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1. Social enterprise, food justice, and food sovereignty

Author

Katherine Merritt, Jill Clark, and Darcy Freedman

Subjects
food justice, food sovereignty, social enterprise, United States, urban food movement, literature review, Agriculture, Human settlements. Communities, HT51-65
Abstract

There is a debate in the literature about whether one can address food system problems with mar­ket-based approaches while seeking food justice or food sovereignty. However, as part of a team of researchers and community leaders, we have found that this debate is less relevant in practice. The concepts are interrelated within real-world food systems. As such, we were motivated to ask, how do social enterprises (SEs) interact with food jus­tice and food sovereignty movements and their visions in order to realize more democratic and equitable local food systems in communities? To answer this question, we conducted a systematic review at the intersection of SE, food sovereignty, and food justice literature. Analyzing nine articles, which included 17 food-related SEs, we found evi­dence of potential interactions between food SEs, food justice, and food sovereignty that are compat­ible (e.g., create employment) and incompatible (e.g., limited ability to address issues like commu­nity employability and green gentrification). The lit­erature includes at least three important character­istics that inform how food-related SEs may interact with food justice and sovereignty, includ­ing employee and ownership demographics, the enterprise business model, and aspects of the food system targeted by the enterprise via market activi­ties. If we consider a systems perspective, we can envision the ways in which the aspects are embed­ded and interdependent in a neoliberal society. SEs, as market-based agents for social change, exist in the same system as justice and sovereignty.

Published
2024
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2. Stigma and efficacy beliefs regarding opioid use disorder treatment and naloxone in communities participating in the HEALing Communities Study intervention.

Author

Nicky Lewis, Barry Eggleston, Redonna K Chandler, Dawn Goddard-Eckrich, Jamie E Luster, Dacia D Beard, Emma Rodgers, Rouba Chahine, Philip M Westgate, Shoshana N Benjamin, JaNae Holloway, Thomas Clarke, R Craig Lefebvre, Michael D Stein, Donald W Helme, Jennifer Reynolds, Sharon L Walsh, Darcy Freedman, Nabila El-Bassel, Kara Stephens, Anita Silwal, Michelle Lofwall, Janet E Childerhose, Hilary L Surratt, Brooke N Crockett, Amy L Farmer, James L David, Laura Fanucchi, Judy Harness, Ben Wilburn, Kelli Bursey, Kristin Mattson, Sarah Mann, Rebecca D Jackson, Aimee Shadwick, Katherine Calver, Deborah Chassler, Jennifer Kimball, Nancy Regan, Jeffrey H Samet, Rachel Sword-Cruz, and Michael D Slater

Subjects
Medicine, Science
Abstract

BackgroundThe HEALing Communities Study (HCS) included health campaigns as part of a community-engaged intervention to reduce opioid-related overdose deaths in 67 highly impacted communities across Kentucky, Massachusetts, New York, and Ohio. Five campaigns were developed with community input to provide information on opioid use disorder (OUD) and overdose prevention, reduce stigma, and build demand for evidence-based practices (EBPs). An evaluation examined the recognition of campaign messages about naloxone and whether stigma and efficacy beliefs regarding OUD treatment and naloxone changed in HCS intervention communities.MethodsData were collected through surveys offered on Facebook/Instagram to members of communities participating in the HCS intervention and wait-list control communities.ResultsParticipants in HCS intervention communities reported a reduction in stigma regarding OUD and increased efficacy beliefs regarding naloxone associated with recognition of campaign messages. However, this finding is cautiously interpreted as there was no clear evidence for recognition differences between the treatment/control conditions.ConclusionStudy findings indicate associations between campaign message recognition and positive outcomes. Results also highlight possible challenges concerning evaluations of social media campaigns using conventional evaluation techniques.Trial registrationClinicalTrials.gov NCT04111939.

