Persistence and transience of food insecurity and predictors among residents of two disadvantaged communities in South Carolina.

BACKGROUND: Little is known about patterns of household food insecurity (HFI) across more than two time points in adults in the United States, the frequency predictors of different trajectories. The distinctions between persistent and transient food insecurity trajectories may be crucial to developing effective interventions. OBJECTIVE: To characterize dominant trajectories of food security status over three time points between 2013 and 2016 and identify demographic, socioeconomic and health-related predictors of persistent and transient HFI. DESIGN: Cohort study in disadvantaged communities in South Carolina. SETTING: and subjects: 397 middle-aged participants, predominantly female, African American, living in USDA-designated food deserts. MAIN OUTCOME MEASURE: Household food insecurity over time using the 18-item USDA's Household Food Security Survey Module. STATISTICAL ANALYSES PERFORMED: Descriptive analyses of food security trajectories and multinomial regression analyses. RESULTS: At baseline (2013-2014), 61% of households reported HFI during the previous 12 months, which decreased to 54% in 2015 and to 51% in 2016. Only 27% of households were persistently food secure, 36% experienced transient and 37% persistent food insecurity. Female sex (OR 2.7, 95%CI 1.2-5.9), being married or living with a partner (OR 2.4, 95CI% 1.1-5.3) and fair health status (OR 4.4, 95%CI 2.2-8.8) were associated with increased odds of persistent food insecurity. Fair health was also a significant predictor of transient food insecurity. CONCLUSIONS: These findings suggest that future research should focus on persistent versus transient trajectories separately and that tailored interventions may be needed to make progress on alleviating food insecurity among disadvantaged communities.

Recruitment and Retention for the Evaluation of a Healthy Food Initiative in Economically Disadvantaged, Majority African American Communities.

Effective recruitment and retention supports equitable participation in research. The aim of this article is to describe recruitment and retention methods among residents of highly disadvantaged, predominantly African American communities in the southeastern United States during the evaluation of a healthy food access initiative. We proposed that active and passive recruitment methods, intensive retention strategies, community outreach and involvement, over-enrollment to anticipate attrition, and applied principles of community participation would achieve the study's recruitment and retention goals. The enrollment goal of 560 was met at 94% (n = 527), and the retention goal of 400 was achieved (n = 408).

Socioeconomic factors associated with diet quality and meeting dietary guidelines in disadvantaged neighborhoods in the Southeast United States.

Objective: To examine diet quality and dietary intake among residents of disadvantaged neighborhoods in the Southeast United States (U.S.) and to examine associations between dietary and socioeconomic factors. Design: We examined baseline data from an evaluation study of a healthy food access initiative. Participants were recruited from two urban settings comprising seven neighborhoods of high household poverty (17% to 62%). Participants completed in-person interviews with measures of education, household income, and food security and one unannounced 24-hour dietary recall by telephone with trained registered dietitians. Food desert residence was coded based on U.S. Census data. Proportions meeting 2010 Dietary Guidelines for Americans and Healthy Eating Index 2010 (HEI-2010) scores were computed. Associations between dietary variables and participant's education, household income, food security, and food desert residence were tested. Results: Participants (n = 465) were predominantly African American (92%), women (80%), and overweight or obese (79%), and 52 ± 14 years of age. Sixty-three percent had low or very low food security, and 82% lived in census tracts of low income and low access to supermarkets (urban food desert). HEI-2010 scores averaged 48.8 ± 13.1. A minority of participants met dietary guidelines. Diet quality was lower among participants with lower education and among those from food insecure households (p < .05). Household income and food security were positively associated with meeting several dietary guidelines (p < .05). Food desert residence was unrelated to diet variables. Conclusions: In this disadvantaged population, significant nutritional concerns were observed, and socioeconomic factors were associated with diet quality and meeting dietary guidelines. Interventions must address broader economic, social, and policy issues such as access to affordable healthy foods.

