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1.

Objective

To evaluate the effects of a supermarket meal bundling and electronic reminder intervention on food choices of families with children.

Design

Quasi-experimental (meal bundling) and randomized, controlled trial (electronic reminders).

Setting

Large supermarket in Maine during 40-week baseline and 16-week intervention periods in 2015–2016.

Participants

English-speaking adults living with at least 1 child aged ≤18 years (n?=?300) with 25% of households participating in the Supplemental Nutrition Assistance Program.

Intervention(s)

(1) Four bundles of ingredients needed to make 8 low-cost healthful meals were promoted in the store through displays and point-of-purchase messaging for 4 weeks each; (2) weekly electronic messages based on principles from behavioral psychology were sent to study participants reminding them to look for meal bundles in the store.

Main Outcome Measures

(1) Difference in storewide sales and individual purchases of bundled items (measured using supermarket loyalty card data) from baseline to intervention in intervention vs control groups.

Analysis

Regressions controlling for total food spending and accounting for repeated measures.

Results

There were no differences in spending on bundled items resulting from the meal bundling intervention or the electronic reminders.

Conclusions and Implications

Overall, there was little impact of healthful meal bundles and electronic reminders on storewide sales or purchases of promoted items in a large supermarket.  相似文献   

2.

Objective

Use Normalization Process Theory to evaluate the implementation and integration of the expanded School Breakfast Program (SBP).

Design

Interviews were conducted during the 2014–2015 school year. Normalization Process Theory guided the interview questions.

Setting

Rural high schools in Minnesota.

Participants

Interviews were conducted with 12 foodservice directors and 11 principals from the Project Break–Fueling Academics and Strengthening Teens intervention. Four of the 12 schools were in their first year of providing the expanded SBP program to their students whereas 8 were in their second year.

Phenomenon of Interest

Normalization Process Theory was used to evaluate the implementation and integration of the expanded SBP into rural Midwestern high schools.

Analysis

Three members of the research team used NVivo 10 software to code and analyze the interviews. Emerged themes were reported.

Results

Modifying the SBP aligned with values of the study participants (coherence). Support was obtained from staff, students, and community members (cognitive participation). Operational work occurred in each school to establish and integrate the modified SBP (collective action). The SBP expansion was assessed through student participation rates (reflexive monitoring).

Conclusions and Implications

Normalization Process Theory can be used to evaluate the implementation, embedding, and integration of a modified SBP into a school program. This evaluation can support other schools in modifying and embedding their SBPs into their school environment.  相似文献   

3.

Objective

Explore current maternal and infant nutrition education practices and family medicine primary care providers' views on a group care model to deliver nutrition education to mother–infant dyads.

Design

In-depth interviews.

Setting

Family medicine clinics in 1 Midwestern US hospital system.

Participants

Family medicine primary care providers (n?=?17) who regularly see infants during well-baby visits.

Phenomenon of Interest

Current maternal and infant nutrition education practices; views on ideal way to deliver nutrition education to mother–infant dyads; feedback on group care model to deliver nutrition education to mother–infant dyads.

Analysis

Audio recordings transcribed verbatim and coded using conventional content analysis.

Results

Family medicine primary care providers are limited in the ability to provide maternal and infant nutrition education and desire a different approach. Group care was the preferred method; it was shared most frequently as the ideal approach to nutrition education delivery and participants reacted favorably when presented with this model. However, there were many concerns with group care (eg, moderating difficult conversations, program implementation logistics, sufficient group volume, and interruption in patient–provider relationship).

Conclusion and Implications

Family medicine primary care providers desire a different approach to deliver nutrition education to mother–infant dyads in clinic. A group care model may be well-accepted among family medicine primary care providers but issues must be resolved before implementation. These results could inform future group care implementation studies and influence provider buy-in.  相似文献   

4.
5.

Objective

To evaluate the effect of the Utah Double Up Food Bucks (DUFB) program on fruit and vegetable (F&V) intake and food security status among Supplemental Nutrition Assistance Program (SNAP) recipients.

Methods

Data were collected in 2015, using a before-and-after study design. At the farmers’ market, a convenience sample of SNAP recipients was recruited for a survey and a 4-week telephone follow-up survey. Differences between the 2 surveys in food security and F&V intake were tested using the Wilcoxon signed-rank test.

