Most individuals with chronic diseases, such as cardiovascular disease, stroke, cancer, and type 2 diabetes, were diagnosed in their late adulthood. The fact that these chronic diseases is a consequence of long-term unhealthy behaviors is often ignored. The unhealthy behaviors are often traced back to the young adulthood (age 18-25). Some young adults may participate in unhealthy behaviors, such as unhealthy diet, under the perception that they are “still young”. However, it is often overlooked that once a habit is established, it is difficult to eliminate or modify it. Furthermore, the awareness that the development of the chronic disease is a gradual progress is deficient. This enhances the perception that doing unhealthy behaviors is benign to the “young body”. Additionally, individuals in this age group start to live independently. Their existing behaviors may change due to the changes in the available resources. Lack of capability to cope with the transition from living at home to living independently has been shown to contribute to an unhealthy diet, especially among college students. Given that unhealthy diet behaviors in young adulthood often remains over the lifetime, there is a need in identifying the factors that motivate the food choices during the transition from high school into college life. The findings of this research suggest that the campus environment is not conducive to a healthy diet. When compared to the students who live on-campus, students who live offcampus (either live with or without family) reported a better dietary quality.

Orientador: Roberto Carlos Burini / Banca: Luis Carlos Giarola / Banca: Kátia Cristina Portero McLellan / Resumo: O papel da inadequação alimentar no advento das doenças cardiovasculares e das morbidades associadas já é conhecido e aceito. O diagnóstico nutricional a nível local é fundamental para que seja possível identificar os fatores associados à escolha alimentar e propor soluções para melhorar a qualidade da alimentação das populações. Caracterizar a população e identificar as variáveis associadas à qualidade alimentar de adultos e idosos usuários da Unidade de Saúde da Família do distrito de Rubião Júnior em Botucatu, SP. Foi aplicado questionário para avaliar as condições sócioeconômicas e demográficas, a história patológica pregressa e a ingestão alimentar. Foi feita aferição de peso, estatura, circunferência da cintura e pressão arterial e medida dos valores sangüíneos de colesterol total e frações, triglicerídeos e glicemia. Foram avaliados 225 indivíduos, sendo 67,7% do sexo feminino e 37,8%, idosos. Os participantes apresentaram 24% de analfabetismo e 46,7% de renda familiar per capita menor que a metade de um salário mínimo. Demonstraram altas prevalências de hipertensão (60,3%), diabetes (17%), dislipidemia (32,6%), excesso de peso (72,8%) e valores elevados de circunferência da cintura (62,7%). Os indivíduos apresentaram, ainda, altas taxas de sedentarismo (70,7%) e tabagismo (27,1%) e importantes desvios alimentares, caracterizados pela elevada ingestão de açúcar simples (40,9%) e lipídeos totais (59,1%) e pelo baixo consumo de fibras (80%) e hortifrutis (85,8%). A qualidade alimentar associou-se diretamente à renda e escolaridade e inversamente aos fatores comportamentais, sedentarismo, tabagismo e alcoolismo. A população em estudo apresenta elevado risco de desenvolver doenças cardiovasculares e alta prevalência de fatores de risco modificáveis para essas doenças, como sedentarismo e alimentação de baixa... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The role of dietary inadequacy in the advent of cardiovascular diseases and its associated morbidities is already known and accepted. The nutritional diagnosis at a local level is essential to identify the factors associated with food choice and to propose solutions to improve the dietary quality of the population. To characterize the population and identify the variables involved with dietary quality of adults and elderly people users of the Family Health Unit of Rubião Júnior, in Botucatu, SP. It was used a questionnaire to evaluate the social, economic and demographic status, the previous pathological history and the food intake of the population. Measurements of height, weight, waist circumference, blood pressure and serum values of total cholesterol and its fractions, glucose and triglycerides were made. 225 people took part in this study, 67,7% of whom were women and 37,8%, elderly. The participants presented 24% of illiteracy and 46,7% of per capita income lower than a half basic salary. Showed high prevalences of hypertension (60,3%), diabetes (17%), dyslipidemia (32,6%), overweight (72,8%) and high values of waist circumference (62,7%). Individuals also presented high levels of inactivity (70,7%), smoking (27,1%) and significant dietary deviations, characterized by high consumption of simple sugars (40,9%) and total lipids (59,1%) and low intake of fibers (80%) and fruits and vegetables (85,8%). The dietary quality was directly linked to income and educational level and, inversely, to behavioral factors, inactivity, smoking and alcoholism. This population presents high risk of developing cardiovascular diseases and high prevalence of modifiable risk factors for these illnesses, such as the lack of both, physical activity and healthful diet. It's essential to include actions aimed at changes in lifestyle in the process of health... (Complete abstract click electronic access below) / Mestre

