BackgroundWomen living in rural areas face unique challenges in achieving a heart-healthy lifestyle that are related to multiple levels of the social-ecological framework. The purpose of this study was to evaluate changes in diet and physical activity, which are secondary outcomes of a community-based, multilevel cardiovascular disease risk reduction intervention designed for women in rural communities.MethodsStrong Hearts, Healthy Communities was a six-month, community-randomized trial conducted in 16 rural towns in Montana and New York, USA. Sedentary women aged 40 and older with overweight and obesity were recruited. Intervention participants (eight towns) attended twice weekly exercise and nutrition classes for 24 weeks (48 total). Individual-level components included aerobic exercise, progressive strength training, and healthy eating practices; a civic engagement component was designed to address social and built environment factors to support healthy lifestyles. The control group (eight towns) attended didactic healthy lifestyle classes monthly (six total). Dietary and physical activity data were collected at baseline and post-intervention. Dietary data were collected using automated self-administered 24-h dietary recalls, and physical activity data were collected by accelerometry and self-report. Data were analyzed using multilevel linear regression models with town as a random effect.ResultsAt baseline, both groups fell short of meeting many recommendations for cardiovascular health. Compared to the control group, the intervention group realized significant improvements in intake of fruit and vegetables combined (difference: 0.6 cup equivalents per day, 95% CI 0.1 to 1.1, p = .026) and in vegetables alone (difference: 0.3 cup equivalents per day, 95% CI 0.1 to 0.6, p = .016). For physical activity, there were no statistically significant between-group differences based on accelerometry. By self-report, the intervention group experienced a greater increase in walking MET minutes per week (difference: 113.5 MET-minutes per week, 95% CI 12.8 to 214.2, p = .027).ConclusionsBetween-group differences in dietary and physical activity behaviors measured in this study were minimal. Future studies should consider how to bolster behavioral outcomes in rural settings and may also continue to explore the value of components designed to enact social and environmental change.Trial registrationclinicaltrials.gov Identifier: NCT02499731. Registered 16 July 2015.

Background The Short Physical Performance Battery (SPPB) is an inexpensive, reliable, and easy‐to‐implement measure of lower‐extremity physical function. Strong evidence links SPPB scores with all‐cause mortality, but little is known about its relationship with incident cardiovascular disease (CVD). Methods and Results Women (n=5043, mean age=79±7) with no history of myocardial infarction or stroke completed 3 timed assessments—standing balance, strength (5 chair stands), and usual gait speed (4 m walk)—yielding an SPPB score from 0 (worst) to 12 (best). Women were followed for CVD events (myocardial infarction, stroke, or CVD death) up to 6 years. Hazard ratios were estimated for women with Very Low (0–3), Low (4–6), Moderate (7–9), and High (10–12) SPPB scores using Cox proportional hazard models adjusted for demographic, behavioral, and health‐related variables including objective measurements of physical activity, blood pressure, lipids, and glucose levels. Restricted cubic splines tested linearity of associations. With 361 CVD cases, crude incidence rates/1000 person‐years were 41.0, 24.3, 16.1, and 8.6 for Very Low , Low , Moderate, and High SPPB categories, respectively. Corresponding fully adjusted hazard ratios (95% CIs) were 2.28 (1.50–3.48), 1.70 (1.23–2.36) 1.49 (1.12–1.98), and 1.00 (referent); P ‐trend <0.001. The dose‐response relationship was linear (linear P <0.001; nonlinear P >0.38). Conclusions Results suggest SPPB may provide a measure of cardiovascular health in older adults beyond that captured by traditional risk factors. Because of its high test‐retest reliability and low administrative burden, the SPPB should be a routine part of office‐based CVD risk assessment.

BackgroundAccurate assessment of fruit and vegetable intake (FVI) is essential for public health nutrition research and surveillance. Blood carotenoid concentrations are robust biomarkers of FVI, but collecting blood samples typically is not feasible in population-based studies. Understanding how well non-invasive measures compare to blood estimates is important for advancing surveillance and evaluation. The objective of this study was to examine the associations between serum carotenoids and four non-invasive measures of FVI in overweight and obese women.MethodsThis study utilized baseline data from 157 overweight or obese women (95.5% white, mean age 58.56 years ± 9.49 years) enrolled in the Strong Hearts, Healthy Communities randomized trial, including two direct measures of carotenoids and three self-reported measures of FVI. Participants completed a fasting blood draw, dermal carotenoid scans using resonance Raman spectroscopy (RRS), a two-item FVI screener modeled after the American Heart Association’s Life’s Simple 7 “My Life Check” tool (modified AHA tool), the National Cancer Institute’s All-Day Fruit and Vegetable Screener (FVS), multiple 24-h dietary recalls, physical measurements, and demographic and health behavior questions. We analyzed blood for total carotenoids and derived total FVI estimates from self-report tools. We used multivariate linear regression models to examine associations between each non-invasive tool and serum carotenoids under four scenarios analogous to different research contexts in which varying breadths of participant data are available. We also calculated adjusted Pearson’s correlations between serum carotenoids, dermal carotenoids, and the self-reported measures.ResultsDermal carotenoids were strongly correlated with serum carotenoids (0.71, P < 0.00067) and associated with serum carotenoids in all regression models (0.42–0.43, P < 0.002). None of the self-reported FVI measures were significantly associated with serum or dermal carotenoids in adjusted regression models or correlation analyses.ConclusionsCompared to self-reported FVI, we found dermal carotenoids measured by RRS to be a superior method to approximate serum carotenoids among overweight and obese women. More research is needed to investigate these assessment methods in diverse populations.Trial registrationClinicalTrials.gov Identifier: NCT02499731, registered July 16, 2015.

Some farmers are offering subsidized or "cost-offset" community supported agriculture (CO-CSA) shares as a strategy to counter market saturation and improve low-income families' access to fresh local foods. However, little is known about farm-

Objective: Explore factors impacting access to and utilization of Double Up Food Bucks (DUFB), a farmers market program that doubles Supplemental Nutrition Assistance Program (SNAP) benefits for use toward the purchase of fruits and vegetables (FV).

Caregiver involvement in interventions for improving children's dietary intake and physical activity behaviors.

No abstract

To improve low-income families' access to fresh local produce, some farmers offer subsidized or "cost-offset" community supported agriculture (CO-CSA) shares. We evaluated a structured planning and implementation process conducted during the final intervention year of the Farm Fresh Foods for Healthy Kids (F3HK) study, which aimed to help participating farmers (N=12)