Increasing rates of overweight, obesity, and related metabolic diseases documented among refugee communities across the United States necessitate greater attention to how processes of integration impact refugee health. These nutritional health trends (e.g., increasing rates of obesity) suggest potential disconnects between refugees' past environments and their conditions after re-settlement, which may contribute to adverse changes in energy balance (diet and exercise). While Bhutanese refugees were among the largest refugee groups entering the US during the five years leading up to this research, very few studies have examined how they have responded to integration and the impact of this transition on their health. Grounded in human adaptability and political economic theories, and adopting a biocultural approach, this dissertation investigates how Bhutanese refugees in “Prospect City” (pseudonym) negotiate changing and unfamiliar structural and sociocultural conditions after resettlement and the consequences for energy balance and nutritional status. The results reveal high rates of overweight and obesity compared to US averages. Age and caste related differences in nutritional status were also found. High rates of overweight and obesity corresponded with an energy imbalance due to over consumption of energy dense traditional foods and limited understanding of the importance of regular exercise. Over consumption of energy dense traditional foods stemmed from several interrelated factors: the abundance of foods in the US, prior experiences with food deprivation, a history of political exile that reinforced desires to preserve cultural food preferences, and joint family efforts to accommodate work-related time constraints by increasing food production and availability. Decreases in exercise appeared to stem from more sedentary lifestyles in the US as a result of work environments and available transportation, coupled with a lack of health knowledge regarding health benefits of physical activity. This dissertation’s findings are being reported to Prospect City’s Bhutanese Community Organization to help develop strategies for improving nutritional health in the community.

Rates of adult obesity in the United States continue to rise, especially among the college-age population who typically practice poor dietary choices, contributing to weight gain. College-age students experience a transitional phase called ‘emerging adulthood’ where they learn autonomy in many areas that influence long-term health status. The purpose of the online health promotion program BUCS: Live Well was to promote self-efficacy in ability to incorporate positive dietary changes, assess incidences of positive dietary habits after completing the program, and determine if weight status, residence, and health perceptions influence dietary behaviors. BUCS: Live Well was successful in assessing current dietary intake, facilitating positive dietary changes, and improving self-efficacy about incorporating positive dietary changes, although it did not promote weight loss. Online health promotion programs for college students are effective in initiating lifestyle modification and need to be available in hopes of reducing the obesity rate in this population.

Nutrition labeling research suggests consumers want nutrition information on the label; however, many do not comprehend it. The purpose of Phase I was to determine the effect of: 1. two levels of nutrition label formats; 2. three levels of nutrition information load on consumers' preference for product choice using adaptive conjoint analysis. A computer interactive interview was conducted on 252 consumers in Crossroads Mall, Salt Lake City, Utah. label alternatives were printed on soup cans to realistically portray the information. The conjoint analysis compared the attributes, nutrition information format, and nutrition information load in addition to brand and price and determined how the study participants ranked choices within each of these attributes and against the other attributes. There were significant differences (p < .000) among all three mean utility values± Standard Error of the Mean (SEM) of information load, most (.300 ± .03) , more (.154 ± .02), and some (-.231 ± .03). There was no difference between graphical (.093 ± .027) and traditional (.055 ± .020) formats (p = .298). For the other attributes, there were significant differences (p < .000) among all brands, Campbell's (.590 ± .03), Private label (-.007 ± .02) Generic (-.361 ± .03) and all prices, (p < .000), low (.431 ± .03), medium (.022 ± .02), and high (-.230 ± .03). Market simulations were performed and market share was shifted from the major brand when nutrition information was added to a Private label or Generic brand. The purpose of Phase II was to determine the effect of: 1. three levels of nutrition information content load; 2. two levels of nutrition information order; 3. three levels of nutrition information format; and 4. four levels of nutrition information expression on consumers' perceptions of label usefulness in purchase decisions. The methodology was the same as Phase I. There were significant differences (p < .000) among all three mean utility values ± SEM of information load, most (.327 ± .02), more (.091 ± .02) , and some (-.213 ± .03), and between the two mean utility values ± SEM of information order, rearranged (.157 ± .03) and traditional (-.02 ± .02). Consumers significantly preferred (p < .000) the graphical format (.148 ± .02) over the graphical nutrient density (.038 ± .02) and traditional (.018 ± .03) formats. Consumers significantly preferred (p < .000) nutrition information stated in absolute numbers and percentages (.296 ± .03), versus absolute numbers only (.028 ± .03), traditional (-.026 ± .03), and percentages only (-.025 ± .03) expressions. The most useful nutrition label in a purchase decision was one that contained the most information, in a rearranged order, with a graphical format, and an absolute number and percentages expression.

