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Innovative Food and Nutrition Approaches to Promote Healthy Lifestyles and Reduce Disparities

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition and Public Health".

Deadline for manuscript submissions: closed (15 October 2021) | Viewed by 37088

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Prof. Dr. Jared T. McGuirt

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Guest Editor

Department of Nutrition, University of North Carolina at Greensboro, Greensboro, NC 27412, USA
Interests: multi-level community and clinical interventions; food access; retail food environment; digital technologies for nutrition education; GIS and spatial analysis; racial and geographic health disparities; rural health; implicit bias; systems and networks

Prof. Dr. Gina Tripicchio

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Co-Guest Editor

Center for Obesity Research and Education, Temple University, Philadelphia, PA 19140, USA
Interests: nutritional education; nutrition; child nutrition community nutrition; disease prevention; childhood/pediatric obesity

Special Issue Information

Dear Colleagues,

Health behaviours are influenced by complex interactions between interpersonal, social, and environmental factors. This complexity makes the modification of health-related behaviours and the adoption of a healthy lifestyle difficult for many to achieve. This is particularly the case for certain population groups who have unequal access to opportunities to learn about nutrition or adopt healthier lifestyles, which has led to concerning disparities in preventable diet-related disease outcomes. Complex issues require innovative solutions. To solve these issues, solutions may be needed that challenge norms and push the boundaries of current health promotion approaches. There has been a recent increase in the use of innovative solutions that create or leverage digital technologies, use systems science, and utilize big data analytics, among others. These types of disruptive innovations are creating new opportunities and value networks for promoting health, and may be necessary to ensure equal opportunity to a healthy lifestyle in the future.

If your research has conducted feasibility or impact testing of innovative approaches to promote healthy lifestyles and dietary habits, including among understudied populations experiencing health disparities, please consider including your work in this special Nutrients supplement: Innovative Food and Nutrition Approaches to Promote Healthy Lifestyles and Reduce Disparities.

Prof. Dr. Jared T. McGuirt
Guest Editor

Prof. Dr. Gina Tripicchio
Co-Guest Editor

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Keywords

innovation
digital technologies
nutrition
disparities

Published Papers (12 papers)

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Research

17 pages, 610 KiB

Open AccessArticle

Delivering Food Resources and Kitchen Skills (FoRKS) to Adults with Food Insecurity and Hypertension: A Pilot Study

by Rebecca L. Rivera, Mariah Adams, Emily Dawkins, Amy Carter, Xuan Zhang, Wanzhu Tu, Armando Peña, Richard J. Holden and Daniel O. Clark

Nutrients 2023, 15(6), 1452; https://doi.org/10.3390/nu15061452 - 17 Mar 2023

Cited by 2 | Viewed by 2896

Abstract

Food insecurity affects nearly 50 million Americans and is linked to cardiovascular disease risk factors and health disparities. The purpose of this single-arm pilot study was to determine the feasibility of a 16-week dietitian-led lifestyle intervention to concurrently address food access, nutrition literacy, cooking skills, and hypertension among safety-net primary care adult patients. The Food Resources and Kitchen Skills (FoRKS) intervention provided nutrition education and support for hypertension self-management, group kitchen skills and cooking classes from a health center teaching kitchen, medically tailored home-delivered meals and meal kits, and a kitchen toolkit. Feasibility and process measures included class attendance rates and satisfaction and social support and self-efficacy toward healthy food behaviors. Outcome measures included food security, blood pressure, diet quality, and weight. Participants (n = 13) were on average {mean (SD)} aged 58.9 ± 4.5 years, 10 were female, and 12 were Black or African American. Attendance averaged 19 of 22 (87.1%) classes and satisfaction was rated as high. Food self-efficacy and food security improved, and blood pressure and weight declined. FoRKS is a promising intervention that warrants further evaluation for its potential to reduce cardiovascular disease risk factors among adults with food insecurity and hypertension. Full article

(This article belongs to the Special Issue Innovative Food and Nutrition Approaches to Promote Healthy Lifestyles and Reduce Disparities)

