Nutrition and health challenges among low-income families of young children in the post COVID-19 era: a qualitative study.

BACKGROUND/OBJECTIVES: In the United States, one in every 5 children is obese with greater likelihood in low-income households. The coronavirus disease 2019 (COVID-19) pandemic may have accelerated disparities in child obesity risk factors, such as poor dietary intake and increased sedentary behaviors, among low-income families because of financial difficulties, social isolation and other struggles. This study reveals insights into nutrition and health challenges among low-income families of young children in West Texas to better understand needs and develop interventions. SUBJECTS/METHODS: In-depth individual interviews were performed via Zoom among 11 families of children under the age of 3. A semi-structured interview guide was developed to explore 3 areas: changes in (1) dietary intake and (2) sedentary behaviors and (3) families' preferences regarding a parent nutrition education program. Each interview was audio-recorded, transcribed, and coded using MaxQDA software. RESULTS: Eating together as a family become challenging because of irregular work schedules during the COVID-19 pandemic. Most parents stated that their children's dietary habits shifted with an increased consumption of processed foods. Many parents are unable to afford healthful foods and have utilized food and nutrition assistance programs to help feed their families. All families reported that their children's screen time substantially increased compared to the pre-pandemic times. Moreover, the majority of parents did not associate child screen time with an obesity risk, so this area could be of particular interest for future interventions. Meal preparation ideas, remote modality, and early timing were identified as key intervention strategies. CONCLUSIONS: Online nutrition interventions that emphasize the guidelines for child screen time and regular meal routines will be effective and promising tools to reach low-income parents for early childhood health promotion and obesity prevention.

Beef Quality Preferences: Factors Driving Consumer Satisfaction.

The current study was designed to broaden the understanding of the attributes impacting the sensory properties of beef when consumed. Using a survey of consumers from three different geographical regions in the United States (US), we determined the impacts of three attributes on overall satisfaction in several different ways. The two main statistical methods used were an Ordinary Least Squares (OLS) model and the Conditional Logit model. Perhaps the most important finding of this study was that flavor was the largest contributor to consumer satisfaction. This finding was consistent throughout all the models. In the base model, flavor represented 59% of the satisfaction rating. Additionally, results indicated domestic beef was preferred over Australian beef by US consumers. Another important finding of the study was the impact of the demographic variables of age, income, and gender on satisfaction. The older group generally placed more emphasis on tenderness, while younger people preferred juicier beef. Males were more responsive than females for all attributes, especially tenderness. Those with higher income were more responsive to tenderness for all quality levels, but the lower income group was more responsive to juiciness. Overall, flavor had the largest impact on consumers' satisfaction level in comparison to tenderness or juiciness.

Evaluating the Impact of Improving Access on Consumption of Fruits and Vegetables in a Rural Community in Texas: A Modeling Study.

Purpose: Most residents in rural regions of the United States consume fewer amounts of fruits and vegetables (FVs) compared with their urban counterparts. Difficulties in access to FVs often contribute to different consumption patterns in rural regions, aside from a lack of education or motivation for eating healthy foods. This article uses simulation methods to estimate the relationship between increasing food access and FV consumption levels in a targeted rural community. Methods: An agent-based model previously developed to predict individual dietary behaviors was used. We adapted it to a rural community in west Texas following a two-step process. First, we validated the model with observed data. Second, we simulated the impact of increasing access on FV consumption. We estimated model parameters from the 2010 census and other sources. Results: We found that decreasing the driving distance to FV outlets would increase FV consumption in the community. For example, a one-mile decrease in driving distance to the nearest FV store could lead to an 8.9% increase in FV consumption; a five-mile decrease in driving distance could lead to a 25% increase in FV consumption in the community. We found that the highest marginal increase in FV consumption was when the driving distance decreased from 3.5 miles to 3 miles. Conclusions: Analysis to inform policy alternatives is a challenge in rural settings due to lack of data. This study highlights the potential of simulation modeling to inform and analyze policy alternatives in settings with scarce data. The findings from modeling can be used to evaluate alternative policies in addressing chronic diseases through dietary interventions in rural regions.

