This study was designed to compare the fatty acid and fruit and vegetable intake of people with and without periodontal disease. Periodontal disease affects approximately 15 percent of the developed world population. Participants filled out a food frequency questionnaire (FFQ) for both fruit and vegetable and fat intake. A sample of whole blood (EDTA) was collected to determine the fatty acid profile of participants’ red blood cell (RBC) membrane. This analytical procedure determines the average fatty acid intake of the participant over the previous 90 to 120 days. Participants were classified as case (n=10, patients diagnosed with periodontal disease) or control group (n=10, patients without periodontal disease). Our hypothesis was that the case group would have higher fat intake and lower fruit and vegetable intake, with lower levels of omega-3 fatty acids and higher levels of omega-6 fatty acids in the RBC membrane. FFQ results indicated that case participants consumed significantly higher amounts of total fat (109.02 vs. 94.46g/d; p= .05), saturated fat (35.102 vs. 28.242g/d; p= .033) and their diets had a higher percentage of total dietary fat (38.73% vs. 34.99%; p=.044). FFQ for fruit and vegetable intake showed no significance between the case and control groups (4.41 vs. 4.56 servings/d; p=.871). For the most part, there were no significant differences between the percent composition of the individual fatty acids isolated from the RBC membrane or in ratios of omega-3 to omega-6 fatty acid groups as determined by RBC fatty acid analysis. Results indicated a numerically lower intake of omega-3 fatty acids in the case than in the control group. Likewise, there was a numerically higher intake of omega-6 fatty acids in the case group. These numbers demonstrate a trend towards the hypothesis being correct and patients with periodontal disease consuming more omega-6 fatty acids and less omega-3 fatty acids.

La précarité est une dimension plus vaste que la pauvreté atteignant presque 15 % de la population française. Les personnes précaires ont plus de risques de développer certaines pathologies, dont des pathologies liées à l’alimentation, le diabète. Une étude d’intervention randomisée a été réalisée auprès d’une population de personnes précaires sur une durée de 12 mois. Les volontaires recevaient des conseils diététiques et/ou des chèques afin de favoriser la consommation de fruits et légumes. D’une consommation initiale d’environ 2,5 portions par jour, avec 30 % de sujets consommant en moyenne moins d’un fruit et légume par jour, l’augmentation moyenne est de 0,7 portions de fruits et légumes par jour, identique dans les deux groupes. Les chèques ont permis une diminution significative du pourcentage de très petits consommateurs. L’impact de la précarité a également été évalué chez des patients diabétiques au cours de trois études transversales. La précarité s’associe à un risque de déséquilibre glycémique et secondairement de rétinopathie, mais sans lien démontré entre la précarité et le stade d’une rétinopathie diabétique. L’une de ces études suggère un lien entre la précarité et le risque de néphropathie diabétique, et démontre une moins bonne qualité de vie des patients. Ces travaux soulèvent des questions sur les multiples freins à une alimentation saine ou à une prise en charge de la maladie pour des personnes précaires et orientent vers des perspectives : cibler les populations, envisager des éducations répétées et il doit être aussi possible de faire mieux avec les mêmes moyens. / Insecurity is a broader dimension of poverty reaching almost 15% of the French population. Insecure people are most at risk of developing various diseases, including diseases related to diet, and diabetes. A randomized intervention study was conducted among deprived volunteers on a period of 12 months. The volunteers were given dietary advice and/or vouchers exchangeable for fresh fruit and vegetables in order to promote their consumption. The baseline consumption was about 2.5 servings of fruit and vegetables per day, with 30% of non daily consumers. The average increase was 0.7 servings of fruits and vegetables per day, in both groups. Vouchers led to a significant decrease in very small consumers. The impact of deprivation has also been evaluated in diabetic patients in three cross-sectional studies. Insecurity was associated with a risk of poor glycemic control and secondarily with retinopathy, but no proven link between deprivation and the stage of diabetic retinopathy. One of these studies suggested a link between insecurity and the risk of diabetic nephropathy. Moreover, deprived patients with diabetes suffer lower quality of life.These studies raise questions about the multiple barriers to a healthy diet or a treatment of chronic disease for deprived people. This is part of the wider reflexion on how to treat these populations, by considering intensified repeated educational programs, and by improving existing approaches.

