Browsing by Author "Houghtaling, Bailey"

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    Factors affecting farmers' willingness and ability to adopt and retain vitamin A-rich varieties of orange-fleshed sweet potato in Mozambique
    Jenkins, Mica; Byker Shanks, Carmen; Brouwer, Roland; Houghtaling, Bailey (2018-12)
    The addition of orange-fleshed sweet potato (OFSP) to the food environment is an effective nutrition-sensitive agricultural approach to improve vitamin A intakes. However, the adoption of this biofortified crop merits further study. The objective of our research was to understand factors that affect Mozambican farmers' adoption and retention of OFSP varieties, with a specific interest in the retention of planting material. Field research was conducted in three provinces of Mozambique during 2015. Provinces with different OFSP intervention histories were selected to allow for the identification of site-specific factors and the impact of variable approaches over time. Qualitative inquiry was used to assess participants' progress through the five stages of the Innovation-Decision process in the Diffusion of Innovations Theory. Ninety-five producers, consumers, and market stakeholders of OFSP participated in semi-structured in-depth interviews and focus groups. Results indicate that diverse factors influenced the adoption and retention of OFSP, including organoleptic qualities, taste preferences, access to planting material, agronomic traits, environmental conditions, lack of capital for inputs and labor, unstable markets, and limited sharing of information and planting material across farmer networks. Current OFSP varieties were acceptable to Mozambican farmers and consumers, but there are several remaining challenges to reaching a critical mass such as lack of access to planting material, perceptions of superior drought tolerance of white-fleshed sweet potato (WFSP), and the belief that OFSP requires additional effort to cultivate (e.g. weed removal, measuring space between plants). Key recommendations which may be considered in future planning for OFSP interventions in Mozambique and other countries include enabling decentralized vine multipliers to provide vines to community members at no cost, continued focus on breeding and distribution of more drought tolerant varieties of OFSP, and training on the similarities in agronomic practices required for producing and preserving OFSP and WFSP.
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    Food retailer actions toward the National Strategy on Hunger, Nutrition, and Health to promote nutrition security: Applicability of the Business Impact Assessment-Obesity as a monitoring tool
    DeNunzio, Maria; Houghtaling, Bailey; Kraak, Vivica; Gardezi, Maaz; Serrano, Elena L.; Misyak, Sarah A. (Society of Behavioral Medicine, 2024-10)
    The White House National Strategy on Hunger, Nutrition, and Health (National Strategy) encourages actions across government and society to promote nutrition security. Nutrition security includes adequate food, diet quality, and equity, and food retail settings can promote these major concepts. Of all National Strategy whole-of-society calls to action, food retailers can contribute to 15 calls as key actors. However, there is currently no standardized monitoring tool to track food retailers’ commitments and actions toward the National Strategy to promote nutrition security. The Business Impact Assessment-Obesity and population-level nutrition (BIA-Obesity), a tool originally developed for corporate accountability monitoring, can be tailored for the National Strategy and nutrition security, given its standardized indicators and process to assess food company policies and commitments across six domains. We discuss the fit of the BIA-Obesity indicators for tracking food retailers’ commitments and actions across four pillars of the National Strategy. Existing indicators are appropriate to monitor components of Pillar 1: Improve Food Access and Affordability; Pillar 2: Integrate Nutrition and Health; Pillar 3: Empower All Consumers to Make and Have Access to Healthy Choices; and Pillar 5: Enhance Nutrition and Food Security Research. We suggest expanding current indicators to include equity, local foods, the digital food environment, and food waste reduction to improve alignment of the BIA-Obesity with the National Strategy. Application of the BIA-Obesity as an existing tool can facilitate data cohesion and more rapid assessment of the food retailer landscape to mutually meet nutrition security goals by 2030.
