Healthy Food Access Research Articles

Healthy Foods in Convenience Stores: Benefits, Barriers, and Best Practices.

Accessing healthy food is a challenge for many. Healthy corner store initiatives have proven successful at promoting healthy food access nationwide. Recent data suggest that 11.8% of Clark County residents and 17.1% of Henderson, Nevada, residents experienced food insecurity. It is crucial to assess the current perceptions and practices of the community before pursuing policy change to ensure that pilot programs reflect its members' needs. This study aimed to identify which healthy foods consumers would like to see offered in convenience stores, assess purchasing behaviors, and explore barriers preventing store owners from carrying healthy foods. In doing so, this study aimed to ensure that the needs of owners and consumers are reflected in local policy changes. Project staff collected data through two approaches: (a) convenience store owner interviews (n = 2; who represented eight stores total) and (b) consumer intercept surveys (n = 88) within low-income census tracts of Henderson, Nevada. The cost of healthy foods-for storeowners and consumers-was a major factor when selecting items to stock. Storeowners also described key contextual barriers such as minimum purchasing requirements, city regulations limiting promotions, and healthy, fresh food not being in high enough demand for the many transient customers passing through. Survey respondents' most commonly reported barrier to accessing healthy food was their lack of availability in convenience stores, suggesting it would be beneficial if stores offered healthier options to increase access. The results of this study will inform the community's next steps to increase access to healthy foods, including implementing a pilot healthy corner store project and a City-sponsored marketing campaign. Our methods and lessons learned may be useful for other municipalities considering health corner and convenience store initiatives.

Food Insecurity and Cognitive Trajectories in Community-Dwelling Medicare Beneficiaries 65 Years and Older

Food insecurity has a known association with prevalent impaired cognition. However, it is unknown whether food insecurity has a longitudinal association with cognitive decline among older adults. To determine whether food insecurity is associated with a faster decline in cognitive function among community-dwelling older adults. This retrospective cohort study used data from a nationally representative sample of Medicare beneficiaries 65 years and older recruited for the National Health and Aging Trends Study (NHATS). Community-dwelling NHATS participants were followed up for a maximum of 7 years (mean [SD] follow-up duration, 5.4 [1.1] years). Data were collected from January 1, 2012, to December 31, 2020, and analyzed from December 23, 2021, to December 6, 2022. Self-reported food insecurity assessed from 2012 to 2019. Primary outcomes were immediate memory, delayed memory, and executive function collected from 2013 to 2020. Immediate and delayed recall were assessed by a 10-item word-list memory task (range, 0-10, with higher scores indicating more words recalled). Executive function was measured by the clock drawing test (range, 0-5, with higher scores indicating more accurate depiction of a clock). Each year's cognitive functions were linked to the prior year's food insecurity data. Linear mixed-effects models with random slopes and intercepts were used to examine the association between food insecurity and cognitive decline. Analytic weights in each year were applied to represent community-dwelling Medicare beneficiaries 65 years and older in 2011. Of 3037 participants, a weighted 57.8% (raw count, 1345) were younger than 75 years, 56.2% (raw count, 1777) were women, and most (84.9% [raw count, 2268]) were White. Over 7 years, 417 (weighted proportion, 12.1%) experienced food insecurity at least once. Food insecurity was associated with a faster decline in executive function in a fully adjusted model: the mean difference of annual change in executive function score between people exposed to and not exposed to food insecurity was -0.04 (95% CI, -0.09 to -0.003) points. However, food insecurity was not associated with changes in immediate and delayed memory (0.01 [95% CI, -0.05 to 0.08] and -0.01 [95% CI, -0.08 to 0.06], respectively). Among community-dwelling older adults, food insecurity was prevalent and associated with a decline in executive function. Interventions and policies aiming to increase healthy food access or reduce food insecurity should be assessed for their impact on older adults' cognitive outcome.