Results

Follow-up surveys were completed with 138 (40%) of the 339 baseline participants. Median F&V consumption increased from 2.82 times per day to 3.29 times per day (median, interquartile range 1.48–3.99 and 3.28–5.02, respectively, P?=?.002). The percentage of DUFB participants who were food secure increased by 15% (P?=?.001).

Conclusions and Implications

The present results add to the growing literature indicating farmers’ market incentives are associated with increased F&V consumption and decreased food insecurity. Although more research is needed, farmers’ market incentives may be an effective area of policy intervention.  相似文献   

6.

Objectives

To describe (1) the use of a diet goal-setting tool in a self-directed online intervention aimed at promoting a healthy lifestyle, and (2) the association of tool use with gestational weight gain (GWG).

Design

Cross-sectional analysis of data from the intervention group in a randomized effectiveness trial.

Setting

An urban county in the northeastern US.

Participants

A total of 898 healthy pregnant women aged 18–35 years with body mass indexes of (BMI) ≥18.5 and <35; 39.1% were low-income.

Main Outcome Measures

Physical, sociodemographic, and psychosocial characteristics; use of tool features; and GWG.

Analysis

Frequencies, chi-square tests of independence, and regression analysis.

Results

Use of the online dietary tool was 45.1% completed the assessment, 35.3% set a goal, and 22.6% engaged in self-monitoring. Among women with normal BMI, setting ≥2 goals and engaging in self-monitoring were significantly (P < .05) associated with less GWG. Among women with higher BMI, setting ≥2 goals was significantly associated with greater GWG.

Conclusions and Implications

Although online diet goal setting is a potentially effective weight management tool for pregnant women with normal BMI, findings suggest that it may not be for higher-BMI women. Additional research is needed to explain this finding.  相似文献   

7.
8.

Objective

To conduct a comprehensive process evaluation of a policy, systems, and environmental (PSE) change intervention.

Design

Quasi-experimental, mixed methods.

Setting

Low-income urban school district.

Participants

Fifth-grade students in 4 schools assigned to 2 intervention and 2 comparison schools (intervention, n?=?142; comparison, n?=?170).

Intervention

Both groups received a nutrition curriculum delivered by classroom teachers. Intervention schools also received 10 PSE lessons taught by paraprofessional educators.

Main Outcome Measures

Quantitative data were obtained from fidelity and observation checklists, grading rubrics and self-reported student surveys. Focus group and interviews provided qualitative data. Quantitative measures included assessments of PSE and fruit and vegetable knowledge, as well as assessment of times fruits and vegetables (FV) were consumed yesterday.

Analyses

Qualitative data were analyzed using inductive content analysis. Quantitative data were analyzed using repeated measures analysis of variance and analysis of co-variance.

Results

Fidelity, dose, reach, and acceptance of PSE intervention were high; students felt more empowered, although PSE lessons were considered lengthy and complicated. Intervention PSE and FV knowledge scores were significantly higher than comparison scores (F37.56, P < .001; and F3.94, P < .05, respectively). However, issues in communication were identified between school staff and researchers.

Conclusions and Implications

Policy, systems, and environmental classroom interventions commented on the differences between quantitative and qualitative assessments, and this suggests the need for more sensitive quantitative assessments. Future research should look at long-term outcomes as this study only looked at short-term outcomes.  相似文献   

9.

Objective

Assess the impact of a web-based gamification program on nutrition literacy of families and explore differences in impact by socioeconomic status.

Design

Quasi-experimental.

Setting

Thirty-seven kindergartens from Portugal.

Participants

Eight hundred seventy-seven families.

Intervention

Web-based social network of participants' interactions, educational materials, apps and nutritional challenges, focused on fruit, vegetables, sugar, and salt.

Main Outcome Measures

Parental nutrition literacy (self-reported survey – 4 dimensions: Nutrients, Food portions, Portuguese food wheel groups, Food labeling).

Analysis

General linear model – Repeated measures was used to analyze the effect on the nutrition literacy score.

Results

Families uploaded 1267 items (recipes, photographs of challenges) and educators uploaded 327 items (photographs, videos) onto the interactive platform. For the intervention group (n?=?106), the final mean (SD) score of nutrition literacy was significantly higher than the baseline: 78.8% (15.6) vs 72.7% (16.2); P < .001, regardless of parental education and perceived income status. No significant differences in the scores of the control group (n?=?83) were observed (final 67.8% [16.1] vs initial 66.4% [15.6]; P?=?.364).

