Qualitative Analysis of Maternal Barriers and Perceptions to Participation in a Federal Supplemental Nutrition Program in Rural Appalachian North Carolina

Background: Little is known about barriers to and perceptions of participation in the in Women, Infants, and Children (WIC) program in rural Appalachia. Purpose: To gain a deeper understanding of maternal barriers and perceptions related to WIC participation in rural Appalachia Methods: Pregnant women and mothers were recruited in-person and via flyers from WIC offices in three counties in Appalachian North Carolina. Four semi-structured focus groups were conducted between May to July 2018. Each focus group was approximately 60 minutes long and included open-ended questions about the overall WIC experience in rural Appalachia. Focus groups were audio-recorded, transcribed verbatim, and content analysis of transcripts was performed by two trained researchers. Identified themes were discussed and consensus was reached by the researchers to generate final themes for four areas of interest: (1) most valued aspects of WIC program, (2) barriers to program participation and benefit redemption, (3) experiences during appointments, and (4) suggestions for improving experiences in program. Results: The most valued aspects of participation were financial benefits and support/resources provided by WIC staff. In contrast, lack of variety of WIC-approved foods and social stigma were perceived as major barriers to participation and redeeming benefits. Implications: This study contributes to a better understanding of the barriers and perceptions related to WIC participation in this geographically and culturally unique area of rural Appalachia. Findings are valuable for informing WIC state-agencies and policymakers whose efforts focus on the identification and development of effective recruitment and retention strategies for WIC-eligible families in rural Appalachia

Convenience Over Nutrition for Recreation League Youth Sport Team Snack and Mealtime Choices

Fifty-six percent of school-aged children participate in team sports, yet there is limited evidence on how participation in youth sports impacts the dietary behaviors of participants and their families. Our team surveyed parents and caregivers of children participating in recreation league youth sports (n = 178) to assess the foods and beverages offered as team snacks and factors that influence team snack choices. Juice was the most popular beverage, and crackers were the most popular snack reported by parents. Convenience, followed by cost and child preference, were the most frequently reported factors influencing team snack choices. Survey items also included factors that influence mealtime behaviors on game and practice days. Convenience, followed by nutrition and taste, were most frequently reported as factors that influenced mealtime behaviors. Almost half of parents said their family’s eating habits changed as a result of recreational youth sports activities, and more than half said their family often or always eats dinner outside of the home on game and practice days. Professionals who work with this age group and their parents, including extension agents, can tailor education to encourage healthy team snacks and promote strategies to make healthy meals accessible on evenings with youth sports

Hypertension in Low-Income Adolescents

Disadvantaged adolescents are at higher risk for undiagnosed and untreated obesity and hypertension. Using nurse-measured weight, height, and blood pressure (BP) as well as self-reported age and activity/lifestyle behaviors, we assessed the prevalence of obesity and hypertension in 573 adolescent patients aged 13.0 to 17.9 years (females: n = 267, 46.6%; males: n = 306, 53.4%) from a clinic serving low-income, ethnically diverse pediatric patients. Body mass index distribution was as follows: 11, underweight (1.9%); 330, healthy weight (57.6%); 105, overweight (18.3%); and 127, obese (22.2%). The age-adjusted height percentile was normally distributed, but distribution by BP category was 326 normotensive (56.9%), 147 prehypertensive (25.7%), 60 with stage 1 hypertension (10.5%), and 40 with stage 2 hypertension (7.0%). Activity and lifestyle behaviors did not adequately explain obesity and hypertension rates. Efforts to prevent/reduce childhood overweight, obesity, and hypertension in underserved populations need to include dietary education, weight control interventions, and physical activity programs specifically tailored to overweight/obese youth and parents

Using the Family to Combat Childhood and Adult Obesity

The purpose of this article is to emphasize the value of the family as a source of behavior change, particularly with respect to attaining achievable goals of weight loss and regular physical activity for youth and their families. We present a review of the literature, providing support for the value of the family in influencing children to form good diet and exercise behaviors and as a source of support and motivation for individuals seeking to lose or control their weight and to start and maintain a physically active lifestyle. Recognizing the importance of family behavior in the development of weight control and weight loss activities is essential. Future work should focus on identifying measurable parameters of family-level weight control behaviors and ways to apply those parameters to help create new interventions that use the strengths of the family for achieving weight control goals

Risk Factors in Adolescent Hypertension

Hypertension is a complex and multifaceted disease, with many contributing factors. While diet and nutrition are important influences, the confounding effects of overweight and obesity, metabolic and genetic factors, racial and ethnic predispositions, socioeconomic status, cultural influences, growth rate, and pubertal stage have even more influence and make diagnosis quite challenging. The prevalence of hypertension in adolescents far exceeds the numbers who have been diagnosed; studies have found that 75% or more go undiagnosed. This literature review summarizes the challenges of blood pressure classification in adolescents, discusses the impact of these confounding influences, and identifies actions that will improve diagnosis and treatment outcomes

Changes in meal participation, attendance, and test scores associated with the availability of universal free school breakfasts.

