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Introduction: More than 32% of adults have obesity in North Dakota (ND), cardiovascular diseases and cancer are the leading causes of death, and at least one in ten adults has diabetes in ND. Healthy eating habit has a protective role against chronic diseases and obesity. A community-based nutrition education program was implemented to identify effective and approachable strategies for developing a long-term intervention that increases fruits and vegetables intake and reduces risk of chronic diseases in ND community. Hypothesis: (1) Nutrition education would increase intake of fruits and vegetables among participants. (2) Participants who received compensation would be more likely to increase their consumption of fresh fruits and vegetables. Method: The pilot program was delivered through the farmer’s market in ND. We delivered six nutrition education sessions focus on the importance of fruits and vegetables on diet, and developing healthy skills related to fruits and vegetables purchasing and cooking. Participants earned a gift certificate at the end of session. Data collected through post-assessment questionnaire. Results: Two hundred and thirty nine participants enrolled and benefited from the program. We found significant increase in fruits and vegetables intake among participants. Results show that increasing access to fresh fruits and vegetables, and providing education about healthy food consumption encouraged market’s visitors to purchase fruits and vegetables. Conclusion: Nutrition education program through farmer’s market has the potential to increase fruits and vegetables intake. The finding suggests that researcher should implement nutrition education intervention as an approach to positively influence eating habits among community.

The COVID-19 pandemic is causing economic devastation and health system instability around the world. It has been reported that virus pandemics result in food crises even before the appearance of health impacts of the virus in the community. Addressing the consequences of food insecurity is critical during public health crises such as the COVID-19 pandemic. Currently, there is no evidence for the best module or practice used to reduce food insecurity during COVID-19 pandemic. However, a previously adapted tool can be used to address and measure community needs as well as expand access to food. The purpose of this report is to introduce the impact of the COVID-19 pandemic on food insecurity among the low-income population of the United States and to provide a suggestion to intervene on the impact. Using a validated tool to identify food insecurity, coupled with urgent immediate policy change, may diminish consequences of food insecurity and protect the health of those most fragile during a pandemic crisis in rural and low-income communities.

Background Mississippi has the lowest rates of breastfeeding of all states at 6 months and at 1 year. Registered nurses working in the maternity setting can be influential in mothers' decision to breastfeed. Purpose The purpose of this study was to examine registered nurses' knowledge and practice related to breastfeeding; and to identify facilitators and barriers to implementing the Ten Steps to Successful Breastfeeding in Mississippi hospitals. Methods 302 Registered nurses working in hospital maternity/birthing settings in Mississippi completed a questionnaire. Breastfeeding knowledge and practices overall scores were categorized into: poor and good. Chi-square analysis and Spearman correlations were used to determine correlations among the variables. Results Overall breastfeeding knowledge and practices of respondents was good. Only 4% earned a perfect score. Most believed they were effective (77%) in meeting the needs of new mothers. Significant positive associations were noted among knowledge and effectiveness, and other variables. Resistance to change and staffing shortages were the main barriers to implementing the Ten Steps; raising awareness about the importance of the Ten Steps and providing a lactation consultant were the main facilitators. Conclusion More research is needed to understand reasons behind low breastfeeding rates in Mississippi.

This study examines the dietary intake changes and factors related to dietary acculturation in international students attending an urban university in the United States. The researchers administered seven focus groups of college-age international students (n = 32) between June and August 2012. The participants were enrolled in Northeastern and Midwestern U.S. universities. A qualitative research inquiry was used for data collection, presentation, and analysis. An interview guide was developed to explore the dietary habits of international students. The results show the participants face many dietary challenges as a result of adapting to American culture. The major dietary-related influences include: the food environment, campus environment, religion, and individual preferences. Additionally, the consequences of dietary changes were associated with undesirable health outcomes including weight gain, increased blood glucose levels, increased cholesterol levels, high blood pressure, and mental problems.

Fruit and vegetable intake as well as physical activity participation in Mississippi is consistently lower than recommendations. We conducted a cross-sectional study to examine fruit and vegetables consumption, fat intake, and moderate-intensity physical activity participation and how these variables relate to socio-demographic factors among medically underserved adults in south Mississippi. Fruit and vegetable consumption and fat intake along with physical activity participation and socio-demographic characteristics was collected from a sample of 161 (48 male and 113 female) adults in south Mississippi. A majority (81.9%) of participants reported consuming less than five servings of fruits and vegetables per day and 54% reported exercising less than three times a week. Only 14% of participants reported eating a low fat diet. Bivariate correlations revealed no significant relationships between fruit and vegetable consumption and fat intake as well as no significant relationships between fruit and vegetable consumption and gender, ethnicity, income, marital status, or education. However, there were significant correlations between physical activity and fat intake (r = -0.21, p = 0.01), and physical activity with fruit and vegetable consumption (r = 0.16, p = 0.05). Higher physical activity rates were associated with decreased fat intake and increased fruit and vegetable consumption. Physical activity was also higher among men (r = -0.16, p = 0.05) and positively correlated with income level (r = 0.21 p = 0.01). In order to effectively identify or develop strategies to improve health by promoting increased fruit and vegetable intake and physical activity, further research is needed to understand the factors that affect behavior choices regarding nutrition and physical activity in this medically underserved adult population.

