American Journal of Health Promotion

Food service guidelines (FSG) policies can impact the nutritional quality of millions of meals sold or served to government employees, citizens in public places, or institutionalized persons. This study examines state FSG policies adopted January 1, 2015 to April 1, 2019, and uses a FSG Classification Tool (FSG Tool) to quantify alignment with nutrition recommendations for public health impact.

Quantitative Content Analysis

State Government Worksites and Facilities

50 states and District of Columbia (D.C.) in the United States.

Frequency of policies and percent alignment to FSG tool.

FSG policies were identified using legal databases to assess state statutes, regulations, and executive orders. Content analysis and coding determined attributes of policies across 4 FSG Tool domains, (1) nutrition standards referenced; (2) behavioral design strategies encouraging selection of healthier offerings; (3) facility efficiency and environmental sustainability; and (4) FSG implementation supports.

From 2015-2019, 5 FSG policies met study inclusion criteria. Four out of 5 policies earned a perfect nutrition score (100%) by referencing nutrition standards that align with the Dietary Guidelines for Americans (DGA) and are operationalized for use in food service venues. Four out of 5 policies included at least 1 implementation supports provision, such as naming an implementing agency, and 2 included provisions that encourage local food sourcing.

From 2015-2019, overall FSG policy comprehensiveness scores ranged from 24% to 73%, with most policies referencing food and nutrition standards that align to national nutrition recommendations. Public health practitioners can educate decision makers on the potential impact of FSG policies on diet-related health outcomes and associated cost savings, as well as other important co-benefits that support locally grown products and environmental sustainability practices.

The purpose of this study is to describe the prevalence of food insecurity among college students and its relationship to on-campus food purchasing patterns and barriers to eating a healthy and sufficient diet, including the relative cost of food items on campus compared to national chain grocery stores.

A campus-wide survey using stratified sampling among undergraduates and food audit.

An urban public university in New England.

A total of 951 surveys completed by undergraduates.

Demographic characteristics, behavioral factors and food security status (measured using the USDA 6-item short form) were collected.

Descriptive and multivariable analyses were conducted to describe differences between food insecure and food secure undergraduates.

Overall, 35% of undergraduates experienced food insecurity in the past year (response rate = 92%). Food insecure undergraduates had different on-campus purchasing patterns than their food secure counterparts. Food insecure students were more likely to report barriers to healthy eating on all measures, including prices (AOR= 8.12, P < .0001), to experience housing insecurity (AOR= 2.64, P = .001) and to report that transportation is a barrier to buying groceries (AOR= 1.63, P = .01). After multivariable adjustment, food insecure undergraduates had higher odds of being African American (AOR= 1.57, P = .031) or other races (more than 1 race) (AOR= 3.35, P = .002) compared to white undergraduates.

Food insecure college students face a variety of barriers to healthy eating on campus, including high food pricing on campus and limited transportation options. Further research is needed to inform campus resource development, policies and programming focused on food insecurity prevention for college students.

To evaluate if nudges delivered by text message prior to an upcoming primary care visit can increase influenza vaccination rates.

Randomized, controlled trial.

Two health systems in the Northeastern US between September 2020 and March 2021.

74,811 adults.

Patients in the 19 intervention arms received 1-2 text messages in the 3 days preceding their appointment that varied in their format, interactivity, and content.

Influenza vaccination.

Intention-to-treat.

Participants had a mean (SD) age of 50.7 (16.2) years; 55.8% (41,771) were female, 70.6% (52,826) were White, and 19.0% (14,222) were Black. Among the interventions, 5 of 19 (26.3%) had a significantly greater vaccination rate than control. On average, the 19 interventions increased vaccination relative to control by 1.8 percentage points or 6.1% (P = .005). The top performing text message described the vaccine to the patient as “reserved for you” and led to a 3.1 percentage point increase (95% CI, 1.3 to 4.9; P < .001) in vaccination relative to control. Three of the top five performing messages described the vaccine as “reserved for you.” None of the interventions performed worse than control.

Text messages encouraging vaccination and delivered prior to an upcoming appointment significantly increased influenza vaccination rates and could be a scalable approach to increase vaccination more broadly.

The Supplemental Nutrition Assistance Program (SNAP) Online Purchasing Pilot (OPP) allows for the online purchase of groceries using SNAP benefits. First implemented in California in late April 2020, little is known about program usage. This study assessed initial implementation of SNAP Online in California using SNAP OPP transaction data from April - October 2020. Insights can identify usage differences by demographics, store availability, and rurality to help inform future pilot programs and nutrition initiatives.

Using generalized estimating equations, we modeled county-level associations between transactions and county-level demographics, rurality, and retailer availability.

