Home gardening in urban poor communities of the Philippines

The deficiencies of micronutrients, in particular iron and vitamin A, are common in the Philippines, but their control measures through supplementation and fortification have shown several weaknesses. The present study examines the outcomes of a community-based approach including promotion of home gardening and a diversified dietary practice. A total of 152 mothers in two poor urban communities in Davao City, the Philippines were interviewed with a structured questionnaire. Participants were also asked to keep a brief 7-day self-administered household food record. Focus group discussions were conducted to obtain in-depth information on their attitudes toward home gardening and vegetable consumption. Home garden produce contributed to the diversification of carbohydrate consumed among participants. However, home garden produce reduced the consumption of protein-rich food. There was therefore no discernible improvement in the diets of participants from the consumption of home garden produce. In communities where there was no greengrocer, respondents shared the produce from home gardens. The community-based diet improvement program facilitated home gardening practices, which influenced the dietary practices of the urban poor. The monitoring of food consumption together with community-based programs needs to be expanded in urban poor communities. Our focus group discussion revealed that there was a cognition linking home gardening and vegetable consumption to poverty among some of the participants. More study is necessary on this finding.     

Home gardening in urban poor communities of the Philippines

The deficiencies of micronutrients, in particular iron and vitamin A, are common in the Philippines, but their control measures through supplementation and fortification have shown several weaknesses. The present study examines the outcomes of a community-based approach including promotion of home gardening and a diversified dietary practice. A total of 152 mothers in two poor urban communities in Davao City, the Philippines were interviewed with a structured questionnaire. Participants were also asked to keep a brief 7-day self-administered household food record. Focus group discussions were conducted to obtain in-depth information on their attitudes toward home gardening and vegetable consumption. Home garden produce contributed to the diversification of carbohydrate consumed among participants. However, home garden produce reduced the consumption of protein-rich food. There was therefore no discernible improvement in the diets of participants from the consumption of home garden produce. In communities where there was no greengrocer, respondents shared the produce from home gardens. The community-based diet improvement program facilitated home gardening practices, which influenced the dietary practices of the urban poor. The monitoring of food consumption together with community-based programs needs to be expanded in urban poor communities. Our focus group discussion revealed that there was a cognition linking home gardening and vegetable consumption to poverty among some of the participants. More study is necessary on this finding.     

A Supplemental Produce and eLearning Nutrition Education Program for Georgians Who Use Safety-Net Clinics for Their Health Care

ObjectiveTo explore the experiences of safety-net clinic patients who engaged in a 12-week supplemental produce and eLearning nutrition education program.MethodsThis mixed-method study employed a nonrandomized comparison study design. Participants (intervention [n = 20] and comparison control [n = 6]) had diet-related chronic diseases. Data collection included pre- and post-intervention, focus group interviews, 24-hour diet recalls, and clinical and anthropometric outcome assessments. Interviews were recorded, transcribed, and coded using the constant comparison method. Nonparametric data analyses were conducted for quantitative data.ResultsThree primary themes emerged: (1) program benefits, (2) challenges to achieving health benefits and optimal engagement of the program, and (3) recommendations for program improvement. Quantitative data analysis did not show significant differences in pre- and post-clinical and anthropometric measures between the intervention and comparison groups.Conclusions and ImplicationsFindings suggest a unique Supplemental Nutrition Assistance Program Education dissemination model that may decrease barriers to healthful eating and increase engagement in eLearning nutrition education.     

Food Gardeners’ Productivity in Laramie,Wyoming: More Than a Hobby

Objectives. We quantified the productivity of food gardens in Laramie, Wyoming, over 3 growing seasons.Methods. From 2012 to 2014, 33 participating gardening households weighed and recorded each harvest. Academic partners measured plot sizes and converted reported harvest weights to volume in cups.Results. The yield of the average 253-square-foot plot was enough to supply an adult with the daily US Department of Agriculture–recommended amount of vegetables for 9 months.Conclusions. Gardeners produced nutritionally meaningful quantities of food; thus, food gardening offers promise as an effective public health intervention for improving food security and nutritional health.In the United States, major public health nutrition problems include low vegetable consumption, high food insecurity and obesity rates, and lack of access to a local grocery store.1–3 Growing vegetables in home and community gardens offers a promising strategy for improving these issues. A large body of observational research suggests that home and community food gardening yields a wide range of health benefits, including improved fruit and vegetable consumption, activity levels, and mental health.4–7However, only a handful of studies have documented how much food gardens yield (Table A, available as a supplement to the online version of this article at http://www.ajph.org), and none have quantified these harvests in terms of vegetable servings provided. We have added to this emerging literature by (1) quantifying harvest results in a climate zone that is more challenging for growing than are the locations of previous studies, (2) quantifying results over 3 growing seasons, (3) calculating harvest values in nutritional terms as servings of vegetables yielded, and (4) quantifying how gardeners used their harvests, whether eaten immediately, stored, or shared.     