Conclusions and Implications

Gamified digital interactive platform seems to be a useful, easily adapted educational tool for the healthy eating learning process. Future implementations of the program will benefit from longer time intervention and assessment of the eating habits of families before and after intervention.  相似文献   

10.

Objective

Early childhood is a crucial time for the development of eating behaviors and food preferences. With increased labor force participation by Australian mothers of young children, grandparents are acting as the main informal carers of grandchildren. Therefore, grandparents have the capacity to influence the feeding of young children and thus their eating behaviors.

Design

Eleven semistructured qualitative interviews.

Setting

Suburban Adelaide, South Australia.

Participants

Grandparents (n?=?11; 9 grandmothers and 2 grandfathers).

Phenomenon of Interest

To gain insight into grandparental perspectives, beliefs, and opinions regarding the feeding of grandchildren aged 1–5 years.

Analysis

Interviews were manually transcribed and coded, and codes were synthesized into common themes.

Results

Four major themes emerged: (1) intergenerational differences (between grandparents and parents); (2) maintaining familial relationships; (3) treating grandchildren with food, and (4) nutritional efficacy. Grandparents thoughtfully managed familial relations, including intergenerational differences, in relation to feeding grandchildren. They showed some cognitive dissonance with regard to provision of treat foods (defined as discretionary foods) in which grandparents simultaneously prioritized healthy foods and treats.

Conclusions and Implications

Grandparents’ social role in the complex psychosocial space of child feeding warrants serious recognition and deeper understanding to engage them fully as stakeholders in children's nutritional health.  相似文献   

11.

Objective

As part of a statewide Supplemental Nutrition Assistance Program–Education program evaluation, Fresh Conversations (FC) facilitators (ie, educators) provided input into a new delivery model.

Methods

The researchers interviewed 25 FC facilitators. Interviews were recorded, transcribed verbatim, and analyzed for common themes.

Results

Most facilitators were women with at least 1 year of FC experience. Key motivators for serving as an FC facilitator included alignment with current employment responsibilities and gerontology interest. Training was viewed as helpful, thorough, and self-explanatory. Implementation challenges included recruitment, public speaking, and time management. Nearly all stated that FC content was important and that other seniors at other congregate meal sites would be interested in FC.

Conclusions and Implications

Findings suggest that facilitators were pleased with FC; however, their experiences might be further improved through enhanced training. Further exploration into community food and nutrition program educators’ feedback is needed to ensure these programs meet their needs as well as those of the audience.  相似文献   

12.

Objective

To identify practices, attitudes, and beliefs associated with intake of traditional foods among Alaska Native women.

Design

Cross-sectional study that measured traditional food intake; participation in food-sharing networks; presence of a hunter or fisherman in the home; the preference, healthfulness, and economic value of traditional foods; and financial barriers to obtaining these foods.

Participants

Purposive sample of 71 low-income Alaska Native women receiving Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) assistance in Anchorage, AK.

Analysis

Bivariate and multivariate regression analyses.

Results

Traditional foods contributed 4% of total daily calories. Given a choice, 63% of participants indicated that they would prefer half or more of the foods they ate to be traditional (ie, not store-bought). The majority of participants (64%) believed that traditional foods were healthier than store-bought foods. Of all participants, 72% relied on food-sharing networks for traditional foods; only 21% acquired traditional foods themselves. Participants who ate more traditional foods preferred traditional foods (B?=?.011 P?=?.02).

Implications for Research and Practice

Traditional food intake was low and findings suggested that Alaska Native women living in an urban setting prefer to consume more but are unable to do so. Future research might examine the effect of enhancing social networks and implementing policies that support traditional food intake.  相似文献   

13.

Objective

To describe a direct observational approach (ie, interactive family board game) to measure familyfunctioning and parenting behaviors of relevance to child weight and weight-related behaviors and to examine family functioning and parenting factors from multiple family dyads (eg, siblings, parent–child) and their associations with child weight and weight-related behaviors.

Design

Cross-sectional, mixed-methods study.

Setting

Two home visits were conducted with families 10days apart with a 7-day observational period between home visits.

Participants

Children (n?=?150) aged 5–7years and their families from 1 of 6 racial and ethnic or immigrant and refugee groups, including African American, Hispanic, Hmong, Native American, Somali, and white, participated in the Family Matters study between 2014 and 2016.

Main Outcome Measure

Child weight status and weight-related behaviors (ie, diet quality, physical activity).

