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The objective of this research was to investigate associations among self-reported health status, chronic conditions, and use of dietary supplements containing botanicals and describe reasons for use among U.S. adult supplement users. This was a cross-sectional analysis using data from the 2009-2014 National Health and Nutrition Examination Survey (NHANES). Supplement information was collected with a 30-day recall interview. Self-reported general health status and doctor-informed diagnoses of chronic conditions were assessed using a health status questionnaire. We used weighted multivariate logistic regressions to assess associations between supplement use and perceived health and number of chronic conditions. Participants were 16,958 non-institutionalized U.S. adults aged 20 years and older. Adults with excellent or very good self-perceived health were more likely to use botanical supplements than adults with good perceived health (adjusted odds ratio [aOR], 1.48; 95% confidence interval [CI], 1.28-1.74). Adults with three or more chronic conditions were more likely to report using botanical supplements than adults with no chronic conditions (aOR, 1.49; 95% CI, 1.13-1.69). The most frequently reported reasons for both non-botanical and botanical supplements use were "personal choice or influenced by advertisements or word of mouth," "improve health," and "specific health conditions" (93.3%, 84.2%, and 64.7%, respectively). While perceptions of health are more positive among adults using botanical supplements, chronic conditions and reasons for botanical supplements use related to personal choice, improving health, or addressing specific conditions were more likely. Differentiating botanical supplements from other complementary and integrative therapies may be useful for facilitating a deeper understanding of the reasons.

Low-income households may acquire foods from purchases, federal food assistance, and alternative food sources (AFS) to meet their food needs. The objectives of this study were to quantify and compa...

BACKGROUND For decades, Americans have increasingly relied on food away from home (FAFH) despite its association with negative health outcomes. Little is known about FAFH frequency and expenditures of adults with lower food security (FS) and their association with health outcomes, such as BMI. OBJECTIVES We evaluated patterns of adults' FAFH purchases by FS status and other demographic characteristics, and examined the association between FAFH frequency and BMI in adults of varying levels of FS. METHODS This cross-sectional study used data from the Consumer Behavior Survey, Food Security Survey, and anthropometric measurements to assess FAFH frequency and expenditures, FS, and calculated BMI of adults (≥18 y) who participated in the NHANES 2007-2014 (n = 20,733). We used multinomial logistic regression to examine the association between FAFH frequency quartiles (quartile 1: 0 n/wk; quartile 2: 1-2 n/wk; quartile 3: 3-4 n/wk; quartile 4: ≥5 n/wk) and BMI by FS category. RESULTS Although FAFH frequency was similar across FS levels, adults with high FS spent more dollars (${\$}$213.60) and a greater proportion (29.4%) of their food budget on FAFH compared with adults with marginal, low, and very low FS (${\$}$133.00, ${\$}$116.20, ${\$}$103.30 and 21.4%, 19.7%, 20.0%, respectively). Obesity prevalence was highest in adults with low FS (42.9%) and very low FS (41.5%), and lowest in adults with high FS (33.7%). FAFH frequency and BMI were positively associated in adults with high (P

To explore perceptions of program impact among Double Up Food Bucks participants in Oregon.Data were collected from 1,223 Double Up Food Bucks participants at 42 Oregon farmers' markets. Chi-square tests of independence and logistic regressions were used to examine associations among key variables.Most participants reported buying more fruits and vegetables (FVs) (91.0%), trying new FV types (82.2%), eating less processed food (69.8%), having more food available at home (81.1%), and perceiving improvements in health (87.9%). Perceptions of affordability were higher among younger adults (P0.001) and households with 3-5 people (P = 0.02), with children (P0.001), and without chronic disease (P = 0.003). Perceptions of increased FV purchases were higher in households with children (P = 0.009) and reported overall health improvements were higher among non-White participants (P = 0.04). Perceptions of increased FV purchases and affordability were associated with other positive program outcomes.Participants may perceive barriers to purchasing FVs from farmers' markets, which are not fully addressed by the increased purchasing power from a FV incentive. Targeted redesign, outreach, and education may improve program experiences among groups with less positive perceptions. Further research to identify explanations for variation in program experience is needed.

