Online Pilot Grocery Intervention among Rural and Urban Residents Aimed to Improve Purchasing Habits

Online grocery shopping has the potential to improve access to food, particularly among low-income households located in urban food deserts and rural communities. The primary aim of this pilot intervention was to test whether a three-armed online grocery trial improved fruit and vegetable (F&V) purchases. Rural and urban adults across seven counties in Kentucky, Maryland, and North Carolina were recruited to participate in an 8-week intervention in fall 2021. A total of 184 adults were enrolled into the following groups: (1) brick-and-mortar “BM” (control participants only received reminders to submit weekly grocery shopping receipts); (2) online-only with no support “O” (participants received weekly reminders to grocery shop online and to submit itemized receipts); and (3) online shopping with intervention nudges “O+I” (participants received nudges three times per week to grocery shop online, meal ideas, recipes, Facebook group support, and weekly reminders to shop online and to submit itemized receipts). On average, reported food spending on F/V by the O+I participants was USD 6.84 more compared to the BM arm. Online shopping with behavioral nudges and nutrition information shows great promise for helping customers in diverse locations to navigate the increasing presence of online grocery shopping platforms and to improve F&V purchases

Giving Families a Voice for Equitable Healthy Food Access in the Wake of Online Grocery Shopping

Understanding the views of families from low-income backgrounds about inequities in healthy food access and grocery purchase is critical to food access policies. This study explored perspectives of families eligible for the Supplemental Nutrition Assistance Program (SNAP) on healthy food access in physical and online grocery environments. The qualitative design used purposive sampling of 44 primary household food purchasers with children (aged ≤ 8), between November 2020–March 2021, through 11 online focus groups and 5 in-depth interviews. Grounded theory was used to identify community-level perceived inequities, including influences of COVID-19 pandemic, SNAP and online grocery services. The most salient perceived causes of inequitable food access were neighborhood resource deficiencies and public transportation limitations. Rural communities, people with disabilities, older adults, racially and ethnically diverse groups were perceived to be disproportionately impacted by food inequities, which were exacerbated by the pandemic. The ability to use SNAP benefits to buy foods online facilitated healthy food access. Delivery fees and lack of control over food selection were barriers. Barriers to healthy food access aggravated by SNAP included social stigma, inability to acquire cooked meals, and inadequate amount of monthly funds. Findings provide a foundation for policy redesign to promote equitable healthy food systems

A Youth-Leader Program in Baltimore City Recreation Centers: Lessons Learned and Applications

Peer-led interventions may be an effective means of addressing the childhood obesity epidemichowever, few studies have looked at the long-term sustainability of such programs. As part of a multilevel obesity prevention intervention, B'More Healthy Communities for Kids, 16 Baltimore college students were trained as youth-leaders (YLs) to deliver a skill-based nutrition curriculum to low-income African American children (10-14 years old). In April 2015, formative research was used to inform sustainability of the YL program in recreation centers. In-depth interviews were conducted with recreation center directors (n = 4) and the YLs (n = 16). Two focus groups were conducted with YLs (n = 7) and community youth-advocates (n = 10). Barriers to this program included difficulties with transportation, time constraints, and recruiting youth. Lessons learned indicated that improving trainings and incentives to youth were identified as essential strategies to foster continuity of the youth-led program and capacity building. High school students living close to the centers were identified as potential candidates to lead the program. Based on our findings, the initial intervention will be expanded into a sustainable model for implementation, using a train-the-trainer approach to empower community youth to be change agents of the food environment and role models.Johns Hopkins Urban Health InstituteGlobal Obesity Prevention Center at Johns HopkinsEunice Kennedy Shriver National Institute of Child Health and Human DevelopmentOffice of the Director, National Institutes of Health [U54HD070725]646 CNPq [GDE: 249316/2013-7]Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD USAUniv Tennessee, Knoxville, TN USAUniv Fed Sao Paulo, Santos, SP, BrazilDept Recreat & Pk City Baltimore, Baltimore, MD USAUniv Maryland Extens, Ellicott City, MD USAUniv Fed Sao Paulo, Santos, SP, BrazilWeb of Scienc

