Dietetics and Clinical Nutrition Commons^™

Exploring Psychosocial Risk Factors For Disordered Eating Among Future Healthcare Professionals: A Cross-Sectional Analysis, Ayron Walker, Manan Roy, Jenna Warnock, Karlee Prater, Alisha Farris, Danielle Nunnery

Appalachian Student Healthcare Research Review

Background. The prevalence of disordered eating (DE) patterns is significantly higher among college-aged students and health-related majors. This study explored associations between DE behaviors and psychosocial risk factors, including adverse childhood experiences (ACEs), food insecurity, weight stigma, fat phobia, and family ‘fat talk’, among health science students at a large, rural U.S university, using an anonymous online survey.

Method. An anonymous online survey was distributed to a randomly selected, cross-sectional sample of 3,000 health science students. Participant responses (n = 550; 18.3% response rate) were analyzed using Pearson’s correlation, and multiple linear regression.

Results. The sample was …

Weight Loss Strategy Disparities Among Anti-Obesity Medication-Eligible Us Adults: A Cross-Sectional Nhanes Analysis, Harshal Parmar, Akhila Archakam, Hitesh Gowda, Leonard Powell

Rowan-Virtua Research Day

Background: Nearly half of US adults meet FDA criteria for anti-obesity pharmacotherapy (AOM), yet utilization remains low. Recent GLP-1RAs prescribing has intensified focus on access disparities, but how weight loss strategy selection varies by social determinants among AOM-eligible adults is poorly understood.

Hypothesis: Weight loss strategy selection among AOM-eligible adults varies by race/ethnicity and food security status, with food insecure populations likely to use maladaptive strategies.

Methods: Survey-weighted cross-sectional analysis of NHANES 2017–March 2020. AOM eligibility: BMI ≥30 or BMI ≥27 with cardiometabolic comorbidity. Among adults reporting past-year weight loss attempts (n=2,100; weighted N=59.5 million), 19 self-reported strategies were compared …

Feasibility Study Of A Screening Decision Tool For Allocating Adults Into Food Is Medicine Programs As An Effective Approach To Target Clinical And Dietary Outcomes Among Rural And Urban Adults, Alison Gustafson, Carolyn Lauckner, Joshua L. Bush, Emily Dimond, Carolina Morales Serrano, Christa Mayfield, Elizabeth T. Anderson Steeves

Dietetics and Human Nutrition Faculty Publications

Objective: Evaluate feasibility (primary), clinical, and cost outcomes (secondary) associated with the use of a screening decision tool for allocating rural and urban adults with hypertension into in a food is medicine (FIM) program.

Design: Participants were allocated to receive either medically tailored meals or grocery prescription (Rx), based on a user-centered designed screening decision tool. Medically tailored meals (MTM) provided 5 meals per week for 12 weeks. The grocery Rx program provided $100 each month for 3 months to purchase food consistent with guidelines for hypertension. Feasibility outcomes included engagement, dose, and program acceptability. Semi-structured interviews were completed with …

Building Community Through Food And Health: Student Initiatives To Address Food Insecurity In Mississippi, Sarah E. Sawaya

Honors Theses

This thesis explores food insecurity in Oxford and Lafayette County, Mississippi, within the broader context of state, national, and global challenges. Over a four-year period, student-led and community organizations collaborated to design programs that addressed both food access and chronic illness prevention through education, outreach, and direct service. Community input was gathered through health screenings, campus engagement, and informal interviews with residents, which guided the development of practical tools like recipe kits, QR code-based cookbooks, and on-site health education. These efforts were rooted in local partnerships and shaped by the lived experiences of those most affected. This project demonstrates that …

Body Mass Index, Sleep, And Food Insecurity Predict Prevalence Of Anxiety And Depression In College Students, Makenzie Barr-Porter, Amelia Sullivan, Jade Mcnamara

