Food Insecurity and Mental Distress Among WIC-Eligible Women in the United States: A Cross-Sectional Study.

BACKGROUND: Women living in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)-eligible households may be pregnant or breastfeeding. Stress during pregnancy and breastfeeding may influence women's mental health making them more vulnerable to higher rates of food insecurity (FI). OBJECTIVE: Determine whether or not FI is associated with moderate-to-severe mental distress among women living in WIC-eligible households, and whether or not the strength of the association differs among WIC participants compared with eligible nonparticipants with low income. DESIGN: Cross-sectional data from the 2011-2018 National Health Interview Survey were utilized. PARTICIPANTS/SETTING: A total of 7,700 women living in WIC-eligible households with at least one child were analyzed. MAIN OUTCOME MEASURES: Moderate-to-severe mental distress was measured using the validated K6 nonspecific psychological distress scale. FI was measured using the 10-item, US Adult Food Security Survey Module. STATISTICAL ANALYSES PERFORMED: Multivariate logistic regression was used to examine the association between FI and mental distress. The conditional effects of WIC participation were examined by including interaction terms for FI and WIC participation as well as by stratifying the sample by WIC participation. RESULTS: Among women in WIC-eligible households, FI was associated with moderate-to-severe mental distress in a dose-response fashion: compared with those who were food secure, the adjusted odds of moderate-to-severe mental distress were 1.8 times higher among those with marginal food security (adjusted odds ratio [AOR] 1.83, 95% CI 1.50 to 2.23), 2.1 times higher among those with low food security (AOR 2.14, 95% CI 1.76 to 2.60), and 3.7 times higher among those with very low food security (AOR 3.73, 95% CI 2.95 to 4.71). The interaction between FI and WIC participation was not significant, with similar associations between FI and mental distress among WIC participants and nonparticipants. CONCLUSIONS: Among this nationally representative sample of women in WIC-eligible households, increasing severity of food insecurity was associated with poor mental health among WIC participants and nonparticipants. WIC participation was not observed to moderate the association between FI and mental distress. More research should consider including mental health screening at WIC clinic visits to enable early identification and referral for care.

Examination of an Online Cooking Education Program to Improve Shopping Skills, Attitudes toward Cooking, and Cooking Confidence among WIC Participants.

The present study examined if adapting the Cooking Matters (CM) curriculum to be used in an online format would improve participants' shopping skills, attitudes toward cooking, and feelings of cooking confidence, similar to the traditionally offered method, which is conducted in person. Results from factor analyses indicated that the online CM program demonstrated construct and content reliability compared to in-person (Cronbach's α ≥ 0.70). Repeated-measures ANOVA revealed a decrease in shopping skills overall (F = 5.91; p ≤ 0.05), consistent across age groups (F = 3.2; p ≤ 0.05) and food security status (F = 7.48; p < 0.01), with larger impacts on the food insecure (FI). Positive cooking attitudes increased with income (F = 2.86; p ≤ 0.05), especially among the <$20,000 and $30-39,000 income brackets. Cooking confidence increased post-intervention (F = 27.2, p < 0.001), with an interaction effect for food security status (F = 7.45; p ≤ 0.01), with greater improvement for households with food insecurity. These findings provide evidence to program and policymakers that virtual nutrition and cooking education services for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) should continue to be supported beyond the pandemic as they reduce barriers to receiving program benefits, nutrition education, and may lead to reductions in household food insecurity.

Randomized Comparative Effectiveness Trial of 2 Federally Recommended Strategies to Reduce Excess Body Fat in Overweight, Low-Income Patients: MyPlate.gov vs Calorie Counting.