Introdução: O comportamento adotado na adolescência é de extrema importância por ser esta uma fase da vida de aprendizagem e formação. Os costumes adquiridos neste estágio constituirão a base da prática alimentar no futuro. Objetivo: Avaliar a qualidade da dieta e seus fatores associados em adolescentes residentes em regiões do Estado São Paulo. Métodos: Estudo transversal de base populacional de uma amostra de 1584 adolescentes, de ambos os sexos, com idade de 12 a 19 anos e 11 meses, incluídos no Inquérito de Saúde de São Paulo - ISA-SP, realizado em 2001-2002. Amostras probabilísticas em dois estágios, setor censitário e domicílio, foram tomadas de cada uma das quatro áreas estudadas (Distrito do Butantã, região sudoeste da grande São Paulo, municípios de Campinas e Botucatu). As informações sobre as características da população de estudo foram obtidas através de questionário e o consumo alimentar pelo Método Recordatório de 24 horas. A qualidade da dieta foi avaliada através do Índice de Qualidade da Dieta (IQD) adaptado para a realidade local. Foi utilizada análise de regressão linear para avaliar a relação entre o IQD e as variáveis independentes. Resultados: A média do IQD foi de 59,7 pontos. Da população estudada, 97,1% apresentou uma dieta inadequada ou que necessita de melhora, sendo que somente 2,9% dos adolescentes possuíam uma dieta considerada saudável de acordo com o IQD. Os valores médios dos componentes do IQD apresentaram-se mais baixos para frutas, leite e derivados e verduras e legumes. Os adolescentes do sexo masculino, praticantes de exercício físico e que residem em casa ou apartamento, apresentaram os maiores escores do IQD. Na análise de regressão linear múltipla, observou-se que quanto maior a idade, menor o IQD e que adolescentes residentes em casa ou apartamento têm um Índice de Qualidade da Dieta maior que os residentes em barraco ou cortiço, independente da idade e ingestão de energia. Conclusão: A qualidade da dieta está associada a melhores condições socioeconômicas e idade. Conhecendo esses fatores associados é possível adaptar políticas e programas de nutrição para atingir as necessidades desta população, prevenindo, principalmente, as doenças crônicas não transmissíveis na idade adulta. / Introduction: The behavior adopting on adolescence is of extreme importance to be a stage of life of learning and formation. The customs acquired in this stage will constitute the base for dietary behavior in the future.Objective: To evaluated the dietary quality and associated factors amog adolescents living in regions of the State of São Paulo.Methods: Cross-sectional population-based study with a sample of 1584 adolescents of both genders, at the age among 12 and 20 years, who were included in the Houschould Health Survey (ISA - SP), performed in 2001-2002. Probabilistic samples were obtained from multi-stage cluster samples (census tracts and homes) of four areas studied (Butantã District, Southwestern sector of the greater São Paulo region and municipality of Campinas and Botucatu). The data about population characteristics were obtained from questionary and the dietary intake by means of the 24- hour recall method. The dietary quality was measured by means of Health Eating Index (HEI), adapted to local realities. Linear regression analyses were performed to evaluated the relationship between HEI and independent variables.Results: Among the population assessed 97.1% presented a poor diet or a diet that needed of improvement and only 2.9% of adolescents had diet respected helthy agreed with the HEI. Average overall score was 59.7 points. Means scores for the index components were lower to fruits, dairy products and leaves and vegetables. Male adolescents, practitioners of physical exercise and residents of house or apartment, presented the major score of the HEI. In the multiple regression analyses, it was observed that the quality of the diet improve with decrease at the age and the adolescents lived in households or apartments have the major HEI than adolescents residents in shack or tenement slum, independent of the age and energy intake.Conclusion: The dietary quality is associated with higher income and age. Knowledge of these associated factors is possible to adapt politics and programs of nutrition to arrive the population´s needs, preventing , mostly, the chronic diseases no transmissible on adult age.

