"We Want to Eat and be Healthy just like Everybody Else:" How Social Infrastructures Affect Nutrition Equity in a Racialized Urban Community in the United States.

Background: Food security and nutrition equity, 2 social determinants of health, are impacted by the coronavirus disease 2019 (COVID-19) pandemic and the racialization of urban communities. Few studies to date have examined how the use of social infrastructures in the United States during COVID-19 affected the ability to achieve food security and nutrition equity. Objectives: To describe how the use of social infrastructures impacts food security and nutrition equity in a majority Black and urban community in the United States. Methods: Semistructured in-depth interviews were conducted with 40 low-income, urban, and predominately Black people living in Buffalo, New York in May-July 2022.A thematic analysis using a phronetic iterative approach informed by the Social Ecological Model, Walsh's Family Resilience Framework, and a framework focused on the advancement of nutrition equity. Results: We identified 9 themes mapped across 3 interrelated domains that impact nutrition equity, including 1) meeting food needs with dignity, 2) supply and demand for fresh and healthy foods, and 3) community empowerment and food sovereignty. We found that people used coping strategies, such as food budgeting and cooking skills, paired with different social infrastructures to meet food needs. People commonly used the Supplemental Nutrition Assistance Program and food pantries to meet food needs over receiving support from family members or friends outside of the household. Poverty, challenges accessing and affording healthy food, and the inability to reciprocate support to others undermined the advancement of nutrition equity despite social infrastructures being available for use. Historical and ongoing acts of disempowerment and disinvestment also hindered the advancement of nutrition equity. Conclusions: Sustained, community-led investment is needed to address structural inequities preventing the advancement of nutrition equity. Social infrastructures should be expanded to inclusively support low-income populations, so wealth generation is possible to address the root cause of food insecurity.

A Novel Process to Recruit and Select Community Partners for a Hybrid Implementation-Effectiveness Study.

BACKGROUND: Creating strong partnerships with community organizations is essential to test implementation of evidence-based interventions. However, partners are often chosen based on convenience rather than capacity or diversity. Streamlined processes are needed to identify qualified, diverse, and invested partners to conduct community-based research. OBJECTIVES: There is a gap in the literature on effective and efficient processes for recruiting partners. This paper aims to fill that gap by describing a novel approach for identifying a diverse group of community organizations to participate in research. METHODS: We used a Request for Partners (RFP) approach to recruit partners to participate in a hybrid implementation-effectiveness study of the Veggie Van mobile market model. The process included formative work to inform RFP development, creation of an external advisory committee, an intent-to-apply round, a full application round, and an inperson training and selection process. Data was collected to characterize applicant size, location, and experience; pre-post surveys were conducted to understand the training's utility. RESULTS: We received 59 intent-to-apply submissions and invited 28 organizations to apply: 17 submitted applications and 12 organizations were chosen as finalists. The process took approximately 8 months to recruit 9 organizations and 32 community sites across 5 states and increased understanding of the intervention and partner responsibilities. CONCLUSIONS: An RFP process is familiar to many community organizations that compete for grant funding but may not have prior research experience. This process streamlined recruitment timelines, increased diversity, and cultivated community among organizations. It may also improve research transparency, study completion, and intervention fidelity.

A Randomized Controlled Trial of a Research-Tested Mobile Produce Market Model Designed to Improve Diet in Under-Resourced Communities: Rationale and Design for the Veggie Van Study.

Mobile produce markets are increasingly popular retail vendors used for providing access to fresh fruits and vegetables (F&V) in under-resourced communities; however, evaluation is limited due to design and implementation challenges. This protocol presents the original design of a randomized control trial aimed at assessing the effectiveness of the evidence-based Veggie Van (VV) mobile market model. Nine US community partner organizations were asked to partner with four community sites serving lower-income areas. Sites are randomized to either intervention or control. Intervention sites will host a mobile market for one year while the control sites will host planning events, with the goal to open a market afterward. Eligible participants are aged ≥ 18, the primary household shopper, live nearby/regularly frequent the site, and have expressed interest in learning about a mobile market. The primary outcome, F&V consumption, will be assessed via dietary recall at baseline and 12 months and compared between the intervention and control sites. This research advances work on the VV model and methods for mobile market evaluation with the addition of more robust measures and the study design. Determining the effectiveness of the VV model is imperative to justify taking it to scale to enhance the impact of mobile markets.