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    Healthy eating and active living policy, systems, and environmental changes in rural Louisiana: a contextual inquiry to inform implementation strategies
    Houghtaling, Bailey; Balis, Laura; Pradhananga, Nila; Cater, Melissa; Holston, Denise (2023-11-13)
    Background Healthy eating and active living policy, systems, and environmental (PSE) changes are implemented across the United States through Cooperative Extension. However, translating multisector PSE changes to practice in community settings is challenging and there is a lack of knowledge about barriers and facilitators to PSE changes among state Extension systems using standardized frameworks. Therefore, a research-to-practice partnership effort aimed to identify Louisiana Cooperative Extension Service Family and Consumer Science (LFCS) practitioners’ barriers and facilitators to implementing PSE changes in rural Louisiana communities. Methods A qualitative approach using the 2022 Consolidated Framework for Implementation Research (2022 CFIR) was used. Focus group discussions were conducted at five LFCS regional trainings between February and May 2022. All LFCS practitioners with any level of experience implementing healthy eating and active living PSE changes were eligible to participate, with emphasis on understanding efforts within more rural communities. Focus group discussions were audio-recorded and transcribed verbatim. Researchers analyzed qualitative data using the constant comparison method and 2022 CFIR domains and constructs including Inner Setting (LFCS organization), Outer Setting (rural Louisiana communities), Innovation (PSE changes), and Individuals (PSE change implementation actors/partners). Results Across the five regions, LFCS practitioners (n = 40) described more barriers (n = 210) than facilitators (n = 100); findings were often coded with multiple 2022 CFIR domains. Reported Inner Setting barriers were lack of formal or informal information sharing and lack of access to knowledge and information. Outer Setting barriers included sustaining and initiating community partnerships and local environmental or political conditions. Individual barriers included a lack of time and expertise, and Innovation barriers included the complex nature of rural PSE changes. Facilitators were mentioned at multiple levels and included community partner buy-in and practitioners’ motivation to implement PSE changes. Conclusions Implementation strategies are needed to build on organizational strengths and to overcome multi-level barriers to PSE change implementation among LFCS practitioners. The results from the in-depth contextual inquiry used could serve as a guide for future pragmatic assessment efforts among other state Extension systems or as a model for identifying barriers and facilitators and associated implementation strategies among other public health systems in the U.S. and abroad.
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    How does eligibility for GusNIP produce prescriptions relate to fruit and vegetable purchases and what factors shape the relationship? A protocol for a secondary analysis of nationally representative data in the USA
    Houghtaling, Bailey; Zhang, Nanhua; Yaroch, Amy; Atkinson, Clare Milburn; Byker Shanks, Carmen (BMJ, 2024)
    Introduction: US Department of Agriculture (USDA) Gus Schumacher Nutrition Incentive Programme (GusNIP) produce prescription programme (PPR) ‘prescriptions’ provide eligible participants with low income, risk for diet-related chronic disease and food insecurity a healthcare issued incentive to purchase lower to no cost fruits and vegetables (FVs). However, GusNIP requirements specify that PPR prescriptions can only be redeemed for fresh (not frozen, canned or dried) FVs. This requirement may prevent participants from fully engaging in or benefiting from GusNIP PPR, given communities with lower healthy food access may have reduced fresh FV accessibility. Methods and analysis: We will use the nationally representative 2012–2013 National Household Food Acquisition and Purchase Survey (FoodAPS) and complementary FoodAPS Geography Component data in a secondary data analysis to examine how household GusNIP PPR eligibility relates to the quantity and variety of fresh, frozen, canned and dried FV purchases and to what extent individual, household and food environment factors shape the relationship. FoodAPS data include household food purchasing and acquisition information across a 7 day period from 14 317 individuals among 4826 households and was collected between April 2012 and January 2013. The FoodAPS Geography Component provides information about the local community/environment relative to FoodAPS households. This study will examine the correlation or association of selected variables between different quantities and varieties of fresh, frozen, canned and dried FVs, as well as correlations among multilevel predictors. Ethics and dissemination: We are following data integrity standards as outlined by agreements with the USDA Economic Research Service. All results of analyses will undergo a thorough disclosure review to ensure no identifiable data are shared. Results will be disseminated to research, practice and policy communities using an Open Access peer-reviewed manuscript(s), scientific and practice presentations, and a public facing report and infographic.
