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Snacking occasions have increased in frequency and energy density in recent decades, with considerable implications for diet. Studies have linked presence of foods in the home with intake of those foods. This study examines home snack food inventories among a large sample of U.S. adults using latent class analysis findings to present latent classes of home snack food inventories and multinomial regression to model classes as correlates of percent of calories from fat. Participants (n = 4,896) completed an online household food environment survey including presence of 23 snack foods in the home and demographics. Less healthy snack foods were more commonly reported than healthier snack foods (M = 4.3 vs. M = 3.5). Among White and Latinx participants, high-income households reported greater numbers of both healthier and less healthy snack foods than lower income households, with larger income-based differences in inventory sizes for healthier snack foods. Latent class analysis revealed three classes by inventory size (Small, Medium, and Large) and three classes by inventory content (Healthy Snacks, Standard American, and Limited Standard American). Compared with the Small Inventory class, the Healthy Snacks class had lower caloric intake from fat (p = 0.002), the Large and Medium Inventory classes had much higher caloric intake from fat (p < 0.0001), and Standard American and Limited Standard American class members had somewhat higher caloric intake from fat (p < 0.0001, and p = 0.0001, respectively). Future research should explore the role of snacks in Americans' diets, their impact on diet quality and health, and how interventions can support healthy home food and snack food environments to foster healthy eating.

Most Indian adolescents, particularly girls and private school students, do not engage in sufficient physical activity (PA). Current understanding of these sociodemographic differences is limited by a focus on exercise, which may not fully capture PA in developing countries. We examined how gender and school type are associated with multiple PA domains and whether associations with gender differ by school type. We randomly selected an equal number of girls and boys (ages 13-16 years) from public and private schools in Southern India (n = 395). Cross-sectional 24-hour time-use surveys measured PA, which was categorized into three domains: chores, errands, and work; play; and transportation. Negative binomial and logistic regression modeled relative differences in domain-specific PA minutes and the probability of engaging in [greater than or equal to]60 minutes of moderate-to-vigorous PA (MVPA), respectively, in the prior 24 hours. Girls and boys were equally likely to meet MVPA recommendations. However, girls spent twice as much active time completing chores, errands, and work (rate ratio = 1.98, 95% confidence interval = [1.32, 2.98]), while boys spent twice as much active time playing (rate ratio = 2.11, 95% confidence interval = [1.23, 3.62]). Public and private school girls spent more active time in chores, errands, and work than boys; however, gender differences were greater among public school students (p value for interaction <0.05). Although comparable MVPA levels for girls and boys are beneficial for physical health, girls may gain fewer cognitive, social, and emotional benefits associated with play. Additional research may clarify why the gendered burden of household responsibilities was greater among public school students. School-based programs to engage girls in active play may help reduce inequities.

Qualitative methods help us understand context, explore new phenomena, identify new research questions, and uncover new models of change. To better understand how researchers in health education and health behavior use qualitative methods, we reviewed qualitative articles published in "Health Education & Behavior" from 2000 to 2015. We identified 48 articles that met our inclusion criteria and extracted information on the qualitative inquiry framework, use of theory, data collection methods, sampling strategy, general analysis approach, and reporting of results. Use of common qualitative inquiry frameworks was rare, with just one grounded theory study, five ethnographies, and one case study. No studies were framed using phenomenological or narrative inquiry approaches. Theory was used most commonly to select sensitizing constructs for analysis (41.7%) and to inform development of data collection instruments (27.1%). Interviews were the most common data collection method (66.7%), with focus groups next most common (39.6%). Sampling was typically purposive (87.5%), although often not labeled as such. Almost all (95.8%) the articles used quotes to illustrate themes and more than half (58.3%) used descriptors of magnitude (e.g., most, some) to report findings. The use of qualitative methods by health education and behavior researchers could be enriched with more intentional application of a broader range of inquiry frameworks. More deliberate application of a range of inquiry frameworks has the potential to broaden the types of research questions asked, application and generation of theory, study design, analytic strategies, and reporting of results.

