Food and Nutrition
Section Newsletter
Spring 2008

Introduction

The rising prevalence of overweight and obesity is a major concern in the United States.  Although the causes of overweight are multi-factorial, diet is an important contributor. While nutrition professionals traditionally focused on individual and familial contributors to dietary behaviors, there is increasing recognition about the importance of neighborhood and policy environments in shaping individual food choice. With this in mind, this edition of the newsletter features articles that focus on nutrition and the food environment.  We hope you enjoy it!

Fresh To You: An Innovative, Public-Private Partnership to Increase Fruit and Vegetable Consumption

Fresh to You (FTY) is an innovative, public-private partnership program between Brown University's Institute for Community Health Promotion, the Rhode Island Department of Health, and the largest fresh fruit and vegetable distributor in Rhode Island.  We identified major barriers to fruit and vegetbale consumption through surveys, focus groups and community assessments conducted in Rhode Island.

Barriers in working adults were high cost, poor quality of available fruits and vegetables, and hectic lifestyles with limited time to shop. Barriers for low-income consumers were high cost, poor quality of available fruits and vegetables and limited access and transportation to stores that sell high quality, affordable produce. FTY addresses all of these barriers by purchasing its fruits and vegetables directly from the distributor and reselling it at prices significantly below retail. The fruits and vegetables come directly from the farmers' crates, and are therefore much fresher and of higher quality than the fruits and vegetables available in grocery stores.

Pilot weekly or biweekly fruit and vegetable markets were set up in one low-income community agency and at two public and private worksites in Rhode Island.  Online surveys conducted at worksites during these pilots found that fruit and vegetable consumption increased almost 70 percent during the weeks that the FTY markets were held for both employees and their families.  Exit interviews at the community markets showed the same trends.  However, it was determined that the cost involved in setting up and breaking down the markets at worksites, along with lost revenue from open cases of fruits and vegetables that could not be sold at regular prices, was prohibitive.  Therefore, it was decided that implementation of the FTY program at worksites would be through an online, pre-order system by which employees place their orders in advance and pick them up pre-packaged on market day. In March 2008, FTY implemented a Web site, www.freshtoyou.com
, through which employees at participating worksites can purchase their produce in advance.

Currently more than 20 worksites are participating, and many more have expressed interest in joining the program.  The low-income market model continues to operate in the community agency, which has recently been approved to accept food stamps. The agency marks up the fruit and vegetable prices slightly to cover their costs. There are plans are under way to expand to low-income housing complexes and other agencies serving low-income communities throughout the state.

For more information, contact Gemma Gorham.

Strategies for Advancing an Environment and Policy Change Agenda for Healthy Eating and Active Living

Promising Strategies for Creating Healthy Eating and Active Living Environments is a newly released resource, prepared by the Prevention Institute on behalf of the Healthy Eating Active Living Convergence Partnership, to help build momentum for environmental change and policy approaches to improving health.  Promising Strategies was created with input from diverse stakeholders and constituencies representing fields such as public health, sustainable food systems, economic development, transportation, planning, climate change and others engaged in accelerating and supporting the movement for healthier communities.  The document thus delineates cross-cutting strategies that have the potential to engage diverse constituencies and address a range of issues that impact healthy eating and active living.

 

Promising Strategies serves as a launch pad for further discussion, a catalyst to understand how specific efforts fit into a broader picture, and identifies areas for collaboration across sectors and fields.  It can serve as a menu of options for various audiences to advance or expand environmental change and policy approaches.  The strategies highlighted in the document focus on environments such as the community, schools, workplaces, health care, government and media. Promising Strategies is available free of cost at http://www.convergencepartnership.org.

 

The Partnership has also released Strategies for Enhancing the Built Environment to Support Healthy Eating and Active Living.  This issue brief focuses on opportunities to support healthy eating and active living through issues related to the built environment and places a similar emphasis on cross-sectoral and environmental change approaches.

 

The Healthy Eating Active Living Convergence Partnership is a collaborative of funders with a shared goal of changing policies and environments to better achieve the vision of healthy people living in healthy places.

 

Prevention Institute is supporting the Partnership through policy research and analysis as part the Institute’s ongoing commitment to addressing health inequities and promoting a cross-disciplinary approach to establishing healthy food and physical activity environments in all communities. For more information see www.preventioninstitute.org or contact Virginia Lee.

