Piloting HealthScore: Feasibility and acceptability of a clinically integrated health coaching program for people living with cancer.

BACKGROUND: Cancer supportive care interventions often have limited generalizability, goal misalignment, and high costs. We developed and piloted a health coaching intervention, UNC HealthScore, in patients undergoing cancer treatment (ClinicalTrials.gov identifier NCT04923997). We present feasibility, acceptability, and preliminary outcome data. METHODS: HealthScore is a six-month, theory-based, multicomponent intervention delivered through participant-driven coaching sessions. For the pilot study, participants were provided a Fitbit, responded to weekly symptom and physical function digital surveys, and met with a health coach weekly to develop and monitor goals. Coaching notes were discussed in weekly interdisciplinary team meetings and provided back to the treating oncology team. Symptom alerts were monitored and triaged through a study resource nurse to relevant supportive care services. Feasibility was determined based on intervention enrollment and completion. Acceptability was based on satisfaction with coaching and Fitbit-wearing and was informed by semistructured exit interviews. Outcomes evaluated for signs of improvement included several PROMIS (Patient-Reported Outcomes Measurement Information System) measures, including the primary intervention target, physical function. RESULTS: From May 2020 to March 2022, 50 participants completed the single-arm pilot. Feasibility was high: 66% enrolled and 71% completed the full intervention. Participants reported an average of 4.8 and 4.7 (out of 5) on the acceptability of coaching calls and using the Fitbit, respectively. Physical function scores rose 3.1 points (SE = 1.1) from baseline to 3 months, and 4.3 (SE = 1.0) from baseline to 6 months, above established minimal clinically important difference (MCID). Improvements above MCID were also evident in anxiety and depression, and smaller improvements were demonstrated for emotional support, social isolation, cognitive function, symptom burden, and self-efficacy. DISCUSSION: HealthScore shows feasibility, acceptability, and promising preliminary outcomes. Randomized studies are underway to determine the efficacy of preserving physical function in patients with advanced cancer.

Formative Research to Create a Farm-to-School Program for High School Students in a Lower Income, Diverse, Urban Community.

BACKGROUND: Using Social Cognitive Theory as a framework, we examined opportunities for promoting local produce consumption among high school students in a lower-income, ethnically diverse, urban community. METHODS: Six focus groups (N = 53) were conducted with students. Using Atlas.ti qualitative software, data were coded and reviewed to identify code categories which could be taken to represent themes. RESULTS: Students (56.8% girls, 86.5% nonwhite) described local produce as being grown "nearby" or "in Connecticut." Overwhelmingly, students perceived local produce to be of higher quality (eg, "tastes better," "fresher") than nonlocal produce. Students reported that the foods served at school are "unnatural" and "made in a factory." Salient perceived outcomes associated with consuming local produce included "benefits the environment," "builds community and trust," and "keeps taxes down." Students recommended hanging large colorful posters highlighting the positive outcomes associated with consuming local produce in school locations with captive audiences such as lunch lines and classrooms. Labels identifying the food origins of cafeteria foods provided as well as taste tests of local produce might support students' self-efficacy for consuming local fruits and vegetables. CONCLUSIONS: These findings provide theory-based strategies for how to promote local produce consumption among a diverse group of urban high schools students.

Agricultural Experiences Are Positively Associated With High School Students' Fruit and Vegetable Perceptions and Consumption.

OBJECTIVE: To examine the relationship between high school students' agricultural experiences and their (1) attitudes about consuming local fruits and vegetables, (2) willingness to try new fruits and vegetables, and (3) fruit and vegetable consumption. DESIGN: Cross-sectional survey research. SETTING: Public high schools in a lower-income, diverse, urban, northeastern community. PARTICIPANTS: A total of 327 students from 3 public high schools. MAIN OUTCOME MEASURE(S): Exposures were prior experience helping on a farm or community garden (yes/no) and having a home garden (yes/no). Outcomes were perceptions about local produce consumption (α = .73), willingness to try new fruits (α = .86) and vegetables (α = .86), and adequate fruit and vegetable consumption (yes/no) as measured by a valid 2-item cup screener. ANALYSIS: Independent t tests, 1-way ANOVA, and chi-square tests were used. RESULTS: Half of students (52.9%) reported prior farm experience; 29.7% reported having a garden at home. Few students reported consuming at least 3 cups/d of vegetables (9.8%) or 2 cups/d of fruit (37.0%). Students with prior farm experience had more favorable scores for local produce perceptions (P = .002) and willingness to try new fruits (P = .001) and vegetables (P < .001) than were students without prior experience. Students with a home garden had more favorable scores for local produce perceptions (P = .02) and willingness to try new fruits (P = .001) and vegetables (P = .001) and more often consumed adequate vegetables (P = .007) than did students without a garden. CONCLUSIONS AND IMPLICATIONS: Those working with high school students might consider offering agriculture experiences that could promote positive fruit and vegetable attitudes and behaviors.

Park Use and Physical Activity Among Mostly Low-to-Middle Income, Minority Parents and Their Children.

BACKGROUND: Limited research has examined park use and physical activity among economically and ethnically diverse families. This study fills that gap. METHODS: Parents (n = 326) completed a questionnaire about their park use (yes/no, parks visited, reasons for nonuse) and physical activity (Godin Leisure Time questionnaire). Geographical Information Systems was used to calculate the distance from respondents' home address to their nearest park. The number of activity features (eg, playgrounds) in parks was determined objectively using the Community Park Audit Tool. RESULTS: Half of respondents were sufficiently active; 87.6% reported park use in the prior 6 months. Among sufficiently active respondents, 92.4% reported park use (P = .011). We found no difference in park proximity between respondents who did and did not report distance as a park use barrier. An objective assessment confirmed fewer activity features in parks near the homes of respondents reporting few activity features as a barrier to park use. The most often visited parks were significantly larger than the less-often visited parks. CONCLUSION: Parks might best support physical activity for families when activity features are carefully planned and equitably distributed across parks. Efforts to promote families' awareness of park locations might be warranted to reduce perceived proximity barriers.

Giving Economically Disadvantaged, Minority Food Pantry Patrons' a Voice: Implications for Equitable Access to Sufficient, Nutritious Food.

This study provides economically disadvantaged, minority food pantry patrons (hereafter, patrons) a meaning-ful voice by examining their experiences trying to obtain sufficient, nutritious food. Five focus groups were conducted using a semistructured discussion guide. Atlast.ti software was used to manage and analyze the data. Patrons reported that pantry staff who preserved their dignity by showing compassion were highly valued. Stigma and shame associated with pantry use were major concerns. Patrons suggested environmental and policy changes to improve their food acquisition experiences. These findings suggest that multilevel interventions addressing food access, food distribution policies, and patron-staff interactions are warranted.