Data analysis is one of the most important, yet least understood, stages of the qualitative research process. Through rigorous analysis, data can illuminate the complexity of human behavior, inform interventions, and give voice to people's lived experiences. While significant progress has been made in advancing the rigor of qualitative analysis, the process often remains nebulous. To better understand how our field conducts and reports qualitative analysis, we reviewed qualitative articles published in "Health Education & Behavior" between 2000 and 2015. Two independent reviewers abstracted information in the following categories: data management software, coding approach, analytic approach, indicators of trustworthiness, and reflexivity. Of the 48 (n = 48) articles identified, the majority (n = 31) reported using qualitative software to manage data. Double-coding transcripts was the most common coding method (n = 23); however, nearly one third of articles did not clearly describe the coding approach. Although the terminology used to describe the analytic process varied widely, we identified four overarching trajectories common to most articles (n = 37). Trajectories differed in their use of inductive and deductive coding approaches, formal coding templates, and rounds or levels of coding. Trajectories culminated in the iterative review of coded data to identify emergent themes. Few articles explicitly discussed trustworthiness or reflexivity. Member checks (n = 9), triangulation of methods (n = 8), and peer debriefing (n = 7) were the most common procedures. Variation in the type and depth of information provided poses challenges to assessing quality and enabling replication. Greater transparency and more intentional application of diverse analytic methods can advance the rigor and impact of qualitative research in our field.

Objectives A skilled workforce is essential to advancing maternal and child health (MCH) in a rapidly changing public health system. Little is known about the MCH workforce's existing capacity to maximize opportunities afforded by ongoing change. We assessed MCH workforce capacity in three areas: Systems Integration, Evidence-Based Decision-Making, and Change Management/Adaptive Leadership. We then examined associations between workforce capacity and modifiable workforce development strategies/resources. Methods Data are from the Public Health Workforce Interests and Needs Survey (PH WINS). The present study was limited to employees working in MCH programs (weighted N = 3062). Workforce capacity was operationalized as self-reported awareness of public health trends and proficiency to perform related skills in the three areas. Survey-weighted generalized estimating equations were used to fit logistic regression models accounting for employee clustering within states. Results While awareness of public health trends was low, the majority of employees (> 70% in each area) reported proficiency to perform skills related to these trends. Capacity was lowest in Systems Integration. Employee engagement in academic partnerships and higher state contributions to MCH program budgets were the strategies/resources most consistently associated with higher capacity. Workplace support was the strongest correlate of capacity in Change Management/Adaptive Leadership. Conclusions for Practice Although employees lacked familiarity with specific public health trends, they were proficient in skills needed to engage in related work. Still, areas for improvement remain. Results provide a baseline against which future training efforts can be evaluated. Academic partnerships and MCH program funding may be useful to prioritize in the context of health transformation., Author(s): Ilana G. Raskind [sup.1] , Theresa Chapple-McGruder [sup.2] , Dara D. Mendez [sup.3] , Michael R. Kramer [sup.4] , Karen D. Liller [sup.5] , Dorothy Cilenti [sup.6] , Martha [...]

Purpose: Rural residents are more likely to be obese than urban residents. Research on how people navigate their local food environments through food acquisition behaviors, such as food shopping and restaurant use, in different types of communities may help to create a deeper understanding of the multilevel determinants of obesity. Methods: Data are from a national sample of US adults ages 18‐75. Respondents were recruited from an online survey panel in 2015 and asked about food shopping, restaurant use, diet and weight (N = 3,883). Comparisons were made by level of rurality as assessed by Rural‐Urban Continuum Codes (RUCC) and self‐reported rurality of the area around their home. Findings: Food acquisition behaviors varied minimally by RUCC‐defined level of rurality, with the exceptions of type and distance to primary food store. Rural residents drove further and were more likely to shop at small grocery stores and supercenters than were residents of semiurban or urban counties. In contrast, all of the food acquisition behaviors varied by self‐reported rurality of residential areas. Respondents living in rural areas shopped for groceries less frequently, drove further, more commonly shopped at small grocery stores and supercenters, and used restaurants less frequently. In multivariable analyses, rural, small town, and suburban areas were each significantly associated with BMI and fruit and vegetable intake, but not percent energy from fat. Conclusion: Findings show that self‐reported rurality of residential area is associated with food acquisition behaviors and may partly explain rural‐urban differences in obesity and diet quality. [ABSTRACT FROM AUTHOR]

