CONNECTING SELF-EFFICACY OF DIETARY CHOICES AND THE ASSOCIATION WITH DIETARY INTAKE AMONG RURAL ADOLESCENTS IN NORTH CAROLINA AND KENTUCKY

Determining the level of belief one has in themselves, or their self-efficacy, can be a key factor to improve certain dietary patterns and choices in the rural youth population. Sugar sweetened food and beverage consumption continues to rise and fruit and vegetable intake remains a struggle in rural areas; addressing both the food environment and adolescents’ self-efficacy could have a lasting impact on changing the nature of a generation of rural student’s food and beverage choices. This study measured self-efficacy levels of (n=425) adolescents in rural Kentucky and North Carolina using the Youth Impact Questionnaire and dietary intake using the NHANES Dietary Screener. Multiple linear regression analysis found that higher levels of self-efficacy resulted in a statistically significant ability to consume more vegetables. Further associations found that higher levels of self-efficacy resulted in increased fruit consumption, and improved added sugar food and beverage selections. These findings suggest that it could be beneficial to target adolescents’ self-efficacy as a way to modify certain health behaviors in a sparse food environment such as these rural Appalachian areas

Evaluation of Program Satisfaction, Quality of Life, Strength, and Fall Risk of Community-Dwelling Older Adults Participating in a Community Exercise Program

Background and Purpose: Exercise programs aimed at prevention of osteoporosis are effective in fall prevention and improving mobility in older adults. This trial examined whether the Bone Builder\u27s community exercise program decreases fall risk and improves mobility in community dwelling females over the age of 60. Methods: Fifty one females ages 60-90 who currently are participating in the Bone Builder\u27s program volunteered to participate in four different assessments as well as two questionnaires. Tests included: the 4-stage balance, timed up and go, gait speed (measured with the GAITRite system), 30 second sit-to-stand, and grip strength. The Functional Efficacy Scale-International (FES-I) and the Quality of Life survey were the two questionnaires used to assess participants\u27 subjective views of fall concern and improvement of living quality. Analysis: Data was entered into an excel file and transferred to SPSS to be analyzed. Descriptive statistics were performed to investigate trends and compare to industry norms for each age group. Results: Overall, all participants were within the normative data ranges on all tests. The eight repeat subjects, on average, scored higher on the tests in comparison to first time study subjects. However, these eight repeat subjects saw a decline from 2013 to 2014 in all tests, except the 30 second sit-to-stand test. Conclusion: Participation in community exercise programs for older adults is beneficial in decreasing fall risk, improving mobility, and improving overall quality of life. As shown by the data, implementing exercise programs and promoting participation in more communities may have a positive effect on the overall safety and well-being of older individuals. This will continue to become increasingly important as the longevity of life is rising, and the baby boomer generation ages and becomes an increased risk for falls

Policy Implications of the COVID-19 Pandemic on Food Security in Rural America: Evidence from Appalachia

Rural communities are disproportionally affected by food insecurity, making them vulnerable to the consequences of supply disruptions caused by the COVID-19 pandemic. While access to food was initially diminished due to food supply disruptions, little is known about the mechanisms through which federal emergency assistance programs impacted food access in rural populations. Through a series of five focus groups in spring 2021, we examined the impact of the COVID-19 pandemic on food access in a rural Appalachian community in Kentucky. Data were analyzed using a Grounded Theory Approach. Findings revealed the following four primary themes: food scarcity in grocery stores; expanded federal food assistance; expanded community food resources; and expanded home gardening. Participants provided details regarding the way increased federal assistance, especially expanded benefits within the Supplemental Nutrition Assistance Program, allowed them to purchase greater quantities of nutritious food. This study unveils the specific impacts of the COVID-19 pandemic on one rural population, including the influence of some social determinants of health on food insecurity. Policymakers and stakeholders should recognize the layered protection of multiple federal emergency assistance programs against food insecurity and the potential for long-term population health promotion in rural areas

Sometimes Hesitancy is Key: Effects of Moral Deliberations on Children\u27s Interpretation of Credibility Cues

Children often treat confident individuals as credible sources of information. Yet, confidence may differentially signify credibility depending upon the domain of knowledge. For example, when dealing with factual information, confident responses indicate greater credibility. However, when deliberating about moral issues, hesitancy may reflect a deeper level of thoughtfulness, and therefore credibility. This study investigated children’s credibility judgments of individuals who differed in the level of confidence (confident vs. hesitant) in two domains of knowledge (factual, moral).In a between-subjects design, children 3-8 years (N=96 planned with 52 participants thus far) listened to a confident and hesitant model make either novel factual (e.g., which animal has an omentum inside?) or moral claims (e.g., which animal should get the last piece of fish?). Across eight trials (4 confident, 4 hesitant), children rated the models on a 4-point scale (0=not at all, 3=a lot) in terms of confidence level, likeability, smartness, and agreement with her answer.Preliminary analyses using a 2 (confidence level) x 2 (domain) x 6 (age) ANOVA indicated significant main effects (psThis research will advance knowledge in how (and when) children use cues about individuals’ credibility when determining who is a trustworthy source of new information. This research will also provide a more nuanced understanding of how children interpret levels of confidence across different domains of knowledge

