems, and environmental (PSE) changes through Faithful Families Thriving Communities (Faithful Families), a faith-based health promotion program, in 3 southern states. METHODS: Faithful Families classes and PSE changes were implemented through a coordinated effort between the Expanded Food and Nutrition Education Program (EFNEP) and Supplemental Nutrition Assistance Program-Education (SNAP-Ed). Changes were measured using a faith community assessment, site reports, and annual reporting. RESULTS: Thirteen faith communities participated in the intervention. A total of 34 PSE changes were implemented across the 3 states, affecting 11 faith communities with 4,810 members across sites. CONCLUSIONS AND IMPLICATIONS: Programs such as Faithful Families can allow EFNEP and SNAP-Ed to coordinate to implement PSE changes in community settings. However, these types of coordinated programs to support faith communities require time for relationship building and trust, adequate training, and strong support for faith-based lay leaders as they carry out this work.

The Four Domain Food Insecurity Scale (4D-FIS): development and evaluation of a complementary food insecurity measure.

The U.S. Department of Agriculture (USDA) Food Security Survey Module (FSSM) is a valuable tool for measuring food insecurity, but it has limitations for capturing experiences of less severe food insecurity. To develop and test the Four Domain Food Insecurity Scale (4D-FIS), a complementary measure designed to assess all four domains of the food access dimension of food insecurity (quantitative, qualitative, psychological, and social).Low-income Black, Latina, and White women (n = 109) completed semi-structured (qualitative) and structured (quantitative) interviews. Interviewers separately administered two food insecurity scales, including the 4D-FIS and the USDA FSSM adult scale. A scoring protocol was developed to determine food insecurity status with the 4D-FIS. Analyses included a confirmatory factor analysis to examine the hypothesized structure of the 4D-FIS and an initial evaluation of reliability and validity. A four-factor model fit the data reasonably well as judged with fit indices. Results showed relatively high factor loadings and inter-factor correlations indicated that factors were distinct. Cronbach's alpha (ɑ) for the overall scale was 0.90 (subscale ɑ ranged from 0.69 to 0.91) and provided support for the scale's internal consistency reliability. There was fair overall agreement between the 4D-FIS and USDA FSSM adult scale, but agreement varied by category. Findings provide preliminary support for the 4D-FIS as a complementary measure of food insecurity, with implications for researchers, practitioners, and policymakers working in U.S. communities.

Faithful Families, Thriving Communities: Bridging Faith and Health Through a State-Level Partnership.

Faith communities are increasingly being recognized as important leaders in community health work, both in the United States and globally. However, faith communities are also often working at or beyond capacity in terms of meeting the social, emotional, and health needs of the communities they serve. To bridge these gaps and build on the significant assets that faith communities possess, the Faithful Families Thriving Communities program was created in 2007 as a partnership between the North Carolina Division of Public Health and North Carolina State University. Based on the social-ecological model, Faithful Families trains and empowers lay leaders from the faith community to coteach and partner with health educators from Cooperative Extension or public health as they support individual members and the faith community at large to adopt changes that can address inequities in their communities related to access to healthy foods and places to be active. This essay highlights the formation and development of this partnership, outlining challenges and best practices for this kind of "bridging" between public health and communities of faith, particularly related to state-level programmatic support and collaboration.

How Social, Cultural, and Economic Environments Shape Infant Feeding for Low-Income Women: A Qualitative Study in North Carolina.

BACKGROUND: This study focuses on the cultural, social, and economic factors that shape infant feeding practices among low-income mothers. OBJECTIVE: The objective was to understand factors that inhibit or facilitate breastfeeding practices of low-income mothers, including how they are linked to broader social, cultural, and economic processes. DESIGN: In-depth qualitative interviews were conducted with women about their feeding practices and food environments, including their experiences with breastfeeding and formula feeding. PARTICIPANTS: The sample was comprised of 98 low-income mothers with at least one child between 2 and 9 years old at the time of interview. RESULTS: Sixteen mothers (16.7%) breastfed for 6 months, and six (6.3%) were still breastfeeding at 12 months. Only 11 mothers (11.5%) exclusively breastfed for 6 months. Women reported several factors influencing infant feeding: interactions with medical providers, work environments, shared living spaces and family supports, and concerns about supply and production. CONCLUSIONS: This research highlights the complex interplay of economic and social barriers that shape how and what low-income women feed their infants. The study contributes to a better understanding of the social, cultural, and economic constraints faced by women in poverty. To improve breastfeeding rates among low-income women, it is important to examine the impacts of poverty and food insecurity on infant feeding practices.

Shared Use of Physical Activity Facilities Among North Carolina Faith Communities, 2013.

INTRODUCTION: Shared use of recreational facilities is a promising strategy for increasing access to places for physical activity. Little is known about shared use in faith-based settings. This study examined shared use practices and barriers in faith communities in North Carolina. METHODS: Faith communities in North Carolina (n = 234) completed an online survey (October-December 2013) designed to provide information about the extent and nature of shared use of recreational facilities. We used binary logistic regression to examine differences between congregations that shared use and those that did not share use. RESULTS: Most of the faith communities (82.9%) that completed the survey indicated that they share their facilities with outside individuals and organizations. Formal agreements were more common when faith communities shared indoor spaces such as gymnasiums and classroom meeting spaces than when they shared outdoor spaces such as playgrounds or athletic fields. Faith communities in the wealthiest counties were more likely to share their spaces than were faith communities in poorer counties. Faith communities in counties with the best health rankings were more likely to share facilities than faith communities in counties that had lower health rankings. The most frequently cited reasons faith communities did not share their facilities were that they did not know how to initiate the process of sharing their facilities or that no outside groups had ever asked. CONCLUSION: Most faith communities shared their facilities for physical activity. Research is needed on the relationship between shared use and physical activity levels, including the effect of formalizing shared-use policies.