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    How the G20 leaders could transform nutrition by updating and harmonizing food-based dietary guidelines
    Kraak, Vivica; Consavage Stanley, Katherine; Patiño, Sofia Rincón-Gallardo; Houghtaling, Bailey; Byker Shanks, Carmen (UN Food and Agriculture Organization, 2022-11-22)
    The G20 is an intergovernmental and multilateral platform comprised of 19 countries and the European Union, which connects prosperous high-income and emerging middle-income countries worldwide. The G20 process could prioritize food systems to address climate change challenges. For this paper, the research team reviewed the G20 countries’ recommendations in national food-based dietary guidelines (FBDGs) for red and processed meat (RPM) compared with available per capita consumption data and expert-recommended targets to promote healthy and sustainable food systems. The results reveal that Indonesia, India and Saudi Arabia have the least red meat available for consumption (less than 10 kilograms (kg) per person per year). Other G20 countries exceed the recommended red meat target of less than or equal to 26 kg per person per year. Sixteen G20 countries have translated their national guidelines into FBDG food graphics for the public. Twelve G20 countries recommend that people limit their RPM daily or weekly to reduce cancer and heart disease risks. Australia, France, Italy, Mexico and the United Kingdom of Great Britain and Northern Ireland align RPM targets with recommendations to limit cooked red meat intake to three or fewer servings (350-500 grams) a week. Six G20 countries (Brazil, Canada, Germany, India, Italy and the United Kingdom of Great Britain and Northern Ireland) recommend minimally processed, plant-rich food choices or environmentally sustainable dietary patterns. The G20 meetings in Indonesia (2022), India (2023) and Brazil (2024) should prioritize and harmonize healthy and sustainable food system policies with international trade policies to mitigate climate change effects and manage sustainability trade-offs.
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    Implementation of Food is Medicine Programs in Healthcare Settings: A Narrative Review
    Houghtaling, Bailey; Short, Eliza; Byker Shanks, Carmen; Stotz, Sarah A.; Yaroch, Amy; Seligman, Hilary; Marriott, James P.; Eastman, Jenna; Long, Christopher R. (Springer Nature, 2024-04-25)
    Food is Medicine (FIM) programs to improve the accessibility of fruits and vegetables (FVs) or other healthy foods among patients with low income and diet-related chronic diseases are promising to improve food and nutrition security in the United States (US). However, FIM programs are relatively new and implementation guidance for healthcare settings using an implementation science lens is lacking. We used a narrative review to describe the evidence base on barriers and facilitators to FIM program integration in US healthcare settings following the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework. Evidence surrounding the EPIS Inner Context was a focus, including constructs Leadership, Organizational Characteristics, Quality and Fidelity Monitoring and Support, Organizational Staffing Processes, and Individual Characteristics. Peer-reviewed and grey literature about barriers and facilitators to FIM programs were of interest, defined as programs that screen and refer eligible patients with dietrelated chronic disease experiencing food insecurity to healthy, unprepared foods. Thirty-one sources were included in the narrative review, including 22 peer-reviewed articles, four reports, four toolkits, and one thesis. Twenty-eight sources (90%) described EPIS Inner Context facilitators and 26 sources (84%) described FIM program barriers. The most common barriers and facilitators to FIM programs were regarding Quality and Fidelity Monitoring and Support (e.g., use of electronic medical records for tracking and evaluation, strategies to support implementation) and Organizational Staffing Processes (e.g., clear delineation of staff roles and capacity); although, barriers and facilitators to FIM programs were identified among all EPIS Inner Context constructs. We synthesized barriers and facilitators to create an EPIS-informed implementation checklist for healthcare settings for use among healthcare organizations/ providers, partner organizations, and technical assistance personnel. We discuss future directions to align FIM efforts with implementation science terminology and theories, models, and frameworks to improve the implementation evidence base and support FIM researchers and practitioners.
