Perceptions of the Right to Food Among Adults Aged 60 Years and Older.

This study explores perceptions of the right to food and issues around food assistance and access among older adults. We conducted 20 semi-structured interviews with adults aged 60+ in Iowa, half of whom were food insecure. Most respondents expressed the right to food concerns freedom of choice rather than physical and financial access. The respondents said poor food access was due to improper choices or not accessing food assistance. While respondents believed food insecurity was morally wrong, they also believed current food assistance services are sufficient. These results have important implications for understanding how older adults think about food access.

A Qualitative Study of Factors Influencing Food Choices and Food Sources Among Adults Aged 50 Years and Older During the Coronavirus Disease 2019 Pandemic.

BACKGROUND: The coronavirus disease 2019 pandemic affected food availability and accessibility for many older adults, especially those experiencing food insecurity. Food citizenship is a theoretical framework that encourages the use of alternate over industrial food sources and can characterize where foods are acquired and how food choices are made. OBJECTIVE: The purpose of this study is to explore how Iowans aged 50 years and older made choices about what foods to acquire and where to acquire foods during the coronavirus disease 2019 pandemic using food citizenship as a theoretical framework. DESIGN: We used in-depth interviews with Iowans aged 50 years and older (N = 60). PARTICIPANTS: We recruited respondents through Area Agencies on Aging, food banks, and food pantries. Individuals who contacted the research team, were aged 50 years and older, and spoke English were eligible. Half of the sample screened as food insecure. STATISTICAL ANALYSIS: We conducted a thematic analysis to identify recurring themes. RESULTS: Food costs, personal preferences, and the healthfulness of food were cited as the most influential factors. Respondents said that the pandemic had not changed how they make choices, but increased prices had made costs more salient. Respondents primarily got their food from industrial food retailers, government programs, or food pantries. More than half of the respondents also acquired food from an alternate food source, such as a farmers' market. Reasons for not using alternate food sources included cost and transportation barriers. CONCLUSIONS: It is essential to ensure that older adults have access to affordable, healthy foods, especially during crises such as the coronavirus disease 2019 pandemic. Alternate food sources provided supplementary, healthy food for many respondents, but there are opportunities to expand the use of these food sources. Incentivizing the use of alternate food sources through government programs and connecting the emergency food system to local producers could increase the consumption of healthy food.

Evaluation of hearing protection device effectiveness for musicians.

OBJECTIVE: To evaluate musicians' personal attenuation and perceptions of three types of hearing protection devices (HPDs): formable foam earplugs and both non-custom and custom versions of uniform attenuation earplugs (UAEs) marketed to musicians. DESIGN: A mixed-methods approach was used to evaluate the HPDs. Audiometric testing obtained hearing levels at baseline and with each HPD across frequencies (125-8000 Hz) to determine personal attenuation ratings and uniformity of attenuation. Participants completed surveys over six months regarding how often they used the HPDs and their perceptions about wearing them. STUDY SAMPLE: Twenty-four musicians were recruited to participate. RESULTS: Substantial variability was observed in the attenuation achieved among participants for each HPD type, but custom UAEs provided the most consistent attenuation across frequencies. Participants' HPD preferences were influenced by multiple factors including personal instrument and specific activity. Custom UAEs were most frequently used but usage rates continually decreased over the 6-month period. CONCLUSIONS: Fit-testing is important to determine fit and sizing. Combining information on the effectiveness of HPDs with musicians' opinions about wearing them can inform recommendations for which types may be the most effective and feasible options for reducing sound exposures.

Association between history of attention-deficit/hyperactivity disorder diagnosis and cardiovascular disease in U.S. adults.