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12 pages, 264 KiB

Open AccessArticle

Socioeconomic Inequalities Impact the Ability of Pregnant Women and Women of Childbearing Age to Consume Nutrients Needed for Neurodevelopment: An Analysis of NHANES 2007–2018

by Rachel Murphy, Keri Marshall, Sandra Zagorin, Prasad P. Devarshi and Susan Hazels Mitmesser

Nutrients 2022, 14(18), 3823; https://doi.org/10.3390/nu14183823 - 16 Sep 2022

Cited by 4 | Viewed by 2176

Abstract

Adequate consumption of nutrients that support infant neurodevelopment is critical among pregnant women and women of childbearing age. Understanding the potential effects of socioeconomic inequalities on nutrient gaps in these life stages is thus important for informing strategies to mitigate negative health consequences. Usual intake (foods and dietary supplements) of neurodevelopment-related nutrients was determined from 24 h recalls among women of childbearing age and pregnant women (20–44 years) using data from 2007–2018 NHANES. Usual intake was compared across household food security, poverty-to-income ratio (PIR), and household participation in federal food and nutrition assistance programs. Intake of EPA + DHA was universally low with >95% of all women (pregnant and non-pregnant) below the DGA recommendation from foods alone. Women in households that participated in the Supplemental Nutrition Assistance Program had a significantly lower intake of multiple nutrients relative to those who did not participate. For example, 50% had intakes below the estimated average requirement (EAR) for vitamin A (versus 32%), 42% were below the EAR for calcium (versus 33%) and 65% were below the EAR for magnesium (versus 42%). Similar gradients were observed by PIR and household food security, and among pregnant women whereby gaps were more evident in those experiencing socioeconomic inequalities. The use of dietary supplements attenuated shortfalls for most nutrients. These findings highlight a critical need to support the nutritional requirements for women of childbearing age and pregnant women. Full article

(This article belongs to the Special Issue Innovative Food and Nutrition Approaches to Promote Healthy Lifestyles and Reduce Disparities)

13 pages, 252 KiB

Open AccessArticle

A Produce Prescription Program in Eastern North Carolina Results in Increased Voucher Redemption Rates and Increased Fruit and Vegetable Intake among Participants

by Mary Jane Lyonnais, Ann P. Rafferty, Susannah Spratt and Stephanie Jilcott Pitts

Nutrients 2022, 14(12), 2431; https://doi.org/10.3390/nu14122431 - 11 Jun 2022

Cited by 2 | Viewed by 2099

Abstract

Few produce prescription programs have taken place in rural areas, in the context of existing public health programs. Thus, the purpose of this mixed-methods study was to examine voucher redemption rates, change in fruit and vegetable intake, and suggestions for improvement among participants enrolled in a produce prescription program occurring in existing public health programs throughout rural eastern North Carolina. We examined voucher redemption rates and conducted pre- (n = 125) and post-intervention surveys assessing fruit and vegetable intake. t-tests were used to examine changes in intake pre- versus post-intervention among 50 participants. Participants (n = 32) also completed a semi-structured, telephone interview. Qualitative data were thematically analyzed to determine potential improvements. The overall voucher redemption rate was 52%. There was a 0.29 (standard deviation = 0.91, p = 0.031) cup increase in self-reported fruit intake comparing post- to pre-intervention data. Qualitative analyses indicated that participants enjoyed the financial benefits of the program and wanted it to continue. The produce prescription program was successful in increasing self-reported fruit intake among participants. More research is needed to determine if changes in intake persist when measured objectively, and on best methods for the program’s financial sustainability. Full article

(This article belongs to the Special Issue Innovative Food and Nutrition Approaches to Promote Healthy Lifestyles and Reduce Disparities)

12 pages, 1351 KiB

Open AccessArticle

EatWellNow: Formative Development of a Place-Based Behavioral “Nudge” Technology Intervention to Promote Healthier Food Purchases among Army Soldiers

by Jared T. McGuirt, Alison Gustafson, Alice S. Ammerman, Mary Tucker-McLaughlin, Basheerah Enahora, Courtney Moore, Danielle Dunnagan, Hannah Prentice-Dunn and Sheryl Bedno

