Journal of Nutrition Education and Behavior最新文献

Objective: To examine whether the 10-item Household Food Security Survey Module (HFSSM) measure validly captures experiences of food insecurity between and across certain groups.

Design: Cross-sectional study.

Participants: The 2019 National Health Interview Survey child survey (n = 1,575).

Main outcome measure: Household Food Security Survey Module experience among respondent characteristics, including child sex, racial and ethnic groups, adult sex, and relative status.

Analysis: Confirmatory factor analysis was conducted to explore the construct validity of the HFSSM and was used as a baseline model for invariance testing. Invariance testing proceeded using multiple group confirmatory factor analysis, which included configural and scalar invariance because of the binary nature of the data.

Results: Confirmatory factor analysis results indicate that a 1-factor model was the best fit for the data. The HFSSM was invariant within the child sex, racial, and ethnic groups, and relative status variables, but the adult sex variable was found to be noninvariant.

Conclusions and implications: The HFSSM can be used for cross-group comparisons in invariant variables. However, female and male adults reporting on behalf of children appear to interpret the measure differently. These data support the use of additional modeling procedures to account for the noninvariance between adult sexual identity when using the HFSSM.

Objective: To assess the relationship between adult intuitive eating and perceived food security during childhood.

Methods: A survey was conducted consisting of the Intuitive Eating Scale-2 and the 6-item short form of the US Household Food Security Module modified to assess perceived food security status in participants aged 0-17 years. Student, faculty, and staff participants (n = 331) were primarily White, women, and aged 18-24 years. Analyses included descriptive statistics, Mann-Whitney U tests, and Kendall's Tau-b correlations.

Results: Overall, perceived childhood food insecurity was negatively correlated with adult intuitive eating (T_b = -0.1, P = 0.03) and body-food choice congruence (T_b = -0.1, P = 0.03). When stratified by gender, among women, perceived childhood food insecurity was negatively correlated with adult intuitive eating (T_b = -0.1, P = 0.04).

Conclusions and implications: Perceived childhood food insecurity and adult intuitive eating warrant further exploration to identify those who may benefit from intuitive eating education.

Objective: To investigate relationships among food security status severity, multilevel food insecurity coping strategies, and depression in single female caregivers of children.

Methods: A convenience sample of US caregivers (n = 86) with high poverty rates provided cross-sectional survey data in 2022-2023. We used regression to examine associations among key variables.

Results: We documented high rates of food insecurity (76%) and depression (78%). More severe food insecurity was associated with more depressive symptoms (P = 0.004) and greater use of community, interpersonal, and individual food insecurity coping strategies (P < 0.05). Food insecurity severity was unrelated to federal policy-related coping strategy use. Greater use of community, interpersonal, and some individual (shopping, tradeoffs) coping strategies was associated with more depressive symptoms (P < 0.05); policy-level strategy use and individual rationing were not.

Conclusions and implications: Findings recommend targeted interventions addressing intersections of coping with food insecurity and mental health among high-risk groups, particularly during high-risk times (e.g., coronavirus 2019 pandemic).

Objective: An evaluation of a team-based pilot program with food vouchers.

Design: Single-arm prepost mixed-method study.

Setting: Two safety-net primary care clinics in San Francisco.

Participants: Black/African American and/or Hispanic/Latinx patients with uncontrolled diabetes (hemoglobin A1c >8%).

Intervention(s): Six-month program including pharmacist and nutritionist visits, transportation assistance, and smoking cessation resources, plus $160 per month of grocery and produce vouchers.

Main outcome measure(s): Glycemic control and blood pressure. Secondary outcomes included qualitative insights into program benefits.

Analysis: Descriptive statistics were used for patient characteristics, voucher use, and program satisfaction. Clinical outcomes used McNemar's tests for paired categorical variables and paired t tests for continuous variables. Interviews were transcribed and analyzed with deductive coding.