Dietetics and Human Nutrition Faculty Publications

This study aimed to assess the relationship between mental health, health behaviors, and food security in young adults in a university environment. Young adults (N = 536) at two United States universities completed a survey assessing health behaviors and characteristics. Logistic regression determined the odds of anxiety and/or depression based on gender identity, body mass index (BMI), food security status (FSS), and sleep restfulness. Over one-third of students were food insecure (36.7%), and almost all reported anxiety (57%) and/or depression (39.1%). Students who identified as female, reported very low FSS, poor sleep, and had higher BMI were at greater odds …

Assessing The Effectiveness Of A Modified Cook Together Eat Together Program On Food Resource Management Behaviors In A Rural Setting, Johanna K. Poysti

Theses and Dissertations--Nutrition and Food Systems

This study evaluated the effectiveness of a modified, hybrid Cook Together, Eat Together (CTET) program on food resource management behaviors in a rural setting. A six-week intervention combining virtual and in-person sessions aimed to improve health behaviors, food resource management skills, and self-efficacy. Although most behavioral changes were not statistically significant, participants reported increased confidence in cooking healthy meals on a budget. Positive qualitative feedback from focus group discussions indicated program feasibility and engagement. Strengths and limitations of the study were discussed as well as recommendations for future research were given.

Food Insecurity And Self-Rated Health Of Older Adults In Appalachia, Sarah Kelley

Electronic Theses and Dissertations

Food insecurity is prevalent in the United States. Although older adults experience food insecurity at lower-than-average rates, this population is vulnerable to the nutrition and health related implications. Food insecurity is tied to both a diminishment of diet quantity and quality, and is associated with incidence of chronic disease, loss of functional status, and quality of life. This survey seeks to fill a gap in research by looking into the prevalence of food insecurity among older adults in Northeast Tennessee, associations between food insecurity and self-rated health, and associations between food insecurity and geographical limitations.

Urban-Rural Disparities In Food Insecurity And Weight Status Among Children In The United States, Jayna M Dave, Tzuan A Chen, Alexandra N Castro, Mamie A White, Elizabeth A Onugha, Sloane Zimmerman, Debbe Thompson

Children’s Nutrition Research Center Staff Publications

Place of residence (urban versus rural) is a contextual determinant of health that has received less attention in the food insecurity literature. The purpose of this study was to assess the urban–rural disparity in the prevalence of food insecurity and weight status among US children. Using data from the National Health and Nutrition Examination Survey (NHANES) 2013–2016 with three age groups of children (2–5, 6–11, and 12–17 years old), the associations of weight status and child and household food security status by urban–rural residence were examined using Rao–Scott Chi-square tests. Statistical significance was set at p < 0.05. Children living in urban areas were significantly more likely to experience household food insecurity (29.15%) compared to their rural counterparts (19.10%), among those aged 6–11 years. The associations between children’s weight status and child and household food security status were significant for children living in urban areas overall and different age groups but not for children living in rural areas. These trends were more pronounced in older age groups. Given the link between food insecurity and higher obesity rates, particularly among urban children, this study highlights the importance of incorporating food security interventions into future obesity prevention programs.

Examining The Nexus Of Food Insecurity And Oral Health, Abigayle Talbot

Honors Theses

This research paper delves into the relationship between oral health and nutrition status among individuals with food insecurity. As both oral health and nutritional well-being play pivotal roles in overall health, understanding their interplay in the context of food insecurity becomes important. This study investigated how inadequate access to food resources, a characteristic of food insecurity, can impact oral health, leading to a spectrum of dental issues. The study explores the impact of compromised oral health on dietary habits, potentially resulting in nutritional deficiencies or malnutrition. By examining the potential pathways through which these factors influence each other, the study …

Childhood Food Insecurity As It Relates To Adult Intuitive Eating Patterns, Lily Langley

Honors Theses

Many American families struggle with food insecurity and do not have the economic capabilities to obtain a sufficient quantity of nutritious food. Childhood food insecurity is associated with negative health effects and altered relationships with food as an adult. Intuitive eating, a non-diet framework that emphasizes mindful eating, may attenuate these effects. It includes unconditional permission to eat, eating for physical rather than emotional reasons, reliance on hunger and satiety cues, and body-food choice congruence. Previous research has not examined whether childhood food insecurity can affect one’s ability to eat intuitively as an adult. The goal of this study was …

A Brief Overview Of Food Insecurity In Southern New Jersey, Lisa Ting Huang, Krisha Darji, Jariatou Diallo, Amin Abdul Khan

Rowan-Virtua Research Day

Atlantic County, located off the Jersey Shore, faces the highest level of food insecurity in New Jersey, with a rate of 11.2% as of 2021, surpassing the state's overall rate of 8.8%. This situation contributes to health issues such as hypertension, diabetes, and heart disease.