While strategies to mitigate risks for foodborne illness and childhood diarrhea via sanitation and behavioral interventions have been explored, there is a dearth of knowledge about household practices regarding food production and use, livestock, and other sources of risk for foodborne illness in urban and peri-urban areas. The objective of this research was to increase understanding of household agricultural practices in Debre Berhan, Ethiopia in order to design targeted behavioral interventions to improve food safety and decrease diarrheal disease. A convenience sample of 21 teachers and parents were recruited for a mixed-methods pilot survey. The survey covered topical areas such as methods for growing, washing, and cooking produce, specifically focusing on practices in home vegetable gardens. Participants were also asked about fertilizers and manures used, animals on the property, and irrigation water sources. Descriptive statistics were calculated, and data were analyzed with SAS 9.2. The majority ofparticipants (76.2%) reported growing some or all of their own food, and many used compost (62.5%) and manure (62.5%) as fertilizer. Uncomposted manure was used as fertilizer by half (50.0%) of respondents who reported the use of manure. Respondents most commonly reported raising chickens (23.8%), yet among those using manure, they most commonly reported using sheep or lamb manure as fertilizer (50%). Most (93.7%) respondents used municipal water to irrigate their crops, while none of the respondents reported using surface water to irrigate. Nearly all (95.2%) reported always washing their produce before eating it. Respondents most commonly requested education regardinghow to more effectively grow produce. This study suggests that children and adults in Debre Berhan may have a high risk of exposure to pathogens via contact with uncomposted manure and multiple species of animals. Findings identify an opportunity for increased education in the topical areas of urban agriculture and diarrheal disease prevention. In particular, education regarding the safe utilization of manure as fertilizer could be included in agricultural extension programs. Additional research is needed to understand the extent of exposure via common household sources to pathogens that cause diarrheal disease.

This study examines the role of computational and Nutrition Facts Label (NFL) skills in health literacy classifications using the Newest Vital Sign (NVS). A convenience sample of 144 SNAP-eligible ...

BackgroundCervical cancer screening and prevention programs have been given considerable attention in high-income countries, while only receiving minimal effort in many African countries. This meta-analytic review aimed to estimate the pooled uptake of cervical cancer screening uptake and identify its predictors in Sub-Saharan Africa.MethodsPubMed, EMBASE, CINAHL, African Journals Online, Web of Science and SCOPUS electronic databases were searched. All observational studies conducted in Sub-Saharan Africa and published in English language from January 2000 to 2019 were included. The Newcastle-Ottawa Scale was applied to examine methodological quality of the studies. Inverse variance-weighted random-effects model meta-analysis was done to estimate the pooled uptake and odds ratio of predictors with 95% confidence interval. I2 test statistic was used to check between-study heterogeneity, and funnel plot and Egger’s regression statistical test were used to check publication bias. To examine the source of heterogeneity, subgroup analysis based on sample size, publication year and geographic distribution of the studies was carried out.ResultsOf 3,537 studies identified, 29 studies were included with 36,374 women. The uptake of cervical cancer screening in Sub-Saharan Africa was 12.87% (95% CI: 10.20, 15.54; I2= 98.5%). Meta-analysis of seven studies showed that knowledge about cervical cancer increased screening uptake by nearly 5-folds (OR: 4.81; 95% CI: 3.06, 7.54). Other predictors include educational status, age, HIV status, contraceptive use, perceived susceptibility, and awareness about screening locations.ConclusionCervical screening uptake is low in Sub-Saharan Africa and influenced by several factors. Health outreach and promotion targeting identified predictors are needed to increase uptake of screening service in the region.sProtocol registrationCRD42017079375

