Diabetes Prevention for Pacific People in the United States: A Mixed-Methods Feasibility Study to Adapt the Diabetes Prevention Program With Samoan/Tongan Church Communities.

OBJECTIVE: To determine baseline characteristics of a group of Samoans/Tongans in Southern California at risk for type 2 diabetes mellitus and identify barriers, cultural factors, and readiness and capacity to implement a culturally tailored Diabetes Prevention Program (DPP) in a faith-based setting. DESIGN: A mixed-methods pilot that included piloting modified DPP sessions, conducting a survey, and focus groups (N = 4). SETTING: Samoan/Tongan faith-based organizations. PARTICIPANTS: Samoan/Tongan church members in Southern California who were interested in lifestyle behavior change. MAIN OUTCOME MEASURES: Surveys assessing sociodemographic, acculturation, health status, food insecurity, and psychosocial factors. Focus groups focusing on attitudes toward the curriculum, opportunities for tailoring, and specific barriers/facilitators for healthy weight, nutrition, and physical activity. RESULTS: Participants (N = 47) were on average 42 years old, female (57%), and identified as Pacific Islander (35% Samoan, 30% American Samoan, and 35% Tongan). Ninety-eight percent of respondents were overweight/obese, and 45% of households were food insecure. Less than half of respondents were born in the United States, and 28% reported "poor" or "fair" English proficiency. Those with higher body mass indexes were more likely to score lower on internal locus of control and self-efficacy for healthy eating and were motivated to lose weight to feel in control of their health. Focus group results revealed that members of the Samoan/Tongan communities are "underserved" and experience a lack of culturally relevant programs to address obesity and chronic disease. Several barriers to healthier lifestyles were identified including adaptation of traditional recipes made in the United States (ie, to be less healthy), role of stress, cultural values (eg, preference for larger body size), and lack of awareness about healthy lifestyles. The church was identified as a resource that could be leveraged further to positively impact health outcomes. CONCLUSIONS: Results demonstrate possible ways to tailor the DPP for US-based Samoan/Tongan populations by harnessing cultural traditions and addressing existing barriers and psychosocial constructs.

A Qualitative Exploration of Indicators of Health Equity Embeddedness Among Public Health Policy Advocacy Campaigns.

There are socioeconomic and racial/ethnic health disparities that warrant policy change to advance health equity. The purpose of this qualitative study was to elucidate primary activities and/or tangible characteristics that indicate that a policy advocacy campaign has an embedded health equity focus. Researchers interviewed policy advocacy experts (n = 13) and campaign leaders (n = 9), transcribed audio recordings of interviews, and conducted a thematic analysis to examine health-equity-related processes within policy campaigns. Based on experiences of policy advocacy experts and campaign leaders, mostly within the Voices for Healthy Kids initiative, several objective aspects and activities were identified that indicate that a policy campaign, and the coalition that conducts the campaign, has an embedded health equity focus. It should be stressed that these activities are not intended to represent the extent of all campaign activities, only the subset of activities and aspects of a campaign that indicate a health equity orientation. Broadly, aspects identified were related to what had the campaign done to engage with the community, who in the community was providing input about direction of the campaign, and how had that community input been used. Authentic Community engagement was seen as the foundation of a campaign's health equity focus. A model synthesizing these findings is included in the results. A major strength of this study is that factors associated with health equity in campaign functioning are not typically assessed. These findings support identification of associated constructs to inform measurement development, and can help guide organizations, campaigns, and researchers working to advance health equity.

Descriptive Characteristics of Nutrition Incentive Projects Across the U.S.: A Comparison Between Farm Direct and Brick and Mortar Settings.

