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.

Background: While farmers' markets are a potential strategy to increase access to fruits and vegetables in rural areas, more information is needed regarding use of farmers' markets among rural residents. Thus, this study's purpose was to examine (1) socio-demographic characteristics of participants; (2) barriers and facilitators to farmers' market shopping in southern rural communities; and (3) associations between farmers' market use with fruit and vegetable consumption and body mass index (BMI). Methods. Cross-sectional surveys were conducted with a purposive sample of farmers' market customers and a representative sample of primary household food shoppers in eastern North Carolina (NC) and the Appalachian region of Kentucky (KY). Customers were interviewed using an intercept survey instrument at farmers' markets. Representative samples of primary food shoppers were identified via random digit dial (RDD) cellular phone and landline methods in counties that had at least one farmers' market. All questionnaires assessed socio-demographic characteristics, food shopping patterns, barriers to and facilitators of farmers' market shopping, fruit and vegetable consumption and self-reported height and weight. The main outcome measures were fruit and vegetable consumption and BMI. Descriptive statistics were used to examine socio-demographic characteristics, food shopping patterns, and barriers and facilitators to farmers' market shopping. Linear regression analyses were used to examine associations between farmers' market use with fruit and vegetable consumption and BMI, controlling for age, race, education, and gender. Results: Among farmers' market customers, 44% and 55% (NC and KY customers, respectively) reported shopping at a farmers' market at least weekly, compared to 16% and 18% of NC and KY RDD respondents. Frequently reported barriers to farmers' market shopping were market days and hours, "only come when I need something", extreme weather, and market location. Among the KY farmers' market customers and NC and KY RDD respondents, fruit and vegetable consumption was positively associated with use of farmers' markets. There were no associations between use of farmers' markets and BMI. Conclusions: Fruit and vegetable consumption was associated with farmers' market shopping. Thus, farmers' markets may be a viable method to increase population-level produce consumption.

Researchers in the Psychology Department and the Nutrition, Dietetics, and Food Sciences Department sought to improve elementary school children’s in-school fruit and vegetable (FV) consumption. To achieve this goal, a program that has proven effective in the UK called the Food Dudes (FD) program was implemented in six local schools. Schools were assigned to either experience the traditional FD program (with prize rewards, such as pencil cases and bubbles), a modified version of the FD program (with praise rewards replacing the prize rewards), or no FD program (the control group). Students who consumed a pre-specified amount of FV each day during the intervention earned a reward according to the program’s schedule. Results showed that students in the Prize schools were consuming more FV than students in the Praise schools and the Control schools at follow-up when the intervention had been removed for six months. While the success of the FD program with prize rewards (i.e., incentives) was encouraging, many teachers reported issues with its implementation. An incentive-based intervention may be difficult for schools to implement due to high labor and material costs, especially without outside assistance. Therefore, we aimed to reduce these costs while maintaining the use of incentives. We developed an intervention based on the principles of gamification in which students earned in-game, virtual rewards for meeting their FV consumption goals each day at school. This intervention was rated favorably by teachers and parents and showed significant increases in school-wide and individual FV consumption in two schools in Logan, UT, but long-term increases were not obtained. Improving children’s dietary decisions, namely FV consumption, is an important goal that can positively impact future health. Sustainable, incentive-based interventions, like the school-wide gamification model developed in this project, represent a promising step toward achieving this goal.

This study examined the social cognitive theory factors of home availability of fruits and vegetables, nutrition knowledge, food preparation ability, and cooking self-efficacy and the demographic factors of race/ethnicity, age, gender, marital status, living situation, and meal plan participation in relation to college students' fruit and vegetable consumption. The study sample was comprised of students attending on-campus classes at Utah State University during spring semester of 2009. Data were collected via traditional pencil-and-paper surveys distributed during classes with students in varying stages of their college education and from different fields of study. In total, 207 surveys were used for the linear regression analysis. Race/ethnicity was not included in the regression model due to lack of sufficient racial/ethnic diversity. Of the remaining variables, availability of fruits and vegetables in the home, cooking self-efficacy, and meal plan participation were found to be significant predictors of college students' fruit and vegetable consumption. Availability in the home was the strongest predictor of fruit and vegetable intake in this sample.