Comparison of School vs Home Breakfast Consumption with Cardiometabolic and Dietary Parameters in Low-Income,Multiracial/Ethnic Elementary School-Aged Children

BackgroundBreakfast consumption is often associated with improving cardiometabolic parameters and diet quality. However, literature evaluating breakfast consumption with these outcomes between the school and home environments is limited.ObjectiveThis study examined relationships between breakfast consumption locations (school vs home) and cardiometabolic parameters, breakfast dietary intake, and daily dietary intake.DesignThis cross-sectional study used baseline data from TX Sprouts, a 1-year school-based gardening, nutrition, and cooking cluster-randomized trial, implemented in 16 elementary schools in Austin, TX, during 2016 to 2019.Participants/settingAnalyses included 383 low-income, multiracial/ethnic elementary school-aged children (mean age = 9.2 years; 60.6% Hispanic; 70.5% free/reduced lunch; 58.5% home breakfast consumers).Main outcome measuresCardiometabolic parameters were obtained via fasting blood draws, and dietary intake was assessed using one 24-hour dietary recall conducted on a random, unannounced weekday. Cardiometabolic and dietary parameters (ie, energy intake, macronutrients, and food group servings) for breakfast and for the day were evaluated.Statistical analyses performedMultivariate analysis of covariance was performed to examine cardiometabolic parameters and dietary intake between school and home breakfasts.ResultsSchool breakfast consumers (SBC) had lower fasting triglyceride levels than home breakfast consumers (HBC) (89.0 mg/dL vs 95.7 mg/dL; P = 0.03) (to convert to mmol/L, multiply by 0.0113). SBC had lower total fat for the day (P = 0.02) and lower total and saturated fat, sodium, and refined grains at breakfast (P ≤ 0.01) than HBC. However, SBC had lower protein at breakfast (P = 0.01) and higher carbohydrates, total sugar, and added sugar for the day and at breakfast (P ≤ 0.03) than HBC.ConclusionsSBC compared with HBC had lower fat intake, which may have contributed to the lower triglyceride level observed in SBC, but also had lower protein intake at breakfast and higher added sugar intake for the day and at breakfast. These results suggest dietary intake differed between HBC and SBC; that is, the home and school environments, but more research is needed to evaluate if such differences are due to School Breakfast Program guidelines.     

Randomized Trial Comparing Consumption of Military Rations to Usual Intake for 21 Consecutive Days: Nutrient Adequacy and Indicators of Health Status

BackgroundThe US military Meal, Ready-to-Eat food ration is approved as a nutritionally adequate sole source of nutrition for ≤21 days. However, the ration continuously evolves, requiring periodic reassessment of its influence on nutritional status and health.ObjectiveTo determine the effects of consuming the US Armed Services Meal, Ready-to-Eat ration for 21 days, relative to usual diets, on nutrient intake, and indicators of nutritional status and cardiometabolic health.DesignParallel-arm, randomized, controlled trial, secondary analysis.ParticipantsSixty healthy, weight stable, free-living adults from the Natick, MA, area participated between June 2015 and March 2017.InterventionParticipants were randomized to consume their usual diet for 31days (CON), or a strictly controlled Meal, Ready-to-Eat-only diet for 21 days followed by their usual diet for 10 days (MRE).Main outcome measuresNutrient intake (absolute and adjusted) throughout the study period, and indicators of nutrition status (vitamins B, D, folate, homocysteine, iron, magnesium, and zinc) and cardiometabolic health (glucose, insulin, and blood lipid levels) before (Day 0), during (Day 10 through Day 21), and after (Day 31) the intervention period.Statistical analysis performedBetween-group differences over time were assessed using marginal models. Models for nutritional status and cardiometabolic health indicators were adjusted for age, initial body mass index, and baseline value of the dependent variable.ResultsEnergy-adjusted fiber; polyunsaturated fatty acids; vitamins A, thiamin, riboflavin, B-6, C, D, and E; and magnesium and zinc intakes all increased in MRE during the intervention and were higher compared with CON (P<0.05), whereas relative protein intake decreased and was lower (P<0.05). Serum triglyceride concentrations averaged 19% (95% CI 0% to 41%) higher in MRE relative to CON during Days 10 to 31 (P=0.05). No statistically significant effects of diet on any other nutritional status or cardiometabolic health indicators were observed.ConclusionsFindings demonstrate that a Meal, Ready-to-Eat ration diet can provide a more micronutrient-dense diet than usual dietary intake aiding in maintenance of nutritional status over 21 days.     

