Development of a Nutrition Environment Assessment Tool for Latino Ethnic Stores.

The objectives were to: (1) adapt the Nutrition Environment Measures Survey for Stores (NEMS-S) to better culturally fit small Latino grocery stores (tiendas) in Iowa; (2) assess the newly adapted Latino NEMS-S for inter-rater and test-retest reliability; and (3) compare Latino and original NEMS-S summary scores. This pilot instrument, containing culturally appropriate foods from the original NEMS-S and 2015 US Dietary Guidelines for Americans, underwent two rounds of formative evaluation. The new instrument and scoring protocol were applied to a random sample of 42 of 81 possible tiendas in Iowa. Cohen's kappa was used to assess inter-rater and test-retest reliability for availability and quality of indicator food items (total scores and food category sub scores). There were no differences in summary scores for inter-rater or test-retest reliability using paired t-tests. Inter-rater agreement was high (range 0.82-1.00; p < 0.001). Tiendas averaged 42.0 ± 7.5 of 57 possible points on the Latino NEMS-S, but only 12.0 ± 4.6 of 54 points on the original NEMS-S (p < 0.001). The Latino NEMS-S is a reliable tool for assessing the food environment within Iowa tiendas. Culturally specific instruments can describe diverse food environments more accurately and guide public health nutrition interventions within communities.

Putting Knowledge into Practice: Low-Income Women Talk about Food Choice Decisions.

Insights into barriers and facilitators for healthy eating are needed to improve low-income women's diets and to decrease disease risk. The study objectives were to explore women's qualitative perceptions of influences on their food choices such as food security, their knowledge of nutrition-related health risk factors and self-efficacy for diet change, and their dietary intakes in practice. Thirty-six women, aged 19-50, who were eligible to receive income-based assistance were recruited in central Iowa. Focus group discussions on defining healthy foods, influences on food choice, and nutrition information sources were analyzed using a socioecological model framework. Demographics, nutrient intake estimates, food security status, health behaviors, and self-efficacy for nutrition behavior change were collected by survey. Most participants were White (61%), single (69%), food insecure (69%), and living with children (67%). Few women met dietary recommendations. Barriers to healthy eating include cost, convenience/preparation time, family taste preferences, and limitations of federal food assistance programs. Facilitators are high self-efficacy for nutrition change and health knowledge on average. These results challenge the strategy of using nutrition education to improve healthy eating and instead show that intervention messaging should focus on limited, achievable steps to improve dietary choices that fit within cost, convenience, and taste constraints.

Dry Bean Preferences and Attitudes among Midwest Hispanic and Non-Hispanic White Women.

Bean (Phaseolus vulgaris L.) intakes in the United States (US) lag behind dietary recommendations despite their positive nutrition profile, health benefits for reducing chronic disease risk, and inclusion in nutrition assistance programs. Low-income groups, including Hispanics, have an increased risk of cardiovascular disease, type 2 diabetes, obesity, and some cancers. Hispanic dietary quality and bean consumption may decline with increasing acculturation. Intakes at recommended levels could improve health in all vulnerable low-income populations. The study objectives were to describe dry and canned bean preferences, consumption frequency, and attitudes among low-income Hispanic and non-Hispanic white women, and to assess if these characteristics differed by ethnicity and acculturation level among the Latinas. A convenience sample of 158 women, aged 18⁻65 years, completed a written survey in English or Spanish at two healthcare clinics, one Special Supplemental Nutrition Program for Women, Infants and Children office, and five County Extension nutrition education and outreach programs in Iowa. Less acculturated Latinas consumed beans more often, preferred dry to canned, bought in bulk, valued color and shape in dry bean selection, and held less positive attitudes toward canned beans in contrast to bicultural/more acculturated and non-Hispanic white women. Ethnicity and acculturation level have a role in varying purchase patterns and attitudes regarding dry and canned beans. Culturally-held differences should be considered in nutrition programs and leveraged to increase consumption and improve health.

Socio-Ecological Barriers to Dry Grain Pulse Consumption among Low-Income Women: A Mixed Methods Approach.

