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A healthy diet is related to a low risk of chronic diseases. A large body of research is devoted to improving social welfare by promoting healthy eating. This dissertation addresses the relation of food and health by analyzing the money and time inputs in food, the food poverty measurement, and a corresponding health outcome. The second chapter extends the current food poverty measure in headcount and proposes a set of Foster, Greer, and Thorbecke (FGT) indices, which is commonly used in development literature, in food poverty to allow for a more comprehensive understanding in food poverty evaluation. The counter-factual analysis on removing the American Recovery and Reinvestment Act (ARRA) component from the food expenditure shows that the original metrics underestimate the reduction to food expenditure poverty associated with ARRA, whereas the FGT indices indicate a slightly larger impact of ARRA in alleviating food poverty. The third chapter uses the same FGT indices in food poverty measurement but focuses on the sensitivity of these measurements to a different spatial and temporary food price. We use linear regression to estimate the local level of food poverty thresholds. The results show the spatial and temporal-specific thresholds are higher than the national threshold. The West region shows the most severe poverty situation, indicating the importance of considering spatial and temporal variations in measuring food expenditure poverty. The decompositions of food expenditures show that both the Supplemental Nutrition Assistance Program (SNAP) benefits and money spent on protein play an essential role in reducing food expenditure poverty. The fourth chapter combines the two datasets used in the previous two chapters to investigate the connection between the resources (money and time) devoted to food and a corresponding health outcome (Healthy Eating Index, HEI). Two-Sample-2-Stage-Least-Square (TS2SLS) model is used to account for the two different datasets in predicting the time spent on food-related activities. After obtaining the time input, a Three-Stage-Least-Square (3SLS) model shows the time input improves the HEI for Non-SNAP households, who are more constrained by time. The decomposition of the impact of education on the HEI shows the indirect impact account for 22% of the total impact. This analysis breaks down the impact of the characteristics on HEI through different channels, thus offers more comprehensive policy recommendations. / Doctor of Philosophy / A healthy diet is related to a low risk of chronic diseases. A large body of research is devoted to improving social welfare by promoting healthy eating. This dissertation is a series of studies on food and health regarding the money and time input on food, the food poverty measurement, and the corresponding health outcome. The second chapter extends the current food poverty measure in headcount and proposes a set of distributional metrics: depth and severity, which measures how far away households are away from the targeted threshold and how severe the food poverty is respectively. These distributional metrics allow for a more comprehensive understanding of food poverty evaluation. We also analyzed the change of the metrics when removing part of the food expenditure funding source. The analysis shows the original metrics tend to underestimate the reduction to food expenditure poverty and indicates a slightly larger impact of removed funding source in alleviating food poverty. The third chapter uses the same distributional food poverty metrics, but focuses on the sensitivity of these measurements to different spatial and temporal food prices. We use linear regression in estimating the local food poverty thresholds. The results show the spatial and temporal-specific thresholds are higher than the national threshold. The West region shows the most severe poverty situation, indicating the importance of considering spatial and temporal variations in measuring food expenditure poverty. The forth chapter combines the two datasets used in the previous two chapters to investigate the connection between the resources (money and time) spent on food and a corresponding health outcome. A special econometrics model is used to predict the time spent on food-related activities with two datasets. After obtaining the time input, a system of equations model shows the time input improves the healthy eating for households who are more constrained by time. The decomposition of the impact of education on healthy eating shows the indirect impact account for 22% of the total impact. This analysis breaks down the impact of the characteristics on HEI through different channels, thus offers more comprehensive policy recommendations.

