Cambodian immigrants have become a large population group in the United States since late 1970s. Traditional heath practices and alcohol consumption during pregnancy and lactation have both been associated with risks of maternal and child health in previous research. However, these associations have never been investigated in the Cambodian immigrant population. The mechanism for the potential interaction is that the traditional health practice, the use of sraa t’nam, which is an alcohol concoction usually consumed during postpartum period, may increase risks for both mothers and children. Sraa t’nam is the traditional alcohol and drinking alcohol during pregnancy and while lactation is not recommended. This study examined the knowledge, attitudes and behaviors of traditional health practices among Cambodian women aged between 15-35 years old living in Massachusetts. Health insurance, acculturation and food security scores were not independently associated with the dependent variable. The odds of ‘ever used sraa t’nam’ were higher (OR 1.67, CI 1.10, 2.51, p<0.05) with every one unit or one person increase in household size, after adjusting for covariates. Similarly, women with at least one child had a 4.54 odds (CI 1.24, 16.5) of reporting that they 'ever used psraa t’nam’ compared to women with no children (p<0.05) U.S.-born women (OR 0.12, CI 0.02, 0.83, p<0.05) and those with more than a high school education (OR 0.13, CI 0.02, 0.71, p<0.05) had lower odds of having 'ever used (psraa t’nam’. Age was independently associated with having ‘ever used sraa t’nam’ (OR 1.32, CI 1.01, 1.74, p<0.05); for every year older, the odds of ever using sraa t’nam increased by 0.32 units. In summary, women who lived in larger households, had at least one child, were foreign-born, had less education, or were older in age had higher odds of reporting that they had ‘ever used sraa t’nam’. Univariate analyses tested for associations between intention to breastfeed, age, smoking status, and intention to use sraa t’nam. Age was positively associated with the intention to breastfeed (OR=1.26, p<0.05), and smoking was also positively associated with the intention to breastfeed (OR=4.81, p<0.05).

The purpose of this mixed methods study was to learn how cultural sensitivity was integrated and perceived in community nutrition education of an existing program offered by the University of Kentucky Cooperative Extension Service Nutrition Education Program. Data collection consisted of a quantitative cultural competence assessment survey tool used with nutrition education paraprofessionals (n=74), qualitative in-depth interviews of nutrition education paraprofessionals (n=8) and focus groups of Hispanic/Latino nutrition education program participants (n=39). Findings were focused in three areas; the cultural sensitivity needs of the program, the perception of nutrition education by participants and the training and professional development needs of nutrition education paraprofessionals. Among the cultural sensitivity needs of the program identified were curriculum resource needs, community referral needs, the importance of community partnerships and the importance of incorporation of children in nutrition education were identified. Among the training and professional development needs of nutrition education paraprofessionals, a need for Hispanic cultural education, language services education and chronic disease education were reported. The value of cross-cultural exchange and the need for chronic disease education in relation to dietary habits were identified by the participant focus group findings.

Introduction: Food insecurity prevalence in Washington County, TN is 14.3% yet 61% of SNAP eligible residents are food insecure. Food insecurity is associated with inadequate consumption of fruits and vegetables, as well as increased risk of chronic disease. Tennessee ranks 47th in the Nation with only 6.7% consuming the recommended fruits and vegetable intake. The Farmacy Pilot Program was developed to encourage increased consumption of produce and to reduce food insecurity among SNAP recipients. Methods: This program provided vouchers to SNAP recipients and their families to buy fresh fruits and vegetables at the farmers market and in the grocery store as a monthly prescription. Participants were recruited from a clinic and two community centers in Washington County. Participants were given $28 - $112 a month depending on household size. Participants were required to attend at least two nutrition classes. Baseline and 6-month follow up assessments were done of food intake patterns among 29 participants, and focus groups were held (n= 11) and a total of 22 interviews conducted. Mixed methods approach was used for analysis: survey data was analyzed on SPSS and thematic analysis conducted for the qualitative data. Results: Major themes that emerged were: decreased cost of produce, increased positive perception of fruits and vegetables, improved perception of their personal health after change in diet, and increased utilization of farmers markets. Barriers identified were cultural and language hurdles, market variability in cost and quality of produce, and transportation. Survey findings included increased intake of green vegetables (t= -2.13, p =.042). Other findings lacked statistical power to detect significance yet were of clinical significance: improvements in frequency of produce consumption, produce variety, and a reduction in food insecurity. Discussion: Providing additional funds targeted on fresh produce can increase food security and increased quantity, frequency and variety of fruits and vegetables consumed. Promoting utilization of farmers market offers a promising avenue for increased consumption of fresh produce and improved social connectedness in the community.