Because children spend significant time in school settings, school-based programs have great potential to prevent childhood obesity. Nutrition education and physical activity programs may be more effective, however, when they engage parents to reinforce key messages and behaviors outside of school settings. The Maryland Food Supplement Nutrition Education program (FSNE) partnered with 23 Title I elementary schools in Maryland to develop and administer Text2BHealthy, an innovative text message program that engages parents in their children’s school-based nutrition education. Text2BHealthy sends 2 behaviorally focused text messages to enrolled parents each week. These messages provide actionable nudges that encourage improved nutrition and physical activity and reference upcoming free or low-cost opportunities and events in the child’s school and the surrounding community. Preliminary evaluation results suggest that Text2BHealthy resulted in improvements on a number of fruit and vegetable practices of parents and their children. Additional evaluation research is needed to demonstrate efficacy of text message programs and program components.

Text messages are increasingly used in the delivery of health education programs. One appealing aspect of this approach is the possibility of remotely collecting participant data to use in program tailoring or evaluation. The purpose of the present study is to test the feasibility of using text messages to collect participant data. Using data from 33 texted evaluation questions sent through the Text2BHealthy nutrition education program for low-income parents (n=108-1521) response rates under different incentive and prompting strategies were examined. Response rates are generally low across a pilot year and three program years, ranging from 10-55%. While incentives seemed to be ineffective at improving response rates, results indicate that prompting participants to respond may increase response rates. Individuals who respond to an initial question are highly likely to respond to a follow-up question (88-99%) and to report positive behaviors (68-100%). Responses received through text may be unrepresentative and positively biased. Text messages may be a supplemental data collection strategy in nutrition education programs, but low response rates and response bias undermine data quality.

While text messages or short messaging service programs are increasingly utilized for delivering health education, few studies have explored the unique challenges of recruiting and retaining participants in such programs. This study utilizes survey and focus group data from Text2BHealthy, a short messaging service–based nutrition and physical activity promotion program, to examine barriers to enrollment and facilitators of retention among parents of elementary school students. Results show that participants were hard to reach with recruitment materials, had difficulty with self-enrollment, and were apprehensive about program costs. However, 89–90 percent of participants were retained. Results suggest that providing manual enrollment options, alternative program delivery methods (e.g. email messages), and opportunities to reenroll may facilitate participation in short messaging service–based health education and promotion programs.

BACKGROUND The purpose of this study was to assess the effect of a school-based nutrition program using a cafeteria environment intervention and classroom nutrition education on self-reported fruit and vegetable (FV) consumption, self-efficacy to select FV, and preference for healthy foods. METHODS Using quasi-experimental pre-post design with 3 study conditions, a total of 665 fourth- and fifth-grade students participated in the study. The comprehensive intervention included a behavioral economics cafeteria intervention and weekly classroom nutrition education for 1 academic year. The intervention was designed and delivered by the extension system. RESULTS The comprehensive group showed significant improvement in some indicators including eating vegetables for lunch (p = .007), number of days eating vegetables (p < .001) and fruits (p < .001) in the last week, and self-efficacy in preparing FV at home (p = .034) compared to the control and cafeteria groups. Food preference of some food items, including oatmeal (p = .036 for cafeteria group, p < .001 for comprehensive group), whole grain noodles (p = .011 for comprehensive group), and vegetables (p = .003 for comprehensive group), significantly improved in the cafeteria and/or comprehensive group. CONCLUSIONS Classroom nutrition education combined with cafeteria improvement has the potential to improve diet-related behavior of elementary school children. Also, collaborative partnership between schools and extension can enhance program sustainability.