The purpose of this study is to describe the programmatic characteristics of current nutrition incentive projects supported by the Gus Schumacher Nutrition Incentive Program (GusNIP). Specifically, implementation characteristics of nutrition incentive projects that were funded in 2019 were compared across brick and mortar (B&M) and farm direct (FD) sites in the United States. Across 10 nutrition incentive (NI) grantees, there were 621 sites that reported data from B&M (n = 156) and FD (n = 465) locations. Among B&M sites, the common food retail types included: large chain traditional supermarket (n = 49) and independent traditional supermarket (n = 46). Among FD sites, the most frequently reported food retail types were farmers markets (n = 371). For B&M sites, the most common financial instruments were loyalty cards (n = 67, 43.5%), followed by an automatic discount at the register (n = 41, 26.6%), and coupons (n = 29, 18.8%). FD sites frequently reported physical financial instruments including tokens (n = 272, 61.1%), followed by paper vouchers (n = 131, 29.4%). Supplemental Nutrition Assistance Program (SNAP) purchases that were eligible to trigger incentives included mainly "all fresh FVs" at B&M sites (n = 98, 48.5%) and "all SNAP eligible items" at FD sites (n = 417, 85.8%). FVs eligible for incentive redemption included mainly "all fresh FVs" for both B&M sites (n = 110, 65.5%) and FD sites (n = 370, 67.6%). In terms of incentive-to-SNAP level ratio, both B&M sites and FD sites reported that they commonly utilized a 1:1 incentive-to-SNAP level ratio (n = 106, 68.8% and n = 261, 94.9% respectively). This paper will provide foundational understanding of the heterogeneity of GusNIP NI projects-specifically between B&M and FD settings-in order to inform future national work and ultimately demonstrate the impact of NI projects on food security status and dietary quality.

Healthy Food Incentive Programs: Findings From Food Insecurity Nutrition Incentive Programs Across the United States.

Diet-related chronic disease remains a public health concern, and low intake of fruits and vegetables disproportionately affects low-income populations. Healthy food incentive (HFI) projects can help close the nutrition gap among low-income populations by increasing purchasing power and access to fruits and vegetables. This study aimed to qualitatively explore lessons learned and best practices from Food Insecurity Nutrition Incentive Grant Program (FINI) grantees across the United States. Thirty semistructured interviews were conducted with FINI grantees and stakeholders in 2018, eliciting best practices and promising findings, policy implications, and knowledge gaps and opportunities to pursue that inform program refinement and sustainability. Telephone and in-person interviews were conducted with FINI grant recipients from 2015 to 2016, specifically, recipients of FINI-funded multiyear community-based projects and large-scale projects. Our results highlighted (1) range of projects and scope, (2) program promotion and awareness, (3) community-based partnerships, (4) technical assistance and peer interactions, (5) measurement and evaluation, (6) program challenges, and (7) future directions and recommendations. Grantees reported a "trifecta of benefits" that affects low-income consumers, farmers, and food retailers. Our findings contribute to understanding how to implement HFI programs in a variety of settings and highlight the variations that can exist between programs, as well as the need for increased technical assistance and synergy between programs (communities of practice). Overall, these findings can help to inform implementation and practice of healthy food incentive programs and the Farm Bill and other policy discussions.

Food Insecurity Nutrition Incentive Grant Program: Implications for the 2018 Farm Bill and Future Directions.

The 2018 Farm Bill was finalized in mid-December of 2018 after months of discussion and debate between policymakers. The Farm Bill has many implications for low-income and food-insecure populations in the United States. One program within the Farm Bill that helps bridge the nutrition gap for low-income Supplemental Nutrition Assistance Program participants is the Food Insecurity Nutrition Incentive Grant Program (FINI). This commentary explores the best practices and promising findings of FINI projects to inform future policy discussions and implementation of FINI. In addition, we discuss knowledge gaps and opportunities within the context of the extant literature. Stakeholders and FINI grantees reported positive impacts of FINI grants, describing outcomes across farmers, grocery store owners, local economies, and Supplemental Nutrition Assistance Program participants (eg, increased fruit and vegetable consumption). The 2018 Farm Bill was largely in alignment with the Academy's recommendations, and preserved the integrity of the Supplemental Nutrition Assistance Program as well as increased funding for FINI.

The Future of the Small Rural Grocery Store: A Qualitative Exploration.