The Live Well Springfield (LWS) movement is a collaborative effort of partner organizations in Springfield, Massachusetts. The project promotes healthy living by increasing knowledge and awareness of food and physical activity. A key LWS strategy was the creation of a website to function as an information hub. In addition to local event and health information, the website features 16 narratives depicting residents practicing healthy lifestyle choices, designed to encourage community engagement. To date, there has been no evaluation of the website’s reach and effect. A mixed methods approach, surveys and focus group discussions, was designed to collect data from people who live, work, or attend school in Springfield. Focus group participants were recruited in person at Springfield Community College, via recruitment posters (distributed at STCC), and through email requests from a previously compiled list of residents willing to be contacted. A website evaluation survey was developed using eHealth research constructs and the Expectation-Confirmation Model (ECM). This survey measured users’ perceived quality and satisfaction with the website. The survey was accessible via the livewellspringfield.org homepage, the LWS Facebook page, and emailed directly to potential respondents. The validated eHealth Literacy Scale (eHEALS) was incorporated into the survey and focus group sessions to assess self-reported skills for using eHealth resources. Each hour-long focus group (n=5 and n=6, respectively) was video/audio recorded and fully transcribed. Focus group transcripts were analyzed to thematically organize responses to narratives and fact-based health messages and assess the appeal, relevance, effectiveness, perceived purpose, and appropriateness. Survey data was analyzed to produce frequencies, descriptive statistics, and correlations. A mean eHEALS score of 4.22 of 5.00 (SD=0.83) was calculated from 36 responses, suggesting this sample felt very knowledgeable and confident using eHealth resources. Health Literacy Advisor (HLA) software was used to analyze an aggregate of all narratives, resulting in a Fry-based reading grade level of 8.4. On a five-point Likert scale, mean satisfaction with the website was 4.71 (SD=0.53), and mean likelihood to return was 4.76 (SD=0.51). Content analysis of focus group transcripts resulted in 184 responses coded for one or more themes. The largest proportion of responses (40.2%) related to effectiveness. One third of these effectiveness-related responses were negative toward the fact-based examples. Although the narratives were greatly preferred in both groups, all respondents made comments or agreed with suggestions to have both affective narratives and strictly fact-based health messages accessible, regardless of initial preferences. Results and interpretations will be reported to LWS partners to inform potential revisions of the website revisions and contribute to ongoing activities of the LWS initiative.

Magister Scientiae (Nutrition Management) - MSc(NM) / The provision of quality nutrition care services is needed to address the national burden of diseases, and to reduce under- and overnutrition in South Africa. Globally, there is a lack of information and data about the perceptions, experience of, and satisfaction with the quality of nutrition care services, both from patients and dietitians. Patients and dietitians are in the best position to provide useful information pertaining to their perception and experience of nutrition care service delivery. The aim of this study was to determine the perceptions of patients and dietitians on the quality of nutrition care service delivery in the Klipfontein/Mitchells Plain Sub-Structure (KMPSS).

The importance of proper nutrition education among older adults is crucial in promoting overall physical health and management of chronic health conditions. However, access to such education has been limited, especially during the COVID-19 pandemic. With the current boom in social media popularity, as well as virtual communication portals such as Zoom, the question must be asked if nutrition education could be effectively implemented for the use of older adults through these electronic channels. The study design for this particular research was a cross sectional survey to inform development of an online nutrition education program for older adults in Northeast Tennessee. (Appendix B). The survey was distributed as a paper-based survey in seven senior centers and as an online Qualtrics survey distributed by all senior center directors in Northeast Tennessee. A total of 160 surveys were collected (61 paper-based, 99 online), with 150 surveys being complete. Frequencies showed that the majority of participants have internet access and use social media platforms, such as Facebook and YouTube, which was not affected by home location, such as rural versus urban. Most participants were interested in participating in a nutrition education program. The survey also revealed more information about seniors in Northeast Tennessee that will be helpful when developing this program.