Nutrients 2022, 14(7), 1458; https://doi.org/10.3390/nu14071458 - 31 Mar 2022

Cited by 2 | Viewed by 2592

Abstract

Approximately 17% of military service members are obese. Research involving army soldiers suggests a lack of awareness of healthy foods on post. Innovative approaches are needed to change interactions with the military food environment. Two complementary technological methods to raise awareness are geofencing (deliver banner ads with website links) and Bluetooth beacons (real-time geotargeted messages to mobile phones that enter a designated space). There is little published literature regarding the feasibility of this approach to promote healthy behaviors in retail food environments. Thus, we conducted a formative feasibility study of a military post to understand the development, interest in, and implementation of EatWellNow, a multi-layered interactive food environment approach using contextual messaging to improve food purchasing decisions within the military food environment. We measured success based on outcomes of a formative evaluation, including process, resources, management, and scientific assessment. We also report data on interest in the approach from a Fort Bragg community health assessment survey (n = 3281). Most respondents agreed that they were interested in receiving push notifications on their phone about healthy options on post (64.5%) and that receiving these messages would help them eat healthier (68.3%). EatWellNow was successfully developed through cross-sector collaboration and was well received in this military environment, suggesting feasibility in this setting. Future work should examine the impact of EatWellNow on military service food purchases and dietary behaviors. Full article

(This article belongs to the Special Issue Innovative Food and Nutrition Approaches to Promote Healthy Lifestyles and Reduce Disparities)

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18 pages, 297 KiB

Open AccessArticle

Impact of a Virtual Culinary Medicine Curriculum on Biometric Outcomes, Dietary Habits, and Related Psychosocial Factors among Patients with Diabetes Participating in a Food Prescription Program

by Shreela V. Sharma, John W. McWhorter, Joanne Chow, Melisa P. Danho, Shannon R. Weston, Fatima Chavez, Laura S. Moore, Maha Almohamad, Jennifer Gonzalez, Esther Liew, Denise M. LaRue, Esperanza Galvan, Deanna M. Hoelscher and Karen C. Tseng

Nutrients 2021, 13(12), 4492; https://doi.org/10.3390/nu13124492 - 15 Dec 2021

Cited by 31 | Viewed by 6484

Abstract

Culinary medicine is an evidence-based approach that blends the art of cooking with the science of medicine to inculcate a healthy dietary pattern. Food prescription programs are gaining popularity in the Unites States, as a means to improve access to healthy foods among patient populations. The purpose of this paper is to describe the implementation and preliminary impact of A Prescription for Healthy Living (APHL) culinary medicine curriculum on biometric and diet-related behavioral and psychosocial outcomes among patients with diabetes participating in a clinic-led food prescription (food Rx) program. We used a quasi-experimental design to assess APHL program impact on patient biometric outcome data obtained from electronic health records, including glycosylated hemoglobin (HbA1c), body mass index (BMI), and blood pressure (n = 33 patients in the APHL group, n = 75 patients in the food Rx-only group). Pre-post surveys were administered among those in the APHL group to monitor program impact on psychosocial and behavioral outcomes. Results of the outcome analysis showed significant pre-to-post reduction in HbA1c levels among participants within the APHL group (estimated mean difference = −0.96% (−1.82, −0.10), p = 0.028). Between-group changes showed a greater decrease in HbA1c among those participating in APHL as compared to food Rx-only, albeit these differences were not statistically significant. Participation in APHL demonstrated significant increases in the consumption of fruits and vegetables, fewer participants reported that cooking healthy food is difficult, increased frequency of cooking from scratch, and increased self-efficacy in meal planning and cooking (p < 0.01). In conclusion, the results of our pilot study suggest the potential positive impact of a virtually-implemented culinary medicine approach in improving health outcomes among low-income patients with type 2 diabetes, albeit studies with a larger sample size and a rigorous study design are needed. Full article

(This article belongs to the Special Issue Innovative Food and Nutrition Approaches to Promote Healthy Lifestyles and Reduce Disparities)