Community Health Advisors' Characteristics and Behaviors, Role Performance, and Volunteer Satisfaction in a Church-Based Healthy Eating and Physical Activity Intervention.

Community Health Advisors (CHAs) contribute to health promotion program effectiveness, but their role in faith-based programs is understudied, and little is known about their role performance or satisfaction. In a dissemination and implementation study, 19 CHAs were trained to provide healthy eating (HE) and physical activity (PA) program training to church committees. Of these, 17 CHAs trained 347 attendees from 115 churches. Thirteen CHAs remained for the 12-month period and provided telephone-based technical assistance (TA) to churches. To evaluate their experiences and satisfaction, CHAs completed questionnaires at baseline and 12 months. Staff observers and church committee members evaluated CHAs' effectiveness as trainers. There were no significant changes in the CHAs' own body mass index, PA, fruit and vegetable intake, or self-rated health but significant increases in their perceived knowledge of PA (p = 0.01) and HE (p = 0.02). CHAs reported high agreement regarding the quality of their training for the role and moderate volunteer satisfaction on average but thought that the time required of them was somewhat more than expected, though they were interested in volunteering for a future, similar role. Church committee members agreed with CHAs' effectiveness as trainers and the helpfulness of the TA calls. Staff observers rated CHAs' as having covered 87.8% of church training content and agreed that, on average, the CHAs were effective trainers. Assessing CHAs' availability, clear communication about the time requirements, and over-recruitment to offset attrition and decrease the workload may be needed to improve retention and support satisfaction.

Community Health Advisors' Participation in a Dissemination and Implementation Study of an Evidence-Based Physical Activity and Healthy Eating Program in a Faith-Based Setting.

Community health advisors (CHAs) have been widely involved in health promotion, but few details on role expectations, retention, and evaluation have been reported. In a dissemination and implementation (D&I) study of an evidence-based healthy eating and physical activity program, 59 churches were randomized to an intervention (n = 39) or control (delayed intervention) (n = 20) condition. In a novel approach, CHAs worked with church committees rather than congregants by providing training (n = 59) and technical assistance (n = 54) to the committees to implement a program focused on structural and policy-level changes to support congregants' behavioral changes. CHA training comprised self-study via electronic training modules, in-person training, and telephone-based training. Evaluation methods were pilot test participants' and CHAs' ratings of their training; observers' ratings of CHAs' church training delivery; church committee members' ratings of the training experience, including CHAs' performance; and data from the TA database to assess CHAs' adherence to the protocol. The main challenge was the early dropout of one CHA and the reduced role of another. CHAs trained 142 intervention and 60 control church committee members in nine sessions; they covered 99% (intervention) and 90% (control) of training content, indicating high fidelity. Observers' scored CHAs' teaching and facilitation skills at 96.7% (intervention) and 80% (control) of the possible score. CHAs completed 92% of intervention and 93% of control TA calls. The great majority of church participants' comments regarding CHAs were positive. This study demonstrates that with training and support, CHAs demonstrate high levels of intervention fidelity, confidence, and competence.

Living in Limbo: Latinas' Assessment of Lower Rio Grande Valley Colonias Communities.

Community asset mapping (CAM) is the collective process of identifying local assets and strategizing processes to address public health issues and concerns and improve quality of life. Prior to implementing a community-based physical activity intervention with Latinas in the Texas Lower Rio Grande Valley, promotoras [community health workers] conducted 16 interactive sessions in 8 colonias. The analysis of the transcribed CAM recordings and on-site observational data resulted in the construction of Living in Limbo as the thematic representation of these Latinas' social isolation and marginalization associated with pervasive poverty, undocumented immigration status or lack of citizenship, their fears emanating from threats to physical and emotional safety, and the barriers created by lack of availability and access to resources.

Dietary Intake, Behaviors and Psychosocial Factors Among Women from Food-Secure and Food-Insecure Households in the United States.