Operational challenges that may affect implementation of evidence-based mobile market interventions.

INTRODUCTION: Mobile produce markets are becoming an increasingly prevalent, accepted, and effective strategy for improving fruit and vegetable (F&V) access and consumption across underserved and lower-income communities. However, there is limited published research on mobile market operations. The goal of this research is to identify the challenges mobile markets face and ways to potentially mitigate those challenges. We will also discuss implications of our findings for future implementation of evidence-based food access interventions. METHODS: We conducted 21 semi-structured key informant (KI) interviews to assess common practices of mobile market organizations that had been operating for 2 + years. We asked KIs about their organizational structure, operations, procurement and logistics, evaluation efforts, marketing and community engagement, success and challenges. A primary qualitative analysis involved deductive coding using qualitative software. A secondary qualitative analysis identified subthemes related to common challenges and remedial practices. A deductive coding process was applied to match identified challenges to the appropriate Consolidated Framework for Implementation Research (CFIR). RESULTS: The leading challenges cited by KIs correspond to the CFIR domains of inner setting (e.g., funding and resources), outer setting (e.g., navigating regulations), and process (e.g., engaging community partnership). Practices that may mitigate challenges include maximizing ancillary services, adopting innovative volunteer and staffing structures, and formalizing agreements with community partners. CONCLUSION: Common and persistent challenges ought to be addressed to ensure and enhance the positive public health impacts of mobile produce markets. Contextual factors, particularly organizational factors, that impact implementation should also be considered when implementing an evidence-based intervention at a mobile market. Further research is needed to determine which innovative solutions are the most effective in mitigating challenges, improving implementation, and enhancing sustainability of mobile markets.

Acquisition, mobility and food insecurity: integrated food systems opportunities across urbanicity levels highlighted by COVID-19.

OBJECTIVE: To investigate acquisition and mobility experiences of food-insecure individuals across urbanicity levels (i.e., urban, suburban, rural) in the early months of the COVID-19 pandemic. DESIGN: Cross-sectional study using a nationally representative online panel to measure where food-insecure individuals acquired food, food acquisition barriers and mobility to food sources, which were evaluated across urbanicity levels using chi-squared tests and 95 % CI. SETTING: USA. PARTICIPANTS: 2011 adults (18 years or older). RESULTS: Food insecurity impacted 62·3 % of adults in urban areas, 40·5 % in rural areas and 36·7 % in suburban areas (P < 0·001). Food acquisition barriers that were significantly more prevalent among food-insecure adults in urban areas were a change in employment status (34·2 %; 95 % CI 27·2 %, 41·1 %; P < 0·0001) and limited availability of food in retailers (38·8 %; 95 % CI 31·7 %, 45·9 %; P < 0·001). In rural areas, food-insecure adults primarily acquired food for the household from supercentres (61·5 %; 95 % CI 50·4 %, 72·5 %; P < 0·05), while locally sourced foods were less common among food-insecure adults in rural areas (6·9 %; 95 % CI 0·01 %, 13·0 %) compared to urban areas (19·8 %; 95 % CI 14·3 %, 25·4 %; P < 0·01). Transportation as a barrier did not vary significantly by urbanicity, but food-insecure adults across urbanicity levels reported utilising a range of transportation modes to acquire food. CONCLUSIONS: A planning approach that links urban and rural areas could address food insecurity by enhancing the integration of food production, transportation and food distribution, building towards a more resilient and equitable food system for all Americans.

Using common practices to establish a framework for mobile produce markets in the United States.