Comparative analysis of the factors contributing to sustainability of a food and nutrition intervention programme: Two case studies from South Africa.

Sustainability of health interventions is a consistent and ongoing issue in Africa. Understanding key aspects of sustainable interventions provides the necessary methods for success. This research evaluates a nutrition intervention implemented in two peri-urban communities in the Free State and Gauteng province in South Africa (SA) respectively. A case study approach was employed using cross-case study analyses, including triangular data collection (empirical research through surveys of respondents; qualitative data collection through researcher journals, diaries, communications and photographs; and research team reflections). The information from these case studies is organized according to a framework from the United States (US) Office of Organizational Health (OAH) to evaluate the sustainability of intervention programmes. All eight of the OAH criteria were met in the Free State community and supported the importance of these key factors for sustainability compared to only three in the Gauteng community. The OAH framework provided a compelling rationale for the relative success of the intervention and clearly showed the Free State project was sustainable. The Gauteng project was not sustainable. Planned interventions should devote significant effort and time towards ensuring sustainability. The OAH guidelines provide key steps that the research shows is relevant to the South African context.

Improving Cancer Risk Awareness Including Obesity as a Risk Factor for Cancer in a Small U.S. Community.

Obesity is a risk for certain types of cancer; however, awareness of obesity as a risk factor for cancer is low. This study evaluated increases in cancer risk awareness, including obesity as a risk factor for cancer, from a quasi-experimental intervention that provided educational materials and community reinforcement for healthy living. The study uses data on participant's awareness of cancer risk factors along with sociodemographic variables collected from in-person surveys (N = 863) at baseline (June 2011) and post intervention (June 2012). The average awareness that overweight and obesity are risk factors for cancer was low (35 %) compared to chewing tobacco (92 %), using tanning bed (73 %), and sunburn (97 %) at baseline. The intervention significantly increased participants' awareness that overweight and obesity are risk factors for cancer. Based on regression analysis, the unadjusted intervention effect on cancer risk awareness was significant: 0.392 ± 0.165 (p value = 0.020) for matched participants and 0.282 ± 0.125 (p value = 0.024) for community participants. The adjusted intervention effect was significant in the matched participants (0.528 ± 0.189, p value = 0.006). Education, income, gender, and age had a significant impact on cancer risk awareness for the community participants. The results show that community intervention that incorporates community reinforcement can have the desired effect regardless of differences at participant level. Such interventions could be used to prevent cancer risk in communities that are at high risk.

Reducing cancer risk in rural communities through supermarket interventions.

Cancer risk is high, and prevention efforts are often minimal in rural communities. Feasible means of encouraging lifestyles that will reduce cancer risk for residents of rural communities are needed. This project developed and tested a model that could be feasibly adopted by rural communities to reduce cancer risk. This model focuses on incorporating multi-faceted cancer risk education in the local supermarket. As the supermarket functions both as the primary food source and an information source in small rural communities, the supermarket focus encourages the development of a community environment supportive of lifestyles that should reduce residents' risk for cancer. The actions taken to implement the model and the challenges that communities would have in implementing the model are identified.

Combination aspirin and/or calcium chemoprevention with colonoscopy in colorectal cancer prevention: cost-effectiveness analyses.

BACKGROUND: Clinical and cohort studies have shown that low-dose aspirin and calcium are effective low-risk strategies for primary prevention of colorectal cancer (CRC). We compared the cost-effectiveness of aspirin and calcium chemoprevention used with colonoscopy for primary prevention of CRCs. METHODS: Markov chain Monte Carlo simulations for a population of 100,000 persons, with a colonoscopy compliance rate of 50%, were used for the analysis. If adenomas were detected, colonoscopy was repeated every 4 years until no adenomas were evident. Data sources included adenoma transition rates, initial adenoma and CRC incidences, and treatment complication rates from existing literature. Age-adjusted U.S. standard population mortality rates were used and costs were from Medicare reimbursement data. The target population was U.S. adults, undergoing CRC screening from ages 50 to 75 years. RESULTS: Outcomes included incremental cost-effectiveness ratios (ICER), life-years saved (LYS), and cancer-free years saved (CFYS). The ICER per LYS for colonoscopy alone dominated compared with no screening. Compared with colonoscopy alone, colonoscopies with aspirin (ICER = $12,950/LYS) or calcium (ICER = $13,041/LYS) were the next most cost-effective strategies. ICERs per CFYS were $3,061 and $2,317 for aspirin and calcium, respectively, when added to colonoscopy. Sensitivity analyses indicated that initial prevalence of adenomas was a main determinant of prevention cost-effectiveness. CONCLUSION: Low-dose aspirin or calcium supplementation may be beneficial when added to colonoscopy, for optimum CRC prevention, at small incremental costs. IMPACT: Cost-effectiveness analyses suggest that aspirin and calcium in combination with colonoscopies are cost-effective for CRC prevention in average-risk populations.