Achieving and maintaining maximal peak bone mass is critical to the prevention of osteoporosis. Adequate calcium intake during youth is a major aspect of proper bone mass development. Because of the importance of calcium, a food frequency questionnaire (FFQ) that estimates calcium intake of 10- to 18-year-old Asian, Hispanic, and white youth living in the western United States was developed. This new FFQ was shown to accurately and reliably estimate calcium intake of these youth. Accuracy among Hispanics, however, was low and requires further evaluation. A second study examined intake of calcium, milk, and non-milk beverages of Hispanic and non-Hispanic white children aged 10 to 11 years and 15 to 18 years living in Utah. Milk fat percentage and source of beverage procurement were considered. Studies assessing the intake of calcium, calcium-rich foods, and foods that may interfere with calcium intake of youth in the United States were reviewed.

The purpose of this study was to describe the nutrition knowledge and child care feeding practices of Early Childhood Education students in a university setting. Thirty-three Early Childhood Education students from seven geographically diverse universities completed a web-based survey assessing nutrition knowledge and child feeding practices. A nutrition knowledge instrument was developed and validated to measure knowledge of nutrition for preschool-aged children. The Comprehensive Feeding Practices Questionnaire, which has been previously validated in parents, was slightly modified and used to assess child feeding practices. Mean scores for the nutrition knowledge and child feeding practices were determined. Multivariate analyses were conducted to determine differences in mean nutrition knowledge and feeding practices scores across sample characteristics. Early Childhood Education students were found to have more knowledge of MyPyramid food groups and dietary sources of nutrients than dietary intake recommendations for preschool-aged children. Students who had completed a college-level nutrition course scored higher on MyPyramid food groups and food sources of nutrients than those who had not, although these differences were not statistically significant. A nonsignificant trend was observed in knowledge of dietary recommendations according to practicum status. Additionally, students who had not started a practicum reported using food as a reward significantly more than students who had completed a practicum. Results suggest roles for both nutrition coursework and practicum training in optimizing nutrition knowledge and child feeding practices among future leaders in early childhood education. Further research is needed to more clearly identify nutrition knowledge and child feeding practices in this population.

This study examines models of community gardens and urban farms and determined a successful hybrid model for future implementation at the Huerta del Valle Community Garden. This was accomplished through analyzing the unique benefits and drawbacks of community gardens and urban farms as defined by the author, and then determining the components of each model that would maximize Huerta del Valle’s social and economic potential. Community gardens are defined in this thesis as places where community members can grow their own food in individual plots, and these spaces often contribute to community building, hands-on gardening education, and improved food access. Urban farms are defined as business models that produce food to sell to the community both to support the business and to improve community food access. Through research of existing community garden, urban farm, and hybrid models, the author determined that the most effective hybrid model includes intensive crop production, crop sales onsite as well as in farmers’ markets and delivery methods, a large community garden, and education programs for the community. The author then offered Huerta del Valle a potential model that includes these components as well as a store front, cooking lessons, value-added products, a Community Supported Agriculture program, and specific themed gardening classes. This complete model will potentially increase Huerta del Valle’s scope so it is able to improve healthy food access throughout Ontario while creating an enduring economic model.

The Village Market is a nonprofit Healthy Corner Store that has been open since May of 2011 in the mixed-use, mixed-income New Columbia housing development in Portland, Oregon's Portsmouth neighborhood. The venture began as a "community-led" effort in partnership with Janus Youth Programs and Home Forward. The project was conceived after a private enterprise in the small grocery space designed into the development failed, leaving the neighborhood without easy access to healthy foods. This dissertation is a case study of the development process, the operation of the market, and the degree to which it addresses food justice and health equity concerns, among others, of residents. It is a case study of the Healthy Corner Store movement that uses food regime theory and political economy perspectives to critically examine the translation of Healthy Corner Store movement theory into practice, highlighting the perspectives of New Columbia residents on the endeavor. It explores the transition of the store from a community-led project to a management-led social enterprise, and the impacts of that approach on local autonomy, food justice, health equity as well as its successes and shortcomings. The store's situation in a mixed-income community meant that it had a particularly diverse set of expectations to navigate, and the changes to the store over time reflect Village Market's growing understanding of the implications of that situation but also a limited capacity to accommodate residents' differing tastes and the price sensitivity that many of them exhibit in their shopping habits.

