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Thesis
Peer Reviewed

A food environment perspective on the fruit and vegetable dietary behaviors of US Hispanics

Sanchez-Flack, Jennifer
Advisor(s): Ayala, Guadalupe X

UC San Diego Electronic Theses and Dissertations (2017)

Background: In the US, 42.5% of Hispanics are obese, which is higher than the national prevalence rate of 34.9%. Diet is a modifiable risk factor for obesity that should be targeted to reduce and prevent disparities within the US Hispanic population. The retail food environment is an important context to study because the greatest contributor to energy intake are from foods and beverages purchased in stores.

Methods: Aim 1 used NHANES data to examine fruit and vegetable (FV) intake by food store type among Hispanics. Differences between customers of various food store type categories were assessed and analyses were performed to estimate associations between intake and food store type categories. Aim 2 used baseline data from El Valor de Nuestra Salud to examine associations between in-store characteristics of product, placement and promotion and FV purchasing among Hispanic customers. Aim 3 used intervention data from El Valor to evaluate group by time differences in product, placement and promotion and group differences in FV purchasing post-intervention.

Results: Aim 1 demonstrated that Hispanics who only purchased FVs from convenience stores were younger and more likely to be born in the US. Results also demonstrated that those who primarily purchased from supermarkets/grocery stores reported higher intakes of FVs than those who only purchased from convenience stores (p<.001, p=.005). Aim 2 indicated that availability of fresh FVs was associated with FV purchasing (p=.01). However, when adjusting for placement, availability of fresh FVs was non-significant. Greater shelf space dedicated to FVs (p=.01) and fewer fresh FV displays (p=.01) was associated with FV purchasing. Analyses also revealed that men reported lower FV purchasing compared to women (p=.02). Aim 3 revealed that El Valor was successful in increasing the promotion of FVs among intervention stores (p<.001) and that intervention store customers reported higher FV purchasing than control store customers (p=.04).

Conclusions: The dissertation findings have important implications for practice, policy and research. The results can inform public health interventions to target in-store characteristics to encourage FV purchasing. It is important to understand and build upon the lessons learned to design, implement, and disseminate successful evidence-based programs.

Cover page: A food environment perspective on the fruit and vegetable dietary behaviors of US Hispanics

Article
Peer Reviewed

Acculturation and Weight Loss Strategies Among Latinas

UC San Diego Previously Published Works (2015)

This study examined the relationship between indicators of acculturation and weight loss strategies among Latinas. Latinas residing in the United States longer had more experience with various weight loss strategies (r = 0.24, p = 0.05). Controlling for demographic factors and BMI, years of U.S. residence was related to whether increased physical activity (OR 1.18, 95% CI 1.01-1.39, p = 0.04) and reduced portion sizes (OR 1.39, 95% CI 1.02-1.91, p = 0.03) were used as strategies for weight loss. More English spoken at home was associated with use of reducing calories as a strategy for weight loss (OR 4.13, 95% CI 1.06-16.09, p = 0.04). Regardless of acculturation level, less empirically supported methods such as using herbal products and a girdle were more prevalent than commonly recommended methods such as using meal replacement products and commercial weight loss programs. Behavioral weight loss interventions for Latinas should consider acculturation to more effectively target subgroups, address cultural practices, and teach lifestyle-appropriate strategies.

Cover page: Acculturation and Weight Loss Strategies Among Latinas

Article
Peer Reviewed

Process Evaluation of a Food Marketing and Environmental Change Intervention in Tiendas That Serve Latino Immigrants in North Carolina

UC Berkeley Previously Published Works (2014)

This article describes a comprehensive process evaluation of an efficacious store-based intervention that increased store customers' fruit and vegetable consumption. The process evaluation plan was designed at study inception and implemented at baseline, during the intervention, and at immediate postintervention. Four Latino food stores were randomly assigned either to an intervention or to a control condition. Data were collected from store managers, employees, and 139 Latino customers. Researchers used manager, employee, and customer interviews; weekly observations of the store environment; and implementation logs to assess reach, dose delivered, dose received, and fidelity. Results indicated that it is possible to reach customers in a store-based intervention. Indicators of dose delivered demonstrated that the intervention was implemented as planned, and in the case of employee training, it exceeded the plan. Dose received data indicated that customers moderately engaged with the intervention activities. Together these suggest that the intervention was delivered with good fidelity. Comprehensive process evaluation efforts can facilitate the identification and elimination of barriers to implementation. This approach can serve as a model for future store-based interventions. The study demonstrated that it is feasible to implement Latino food store-based interventions to increase access to and consumption of fruits and vegetables.

Cover page: Process Evaluation of a Food Marketing and Environmental Change Intervention in Tiendas That Serve Latino Immigrants in North Carolina

Article
Peer Reviewed

Evaluation Protocol To Assess an Integrated Framework for the Implementation of the Childhood Obesity Research Demonstration Project at the California (CA-CORD) and Massachusetts (MA-CORD) Sites

UC Berkeley Previously Published Works (2015)

Background

The long-term success of child obesity prevention and control efforts depends not only on the efficacy of the approaches selected, but also on the strategies through which they are implemented and sustained. This study introduces the Multilevel Implementation Framework (MIF), a conceptual model of factors affecting the implementation of multilevel, multisector interventions, and describes its application to the evaluation of two of three state sites (CA and MA) participating in the Childhood Obesity Research Demonstration (CORD) project.