The objective of this research is to understand and address the persistence of food insecurity in Atlantic County. Community stakeholders and local physicians were interviewed to identify barriers and disparities contributing to food insecurity.

Methods included a literature review using keywords like "food insecurity" and "southern New Jersey". Proposed interventions suggest collaboration with health centers …

Relationship Between Food Security, Nutrition Security, And Diabetes: The Role Of Supplemental Nutrition Assistance Program Participation, Maha Almohamad, Jayna M Dave, Eric E Calloway, Ruosha Li, Shreela Sharma

Faculty, Staff and Student Publications

BACKGROUND: Inadequate nutrition and poor diet quality are associated with a heightened risk of diabetes. The connection between food insecurity measures and diabetes has been established, with evidence indicating that Supplemental Nutrition Assistance Program (SNAP) participation contributes to reductions in food insecurity. Recently developed nutrition security measures, defined as the ability to acquire healthful foods to prevent diseases, and their association with diabetes and SNAP participation are not yet understood.

OBJECTIVES: This study aimed to assess the relationship between food security and nutrition security in relation to diabetes overall and by SNAP participation and nutrition security as potential modifiers.

METHODS: …

Risk Of Food Insecurity Reflects Health Status In Adult Relatives Of Prek Children – ​ Data From The Steps Snap-Ed Research Study​, Lisa M B Salinas, Karla Cortez, Brenda Rodriguez, Joseph Reyes, Moises Cisneros, Elizabeth Alanis, Zasha Romero, Lin Wang, Juan C. Lopez-Alvarenga, Roberto Treviño-Peña

Research Symposium

Background: Past research shows a correlation between household food insecurity and chronic medical conditions such as diabetes in the general U.S. population as well as metabolic syndrome-related cardiometabolic markers in Hispanic/Latino youth. Furthermore, minority status, including Hispanic/Latino identity, shows an association with low food security and diabetes. The Hunger Vital Sign (HVS) is a validated screener designed to assess risk of food insecurity within households. This study analyzes associated factors related to the screener’s 2 questions, specifically targeting PreK 4-year-old children and their household relatives. The first question assesses concern about food running out before obtaining more due to financial …

Regional Variability In The Prevalence Of Food Insecurity And Diet Quality Among United States Children, Jayna M Dave, Tzuan A Chen, Alexandra N Castro, Mamie White, Elizabeth A Onugha, Sloane Zimmerman, Debbe Thompson

Children’s Nutrition Research Center Staff Publications

Understanding the association between food security status (FSS) and diet quality in children is crucial. This study investigated regional variability in FSS, participation in the federal nutrition assistance program (FNAP), and diet quality among US children. National Health and Nutrition Examination Survey (NHANES) data from 2013 to 2016 were analyzed. The association between FSS, FNAP participation, and diet quality (Healthy Eating Index—HEI-2015) was assessed using multiple linear/logistic regression models. The sample included 6403 children (mean age: 7.5 years; 51% male; 33% Hispanic). Within the sample, 13% reported child food insecurity, and 30% reported household food insecurity. Additionally, 90% participated in …

Feasibility Of A Food-Based Diabetes Self-Management Education Intervention For Food Insecure Patients With Type 2 Diabetes: A Convergent Mixed Methods Study, Eliza Short, Debbe Thompson, Douglas Taren, Holly Bryant, Rhonda Gonzalez, Jessi Sheava, Melanie Hingle

Children’s Nutrition Research Center Staff Publications

Objective: To assess the feasibility of a food-based diabetes self-management education and support (DSMES) intervention delivered to persons with type 2 diabetes (T2DM) and food insecurity.