PURPOSE: Since 2011, US authorities have supported the following 2 approaches to healthier body fat composition: the Centers for Disease Control and Prevention National Diabetes Prevention Program's calorie counting (CC) approach and the US Department of Agriculture's MyPlate (adherence to federal nutrition guidelines). The purpose of this study was to compare the effect of CC vs MyPlate approaches on satiety/satiation and on achieving healthier body fat composition among primary care patients. METHODS: We conducted a randomized controlled trial comparing the CC and MyPlate approaches from 2015 to 2017. The adult participants were overweight, of low income, and were mostly Latine (n = 261). For both approaches, community health workers conducted 2 home education visits, 2 group education sessions, and 7 telephone coaching calls over a period of 6 months. Satiation and satiety were the primary patient-centered outcome measures. Waist circumference and body weight were the primary anthropometric measures. Measures were assessed at baseline, 6 months, and 12 months. RESULTS: Satiation and satiety scores increased for both groups. Waist circumference was significantly decreased in both groups. MyPlate, but not CC, resulted in lower systolic blood pressure at 6 months but not at 12 months. Participants for both MyPlate and CC reported greater quality of life and emotional well-being and high satisfaction with their assigned weight-loss program. The most acculturated participants showed the greatest decreases in waist circumference. CONCLUSIONS: A MyPlate-based intervention might be a practical alternative to the more traditional CC approach to promoting satiety and facilitating decreases in central adiposity among low-income, mostly Latine primary care patients.

Comparative Effectiveness RCT of Two Weight Loss Strategies in Primary Care Patients: MyPlate.gov vs Calorie Counting.

Context: Since 2011, the U.S. government has supported two approaches to achieve healthier body fat composition: the Diabetes Prevention Program calorie counting (CC) approach, and adherence to federal nutrition guidelines at www.choosemyplate.gov (MyPlate). Objective: Compare the effect of the CC versus MyPlate approach on satiety/satiation and on achieving healthier body fat composition in the primary care setting. Study Design: Randomized, controlled trial comparing the MyPlate and CC approaches from 2015 to 2017. Setting: A federally qualified health center in Long Beach, California. Population: Adult, low-income, mostly Latina patients (N=261) with a BMI between 27 and 40.4 were randomized to condition and followed for twelve months (76.6% retention). Interventions: Eleven health education sessions featuring MyPlate versus CC messages. Community health workers conducted two home visits, two group education sessions and 7 telephone coaching calls over six months. Outcome Measures: Satiation and satiety were primary patient-centered outcomes. Waist circumference and body weight were primary anthropometric measures. These were assessed at baseline, 6- and 12-months follow-up. Results: Satiation and satiety scores increased for both groups; neither group lost significant body weight, and only the MyPlate condition reduced waist circumference by 2 cm at 12 months. Both conditions reported consuming proportionately more fruits and vegetables and fewer sugary beverages at 12 months. MyPlate but not CC participants experienced lower systolic blood pressure at 6 months follow-up; neither group had lower blood pressure at 12 months. Both MyPlate and CC participants reported higher quality of life and emotional well-being at 12 months and high satisfaction with their assigned weight loss program. At 12 months follow-up, the most acculturated participants experienced the greatest reduction in waist circumference. Conclusions: A MyPlate-based intervention may be a practical alternative to the more traditional CC approach to promoting satiety and facilitating reduction in central adiposity among low-income mostly Latina overweight primary care patients. Our results align with recommendations favoring a diet rich in diverse, fiber-rich foods. More research is warranted to investigate satiety-enhancing approaches to desirable weight control in diverse populations and the use of community health workers as change agents.

Partnerships and Community Engagement Key to Policy, Systems, and Environmental Achievements for Healthy Eating and Active Living: a Systematic Mapping Review.