Methods/design

A convergent mixed-methods design is used to document intervention activities and identify determinants of implementation effectiveness at the CA-CORD and MA-CORD sites. Data will be collected from multiple sectors and at multiple levels of influence (e.g., delivery system, academic-community partnership, and coalition). Quantitative surveys will be administered to coalition members and staff in participating delivery systems. Qualitative, semistructured interviews will be conducted with project leaders and key informants at multiple levels (e.g., leaders and frontline staff) within each delivery system. Document analysis of project-related materials and in vivo observations of training sessions will occur on an ongoing basis. Specific constructs assessed will be informed by the MIF. Results will be shared with project leaders and key stakeholders for the purposes of improving processes and informing sustainability discussions and will be used to test and refine the MIF.

Conclusions

Study findings will contribute to knowledge about how to coordinate and implement change strategies within and across sectors in ways that effectively engage diverse stakeholders, minimize policy resistance, and maximize desired intervention outcomes.

Cover page: Evaluation Protocol To Assess an Integrated Framework for the Implementation of the Childhood Obesity Research Demonstration Project at the California (CA-CORD) and Massachusetts (MA-CORD) Sites

Article
Peer Reviewed

A Mixed Methods Comparison of Oral Hygiene Behaviors by Gender Among Mexican-Origin Young Adults in California

UC San Diego Previously Published Works (2025)

Objective

This mixed methods study explores gender differences in, and reasons for, toothbrushing and flossing among Mexican-origin adults.

Methods

Interviews and surveys about oral hygiene behaviors were collected from 72 adults (ages 21-40) living on the California-Mexico border. Interviews were audio-recorded, transcribed in their original language (English/Spanish), then coded. Survey responses were linked to coded transcripts in Dedoose. Qualitative reports were thematically analyzed for each behavior, stratified into four groups by gender and whether or not participants met American Dental Association (ADA) weekly guidelines (brushing ≥ 14/week; flossing ≥ 7/week). Self-reported weekly frequencies of brushing and flossing were collected continuously, and then dichotomized as meeting guidelines or not. Kruskal-Wallis and chi-square tests assessed differences in hygiene behavior frequency by gender. Negative binomial and logistic regressions were performed, accounting for socio-demographic characteristics.

Results

Overall, 76% and 40% of adults met ADA guidelines for brushing and flossing, respectively. There were no differences in meeting ADA guidelines by gender. When brushing was examined continuously, women brushed 1.24 (1.05-1.47; p = 0.0099) times the rate of weekly brushing than men in the full model; flossing frequency differences were not found. Men and women, whether ADA guidelines were met or not, identified similar brushing and flossing facilitators (health concerns, aesthetics), and barriers (lack of time, not being home). Some women (mothers) were motivated to brush to be role models for their children. Self-efficacy, or confidence in ability to brush or floss, was described differently by adults who met ADA guidelines (high self-efficacy) compared to the adults not meeting guidelines (low self-efficacy).

Conclusions

Integrating quantitative and qualitative data obtained from Mexican-origin adults identified few differences in both oral hygiene behaviors and the factors that influence their enactment.

Cover page: A Mixed Methods Comparison of Oral Hygiene Behaviors by Gender Among Mexican-Origin Young Adults in California

Creative Commons 'BY' version 4.0 license

Article
Peer Reviewed

What Happens When Parents and Children Go Grocery Shopping? An Observational Study of Latino Dyads in Southern California, USA

UC Santa Barbara Previously Published Works (2017)

The objective of this study was to observe parent-child interactions in tiendas, limited assortment food stores catering to Latinos in the United States, and to examine the extent to which child involvement influenced these interactions and their purchase outcomes. Two confederates, one posing as a tienda employee and one posing as a customer, observed the entire shopping trip of 100 Latino parent-child (mean age = 8 years) dyads and coded the following: number and type of parent- and child-initiated request interactions, types of purchase influence attempts used by children and how parents responded, and whether the product was purchased. Level of child involvement was examined as a potential influencing factor on purchasing. The observations were relatively short (mean duration of 10 minutes), reflecting the "quick trip" nature of the observed shopping trips. From the 100 parent-child dyads, 144 request interactions were observed, and among dyads with at least 1 request interaction during the shopping trip, the average number of request interactions per dyad was 2. Children initiated most of the request interactions by asking for a product or simply placing it in the basket; parents initiated 24% of the request interactions. Child involvement in shopping and checkout were associated with spending and purchase outcomes. These results indicate that children and parents influence each other during grocery shopping, and children who are more involved have greater influence over purchases. Furthermore, this study identified a number of targets for future family/parent and consumer food environment interventions.

Cover page: What Happens When Parents and Children Go Grocery Shopping? An Observational Study of Latino Dyads in Southern California, USA

Article
Peer Reviewed

Fruit and Vegetable Intake of US Hispanics by Food Store Type: Findings from NHANES

UC San Diego Previously Published Works (2019)

This study examined fruit and vegetable intake by food store type shopped among US Hispanics. Using National Health and Nutrition Examination Survey 2011-2012 data, T test and chi-square tests examined differences between Hispanic consumers by food store type. Negative binomial regression analyses estimated associations between fruit and vegetable intake and food store type. Hispanics who only purchased fruits and vegetables from convenience stores were younger and more likely US born. They reported lower intakes of fruit and vegetables than individuals who purchased these foods from supermarket/grocery stores. Those who primarily purchased fruits and vegetables from supermarkets/grocery stores consumed 0.92 (p < .001) greater fruit cup equivalents and 0.26 (p = .001) greater vegetable cup equivalents than those who only purchased from convenience stores. Research on the influence of shopping in multiple food store types is needed to develop targeted in-store intervention strategies to encourage healthier food purchases. Results provide support for policy-level research such as minimum stocking requirements for healthy foods in convenience stores.

Cover page: Fruit and Vegetable Intake of US Hispanics by Food Store Type: Findings from NHANES

Article
Peer Reviewed