Nutritional & Nutritional & Cultural AccessCultural Access

Phase 2 Team CPhase 2 Team C

Elisabet Eppes & Angela TamElisabet Eppes & Angela Tam

Providing Providing nutrient dense nutrient dense

foodsfoodsBarriers & LimitationsBarriers & Limitations

Intertwining Intertwining factorsfactors

grandma vs. dad in grandma vs. dad in the homethe home

single mothersingle mother

new mothers have new mothers have lifestyle changes, lifestyle changes, social isolation and social isolation and poor health status riskpoor health status risk

higher food insecurity higher food insecurity associated with stress associated with stress and depressive and depressive symptomssymptoms

maternal supportmaternal support

recent childbirthrecent childbirth

depression and other depression and other psychosocial issuespsychosocial issues

Laraia et al., 2009

race & low incomerace & low income

3x as many African Americans experience 3x as many African Americans experience food insecurity than non-Hispanic whites food insecurity than non-Hispanic whites (Laraia et al, 2009)(Laraia et al, 2009)

financial constraints: pay for non-food financial constraints: pay for non-food expenses due to season (utilities)expenses due to season (utilities)

low wage jobs (long hours, little time for food low wage jobs (long hours, little time for food prep and shopping)prep and shopping)

requiring government benefits (rely on FNS requiring government benefits (rely on FNS means infrequent shopping and low intake of means infrequent shopping and low intake of fresh foods due to depletion at end of month) fresh foods due to depletion at end of month) (Patil et al, 2009)(Patil et al, 2009)

household household compositioncomposition

households with children households with children experience higher rates of experience higher rates of

food insecurity food insecurity

(Laraia et al, 2009)(Laraia et al, 2009)

Latina women in a study in Latina women in a study in CA reported reducing food CA reported reducing food intake in winter to spare intake in winter to spare

more food for other family more food for other family members members

(Dubowitz et al, 2007)(Dubowitz et al, 2007)

geographic factors & geographic factors & moremore

food qualityfood quality healthy food is healthy food is less less

convenientconvenient

lack of high quality lack of high quality produce and other produce and other nutritious sold locallynutritious sold locally

no supermarkets or large no supermarkets or large grocery stores nearbygrocery stores nearby

transportation is transportation is problematic for low problematic for low incomeincome

neighborhood neighborhood foodsfoods

believed to carry low qualitybelieved to carry low quality

quality and nutritional quality and nutritional value of prepared/fast food value of prepared/fast food proved to be of very little proved to be of very little consequence consequence to US-born to US-born English-speaking women than English-speaking women than to foreign born women in to foreign born women in same neighborhoodsame neighborhood

low income African American low income African American neighborhoods neighborhoods may never may never have had the chance to have had the chance to develop taste develop taste for high for high quality foodsquality foods

Dubowitz et al, 2007and Zenck et al, 2009

Accessing Accessing culturally culturally

appropriate foodsappropriate foodsBarriers & LimitationsBarriers & Limitations

immigrant status vs. immigrant status vs. U.S. citizenshipU.S. citizenship

not as much food not as much food preparation emphasis preparation emphasis in US in US as in other countries (Mexico)as in other countries (Mexico)

fast food availability fast food availability and and accessibility has contributed accessibility has contributed to to worse dietary habits worse dietary habits (a (a study in Latino population)study in Latino population)

inadequate physical inadequate physical access to high quality access to high quality fruits and vegetables fruits and vegetables normallynormally available in home available in home countries or prepared by countries or prepared by parents is parents is a barrier to a barrier to eating fruits and eating fruits and vegetables for Latinos vegetables for Latinos

longer periods of time in longer periods of time in US US are associated with are associated with greatergreater likelihood of likelihood of consumption of seasonings, consumption of seasonings, drinks, drinks, vegetables, vegetables, added added sugar and sweets, milk and sugar and sweets, milk and oils.oils.

time constraints due to time constraints due to low wage jobs low wage jobs carry over carry over to food preparation priority to food preparation priority for foreign-born women for foreign-born women

childrenchildren are agents of diet are agents of diet change and influence change and influence parentsparents

Zenk et al, 2009 and Patil et al, 2009 and Dubowitz et alZenk et al, 2009 and Patil et al, 2009 and Dubowitz et al

TheyThey’’ve been there, ve been there, and done that.and done that.

