Community adaptations to an impending food desert in rural Appalachia, USA.

INTRODUCTION: The United States Department of Agriculture (USDA) describes a food desert as an urban neighborhood or rural town without ready access to fresh, healthy, and affordable food. An estimated 2.3 million rural Americans live in food deserts. One goal of the USDA is to eliminate food deserts. However, at a time when some food deserts are being eliminated, hundreds of grocery stores are closing, causing other food deserts to arise. The literature is scarce on how a community adapts to an impending food desert. Alderson, West Virginia, USA (population 1184) rallied to face an impending food desert when the only grocery store in town closed in December 2014. This study investigated how this small rural community adapted to its oncoming food desert. METHODS: A community member survey was administered to 155 Alderson families (49%) to determine how the new food desert affected family food acquisition and storage behaviors. A restaurant survey was given to the town's four restaurants to determine how the food desert affected their businesses. Sales data for a new food hub (Green Grocer) was obtained to see if this new initiative offset the negative effects of the food desert. ANOVA and t-tests were used to compare group numerical data. Two group response rates were compared by testing the equality of two proportions. Categorical data were analyzed with the χ2 or frequency distribution analysis. Group averages are reported as mean ± standard error of the mean. Significance for all analyses was set at p<0.05. RESULTS: Even though 86% of the population shopped at the new Green Grocer, 77% did most of their shopping at a store at least 17.7 km (11 miles) from home. The number of long-distance monthly shopping trips made after the food desert (3.3±0.4) did not change significantly (p=0.16) from the number before the food desert (2.8±0.3). Price comparisons among the Green Grocer and three distant supermarkets showed a 30% savings by traveling to distant supermarkets. Frequency of monthly restaurant visits did not change after the emergence of the food desert (2.98±0.54 vs 3.05±0.51, p=0.85). However, restaurant patrons requested to buy fresh produce and dairy from the restaurants to use for their own home cooking. Food pantry use increased by 43%, with community members requesting more fresh produce, meat, and dairy. The food desert triggered a 21% increase in home gardening and an 11% increase in home food preservation. CONCLUSIONS: Opening a Green Grocer offset only some of the effects of the food desert, because community members use it as a convenience store to purchase fresh produce and dairy products that families may lack before their next long-distance trip to a supermarket. Alderson's low-income residents now rely more heavily on food pantry assistance, while a small number of other residents have started gardening and food preservation. The first factor governing food acquisition behavior in rural Appalachia is food pricing, with the proximity of food access coming in second. How to overcome these two major barriers to food security in the midst of current economics and marketing remains to be answered.

Misconceptions about health and disease prevention behaviors of rural Appalachian Americans.

BACKGROUND: Appalachia is one of the unhealthiest regions in the United States due to poor disease prevention behaviors. OBJECTIVE: Determine if self-perceived health of rural Appalachians is related to participation in disease prevention behaviors. METHODS: Rural Appalachian adults (n=437) were surveyed regarding their self-perceived health and disease prevention behaviors. Healthy behaviors included: moderate (≥ 90 min/wk) and vigorous (≥ 45 min/wk) physical activity, sugared drink consumption (≤ 1 sugared drink/d), smoking (non-smoker), alcohol consumption (≤ 1 drink/d), blood pressure (≤ 120/80 mm Hg), and fast food consumption (≤ 1 time/wk). Participants were grouped where healthy = (self-health rating > 5 on a 0-10 scale), BMI < 25, and blood pressure (≤ 120/80 mm Hg). Jaccard Binary Similarity (JBS) coefficients and Russell and Rao (RR) dichotomy coefficients determined the association and predictability of self-health ratings and disease prevention behaviors. T-tests determined group differences in the number of disease prevention behaviors. RESULTS: Individuals who reported being healthy had high JBS coefficients for having healthy sugared drink consumption (0.552), not smoking (0.704), low alcohol consumption (0.742), and low fast food consumption (0.481). RR results were similar to JBS results. Not smoking and low alcohol consumption were highly correlated (r=0.87). Those with a good health perception practiced more disease prevention behaviors (mean±SEM, 2.84±0.06) than those with a poor health perception (2.19±0.10, p<0.001). Good health perceptions were not strongly related to obesity and inactivity. CONCLUSIONS: Appalachians are not indifferent about their health. However, Appalachians may not understand how inactivity and obesity relate to disease.

Activity patterns and perceptions about active transport to school.