Changes in physical activity, diet, sleep, and mental well-being when starting university: A qualitative exploration of Australian student experiences

Objective: To explore young adult’s experiences of how starting university influenced their physical activity, diet, sleep, and mental well-being, and barriers and enablers to health behavior change. Participants: University students aged 18–25 years. Methods: Three focus groups were conducted in November 2019. Inductive thematic approach was utilized to identify themes. Results: Students (female: n = 13, male: n = 2, other gender identity: n = 1, 21.2 (1.6) years) reported mental well-being, physical activity levels, diet quality and sleep health were negatively affected. Stress, study demands, university timetabling, not prioritizing physical activity, cost and availability of healthy foods, and difficulty falling asleep were key barriers. Health behavior change interventions aiming to support mental well-being need to include both information and support features. Conclusions: There is a significant opportunity to improve the transition to university for young adults. Findings highlight areas to target in future interventions to improve physical activity, diet, and sleep of university students.

Is there an association between maternal factors and the development of early childhood caries?

To assess the possible associations between the following characteristics/behavior of the mother: oral health, oral hygiene, smoking habits, diet, food insecurity, stress, employment, marital status, household income and size and insurance status, with the development of dental caries in their children up to 3 yearsold. Pregnant women aged 18 yearsor more who delivered at term and whose children had regular dental check-ups were enrolled in a longitudinal study. Oral health status of participants was assessed at enrollment, 2 months and annually thereafter. Sociodemographic characteristics and mothers' behaviors were collected through face-to-face and telephone interviews. By the three-year visit, 6% of the children had 1 or more cavitated dentine caries lesions. Maternal education and state of residence increased the chances of the child presenting with a caries lesion by the age of three, in addition to influencing the magnitude of the associations detected with other variables. Mothers' prior pregnancies, maternal cigarette smoking, household income and untreated dental decay were also significantly related to childhood caries. Sociodemographic variables were shown to have an important influence on the development of early childhood caries, highlighting the need of addressing structural problems that limit the availability of dental care and healthy foods.

Abstract P510: Increase in Obesity Reduction Initiatives in San Francisco After Sugary Beverages Tax Implementation

A diet high in sugar sweetened beverages (SSB, has been shown to be associated with adverse health outcomes. Several cities across the US have implemented SSB taxes to decrease consumption and distribution of sugary drinks. Revenues generated from taxes were often allocated to fund public health programs and enhancements to reduce obesity. We examined efforts in San Francisco where the Sugary Drinks Distributor Tax (SDDT or “soda tax”) was implemented in 2018. SDDT legislation mandated the establishment of the Sugary Drinks Distributor Tax Advisory Committee (SDDTAC), responsible for making annual recommendations for the allocation of tax-generated revenues. We reviewed SDDTAC recommendations and funding for new and existing services that support public health through reduction and prevention of diet related diseases. We assessed if there was a significant increase in funding and number of health promotion programs implemented in San Francisco after the implementation of the SDDT. We documented obesity prevention initiatives resulting from increased tax revenue. We reviewed city government budget documents and press releases at least 1 year before tax implementation (2017) and 4 years post (2018-2022). We cataloged initiatives for adults and children including health education, nutrition and lifestyle, and community projects. The first full year of SDDT implementation (2018-19) saw the highest revenue generated at $16,097,908. Total revenue for the implementation period (2018-2021) was reported as $42,415,548. The revenue generated in the first six months of fiscal year (FY) 2018 was spent in FY2019-2020. During that period, the San Francisco Public Health Foundation awarded 26 one-year SDDT community grants - aligning with priority expenditure categories for SDDTAC - totaling $1,702,211. SDDTAC priority categories include decreasing consumption of sugary drinks, increasing water consumption, oral health, healthy food access, physical activity, and other (e.g. research/Community-Based Participatory Research, new innovations, etc.). [ACV1] In FY2019-2020 78% of SDDT revenues were spent on Healthy Communities, oral health, Healthy Food Purchasing Supplement grants and SF City Funded Agencies’ programming. The remaining 22% were spent on social media grants, infrastructure, and administrative costs. To address COVID-19, $1.65 million of unused funds from FY2019-20 supported food security and food distribution for vulnerable populations. Tax generated funding for 65 new or existing programs since implementation. New programs are funded each year: five new Policy Systems and Environmental Change programs were funded in FY2019-2020 and one new school-based program funded in FY2021-22. We observed a significant increase in number of health programs in San Francisco since SDDT implementation.