OBJECTIVES: Rural communities face unique challenges to and opportunities for offering more healthful foods and are often understudied in comparison to their urban counterparts. The purpose of this study was to conduct a qualitative assessment of rural storeowners' perceptions of their communities, their business practices, and factors that influences their viability, sustainability, and ability to support healthy food choices. METHODS: We conducted interviews with storeowners (N = 15) in small stores in rural Nebraska and explored perceptions of business practices, role in the community, and consumer demand for more healthful foods. RESULTS: The storeowners reported strategies they employ to remain competitive, such as selling alcohol and tobacco, focusing on customer service, and ensuring quality of products. Manufacturer and distributor agreements often put constraints on their business models. Key challenges reported included a dwindling population and competition with larger chains in neighboring towns set in a sparsely populated landscape. Goals for the future included expanding equipment, largely to offer more prepared foods. CONCLUSIONS: This study adds to the literature around food access in rural communities, and can inform future implementation strategies to work with storeowners to improve healthy food access.

Auxiliary measures to assess factors related to food insecurity: Preliminary testing and baseline characteristics of newly designed hunger-coping scales.

The objective of this paper is to describe the development and preliminary testing of new scales to assess hunger-coping behaviors in a very low-income population. Very low-income adults (≥ 19 years), caregivers to at least one child (n = 306) completed a survey in a community setting (e.g., libraries). The survey included novel items assessing hunger-coping behaviors (e.g., trade-offs to purchase food, strategies to stretch and obtain food), food insecurity status, and physiological hunger. Internal consistency of hunger-coping scales, one-way ANOVAs, post-hoc analyses, Spearman's correlations among variables. Respondents were 75% female, 51% African American, 34% White, and 15% Hispanic, and 73% earned <$20,000/year. Four scales emerged: hunger-coping trade-offs, financial coping strategies, rationing coping strategies, and physiological adult hunger symptoms. All scales demonstrated acceptable internal consistency (α/KR-20 = 0.70-0.90). Predictive, construct, and content validity were demonstrated by correlations between hunger-coping scales and food insecurity (FI), measured with the USDA 6-item HFSSM (rs = 0.42-0.68, ps < 0.001). Higher levels of hunger-coping trade-offs (F(2,297) = 42.54, p < 0.001), financial coping strategies (F(2,287) = 70.77, p < 0.001), and rationing coping strategies (F(2,284) = 69.19, p < 0.001), corresponded with increasing levels of FI. These preliminary results support use of newly developed hunger-coping scales in a very low-income population and can compliment traditional food security measures to inform hunger prevention policy and programming.

A workplace farmstand pilot programme in Omaha, Nebraska, USA.

OBJECTIVE: To explore the feasibility of a workplace farmstand programme through the utilization of an online ordering system to build awareness for local food systems, encourage community participation, and increase local fruit and vegetable availability. DESIGN: A 4-week pilot to explore feasibility of workplace farmstand programmes through a variety of outcome measures, including survey, mode of sale, weekly sales totals and intercept interviews. SETTING: A large private company in Sarpy County, Omaha, Nebraska, USA. SUBJECTS: Employees of the company hosting the farmstand programme. RESULTS: Pre-programme, a majority of employees indicated that quality (95·4 %), variety (94·6 %) and cost of fruits and vegetables (86·4 %) were driving factors in their fruit and vegetable selection when shopping. The availability of locally or regionally produced fruits and vegetables was highly important (78·1 %). Participants varied in their definition of local food, with nearly half (49·2 %) reporting within 80·5 km (50 miles), followed by 160·9 km (100 miles; 29·5 %) and 321·9 km (200 miles; 12·1 %). Weekly farmstand purchases (both walk-ups and online orders) ranged from twenty-eight to thirty-nine employees, with weekly sales ranging from $US 257·95 to 436·90 for the producer. The mode of purchase changed throughout the pilot, with higher use of online ordering in the beginning and higher use of walk-up purchasing at the end. CONCLUSIONS: The workplace farmstand pilot study revealed initial interest by both employees and a producer in this type of programme, helped to establish a sustained producer-employer relationship and led to additional opportunities for both the producer and employer.