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Objective:Food insecurity is associated with a greater risk of depression among low-income adults in the USA. Members of food-insecure households have lower diet diversity than their food-secure counterparts. This study examined whether diet diversity moderates the association between food insecurity and depression.Design:Multiple logistic regression was conducted to examine independent associations between food insecurity and depression, between diet diversity and depression, and the moderating effect of diet diversity in the food insecurity–depression link.Setting:Cross-sectional data from the National Health and Nutrition Examination Survey (2013–2014).Participants:2636 low-income adults aged 18 years and older.Results:There was a positive association between food insecurity and depression among low-income adults. Diet diversity was not associated with depression. Diet diversity had a moderating effect on the association between food insecurity and depression among low-income adults.Conclusions:Food insecurity is independently associated with depression among low-income adults in the USA. However, this association differs across levels of diet diversity. Longitudinal studies are needed to confirm the role diet diversity may play in the pathway between food insecurity and depression.

Objective Use process and outcome evaluation techniques to evaluate a Sodium Reduction in Communities Program implemented with 58 schools, 17 early childhood education (ECE) centers, and 5 community meals programs across northwest Arkansas. Use of Theory or Research Increased sodium consumption is associated with increased risk of hypertension and cardiovascular disease, and sodium reduction is associated with numerous health benefits. Community-based participatory research and behavioral economics approaches were used to develop tailored strategies to reduce sodium. Target Audience The target audience includes program staff, K-12 and ECE students and staff, low-income individuals accessing community meals, and managers of partner programs. Program Description A variety of sodium reduction strategies, including ingredient substitutions, meal/menu modifications, standardized purchasing lists, and behavioral economics were implemented across all sites to reduce the sodium content of meals. Evaluation Methods To evaluate program implementation, data were collected at baseline and annually thereafter. Evaluation data were collected via detailed menu information, production records, point-of-sale records, purchasing lists, and interviews with program staff. Each year, evaluation findings are used to improve program activities. Results The program now reaches more than 50,000 individuals per day. To date, 90 menu items have been affected by recipe modification across all sites. From Baseline to Year 3, the sodium content of entrees offered, entrees served, and meals served in schools decreased 13.5%, 4.7%, and 3.8%, respectively. Among ECEs and community meals, the sodium content of meals offered and meals served decreased 39.4% and 18.8%, respectively, from Baseline to Year 3. Conclusion Sodium reduction strategies in schools, ECEs, and community meals programs lead to a reduction in sodium served to students, staff, and clients. The program will continue to be expanded and enhanced using process and outcomes evaluation findings, ultimately leading to a reduction in sodium consumption and chronic disease incidence in northwest Arkansas. Funding Centers for Disease Control and Prevention.

Objectives: In this study, we assessed the effect of Family Diabetes Self-Management Educa- tion (DSME) intervention on changes in self-care behaviors among Marshallese adults with type 2 diabetes. Methods: Marshallese adults (N = 211) with type 2 diabetes were randomized to a Family DSME intervention or a Standard DSME intervention. We assessed changes in diabetes- related self-care behaviors from baseline to 12 months within and between study arms using descriptive statistics and mixed effects logistic regression models adjusted for demographic characteristics and use of diabetes medication. Results: Family DSME participants had increased engagement in glucose monitoring and doctor visits, whereas Standard DSME participants had increased engagement in glucose monitoring. Family DSME participants increased engagement in glucose monitoring more than Standard DSME participants. Conclusions: DSME can improve some diabetes related self-care behaviors. Future studies on diabetes management should consider developing and testing interventions that seek to improve long-term rates of engagement in self-care behaviors.

Background Farm to Institution (FTI) programs and policies aim to increase utilization of locally grown and processed food products in institutions such as colleges, schools, hospitals, state agencies, and other private and public entities. FTI's goal is to spur local economic development through engaging regional farms and producers, and to provide healthier, fresher food choices. This project aimed to examine the current state of FTI in Arkansas and highlight opportunities for further development. Objective To determine motivators, barriers, and strategies for reaching local food procurement goals in institutions in Arkansas following the passing of statewide FTI reporting and procurement legislation. Study Design, Setting, Participants We surveyed 1,980 Arkansas institutions including schools, universities, state agencies, and childcare centers in a web-based survey. Eligibility for the survey required that an institution receive at least $25,000 in state funding and offer a food service program. Of the recipients who completed the screener (22%; n = 454), 9% (n = 176) met the criteria for eligibility and completed the survey. Measurable Outcome/Analysis Questions explored food budget, agency commitment, motivators, barriers, and plans for future procurement. Data was compiled and analyzed using REDCap. Results Current local food procurement was approximately 15% for institutions completing the survey. Commonly reported approaches for increasing this percentage include local engagement with farms, farmers’ markets, and vendors; learning more about legislative requirements; and improving local food tracking methods. Institutions also highlighted significant barriers of food supply as well as knowledge of where and how to purchase local foods. Conclusion In 2019, Arkansas passed Act 796, which institutes a goal of at least 20% of an agency's purchases of food products be spent on local farm and food products, and requires institutions to annually report spending. Our findings provide a baseline for FTI in Arkansas under Act 796, and highlight a variety of important opportunities for further expansion, evaluation, and programing to improve FTI at multiple levels within the supply chain. Funding Arkansas Department of Agriculture.

Objective Cigarette smoking is a risk factor for cervical, vaginal, vulvar, and anal dysplasia. We will study the prevalence of cigarette smoking in patients with genital dysplasia and effect of counseling on smoking cessation. Methods All patients with genital dysplasia were screened for smoking history. One clinician provided smoking cessation counseling using the US Department of Health 5 A's technique: ask patients about their smoking status, advise smokers to quit, assess their readiness to quit, assist with their smoking cessation effort, and arrange for follow-up visits. Patients were informed on how smoking may cause worsening of genital dysplasia and increased risk of progression to cancer. Each patient received 2 counseling sessions, but no pharmacological or psychological interventions. Smoking cessation was evaluated by patient self-report via phone or during clinic visits. Results From January 2007 to December 2010, 344 patients were referred to our gynecologic oncology clinic for evaluation of genital dysplasia. Patients who were smokers (n=125, 36%) were counseled to cease smoking in 2 counseling sessions, with 100% compliance for attendance. At study analysis (July 2011), 83 patients still smoke and 40 patients quit smoking (smoking cessation rate of 32%). Caucasian patients (P=.0013) and patients with vulvar dyplasia (P=.411) seemed to smoke more than other races and patients with cervical/vaginal dysplasia respectively. Conclusion Smoking cessation counseling for the genital dysplasia patients who smoked was associated with smoking cessation in 32% of the patients.