Transaction data from California’s Department of Social Services (CDSS) was linked with publicly-available, county-level demographics.

Anonymized county-level data on SNAP Online transactions and CalFresh households.

The primary outcome was successful SNAP Online food transactions per county.

Generalized estimating equation models with clustering by county was used.

During the first 7 months, median SNAP Online transactions per county per month was 665; 2.7% of total SNAP redemptions were from SNAP Online. Counties with more female-led, disabled, Latino, or Asian CalFresh households had fewer Amazon transactions. Each additional Walmart per county corresponded to 260.7 more Walmart transactions (P < .001). Each percent increase in county zip codes covered by Amazon Fresh corresponded to 45.4 fewer Walmart transactions (P < .05) and 37.3 more Amazon transactions (P < .001).

Number of stores per county was associated with greater online grocery transactions, whereas rurality was not. County-level SNAP demographics correlated with transactions at particular retailers.

To expand the reach of health-promotion efforts for people with disabilities, we piloted a health-coaching intervention with a disability-specific curriculum. We evaluated the intervention’s effects on health-related quality of life and health behavior change.

Mixed-methods research design using pre-post measures and semi-structured interviews.

A convenience sample of community-dwelling adults with disabilities (n = 39).

Participants engaged in a curriculum-based health coaching intervention, titled Health My Way, which used weekly one-on-one coaching for up to 12 weeks.

Participants completed pre- and post-intervention surveys including questions from the Health-Related Quality of Life (HRQOL) measure and the Health-Promoting Lifestyle Profile II. A subset of participants completed in-depth interviews to explore how health coaching influences health behavior change (n = 12).

We found statistically significant effects on poor-health days due to physical and mental health, and effects on physical activity. We saw additional effects with engagement in relevant curriculum content. Qualitative main themes (tailoring of information, enthusiasm for personally meaningful goals, and social support) indicated processes by which health coaching supported health behavior changes.

The results of this pilot study indicate health coaching appears to be effective for improving HRQOL and health behavior, especially physical activity, for people with disabilities. Apparent key factors include enthusiasm for personally meaningful goals, having tailored information, and social support.

To explore factors associated with community garden use.

Environmental assessment of community gardens and semi-structured interviews.

New Orleans, Louisiana.

10 community gardens (environmental assessment), 20 community members (including garden users and non-users) and garden administrators (qualitative interviews).

Gardens were assessed based on (1) accessibility, (2) information, (3) design, (4) cleanliness, (5) walkability, (6) parking, and (7) noise. Semi-structured interviews took place over Zoom; transcribed interviews were analyzed using thematic analysis.

Gardens assessed in the environmental assessment ranked high in design and cleanliness but low on accessibility and information availability. Salient themes from the qualitative interviews include skill-building, access to fresh foods, and increased social engagement as enablers of community garden participation, with availability of information and time as both potential enablers of, or barriers to, participation. Community members perceived that gardens could increase fresh food access, while administrators believed that it is not possible for community gardens to produce enough food to create community-wide impact, highlighting instead the importance of the social aspects of the garden as beneficial for health.

Community gardens should improve garden physical accessibility and information availability to incentivize use. Community gardens are valued as means for skill-building and social engagement. Future research should prioritize investigating the association between the social aspects of participating in community gardens and health outcomes.

The present study conducted a social media content analysis on videos describing the Mediterranean Diet (MedDiet) posted onYouTube.

YouTube TM online video sharing and social media platform.

Three independent content experts evaluated 141 YouTube videos on the MedDiet in August 2020 utilizing standard rubric and protocol. Data abstracted include media source(s) of posted videos, and viewer exposure/engagement metrics. Information quality was measured by each content expert independently through use of the DISCERN instrument, a 16-item tool designed to assess reliability, dependability, and trustworthiness of an online source, scores were then aggregated for analysis.

A majority of videos (n = 102, 72.3%) were educational in nature. A third of videos were less clear and less credible on information presented (n = 46, 32.6%). Most videos were posted by an individual (n = 79, 56%), and the majority of videos were rated as medium quality (n = 88, 62.4%). Overall level of user engagement as measured by number of “likes,” “dislikes,” and user comments varied widely across all sources of media. Exploratory correlation analysis suggests that the number of a video’s views, comments, likes, and dislikes are not correlated with quality.

Study findings suggest that MedDiet health promotion and education via YouTube has the potential to reach and inform clients; however, existing video content and quality varies significantly. Future intervention research focused on MedDiet should further examine possible predictors of high quality MedDiet content utilizing diverse online video sharing platforms.

Evaluate if there is a(n): 1) reduction in health risk behaviors and 2) association between health and wellness initiative participation and claims costs decreases overtime.