Abstract P261: Associations Between Adolescent Social Determinants and Adult Cardiovascular Health in the Add Health Cohort

Introduction: Hypertension is the leading risk factor for cardiovascular disease in the US. Individual social determinants of health (SDoH; e.g., housing and healthy food availability) are associated with hypertension in cross-sectional samples. However, there is a need to better understand how the social environment during youth impacts future hypertension risk to identify targets for primordial prevention and reduce health disparities. Objective: This study aimed to identify whether patterns of SDoH during adolescence were associated with hypertension risk during adulthood in a nationally representative sample. Methods: This analysis utilized public-use data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) waves I and V (n=1,703). Using the Healthy People 2030 Framework, proxy measures for each domain of SDoH were identified from adolescent survey data (Wave I, age range 12-19 years). Blood pressure (BP) from in-home assessments (Wave V, age range age 32-42 years) was categorized as ‘normal’, ‘elevated’, or ‘hypertensive’ by ACC/AHA criteria. K-metoid (PAM) cluster analysis and assessment of silhouette width identified clusters of participants with similar patterns of SDoH during youth. Multinomial logistic regressions with bootstrapping estimated the odds of BP category membership relative to cluster membership. Models controlled for body mass index, smoking, age, sex, race, ethnicity, and medications. Analyses accounted for the complex sampling design, including appropriate Wave V weighting factors. Results: Three clusters were identified with distribution among ‘normal’, ‘elevated’, and ‘hypertensive’ BP categories, respectively, as: Cluster 1 (n=715), 40.3%, 12.3%, and 47.4%, Cluster 2 (n=499) 37.0%, 11.3%, and 51.7%, and Cluster 3 (n=489) 33.7%, 10.9%, and 55.4%. Primary differences among clusters included more frequent history of physical examinations in Cluster 1 vs. 2 and 3, and Cluster 2 vs. 3, greater feelings of safety in school and closeness to people at school in Cluster 2 vs. 1 and 3, and greater perceived prejudice at school in Cluster 1 vs. 2 and Cluster 2 vs. 3 (all p<0.05). In fully adjusted models, participants in Cluster 3 had greater odds of being hypertensive than those in Cluster 1 (OR: 1.45, 95% CI: 1.02, 2.08). Black or African American participants had greater odds of elevated (OR: 2.53, 95% CI: 1.56, 4.12) or hypertensive (OR: 2.22, 95% CI: 1.58, 3.11) BP, relative to whites. Females had lower odds of elevated (OR: 0.56, 95% CI: 0.34, 0.91) or hypertensive (OR: 0.32, 95% CI: 0.23, 0.45) BP, relative to males. Conclusions: SDoH during adolescence, specifically health care access and quality, may be associated with cardiovascular health during adulthood. Future research that includes more direct assessments of each SDoH domain across the lifespan will help to identify interventional targets for primordial prevention.

Abstract MP43: The Role of the Physical Environment in Racial Differences in Sleep Duration

Background: Racial and ethnic sleep disparities have been documented; however, the mechanisms are unclear. The physical environment is associated with sleep duration and may explain sleep disparities. We examined the physical environment as a mediator of racial differences in sleep duration using data from the Multi-Ethnic Study of Atherosclerosis (N=2073). Methods: Participants underwent 1-week actigraphy, completed questionnaires on the neighborhood environment, and addresses were geocoded and linked to physical environment features. Actigraphy-measured sleep duration was analyzed as both continuously and categorically (short sleep duration < 6 hours vs. ≥ 6 hours). Physical environment characteristics included availability of healthy foods, aesthetic quality, walking environment, walking destination density, the proportion of land dedicated to retail space and an overall built environment score. Multi-level linear and Poisson regression models with robust variance were fit to examine associations of race, physical environment, and sleep duration with adjustment for covariates. Direct and indirect mediation was tested via path models. Results: The mean age was 68.6 ± 9.2 years. Approximately 46% of participants were male and 37.7% White, 27.7% Black, 23.1% Hispanic, and 11.5% Chinese American. The prevalence of short sleep (6 hours) was highest for racial minorities, ranging from 32.2% to 44.3% compared to 19.2% for White adults. A higher built environment factor score was associated with shorter sleep duration. The physical environment partially mediated racial disparities in sleep duration between Hispanic and White adults. A significant indirect effect of race on sleep duration via aesthetic quality, walking destination density, proportion retail and the built environment factor score was detected, explaining 4.0%, 27.2%, 7.6%, and 37.8%, respectively of the association between race and sleep duration for Hispanic individuals, compared to White individuals. The physical environment did not explain the Black-White or Chinese-White disparity in sleep duration. Conclusion: Black, Hispanic, and Chinese individuals had shorter sleep duration than White individuals. The Hispanic-White disparity in sleep duration was partially explained by the physical environment. These findings suggest that the physical environment may be an important mechanism in which racial disparities in sleep exist and a likely a target for intervention.

