Mobile markets are an increasingly popular method for providing access to fresh fruits and vegetables (F/V) in underserved communities; however, evaluation of these programs is limited, as are ...descriptions of their development, study designs, and needs of the populations they serve.
Our aim was to describe the development and theoretical basis for Veggie Van (VV), a mobile produce market intervention, the study design for the VV evaluation, and baseline characteristics of the study population.
The protocol and sample for a cluster-randomized controlled trial with 12 sites are described.
Community partner organizations in the Triangle region of North Carolina that primarily served lower-income families or were located in areas that had limited access to fresh produce were recruited. Eligible individuals at each site (older than 18 years of age, self-identified as the main shoppers for their household, and expressed interest in using a mobile market) were targeted for enrollment. A total of 201 participants at 12 sites participated in the VV program and evaluation, which was implemented from November 2013 to March 2016.
Change in F/V intake (cups/day), derived from self-reported responses to the National Cancer Institute F/V screener, was the main outcome measure.
We performed a descriptive analysis of baseline sample characteristics.
Mean reported F/V intake was 3.4 cups/day. Participants reported generally having some access to fresh F/V, and 57.7% agreed they could afford enough F/V to feed their family. The most frequently cited barriers were cost (55.7%) and time to prepare F/V (20.4%). Self-efficacy was lowest for buying more F/V than usual and trying new vegetables.
By addressing cost and convenience and building skills for purchasing and preparing F/V, the VV has the potential to improve F/V consumption in underserved communities.
Action Through Churches in Time to Save Lives (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). Intervention participants received three 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. The main outcomes were up-to-date colorectal cancer screening and Metabolic Equivalency Task (MET)-hours/week of moderate–vigorous PA. 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 = .25). Baseline MET-hours/week of PA was 7.8 (95% confidence interval 6.8, 8.7) for intervention and 8.7 (95% confidence interval 7.6, 9.8) for the comparison group. There were no significant changes (p = .15) in PA for intervention (-0.30 MET-hours/week) compared with 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.
Abstract
Perception-based and objective food access measures are often examined as factors influencing individuals’ shopping decisions and dietary habits, but the relative influence of these two ...factors on behaviors needs further examination. This study sought to (a) determine if perception-based and objective measures of fruit and vegetable (F&V) access were related and (b) examine perception-based and objective access measures as predictors of F&V consumption. Participants were recruited as part of a larger intervention study from 12 sites across three urban North Carolina counties. Perception-based food access measured included self-reported perceptions of convenience, variety, and quality of F&V within a neighborhood. Food outlet density was used as the objective measure. This was derived by summing the total number of geocoded convenience stores, grocery stores, supermarkets, and supercenters located within 1 road network mile of participants’ home address. Associations between perception-based and objective measures were examined using Pearson’s correlations, and associations of F&V access and intake were examined using linear regression models. Pearson correlations between perception-based and objective measures revealed that F&V variety was associated with supermarkets. Regression results show that perception-based barriers to F&V access were not significantly associated with intake, but supercenter density within 1 mile was significantly associated with decreased F&V intake. Common measures of perception-based and objective measures of food access may not be the best predictor of F&V intake. Understanding the relationships of these factors for lower-income populations can offer guidance for future policies and programs.
•Aspects of the enriched home environment were related to child energy intake.•Home environment and energy intake accounts for 18% of variance in child percent overBMI.•Enriching a child’s ...environment is a novel approach to preventing childhood obesity.
Longitudinal research suggests that living in a cognitively enriched home environment, in which access to activities including hobbies and books are plentiful, can prevent excess weight gain and obesity in children. In order for the enriched home environment to influence weight it should influence energy and macronutrient intake and/or energy expenditure. To test this hypothesis, we used a cross sectional design to study aspects of the child’s enriched home environment along with energy and macronutrient intake. A sample of 158 6–9-year-old children measured between February 2017 – April 2019 in Buffalo, NY were selected from a larger study based on criteria for accurate reporting of energy intake using the Block Kid’s Food Frequency Questionnaire. Results showed that the Home Observation for Measurement of the Environment (HOME) subscales enriched environment, parental warmth and an integrated family structure were negatively related to child percent overBMI. Hierarchical regression showed that each of these factors improved variance in child percent overBMI accounted for beyond dietary intake or macronutrients, specifically accounting for a total of 18.2% variance in models controlling for total energy intake. These results provide the first demonstration that characteristics of a child’s home environment are associated with lower energy intake and independently associated with percent overBMI beyond knowledge of diet. Enriching a child’s home environment by providing alternative activities to eating, improving parental warmth and providing opportunities for parents to interact positively with their children may be novel ways to reduce childhood obesity that should be experimentally tested in future research.
