BACKGROUND:The physical and social environments surrounding food, whether perceived or observed, can influence consumers' food choices by changing food access, and affordability, or by changing settings where food-related behaviors occur.AIM:To describe older adults' perceived food environment, identify the most important sites and factors that enable healthy eating, and explore older adults' recommendations for communities to facilitate fruit and vegetable consumption.METHODS:Participants aged 60 and older from metropolitan areas in Massachusetts, Iowa, and Illinois completed a researcher-administered survey to rate the perceived environment including accessibility, availability, and affordability of fruits and vegetables, and perceived importance of factors and establishments related to fruit and vegetable consumption. Participants also suggested changes for establishments to facilitate fruit and vegetable consumption.RESULTS:The majority of the 142 participants perceived their food environment for fruits and vegetables as not difficult to access (85.2%) with good or excellent availability (90.1%). Education, marital status, and race were associated with some aspects of the perceived food environment. Perceived accessibility and supermarkets were rated as the most important factor and establishment, respectively, to facilitate fruit and vegetable consumption across all study sites. Participants proposed recommendations to address the availability, quality, accessibility and affordability of fruits and vegetables.CONCLUSION:Interventions promoting accessible, affordable, quality fruits and vegetables may improve older adult consumers' perceptions of their food environment. Communities may also use undervalued resources such as mobile markets more strategically to provide additional support for healthy eating in older adults.

Online focus groups (OFGs) in health research allow researchers to gain insight into sensitive health topics, reach people with disabilities, and overcome geographic, physical, and medical limitations in data collection. The OFGs can be held synchronously in real time with all participants online simultaneously, or asynchronously, enabling participants to join at their convenience. In this article, we compare OFGs with face-to-face focus groups in nutrition and health-related research with respect to administration and data quality retrieval. As part of a multistate research project on assessment of the nutrition environment for older adults that used OFGs, the researchers' firsthand review experience and lessons learned are discussed.

Communities can provide an “age-friendly” environment to support healthy eating in older adults (OA) by addressing the highest priority approaches that promote key enablers of good nutrition. Using the Social Ecological Model, nutrition and aging professionals (n=30) from two rural (WV, IA) and two urban (MA, NY) city/county regions participated in focus group discussions to identify and prioritize enablers and behavioral settings essential for OA nutrition. Transcripts were recorded and analyzed for major themes using content analysis. The most important enablers were accessibility and cost, transportation and social support. Recommendations to improve enablers included nutrition education and outreach; modifying or expanding services and advocacy to improve accessibility and transportation; gearing program or food content and the built environment specifically to OA needs; addressing partnerships, policies, discounts and financial assistance to improve affordability; and fostering social support and empowerment. Community-based interventions targeting enablers can support older residents in achieving optimal nutritional health.

Community planners such as policymakers and health care and nutrition service providers can create an "age-friendly" environment to support healthy eating in older residents by addressing the highest priorities that enable older adults to improve their dietary intake through different food-related community settings. To identify and prioritize these factors that facilitate behavioral change (enablers) and behavioral settings important for older adult nutrition based on the social ecological model, nutrition and aging professionals (n = 30) from two rural (West Virginia, Iowa) and two urban (Massachusetts, New York) city/county regions (communities) participated in an online or live focus group discussion and completed an analytic hierarchy process survey online. Overall, the most important perceived enablers were accessibility and cost, followed by transportation and social support, but their relative importance varied by community. Participants from all communities considered congregate meal sites and food banks among the most important behavioral settings. Participants from most communities considered food stores to be important and also highlighted other settings unique to the area, such as senior housing, neighborhood, and farmers' markets. By targeting interventions to address the most notable enablers and behavioral settings specific to their community, planning groups can enhance their older residents' ability to achieve optimal nutritional health.

A structured interview protocol was used to investigate the ability of older adults (n = 89, age ≥ 65 years) to accurately determine whether three common food items were whole grain, and to assess the package information used in their decision process. Cereal and crackers, which were both whole grain products, were correctly identified by 63% and 66% of participants, respectively. Bread (a refined product), was correctly identified by only 19% of participants, while 46% of participants misidentified the bread as being whole grain. The ingredient list was the information most frequently cited in deciding if a food was whole grain, but participants varied in their ability to accurately interpret it. Package information considered nonpertinent (e.g., the Nutrition Facts label) in identifying a whole grain product was used almost as often as the ingredient list. Older adults would benefit from whole grain education programs that focus on accurately interpreting package information.