Ending Hunger: How COVID-19 Revealed a Path to Food Access for All

This article explores how a devastating hunger crisis, which seemed destined to accompany the COVID-19 pandemic in the United States, was thwarted by historic federal emergency food policy interventions. We outline the vital public policy innovations in food access launched during the COVID-19 pandemic as well as the nonprofit emergency food network programs designed to implement and accompany these policies. In particular, we focus on innovations that addressed hunger for two vulnerable groups, children and the elderly, and we describe how these innovations increased food access. Finally, we advocate for the continuation of COVID-19 anti-hunger pandemic policies in the “next normal” because they reveal a path to end hunger that preserves people’s dignity and provides healthy and affordable food access for all.

Mothers’ Experience and Perceived Barriers to Practice Healthy Feeding to Their School Going Children

A cross-sectional study was conducted between January and December of 2018 in some randomly selected schools under Dhaka City Corporation, Bangladesh, to examine mothers’ experience and their perceived barriers to practice healthy feeding to their school going children. We adopted convenient sampling technique. A total of 120 mothers participated in this study who had children aged between six and eight years. A pre-tested, semi-structured questionnaire was used for data collection. Questionnaire was formatted in both Bangla and English language. However, the participants chose Bangla version for filling up the survey questionnaire. A modified Likert’s scale was used. Socio-demographic variables, mothers’ feeding practice and perceived barriers were analysed using descriptive statistics. 58.2% of the participants belonged to 30-35 years age group, while 41.8% to 36-40 years age group. Among them, higher secondary passed 3.4%, while 35.3% had their university graduation, and 61.3% completed postgraduation. 6.7% had poor economic status, while 73.3% were semi-elite and 20% were from elite income group. Among them, 75% were Muslim, 14.2% Hindu, 7.5% Christian and 3.3% Buddhist. 21.7% of the mothers found availability of healthy food as 'very easy' and 66.7% found it 'easy', while 9.2% found it 'difficult'; only 2.5% found it 'very difficult'. Only 11.6% of the mothers found preparation of healthy meal inconvenient, while 71.7% found it convenient and 16.7% found it very convenient. Regarding taste of a healthy meal, 2.5% reported as 'very monotonous', 37.5% as 'monotonous', 54.2% reported as 'charming' and only 5.8% stated it as 'very charming'. Preparation cost of a healthy meal was reported as costly by only 15.8% of the mothers, while cost effective by 76.7%, and very cost effective by the rest 7.5%. 42.4% of the mothers stated that their children have the habits of taking meal sitting with the family members, while 48.8% were fed while watching TV, and 8.8% reported that they fed their children while they were playing. Only 37.5% of mothers reported that their children found it pleasant taking healthy food. Regarding time spent on feeding the children, 17.5% stated 'very time consuming', while 68.3% stated 'time consuming', and only 14.2% found it 'timesaving'. Only 20.8% of mothers reported that they could conveniently feed their children healthy food. Difficulties experienced by the mothers were strong aversion (15.8%), fast food preference (22.5%), varieties of food preference (61.7%).
 CBMJ 2023 January: Vol. 12 No. 01 P: 93-98