Graduate Nutrition Researchers Work with Dr. Sharkey to Assess the Availability of Healthy Fast Food and Grocery Options in Rural Areas of Texas

Dr. Joseph Sharkey, PhD, MPH, RD, is associate professor of social and behavioral health at Texas A&M School of Rural Public Health and  Principal Investigator for the Brazos Valley Food Environment Project (BVFEP), which used ground-truthing to identify and map all food stores and food service places in six rural counties (~4,400 mi2).1

 

Two Texas A&M nutrition graduate students joined the BVFEP to conduct research projects for their theses. Jennifer Creel, MS, RD (now a student in P.A. school) developed an interest in the availability of healthy options, especially for individuals who have to rely on away-from-home food for many of their meals. Jennifer and Dr. Sharkey developed an observational survey to collect data on-site from all fast food opportunities in the six rural counties – traditional fast food restaurants (44 percent of fast food opportunities in rural study area) and non-traditional fast food venues of convenience stores, supermarkets and grocery stores. The survey captured menu items (entrées, side dishes, beverages and deserts), identification of nutritional information, and preparation methods. Importantly, Jennifer’s study found that the majority of opportunities for rural residents to purchase fast-food items came from store formats other than traditional fast food restaurants. Non-traditional fast food outlets were spatially more accessible to rural neighborhoods.

 

Brenda Bustillos, MS, RD (and now dietitian with the U.S. Army) documented the availability of healthy food alternatives in traditional, convenience and non-traditional (dollar stores and mass merchandisers) food stores in two of the rural counties. Brenda and Dr. Sharkey developed a survey that she administered in each of the food stores to capture availability, variety, and lowest price for healthy food alternatives (e.g., low-fat, lean, whole wheat). Food categories included fruit, vegetables, meat, dairy, fats and grains. For fruit and vegetables, data were collected for fresh, canned and frozen. Over the last several years, the retail food environment has undergone changes that influence the type of stores that market food products. Brenda found that non-traditional food stores needed to be included in order to fully understand what food items were available to rural families. Dr. Sharkey’s team has followed this work with similar assessments in six other counties.

 

1 Sharkey J, Horel S. Neighborhood Socioeconomic Deprivation and Minority Composition Are Associated with Better Potential Spatial Access to the Food Environment in a Large Rural Area. J Nutr 2008;138:620-627.

Food and Environment Working Group

For four years, the Food and Nutrition and Environment Sections have collaborated around public health issues at the intersection of food, agriculture and environment.  

Public health issues, as described in the Association's new (2007)
position paper "Towards a Healthy, Sustainable Food System,"
and earlier policy statements, arise from intertwined factors including: the industrialization of agriculture; its intensive use of water, antibiotics, chemical inputs, fossil fuels and other resources; focus on processed foods; overproduction of certain crops and efforts to find mouths to eat them; inadequate regulation and enforcement of food safety, worker health and other processes; inadequate distribution infrastructures for healthy foods; and an often low wage and immigrant work force and powerful agribusiness firms.  

This industrialized food system has nutritional and environmental health implications, including its contribution to the lack of access to healthy foods and to obesity, and also leads to food safety threats, climate change, environmental pollution and depletion, and the rise in antibiotic-resistant infections.  

Public health professionals are increasingly at the forefront of challenging these threats, and at the forefront of promoting alternatives. Food and environment issues continue to gain visibility and traction with increased public interest in local and sustainably produced foods, the obesity epidemic, the recent passage of the Farm Bill, and the international crisis of rising food prices.

Bridging sections, the APHA "Food and Environment Working Group" has sought to encourage interdisciplinary scientific, social and policy interchange and ultimately to work towards broader public health community engagement in food/environment issues.  Four years ago, the group began efforts to bring people together through the APHA scientific program; we have continued to highlight sessions of joint interest, now formalized in a joint track of sessions.  To encourage informal interchange, we've also organized social events. Two years ago at APHA in Boston, at least 70 people attended an evening event featuring locally sourced food and wines.  At last year's conference in D.C., more than 100 came out to Clyde's of Gallery Place to eat, drink and share ideas.  The event coincided with the APHA's August 2007 W.K. Kellogg Foundation grant to support organizing in selected communities around public health and agricultural policy issues.