Health risk behavior change consisted of the analysis of pre (2009) – post (2019) measures of health questionnaire participants. The medical and pharmaceutical claims costs evaluation consisted of a time-series (2016-2019) design with a comparison group.

A large mid-western university with a health system.

The health risk behavior sample ranged from 5215-5399, depending on the variable of interest. The medical and pharmaceutical costs sample used a cohort of participants (participating all 4 years, n=11114) and non-participants (not participating all 4 years, n=4776).

Comprehensive employee health and well-being initiative.

McNemar’s tests were used to identify bivariate associations between 2009 and 2019 health risks. The claims cost analysis used propensity score matching based on select demographics and linear mixed-effects regression modeling.

Results show statistically significant (P > .001) improvements (ranging from −2.1% to −12.5%) in 7 of 8 health risk behaviors. 2016 and 2019 claims costs have a lower statistically significant (P > .001) percent increase for participants (32.6%) compared to non-participants (47.5%).

Employers, may consider implementing a comprehensive health and wellness program as part of their strategy to assist in health behavior risk reduction and health care cost containment.

This study tested the relative efficacy of a culturally tailored dramatic narrative promoting COVID-19 vaccination in changing attitudes and behavioral intent among unvaccinated Latinas compared to a nonnarrative control containing similar information.

A pretest-posttest experimental study with unvaccinated Latinas randomly assigned to watch either a dramatic narrative featuring Latina characters countering prevalent myths about COVID-19 vaccines or a nonnarrative film containing similar information (control condition).

The experiment was hosted online with the films embedded in the survey.

Three-hundred-ninety adult Latinas living in the United States (mean age = 33.4 years; SD = 11.2) who had not been vaccinated against COVID-19 despite being eligible. At pretest, 57.7% were hesitant and 42.3% were resistant (refusing) to get vaccinated.

Self-reported measures of engagement with the film, COVID-19 vaccine attitudes, and intent to get vaccinated within 30 days at pretest and posttest.

Resistant women were significantly more engaged in the dramatic narrative than the nonnarrative control film (P = .03). Being engaged in a film predicted more positive post-viewing attitudes toward the vaccine (b = .28; P < .001) and higher intent to get vaccinated (b = 2.34, P < .001).

Using culturally tailored stories to promote healthy behaviors such as vaccination can be an effective way of reaching resistant audiences.

Older men have lower participation rates than females in health promotion interventions. We conducted a qualitative review of 20 years of existing research across a variety of academic search databases to outline the barriers, facilitators, and recommendations for this imbalance.

A systematic search was conducted across Google Scholar, PubMed, MEDLINE, CINAHL, Academic Search Premier, Psychology and Behavioral Sciences Collection, and Web of Science from dates January 1, 2000 – December 31, 2020.

Abstracts were screened based on: original research, English language, recruitment or participation, health promotion or health program, and male gender.

Of 1194 initial search results, 383 article abstracts were thoroughly screened for inclusion and 26 articles met inclusion criteria.

Included studies were coded and analyzed using Grounded Theory.

Barriers included masculine gender roles as well as program scope, environment, and gender of the instructors and other participants. Facilitators included creating social groups of older males that participate in a variety of activities together, including hobbies and health promotion, over a long period of time.

Health promotion interventions should involve men in all aspects of program planning and implementation, take into account men’s existing relationships and interests to create gender-sensitive programming, and clearly delineate the benefits to participation.

To document and analyze the food systems interventions delivered by community health workers (CHW) serving as educators within the United States (U.S.)

Ten databases (ie, Agricola, CAB Abstracts, CINAHL, ERIC, Proquest Social Science and Education, Proquest Theses and Dissertations, PubMed, Scopus, SocIndex, Web of Science) and gray-literature repositories were searched for publications between 2005-2020.

English-language and U.S. studies included with CHW as educators or facilitators for food systems interventions. Food systems defined as processes of production, processing, distribution, marketing, access, preparation, consumption, and disposal of food products. Studies excluded for clinical settings; non-adult CHWs; CHWs with medical or public health credentials; and programming guides, reviews, and commentaries.

Variables included CHW and intervention description, priority population, food system processes, and targeted and unexpected outcomes.

Data were analyzed by the lead investigator and described narratively.

Of 43 records, CHWs educated for consumption (n = 38), preparation (n = 33), and food access (n = 22) to improve health of priority populations. Community health workers educated for the highest number of food system processes in garden-based interventions. Programs reached many underserved racial and socioeconomic populations.

The CHW model has been used to educate in interventions for all food systems processes and reached many diverse underserved audiences. Future work must explore garden-based food systems education and CHWs as community change agents.