Stewart Manor, Lee County, North Carolina : an action-oriented community diagnosis : findings and next steps of action

This document details the steps in an Action Oriented Community Diagnosis (AOCD), as implemented in a public housing apartment complex, Stewart Manor, located in Sanford, North Carolina. A group of five students from the University of North Carolina—Chapel Hill, School of Public Health’s Department of Health Behavior and Health Education, in conjunction with residents and service providers of Stewart Manor, carried out the AOCD process. This document begins with the definition, overview, and goals of the AOCD process. The next section includes the methods used throughout this AOCD, including an account of the steps taken by those involved in the AOCD process, from entry into the Stewart Manor community to data collection and analysis. Following this section, background information on Lee County, Sanford, and Stewart Manor is included, such as health statistics, demographic data, and historical information. The next major section of this paper includes a discussion of the themes that emerged from interviews with both residents of Stewart Manor and those who provide services to Stewart Manor. These themes are discussed in detail and their respective sections in the paper include the perspectives of residents, service providers, and AOCD student team members. A community forum was held to address many of these themes, and the next section of the paper covers the progression of the community forum, as well as the action steps identified by each individual group. This document then concludes with recommendations the AOCD student team developed for residents of Stewart Manor. The AOCD student team members hope that the residents of Stewart Manor and service providers can use these recommendations, as well as other information presented in this document, as they progress toward positive change for the entire community.Master of Public Healt

Nutrition-related policy and environmental strategies to prevent obesity in rural communities: A systematic review of the literature, 2002-2013

Introduction Residents of rural communities in the United States are at higher risk for obesity than their urban and suburban counterparts. Policy and environmental-change strategies supporting healthier dietary intake can prevent obesity and promote health equity. Evidence in support of these strategies is based largely on urban and suburban studies; little is known about use of these strategies in rural communities. The purpose of this review was to synthesize available evidence on the adaptation, implementation, and effectiveness of policy and environmental obesity-prevention strategies in rural settings. Methods The review was guided by a list of Centers for Disease Control and Prevention Recommended Community Strategies and Measurements to Prevent Obesity in the United States, commonly known as the COCOMO strategies. We searched PubMed, Cumulative Index of Nursing and Allied Health Literature, Public Affairs Information Service, and Cochrane databases for articles published from 2002 through 2013 that reported findings from research on nutrition-related policy and environmental strategies in rural communities in the United States and Canada. Two researchers independently abstracted data from each article, and resolved discrepancies by consensus. Results Of the 663 articles retrieved, 33 met inclusion criteria. The interventions most commonly focused on increasing access to more nutritious foods and beverages or decreasing access to less nutritious options. Rural adaptations included accommodating distance to food sources, tailoring to local food cultures, and building community partnerships. Conclusions Findings from this literature review provide guidance on adapting and implementing policy and environmental strategies in rural communities

Developing an agenda for research about policies to improve access to healthy foods in rural communities: a concept mapping study

Background Policies that improve access to healthy, affordable foods may improve population health and reduce health disparities. In the United States most food access policy research focuses on urban communities even though residents of rural communities face disproportionately higher risk for nutrition-related chronic diseases compared to residents of urban communities. The purpose of this study was to (1) identify the factors associated with access to healthy, affordable food in rural communities in the United States; and (2) prioritize a meaningful and feasible rural food policy research agenda. Methods This study was conducted by the Rural Food Access Workgroup (RFAWG), a workgroup facilitated by the Nutrition and Obesity Policy Research and Evaluation Network. A national sample of academic and non-academic researchers, public health and cooperative extension practitioners, and other experts who focus on rural food access and economic development was invited to complete a concept mapping process that included brainstorming the factors that are associated with rural food access, sorting and organizing the factors into similar domains, and rating the importance of policies and research to address these factors. As a last step, RFAWG members convened to interpret the data and establish research recommendations. Results Seventy-five participants in the brainstorming exercise represented the following sectors: non-extension research (n = 27), non-extension program administration (n = 18), “other� (n = 14), policy advocacy (n = 10), and cooperative extension service (n = 6). The brainstorming exercise generated 90 distinct statements about factors associated with rural food access in the United States; these were sorted into 5 clusters. Go Zones were established for the factors that were rated highly as both a priority policy target and a priority for research. The highest ranked policy and research priorities include strategies designed to build economic viability in rural communities, improve access to federal food and nutrition assistance programs, improve food retail systems, and increase the personal food production capacity of rural residents. Respondents also prioritized the development of valid and reliable research methodologies to measure variables associated with rural food access. Conclusions This collaborative, trans-disciplinary, participatory process, created a map to guide and prioritize research about polices to improve healthy, affordable food access in rural communities

Healthy Food Environments in Food Pantries: Lessons Learned from a Sodium Reduction Intervention

In the United States, food pantries increasingly serve as regular food sources for low income households experiencing high rates of chronic disease, including hypertension. Sodium consumption is a modifiable risk factor for hypertension, so pantry customers would benefit from access to low-sodium foods. Pantry customers often experience difficulty acquiring healthy foods, however; little is known about pantry foods’ sodium content specifically. This study assesses the sodium content of pantry foods and lessons learned from an adaptable intervention to support pantries in adopting policies and environmental changes to make healthy, lower-sodium foods appealing and accessible. We conducted sodium assessments of food at 13 food pantries, tracked implementation of intervention strategies, and interviewed 10 pantry directors. More than half of food items in 11 categories met sodium standards for foods to be chosen “often”. Pantry directors reported valuing the intervention approach and implemented six of nine behavioral economics strategies, especially those targeting the visibility and convenience of foods, along with layout changes and expanded customer choice. One pantry adopted an agency-specific nutrition policy and 12 adopted a coalition-level policy. Results can inform intervention efforts to make available healthy options appealing and easy to select while also improving the customer experience in food pantries

Advancing Rural Food Access Policy Research Priorities: Process and Potential of a Transdisciplinary Working Group

Residents of rural communities currently face disproportionately higher risk for nutrition-related chronic diseases compared to residents of urban communities. Rural residents also face disparities and unique barriers in accessing healthy, affordable foods. In 2011, participants of the Centers for Disease Control and Prevention (CDC)–funded Nutrition and Obesity Policy Research and Evaluation Network (NOPREN) formed the Rural Food Access Working Group (RFAWG). Since then, the RFAWG has been focusing on conducting collaborative transdisciplinary research that includes a concept mapping project that identified and prioritized policy research ideas perceived as important to improving access to healthy, affordable foods in rural communities. This commentary reflects on the process and potential of this emergent transdisciplinary RFAWG to advance rural food access policy research priorities, sharing how after nearly two years of convening, RFAWG has identified and started to address various rural food access policy research needs and opportunities that the group has deemed important for the near and long-term. The research priorities and process taken thus far by RFAWG reflect the participants' own work, institutional and geographic strengths, and negotiated approaches to collaborating with the transdisciplinary team using pooled but often limited resources. The group has benefited from the involvement of a variety of experts skilled in various disciplines and research methodologies touching the food system. RFAWG continues to strategize methods to advance rural food access policy research priorities through transdisciplinary team efforts, innovative partnerships, rigorously designed research processes, and contextually crafted dissemination and translation approaches