OBJECTIVE: To examine the association between attention-deficit/hyperactivity disorder (ADHD) and cardiovascular disease (CVD) in a nationally representative population sample of adults in the United States. METHOD: We included adults aged 18 years or older who participated in the National Health Interview Survey 2007 and 2012, because information about ADHD diagnosis among adults was only available in these two cycles. Physician-diagnosed ADHD and CVD were defined based on an affirmative response in the questionnaire during a household interview. Logistic regression with survey sampling weights was used to estimate the odds ratio (OR) and 95% confidence intervals (CIs) of CVD. RESULTS: This analysis included 57,728 adults (weighted mean age 46.20 years; 47.66% males). Among them, 1,790 reported physician-diagnosed ADHD, 7,906 had CVD, 4,061 had coronary heart disease (CHD), and 1,749 had stroke. The age-adjusted prevalence of CVD was 19.72% (95% CI [16.56%, 22.88%]) among individuals with ADHD, and 12.09% (95% CI [11.75%, 12.43%]) among those without ADHD. After adjustment for age, sex, race/ethnicity, education level, family income level, smoking, alcohol drinking, physical activity, and body mass index, the OR of CVD, CHD and stroke in association with ADHD was 2.06 (95% CI [1.58, 2.68]), 1.88 (95% CI [1.31, 2.69]), and 1.75 (95% CI [1.07, 2.86]), respectively. CONCLUSIONS: In a nationally representative sample of U.S. adults, we found a significant, positive association between a history of ADHD diagnosis and CVD. Further investigation is needed to replicate our findings and determine the underlying mechanisms. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Relationship between Political, Economic, Social, and Cultural Vulnerability and Food Insecurity among Adults Aged 50 Years and Older.

Individuals experience food insecurity when they worry about or have limited access to nutritious foods. Food insecurity negatively impacts older adults' health. Social exclusion is a theoretical framework describing how unequal access to rights, resources, and capabilities results in political, economic, social, and cultural vulnerability, which leads to health disparities. We used the Health and Retirement Study to cross-sectionally examine associations between vulnerability and experiencing food insecurity in adults 50 years and older using the social exclusion framework. We tested the association between experiencing food insecurity and indicators of political, economic, social, and cultural vulnerability using logistic regression controlling for demographic and health-related factors. Analyses were performed with all respondents and sub-group of respondents with incomes less than 400% of the federal poverty level (FPL). Assets (OR = 0.97 in both samples), income (OR = 0.85, 0.80 in 400% FPL sub-sample), perceived positive social support from other family (OR = 0.86, 0.84 in 400% FPL sub-sample), and perceived everyday discrimination (OR = 1.68, 1.82 in 400% FPL sub-sample) were significantly associated with food insecurity. Perceived positive social support from spouses, children, or friends and U.S. citizenship status were not significantly associated with food insecurity. Further research is needed to define and measure each dimension of vulnerability in the social exclusion framework. Interventions and policies designed to prevent food insecurity should address these vulnerabilities.

Association of Attention-Deficit/Hyperactivity Disorder With E-Cigarette Use.

INTRODUCTION: E-cigarette use in young people has emerged as a public health concern in the U.S. Previous studies have shown that individuals with attention-deficit/hyperactivity disorder are more likely to use conventional cigarettes. However, little is known about their use of E-cigarettes. This study examines the association of attention-deficit/hyperactivity disorder with E-cigarette and other tobacco product use among undergraduate and graduate students in the U.S. METHODS: This study included data from 195,443 U.S. undergraduate and graduate students aged 18-39 years who participated in the National College Health Assessment surveys from spring 2017 to fall 2018. History of attention-deficit/hyperactivity disorder diagnosis and current use of conventional cigarettes, E-cigarettes, and other tobacco products were ascertained by questionnaires. Logistic regression models estimated the ORs and 99% CIs of use of conventional cigarettes, E-cigarettes, and other tobacco products according to attention-deficit/hyperactivity disorder history. RESULTS: Among the 195,443 students, 16,800 (8.35%) were current conventional cigarette users and 15,863 (7.89%) were current E-cigarette users; 16,283 (8.10%) had a history of attention-deficit/hyperactivity disorder diagnosis. After adjustment for demographics, socioeconomics, lifestyle factors, BMI, anxiety, and depression, the OR of E-cigarette use among participants with attention-deficit/hyperactivity disorder, compared with those without attention-deficit/hyperactivity disorder, was 1.72 (99% CI=1.60, 1.85), which was comparable to the magnitude of associations for other tobacco products. CONCLUSIONS: Among U.S. undergraduate and graduate students, there is a significant association between attention-deficit/hyperactivity disorder diagnosis and current use of E-cigarettes. Health consequences of E-cigarette use among individuals with an attention-deficit/hyperactivity disorder diagnosis warrant further investigation.

