Consumption Frequency of Foods Away from Home Linked with Higher Body Mass Index and Lower Fruit and Vegetable Intake among Adults: A Cross-Sectional Study

Introduction. Consumption of foods prepared away from home (FAFH) has grown steadily since the 1970s. We examined the relationship between FAFH and body mass index (BMI) and fruit and vegetable (FV) consumption. Methods. Frequency of FAFH, daily FV intake, height and weight, and sociodemographic data were collected using a telephone survey in 2008-2009. Participants included a representative sample of 2,001 adult men and women (mean age 54±15 years) residing in King County, WA, with an analytical sample of 1,570. Frequency of FAFH was categorized as 0-1, 2–4, or 5+ times per week. BMI was calculated from self-reported height and weight. We examined the relationship between FAFH with FV consumption and BMI using multivariate models. Results. Higher frequency of FAFH was associated with higher BMI, after adjusting for age, income, education, race, smoking, marital status, and physical activity (women: p=0.001; men: p=0.003). There was a negative association between frequency of FAFH and FV consumption. FAFH frequency was significantly (p<0.001) higher among males than females (43.1% versus 54.0% eating out 0-1 meal per week, resp.). Females reported eating significantly (p<0.001) more FV than males. Conclusion. Among adults, higher frequency of FAFH was related to higher BMI and less FV consumption

Strength Training Improves Body Image and Physical Activity Behaviors Among Midlife and Older Rural Women

The effect of strength training on body image is understudied. The Strong Women Program, a 10-week, twice weekly strength-training program, was provided by Extension agents to 341 older rural women (62±12 years); changes in body image and other psychosocial variables were evaluated. Paired-sample t-test analyses were conducted to assess mean differences pre- to post-program. Strength training was associated with significant improvements in several dimensions of body image, health-related quality of life, and physical activity behaviors, satisfaction, and comfort among rural aging women—an often underserved population that stands to benefit considerably from similar programs

Spatial considerations for implementing two direct-to-consumer food models in two states

To open new markets, some farmers have adapted direct-to-consumer (DTC) models, such as Community Supported Agriculture (CSA), to reach new settings or audiences. We compared sociodemographic and geospatial contexts to farmers\u27 experience with one of two DTC innovations: a cost-offset CSA for low-income families and food boxes distributed through rural convenience stores. We geocoded addresses of thirteen farms and DTC pickup sites in two U.S. states (Vermont and Washington) and calculated road network distances from pickup to supermarket, farmers\u27 market, and farm. We compiled Census block-level demographic and transportation data, and compared it to postseason interviews to explore the effect of suitability of the pickup location; proximity to food retail; and potential farmer burden. Most pickup areas were heavily car-dependent, with low walkability and few public transportation options. Conventional sources of fresh produce were within six miles of most pickups, but farmers markets were further away. Despite modest profitability, both models were deemed worth pursuing, as they expanded farmers\u27 customer base. Farmers implementing the store-distributed food box were sensitive to market trends and customer needs in choosing pickup location. Farmers seemed more concerned with marketing in convenience store settings, and finding efficient ways to conduct recordkeeping than with delivery distances

A qualitative study of factors related to cardiometabolic risk in rural men

Abstract Background Rural men are known to have poor health behaviors, which contribute to their elevated burden of cardiometabolic disorders in the United States. Although regular physical activity, healthy eating, and avoiding tobacco can reduce cardiometabolic risk, little is known about how to engage rural men in health promotion programs. To bridge this gap in evidence, we investigate knowledge of modifiable cardiometabolic risk factors among rural men in the western United States, identify their concerns related to heart health and motivation to reduce risk, and explore individual, social, and community-level influences on heart-healthy behaviors, specifically diet, physical activity, and tobacco use. Methods We conducted seven focus groups with 54 sedentary, overweight/obese men (mean body mass index [BMI] = 31.3 ± 4.6) aged 43–88 residing in government-designated “medically underserved” rural Montana towns in September and October 2014. All sessions were audio-recorded and transcribed verbatim. Transcripts were coded and analyzed thematically using Nvivo software. Participants also completed a brief questionnaire about personal characteristics and health behaviors. These data were explored descriptively. Results Despite being classified as overweight/obese and sedentary, no participants reported to be in poor health. Many men described health relative to self-reliance and the ability to participate in outdoor recreation; concern with health appeared to be related to age. Participants were generally knowledgeable of heart-healthy behaviors, but many felt fatalistic about their own risk. Catalysts for behavior change included a serious medical event in the household and desire to reduce aging-associated functional decline. Barriers to adopting and maintaining healthy eating and physical activity habits and abstaining from tobacco included normative beliefs around masculinity and individual liberty, the limited social universe of small towns, winter weather, time constraints, and preferences for unhealthy foods. Facilitators included behavioral self-monitoring, exercising with a partner, and opportunities for preferred activities, such as hunting and team sports. Conclusions These findings provide important insight about influences on rural men’s health behaviors and provide guidance for possible intervention strategies to promote cardiometabolic health. Trial registration ClinicalTrials.gov NCT02499731 . Registered 1 July 2015

