A Cross-Sectional Study of Grocery Shopping Factors of Importance among Food-Insecure African Americans.

The objective of this study was to (1) assess via cross-sectional survey the prevalence of food insecurity among African Americans [AAs] after their most recent grocery shopping trip, and (2) examine the grocery shopping factors of importance and characteristics of food-insecure AA grocery shoppers. Most (70.4%) were food-insecure. Food-insecure grocery shoppers were significantly more likely to be younger, less educated, who often skipped meals and/or practiced fasting, accessed a food pantry, were SNAP recipients, were considered to not be in "good" health, and who had higher BMI compared to food-secure shoppers (p ≤ 0.03 * for all). Our data showed that AAs shopped for groceries a mean 2.20 ± 1.29 times per week, for low prices (72.1%), without a weekly budget (58.9%), with a grocery list (44.6%) or using an app (27.6%), for high-quality vegetables (27.5%), for good customer service (22.9%), for store brands (20.8%) and name brands (17.9%).Food-insecure shoppers were significantly more likely to grocery shop more times per week, have a weekly budget, and use an app, but were significantly less likely to report store brands, name brands, good customer service, and high-quality vegetables as grocery factors of importance (p ≤ 0.03 * for all). Grocery strategies such as shopping with a grocery app and/or grocery list could help food-insecure AAs reduce grocery trips, promote meal planning to save money, and avoid skipping meals/fasting, while eating healthier.

Profile of a Food-Insecure College Student at a Major Southeastern University: A Randomized Cross-Sectional Study.

Ten percent of Americans are food-insecure. Few known studies have accessed college food insecurity via random sampling. An online cross-sectional survey (n = 1087) was distributed via email to a random sample of undergraduate college students. Food insecurity was determined by the USDA Food Security Short Form. Data were analyzed using JMP Pro. Results: Thirty-six percent of the students were food-insecure. Most food-insecure students were enrolled full-time (93.6%), female (81.2%), received financial aid (77.9%), lived off-campus (75.0%), non-white (59.6%), and employed (51.7%). Food-insecure students had a significantly lower GPA (p < 0.001 *), were more likely to be non-white (p < 0.0001 *), and were more likely to have received financial aid compared to food-secure students (p < 0.0001 *). Food-insecure students were significantly more likely to have lived in government housing, had free or reduced lunch, used SNAP and WIC benefits, and received food from a food bank during childhood (p < 0.0001 * for all). Food-insecure students were significantly less likely to report that they experienced a food shortage to counseling and wellness personnel, a resident assistant, and their parents (p < 0.05 * for all). Discussion: College students might be at greater risk for food insecurity if they are non-white, first-generation students, employed, on financial aid, and have a history of accessing government assistance during childhood.

African American Women's Willingness to Participate in Online Health Communities During COVID-19.

Introduction: The use of online health communities (OHCs) for health information, disease self-management, and social support increased during the COVID-19 pandemic. However, there are limited data on the willingness of African American women (AAW) to participate in OHCs. Materials and Methods: A sample of 985 AAW completed an online survey. Multinomial logistic regression examined associations between three age groups (18-29, 30-50, and 51+ years) and 10 motivators and 10 barriers to participating in OHCs. Women 51+ years were the referent group. Results: Women 51+ years were more likely to have been diagnosed with obesity and hypertension than the other groups (p < 0.01), but less likely to be diagnosed with a mental health condition than the other groups (p < 0.01). The top 2 motivators were to learn about a disease/condition (70%) and to prevent a disease/condition (64%). There were no significant differences with these variables. However, compared with women 18-29 years of age, women 51+ years were more likely to be motivated to manage an illness (p < 0.001), and more likely than the other groups to be motivated to support others (p = 0.011). The top 2 barriers were being too busy (53%) and privacy concerns (45%). Compared with women in the two other groups, women 51+ years were more concerned about privacy (p < 0.001). Discussion: AAW expressed a willingness to participate in OHCs. Willingness to participate in OHCs will vary by the topic and disease/condition and the age group. Conclusions: Opportunities exist to recruit AAW in age-specific OHCs.

"I Want a Program That Looks at My Whole Life." A Focus Group Study on the Ideal Components for an mHealth Weight Management Program for African American Women.