Evidence has linked supermarkets, large grocery stores and warehouse clubs to better nutrition including fruit and vegetable intake in people living nearby while showing the opposite for convenience stores and small grocery stores. In western Massachusetts including Berkshire, Franklin, Hampden and Hampshire Counties, there are twice as many convenience stores and dollar stores as supermarkets and grocery stores. It is important to understand whether stores that carry a limited line of food products such as convenience stores and dollar stores can serve as an alternative source of fruits and vegetables in areas where supermarkets, grocery stores, and supercenters, which carry a full line of food products, are hard to access. The current study aims to understand whether there are any disparities in fruit and vegetable access and price across store types and to identify the role of limited‐line food retailers in providing fruits and vegetables. A list of all food retailers in the four counties was downloaded from the Reference USA database 2015. Four trained researchers visited a sample of randomly selected stores stratified for city and store type (n=80) in October 2015. Inter‐rater reliability was analyzed for quality control. Stores were grouped into full‐line retailers and limited‐line retailers based on store type. Chi‐square tests/Fisher's Exact Tests and t‐tests/Mann‐Whitney U Tests were used to compare the availability and prices between groups, respectively. Store audits were completed in 57 of the stores (15 stores were either closed or not able to be located; six stores refused to give permission; two stores were misclassified as food retailers). Stores were assessed on the availability and lowest price of a list of fruits and vegetables most commonly consumed by the US population including fresh, frozen, and canned fruits and vegetables; 100% unsweetened fruit juice; and canned and dried beans and legumes. Only 29% of the food retailers visited were full‐line food retailers while the rest had a limited product line. Full‐line food retailers were more likely to carry any fresh fruit (p=0.01), any fresh vegetables (p<0.0001) and any frozen vegetables (p<0.0001), but not orange or apple juice, applesauce, canned tomatoes, canned corn or canned beans compared to limited‐line food retailers. Overall, full‐line food retailers also had significantly higher numbers of fresh fruits, fresh vegetables, canned fruits, canned vegetables, and frozen vegetables than limited‐line food retailers (p<0.0001 for all items). When products available at five and more stores in both store type groups were examined, full‐line food retailers had lower prices for two out of three fresh fruits, one in five fresh vegetables, orange and apple juice, 75% of canned or frozen products and beans than limited‐line retailers. The limited‐line food retailers in western Massachusetts could potentially serve as sources of 100% unsweetened fruit juices, canned fruits and vegetables, and canned beans for people living nearby to meet the dietary recommendations for fruits and vegetables, although maybe at a higher cost. In addition, efforts and resources could also be allocated to bringing more fresh produce to the limited‐line food retailers. Support or Funding Information Supported in part by USDA NIFA Regional Project NE1439

Objective Examine compliance with recommended food safety practices in television cooking shows. Methods Using a tool based on the Massachusetts Food Establishment Inspection Report, raters examined 39 episodes from 10 television cooking shows. Results Chefs demonstrated conformance with good retail practices for proper use and storage of utensils in 78% of episodes; preventing contamination (62%), and fingernail care (82%). However, 50% to 88% of episodes were found to be out of compliance with other personal hygiene practices, proper use of gloves and barriers (85% to 100%), and maintaining proper time and temperature controls (93%). Over 90% failed to conform to recommendations regarding preventing contamination through wiping cloths and washing produce. In only 13% of episodes were food safety practices mentioned. Conclusions and Implications There appears to be little attention to food safety during most cooking shows. Celebrity and competing chefs have the opportunity to model and teach good food safety practices for millions of viewers.

The prevalence of cardiovascular disease (CVD) in South Asia is higher than in any other developing countries. The diversity of diets in populations among developing countries may be one explanation for the differences in CVD. This study was carried out to explore the association between dietary patterns and the presence of cardiovascular risk factors among Pakistani low income urban adults.

Participants will learn about the effectiveness of food safety training for early childcare educators working in farm to preschool programs.

