Background: Food swamps, which have a high density of outlets selling unhealthy food relative to healthier options, are a major driver of diet-related disparities in urban communities. However, no validated food swamp measurement tools exist at the neighborhood level. Methods: We developed the Food Swamp Environment Audit Tool (FS-EAT) using community-based participatory research. FS-EAT includes 19 items as-sessing street-level food outlet types, accessibility features, food marketing, pricing, social features, and store-level information and food availability. Reliability and validity testing were performed using stakeholder surveys and feedback from the community advisory board (CAB). We compared secondary National Establishment Time Series (NETS) 2020 with FS-EAT food store data using positive predictive values and sensitivity scores. We computed Spearman's rank correlation coefficients to measure the alignment between block group-level food swamp and non-food swamp classifications, comparing FS-EAT data with NETS 2020 data. Results: Interrater reliability was strong (κ = 0.82), and 80% of stakeholders rated FS-EAT items as relevant/extremely relevant. CAB members con-firmed that FS-EAT maps aligned better with lived experiences than the secondary NETS data. GIS analyses showed that FS-EAT maps captured more accurate and timely food swamp exposure compared to NETS. When validated against the NETS 2020 business list, the FS-EAT demonstrated an overall sensitivity of 45.3% and a PPV of 68.2%. We con-firmed fewer than half of NETS-listed outlets through FS-EAT ground observation, yet more than two-thirds of audit-identified stores were also present in the NETS database. Sensitivity was highest for convenience stores (74.4%) and lowest for limited-service restaurants (29.2%). Resident perceptions were moderately correlated with FS-EAT scores (r = 0.5). While both sources agreed on the food swamp classification in 18 block groups, 15 block groups (38.5%) were classified as food swamps by the FS-EAT audit data but as non-food swamps by the NETS data. Discussion: The FS-EAT tool captures nuanced features needed to assess the level of neighborhood food swamp exposure and contributes a systematic, cost-effective way to identify neighborhood-level food swamps.

Background Person-centered breastfeeding counseling is a key but often overlooked aspect of high-quality services. We explored women’s experiences of the Breastfeeding Heritage and Pride™ program, an evidence-based breastfeeding peer counseling program serving women with low incomes in the United States. Methods This study was conducted through an equitable community-clinical-academic partnership and guided by the World Health Organization (WHO) quality of care framework for maternal and newborn health, which highlights three domains of positive experiences of care: effective communication; respect and dignity; and emotional support. In-depth interviews were conducted with a purposive sample of women participating in the Breastfeeding Heritage and Pride™ program. Women were asked to describe their experiences with the program including examples of when good quality counseling was or was not provided. Each interview was conducted in English or Spanish, audio-recorded, and transcribed verbatim. Data were analyzed using reflexive thematic analysis. Once themes were generated, they were organized according to the three care experience domains in the WHO quality of care framework. Results Twenty-eight in-depth interviews were conducted with a racially/ethnically and socio-economically diverse sample of women. Three themes described effective communication practices of peer counselors: tailoring communication to meet women’s individual needs; offering comprehensive and honest information about infant feeding; and being timely, proactive, and responsive in all communications across the maternity care continuum. Two themes captured why women felt respected. First, peer counselors were respectful in their interactions with women; they were courteous, patient, and non-judgmental and respected women’s infant feeding decisions. Second, peer counselors showed genuine interest in the well-being of women and their families, beyond breastfeeding. The key theme related to emotional support explored ways in which peer counselors offered encouragement to women, namely by affirming women’s efforts to breastfeed and by providing reassurance that alleviated their worries about breastfeeding. These positive experiences of counseling were appreciated by women. Conclusions Women described having and valuing positive experiences in their interactions with peer counselors. Efforts to expand access to high-quality, person-centered breastfeeding counseling should, as part of quality assurance, include women’s feedback on their experiences of these services.