Perceptions of Low-Income Students Completing a Nutrition Education Program

ObjectiveTo capture students’ perceptions of participating in a nutrition education program.DesignFocus groups (n = 16).SettingLow-income schools in Rhode Island.ParticipantsA total of 64 low-income, ethnically and racially diverse third-grade students, 93.5% of whom were eligible for free or reduced-price meals, 62% of whom were Hispanic, and 16% of whom were black.Main Outcome Measure(s)Perceptions about the program's impact on food and beverage consumption, the value of the program, potential changes for improvement, and barriers to change.AnalysisFocus groups were recorded, transcribed, and coded using a hybrid approach of inductive and deductive thematic analysis. Interrater agreement was calculated.ResultsStudents perceived that the program positively influenced their attitudes toward making healthy choices and what they and their families were eating. Students reported increased empowerment, bravery to try new foods, and knowledge. Students enjoyed the program but suggested increasing the duration and frequency of lessons and including peer-to-peer education. Students felt that the tastiness of unhealthy food was a barrier to choosing healthier food.Conclusions and ImplicationsFindings suggest that the program may have improved students’ knowledge, empowerment, and bravery, and that this had a positive influence on healthy food consumption for students and their families. Input from students will help inform future modifications to the curriculum.     

Home gardening and food preservation practices of the elderly in rural Kentucky

Previous research on the nutritional vulnerability of the elderly has failed to examine the unique potential for dietary enhancement provided by gardening and food preservation among the rural elderly. The goal of this paper is to describe contemporary home gardening and food preservation practices in persons 55 years and older in rural Kentucky. Data come from a year of qualitative research and two subsequent surveys designed to record seasonal variation in diet and nutritional strategies of a sample of 639 respondents. Fifty‐six percent of the elders had home gardens; they were in better functional status and less likely to live alone than nongardeners. A core garden of 7 items most commonly raised was identified from a total of 22 items reported. Most elders preserved home produce; preservation techniques specific to particular foods are identified. Patterns of foods grown and favored preservation techniques are analyzed in relation to historical traditions, traditional beliefs, and food preferences in the region.     

Beyond the clinical walls: registered dietitian nutritionists providing medical nutrition therapy in the home setting

BACKGROUD/OBJECTIVESRegistered dietitian nutritionists (RDN) are providers of medical nutrition therapy (MNT) to address health and chronic disease. Traditionally, RDNs have provided care in healthcare facilities including hospitals and private care facilities. The purpose of this study was to determine how RDN individualized MNT in the home impacted nutrition, physical activity, and food security.SUBJECTS/METHODSThis is a secondary data analysis. The mean age of the participants (n = 1,007) was 51.6 years old with a mean body mass index (BMI) of 34.1 kg/m². Individualized MNT visits were delivered by an RDN in the home setting from January to December 2019. Participants were referred by healthcare professionals or self-referred. Participants had MNT benefits covered by their health insurance plan (43.3% Medicaid; 39.8% private insurance; 7.9% Medicare, 9% other). Health outcomes related to nutrition care were measured. Outcomes included self-reported consumption of nutrition factors and physical activity. Our secondary outcome focused on food security. The changes in weight, BMI, physical activity, and nutrition factors were analyzed by a linear regression model or linear mixed model, adjusting for age, sex, baseline value, and number of appointments. Food security was summarized in a 2 by 2 contingency table.RESULTSBaseline values had significantly negative impacts for all changes and number of appointments was significant in the changes for weight and BMI. Increases in physical activity were significant for both female and male participants, 10.4 and 12.6 minutes per day, respectively, while the changes in weight and BMI were not. Regarding dietary factors, the consumption total servings per day of vegetables (0.13) and water (3.35) significantly increased, while the consumption of total servings of whole grain (−0.27), fruit (−0.32), dairy (−0.80) and fish (−0.81) significantly decreased. About 24% (of overall population) and 45% (of Medicaid population) reported improvements in food security.CONCLUSIONSThis study found that home visits were a useful setting for MNT delivered by RDNs. There is a strong need for individualized counseling to meet the participants'' needs and personal goals.     