Design: This single arm pre-/post convergent mixed methods study tested the feasibility of a 3-month intervention using food boxes, recipes, DSMES and dietitian visits. Feasibility benchmarks assessed were acceptability (> 50 % participants satisfied), demand (> 50 % used program components) and implementation (75 % adherence, 80 % retention). Assessments included: self-reported food security, health-related quality of life, diabetes self-efficacy, socio-demographic and dietary intake, height, weight, and HbA1c and one in-depth interview with participants …

Dietary Intake And Quality Among Stroke Survivors: Nhanes 1999-2018, Erika R Zoellner, Mindy A Patterson, Anjail Z Sharrief, Sean I Savitz, Wesley J Tucker, Derek C Miketinas

Faculty, Staff and Student Publications

Background: Nutrition is an important modifiable risk factor for prevention and treatment of stroke. However, examination of nutrient intake and diet quality in stroke survivors is limited.

Objectives: The aim of the study was to estimate usual nutrient intake and diet quality in US adults with and without a history of self-reported stroke.

Methods: Using US National Health and Nutrition Examination Survey (NHANES) 1999-2018, we analyzed demographics, health history, and dietary intake data in 1626 individuals with a history of stroke matched for age, gender, and survey cycle to respective controls (n=1621) with no history of stroke. A minimum of …

Accessibility Of On-Campus Food Pantries: A Comparative Review, Jayden Parrott

Honors Projects

This project explores ways in which food pantries across Ohio college campuses are accommodating for those with food restrictions such as food allergies, religious diets, or personal choice (vegan/vegetarian). Food insecurity is a widespread issue that affects many Americans. College students especially bear the burden of this issue. Food pantries are a common institution to combat food insecurity, and these work for many of the individuals that use them. Those with special dietary needs, however, may find more difficulty when accessing these resources. Having a food allergy or being on a religious or personal diet may impact how you can …

Nutrition Care For The Transgender Population: A Retrospective Study To Investigate Relationships Between The Nutrition Care Process Model And Patient Outcomes, Alana Minnee Marrero Gonzalez

UNF Graduate Theses and Dissertations

One of the most important roles of the registered dietitian nutritionist is to provide medical nutrition therapy that is fitting to an individual’s culture, reality, ethnicity, and dietary preferences. A review of existing literature exposes the lack of information available on LGBTQ (lesbian, gay, bisexual, transgender, queer) health, for transgender communities. The purpose of this research was to generate knowledge of the nutrition-related problems and barriers to adequate nutrition and health, and their impact in nutrition assessment in a sample of Hispanic transgender adult patients living in San Juan, Puerto Rico. A retrospective observational study was conducted, data from 114 …

Walking The Talk: A Qualitative Exploration Of Gatekeeping Staff Perceptions Surrounding Implementation Of Nutrition Policy In Florida Food Banks, Rachel Lynn Mccandless

UNF Graduate Theses and Dissertations

Food insecurity is an independent risk factor for adverse health outcomes; providing nutrient-dense food through the emergency food system to individuals who regularly seek assistance can impact population-level health disparities. This research explored the extrinsic and intrinsic barriers and facilitators surrounding formal nutrition policy implementation as seen by the logistical gatekeepers in a sample of Feeding Florida food banks. A secondary aim of this research was to explore the change readiness of these same logistical decision-makers in nutrition policy implementation. Research Questions included the following: What are the critical gatekeeping staff perceptions of the barriers and facilitators to implementing formal …

Implementing Food Insecurity Screening On A College Campus, Norma Martinez

Doctor of Nursing Practice

Background. Students attending universities have higher rates of food insecurity than U.S. households. Most college campuses do not routinely screen students for food insecurity, which can affect students’ health and school performance. Currently, the university health clinic does not screen students for food insecurity. Purpose. To screen all students who present to the university clinic for food insecurity and evaluate students with food insecurity for malnutrition. Evidence. Foreman et al. (2018) and Abu and Oldewage-Theron (2019) found that food insecurity was present at some of the largest Texas universities at rates higher than the national average. Project Objectives. To screen …