INTRODUCTION: Policy, systems, and environmental (PSE) change approaches frequently address healthy eating and active living (HEAL) priorities. However, the health effects of PSE HEAL initiatives are not well known because of their design complexity and short duration. Planning and evaluation frameworks can guide PSE activities to generate collective impact. We applied a systematic mapping review to the Individual plus PSE Conceptual Framework for Action (I+PSE) to describe characteristics, achievements, challenges, and evaluation strategies of PSE HEAL initiatives. METHODS: We identified peer-reviewed articles published from January 2009 through January 2021 by using CINAHL, Web of Science, MEDLINE, PsycINFO, and CAB Abstracts databases. Articles describing implementation and results of PSE HEAL initiatives were included. Activities were mapped against I+PSE components to identify gaps in evaluation efforts. RESULTS: Independent reviewers examined 437 titles and abstracts; 52 peer-reviewed articles met all inclusion criteria. Twenty-four focused on healthy eating, 5 on active living, and 23 on HEAL. Descriptive analyses identified federal funding of initiatives (typically 1-3 years), multisector settings, and mixed-methods evaluation strategies as dominant characteristics. Only 11 articles reported on initiatives that used a formal planning and evaluation framework. Achievements focused on partnership development, individual behavior, environmental or policy changes, and provision of technical assistance. Challenges included lack of local coalition and community engagement in initiatives and evaluation activities and insufficient time and resources to accomplish objectives. The review team noted vague or absent descriptions of evaluation activities, resulting in questionable characterizations of processes and outcomes. Although formation of partnerships was the most commonly reported accomplishment, I+PSE mapping revealed a lack of engagement assessment and its contributions toward initiative impact. CONCLUSION: PSE HEAL initiatives reported successes in multiple areas but also challenges related to partnership engagement and community buy-in. These 2 areas are essential for the success of PSE HEAL initiatives and need to be adequately evaluated so improvements can be made.

Implementation of an Individual + Policy, System, and Environmental (I + PSE) Technical Assistance Initiative to Increase Capacity of MCH Nutrition Strategic Planning.

INTRODUCTION: Childhood obesity disproportionately affects low-income women, children, racial/ethnic minorities, and rural populations. To effectively promote sustainable change, healthy eating and active living initiatives should apply individual plus policy, systems, and environmental (I + PSE) approaches. METHODS: Four public health maternal and child nutrition teams selected through an application process participated in 12 months of technical assistance (TA) to develop action plans incorporating I + PSE in nutrition programming. TA included: (1) online modules; (2) community of practice (CoP) meetings; and (3) individual coaching sessions. Teams completed midpoint and endpoint surveys to assess TA knowledge and process outcomes. Semi-structured, in-depth interviews conducted post TA were transcribed and content analysis used to characterize themes and sub-themes. RESULTS: Facilitators to implementing I + PSE approaches included TA delivery through online modules, participation in the CoP, and individual coaching to address barriers to implementation and leadership support. Barriers were time and funding limitations, working in isolation, and lack of infrastructure and self-efficacy. Co-learning helped TA teams overcome stagnancy and promote development of creative solutions. Teams recognized relationship-building as integral to systems development. DISCUSSION: Lessons learned occurred across three main areas: relationships, capacity-building, and barriers encountered. Relationship formation takes time and is often not recognized as an asset impacting public health programing. Relationship direction - upstream, downstream, and lateral - affects ability to build organizational and systems capacity. While this study includes a small number of public health nutrition teams, this practice-based research highlights the value of I + PSE TA to tackle complex problems, with reciprocal, multisectoral support to enhance public health nutrition program impact.

Dietary Habits of 2- to 9-Year-Old American Children Are Associated with Gut Microbiome Composition.