OBJECTIVES: To document physical activity patterns and perceptions about active transport to school. METHODS: Children's activity was measured. Children and parents were surveyed about active transport to school. RESULTS: Children were most active after (465 ± 20 cpm) and least active before (379 ± 18 cpm) and during school (351 ± 13 cpm). Weight was not related to activity. Boys were more confident than girls, whereas parents felt more confident than children did about active transport. CONCLUSIONS: Active transport programs will likely have a greater impact on before-school activity than after school. Perceptions concerning active transport should be assessed, and parent/child discrepancies rectified prior to program implementation.

After-school physical activity and eating behaviors of middle school students in relation to adult supervision.

OBJECTIVE: Examine after-school activity patterns, eating behaviors, and social environment of overweight and normal weight middle school students. DESIGN: Eating and physical activity behaviors of 141 students, ages 10-14, were monitored. Students completed a diary documenting type of activity, location, adult supervision, accompanying participants, and eating habits from 3:00 pm-12:00 am. SETTING: Three middle schools, grades 6-8. MAIN OUTCOME MEASURES: Body mass index, estimated energy expenditure, eating behavior, active time, sedentary time, supervised time. ANALYSIS: t tests, ANOVA, chi-square, correlation coefficients. Significance set at P < .05. RESULTS: Children spent 76% of time sedentary, and 85% of sedentary time was under adult supervision (r = 0.76). Active time related to time with friends (r = 0.64) and family (r = 0.46). Children spent 40% of eating time consuming unhealthful food, and adults supervised 86% of children's eating. Overweight and normal weight children were similarly active (335 ± 156 vs 373 ± 194 counts per minute). Overweight girls spent more eating time (77%) eating healthfully than overweight boys (57%). CONCLUSIONS AND IMPLICATIONS: Children should be given access to healthful food and encouraged to eat healthfully when alone and with friends. Adults should be more physically engaged with children. Children should be encouraged to eat under adult supervision and with their families.

Self-rated health in rural Appalachia: health perceptions are incongruent with health status and health behaviors.

BACKGROUND: Appalachia is characterized by poor health behaviors, poor health status, and health disparities. Recent interventions have not demonstrated much success in improving health status or reducing health disparities in the Appalachian region. Since one's perception of personal health precedes his or her health behaviors, the purpose of this project was to evaluate the self-rated health of Appalachian adults in relation to objective health status and current health behaviors. METHODS: Appalachian adults (n = 1,576) were surveyed regarding health behaviors - soda consumer (drink ≥ 355 ml/d), or non-consumer (drink < 355 ml/d), fast food consumer (eating fast food ≥ 3 times/wk) or healthy food consumer (eating fast food < 3 times/wk), smoking (smoker or non-smoker), exercise (exerciser > 30 min > 1 d/wk) and sedentary (exercise < 30 min 1 d/wk), blood pressure medication (yes, no), and self-rated health. Blood pressure was measured through auscultation and serum cholesterol measured via needle prick. Weight status was based on BMI: normal weight (NW ≥ 18.5 and < 25.0), overweight (OW ≥ 25.0 and < 30.0), and obese (OB ≥ 30.0). Jaccard Binary Similarity coefficients, odds ratios, chi-square, and prevalence ratios were calculated to evaluate the relationships among self-rated health, objective health status, and health behaviors. Significance was set at p < 0.05. RESULTS: Respondents reported being healthy, while being sedentary (65%), hypertensive (76%), overweight (73%), or hyperlipidemic (79%). Between 57% and 66% of the respondents who considered themselves healthy had at least two disease conditions or poor health behaviors. Jaccard Binary Similarity coefficients and odds ratios showed the probability of reporting being healthy when having a disease condition or poor health behavior was high. CONCLUSIONS: The association between self-rated health and poor health indicators in Appalachian adults is distorted. The public health challenge is to formulate messages and programs about health and health needs which take into account the current distortion about health in Appalachia and the cultural context in which this distortion was shaped.

Attitudes of overweight and normal weight adults regarding exercise at a health club.

OBJECTIVE: To compare attitudes of overweight (OW) and normal weight (NW) adults regarding health club exercise. DESIGN: A 46-item survey (23 pairs of attitude/value statements) measured attitudes toward exercising at a health club 30 minutes, twice a week, for a month. SETTING: Survey posted on surveymonkey.com. Respondents (men = 730, women = 822). MAIN OUTCOME MEASURES: Attitudes toward exercise, exercise intent. ANALYSIS: t tests, Mann-Whitney rank sum, 2-way analysis of variance, Pearson rank correlations. Significance set at P < .05. RESULTS: More than NW, OW believe exercise improves appearance (P < .001) and self image (P < .03). OW feel more embarrassed and intimidated about exercising, exercising around young people, exercising around fit people, and about health club salespeople than NW (P < .001). OW and NW feel the same about exercising with the opposite sex, complicated exercise equipment, exercise boredom, and intention to exercise. Age rather than weight affects exercise intent. OW Caucasians (C) have less exercise intent than OW non-C. OW women are more embarrassed about exercising than NW women and OW men. The heavier the subject's weight, the lower his or her perception of health (r = -0.53, P < .001). CONCLUSIONS AND IMPLICATIONS: Increasing the OW person's positive beliefs while decreasing negative beliefs about health club exercise will improve his or her intent to exercise at a health club.