BACKGROUND: The high rate of obesity, ownership of smartphones, and online search for nutrition and dieting information among African American women (AAW) provide a unique opportunity to develop cost-effective, accessible, and acceptable mHealth weight management programs for them. Furthermore, they should participate in the development and evaluation of these programs. OBJECTIVE: To explore ideal components of a culturally relevant mHealth weight management program for AAW and to examine how these components may vary by age group. DESIGN: Twelve focus group triads were conducted with AAW in north central Florida. The framework method was used to manage, organize, synthesize, and analyze data themes by age groups: 18 to 29 (young), 30 to 50 (middle age), and 51+ (older). PARTICIPANTS/SETTING: Thirty-six smartphone owners who expressed a desire to lose weight were recruited through several community partnerships. RESULTS: Based on body mass index (BMI), young women were classified as overweight (BMI 26.23 ± 6.7), middle-aged women as obese (BMI30.72 ± 8.31), and older women as obese (BMI 31.03 ± 5.67). Most searched online for dieting information within the past 12 months. Five overarching themes for designing mHealth weight management programs were identified: (1) holistic program that goes beyond dieting; (2) social media integration for support and sense of community; (3) self-monitoring app; (4) two-way text messaging; and (5) programs of varying lengths and meaningful incentives. CONCLUSION: AAW were receptive to mHealth weight management programs, which may be appealing during and after the COVID-19 pandemic. Holistic programs of 4 to 6 weeks that addressed stress eating, had a social media component, and included a few educational texts per week may be appealing to AAW.

Smartphone Usage, Social Media Engagement, and Willingness to Participate in mHealth Weight Management Research Among African American Women.

BACKGROUND: African American women (AAW) are in a unique position to be recruited into mobile (mHealth) weight management research and programs due to their high rates of obesity and their high ownership of smartphones. AIM: This study examined smartphone usage, social media engagement, and willingness to participate in mHealth weight management among AAW in north-central Florida, United States. METHODS: A self-administered survey was completed by a convenience sample of 425 smartphone owners in north-central Florida. RESULTS: Mean age was 34.84 ± 13.74, with age distribution of 18 to 29 (45%), 30 to 50 (39%), and 51+ years (17%). Mean body mass index was 29.52 ± 8.18. Most used smartphones to access the Internet daily and were engaged with eight social media sites, such as Facebook (85%), YouTube (75%), and Google+ (57%). Compared to those 51+, those 18 to 29 were more likely to use YouTube (odds ratio [OR] = 2.52, p = .017) and Instagram (OR = 10.90, p < .0001), but they were less likely to use Google+ (OR = 0.40, p = .009). Compared to those 51+, those 30 to 50 were more likely to use Instagram (ß = 1.28, OR = 3.61, p = .014) and Facebook (ß = 1.04, OR = 2.84, p < .006). Most were willing to participate in research that used text messages (73%), smartwatches/fitness trackers (69%), and smartphone apps (68%). Compared to those 51+, women 18 to 29 were more likely to report willingness to use a smartphone app (OR = 5.45, p < .0001) as were those 30 to 50 (OR = 3.14, p < .0001). CONCLUSION: AAW's high ownership of smartphones, use of mHealth apps and tools, and willingness to participate in mHealth research has the potential to curb the obesity epidemic by participating in mHealth weight management programs and research.

"You Have to Approach Us Right": A Qualitative Framework Analysis for Recruiting African Americans Into mHealth Research.

BACKGROUND: Despite the high ownership of smartphones, African Americans (AAs) remain underrepresented in health research and specifically mobile health (mHealth) research. This may be due to ineffective recruitment efforts. PURPOSE: To explore strategies for recruiting AAs into mHealth research and examine how these strategies may vary by gender and age-group. METHOD: Twenty triad focus groups ( n = 60) were conducted with AA males ( n = 9 groups) and females ( n = 11 groups). The framework method was used to manage, organize, synthesize, and analyze data themes by gender and age-group (18-29, 30-50, 51+). RESULTS: Most participants owned smartphones (71%) and were willing to participate in mHealth research (62%). The participants' narrative revealed the tension between mistrust of researchers and the excitement of participating in technology-based research. Both genders and all age-groups can be reached via word-of-mouth because it is "the best advertisement." Personal contact must precede traditional and electronic recruitment strategies because "we have to know you." Churches are excellent places for recruitment because they are "trustworthy" and have a "repeat audience." Facebook may be effective for both genders and all age-groups because "everybody is on Facebook" and it can "reach more people than text and e-mail." Beauty/barber shops may be limited in reaching both genders and age-groups, but especially young women who style their own hair natural, and young men who wear braids and dreadlocks. Personal contact must precede traditional and electronic recruitment strategies because "we have to know you." CONCLUSION: A tailored, multipronged strategy that combines traditional recruitment methods with texting, e-mail, and social media may be effective in recruiting AA adults into mHealth research.