Published
2024
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3. Risk factors and geographic disparities in premature cardiovascular mortality in US counties: a machine learning approach

Author

Weichuan Dong, Issam Motairek, Khurram Nasir, Zhuo Chen, Uriel Kim, Yassin Khalifa, Darcy Freedman, Stephanie Griggs, Sanjay Rajagopalan, and Sadeer G. Al-Kindi

Subjects
Medicine, Science
Abstract

Abstract Disparities in premature cardiovascular mortality (PCVM) have been associated with socioeconomic, behavioral, and environmental risk factors. Understanding the “phenotypes”, or combinations of characteristics associated with the highest risk of PCVM, and the geographic distributions of these phenotypes is critical to targeting PCVM interventions. This study applied the classification and regression tree (CART) to identify county phenotypes of PCVM and geographic information systems to examine the distributions of identified phenotypes. Random forest analysis was applied to evaluate the relative importance of risk factors associated with PCVM. The CART analysis identified seven county phenotypes of PCVM, where high-risk phenotypes were characterized by having greater percentages of people with lower income, higher physical inactivity, and higher food insecurity. These high-risk phenotypes were mostly concentrated in the Black Belt of the American South and the Appalachian region. The random forest analysis identified additional important risk factors associated with PCVM, including broadband access, smoking, receipt of Supplemental Nutrition Assistance Program benefits, and educational attainment. Our study demonstrates the use of machine learning approaches in characterizing community-level phenotypes of PCVM. Interventions to reduce PCVM should be tailored according to these phenotypes in corresponding geographic areas.

Published
2023
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5. Indicators of readiness and capacity for implementation of healthy food retail interventions

Author

Jennifer Sanchez-Flack, Kakul Joshi, Eunice Lee, and Darcy Freedman

Subjects
Healthy Food Retail, Dietary Behavior, Policy, System, and Environmental Interventions, Program Implementation, Agriculture, Human settlements. Communities, HT51-65
Abstract

Healthy food retail (HFR) interventions are a recommended strategy to improve the dietary behaviors of low-income residents with limited access to healthy food; however, tools are needed to assess, tailor, and implement HFR plans to local contexts. The present study identifies factors influ­encing HFR implementation and presents findings related to identifying, operationalizing, and priori­tizing facilitators of and barriers to implementing HFR interventions within low-resource rural and urban contexts. Practitioners and community resi­dents, recruited from nine counties in Ohio, par­ticipated in semistructured interviews and focus groups. Grounded theory methodology was used to develop themes and indicators of readiness and capacity for successful HFR implementation. Con­sensus conference feedback from an expert panel prioritized themes and indicators based on their perceived relevance and importance for successful­ly implementing HFR interventions. Five themes were identified as influential factors: (1) corner store awareness and perception, (2) organizational and practitioner capacity, (3) community attitudes and perceptions, (4) logistical factors, and (5) net­works and relationships. Additionally, 18 indicators within the five themes were identified to further illustrate influential factors to HFR implementa­tion. The themes and indicators presented in this research have been synthesized into the PSE READI tool[1] (developed outside of this research). The PSE READI tool uniquely provides an oppor­tunity to assess, tailor, and implement HFR plans to the local contexts by considering the key themes and influential factors that emerged from this community-level, qualitative research. [1] The PSE READI website is https://PSEREADI.org

Published
2021
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6. Proceedings from the 9th annual conference on the science of dissemination and implementation

