Introduction. Consumption of foods prepared away from home (FAFH) has grown steadily since the 1970s. We examined the relationship between FAFH and body mass index (BMI) and fruit and vegetable (FV) consumption.Methods. Frequency of FAFH, daily FV intake, height and weight, and sociodemographic data were collected using a telephone survey in 2008-2009. Participants included a representative sample of 2,001 adult men and women (mean age54±15years) residing in King County, WA, with an analytical sample of 1,570. Frequency of FAFH was categorized as 0-1, 2–4, or 5+ times per week. BMI was calculated from self-reported height and weight. We examined the relationship between FAFH with FV consumption and BMI using multivariate models.Results. Higher frequency of FAFH was associated with higher BMI, after adjusting for age, income, education, race, smoking, marital status, and physical activity (women:p=0.001; men:p=0.003). There was a negative association between frequency of FAFH and FV consumption. FAFH frequency was significantly (p<0.001) higher among males than females (43.1% versus 54.0% eating out 0-1 meal per week, resp.). Females reported eating significantly (p<0.001) more FV than males.Conclusion. Among adults, higher frequency of FAFH was related to higher BMI and less FV consumption.

Childhood obesity persists in the United States and is associated with serious health problems. Higher rates of obesity among children from disadvantaged households may be, in part, attributable to disparities in access to healthy foods such as fruits and vegetables. Community supported agriculture can improve access to and consumption of fresh produce, but the upfront payment structure, logistical barriers, and unfamiliarity with produce items may inhibit participation by low-income families. The aim of this project is to assess the impact of subsidized, or “cost-offset,” community supported agriculture participation coupled with tailored nutrition education for low-income families with children. The Farm Fresh Foods for Healthy Kids community-based, randomized intervention trial will build on formative and longitudinal research to examine the impact of cost-offset community supported agriculture on diet and other health behaviors as well as the economic impacts on local economies. The intervention will involve reduced-price community supported agriculture shares which can be paid for on a weekly basis, nine skill-based and seasonally-tailored healthy eating classes, and the provision of basic kitchen tools. Low income families with at least one child aged 2–12 years will be recruited to join existing community supported agriculture programs in New York, North Carolina, Vermont, and Washington. In each program, families will be randomized 1:1 to intervention or delayed intervention groups. Data will be collected at baseline, and in the fall and spring for 3 years. The primary outcomes are children’s intake of fruits and vegetables and foods high in sugar and/or (solid) fat, as well as diet quality; secondary outcomes include physical, behavioral, psychosocial, and environmental variables. Cost-effectiveness and economic impact at the farm and community levels also will be assessed. This integrated project will provide important information and contribute to the evidence base regarding the use of local agricultural interventions to improve children’s dietary behaviors and weight maintenance. Findings also will inform the development of a toolkit for farmers and education modules related to local food system innovations for undergraduate and graduate students. ClinicalTrials.gov NCT02770196 . Registered 5 April 2016.

Background: The Short Physical Performance Battery (SPPB) is an inexpensive, reliable, and easy‐to‐implement measure of lower‐extremity physical function. Strong evidence links SPPB scores with all‐cause mortality, but little is known about its relationship with incident cardiovascular disease (CVD). Methods and Results: Women (n=5043, mean age=79±7) with no history of myocardial infarction or stroke completed 3 timed assessments—standing balance, strength (5 chair stands), and usual gait speed (4 m walk)—yielding an SPPB score from 0 (worst) to 12 (best). Women were followed for CVD events (myocardial infarction, stroke, or CVD death) up to 6 years. Hazard ratios were estimated for women with Very Low (0–3), Low (4–6), Moderate (7–9), and High (10–12) SPPB scores using Cox proportional hazard models adjusted for demographic, behavioral, and health‐related variables including objective measurements of physical activity, blood pressure, lipids, and glucose levels. Restricted cubic splines tested linearity of associations. With 361 CVD cases, crude incidence rates/1000 person‐years were 41.0, 24.3, 16.1, and 8.6 for Very Low , Low , Moderate, and High SPPB categories, respectively. Corresponding fully adjusted hazard ratios (95% CIs) were 2.28 (1.50–3.48), 1.70 (1.23–2.36) 1.49 (1.12–1.98), and 1.00 (referent); P ‐trend <0.001. The dose‐response relationship was linear (linear P 0.38). Conclusions: Results suggest SPPB may provide a measure of cardiovascular health in older adults beyond that captured by traditional risk factors. Because of its high test‐retest reliability and low administrative burden, the SPPB should be a routine part of office‐based CVD risk assessment.

