Prevalence and Determinants of Undiagnosed Liver Steatosis and Fibrosis in a Nationally Representative Sample of US Adults.

Background Chronic liver diseases account for approximately 1.9 million deaths globally every year and negatively affect health-related quality of life. Early detection of liver disease may enable timely treatment, potentially improving patient outcomes. This study aimed to determine the prevalence and determinants of liver steatosis and fibrosis in US adults with no previously diagnosed liver condition. Methods We conducted an observational, nationally representative, cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) conducted from January 2017 to March 2020. Study participants were 7,391 adults aged 21 and older with no history of diagnosed liver disorders who underwent vibration-controlled transient elastography (VCTE) to determine liver steatosis and fibrosis. Controlled attenuation parameter (CAP) values between 248 and 267 dB/m were classified as mild steatosis, and those over 267 dB/m as advanced steatosis. Liver stiffness measurement (LSM) values between 7.65 and 13 kPa were classified as moderate/severe fibrosis, and those over 13 kPa as cirrhosis. Covariates included age, sex, race, body mass index (BMI), diabetes mellitus, kidney disease, smoking history, alcohol intake, alanine aminotransferase (ALT), aspartate aminotransferase (AST), physical activity, sedentary time, and sleep time. The associations of subject characteristics with liver CAP and LSM were evaluated using survey multivariable linear regression. Shapley Additive Explanations values determined the relative importance of each attribute in the model. The discriminative performance of classification models was assessed using the area under the receiver operating characteristic (AUROC) curve. Results The population prevalence of liver steatosis was 57.2% (10.2% mild; 47.0% advanced). The relative importance of covariates in predicting liver CAP was 63.1% for BMI, 10.7% for ALT, and less than 10% for the other covariates. The prevalence of significant fibrosis was 11.4% (8.3% moderate/severe fibrosis; 3.1% cirrhosis). The relative importance of covariates in predicting LSM was 67.3% for BMI and less than 10% for the other covariates. BMI alone demonstrated acceptable discriminative performance in classifying varying severities of steatosis and fibrosis (AUROC range 72%-78%) at cutoffs between 28 and 33 kg/m2. Conclusions Undiagnosed chronic liver disease based on VCTE findings is highly prevalent among US adults, particularly in obese individuals. Efforts to increase awareness about liver disease and to reconsider existing BMI thresholds for liver disease screening may be warranted.

The GOAL-Hem journey: Shared decision making and patient-centred outcomes.

INTRODUCTION: GOAL-Hem is a novel, haemophilia-specific, patient-centred outcome measure (PCOM) based on goal attainment scaling, allowing people with haemophilia (PwH) to set and monitor the attainment of individualized goals for treatment. AIM: To provide a thorough overview of the creation, validation, and development of GOAL-Hem. METHODS: Clinician workshops were held to develop a haemophilia-specific goal menu. Qualitative data from semistructured interviews with PwH and their caregivers guided further revisions to the goal menu (i.e., goal domains and descriptors). A feasibility study was performed including a 12-week, prospective, noninterventional evaluation involving clinicians and PwH at four US haemophilia treatment centres. Finally, the Patient Voice Study gathered feedback from PwH and their caregivers via an online survey, interviews, and a focus group. RESULTS: The feasibility study validated GOAL-Hem with successful outcomes in construct/content validity and responsiveness, including a large effect in patient- and clinician-rated goal attainments. The Patient Voice Study led to significant refinement of GOAL-Hem goals and descriptors, resulting in a more straightforward and relatable menu for PwH and their caregivers. Overall, GOAL-Hem captured qualitative data in areas important to PwH and employed quantitative methods to evaluate meaningful changes in those areas. The individualized tool was well equipped to handle the complex and chronic nature of haemophilia and was endorsed by PwH, their caregivers, and clinicians. CONCLUSION: The GOAL-Hem development journey may serve as a roadmap for other PCOMs in a variety of settings, including clinical studies, haemophilia treatment centres for care planning, and as a tool to gather real-world evidence.

Using Process Evaluation Results to Compare Peer and Adult Leader Delivery of the PAWS (Peer-Education about Weight Steadiness) Club Program.