The population of Americans over age 65 is expected to increase from a reported 12 percent in 1988 to 22 percent by the year 2030. Nutrition screening and intervention can help combat the rising need for health care and other services among the elderly by preventing or delaying disability and dependency. This study was designed to determine the degree of nutritional risk present within the elderly population in rural and urban areas in the state of Utah by conducting an initial nutrition screening using the Determine Your Nutritional Health checklist developed by the Nutrition Screening Initiative. Congregate meal sites were stratified according to urbanization and fifteen centers were selected from both rural and urban counties. Congregate meal participants present at the site completed a Determine Your Nutritional Health checklist and survey asking additional demographic data including age, sex, marital status, living situation, frequency of participation in congregate meals, and if they had previously used the checklist. A total of 838 valid surveys was collected from 29 congregate meal sites throughout the state of Utah. Fifty-seven percent of participants scored in the "good nutritional health" category, 27.7 percent were at moderate nutrition risk, and 15.4 percent scored in the high nutrition risk category. Nutrition risk category was significantly associated with gender, marital status, and cohabitation status. Women, unmarrieds, and individuals living alone scored more frequently in a higher nutrition risk category. Results of this study reflect influences on nutrition risk found in a sample of congregate meal participants in the state of Utah. These results can help the state of Utah identify the common risk factors within this segment of its population, i.e. gender, marital status, cohabitation status, acute/chronic disease, eating alone, and polypharmacy, to plan education and/or intervention for individuals who are at risk.

ABSTRACT FOOD INSECURITY AND CULTURE- A STUDY OF CAMBODIAN AND BRAZILIAN IMMIGRANTS SEPTEMBER 2013 SARVNAZ MODARRESI GHAVAMI, B.S., IRAN UNIVERSITY OF MEDICAL SCIENCES M.S., UNIVERSITY OF MASSACHUSETTS AMHERST Directed by: Jerusha Nelson Peterman Vulnerable immigrant populations such as refugees and undocumented immigrants are at higher risk for food insecurity and its health consequences than other low- income populations. Acculturation and adaptation of certain coping strategies, as well as certain characteristics, make these populations vulnerable to food insecurity. This thesis focuses on two of the understudied immigrant populations in Lowell, Massachusetts: Brazilian immigrants and Cambodian refugees and immigrants. To better understand food insecurity, acculturation, and coping strategies of these immigrant populations, we conducted a mixed-methods study with two Brazilian focus groups (n=16) and three Cambodian focus groups (n=21). We assessed 1) food security experiences, 2) the role of acculturation in the aspects of food security status, and 3) the role of coping strategies in the food insecurity and acculturation of these populations. Participants were similar with respect to age, income, length of stay in the U.S. across both Brazilian and Cambodian groups. Native language was the preferred language spoken at home. In quantitative survey analyses, Cambodians participants experienced higher rates of food insecurity compared to Brazilians (91% vs. 25%, p<0.001). Cambodians experienced greater food hardship in their home countries compared to the Brazilian immigrants (66.6% vs. 43.7%). Throughout the focus groups, Cambodians talked about a difficult food environment in which desired foods were not available or accessible to them. In contrast, the Brazilians seemed to enjoy a suitable food environment. Dietary acculturation was also evident in both groups. However, Cambodians expressed more indications of adapting to what they considered an American diet. Also, Cambodians seemed to engage in more risky strategies that could potentially exacerbate their food security status and health than Brazilians. These results suggest that some of the possible contributing factors to the higher rates of food insecurity in the Cambodian groups are their employment of risky coping strategies, as well as the difficult food environment. The difficult food environment along with their past food experience might have played a role in the greater dietary acculturation in the Cambodian groups.