No description available.

Objective. Determine the relationship between dietary quality and body weight/composition in college women. Specific emphasis was made regarding adherence to current MyPyramid guidelines, fruit, vegetable and junk food consumption. Design/Participants. The study used a cross-sectional design. One hundred and sixty three women were recruited to participate in the study. All participants were university students (20.4 ± 1.6 y). Diet intake was measured using the Dietary History Questionnaire (DHQ) and the Healthy Eating Index (HEI) was calculated to assess diet quality. Body fat percentage was assessed using the Bod Pod and BMI was calculated using height and weight measurements. Physical activity was measured objectively using accelerometers over seven consecutive days. Results. There was no significant difference in BMI or body fat percentage across university year. There was no relationship between diet quality (as measured using the Healthy Eating Index) and percent body fat or BMI. The number of MyPyramid equivalents of fruit was negatively correlated to body fat percentage (r = -0.2, p ≤ 0,05) but not BMI (r = -0.093, p =0.26). The number of MyPyramid equivalents of dairy was also negatively related to both body fat percentage (r = -0.21, p ≤ 0.05) and BMI (r = -0.21, p ≤ 0.05). Percentage of calories from Non Nutrient Dense Foods (NNDF) was positively related to percent body fat ( r= 0.179, p = 0.029). For every 1-percentage increase in NNDF, there was a 0.12 percentage point increase in body fat. Conclusion. Increasing fruit, dairy, and vegetable intake, and reducing intake from Non Nutrient Dense Foods (NNDF) such as French fries, cookies, and candy, may have a beneficial influence on body composition in college women.

This thesis investigates the relationship between smallholder farm household networks for food acquisition and agricultural production, food security and dietary quality in the Mount Elgon region of western Kenya and eastern Uganda. Food security and dietary quality were measured through calorie consumption of the female household head in a 24 hour dietary recall, the calculation the World Food Program Food Consumption Score (WFP FCS), and the calculation of the percentage of energy sourced from staples in the diet. Correlations between these indicators support that the WFP FCS is capturing elements of both sufficiency and quality of diet. Subsequent application of Ordinary Least Squares regression determines that both food acquisition networks and technology networks for agricultural production have a statistically significant positive impact upon calorie procurement across the sites included in the study. However, networks for agricultural production appear to operate differently in different locations with regard to dietary quality. Interpretation of qualitative data gathered through interviews with agricultural service sector providers and focus groups regarding these local networks for agricultural production suggests that this might be due to differences in the types of crops promoted and attitudes held regarding food security and dietary quality prevalent in these different localities. Overall, the results suggest that both food acquisition networks and agricultural production networks are important avenues through which gains in food security may be realized. However, development efforts need to be mindful of the crops and attitudes promoted by these networks to secure gains in both caloric sufficiency and dietary quality. / Master of Science / CCRA-8 (Technology Networks for Sustainable Innovation)

<p>Food insecurity, or limited access to enough foods for an active, healthy life, characterizes the situation of 65% of US food pantry clients. Food insecurity is associated with poor dietary intake of key food groups and nutrients, diet-related chronic disease, poor physical and mental health, and reduced quality of life. Although food pantry clients are prevalently food insecure, there is a sizeable proportion of clients who are classified as food secure (FS), or report having adequate access to healthy foods. Previous studies suggest that food secure pantry clients may use pantry resources differently, and have diets that differ in quality and intake, compared to food insecure clients (including low food secure [LFS] and very low food secure [VLFS] clients). </p><p>Food pantries may be an important venue for interventions to improve food security and dietary outcomes. Since dietary intake and use of food pantries may