The transition to college is marked by poorer eating behaviors. The Theory of planned behavior (TPB) represents a promising tool for predicting eating behaviors through the examination of attitudes (ATT), subjective norms (SN), perceived behavioral control (PBC), and intention (INT). Despite prior application of the TPB, there exist several key methodological issues in the literature addressing eating behaviors. The present study utilized an enhanced dietary assessment methodology, the ASA24 dietary recall, and a short-term prospective design to assess the healthy eating behaviors of emerging adults in college. Dietary recalls of 68 participants (average age = 20.76 years; 70.6% female; 70.6% non-Hispanic, 48.5% White, 22.10% Black/African American, 13.20% Asian) were analyzed using the Healthy Eating Index (HEI)-2010 scoring system. Results revealed that very few college students are meeting recommended dietary guidelines. Linear regression indicated that the indirect TPB variables (ATT, SN, and PBC) were related to INT (F[3,64] = 19.67, p < .001), although SN did not account for unique variance. Further, the direct TPB variables (INT and PBC) were related to HEI-2010 scores (F[2,65] = 4.00, p = .023); however, only PBC accounted for significant variance. Overall, findings suggest that more favorable attitudes relate to intention, but only perceived behavioral control consistently relates to actual healthy eating behavior.

abstract: Background: Healthy eating plays critical roles in the prevention of many chronic diseases, but there are many barriers in life that prevent people from adopting and maintaining healthy diets. Thus, identifications of barriers that people perceive they have in trying to eat healthy can guide the strategies for dietary behavior change interventions by taking account of the barriers. Objective: The purpose of this study was to identify and quantify the perceived barriers to healthy eating (PBHE), to investigate the relationship between socioeconomic factors and PBHE, and to explore the associations between PBHE and dietary intake among parents of elementary-school aged children living in South Phoenix, AZ. Methods: Socioeconomic factors and PBHEs were obtained via survey and diet was assessed by two interviewer-assisted 24 h diet recalls. The associations between employment and PBHEs, education and PBHEs, and household monthly income and PBHEs were analyzed by Mann-Whitney Test, Kruskal Wallis Test, and Spearman’s correlation test, respectively. The relationship between PBHEs and dietary intake were analyzed by Spearman’s correlation test. Linear regression was used to assess the associations between total PBHE, and dietary intake (including added sugar, fruit and vegetable), adjusted by covariates (including socioeconomic status, birth country, age and gender). Results: Of 149 participants who completed the survey (mean age = 38.47±7.08 y), 136 completed the 24 h diet recalls. The mean reported total, social support, emotions and daily mechanics PBHE scores were 2.63±0.91, 2.52±1.16, 2.71±1.06, and 2.58±0.95, respectively, out of a 5-point scale. Daily fruit, vegetable, sugar-sweetened beverage, sweetened foods, and added sugar intake were reported as 1.66±1.56 servings, 2.45±1.43 servings, 1.19±1.30 servings, 2.02±2.12 servings and 49.93±31.17 g, respectively. Employment status was significantly associated with total PBHE (Z = -2.28, p=0.023), and support PBHE (Z = -2.623, p=0.009). Education was significantly related to total PBHE (χ2 = -7.987, p=0.046), and daily mechanics PBHE (χ2= 11.735, p=0.008). Household monthly income levels were significantly correlated to daily mechanics PBHE (r = -0.265, p=0.005). Added sugar was positively correlated with total PBHE (r=0.202, p=0.020), emotions PBHE (r=0.239, p=0.006), and daily mechanics PBHE (r=0.179, p=0.040). Sugar sweetened beverage intake was significantly related to emotions PBHE (r=0.183, p=0.035). When adjusting for socioeconomic factors in the regression analysis, there was no significant association between PBHE and diet intake. Conclusion: Overall, results suggest PBHEs listed in this study are mainly associated with socioeconomic factors, but they are not related to diet intake. Future studies will focus on the precise role of overcoming some identified barriers in improving healthy eating behaviors, and the causality between barriers and healthy eating. / Dissertation/Thesis / Masters Thesis Nutrition 2018