Food security is the ability to obtain enough nutritionally adequate food at all times. In 2011, 14.9% of U.S. households were food insecure. Food insecure populations have increased risk of chronic diseases and micronutrient deficiencies. Cyclical resource attainment may lead to inconsistent energy intakes, while resource management skills like budgeting may counter this. Qualitative research is limited on food preferences, what is purchased during resource constraint and how they compare with dietary recommendations. This study describes food choices and coping strategies that low-income, food insecure households use to obtain foods when resources are constrained. Four sets of two focus groups recruited SNAP participants and eligibles from Massachusetts (total participants=22) to discuss (1) food choices and planning and (2) purchasing strategies utilized. Content analysis was used to describe “favorite/important”, “healthy” and “unhealthy” foods, foods purchased, coping strategies, and to compare responses with USDA food groups. Participants were classified as cyclic (evidence of uneven monthly food purchases) or constant spenders (evidence of constant monthly food purchases). Reported coping strategies and food purchases were compared between cyclic and constant spenders. Protein/meat, grains, and vegetables were top “favorite/important” choices. Top “healthy” food designations were vegetables, proteins and grains, which closely mirrored USDA recommendations. Four self-described “unhealthy” food categories emerged: fast/take-out; “processed”; solid-fat home foods; sugar-laden desserts/beverages. Fourteen participants were classified as “cyclic”, while seven participants as “constant”. Cyclic spenders utilized coping strategies similarly described to obtain “enough” food and exhibited unsustainable practices as depriving self for others. Constant spenders closely matched resource management strategies utilized to obtain the “kinds” of foods desired, like budgeting. While other food purchases were similar, cyclic spenders reported not purchasing fruit and vegetables in times of constrained resources. This study provides needed qualitative information on how low-income individuals describe important, healthy and unhealthy foods and what is purchased in times of resource constraints. These findings support previous research showing cyclical resource attainment can lead to nutritional risks, while financial management skills can increase food security through constant access to foods. The results highlight the need for resource management education and stress specific areas of nutrition education.

OPTIMIZING MICRONUTRIENT INTAKE OF LACTATING WOMEN IN KWAZULU-NATAL, SOUTH AFRICA, THROUGH INCREASED WILD EDIBLE PLANT CONSUMPTION Kerry Pearson Micronutrient consumption in KwaZulu-Natal, South Africa, is insufficient to meet the needs of lactating women. Inadequate intake negatively impacts the health of both the mother and infant. Increasing consumption of wild edible plants has been recommended to combat these deficiencies, but information has not yet been provided on which types of wild plants should be eaten or in what quantity. The objective of this study was to determine the optimal mixture of wild edible plants that needs to be consumed to meet the micronutrient needs of lactating women in rural KwaZulu-Natal, South Africa. This was done by creating optimization models using linear programming. Components of these models included identifying gaps between current micronutrient intake and recommended intake levels and the creation of composite nutrient profiles for groups of wild edible plants available in KwaZulu-Natal. One model calculated the optimum amount of wild edible plants that would need to be consumed in addition to the current diet to meet micronutrient recommendations. A second semi-isocaloric model calculated the optimum amount of wild edible plants that would need to be consumed if half the additional calories would replace an equivalent number of calories of the main staple food, maize. A combination of 250g leafy vegetables and 349g fruit, replacing 54g of maize meal, was determined to be the best model. This mixture will meet the micronutrient needs of 50% of lactating women and would add only 192 calories to the diet. The same blend will meet the needs of 75% of women for all nutrients except calcium, zinc, thiamin, and riboflavin. It is hoped that increased use of wild plants will also increase physical activity and make the consumption of high quality animal products more economically feasible. Understanding forces that have brought about current dietary patterns in this population and working in tandem with other nutrition intervention programs will be the best way to successfully implement these goals. More complete information is needed on the nutrient profiles of wild edible plants in South Africa and on how anti-nutrients in these plants effects bioavailability of nutrients and the health of the consumer. Despite these limitations, it is clear that a reasonable increase in wild edible plant consumption can have a tremendous positive impact on micronutrient consumption of lactating women in KwaZulu-Natal, South Africa.