OBJECTIVE: Determine whether macro- and micro-nutrient intake, energy intake, diet quality, adherence to recommended dietary intake, and psychosocial and behavioral factors are associated with household food security. DESIGN: Baseline data from in-person interviews and telephone-based, 24-hour dietary recall from women recruited to a diet and physical activity controlled trial. SETTING: Neighborhoods encompassing 18 urban census tracts in South Carolina. PARTICIPANTS: Participants (n=202) were predominantly African American (87%), overweight or obese women aged 25 to 51 years with mean body mass index of 40.6±8.7. MAIN OUTCOME MEASURES: Macro- and micro-nutrient intake, energy intake, diet quality, adherence to recommended dietary intake (via multi-pass, 24-h recall); diet-related self-efficacy and social support, healthy/lowfat and emotional eating behaviors, and depressive symptoms. RESULTS: Women in food-secure (FS) and food insecure (FI) households were not different on health and sociodemographic characteristics. Women in FI households had lower self-efficacy and healthy/low-fat eating behaviors, and higher emotional eating and depressive symptoms compared with women in FS households. The groups did not differ on social support. Significant dietary differences were few (FS>FI on protein and lean meat; FS

Implementing a Community Empowerment Center to Build Capacity for Developing, Implementing, and Sustaining Interventions to Promote Community Health.

The Community Empowerment Center used a community-engaged approach to build capacity among residents to develop and implement interventions focused on creating a healthier environment. The Center partnered with residents living in a public housing community and adjacent low-income neighborhood and provided support through a mini-grant program. A six-session training program guided community members in mini grant development; 25 individuals attended at least one session. Six grant proposals were submitted; three were awarded $12,000 each for intervention implementation. Findings offer a model for engaging residents from low-resource settings in intervention development, implementation, and sustainability for community health promotion.

Body Size Perceptions among Overweight and Obese African American Women.

OBJECTIVE: Understanding body size perceptions and discrepancies among African American women may have implications for effective weight-loss interventions. The purpose of this study is to examine body size perceptions of economically disadvantaged, overweight and obese African American women. DESIGN: Cross-sectional using baseline data from a randomized controlled trial. SETTING: 18 census tracts in a central South Carolina city where ≥ 25% of residents were below poverty income. PARTICIPANTS: 147 economically disadvantaged, overweight and obese African American women. MAIN OUTCOME MEASURES: Using Pulvers' figure rating scale, participants chose the figure: 1) closest to their current figure; 2) they would be satisfied with; and 3) with a body weight that would be a health problem for the average person. Mean body mass indices corresponding to each figure were compared with those in a large sample of White women. RESULTS: Most participants wanted to be smaller (mean=2.6 figures smaller) than their current size. A majority (67%) chose the largest figure as representing a body size that could lead to a health problem, and most (60%) chose a current figure smaller than the figure they believed would be associated with health problems. The mean body mass index for women selecting any given figure as their current size was significantly larger (5.2-10.8 kg/m(2) larger, P<.0001) than those established in the sample of White women. CONCLUSIONS: Although women desired a smaller body size, there nonetheless were misperceptions of body size and the associated health consequences. Body size misperceptions and/or satisfaction may pose barriers for effective weight-loss.

Predicting outdoor recreation area use in a Southeastern US county: a signal detection analysis.

Use of outdoor recreation areas (ORAs) is correlated with physical activity (PA) in community-dwelling adults. Additionally, the wide spread availability of ORAs, including their placement in disadvantaged neighborhoods, make them an especially promising venue through which to promote PA. The purpose of this study was to examine the combination of individual-level factors associated with ORA use in a socioeconomically diverse Southeastern US county. A 2011 random digit-dial survey included 829 adults aged 18+ years with complete data; questions assessed PA level and use/perceived safety of ORAs. Signal detection analysis, a non-parametric recursive partitioning technique, identified cutpoints for defining subgroups of respondents based on ORA use. Seven subgroups were defined ranging from 77.2 % ORA use (younger, met PA recommendations) to 31.8 % ORA use (older, perceived ORAs to be less safe). Signal detection did not identify gender or race as important for defining subgroups. Results suggest that gendered and ethnically-focused ORA promotion campaigns might be unnecessary. Instead, efforts could focus on increasing awareness of ORA facilities among older, less active adults.