Planning is well under way for the 2008 social event, to be held on
Tuesday, Oct. 28 at 6:30.  We hope you will join us to sample San Diego's freshest and local-est.  We are also seeking to raise money to bring individuals engaged in the San Diego food system to the conference, and to support other activities to build the profile of food and agriculture issues within public health.  Many of us are already looking to "Farm Bill 2013" and developing activities aimed at building a stronger and more influential public health voice in the debates.

Stay tuned for information about participating in San Diego activities.

If you're interested in joining our active working group, e-mail Roni
Neff,
PhD.

Finding Food in Chicago and the Suburbs: The Report of the Northeastern Illinois Community Food Security Assessment

There has been a growing interest in the relationship between the neighborhood food environment and dietary practices/weight status at the individual level. The Northeastern Illinois Community Food Security Assessment studied food access patterns in the six-county Chicago metropolitan area.  Location data was collected and compared to community demographics for 2007 for both independent and chain supermarkets and classified by type.  Chain store data were also collected in 2007.

 

Six communities within Chicago were also studied in depth.  In all of these, market basket studies were completed.  In five communities, a series of structured group interviews with consumers, store managers and service providers was conducted.  In three communities, a series of door-to-door household surveys on hunger and access to emergency food was collected.  Researchers partnered with local community groups to collect data and help disseminate results.  Primary conclusions include:

 

Food Access Mapping:

·         Lower-income African-American neighborhoods, both in the city and in the suburbs, have relatively low access to supermarkets.

·         Hispanic neighborhoods also have low access to chain supermarkets, but have many independent stores. 

·         Particular areas of poor food access found include many predominantly African-American portions of inner-city Chicago and its suburbs.

·         More full-service chain stores closed than opened during the period 2005 to 2007.  Discount chains, specialty chains and supercenters have opened new locations.  However, except discount chains, few stores are opening in predominantly African-American neighborhoods.

 

Consumer and Retailer Interviews:

·         Inadequate transportation is a barrier to getting to food; many people need to travel by bus, often with transfers.

·         Consumers felt small stores in their communities were dirty and unkempt, sometimes with rude and disrespectful staff.

·         Many retail food owners feel they offer healthy foods, but also cited some barriers to doing so.

·         Particularly vulnerable groups included older adults, and unemployed, disabled, and homeless individuals.

 

Price and Availability Study:

·         Full-service chain supermarkets carried by far the most grocery items, followed by discount and independent supermarkets.

·         Discount supermarkets were by far the cheapest of the store types, but often carried few items specific to the dominant ethnic group in a community.

 

Door-to-door and Food Pantry Recipient Surveys:

·         With only one exception, everyone surveyed who utilized a food pantry was food insecure.

Feasibility of Corner Store Interventions in Low-Income Urban Communities

There is much recent interest in improving the food environment to reduce risk for chronic disease by increasing the accessibility of healthy foods.  While corner store-based nutrition interventions have emerged as a potential strategy, the feasibility of such programs has rarely been assessed.

Baltimore Healthy Stores (BHS) is a community-based program to improve accessibility to and availability of healthy foods for low-income African Americans.  In 2006-2007, we conducted a 10-month corner store-based feasibility trial in Baltimore city.  Using a quasi-experimental study design, seven corner stores and two supermarkets received 10 month interventions, and six corner stores and two supermarkets served as comparison.  All the corner stores were owned and operated by Korean American merchants.

The intervention strategies for Korean American storeowners included: 1) incentives to minimize the potential of financial risk of the stores; 2) guidelines to encourage positive relationships with community members; 3) posters related to food purchasing, stocking and placing to stock promoted healthy foods effectively; and 4) nutrition education to ensure longer sustainability of the program by improving nutrition related knowledge of storeowners. All these materials were prepared or delivered in Korean.

The intervention strategies for African American consumers were comprised of in-store materials such as posters, educational displays, and fliers and shelf labels, in-store activities such as taste tests and incentives (coupons, incentive cards, giveaways).  Interventionists visited each of the intervention stores on a weekly basis to conduct taste tests, distribute promoted food samples and giveaways, and interact with customers to explain nutritional messages.  The selection of foods for promotion was based on 24-hour dietary recalls from community members that identified foods that contributed the most energy, sugar and fat to the diet.

BHS was evaluated at the store and consumer level through interviews and structured questionnaires, which included pre-post assessment of store food stocking.  The program was found to be culturally and economically acceptable to store owners and consumers.  Analyses of process and impact data are currently under way and will be submitted for review in peer-reviewed journals in late 2008.