Results: A total of 45 participants redeemed 68.7% of vouchers. Uncontrolled hypertension (≥ 140/90 mmHg) decreased significantly from 45.9% to 21.6% (P = 0.007, n = 41). There was no statistically significant change in mean hemoglobin A1c from baseline to program end (10.1% vs 9.7%; P = 0.17). Mean low-density and body mass index were not significantly different. Major themes from interviews include changes in health behaviors, improved relationships with food, and strengthened engagement with team-based care.

Conclusions and implications: Combining vouchers and team-based care may be an avenue to improve care for patients with diabetes. Further investigation of this program model through a larger and rigorously designed study is needed for conclusive findings on this approach.

Objective: This study aimed to explore dietetic students' opinions regarding the graduate degree requirement and to determine how many students plan on completing the requirements to become registered dietitian nutritionists (RDNs).

Methods: An electronic cross-sectional survey was sent via email to dietetic program directors (N = 603) with the request to forward it to their current students. Open-ended answers were analyzed using a conventional content analysis. Pearson Chi-square tests of independence and Cramer's V tests were used to assess between-group differences based on gender, program type, and race/ethnicity.

Results: Of respondents (N = 603), most (94%) planned to earn the RDN credential. Three categories of data were identified: individual considerations (e.g., future salaries, financial burden, time commitment); support and skepticism toward the graduate degree requirement; and the requirement's perceived impact on the dietetics profession. Most believed the change to educational requirements had beneficial aspects and planned on becoming RDNs.

Conclusions and implications: Understanding current students' perspectives on the requirement change can help stakeholders address concerns and leverage the strengths identified. Future research could explore how these perceptions influence dietetic students' decisions over time.

Objective: Valid, reliable, and comprehensive instruments enable early care and education (ECE) sites to self-assess nutrition and physical activity practices and policies, but availability is limited. Therefore, we developed and assessed the test-retest reliability and convergent validity of the Site-Level Assessment Questionnaire (SLAQ).

Design: Reliability testing compared questionnaires completed by ECE personnel at 2 time points (reliability pairs). Convergent validity testing compared questionnaires completed by ECE personnel with questionnaires completed by researchers (validity pairs). Semistructured interviews with personnel who completed the SLAQ informed revisions.

Setting: California Supplemental Nutrition Assistance Program Education-eligible ECE sites.

Participants: Convenience sample of 32 ECE sites (18 school districts; 14 Head Starts).

Variables measured: Seventy-six items assessing wellness policies, federal food program participation, meals, snacks, beverages, food environment, feeding practices, nutrition education, gardens, physical activity, screen time, family involvement, and breastfeeding support.

Analysis: Weighted κ test statistics and percent agreement were calculated for each item to assess agreement between reliability pairs and validity pairs.

Results: Eighty-eight percent of items showed moderate or higher reliability; 52% had moderate or higher validity. On the basis of these results and interview findings, the SLAQ was revised to address issues identified.

Conclusions and implications: Findings suggest acceptable validity and reliability of the SLAQ for assessing policies and practices at SNAP-Ed-eligible ECE sites in California. Further testing with larger, randomly selected, and geographically and socioeconomically diverse populations could broaden its application. As is, the comprehensive assessment data the SLAQ provides can be used to identify opportunities for improving ECE practices and policies that support children's health.

Objective: To examine if variation in session format and content of a prenatal obesity prevention program is associated with fruit and vegetable (FV) voucher redemption in Hispanic/Latino pregnant participants.

Methods: A secondary analysis of participants who received FV vouchers in a single-arm feasibility trial. We used linear regressions to assess associations between program session format (group vs individual) and FV voucher redemption rate, with session content (nutrition vs other lifestyle content [e.g., stress management or physical activity]) as a secondary predictor.

Results: Participants (n = 131) who attended a greater percentage of sessions in group format had increased voucher redemption rates (B = 0.37 [95% confidence interval, 0.05-0.70]. P = 0.03). Attending a higher percentage of group sessions with nutrition content rather than other lifestyle content was associated with a higher redemption rate (B = 0.19 [95% confidence interval, 0.002-0.38], P = 0.05).

Conclusions and implications: Pairing FV voucher distribution with nutrition counseling delivered in a group format may increase utilization of FV vouchers.