Perceived barriers to exercise and healthy eating among women from disadvantaged neighborhoods: results from a focus groups assessment.

This study explored perceptions and experiences with barriers to exercise and healthy eating among women from predominately African American, disadvantaged neighborhoods. Four focus groups (n = 28) were conducted between April and May 2008 with overweight or obese women (93% African American; 34.3 ± 8.9 years; body mass index [BMI] 40.4 ± 8.5). Individual, social, and environmental factors were frequently mentioned as barriers to exercise and healthy eating. Insults from strangers about their body size (e.g., from children or people at the gym), and feelings of intimidation and embarrassment about not being able to complete exercises due to their body size were described as barriers to exercise. Lack of support and pressure from family, friends, and co-workers were barriers to healthy eating; participants experienced pressure from family and friends to eat more and were told they did not need to lose weight. Participants discussed the importance of not losing their curves; this concern needs to be considered when developing weight control programs for African American women. The findings of this qualitative study guided the development of a weight loss intervention for women from disadvantaged neighborhoods.

Patterns of sedentary behavior in overweight and obese women.

OBJECTIVES: Few studies have objectively quantified sedentary behavior, particularly in special population subgroups. This study quantified the volume of and breaks from sedentary behavior in a sample of overweight and obese, primarily African American, women. DESIGN: Cross-sectional. SETTING: 18 census tracts in Columbia, South Carolina with higher than state and national poverty levels. PARTICIPANTS: 197 overweight/obese women (87% African American). Mean age 38.3 +/- 7.6 years, mean body mass index 40.6 +/- 8.8 kg/m2. MAIN OUTCOMES MEASURES: Using a cut point of < 100 counts/minute, estimated daily averages of: 1) total volume, 2) > or = 10, 30, and 60-minute bouts, and 3) patterns of sedentary behavior according to time of day and day of the week were computed. Total breaks, or interruptions, in sedentary time were also calculated. RESULTS: Participants were sedentary 64.1% of the day, engaging in 10.5 +/- 2.8 daily bouts of sedentary behavior per hour of sedentary time; each bout lasted approximately 6.4 +/- 1.7 minutes. All participants engaged in > or = 1 daily bout of sedentary behavior > or = 10 and > or = 30 minutes, and most (83%) engaged in > or = 1 bout > or = 60 minutes. Participants were slightly more sedentary during the evening (6 pm-midnight) and on weekdays. On average, participants took 90.9 +/- 16.0 breaks from sedentary behavior; each break lasted 3.3 +/- .8 minutes. CONCLUSIONS: Women engaged in more sedentary behavior than that reported in national data sets. In an effort to improve public health, efforts should not only focus on increasing physical activity, but also on decreasing time spent sedentary.

Newspaper content analysis in evaluation of a community-based participatory project to increase physical activity.

This study conducted a newspaper content analysis as part of an evaluation of a community-based participatory research project focused on increasing physical activity through policy and environmental changes, which included activities related to media advocacy and media-based community education. Daily papers (May 2003 to December 2005) from both the intervention and comparison counties were reviewed for topics related to physical activity and an active living environment (e.g. safety, policy, urban design, transportation and recreational resources). A total of 2681 articles from 1764 newspapers were analyzed. The intervention county had a greater proportion of articles on the selected topics. Specifically, the intervention county had a greater proportion of articles in topics related to safety, policy and community initiatives, as well as in sidewalks and recreational facilities; both priority areas for the intervention. Prominence of the articles was assessed using a composite index score. Generally, prominence of the topics analyzed was low. Articles in the sidewalks and recreational facilities topic category in the intervention county had higher prominence scores on average than the comparison county. The study demonstrates that media content analysis can be a valuable component in evaluating community-based interventions.

Effects of a food hub initiative in a disadvantaged community: A quasi-experimental evaluation.