Interventions & StrategiesInterventions & Strategies

Urban Food Urban Food Store Store

Intervention Intervention positively positively

affects food-affects food-related related

psychosocial psychosocial variables and variables and

food behaviors food behaviors

first food store intervention trial first food store intervention trial in low income urban areain low income urban area

components of increasing components of increasing nutritious food stocked, point of nutritious food stocked, point of purchase promotion, nutrition purchase promotion, nutrition education efforts (modest push education efforts (modest push only)only)

had culturally competent liaison had culturally competent liaison to work with store ownersto work with store owners

no significant difference in no significant difference in materials exposure and food materials exposure and food getting behaviors between getting behaviors between intervention and comparison intervention and comparison groupsgroups

highest exposure and difference highest exposure and difference within intervention group within intervention group included food demos and taste included food demos and taste tests, which affected food tests, which affected food preparation and intention of preparation and intention of healthy food choiceshealthy food choices

Joel Gittelsohn et alJoel Gittelsohn et al

20102010

Studies with focus Studies with focus groupsgroups

Unpacking dietary acculturation Unpacking dietary acculturation among new Americans: Results among new Americans: Results from formative research with from formative research with

African refugeesAfrican refugees

children play a role in children play a role in whatwhat’’s eaten in the home s eaten in the home (very true for those with (very true for those with recent immigrant status)recent immigrant status)

home foods are expensive home foods are expensive in the USin the US

knowledge transfer: knowledge transfer: obstacle of language and obstacle of language and literacy, but willingness to literacy, but willingness to learn new recipes and eat learn new recipes and eat American foodAmerican food

Life course, immigrant status and Life course, immigrant status and acculturation in food purchasing acculturation in food purchasing

and preparation among low-and preparation among low-income mothersincome mothers

1 in 9 US citizens are 1 in 9 US citizens are immigrants and 1 in 4 low-immigrants and 1 in 4 low-wage workers are immigrantswage workers are immigrants

plenty of food and cheaper, plenty of food and cheaper, but of lower qualitybut of lower quality

more commitment to food more commitment to food preparation preparation

US born women likely to eat US born women likely to eat out/take out and shop in only out/take out and shop in only 1 or 2 places1 or 2 places

Patil et al (2009)Patil et al (2009) Dubowitz et al (2007)Dubowitz et al (2007)

Recommendations Recommendations for King Countyfor King County

Interventions & StrategiesInterventions & Strategies

research + WICresearch + WIC

increasing fresh fruit and vegetable variety to increasing fresh fruit and vegetable variety to appropriate to frequented grocery stores (closer to appropriate to frequented grocery stores (closer to residence)residence)

approving WIC checks for use in popular ethnic approving WIC checks for use in popular ethnic grocery stores, regardless of proximitygrocery stores, regardless of proximity

increasing supply in convenience/corner store to increasing supply in convenience/corner store to provide culturally appropriate and nutritious food provide culturally appropriate and nutritious food options that are reasonable in price and qualityoptions that are reasonable in price and quality

parallel educational program that includes food parallel educational program that includes food samples and cooking demonstrationssamples and cooking demonstrations

referencesreferences1. Dubowitz T, Acevedo-Garcia D, Salkeld J, et al. Lifecourse, immigrant status and acculturation in food purchasing and preparation among low-income mothers. Public Health Nutr. 2007;10(4):396-404. (doi: 10.1017/S1368980007334058). 2. Gittelsohn J, Song HJ, Suratkar S, et al. An urban food store intervention positively affects food-related psychosocial variables and food behaviors. Health Educ Behav. 2010;37(3):390-402. (doi: 10.1177/1090198109343886). 3. Grigsby-Toussaint DS, Zenk SN, Odoms-Young A, et al. Availability of commonly consumed and culturally specific fruits and vegetables in African-american and Latino neighborhoods. J Am Diet Assoc. 2010;110(5):746-52. (doi: 10.1016/j.jada.2010.02.008). 4. Laraia BA, Borja JB, Bentley ME. Grandmothers, fathers, and depressive symptoms are associated with food insecurity among low-income first-time African-American mothers in North Carolina. J Am Diet Assoc. 2009;109(6):1042-7. (doi: 10.1016/j.jada.2009.03.005). 5. Patil CL, Hadley C, Nahayo PD. Unpacking dietary acculturation among new Americans: results from formative research with African refugees. J Immigr Minor Health. 2009;11(5):342-58. (doi: 10.1007/s10903-008-9120-z). 6. Zenk SN, Lachance LL, Schulz AJ, et al. Neighborhood retail food environment and fruit and vegetable intake in a multiethnic urban population. Am J Health Promot. 2009;23(4):255-64. (doi: 10.4278/ajhp.071204127).