Conformational Entropy as a Means to Control the Behavior of Poly(diketoenamine) Vitrimers In and Out of Equilibrium.

Control of equilibrium and non-equilibrium thermomechanical behavior of poly(diketoenamine) vitrimers is shown by incorporating linear polymer segments varying in molecular weight (MW) and conformational degrees of freedom into the dynamic covalent network. While increasing MW of linear segments yields a lower storage modulus at the rubbery plateau after softening above the glass transition (Tg ), both Tg and the characteristic time of stress relaxation are independently governed by the conformational entropy of the embodied linear segments. Activation energies for bond exchange in the solid state are lower for networks incorporating flexible chains; the network topology freezing temperature decreases with increasing MW of flexible linear segments but increases with increasing MW of stiff segments. Vitrimer reconfigurability is therefore influenced not only by the energetics of bond exchange for a given network density, but also the entropy of polymer chains within the network

A Qualitative Evaluation of Double Up Food Bucks Farmers’ Market Incentive Program Access

Objective Explore factors affecting access to and use of Double Up Food Bucks (DUFB), a farmers’ market program that doubles Supplemental Nutrition Assistance Program benefits for use toward the purchase of fruits and vegetables (FV). Design Focus groups. Setting Metro and nonmetro counties in Utah and western Upstate New York. Participants Nine groups composed of 62 low-income adults (3–9/group). Phenomena of Interest Satisfaction with, barriers to, and facilitators of program use; suggestions for improvement. Analysis Transcribed verbatim and coded thematically in NVivo 11 software according to template analysis. Results Program satisfaction was high and driven by FV affordability, perceived support of local farmers, positive market experiences, and high-quality FV. Primary barriers to using DUFB were lack of program information and inconvenient accessibility. Insufficient program communication was a consistent problem that elicited numerous suggestions regarding expansion of program marketing. Emergent topics included issues related to the token-based administration of DUFB and debate regarding stigma experienced during DUFB participation. Conclusions and Implications Results suggest that although DUFB elicits many points of satisfaction among users, program reach may be limited owing to insufficient program marketing. Even among satisfied users, discussion of barriers was extensive, indicating that program reach and impact may be bolstered by efforts to improve program accessibility

Factors related to leader implementation of a nationally disseminated community-based exercise program: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>The benefits of community-based health programs are widely recognized. However, research examining factors related to community leaders' characteristics and roles in implementation is limited.</p> <p>Methods</p> <p>The purpose of this cross-sectional study was to use a social ecological framework of variables to explore and describe the relationships between socioeconomic, personal/behavioral, programmatic, leadership, and community-level social and demographic characteristics as they relate to the implementation of an evidence-based strength training program by community leaders. Eight-hundred fifty-four trained program leaders in 43 states were invited to participate in either an online or mail survey. Corresponding community-level characteristics were also collected. Programmatic details were obtained from those who implemented. Four-hundred eighty-seven program leaders responded to the survey (response rate = 57%), 78% online and 22% by mail.</p> <p>Results</p> <p>Of the 487 respondents, 270 implemented the program (55%). One or more factors from each category – professional, socioeconomic, personal/behavioral, and leadership characteristics – were significantly different between implementers and non-implementers, determined by chi square or student's <it>t</it>-tests as appropriate. Implementers reported higher levels of strength training participation, current and lifetime physical activity, perceived support, and leadership competence (all p < 0.05). Logistic regression analysis revealed a positive association between implementation and fitness credentials/certification (p = 0.003), program-specific self-efficacy (p = 0.002), and support-focused leadership (p = 0.006), and a negative association between implementation and educational attainment (p = 0.002).</p> <p>Conclusion</p> <p>Among this sample of trained leaders, several factors within the professional, socioeconomic, personal/behavioral, and leadership categories were related to whether they implemented a community-based exercise program. It may benefit future community-based physical activity program disseminations to consider these factors when selecting and training leaders.</p

