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Although consumption of fruits and vegetables is associated with reduced risk of disease, many Americans do not eat the recommended quantity or variety. This is especially true for low-income populations, who may face significant barriers to accessing fresh produce, including cost. Community-supported agriculture (CSA) Partnerships for Health is a subsidized community-supported agriculture program designed to reduce barriers to accessing fresh produce in a low-income population. This Photovoice study gave participants ( n = 28) an opportunity to take photos representing how the program affects their lives. The aim was to understand the program’s impact from the perspective of CSA members. Participants had 2 to 4 weeks to take photographs, and then selected a few to discuss during a subsequent focus group. Through this discussion, we learned that participants see the program as (a) supporting positive changes to their physical and social health and (b) facilitating learning about new foods, cooking, and agriculture. The study suggests that a reduced-cost CSA membership that incorporates cooking education supports participants’ ability to try new foods, build skills, and improve health outcomes.

Empirical evidence describes the negative outcomes people with mental health disorders experience due to societal stigma. The aim of this study was to examine the role of gender and rural-urban living in perceptions about mental illness. Participants completed the Day’s Mental Illness Stigma Scale, a nationally validated instrument for measuring stigma. Directors of Chambers of Commerce in North Dakota distributed the electronic survey to their members. Additionally, distribution occurred through use of social media and other snowball sampling approaches. Analysis of data gathered from 749 participants occurred through examination of the difference in perceptions based on geography and gender. The zip codes of residence were sorted to distinguish between rural and urban participants. Application of weighting measures ensured closer alignment with the general population characteristics. Findings indicate that for the majority of the seven stigma measures the Day’s Mental Illness Stigma Scale examines, the coefficient of rural–gender interactions was positive and highly significant with higher levels of stigma in rural areas. Females exhibited lower stigma perceptions than males. However, women living in rural areas held higher degrees of stigma compared to urban residing females. Implications of the study include the need to advance mental health literacy campaigns for males and people residing in rural communities. Additional empirical studies that examine the role of geography and gender in understanding stigma toward people with mental health disorders will result in improved treatment outcomes due to increased and focused educational efforts.

Background. Time insufficiency is frequently cited as a reason for poor dietary habits. This does not adequately explain the variations in how time is perceived as a factor in healthy eating. Aims. This study placed the eating behaviors of rural Australian women within the contexts of their stories to understand the factors that influenced healthy eating and how rural communities could enhance their health and well-being. Method. A three-phase sequential multimode narrative inquiry was used within four communities in rural Queensland, Australia. Each phase used a different mode of data collection: photo elicitation focus groups, narrative interviews, participatory workshops. Data were thematically analyzed iteratively to inform subsequent phases. Results. Nine final themes were identified. This article explored the theme of time and two contrasting perceptions of time sufficiency regarding healthy eating within a rural context during a drought. Discussion. Exploration of “time as a commodity” and “time as a duty” allowed a deeper understanding of time as a social and environmental determinant of health. Conclusion. Time’s influence on healthy eating is much more than the minutes it takes to prepare a meal. To fully appreciate its impact, time should be considered as a social and environmental determinant of health.

School enrollment, mobility, and occupation are each important factors to consider when examining HIV (human immunodeficiency virus) infection risk among youth in sub-Saharan Africa. Through an analysis of narrative life histories from 30 HIV-positive and 30 HIV-negative youth (aged 15-24 years), matched on gender, age, and village and purposively selected and interviewed from the Rakai Community Cohort Study, this article shows the complex connection between leaving school, mobility, and occupation with implications for HIV risk. We identified a pattern of risk factors that was present in many more HIV-positive than HIV-negative youth life stories. These HIV-positive youth shared a similar pathway during their transition to adulthood: After leaving school, they moved in search of occupations; they then engaged in risky occupations before eventually returning to their home village. Linking the lines of inquiry on school enrollment, mobility, and risky occupations, our findings have important implications for adolescent health research, practice, and policy in Uganda and across sub-Saharan Africa and the developing world.

Rural incarcerated women have an increased risk of acquiring the human immunodeficiency virus (HIV) and the hepatitis C virus (HCV) due to prevalent engagement in drug use and sexual behaviors. Limited research has investigated HIV and HCV knowledge in this high-risk population. Furthermore, the interplay of sociodemographic factors (i.e., education, age, income, and sexual orientation) and risky behavior is understudied in this population. The present study evaluated a sample of adult, predominately White women from rural Kentucky ( n = 387) who were recruited from local jails. The sample had high HIV and HCV knowledge but also reported extensive risk behaviors including 44% engaging in sex work and 75.5% reporting a history of drug injection. The results of multiple regression analysis for risky sexual behavior indicated that sexual minority women and those with less HIV knowledge were more likely to engage in high-risk sexual behaviors. The regression model identifying the significant correlates of risky drug behavior indicated that HIV knowledge, age, and income were negative correlates and that sexual minority women were more likely to engage in high-risk drug use. When HCV knowledge was added to the regression models already including HIV knowledge, the interaction was significant for drug risk. Interventions for rural imprisoned women should consider the varied impact of sociodemographic background and prioritize HIV education to more effectively deter risky sexual and drug behaviors.