differ by food security status, the efficacy of such interventions may also differ by food security status. A social ecological modeled (SEM), community-based intervention in the food pantry setting is promising in sustaining local change efforts and may facilitate long-term implementation of strategies to improve diet-related outcomes among food pantry clients. Therefore, the aims of this dissertation were to 1) characterize differences in diet quality and intake between FS, LFS and VLFS pantry clients; 2) explore associations between the nutritional quality of the pantry food environment (foods in stock and foods distributed to clients) and client diet quality by food security status; and 3) evaluate the intermediate effects of a SEM, community-based intervention to improve diet-related outcomes among pantry clients with comparison by food security status.</p><p>Aim 1 was addressed by examining associations between food security and both diet quality and usual intake (in separate mixed multiple linear regression models) in a cross-sectional analysis of adult food pantry clients at baseline. FS status was associated with a higher Healthy Eating Index-2010 (HEI-2010) whole grains score, as well as a higher mean usual intakes of whole grains and iron, compared to LFS status. FS status was also associated with higher mean usual intakes of dark green vegetables and total dairy compared to LFS and VLFS status.</p><p>Aim 2 was addressed by evaluating the relationship between the quality of the mix of foods in stock (pantry inventories) and distributed (client food bags) at food pantries with client diet quality, and investigating how these relationships varied by food security status, in a cross-sectional analysis of adult food pantry clients at baseline. Client food bag HEI-2010 scores were positively associated with client diet scores for the total vegetables, total fruit, total protein foods, and sodium components, while pantry inventory HEI-2010 scores were negatively associated with client diet scores for the total score and for the total fruit and fatty acids components. VLFS clients consumed more whole grains from client food bags compared to FS clients, and consumed more greens and beans from pantry inventories compared to LFS clients.</p><p>Aim 3 was addressed by evaluating longitudinal changes in adult food security, diet quality and usual intake over the first two years (baseline to midpoint) of a three-year SEM, community-based food pantry intervention‒ Voices for Food (Clinical Trial Registry: NCT0356609). Adult food security score improved in the intervention group, while HEI-2010 total score and several component scores improved in the comparison group. When comparing the change in main outcomes over time between the intervention and comparison groups, no favorable differences were observed at this intermediate time point.</p><p> </p><p>Food pantries do not comprise a homogeneous population of clients. Pantry clients have different quality diets and rely on pantries to acquire different types of foods depending on their food security status. Food pantries may be an important venue to target interventions that improve diet-related outcomes, with consideration for the complex interplay between food security status, the pantry food environment and availability of resources to prepare healthy foods. Evaluation of the final study time point, as well as further investigation of the dose-dependent effect of each intervention component and other individual community characteristics, may elucidate the relationship between the intervention and client outcomes.</p><p></p>

Introdução: O baixo peso ao nascer (BPN) representa risco crucial para as crianças. Em contrapartida, a amamentação é considerada a estratégia de maior impacto na redução da mortalidade em crianças menores de cinco anos. O aleitamento materno exclusivo (AME) é recomendado até o sexto mês de vida, devendo ser complementado até dois anos de idade ou mais. Crianças com consumo alimentar inadequado desde a infância tendem ao desenvolvimento precoce de sobrepeso e obesidade, além de outras doenças crônicas associadas. Objetivo: Verificar o padrão de aleitamento materno (AM) e as práticas de alimentação complementar de lactentes menores de um ano nascidos com baixo peso e analisar a influência de determinantes individuais e contextuais. Métodos: Estudo transversal com dados de 64 municípios brasileiros (incluindo as capitais e Distrito Federal) que abrangeu 5115 lactentes menores de um ano com BPN da Pesquisa de