Master of Science / Department of Food, Nutrition, Dietetics and Health / Sara K. Rosenkranz / Evidence from physical activity interventions suggests that women, in particular, may overcompensate for exercise energy expenditure by increasing caloric intake. Sedentary behavior and poor diet quality are independent risk factors for many major chronic diseases including cardiovascular disease (CVD). It is unknown whether insufficiently active women alter dietary quality or caloric intake when participating in an intervention to reduce sedentary behavior. Insufficiently active women (n=49) working full-time sedentary jobs were randomized into one of two 8-week sedentary interventions occurring during the work week [short breaks (SB) (1-2 min every half hour, n=24) or long breaks (LB) (15 min twice daily, n=25)]. Dietary information was collected through 3-day food records at baseline, week 4 and week 8. Dietary quality was assessed using the Alternative Healthy Eating Index 2010 (AHEI-2010). CVD risk factors (systolic and diastolic blood pressure (BP), fasting cholesterol, triglycerides, and blood glucose, and body mass index) were assessed at baseline and week 8. For all participants there were no changes in AHEI-2010 scores over time (baseline: M=53.4, 95% CI [49.2, 57.6], week 4: M=50.3, 95% CI [45.9, 54.7], week 8: M=48.4, 95% CI [44.1, 52.7], p>0.05). Average caloric intake in the SB group (baseline: M=1943.8 kcals/day, 95% CI [1716.2, 2171.5], week 4: M=1728.8 kcals/day, 95% CI [1462.4, 1995.2], week 8: M=1616.8 kcals/day, 95% CI [1450.2, 1783.4]) decreased significantly from baseline to week 4 (p=0.015) and baseline to week 8 (p=0.002). There were no significant changes in caloric intake in the LB group (p>0.05) at either time point. In all participants, absolute changes in LDL were positively correlated with absolute changes in caloric intake (r=0.473, p=0.005). There were no other significant associations between changes in dietary quality or caloric intake with changes in any other CVD risk factor (p>0.05). Following an 8-week sedentary intervention in the workplace, insufficiently active women did not alter their dietary quality, but decreased caloric intake. Future research should explore sedentary interventions compared to physical activity interventions in women as a means to create negative energy balance, as sedentary breaks throughout the day may be effective for improving health outcomes.

This research examined the psychosocial factors influencing physical activity and fruit and vegetable intake behaviour, intentions and health cognitions in secondary school children in the United Arab Emirates. Study 1 examined the prediction of Theory of Planned Behaviour (Ajzen, 1991) and Prototype/Willingness Model (Gibbons and Gerrard, 1995) on behaviour, intentions and cognitions in 536 secondary school students. Findings indicated that attitudes, subjective norms, perceived behavioural control and prototype perceptions accounted for a significant proportion of behavioural intentions, after controlling for parental behaviour. Prototype variables, especially similarity, improved the predicting validity of the Theory of Planned Behaviour. Some differences between age and gender were noted. Prototype similarity appeared to be the strongest predictor of behavioural intentions out of the prototype measures. Study 2 tested the effectiveness of an action planning intervention (Gollwitzer, 1993) and image intervention (Gibbons and Gerrard,1995) in 188 secondary school students. A longitudinal design was employed collecting data over 6 months measuring behaviour, behavioural interventions and components from the Theory of Planned Behaviour and Prototype/Willingness Model. Participants in the action‐planning group were asked to form specific implementation intentions of physical activity and fruitand vegetable intake. Participants in the image group were asked to consider favourable behaviour specific prototype and describe them. Findings revealed no significant intervention effects on intentions or behaviour. Some significant effects were seen on health cognitions across time points and conditions. Study 3 explored knowledge, outcome expectations, facilitators and social modelling, drawing from Social Cognitive Theory (Bandura, 1986) by conducting 8 semistructured focus group interviews (N=40). Emerging themes were: ‘Knowledge of physical activity’, ‘Impact on health, wellbeing and physical appearance’, ‘Having fun together’, ‘Important role models’ ‘Knowledge of healthy eating’, ‘Physical and psychological rewards’, ‘Availability and appearance’ and ‘Sometimes yummy and sometimes yucky’. Findings highlighted enjoyment and social factors as strong influences of physical activity and fruit and vegetable intake. The overall findings provided some evidence for future implications and further quantitative and qualitative approaches were recommended to further establish the influential factors of children’s healthy eating and physical activity habits in the Middle East.