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    Improving Fruit and Vegetable Accessibility, Purchasing, and Consumption to Advance Nutrition Security and Health Equity in the United States
    Houghtaling, Bailey; Greene, Matthew; Parab, Kaustubh V.; Singleton, Chelsea R. (MDPI, 2022-09)
    In recent years, national and local efforts to improve diet and health in the United States have stressed the importance of nutrition security, which emphasizes consistent access to foods and beverages that promote health and prevent disease among all individuals. At the core of this endeavor is fruit and vegetable (FV) consumption, a dietary practice that is integral to attaining and sustaining a healthy diet. Unfortunately, significant inequities in FV accessibility, purchasing, and consumption exist, particularly among populations that are socially and economically disadvantaged. To achieve nutrition and health equity in the United States, the field must center the goal of nutrition security and initiatives that aim to increase FV consumption, specifically, in future work. The International Journal of Environmental Research and Public Health (IJERPH) Special Issue titled "Nutrition and Health Equity: Revisiting the Importance of Fruit and Vegetable Availability, Purchasing, and Consumption" features several scholarly publications from experts conducting timely research on these topics. In this commentary, we (1) summarize the U.S.-based literature on inequities in FV accessibility, purchasing, and consumption, (2) describe how the contributions to this IJERPH special issue can advance nutrition security and health equity, and (3) outline future research questions from our perspective.
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    Matching barriers and facilitators to implementation strategies: recommendations for community settings
    Balis, Laura E.; Houghtaling, Bailey (2023-11-21)
    Background Implementation science aims to improve the integration of evidence-based interventions in real-world settings. While its methods and models could potentially apply to any field with evidence-based interventions, most research thus far has originated in clinical settings. Community settings often have fewer resources, missions beyond health, and a lack of support and expertise to implement evidence-based interventions when compared to many clinical settings. Thus, selecting and tailoring implementation strategies in community settings is particularly challenging, as existing compilations are primarily operationalized through clinical setting terminology. In this debate, we (1) share the process of using an existing match tool to select implementation strategies to increase uptake of nutrition and physical activity policy, systems, and environment interventions in community settings and (2) discuss the challenges of this process to argue that selecting implementation strategies in community settings has limited transferability from clinical settings and may require a unique implementation strategy compilation and pragmatic matching tool. Matching barriers to implementation strategies The impetus for this debate paper came from our work selecting implementation strategies to improve the implementation and eventual scaling of nutrition and physical activity policy, systems, and environment interventions in a community settings. We conducted focus groups with practitioners and used the Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change match tool to select potential implementation strategies to overcome prominent barriers. There was limited congruence between tool outputs and optimal strategies, which may in part be due to differences in context between clinical and community settings. Based on this, we outline needs and recommendations for developing a novel and pragmatic matching tool for researchers and practitioners in community settings. Conclusions More work is needed to refine the implementation barrier-strategy matching process to ensure it is relevant, rapid, and rigorous. As leading implementation strategy scholars note, as more researchers document contextual factors and strategies selected to address them, the knowledge base will increase, and refined mapping processes can emerge.