University students have low levels of fruit and vegetable consumption (FVC). There is a paucity of research about changing FVC in this population, including the specific use of environmental cues to influence behaviour change. The purpose of this research was to investigate the effect of a cue (a modified plate design and/or plate size) on FVC while exploring explicit cognitions and attitudes in first year undergraduates. Methods: This study utilized an experimental pre-post randomized control group design across six weeks, with two recruitment waves. First year full-time University students living off campus and consuming less than six servings of fruits and vegetables were eligible. Participants (n=39) were randomly assigned to intervention with an 8-inch dinner plate displaying recommended portion sizes, with an 8-inch dinner plate with no design, or a control group. All participants completed a food frequency questionnaire (FFQ), 24-hour food recall (24Hr), demographics, anthropometry and intentions toward FVC, with intervention groups receiving a lesson on Canada’s Food Guide in addition to their plate. Results: Eight out of twelve outcome measures had meaningful time by group effect sizes (ɳ2>0.06). For fruit frequency (per day), the effect was statistically significant (p=0.03). Adherence to plate use varied (design plate: 0.69±2.38 to 4.23±5.55 times per week; plain plate 3.39±7.31 to 12.80±7.89 times per week) but was low in the designed plate condition (average 4 use: 2.46±3.88 times per week). Baseline intention, affective and instrumental attitudes, perceived behavioural control, subjective norms and automaticity did not predict FVC. Conclusion: An environmental cue in the form of a modified dinner plate may significantly influence fruit and vegetable consumption in young adults. Change occurred despite low plate use, which appears to indicate that the role of the plate was more explicit; participants may have become more consciously aware of portion size because of the plate cue. It also appeared, based on effect sizes, that affective attitudes, subjective norms and automaticity may have been influenced. This pilot study established the effect sizes needed to power a larger randomized controlled trial and fully test the impact of the environmental cue. / Graduate / 0573 / 0570 / 0680 / hmrose@uvic.ca

In Australia, and other Western countries, there are marked socioeconomic inequalities in mortality from chronic, diet-related diseases. Research in these countries has shown that adults from low socioeconomic backgrounds experience greater morbidity and mortality from these conditions compared to their higher-status counterparts. In recent decades, much research has focused on factors that may contribute to these inequalities. Dietary intakes are thought to account for a large proportion of the socioeconomic variability in health, and there is some evidence suggesting that the psychosocial foundations laid down in adolescence are important influences on these dietary intakes. In Australia, however, existing research examining socioeconomic differences in dietary intakes is limited. Most previous research has looked at dietary intakes in adulthood, and have not considered examining for socioeconomic differences in adolescence. Furthermore, not much is known about the health and nutrition-related beliefs, attitudes and perceptions of adolescents that may contribute to socioeconomic differences in dietary intakes. This study examined these issues by analysing for socioeconomic differences in food and nutrient intakes among both adolescents and adults. It also investigated some health and nutrition-related beliefs, attitudes and perceptions of adolescents from different socioeconomic backgrounds. Data from a national cross-sectional survey, the 1995 Australian National Nutrition Survey, were analysed to determine socioeconomic differences in food and nutrient intakes. Qualitative interviews were undertaken with adolescents to investigate their health and nutrition-related beliefs, attitudes and perceptions. The results show that compared to adults, there is less socioeconomic inequality in food and nutrient intakes among adolescents. Intakes of some anti-oxidant vitamins and folate were directly related with socioeconomic position among adults. Adults from low socioeconomic backgrounds were less likely to consume fruits or vegetables. They consumed a lower variety of fruits and vegetables and were less likely to choose fruits and vegetables high in vitamin A, folate and vitamin C. The results showed that these differences may be due to adults from low socioeconomic backgrounds being less likely to want to increase their fruit and vegetable intakes, and perceiving price and storage as barriers to doing so. There were a small number of socioeconomic differences in adolescents' beliefs, attitudes and perceptions about nutrition and health that may contribute to dietary intake inequalities in adulthood. Adolescents from lower socioeconomic backgrounds were less likely to see health as being important for achieving goals, and identified nutrients and sleep as influencing their health less frequently. These adolescents also referred to dietary recommendations, nutrient intakes, dairy foods and avoiding school canteen foods less frequently when describing a healthy diet. A number of recommendations about the design and targeting of nutrition-promotion campaigns and interventions are discussed, as well as future directions for research on socioeconomic differences in dietary intakes.