Introdução: O aumento na prevalência de doenças crônicas não transmissíveis (DCNT) tem resultado em mudança nos padrões de mortalidade em vários países, inclusive no Brasil. Considerando associação entre transição demográfica, nutricional e epidemiológica, há necessidade de ações em saúde direcionadas à prevenção de doenças e agravos, aliada a estratégias de promoção da saúde da população, de forma a proporcionar maior qualidade de vida aos indivíduos. Objetivo: Conduzir análise custo-efetividade da dieta de uma amostra de pacientes com idade igual ou superior a 50 anos, usuários de Unidades Básicas de Saúde (UBS) do município de Bauru (SP), comparando-se com um padrão de alimentação saudável dentro de parâmetros nutricionais recomendados, preferências alimentares locais e custo similar à alimentação usual dos pacientes. Metodologia: Tratou-se de estudo transversal com caráter retrospectivo, originado de projeto de pesquisa de maior abrangência intitulado \"Relação entre atividade física habitual e desenvolvimento de síndrome metabólica e comorbidades associadas em usuários do sistema público de saúde: Um estudo de coorte de 8 anos\", incluindo aplicação de recordatório 24 horas para registro do consumo alimentar. Adicionalmente, foi realizada pesquisa de preços no varejo para estimativa dos custos da alimentação rotineira e calculada qualidade da dieta por meio do Índice Qualidade da Dieta Revisado adaptado para população brasileira para avaliação da razão custo-efetividade da alimentação dos pacientes da amostra. Resultados: Identificou-se influência positiva da classe econômica, consumo de bebidas alcoólicas e escore de qualidade nutricional da dieta sobre custos da alimentação dos pacientes; assim como incremento da RCE em relação à idade, à escolaridade e ao consumo de bebidas alcoólicas dos indivíduos. Conclusão: A partir da estimativa do custo diário da alimentação, verificou-se possibilidade de mudança na dieta a baixo custo, de forma a reduzir o impacto do fator renda na tomada de decisão pela melhoria da qualidade nutricional da alimentação da população. / Introduction: The increase in the prevalence of non-communicable diseases (NCDs) has resulted in a change in mortality patterns in several countries, including Brazil. Considering the association between demographic, nutritional and epidemiological transition, there is a need for health actions directed to the prevention of diseases and conditions, allied with strategies to promote the health of the population, in order to provide a better quality of life for individuals. Objective: To conduct a cost-effectiveness analysis of the diet of a sample of patients aged 50 years or older, users of Basic Health Units (UBS) in the city of Bauru (SP), comparing them with a healthy eating pattern inside of recommended nutritional parameters, local food preferences and cost similar to the usual diet of the patients. Methodology: This is a retrospective cross-sectional study from a larger research project entitled \"Relationship between habitual physical activity and the development of metabolic syndrome and associated co-morbidities in users of the public health system: An 8-year cohort study \", including application of a 24-hour recall to record food consumption. In addition, a retail price survey was conducted to estimate the costs of routine feeding and calculated diet quality using the Revised Diet Quality Index adapted for the Brazilian population to evaluate the cost-effectiveness ratio of the sample patients\' feed intake. Results: We identified a positive influence of the economic class, consumption of alcoholic beverages and score of nutritional quality of the diet on costs of the patients\' diet; as well as increase of the RCE in relation to the age, the schooling and the consumption of alcoholic beverages of the individuals. Conclusion: From the estimated daily cost of food, was checked a possibility to change the low cost diet, in order to reduce the impact of the income factor in decision making in favor of improving the nutritional quality of the population\'s diet.