BackgroundThe Breastfeeding Heritage and Pride program (BHP) provides evidence-based breastfeeding peer counseling to low-income women. Due to the COVID-19 pandemic, BHP shifted from delivering in-person and virtual services to providing only virtual services. Program adaptations can impact implementation success, which could influence program effectiveness. We documented program adaptations and explored their impacts on implementation outcomes, guided by the Model for Adaptation Design and Impact.MethodsThrough a community-clinical-academic partnership, we conducted in-depth interviews with 12 program implementers and peer counselors and conducted a rapid qualitative analysis. To efficiently capture information on adaptations over time, we collected and analyzed information from program meetings and extracted data from a program report. We then triangulated data from these multiple sources.ResultsPeer counselors received training on virtual service delivery and increased supportive supervision. They recruited women via phone instead of in hospitals, which was viewed as feasible. In-person counseling visits at hospitals and clients' homes were replaced with phone and video calls. Examples of changes to the content delivered included breastfeeding education in the context of the pandemic such as the latest COVID-related infant feeding guidance, provision of face masks, and more assistance with social and economic challenges. Although peer counselors increasingly adopted video calls as a substitute for in-person visits, they emphasized that in-person visits were better for relationship building, helping with breastfeeding problems like latching, and identifying barriers to breastfeeding in the home environment like limited familial support. While adaptations were reactive in that they were made in response to the unanticipated COVID-19 pandemic, most were made with clear goals and reasons such as to ensure the safety of peer counselors and clients while maintaining service delivery. Most adaptations were made through a systematic process based on program implementers' expertise and best practices for peer counseling and were largely but not fully consistent with BHP's core functions.DiscussionBHP was able to shift to virtual service delivery for continued provision of breastfeeding counseling during the pandemic. Overall, virtual services worked well but were less optimal for several aspects of counseling. Evaluations of program effectiveness of virtual services are still needed.

Objectives: We explored associations between night eating and health outcomes in Latinos with type 2 diabetes. Methods: Participants (n = 85) completed surveys, were measured for anthropometrics, provided blood samples, and wore Holter monitors for 24 hours to assess heart rate variability. Results: Participant mean age was 60.0 years, hemoglobin A1c was 8.7%, most preferred Spanish (92%), and had less than a high school education (76%). Compared with their counterparts who denied night eating, night eaters had lower heart rate variability in the low (Cohen's d = -0.55; P = 0.04) and very-low-frequency bands (d = -0.54, P = 0.05), and reported more emotional eating (d = 0.52, P = 0.04), and poorer sleep quality (Cohen's h = 0.64). They did not differ on beverage intake or depressive symptoms. In regression that included depressive symptoms, associations between night eating and outcomes became nonsignificant. Conclusions and Implications: Night eaters demonstrated worse health outcomes. If results are replicated, nutrition education for this population might focus on night eating.

Background In the United States, Black and Hispanic mothers have lower breastfeeding rates compared with White mothers. To address breastfeeding inequities, the Breastfeeding Heritage and Pride program (BHP) provides breastfeeding support for predominately low-income minority mothers in Connecticut and Massachusetts. We described the process of designing BHP, the program model, and its impact on breastfeeding outcomes. Methods This BHP case study is based on in-depth interviews with BHP designers and implementers, peer counselors, and clients; a literature review of BHP impact evaluation studies; and a review of BHP materials. To guide the analysis and organize results, we used the Community Energy Balance Framework, an equity-oriented, multi-level framework for fostering healthy lifestyles. Results The Hispanic Health Council designed BHP to address barriers to breastfeeding identified through formative qualitative research with the Latino community, namely lack of role models, limited social support, embarrassment when breastfeeding in public, lack of breastfeeding knowledge, and a norm of formula feeding. According to the BHP model, clients receive education and support through in-person home and hospital visits supplemented by phone calls, beginning prenatally and continuing through one year postpartum. Counseling is delivered by peer counselors, women who have successfully breastfed, have similar cultural roots and life experiences as the clients they serve, and have completed intensive training on lactation management and communication skills. International Board Certified Lactation Consultants provide clinical guidance and ongoing training to peer counselors, as well as direct support to clients, if more specialized knowledge and clinical expertise is needed. Clients facing housing and food insecurity or other socio-economic obstacles that may negatively influence breastfeeding and health and well-being more broadly are connected to other health and social services needed to address their social determinants of health needs, including health care access and food and rent assistance programs. To continuously improve service delivery, BHP has a robust monitoring and evaluation system. In two randomized-controlled trials, BHP was shown to improve breastfeeding initiation and duration of any and exclusive breastfeeding. Conclusions BHP highlights the importance of community-engaged formative research for informing breastfeeding program design. It also provides an evidence-based example of a program model that offers a continuum of breastfeeding support, considers cultural-contextual influences on breastfeeding and social determinants of health, and incorporates continuous quality improvement.