Determinants of delayed detection of cancers in Texas counties in the United States of America.

INTRODUCTION: Previous studies have shown that delayed detection of several cancers is related to socioeconomic deprivation as measured by the Wellbeing Index (WI) in Texas, the United States of America (USA). The current study investigates whether delayed cancer detection is related to lack of health insurance, physician shortage and higher percentages of Hispanics rather than WI per se since these factors are directly related to delayed cancer detection and may confound WI. METHODS: Cancer data and potential determinants of delayed cancer detection are derived from Texas Cancer Registry, Texas State Data Center, and Texas Department of State Health Services and U.S. Census Bureau. Texas cancer data from 1997 to 2003 are aggregated to calculate age-adjusted late- and early-stage cancer detection rates. The WI for each county is computed using data from the USA Census 2000. A weighted Tobit regression model is used to account for population size and censoring. The percentage of late-stage cancer cases is the dependent variable while independent variables include WI and the aforementioned potential confounders. RESULTS: Delayed detection of breast, lung, colorectal and female genital cancers is associated with higher percentage of uninsured residents (p < 0.05). Delayed detection is also associated with physician shortage and lower percentages of Hispanics for certain cancers ceteris paribus ( p < 0.05). The percentage of late-stage cases is positively correlated with WI for lung, and prostate cancers after adjusting for confounders ( p < 0.05). CONCLUSIONS: The percentages of uninsured and Hispanic residents as well as physician supply are determinants of delayed detection for several cancers independently of WI, and vice versa. Identification of these determinants provides the evidence-base critical for decision makers to address specific issues for promoting early detection in effective cancer control.

Correlation of the ratio of metastatic to non-metastatic cancer cases with the degree of socioeconomic deprivation among Texas counties.

BACKGROUND: Previous studies have demonstrated that cancer registrations and hospital discharge rate are closely correlated with census data-based socioeconomic deprivation indices. We hypothesized that communities with higher degrees of socioeconomic deprivation tend to have a higher ratio of metastatic to non-metastatic cancer cases (lung, breast, prostate, female genital system, colorectal cancers or all types of cancers combined). In this study, we investigate the potential link between this ratio and the Wellbeing Index (WI) among Texas counties. RESULTS: Cancer data in 2000 were provided by the Texas Cancer Registry, while data on the ten socioeconomic variables among the 254 Texas counties in 2000 for building the WI were obtained from U.S. Census Bureau. The ten socioeconomic status variables were subjected to the principal component analysis, and the first principal component scores were grouped into deciles for the WI (1 to 10) and the 254 Texas counties were classified into 10 corresponding groups. Weighted linear regression analyses and a Cochran-Armitage trend test were performed to determine the relationship between the ratio of age-adjusted metastatic to non-metastatic cancer incidence cases and WI. The ratios of metastatic to non-metastatic cases of female genital system cancer (r2 = 0.84, p = 0.0002), all-type cancers (r2= 0.73, p = 0.0017) and lung cancer (r2= 0.54, p = 0.0156) at diagnosis were positively correlated with WI. CONCLUSIONS: The ratios of metastatic to non-metastatic cases of all-type, female genital system and lung cancers at diagnosis were statistically correlated with socioeconomic deprivation. Potential mediators for the correlation warrant further investigation in order to reduce health disparities associated with socioeconomic inequality.