Author

David Chambers, Lisa Simpson, Gila Neta, Ulrica von Thiele Schwarz, Antoinette Percy-Laurry, Gregory A. Aarons, Ross Brownson, Amanda Vogel, Shannon Wiltsey Stirman, Kenneth Sherr, Rachel Sturke, Wynne E. Norton, Allyson Varley, Cynthia Vinson, Lisa Klesges, Suzanne Heurtin-Roberts, M. Rashad Massoud, Leighann Kimble, Arne Beck, Claire Neely, Jennifer Boggs, Carmel Nichols, Wen Wan, Erin Staab, Neda Laiteerapong, Nathalie Moise, Ravi Shah, Susan Essock, Margaret Handley, Amy Jones, Jay Carruthers, Karina Davidson, Lauren Peccoralo, Lloyd Sederer, Todd Molfenter, Ashley Scudder, Sarah Taber-Thomas, Kristen Schaffner, Amy Herschell, Eva Woodward, Jeffery Pitcock, Mona Ritchie, JoAnn Kirchner, Julia E. Moore, Sobia Khan, Shusmita Rashid, Jamie Park, Melissa Courvoisier, Sharon Straus, Daniel Blonigen, Allison Rodriguez, Luisa Manfredi, Andrea Nevedal, Joel Rosenthal, David Smelson, Christine Timko, Nicole Stadnick, Jennifer Regan, Miya Barnett, Anna Lau, Lauren Brookman-Frazee, Erick Guerrero, Karissa Fenwick, Yinfei Kong, Gregory Aarons, Rebecca Lengnick-Hall, Benjamin Henwood, Nina Sayer, Craig Rosen, Robert Orazem, Brandy Smith, Lindsey Zimmerman, David Lounsbury, Rachel Kimerling, Jodie A. Trafton, Steven Lindley, Rahul Bhargava, Hal Roberts, Laura Gibson, Gabriel J. Escobar, Vincent Liu, Benjamin Turk, Arona Ragins, Patricia Kipnis, Ashley Ketterer Gruszkowski, Michael W. Kennedy, Emily Rentschler Drobek, Lior Turgeman, Aleksandra Sasha Milicevic, Terrence L. Hubert, Larissa Myaskovsky, Youxu C. Tjader, Robert J. Monte, Kathryn G. Sapnas, Edmond Ramly, Diane R Lauver, Christie M Bartels, Shereef Elnahal, Andrea Ippolito, Hillary Peabody, Carolyn Clancy, Randall Cebul, Thomas Love, Douglas Einstadter, Shari Bolen, Brook Watts, Vera Yakovchenko, Angela Park, William Lukesh, Donald R. Miller, David Thornton, Mari-Lynn Drainoni, Allen L. Gifford, Shawna Smith, Julia Kyle, Mark S Bauer, Daniel Eisenberg, Celeste Liebrecht, Michelle Barbaresso, Amy Kilbourne, Elyse Park, Giselle Perez, Jamie Ostroff, Sarah Greene, Michael Parchman, Brian Austin, Eric Larson, Stefanie Ferreri, Chris Shea, Megan Smith, Kea Turner, Jennifer Bacci, Kyle Bigham, Geoffrey Curran, Caity Frail, Cory Hamata, Terry Jankowski, Wendy Lantaff, Melissa Somma McGivney, Margie Snyder, Megan McCullough, Chris Gillespie, Beth Ann Petrakis, Ellen Jones, Carol VanDeusen Lukas, Adam Rose, Sarah J. Shoemaker, Jeremy Thomas, Benjamin Teeter, Holly Swan, Appathurai Balamurugan, Meghan Lane-Fall, Rinad Beidas, Laura Di Taranti, Sruthi Buddai, Enrique Torres Hernandez, Jerome Watts, Lee Fleisher, Frances Barg, Isomi Miake-Lye, Tanya Olmos, Emmeline Chuang, Hector Rodriguez, Gerald Kominski, Becky Yano, Stephen Shortell, Mary Hook, Linda Fleisher, Alexander Fiks, Katie Halkyard, Rachel Gruver, Emily Sykes, Kimberly Vesco, Kate Beadle, Joanna Bulkley, Ashley Stoneburner, Michael Leo, Amanda Clark, Joan Smith, Christopher Smyser, Maggie Wolf, Shamik Trivedi, Brian Hackett, Rakesh Rao, F. Sessions Cole, Rose McGonigle, Ann Donze, Enola Proctor, Amit Mathur, Emmanuela Gakidou, Stephen Gloyd, Carolyn Audet, Jose