Hazard Analysis and Critical Control Point (HACCP) has been effective in identifying and controlling foodborne hazards at different stages of the consumer food chain. In this study the HACCP model was applied at the household level to identify sanitation and food handling ‘Critical Control Points’ (CCPs) in the preparation of a ‘Chicken and Salad’ (CS) meal.A total of 60 Puerto Rican women were provided spices in addition to the main ingredients such as chicken breasts (CB) and lettuce and tomatoes (LT) to prepare CS in their home kitchens. Food and kitchen surface samples were collected at various stages of food preparation for total and coliform counts and to test for the presence of Listeria, Campylobacter, Salmonella genus and S. aureus. In addition, various food-handling behaviors such as thawing methods, hygiene practices, and use of cutting boards were observed and recorded to: (a) compare with the microbial testing results, and (b) identify CCPs in the CS meal preparation. Based on the microbiological and observation results, the following stages of meal preparation were identified as CCPs: (1) CB Thawing; (2) Cutting CB; (3) Hand washing after handling CB and before handling LT, and (4) Washing LT. Of the pathogens tested, S. aureus was present most commonly in all the food and surface samples. Five percent of LT samples or prepared salad were found positive for Listeria genus. A peer-reviewed article *Author for correspondence: 860.486.5073; Fax: 860.486.3674 E-mail: rafael.perez-escamilla@uconn.edu 544 FOOD PROTECTION TRENDS | JULY 2007

Supported by the National Institute of Minority Health and Health Disparities (R01MD005879) to Drs. Rafael Pérez-Escamilla and Julie Wagner and the American Diabetes Association (7-13-TS-31) to Dr. Julie Wagner.

BACKGROUNDHousehold food insecurity (HFI) is a stressor that is associated with type 2 diabetes (T2D). However, little is known about HFI and the insulin resistance (IR) underlying T2D, and the mechanisms involved.OBJECTIVEWe examined the cross-sectional association between HFI and IR among low-income Latinos with T2D and tested whether inflammation and stress hormones mediated this association.METHODSHFI was measured with the 6-item US Household Food Security Survey module. IR was calculated from fasting plasma blood glucose and serum insulin. Inflammation was indicated by high-sensitivity C-reactive protein (hsCRP), and stress hormones included urinary cortisol, metanephrine, and normetanephrine. To test for an indirect effect of HFI on homeostasis model assessment of IR, a parallel multiple mediation model was run with biological markers that significantly differed between food security status-entered as mediators in the model. We used 95% bias-corrected bootstrap CIs, with 10,000 bootstrap samples, to assess the significance of the indirect effects.RESULTSThe 121 participants with T2D were primarily Puerto Rican (85.8%), aged mean = 60.7 y, and 74% were female. Eighty-two (68%) were classified as food insecure. Compared with food-secure individuals, food-insecure individuals had a significantly higher IR [mean difference (Δ) = 7.21, P = 0.001], insulin (Δ = 9.7, P = 0.019), glucose (Δ = 41, P < 0.001), hsCRP (Δ = 0.8, P = 0.008), cortisol (Δ = 21, P = 0.045), and total cholesterol (Δ = 29, P = 0.004). Groups did not differ on other lipids, metanephrine, normetanephrine, or A1c. The mediation model showed a significant direct effect of HFI on hsCRP (P = 0.020) and on cortisol (P = 0.011). There was a direct effect of cortisol (P = 0.013), hsCRP (P = 0.044), and HFI on IR (P = 0.015). The total combined indirect effect of HFI through cortisol and hsCRP indicated partial mediation.CONCLUSIONSAmong Latinos with T2D, HFI is associated with IR partially through inflammation and stress hormones. Interventions to ameliorate HFI and mitigate its effects on inflammation, stress, and IR are warranted. This trial was registered at clinicaltrials.gov as NCT01578096.