Growing urban health: community gardening in South-East Toronto

This article describes results from an investigation of the health impacts of community gardening, using Toronto, Ontario as a case study. According to community members and local service organizations, these gardens have a number of positive health benefits. However, few studies have explicitly focused on the health impacts of community gardens, and many of those did not ask community gardeners directly about their experiences in community gardening. This article sets out to fill this gap by describing the results of a community-based research project that collected data on the perceived health impacts of community gardening through participant observation, focus groups and in-depth interviews. Results suggest that community gardens were perceived by gardeners to provide numerous health benefits, including improved access to food, improved nutrition, increased physical activity and improved mental health. Community gardens were also seen to promote social health and community cohesion. These benefits were set against a backdrop of insecure land tenure and access, bureaucratic resistance, concerns about soil contamination and a lack of awareness and understanding by community members and decision-makers. Results also highlight the need for ongoing resources to support gardens in these many roles.     

Qualitative Research in Phoenix,AZ, Exploring Support for Public–Private Partnerships to Expand the Reach of the Fresh Fruit and Vegetable Program

BackgroundFruit and vegetable (F/V) consumption among school-aged children falls short of current recommendations. The development of public–private partnerships (PPPs) has been suggested as an effective approach to address a number of public health concerns, including inadequate F/V consumption. The US Department of Agriculture's Fresh Fruit and Vegetable Program (FFVP) provides F/V as snacks at least twice per week in low-income elementary schools. In addition to increasing F/V consumption behaviors at school, children participating in the FFVP make more requests for F/V in grocery stores and at home, suggesting the impact of the program extends beyond school settings.ObjectiveThis study explored the potential for establishing successful PPPs between schools and food retailers to promote the sales of F/V in low-income communities.DesignSemi-structured interviews and focus groups were conducted with participants from 4 groups of stakeholders.Participants/settingGrocery store and produce managers from 10 grocery stores, FFVP personnel from 5 school districts and 12 schools, and parents of children attending 3 different FFVP-participating schools, all in the Phoenix, AZ, metropolitan area participated in interviews and focus groups.Statistical analyses performedData were analyzed using a directed content analysis approach to examine benefits, barriers, and strategies for developing a PPP.ResultsKey perceived benefits of creating a PPP included the potential to increase store sales, to enhance public relations with the community, and to extend the impact of the FFVP to settings outside of schools. Barriers included offering expensive produce through the FFVP and the potential lack of communication among partners. Strategies for developing a PPP included using seasonal produce and having clear instructions for teachers and staff. Parents reported their children requesting more F/V as a result of FFVP participation.ConclusionsStakeholders support forming PPPs. Partnerships between FFVP schools and retailers can be mutually beneficial and have a positive impact on children and their families.     

Breakfast Consumption May Improve Fasting Insulin,HOMA-IR,and HbA1c Levels in Predominately Low-Income,Hispanic Children 7–12 Years of Age

Children from low-income households and minority families have high cardiometabolic risk. Although breakfast consumption is known to improve cardiometabolic health in children, limited randomized control trials (RCT) have explored this association in low-income and racial/ethnic U.S. minority families. This study conducted secondary analyses from TX Sprouts, a school-based gardening, cooking, and nutrition education RCT, to examine the intervention effect on breakfast consumption and how changes in breakfast consumption impact cardiometabolic risk in predominately low-income, multi-ethnic children. TX Sprouts consisted of 16 schools (8 intervention; 8 control) in greater Austin, TX. A total of 18 lessons were taught, including topics on breakfast consumption benefits and choosing healthy food options at school. Children completed clinical measures (e.g., anthropometrics, body composition via bioelectrical impedance), and the number of breakfast occasions (BO) per week (at home and school) was captured via validated survey at baseline and post-intervention. Post-study—Baseline changes in breakfast consumption were used to categorize students as: maintainers (BO −1 to 1 day/week), decreasers (BO ≤−2 day/week), and increasers (BO ≥2 day/week). Optional fasting blood draws were performed on a subsample. Generalized weighted linear mixed modeling tested differences between intervention and control, with schools as random clusters. Analysis of covariance and linear regression examined changes in breakfast consumption on cardiometabolic outcomes, controlling for age, sex, race/ethnicity, free and reduced-price school meal participation (FRL), school site, breakfast location, physical activity, baseline cardiometabolic measures, and BMI z-score. This study included 1417 children (mean age 9 years; 53% male; 58% Hispanic, 63% FRL; breakfast consumption patterns: 63% maintainers, 16% decreasers, and 21% increasers). There was no intervention effect on changes in breakfast consumption. Compared to decreasers, increasers had an increase in insulin (−0.3 µIU/mL vs. +4.1 µIU/mL; p = 0.01) and a larger increase in HOMA-IR (+0.4 vs. +1.5; p < 0.01). Every one-day increase in breakfast consumption decreased fasting insulin by 0.44 µIU/mL, HOMA-IR by 0.11, and hemoglobin A1c by 0.01% (p ≤ 0.03). Increased breakfast consumption was linked to improved glucose control, suggesting breakfast can mitigate risk in a high-risk population. To better understand underlying mechanisms linking breakfast consumption to improved metabolic health, RCTs focusing on breakfast quality and timing are warranted.     