Food Insecurity In Collegiate Athletes During Covid-19, Elizabeth Swindell

Honors Theses

A study done by Georgetown University in 2019 found that one-fourth of NCAA, D1 collegiate athletes experience food insecurity. The study purpose was to examine food security levels in student athletes at a southern university and the impact of the COVID-19 pandemic on food security in these students. A survey was completed by student athletes to determine their food security levels during the 2020 academic year at the onset of the COVID-19 pandemic. The survey included questions relating to food security based on the USDA’s food insecurity module as well as questions specifically related to the impact of food security …

Food Assistance Use Among Food Bank Clients Affected By Type 2 Diabetes, Eliza Short, Jayati Sharma, Debbe I Thompson, Douglas Taren, Rhonda Gonzalez, Melanie Hingle

Children’s Nutrition Research Center Staff Publications

Objective: To understand the perspectives of food bank clients affected by type 2 diabetes (T2DM).

Design: Semi-structured in-depth interviews conducted with food bank clients.

Setting: Arizona regional food bank.

Participants: Twenty English- and Spanish-speaking food bank clients with T2DM or living with a person with T2DM, aged 45-83 years, majority female, Hispanic, and food insecure.

Phenomenon of interest: Food bank use and preferences, and how these related to T2DM management.

Analysis: A hybrid thematic analysis combining inductive and deductive reasoning.

Results: Three organizing themes emerged from the analysis. First, food assistance was influenced by food preferences and the ability to …

Prevalence Of Food Insecurity In The General College Population And Student-Athletes: A Review Of The Literature, Elizabeth L. Abbey, Melissa Brown, Christine Karpinski

Nutrition Faculty Publications

Purpose of Review: The purpose of this review is to examine the prevalence of food insecurity (FI) among the general college student population with a focus on student-athletes and the impact of the COVID-19 pandemic on FI in these groups. Recent Findings: FI is estimated to be more prevalent in college students than in the general population, although ranges vary widely. Less is known about FI among college student-athletes. Data on changes in FI prevalence pre-pandemic and during is mixed. Summary: Colleges and universities should invest in interventions to address FI on their campuses, and further research on FI among …

Intuitive Eating Behaviors Among A Sample Of Food Secure And Food Insecure College Students, Morgan Stocker, Christin Seher Phd, Rdn, Ld

Williams Honors College, Honors Research Projects

Intuitive Eating (IE) is a food mindset focusing on honoring hunger and fullness, while rejecting the diet mentality. Research demonstrates a clear link between IE and health outcomes across many populations, including college students. Despite a growing body of literature, we still know very little about what complexities food insecurity may present for individuals trying to adopt IE behaviors. This study builds off prior research to investigate IE behaviors in food insecure and food secure students through a Qualtrics survey utilizing the Intuitive Eating Scale-2 (IES-2) and the United States Department of Agriculture (USDA) Six-Item Short Form to determine food …

Policy Implications Of The Covid-19 Pandemic On Food Security In Rural America: Evidence From Appalachia, Kathryn M. Cardarelli, Emily M. Dewitt, Rachel Gillespie, Rachel Hogg-Graham, Heather Norman-Burgdolf, Janet T. Mullins

Dietetics and Human Nutrition Faculty Publications

Rural communities are disproportionally affected by food insecurity, making them vulnerable to the consequences of supply disruptions caused by the COVID-19 pandemic. While access to food was initially diminished due to food supply disruptions, little is known about the mechanisms through which federal emergency assistance programs impacted food access in rural populations. Through a series of five focus groups in spring 2021, we examined the impact of the COVID-19 pandemic on food access in a rural Appalachian community in Kentucky. Data were analyzed using a Grounded Theory Approach. Findings revealed the following four primary themes: food scarcity in grocery stores; …