Analysis

Adjusted logistic and linear regression models with robust SEs were used in analysis.

Results

Higher family functioning scores across the majority of family dyads were significantly associated with lower child weight status (P < .05). In addition, some family functioning scores were associated with child diet and physical activity, but not consistently. Parenting behavior scores were inconsistently associated with child weight and weight-related outcomes.

Conclusions and Implications

Results suggest that the interactive family board game task is a direct observational approach that researchers can use with family members to measure family functioning and parenting behaviors related to childhood obesity. Future interventions may want to consider including multiple family members in both measurement and intervention development to target childhood obesity.  相似文献   

14.

Objective

To evaluate Food, Health, & Choices, two 10-month interventions.

Design

Cluster-randomized, controlled study with 4 groups: curriculum, wellness, curriculum plus wellness, and control.

Setting

Twenty elementary schools (5/group) in New York City.

Participants

Fifth-grade students (n?=?1,159). At baseline, 44.6% were at the ≥85th body mass index (BMI) percentile for age and 86% qualified for free or reduced-price lunch.

Intervention

Curriculum was 23 science lessons based on social cognitive and self-determination theories, replacing 2 mandated units. Wellness was classroom food policy and physical activity bouts of Dance Breaks.

Main Outcome Measures

For obesity, age- and sex-specific BMI percentiles were used (anthropometric measures). The researchers also employed 6 energy balance-related behaviors and 8 theory-based determinants of behavior change (by questionnaire).

Analysis

Pairwise adjusted odds in hierarchical logistic regression models were determined for >85th BMI percentile. Behaviors and theory-based determinants were examined in a 2-level hierarchical linear model with a 2?×?2 design for intervention effects and interactions.

Results

Obesity showed no change. For behaviors, there was a negative curriculum intervention change in physical activity (P?=?.04). The wellness intervention resulted in positive changes for sweetened beverages frequency (P?=?.05) and size (P?=?.006); processed packaged snacks size (P?=?.01); candy frequency (P?=?.04); baked good frequency (P?=?.05); and fast food frequency (P?=?.003), size (P?=?.01), and combo meals (P?=?.002). Theory-based determinants demonstrated no change.

Conclusions and Implications

The findings of the lack of a decrease in obesity, behavior changes only for the wellness intervention, and no changes in theory-based determinants warrant further research.  相似文献   

15.

Background

Big data analytics are becoming more prevalent due to the recent availability of health data. Yet in spite of evidence supporting the potential contribution of big data analytics to health policy makers and care providers, these tools are still too complex to be routinely used. Further, access to comprehensive datasets required for more accurate results is complex and costly. Consequently, big data analytics are mostly used by researchers and experts who are far removed from actual clinical practice. Hence, policy makers should allocate resources to encourage studies that clarify and simplify big data analytics so it can be used by non-experts (e.g., clinicians, practitioners and decision-makers who may not have advanced computer skills). It is also important to fund data collection and integration from various health IT, a pre-condition for any big data analytics project.

Objectives

To methodologically clarify the rationale and logic behind several analytics algorithms to help non-expert users employ big data analytics by understanding how to implement relatively easy to use platforms as Azure ML.

Methods

We demonstrate the predictive power of four known algorithms and compare their accuracy in predicting early mortality of Congestive Heart Failure (CHF) patients.

Results

The results of our models outperform those reported in the literature, attesting to the strength of some of the models, and the utility of comprehensive data.

Conclusions

The results support our call to policy makers to allocate resources to establishing comprehensive, integrated health IT systems, and to projects aimed at simplifying ML analytics.  相似文献   

16.

Objective

Examine associations between food insecurity and multiple demographic, socioeconomic, acculturation, social risk factor, and food access variables.

Design

Data are from Sinai Community Health Survey 2.0, a cross-sectional, population-based probability survey of adults.

Setting

Ten selected community areas in Chicago.

Participants

Adults aged 18 years and over who completed the Household Food Security Scale (HFSS) portion of the survey were included in the analysis (n?=?1,041).

Main Outcome Measures

Food insecurity as defined by the HFSS was the dependent variable. Independent variables included multiple demographic, socioeconomic, acculturation, social risk factor, and food access variables.

Analysis

Multivariate logistic regression, along with a manual backward selection process, was used to examine predictors of food insecurity. A P of .05 was used to determine statistical significance.

