Background Nutrition interventions promoting healthy food choices aim to address health challenges of residents in low-income environments. Research about the effectiveness of nutrition interventions in low-income populations is limited, particularly for those in rural areas. Behavioral economics (BE) strategies demonstrate effectiveness for improving eating behaviors in some settings. However, the efficacy of BE interventions in retail food stores serving low-income populations residing in rural and urban geographies is nascent. Objective This systematic literature review aims to identify and compare nutrition interventions implemented in rural and urban low-income retail food stores, including BE strategies when applied. Methods This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Reviewers searched five databases for peer-reviewed publications from October 2010 to October 2019. Included studies implemented a nutrition intervention in low-income retail food stores and provided a quantitative outcome evaluation with results separated by rural and urban geography. BE interventions were analyzed based on the MINDSPACE framework for behavior change. Results Forty-six separate publications (n ¼ 20 rural, n ¼ 26 urban) in the United States, Canada, Europe, New Zealand, and Australia were included. Researchers independently rated publications as low risk of bias (n ¼ 4), moderate (n ¼ 18), or high risk of bias (n ¼ 24) using the Quality Assessment Tool for Quantitative Studies. Studies (n ¼ 18) demonstrated positive outcomes for customer purchases, store sales, or participant intake of targeted healthy foods. Overall, most effective interventions included point-ofpurchase signage (n ¼ 16) and product placement strategies (n ¼ 4 urban). Rural studies included financial incentives combined with participant education (n ¼ 2) and incorporated culturally appropriate messengers and/or symbols (n ¼ 5) to improve healthy food purchases and intake. Conclusions Improved research quality and tailored evidence-based interventions, including BE strategies, are necessary in retail food environments to promote healthy eating behaviors in low-income populations.

No abstract

Rural surveys tend to oversample easy to reach populations, which can misrepresent community health needs. To achieve baseline data reflective of the communities served by the high obesity program (HOP), an innovative evaluation plan was created to prioritize equity and reflect the whole community. Principles of Community-Based Participatory Research (CBPR) were used to guide instrument development, research protocols, and data collection. A random sample of addresses created with United States Postal Service records provided a representative list of addresses in three HOP counties in Louisiana. Local data collectors were recruited to go door to door at the selected addresses to collect in-person surveys (N = 682; response rate of 84%). Over a quarter of participants reported using the charitable food system and walking for transportation at least weekly. Collecting door to door data in rural communities presents unique challenges, including abandoned properties, inaccurate address records, loose dogs, and at times, racial tensions and houses far removed from public roads. Lessons learned include the importance of local knowledge, adapting protocols to fit local conditions, and community awareness of the survey. Health practitioners need confidence when they are making data-based decisions about interventions, and one way to provide this confidence is to collect data from a true cross-section of the community. With a plan and in partnership with community members, a probability sample is feasible to collect in rural communities.

No abstract

Rural communities are resource-constrained and at higher risk of obesity and obesity-related conditions. Thus, studying self-assessed health status and underlying vulnerabilities is critical to provide insights to the program planners for effective and efficient planning of obesity prevention programs. This study aims to investigate the correlates of self-assessed health status and subsequently determine the obesity vulnerability level of residents in rural communities. Randomly sampled data were obtained from in-person community surveys in three rural Louisiana counties–East Carroll, Saint Helena, and Tensas–in June 2021. The association of social-demographic factors, grocery store choice, and exercise frequency with self-assessed health was investigated using the ordered logit model. An obesity vulnerability index was constructed using the weights obtained from the principal component analysis. The results show that gender, race, education, possession of children, exercise frequency, and grocery store choice significantly influence self-assessed health status. Around 20% of respondents fall into the most-vulnerable segment and 65% of respondents are vulnerable to obesity. The obesity vulnerability index ranged from -4.036 to 4.565, indicating a wide heterogeneity in the vulnerability level of rural residents. The findings show that the self-assessed health status of rural residents is not promising along with a high level of vulnerability to obesity. The findings from this study could serve as a reference in the policy discussion regarding an effective and efficient suite of interventions in rural communities to address obesity and promote well-being.