BackgroundFruit and vegetable consumption reduces chronic disease risk, yet the majority of Americans consume fewer than recommended. Inadequate access to fruits and vegetables is increasingly recognized as a significant contributor to low consumption of healthy foods. Emerging evidence shows the effectiveness of community gardens in increasing access to, and consumption of, fruits and vegetables.MethodsTwo complementary studies explored the association of community garden participation and fruit and vegetable consumption in rural communities in Missouri. The first was with a convenience sample of participants in a rural community garden intervention who completed self-administered surveys. The second was a population-based survey conducted with a random sample of 1,000 residents in the intervention catchment area.ResultsParticipation in a community garden was associated with higher fruit and vegetable consumption. The first study found that individuals who worked in a community garden at least once a week were more likely to report eating fruits and vegetables because of their community garden work (X2 (125) = 7.78, p = .0088). Population-based survey results show that 5% of rural residents reported participating in a community garden. Those who reported community garden participation were more likely to report eating fruits 2 or more times per day and vegetables 3 or more times per day than those who did not report community garden participation, even after adjusting for covariates (Odds Ratio [OR] = 2.76, 95% Confidence Interval [CI] = 1.35 to 5.65).ConclusionThese complementary studies provide evidence that community gardens are a promising strategy for promoting fruit and vegetable consumption in rural communities.

Introduction A better understanding of mis-implementation in public health (ending effective programs and policies or continuing ineffective ones) may provide important information for decision makers. The purpose of this study is to describe the frequency and patterns in mis-implementation of programs in state and local health departments in the U.S. Methods A cross-sectional study of 944 public health practitioners was conducted. The sample included state (n=277) and local health department employees (n=398) and key partners from other agencies (n=269). Data were collected from October 2013 through June 2014 (analyzed in May through October 2014). Online survey questions focused on ending programs that should continue, continuing programs that should end, and reasons for endings. Results Among state health department employees, 36.5% reported that programs often or always end that should have continued, compared with 42.0% of respondents in local health departments and 38.3% of respondents working in other agencies. In contrast to ending programs that should have continued, 24.7% of state respondents reported programs often or always continuing when they should have ended, compared to 29.4% for local health departments and 25% of respondents working in other agencies. Certain reasons for program endings differed at the state versus local level (e.g., policy support, support from agency leadership), suggesting that actions to address mis-implementation are likely to vary. Conclusions The current data suggest a need to focus on mis-implementation in public health practice in order to make the best use of scarce resources.

Context The prevalence of obesity has risen sharply in the United States in the past few decades. Etiologic links between obesity and substance use disorders have been hypothesized. Objective To determine whether familial risk for alcohol dependence predicts obesity, and whether any such association became stronger between the early 1990s and early 2000s. Design Repeated cross-sectional surveys; analyses of the National Longitudinal Alcohol Epidemiologic Survey (1991–92) and the National Epidemiologic Survey on Alcohol and Related Conditions (2001–02) were conducted. Setting The non-institutionalized, adult population of the U.S. in 1991–92 and 2001–02. Participants Individuals drawn from population-based, multi-stage, random samples (N=39,312 and 39,625). Main Outcome Measures Obesity, defined as a body mass index >= 30 based on self-reported height and weight, and predicted from family history of alcoholism and/or problem drinking. Results In 2001–02, women with a family-history of alcoholism, operationalized as having biological parent or sibling with a history of alcoholism or alcohol problems, had 49% higher odds for obesity than those without a family history (OR=1.48, 95 % CI: 1.36, 1.61; p<0.0001), a highly significant increase (p<0.0001) from the odds ratio of 1.06 (95% CI: 0.97, 1.16) estimated for 1991–92. For men in 2001–02, the association was significant (OR=1.26; 95% CI: 1.14–1.38, p<0.0001), but not as strong as for women. Both the association and the secular trend for women were robust to adjustment for covariates, including sociodemographic variables smoking, alcohol use, alcohol/drug dependence, and major depression. Similar trends were observed for men, but did not meet statistical significance criteria after adjustment for covariates. Conclusion The results provide epidemiologic support for a link between familial alcoholism risk and obesity for women, and possibly for men. This link has emerged in recent years, and may result from an interaction between a changing food environment and predisposition to alcoholism and related disorders.

Background Prior to the establishment of the uniform drinking age of 21 in the United States, many states permitted legal purchase of alcohol at younger ages. Lower drinking ages were associated with several adverse outcomes, including elevated rates of suicide and homicide among youth. The objective of this study is to examine whether individuals who were legally permitted to drink prior to age 21 remained at elevated risk in adulthood. Methods Analysis of data from the U.S. Multiple Cause of Death files, 1990–2004, combined with data on the living population from the U.S. Census and American Community Survey. The assembled data contained records on over 200,000 suicides and 130,000 homicides for individuals born between 1949 and 1972, the years during which the drinking age was in flux. Logistic regression models were used to evaluate whether adults who were legally permitted to drink prior to age 21 were at elevated risk for death by these causes. A quasi-experimental analytical approach was employed which incorporated state and birth year fixed effects to account for unobserved covariates associated with policy exposure. Results In the population as a whole, we found no association between minimum drinking age and homicide or suicide. However, significant policy-by-sex interactions were observed for both outcomes, such that women exposed to permissive drinking age laws were at higher risk for both suicide (OR=1.12; 95% CI 1.05, 1.18, p=0.0003) and homicide (OR=1.15; 95% CI 1.04, 1.25; p=0.0028). Effect sizes were stronger for the portion of the cohort born after 1960, whereas no significant effects were observed for women born prior to 1960. Conclusions Lower drinking ages may result in persistent elevated risk for suicide and homicide among women born after 1960. The national drinking age of 21 may be preventing about 600 suicides and 600 homicides annually.

BackgroundRural residents are less likely than urban and suburban residents to meet recommendations for nutrition and physical activity. Interventions at the environmental and policy level create environments that support healthy eating and physical activity.Community ContextHealthier Missouri Communities (Healthier MO) is a community-based research project conducted by the Prevention Research Center in St. Louis with community partners from 12 counties in rural southeast Missouri. We created a regional partnership to leverage resources and enhance environmental and policy interventions to improve nutrition and physical activity in rural southeast Missouri.MethodsPartners were engaged in a participatory action planning process that included prioritizing, implementing, and evaluating promising evidence-based interventions to promote nutrition and physical activity. Group interviews were conducted with Healthier MO community partners post intervention to evaluate resource sharing and sustainability efforts of the regional partnership.OutcomeCommunity partners identified the benefits and challenges of resource sharing within the regional partnership as well as the opportunities and threats to long-term partnership sustainability. The partners noted that the regional participatory process was difficult, but the benefits outweighed the challenges.InterpretationRegional rural partnerships may be an effective way to leverage relationships to increase the capacity of rural communities to implement environmental and policy interventions to promote nutrition and physical activity.