OBJECTIVE:The purpose of this study was to evaluate the effectiveness of a peer coaching smoking cessation program in a high-risk Medicaid population.DESIGN AND SAMPLE:In this manuscript, we present an evaluation of a pilot program. Participants (N = 138) were recruited out of a larger smoking cessation program administered statewide and funded by the Center for Medicare and Medicaid Services. The participant sample was diverse, with 52% self-identifying as White, 39% as Black, and 56% Latino ethnicity (any race).METHODS:Motivational interviewing techniques were utilized by peer coaches in clinical and community settings to achieve smoking cessation using face-to-face, telephone, and text/email encounters over a period of 6 months.RESULTS:There was a statistically significant increase in the number of participants who had quit smoking from program enrollment to discharge (5.1%-18.5%, p = 0.02). Number of peer coaching encounters predicted quitting in program participants.CONCLUSIONS:This study adds to the literature that community-based smoking cessation services led by peer coaches can be effective in a diverse, high-risk population.

OBJECTIVE:The study aims were to (i) identify determinants of Nutrition Facts Panel (NFP) use and (ii) describe the association between NFP use and dietary intake among Latinos with type 2 diabetes. DESIGN:Baseline cross-sectional data from a clinical trial were used to assess the association between NFP use and dietary intake. Diet was measured using two methods: (i) a diet quality score (the Healthy Eating Index-2010) derived from a single 24 h recall and (ii) dietary pattern (exploratory factor analyses) from an FFQ. Multivariable logistic and non-parametric quantile regressions were conducted, as appropriate. Settings Hartford County, Connecticut, USA. SUBJECTS:Latino adults (n 203), ≥21 years of age, with diagnosed type 2 diabetes, glycosylated Hb≥7 %, and without medical conditions limiting physical activity. RESULTS:Participants' education level, diabetes-related knowledge and English speaking were positively associated with NFP use. At the higher percentiles of diet quality score, NFP use was significantly associated with higher diet quality. Similarly, NFP users were more likely to consume a 'healthy' dietary pattern (P=0·003) and less likely to consume a 'fried snack' pattern (P=0·048) compared with NFP non-users. CONCLUSIONS:The association between reported NFP use and diet quality was positive and significantly stronger among participants who reported consuming a healthier diet. While NFP use was associated with a healthier dietary pattern, not using NFP was associated with a less-healthy, fried snack pattern. Longitudinal studies are needed to understand whether improving NFP use could be an effective intervention to improve diet quality among Latinos with type 2 diabetes.

The primary aim of the Nutrition Education, Access and Texting (NEAT) trial was to assess the impact of distribution of incentive coupons along with a texting‐based marketing campaign promoting usage of a Mobile Market (MM), on increasing access to, and purchase and intake of fruit and vegetables among SNAP‐Ed participants. 193 non‐pregnant adult Hartford residents, with children 5 years old and under, attending a SNAP‐Ed “My Plate” educational session, were included in the trial. Participants also needed to have an unlimited texting plan and be willing to receive daily text messages for a 4‐week period. NEAT followed a randomized trial design. Participants were recruited and screened for eligibility at WIC offices and other community settings, and invited to participate in a one‐hour My Plate group session. Before the session, participants were consented; they then completed a 30‐minute baseline survey including data on socio‐demographics and fruit and vegetable shopping, purchasing and eating habits. Pre‐t and post‐tests were applied before and after the educational session to assess changes in nutrition knowledge and attitudes due to the session. Immediately after the nutrition education session, participants were randomly assigned. Those in the experimental group received four $5 coupons for use at the MM during the next 6 weeks, plus a month of daily text messages, informing them about MM stop locations, tips on preparing/eating more fruit and vegetables, and reminders to use their coupons (n=100). Control group participants received only text messages for a month, informing them about free family events within the community (n=93). After the 4‐week intervention period, participants from both groups completed a 6‐week follow‐up phone interview to document fruit and vegetable shopping, purchasing practice and intake habits, as well as their experience using the MM and text message satisfaction. Both groups had similar socio‐demographic characteristics, with a mean age of 32±8.81 years, 79% were Hispanic, mostly female (96%), and receiving SNAP benefits (80%). They also had similar baseline fruit and vegetable shopping, purchasing and consumption practices. Findings from the follow‐up survey (n=169) showed that participants from the intervention group spent significantly more on fruits than those in the control group ($42 vs. $30, p=0.027), and a significantly higher percentage of participants from the intervention group reported buying their produce at the MM than participants from the control group (46% vs. 23%, p=0.002). There was a significant increase in fruit intake (p=0.001) in the intervention group, but not in the control group. Both groups were highly satisfied with their respective text messages. MM customer satisfaction was also very high. Pre and post test results showed significant improvements in knowledge (59.64±20.29 vs 71.14±21.99) p=0.000 as a result of the nutrition education session. NEAT was successfully implemented and it lead to higher use of the MM, more money spent on fruits, and higher intake of produce.Support or Funding InformationUSDA Food and Nutrition Service via Cornell University