Barriers and Motivators to Participating in mHealth Research Among African American Men.

Most African American (AA) men own a smartphone, which positions them to be targeted for a variety of programs, services, and health interventions using mobile devices (mHealth). The goal of this study was to assess AA men's use of technology and the barriers and motivators to participating in mHealth research. A self-administered survey was completed by 311 men. Multinomial logistic regression examined associations between three age groups (18-29 years, 30-50 years, and 51+ years), technology access, and motivators and barriers to participating in mHealth research. Sixty-five percent of men owned a smartphone and a laptop. Men aged 18 to 29 years were more likely willing to use a health app and smartwatch/wristband monitor than older men ( p < .01). Men aged 18 to 29 years were also more likely than older men to be motivated to participate for a free cell phone/upgraded data plan and contribution to the greater good ( p < .05). Older men were more likely than younger ones to be motivated to become more educated about the topic ( p < .05). Younger men were more likely than older ones to report lack of interest in the topic as a barrier to participating ( p < .01), while older men were more likely than younger ones to cite lack of research targeted to minority communities as a barrier ( p < .05). This study suggests that culturally tailored mHealth research using smartphones may be of interest to AA men interested in risk reduction and chronic disease self-management. Opportunities also exist to educate AA men about the topic at hand and why minority men are being targeted for the programs and interventions.

eHealth Literacy, Online Help-Seeking Behavior, and Willingness to Participate in mHealth Chronic Disease Research Among African Americans, Florida, 2014-2015.

INTRODUCTION: The high rate of ownership of smartphones among African Americans provides researchers with opportunities to use digital technologies to reduce the prevalence of chronic diseases in this population. This study aimed to assess the association between eHealth literacy (EHL) and access to technology, health information-seeking behavior, and willingness to participate in mHealth (mobile health) research among African Americans. METHODS: A self-administered questionnaire was completed by 881 African American adults from April 2014 to January 2015 in north central Florida. EHL was assessed by using the eHealth Literacy Scale (eHEALS) with higher scores (range, 8-40) indicating greater perceived skills at using online health information to help solve health problems. RESULTS: Overall eHEALS scores ranged from 8 to 40, with a mean of 30.4 (standard deviation, 7.8). The highest score was for the item "I know how to find helpful health resources on the Internet," and the lowest score was for "I can tell high quality from low quality health resources on the Internet." Most respondents owned smartphones (71%) and searched online for health information (60%). Most were also willing to participate in health research that used text messages (67%), smartwatches/health tracking devices (62%), and health apps (57%). We found significantly higher eHEALS scores among women, smartphone owners, those who use the Internet to seek health information, and those willing to participate in mHealth research (P < .01 for all). CONCLUSION: Most participants owned smartphones, used the Internet as a source of information, and were willing to participate in mHealth research. Opportunities exist for improving EHL and conducting mHealth research among African Americans to reduce the prevalence of chronic diseases.

Willingness of African American Women to Participate in e-Health/m-Health Research.

INTRODUCTION: Due to high rates of technology adoption, African American women are well positioned to benefit from e-health/mobile health (m-health) interventions; yet, there are limited data on understanding their use of technology and willingness to participate in e-health/m-health research. MATERIALS AND METHODS: A self-administered survey was completed by 589 African American women. Survey items measured sociodemographics, technology use and access, and willingness to participate in e-health/m-health research. Multinomial logistic regression examined associations among three age groups (18-29, 30-50, and 51+years old) and technology access, as well as motivators and barriers to participating in e-health/m-health research. RESULTS: Most participants were willing to receive text messages as part of a research study. Many reported using a health-related application in the past 30 days, with younger women more likely to do so than older women (p<0.0001). Younger women were more likely than older women to be motivated for the greater good (p<0.01) and for financial incentives (p=0.02), whereas older women were more likely than younger women to be motivated if referred by a healthcare provider (p=0.02). Younger women were more likely than older women to report concerns about data plans (p<0.01 for all), whereas older women were more likely to report a lack of a smartphone (p=0.048) and privacy concerns (p<0.001). CONCLUSIONS: Culturally tailored e-health/m-health research using smartphones may be of interest to African American women who are interested in risk reduction and chronic disease self-management. Barriers such as smartphone data plans and privacy will need to be addressed.