Food insecurity is a substantial stressor for many households. Though an association between food insecurity and depression has been well established, most studies have been cross-sectional. Although many receive benefits from the Supplemental Nutrition Assistance Program (SNAP), its role in reducing distress associated with food insecurity is unclear. Using data from 1,225 women who participated in the Fragile Families and Child Wellbeing Study, this study investigated 1) whether change in food security status predicts change in depression severity over a two-year period, 2) whether participating in SNAP predicts depression, and 3) whether the relationship between food insecurity and depression varies based on receipt of SNAP. Food insecurity was linked to probability of depression over time. Additionally, for those who became food insecure over the two-year period, losing SNAP benefits was associated with increased probability of depression, while gaining benefits was associated with reduced probability of depression. This suggests that the SNAP program offsets emotional hardship for those who have recently become food insecure. Further research is needed to evaluate the most efficient and efficacious means to reduce food insecurity and improve emotional wellbeing among vulnerable families.

This study explored the role of social support as low-income individuals endure experiences of food insecurity. The sample includes 37 participants who indicated being challenged by food insecurity and identified using social networks in some capacity in the acquisition of food. Data was analyzed following a grounded theory approach. Participants emphasized the utility of networks (family, friends, coworkers, and neighbors) and the value of resource exchange and pooling strategies to reduce impacts of food insecurity. Attention is given to the appraisal process, which includes assessing one’s own needs and resources as well as their network’s ability to offer help. Important implications for policy and practice addressing social safety net and food programs are discussed.

Undocumented Latino immigrants often struggle to provide food for their families. In an attempt to inform efforts to create effective programs and policies promoting food security, this study explored the experience of food insecurity for low-income, undocumented Latino immigrants. In-depth qualitative interviews were conducted with 24 undocumented Latino immigrants. Modified grounded theory was used to analyze the interview data. The experience of food insecurity was similar to other groups' experiences, as it entailed inadequate amount and quality of food. However, immigration and documentation status presented unique vulnerabilities for food insecurity related to unfamiliar food environments, remittances and separation, employment, and community and government resources. Cultural and structural factors that may shape the experience of and response to food insecurity are discussed along with implications for policy and programming.

Kitchen gardens may improve family food security and nutrition. While these gardens are the domain of women in Afghanistan, women face unique challenges accessing training and resources to maximize small-scale agricultural output. The University of Maryland's Women in Agriculture Project builds capacity among female extension educators to work with vulnerable women to implement and maintain kitchen gardens. Extension educators use experiential methods to teach vegetable gardening, apiculture, small-scale poultry production, post-harvest handling and processing, nutrition and marketing through workshops, demonstration gardens and farmer field schools. This paper explores contextual factors related to women's food security and agricultural opportunities, describes key project activities and approaches and discusses project success and challenges, sustainability and implications for future programs.

The purpose of this study was to explore the relationship between health literacy and nutrition behaviors using a low-income sample. Face-to-face surveys at 11 social services offices generated a convenience sample of 154 Supplemental Nutrition Assistance Program (SNAP)-eligible adults. We assessed health literacy, fruit and vegetable intake, food label use, consumption of healthy foods, and demographic characteristics. Thirty seven percent of the sample had adequate health literacy as measured by the Newest Vital Sign (NVS). Race and parenthood were significantly related to health literacy scores. Adequate health literacy, as measured by the NVS, was associated with frying chicken less often and eating the peels of fresh fruit more often. The findings suggest that health practitioners should ensure nutrition-related messages are accessible to all of their clients, especially those with the lowest health literacy levels.

Objective To examine the relationship between household food security and children’s and parents’ fruit, vegetable, and breakfast consumption and fruit and vegetable availability. Design Cross-sectional study using matched parent-child surveys. Setting Title I elementary schools in Maryland. Participants Ninety-two low-income parent-child dyads recruited from fourth-grade nutrition education programs completing a baseline evaluation. Main Outcome Measures Fruit and vegetable intake, breakfast consumption, and fruit and vegetable availability in home and school. Analysis Chi-square tests, 1-way ANOVA. Results Thirty-six percent of parents reported low/very low household food security, and both parents and students reported low fruit and vegetable intake. Students from households with low food security who were not participating in school nutrition programs had the lowest vegetable consumption and the fewest number of days consuming breakfast, indicating a relatively greater need for enrollment than their peers. Conclusions and Implications Few differences between children in food-secure and food-insecure households were observed, which underscores the need for research on food insecurity and children’s eating behaviors. Examination of other factors influencing fruit and vegetable intake and improvements in food environments and programs are needed. Efforts to increase enrollment among eligible students in school nutrition programs may reduce negative consequences of household food insecurity.