This study investigates student outcomes associated with changes in the availability of universal free breakfasts at elementary schools in the Guilford County Schools ðGCSÞ in North Carolina. In 2007–8, the GCS offered universal free breakfasts in schools with high proportions of economically disadvantaged students. In 2008–9, the GCS reduced its universal free programs, with the affected schools returning to eligibility-based programs. We examine how breakfast and lunch participation, attendance, and reading, math, and science test scores changed across years at affected and unaffected schools. We find that the switch from a universal free to an eligibility-based School Breakfast Program reduced breakfast participation substantially with the largest changes occurring among students who were not eligible for free or reduced-price meals. The changes to eligibility-based provision were associated with decreases in lunch participation for paid-eligible students but not for other students. The changes to eligibility-based provision did not harm test scores or attendance

Determinants of food security and diet among rural and urban Latino/Hispanic.

Rural migration and food insecurity of Latino immigrants is high. The goal of this study was to examine food insecurity among Latino immigrants in a rural region (N?=?119) in comparison to urban Latinos (N?=?166). The objectives were to examine, identify, and compare determinants of food security, weight status, and diet between urban and rural Latinos. Household surveys were conducted by 2 trained bilingual/bicultural interviewers. Data on food security, body mass index, self-reported weight change since US arrival, diet, and barriers to healthy eating were collected. Rural Latinos were more likely to be overweight and have low food security than urban Latinos. Difficulty eating healthy and increased time in the United States were the primary determinants of low food security and poor diet among rural Latinos. Rurality and food insecurity pose a barrier for Latino immigrants and must be addressed further

Cultural adaptation resources for nutrition and health in new immigrants in Central North Carolina.

This paper presents results of a study that was conducted for the purposes of describing available human services resources relating to nutrition, physical health, and behavioral health for new and recent immigrants (predominantly Mexican immigrants, but groups from Southeast Asia and continental Africa as well) in Guilford County, NC. Sixty-five service providers were determined to represent cultural adaptation resources providing either direct and/or ancillary assistance to limited English proficient immigrants. Seventeen direct assistance providers specialized in food and nutrition programs, but only 2 had targeted programs for addressing food scarcity, insecurity, and nutritional deficiencies in immigrant households. Four of 15 direct physical health services providers had clinical care or specialty programs for immigrants. Finally, 5 of 16 direct behavioral health care providers offered mental health treatment and counseling services adapted specifically for targeted immigrant groups. These findings highlight the limited development of the existing human services network to increase its capacity to provide nutrition and health related services to a growing community of diverse immigrant groups. These descriptive results underscore a need for additional local level or community based resources to be directed towards increasing the community’s ability to provide essential human services to population groups not yet language proficient and acculturated to “American community standards.

Active Living in the Trucking Sector: Environmental Barriers and Health Promotion Strategies.

Background: As one of the most underserved segments of the U.S. labor force, truck drivers have been associated with a series of morbid conditions intimately linked to their occupational milieux, their mostly unhealthful nutritional intake and sedentary lifestyles, and their resulting excess weight-gain. Methods: This paper reports data from a baseline assessment of 25 trucking work settings located around interstate highways I-40 and I-85 in North Carolina. It examines how the environmental attributes of these work settings influence the physical and recreational activity behaviors of truckers, compares findings with those from other occupational environments, and brings to the fore a new health promotion paradigm for trucking worksites. Results: Findings support growing empirical and anecdotal evidence that trucking work settings remain not only active-living deserts, but overall unhealthful places. A scan of physical, social, and information environments within trucking worksites as well as physical environments of surrounding communities reveal only meager opportunities for physical and recreational activity for truckers. Conclusion: This paper places the highly underserved population of truckers firmly within the discourse of worksite health promotion, and calls for comprehensive multistakeholder wellness strategies that address a multitude of risk factors linked to the occupational context