O conceito de soberania alimentar surgiu após outros conceitos acerca das questões alimentares. Um deles é o conceito de segurança alimentar que após a II Guerra Mundial já trazia à tona critérios ditos como essenciais para uma alimentação digna e correta. No entanto, ainda não se falava tanto da influência da liberdade e dos modelos de produção da agricultura, que vieram a fazer parte da pauta de discussões mundiais sobre alimentação, principalmente a partir da década de 1990, período em que a partir de inúmeras discussões e propostas de movimentos sociais, foi criado o conceito de soberania alimentar. Tal conceito foi baseado no fato de que todos os indivíduos, comunidades, povos e países possuem o direito de definir suas próprias políticas da agricultura, do trabalho, do alimento e da terra. Sendo assim, o conceito de soberania alimentar chamou atenção para outras questões além da qualidade dos alimentos e por este motivo o conceito ganhou e vem ganhando grandes conotações nas cúpulas de discussões mundiais sobre alimentação. Deste modo, a presente pesquisa teve por objetivo analisar e avaliar a tratativa do conceito de soberania alimentar e suas implicações no âmbito da gestão do programa de alimentação escolar do município de Piracicaba-PNAE (SP), analisar a existência (ou não) de articulação entre o programa de alimentação escolar do município e o Programa Nacional de Fortalecimento da Agricultura Familiar (PRONAF) e identificar e analisar as deliberações do Conselho de Alimentação Escolar (CAE) face ao conceito de soberania alimentar. Para isso, foram realizadas pesquisas bibliográficas, análise documental e entrevistas semi-estruturadas para atingir os objetivos da pesquisa. Com base nas metodologias desenvolvidas, foi possível verificar que o conceito de soberania alimentar é pouca explorado e inserido no PNAE, ainda que seja encontrado nas falas dos gestores e alguns documentos relacionados ao programa. Um grande desafio para a efetiva incorporação da soberania alimentar no PNAE é a diversidade de atores e setores que envolvem a sua gestão. Quanto ao PRONAF e o CAE pode-se concluir que para o CAE, visa-se a necessidade de projetos contínuos e mais atrelados às necessidades de gestão e operacionalização do PNAE e no que tange ao PRONAF observou-se que para aumento da parceria entre o PNAE e os agricultores familiares, constatou-se a necessidade de se realizar ajustes nas leis do PRONAF, que aproxime e promova as parcerias entre as duas políticas e consequentemente beneficie os beneficiários. / The concept of food sovereignty came after other concepts about food issues. One is the concept of food security which have brought to be an essential criterion for a dignified and proper nutrition after World War II. However, still not talked so much the influence of freedom and agricultural production models, which became part of the agenda of global discussions on food, mainly from the 1990s, during which from numerous discussions and proposals of social movements, the concept of food sovereignty was created. The concept looked on the fact that all individuals, communities, peoples and countries have the right to set their own policies on agriculture, labor, food and land. Thus, the concept of food sovereignty has drawn attention to issues other than food quality and for this reason the concept won and still gaining great connotations in the summits of global discussions about food. Thus, this study aimed to analyze and evaluate the dealings of the concept of food sovereignty and its implications in the management of the school feeding program in the city of Piracicaba-PNAE (SP), analyze the existence (or not) of articulation between the school feeding program of the municipality and the National Program for Strengthening Family Agriculture (PRONAF) and identify and analyze the decisions of the School Feeding Council (CAE) to the concept of food sovereignty. For this, were realized literature searches, document analysis and semi-structured interviews to achieve the research objectives. Based on the methodologies developed, it found that the concept of food sovereignty is little explored and inserted in PNAE, although it is found in the statements of managers and some documents related to the program. The biggest challenge for the effective incorporation of food sovereignty in the PNAE is the diversity of actors and sectors involving management. As for the PRONAF and CAE can be concluded that for CAE, the objective is the need for continuous projects and more linked to the needs of management and operation of PNAE and in relation to PRONAF was observed that to increase the partnership between PNAE and family farmers, there was the need to make adjustments in the laws of PRONAF, that approach and promote partnerships between the two policies and consequently benefit the beneficiaries.