Employer-Supported Volunteerism in Rural Worksites.

Employer-supported volunteerism has the potential to benefit employees and ultimately have a positive business impact. Volunteerism has been linked to improved quality of life, reduced morbidity, and higher self-rated health. This study was designed to understand what small, rural worksites are doing with regard to volunteerism, and what their barriers are to such activities. An online survey was distributed to worksites using the social network of a Resource, Conservation, and Development Council, a rural nonprofit entity. Analyses included descriptive statistics, and for qualitative data, review and summary of common themes. Thirty-eight worksites responded, representing a wide range of worksite types. Volunteer activities requiring less time and resources to organize were more commonly employed versus group-based activities. Identified barriers included time, costs, small staffing numbers, perceived employee lack of interest, worksite policies, distance to volunteer sites, language barriers, and lack of awareness of opportunities. Despite a variety of challenges, some forms of employer-supported volunteerism seem feasible even in very small rural worksites. Worksite type, culture, and leadership are likely to be determinants of the extent and nature of employer-supported volunteerism. Strategies to encourage greater volunteerism need to be tailored to the interests and resources of each site. Occupational health nurses should consider incorporating some form of employee volunteerism activities within their health promotion programming, as it is consistent with an overall strategy of enhancing employee well-being. This could lead to positive business impacts such as increased employee engagement, improved recruitment and retention, and improved productivity.

Prevalence of Physical Activity Policies and Environmental Strategies in Communities and Worksites: The Iowa Community Transformation Grant.

OBJECTIVE: This study describes results of community and worksite assessments of physical activity policies and environmental strategies in 26 Iowa counties. METHODS: Community coalition members completed the Community Health Assessment and Group Evaluation tool. The study explored findings using descriptive statistics and examined rural-urban differences in two of the five assessed sectors: community and worksites. RESULTS: Lower community scores (ie, needing improvement) were found for complete streets, bicycle use, and street calming. Higher scores (ie, identified strengths) were found for land use plans, maintain parks, and sidewalks Americans with Disabilities Act compliant. Worksites scored lower on promote stairwells, encourage non-motorized commuting, and implement activity breaks but higher on subsidize gym membership and provide area for physical activity. No rural-urban differences were found. CONCLUSIONS: Results identify opportunities to enhance community and worksite policies and environmental strategies to increase physical activity.

Evaluating Policy, Systems, and Environmental Change Interventions: Lessons Learned From CDC's Prevention Research Centers.

