IntroductionObesity is the leading preventable cause of illness and a major contributor to chronic disease. Eating fresh fruits and vegetables can help manage and prevent weight gain and reduce the risk of chronic diseases. Low-income communities often lack stores that sell fresh fruit and vegetables and have instead stores that sell foods low in nutritional value. The objective of this study was to understand perceived community-level barriers to fruit and vegetable consumption among low-income people.MethodsWe conducted 8 focus groups involving 68 low-income participants in 2 North Carolina counties, from May 2011 through August 2011. The socioecological model of health guided data analysis, and 2 trained researchers coded transcripts and summarized findings. Four focus groups were conducted in each county; 1 was all male, 5 all female, and 2 mixed sexes. Most participants were black (68%), most were women (69.1%), and most had a high school education or less (61.8%). Almost half received support from either the Supplemental Nutrition Assistance Program or another government assistance program.ResultsWe identified 6 major community-level barriers to access to fruits and vegetables: cost, transportation, quality, variety, changing food environment, and changing societal norms on food.ConclusionPolicymakers should consider supporting programs that decrease the cost and increase the supply of high-quality fruits and vegetables in low-income communities.

Disparities in dietary behaviors have been directly linked to the food environment, including access to retail food outlets. The Coronavirus Disease of 2019 (COVID-19) pandemic has led to major changes in the distribution, sale, purchase, preparation, and consumption of food in the United States (US). This paper reflects on those changes and provides recommendations for research to understand the impact of the pandemic on the retail food environment (RFE) and consumer behavior. Using the Retail Food Environment and Customer Interaction Model, we describe the impact of COVID-19 in four key areas: (1) community, state, tribal, and federal policy; (2) retail actors, business models, and sources; (3) customer experiences; and (4) dietary intake. We discuss how previously existing vulnerabilities and inequalities based on race, ethnicity, class, and geographic location were worsened by the pandemic. We recommend approaches for building a more just and equitable RFE, including understanding the impacts of changing shopping behaviors and adaptations to federal nutrition assistance as well as how small food business can be made more sustainable. By better understanding the RFE adaptations that have characterized the COVID-19 pandemic, we hope to gain greater insight into how our food system can become more resilient in the future.

Background Obese women have lower levels of physical activity than non-obese women, but it is unclear what drives these differences. Methods Mixed methods were used to understand why obese women have lower physical activity levels. Findings from focus groups with obese white women age 50 and older (N=19) were used to develop psychosocial items for an online survey of white women (N=195). After examining the relationship between weight group (obese vs. non-obese) and exercise attitudes, associated items (p<0.05) were tested for potential mediation of the relationship between weight and physical activity. Results Obese women were less likely than non-obese women to report that they enjoy exercise (OR 0.4, 95%CI 0.2–0.8) and were more likely to agree their weight makes exercise difficult (OR=10.6, 95%CI 4.2–27.1) and they only exercise when trying to lose weight (OR=3.8, 95%CI 1.6–8.9). Enjoyment and exercise for weight loss were statistically significant mediators of the relationship between weight and physical activity. Conclusions Exercise interventions for obese women may be improved by focusing on exercise enjoyment and the benefits of exercise that are independent of weight-loss.

Low fruit and vegetable (F&V) consumption is associated with higher rates of obesity and chronic disease among low-income individuals. Understanding attitudes towards F&V consumption and addressing policy and environmental changes could help improve diet and reduce disease risk. A survey of North Carolinians receiving government assistance was used to describe benefits, barriers, and facilitators of eating F&V and shopping at farmers’ markets in this population. A total of 341 eligible individuals from 14 counties completed the survey. The most commonly cited barriers to eating F&V were cost (26.4%) and not having time to prepare F&V (7.3%). Facilitators included access to affordable locally grown F&V (13.5%) and knowledge to quickly and easily prepare F&V (13.2%). Among people who did not use farmers’ markets, common barriers to shopping there were not being able to use food assistance program benefits (35.3%) and not knowing of a farmers’ market in their area (28.8%); common facilitators included transportation (24.8%) and having more information about farmers’ market hours (22.9%). In addition to breaking down structural/environmental barriers to farmers’ market usage, there is a need to disseminate promotional information about farmers’ markets, including hours, location, and accepted forms of payment.

The ACTS of Wellness was a cluster-randomized controlled trial developed to promote colorectal cancer screening and physical activity (PA) within urban African-American churches. Churches were recruited from North Carolina (n=12) and Michigan (n=7) and were randomized to intervention (n=10) or comparison (n=9). Church members age 50 and older completed self-administered baseline and post-intervention surveys. Intervention participants received 3 mailed tailored newsletters addressing colorectal cancer screening and PA behaviors over approximately 6 months. Individuals who were not up-to-date for screening at baseline could also receive motivational calls from a peer counselor. Comparison churches received Body & Soul, a fruit and vegetable promotion program. The main outcomes were up-to-date colorectal cancer screening and Metabolic Equivalency Task (MET)-hours/week of moderate-vigorous PA. MET-hours/week of PA was calculated using frequency, duration and intensity of reported activities with a MET score>3 (i.e. moderate intensity or greater). Multivariate analyses examined changes in the main outcomes controlling for church cluster, gender, marital status, weight and baseline values. Baseline screening was high in both intervention (75.9%, n=374) and comparison groups (73.7%, n=338). Screening increased at follow-up: +6.4 and +4.7 percentage points for intervention and comparison respectively (p=0.25). Baseline MET-hours/week of PA was 7.8 (95%CL 6.8–8.7) for intervention and 8.7 (95%CL 7.6–9.8) for the comparison group. There were no significant changes (p=0.15) in PA for intervention (−0.30 MET-hours/week) compared to the comparison (−0.05 MET-hours/week). Among intervention participants, PA increased more for those who participated in church exercise programs and screening improved more for those who spoke with a peer counselor or recalled the newsletters. Overall, the intervention did not improve PA or screening in an urban church population. These findings support previous research indicating that structured PA opportunities are necessary to promote change in PA and churches need more support to initiate effective peer counselor programs.