BACKGROUND: The human gut microbiome is recognized as an important determinant of human health, yet little is known about how dietary habits are related to the microbiome in post-weaned, pre-pubescent children. OBJECTIVE: The goal of this work was to link quantitative dietary intake with microbiome features in a diverse population of children consuming a predominantly Western diet. DESIGN: This was a cross-sectional study. PARTICIPANTS/SETTINGS: English- or Spanish-speaking families with healthy children between the ages of 2 and 9 years were recruited from a community-based, early childhood learning center in suburban Los Angeles, California between June and September 2014. MAIN OUTCOME MEASURES: Children included in the analyses (n=75) contributed three fecal samples and three quantitative 24-hour dietary recalls using the multiple-pass method with an average of 5.7 days between samples. Microbial communities of each fecal sample were characterized using Illumina sequencing of the 16S ribosomal RNA gene. Dietary recalls were analyzed using the Automated Self-Administered 24-Hour Recall Dietary Assessment Tool. STATISTICAL ANALYSIS PERFORMED: Associations between dietary factors and microbiome features were assessed using the Kruskal-Wallis test, Spearman rank correlations, or permutational multivariate analysis of variance. For demographic and health-related variables, χ2 analyses were used to test for differences between age groups for categorical variables. RESULTS: Our results show that age is correlated with three metrics of microbiome diversity (P<0.05) and is associated with both community structure (P=0.0488) and membership (P=0.0002). Several dietary food groups and nutrients were likewise associated with microbiome features. For example, consumption of non-whole-grain foods was associated with community structure (P=0.0089) and membership (P=0.0057), but not diversity (P>0.05). Likewise, the relative abundance of several bacterial taxa were linked to consumption of particular food groups and/or nutrients, as illustrated by the positive associations between total fruit (Pfalsediscovery rate<0.05) and fiber (Pfalsediscovery rate<0.05) consumption with the relative abundance of the Lachnospira genera. CONCLUSIONS: This hypothesis-generating study demonstrates that the composition of the child gut microbiome remains dynamic beyond the age of 3 years and responds to dietary differences across individuals. In particular, non-whole-grain foods fortified with vitamins and minerals appear to be associated with the composition of the microbiome. Future interventional or model organism-based studies will be needed to test these associations between diet and microbiome composition.

Comparative effectiveness trial comparing MyPlate to calorie counting for mostly low-income Latino primary care patients of a federally qualified community health center: study design, baseline characteristics.

BACKGROUND: Primary care-based behavior change obesity treatment has long featured the Calorie restriction (CC), portion control approach. By contrast, the MyPlate-based obesity treatment approach encourages eating more high-satiety/high-satiation foods and requires no calorie-counting. This report describes study methods of a comparative effectiveness trial of CC versus MyPlate. It also describes baseline findings involving demographic characteristics and their associations with primary outcome measures and covariates, including satiety/satiation, dietary quality and acculturation. METHODS: A comparative effectiveness trial was designed to compare the CC approach (n = 130) versus a MyPlate-based approach (n = 131) to treating patient overweight. Intervenors were trained community health workers. The 11 intervention sessions included two in-home health education sessions, two group education sessions, and seven telephone coaching sessions. Questionnaire and anthropometric assessments occurred at baseline, 6- and 12 months; food frequency questionnaires were administered at baseline and 12 months. Participants were overweight adult primary care patients of a federally qualified health center in Long Beach, California. Two measures of satiety/satiation and one measure of post-meal hunger comprised the primary outcome measures. Secondary outcomes included weight, waist circumference, blood pressure, dietary quality, sugary beverage intake, water intake, fruit and vegetable fiber intake, mental health and health-related quality of life. Covariates included age, gender, nativity status (U.S.-born, not U.S.-born), race/ethnicity, education, and acculturation. ANALYSIS: Baseline characteristics were compared using chi square tests. Associations between covariates and outcome measures were evaluated using multiple regression and logistic regression. RESULTS: Two thousand eighty-six adult patients were screened, yielding 261 enrollees who were 86% Latino, 8% African American, 4% White and 2% Other. Women predominated (95%). Mean age was 42 years. Most (82%) were foreign-born; 74% chose the Spanish language option. Mean BMI was 33.3 kg/m2; mean weight was 82 kg; mean waist circumference was 102 cm. Mean blood pressure was 122/77 mm. Study arms on key baseline measures did not differ except on dietary quality and sugary beverage intake. Nativity status was significantly associated with dietary quality. CONCLUSIONS: The two treatment arms were well-balanced demographically at baseline. Nativity status is inversely related to dietary quality. TRIAL REGISTRATION: NCT02514889 , posted on 8/4/2015.

Food Insecurity and Health Outcomes Among Older Adults: The Role of Cost-Related Medication Underuse.