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    Prioritizing Food Retailer Perspectives for Environmental Change in Food Stores to Encourage Healthy Dietary Purchases Among Low-Income Consumers in the United States
    Houghtaling, Bailey (Virginia Tech, 2019-05-06)
    Supplemental Nutrition Assistance Program (SNAP)-authorized store environments could be improved to favor consumer purchase of healthy products. Engaging with the key intermediaries who can use marketing-mix and choice-architecture (MMCA) strategies to encourage low-income consumers to purchase healthy products aligned with the Dietary Guidelines for Americans (DGA), 2015-2020 is essential. This PhD research describes five investigations that explored the perspectives of food store owners, managers, and corporate or independent businesses (e.g., retailers) to inform healthy food retail approaches: (1) a systematic review of the literature (1980-2017) identified social-ecological influencers of food store retailers' decision-making and ability to use MMCA strategies to encourage healthy dietary purchases in the United States (US); (2) SNAP-authorized retailers' perceived feasibility and costs to implement healthy MMCA strategies in rural stores were assessed (n=29); (3) SNAP-authorized retailers' healthy food and beverage perceptions and DGA-aligned product offerings were documented; (4) prevalent SNAP-authorized food store retailers in the US and between two states were identified to inform settings where healthy food retail approaches could reach numerous SNAP consumers; (5) and the availability of corporate social responsibility commitments to use MMCA strategies to improve consumers' diet quality among prevalent SNAP-authorized food store chains was explored. The collective findings from the review and four studies were that multiple social-ecological factors (e.g., skills/knowledge, consumers, suppliers) influenced US retailers' decision-making and ability to use MMCA strategies that favor healthy products. Rural retailers perceived prompting and proximity (e.g., labeling and location) strategies as feasible and less costly compared to other MMCA strategies. Some misalignments of healthy food perceptions and food store availability were identified and indicated a need for trainings to enhance the success of healthy food retail programs. To reach numerous SNAP consumers, healthy food retail programs should target nontraditional (e.g., non-grocery) food stores with varied approaches by state. However, few prevalent SNAP-authorized retailers have made public, voluntary commitments to reduce obesity and may reflect a low readiness to engage in partnerships to establish healthy food retail environments. Future research should document approach to and the impact of using MMCA strategies to encourage healthier consumer purchases on business outcomes among diverse store contexts.
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    A rapid review of stocking and marketing practices used to sell sugar-sweetened beverages in US food stores
    Houghtaling, Bailey; Holston, Denise; Szocs, Courtney; Penn, Jerrod; Qi, Danyi; Hedrick, Valisa E. (2020-12)
    Sugar-sweetened beverages (SSBs) are a primary source of added sugars in the American diet. Habitual SSB consumption is associated with obesity and noncommunicable disease and is one factor contributing to U.S. health disparities. Public health responses to address marketing-mix and choice-architecture (MMCA) strategies used to sell SSB products may be required. Thus, our goal was to identify original research about stocking and marketing practices used to sell SSB in U.S. food stores. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the World Health Organization (WHO) protocol for rapid reviewing. We searched six databases and Google Scholar using key terms focused on store type and SSB products. We characterized results using an MMCA framework with categories place, profile, portion, pricing, promotion, priming or prompting, and proximity. Our search resulted in the identification of 29 articles. Most results focused on profile (e.g., SSB availability) (n = 13), pricing (e.g., SSB prices or discounts) (n = 13), or promotion (e.g., SSB advertisements) (n = 13) strategies. We found some evidence of targeted MMCA practices toward at-risk consumers and differences by store format, such as increased SSB prominence among supermarkets. The potential for systematic variations in MMCA strategies used to sell SSB requires more research. We discuss implications for public health, health equity, and environmental sustainability.
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    Supplemental Nutrition Assistance Program (SNAP)-authorized retailers received a low score using the Business Impact Assessment for Obesity and population-level nutrition (BIA-Obesity) tool
    Houghtaling, Bailey; Englund, Tessa; Chen, Susan; Pradhananga, Nila; Kraak, Vivica; Serrano, Elena L.; Harden, Samantha M.; Davis, George C.; Misyak, Sarah A. (2022-06-20)
    Background The Supplemental Nutrition Assistance Program (SNAP) supports Americans with lower income to purchase dietary products at authorized retailers. This research aimed to evaluate SNAP-authorized retailers’ public commitments in support of nutrition security and to examine differences between traditional grocers and nontraditional (e.g., convenience, drug, dollar) SNAP-authorized retailers’ public commitments. Methods Prominent United States (U.S.) SNAP-authorized retailers nationally and in two U.S. states (California and Virginia) were identified based on number of store locations (n = 61). Public information available in grey literature were reviewed and scored using the Business Impact Assessment for Obesity and population-level nutrition (BIA-Obesity) tool. SNAP-authorized retailers were classified as traditional (e.g., grocery) or nontraditional (e.g., non-grocery) retailers. Total BIA-Obesity from 0 to 615, representing low to optimal support) and category scores were calculated for corporate strategy, relationships with external organizations, product formulation, nutrition labeling, product and brand promotion, and product accessibility. Descriptive statistics were used to describe BIA-Obesity scores overall and by category. Mann–Whitney U was used to test for potential differences in median BIA-Obesity total scores between traditional and nontraditional SNAP-authorized retailers (a priori, p < 0.05). Results Average total BIA-Obesity scores for SNAP-authorized retailers ranged from 0 to 112 (16.5 ± 23.3). Total BIA-Obesity scores for traditional SNAP-authorized retailers (32.7 ± 33.6; median 25) were higher than nontraditional SNAP-authorized retailer scores (11.2 ± 16; median 5) (p = 0.008). For BIA-Obesity categories, average scores were highest for the category relationships with external organizations (8.3 ± 10.3) and lowest for promotion practices (0.6 ± 2.1). Conclusions Results of this research underscore a dearth of available evidence and substantial opportunity for improvement regarding SNAP-authorized retailer strategies to support nutrition security among Americans with lower income.