INTRODUCTION: The field of public health is increasingly implementing initiatives intended to make policies, systems, and environments (PSEs) more supportive of healthy behaviors, even though the evidence for many of these strategies is only emerging. Our objective was 3-fold: 1) to describe evaluations of PSE-change programs in which the evaluators followed the steps of the Centers for Disease Control and Prevention's (CDC's) Framework for Program Evaluation in Public Health, 2) to share the resulting lessons learned, and 3) to assist future evaluators of PSE-change programs with their evaluation design decisions. METHODS: Seven Prevention Research Centers (PRCs) applied CDC's framework to evaluate their own PSE-change initiatives. The PRCs followed each step of the framework: 1) engage stakeholders, 2) describe program, 3) focus evaluation design, 4) gather credible evidence, 5) justify conclusions, and 6) ensure use and share lessons learned. RESULTS: Evaluation stakeholders represented a range of sectors, including public health departments, partner organizations, and community members. Public health departments were the primary stakeholders for 4 of the 7 evaluations. Four PRCs used logic models to describe the initiatives being evaluated. Their evaluations typically included both process and outcome questions and used mixed methods. Evaluation findings most commonly focused on contextual factors influencing change (process) and the adoption or implementation of PSE-change strategies (outcome). Evaluators shared lessons learned through various channels to reach local stakeholders and broader public health audiences. CONCLUSION: Framework for Program Evaluation in Public Health is applicable to evaluations of PSE-change initiatives. Using this framework to guide such evaluations builds practice-based evidence for strategies that are increasingly being used to promote healthful behaviors.

Vending Assessment and Program Implementation in Four Iowa Worksites.

The worksite food environment, including vending options, has been explored as an important contributor to dietary decisions made every day. The current study describes the vending environment, and efforts to change it, in four Iowa worksites using a series of case studies. Data were gathered by local coordinators as part of the Iowa Community Transformation Grant project. Data were collected from three sources. First, the Nutrition Environment Measures Survey-Vending was used to assess healthy vending options in worksite machines before and after the intervention. Second, employee vending behavior was evaluated with a pre-, post-intervention survey. Items assessed attitudes and behaviors regarding vending, plus awareness and reaction to intervention activities. Third, program coordinators documented vending machine intervention strategies used, such as social marketing materials and product labels. The Nutrition Environment Measures Survey-Vending documented that the majority of vending options did not meet criteria for healthfulness. The vending survey found that employees were generally satisfied with the healthier items offered. Some differences were noted over time at the four worksites related to employee behavior and attitudes concerning healthy options. There were also differences in intervention implementation and the extent of changes made by vending companies. Overall, findings demonstrate that a large percentage of employees are constrained in their ability to access healthy foods due to limited worksite vending options. There also remain challenges to making changes in this environment. Findings have implications for public health practitioners to consider when designing healthy vending interventions in worksites.

Indirect and direct perceived behavioral control and the role of intention in the context of birth control behavior.

Unintended pregnancies can have negative consequences for both mother and child. The focus of this study was to utilize perceived behavioral control measures (PBC; part of the theory of planned behavior) to identify relevant behavioral determinants of birth control use. This study also tested associations between direct and indirect PBC measures and intention of birth control use and between intention and birth control use. The methods included a randomly selected sample of patients at a health care system in the Upper Midwest who were sent a self-administered survey, with 190 non-pregnant women returning completed surveys. Participants indicated a high level of control over using birth control, and a significant positive correlation was observed between direct and indirect PBC measures. Participants also reported high intentions to use birth control, and a significant positive correlation was observed between intention and PBC. Additionally, both PBC measures and intention were independently and significantly associated with behavior, and PBC remained significantly associated with behavior when intention was added into the model. In conclusion, compared to the previous literature, this study is unique in that it examines indirect PBC measures and also the important role that PBC plays with actual birth control behavior.

Environmental influences on physical activity in rural Midwestern adults: a qualitative approach.

Qualitative research can be used to examine multiple factors associated with physical activity and help practitioners identify language used by the rural adult population when discussing this behavior. Three focus groups were conducted among 19 residents of multiple towns in a rural Midwestern county to examine the language and influences on rural physical activity. Focus group members were asked to define physical activity, exercise, community, and neighborhood. They were asked about the activities they engaged in and facilitators and barriers to those activities. A guidebook was developed to capture major themes and common patterns that emerged in the responses to the topics discussed. The data were reviewed for repeated statements and points that were agreed on by multiple participants. Important factors associated with physical activity include the importance of social support and modeling physical activity behavior. Also, the influence of pets and children was important for engaging these adults in physical activity. The focus group members engaged in walking and bicycling in their neighborhood streets and community trails, and desired to see community buildings be open to the public for exercise. This study revealed contextual issues and culturally relevant language for practitioners to use in tailoring physical activity measurement tools or designing interventions for a rural adult population. Social support (specifically, seeing others being active and using pets as motivators for being active) and policy attitudes may be targeted for interventions to increase physical activity in rural adults.