Prevalência de Aleitamento Materno (PPAM) em Municípios Brasileiros, 2008. O questionário continha questões sobre a prática de AM e sobre o consumo de todos os grupos alimentares nas últimas 24 horas. A tese gerou três manuscritos: 1) Descreve as práticas de aleitamento materno, o consumo de líquidos e alimentos semi-sólidos nas últimas 24 horas e os indicadores de consumo alimentar de lactentes entre seis e 11,9 meses segundo estratos de BPN. 2) Avalia os determinantes individuais e contextuais do AME. 3) Analisa a influência de determinantes individuais e contextual sobre a dieta diversificada e sobre o consumo de alimentos ultraprocessados em lactentes de seis a 11,9 meses com BPN. Nos manuscritos 2 e 3, os determinantes individuais corresponderam às características socioeconômicas (representadas pela proxy escolaridade materna), dos lactentes (idade; sexo), maternas (faixa etária; situação de trabalho; paridade) e aos serviços de saúde (local de acompanhamento ambulatorial). No manuscrito 2 foi incluído também o \'nascimento em Hospital Amigo da Criança (HAC)\'. Os determinantes contextuais corresponderam às características dos municípios, representadas pelas variáveis \'número de Bancos de Leite Humano (BLH) por mil nascidos vivos\' e \'Índice de Desenvolvimento Humano do município\' no manuscrito 2, e \'prevalência estimada de desnutrição infantil\' como proxy de pobreza, no manuscrito 3. Para análise, utilizou-se regressão de Poisson com estrutura multinível e adotou-se nível de significância de 5%. Resultados: Descritos de acordo com cada manuscrito produzido: 1) No estrato de muito BPN o AME até 60 dias e 90 dias foi mais elevado do que nos demais, mas com intervalos de confiança superpostos. A prevalência de AME em menores de seis meses apresentou patamar semelhante nos três estratos de peso ao nascer. A prevalência de AM na primeira hora de vida e o AM foram mais prevalentes entre os nascidos com 2000 a 2499g. Observou-se consumo elevado de alimentos ultraprocessados (AUP) em lactentes de 6|-9 e de 9|-12 meses, sendo esta prevalência maior quanto maior o PN. As prevalências dos indicadores de consumo alimentar estão aquém do recomendado. 2) O AME foi mais prevalente entre lactentes cujas mães tinham de 20 a 35 anos (RP=1,35; IC95%=1,09-1,69), não trabalhavam fora (RP=1,36; IC95%=1,08-1,71) ou estavam em licença maternidade(RP=1,30; IC95%=1,06-1,59); lactentes que nasceram em HAC (RP=1,22; IC95%=1,09-1,37) e que residiam em municípios com maior número de BLH por mil nascidos vivos (RP=1,42; IC95%=1,14-1,76). 3) Aproximadamente 59% dos lactentes consumiram alimentos ultraprocessados, enquanto 29% apresentaram dieta diversificada. Crianças cujas mães residiam em municípios com prevalência de desnutrição infantil inferior a 10% (RP=1,66; IC95%=1,23-2,24), tinham escolaridade superior (RP=1,37; IC95%=1,18-1,60) e trabalhavam fora de casa (RP=1,29; IC95%=1,12-1,49) foram mais propensas a oferecer uma alimentação diversificada. O consumo de alimentos ultraprocessados foi maior entre lactentes cujas mães residiam em municípios com prevalência de desnutrição infantil inferior a 10% (RP=1,17; IC95%=1,04-1,31), eram mais jovens (RP=1,30; IC95%=1,15-1,46) e multíparas (RP=1,16; IC95%=1,03-1,30). Conclusões: A tese evidenciou o efeito independente de estratégias que integram a Política Nacional de Aleitamento Materno. Nascer em HAC, residir em município com maior disponibilidade de BLH e o direito à licença maternidade remunerada exercem influência positiva sobre a prática de AME. Este resultado aponta para a necessidade de expansão da cobertura dessas estratégias com vistas ao cumprimento das metas de AM propostas pela OMS. Foi detectado impacto de fatores individuais e contextuais sobre a qualidade da dieta que demandam o desenvolvimento de estratégias eficazes para aumentar o consumo de alimentos in natura ou minimamente processados e diminuir o consumo de ultraprocessados nesta população vulnerável. / Introduction: Low birth weight (LBW) represents a major risk to children. On the other hand, breastfeeding is recognized as the strategy with the greatest impact on reducing childhood mortality. Thus, exclusive breastfeeding (EBF) is recommended up to the sixth month of the child\'s life and should be complemented up to two years of age or more. Inadequate nutrition during early childhood is associated with early development of overweight, obesity, and other chronic diseases. Objectives: 1) To verify the breastfeeding pattern and complementary feeding practices of infants under