12 pages, 876 KiB

Open AccessArticle

Home-Based Monitoring of Eating in Adolescents: A Pilot Study

by Ghassan Idris, Claire Smith, Barbara Galland, Rachael Taylor, Christopher John Robertson and Mauro Farella

Nutrients 2021, 13(12), 4354; https://doi.org/10.3390/nu13124354 - 3 Dec 2021

Cited by 2 | Viewed by 1963

Abstract

Objectives: To investigate eating episodes in a group of adolescents in their home-setting using wearable electromyography (EMG) and camera, and to evaluate the agreement between the two devices. Approach: Fifteen adolescents (15.5 ± 1.3 years) had a smartphone-assisted wearable-EMG device attached to the jaw to assess chewing features over one evening. EMG outcomes included chewing pace, time, episode count, and mean power. An automated wearable-camera worn on the chest facing outwards recorded four images/minute. The agreement between the camera and the EMG device in detecting eating episodes was evaluated by calculating specificity, sensitivity, and accuracy. Main results: The features of eating episodes identified by EMG throughout the entire recording time were (mean (SD)); chewing pace 1.64 (0.20) Hz, time 10.5 (10.4) minutes, episodes count 56.8 (39.0), and power 32.1% (4.3). The EMG device identified 5.1 (1.8) eating episodes lasting 27:51 (16:14) minutes whereas the cameras indicated 2.4 (2.1) episodes totaling 14:49 (11:18) minutes, showing that the EMG-identified chewing episodes were not all detected by the camera. However, overall accuracy of eating episodes identified ranged from 0.8 to 0.92. Significance: The combination of wearable EMG and camera is a promising tool to investigate eating behaviors in research and clinical-settings. Full article

(This article belongs to the Special Issue Innovative Food and Nutrition Approaches to Promote Healthy Lifestyles and Reduce Disparities)

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12 pages, 965 KiB

Open AccessFeature PaperArticle

Development and Preliminary Feasibility of iByte4Health: A Mobile Health (mHealth) Pediatric Obesity Prevention Intervention to Engage Parents with Low-Income of Children 2–9 Years

by Gina L. Tripicchio, Melissa Kay, Sharon Herring, Travis Cos, Carolyn Bresnahan, Danielle Gartner, Laura Stout Sosinsky and Sarah B. Bass

Nutrients 2021, 13(12), 4240; https://doi.org/10.3390/nu13124240 - 25 Nov 2021

Cited by 6 | Viewed by 3038

Abstract

This research describes the development and preliminary feasibility of iByte4Health, a mobile health (mHealth) obesity prevention intervention designed for parents with a low-income of children 2–9 years of age. Study 1 (n = 36) presents findings from formative work used to develop the program. Study 2 (n = 23) presents a 2-week proof-of-concept feasibility testing of iByte4Health, including participant acceptability, utilization, and engagement. Based on Study 1, iByte4Health was designed as a text-messaging program, targeting barriers and challenges identified by parents of young children for six key obesity prevention behaviors: (1) snacking; (2) physical activity; (3) sleep; (4) sugary drinks; (5) fruit and vegetable intake; and (6) healthy cooking at home. In Study 2, participants demonstrated high program retention (95.7% at follow-up) and acceptability (90.9% reported liking or loving the program). Users were engaged with the program; 87.0% responded to at least one self-monitoring text message; 90.9% found the videos and linked content to be helpful or extremely helpful; 86.4% found text messages helpful or extremely helpful. iByte4Health is a community-informed, evidenced-based program that holds promise for obesity prevention efforts, especially for those families at the increased risk of obesity and related disparities. Future work is warranted to test the efficacy of the program. Full article

(This article belongs to the Special Issue Innovative Food and Nutrition Approaches to Promote Healthy Lifestyles and Reduce Disparities)

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25 pages, 838 KiB

Open AccessArticle

Local Value Chain Models of Healthy Food Access: A Qualitative Study of Two Approaches

by Kathleen Krzyzanowski Guerra, Andrew S. Hanks, Zoë T. Plakias, Susie Huser, Tom Redfern and Jennifer A. Garner

