Development of EFNEP and SNAP-Ed Core Competencies in the Land-Grant University System.

This report describes the development and revision of core competencies for the Expanded Food and Nutrition Education Program and Supplemental Nutrition Assistance Program-Education program leaders, supervisors, and paraprofessional educators across the land-grant university system. The developing curriculum methodologies were used to engage panels of exemplary employees and an advisory panel of program leaders. A crosswalk examined key documents, and a gap analysis explored the competencies of similar professions. The resulting job duties and tasks reflect cultural, environmental, and educational trends. The core competencies are critical for writing job descriptions, guiding hiring, evaluating performance, and providing initial and ongoing training for the Expanded Food and Nutrition Education Program and Supplemental Nutrition Assistance Program-Education.

Policy Implications of the COVID-19 Pandemic on Food Insecurity in Rural America: Evidence from Appalachia.

Rural communities are disproportionally affected by food insecurity, making them vulnerable to the consequences of supply disruptions caused by the COVID-19 pandemic. While access to food was initially diminished due to food supply disruptions, little is known about the mechanisms through which federal emergency assistance programs impacted food access in rural populations. Through a series of five focus groups in spring 2021, we examined the impact of the COVID-19 pandemic on food access in a rural Appalachian community in Kentucky. Data were analyzed using a Grounded Theory Approach. Findings revealed the following four primary themes: food scarcity in grocery stores; expanded federal food assistance; expanded community food resources; and expanded home gardening. Participants provided details regarding the way increased federal assistance, especially expanded benefits within the Supplemental Nutrition Assistance Program, allowed them to purchase greater quantities of nutritious food. This study unveils the specific impacts of the COVID-19 pandemic on one rural population, including the influence of some social determinants of health on food insecurity. Policymakers and stakeholders should recognize the layered protection of multiple federal emergency assistance programs against food insecurity and the potential for long-term population health promotion in rural areas.

"We're, Like, the Most Unhealthy People in the Country": Using an Equity Lens to Reduce Barriers to Healthy Food Access in Rural Appalachia.

INTRODUCTION: Obesity disproportionately affects rural communities, and Appalachia has some of the highest obesity rates in the nation. Successful policy, systems, and environmental (PSE) interventions to reduce obesity must reflect the circumstances of the population. We used a health equity lens to identify barriers and facilitators for healthy food access in Martin County, Kentucky, to design interventions responsive to social, cultural, and historical contexts. METHODS: We conducted 5 focus groups in Martin County, Kentucky, in fall 2019 to obtain perspectives on the local food system and gauge acceptability of PSE interventions. We used grounded theory to identify perceived barriers and facilitators for healthy eating. RESULTS: Thirty-four adults (27 women; median age, 46 years) participated in 5 groups. One prominent theme was declining interest in farming; many participants believed this decline was generational. One participant noted, "Most of my adult male relatives worked in the coal mines, and they worked 6 days a week. . . . My grandpa had the garden, but then my dad's generation is the one quit gardening." Another shared, "You would probably have to have someone to teach [gardening]." Instead of enhancing farmers markets, participants suggested building community capacity for home gardens to increase vegetable consumption. CONCLUSION: Our findings demonstrate the importance of obtaining community input on the development of PSE interventions to mitigate inequities in obesity. Although farmers market interventions were deemed not feasible, other solutions to enhance access to produce were identified. Developers of community-responsive PSE interventions to improve healthy eating in rural, food-insecure locations should consider using an equity-oriented prevention framework to ensure acceptable interventions.

Hospitalization Rates Related to Coordinated Home Health Care Services With a Community Oncology Practice.

PURPOSE: Oncology care reimbursement has been shifting from a traditional fee-for-service model to either 1- or 2-sided risk models during the past 5 years. A major expense associated with the total cost of care is hospitalization cost. The study set out to investigate whether the creation of an Advanced Community Care Model (ACCM) of home health care would affect 60-day hospitalization and 30-rehospitalization rates in a community oncology setting. METHODS: In conjunction with a single home health care organization, an ACCM was modified for oncology care to include intervention protocols to address antiemetic issues, pain control, dehydration, shortness of breath, diarrhea, and fever. Weekly and monthly joint management meetings began. Quality metrics were defined. RESULTS: Overall, 457 unique home health care admissions were evaluated. Hospitalization associated with intervention protocols was evaluated. Sixty-day hospitalization rates decreased from 14% to 8%. Thirty-day rehospitalization rates decreased from 25% to 10%. CONCLUSION: An oncology ACCM, as created in this study, appears to have reduced both 60-day hospitalization and 30-day rehospitalization rates.

Evaluation of a social marketing approach to healthy, home-cooked family meals for low-income mothers of young children.

Cooking is a complex behavior associated with more frequent and nutrient-dense family meals. The Cook Together, Eat Together (CTET) social marketing program used formative, process, and outcome evaluations over a 3-year period to design a program to increase fruit and vegetable intake and frequency of family meals. We used a quasi-experimental, mixed-methods design with a nonequivalent comparison group to evaluate fruit and vegetable intake and family meals. Eight focus groups of mothers in low-income families with young children revealed two predominant behavioral mediators: (i) importance of family time and (ii) desire for children to learn to cook and become self-sufficient adults. Program design was grounded in formative evaluation and organized by the four Ps of social marketing: (i) product-learning to prepare healthy meals while teaching children to cook; (ii) price-lowered by reducing barriers of food cost, kitchen clean-up, meal planning, grocery shopping; (iii) placement-in neighborhood gathering places with a "cooking social"; and (iv) promotion-flyers, newsletters, and social media. Outcome indicators were assessed pre/post intervention with questions from instruments validated for the audience. Significant changes (n = 68, p ≥ .002, Bonferroni adjustment for p = .05, Cohen's d = .50 medium effect size) were found in consumption of fruits and vegetables with an average increase of half cup each per day. CTET participation significantly increased fruits and vegetables served and eaten at family meals. A social marketing approach can help families with young children increase fruit and vegetable consumption.