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    A systematic review of factors that influence food store owner and manager decision making and ability or willingness to use choice architecture and marketing mix strategies to encourage healthy consumer purchases in the United States, 2005–2017
    Houghtaling, Bailey; Serrano, Elena L.; Kraak, Vivica; Harden, Samantha M.; Davis, George C.; Misyak, Sarah A. (2019-01-14)
    Background Altering food store environments is a promising approach to encourage healthy product purchases by consumers to improve their diet quality and health. Food store owners and managers are intermediaries to ensure that environmental changes are enacted. Despite their role as gatekeepers to implement and sustain healthy food environment changes, no systematic review has been published that examines food store owner and manager (retailer) data. Thus a review of retailer information available within the expansive United States (US) food environment literature was the purpose of this research. Methods The PRISMA protocol was used. A search strategy, including published articles from years 1980–2017, was applied to six databases to locate relevant articles that addressed the perspective of food store retailers in the US. Data were extracted, organized, and agreed upon between two authors based on pre-designed constructs: (1) a social-ecological model to capture factors that influence retailer decision making; and (2) a marketing-mix and choice-architecture framework to examine perspectives of applied (or the prospective application of) strategies at the store-level. Study quality was assessed using quality criteria checklists for qualitative and quantitative research. Results Thirty-one articles met inclusion criteria and most studies (n = 22) were qualitative and conducted in urban food stores (n = 23). Multiple social-ecological factors influenced retailer decision making and ability or willingness to use marketing-mix and choice-architecture strategies to improve consumers’ healthy choices to support dietary quality. These factors included: conflicting training outcomes to enhance retailers’ knowledge and skills (individual, n = 9); the importance of trust (interpersonal, n = 8); views about marketing-mix and choice-architecture strategies in the food environment (n = 25); consumer demand or demographics (community, n = 19); supplier and food store management variables (systems or sectors, n = 18); local and federal policy (n = 8); and support for community health (norms/values, n = 8). Conclusions Research partnerships can support favorable business and public health outcomes to align with retailers’ business models and available resources. A participatory and translational approach to food environment research will likely maximize public health impact. Urban and rural food store retailers are important actors for future research to inform the feasibility of store retailers to apply MMCA strategies that are profitable and promote health.
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    Using the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework to Advance the Science and Practice of Healthy Food Retail
    Houghtaling, Bailey; Misyak, Sarah A.; Serrano, Elena L.; Dombrowski, Rachael D.; Holston, Denise; Singleton, Chelsea R.; Harden, Samantha M. (Elsevier, 2023-03)
    Although healthy food retail strategies are widely used, there appears to be a limited understanding of the processes and determinants for successful adoption, implementation, and sustainment. To fill this gap, we recommend the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework to be used to advance the science and practice of healthy food retail. In this perspective, we: (1) introduce EPIS and describe why it was chosen as a recommended implementation science framework for healthy food retail, (2) highlight healthy food retail evidence supporting EPIS, and (3) discuss research and practice needs mov-ing forward.