Association of Perceived Neighborhood Health With Hypertension Self-care

Hypertension self-management is recommended for optimal blood pressure (BP) control, but self-identified residential contextual factors that hinder hypertension self-care are understudied. To quantify perceived neighborhood health and hypertension self-care and assess interactions with the area deprivation index (ADI) and healthy food availability at home. A cross-sectional study was conducted in Baltimore, Maryland, including primary care adults enrolled in the Achieving Blood Pressure Control Together trial between September 1, 2013, and June 30, 2014. Participants were Black and had at least 2 BP readings greater than or equal to 140/90 mm Hg in the 6 months before enrollment. Analyses were conducted from August 5, 2021, to January 28, 2022. Participants' perceived neighborhood health, defined as the mean standardized score across 4 subdomains of aesthetic quality, walkability, safety, and violence, with a higher score signifying better neighborhood health. Hypertension self-care behavior and self-efficacy. Multivariable generalized linear models were fit regressing each outcome on perceived neighborhood health (higher scores on each domain signify better perceived neighborhood health), adjusted for confounders, and interaction terms between neighborhood health and potential modifiers (ADI [higher percentiles correspond to more deprivation] and healthy food availability [higher scores indicate greater availability]) of the primary association were included. Among 159 participants (median [IQR] age, 57 [49-64] years; mean [SD] age, 57 (11) years; 117 women [74%]), median (IQR) hypertension self-care behavior was 50 (45-56) and self-efficacy was 64 (57-72). Better perceived neighborhood health was associated with greater hypertension self-care behavior (β, 2.48; 95% CI, 0.63-4.33) and self-efficacy (β, 4.42; 95% CI, 2.25-6.59); these associations persisted for all neighborhood health subdomains except aesthetic quality. There were no statistically significant interactions between perceived neighborhood health or its subdomains with ADI on self-care behavior (P = .74 for interaction) or self-efficacy (P = .85 for interaction). However, better perceived neighborhood aesthetic quality had associations with greater self-care behavior specifically at higher healthy food availability at home scores: β at -1 SD, -0.29; 95% CI, -2.89 to 2.30 vs β at 1 SD, 2.97; 95% CI, 0.46-5.47; P = .09 for interaction). Likewise, associations of perceived worse neighborhood violence with lower self-care behavior were attenuated at higher healthy food availability at home scores (β for -1 SD, 3.69; 95% CI, 1.31-6.08 vs β for 1 SD, 0.01; 95% CI, -2.53 to 2.54; P = .04 for interaction). In this cross-sectional study, better perceived neighborhood health was associated with greater hypertension self-care among Black individuals with hypertension, particularly among those with greater in-home food availability. Thus, optimizing hypertension self-management may require multifaceted interventions targeting both the patients' perceived contextual neighborhood barriers to self-care and availability of healthy food resources in the home.

Dietary Quality and Diet-Related Factors Among Female Adults of Reproductive Age With and Without Disabilities Participating in the National Health and Nutrition Examination Surveys, 2013-2018.

Female adults of reproductive age (18 to 44 years) with disabilities have higher rates of health-risk behaviors and chronic conditions compared with their counterparts without disabilities; however, there is limited examination of diet. Our aim was to examine associations of self-reported disability status with diet quality and diet-related factors. Cross-sectional data were from the National Health and Nutrition Examination Surveys, 2013-2018. Female adults aged 18 through 44 years were included. Disability was defined as serious difficulty hearing, seeing, concentrating, walking, dressing, and/or running errands due to physical, mental, or emotional conditions. The Healthy Eating Index-2015 assessed diet quality. Diet-related factors included self-rated diet healthfulness, meal characteristics, food security, and food assistance programs. Multivariable linear regression estimated differences in Healthy Eating Index-2015 scores for a given day and multivariable Poisson regression estimated adjusted prevalence ratios and 95% CI of diet-related factors by disability status. Of 3,579 female adults, 557 (16%) reported any disabilities, 207 (6%) of whom reported having 2 or more types of disabilities. Differences in mean Healthy Eating Index-2015 scores for a given day were one-third to one-half a point lower for fruits, total protein foods, and seafood and plant proteins among female adults with 2 or more types of disabilities compared with those without disabilities. Female adults with any disabilities were more likely to rate their diet as poor, have low food security, participate in food-assistance programs, and consume frozen foods or pizza, compared with those without disabilities (adjusted prevalence ratio ranged from 1.35 to 1.93); they were less likely to be the main food planner or preparer or shopper for their households. Some indicators of diet quality and diet-related factors differed between female adults with and without disabilities. Additional investigation of dietary intakes and behaviors, as well as access to and availability of healthy foods, among female adults with disabilities is necessary.