La précarité est une dimension plus vaste que la pauvreté atteignant presque 15 % de la population française. Les personnes précaires ont plus de risques de développer certaines pathologies, dont des pathologies liées à l’alimentation, le diabète. Une étude d’intervention randomisée a été réalisée auprès d’une population de personnes précaires sur une durée de 12 mois. Les volontaires recevaient des conseils diététiques et/ou des chèques afin de favoriser la consommation de fruits et légumes. D’une consommation initiale d’environ 2,5 portions par jour, avec 30 % de sujets consommant en moyenne moins d’un fruit et légume par jour, l’augmentation moyenne est de 0,7 portions de fruits et légumes par jour, identique dans les deux groupes. Les chèques ont permis une diminution significative du pourcentage de très petits consommateurs. L’impact de la précarité a également été évalué chez des patients diabétiques au cours de trois études transversales. La précarité s’associe à un risque de déséquilibre glycémique et secondairement de rétinopathie, mais sans lien démontré entre la précarité et le stade d’une rétinopathie diabétique. L’une de ces études suggère un lien entre la précarité et le risque de néphropathie diabétique, et démontre une moins bonne qualité de vie des patients. Ces travaux soulèvent des questions sur les multiples freins à une alimentation saine ou à une prise en charge de la maladie pour des personnes précaires et orientent vers des perspectives : cibler les populations, envisager des éducations répétées et il doit être aussi possible de faire mieux avec les mêmes moyens. / Insecurity is a broader dimension of poverty reaching almost 15% of the French population. Insecure people are most at risk of developing various diseases, including diseases related to diet, and diabetes. A randomized intervention study was conducted among deprived volunteers on a period of 12 months. The volunteers were given dietary advice and/or vouchers exchangeable for fresh fruit and vegetables in order to promote their consumption. The baseline consumption was about 2.5 servings of fruit and vegetables per day, with 30% of non daily consumers. The average increase was 0.7 servings of fruits and vegetables per day, in both groups. Vouchers led to a significant decrease in very small consumers. The impact of deprivation has also been evaluated in diabetic patients in three cross-sectional studies. Insecurity was associated with a risk of poor glycemic control and secondarily with retinopathy, but no proven link between deprivation and the stage of diabetic retinopathy. One of these studies suggested a link between insecurity and the risk of diabetic nephropathy. Moreover, deprived patients with diabetes suffer lower quality of life.These studies raise questions about the multiple barriers to a healthy diet or a treatment of chronic disease for deprived people. This is part of the wider reflexion on how to treat these populations, by considering intensified repeated educational programs, and by improving existing approaches.

abstract: Fruit and vegetable consumption among school children falls short of current recommendations. The development of Public-Private Partnerships (PPP), which combine the resources of government entities with the resources of private entities, such as businesses or not-for-profit agencies, has been suggested as an effective approach to address a number of public health concerns, including inadequate fruit and vegetable consumption. The United States Department of Agriculture's (USDA) Fresh Fruit and Vegetable Program (FFVP) provides fruits and vegetables as snacks at least twice per week in low-income elementary schools. In addition to increasing fruit and vegetable consumption behaviors at school, children participating in the FFVP have been found to make more requests for fruits and vegetables in grocery stores and at home, suggesting the impact of the program extends beyond school settings. The purpose of this multicase study was to describe key stakeholders' perceptions about creating PPPs between schools and nearby retailers to cross-promote fruits and vegetables in low-income communities, using the FFVP. Semi-structured interviews were conducted with participants from three cases groups: grocery store/produce managers (n=10), district FFVP personnel (n=5) and school FFVP personnel (n=12). Data were analyzed using a directed content analysis approach using constructs from the Health Belief Model, including benefits, barriers, strategies, and motivation. While findings varied by case group, key benefits of creating a PPP included the potential to increase store sales, to enhance public relations with the community, and to extend the impact of the FFVP to settings outside of schools. Barriers included offering expensive produce through the FFVP, time/labor-associated costs, and needing approval from authorities and supervisors. Strategies for developing a PPP included using seasonal produce and having clear instructions for teachers and staff. Stakeholders reported being motivated to create a PPP by the potential to improve health outcomes in children and by wanting to help the community. Both objective and subjective measures were suggested to measure the success of such a partnership. Finally, the educational component of the USDA's Supplemental Nutrition Assistance Program (SNAP-Ed) has the potential to serve as a catalyst for organizing a PPP between FFVP-participating schools and nearby grocery stores. / Dissertation/Thesis / Doctoral Dissertation Nutrition 2017

abstract: Despite the literature suggesting that fruits and vegetables (F&V) can have a protective outcome against overweight, obesity and chronic diseases, consumption is still inadequate. In order to address under consumption of F&V among children, schools have become a platform for a variety of food programs. The Fresh Fruit and Vegetable Program (FFVP), a United States Department of Agriculture (USDA) initiative, aims to increase exposure and consumption of F&V in low-income school children by providing F&V snacks. Participation in FFVP has been associated with higher preference and consumption of F&V and research also suggests that the program has the potential to decrease rates of overweight and obesity. The benefits of this program have been found to extend outside of the school setting, with higher requests for F&V at home and at the grocery store. This study aims to explore how children’s participation in the FFVP influences home food environments and shopping practices through qualitative analysis focus group data. Four focus groups were held with parents (n=25) from three FFVP participating schools. The data was analyzed using an inductive thematic analysis approach to find themes within the discussions. The findings were grouped into three categories: General Perceptions of FFVP, Impact of FFVP on the Home Food Environment, and Impact of FFVP on Shopping Practices. For General Perceptions of FFVP, themes were: Children learn about and enjoy F&V, awareness of farm to school programs, and children make healthier choices. Impact of FFVP on the Home Food Environment included the themes: Choosing heathier foods and snacks, parent F&V behaviors, children request F&V at home, and children talk about or bring F&V home. Finally, Impact of FFVP on Shopping Practices included the themes: children’s involvement in shopping, children request to buy F&V, children request non-produce items, and parents decline or limit unhealthy requests. This qualitative study provides valuable insights about how FFVP participation influences child and family behaviors towards F&V at home and in the grocery store. School food programs, such as the FFVP, have a positive influence on F&V related behaviors among children and should be continued and expanded. / Dissertation/Thesis / Masters Thesis Obesity Prevention and Management 2018