To date, there is limited published literature on process evaluation of adolescent health promotion programs. In this paper, we describe the methods and results of PAWS Club process evaluation over 2 years of implementation to compare the effectiveness of delivery by peer and adult leaders. PAWS (Peer-education About Weight Steadiness) Club was a 12-week healthy lifestyle program, delivered to 6th and 7th graders by peer and adult educators, using cluster randomized controlled design. Peer educators were 8th graders in the program schools and adult educators were staff/teachers in the program schools. Trained university students filled out fidelity logs at each session led by peer and adult educators to assess program delivery. The fidelity logs included questions to collect information about the number of participants, duration of the session, percent of activities completed, and if lessons started on time, lesson objectives were clearly stated, lesson objectives were emphasized, demonstrations were visible to participants, all activities were completed, the leader was familiar with lessons, the leader maintained an appropriate pace, the leader kept participants on track, and the leader asked if participants had any questions. Adult educators had a higher mean performance for all questions compared to peer leaders. Significant differences were observed for emphasizing lesson objectives (p = 0.005), making demonstrations visible to participants (p = 0.031), being familiar with the lesson plan (p = 0.000), maintaining an appropriate pace (p = 0.000), keeping participants on track (p = 0.000), and asking if participants had any questions (p = 0.000). Significance was set at p < 0.05. Findings from the current study have implications for designing and conducting a process evaluation of complex healthy lifestyle programs with adolescents in schools. Additional training of peer educators may be needed to enhance program delivery.

Fresh- and lean-pork intake in relation to functional limitations among US older adults, 2005-2016.

BACKGROUND: Pork consumption, in particular fresh/lean-pork consumption, provides protein and other essential micronutrients that older adults need daily and may hold the potential to prevent functional limitations resulting from sub-optimal nutrition. AIM: Assess fresh/lean-pork intake in relation to functional limitations among older adults in the USA. METHODS: Individual-level data came from the National Health and Nutrition Examination Survey (NHANES) 2005-2016 waves. Nineteen validated questions assessed five functional limitation domains: activities of daily living (ADLs); instrumental activities of daily living (IADLs); leisure and social activities (LSAs); lower extremity mobility (LEM); and general physical activities (GPAs). Logistic regressions were performed to examine pork, fresh-pork and fresh lean-pork intake in relation to functional limitations among NHANES older adults (n = 6135). RESULTS: Approximately 21, 18 and 16% of older adults consumed pork, fresh pork and fresh lean pork, respectively. An increase in pork consumption by 1 oz-equivalent/day was associated with a reduced odds of ADLs by 12%, IADLs by 10% and any functional limitation by 7%. An increase in fresh-pork consumption by 1 oz-equivalent/day was associated with a reduced odds of ADLs by 13%, IADLs by 10%, GPAs by 8%, and any functional limitation by 8%. Similar effects were found for fresh lean-pork consumption on ADLs, IADLs, GPAs and any functional limitation. CONCLUSION: This study found some preliminary evidence linking fresh/lean-pork consumption to a reduced risk of functional limitations. Future studies with longitudinal/experimental designs are warranted to examine the influence of fresh/lean-pork consumption on functional limitations.

Cognitive Distraction at Mealtime Decreases Amount Consumed in Healthy Young Adults: A Randomized Crossover Exploratory Study.

BACKGROUND: Environmental distractions have been shown to affect eating patterns. OBJECTIVE: The purpose of this study was to determine the effects of a cognitive distraction on amount, preference, and memory of food consumed and perceptions of fullness, hunger, and enjoyment of food in a healthy young-adult population. METHODS: A randomized controlled crossover study of 119 healthy adults (20.2 ± 1.4 y; 57% women; 48% white) assigned participants to begin under either the distracted (DIS, n = 55) or control (CON, n = 64) conditions. DIS participants consumed a meal of quiche while completing a Rapid Visual Information Processing (RVIP) for 15 min. CON participants ate without any task assignment. After a 30-min rest period, participants were offered a snack and given 5 min to eat ad libitum. Participants completed a survey assessing fullness, hunger, and enjoyment of the meal using 100 mm visual analogue scales. One week later, participants completed the opposite condition. Data were analyzed using ANOVA. RESULTS: Those in DIS consumed 13 g less of the meal (P < 0.001), even when comparing by initial condition (P < 0.001) and adjusting for sex (P < 0.001). A carryover effect of initial condition was found (P < 0.001), such that participants first assigned to DIS condition consumed less (95.2 ± 61.7 g) when distracted compared to all other condition combinations (127-133 g). Those in DIS had decreased accuracy for both memory of quiche received (absolute difference, 1.1 ± 1.6 compared with 0.7 ± 1.2 for CON, P < 0.001) and memory of quiche consumed (0.8 ± 1.1 for DIS compared with 0.7 ± 1.2 for CON, P = 0.007). CONCLUSIONS: When distracted, healthy young adults consumed significantly less food and their memory of the meal was dampened. These findings underscore the potential importance of cognitive distraction in affecting food intake. This trial was registered at clinicaltrials.gov as NCT04078607.