The cumulative effect of gun homicide-related loss on neighborhood perceptions among street-identified black women and girls: A mixed-methods study

Racial disparities in death indicate that Black women and girls are disproportionately bereaved by violent loss across their lifetime. Yet the context and consequences of this loss remain largely understudied. This study examines the effect of gun homicide-related loss of relative/friends on subjective neighborhood perceptions among street-identified Black women and girls (ages 16 to 54). The study used a convergent mixed-methods design, with simultaneous quantitative and qualitative components. Data were collected from two low-income, high-crime neighborhoods in Wilmington, Delaware. Quantitative data (n = 277) included a community-based survey on health, opportunity and violence. Qualitative data (n = 50) included semi-structured interviews primarily from a sub-group of the survey population. This study used a street participatory action research (Street PAR) methodology, which included members of the target population onto the research project. OLS regression analyses predicted the effect of exposure to gun homicide on perceptions of neighborhood social environment (i.e., safety, aesthetic quality, walkability, social cohesion, and availability of healthy foods). Interviews were analyzed using grounded theory. Approximately 87% of those surveyed were exposed to a relative/friend gun homicide. All interviewees were exposed to a relative/friend gun homicide. Exposure to the gun homicide of either a relative or friend alone was nonsignificant. But the combination of exposure to gun homicides of both a relative and friend was significantly related to poorer neighborhood perceptions, even when controlling for co-occurring factors. Mixed-method findings indicate that the cumulative impact of gun homicide-related loss matters most in shaping negative neighborhood perceptions. Qualitative data suggest that losing multiple members of one's familial and peer networks to homicide is a powerful form of co-victimization that alters how participants conceptualize and navigate public space. Interventions to decrease gun violence should consider how traumatic loss has unintended consequences on the quality of life of co-victims and those in close proximity to street life.

Qualitative exploration of the reasons for not using nutritional warnings after policy implementation in Uruguay.

Nutritional warnings have gained popularity, particularly in the region of the Americas, to facilitate the identification of products with excessive content of nutrients associated with non-communicable diseases and encourage healthier food choices. Although warnings have been shown to be effective, an in-depth understanding of the reasons why some consumers do not use them is still lacking. The aim of the present work was to explore self-reported use of nutritional warnings and to identify the reasons for not considering nutritional warnings for making food purchase decisions after policy implementation in Uruguay. A non-probabilistic sample of 858 Uruguayan participants was recruited using an advertisement on Facebook and Instagram. Through an online survey, self-reported use of nutritional warnings was asked using a closed-open ended questions. Participants who reported not considering warnings to make their purchase decisions were asked to explain the reasons why using an open-ended question. Responses were analysed using deductive coding, based on the Behavioural Drivers Model. Thirty seven percent of the participants stated that the warnings had not influenced their purchase decisions. Motives for not being influenced by the warnings were related to lack of interest, attitudes, lack of perceived self-efficacy, cognitive biases and limited rationality when making purchase decisions. In addition, structural barriers, such as availability, cost and trust in the food industry also emerged from participants' responses. Strategies to encourage the use of warnings should include communication campaigns and policies to address structural barriers related to the perceived availability and affordability of healthy foods.

How Important are Digital Technologies for Urban Food Security? A Framework for Supply Chain Integration using IoT

This paper aims to understand the role of digital technologies in food system innovations for healthy food access and waste reduction. It seeks to expand the knowledge of commercial food system interventions from the industrial supply side for improving public and planetary health. For this, we review the literature on urban food supply chains and synthesize the findings (from 33 screened articles) into thematic clusters. The first iteration of the review gives an overview of food supply chain problems and possible Industry 4.0-based solutions. Four technology intervention opportunities for integrated supply chains emerge from the literature, namely digital platforms, enterprise information systems, traceability systems, and blockchain. Findings indicate limited empirical research on supply chain digitalization for healthy food access. Therefore, this position paper presents a framework for supply chain integration in urban food systems, emphasizing digital technology interventions and the research directions for food supply chain digitalization.