Fotonovelas, booklet versions of soap operas that use pictures to tell dramatic stories, have been a very popular mass entertainment medium in Latin America. Fotonovelas have recently been used as an educational tool among Latinos. The main objective of this project is to describe the development and evaluation of a culturally appropriate heart disease prevention fotonovela based on the American Heart Association “The Simple Seven Steps to Prevent Heart Disease” targeting Spanish speaking Latinos. These steps promote controlling blood pressure, blood cholesterol, blood sugar, and weight as well as getting active, eating better, and stopping smoking. Mixed‐methods community‐based participatory research was used for development and evaluating the fotonovela. To be included, participant's had to be ≥18 years old, Latinos, residents of Hartford and; able to read and write Spanish. The formative qualitative research consisted of three phases. First, two focus groups were conducted with 22 participants to assess the face validity, and to obtain community input about the best way to design the fotonovela plot and format to deliver the target messages. Data from these two focus group was used to develop a first draft of the fotonovela. The second phase involved testing the face validity of the draft fotonovela through a third focus group with 4 participants who were part of the two initial focus group. In the third phase of the study the face validity of the fotonovela was confirmed with a new group of 14 participants recruited to participate in a fourth focus group. Focus groups participants were mostly female (81%) were on average 37±17 years old, 31% had completed high school or more, 50% were unemployed and 75% were receiving SNAP benefits. The knowledge, attitude, and planned behavior evaluation was conducted with 100 individuals answering a survey before and after reading the fotonovela. Knowledge was assessed with an 8‐item questionnaire designed for this study. Of these participants, 84% were female who were on average 42.5±15.1 years old, 78% primarily spoke Spanish, 28% had less than high school education and 61% were SNAP participants. After reading the fotonovela, participants increased their knowledge on the seven steps for heart disease prevention significantly (63.7±16.3 pre‐test vs 78.8±13.1 at post‐test, p=0.000), and almost all were highly satisfied with it (96%). After reading the fotonovela, when participants were asked to mention at least three steps that they would commit to follow, 93% wanted to be more active (93%), 98% wanted to eat better, 76% to avoid smoking, 28% to control blood sugar, and 24% to control their cholesterol levels. In conclusion, this culturally and literacy appropriate increased knowledge had strong face validity and may help motivate Latinos to take steps to prevent heart disease.Support or Funding InformationFunded by the American Heart Association

Food insecurity disproportionately affects Latinos. Whether food insecurity as a stressor, is associated with decreased heart rate variability (HRV), a non‐invasive measure of autonomic status which predicts poor cardiovascular outcomes, is unknown. This study examined the relationship between food insecurity and HRV among U. S. Latinos with type 2 diabetes. Secondary data analysis of baseline data from the CALMS‐D stress management trial was conducted. Participants completed surveys of food insecurity, demographics, and socioeconomic status. Participants wore a 7‐lead, 3‐channel ambulatory ECG monitor (Holters) for 24 hours. HRV indices included standard deviation of the R‐R interval (SDNN), and log‐normalized very low frequency (lnVLF) 0.0033 to < 0.04 Hz; low frequency (lnLF) 0.04 to <0.15 Hz; and high frequency (lnHF) 0.15 to 0.40 Hz. ANOVA and ANCOVA were used for statistical analyses. Of the 94 participants, 46 reported diabetes‐related food insecurity and 48 reported diabetes‐related food security. Participants who were diabetes‐related food insecure (“In the past year, has it happened to you that you did not have enough money to buy the food you should eat for your diabetes?”) had lower SDNN, lnVLF, lnLF, and lnHF, all p<.05, even after adjusting for glycemic control and socioeconomic hardship. Food insecurity is a powerful and unique form of social adversity. Efforts to address food insecurity may benefit diabetes outcomes. Support or Funding Information This study was funded by the National Institute of Minority Health and Health Disparities (grant number 5 R01 MD005879 to J.W. and R.P.‐E., principal investigators) and by the American Diabetes Association (7‐13‐TS‐31 to J.W., principal investigator).