Food Insecurity among College Students Differs by Questionnaire Modality: An Exploratory Study.

Objectives: Literature suggests that college (ie, post-secondary) students experience food insecurity (FI) at alarming rates. However, the commonly used FI questionnaires have undergone limited evaluations for accuracy in this sub-population. The objective of this exploratory study was to evaluate if FI estimates among college students differ by survey distribution modality. Methods: A test-retest study was conducted from October to December 2017. A random sample of undergraduate students (N = 343) participated in an online survey. After completing the survey, a random sample of these students (N = 66; 29%) completed the same items in paper-and-pencil format. Responses were compared with percent agreement and kappa (κ) coefficients. Results: Students were less likely to affirm each item on paper-and-pencil questionnaires. Percent agreement ranged from 71.2% to 96.9% across items, and κ coefficients ranged from poor to fair. FI prevalence differed by 15% between online and paper-and-pencil assessments (40.9% and 25.8%, respectively). Percent agreement for FI categorization was 75.8% and κ=0.47. Conclusions: Differing survey modalities resulted in varying FI classifications in a sample of under-graduate students. Though limited by size and representativeness, this supports the need for further testing of FI surveys, as accurate FI estimates are essential to serving college students.

Food Insecurity among College Students in the United States: A Scoping Review.

Reports of college students experiencing food insecurity (FI), defined as inadequate access, availability, adequacy, and stability of food, have sparked national calls for alleviation and prevention policies. However, there are a wide variety of FI rates reported across studies and even among recent literature reviews. The current scoping review aimed to develop a weighted estimated prevalence of FI among US students using a comprehensive search approach. In addition, study characteristics that may be related to the high variability in reported FI prevalence were explored. To address these aims, the peer-reviewed and gray literature on US college student FI was systematically searched to identify 12,044 nonduplicated records. A total of 51 study samples, across 62 records, met inclusion criteria and were included in the current review. The quality of the included studies was moderate, with an average rate of 6.4 on a scale of 0-10. Convenience (45%) and census (30%) sampling approaches were common; only 4 study samples were based on representative sampling strategies. FI estimates ranged from 10% to 75%. It was common for very low security to be as prevalent as, or more prevalent than, low food security. The surveying protocols used in the studies were related to the FI estimates. The USDA Short Form Food Security Survey Module (FSSM; 50%) and the USDA Adult FSSM (40%) prevalence estimates were larger than for the full USDA Household FSSM (13%). When these surveys referenced a 12-mo period, FI estimates were 31%. This was a lower FI estimate than surveys using reference periods of 9 mo or shorter (47%). The results indicate that FI is a pressing issue among college students, but the variation in prevalence produced by differing surveys suggests that students may be misclassified with current surveying methods. Psychometric testing of these surveys when used with college students is warranted.

Implementation and Evaluation of the Abriendo Caminos Program: A Randomized Control Trial Intervention for Hispanic Children and Families.

OBJECTIVE: To describe the methodology of a family-focused, culturally tailored program, Abriendo Caminos, for the prevention of excess weight gain in children. DESIGN: Randomized control trial with outcome assessment at pretest, posttest, and 6 months after intervention or abbreviated-attention control group. SETTING: Community setting across 5 sites (Illinois, California, Iowa, Texas, and Puerto Rico). PARTICIPANTS: Mexican American and Puerto Rican families (parent and 1 child aged 6-18 years). A sample size of 100 families (50 intervention and 50 control) per site (n = 500) will provide adequate power to detect intervention effects. INTERVENTION: Families will participate in 6 weekly, 2-hour group workshops on nutrition education through combined presentations and activities, family wellness, and physical activity. MAIN OUTCOME MEASURES: The primary outcome is prevention of excess weight gain in children; secondary outcomes include changes in child diet, specifically fruit, vegetable, and sugar-sweetened beverage consumption, and changes in parents' diets and improvement of family routines. Measures will be collected at baseline, postintervention, and 6 months after. ANALYSIS: Modeling to assess changes within and between experimental groups will be checked using standard methods including assessment of model fit, influence diagnostics, adjusted R2, and multicollinearity. Significance of effects will be examined using Type III tests.