Salato, Sten Vermund, Rivet Amico, Stephanie Smith, Beatha Nyirandagijimana, Hildegarde Mukasakindi, Christian Rusangwa, Molly Franke, Giuseppe Raviola, Matthew Cummings, Elijah Goldberg, Savio Mwaka, Olive Kabajaasi, Adithya Cattamanchi, Achilles Katamba, Shevin Jacob, Nathan Kenya-Mugisha, J. Lucian Davis, Julie Reed, Rohit Ramaswamy, Gareth Parry, Sylvia Sax, Heather Kaplan, Keng-yen Huang, Sabrina Cheng, Susan Yee, Kimberly Hoagwood, Mary McKay, Donna Shelley, Gbenga Ogedegbe, Laurie Miller Brotman, Roman Kislov, John Humphreys, Gill Harvey, Paul Wilson, Robert Lieberthal, Colleen Payton, Mona Sarfaty, George Valko, Rendelle Bolton, Christine Hartmann, Nora Mueller, Sally K. Holmes, Barbara Bokhour, Sarah Ono, Benjamin Crabtree, Leah Gordon, William Miller, Bijal Balasubramanian, Leif Solberg, Deborah Cohen, Kate McGraw, Andrew Blatt, Demietrice Pittman, Helen Kales, Dan Berlowitz, Teresa Hudson, Christian Helfrich, Erin Finley, Ashley Garcia, Kristen Rosen, Claudina Tami, Don McGeary, Mary Jo Pugh, Jennifer Sharpe Potter, Krysttel Stryczek, David Au, Steven Zeliadt, George Sayre, Jennifer Leeman, Allison Myers, Jennifer Grant, Mary Wangen, Tara Queen, Alexandra Morshed, Elizabeth Dodson, Rachel Tabak, Ross C. Brownson, R. Chris Sheldrick, Thomas Mackie, Justeen Hyde, Laurel Leslie, Itzhak Yanovitzky, Matthew Weber, Nicole Gesualdo, Teis Kristensen, Cameo Stanick, Heather Halko, Caitlin Dorsey, Byron Powell, Bryan Weiner, Cara Lewis, Patricia Carreno, Kera Mallard, Tasoula Masina, Candice Monson, Taren Swindle, Zachary Patterson, Leanne Whiteside-Mansell, Rochelle Hanson, Benjamin Saunders, Sonja Schoenwald, Angela Moreland, Sarah Birken, Justin Presseau, David Ganz, Brian Mittman, Deborah Delevan, Jennifer N. Hill, Sara Locatelli, Gemmae Fix, Jeffrey Solomon, Sherri L. Lavela, Victoria Scott, Jonathan Scaccia, Kassy Alia, Brittany Skiles, Abraham Wandersman, Anne Sales, Megan Roberts, Amy Kennedy, Muin J. Khoury, Nina Sperber, Lori Orlando, Janet Carpenter, Larisa Cavallari, Joshua Denny, Amanda Elsey, Fern Fitzhenry, Yue Guan, Carol Horowitz, Julie Johnson, Ebony Madden, Toni Pollin, Victoria Pratt, Tejinder Rakhra-Burris, Marc Rosenman, Corrine Voils, Kristin Weitzel, Ryanne Wu, Laura Damschroder, Christine Lu, Rachel Ceccarelli, Kathleen M. Mazor, Ann Wu, Alanna Kulchak Rahm, Adam H. Buchanan, Marci Schwartz, Cara McCormick, Kandamurugu Manickam, Marc S. Williams, Michael F. Murray, Ngoc-Cam Escoffery, Erin Lebow-Skelley, Hallie Udelson, Elaine Böing, Maria E. Fernandez, Richard J. Wood, Patricia Dolan Mullen, Jenita Parekh, Valerie Caldas, Elizabeth A. Stuart, Shalynn Howard, Gilo Thomas, Jacky M. Jennings, Jennifer Torres, Christine Markham, Ross Shegog, Melissa Peskin, Stephanie Craig Rushing, Amanda Gaston, Gwenda Gorman, Cornelia Jessen, Jennifer Williamson, Dianne Ward, Amber Vaughn, Ellie Morris, Stephanie Mazzucca, Regan Burney, Shoba Ramanadhan, Sara Minsky, Vilma Martinez-Dominguez, Kasisomayajula Viswanath, Megan Barker, Myra Fahim, Arezoo Ebnahmady, Rosa Dragonetti, Peter Selby, Margaret Farrell, Jordan Tompkins, Wynne Norton, Kaelin Rapport, Margaret