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1.

Merchant Attitudes Toward a Healthy Food Retailer Incentive Program in a Low-Income San Francisco Neighborhood.

McDaniel, Patricia A; Minkler, Meredith; Juachon, Lisa; Thayer, Ryan; Estrada, Jessica; Falbe, Jennifer
| Idioma(s): Inglés
In low-income urban communities across the United States and globally, small stores frequently offer processed foods, sodas, alcohol, and tobacco but little access to healthy products. To help address this problem, the city of San Francisco created a healthy food retailer incentive program. Its success depends, in part, on retailers' willingness to participate. Through in-person interviews, we explored attitudes toward the program among store owners or managers of 17 nonparticipating stores. Eleven merchants were uninterested in the program due to negative past experiences trying to sell healthier products, perceived lack of customer demand, and fears that meeting program requirements could hurt profits. Six merchants expressed interest, seeing demand for or opportunity in healthy foods, foreseeing few difficulties in meeting program requirements, and regarding the assistance offered as appealing. Other municipalities considering such interventions should consider merchants' perspectives, and how best to challenge or capitalize on retailers' previous experiences with selling healthy foods.
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2.

Adequação normativa dos planos estaduais de segurança alimentar e nutricional no Brasil/ Compliance with guidelines by state plans for food and nutritional security in Brazil/ Adecuación normativa de los planes estatales de seguridad alimentaria y nutricional en Brasil

Machado, Mick Lennon; Gabriel, Cristine Garcia; Soar, Claudia; Mamed, Gisele Rockenbach; Machado, Patrícia Maria de Oliveira; Lacerda, Josimari Telino de; Martins, Milena Corrêa; Marcon, Maria Cristina
| Idioma(s): Portugués
Resumo: Com o intuito de analisar a adequação dos Planos Estaduais de Segurança Alimentar e Nutricional (PlanSAN) às normas estabelecidas pela Política Nacional de Segurança Alimentar e Nutricional (PNSAN), foi realizada pesquisa descritiva e documental, com coleta de dados entre agosto a outubro de 2016. O acesso aos planos foi realizado na página de Internet da Câmara Interministerial de Segurança Alimentar e Nutricional (CAISAN) ou dos governos estaduais, com coleta de informações complementares no âmbito dos estados. Todos os estados brasileiros aderiram ao Sistema de Segurança Alimentar e Nutricional (SISAN), entretanto menos da metade (13 estados, 48%) elaborou seus planos, destacando-se alguns aspectos: 5 (38%) dos PlanSAN tinham vigência correspondente ao plano plurianual do estado; 5 (38%) dos PlanSAN descreviam os requisitos orçamentários para execução das metas propostas; e 7 (54%) descreviam mecanismos de monitoramento do plano e apenas 2 (15%) definiam metodologia para monitoramento de segurança alimentar e nutricional. O menor tempo de existência da CAISAN e de adesão parecem estar relacionados com a inexistência de PlanSAN. Ainda que a maioria dos estados com planos atendam algumas normativas estabelecidas pela PNSAN, esses instrumentos tornam-se frágeis e pouco exequíveis quando não possuem vinculação orçamentária para suas metas. Pelo fato de a PNSAN ser estruturalmente intersetorial, a construção dos planos depende de um trabalho coletivo das diversas secretarias de governo. Reforça-se que os itens analisados foram todos normativos, o que implica necessidade do estabelecimento de mecanismos que garantam a sua adequada execução. Abstract: A descriptive and documental study was performed from August to October 2016 to analyze compliance by state plans for food and nutritional security (PlanSAN) with the guidelines set by the Brazilian National Policy for Food and Nutritional Security (PNSAN). The state plans were accessed via the websites of the Inter-Ministerial Chamber for Food and Nutritional Security (CAISAN) or the state governments, plus complementary data collection at the state level. All the states of Brazil joined the National System for Food and Nutritional Security (SISAN), while fewer than half (13 states, 48%) had drafted their plans. Of these, 5 (38%) of the PlanSAN had schedules that coincided with the same state's pluriannual plan, 5 (38%) of the PlanSAN specified the budget requirements for meeting the proposed targets, 7 (54%) specified mechanisms for monitoring the plan, and only 2 (15%) defined methodologies for monitoring food and nutritional security. The recent existence of (and adherence to) the CAISAN appear to be related to the lack of state plans in half the states. Although most of the states that did have plans met some of the guidelines laid out by the PNSAN, these mechanisms become weak and impractical when they lack earmarked budget funds to meet their targets. Since the PNSAN is structurally inter-sectorial, the development of plans requires collective work by various government departments. Importantly, the items analyzed here are all guidelines, which implies the need for mechanisms to monitor their actual implementation. Resumen: Con el propósito de analizar la adecuación de los planes estatales de seguridad alimentaria y nutricional (PlanSAN), a las normas establecidas por la Política Nacional de Seguridad Alimentaria y Nutricional (PNSAN), se realizó una investigación descriptiva y documental, con una recogida de datos entre agosto a octubre de 2016. El acceso a los planes se realizó en el sitio web de la Cámara Interministerial de Seguridad Alimentaria y Nutricional (CAISAN) de los gobiernos estatales, con una recogida de información complementaria en el ámbito de los estados. Todos los estados brasileños se adhirieron al Sistema de Seguridad Alimentaria y Nutricional (SISAN), mientras que menos de la mitad (13 estados, un 48%) elaboró sus planes, destacándose algunos aspectos: 5 (38%) de los PlanSAN tenían una vigencia correspondiente al plan plurianual del estado; 5 (38%) de los PlanSAN describían los requisitos presupuestarios para la ejecución de las metas propuestas; y 7 (54%) describían mecanismos de monitoreo del plan y solamente 2 (15%) definían la metodología para el monitoreo de la seguridad alimentaria y nutricional. El menor tiempo de existencia de la CAISAN y de adhesión parecen estar relacionados con la inexistencia de PlanSAN. A pesar de que la mayoría de los estados con planes atiendan algunas normativas establecidas por la PNSAN, esos instrumentos se convierten en frágiles y poco viables, cuando no poseen una vinculación presupuestaria para sus metas. Debido al hecho de que el PNSAN sea estructuralmente intersectorial, la construcción de los planes depende de un trabajo colectivo de las diversas secretarías de gobierno. Se refuerza que los ítems analizados fueron todos normativos, lo que implica necesidad del estabelecimiento de mecanismos que garanticen su adecuada ejecución.
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3.