Objectives
Weight control is an exercise benefit, important for older Black women, a group experiencing obesity disparities. We compared perceived exercise benefits and barriers between Black women ...with and without obesity and determined which mediated the weight group-exercise relationship.
Methods
A survey (
n
= 234) was administered to determine attitudinal agreement between weight groups (obese or non-obese). Multiple mediation analysis was used to investigate if attitudes mediated the weight group-exercise relationship.
Results
High agreement with all exercise benefits was observed between women with and without obesity. Compared with women without obesity, women with obesity were more likely to report the barriers of only exercising to lose weight (OR = 2.52, 95% CI 1.40–4.55), lack of will power (OR = 1.82, 95% CI 1.05–3.19), weight (OR = 3.04, 95% CI 1.34–6.83), and cost (OR = 2.14, 95% CI 1.02–4.47). Exercising to lose weight and lack of will power mediated the weight group-exercise relationship.
Conclusions
Women largely agreed on the exercise benefits. Lack of will power and engaging in exercise only for weight loss were barriers that were more common among older Black women with obesity. The barriers partially explained the lower exercise engagement in women with obesity. Future work may address these barriers to increase exercise in older Black women.
Screening for colorectal cancer can reduce incidence and death, but screening is underused, especially among vulnerable groups such as Medicaid patients. Effective interventions are needed to ...increase screening frequency. Our study consisted of a controlled trial of an intervention designed to improve colorectal cancer screening among Medicaid patients in North Carolina.
The intervention included a mailed screening reminder letter and decision aid followed by telephone support from an offsite, Medicaid-based, patient navigator. The study included 12 clinical practices, 6 as intervention practices and 6 as matched controls. Eligible patients were aged 50 years or older, covered by Medicaid, and identified from Medicaid claims data as not current with colorectal cancer screening recommendations. We reviewed Medicaid claims data at 6 months and conducted multivariate logistic regression to compare participant screening in intervention practices with participants in control practices. We controlled for sociodemographic characteristics.
Most of the sample was black (53.1%) and female (57.2%); the average age was 56.5 years. On the basis of Medicaid claims, 9.2% of intervention participants (n = 22/240) had had a colorectal cancer screening at the 6-month review, compared with 7.5% of control patients (n = 13/174). The adjusted odds ratio when controlling for age, comorbidities, race, sex, and continuous Medicaid eligibility was 1.44 (95% confidence interval, 0.68-3.06). The patient navigator reached 44 participants (27.6%).
The intervention had limited reach and little effect after 6 months on the number of participants screened. Higher-intensity interventions, such as use of practice-based navigators, may be needed to reach and improve screening rates in vulnerable populations.
Low-income communities often lack access to supermarkets and healthy foods. Enhanced stocking requirements for staple foods for Supplemental Nutrition Assistance Program (SNAP)-authorized retailers ...may increase availability of healthy foods in smaller stores which are prevalent in low-income areas. This study aimed to evaluate the extent that small food stores located in low-income areas met the U.S. Department of Agriculture's 2016 final rule on SNAP-authorized retailer stocking requirements, which increased the minimum number of required staple food varieties from three to seven for each staple food category, required a depth of stock of three units of each variety, and increased the required number of categories with perishables from two to three. A multisite research project was conducted in 2017. Nine research teams located in seven U.S. states audited the availability of perishable and nonperishable staple foods and beverages in 351 small food stores in low-income areas. Analyses determined the extent to which stores met all or part of the stocking requirements and tested differences by store type. 30.2% of stores met all of the 2016 final rule requirements; 86.3% met the requirements for fruits and vegetables, whereas only 30.5% met requirements for dairy. 53.1% of non-chain small grocery stores met all requirements compared to 17.1% of convenience stores (p < .0001). Less than one half of the food stores audited met the U.S. Department of Agriculture's 2016 final rule that would expand SNAP-authorized retailer stocking requirements suggesting that, if implemented, the rule may generate increased offerings of staple foods in small stores in low-income areas.