Promoting Cooking, Nutrition, and Physical Activity in Afterschool Settings.

Objective: In this study, we evaluated the afterschool PAWS (Peer-education About Weight Steadiness) Club program delivered by peer or adult educators to improve food choices, physical activity, and psychosocial variables related to healthy eating. Methods: We had 109 adolescents (53 in adult-led group; 56 in peer-led group) participate in a cluster randomized controlled intervention. The 12-session curriculum framed within Social Cognitive Theory (SCT) and Stages of Change addressed mediators of behavior change related to cooking skills, food intake, and physical activity. Anthropometric, dietary intake, physical activity, and SCT mediators were assessed at baseline, post-intervention, and 6-months post-intervention. Results: Adolescents in the peer-led group significantly improved whole grain intake at post-intervention (p = .017) and 6-months post-intervention (p = .014). Both peer-led and adult-led groups had significant reductions in caloric intake at 6-months post-intervention (p = .047). Only the adult-led group improved self-efficacy (SE) and social/family support (SS) for healthy eating at post-intervention [p = .019 (SE); p = .048 (SS)] and 6-months post-intervention [p = .036 (SE); p = .022 (SS)]. Conclusions: The PAWS Club program promoted lower caloric intake by adolescents. Peer educators were effective at increasing whole grains in adolescents, and adult educators contributed to positive changes in SE and SS related to healthy eating.

College students' interpretations of food security questions: results from cognitive interviews.

BACKGROUND: Food insecurity (FI) - the lack of sufficient access to food to maintain a healthy lifestyle - among college (i.e. post-secondary or higher education institution) students has become a prominent issue in the U.S. However, it is not clear if high rates of FI among students are due to the modern experience in higher education institutions or due to underlying issues in common surveying methods. To understand if there were underlying content validity issues, the present study had two primary research questions: 1) How do students interpret the U.S. Department of Agriculture (USDA) Food Security Survey Module (FSSM) questionnaire items, and 2) How do responses of students experiencing FI compare with the theorized experiences and coping responses? METHODS: Thirty-three undergraduate students, aged 18- to 24-years old and fluent in English were recruited from a single 4-year university. During a 60-min session, participants completed the 10-item Adult FSSM and then were cognitively interviewed about their responses using the think-aloud method. Interview transcripts were analysed by two researchers using a collaborative process and basic interpretative approach. RESULTS: Students were on average 19.5 years old (± 1.2 years), the majority were in their freshman or sophomore (i.e., first or second) year, and 67% (n = 22) experienced FI. Results indicated that students' interpretations of key terms - such as "money for more," "balanced meals," and "real hunger" - diverge from expectations. Furthermore, students categorized as food insecure reported experiences and responses to FI that varied from theoretical dimensions of the process. CONCLUSIONS: Though limited by sample size and representativeness, the present results indicate that the content validity of the FSSM may be compromised in this population and the managed process of FI may present differently among college students. Further psychometric research on modifications to the FSSM or with new FI assessment tools should be conducted with college students.

Impact of Beef and Beef Product Intake on Cognition in Children and Young Adults: A Systematic Review.

(1) Background: Undernutrition and micronutrient deficiency have been consistently linked to cognitive impairment among children and young adults. As a primary source of dietary animal protein, beef consumption holds the potential to improve diet quality and positively influence cognitive function. This study systematically reviewed evidence linking beef intake to cognition among children and young adults. (2) Methods: A literature search was conducted in seven electronic bibliographic databases for studies assessing the impact of beef consumption on cognition. (3) Results: We identified eight studies reporting results from five unique interventions. Two interventions were conducted in Kenya, two in the U.S. and one in four countries including Guatemala, Pakistan, Democratic Republic of the Congo and Zambia. Only one intervention employed a non-feeding control arm and found beef consumption to improve cognitive abilities compared to the control. However, the other interventions comparing beef consumption to other food types found no consistent result. (4) Conclusions: Evidence pertaining to the impact of beef consumption on cognition remains limited due to the small and heterogeneous set of studies. Future research should adopt a population representative sample and longer follow-up period, employ a non-feeding control arm and comprehensively measure nutrient intakes among study participants.