Perceived Resources and Environmental Correlates of Domain-Specific Physical Activity in Rural Midwestern Adults.

BACKGROUND: Rural adults participate in lower levels of physical activity (PA) than urban or suburban adults. Due to known effects of the environment on PA participation, this study examined perceived ecological correlates (social, environmental, and policy) of domain- and intensity-specific PA in rural adults. METHODS: A cross-sectional survey was completed by 143 individuals residing in the rural Midwest. PA was measured using the International Physical Activity Questionnaire; correlates of PA were measured using a modified version of the PA in Communities Questionnaire. Multiple regression analyses were conducted using general linear modeling. RESULTS: Predictors of PA included: employers providing time for exercise (P = .0003); available shopping malls (P = .0032); activity-friendly community aspects (P = .0048); favorable policy attitudes (P = .0018): participation in sports (P < .0001); encouragement from friends (P = .0136); awareness (P = .0015) and use (P = .0113) of community resources; and having hills (P = .0371). CONCLUSIONS: Correlates of PA in various domains and intensities in rural adults are multifactorial and occur at different levels of the environment. Findings from this study can be used to tailor PA interventions in rural adults, with respect to specific domains and intensity in which the PA occurs.

Nutrition Information In Community Newspapers: Goal Framing, Story Origins, and Topics.

Obesity rates are high in the rural United States. Because small communities often have few health care practitioners, nutrition news in community newspapers may be a useful source of information. This content analysis of a random sample of 164 nutrition stories from 10 community newspapers in the rural West North Central Midwest was guided by concepts from goal-framing theory. Locally generated stories comprised nearly half of the sample, suggesting that nutrition is a salient topic in many rural communities. Hedonic frames related to food enjoyment were twice as frequent as health improvement frames. Results suggest food promotion was the most common topic of nutrition stories, with guidelines for a healthy diet appearing about half as often. Stories about a healthy diet and food promotion were most often written locally. Findings are discussed with recommendations for improvement of community news coverage of nutrition.

Perceived correlates of domain-specific physical activity in rural adults in the Midwest.

PURPOSE: In response to calls for more specificity when measuring physical activity, this study examined perceived correlates of this behavior in rural adults separately by the domain in which this behavior occurs (ie, home care, work, active living, and sport). METHODS: A cross-sectional survey was completed by 407 adults from 2 rural towns in the Midwest. The questionnaire assessed the perceived social and physical environment, including neighborhood characteristics, as well as barriers to being active. The Kaiser Physical Activity Survey captured domain-specific activity levels. The response rate was 25%. Multiple regression analyses were conducted to examine the associations between social and physical environment factors and domain-specific physical activity. FINDINGS: Having a favorable attitude toward using government funds for exercise and activity-friendly neighborhood characteristic were positively associated with active living. Friends encouraging exercise was positively associated with participation in sport. Barriers were inversely associated with active living and sport. Total physical activity was positively associated with workplace incentives for exercise, favorable policy attitudes toward supporting physical education in schools and supporting the use of government funds for biking trails, and it was inversely associated with barriers. There were no factors associated with physical activity in the domains of work or home care. CONCLUSIONS: Correlates of physical activity are unique to the domain in which this behavior occurs. Programs to increase physical activity in rural adults should target policy attitudes, neighborhood characteristics, and social support from friends while also working to decrease personal barriers to exercise.

Improving rural newspaper coverage of nutrition stories: an educational assessment of editors' attitudes and learning needs.