The purpose of this study is to examine the relationship between food security and cost-related medication underuse among older adults (persons aged 65 years and older) in the United States; and to determine if this relationship differs by sex, chronic disease status, and type of health insurance. Data are from a combined sample of older adults in the 2011 and 2012 National Health Interview Survey (N = 10,401). Both bivariate and multivariate analyses show a dose-response relationship between food insecurity and cost-related medication underuse among the elderly--increasing likelihood of cost-related medication underuse with increasing severity of food insecurity (P < 0.001). This association is not conditional on sex, chronic disease status, or type of health insurance. However, females and those with a chronic condition are more likely to report cost-related medication underuse than males and those without a chronic condition respectively; and older adults with Medicare and Medicaid or other public insurance are less likely to report cost-related medication underuse than older adults with only Medicare.

Food Insecurity and Cost-Related Medication Underuse Among Nonelderly Adults in a Nationally Representative Sample.

OBJECTIVES: We investigated whether nonelderly US adults (aged 18-64 years) in food-insecure households are more likely to report cost-related medication underuse than the food-secure, and whether the relationship between food insecurity and cost-related medication underuse differs by gender, chronic disease, and health insurance status. METHODS: We analyzed data from the 2011 and 2012 National Health Interview Survey (n = 67 539). We examined the relationship between food insecurity and cost-related medication underuse with the χ(2) test and multivariate logistic regression with interaction terms. RESULTS: Bivariate and multivariate analyses showed a dose-response relationship between food insecurity and cost-related medication underuse, with an increasing likelihood of cost-related medication underuse with increasing severity of food insecurity (P < .001). This association was conditional on health insurance status, but not substantially different by gender or chronic disease status. Being female, low-income, having no or partial health insurance, chronic conditions, functional limitations, or severe mental illness were positively associated with cost-related medication underuse. CONCLUSIONS: Using food insecurity as a risk factor to assess cost-related medication underuse could help increase identification of individuals who may need assistance purchasing medications and improve health for those in food-insecure households.

Global assessment of select phytonutrient intakes by level of fruit and vegetable consumption.

Despite dietary recommendations that have repeatedly underscored the importance of increasing consumption of fruits and vegetables, intakes worldwide are lower than recommended levels. Consequently, the diets of many individuals may be lacking in nutrients and phytonutrients typical of a diet rich in a variety of fruits and vegetables. In the present study, we estimated phytonutrient intakes by adults categorised by sex, level of fruit and vegetable consumption (< 5 v. ≥ 5 servings/d), and geographic diet cluster. Intakes of nine select phytonutrients were estimated from the 2002-4 World Health Survey fruit and vegetable servings intake data (n 198,637), the FAO supply utilisation accounts data, and phytonutrient concentration data obtained from the US Department of Agriculture databases and the published literature. Percentage contributions to each phytonutrient intake from fruit and vegetable sources were also estimated. Estimated intakes of phytonutrients from fruits and vegetables varied across the thirteen geographic diet clusters, reflecting regional differences in both numbers and proportions of fruit and vegetable servings consumed, and the specific types of fruits and vegetables available in the diet. The mean phytonutrient intakes by adults consuming ≥ 5 servings/d of fruits and vegetables were approximately 2- to 6-fold the mean phytonutrient intakes by adults with low fruit and vegetable consumption (< 5 servings/d). In some cases, phytonutrient intakes by adults consuming ≥ 5 servings/d of fruits and vegetables in one geographic diet cluster were lower than the intakes by adults reporting < 5 servings/d in another cluster. The findings from this assessment provide important information regarding the major dietary patterns of phytonutrient intakes across geographic diet clusters.

Life Course Perspective: evidence for the role of nutrition.