one year of age who were born with low weight and, 2) to assess the influence of its individual and contextual determinants. Methods: This cross-sectional analysis included 5,115 infants less than one year of age born with LBW from the Second National Survey of Breastfeeding Prevalence (IIPPAM). The survey evaluated the situation of breastfeeding and complementary feeding in 64 Brazilian municipalities (including capitals and the Federal District). Dietary data was collected using a questionnaire with dichotomous questions about breastfeeding practices and consumption of foods from all food groups in the previous 24 hours. The thesis generated three manuscripts as follows: 1) The first one describes breastfeeding practices, consumption of any liquids (including non-human milk) and semi-solid foods in the last 24 hours, and indicators of young child feeding practices of infants between six and 11.9 months according to birth weight strata. 2) The second manuscript evaluates individual and contextual determinants of exclusive breastfeeding. 3) The third one assesses the influence of individual and contextual factors on dietary diversity and on consumption of ultraprocessed foods in LBW infants between six and 11.9 months of age. The individual-level-factors studied on manuscripts 2 and 3 were: socioeconomic (represented by the proxy maternal education), infants (age, sex), maternal (age range, work situation, parity), and health services (type of outpatient follow-up). The individual-level-factor \'being born in a Baby-Friendly Hospital (BFH)\' was also studied on manuscript 2. The community-level factors studied at the second level in the manuscript 2 included municipalities\' characteristics (number of Human Milk Banks (HMB) per thousand live births in each municipality in 2007, and Human Development Index of the municipality, used as proxy of poverty). The community-level factor studied at the second level in manuscript 3 was municipal prevalence of childhood malnutrition, used as a proxy for poverty. The individualized effect of the study factors on the outcome was evaluated using multilevel Poisson regression analysis. For all manuscripts, a significance level of 5% was adopted. Results: Summary of the findings of each manuscript produced: 1) In the stratum of very LBW, the rates EBF up to 60 and 90 days were higher among very LBW infants compared to others, however with overlapping confidence intervals. The overall prevalence of breastfeeding in infants under six months was similar among the groups. The rates of breastfeeding in the first hour of life and total breastfeeding were both higher among those born with weight between 2000 and 2499g. A high consumption of ultraprocessed foods was observed among infants aged 6|-9 and 9|-12 months, and it was noted that the higher the birth weight the higher was the prevalence of consumption. The prevalence of food groups consumption indicators are below the recommended. 2) EBF was more prevalent among infants born with LBW whose mothers were 20-35 years old, those who did not work outside the home or were on paid maternity leave; those born in a BFH; and those who lived in municipalities with the highest number of HMB per thousand live births. 3) Approximately 59% of infants consumed ultraprocessed foods, while 29% achieved dietary diversity. Mothers with the highest education level, those who worked outside the home, and who lived in municipalities with a prevalence of child malnutrition below 10% were more likely to offer a diverse diet. Consumption of ultra-processed foods was higher among infants whose mothers were younger, multiparous, and who lived in municipalities with a prevalence of child malnutrition below 10%. Conclusions: The thesis augments the evidence that integrated actions of the National Breastfeeding Program already implemented in Brazil - BFH Initiative, Brazilian Network of HMB, and adoption of labor laws for paid maternity leave - are associated with EBF even in the vulnerable population of infants born with LBW. Our results also suggest the need to expand and intensify the coverage of these strategies in order to meet the goals of breastfeeding proposed by the World Health Organization. Our findings also indicate the effects of individual and community-level factors on the dietary quality of this population, suggesting a need for developing effective strategies to increase consumption of unprocessed or minimally processed foods, while decreasing the ultra-processed counterpart for this vulnerable population.