Local newspapers are an important source of information for rural residents but often lack accurate or helpful nutrition-related information. To improve the quantity and quality of nutrition stories in rural, local newspapers, it is important to understand the perspective of editors. An online survey of 51 rural Midwest editors was conducted to assess attitudes toward writing nutrition stories, sources of information, perceived challenges, and interest in learning more about writing such stories. Of respondents, 49% were female, and 63% had at least a 4-year college degree. Through a mix of closed- and open-ended questions, the majority indicated positive attitudes toward nutrition stories, were confident in their abilities to write them, and expressed interest in learning more. Challenges cited include lack of print space, small staff, lack of specific requests from readers for nutrition stories, and the need to avoid offending local agricultural businesses. Results should be useful in planning an educational intervention for editors. Meanwhile, public health practitioners should provide concise press releases to their local newspapers about their activities. Also, greater expressions of appreciation from public health professionals and other readers may lead to higher prioritization of nutrition-related stories, and ultimately to an environment more supportive of healthy eating.

The rural restaurant healthy options program: response of rural, local newspapers to a program press release.

Local media should be used to raise awareness of health promotion programs. In rural areas, local newspapers provide an opportunity to reach large numbers of residents. Although there are expert guidelines describing the process for successfully engaging local media, little has been documented regarding the range of responses that local, rural newspapers might have when approached about covering health promotion programs. This study describes the response of rural, local newspapers to a press release about a health promotion program taking place in 28 restaurants in different rural towns. The most common reason for not publishing a story was that it would constitute free advertising for the restaurant. Twenty-two stories were analyzed using descriptive statistics. The majority of the responding newspapers were weeklies, and 16 published the full press release verbatim. Three stories included photos, and five included quotes. Headlines typically included the name of the restaurant and the university partner. The overall response rate is encouraging; however, there is considerable room for improvement in terms of personalizing the story with photos or quotes. Greater efforts may be required to obtain this depth of coverage, including training for local journalists to increase their interest and confidence in covering health promotion issues.

Promoting healthy choices in non-chain restaurants: effects of a simple cue to customers.

This study tested a novel intervention to influence restaurant customer ordering behavior, with measurements at baseline and 3, 6, and 12 months postintervention in four owner-operated restaurants in the Midwest. A sample of 141 to 370 customers was surveyed at each time point. The response rate was 70% to 84% with 59% women, 98% White, and a mean age of 53 years. Table signs listed changes customers might consider, for example, asking for meat broiled instead of fried or requesting smaller portions. Customer surveys measured program reach and effectiveness. Owner interviews measured perceptions of program burden and customer response. Order slips were analyzed for evidence of changes in ordering. Window signs were noticed by 40%, 48%, and 45% of customers at each follow-up, respectively. Table signs were noticed by 67%, 71%, and 69% of customers, respectively. Of those, 34% at each time point stated that the signs influenced their order. Examples of how orders were influenced were elicited. Order slip data not only did not show significant changes but was also found to be an inadequate measure for the intervention. Owners reported no concerns or complaints. This intervention resulted in small but positive behavior changes among a portion of customers. Because of its simplicity and acceptability, it has great potential for dissemination.

Healthy option preferences of rural restaurant customers.

In preparation for an intervention study in three rural Iowa restaurants, 250 customers were surveyed regarding their interest in dietary change, perceptions of the restaurant, and interest in healthy options. Customers were ages 18 to 88, with a mean age of 52, and 53% were women. Most agreed that the restaurant offers healthy meals. Options customers stated they were most likely to order if available included meat that is baked or broiled, whole-wheat bread, fresh fruit or steamed vegetables, and regular salad dressing on the side. They were least interested in low-fat sour cream, low-fat salad dressing, low-fat milk, low-calorie dessert, and holding high-fat ingredients. Women were more likely to indicate interest in healthy options than were men. Interest in several options was also positively associated with age. Increasing the healthy options in restaurants may be especially effective in changing the dietary intake of women and older adults.