The Impact Of The Covid-19 Pandemic On Food Distribution At Emergency Food Assistance Organizations In The Southwestern United States: A Qualitative Investigation, Alexandra N Castro, Mamie A White, Ariun Ishdorj, Debbe Thompson, Jayna M Dave

Children’s Nutrition Research Center Staff Publications

This study aimed to identify changes in food distribution operations at emergency food assistance organizations (EFAOs) during the COVID-19 pandemic. EFAOs across the Houston metro area, TX (human service centers and food pantries) as well as the Houston Food Bank (HFB) participated in the qualitative study. Data were collected via individual semi-structured interviews and focus group (December 2020–February 2021), and coded using semi-structured thematic analysis. Categories were pre-identified based on the interview questions. Direct quotes supported subcategories. Directors from 18 EFAOs were interviewed; 8 HFB leadership staff participated in a focus group. Four major categories of change due to COVID-19 …

Examining Food Security, Choices And Barriers Among Community Supported Agriculture Participants During Covid- 19 In Kentucky, Martha J. Biddle, Junghee Kang, Julie Derringer, Anna Rose, Dawn Brewer, Misook L. Chung, Terry A. Lennie, Gia Mudd-Martin, Timothy A. Woods

UK CARES Faculty Publications

The coronavirus disease (COVID-19) pandemic is challenging food security. Our study’s purpose was to examine relationships among food security status, eating patterns and perceived barriers to food choices among shareholders (N = 209) in a Community Supported Agriculture (CSA) program during stay- at-home restrictions due to the pandemic. The food insecure group (n = 33) reported lower consumption of fruits/vegetables, whole grains and greater consumption of fast foods and more barriers to food choices compared to the food secure group (p < .05). A low food insecure proportion (16%) among the CSA participants suggests a potential role of a CSA program to prevent food insecurity.

The Silence Of Food Insecurity: Disconnections Between Primary Care And Community Organizations, Nicole K. Runkle, David A. Nelson

Journal of Patient-Centered Research and Reviews

Purpose: Food insecurity is a prominent issue in the United States, and it is well established that food insecurity is linked to health and chronic illnesses. Studies show that screening for food insecurity is not yet part of standardized practice among all primary care physicians, nor are care providers comfortable with how to proceed with a patient who presents with this issue. Food insecurity is often handled by community-based organizations (CBOs) such as food pantries. Family medicine and pediatric clinics (FMPC) and CBOs hold unique relationships with their clients and can benefit from partnerships with each other to improve health …

Investigation Of The Multidimensional Determinants Of Nutritionally Risky Coping Strategies And Tradeoffs In Adults, Cheryl Marsland

UNF Graduate Theses and Dissertations

Multidimensional determinants influence use of negative nutrition coping strategies and tradeoffs in households accessing food relief. The objective of this study is to examine negative nutrition coping strategies and tradeoffs at different levels of food insecurity in households accessing food relief and investigate how these behaviors relate to experience-based food insecurity dimensions and populations at risk. This secondary data analysis is from the cross-sectional Sunshine State Hunger Survey (SSHS) conducted June 2018 to August 2018. Over 600 adults were surveyed capturing households of Floridians who accessed 18 direct service charities and community groups that provide food relief across the Tampa …

Beyond Clinical Food Prescriptions And Mobile Markets: Parent Views On The Role Of A Healthcare Institution In Increasing Healthy Eating In Food Insecure Families., Emily Dewit, Emily Meissen-Sebelius, Robin P. Shook, Kimberly Pina, Evelyn Donis De Miranda, Michelle J. Summar, Emily A. Hurley

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Children in food-insecure families face increased barriers to meeting recommendations for fruit and vegetable consumption. Hospitals and pediatric healthcare institutions have attempted to alleviate food-insecurity through various internal programs like food prescriptions, yet little evidence for these programs exist. Consistent with a patient-centered perspective, we sought to develop a comprehensive understanding of barriers to fruit and vegetable consumption and a parent-driven agenda for healthcare system action.

METHODS: We conducted six qualitative focus group discussions (four in English, two in Spanish) with 29 parents and caregivers of patients who had screened positive for food-insecurity during visits to a large pediatric …