A Pilot Fruit and Vegetable Prescription (FVRx) Program Improves Local Fruit and Vegetable Consumption, Nutrition Knowledge, and Food Purchasing Practices.

Fruit and Vegetable Prescription (FVRx) programs rely on diverse community and clinic partnerships to improve food security and fruit and vegetable consumption among medically underserved patient populations. Despite the growth in these programs, little is known about the feasibility or effectiveness of the unique partnerships developed to implement FVRx programs conducted in both community and free safety-net clinic settings. A 6-month nonrandomized controlled trial of an FVRx program was pilot tested with 54 Supplemental Nutrition Assistance Program (SNAP)-eligible adults with diet-related chronic conditions. The intervention combined monthly produce prescriptions for local produce at a farmers market, SNAP-Ed direct nutrition education, and health screenings for low-income adults. Process and outcome evaluations were conducted with respective samples using administrative program data (recruitment, retention, and prescription redemption) and self-administered pre- and postintervention surveys with validated measures on dietary intake, nutrition knowledge and behavior, and food purchasing practices. Descriptive statistical analyses were conducted. The FVRx program retained 77.3% of participants who spent nearly 90% of their prescription dollars. After the intervention, the FVRx group reported significantly increased total intake of fruits and vegetables, knowledge of fresh fruit and vegetable preparation, purchase of fresh fruits and vegetables from a farmers market, and significantly altered food purchasing practices compared with the control group. Community-based nutrition education organizations enhance the feasibility and effectiveness of community and clinic-based FVRx programs for improving low-income adults' ability to enhance food and nutrition-related behaviors.

Produce Prescriptions and Nutrition Education Improve Experiences and Perceptions of Farm Direct Settings in Adults With Low Income.

OBJECTIVE: To examine Fruit and Vegetable Prescription (FVRx) Program participants' and nonparticipants' experiences and perceptions of farm direct (FD) settings. DESIGN: Multiple-case study of adults with low income from 3 study groups: (1) FVRx intervention (produce prescription, nutrition education [NE], financial literacy education, health screening), (2) NE only, and (3) control (standard health care). Participant interviews with each group at baseline and 6 months. SETTING: Supplemental Nutrition Assistance Program-Education (SNAP-Ed) eligible adults from 3 Georgia counties. PARTICIPANTS: A total of 46 adults with ≥ 1 diet-related condition. PHENOMENA OF INTEREST: Fruit and Vegetable Prescription Program participant and nonparticipant experiences and perceptions of FD settings. ANALYSIS: Constant comparative methods and thematic analysis of qualitative interview data across groups. FINDINGS: Two main themes emerged: (1) baseline FD setting experiences and perceptions and (2) divergent experiences and perceptions with FD settings postintervention. Participants across each group employed price-conscious food purchasing practices because of limited food budgets, limiting local food access. Combining produce prescription, NE, and farmers' market access enhanced FVRx participant associations with FD settings to reinforce motivation for accessing and purchasing fruits and vegetables beyond program participation. CONCLUSIONS AND IMPLICATIONS: Fruit and Vegetable Prescription Programs reduce multiple barriers to participating in FD settings compared with NE or standard health care alone.

Current Landscape of Produce Prescription Programs in the US.

OBJECTIVE: To understand the design and implementation models of US produce prescription programs. METHODS: In a mixed-methods study, program providers completed an online survey and an individual phone interview regarding their 2019 programming. RESULTS: Twenty-three programs completed surveys; 20 completed interviews. Program locations included the mid-Atlantic (26%), Northeast (9%), Midwest (30%), Southwest (17%), and Western regions (17%). Although program models varied, programs generally included a health care visit, usually at a safety-net clinic, and nutrition education, typically counseling, advice, or classes. Prescriptions tended to be farmers market vouchers worth a median of $15 a week (interquartile range, $7.81-$20.00). Transportation was a problem for nearly half of the programs. CONCLUSIONS AND IMPLICATIONS: Current produce prescription program characteristics and operations can serve as a blueprint for new and existing programs. Future research should determine program best practices and the opportunity cost between program standardization and local flexibilities.