Background: Food insecurity (FI), diabetes prevalence, and poor diabetes outcomes all disproportionately affect Latinos in the United States. Heart rate variability (HRV) reflects autonomic tone, is associated with glycemic control, and predicts mortality in type 2 diabetes. It is unknown whether FI is related to HRV and, if so, whether glycemic control accounts for this association. Objective: This exploratory cross-sectional study examined FI and HRV among US Latinos with type 2 diabetes. Methods: Participants reported demographic characteristics, socioeconomic status, and FI, including the 6-item USDA food security module and a 1-item measure of diabetes-specific food security. Participants wore an ambulatory electrocardiogram monitor for 24 h. In the time domain, HRV was assessed with the SD of the R-R interval (SDNN). In the frequency domain, the power spectrum was integrated over 3 frequency bands-very low frequency (VLF), low frequency (LF), and high frequency (HF)-and then natural log transformed. Unadjusted ANOVA and ANCOVA adjusted for age, sex, glycated hemoglobin (HbA1c), and indicators of socioeconomic status compared food security groups on HRV. Results: Participants' mean ± SD age was 59.7 ± 10.9 y, and 73% were women. Of the 94 participants, 63 reported FI according to the USDA food security module and 46 reported FI according to the diabetes-specific measure. Mean ± SD HbA1c was 8.6% ± 1.7% and was marginally higher among those reporting diabetes-specific FI than those reporting diabetes-specific food security. Participants who reported diabetes-specific FI had lower SDNN, VLF, LF, and HF HRV with effect sizes in the small-to-medium range. Differences remained significant even after controlling for age, sex, socioeconomic hardship, and HbA1c. The 6-item USDA food security module was not associated with HRV. Conclusions: Diabetes-specific FI may be a unique risk factor for poor health outcomes among US Latinos. Efforts to address FI could benefit diabetes outcomes.

INTRODUCTIONHousehold food insecurity (HFI) is associated with chronic diseases, including diabetes, among lower income Latinos. We examined the associations between HFI and blood glucose levels and insulin resistance in this population.APPROACHWe studied a sample of 120 Latinos with type 2 diabetes who completed baseline assessments for the CALMS‐D stress management trial. HFI was measured with a 5‐item version of the US Household Food Security Survey Module (Cronbach alpha=0.87). Households were classified as either food secure, mild/moderate food insecure, or severe food insecure. We also categorized individuals as food secure versus food insecure. Fasting glucose and insulin levels were measured and the log‐transformed HOMA‐IR values were used for analyses.RESULTSMean age was 61 years, 74% were female and mean HbA1c was 8.6%. Analysis of variance showed a significant (p<0.001) dose‐response association between fasting blood glucose levels and HFI severity before and after adjusting for gender, education, household income, body mass index and insulin use. The adjusted blood glucose means (SE) across HFI categories were: food secure, 144.8 (8.5); mild/moderate food insecure, 175.8 (7.2); severe food insecure, 200.5 (10.9) mg/dl. When HFI was dichotomized as food secure vs insecure, a significant relationship (pCONCLUSIONSFasting blood glucose and insulin resistance are associated with HFI among Latinos with diabetes. Food insecure individuals had higher fasting glucose and more severe insulin resistance than food secure individuals. Providers that serve disadvantaged populations with type 2 diabetes should consider routinely screening for HFI.Support or Funding InformationThis work is supported by: Stress Management Among Latinos With Type 2 Diabetes (CALMS‐D) (NIMHD R01MD005879‐01).