The "Life Course Perspective" proposes that environmental exposures, including biological, physical, social, and behavioral factors, as well as life experiences, throughout the entire life span, influence health outcomes in current and future generations. Nutrition, from preconception to adulthood, encompasses all of these factors and has the potential to positively or negatively shape the individual or population health trajectories and their intergenerational differences. This paper applies the T2E2 model (timing, timeline, equity and environment), developed by Fine and Kotelchuck, as an overlay to examine advances in nutritional science, as well as the complex associations between life stages, nutrients, nutrigenomics, and access to healthy foods, that support the life course perspective. Examples of the application of nutrition to each of the four constructs are provided, as well as a strong recommendation for inclusion of nutrition as a key focal point for all health professionals as they address solutions to optimize health outcomes, both domestically and internationally. The science of nutrition provides strong evidence to support the concepts of the life course perspective. These findings lend urgency to the need to improve population health across the life span and over generations by ensuring ready access to micronutrient-dense foods, opportunities to balance energy intake with adequate physical activity and the need for biological, social, physical, and macro-level environments that support critical phases of human development. Recommendations for the application of the life course perspective, with a focus on the emerging knowledge of nutritional science, are offered in an effort to improve current maternal and child health programs, policies, and service delivery.

The 2007 los angeles mommy and baby study: a multilevel, population-based study of maternal and infant health in los angeles county.

Objectives. In order to comprehensively examine the risks and resources associated with racial-ethnic disparities in adverse obstetric outcomes, the Los Angeles County Department of Public Health and the University of California, Los Angeles, joined efforts to design and implement the 2007 Los Angeles Mommy and Baby (LAMB) study. This paper aims to present the conceptual frameworks underlying the study's development, highlight the successful collaboration between a research institution and local health department, describe the distinguishing characteristics of its methodology, and discuss the study's implications for research, programs, and policies. Methods. The LAMB study utilized a multilevel, multistage cluster design with a mixed-mode methodology for data collection. Two samples were ultimately produced: the multilevel sample (n = 4,518) and the augmented final sample (n = 6,264). Results. The LAMB study allowed us to collect multilevel data on the risks and resources associated with racial-ethnic disparities in adverse obstetric outcomes. Both samples were more likely to be Hispanic, aged 20-34 years, completed at least 12 years of schooling, and spoke English. Conclusions. The LAMB study represents the successful collaboration between an academic institution and local health department and is a theoretically based research database and surveillance system that informs effective programmatic and policy interventions to improve outcomes among LAC's varied demographic groups.

Low vitamin B12 intake during pregnancy and lactation and low breastmilk vitamin 12 content in rural Kenyan women consuming predominantly maize diets.

BACKGROUND: Vitamin B12 deficiency during pregnancy and lactation may negatively affect fetal growth, brain development, pregnancy outcome, and breastmilk vitamin B12 content. OBJECTIVE: To examine associations between pregnant and lactating women's vitamin B12 intake and pregnancy outcomes, breastmilk vitamin B12 concentration, and growth and development of breastfed infants from birth to 6 months. METHODS: One hundred thirty-eight Kenyan women were followed during pregnancy, with 98 followed through 6 months of lactation and providing 294 randomly collected breastmilk samples. Maternal hematologic analyses were performed for erythrocyte morphology, erythrocyte size, and serum vitamin B12 concentration. Women's and infants'food intake was assessed. Breastmilk vitamin B12 was measured by a competitive binding isotope dilution technique. Infant anthropometric data and the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) were assessed within 3 days after birth. The Infant Bayley Motor Scale was assessed at 6 months. Statistical analyses included simple regression and correlation analyses in relation to vitamin B12 status and gestational age. RESULTS: Intrauterine growth restriction and stillbirths were correlated with maternal macrocytic anemia and hypersegmented polymorphonuclear nuclei. Postpartum maternal vitamin B12 intake influenced breastmilk vitamin B12 levels 1 to 6 months postpartum. No associations were found between vitamin B12 intake during pregnancy or vitamin B12 levels in breastmilk and infant length, weight, or head circumference at birth or 6 months. Vitamin B12 intake during pregnancy was correlated with improved scores on infants' BNBAS reflex subscale (R = -0.19, p = .05) with adjustment for gestational age. Bayley Motor Scale results at 6 months were not significantly associated with breastmilk or supplemental feeding vitamin B12 content. CONCLUSIONS: Vitamin B12 deficiency may adversely affect pregnancy outcome, infant reflexes at birth, and breastmilk vitamin B12 content.

