Abstract
Purpose: This study examines the association between neighbourhood environment attributes and physical activity in Ghana. The study seeks to answer the following research questions 1. What is people’s perception about the neighbourhood environment in Ghana? 2.What proportion of Ghanaians are meeting the WHO physical activity (PA) guidelines, and what are their socio- demographic characteristics? 3.Which perceived neighbourhood environment attributes are associated with physical activity in Ghana?
Methods: The International Physical Activity Questionnaire (IPAQ) and the Neighbourhood Environment Walkability Scale (NEWS)-Africa instrument were used in a cross-sectional study to gather data from 1075 people aged 17 years and above selected from diverse communities (by socioeconomic status (SES) and residential density in three regions of Ghana). Physical activity was the dependent variable for the study, and it was measured using two indicators: (1) active transportation and (2) leisure physical activity.
Results/findings: Approximately 53% of the respondents were female. Most roads in respondents’ immediate neighbourhoods in Ghana have no sidewalk, pedestrian crossing bicycle lanes and lighting. However, there are many alternative roads, footpaths and short cuts for moving from one destination to another and easily accessible. About one out of four respondents meets the WHO PA guidelines, more males met the WHO physical activity recommendation than females in the study. Respondents aged 17-19 years (21.2%) and 30-39 years (20.6%) recorded the highest level of high PA. Surprisingly, participants who perceived their neighbourhood to be characterized by very densely packed small houses including informal settlement reported low overall physical activity in this study
Five neighbourhood environment attributes, residential density (p value<0.001), proximity to service facilities/places (p value<0.001), access to service facilities/places (p value<0.001), place for walking/cycling/playing(p value<0.01), and crime safety(p value<0.01), showed significant associations with overall PA.
CONCLUSION: Findings from this study will help create awareness about the link between neighbourhood environment and PA in Ghana. Strategies to promote and increase PA in Ghana should consider built environmental attributes as an important factor to consider. Further studies on the neighbourhood environment and physical activity in Ghana is recommended, possibly a multidisciplinary study.

Abstract
Purpose: This study assessed self-perceived health status and physical activity among the youth and adult in Ghana before, during, and after the COVID-19 restrictions. The study seeks to answer questions like; what is your perception about your health status during the covid-19 pandemic, and associated restrictions? How often do you engage in physical activity like walking/jogging/play /sports in a week? How did the covid-19 pandemic and the associated restrictions affect your physical activity behaviour of respondent?
Methods: The study was a cross-sectional survey that used on-line data collection method (surveylex link). The Surveylex package includes demographic information items, a non-linguistic speech analyses, international physical activity questionnaire (IPAQ), general anxiety disorder-7 (GAD-7), and patient health questionnaire-9 (PHQ9). The Statistical Package for Social Sciences (SPPSS) version 25 use for data analysis. Descriptive Statistics of demographic characteristics were reported in percentages using tables, bar chart and graphs. A multinomial regression analyses was employed to establish the association between perceived health status and physical activity levels of participants during the pandemic period in Ghana.
Results/findings: Out of the 937 participants involved in the study, 56.5 % were males and 43% females. Fifty-eight percent (58%) of respondent have not been vaccinated against the Covid-19 pandemic as at the time of the study. Most participants perceived their health status to be excellent and very good conditions. About 3 out of 4 participants were within the normal weight category, and 9.5% of them been overweight. Responding to place where participants perform physical activity about 30% indicated no physical activity, whereas almost half of them said they do it at home. Places where participants engaged in physical activity during the COVID-19 pandemic, and gender showed significant association with levels of PA. However, how individuals perceived their health status did not show significant association with physical activity in this study.
Conclusion: A high proportion of participants reported performing physical activity in their homes during the pandemic. The home is a convenient place to engage in physical activity and must be encouraged especially during pandemic restrictions.

Title: Echando una Mano: Community Food and Nutrition Assistance Providers’ Perceptions of their Ability to Adequately Serve Low-Income and non-English speaking Latino adults in the U.S.

Presenting Author: Miguel Angel Lopez
Corresponding Authors: Pia Chaparro, Julia Fleckman, Joseph Molloy, Amy George, Melissa Fuster

Abstract:

Purpose: To examine community food and nutrition assistance providers’ (CFNAPs) perceptions of low-income, non-English-speaking Latino adults in the U.S., and CFNAPs’ ability to provide adequate food and nutrition assistance to them.