Food Perceptions and Dietary Changes for Chronic Condition Management in Rural Peru: Insights for Health Promotion.

Perez-Leon, Silvana; Pesantes, M Amalia; Aya Pastrana, Nathaly; Raman, Shivani; Miranda, Jaime; Suggs, L Suzanne
| Idioma(s): Inglés
Peru is undergoing a nutrition transition and, at the country level, it faces a double burden of disease where several different conditions require dietary changes to maintain a healthy life and prevent complications. Through semistructured interviews in rural Peru with people affected by three infectious and noninfectious chronic conditions (type 2 diabetes, hypertension, and neurocysticercosis), their relatives, and focus group discussions with community members, we analyzed their perspectives on the value of food and the challenges of dietary changes due to medical diagnosis. The findings show the various ways in which people from rural northern Peru conceptualize good (buena alimentación) and bad (mala alimentación) food, and that food choices are based on life-long learning, experience, exposure, and availability. In the context of poverty, required changes are not only related to what people recognize as healthy food, such as fruits and vegetables, but also of work, family, trust, taste, as well as affordability and accessibility of foods. In this paper we discuss the complexity of introducing dietary changes in poor rural communities whose perspectives on food are poorly understood and rarely taken into consideration by health professionals when promoting behavior change.
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4.

Promoting Health Through Engagement in Occupations That Maximize Food Resources.