Introdução: O aumento na prevalência de doenças crônicas não transmissíveis (DCNT) tem resultado em mudança nos padrões de mortalidade em vários países, inclusive no Brasil. Considerando associação entre transição demográfica, nutricional e epidemiológica, há necessidade de ações em saúde direcionadas à prevenção de doenças e agravos, aliada a estratégias de promoção da saúde da população, de forma a proporcionar maior qualidade de vida aos indivíduos. Objetivo: Conduzir análise custo-efetividade da dieta de uma amostra de pacientes com idade igual ou superior a 50 anos, usuários de Unidades Básicas de Saúde (UBS) do município de Bauru (SP), comparando-se com um padrão de alimentação saudável dentro de parâmetros nutricionais recomendados, preferências alimentares locais e custo similar à alimentação usual dos pacientes. Metodologia: Tratou-se de estudo transversal com caráter retrospectivo, originado de projeto de pesquisa de maior abrangência intitulado \"Relação entre atividade física habitual e desenvolvimento de síndrome metabólica e comorbidades associadas em usuários do sistema público de saúde: Um estudo de coorte de 8 anos\", incluindo aplicação de recordatório 24 horas para registro do consumo alimentar. Adicionalmente, foi realizada pesquisa de preços no varejo para estimativa dos custos da alimentação rotineira e calculada qualidade da dieta por meio do Índice Qualidade da Dieta Revisado adaptado para população brasileira para avaliação da razão custo-efetividade da alimentação dos pacientes da amostra. Resultados: Identificou-se influência positiva da classe econômica, consumo de bebidas alcoólicas e escore de qualidade nutricional da dieta sobre custos da alimentação dos pacientes; assim como incremento da RCE em relação à idade, à escolaridade e ao consumo de bebidas alcoólicas dos indivíduos. Conclusão: A partir da estimativa do custo diário da alimentação, verificou-se possibilidade de mudança na dieta a baixo custo, de forma a reduzir o impacto do fator renda na tomada de decisão pela melhoria da qualidade nutricional da alimentação da população. / Introduction: The increase in the prevalence of non-communicable diseases (NCDs) has resulted in a change in mortality patterns in several countries, including Brazil. Considering the association between demographic, nutritional and epidemiological transition, there is a need for health actions directed to the prevention of diseases and conditions, allied with strategies to promote the health of the population, in order to provide a better quality of life for individuals. Objective: To conduct a cost-effectiveness analysis of the diet of a sample of patients aged 50 years or older, users of Basic Health Units (UBS) in the city of Bauru (SP), comparing them with a healthy eating pattern inside of recommended nutritional parameters, local food preferences and cost similar to the usual diet of the patients. Methodology: This is a retrospective cross-sectional study from a larger research project entitled \"Relationship between habitual physical activity and the development of metabolic syndrome and associated co-morbidities in users of the public health system: An 8-year cohort study \", including application of a 24-hour recall to record food consumption. In addition, a retail price survey was conducted to estimate the costs of routine feeding and calculated diet quality using the Revised Diet Quality Index adapted for the Brazilian population to evaluate the cost-effectiveness ratio of the sample patients\' feed intake. Results: We identified a positive influence of the economic class, consumption of alcoholic beverages and score of nutritional quality of the diet on costs of the patients\' diet; as well as increase of the RCE in relation to the age, the schooling and the consumption of alcoholic beverages of the individuals. Conclusion: From the estimated daily cost of food, was checked a possibility to change the low cost diet, in order to reduce the impact of the income factor in decision making in favor of improving the nutritional quality of the population\'s diet.

ReadNPlay for a Bright Future develops a variety of projects aimed at promoting healthy living in families with young children in Northeast Tennessee. The purposes of this research are: (1) to collect parents’ and caregivers’ perspectives on healthy eating for the purpose of designing a new book in the ReadNPlay children’s book series to be entitled A Farmers Market Adventure (2) to collect the preferences of parents and guardians related to website and mobile application (app) usage to help shape the development of a new ReadNPlay My Baby Book app. Anonymous clipboard surveys were administered to attendees of regional community events during July of 2013. Survey items asked parents about healthy eating in the context of their families and the role of parenting websites and mobile apps in their families. The results from these surveys were summarized using Excel. A total of 100 surveys were collected. It was found that when parents were asked to identify barriers to healthy eating, the most common responses were picky eaters in the household (30%) followed by lack of time (22%). When asked to identify things that have helped parents to encourage healthy eating in their families, the three most common responses were good recipes (20%), good role models (16%), and farmers markets (16%). Twenty-eight percent of parents surveyed do not use websites or apps for parenting, while those who do use parenting websites or apps identified advice from experts (20%) and advice from other parents (18%) to be the two features most commonly desired in such a resource. When asked what they do not like about website and app usage, 20% of parents indicated that these tools are “too complicated.” However, when parents are told that our group of pediatricians was developing a free mobile application for families designed to help them keep track of their baby’s growth, development, and eating habits, 75% of parents said such an app would be very helpful to them (25% said a little helpful). These results will inform a new ReadNPlay children’s book themed around healthy eating behaviors, overcoming pickiness, and shopping with families at farmers markets and a new ReadNPlay mobile app for families to be use in conjunction with infant-toddler well child visits.