Methods: Semi-structured interviews were conducted with CFNAPs (n=20) in the U.S. from August to November 2022. CFNAPs who participated in the interviews were employed in community healthcare centers, community gardens, public health departments, food banks or pantries, and teaching kitchens. Interviews were transcribed verbatim. Transcripts were analyzed inductively using a thematic content analysis, and guided by a theoretical framework on language use, social power, and health care. Following the analysis, randomly selected interviewees (n=8) were asked to return for member checking. In the member checking, CFNAPs were presented with the results of the research study and given the opportunity to provide feedback on the results.

Results: While linguistically adapting food and nutrition assistance (e.g., using a translation service) can be beneficial, it fails to address pervasive social structures that may limit the adequacy of food and nutrition assistance provided to low-income, non-English speaking Latino adults. Social structures identified were categorized into three themes; the themes include perceived: 1) presence of social authority when clients seek food and nutrition assistance; 2) lack of clients’ adequation (i.e., similar social standing) when seeking food and nutrition assistance; and 3) diminished clients’ authentication (i.e., ability to verify information) of food and nutrition assistance. These factors were perceived as barriers for non-English-speaking Latino adults to participate in, and receive adequate services from, community food and nutrition assistance programs.

Conclusion: Presence of social authority, lack of adequation, and diminished authentication when seeking food and nutrition assistance from CFNAPs were identified as social structures in the U.S. that may disparage linguistically isolated individuals. To equitably serve non-English-speaking Latino adults, a paradigm shift that recognizes biases against non-English speakers and Latino people is warranted. The relationship between language discordance and inadequate food and nutrition assistance programming among low-income, non-English speaking Latino adults begs for the continued conceptualization and understanding of the paths inequities across language groups influence disparate access to, and adequacy of, food and nutrition assistance.

Purpose: to present the protocol of the RUNfH study, that intends to promote physical activity (PA) among Brazilian vulnerable adults.
Methods: This is a quasi-experimental design project, which will be conducted in two steps. Firstly, barriers and facilitators for PA will be mapped using the concept mapping approach. Following the findings of the first step, a 16-week intervention program, using running/walking, will be implemented. The project will target adults with low socio-economic status who are users of the local Basic Health Units in three Brazilian cities, situated in the North (Tucuruí, Pará; Augustinópolis, Tocantins) and Northeast (Paulo Afonso, Bahia) regions. Eligible participants will include adults aged ≥30 years, physically inactive according to national guidelines, not engaged in PA programs over the last three months, and interested in taking part in a walking/running program. Sociodemographic variables (age, sex, perception of health), PA (IPAQ and the number of steps), quality of life (Euroqol 5 Dimensions), sleep quality (Pittsburg Sleep Inventory), well-being (WHO-5), blood pressure, glucose, HDL and total cholesterol, triglycerides, anthropometric variables (height, body mass, waist, and hip circumferences), mental health (Level 1 Cross-Sectional Symptom Scale), and cardiovascular risk (Framingham score) will be assessed before and immediately after intervention. Statistical analysis will include mean comparison, regression analysis, and effect size estimation.
Conclusion: Given the higher prevalence of physical inactivity and increased risk for non-communicable diseases among individuals from low socioeconomic classes in Brazil, the RUNfH project seeks to offer a possible scalable strategy at a national level, to reduce inequities in PA among adults, with possible positive impacts on their health.