Phytonutrient intake by adults in the United States in relation to fruit and vegetable consumption.

BACKGROUND: Individuals consuming diets dense in fruits and vegetables consume an array of phytonutrients as well as recognized nutritional components, including vitamins, minerals, and fiber. There is a growing body of evidence that phytonutrients may play positive roles in health. OBJECTIVE: The purpose of this research was to estimate usual intakes of nine individual phytonutrients by Americans consuming recommended levels of fruits and vegetables compared to intakes by adults not meeting these recommendations, and to identify contributions of food sources to total phytonutrient intakes. The phytonutrients examined in this study are found predominantly in fruits and vegetables. DESIGN: Food consumption data from the National Health and Nutrition Examination Surveys 2003-2006 and phytonutrient concentration data from US Department of Agriculture databases and the published literature were used to estimate energy-adjusted usual intakes. Student's t tests were used to compare mean energy-adjusted phytonutrient intakes between subpopulations who consumed recommended amounts of fruits and vegetables vs those who did not. Percentage contributions of each phytonutrient by food source were estimated for all adults. RESULTS: Energy-adjusted intakes of all phytonutrients other than ellagic acid were considerably higher among both men and women meeting dietary recommendations for fruit and vegetable intakes compared to those not meeting the recommendations; energy-adjusted intakes of ellagic acid were higher only among women meeting vs not meeting the recommendations. For five of the nine phytonutrients (α-carotene, ß-cryptoxanthin, lycopene, hesperetin, and ellagic acid), a single food accounted for 64% or more of the total intake of the phytonutrient. CONCLUSIONS: Energy-adjusted intakes of carotenoids and flavonoids are higher among men and women whose diets conform to dietary guidance for fruits and vegetables. A limited number of foods provide the majority of these phytonutrients. Findings from this research provide important reference information on the phytonutrient contributions of a diet rich in fruits and vegetables.

Effect of a targeted subsidy on intake of fruits and vegetables among low-income women in the Special Supplemental Nutrition Program for Women, Infants, and Children.

OBJECTIVES: Intake of fruits and vegetables protects against several common chronic diseases, and low income is associated with lower intake. We tested the effectiveness of a subsidy for fruits and vegetables to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). METHODS: Women who enrolled for postpartum services (n=602) at 3 WIC sites in Los Angeles were assigned to an intervention (farmers' market or supermarket, both with redeemable food vouchers) or control condition (a minimal nonfood incentive). Interventions were carried out for 6 months, and participants' diets were followed for an additional 6 months. RESULTS: Intervention participants increased their consumption of fruits and vegetables and sustained the increase 6 months after the intervention was terminated (model adjusted R(2)=.13, P<.001). Farmers' market participants showed an increase of 1.4 servings per 4186 kJ (1000 kcal) of consumed food (P<.001) from baseline to the end of intervention compared with controls, and supermarket participants showed an increase of 0.8 servings per 4186 kJ (P=.02). CONCLUSIONS: Participants valued fresh fruits and vegetables, and adding them to the WIC food packages will result in increased fruit and vegetable consumption.

Choices made by low-income women provided with an economic supplement for fresh fruit and vegetable purchase.