"It was an unexpected bond": How an emerging participant-driven online social network may be enhancing an eLearning nutrition education & supplemental produce intervention.

OBJECTIVE: The purpose of this paper is to describe a participant-driven, online text message-based social support network that emerged from an eLearning nutrition education and supplemental produce intervention. METHODS: Adults (n = 20) who utilized a safety-net clinic for their healthcare participated in a 12-week smartphone-based nutrition education eLearning program using loaned smartphones. Participants also received a box of fresh produce weekly. Participants received weekly text message reminders to collect their produce, and from this researcher-initiated reminder text, a supportive, participant-led, all-group text message thread commenced. Researchers collected all 471 text messages in this all-group thread and included them in the qualitative content analysis of pre and post intervention focus groups. RESULTS: The original design of the eLearning nutrition education program was to asynchronously engage learners with nutrition education resources. However, participants themselves initiated a robust group text message support system through which they shared encouragement, recipes, grocery shopping tips, and images of food they prepared with the produce box amongst themselves for the duration of the 12-week intervention. CONCLUSION: The novel nature by which these participants voluntarily engaged in this peer-to-peer nutrition education-focused text message conversation exemplifies participants becoming agents in their own learning experience and will be used to enhance future eLearning nutrition education experiences developed by our team.

Advancing Science while Training Undergraduates: Recommendations from a Collaborative Biology Research Network.

Biology research is becoming increasingly dependent on large-scale, "big data," networked research initiatives. At the same time, there has been a corresponding effort to expand undergraduate participation in research to benefit student learning and persistence in science. This essay examines the confluence of this trend through eight years of a collaboration within a successful biology research network that explicitly incorporates undergraduates into large-scale scientific research. We draw upon interviews with faculty in this network to consider the interplay of scientific and pedagogical objectives at the heart of this undergraduate-focused network research project. We identify ways that this network has expanded and diversified access to scientific knowledge production for faculty and students and examine a goal conflict that emerged around the dual objectives of mentoring emerging scientists while producing high-quality scientific data for the larger biology community. Based on lessons learned within this network, we provide three recommendations that can support institutions and faculty engaging in networked research projects with undergraduates: (1) establish rigorous protocols to ensure data and database quality, (2) protect personnel time to coordinate network and scientific processes, and (3) select appropriate partners and establish explicit expectations for specific collaborations.

A Supplemental Produce and eLearning Nutrition Education Program for Georgians Who Use Safety-Net Clinics for Their Health Care.

OBJECTIVE: To explore the experiences of safety-net clinic patients who engaged in a 12-week supplemental produce and eLearning nutrition education program. METHODS: This mixed-method study employed a nonrandomized comparison study design. Participants (intervention [n = 20] and comparison control [n = 6]) had diet-related chronic diseases. Data collection included pre- and post-intervention, focus group interviews, 24-hour diet recalls, and clinical and anthropometric outcome assessments. Interviews were recorded, transcribed, and coded using the constant comparison method. Nonparametric data analyses were conducted for quantitative data. RESULTS: Three primary themes emerged: (1) program benefits, (2) challenges to achieving health benefits and optimal engagement of the program, and (3) recommendations for program improvement. Quantitative data analysis did not show significant differences in pre- and post-clinical and anthropometric measures between the intervention and comparison groups. CONCLUSIONS AND IMPLICATIONS: Findings suggest a unique Supplemental Nutrition Assistance Program Education dissemination model that may decrease barriers to healthful eating and increase engagement in eLearning nutrition education.

Becoming a "Science Person": Faculty Recognition and the Development of Cultural Capital in the Context of Undergraduate Biology Research.