Purpose: Promoting food and nutrition security is a shared objective for nutrition programs across the United States (U.S.). Still, prior scholarship has established disparities in food insecurity and diet-related chronic disease within specific sociodemographic groups. As such, this scoping review aimed to identify the strategies implemented within U.S. nutrition programs to promote equity, diversity, and inclusion (EDI) and explore how they addressed intersectional stigma.
Methods: Included articles needed to be published in English, during or after 1990, and to detail intentional EDI strategies applied within U.S. nutrition programs (including federal and local programming). The search strategy was created in collaboration with a research librarian. Five databases–Academic Search Complete, Agricola, CABDirect, PubMed, and SocINDEX--were selected to locate peer-reviewed literature, and grey literature searches were also carried out among relevant websites. Data extracted included author; publication year; source type; objective; study design; location; funder; EDI strategy components; outcomes; priority population information; alignment with principles to address intersectional stigma; and EDI strategy results and lessons learned.
Results/findings: Of the 46 included sources, 24 concentrated on federal programs, 20 on local programs, and two presented EDI strategies applicable to both. EDI strategies were grouped and synthesized into eight strategy types to improve the relevance, appropriateness, and/or access within nutrition programming for priority populations [e.g., program design or adaptation (n=18); food justice/anti-racism training (n=11); increase access to federal nutrition program services (n=8); hire or develop staff to better serve priority populations (n=6); expand nutrition program partnerships (n=5); increase accessibility of healthy and culturally preferred foods (n=5); implement nutrition-associated policies to mitigate disparities (n=4); and organizational change strategies (n=3)]. Principles to address intersectional stigma regarding the approach to EDI strategies were found in 39 sources.
Conclusions: Review findings add to the current discourse on advancing EDI, specifically within the context of U.S. policies and programs that influence food and nutrition security and health equity and can be used as a platform to build on in similar countries. Practitioners and researchers working to address EDI in nutrition programs are encouraged to use the categories and strategies identified by this review as examples for moving EDI forward.

Purpose:
Produce prescription programs (PPRs) provide prescriptions for fruits and vegetables in clinical settings. This study involves five diverse PPRs operating across the United States (US) and serving individuals with low incomes and type 2 diabetes (T2D). PPPT2D tests the hypothesis that PPR participants will see greater improvements in HbA1c and other related health outcomes compared to control participants.

Methods:
The study is enrolling ~500 participants. Intervention participants receive PPR plus Standard of Care and control participants receive Standard of Care only. Survey and electronic health record (EHR) data are collected from both groups at enrollment and at 4 to 6 months. The primary outcome of interest is HbA1c. Secondary outcomes include fruit and vegetable intake, food security, and healthcare utilization. Adjusted linear mixed-effect models accounting for clustering will test for differences in HbA1c trajectories between intervention and control participants.

Costs to administer a PPR during a 6-month period of implementation will be used in a preliminary within-trial horizon cost-effectiveness analysis using incremental cost-effectiveness ratios and acceptability curves.

To understand participating site’s implementing staff and PPR participant experiences, semi-structured interviews are collected pre/post PPR intervention. The transcribed interviews will be coded using thematic content analysis methods to understand concepts such as program feasibility and emergent best practices.

Results:
Baseline descriptive data will be available by early 2024 to show characteristics of intervention and Standard of Care participant population. Other results to be presented include preliminary qualitative and cost-effectiveness results.

Conclusions:
This study uses a multiple methods research design to simultaneously evaluate the impact of PPR programs on health outcomes, cost-effectiveness, and program feasibility across clinics serving diverse populations in five US states. Baseline data will describe similarities and differences in demographics and health status of PPR program participants across sites. PPPT2D will address gaps in diabetes translational science related to the effectiveness, cost-effectiveness, and implementation challenges and opportunities for Food Is Medicine programs in improving diabetes management. The intervention is aligned with current trends in public policy and public health programming, which can be applied across settings and geographies.

Purpose: To identify innovations and lessons learned from produce prescription programs (PPR) implemented across the United States (U.S.).

Methods: We conducted qualitative interviews with key informants from a purposeful sample (n=13) of produce prescription (PPR) programs funded through the U.S. Department of Agriculture’s Gus Schumacher Nutrition Incentive Program (GusNIP). PPR programs were selected to be representative of important contextual characteristics like geography and populations served. Key informants (n=33), such as clinicians, nutrition educators, and food retailers were interviewed about a myriad of topics including their role, characteristics of their program, implementation challenges and successes, and perspectives on evidence and scalability. Interviews were 45-60 minutes long, audio recorded, and transcribed verbatim. Using a content analysis approach, two team members independently coded each transcript to identify emergent themes using NVivo software.