The StrongWomen Change Clubs: Engaging Residents to Catalyze Positive Change in Food and Physical Activity Environments

Introduction. The epidemic of obesity is a multifaceted public health issue. Positive policy and environmental changes are needed to support healthier eating and increased physical activity. Methods. StrongWomen Change Clubs (SWCCs) were developed through an academic-community research partnership between researchers at Cornell University and Tufts University and community partners (cooperative extension educators) in rural towns in seven U.S. states. Extension educators served as the local leader and each recruited 10–15 residents to undertake a project to improve some aspect of the nutrition or physical activity environment. Most residents had limited (or no) experience in civic engagement. At 6 and 12 months after implementation, the research team conducted key informant interviews with SWCC leaders to capture their perceptions of program process, benchmark achievement, and self-efficacy. Results. At 12 months, each SWCC had accomplished one benchmark; the majority had completed three or more benchmarks. They described common processes for achieving benchmarks such as building relationships and leveraging stakeholder partnerships. Barriers to benchmark achievement included busy schedules and resistance to and slow pace of change. Conclusion. Findings suggest that community change initiatives that involve stakeholders, build upon existing activities and organizational resources, and establish feasible timelines and goals can successfully catalyze environmental change

Protocol paper for the ‘Harnessing resources from the internet to maximise outcomes from GP consultations (HaRI)’ study: a mixed qualitative methods study

Introduction Many patients now turn to the internet as a resource for healthcare information and advice. However, patients’ use of the internet to manage their health has been positioned as a potential source of strain on the doctor–patient relationship in primary care. The current evidence about what happens when internet-derived health information is introduced during consultations has relied on qualitative data derived from interview or questionnaire studies. The ‘Harnessing resources from the internet to maximise outcomes from GP consultations (HaRI)’ study combines questionnaire, interview and video-recorded consultation data to address this issue more fully. Methods and analysis Three data collection methods are employed: preconsultation patient questionnaires, video-recorded consultations between general practitioners (GP) and patients, and semistructured interviews with GPs and patients. We seek to recruit 10 GPs practising in Southeast England. We aim to collect up to 30 patient questionnaires and video-recorded consultations per GP, yielding up to 300. Up to 30 patients (approximately three per participating GP) will be selected for interviews sampled for a wide range of sociodemographic characteristics, and a variety of ways the use of, or information from, the internet was present or absent during their consultation. We will interview all 10 participating GPs about their views of online health information, reflecting on their own usage of online information during consultations and their patients’ references to online health information. Descriptive, conversation and thematic analysis will be used respectively for the patient questionnaires, video-recorded consultations and interviews. Ethics and dissemination Ethical approval has been granted by the London–Camden & Kings Cross Research Ethics Committee. Alongside journal publications, dissemination activities include the creation of a toolkit to be shared with patients and doctors, to guide discussions of material from the internet in consultation

Long-Term Body Weight Maintenance among StrongWomen–Healthy Hearts Program Participants

Background. The repeated loss and regain of body weight, referred to as weight cycling, may be associated with negative health complications. Given today’s obesity epidemic and related interventions to address obesity, it is increasingly important to understand contexts and factors associated with weight loss maintenance. This study examined BMI among individuals who had previously participated in a 12-week, evidence-based, nationally disseminated nutrition and physical activity program designed for overweight and obese middle-aged and older women. Methods. Data were collected using follow-up surveys. Complete height and weight data were available for baseline, 12-week program completion (post-program) and follow-up (approximately 3 years later) for 154 women (response rate = 27.5%; BMI characteristics did not differ between responders and nonresponders). Results. Mean BMI decreased significantly from baseline to post-program (−0.5, P<0.001) and post-program to follow-up (−0.7, P<0.001). Seventy-five percent of survey respondents maintained or decreased BMI post-program to follow-up. Self-efficacy and social support for healthy eating behaviors (but not physical activity) were associated with BMI maintenance or additional weight loss. Conclusions. These findings support the durability of weight loss following participation in a relatively short-term intervention