Schmelzer, Laura; Leto, Theresa
| Idioma(s): Inglés
Poverty is a complex problem in the United States with far-reaching consequences, often leading to a lack of food or lack of access to food. Proper nutrition and food intake are foundational to health and well-being. This participatory action research (PAR) project explored the challenges associated with living in poverty and managing food resources. Stakeholders engaged in a multiphase PAR process, which resulted in the development and implementation of a 7-wk occupation-based program. The program promotes graded learning of specific skills for managing food resources and emphasizes empowering each participant. Preliminary results indicate statistically significant improvements in participants' ability to make meals with certain food items and in perceived satisfaction and performance in self-identified activities related to food resource management. These findings support the feasibility of the program and the need for participant-driven, occupation-based approaches to improving food security.
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5.

Relative contributions of recommended food environment policies to improve population nutrition: results from a Delphi study with international food policy experts.

Mahesh, Rewena; Vandevijvere, Stefanie; Dominick, Clare; Swinburn, Boyd
| Idioma(s): Inglés
OBJECTIVE: To determine weightings for the relative contributions of nineteen widely recommended good practice food environment policies to improve population nutrition, based on evidence of effectiveness and expert ratings, to facilitate benchmarking of the implementation of food environment policies globally. DESIGN: A two-round Delphi study was performed in 2015, whereby international food policy experts (n Round1 27, n Round2 21) compared effectiveness of all possible pairs of policy domains and good practice policies within domains to improve population nutrition according to the Saaty scale (1 to 9). Weightings for each domain and policy were derived from expert ratings based on the Analytic Hierarchy Process method. SETTING: International. SUBJECTS: Food policy experts. RESULTS: Out of the seven policy domains, Food Prices and Food Promotion received the highest weightings for impact on improving population nutrition, while Food Trade received the lowest weighting. Among the nineteen specific policies, taxing unhealthy foods (3·8 (0·7)), healthy food provision in schools (2·8 (0·4)) and minimizing taxes on healthy foods (2·6 (0·4)) were given the highest weightings, while nutrient declarations on packaged foods (1·2 (0·2)) and healthy food policies in private-sector workplaces (1·0 (0·2)) received the lowest weightings (mean (95 % CI)). CONCLUSIONS: Expert-derived weightings on the relative contributions of recommended food environment policies to improve population nutrition will facilitate monitoring and benchmarking the implementation of these policies by governments among countries globally. Additional weightings for contributions of policies to reducing nutrition inequalities and improving consumer and child rights could be developed in the future.
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6.

Use of a Unique Farmers' Market Program Targeting Lower-Income Community Members.

Lawrence, Brittany; Greer, Anna E; Zimeri, Anne Marie; Hernandez, Daphne C; Ahn, SangNam; Jones, Shaakira; Smith, Matthew Lee
| Idioma(s): Inglés
We examined use of a farmers' market that leverages community partnerships to provide free produce to lower-income persons. Participants (n = 422) were asked to complete a questionnaire and given an ID number, which was used to track market use from 2014 to 2015. Chi square tests were used to examine associations between 2014/2015 market use and reasons for market use, financial support received, and how attendees had learned about the market. Ordinal regression was used to identify household characteristics associated with increased market attendance. Although the proportion of lower-income attendees declined over the study period, a substantial proportion of households in 2014 (69.1%) and 2015 (54.6%) were below the poverty threshold. We identified significant differences in attendees' reasons for market use and ways attendees heard about the market from 2014 to 2015. The most frequently reported reason for 2014 market use was retirement/fixed income (P < 0.001) and in 2015 was low-income (P < 0.001). Most attendees heard about the market through flyers (P < 0.001) and word of mouth (P ≤ 0.001) in 2014 and through local, non-profit services (P < 0.001) in 2015. In the ordinal regression, households with an older person registering the household for the market used the market more times per year (P < 0.001). Impoverished households (P = 0.020) and households receiving more financial support services (P < 0.001) used the market fewer times per year. While a substantial proportion of lower-income persons used the free-produce market, frequency of use was still lowest among this group indicating a need to address barriers beyond produce cost.
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7.

Community-Wide Efforts to Improve the Consumer Food Environment and Physical Activity Resources in Rural Kentucky.