Little is known about the prevalence and correlates of food insecurity among immigrants and refugees. Acculturation and social connectedness may influence food insecurity (lack of access at all times to enough food for an active, healthy life) by affecting a person's ability to access and use governmental and charitable food assistance programs, as well as other community-based or informal food-related resources. We explored associations of acculturation and social connectedness with food insecurity among diverse immigrants and refugees living in metropolitan Atlanta, a major destination for these populations in recent years. From 2017 to 2018, we surveyed 162 adults attending health fairs or programs hosted by two community-based organizations serving immigrants and refugees. Food insecurity within the past year was assessed using the American Academy of Pediatrics' two-item questionnaire. Acculturation indicators included heritage culture and American acculturation scores (Vancouver Acculturation Index), English fluency, heritage language fluency, and percentage of lifetime in the USA. Social connectedness was operationalized using measures of religious attendance and social isolation. We conducted a multivariable logistic regression controlling for age, sex, education, household income, employment status, and household size. In the sample, 51.9% identified as Vietnamese, 16.0% Hispanic, 15.4% Burmese, 14.8% Bhutanese or Nepali, and 1.8% other. The average age was 39.10 (standard deviation [ SD ] =13.83), 34.0% were male, 73.8% had below a Bachelor's degree, and 49.7% were unemployed. Average scores for American acculturation (mean [ M ] = 3.26, SD = 1.05, range 1–5) were lower than heritage acculturation (M = 4.34, SD = 0.68, range 1–5). Additionally, 43.4% were fluent in English. Average percentage of life in the USA was 40.59% (SD = 33.48). Regarding social connectedness, 55.9% regularly attended religious services. Average social isolation scores were 3.93 (SD = 1.34, range 3–9). Overall, past-year food insecurity was reported by 17.3% (34.6% in Hispanics, 24.0% in Burmese, 13.1% in Vietnamese, and 8.3% in Bhutanese or Nepali). In adjusted models, food insecurity was associated with English fluency (adjusted odds ratio [aOR] = 0.36, p =.03) and social isolation (aOR = 2.29, p <.001) but not other measures of acculturation or religious attendance. Limited English proficiency may make it more difficult to navigate or use governmental and charitable food assistance programs. Social isolation may hinder individuals from obtaining information about food assistance programs, receiving aid for services navigation, and sharing or borrowing food from family, friends, and neighbors. Interventions should seek to improve access to English language and literacy services, enhance the linguistic and cultural competency of service providers, and build social connectedness among immigrants and refugees. [ABSTRACT FROM AUTHOR]

Objective: To investigate the potential dietary impact of the opening of new retailers of healthy foods.Design: Systematic review of the peer-reviewed research literature.Setting: References published before November 2015 were retrieved from MEDLINE, EMBASE and Web of Science databases using keyword searches.Subjects: The outcome of the review was change in fruit and vegetable consumption among adults.Results: Of 3514 references retrieved, ninety-two articles were reviewed in full text, and twenty-three articles representing fifteen studies were included. Studies used post-test only (n 4), repeated cross-sectional (n 4) and repeated measures designs (n 7) to evaluate the dietary impact of supermarket (n 7), farmers' market (n 4), produce stand (n 2) or mobile market (n 2) openings. Evidence of increased fruit and vegetable consumption was most consistent among adults who began shopping at the new retailer. Three of four repeated measures studies found modest, albeit not always statistically significant, increases in fruit and vegetable consumption (range 0·23-0·54 servings/d) at 6-12 months after baseline. Dietary change among residents of the broader community where the new retailer opened was less consistent.Conclusions: The methodological quality of studies, including research designs, sampling methods, follow-up intervals and outcome measures, ranged widely. Future research should align methodologically with previous work to facilitate meta-analytic synthesis of results. Opening a new retailer may result in modest short-term increases in fruit and vegetable consumption among adults who choose to shop there, but the potential longer-term dietary impact on customers and its impact on the broader community remain unclear. [ABSTRACT FROM AUTHOR]