BACKGROUNDEvidence increasingly indicates that poor sleep quality is a major public health concern. Household food insecurity (HFI) disproportionately affects Latinos and is a novel risk factor for poor sleep quality. Psychological distress may be a potential mechanism through which HFI affects sleep quality. Sleep, food insecurity, and distress are linked to type 2 diabetes mellitus.OBJECTIVESWe examined the relations between HFI, psychological distress, and sleep quality and tested whether psychological distress mediates the relation between HFI and sleep in people with diabetes mellitus.METHODSLatinos with type 2 diabetes mellitus (n = 121) who completed baseline assessments for the CALMS-D (Community Health Workers Assisting Latinos Manage Stress and Diabetes) stress management intervention trial completed the US Household Food Security Survey, and measures of depressive symptoms [Personal Health Questionnaire Depression Scale (PHQ-8)], anxiety symptoms [Patient-Reported Outcomes Measurement Information System (PROMIS)-short], diabetes distress [Problem Areas in Diabetes Questionnaire (PAID-5)], and sleep quality [Pittsburgh Sleep Quality Index (PSQI)]. Psychological distress was operationalized with the PHQ-8, PROMIS-short, and PAID-5 scales. We used unadjusted and adjusted indirect effect tests with bias-corrected bootstrapped 95% CIs on 10,000 samples to test both relations between variables and potential mediation.RESULTSMean age was 61 y, 74% were women, and 67% were food insecure. Experiencing HFI was associated with both greater psychological distress and worse sleep quality (P < 0.05). Depressive symptoms (adjusted R2: 2.22, 95% CI: 1.27, 3.42), anxiety symptoms (adjusted R2: 1.70, 95% CI: 0.87, 2.85), and diabetes mellitus distress (adjusted R2: 0.60, 95% CI: 0.11, 1.32) each mediated the relation between HFI and worse sleep quality with and without adjustment for age, education, income, marital status, and employment status.CONCLUSIONSHousehold food insecurity is a common and potent household stressor that is associated with suboptimal sleep quality through psychological distress. Efforts to improve food security and decrease psychological distress may yield improved sleep in this high-risk population. The CALMS-D stress management trial was registered at clinicaltrials.gov as NCT01578096.

Objective: Identify barriers and facilitators to improve prenatal fruit and vegetable (F&V) intake among Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)-eligible Latinas using the Health Action Process Approach framework.Design: Qualitative data were collected via audiotaped in-depth interviews as part of a larger study to design an intervention to increase prenatal F&V intake.Setting: Hartford, Connecticut.Participants: Forty-five WIC-eligible Latinas completed the study. Included women were: >= 18 years old; in 2nd or 3rd trimester; having a singleton pregnancy; overweight or obese (ie, pregravid body mass index >= 25); not on a restricted diet; nonsmokers.Phenomenon of Interest: Prenatal factors that promote and hinder F&V intake.Analysis: Transcripts were independently read and coded, and a consensus was reached about emerging themes.Results: Ten factors influenced prenatal F&V intake: social support, family structure, F&V access, F&V preferences, F&V knowledge, F&V health outcome expectations, self-efficacy, intentions, F&V action/coping planning strategies, and maternal health status.Conclusions and Implications: Social support from family/friends emerged as the primary distal factor driving prenatal F&V intake. Interventions designed to empower pregnant Latinas to gain the access, confidence, knowledge, and strategies necessary to consume more F&Vs must consider strengthening support to achieve the desired outcome.

IntroductionUnemployment is common in persons with severe mental illness (SMI) and more in Latino population. Department of Mental Health and Addiction Services (DMHAS) of Connecticut offers a supported employment (SE) Program to help clients get competitive work in integrated settings with nondisabled workers in the community.ObjectiveCapture perspectives of key informant groups to describe barriers for linking Latinos with SMI to employment and adapt SE Services for subpopulations.MethodFour focus groups were conducted (employment specialists, case managers and peer support counselors/employers/two with clients-one in Spanish and other in English). They were conducted during January-February 2015, 70–90 minutes each one. A question guide was developed for each group. Participants per focus group ranged from 3–10, voluntarily. Two new questionnaires to the baseline pack were developed: challenges to Employment Assessment–provider and client version.ResultsThirty individuals participated. Several barriers to employment were reported. Clients and staff reported criminal record, lack of employment history and lack of motivation. Staff described client hygiene, mental status, physical health, substance abuse and discrimination. Clients, staff and employers reported language barrier for Latinos who don’t speak English. Non-adherence to medication was reported by clients and employers. About Spanish-Speaking Latinos with mental illness, medication, discrimination, previous abuse by employers, inappropriate employment, difficulties of the job interview and computer skills appeared as challenges. English-Speaking Latinos with mental illness identified transport, stability, support, keeping apartment and financial needs.ConclusionsFocus groups can help in knowledge about the diversity of Latino communities to improve SE Services and outcomes for Latinos.Disclosure of interestThe authors have not supplied their declaration of competing interest.