Results/findings: Key themes emerged around innovations in nutrition education, the role of technology, and implementation challenges. Nutrition education was a core component of PPR programs; interviewees described a wide variety of delivery formats, for example: recording online cooking tutorial videos; supplying healthcare providers with messaging/materials; using social media to foster social support; linking nutrition education with complementary services (e.g., accessing food assistance); and garden-based nutrition education -- including food waste and composting. Interviewees described how technology is necessary to scaling programs efficiently, yet there remain many opportunities for growth and innovation. Key functions of technology included enrollment and patient screening, administration of vouchers (e.g., point-of-sale systems at food retailers), reporting and evaluation, and leveraging electronic health records. Implementation challenges highlighted include healthcare organizations burdened with COVID-19 and inability to focus on PPR delivery; challenges in conducting evaluations including limitations in obtaining healthcare metrics; limited capacity and bandwidth across organizations and teams; and participants’ transportation barriers.

Conclusions: PPR programs in the U.S. vary greatly across settings (e.g., geographic context, population density, healthcare involvement) and implement many innovative components as part of their program. This study illuminated these innovative components as well as barriers and facilitators to inform implementation and adoption of PPR programs. Given this variation, as PPR programs are adopted internationally, nuances in settings should be considered.

Purpose: Food insecurity involves unreliable access to enough nutritionally adequate food. In 2022, food insecurity impacted over one-in-five Latinx U.S. adults, who were at an increased risk of food insecurity compared to White adults. There is thus an urgent need to identify sustainable strategies to prevent food insecurity in the Latinx population. Promoting food literacy, the understanding of how food choices impact health outcomes, could improve food security but has seldom been studied among Latinx adults.

Methods: A secondary data analysis was conducted using data from the Computerized Physical Activity Support for Seniors (COMPASS) Trial to determine if two different nutrition interventions impacted the food security status of older, low-income Latinx U.S. adults. Participants were assigned to one of the two interventions: 1) the culturally tailored Food Literacy and Nutrition (FLAN) curriculum, or 2) a Nutrition Information only control. The U.S. Household Food Security Survey Module: Six-Item Short Form was used to collect self-reported data on food security. Longitudinal general linear models were analyzed to determine if either intervention improved food security.

Results: On average, participants (n=39) were 61.5 years of age (SD=6.7), mostly female (69%), and reported Spanish as their primary language (69%). No between-group differences in food security status existed at baseline (b=-0.15, SE=0.17, p=0.37). Across all participants, food insecurity at baseline was associated with an increased odds of food insecurity at 6 months (OR=1.45, 95% CI=1.06, 1.99; p=0.03) but not at 12 months. While there were no between-group differences in the odds of food insecurity at 6 months, latter estimates indicated that the FLAN group had 29% lower odds of food insecurity at 12 months (AOR=0.71, 95% CI=0.54, 0.95; p=0.03) compared to the Nutrition Information only control group.

Conclusions: The FLAN curriculum, a bilingual and culturally tailored food literacy course, aimed to increase food literacy by teaching concepts involving budgeting, food choices, and healthful cooking. Evidence from this investigation demonstrates the potential longer-term effects of using the FLAN curriculum to prevent food insecurity among older, low-income Latinx adults. Further investigation into the utility of food literacy as an intervention component to address food insecurity is warranted.

Purpose

The impact of food insecurity on diet quality, fruit and vegetable (FV) intake, weight, and health outcomes has been heavily documented. Despite concerted efforts to address health disparities related to food insecurity through policy, systems, and environmental approaches, weight bias – a significant driver of these disparities – is often left out of the conversation. The purpose of this presentation is to describe lessons learned about weight stigma from a national evaluation of healthy food incentives. Recommendations will address weight stigma in future public health research.

Methods

The authors are members of the Gus Schumacher Nutrition Incentive Program’s (GusNIP) National Training, Technical Assistance, Evaluation, and Information Center (NTAE), which supports implementation and evaluation of healthy food incentive programs across the U.S. The NTAE is working to center diversity, equity, and inclusion (DEI) in their work. Specific to the measurement of diet-related interventions, DEI approaches may include disaggregated sociodemographic metrics, culturally tailored dietary assessments, and considerations for weight bias. The NTAE recently developed a public-facing resource that provides validated methods to understand weight bias within healthy food incentive interventions and may help to better understand health-related inequities. Weight bias assessment within healthy food incentive projects will be described as a strategy that can also provide insight into existing population health.