Disruptive Innovations to Achieve Health Equity Through Healthcare and Research Transformation.

In order to achieve health equity, we must implement innovative health system, public health, and policy-level interventions to address the historical root causes of structural and institutional racism embedded in our medical and social systems. A history of unconsented medical and research experimentation on vulnerable groups and residual healthcare provider biases toward minoritized patients has led to patient distrust of medical systems and poor quality of care. Historical discriminatory housing and lending policies resulted in racial residential segregation and neighborhoods with inadequate housing, healthy food access, and educational resources, resulting in present-day social determinants of health (SDOH). To reduce these disparities and achieve health equity, four disruptive healthcare innovations are recommended: (i) infuse health equity principles into clinical workflows by implementing National Culturally and Linguistically Appropriate Services Standards; (ii) address poverty-related SDOH; (iii) deliver care and recruit for research in nonclinical settings to reach marginalized communities; and (iv) leverage health system subject matter experts to advocate for health equity policies. During the COVID-19 pandemic we leveraged the diversity of our workforce to deliver bilingual and culturally tailored COVID-19 testing, education, and vaccines to the Hispanic and Black communities in nonclinical settings, the primary marginalized communities served by our health system that were also disproportionately impacted by COVID-19 infections, hospitalizations, and deaths. Now that we understand the importance of using innovative health equity strategies to reach marginalized communities, we must continue to re-engineer our healthcare systems to deliver care outside of our brick and mortar to overcome barriers in access to care and mistrust in the healthcare establishment stemming from past abuses and remaining experiences of bias.

Retail Food Environment around Schools in Barcelona by Neighborhood Socioeconomic Status: Implications for Local Food Policy.

Childhood obesity is a relevant public health problem. The school food environment has been identified as an important factor for promoting healthy eating behaviors. This study assessed the availability of and proximity to unhealthy food stores around schools (n = 22) in the city of Barcelona and its association with neighborhood socioeconomic status (NSES). We conducted this cross-sectional study between 2019 and 2020. First, we identified all food retailers (n = 153) within a 400-m buffer around each school and identified those selling unhealthy food products. Then, we used Poison regression models to measure the association between NSES and the healthy food availability index (HFAI), adjusting for population density and distance. A total of 95% of the food establishments studied were classified as unhealthy (n = 146). In all, 90% of schools that had, at least, two unhealthy retailers in their proximity. There were significant differences in the mean distance to unhealthy establishments according to neighborhood SES and population density (p < 0.05). We found a positive association between schools located in higher SES neighborhoods and a higher availability and affordability of healthy food products (IIR = 1.67, 95% CI = 1.45−1.91 p = 0.000). We found strong social inequalities in the supply of healthy foods in Barcelona. Local food policy interventions addressing retail food environment around schools should consider socioeconomic inequalities.

Economic Growth and Adult Obesity Rates in Rural America

Obesity has become an increasingly severe problem in the United States. From 2008 to 2018, the adult obesity rate rose from 33.8% to 42.4%, with rates that are notably higher in rural areas when compared to their urban counterparts. Meanwhile, rural regions have experienced relatively slower employment growth and higher poverty rates during the recovery from the Great Recession. Social scientists are interested in determinants of – and potential solutions to – this rise in obesity rates. The existing literature has focused on the relationship between obesity and social/economic factors, such as the number of fast-food restaurants, limited physical activity, and unemployment rates. However, one unexplored question is whether the level of economic growth experienced by a rural area plays a role in the obesity problem. This paper assesses the impact of economic growth (measured by county-level GDP per capita) on obesity rates (measured by the county-level percentage of adults with BMI higher than 30) in rural America. Nationwide, data is collected on a host of demographic and economic characteristics for all non-metropolitan counties from 2012 to 2016, resulting in a county-level panel data set (n=1,948, t=5). Control variables include age, race and ethnicity, unemployment rates, rates of physical inactivity, food assistance program participation, and an index measuring healthy food availability. Two different econometric approaches were applied: (1) a fixed-effects panel regression model and (2) a difference-in-difference model using propensity score matching (PSM). The results of both econometric models suggest there is no relationship between economic growth and future obesity rates. This suggests that programs focused on rural economic growth may not affect other quality-of-life metrics. The conclusion discusses these competing interests and how regional scientists can play a role in future research in this area.