We argue that cultural capital plays an underexamined role in students' recognition as budding scientists by faculty. By triangulating interview data from undergraduates and faculty mentors in a multi-institutional biology research network, we identified a set of intersecting domains of capital that help render students recognizable to faculty. We argue that faculty recognition often reflects a (mis)alignment between the cultural capital that students possess and display and what faculty expect to see. To understand why mis- or underrecognition occurs, and how this influenced students' opportunities to further develop cultural capital, we explored our data set for patterns of explanation. Several key themes cut across students' experiences and influenced their recognition by faculty: Faculty more easily recognized students interested in research science trajectories and those involved in institutional programs to support science, technology, engineering, and mathematics success. Students with competing family responsibilities struggled to maintain faculty recognition. Finally, faculty who broadened their scopes of recognition were able to affirm the science identities of students with fewer incoming cultural resources in science and support their development of capital. Students can and do develop scientific cultural capital through practice, but this requires access to research and mentorship that explicitly teaches students the implicit "rules of the game."

Why women choose compounded bioidentical hormone therapy: lessons from a qualitative study of menopausal decision-making.

BACKGROUND: In recent years, compounded bioidentical hormone therapy (CBHT) has emerged as a popular alternative to manufactured, FDA approved hormone therapy (HT)-despite concerns within the medical community and the availability of new FDA approved "bioidentical" products. This study aims to characterize the motivations for using CBHT in a U.S. sample of ordinary midlife women. METHODS: We analyze data collected from 21 current and former users of CBHT who participated in a larger qualitative study of menopausal decision-making among U.S. women. Interviews and focus groups were audio-recorded, transcribed verbatim, and analyzed thematically using an iterative inductive and deductive process. RESULTS: Although women's individual motivations varied, two overarching themes emerged: "push motivations" that drove women away from conventional HT and from alternative therapies, and "pull motivations" that attracted women to CBHT. Push motivations focused on (1) fear and uncertainty about the safety of conventional HT, (2) an aversion to conjugated estrogens in particular, and (3) and overarching distrust of a medical system perceived as dismissive of their concerns and overly reliant on pharmaceuticals. Participants also voiced dissatisfaction with the effectiveness of herbal and soy supplements. Participants were attracted to CBHT because they perceive it to be (1) effective in managing menopausal symptoms, (2) safer than conventional HT, (3) tailored to their individual bodies and needs, and (4) accompanied by enhanced clinical care and attention. CONCLUSIONS: This study finds that women draw upon a range of "push" and "pull" motivations in their decision to use CBHT. Importantly, we find that women are not only seeking alternatives to conventional pharmaceuticals, but alternatives to conventional care where their menopausal experience is solicited, their treatment goals are heard, and they are engaged as agents in managing their own menopause. The significance of this finding goes beyond understanding why women choose CBHT. Women making menopause treatment decisions of all kinds would benefit from greater shared decision-making in the clinical context in which they are explicitly invited to share their experiences, priorities, and preferences. This would also provide an opportunity for clinicians to discuss the pros and cons of conventional HT, CBHT, and other approaches to managing menopause.

Is There a Role for Complementary and Alternative Medicine in Preventive and Promotive Health? An Anthropological Assessment in the Context of U.S. Health Reform.

Chronic conditions associated with lifestyle and modifiable behaviors are the leading causes of morbidity and mortality in the United States. The implementation of the Affordable Care Act offers an historic opportunity to consider novel approaches to addressing the nation's public health concerns. We adopt an anticipatory anthropological perspective to consider lifestyle behavior change as common ground shared by practitioners of both biomedicine and common forms of complementary and alternative medicine (CAM). At issue is whether CAM practitioners might play a more proactive and publicly endorsed role in delivering preventive and promotive health services to address these needs. Recognizing that this is a contentious issue, we consider two constructive roles for engaged medical anthropologists: (1) as culture brokers helping to facilitate interprofessional communities of preventive and promotive health practice and (2) in collaboration with health service researchers developing patient-near evaluations of preventive and promotive health services on patient well-being and behavior change.