A quasi-experiment evaluated a food hub's (FH) impact in a low-income/low-access (food desert) setting on fruit and vegetable (F&V) intake, diet quality, kilocalories, perceived food environment, BMI, and farmers' market shopping versus a matched community (n = 265 FH, n = 262 Comparison). Comparison shoppers had better baseline perceptions of their food environment, but FH shoppers improved significantly more than Comparison shoppers. Comparison shoppers significantly increased F&V intake versus FH shoppers. Effects were not significant for other diet outcomes, BMI, or farmers' market shopping. Factors besides spacial access to healthy food need consideration to address dietary intake and obesity in disadvantaged communities.

A food hub to address healthy food access gaps: Residents' preferences.

Interventions aimed at improving access to healthy food in low-income communities should consider the preferences of residents. Household food shoppers in two urban, low-income communities were asked about their preferences for vendors at, and qualities of, a potential nearby food hub. Universally, participants preferred availability of whole foods, primarily fruits and vegetables. They also favored cleanliness, quality, and affordability. The demographics and preferences of potential customers raise central issues that would need to be integrated into the development of a food hub, namely affordability (likely through subsidization), attention to accommodation and cultural accessibility, and programming that builds community.

Socioecological Path Analytic Model of Diet Quality among Residents in Two Urban Food Deserts.

BACKGROUND: Diet is critical to chronic disease prevention, yet there are persistent disparities in diet quality among Americans. The socioecological model suggests multiple factors, operating at multiple levels, influence diet quality. OBJECTIVE: The goal was to model direct and indirect relationships among healthy eating identity, perceived control of healthy eating, social support for healthy eating, food retail choice block scores, perceptions of healthy food availability, and food shopping behaviors and diet quality measured using Healthy Eating Index-2010 scores (HEI-2010) for residents living in two urban communities defined as food deserts. DESIGN: A cross-sectional design was used including data collected via self-reported surveys, 24-dietary recalls, and through objective observations of food retail environments. PARTICIPANTS/SETTING: Data collection occurred in 2015-2016 in two low-income communities in Cleveland (n=243) and Columbus (n=244), OH. MAIN OUTCOME MEASURE: HEI-2010 scores were calculated based on the average of three 24-hour dietary recalls using the Nutrition Data System for Research. ANALYSIS: Separate path models, controlled for income, were run for each community. Analysis was guided by a conceptual model with 15 hypothesized direct and indirect effects on HEI-2010 scores. Associations were considered statistically significant at P<0.05 and P<0.10 because of modest sample sizes in each community. RESULTS: Across both models, significant direct effects on HEI-2010 scores included healthy eating identity (ß=.295, Cleveland; ß=.297, Columbus, P<0.05) and distance traveled to primary food store (ß=.111, Cleveland, P<0.10; ß=.175, Columbus, P<0.05). Perceptions of healthy food availability had a significant, inverse effect in the Columbus model (ß=-.125, P<0.05). The models explained greater variance in HEI-2010 scores for the Columbus community compared with Cleveland (R2=.282 and R2=.152, respectively). CONCLUSIONS: Findings highlight the need for tailored dietary intervention approaches even within demographically comparable communities. Interventions aimed at improving diet quality among residents living in food deserts may need to focus on enhancing healthy eating identity using culturally relevant approaches while at the same time addressing the need for transportation supports to access healthy food retailers located farther away.

Correlates of physical activity among African American and white women.

OBJECTIVE: To compare potential correlates of physical activity between African American and white women. METHODS: A random-digit-dialed telephone survey was conducted in central South Carolina. Bivariate and multivariate analyses focused on women aged 18+ (N = 1176). RESULTS: African American women reported greater maintenance of sidewalks and public parks than did white women, who reported higher physical activity, exercise self-efficacy, access to indoor walking facilities, and knowledge of mapped-out walking routes. Exercise self-efficacy was the only significant correlate of physical activity among both African American and white women. CONCLUSIONS: Self-efficacy was a robust cross-sectional correlate of physical activity in women.