Adolescence is an important developmental period marked by a transition from primarily parental-controlled eating to self-directed and peer-influenced eating. During this period, adolescents gain autonomy over their individual food choices and eating behavior in general. While parent-feeding practices have been shown to influence eating behaviors in children, little is known about how these relationships track across adolescent development as autonomy expands. The purpose of this qualitative study was to identify factors that impact food decisions and eating autonomy among adolescents. Using the food choice process model as a guide, four focus groups were conducted with 34 adolescents. Focus group discussion was semi-structured, asking teens about influences on their food choices across different food environments, their involvement with food purchasing and preparation, and perceived control over food their choices. Focus group transcripts were analyzed using deductive and inductive code creation and thematic analysis. This study found six leading influences on adolescents' food choices and identified additional factors with prominence within specific environmental contexts. This study distinguished a broader spectrum of factors influencing adolescent food choice that extend beyond “convenience” and “taste” which have previously been identified as significant contributors. The degree of control that teens reported differed by eating location, occasion, and social context. Finally, adolescents demonstrated various levels of engagement in behaviors related to their eating autonomy. Identifying the emergent themes related to adolescent autonomy was the first step toward the goal of developing a scale to evaluate adolescent eating autonomy.

BackgroundPoorer diets and subsequent higher rates of chronic disease among lower-income individuals may be partially attributed to reduced access to fresh fruits and vegetables (F&V) and other healthy foods. Mobile markets are an increasingly popular method for providing access to F&V in underserved communities, but evaluation efforts are limited. The purpose of this study was to determine the impact of Veggie Van (VV), a mobile produce market, on F&V intake in lower-income communities using a group randomized controlled trial.MethodsVV is a mobile produce market that sells reduced-cost locally grown produce and offers nutrition and cooking education. We recruited 12 sites in lower-income communities in North Carolina (USA) to host VV, randomizing them to receive VV immediately (intervention) or after the 6-month study period (delayed intervention control). Participants at each site completed baseline and follow-up surveys including F&V intake, perceived access to fresh F&V and self-efficacy for purchasing, preparing and eating F&V. We used multiple linear regression to calculate adjusted differences in outcomes while controlling for baseline values, education and clustering within site.ResultsAmong 142 participants who completed the follow-up, baseline F&V intake was 3.48 cups/day for control and 3.33 for intervention. At follow-up, adjusted change in F&V consumption was 0.95 cups/day greater for intervention participants (p = 0.005), but was attenuated to 0.51 cups per day (p = 0.11) after removing extreme values. VV customers increased their F&V consumption by 0.41 cups/day (n = 30) compared to a 0.25 cups/day decrease for 111 non-customers (p = 0.04). Intervention participants did not show significant improvements in perceived access to fresh F&V, but increased their self-efficacy for working more F&V into snacks (p = 0.02), making up a vegetable dish with what they had on hand (p = 0.03), and cooking vegetables in a way that is appealing to their family (p = 0.048).ConclusionsMobile markets may help improve F&V intake in lower-income communities.Trial registrationClinicaltrials.gov ID# NCT03026608 retrospectively registered January 2, 2017.Electronic supplementary materialThe online version of this article (10.1186/s12966-017-0637-1) contains supplementary material, which is available to authorized users.

IntroductionEvidence-based health promotion programs that are disseminated in community settings can improve population health. However, little is known about how effective such programs are when they are implemented in communities. We examined community implementation of an evidence-based program, Body and Soul, to promote consumption of fruits and vegetables.MethodsWe randomly assigned 19 churches to 1 of 2 arms, a colon cancer screening intervention or Body and Soul. We conducted our study from 2008 through 2010. We used the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to evaluate the program and collected data via participant surveys, on-site observations, and interviews with church coordinators and pastors.ResultsMembers of 8 churches in Michigan and North Carolina participated in the Body and Soul program. Mean fruit and vegetable consumption increased from baseline (3.9 servings/d) to follow-up (+0.35, P = .04). The program reached 41.4% of the eligible congregation. Six of the 8 churches partially or fully completed at least 3 of the 4 program components. Six churches expressed intention to maintain the program. Church coordinators reported limited time and help to plan and implement activities, competing church events, and lack of motivation among congregation members as barriers to implementation.ConclusionsThe RE-AIM framework provided an effective approach to evaluating the dissemination of an evidence-based program to promote health. Stronger emphasis should be placed on providing technical assistance as a way to improve other community-based translational efforts.