Findings

In the literature, food insecurity is associated with a higher risk of obesity, cardiovascular disease, type 2 diabetes, hypertension, asthma, depression, and mental illness. Interventions with food insecure populations, including healthy food incentives, have focused on obesity prevention. There is an existing knowledge gap regarding how the effects of weight stigma impact evaluation and effectiveness of nutrition programming. Weight bias evaluation approaches will be explored, including measuring implicit and explicit bias, perceptions on overweight and obesity, and internalized stigma.

Conclusions

Programs that provide healthy food incentives are promising regarding reducing health-related disparities amongst individuals with food insecurity, but it is imperative that this evidence captures and controls for other known influences including weight stigma, especially when overweight and obesity are an intervention focus. More broadly, accounting for weight stigma could improve and sharpen the evidence surrounding nutrition programming internationally.

Purpose: Examine Supplemental Nutrition Assistance Program (SNAP) Nutrition Incentive Program customer survey respondent differences by rural vs. urban status, focused on nutrition-related issues.

Methods: Survey recruitment occurred in person at program sites. Survey options included in-person (paper copy; electronic device) or off-site (research team called or they took the survey online). Data were collected from June-August 2023. Participants were ≥19 years old, able to read and/or speak English, Spanish or Arabic, and SNAP and Nebraska Double Up Food Bucks participants. Respondents received a $10 stipend for completion. Survey data were recorded in Qualtrics and exported into SPSS with distributions, frequencies and percentages calculated for nutrition-related survey components of rural vs. urban responses (determined by ZIP Code).

Results/findings: There were 120 surveys completed, 117 with ZIP Codes (n=37 rural; n=80 urban). Overall, half or more reported low to very low food security (50%), SNAP benefits ˃1 year (65%), and positive program experiences (81%). Rural participants reported higher percentages for planning meals ahead of time (15% difference) and making a list before shopping (11% difference) most of the time to almost always. Compared to urban, rural agreed more that they had easy access to fruits and vegetables (FV) of high quality in their neighborhood (17% difference) but disagreed more regarding access to a large selection of FV (13% difference). Urban respondents reported higher percentages (one or more times/day) for fruit (14% difference) and vegetable (18% difference) consumption and most of the time to almost always thinking about healthy choices when deciding what to eat (10% difference), cooking meals at home using healthy ingredients (13% difference), and feeling confident about cooking healthy meals (10% difference).

Conclusions: Findings suggest urban respondents were consuming more and had access to larger selections of FV than rural, with rural reporting higher percentages regarding ease of access to and quality of FV. Since nutrition education is a program component, these findings suggest more efforts should be made in rural sites to increase efficacy of healthy ingredient selection and meal preparation confidence. Working with retailers to increase the selection of FV may help increase FV consumption in rural areas.

Purpose: This cross-sectional study aimed to characterize the need for supporting nutrition among older adults or seniors 60 years or older living in Central Texas. With two of the largest cities in the U.S. – Austin and San Antonio, rapidly growing populations, and increasing socioeconomic disparities, policy stakeholders require evidence for deciding about senior nutrition programs. We hypothesized that the two policy regions would differ in socioeconomic disadvantage and resources. This study is part of the first asset mapping effort for senior nutrition in this large region.

Methods: We defined a policy-relevant study area of 23 rural and urban counties, comprised of 857 Census Tracts (CTs), based on the two local council of government (COG) regions for the Austin and San Antonio, Texas Metro areas (21,083 square miles). Data came from the U.S. Census. The index included seven indicators of unmet need: income, transportation, food, government assistance, health insurance, physical disability, and household composition. We used quintiles to rank each factor and calculated an index score based on the sum. Statistics were used to determine index characteristics. Wilcoxon test determined statistically significant differences between the two regions. R language and ArcGIS Pro were used for statistics and mapping.

Results/findings: The index showed a nearly symmetric distribution with a median value of 18, and range of 7 to 35 (least to most disadvantage). Based on this index, socioeconomic disadvantage was greater for the San Antonio compared to the Austin region (Wilcoxon W = 119212; p < 0.0001). Visual analysis of the map showed that CTs located near the Interstate 35 transportation corridor had relatively less disadvantage, while counties and CTs located farther away had more disadvantage. Four outliers were identified within the Austin region, or smaller areas with extreme disadvantage, which were confirmed through member checking.