Critical Anthropology of Global Health "takes a stand" statement: a critical medical anthropological approach to the U.S.'s Affordable Care Act.

The Affordable Care Act (ACA) of 2010--the U.S.'s first major health care reform in over half a century-has sparked new debates in the United States about individual responsibility, the collective good, and the social contract. Although the ACA aims to reduce the number of the uninsured through the simultaneous expansion of the private insurance industry and government-funded Medicaid, critics charge it merely expands rather than reforms the existing fragmented and costly employer-based health care system. Focusing in particular on the ACA's individual mandate and its planned Medicaid expansion, this statement charts a course for ethnographic contributions to the on-the-ground impact of the ACA while showcasing ways critical medical anthropologists can join the debate. We conclude with ways that anthropologists may use critiques of the ACA as a platform from which to denaturalize assumptions of "cost" and "profit" that underpin the global spread of market-based medicine more broadly.

Reconsidering the placebo response from a broad anthropological perspective.

This paper considers how the full range of human experience may catalyze a placebo response. The placebo effect has been characterized as something to control in clinical research, something to cultivate in clinical practice and something present in all healing encounters. We examine domains in which the term 'placebo' is used in discourse: clinical research, clinical practice, media representations of treatment efficacy and lay interpretations of placebo--an underresearched topic. We briefly review major theoretical frameworks proposed to explain the placebo effect: classical conditioning, expectancy, the therapeutic relationship and sociocultural 'meaning.' As a corrective to what we see as an overemphasis on conscious cognitive approaches to understanding placebo, we reorient the discussion to argue that direct embodied experience may take precedence over meaning-making in the healing encounter. As an example, we examine the neurobiology of rehearsing or visualizing wellness as a mode of directly (performatively) producing an outcome often dismissed as a 'placebo response.' Given body/mind/emotional resonance, we suggest that the placebo response is an evolutionarily adaptive trait and part of healing mechanisms operating across many levels--from genetic and cellular to social and cultural.

The compliance paradox: what we need to know about "real-world" dietary supplement use in the United States.

Current research on dietary supplements (primarily survey-based prevalence studies and clinical trials of safety and efficacy) is inadequate for understanding how consumers use supplements in the real world. Analyzing interview data from formative research with dietary supplement users (N=60), we observed skepticism in the way our informants interpret scientific information about supplements, trust in referrals from those they feel are like them, and experimentation with products in order to tailor them to their bodies and needs. We stress the need for qualitative research focusing on patterns of supplement use in context (rather than as isolated supplements in fixed doses), the network effect of supplement use, and the way information about supplements is translated and transmitted. Furthermore, we urge clinicians to pay careful attention not only to whether patients are taking dietary supplements, but also how supplements are being used alone and in combination with other supplements, pharmaceuticals, and over-the-counter (OTC) medications.

For my wellness, not just my illness: North Americans' use of dietary supplements.

Passage of the DSHEA in 1994 created a new "liminal" category for the FDA: dietary supplements are regulated as neither food nor drugs. However, there appears to be a significant disconnect between the "official" discourse surrounding dietary supplements and supplement users' actual practices. Despite this discrepancy, and the inadequacy of surveys to capture the dynamics of pharmaceutical practice, there is little ethnographic information available on the ways that Americans think about or use dietary supplements. We offer some preliminary observations from a pilot ethnographic study of Americans' use of dietary supplements in which we consider not only the reasons why people are using supplements, but how they are using them, and how their experimentation has been influenced by the information they seek and receive from a variety of sources. We illustrate how anthropological studies of supplement related practice can help us better understand Americans' attraction to and use of dietary supplements, and suggest that anthropology can contribute to a more balanced perspective on supplement use-one that moves the study of supplements beyond surveys and randomized controlled studies of efficacy to considerations of patterns of use in context, user expectations, and measures of perceived effectiveness.