Gustafson, Alison; McGladrey, Margaret; Stephenson, Tammy; Kurzynske, Janet; Mullins, Janet; Peritore, Nicole; Cardarelli, Kathryn; Vail, Ann
| Idioma(s): Inglés
Community interventions to improve access to food and physical activity resources can reduce obesity rates and improve obesity-related health outcomes. We describe a Kentucky community project that consisted of collaborating with grocery store managers to improve the consumer food environment and partnering with community members to improve walking trails, bicycle racks, and other physical activity resources. We surveyed 2 random samples of community residents in 6 participating rural counties, 741 in 2016 (year 1) and 1,807 in 2017 (year 2). Fruit and vegetable intake significantly increased from year 1 (mean servings fruits, 2.71; vegetables, 2.54) to year 2 (mean servings fruit, 2.94; vegetables, 2.72). Although moderate physical activity did not change from year 1 to year 2, concern among residents about places to be physically active improved (P = .04). Involving community members in promoting obesity prevention programs may improve dietary intake and alleviate community concern about physical activity.
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8.

Indicators of a health-promoting local food environment: a conceptual framework to inform urban planning policy and practice.

Murphy, Maureen; Badland, Hannah; Koohsari, Mohammad Javad; Astell-Burt, Thomas; Trapp, Georgina; Villanueva, Karen; Mavoa, Suzanne; Davern, Melanie; Giles-Corti, Billie
| Idioma(s): Inglés
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9.

Implementation of a Rooftop Farm Integrated With a Teaching Kitchen and Preventive Food Pantry in a Hospital Setting.

Musicus, Aviva A; Vercammen, Kelsey A; Fulay, Aarohee P; Moran, Alyssa J; Burg, Tracey; Allen, Lindsay; Maffeo, David; Berger, Andi; Rimm, Eric B
| Idioma(s): Inglés
Safety-net hospitals serving populations with disproportionately high levels of poverty, food insecurity, and chronic disease can utilize innovative strategies to improve the health and environment of their communities. Boston Medical Center in Boston, Massachusetts, constructed an on-site rooftop farm to provide fresh produce for the hospital's preventive food pantry, teaching kitchen, cafeterias, and inpatient meal services. This novel model can be replicated by other organizations aiming to alleviate food insecurity, encourage healthy eating, and promote environmental sustainability.
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10.

Dietary Impact of Produce Prescriptions for Patients With Hypertension.

Trapl, Erika S; Smith, Samantha; Joshi, Kakul; Osborne, Amanda; Benko, Michele; Matos, Anna Thornton; Bolen, Shari
| Idioma(s): Inglés
INTRODUCTION: Little is known regarding the impact of produce prescriptions within the context of hypertension visits at safety net clinics. We evaluated intervention effectiveness on patient usage of farmers markets and dietary change related to fruit and vegetable consumption. METHODS: Health Improvement Partnership - Cuyahoga worked with 3 clinics to integrate, implement, and evaluated a produce prescription for hypertension (PRxHTN) program. PRxHTN involves 3 monthly, nonphysician provider visits, comprising blood pressure measurement, nutrition counseling, and four $10 farmers market produce vouchers, for hypertensive adult patients screening positive for food insecurity. Dietary measures were collected at visits 1 and 3. Voucher use was tracked via farmers market redemption logs. RESULTS: Of the 224 participants from 3 clinics, most were middle-aged (mean age, 62 y), female (72%), and African American (97%) and had a high school education or less (62%). Eighty-six percent visited a farmers market to use their produce vouchers, with one-third reporting it was their first farmers market visit ever. Median number of farmers market visits was 2 (range: 0-6), and median number of vouchers redeemed was 8 (range: 0-12). Among the subsample with follow-up survey data (n = 137), significant improvement in fruit and vegetable consumption was observed as well as a decline in fast food consumption. CONCLUSION: PRxHTN participants visited at least 1 farmers market, reported increases in provider communication related to diet, and exhibited significant changes in dietary behavior. PRxHTN can serve as a strong model for linking safety net clinics with farmers markets to promote community resource use and improve fruit and vegetable consumption among food-insecure patients with hypertension.
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