Objective: To assess whether a nutrition and body image program improved healthy food consumption, physical activity, eating pathology, and psychosocial factors for women in recovery from substance use.

Design: Secondary data, pretest-posttest.

Setting: In-person intervention conducted in 6 substance use recovery centers.

Participants: Six hundred and seven adult women.

Intervention: Ten-week, 90-minute weekly intervention led by trained instructors.

Main outcome measures: Self-report demographics, drug-use history, general nutrition and health behaviors, thin-ideal internalization, body dissatisfaction, eating pathology, binge eating, and intuitive eating. Researchers collected anthropometric/physiological measures.

Analysis: Paired t tests using Cohen's d tested the differences between pretest and posttest total scores on all outcome measures; univariate analysis of variance tests were used for pretest participant comparison.

Results: Participants demonstrated statistically significant (P < 0.05) improvements in general nutrition, physical activity, thin-ideal internalization, body dissatisfaction, eating pathology, binge eating, and intuitive eating behaviors compared with pretest, with effect sizes ranging from small to large (d = 0.11-0.83). Participants also reported decreases in weight-related concerns.

Conclusions and implications: Healthy eating and physical activity significantly increased, whereas thin-ideal internalization, body dissatisfaction, and disordered eating symptoms significantly decreased. Results support this program to augment existing substance use treatment to address nutrition, physical activity, body image, eating pathology, and weight-related issues in women.

Objective: To examine the spatial distribution of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) authorized vendors across the US, focusing on their placement within socioeconomically disadvantaged neighborhoods (SDNs) and differences by urban-rural context.

Methods: Using 2022 WIC vendor data, Area Deprivation Index measures, and population data from the American Community Survey, we conducted spatial analyses of the proportions and densities of WIC vendors in SDNs. Vendors were classified as located in SDNs if they fell within census block groups in Area Deprivation Index deciles 6-10. Descriptive and spatial analytic maps were used to visualize the variation in vendor proportions and density (per 10,000 people) across states and regions.

Results: Disparities were observed across states and by rurality. Several states, primarily in the Southeast and Northeast, had < 50% of vendors and < 2 vendors per 10,000 people in their SDNs. Many Midwestern and Plains states had > 65% of vendors and > 2 vendors per 10,000 people in their SDNs. Urban-rural analyses suggest rural SDNs may have better vendor access than urban SDNs, and spatial clustering revealed potentially high-access clusters concentrated in the Midwest and Plains.

Conclusions and implications: Geographic access to WIC vendors varies substantially by state, region, and rurality, revealing inequities that may contribute to disparities in WIC participation and benefit redemption. Ensuring vendor placement within areas of higher socioeconomic disadvantage could enhance program access and effectiveness.

Objective: To explore the capacity for future sustainability of policy, systems, and environmental (PSE) change strategies adopted through Supplemental Nutrition Assistance Program-Education (SNAP-Ed) programming.

Design: Qualitative study using semistructured interviews.

Setting: Southeastern state.

Participants: Key personnel (n = 30) from sites (n = 30) that adopted a PSE strategy in partnership with SNAP-Ed.

Phenomenon of interest: Domains of capacity for future sustainability of PSE strategies.

Analysis: Interview transcripts were analyzed to identify if sustainability domains were evidenced or not evidenced. Themes of sustainability were identified.

Results: Themes included: (1) sustained and going strong, (2) sustained with site investment but unstable, (3) sustained but lacking site investment, (4) sustained but with site planning to discontinue, and (5) not sustained but with site interested in reviving. The partnership and continued SNAP-Ed involvement were the domains most evidenced among high vs low-capacity sites.

Conclusions and implications: Most PSE strategies examined had been maintained, though not all the sites demonstrated high capacity for future strategy sustainability. Findings underscore the need to ensure a team approach in implementing PSE strategies that include leadership from people previously eligible for SNAP-Ed programming. Because of the elimination of SNAP-Ed funding, the findings can help inform the development and delivery of future nutrition education and promotion programs.