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BACKGROUND: Recent epidemiological data indicate that one-third of the U.S. adult population is obese. As a result, healthcare professionals and policy makers are looking to identify creative methods to address this critical health concern. One way that may show promise to promote positive health changes is to convert mechanical energy produced through exercise into stored electricity via energy harvesting (EH) exercise. Previous research has linked pro-environmental attitudes with increased participation in sustainable behaviors. Other research has examined associations between consumption of fruits and vegetables and exercise participation. However, little research examines the association between exercise behavior and environmental concern. And more specifically, EH exercise. OBJECTIVE: To identify if EH exercise can act as a motivating factor to increase exercise participation. METHODS: Phase 1: Qualitative data were collected through a series of one-hour focus groups with ENERGIA Studio members who participate in EH exercise. Four focus groups were completed with 1-5 participants per group (n=12). Topics examined included: 1) perceived effect of EH exercise on the environment and its ability to act as a motivating factor to increase exercise participation; 2) participation in sustainable behaviors and attitudes toward energy conservation and environmental concerns; and 3) perceived benefits of and barriers to fruit and vegetable consumption and exercise participation. Data were used to inform a survey to examine the relationship between how environmental concern influences exercise and dietary practices. Phase 2: Fifteen participants from UMass Permaculture who had irregular exercise participation and pro-environmental beliefs completed an online survey. RESULTS: Significant results were found for associations between: environmental concern and sustainable and organic fruit and vegetable purchasing (p=0.008; p=0.048) among non-exercisers; health concern and organic purchasing (p=0.015) among exercisers; and sustainable practices and fruit and vegetable intake (X2 (1, 12) = 5.285, p=0.022) among non-exercisers. No significant results were found between environmental concern and EH exercise self-efficacy or exercise and fruit and vegetable intake. CONCLUSIONS: This study provides additional research examining how environmental concern may affect dietary and exercise habits. Using the threat of the environment may serve as a potential motivator to increase EH exercise participation and fruit and vegetable intake.

Children's energy consumption is outweighing their energy expenditure, increasing the risk for childhood obesity. While pediatric obesity continues to be a problem in America, the data are clear that those of low socioeconomic status are especially at risk for weight gain. The purpose of this study was to evaluate if a healthy lifestyle program could affect participants' diet and physical activity behavior. A program was planned and conducted using the curriculum from the "We Can" program established by the National Heart, Lung, and Blood Institute. Residents of the Jefferson City Housing Authority were asked to participate. No resident attended or completed the healthy lifestyle program. Follow-up focus groups with stakeholders and potential participants showed that lack of motivation was the greatest barrier to participation. Further investigation is needed to determine a more suitable venue to educate at-risk populations regarding the risk associated with pediatric obesity.

The epidemic of adolescent obesity has become one of the greatest public health concerns in the United States. Approximately 20.5% of adolescents of both sexes aged 12-19 years are considered obese. Higher rates of obesity are evident in ethnic minority and lower income status children with the highest prevalence among Hispanic/Latino and Black populations. The causes for obesity are multifactorial in nature and highlight disparities nationwide. These factors include socioeconomic status, education, environment, availability and access to fresh fruits and vegetables, and behavior patterns. Successful intervention methods that have reduced the impact of adolescent obesity have incorporated nutrition knowledge and culinary skill building into afterschool programs. Pink and Dude Chefs, a 12-lesson nutrition education and culinary skills afterschool program targeted toward middle school students, aims to improve nutrition knowledge and dietary behavior in low income and minority populations. Based off of evidence-based curriculum, the program focuses on culinary fundamentals while incorporating nutrition lessons about macronutrients, micronutrients, label reading, kitchen safety, and USDA guidelines. Research assistants from California Polytechnic State University, San Luis Obispo and Vanderbilt University in Tennessee, were trained to implement each lesson. The program took place at Mesa Middle School in Arroyo Grande, CA; Shandon, CA; and two sites in Nashville, TN from Spring 2014 to Fall 2014. Thirty-two middle school students participated in the study aged 11-14 years. Questionnaires were used to measure fruit and vegetables preferences, nutrition knowledge, and fruit and vegetable intake. Results indicate that participants’ fruit and vegetable preferences, nutrition knowledge and fruit and vegetable intake all increased. However, statistical significance was only achieved with nutrition knowledge, likely due to small sample size. If programs such as Pink and Dude Chefs show promise for decreasing risk for obesity, the public health impact could improve long-term health outcomes for adolescents and mitigate obesity related consequences.

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