Nutrients 2021, 13(11), 4145; https://doi.org/10.3390/nu13114145 - 19 Nov 2021

Cited by 2 | Viewed by 3302

Abstract

Food value chains are increasingly recognized as more equitable alternatives to traditional supply chains and may represent a novel mechanism to achieve health equity at the local level. Country Fresh Stops (CFS) and Donation Station (DS) are two complementary programs that are part of a more robust value chain designed to support local agriculture in Appalachia Ohio. As the first study of these programs in the peer-reviewed literature, the objectives were to identify factors that facilitate or hinder the implementation of these two local value chain models of healthy food access and to identify the perceived impacts from the perspective of the sites implementing them. In-depth, semi-structured interviews were conducted with CFS (n = 7) and DS (n = 10) site representatives in January 2020. Template analysis was used to identify themes through a priori and inductive codes. Participants identified two primary facilitators: support from partner organizations and on-site program stewardship. Produce (and program) seasonality and mitigating food waste were the most cited challenges. Despite challenges, both CFS and DS sites perceive the models to be successful efforts for supporting the local economy, achieving organizational missions, and providing consumers with greater access to locally grown produce. These innovative programs demonstrate good feasibility, but long-term sustainability and impacts on other key stakeholders merit further investigation. Full article

(This article belongs to the Special Issue Innovative Food and Nutrition Approaches to Promote Healthy Lifestyles and Reduce Disparities)

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15 pages, 279 KiB

Open AccessArticle

Acceptability and Willingness to Pay for a Meal Kit Program for African American Families with Low Income: A Pilot Study

by Kaley Carman, Lauren H. Sweeney, Lisa A. House, Anne E. Mathews and Karla P. Shelnutt

Nutrients 2021, 13(8), 2881; https://doi.org/10.3390/nu13082881 - 21 Aug 2021

Cited by 16 | Viewed by 3720

Abstract

Food insecurity is a persistent issue among individuals with low income and is associated with various nutrition- and health-related consequences. Creative approaches to increasing food access should be investigated as possible solutions. Meal kits, which are boxes or bags of fresh and shelf-stable ingredients for one or more meals, along with a step-by-step recipe showing how to cook each meal at home, may serve as a creative solution. Meal kits have historically been marketed to higher-income demographics. The purpose of this pilot study was to investigate the utilization, acceptability, and willingness to pay for a healthy meal kit program among African American main food preparers with children and low income (n = 36). Participants received a healthy meal kit with three recipes and ingredients, a cooking incentive, and a nutrition handout weekly for six weeks. Data were collected on participants’ use, acceptability, and willingness to pay for the meal kits and analyzed using descriptive statistics. The intervention was highly utilized, and participants reported high acceptability ratings for most recipes. After the intervention, participants were willing to pay $88.61 ± 47.47 for a meal kit with three meals, each with four portions, which was higher than indicated at baseline and similar to the cost to produce the kits. Meal kits may offer a creative solution to improving food access if affordable for families with low income. Full article

(This article belongs to the Special Issue Innovative Food and Nutrition Approaches to Promote Healthy Lifestyles and Reduce Disparities)

9 pages, 250 KiB

Open AccessArticle

Assessment of Cooking Matters Facebook Platform to Promote Healthy Eating Behaviors among Low-Income Caregivers of Young Children in the United States: A Pilot Study

by Qi Zhang, Jill Panichelli and Leigh Ann Hall

Nutrients 2021, 13(8), 2694; https://doi.org/10.3390/nu13082694 - 4 Aug 2021

Cited by 4 | Viewed by 2204

Abstract

How best to deliver healthy-eating education through social media among a low-income population remains understudied. To assess the impact of the Cooking Matters (CM) Facebook page on healthy eating behaviors among low-income caregivers, we conducted a pre–post survey of new CM Facebook followers in early 2020. A convenience sample was recruited at baseline from WICShopper app users and the CM Facebook page. The recruited sample included 397 low-income caregivers of a child younger than 6 who never followed CM Facebook. Among the baseline caregivers, 184 completed the follow-up survey. Paired t-test and McNemar–Bowker tests were conducted to compare the outcomes pre- and post-following CM Facebook. A binary indicator was developed to measure whether the outcomes were improved (1 = Improved; 0 = Not improved). Multi-variable logistic regressions were applied to examine the relationship between whether the outcome was improved with reference to the baseline socio-demographics. No significant differences were detected between pre and post outcomes overall (p > 0.05), except improvement in feeding healthy meals within the budget available (p < 0.05). However, improvement in select outcomes was more significant in men and single-parent households. The CM Facebook page could be an important platform to influence low-income caregivers of young children. Full article