Results

Respondents reporting English as their primary language (odds ratio [OR]?=?0.31; P?=?.002) had significantly lower odds of experiencing food insecurity. Respondents who reported feeling lonely (OR?=?1.86; P?=?.024) had significantly higher odds of experiencing food insecurity. Emergency food use (OR?=?3.89; P?=?.001) and food stamp benefit receipt (OR?=?2.79; P?=?.001) were also associated with food insecurity. Race/ethnicity demonstrated a strong relationship with food insecurity in early models, but this relationship appeared to be mediated by language and social risk factors. In the final adjusted model, most demographic and socioeconomic variables, including race/ethnicity, gender, and education were not significantly associated with food insecurity.

Conclusions and Implications

The burden of food insecurity was not shared equally across populations. This analysis sheds light on significant predictors of food insecurity in several diverse communities in Chicago. Findings can help inform tailored interventions by guiding food assistance programs to those most in need.  相似文献   

17.

Objective

To measure the effectiveness of a new sensory education program for Australian primary (elementary) schoolchildren (Vegetable Education Resource to Increase Children's Acceptance and Liking [VERTICAL]) designed to increase vegetable enjoyment and positively predispose to vegetable consumption.

Methods

Pretest and posttest (collected 2 weeks after intervention) survey data (n?=?299) on cognitive, attitudinal, and behavioral factors associated with vegetable consumption were compared between the intervention (which followed VERTICAL, a program consisting of five?1-hour teacher-led interventions) and control students (aged 8–12 years) from Sydney primary schools.

Results

The VERTICAL intervention increased knowledge about vegetables and the senses (P?=?.002), the ability to verbalize sensations (P < .001), vegetable acceptance (P?=?.007), and willingness to try vegetables (P?=?.05). Middle primary students gained more positive attitudes toward vegetable consumption (P?=?.009). Moreover, VERTICAL had no effect on food neophobia, perceived norms of teacher and peers, emotions, behavioral intentions, and vegetables tried.

Conclusions and Implications

Behavioral change was achieved through VERTICAL in a short intervention, supporting further development and validation.  相似文献   

18.

Objectives

This study examines gender differences in heart disease experiences of individuals in Turkey by employing individual level data from a nationally representative survey.

Methods

By using Turkish Health Survey, this study constructs a binary indicator for heart disease experiences of individuals, which accounts for heart problems such as myocardial infarction, coronary heart disease and angina pectoris. Binary logistic regression models are estimated for quantification of associations between prevalence of heart diseases, gender and other risk factors.

Results

Empirical results imply that females are significantly less likely to experience heart diseases in Turkey. Age and hypertension issues are directly correlated with heart problems for both males and females. Perceived health status is negatively associated with probability of experiencing heart diseases for both males and females in Turkey. Having diabetes is a positive significant predictor of heart disease experiences for Turkish females. Females with higher household income level are less likely to have heart diseases. Finally, education level and lifestyle indicators such as smoking, physical activity, fruit, vegetable and alcohol consumption display mixed results.

Conclusions

This study suggests that there are gender differences in prevalence and risk factors of heart diseases in Turkey. Complementing the earlier literature, findings of this study imply that gender specific health interventions would be effective in coping with heart related diseases.  相似文献   

19.

Objective

This study determined how people who live in low-income households can consume an affordable, nutritious diet.

Design

A community-based participatory research (CBPR) project was completed that developed and priced 2 weeks of healthy menus that met US Department of Agriculture Dietary Guidelines for Americans. Prices were collected from a market basket survey of 13 stores in the city of Chico during October, 2010. Initial menu development began in 2011–2012. Menus were reviewed in 2017 and reflect current guidelines.

Setting

Chico, CA.

Main Outcome Measures

Macro dietary objectives including the caloric content and servings of fat, sugar, whole grains, and fruits and vegetables. The cost of purchasing the market basket of goods for a family of 4 that achieved those objectives was determined.

Results

The 2 weeks of menus all met dietary objectives on average. The daily cost varied from $19 to $31 when food was purchased from a bulk supermarket, with an average daily cost of $25. Average monthly cost was $756 in 2010 dollars, or $838 in 2015 dollars.

Conclusions and Implications

People living in low-income households can afford to eat healthily. Using CBPR principles, daily targets, and technical support, public health partners can partner with community members for member-defined solutions that are affordable and meet dietary guidelines. Access to stores that sell low-price bulk items is important to being able to afford a healthy diet.  相似文献   

20.
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