Cardiovascular disease is the leading cause of death in the United States and places substantial burden on the health care system. Rural populations, especially women, have considerably higher rates of cardiovascular disease, influenced by poverty, environmental factors, access to health care, and social and cultural attitudes and norms. This community-based study will be a two-arm randomized controlled efficacy trial comparing a multi-level, community program (Strong Hearts, Healthy Communities) with a minimal intervention control program (Strong Hearts, Healthy Women). Strong Hearts, Healthy Communities was developed by integrating content from three evidence-based programs and was informed by extensive formative research (e.g. community assessments, focus groups, and key informant interviews). Classes will meet twice weekly for one hour for 24 weeks and focus on individual-level skill building and behavior change; social and civic engagement are also core programmatic elements. Strong Hearts, Healthy Women will meet monthly for hour-long sessions over the 24 weeks covering similar content in a general, condensed format. Overweight, sedentary women 40 years of age and older from rural, medically underserved communities (12 in Montana and 4 in New York) will be recruited; sites, pair-matched based on rurality, will be randomized to full or minimal intervention. Data will be collected at baseline, midpoint, intervention completion, and six-month, one-year, and eighteen months post-intervention. The primary outcome is change in body weight; secondary outcomes include physiologic, anthropometric, behavioral, and psychosocial variables. In the full intervention, engagement of participants’ friends and family members in partnered activities and community events is an intervention target, hypothesizing that there will be a reciprocal influence of physical activity and diet behavior between participants and their social network. Family members and/or friends will be invited to complete baseline and follow-up questionnaires about their health behaviors and environment, height and weight, and attitudes and beliefs. Strong Hearts, Healthy Communities aims to reduce cardiovascular disease morbidity and mortality, improve quality of life, and reduce cardiovascular disease-related health care burden in underserved rural communities. If successful, the long-term goal is for the program to be nationally disseminated, providing a feasible model to reduce cardiovascular disease in rural settings. ClinicalTrials.gov Identifier: NCT02499731 Registered on July 1, 2015.

This paper examines fruit and vegetable intake (FVI) in low-income households that participated in a cost-offset (CO), or 50% subsidized, community-supported agriculture (CSA) program. CSA customers paid farms upfront for a share of the harvest, and received produce weekly throughout the growing season. A cohort of adults and children 2–12 y in a summer CO-CSA were surveyed online twice: August 2015 (n = 41) and February 2016 (n = 23). FVI was measured by the National Cancer Institute’s (NCI) Fruit and Vegetable Screener (FVS) and an inventory of locally grown fruits and vegetables. FVI relative to United States (US) recommendations and averages, and across seasons, were tested with non-parametric tests and paired t-tests (p < 0.05). Both adults and children in the CO-CSA had higher FVI than the US averages, and more often met recommendations for vegetables. Some summer fruits and vegetables were more often eaten when locally in-season. The CO-CSA model warrants further examination as an avenue for improving vegetable consumption among adults and children in low-income households. However, causality between CO-CSA participation and FVI cannot be inferred, as CO-CSA participants may be positive deviants with respect to FVI. A multi-state randomized controlled trial is currently underway to evaluate impacts of CO-CSAs on FVI and related outcomes.