Conclusions: Findings will be used for an asset mapping study identifying grocery and meal sites, both federally funded and non-profit organizations, and integrated into a project to design a new, multi-functional app for senior nutrition programs; launch health interventions addressing food insecurity and social isolation; and advocate for strengthening senior nutrition programs in Central Texas.

Purpose: Understanding the social and economic factors influencing the availability and accessibility of culturally preferred foods is central to developing policy, systems, and environmental (PSE) changes that expand food security. Building on a decades-long community-university partnership and using a community-engaged research approach, this study examined Latinx household food preferences for and accessibility to culturally preferred foods in two counties in Oregon (USA) in 2022-2023.

Participants: Participants were mothers aged 18 years and older (M=39.2yrs SD=9.5), identified as Latina (73% Mexican origin; 17%; Central/South American origin; 89% Spanish-speaking) and had lived in the United States for an average of 18.8 (SD=10.5) years.

Methods: A mixed methods study with a convenience sample was conducted. Participants (n= 101) completed an online survey containing standardized scales examining household dietary practices, food security status, and sociodemographic characteristics. In-depth interviews with a subset of 31 participants explored participants’ cultural food preferences and practices.

Qualitative data (using NVivo 14) were analyzed using a combination of inductive and deductive approaches to explore cultural food preferences, food security experiences, and food access.

Multivariable logistic regression analyses (using Stata SE 18) will examine the associations between household dietary practices and food security, adjusting for sociodemographic characteristics.

Results/Findings:
On average, participants prepared meals at home 5.9 (1.9) days within the last week, and the majority (83.2%) had vegetables all or most of the time in the home. 35.5% experienced high food security; however, 54.5% reported being unable to afford nutritious meals in the last 12 months. Qualitative data indicated a strong preference for fresh, local, and organic foods (compared to a general mistrust of conventional and packaged foods). Cultural, health, and cost reasons guided their food choices.

Conclusions:
Latinx families value cultural foods despite challenges in accessing healthy, fresh foods. They remain focused on providing home-prepared meals that meet health needs. Collaboration between safety-net programs, local food producers, and nutrition education programs to create PSE change for greater access to fresh foods could increase cultural food security among Latinx households.

Purpose: Food insecurity (FI) in Puerto Rico (PR) reached as high as 40% after the COVID-19 pandemic. Our purpose was to describe the current FI status and its association with sociodemographic variables and participation in the Nutrition Assistance Program (NAP) which exists instead of SNAP in most US territories.

Methods: An online survey was distributed between June-August 2023 to adults living in PR via public school networks. The survey captured sociodemographics and FI (6-item USDA). A poverty variable was created by comparing household annual income to the 2022 USA poverty threshold for their household size. Only participants who responded to all food security questions were included in the analysis (n=681 out of n=993 for total survey). Respondents were considered food insecure if they had low or very low food security. Logistic regression modeled FI dependent on variables that were significantly associated with FI. All analyses were conducted in SPSS V27 and SAS 9.4.

Results: The majority of the sample was female (76.5%), ages 25-54 (68%), had completed ≤two years of college (60.6%), were employed (62%) and had an annual household income ≤$30,000 (65.9%). Nearly 43% of respondents participated in NAP. The majority of the sample (76.5%) was food insecure: 35.2% (n=240) had very low food security and 41.3% (n=281) had low food security. In logistic regressions, FI was associated with NAP (OR 1.40, 95% CI:0.9-2.1 p=0.13 ), Education- Two years of college (OR 1.17,0.68-2.01 p=0.02), Bachelors (OR 0.62 95% CI 0.36-1.05, p=0.08), Masters or Above (OR 0.58 95%CI: 0.30-1.11 p=0.11), poverty (OR 1.46 95% CI:0.95-2.25 p=0.08).

Conclusion: Our results show a large proportion of the sample, which is similar in sociodemographics to the general PR population, experienced FI. The rates were higher than previously reported (40%) using similar sampling methods. These findings warrant further study and emphasizes the heightened need to address FI through effective multi-sectoral policies in the archipelago.