Access to affordable fruit and vegetables (F&V) remains a challenge within underserved communities across the United States. Mobile produce markets (mobile markets) are a well-accepted and effective strategy for increasing F&V consumption in these communities. Mobile market organizations share similar missions that focus on food, health, and empowerment, participate in incentive programs, offer nutrition education, utilize grassroots-based marketing strategies, prioritize local produce, and sell competitively priced produce through a market style. While mobile markets have become increasingly prevalent, models vary widely. Establishing standardized practices is essential for ensuring the effectiveness and sustainability of this important food access program. This research seeks to identify common practices of established mobile markets and describe the resources they rely on.

Promoting active commuting to school through environmental and policy supports in Buffalo, New York.

BACKGROUND: Children in Buffalo, New York, have limited opportunities for safe, enjoyable physical activity. The Healthy Kids, Healthy Communities-Buffalo partnership established in 2009 created environmental and policy supports to facilitate physical activity among youth. METHODS: This article uses a mixed-methods approach to document environment and policy changes in support of active commuting to school. Built environment data were collected using a pre-post research design with the Street Design Environmental Audit Tool. Supplementary sources of information include Geographic Information Systems, US Census data, and property parcel data. RESULTS: This exploratory study found modest improvements in the built environment during the period of assessment. Specifically, sidewalk conditions were improved. In addition, assessment of citywide policy indicates that systemic supports for active living have been put into place through the new (proposed) land use plan and the proposed zoning ordinance. CONCLUSIONS: Exploratory evaluation results suggest that Healthy Kids, Healthy Communities-Buffalo partnership was able to make some environmental and policy changes to promote active transportation. A long-term assessment is required to develop a fuller understanding of how environmental and policy changes impact active transportation.

The built environment moderates effects of family-based childhood obesity treatment over 2 years.

BACKGROUND: Research suggests the neighborhood built environment is related to child physical activity and eating. PURPOSE: The purpose of this study was to determine if characteristics of the neighborhood environment moderate the relationship between obesity treatment and weight loss, and if outcomes of particular treatments are moderated by built environment characteristics. METHOD: The relationship between the built environment and standardized BMI (zBMI) changes for 191 8-12-year-old children who participated in one of four randomized, controlled trials of pediatric weight management was assessed using mixed models analysis of covariance. RESULTS: At 2-year follow-up, greater parkland, fewer convenience stores, and fewer supermarkets were associated with greater zBMI reduction across all interventions. No treatments interacted with characteristics of the built environment. CONCLUSIONS: Activity- and eating-related built neighborhood characteristics are associated with child success in behavioral obesity treatments. Efficacy may be improved by individualizing treatments based on built environment characteristics.

Leveraging neighborhood-scale change for policy and program reform in Buffalo, New York.

BACKGROUND: The Healthy Communities Initiative (HCI) affects 8500 employees working in the Buffalo Niagara Medical Campus and 8925 residents of adjacent neighborhoods, where 37% of people live below the poverty line, and a majority (68.7%) identify themselves as African-American. INTERVENTION: The HCI partnership, which includes multi-sectoral and multi-disciplinary organizations and neighborhood residents, implemented the Active Living by Design community action model with greatest emphasis on achieving policy and planning changes to support active living behaviors. RESULTS: The master plan of the campus now incorporates active living as a guiding principle. Physical improvements to support walking and bicycling in the target area have been planned and implemented through a $14 million federal transportation grant. The partnership facilitated the creation of a citywide Bicycle and Pedestrian Advisory Board and the passage and implementation of an ordinance to enhance bicycling infrastructure within the city. LESSONS LEARNED: Buffalo's experience suggests that to achieve lasting environmental change in the context of a medical campus and its surrounding neighborhoods, it is critical to: (1) engage neighborhood residents from the outset to build social capital; (2) cultivate a diverse partnership; (3) use a comprehensive approach; (4) balance long-term goals with short-term accomplishments; (5) integrate active living concerns within existing policy and planning mandates; and (6) make sustainability a priority. CONCLUSIONS: Environmental changes in the public domain that support active living require collaboration among public, nonprofit, and private sectors; citizen engagement; and the presence of a legal and structural framework provided by government policies and plans to direct future development.