The purpose of this study was to determine the socio-ecological influences on dry grain pulse consumption (beans, peas, lentils, chickpeas) among low-socioeconomic women in Iowa. Seven focus groups were conducted, with 36 women who qualified for income-based federal assistance. Data were collected from October 2017 to January 2018. Participants completed a survey that gathered individual demographics, assessed perceptions of dry grain pulses, and level of food security. Fifty-eight percent of the women were non-Hispanic white, and 39% were African American, all with an average age of 34.7 years. Thirty-three percent of the women consumed pulses less than once per week. Over 80% agreed that beans were healthful and satiating. Some health benefits of beans were unknown by more than 33% of the population, e.g., lower cancer risk, lower LDL, maintain blood glucose. Only 30% of the women were food secure. Focus group audio recordings were transcribed and analyzed by two researchers, using the grounded theory approach. At the policy level, participants knew pulses were included in USA federal nutrition assistance programs like the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Pulses were widely available in grocery stores in communities. Interpersonally, women felt that male partners preferred meats, and children needed animal-source proteins. Individually, women perceived uncooked dry pulses were challenging to prepare. Conclusively, more detailed instruction on pulse preparation, different pulse varieties, and offering canned pulses through WIC may increase consumption.

Health Behaviors among Low-income Hispanic and Non-Hispanic White Women.

OBJECTIVES: We determined relationships between food behaviors and health-risk factors by acculturation among limited-income Hispanic and non-Hispanic white women. METHODS: Women aged 18-49 years were recruited from income-based programs in metro-Phoenix, Arizona. Self-administered surveys in English or Spanish included demographics, a 10-item food behavior checklist, health-risk factors, food security, and acculturation. Differences by 4 acculturation/ethnicity categories were assessed with chi-square and analysis of variance (ANOVA). We created a food behavior scale. RESULTS: Eighty-two percent self-identified as Hispanic (N = 358), with 45% Hispanic-dominant, 25% bicultural, 12% English-dominant, and 18% non-Hispanic white for acculturation status. Food behavior checklist results showed that English-dominant Hispanic and non-Hispanic white women were more likely to feed their children soon after waking, refrigerate meat/dairy promptly, not add salt to food, smoke cigarettes and be food insecure (p < .001). Education, not acculturation, was a significant predictor of the food behavior scale. BMI did not differ by acculturation, but 33% of Hispanic-dominant Latinas did not know their height and/or weight. These less acculturated Latinas had significantly greater food security, but lacked health insurance and years of education. CONCLUSIONS: Program outreach tailored by acculturation that considers educational level is needed to emphasize existing positive behaviors and address knowledge gaps among low socioeconomic women to improve health and reduce disparities.

Knowledge Gaps of the Health Benefits of Beans among Low-Income Women.

OBJECTIVES: We determined knowledge of the health benefits of consuming beans, and assessed if awareness varied by acculturation status among Hispanic and non-Hispanic low-income women. METHODS: We used a self-administered survey with Iowa women aged 18-65 years who were eligible to receive income-based services through 2 healthcare clinics, a WIC clinic, and Extension Outreach. Chi-square and ANOVA were used to compare bean health benefit knowledge, demographics, health-risk factors, nutrition information seeking, and self-efficacy by acculturation categories. RESULTS: Of the 158 women who completed the survey, 58% were Hispanic, with a mean age of 36 years. In terms of acculturation, 24% were Hispanic-dominant, 30% bicultural, and 46% English dominant. Over 50% of all respondents did not know bean consumption lowered cholesterol, aided blood glucose control, or reduced some cancer risks. Responses for 5 of 7 knowledge statements differed significantly by acculturation. Hispanic-dominant and bicultural women reported significantly better health, higher bean consumption, and less cigarette smoking than English-dominant women. Bicultural and English-dominant women were more likely to use the Internet for nutrition information. CONCLUSIONS: There are knowledge gaps about the health benefits of bean consumption among low-income women. Nutrition education to improve their knowledge may lead to increased bean consumption, reducing health disparities and improving nutrition.