Hargreaves, Rebekka Lee, Gina Kruse, Charles Deutsch, Emily Lanier, Ashley Gray, Aaron Leppin, Lori Christiansen, Karen Schaepe, Jason Egginton, Megan Branda, Charlene Gaw, Sara Dick, Victor Montori, Nilay Shah, Ariella Korn, Peter Hovmand, Karen Fullerton, Nancy Zoellner, Erin Hennessy, Alison Tovar, Ross Hammond, Christina Economos, Christi Kay, Julie Gazmararian, Emily Vall, Patricia Cheung, Padra Franks, Shannon Barrett-Williams, Paul Weiss, Erica Hamilton, Luana Marques, Louise Dixon, Emily Ahles, Sarah Valentine, Derri Shtasel, Ruben Parra-Cardona, Mary Northridge, Rucha Kavathe, Jennifer Zanowiak, Laura Wyatt, Hardayal Singh, Nadia Islam, Madalena Monteban, Darcy Freedman, Kimberly Bess, Colleen Walsh, Kristen Matlack, Susan Flocke, Heather Baily, Samantha Harden, NithyaPriya Ramalingam, VCE Physical Activity Leadership Team, Rachel Gold, Erika Cottrell, Celine Hollombe, Katie Dambrun, Arwen Bunce, Mary Middendorf, Marla Dearing, Stuart Cowburn, Ned Mossman, Gerry Melgar, Suellen Hopfer, Michael Hecht, Anne Ray, Michelle Miller-Day, Rhonda BeLue, Greg Zimet, Eve-Lynn Nelson, Sandy Kuhlman, Gary Doolittle, Hope Krebill, Ashley Spaulding, Theodore Levin, Michael Sanchez, Molly Landau, Patricia Escobar, Nadia Minian, Aliya Noormohamed, Laurie Zawertailo, Dolly Baliunas, Norman Giesbrecht, Bernard Le Foll, Andriy Samokhvalov, Zachary Meisel, Daniel Polsky, Bruce Schackman, Julia Mitchell, Kaitlyn Sevarino, Sarah Gimbel, Moses Mwanza, Marie Paul Nisingizwe, Catherine Michel, Lisa Hirschhorn, Mahrukh Choudhary, Della Thonduparambil, Paul Meissner, Hilary Pinnock, Melanie Barwick, Christopher Carpenter, Sandra Eldridge, Gonzalo Grandes-Odriozola, Chris Griffiths, Jo Rycroft-Malone, Elizabeth Murray, Anita Patel, Aziz Sheikh, Stephanie J. C. Taylor, Martin Guilliford, Gemma Pearce, Diane Korngiebel, Kathleen West, Wylie Burke, Peggy Hannon, Jeffrey Harris, Kristen Hammerback, Marlana Kohn, Gary K. C. Chan, Riki Mafune, Amanda Parrish, Shirley Beresford, K. Joanne Pike, Rachel Shelton, Lina Jandorf, Deborah Erwin, Thana-Ashley Charles, Laura-Mae Baldwin, Brooke Ike, Jacqueline Fickel, Jason Lind, Diane Cowper, Marguerite Fleming, Amy Sadler, Melinda Dye, Judith Katzburg, Michael Ong, Sarah Tubbesing, Molly Simmons, Autumn Harnish, Sonya Gabrielian, Keith McInnes, Jeffrey Smith, John Ferrand, Elisa Torres, Amy Green, Angela R. Bradbury, Linda J. Patrick-Miller, Brian L. Egleston, Susan M. Domchek, Olufunmilayo I. Olopade, Michael J. Hall, Mary B. Daly, Generosa Grana, Pamela Ganschow, Dominique Fetzer, Amanda Brandt, Rachelle Chambers, Dana F. Clark, Andrea Forman, Rikki S. Gaber, Cassandra Gulden, Janice Horte, Jessica Long, Terra Lucas, Shreshtha Madaan, Kristin Mattie, Danielle McKenna, Susan Montgomery, Sarah Nielsen, Jacquelyn Powers, Kim Rainey, Christina Rybak, Christina Seelaus, Jessica Stoll, Jill Stopfer, Xinxin Shirley Yao, Michelle Savage, Edward Miech, Teresa Damush, Nicholas Rattray, Jennifer Myers, Barbara Homoya, Kate Winseck, Carrie Klabunde, Deb Langer, Avi Aggarwal, Elizabeth Neilson, Lara Gunderson, Marla Gardner, Liam O’Sulleabhain, and Candyce Kroenke