Application of machine learning to discover interactions predictive of dietary lapses.

The purpose of this study it to build a machine learning model to predict dietary lapses with comparable accuracy, sensitivity, and specificity to previous literature while recovering predictor interactions. The sample for the current study consisted of merged data from two separate studies of individuals with obesity/overweight (total N = 87). Participants completed six ecological momentary assessment surveys per day where they were asked about 16 risk factors of lapse and if they had lapsed from their dietary prescriptions since the previous survey. Alcohol consumption and self-efficacy were the most prevalent in the top 10 stable interactions. Alcohol consumption decreased the protective effect of self-efficacy, motivation, and planning. Higher planning predicted higher risk for lapse only when consuming alcohol. Low motivation, hunger, cravings, and lack of healthy food availability increased the protective effect of self-efficacy. Higher self-efficacy increased risk effect of positive mood and having recently eaten a meal on lapse. For individuals with lower levels of self-efficacy, planning increased the risk of lapse. Alcohol intake and self-efficacy interact with several variables to predict dietary lapses, and these interactions should be targeted in just-in-time adaptive interventions that deliver interventions for lapses.

Culturally adapting an evidence-based intervention to promote a healthy diet and lifestyle for Yup’ik Alaska native communities

ABSTRACT Underserved populations are at increased risk for obesity and related cardiovascular disease, type 2 diabetes, and other chronic diseases. Lack of access to healthy foods, sedentary behaviour, and other social environmental factors contribute to disease risk. Yup’ik Alaska Native communities are experiencing lifestyle changes that are likely to affect their cardiometabolic risks. Barrera & Castro’s Cultural Adaptation Framework was used to adapt an evidence-based intervention (EBI) originally designed for Latino communities for use in Yup’ik communities. Focus groups and key informant interviews were held in two Yup’ik communities. Major themes included causes of obesity, barriers and facilitators to healthy foods and physical activity, and intervention ideas. The adaptation process was guided by a Community Planning Group of Yup’ik women and included information gathering, preliminary adaptation design, preliminary adaptation tests, and adaptation refinement. Two of the adapted educational modules were pilot tested. Involving community members as co-researchers in cultural adaptation is vital for an EBI to be effective in another population. Small group gatherings led by local lay health workers are culturally appropriate and may be an effective health promotion model in Yup’ik communities. Social environmental factors affecting healthy food availability and physical activity need further exploration.

IMPLEMENTATION RESEARCH: INTERGENERATIONAL PROGRAMS ACROSS UNIVERSITY SETTINGS

Abstract Implementing intergenerational programs within university settings has been associated with benefits for all generations involved, which often includes young children, university students, and older adults. However, from conceptualization to pilot testing to evaluation, challenges and opportunities present themselves. This symposium will highlight implementation realities for intergenerational programs within higher education settings. This symposium will specifically address dimensions of: geography (rural versus urban), modality (such as in-person, virtual, or a mix), community/university partnerships, and scholarship for faculty balancing instruction and research demands. Addressing stages of implementation, the papers reflect a continuum from pre-planning to pilot to more advanced stages of implementation. First, Lisa Borrero will highlight challenges and opportunities of conceptualizing fully online intergenerational programming, including the pre-implementation planning, execution, and evaluation stages.The second paper from Ladan Ghazi Saidi will describe pre-implementation tasks completed to establish interest in intergenerational programming in a rural setting, as well as challenges stemming from the pandemic. Third, Jill Juris and colleagues will highlight an online intergenerational technology program offered from a rural Western North Carolina university that began implementation during the pandemic.Fourth, Rachel Scrivano and colleagues will describe a community-based participatory research method that bridged the gap between expectations and reality of implementing a 5-year intergenerational program focused on healthy food access. The fifth paper from Skye Leedahl and colleagues will discuss the implementation experiences of an intergenerational, reverse mentoring, technology program that has evolved for seven years at a Rhode Island public university and utilizes community partners from across the state.