BackgroundText-based programs have been shown to effectively address a wide variety of health issues. Although little research examines short message service (SMS) text messaging program characteristics that predict participant retention and attrition, features of SMS text message programs, such as program duration and intensity, message content, and the participants’ context, may have an impact. The impact of stop messages—messages with instructions for how to drop out of an SMS text message program—may be particularly important to investigate. ObjectiveThe aim of this study was to describe attrition from Text2BHealthy, a text-based nutrition and physical activity promotion program for parents of low-income elementary school children, and to determine the impact of message content and number of stop messages received on attrition. MethodsUsing data from 972 parents enrolled in Text2BHealthy, we created Kaplan-Meier curves to estimate differences in program duration for different SMS text message types, including nutrition, physical activity, stop, and other messages. Covariates, including rurality and number of stop messages received, were included. ResultsRetention rates by school ranged from 74% (60/81) to 95.0% (132/139), with an average retention rate of 85.7% (833/972) across all schools. Program duration ranged from 7 to 282 days, with a median program duration of 233 days and an average program duration of 211.7 days. Among those who dropped out, program duration ranged from 7 to 247 days, with a median program duration of 102.5 days. Receiving a stop message increased the probability of attrition compared with receiving messages about nutrition, physical activity, or other topics (hazard ratio=51.5, 95% CI 32.46-81.7; P

This study examined changes in food security status over time in a sample of rural, low-income mothers. Independent samples t-tests determined differences between food-secure and food-insecure mothers on variables such as employment status, food resource management skills, food assistance, and economic well-being at 3 points in time. Findings indicate that mothers in food-secure households were significantly more likely to possess food resource management skills than mothers in food-insecure households in the first wave of data, but that this relationship was not found when examined in the second and third waves. Findings emphasize the need for further research and testing with nutrition education programs to identify the extent to which skills and resources protect rural, low-income families from food insecurity.

The purpose of this study was to examine the conceptual gap between self-perceived weight and body mass index (BMI), and to assess the knowledge gap between perceived importance of following dietary guidelines and health literacy levels. Adults (n = 131) eligible for the Supplemental Nutrition Assistance Program (SNAP) were interviewed at eleven SNAP regional offices in Maryland. Based on BMI calculated from self-reported height and weight, 65.6 % of participants were overweight or obese while 40.5 % perceived that they were overweight or obese. In sub-group analysis categorized by BMI, only 20.0 % in the overweight and 20.0 % in the obese group correctly perceived themselves as being overweight or obese. Following dietary guidelines was perceived as important by a majority of participants, but only 43.5 % had adequate health literacy. Conceptual and knowledge gaps between self-perception and objective health status existed in the low-income SNAP-eligible sample. Future studies need to address these gaps because misperceived weight status and insufficient health literacy are critical barriers to inducing behavioral change.

E. Maring 1 , G. Raspanti 1 , G. Jaschek 2 , K. Hogan 3 , C. Farmer 4 , D. Lovell 3 , S. Grutzmacher 5 , P. Parikh 6 , S. Olcese 6 ; 1 University of Maryland, Maryland Institute for Applied Environmental Health, College Park, MD/US, 2 University of Maryland, Epidemiology and Biostatistics, College Park, MD/US, 3 University of Maryland, A. James Clark School of Engineering, College Park, MD/US, 4 University of Maryland, Dean’s Office, College Park, MD/US, 5 University of Maryland, Department of Family Science, College Park, MD/US, 6 University of Maryland, Global Public Health Scholars, College Park, MD/US