Parenting Behavior and Child Emotion Regulation During a Delay Task

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Community-Based Efforts Aim to Improve the Food Environment within a Highly Obese Rural Appalachian County

Rural communities in Appalachia are displaying increased obesity prevalence, yet traditional interventions have not provided a broad enough impact to improve dietary consumption patterns. Therefore, expanding efforts that address the food environment and incorporate behavioral nudges through community-developed marketing strategies may be a viable mechanism to improve food and beverage choices within this unique population. This study installed shelf-wobblers across n = 5 gas stations in one rural Appalachian county in Kentucky. Smart Snacks were identified from store inventory lists utilizing the CDC Food Service Guideline for Federal Facilities calculator and were categorized into high-protein snacks, low-fat carbohydrate snacks, meal replacement snacks, and no-calorie beverages. NEMS-CS audits were conducted, and monthly sales data was collected at baseline and for six months thereafter for each store location. A difference-in-difference model was used, adjusting for total sales or total mean sales for each Smart Snack model to assess the percentage change within and between stores. Overall, percent change in mean sales and total sales across all stores resulted in a percentage increase of sales of Smart Snack items following wobbler installment. This study provides unique insight into how a community-driven approach to marketing can influence the sale of healthier food and beverage items

Impact of community-driven interventions on dietary and physical activity outcomes among a cohort of adults in a rural Appalachian county in Eastern Kentucky, 2019–2022

Several environmental level factors exacerbate poor health outcomes in rural populations in the United States, such as lack of access to healthy food and locations to be physically active, which support healthy choices at the individual level. Thus, utilizing innovative place-based approaches in rural locations is essential to improve health outcomes. Leveraging community assets, like Cooperative Extension, is a novel strategy for implementing community-driven interventions. This prospective cohort study (n = 152), recruited in 2019 and surveyed again in 2020 and 2021, examined individual level changes in diet and physical activity in one rural Appalachian county. During this time, multiple community-driven interventions were implemented alongside Cooperative Extension and several community partners. Across the three-year study, the cohort indicated increases in other vegetables and water and reductions in fruits and legumes. There were also reductions in less healthy items such as French fries and sugar-sweetened beverages. The cohort also reported being less likely to engage in physical activity. Our findings suggest that key community-driven programs may have indirect effects on dietary and physical activity choices over time. Outcomes from this study are relevant for public health practitioners and community organizations working within rural Appalachian communities to address health-related behaviors

“We’re, like, the Most Unhealthy People in the Country”: Employing an Equity Lens to Reduce Barriers to Healthy Food Access in Rural Appalachia

Introduction Obesity disproportionately affects rural communities, and Appalachia has some of the highest obesity rates in the nation. Successful policy, systems, and environmental (PSE) interventions to reduce obesity must reflect the circumstances of the population. We used a health equity lens to identify barriers and facilitators for healthy food access in Martin County, Kentucky, to design interventions responsive to social, cultural, and historical contexts. Methods We conducted 5 focus groups in Martin County, Kentucky, in fall 2019 to obtain perspectives on the local food system and gauge acceptability of PSE interventions. We used grounded theory to identify perceived barriers and facilitators for healthy eating. Results Thirty-four adults (27 women; median age, 46 years) participated in 5 groups. One prominent theme was declining interest in farming; many participants believed this decline was generational. One participant noted, “Most of my adult male relatives worked in the coal mines, and they worked 6 days a week. . . . My grandpa had the garden, but then my dad’s generation is the one quit gardening.” Another shared, “You would probably have to have someone to teach [gardening].” Instead of enhancing farmers markets, participants suggested building community capacity for home gardens to increase vegetable consumption. Conclusion Our findings demonstrate the importance of obtaining community input on the development of PSE interventions to mitigate inequities in obesity. Although farmers market interventions were deemed not feasible, other solutions to enhance access to produce were identified. Developers of community-responsive PSE interventions to improve healthy eating in rural, food-insecure locations should consider using an equity-oriented prevention framework to ensure acceptable interventions

Rural SNAP Participants and Food Insecurity: How Can Communities Leverage Resources to Meet the Growing Food Insecurity Status of Rural and Low-Income Residents?

The burden of obesity disproportionately influences poor health outcomes in rural communities in the United States. Various social and environmental factors contribute to inadequate food access and availability in rural areas, influencing dietary intakes and food insecurity rates. This study aims to identify patterns related to food insecurity and fruit and vegetable consumption within a SNAP-eligible and low-income, highly obese rural Appalachian community. A prospective cohort was implemented to identify gaps in resources addressing obesity and food insecurity challenges. SAS 9.4 software was used to examine differences in dietary intakes and shopping practices among SNAP participants. Among participants (n = 152), most reported an annual household income less than USD 20,000 (n = 90, 60.4%), 29.1% reported food insecurity, and 39.5% reported receiving SNAP benefits within the last month. The overall mean FV intake was 3.46 daily servings (95% CI: 3.06–3.91) among all participants. SNAP participation was associated with food insecurity (p = 0.007) and those participating in SNAP were two times more likely to report being food insecure (OR = 2.707, 95% CI: 1.317, 5.563), relative to non-participants. These findings further depict the need for intervention, as the burden of food insecurity persists. Tailoring health-promoting initiatives to consider rurality and SNAP participation is vital for sustainable success among these populations