Hypertension is one of the most common chronic diseases affecting more than 25% of adults worldwide. In Pakistan, 33% of the adult population suffers from hypertension. Numerous epidemiological studies have demonstrated the critical role of dietary patterns in the causation, prevention and management of hypertension. There's a dearth of evidence from South Asia in this regard. The present study aimed to identify the association between dietary patterns and hypertension among 4304 low income urban adults who participated in the Control of Blood Pressure and Risk Attenuation (COBRA) study in Karachi, Pakistan. Dietary information was collected by a 33-item food frequency questionnaire and 3 unique dietary patterns namely; fat and sweet, fruit and vegetable, and seafood and yogurt patterns were derived using principal component factor analyses. We used univariate and multivariable logistic regression to examine the association between dietary patterns and hypertension. Men were more likely to have hypertension, while increase in age, and body mass index were also associated with hypertension (p<0.001). After adjusting for age, gender, education, marital status, body mass index, and tobacco use; the seafood and yogurt pattern was less likely (OR=0.78: 95% CI: 0.63, 0.98; p-value 0.03) to be associated with hypertension, whereas no significant associations were seen for other two dietary patterns. These findings suggest that certain dietary patterns may be associated with hypertension among Pakistani low income urban adults.

Hypertension affects 33% of the adult population in Pakistan. Various studies have shown the critical role of specific dietary patterns in the prevention and management of hypertension. However, the dietary determinants of hypertension in Pakistan remain unknown. In this study we aimed to identify dietary patterns from baseline food frequency data and assess their associations with hypertension in 5491 subjects from the Control of Hypertension and Risk Attenuation (COBRA) study, 2004. Factor analysis was used to identify the “fat and sweet”, “fruit and vegetable” and “seafood and yogurt” patterns with 20% variance in food intake. Associations between dietary patterns and subject characteristics were assessed using ANOVA and chi square tests. Odds of hypertension were higher in women and increased with age and BMI in both genders (<0.001). When adjusted for covariates, the seafood and yogurt (OR= 0.72: 95% CI: 0.61,0.84; p‐value <0.001) and fruit and vegetable (OR =0.89: 95% CI: 0.80,0.99; p‐value= 0.039) patterns were inversely related with hypertension, whereas no significant association was seen for the fat and sweet pattern. Our findings suggests that specific dietary patterns may have a role in regulating blood pressure in this population, however, more prospective studies are needed.

Many environmental settings and influences can affect food choices and eating behaviors in the growing population of community-dwelling older adults. Using the Social Ecological model, an expert panel participated in online discussions and an Analytic Hierarchy Process survey to identify the most important and changeable environmental settings and enabling factors that promote healthy eating in older adults. Food stores were rated most important when considering accessibility and affordability. Congregate nutrition sites were important for social support along with supporting access and affordability of healthful foods and living accommodations. Senior housing, health care, and religious settings also contributed to the goal of promoting healthful eating in aging adults. Restaurants were rated of lower importance. Based on these results, it is recommended that community food policies include the nutritional needs of older adults by addressing food accessibility and affordability, social support, and living accommodations, with a focus on congregate nutrition sites, food stores, senior housing, health care, and religious organizations.

Dietary pattern analysis is an epidemiological method designed to consider the complexity of food preferences and diet patterns of populations. Few studies from South Asia have used this methodology to describe population food intake. Our objective was to identify dietary patterns and understand their associations with sociodemographic, anthropometric and life-style factors among low-income Pakistani urban adults. Dietary information was collected by a thirty-three-item FFQ and dietary patterns were derived by principal component analyses in 5491 subjects enrolled in the Control of Blood Pressure and Risk Attenuation (COBRA) study. Three dietary patterns were identified: a fat and sweet pattern characterised by fried snacks/foods, desserts, organ meats, bakery products, Pakistani bread and food purchased from outside the home; a fruit and vegetable pattern including fruits, juices, raw and cooked vegetables, lean meat and low-fat milk; and a seafood and yogurt pattern identified by prawns, fish, potatoes and yogurt. The fat and sweet pattern scores were low among older subjects, those with high BMI and waist circumference but high among females and physically active participants. The fruit and vegetable pattern was associated with younger age, high BMI, education and non-tobacco use. The seafood and yogurt pattern was associated with high BMI, increased physical activity and non-tobacco use. In conclusion, distinct dietary patterns exist for the Pakistani population that may be related to some of the population characteristics and thus may have importance in suggesting dietary and life-style interventions in the prevention of chronic diseases.