The Supplemental Nutrition Assistance Program (SNAP) is the largest domestic hunger safety net program in the United States. It has been shown that SNAP increases households' purchasing power. However, only a quarter of Americans follow recommended healthy eating patterns. Hence, there is a question whether the additional income from SNAP transfers to healthier eating. This paper addresses three questions. First, what factors explain SNAP participation of low-income individuals in addition to basic income eligibility requirements? Second, does SNAP participation increase fruit and vegetable consumption? Third, what effect does the Supplemental Nutrition Assistance Program Education (SNAP-Ed) in Arizona have on fruit and vegetable consumption for low-income households? The data used in this study were drawn from two waves of the Arizona Behavioral Risk Factor Surveillance System survey. The study found people in Arizona ate fruits, on average 1.4 times per day and vegetables 1.6 times per day. Marital and household arrangement status significantly affected both SNAP participation and fruit and vegetable consumption, but effects for men and women differed. Distance from services assisting with SNAP enrollment appeared to have no negative effect on eligible respondent enrollment. People living in counties with more SNAP-Ed contractors per person below 125% of the poverty line consumed more fruits and vegetables, but the effect was only marginally significant. Future research should consider more geographically specific measures of SNAP-Ed reach.

The Food neophobia (FN) behaviors in children are developed during childhood and can be influenced by parental FN and feeding behaviors. The objective of this study was to evaluate the relationship between FN and fruit and vegetable neophobia (FVN) among parents, the parents-reports on child's behavior and child self-reports. The effect of parental feeding practices and demographic variables on children’s FN and FVN were evaluated. Sixty-eight parents paired with their elementary school children (aged 7-12 years) in San Luis Coastal Unified School District participated in this study. Results indicated that parents reported their children more neophobic than children self-reported neophobia; however, there was a significant association between parents-reported child FN and child self-reported FN (r=0.62, p<0.05). FVN behaviors were positively and consistently correlated with FN in both parents and children. Parents with the highest income levels used less restriction for weight and child control strategies to feed their children (p<0.05). More pressure to eat was applied significantly for younger children, which increased their levels of food and FVN as reported by parents.

Using a community-based participatory research (CBPR) approach, community members, community stakeholders, and academic researchers from Virginia Tech formed a community-academic partnership in 2009. In the formative months, the coalition decided to focus on reducing obesity in the region. The coalition adopted the name of The Dan River Partnership for a Healthy Community (DRPHC) with a mission to "foster community partnerships to combat obesity in the Dan River Region through healthy lifestyle initiative". During a planning workshop, the DRPHC created six causal models for the root causes of obesity in the region. Two causal models that focused on geographic and environmental influences for obesity are the foundation for this series of research. The focus of this dissertation is at the intersection of the food and physical activity environments and their characteristics that contribute to meeting fruit and vegetable intake and minutes of physical activity recommendations. The food environment is one aspect of built environment research that examines food locations for procurement and the variety, availability, and quality of different food options. To date, the vast majority of research on the food environment is based in urban, suburban, and metropolitan areas with high residential densities and populations. Rural areas are often understudied because of their dispersed and hard-to-reach populations; yet these individuals experience some of the worst health outcomes in the nation. This is due, in part, to the large overlaps of rural regions and food deserts, resulting in poor food choices and poor diets. The overall objective of this dissertation is to examine the associations of the food and physical activity environments with individual healthy behaviors. Three studies were conducted within the broader research plan to meet the overall objective. The first study systematically examined the food environment using the Nutrition Environment Measures Survey (NEMS) for all food outlets in Danville, VA, a small regional city within the health disparate region, to compare differences in healthy available food options by block group race and income. The second study expanded NEMS methodology to encompass all food outlets in the three-county Dan River region to examine if food environment and availability of healthy options was predictive of meeting fruit and vegetable intake recommendations. The last study examined the objective and perceived distance individuals must travel to reach a physical activity outlet and whether or not distance was a predictive factor of individual weekly minutes of moderate to vigorous physical activity and meeting physical activity recommendations. / Ph. D.