Background. Childhood obesity is a significant but largely modifiable health risk, disproportionately affecting socioeconomically disadvantaged, racial/ethnic minority, and rural children. Elementary school–aged children typically experience the greatest increases in excess weight gain and therefore are important targets for reducing adolescent and adult obesity while improving children’s health. Our study evaluated outcomes of a 3-year elementary school–based program for reducing obesity in American Indian and White students attending eight rural schools in the U.S. upper Midwest. Method. Researchers measured body mass indexes (BMI) and other health indicators and behaviors of 308 beginning third-grade students and then again at the end of students’ third, fourth, and fifth grades. The primary focus of this study is a mixed multilevel longitudinal model testing changes in age- and gender-adjusted BMI z scores ( zBMI). Results. There was a significant decrease in zBMI across the 3-year study period. Ethnicity analyses showed that White students had overall decreases in zBMI whereas American Indian students’ zBMIs remained stable across the program. Comparisons with children from an age- and cohort-matched national sample provided support for the effectiveness of the school program in reducing BMI and obesity during the study period. Conclusion. An elementary school–based health program that addresses a range of students’ obesity-related health behaviors, the school health environment, and that involves educators and parents is an effective intervention for reducing or stabilizing BMI in rural White and American Indian students. School health programs for students living in rural communities may be especially effective due to greater school and community cohesiveness, and valuing of the school’s primary role in improving community health.

Reproductive health indicators in Nigeria remain among the poorest in the world. Modern contraceptive prevalence rate has remained practically at the same level since 2003. Whereas contraceptive use is higher in urban compared with rural areas, the majority of urban women are not using a modern contraceptive method. Low contraceptive use in the country results from unfavorable ideational variables, including knowledge, values, beliefs, and norms. Ideational segmentation allows program planners to identify groups that are homogenous with respect to ideational variables and which have similar informational and skills strengthening needs. In this study, we conducted latent class analyses with longitudinal data collected from a sample of women in 2010/2011 and 2014 to identify distinct ideational segments among women of reproductive age in six Nigerian cities at the two points in time. The analysis revealed three ideational segments at baseline: (a) Inefficacious, misinformed and unsupported, labeled “Disempowered,” 58.8%; (b) Efficacious, misinformed, and unsupported, labeled “Unsupported,” 31.8%; and (c) efficacious, supported but misinformed, labeled “Skeptics, 9.4%. These groups differ in terms of sociodemographic characteristics and contraceptive use and intention to use. At endline, four ideational segments were identified: (a) Inefficacious, misinformed and unsupported, labeled “Disempowered,” 28.9%; (b) Efficacious, supported but misinformed, labeled “Skeptics,” 28.5%; (c) Efficacious, informed but unsupported, labeled “Unsupported,” 27.0%; and (d) efficacious, informed and supported, labeled “Empowered,” 15.6%. Exposure to Nigerian Urban Reproductive Health Initiative communication interventions was one of the most significant predictors of improvements in ideational characteristics over time. Messages tailored to the informational needs of the various ideational segments and that address their worldview are needed to increase contraceptive use.

Background. The Healthy, Hunger-Free Kids Act of 2010 authorizes the U.S. Department of Agriculture (USDA) to establish nutritional standards for all foods sold in schools participating in federally funded meal programs. These foods, known as competitive foods, are commonly found in school cafeterias, vending machines, fundraisers, and snack bars and are associated with unhealthy dietary patterns. However, little is known about the regulatory process and opportunities for public participation to improve school food. Aims. This study investigates public commentary on the USDA’s proposed rules governing competitive foods in schools. Methods. On February 8, 2013, the USDA’s Food and Nutrition Service solicited public comments via Regulations.gov. A corpus of 247,871 public comments was obtained. Duplicate and near-duplicate comments were removed resulting in 3,032 unique comments. Two researchers content analyzed 10% of the sample, removing nonrelevant comments ( n = 249). Results. A majority of commenters are women, and mention their affiliation. Comments tend to be short, and exhibit low levels of complexity. An overwhelming majority of comments expressed concerns about the public health of youth vis-à-vis the new rule, whereas a small but vocal minority opposed the rule for financial and labor reasons and/or opposition to further government regulation. Discussion. Commentary on proposed rules should be specific, avoiding off-topic remarks. Commenters should be strategic, include their credentials, and provide a rationale for their position. Conclusion. The rules governing competitive foods are poised to reverse the childhood obesity epidemic, and public commentary may shape these rules.

Background. Family homes are a key setting for developing lifelong eating and physical activity habits, yet little is known about how family home nutrition and physical activity (FNPA) environments influence food insecurity (FI) and childhood obesity, particularly in rural settings. Aims. This study examined associations among FNPA, FI, and body mass index (BMI) in rural children. Method. Parents of 186 elementary school–age children completed FNPA and FI surveys. Child anthropometrics were directly measured. Logistic and linear regressions were used to examine associations. Results. Approximately 37% of children were overweight/obese; 43% of families were at risk for FI. Children whose families limited watching TV while eating were less likely to be obese (odds ratio [OR] = 0.56, p = .03) as were children whose families monitored intake of chips, cookies, and candy (OR = 0.54, p = .01). FI was higher in obese than normal weight children (OR = 11.00, p = .003) but only among families not eligible to receive free/reduced-cost school meals. Among eligible families, lower odds of FI were found for those who ate meals together often (OR = 0.31, p = .04) and for those with children frequently enrolled in organized sports/activities (OR = 0.65, p = .04). Findings were not significant after adjusting for multiple comparisons. Discussion. Results suggest that favorable FNPA factors were associated with healthier BMI and lower odds of FI. Conclusion. Opportunities for healthy eating at home may support rural children’s weight health. Additional resources may be necessary to promote food security among low-income families. Future research is warranted to better understand FNPA in relationship to the disproportionate rates of obesity and FI in rural populations.