Fresh and Fresh Lean Beef Intake in Relation to Functional Limitations among US Older Adults, 2005-2016.

Objectives: In this study, we assessed fresh and fresh lean beef intake in relation to functional limitations among US adults 65 years and older. Methods: We conducted logistic regressions on individual-level 24-hour dietary recall and health indicator data (N = 6135) retrieved from 2005-2016 National Health and Nutrition Examination Survey. Results: Approximately 51%, 14%, and 9% of older adults consumed beef, fresh beef, and fresh lean beef, respectively. Daily increase in fresh beef consumption by one-ounce-equivalent was associated with a reduction in the odds of lower extremity mobility limitation (LEM) by 16% (95% confidence interval [95% CI]: 4%-27%), general physical activities limitation by 13% (95% CI: 1%-24%), and any functional limitation by 14% 95% CI: (2%-24%). Daily increase in fresh lean beef consumption by one-ounce-equivalent was associated with a reduction in the odds of LEM by 22% (95% CI: 7%-34%) and any functional limitation by 15% (95% CI: 1%-28%). We identified no association with activities of daily living, instrumental activities of daily living, or leisure and social activities limitations. Conclusions: Preliminary evidence links fresh and fresh lean beef consumption to reduced functional limitation risk. Future studies with longitudinal/experimental design are warranted to examine the relationship between fresh/lean beef consumption and functional limitations among older adults.

Are estimates of food insecurity among college students accurate? Comparison of assessment protocols.

A growing body of literature suggests that post-secondary students experience food insecurity (FI) at greater rates than the general population. However, these rates vary dramatically across institutions and studies. FI assessment methods commonly used in studies with college students have not been scrutinized for psychometric properties, and varying protocols may influence resulting FI prevalence estimates. The objective of this study was to assess the performance of standard food security assessment protocols and to evaluate their agreement as well as the relative accuracy of these protocols in identifying student FI. A randomized sample of 4,000 undergraduate students were invited to participate in an online survey (Qualtrics, LLC, Provo, Utah, USA) that evaluated sociodemographic characteristics and FI with the 2-item food sufficiency screener and the 10-item USDA Adult Food Security Survey Module (FSSM; containing the abbreviated 6-item module). Four hundred sixty-two eligible responses were included in the final sample. The psychometric analysis revealed inconsistencies in college student response patterns on the FSSM when compared to national evaluations. Agreement between FI protocols was generally high (>90%) but was lessened when compared with a protocol that incorporated the 2-item screener. The 10-item FSSM with the 2-item screener had the best model fit (McFadden's R2 = 0.15 and Bayesian Information Criterion = -2049.72) and emerged as the tool providing the greatest relative accuracy for identifying students with FI. Though the 10-item FSSM and 2-item screener yields the most accuracy in this sample, it is unknown why students respond to FSSM items differently than the general population. Further qualitative and quantitative evaluations are needed to determine which assessment protocol is the most valid and reliable for use in accurately identifying FI in post-secondary students across the U.S.

Total, Fresh, Lean, and Fresh Lean Beef Consumption in Relation to Nutrient Intakes and Diet Quality among U.S. Adults, 2005⁻2016.

(1) Background: This study assessed the influence of beef consumption on nutrient intakes and diet quality among U.S. adults. (2) Methods: Nationally-representative sample (n = 27,117) from 2005⁻2016 National Health and Nutrition Examination Survey was analyzed. First-difference estimator addressed confounding bias from time-invariant unobservables (e.g., eating habits, taste preferences) by using within-individual variations in beef consumption between 2 nonconsecutive 24 h dietary recalls. (3) Results: Approximately 54%, 39%, 12%, and 7% of U.S. adults consumed beef, lean beef, fresh beef, and fresh lean beef, respectively. Overall diet quality measured by the Health Eating Index-2015 (HEI-2015) score among beef, fresh beef, lean beef, and fresh lean beef consumers was lower than beef non-consumers. Regression analyses found that beef, fresh beef, lean beef, and fresh lean beef consumption was associated with higher daily intakes of total energy, protein, sodium, choline, iron, selenium, zinc, phosphorus, and multiple B vitamins. Beef, fresh beef, and lean beef consumption but not fresh lean beef consumption was associated with higher saturated fat intake. Beef consumption was not found to be associated with overall dietary quality measured by the HEI-2015 score. (4) Conclusions: Beef consumers may increase the intake of fresh and lean beef over total beef consumption to maximize the nutritional gains from beef portions while minimizing the resulting increases in energy, saturated fat, and sodium.