Developing weight management messages and interventions for baby boomer men.

The goal of this study was to explore the weight management experiences of Baby Boomer men (born between 1946 and 1964) and to use the information to develop targeted messages and interventions. Twenty men were interviewed. The Health Belief Model was used as the study's theoretical framework. Men correctly identified health risks of being obese. However, most believed that body mass index and weight charts were unrealistic, and a few felt that they would be too "skinny" at the recommended weight. Wives were sources of nutrition information and social support. Perceived benefits of losing weight included reduced risk for health problems and looking good. Perceived barriers included apathy and weight loss programs being "too feminine." Motivators for losing weight included being diagnosed with a health problem, health requirements for work, and financial incentives. The data themes suggest ways to develop male-specific messages and interventions that consider the aging body.

Using the health belief model to develop culturally appropriate weight-management materials for African-American women.

African-American women have the highest prevalence of adult obesity in the United States. They are less likely to participate in weight-loss programs and tend to have a low success rate when they do so. The goal of this project was to explore the use of the Health Belief Model in developing culturally appropriate weight-management programs for African-American women. Seven focus groups were conducted with 50 African-American women. The Health Belief Model was used as the study's theoretical framework. Participants made a clear delineation between the terms healthy weight, overweight, and obese. Sexy, flirtatious words, such as thick, stacked, and curvy were often used to describe their extra weight. Participants accurately described the health risks of obesity. Most believed that culture and genetics made them more susceptible to obesity. The perceived benefits of losing weight included reduced risk for health problems, improved physical appearance, and living life to the fullest. Perceived barriers included a lack of motivation, reliable dieting information, and social support. Motivators to lose weight included being diagnosed with a health problem, physical appearance, and saving money on clothes. Self-efficacy was primarily affected by a frustrated history of dieting. The data themes suggest areas that should be addressed when developing culturally appropriate weight-loss messages, programs, and materials for African-American women.

Position of the American Dietetic Association: promoting and supporting breastfeeding.

It is the position of the American Dietetic Association that exclusive breastfeeding provides optimal nutrition and health protection for the first 6 months of life and breastfeeding with complementary foods from 6 months until at least 12 months of age is the ideal feeding pattern for infants. Breastfeeding is an important public health strategy for improving infant and child morbidity and mortality, improving maternal morbidity, and helping to control health care costs. Breastfeeding is associated with a reduced risk of otitis media, gastroenteritis, respiratory illness,sudden infant death syndrome,necrotizing enterocolitis, obesity, and hypertension. Breastfeeding is also associated with improved maternal outcomes, including a reduced risk of breast and ovarian cancer, type 2 diabetes, and postpartum depression.These reductions in acute and chronic illness help to decrease health care-related expenses and productive time lost from work. Overall breastfeeding rates are increasing, yet disparities persist based on socioeconomic status, maternal age, country of origin,and geographic location. Factors such as hospital practices, knowledge, beliefs, and attitudes of mothers and their families, and access to breastfeeding support can influence initiation, duration, and exclusivity of breastfeeding. As experts in food and nutrition throughout the life cycle, it is the responsibility of registered dietitians and dietetic technicians, registered, to promote and support breastfeeding for its short-term and long-term health benefits for both mothers and infants.

Cluster analysis defines distinct dietary patterns for African-American men and women.

BACKGROUND: African Americans have a higher prevalence of diet-related chronic diseases than the general US population. Recent evidence suggests that examining dietary patterns rather than specific nutrients may better allow public health professionals to translate national dietary goals into practical dietary recommendations that are culturally relevant and sex-specific. OBJECTIVE: To examine and characterize the dietary patterns of African-American men and women using cluster analysis. DESIGN: Participants older than the age of 18 years were recruited from a variety of locations and completed a self-administered questionnaire. SUBJECTS/SETTING: Seven-hundred sixty-three African-American men and women in North Central Florida. STATISTICAL ANALYSES PERFORMED: Cluster analysis was done with the VARCLUS procedure and Ward's clustering approach in the Statistical Analysis System program. The pseudo-t(2) statistic was then used to identify the optimal numbers of clusters of men and women with distinctive food-consumption patterns. RESULTS: Cluster analyses identified six clusters of men with 13 distinctive dietary patterns and six clusters of women with 15 distinctive dietary patterns. Pairwise comparisons of group means indicated notable differences in intakes between clusters of women in all but two food clusters. Pairwise comparisons of group means indicated notable differences in intakes between clusters of men in all but two food clusters. CONCLUSIONS: The study illustrated that cluster analysis can be used to identify groups of African Americans with unique patterns of food consumption. They also suggest that a single "typical" eating pattern does not exist for African Americans and that dietary pattern vary by sex.