Subjects
Medicine (General), R5-920
Published
2017
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7. Evaluation of a Peer-to-Peer Approach to Improve the Reach of Farmers’ Markets among Low-income Populations

Author

Darcy Freedman, Eunlye Lee, Susan Flocke, Rachael Sommer, Erika S. Trapl, Amanda Osborne, and Elaine Borawski

Subjects
food security, supplemental nutrition assistance program, farmers’ market, dissemination science, health equity, Special aspects of education, LC8-6691, Public aspects of medicine, RA1-1270
Abstract

Farmers’ markets have been implemented to improve access to nutritious foods, yet use is low among people receiving Supplemental Nutrition Assistance Program (SNAP) benefits. This study’s objectives were to assess the feasibility of implementing the FreshLink Ambassador intervention to promote use of farmers’ markets located in high SNAP neighborhoods, describe information dissemination by Ambassadors, and evaluate intervention impact on SNAP use. The theory-based and data-driven intervention trained nine community residents as FreshLink Ambassadors in 2017; eight completed the study. Ambassadors conducted weekly outreach disseminating coupons to promote use of three intervention markets. Four comparison markets were selected to evaluate impact on SNAP use. SNAP sales from 2016 to 2017, standardized per vendor per market day open, were compared using paired and cluster-adjusted t-tests, p < .05. FreshLink Ambassadors conducted 155 outreach events reaching 1,138 people through coupon dissemination. The coupon redemption rate was 13.9%; redemption was significantly higher for people 50+ years of age, without children in the household, not currently receiving SNAP benefits, and living in the zip code with an intervention market. Intervention versus comparison markets had greater improvements in standardized SNAP sales ($0.73 vs. $0.44). These changes were not statistically significant but may be practically significant for farmers’ market operations. Findings provide evidence that implementation of the peer-to-peer outreach approach was feasible and coupon redemption rates exceeded industry standards indicating the “product” promoted by FreshLink Ambassadors was considered advantageous. Future research is warranted to evaluate different strategies intended to promote social access to farmers’ markets within a broader agenda to advance health equity.

Published
2019
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10. Risk Factors and Geographic Disparities in Premature Cardiovascular Mortality in US Counties: A Machine Learning Approach

Author

Weichuan Dong, Issam Motairek, Khurram Nasir, Zhuo Chen, Uriel Kim, Yassin Khalifa, Darcy Freedman, Stephanie Griggs, Sanjay Rajagopalan, and Sadeer G. Al-Kindi

Subjects
Multidisciplinary
Abstract

Disparities in premature cardiovascular mortality (PCVM) have been associated with socioeconomic, behavioral, and environmental risk factors. Understanding the “phenotypes”, or combinations of characteristics associated with the highest risk of PCVM, and the geographic distributions of these phenotypes, is critical to targeting PCVM interventions. This study applied classification and regression tree (CART) to identify county phenotypes of PCVM and geographic information systems to examine the distributions of identified phenotypes. Random forest analysis was applied to evaluate relative importance of risk factors associated with PCVM. The CART analysis identified seven county phenotypes of PCVM, where high-risk phenotypes were characterized as having greater percentages of people with lower income, higher physical inactivity, and higher food insecurity. These high-risk phenotypes were mostly concentrated in the Black Belt of the American South and the Appalachian region. The random forest analysis identified additional risk factors associated with PCVM, including broadband access, smoking, receipt of Supplemental Nutrition Assistance Program benefits, excessive drinking, and educational attainment. Overall, county-level risk factors explained 52% of the inter-county variation in PCVM. Our study demonstrates the use of machine learning approaches in characterizing area-level phenotypes of PCVM. Interventions to reduce PCVM should be tailored according to these phenotypes in corresponding geographic areas.

Published
2022
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11. Food insecurity and atherosclerotic cardiovascular disease risk in adults with diabetes

Author

Tony Dong, Kristen Harris, Darcy Freedman, Scott Janus, Stephanie Griggs, Yasaswini Iyer, Khurram Nasir, Ian J. Neeland, Sanjay Rajagopalan, and Sadeer G. Al-Kindi

Subjects
Nutrition and Dietetics, Endocrinology, Diabetes and Metabolism
Abstract