The neighborhood and home environments: disparate relationships with physical activity and sedentary behaviors in youth.

BACKGROUND: To increase participation in physical activity, it is important to understand the factors associated with a child's choice to be physically active or sedentary. The neighborhood and home environments may be related to this choice. PURPOSE: To determine whether the neighborhood environment or number of televisions in the home environment are independently associated with child physical activity and television time. METHODS: The associations of the neighborhood and home environments on active and sedentary behaviors were studied in 44 boys and 44 girls who wore accelerometers and recorded their television watching behaviors. Neighborhood environment variables were measured using extensive geographic information systems analysis. RESULTS: Hierarchical regression analyses were used to predict physical activity after controlling for individual differences in age, socioeconomic status, percentage overweight, and time the accelerometer was worn in Step 1. Sex of the child was added in Step 2. A neighborhood design variable, street connectivity, accounted for an additional 6% (p

Reducing sedentary behavior: the relationship between park area and the physical activity of youth.

This study was designed to determine whether the characteristics of the neighborhood environment are related to the substitution of physical activity for sedentary behavior among youth. Fifty-eight 8- to 15-year-old youth were studied in a within-subjects crossover design with three phases: baseline, increased sedentary behavior, and decreased sedentary behavior. The relations between changes in physical activity and design, diversity, and density attributes of the neighborhood environment were determined using random coefficient models. Compared with girls, boys showed greater increases in physical activity when sedentary behaviors were reduced and greater decreases in physical activity when sedentary behaviors were increased. Greater access to parks was associated with greater physical activity when sedentary behaviors were reduced.

Association of access to parks and recreational facilities with the physical activity of young children.

OBJECTIVE: To determine associations of the neighborhood and home television environments with young children's physical activity. METHOD: 32 boys and 27 girls age 4 to 7 years wore accelerometers for 3 weekdays and 1 weekend day. The number of televisions in the home and television watching of the child were monitored using TV Allowance units for 3 weeks. A geographic information system was used to measure neighborhood environment variables. RESULTS: Hierarchical regression analysis was used to predict physical activity, initially controlling for sex, age, socioeconomic status, adiposity, and child television watching in step 1. In step 2, the number of televisions did not significantly increase the amount of variability accounted for in the prediction of physical activity. In step 3, housing density and the interaction of housing density by sex accounted for an incremental 12% (p < 0.05) of the variability and in step 4 percentage park plus recreation area accounted for a further 10% (p < 0.05) of the variability. Greater housing density predicted increased physical activity of boys, but not girls. CONCLUSION: Neighborhoods with increased proximity between homes and a greater proportion of park area are associated with greater physical activity in young children.

Purchases of food in youth. Influence of price and income.

One way to increase choice of healthy over unhealthy behaviors is to increase the cost of less healthy alternatives or reduce the cost of healthier alternatives. The influence of price on purchases of healthy and unhealthy foods was evaluated in two laboratory experiments. In Experiment 1, thirty-two 10- to 12-year-old youth were given $5.00 and allowed to purchase multiple portions of a healthy food (fruit or vegetable) and a less healthy food (higher-fat snack). The price of one type of food varied from $0.50 to $2.50, while the price of the other type was held at $1.00. Increasing the price of a type of food reduced purchases of that type of food, but did not lead to substitution with the alternative type of food. In Experiment 2, twenty 10- to 14-year-old youth were given $1.00, $3.00, and $5.00 to purchase healthy and unhealthy foods. The price of each food was raised and lowered by 25% and 50%. Raising the price of healthy or unhealthy foods resulted in decreased purchases of those foods, and income available interacted with price to predict the pattern of substitution of alternative foods. These results show the potential for controlled laboratory studies of price and food purchases, and show that the substitution of healthier for unhealthy food is related to available money.