Grit is Associated with Food Security among US Parents and Adolescents.

Objectives: We investigated whether the Short Grit Scale (Grit-S) predicted odds of food insecurity (FI) among adults and their children. Methods: A cross-sectional panel of parent-child dyads completed an online questionnaire. Eligible dyads included parents with household income below the 2015 median ($52,250 USD/year) and their self-selected household child between the ages of 13 to 17 years. An online questionnaire assessed: (1) FI using the 18-item Household Food Security Survey Module and the Food Security Survey Module for Youth; (2) perseverance and determination using the validated 8-item Grit-S; and (3) sociodemographic FI predictors. Logit regression models estimated the relationship between odds of FI and predictors among parents and children, separately. Results: Among 252 parents, 61.1% reported household FI. Parents' Grit-S score (N = 179) was associated with a significantly lower odds of household FI (OR= 0.4; 95%CI= 0.2, 0.8; p < .01) while adjusting for established predictors. Mean (±SD) Grit-S was 3.1 (±0.7). Children's Grit-S score (N = 178) was associated with a significantly lower odds of child FI (OR= 0.6; 95%CI= 0.4, 0.9; p < .05) while adjusting for established predictors. Conclusions: Perseverance and determination, also known as "grit," may be one further explanation for why some poor households are food secure.

Wasted food: A qualitative study of U.S. young adults' perceptions, beliefs and behaviors.

U.S. consumers, namely young adults, are one of the largest sources of preventable food waste. However, the antecedents of wasted food among young adults in the U.S. are unknown. This study aimed to explore the perceptions, beliefs and behaviors related to wasted food among 18- to 24-year-old adults. Fifty-eight individuals (63.8% female) with an average age of 20.2 y (±1.6) who lived in a residence where they had control over some food purchases (excluding co-op or other communal housing, and living with parents) participated in 75-min focus groups during spring of 2016. Thirty participants lived in residence halls at a university and the remaining 28 lived in off-campus dwellings. Focus group transcriptions were analyzed for themes by two investigators using a constant-comparative approach. Inductive thematic analyses provided insights that were broadly categorized into: 1) awareness and knowledge of wasted food, 2) factors that influence food waste behaviors, and 3) suggested interventions to reduce wasted food. Results provide evidence of heterogeneity in perceptions, beliefs, and behaviors related to wasted food based on dwelling type. Insights from the current study may be used to inform observational or intervention work focused on reducing wasted food by young adults.

Exploring the association of urban or rural county status and environmental, nutrition- and lifestyle-related resources with the efficacy of SNAP-Ed (Supplemental Nutrition Assistance Program-Education) to improve food security.

OBJECTIVE: To investigate the association of policy, systems and environmental factors with improvement in household food security among low-income Indiana households with children after a Supplemental Nutrition Assistance Program-Education (SNAP-Ed) direct nutrition education intervention. DESIGN: Household food security scores measured by the eighteen-item US Household Food Security Survey Module in a longitudinal randomized and controlled SNAP-Ed intervention study conducted from August 2013 to April 2015 were the response variable. Metrics to quantify environmental factors including classification of urban or rural county status; the number of SNAP-authorized stores, food pantries and recreational facilities; average fair market housing rental price; and natural amenity rank were collected from government websites and data sets covering the years 2012-2016 and used as covariates in mixed multiple linear regression modelling. SETTING: Thirty-seven Indiana counties, USA, 2012-2016. SUBJECTS: SNAP-Ed eligible adults from households with children (n 328). RESULTS: None of the environmental factors investigated were significantly associated with changes in household food security in this exploratory study. CONCLUSIONS: SNAP-Ed improves food security regardless of urban or rural location or the environmental factors investigated. Expansion of SNAP-Ed in rural areas may support food access among the low-income population and reduce the prevalence of food insecurity in rural compared with urban areas. Further investigation into policy, systems and environmental factors of the Social Ecological Model are warranted to better understand their relationship with direct SNAP-Ed and their impact on diet-related behaviours and food security.