Body weight and perceived social pressure to exercise at a health club.

OBJECTIVE: To determine the social pressure overweight (OW, n=1183) and normal-weight (NW, n=550) adults perceive regarding health club exercise. METHODS: A 12-item survey, based on the theory of reasoned action and theory of planned behavior, measured subjective norm toward exercising at a health club 30 min, twice a week, for the next month. RESULTS: OW feel more social pressure to exercise at a club than do NW, but motivation to comply is the same between groups. CONCLUSIONS: Exercise interventions for OW should capitalize on individual perceived social pressures to exercise by designing strategies to increase motivation to comply with these pressures.

Effects of caloric restriction and overnight fasting on cycling endurance performance.

In addition to aerobic endurance and anaerobic capacity, high power-to-weight ratio (PWR) is important for cycling performance. Cyclists often try to lose weight before race season to improve body composition and optimize PWR. Research has demonstrated body fat-reducing benefits of exercise after fasting overnight. We hypothesized that fasted-state exercise in calorie-restricted trained cyclists would not result in performance decrements and that their PWR would improve significantly. We also hypothesized that substrate use during fasted-state submaximal endurance cycling would shift to greater reliance on fat. Ten trained, competitive cyclists completed a protocol consisting of baseline testing, 3 weeks of caloric restriction (CR), and post-CR testing. The testing sessions measured pre- and post-CR values for resting metabolic rate (RMR), body composition, VO2, PWR and power-to-lean weight ratio (PLWR), and power output, as well as 2-hour submaximal cycling performance, rating of perceived exertion (RPE), and respiratory exchange ratio (RER). There were no significant differences between baseline and post-CR for submaximal trial RER, power output, VO2, RMR, VO2max, or workload at VO2max. However, RPE was significantly lower, and PWR was significantly higher post-CR, whereas RER did not change. The cyclists' PWR and body composition improved significantly, and their overall weight, fat weight, and body fat percentage decreased. Lean mass was maintained. The cyclists' RPE decreased significantly during 2 hours of submaximal cycling post-CR, and there was no decrement in submaximal or maximal cycling performance after 3 weeks of CR combined with overnight fasting. Caloric restriction (up to 40% for 3 weeks) and exercising after fasting overnight can improve a cyclist's PWR without compromising endurance cycling performance.

Use of a weight loss index for evaluating weight management in adults.

OBJECTIVE: A quantitative method for evaluating weight loss using the body mass index (BMI) standard 25, during part or the entire weight loss continuum, was designed and tested. DESIGN: Weight Loss Index (WLI) represents the area under the curve of the graphical representation of the weight loss attempt; x-axis=time, y-axis=BMI, BMI standard=25.0. SETTING: Reliability of the WLI for 1-5 years of weight loss efforts in 50 overweight (BMI=39.1+/-7.6) patients was evaluated by comparing their calculated WLI to a weight loss ratio, derived using a traditional 2-point comparison. Weight Loss Index sensitivity was tested by sending weight loss scenarios to obesity experts, who were asked to rank success of each weight loss attempt within a scenario. Expert rankings were compared to WLI rankings. VARIABLES MEASURED: Age, weight, height, BMI, WLI. ANALYSIS: Dependent t-test for WLI versus pre-post BMI values. Spearman's correlation coefficients for WLI versus expert rankings. Significance, P<.05. RESULTS: Weight Loss Index better described weight loss attempts for overweight adults than did traditional 2-point comparisons. Obesity experts could not distinguish differences in weight loss success among patients with fluctuating weights, but the WLI categorically ranked these individuals. CONCLUSIONS AND IMPLICATIONS: Using the WLI, researchers and clinicians can compare the weight loss attempts within an individual, among individuals, and among groups of individuals against the standard BMI reference of 25.0.

The weight-loss-at-any-cost environment: how to thrive with a health-centered focus.