Adults with diabetes are at an increased risk of atherosclerotic cardiovascular disease (ASCVD), and food insecurity may be a major and underappreciated risk compounder in this population. We sought to analyze the prevalence of food insecurity and its association with ASCVD in adults with diabetes.A total of 6424 participants with diabetes were included from the 2019 and 2020 National Health Interview Survey. Food insecurity was determined with a 10-question U.S. Adult Food Security Survey Module, and classified as high, marginal, low, and very low. ASCVD was defined as a self-reported history of coronary artery disease, myocardial infarction, or stroke.Of the 6424 included participants (weighted: n = 21 690 217), 5 405 543 (24.4%) reported a history of ASCVD and 2 946 061 (13.3%) were identified as food insecure (low or very low food security). Adults with food insecurity were more likely to have ASCVD than adults who were food secure (28.9% vs 23.7%; P = 0.008). In the multivariate analyses adjusted for traditional cardiovascular risk factors, all levels of food insecurity were associated with ASCVD compared with food-secure adults (marginal security: odds ratio [OR]: 1.60; 95% confidence interval [CI], 1.18-2.18]; P = 0.003; low security: OR: 2.09; 95% CI, 1.58-2.74]; P0.001; very low security: OR: 1.69; 95% CI, 1.22-2.34]; P = 0.001). The association persisted when adjusted for income, location, education, and insurance status. In adults with diabetes and ASCVD, income was a negative factor for food insecurity (OR: 0.71; 95% CI, 0.62-0.80; P0.001), but female sex and smoking were positive factors (OR: 1.90; 95% CI, 1.29-2.80; P = 0.001; and OR: 1.97; 95% CI, 1.23-3.18; P = 0.005; respectively). At younger ages, the prevalence of food insecurity increased, especially in adults with ASCVD.We showed that 13% of U.S. adults with diabetes are food insecure, which was associated with ASCVD independent of traditional and socioeconomic risk factors. Our findings emphasize the importance of recognizing food insecurity as a driver of ASCVD in adults with diabetes, and encourage future efforts at reducing this disparity.

Published
2023
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13. Dissemination of an Electronic Manual to Build Capacity for Implementing Farmers' Markets with Community Health Centers

Author

M Aaron, Guest, Darcy, Freedman, Kassandra A, Alia, Heather M, Brandt, and Daniela B, Friedman

Subjects
Crops, Agricultural, Canada, Community-Based Participatory Research, Internet, Farmers, Time Factors, Universities, Information Dissemination, Commerce, Community Health Centers, Health Promotion, Kenya, Community-Institutional Relations, United States, Diet, Manuals as Topic, Surveys and Questionnaires, Original Research Articles, Urban Health Services, Humans, Rural Health Services, Diffusion of Innovation
Abstract

Community–university partnerships can lend themselves to the development of tools that encourage and promote future community health development. The electronic manual, “Building Farmacies,” describes an approach for developing capacity and sustaining a community health center–based farmers’ market that emerged through a community–university partnership. Manual development was guided by the Knowledge to Action Framework and experiences developing a multivendor, produce‐only farmers’ market at a community health center in rural South Carolina. The manual was created to illustrate an innovative solution for community health development. The manual was disseminated electronically through 25 listservs and interested individuals voluntarily completed a Web‐based survey to access the free manual. During the 6‐month dissemination period, 271 individuals downloaded the manual. Findings highlighted the value of translating community‐based participatory research into user‐friendly manuals to guide future intervention development and dissemination approaches, and demonstrate the need to include capacity building opportunities to support translation and adoption of interventions.

Published
2015

14. Corpus

Author

Darcy Freedman, Lisa Jean Moore, and Monica J. Casper

Published
2011
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15. Environmental barriers to HIV prevention among incarcerated adolescents: a qualitative assessment

Author

Darcy, Freedman, Laura F, Salazar, Richard A, Crosby, and Ralph J, DiClemente

Subjects
Adult, Male, Georgia, Adolescent, Communication, Prisoners, HIV Infections, Sex Education, Environment, Focus Groups, Condoms, Risk-Taking, Adolescent Behavior, Risk Factors, Humans, Female, Parent-Child Relations, Qualitative Research
Abstract

The purpose of this research was to identify environmental factors that influence incarcerated adolescents' risk for HIV/STDs. Based on data from six gender-stratified focus groups consisting of 28 incarcerated adolescents from three detention centers in Georgia, the following salient environments emerged: schools, families, peer groups, neighborhoods, malls, and detention centers. These environments represent places in which factors related to sexual decision-making are embedded for this high-risk population. Within these environments, five factors influence their risk for HIV/STDs: (1) hierarchical messages that promote abstinence and risk reduction, (2) availability and accessibility of condoms, (3) acceptability of condoms, (4) availability of comprehensive sex education, and (5) parental communication about sex and risk reduction. Increased understanding of the role of these factors may contribute to the development of integrated interventions designed to prevent HIV/STDs among incarcerated adolescents.

Published
2005

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