Farm to Preschool Programs link farmers with early childcare centers (ECC) to increase local fruits and vegetables (LFV) used. To target nutrition and food safety education, it is important to identify factors related to adoption of farm and garden (FG) activities and LFV use in ECCs. An online survey was sent to 600 random ECC in MA and NH, with 118 educator (E) responses. Psychosocial factors related to LFV (benefits, barriers, self‐efficacy) were rated 1–5. FG activities and % of produce served as LFV were self‐reported, and related to psychosocial factors. Half of E did not know if FV were local and of those that did know, over half reported < 25% LFV. Most E perceived benefits of LFV and few barriers; however >;40% E perceived that LFV are too expensive. Overall self‐efficacy was low, with only 21% of E agreeing that they can get most of the LFV they want all year. About half of the sites had taken children on farm field trips and planted a garden; over 30% had used LFV in snacks or taste tests; few had invited a farmer to the ECC or held a harvest festival or farmers market. Perceived benefits and self‐efficacy were related to % of LFV served. Fewer barriers and higher benefits were related to more classroom FG activities. Nutrition education should thus address ways to increase perceived benefits, decrease barriers and improve self‐efficacy to LFV. Food safety education should address issues of FG visits, gardens, snacks and tasting LFV.Grant Funding Source: This project is supported by The National Integrated Food Safety Initiative (NIFSI) Competitive Grant Program from the USDA National Institute of Food and Agriculture, Award 2011–51110‐30996.

This study examined the role of social support in influencing dietary quality in older African American public housing residents, specifically investigating individual (age, education, gender, marital status, and living arrangement), social support (help with meals, social network size, frequency of contact, and proximity or distance from network), and dietary factors (number of meals consumed daily, dietary quality). A random sample (n = 80) of public housing residents age 55+ living in a Northeastern community was interviewed. Data were analyzed using Pearson correlation coefficients, multiple regression analyses, and structural equation modeling (SEM). Given the limited sample size, a SEM path model was developed based on observed associations in correlation and regression analyses. Results show that number of meals, frequency of contact, and proximity significantly influenced dietary quality. However, dietary quality was indirectly influenced by education, marital status, having a housemate, and help with meals, highlighting influence of both individual and social factors.

OBJECTIVE:To assess how postsecondary online nutrition education courses (ONEC) are delivered, determine ONEC effectiveness, identify theoretical models used, and identify future research needs. DESIGN:Systematic search of database literature. SETTING:Postsecondary education. PARTICIPANTS:Nine research articles evaluating postsecondary ONEC. MAIN OUTCOME MEASURES:Knowledge/performance outcomes and student satisfaction, motivation, or perceptions. ANALYSIS:Systematic search of 922 articles and review of 9 articles meeting search criteria. RESULTS:Little research regarding ONEC marketing/management existed. Studies primarily evaluated introductory courses using email/websites (before 2000), or course management systems (after 2002). None used true experimental designs; just 3 addressed validity or reliability of measures or pilot-tested instruments. Three articles used theoretical models in course design; few used theories to guide evaluations. Four quasi-experimental studies indicated no differences in nutrition knowledge/performance between online and face-to-face learners. Results were inconclusive regarding student satisfaction, motivation, or perceptions. CONCLUSIONS AND IMPLICATIONS:Students can gain knowledge in online as well as in face-to-face nutrition courses, but satisfaction was mixed. More up-to-date investigations on effective practices are warranted, using theories to identify factors that enhance student outcomes, addressing emerging technologies, and documenting ONEC marketing, management, and delivery. Adequate training/support for faculty is needed to improve student experiences and faculty time management.

The objective of this investigation is to describe the associations of number of eating episodes and proportion of meals eaten away from home with total serum cholesterol. Data from 499 participants, recruited from a health maintenance organization in central Massachusetts, aged 20-70, were used for this analysis. Dietary information and total blood cholesterol were obtained at five sampling points (baseline and four consecutive quarters) during the one-year follow-up. A cross-sectional study was conducted. The results from the study do not support the hypothesis that the number of eating episodes per day is associated with total blood cholesterol. However, we noted that the mean concentration of total cholesterol decreased with increasing number of eating episodes among women, although the adjusted mean among three categories of number of eating episodes per day was not statistically significant. On the other hand, the results of our study suggest that increased frequency of meals (breakfast, lunch, or dinner) eaten away from home is positively associated with mean total blood cholesterol concentration. Furthermore, meals eaten away from home, especially breakfast and dinner, were significantly higher in total calories, and percent calories from total and saturated fat, but lower in percent calories from protein and carbohydrate, and grams of fiber, than corresponding meals eaten at home. We conclude that eating out may have adverse influences on blood lipids. Further research is needed to better understand the impact of eating away from home on blood lipids. [N A J Med Sci. 2011;4(4):222-231.]