IMPACT OF THE B’MORE HEALTHY COMMUNITIES FOR KIDS INTERVENTION ON DIET AND FOOD-RELATED BEHAVIORS AMONG LOW-INCOME URBAN AFRICAN AMERICAN YOUTH AND THEIR ADULT CAREGIVERS

Background: Consumption of foods and beverages rich in sugar, fat, and salt remains high across all races and ages in the United States. In view of the multifactorial etiology of weight gain, efforts that simultaneously address multiple levels of the food system are recommended that will impact on food selection and consumption. Thus, multilevel multicomponent interventions to address childhood obesity and improve food-related behaviors and intake are needed, particularly in low-resource settings. It is also important to test whether community interventions are effective in ‘real-world’ conditions and in hard-to-reach populations, as participants need to have sufficient exposure to the intervention. Objective: To evaluate how a multilevel multicomponent childhood obesity prevention intervention impacted the diet and food-related behaviors of low-income urban, predominantly African American families living in neighborhoods with low access to healthy foods in Baltimore City, and to evaluate the patterns of exposure to the different components of the intervention. Methods: B’more Healthy Communities for Kids (BHCK) was a group-randomized controlled trial in 30 low-income areas in Baltimore for 534 African American youth aged 9-15 years old. BHCK components (policy, wholesaler, small stores, youth-mentor led nutrition education, and social media) simultaneously promoted purchase and consumption of low-sugar, low-fat foods/beverages. Exposure to the different intervention components was assessed via post-intervention interviews with 385 youths and their adult caregivers. Exposure scores were generated based on self-reported viewing of BHCK materials and participating in activities. Food consumption in youth (n=357) was assessed pre/post-intervention using the Block Kids Food Frequency Questionnaire. Analyses were stratified by age (school-age: 9-12; adolescent: 13-15). Additionally, caregivers’ (n=516) self-reported household food acquisition frequency for food items over 30 days, and usual consumption of fruit and vegetable (FV) was assessed in a sub-sample of 226 caregivers via the NCI FV Screener. Hierarchical multilevel models were conducted with random effects at the community and individual levels and assessed average-treatment-effects (ATE). Treatment-on-the-treated-effect (TTE) analyses evaluated the correlation between behavioral change and exposure to BHCK among adults. Results: The BHCK intervention group was more exposed to the program components, and the comparison group also received some exposure, though to a lesser degree. In ATE analysis, youth in the intervention group purchased almost 1.5 more healthier food/beverage items per week, compared to their counterparts (β = 1.4; 95% CI: 0.1; 2.8). The age-stratified analysis demonstrated that BHCK decreased kcal intake from sweet snacks among intervention adolescents (13-15 years old) by 3.5% compared to their counterparts (β = -3.5; 95% CI: -7.76; -0.05). No significant effect of the intervention was found on caregiver food-related behaviors in the ATE analysis. However, the TTE showed a statistically significant increase in daily intake of fruits by 0.2 servings among adult participants who reported higher exposure to the intervention (0.2+0.1; 95% CI 0.1;0.5). Caregivers reporting greater exposure to social media tripled their daily fruit intake (3.1+0.9; 95% CI 1.3;4.9), compared to baseline. Conclusions: Multilevel, multicomponent environmental childhood obesity programs are a promising strategy to improve eating behaviors among low-income urban youth. Child-focused community-based nutrition interventions may also benefit family members. Future community-based environmental intervention trials targeting low-income populations may consider enrolling larger sample sizes and improving program intensity, as the likelihood of low exposure is high. Future multilevel studies should consider using social media to improve reach and engage caregiver participants

A multilevel, multicomponent childhood obesity prevention group-randomized controlled trial improves healthier food purchasing and reduces sweet-snack consumption among low-income African-American youth