(This article belongs to the Special Issue Innovative Food and Nutrition Approaches to Promote Healthy Lifestyles and Reduce Disparities)

13 pages, 294 KiB

Open AccessArticle

Stakeholders’ Views on Mobile Applications to Deliver Infant and Toddler Feeding Education to Latina Mothers of Low Socioeconomic Status

by Alexandra L. MacMillan Uribe, Hannah G. Rudt and Tashara M. Leak

Nutrients 2021, 13(8), 2569; https://doi.org/10.3390/nu13082569 - 27 Jul 2021

Cited by 1 | Viewed by 1980

Abstract

Infant- and toddler-feeding (ITF) practices are critical to long-term health and chronic disease prevention. Using mobile applications (apps) to promote desirable ITF practices shows promise for overcoming challenges of in-person education. However, the viability of ITF apps for Latina mothers of low-socioeconomic status (SES) remains unclear. The objective of this study was to characterize stakeholders’ views on Latina mothers’ capability, motivation, and barriers to using ITF apps. New York City-based health professionals who frequently engage with Latina mothers of low SES completed in-depth interviews. Directed content analysis was used to identify themes through theoretical and inductive codes. Participants included dietitians, nutrition educators, and physicians (n = 17). The following themes were identified: (1) Most Latina mothers of low-SES are tech-savvy (i.e., high capability and experience using smartphones and apps); (2) Apps are an appealing way to deliver ITF education; (3) There are challenges to using apps that must be carefully considered for ITF education development. Overall, ITF apps are a viable option as skills and use appear high among Latina mothers. Key considerations for app development include targeted app promotion; detailed instructions for obtaining and using app; more visuals, less text for low literacy and multiple dialects; making key features available offline. Full article

(This article belongs to the Special Issue Innovative Food and Nutrition Approaches to Promote Healthy Lifestyles and Reduce Disparities)

7 pages, 216 KiB

Open AccessCommunication

Perceived Facilitators and Barriers to Engaging with a Digital Intervention among Those with Food Insecurity, Binge Eating, and Obesity

by Anu Venkatesh, Angela Chang, Emilie A. Green, Tianna Randall, Raquel Gallagher, Jennifer E. Wildes and Andrea K. Graham

Nutrients 2021, 13(7), 2458; https://doi.org/10.3390/nu13072458 - 19 Jul 2021

Cited by 6 | Viewed by 3071

Abstract

Interventions that address binge eating and food insecurity are needed. Engaging people with lived experience to understand their needs and preferences could yield important design considerations for such interventions. In this study, people with food insecurity, recurrent binge eating, and obesity completed an interview-based needs assessment to learn facilitators and barriers that they perceive would impact their engagement with a digital intervention for managing binge eating and weight. Twenty adults completed semi-structured interviews. Responses were analyzed using thematic analysis. Three themes emerged. Participants shared considerations that impact their ability to access the intervention (e.g., cost of intervention, cost of technology, accessibility across devices), ability to complete intervention recommendations (e.g., affordable healthy meals, education to help stretch groceries, food vouchers, rides to grocery stores, personalized to budget), and preferred intervention features for education, self-monitoring, personalization, support, and motivation/rewards. Engaging people with lived experiences via user-centered design methods revealed important design considerations for a digital intervention to meet this population’s needs. Future research is needed to test whether a digital intervention that incorporates these recommendations is engaging and effective for people with binge eating and food insecurity. Findings may have relevance to designing digital interventions for other health problems as well. Full article

(This article belongs to the Special Issue Innovative Food and Nutrition Approaches to Promote Healthy Lifestyles and Reduce Disparities)

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