<p>  </p> <p>Food insecurity describes the lack of access to foods and affects 10.2% of general U.S. households and 27% of low-income households in 2021. Food insecurity is a pervasive public health concern in the United States and has been linked to poor dietary intake and diet quality, overweight and obesity (especially among women), and risk of other chronic diseases, such as diabetes, hypertension and dyslipidemia. </p> <p>To better understand food security status and address its associated health and dietary outcomes among low-income populations, a conceptualized model was built and served as research framework for the dissertation, including 1) internal factors and motivations, such as traits related to self-efficacy and sufficiency that may influence diet and health; 2) external factors of temporary support, such as financial benefits from assistance programs that low-income populations are eligible for that may influence diet and health; and 3) external factors of potentially long-term support, such as nutrition education programs targeting low-income groups that may foster internalized knowledge that could sustain impact and improvement of diet and health in the long-term. Each chapter of this dissertation addresses a component of the model.</p> <p>Cross-sectional analysis of a sample of rural veterans using food pantries quantified psychological traits related to self-motivation and efficacy including grit and help seeking, at the individual and internal factors level of the conceptualized model, and their links to food security and resource use, and revealed an inverse association between grit score and risk of food insecurity. The findings provided evidence for future interventions targeting food insecurity improvement to include education and resources that address traits related to self-efficacy, such as grit, among low-income populations to improve health outcomes directly or through improving food security or use of resources. </p> <p>Using nationally representative data, the second study investigated relationships between food assistance through the Supplemental Nutrition Assistance Program (SNAP) participation, a type of societal level external support, and dietary outcomes among low-income older U.S. adults. There were no differences in dietary quality, usual nutrient intake or risk of inadequacy between SNAP participants and eligible nonparticipants. Furthermore, results revealed a high prevalence of not meeting the Estimated Average Requirement from dietary sources for several nutrients (vitamins A, C, D, E, calcium, and magnesium) but the prevalence was lower when nutrients from dietary supplements were included. The results highlight a need for continued effort to improve nutrient and dietary intake among low-income older adults.</p> <p>External factors of potentially long-term support (e.g. nutrition education and food assistance) were evaluated for relationships with body mass index. A longitudinal sample of low-income women interested in participating in nutrition education through SNAP-Education (SNAP-Ed) was examined to determine the relationship between nutrition education (SNAP-Ed) and food assistance program participation through (SNAP, WIC), separately and in combination, with long-term changes in body mass index. No differences in changes of weight status over time were observed by nutrition education, food assistance, or combination participation. The prevalence of obesity was high among this sample, calling for targeted obesity prevention interventions and further support of healthy lifestyle promotion among low-income populations. </p> <p>The findings shown in this dissertation further reveal a high health burden among low-income groups. The studies filled several research gaps described in the conceptualized model. The results may be used to inform future tailored interventions to address food insecurity, dietary and health outcomes at individual and societal levels, incorporating internal motivation and external support to mediate health and dietary risks among low-income population.</p>