Vouchers for fresh fruit and vegetable purchase were provided to low-income women participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Los Angeles, CA. As the program is currently constituted, the supplemental foods provided contain no fresh produce except for carrots for exclusively breastfeeding women. This study investigated whether providing supplemental financial support specifically for purchase of fresh fruits and vegetables would result in high uptake of the supplement, and what the individuals would choose to purchase. A total of 602 women enrolling for postpartum services at three selected WIC program sites in Los Angeles were recruited. Sites were assigned to intervention with vouchers redeemable at a local supermarket, a nearby year-round farmers' market, and a control site with a minimal nonfood incentive. Vouchers were issued bimonthly, at the level of US $10/wk, and carried out for 6 months. Of 454 participants who completed the study (75.4%), 86% were Hispanic, 7% non-Hispanic black, and 7% of other ethnic backgrounds. Assessment of uptake was by voucher redemption rates and was approximately 90% for both groups. Participants reported purchasing a wide variety of items at both sites. The 10 most frequently mentioned items were oranges, apples, bananas, peaches, grapes, tomatoes, carrots, lettuce, broccoli, and potatoes. In conclusion, low-income women used the supplement provided almost fully, and purchased a wide variety of fresh fruits and vegetables for their families. No particular barriers arose to redemption of the vouchers by either the participants or the retail vendors.

Obesity and cardiovascular risk factors in younger breast cancer survivors: The Cancer and Menopause Study (CAMS).

BACKGROUND: Breast cancer patients today can expect long-term survival; however, weight gain is a common problem after treatment and increases the risk for recurrence, cardiovascular disease and diabetes. The multi-ethnic cohort from the Cancer and Menopause Study, designed to examine the reproductive and late cardiovascular health effects of treatment in younger female breast cancer survivors (BCS), was used to describe the relationship of behavioral and treatment variables to body mass index (BMI), physical activity (PA), and cardiovascular risk factors. METHODS: Stage 0, I or II breast cancer survivors who were < or = 50 years at diagnosis and 2-10 years disease-free survivors (mean 5.9 +/- 2.3 years) were recruited from two tumor registries to complete a mail survey that included information on demographics, health-related quality of life, reproductive health, cancer treatment, PA, weight and height. A sub-sample completed an office visit where fasting blood lipids, blood pressure (BP), height and weight were measured. Linear regression analysis was used to model the following outcomes: BMI, PA, blood lipids and BP. RESULTS: Current BMI was positively associated with higher BMI prior to diagnosis, unhappiness with body image and negatively associated with current total PA (model p < 0.001). More work, home and leisure PA were all positively associated with greater physical functioning and higher energy levels (all models, p < 0.001). Total and LDL cholesterol were positively associated with number of years since diagnosis and negatively associated with leisure PA (both models, p < 0.001), while systolic and diastolic BP were both positively associated with age, current use of BP medications and current BMI (models, p < 0.001). CONCLUSIONS: Obesity in these BCS is prevalent and associated with premorbid obesity and decreased current physical activity but not with adjuvant treatment. Given the negative health consequences of weight gain and obesity after breast cancer, continued study of the etiology of weight gain, and potential targets for weight gain prevention are required. Interventions that target PA may be important for weight maintenance in BCS.

Development of a spanish-language version of the U.S. household food security survey module.

A survey module used to monitor the prevalence of household food insecurity and hunger in the United States was developed by a broadly based collaborative project with leadership from the USDA and the National Center for Health Statistics (NCHS). It has been administered annually since 1995 as a supplement to the Census Bureau's Current Population Survey (CPS) and is part of the National Health and Nutrition Examination Survey (NHANES) and other national surveys. Spanish is the second most common language in the United States, yet no standardized Spanish-language version of this instrument has yet been sanctioned by the relevant federal agencies. In the CPS, interviewers free-translate the questions while interviewing respondents who prefer to have the interview conducted in Spanish. National prevalence data indicate relatively high rates of food insecurity for Hispanic households, raising the question whether methodological artifacts may contribute to these rates. We analyzed eight Spanish-language versions of the instrument that have been used in published work for variability in wording and phrasing. We then conducted focus groups of low-income Spanish-speaking participants from Mexico, Central America, Puerto Rico and Cuba to refine a single Spanish-language instrument. We also employed professional translators to render the English instrument into "standard" Spanish; both instruments were then back-translated. The focus group-derived instrument uses simpler language and grammar; its back-translation integrity to the English version was slightly better than the professionally translated version. We provide the instrument for use and further testing by other investigators.