Recruitment strategies and costs for a community-based physical activity program.

A community-based participatory research project using social marketing strategies was implemented to promote physical activity among women aged 35 to 54 who were insufficiently active or completely inactive. A variety of media were used to disseminate messages about how to enroll in Step Up. Step Out! This article describes the effectiveness and cost of the recruitment strategies and lessons learned in recruiting the women. Of the total inquiries (n = 691), 430 women were eligible and enrolled in the program. Based on data from questionnaires, the most effective method of recruiting women into Step Up. Step Out! was word of mouth (36%). Newspaper ads accounted for 29% of the women's responses. The least effective method was billboards. Mass media was not as effective in recruiting women for the program as interpersonal efforts such as word of mouth. Interpersonal efforts are a valuable and possibly underrated recruitment and promotion tool.

Sumter County on the Move! Evaluation of a Walking Group Intervention to Promote Physical Activity Within Existing Social Networks.

BACKGROUND: Social network-driven approaches have promise for promoting physical activity in community settings. Yet, there have been few direct investigations of such interventions. This study tested the effectiveness of a social network-driven, group-based walking intervention in a medically underserved community. METHODS: This study used a quasi-experimental pretest-posttest design with 3 measurement time points to examine the effectiveness of Sumter County on the Move! in communities in Sumter County, SC. A total of 293 individuals participated in 59 walking groups formed from existing social networks. Participants were 86% females, 67% black, and 31% white, with a mean age of 49.5 years. Measures included perceptions of the walking groups; psychosocial factors such as self-regulation, self-efficacy, and social support; and both self-reported and objectively measured physical activity. RESULTS: The intervention produced significant increases in goal setting and social support for physical activity from multiple sources, and these intervention effects were sustained through the final measurement point 6 months after completion of the intervention. Nonetheless, few of the desired changes in physical activity were observed. CONCLUSION: Our mixed results underscore the importance of future research to better understand the dose and duration of intervention implementation required to effect and sustain behavior change.

Food Acquisition and Shopping Patterns among Residents of Low-Income and Low-Access Communities in South Carolina.

BACKGROUND: Little is known about the food acquisition and shopping habits of residents living in food deserts. OBJECTIVE: To identify distinct food acquisition and shopping patterns among residents, most of whom (81%) live in food desert (low income and low access) census tracts, and characterize these patterns with respect to the residents' socioeconomic status, nutrition knowledge, and perceptions of their food environment. DESIGN: This is a cross-sectional study. PARTICIPANTS/SETTING: Four hundred sixty-six primary food shoppers were included from two counties in South Carolina during 2013-2014. MAIN OUTCOME MEASURES: Participants' self-reported food acquisition and shopping habits, including shopping distance; frequency; store type; transportation mode; use of farmers' markets, food banks/pantries, and church/social service organizations, were used to develop shopping patterns and group residents. Supplemental Nutrition Assistance Program participation, food security, income, and education, nutrition knowledge, and perceptions of the food environment were used to characterize these groups. STATISTICAL ANALYSES PERFORMED: Latent class analysis and multinomial logistic regression were used to identify and characterize patterns, respectively. RESULTS: Three patterns were identified, including those who use community food resources, are infrequent grocery shoppers, and use someone else's car or public transportation when shopping (Class 1) (35%), those who use community food resources and are more frequent and proximal shoppers (Class 2) (41%), and those who do not use community food resources and are distal shoppers (Class 3) (24%). Compared with Class 3, Class 1 had comparatively lower socioeconomic status. Class 2 also had comparatively lower socioeconomic attributes except for income. Class 2 was not significantly different from Class 1 except that a higher proportion in Class 1 saw food access as a problem. No significant differences across classes were found regarding fruit and vegetable recommendation knowledge. CONCLUSIONS: Shopping frequency, use of community food resources, transportation methods, and shopping distance were the key factors that defined distinct patterns among residents living in low-income areas. Future interventions to increase healthy food access in underserved areas should not only consider accessibility but also community food resource use.