Type of tobacco product used: are there differences between university and community college students?

This article describes and compares smoking prevalence, types of tobacco products used, and motivation to quit among college students at universities and community colleges. Data were collected using the Florida Annual College Tobacco Survey (FACTS). Nine universities and eight community colleges participated in the study (n = 4973). Most students (69%) experimented with tobacco. Cigarettes were used more often (57.4%), followed by Black 'N Mild (31.8%), cigars (30.1%), kreteks/bidis (24.1%), smokeless tobacco (13.9%), and pipe (8.9%). University students were more likely than community college students to have tried kreteks/bidis and cigars (p < .05). University students experimented at a significantly earlier age with cigarettes and pipes while community college experimented at a significantly earlier age with cigars and kreteks/bidis (p < .05). The majority of cigarette smokers (62%) were not interested in quitting. The implications for college tobacco education programs are discussed.

Position of the American Dietetic Association: Promoting and supporting breastfeeding.

It is the position of the American Dietetic Association (ADA) that exclusive breastfeeding provides optimal nutrition and health protection for the first 6 months of life, and breastfeeding with complementary foods for at least 12 months is the ideal feeding pattern for infants. Breastfeeding is also a public health strategy for improving infant and child health survival, improving maternal morbidity, controlling health care costs, and conserving natural resources. ADA emphasizes the essential role of dietetics professionals in promoting and supporting breastfeeding by providing up-to-date, practical information to pregnant and postpartum women, involving family and friends in breastfeeding education and counseling, removing institutional barriers to breastfeeding, collaborating with community organizations and others who promote and support breastfeeding, and advocating for policies that position breastfeeding as the norm for infant feeding. ADA also emphasizes its own role by providing up-to-date information to the public, encouraging empirical research, providing continuing education opportunities, providing cultural sensitivity and cultural competence training to dietetics professionals, and encouraging universities to review and update undergraduate and graduate training programs.

Factors influencing food choices, dietary intake, and nutrition-related attitudes among African Americans: application of a culturally sensitive model.

OBJECTIVES: The goals of the project were: (1) to explore how culture and community impact on the nutrition attitudes, food choices, and dietary intake of a selected group of African Americans in north central Florida; and (2) to identify segments of the population and community that should be targeted for education programs, desirable components of nutrition education programs, topics of interest, and health promotion channels to reach the target group. DESIGN: Six focus groups were conducted with African American males and females. The data were analyzed using the PEN-3 model, a theoretical model that centralizes culture as the primary reason for health behavior and the primary consideration for health promotion and diseases prevention programs. RESULTS: There was a general perception that 'eating healthfully' meant giving up part of their cultural heritage and trying to conform to the dominant culture. Friends and relatives usually are not supportive of dietary changes. Barriers to eating a healthful diet also included no sense of urgency, the social and cultural symbolism of certain foods, the poor taste of 'healthy' foods, the expense of 'healthy' foods, and lack of information. Segments of the population that potentially could be motivated to make dietary changes included women, men with health problems, young adults, the elderly, and those diagnosed with a severe, life-threatening disease. CONCLUSION: The findings suggest that the PEN-3 model is an appropriate framework for assessing how community and culture impact dietary habits of African Americans. African Americans will need information on basic nutrition topics such as serving sizes and reading food labels. The findings also suggest that programs and materials should be specifically developed for churches, neighborhood grocery stores, and local restaurants.

Gender differences in body mass index and weight loss strategies among African Americans.

The goals of this study were to examine gender differences in body satisfaction, obesity status, and weight loss strategies among African Americans. A self-administered survey was completed by a convenient sample of 789 African Americans, but 763 provided weight and height information. Significantly more men than women were satisfied or very satisfied with their weight. Based on self-reported weights, the mean body mass index for both men (26.61+/-4.23) and women (26.44+/-5.80) was greater than 25, thus classifying them as being overweight. Sixty-two percent of respondents had tried to lose weight in the last 12 months, with significantly more women trying to lose weight than men (P<.0001). Of those who tried to lose weight, most tried to lose weight by decreasing fried foods, decreasing sweets, and increasing exercise levels. Women were significantly more likely than men to use liquid meals, to use diet pills, to join a weight loss program, and to increase exercise levels to lose weight (P<.05).