The aim of the present study was to determine the effect of vitamin D supplementation (4000 IU or 6000 IU of cholecalciferol daily for 6 months) on fasting plasma glucose, fasting insulin, glycated hemoglobin, and lipid profile in a sample of African-Americans and Hispanics with T2D and vitamin D insufficiency. Seventy five participants were recruited by community outreach. Plasma glucose concentration was measured by hexokinase enzymatic method. Glycated hemoglobin was measured by the DCA2000+ system. Insulin in fasting blood was determined by radioimmunoassay. Plasma total cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein cholesterol were assayed by enzymatic methods. Serum vitamin D concentrations were measured with an enzyme-immunoassay kit. Mixed model was used to compare treatment effects and Bonferroni multiple comparison tests was used to detect significant changes from baseline, 3 months, and 6 months on the outcome variables. Significant improvements in serum 25(OH)D levels were seen from baseline to 3 month and 6 months respectively in both treatments (from 22.25 ± 7.19 to 37.34 ± 12.31 and 37.99 ± 13.22, PPP=0.040) was observed. Similarly, a significant change in serum triglycerides was observed at 6 months in the 6000 IU group (from 201.44 ± 91.35 to 172.92 ± 76.87 mg/dl, P=0.037). However, when the model was adjusted for confounders, significance was lost. Vitamin D supplementation did not improve glucose homeostasis in this sample. The positive effect of vitamin D supplementation on lipid profile may be mediated by other cofactors related to vitamin D metabolism.

Factors associated with and barriers to participation in Supplemental Nutrition Assistance Program (SNAP) and the effect participation has on food security, nutrition status, disease status and quality of life was investigated in a cross-sectional study including 175 HIV infected individuals. In addition, the effect of a targeted nutrition education on nutrition knowledge, readiness to dietary behavior change, nutrition status, disease status and quality of life was also investigated among a subset of the population (N = 45) in a randomized clinical control trial. SNAP participation rate was 70.3%, similar to the State of Florida and national participation rates. SNAP participation was positively and independently associated with being born in the US (P < 0.001), having monthly income less than $1000 (P = 0.006), and receiving antiretroviral treatment (P < 0.001). Participation barriers include denial of participation by program, recent incarceration, living in a shelter where participation is not allowed and unawareness of eligibility status. In regression analyses, SNAP participation was not significantly associated with improved food security, nutrition status, disease status and health related quality of life (HRQOL). Over half (56%) of the population experienced food insecurity and had inadequate intakes of half of the nutrients assessed. Illicit drug, alcohol and cigarette use were high in this population (31%, 55% and 63% respectively), and affected food security, nutrients intake, disease status and HRQOL. The nutrition education intervention resulted in a trend towards improvements nutrition knowledge, self-efficacy, and readiness to change without impacting nutrition status, disease state and quality of life. Food insecurity and other nutrition related issues, with implications for treatment, management and cost of HIV disease, continue to plague infected individuals living in poverty. More resources, including food and nutrition programs, specifically targeted towards this population are needed to address these issues.

This study used the 1987-88 USDA Nationwide Food Consumption Survey to investigate the contribution meat products make to intakes of nutrients at risk of inadequate or excessive consumption by women. The study is unique in that meat nutrients were extracted from mixed dishes, providing a more accurate picture of consumption. Cluster analysis was used to classify nonpregnant, nonlactating women 19 years and older based on their consumption patterns of total meat and individual meats (beef, poultry, processed meats, pork and seafoods) as percent of caloric intake. Total fat and SFA intakes exceeded National Research Council (NRC) goals regardless of meat intake level. Results indicate an inverse relationship of total energy intake and calories from all meats. Total fat intakes had a small, positive relationship with meat calories. Saturated fatty acid (SFA) intakes appeared to have a weak, positive relationship. Vitamin B6 intakes were below the RDA in all clusters but were adequate relative to protein intakes. Iron intakes of women under age 51 were less than 70% of RDA. Zinc had a strong, positive association with total meat intake. Individuals that did not consume beef met only 48% to 62% of RDA. An analysis to determine if increases in vitamin 86, iron, and zinc seen with high meat intake were due to increased meat or caloric intake showed that total fat and SFA increased 12% and 8%, respectively, when ≤ 2 ounces of meat and ≤ 6 ounces of meat were consumed. All of the increase was derived from meat. Vitamin B6, iron, and zinc increased 100%, 59%, and 132%, respectively; 77%, 64%, and 90% were due to meat. In summary, women's diets were significantly low in iron and zinc, which are strongly present in meat products, especially beef. Intakes of vitamin B6 appear to meet calculated needs, but some women may be at risk due to the increased requirements found with age and the low bioavailabilty of plant sources. Attempting to reduce total fat and SFA intakes by reducing meat intake, especially red meat, may have a deleterious effect on women's nutrient status.