Increased levels of unconjugated bilirubin are neurotoxic, but the mechanism leading to neurological damage has not been completely elucidated. Innovative strategies of investigation are needed to ...more precisely define this pathological process. By longitudinal in vivo bioluminescence imaging, we noninvasively visualized the brain response to hyperbilirubinemia in the MITO-Luc mouse, in which light emission is restricted to the regions of active cell proliferation. We assessed that acute hyperbilirubinemia promotes bioluminescence in the brain region, indicating an increment in the cell proliferation rate. Immunohistochemical detection in brain sections of cells positive for both luciferase and the microglial marker allograft inflammatory factor 1 suggests proliferation of microglial cells. In addition, we demonstrated that brain induction of bioluminescence was altered by pharmacological displacement of bilirubin from its albumin binding sites and by modulation of the blood-brain barrier permeability, all pivotal factors in the development of bilirubin-induced neurologic dysfunction. We also determined that treatment with minocycline, an antibiotic with anti-inflammatory and neuroprotective properties, or administration of bevacizumab, an anti-vascular endothelial growth factor antibody, blunts bilirubin-induced bioluminescence. Overall the study supports the use of the MITO-Luc mouse as a valuable tool for the rapid response monitoring of drugs aiming at preventing acute bilirubin-induced neurological dysfunction.
Neural stem cells generate neurons in the hippocampal dentate gyrus in mammals, including humans, throughout adulthood. Adult hippocampal neurogenesis has been the focus of many studies due to its ...relevance in processes such as learning and memory and its documented impairment in some neurodegenerative diseases. However, we are still far from having a complete picture of the mechanism regulating this process. Our study focused on the possible role of cyclic nucleotide-gated (CNG) channels. These voltage-independent channels activated by cyclic nucleotides, first described in retinal and olfactory receptors, have been receiving increasing attention for their involvement in several brain functions. Here we show that the rod-type, CNGA1, and olfactory-type, CNGA2, subunits are expressed in hippocampal neural stem cells in culture and in situ in the hippocampal neurogenic niche of adult mice. Pharmacological blockade of CNG channels did not affect cultured neural stem cell proliferation but reduced their differentiation towards the neuronal phenotype. The membrane permeant cGMP analogue, 8-Br-cGMP, enhanced neural stem cell differentiation to neurons and this effect was prevented by CNG channel blockade. In addition, patch-clamp recording from neuron-like differentiating neural stem cells revealed cGMP-activated currents attributable to ion flow through CNG channels. The current work provides novel insights into the role of CNG channels in promoting hippocampal neurogenesis, which may prove to be relevant for stem cell-based treatment of cognitive impairment and brain damage.
The present work aims to identify the predictors of COVID-19 in-hospital mortality testing a set of Machine Learning Techniques (MLTs), comparing their ability to predict the outcome of interest. The ...model with the best performance will be used to identify in-hospital mortality predictors and to build an in-hospital mortality prediction tool. The study involved patients with COVID-19, proved by PCR test, admitted to the "Ospedali Riuniti Padova Sud" COVID-19 referral center in the Veneto region, Italy. The algorithms considered were the Recursive Partition Tree (RPART), the Support Vector Machine (SVM), the Gradient Boosting Machine (GBM), and Random Forest. The resampled performances were reported for each MLT, considering the sensitivity, specificity, and the Receiving Operative Characteristic (ROC) curve measures. The study enrolled 341 patients. The median age was 74 years, and the male gender was the most prevalent. The Random Forest algorithm outperformed the other MLTs in predicting in-hospital mortality, with a ROC of 0.84 (95% C.I. 0.78-0.9). Age, together with vital signs (oxygen saturation and the quick SOFA) and lab parameters (creatinine, AST, lymphocytes, platelets, and hemoglobin), were found to be the strongest predictors of in-hospital mortality. The present work provides insights for the prediction of in-hospital mortality of COVID-19 patients using a machine-learning algorithm.
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