Peer-Led Culinary Skills Intervention for Adolescents: Pilot Study of the Impact on Knowledge, Attitude, and Self-efficacy.

OBJECTIVE: To assess the impact and feasibility of a culinary skills intervention for adolescents led by peer educators compared with adult educators. METHODS: Adolescents (aged 11-14 years) were randomized to peer educator (n = 22) or adult educator (n = 20) groups and attended 2 2.5-hour culinary skills lessons addressing knife skills, cooking methods, and recipes. Knowledge, attitude, and self-efficacy measurements were completed before and immediately after the intervention and at 3 and 6 months after the intervention. Fidelity checklists assessed the feasibility of program delivery. Differences within and between groups over time were assessed using ANOVA. RESULTS: Adolescents (n = 42) increased knowledge (3.7 ± 2.6 points [mean ± SD]; P < .001), attitude (0.8 ± 4.5; P < .05), and self-efficacy of cooking (2.6 ± 5.3; P < .001) and cooking method (1.7 ± 4.6; P < .01) after intervention. Peer and adult educators were equally able to deliver the intervention. CONCLUSIONS AND IMPLICATIONS: Peers and adults can feasibly lead a culinary skills program for adolescents that increases knowledge. To affect attitude and self-efficacy, additional training of peer educators may be needed.

Feasibility of a Grocery Store Tour for Parents and Their Adolescents: A Randomized Controlled Pilot Study.

OBJECTIVE: To evaluate the feasibility of a grocery store tour for parents and their adolescents being led by adults or adolescent peers. DESIGN: Randomized controlled pilot study with surveys at baseline and post-program, and at 3- and 6-month follow-up. SETTING: Midwestern midsized grocery stores. PARTICIPANTS: Sixty-one parents and their 71 11- to 14-year-old adolescents. INTERVENTION: Nutrition education during 1 90-minute grocery store tour. MAIN OUTCOME MEASURES: Process observations and participants' tour perceptions provided fidelity outcomes. Questionnaires quantitatively assessed participants' knowledge, self-efficacy, and tour strategy use. ANALYSIS: Chi-square and McNemar tests were used to analyze categorical data, and Kruskal-Wallis, Wilcoxon signed-rank, and Mann-Whitney U tests were employed for continuous variables (significance at P < .05). RESULTS: Over 90% of tour tasks were rated as completed well for adult and peer leaders. Participants had positive tour perceptions but noted deficiencies in teen leaders' knowledge and leadership skills. Overall, parents and adolescents retained increased self-efficacy from pre-tour to post-tour intervals. Despite limited knowledge retention, parents reported they had increased (6.5 ± 4.19) healthful grocery shopping behaviors in the 6 months after the intervention. CONCLUSIONS AND IMPLICATIONS: Peers may feasibly lead grocery store tours but they may need additional resources and support to be highly effective.

Influence of seasoning on vegetable selection, liking and intent to purchase.

Low vegetable intake continues to be a health concern, and strategies to increase vegetable intake have resulted in only small increases. One strategy that has received less attention is the use of seasonings. This study's objective was to determine the impact of seasoning on vegetable selection, liking, and intent to purchase. We conducted a 3-week study in a public café on a university campus. Customers buying a main dish could select a vegetable side (seasoned [SS] or steamed [ST]) at no cost. Based on café data and power analysis (alpha 0.05, 80% power), 2 days per vegetable pair were conducted with carrot, broccoli, and green bean pairs randomized 3 days/week 1 and 3, with normal service week 2. Selection was greater for SS vs ST, n = 335 vs. 143 for all 3 vegetables combined; n = 97 vs 47 for carrots; n = 114 vs. 55 for broccoli; n = 124 vs. 41 for green beans (p < 0.001 Chi-Square). Liking responses were similar for SS vs ST and were high for all vegetables. Response distribution was not significantly different for SS vs ST vegetables when people were asked if they would purchase the vegetable that they selected. More customers chose the 'somewhat likely' and 'very likely' (n = 353) than the 'not likely' and 'definitely would not' (n = 121) purchase responses. Regression showed that people who did not often consume a vegetable with lunch while dining out were 1.59 times more likely to select the SS vegetables over the ST (p = 0.007). Given a choice, consumers were more likely to select a seasoned vegetable. With low vegetable consumption as a predictor of seasoned vegetable choice, offering seasoned vegetables may increase intake in those with poor vegetable intake in a café setting.