A Mentor-Led Text-Messaging Intervention Increases Intake of Fruits and Vegetables and Goal Setting for Healthier Dietary Consumption among Rural Adolescents in Kentucky and North Carolina, 2017.

Introduction-Text-messaging interventions hold promise for successful weight loss interventions. However, there is limited research on text-messaging interventions to improve dietary intake among rural adolescents, who are at greater risk for obesity and related risk factors. The goal of this study was to test an eight-week, mentor-led text-messaging intervention among 14⁻16-year-old rural adolescents: the "Go Big and Bring It Home" Project to improve fruit and vegetable and healthy beverage intake. Methods and Materials-Eight rural high schools in eastern Kentucky and eastern North Carolina participated (n = 4 were randomized as intervention schools and n = 4 were randomized as control schools). Adolescents were recruited to participate in the eight-week text-messaging intervention. The text messages were primarily affective messages, and included a weekly challenge related to consuming fruits, vegetables, or healthy/low-calorie beverages. Undergraduate nutrition students sent text messages on Tuesday and Saturday every week over the eight-week period via the "Group Me" mobile application. Delayed controls received no information or text messages during the eight-week intervention. Fruit and vegetable intake was measured with the National Cancer Institute Fruit and Vegetable screener and beverage intake was assessed using the Beverage Questionnaire-10 (BEVQ-10). Intention-to-treat analyses were conducted among all those that completed the baseline and post-intervention survey (n = 277 intervention students and n = 134 delayed control students). All linear regression models were adjusted for race and were clustered on school to control for intraclass correlation. Results-In adjusted analyses, there was a statistically significant positive intervention effect on the primary outcome of fruit and vegetable servings/day with a mean difference between intervention and control participants of 1.28 servings/day (95% Confidence Interval 1.11, 1.48). There was no intervention effect on beverage intake. There was a statistically significant increase in the odds of goal setting for healthier dietary behaviors among intervention participants relative to controls. Conclusion-An eight-week text-messaging intervention led to increases in self-reported fruit and vegetable intake and improvements in goal setting for healthier dietary behaviors. Due to the use of undergraduate students to deliver the messages, and use of an existing web application, this text-messaging intervention can be sustained in underserved, rural environments. Thus there is potential for significant reach and public health impact to improve dietary patterns.

Community-Wide Efforts to Improve the Consumer Food Environment and Physical Activity Resources in Rural Kentucky.

Community interventions to improve access to food and physical activity resources can reduce obesity rates and improve obesity-related health outcomes. We describe a Kentucky community project that consisted of collaborating with grocery store managers to improve the consumer food environment and partnering with community members to improve walking trails, bicycle racks, and other physical activity resources. We surveyed 2 random samples of community residents in 6 participating rural counties, 741 in 2016 (year 1) and 1,807 in 2017 (year 2). Fruit and vegetable intake significantly increased from year 1 (mean servings fruits, 2.71; vegetables, 2.54) to year 2 (mean servings fruit, 2.94; vegetables, 2.72). Although moderate physical activity did not change from year 1 to year 2, concern among residents about places to be physically active improved (P = .04). Involving community members in promoting obesity prevention programs may improve dietary intake and alleviate community concern about physical activity.

Direct Effects of the Home, School, and Consumer Food Environments on the Association between Food Purchasing Patterns and Dietary Intake among Rural Adolescents in Kentucky and North Carolina, 2017.

Background: Obesity rates are higher among rural versus urban adolescents. To examine possible mechanisms for the rural-urban adolescent obesity disparity, we examined the direct and indirect effects of food purchasing patterns, and the home, school, and consumer food environments on dietary intake among rural adolescents. Methods: A baseline survey was conducted among adolescents in eight rural high schools (four in Eastern Kentucky, and four in Eastern North Carolina). Participants answered questions about food purchasing patterns, dietary intake, home food availability, and demographics. The school and consumer food environments were assessed using validated measures from the School Meals Cost Study (United States Department of Agriculture-Mathematica) and the Nutrition Environment Measurement Survey for Stores, Restaurants, and Corner Stores. Results: Of 432 adolescents, 55% were normal weight, 24% were overweight, and 21% were obese. There was a direct association between unhealthy food purchasing patterns (shopping frequently at gas stations, fast food, and dollar stores) and consuming more added sugars, when compared to those with a healthy shopping pattern (shopping less frequently at gas stations, fast food, and dollar stores) [Odds Ratio = 2.41 (95% CI (confidence interval) 0.99, 3.82)]. Those who reported always having fruits and vegetables in the home consumed more servings of fruits and vegetables [OR = 0.31 cups (95% CI 0.22, 0.44)] compared to those who reported never having fruits and vegetables in the home. Adolescents attending a school with a low healthy food availability score consumed fewer servings of fruits and vegetables [-0.001 (95% CI -0.001, 0.0001)] compared to those attending a school with a high healthy food availability score. Conclusions: There are direct associations between food purchasing patterns, the home and school food environments, and dietary intake among rural adolescents. These cross-sectional results informed the development of the "Go Big and Bring it Home" program, a text messaging intervention to improve adolescents' fruit, vegetable, and healthy beverage intake.