Background: Mississippi has the lowest rates of breastfeeding in the United States at 6 and 12 months. There is growing evidence that the rates and duration of infant breastfeeding improve after hospitals implement the Ten Steps to Successful Breastfeeding; moreover, the Ten Steps approach is considered the standard model for evaluation of breastfeeding practices in birthplaces. Research aim: This study aimed to examine the implementation level of the Ten Steps and identify barriers to implementing the Ten Steps in Mississippi hospitals. Methods: A cross-sectional self-report survey was used to answer the research aim. Nurse managers of the birthing and maternity units of all 43 Mississippi hospitals that provided birthing and maternity care were recruited. A response rate of 72% ( N = 31) was obtained. Implementation of the Ten Steps in these hospitals was categorized as low, partial, moderate, or high. Results: The researcher classified implementation in 29% of hospitals as moderate and in 71% as partial. The hospital level of implementation was significantly positively associated with the hospital delivery rate along with the hospital cesarean section rate per year. The main barriers for the implementation process of the Ten Steps reported were resistance to new policies, limited financial and human resources, and lack of support from national and state governments. Conclusion: Breastfeeding practices in Mississippi hospitals need to be improved. New policies need to be established in Mississippi to encourage hospitals to adopt the Ten Steps policies and practice in the maternity and birthing units.

Objective: The aim of this study was to examine the relationship between the individuals’ perception of their weight status andthe stage of change they are currently in among an overweight and obese, medically underserved population in south Mississippi. Methods: One hundred eighty-two adults were surveyed at healthcare facilities in south Mississippi using a tablet application. Inclusion criteria were: BMI of 25 or greater, over 21 years of age, and not pre or postpartum. About 62% (n = 114) metthe inclusion criteria. Participants completed a survey pertaining to: weight perception, stage of change for weight loss, andother variables. Statistical analysis were used to analyze participant responses. Weight perception accuracy was determined bycomparing participant responses about weight status to their BMI classification. Results: Weight perception accuracy was a significant predictor of stage of change for weight loss, after controlling forconfounding factors. A Lin’s concordance correlation coefficient analysis revealed that participants do not portray themselves astheir BMI classifies them (Pearson p = .46). Ordinal regression analysis displayed that those with a mismatched were likely to beat an advanced stage of change compared to those with matched weight perception accuracy and BMI. Conclusions and implication: This study exemplifies that overweight and obese individuals who view themselves as overweightare more apt to be in active stage of change for weight loss. Weight management interventions should address weight perceptionsin overweight and obese individuals who are at a lower stage of change for weight loss.

Researchers have studied international students' adjustment issues using different approaches and methods over several years. This varying landscape suggested a different understanding about the role of dietary acculturation on international student's movements. International students' mobility affects their dietary habits, food choices, and physical behavior. As international students move from one country to another, they may adopt to the culture of their host country. This adoption may affect their food practices and choices, and can lead to changes in the students eating behaviors. The aim of this chapter is to provide a research context and draw out documented issues such as: impact of dietary acculturation on international students, changes in dietary habits and food practices following temporal migration, and health consequences due to the dietary acculturation. This chapter also represents varying qualitative and quantitative perspectives on the international students' eating experiences in colleges and universities, and discusses approaches to moderate the negative impact of dietary acculturation on international students.

Objective: This study sought to examine the reasons for nonattendance of nutrition appointments and explore the determinants that contribute to this phenomenon among medically underserved and uninsured individuals.Methods: A cross-sectional quantitative study was conducted with five sections questionnaires distributed at a healthcare clinic in a rural area in south Mississippi. Participants (n=346) were surveyed who had attended the clinic for a health appointment. Nutrition appointment attendance, reasons to miss a scheduled nutrition appointment, and effective appointment reminders were evaluated. Descriptive statistics were determined for the variables, Chi square and bivariate correlation tests were used to determine relationships between participants’ demographics, health conditions, and other variables.Results: About 87% of participants indicated that they had not attended a nutrition appointment and 26.8% indicated that they had missed a nutrition appointment. Most participants specified that forgetfulness (39%) and transportation problems (25%) were the most likely reasons to miss a nutrition appointment. Most indicated that a phone call would be the most effective appointment reminder. About half of participants believed the reason behind missing a nutrition appointment is that their physicians did not place importance on attending such appointment. No significant association or differences were found between the variables.Conclusion: Findings can be used to improve access to nutrition counseling among underserved patients, and to develop effective appointment reminders to decrease nonattendance rates. Future research is warranted to analyze the effect that nutrition appointments has on individual’s health.