Although scientists are supposed to be objective and unbiased, and science itself is held as the epitome of objectivity, scientists often force data to fit their preexisting paradigm or deny the existence of data that fall outside their paradigm. The Health At Every Size (HAES) paradigm lies outside the traditional obesity treatment paradigm. However, there are ample data to support the notion that people can be healthy at every size and that weight loss is not necessary for improved health. This article explains how each of us who remains surrounded by the weight-loss-at-any-cost environment can implement HAES practices into our work without additional investment of resources. Techniques are discussed as to how we can incorporate measures other than weight and size into our treatment outcomes, how we can be open-minded to research and clinical practices that are outside our preconceived notions of how things should be, how we can rid ourselves of the assumption that everyone responds to treatment in the same manner, how we can explore clients' feelings to discover the root of their behaviors, and how we can go beyond teaching clients how to behave and teach them how to change behavior.

Effects of exercise on vasodilatory capacity in endurance- and resistance-trained men.

To determine vasodilatory responsiveness we measured forearm blood flow (FBF) following reactive hyperemia (RH), prior to and following a bout of maximal aerobic exercise in endurance- (n=14) and resistance-trained men (n=10). Both groups were similar in height, body mass, and percentage body fat. Using strain-gauge plethysmography, resting FBF was higher in the resistance-trained group [4.82 (0.84) vs 3.33 (1.17) ml min(-1) 100 ml(-1) of tissue; P<0.05]. However, the resistance-trained group had a 17%-29% lower pre-exercise FBF response to RH for the first 45 s (P<0.05). Following the maximal exercise bout there were no group differences in FBF. Post-exercise FBF was higher compared to pre-exercise values in both the endurance- (P<0.001) and resistance- (P<0.01) trained groups. Endurance-trained men appear to have a greater peak vasodilatory capacity compared to resistance-trained men, and acute maximal exercise increased the vasodilatory capacity in both groups. Acute exercise also equalized the peak vasodilatory response between the endurance- and resistance-trained groups, suggesting the potential for flow-mediated vasodilatation was similar for both groups.

Effects of clothing on accuracy and reliability of air displacement plethysmography.

PURPOSE: The purpose of this investigation was to quantify the effects of different attire on the accuracy and reliability of estimating percent body fat (%fat) by using air displacement plethysmography (ADP). METHODS: Fifteen adults were tested four times on four separate occasions. Each session consisted of estimating %fat with ADP wearing a swimsuit (ADP(SS)), a hospital gown (ADP(HG)), and in the nude (ADP(N)), plus assessment by hydrostatic weighing (HW). RESULTS: An ANOVA revealed no significant differences within any of the four methods over the 4 days. Intraclass correlation coefficients revealed a strong relationship for repeated measures in ADP(SS) (r = 0.981), ADP(HG) (r = 0.993), ADP(N) (r = 0.989), and HW (r = 0.976). Mean data for each condition indicated a significant underestimation (P < 0.05) of %fat while wearing a hospital gown (13.8 +/- 7.7%) compared with ADP(SS) (22.0 +/- 7.8%), ADP(N) (23.5 +/- 7.5%), and HW (22.6 +/- 6.8%). CONCLUSION: Reliability of ADP does not appear to be compromised by clothing; however, wearing a hospital gown significantly affects accuracy, reducing %fat estimations by approximately 9% compared with the recommended swimsuit. Measurement in the nude does not provide more reliable or accurate measures than wearing a swimsuit.

Variation in the anthropometric dimensions for estimating upper and lower body obesity.

A literature review identified 29 anthropometric methods to estimate body fat distribution, but no valid standardized set of criterion values to categorize upper and lower body obesity. The purpose of this investigation was to observe the influence of different anthropometric methods for categorizing upper and lower body obesity. Three common girth methods (waist:iliac crest, iliac crest: hip, and waist:hip) for waist to hip ratios (WHR) and one common skinfold method for trunk to extremity ratio were compared in 119 obese women (38.4 ± 5.3% fat) and 81 obese men (31.3 ± 5.2% fat). Significant differences were found in the WHR among all three girth methods for women, but for only the waist:hip method for men. A significant interaction between method and sex was also apparent. The different WHR methods resulted in a significantly different percentages of the population categorized as having lower, normal, and upper body obesity. Kappa statistics demonstrated significant agreement among the three methods to place subjects into similar fat distribution categories for men (κ = 0.133; z = 4.03), but not for women (κ = 0.059; z = 2.20). There was also no significant correlation between any of the circumference and skinfold methods for men (r = 0.20, 0.10 and 0.15, respectively); yet, significant correlations were found between the iliac crest:hip (r = 0.30) and waist:hip (r = 0.45) methods and the skinfold method for women. In summary, girth methods for estimating body fat distribution in terms of lower and upper body obesity need validation and standardization. © 1994 Wiley-Liss, Inc.