Public nutrition: Why,What, How?

Public Nutrition is a field of professional study and practice that has existed for many years without being named as such. It encompasses the disciplines that deal with factors affecting the food consumption and nutritional outcomes of populations, and goes beyond the definition of Public Health Nutrition by including the study of public policy in areas outside of health and nutrition as traditionally defined, that nonetheless can have profound effects on nutrition. Career paths in Public Nutrition exist at a variety of professional levels, including practitioners and direct service providers; administrators and planners; policy makers; and researchers and educators. The professional preparation of those working in Public Nutrition typically combines education and experience in nutritional science, social science, and sometimes management and planning. The field of Public Nutrition is important in providing a critical link between advances in understanding biomedical determinants of nutrition and the application of such understanding in programs and policies. However, the study of Public Nutrition goes beyond this: it represents an agenda of research and practice in its own right. Public Nutrition includes the study of how specific policies, in varying contexts, affect food consumption and nutrition outcomes; it includes the study of determinants of program effectiveness in improving these outcomes. Specific training programs in Public Nutrition do exist; the elements of a curriculum in Public Nutrition include social science research skills (data collection, management, analysis and interpretation), an understanding of economic, social, political, and behavioral determinants of food consumption, health and nutrition; a grounding in nutritional science. Field experience is an essential part of the preparation of Public Nutrition professionals.     

Health Blief Model-based intervention to improve nutritional behavior among elderly women

BACKGROUND/OBJECTIVESNutrition is a determinant factor of health in elderly people. Independent living in elderly people can be maintained or enhanced by improvement of nutritional behavior. Hence, the present study was conducted to determine the impact of Health Belief Model (HBM)-based intervention on the nutritional behavior of elderly women.SUBJECTS/METHODSCluster-random sampling was used to assess the sample of this clinical trial study. The participants of this study attended a 12-week nutrition education program consisting of two (2) sessions per week. There was also a follow-up for another three (3) months. Smart PLS 3.5 and SPSS 19 were used for structural equation modeling, determination of model fitness, and hypotheses testing.RESULTSThe findings indicate that intervention had a significant effect on knowledge improvement as well as the behavior of elderly women. The model explained 5 to 70% of the variance in nutritional behavior. In addition, nutritional behavior was positively affected by the HBM constructs comprised of perceived susceptibility, self-efficacy, perceived benefits, and barriers after the intervention program.CONCLUSIONThe results of this study show that HBM-based educational intervention has a significant effect in improving nutritional knowledge and behavior among elderly women.     

Parents’ Perceptions of 5210 Nutrition Messaging and Child Weight Status

ObjectiveTo explore parent perceptions of child weight status and 5210 nutrition messaging recommendations, including daily consumption of 5 fruits and vegetables, limiting child screen time to ≤2 hours, incorporating 1 hour of daily physical activity, and no consumption of sugary, sweetened beverages.MethodsUsing the Convergence Model of Communication as a framework, qualitative focus groups (n = 5) were conducted at 4 Head Start sites across 1 Ohio County. Twenty-eight parents aged 20–60 years comprised the groups. A deductive analysis technique with respondent validation was used.ResultsParents have limited understanding of 5210 messages delivered by the program. Parent food preferences, family finances, and children's picky eating were identified as barriers to integrating healthy eating habits at home. Parents prefer practical strategies regarding how to integrate healthy eating habits into the home environment. Participants expressed concern about children's psychological health and happiness vs weight status.Conclusions and ImplicationsUnderstanding parental perceptions of 5210 messaging and program-reported weight status may assist Head Start programs in addressing childhood obesity through focused parent education and support.