Employment Opportunities

University of California, Berkeley

School of Public Health

Associate Professor or Professor of Public Health Nutrition

 

The School of Public Health at the University of California, Berkeley, seeks a distinguished scholar to provide leadership in Public Health Nutrition within the Division of Community Health and Human Development.  The position offers opportunities for collaboration within the School of Public Health, the Dr. Robert C. and Veronica Atkins Center for Weight and Health, and other Berkeley campus centers and departments.

 

QUALIFICATIONS:

The successful candidate is expected to possess strong evidence of leadership, teaching, and research in an area of public health nutrition, which can include:  planning and evaluating community or school - based interventions, social marketing, health communication, psychology and education, environmental nutrition, agriculture and food systems, food and nutrition policy, economics of food and nutrition, nutrition related disease prevention and management, or nutritional epidemiology.

Applicants must have a doctoral degree in nutrition, a biological science, medicine, epidemiology or other field of public health, with teaching experience and a demonstrated record of public health nutrition research. Candidates should have excellent qualitative and/or quantitative research skills, multidisciplinary research interests, documented success in receiving extramural funding, and strong teaching skills. A nutrition science background is preferred.

 

We are particularly interested in candidates who have experience working with students from diverse backgrounds and have a demonstrated commitment to improving access to higher education for disadvantaged students.

 

DESCRIPTION OF RESPONSIBILITIES:

Collaborate with faculty colleagues to develop strong research and training programs in public health nutrition, conduct externally-funded research, develop and teach upper division and graduate level courses, advise and mentor graduate students, and perform committee and professional service within and outside the university.

 

TO APPLY:

Please register at http://esph.berkeley.edu:80/candidate/selRegister.php?i=44 and upload PDF’s of a letter of application, including statements of current and future research interests and teaching philosophy, curriculum vitae, sample publications, and names and contact information for three references. For further information, please contact Noriko Katagiri, (510) 642-6095.

 

DEADLINE: July 15, 2008

 

The University of California is an Equal Opportunity, Affirmative Action Employer

Funding Opportunities

NOW OPEN: Healthy Eating Research

2008 Call for Proposals - Rapid-Response Grants

This is a joint call for proposals from the Robert Wood Johnson Foundation's Healthy Eating Research and Active Living Research programs. This call for proposals supports time-sensitive, opportunistic studies to evaluate changes in policies or environments with the potential to reach children who are at highest risk for obesity, including African American, Latino, Native American, Asian American, and Pacific Islander children (ages 3 to 18) who live in low-income communities or communities with limited access to affordable healthy foods and/or safe opportunities for physical activity.

Healthy Eating Research is a $16 million national program of the Robert Wood Johnson Foundation. The program supports research on environmental and policy strategies to promote healthy eating among children to prevent childhood obesity, especially among the low-income and racial and ethnic populations at highest risk for obesity. Findings will advance the Foundation's efforts to reverse the childhood obesity epidemic by 2015. The program is directed by Mary Story, PhD, RD, professor in the division of epidemiology and community health at the University of Minnesota School of Public Health.

FYI.....

UNNATURAL CAUSES...is inequality making us sick?: A four-hour documentary series exploring America's racial and socioeconomic inequities in health

UNNATURAL CAUSES sounds the alarm about the extent of our alarming socio-economic and racial inequities in health — and searches for their root causes. But those causes are not what we might expect. While we pour more and more money into drugs, dietary supplements and new medical technologies, UNNATURAL CAUSES crisscrosses the country investigating the findings that are shaking up conventional understanding of what really makes us healthy — or sick.

This is a story that implicates us all. We’re spending $2 trillion a year and rising on health care, more than twice per person than the average industrialized nation. Yet American life expectancy ranks 29th in the world, behind Costa Rica. Infant mortality? Cypress, Slovenia and Malta do better. One third of Americans are obese. Chronic illness now costs American businesses more than $1 trillion a year in lost productivity.

It turns out there’s much more to our health than bad habits, health care or unlucky genes. The social conditions in which we are born, live and work profoundly affect our well-being and longevity.

The four-hour series, broadcast by PBS, was conceived as part of an ambitious communications and public engagement campaign conducted with leading public health, policy and community-based organizations. The campaign aims to use the series and companion materials to help reframe the national debate over health and what we can — and should — do to tackle our health inequities.

For more information log on to: http://www.unnaturalcauses.org/