Objective: To evaluate the implementation of a community-based cardiovascular disease prevention program for rural women: Strong Hearts, Healthy Communities (SHHC). Design: Mixed-methods process evaluation. Setting/Participants: 101 women from eight rural, medically underserved towns were enrolled in the SHHC program; 93 were enrolled as controls. Eligible participants were 40 years or older, sedentary, and overweight or obese. Local health educators (n=15) served as SHHC program leaders within each town. Outcome Measures: Reach, fidelity, dose delivered, dose received, and program satisfaction were assessed using after-class surveys, participant satisfaction surveys, interviews with program leaders, and participant focus groups. Analysis: Descriptive statistics, chi-square tests, thematic analysis. Results: Intervention sites reported high levels of fidelity (82%) to the program; average attendance was 67%. Most SHHC participants were satisfied with their experience and reported benefits such as camaraderie and awareness building. Common recommendations included increasing class time, expanding exercise variety, and enhancing group discussion.

Background (Background, Rationale, Prior Research, and/or Theory): Frequent consumption of sugarsweetened beverages (SSBs), fast food, and sweets is associated with obesity. Fast food restaurants and marketing of unhealthful foods and beverages are especially prevalent in lower-income areas and neighborhoods populated by non-Whites. Objective: Examine trends in intake of SSBs, fast food, and sweets by race/ethnicity among low-income mothers in California. Study Design, Setting, Participants, Intervention: Randomly sampled mothers from households eligible for the Supplemental Nutrition Assistance Program participated in cross-sectional telephone interviews in 2015, 2016, and 2017. Outcome Measures and Analysis: Separate items assessed number of times mothers drank regular soda, sports drinks, energy drinks, sweetened coffee/tea, and sweetened fruit juice. Trained interviewers asked about times eating food from a fast food restaurant and times eating sweets (e.g. cake, cookies, ice cream). Responses were standardized to represent times per week. Three-year comparisons for Latina, African American, and White mothers were analyzed separately by ANOVA with Tukey's HSD for post hoc comparisons. Results: Over 13,000 Latina (69%), White (18%), and African American (14%) mothers responded across the three years. Levels of intake of SSBs and sweets remained unchanged. Unadjusted analyses found increases in fast food consumption for Latina and African American mothers. Conclusions and Implications: Levels of intake of sugar from SSBs or sweets were stable among low-income mothers in California. This conclusion is based on the statistical power of our analyses; however, we recognize the possibility of Type II error from such claims. Fast food intake increased over the past three years among Latina and African American, but not White mothers. This may be related to environmental influences (more restaurants or advertisements targeting Latinas and African Americans). Our study is limited by the unknown types or quantities of foods consumed from fast food restaurants. Funding: USDA.