Abstract Background Consumption of foods and beverages rich in sugar remains high across all races and ages in the United States. Interventions to address childhood obesity and decrease sugar intake are needed, particularly in low-income settings. Methods B’more Healthy Communities for Kids (BHCK) was a group-randomized, controlled trial implemented among 9–15-year olds in 30 low-income areas of Baltimore. We increased access to low-sugar foods and beverages at wholesalers and small food stores. Concurrently, we encouraged their purchase and consumption by children through youth-led nutrition education in recreation centers, in-store promotions, text messaging and a social media program directed at caregivers. Sugar consumption (sugar sweetened beverage (SSB), sweets) in youth was assessed pre- (n = 534) and post-intervention (n = 401) using the Block Kids Food Frequency Questionnaire. Purchasing of 38 healthier and 28 less healthier food/beverage varieties in the previous 7 days was assessed via self-report. Multilevel models at the community and individual levels were used. Analyses were stratified by age (younger: 9–12-year olds (n = 339) vs older: 13–15 (n = 170)). Models were controlled for child’s sex, race, total daily caloric intake, and caregiver’s age and sex. Results Overall baseline mean healthier food purchasing was 2.5 (+ 3.6; min. 0, max. 34 items per week), and unhealthier food purchasing 4.6 (+ 3.7; 0–19 items per week). Mean intake at baseline for kcal from SSB was 176 (+ 189.1) and 153 (+ 142.5), and % of calories from sweets (i.e. cookies, cakes, pies, donuts, candy, ice cream, sweetened cereals, and chocolate beverages) was 15.9 (+ 9.7) and 15.9 (+ 7.7) in comparison and intervention youth, respectively. Intervention youth increased healthier foods and beverages purchases by 1.4 more items per week than comparison youth (β = 1.4; 95% CI: 0.1; 2.8). After the intervention, there was a 3.5% decrease in kcal from sweets for older intervention youth, compared to the control group (β = − 3.5; 95% CI: -7.76; − 0.05). No impact was seen on SSB consumption. Conclusion BHCK successfully increased healthier food purchasing variety in youth, and decreased % calories from sweet snacks in older youth. Multilevel, multicomponent environmental childhood obesity programs are a promising strategy to improve eating behaviors among low-income urban youth. Trial registration NCT02181010 (July 2, 2014, retrospectively registered)

Additional file 1: of Exposure to a multi-level multi-component childhood obesity prevention community-randomized controlled trial: patterns, determinants, and implications

CONSORT checklist of the B’more Health Communities for Kids program. (DOCX 158 kb

Ehretia dichotoma Bl.

原著和名: リウキウチシャノキ科名: ムラサキ科 = Boraginaceae採集地: 沖縄県 石垣島 大浜 (琉球 石垣島 大浜)採集日: 1980/12/24採集者: 萩庭丈壽整理番号: JH001285国立科学博物館整理番号: TNS-VS-95128

Challenges and Lessons Learned from Multi-Level Multi-Component Interventions to Prevent and Reduce Childhood Obesity

Multi-level multi-component (MLMC) strategies have been recommended to prevent and reduce childhood obesity, but results of such trials have been mixed. The present work discusses lessons learned from three recently completed MLMC interventions to inform future research and policy addressing childhood obesity. B’more Healthy Communities for Kids (BHCK), Children’s Healthy Living (CHL), and Health and Local Community (SoL) trials had distinct cultural contexts, global regions, and study designs, but intervened at multiple levels of the socioecological model with strategies that address multiple components of complex food and physical activity environments to prevent childhood obesity. We discuss four common themes: (i) How to engage with community partners and involve them in development of intervention and study design; (ii) build and maintain intervention intensity by creating mutual promotion and reinforcement of the intervention activities across the multiple levels and components; (iii) conduct process evaluation for monitoring, midcourse corrections, and to engage stakeholder groups; and (iv) sustaining MLMC interventions and its effect by developing enduring and systems focused collaborations. The paper expands on each of these themes with specific lessons learned and presents future directions for MLMC trials