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EATING GOOD IN THE NEIGHBORHOOD? A QUALITATIVE INVESTIGATION OF
SENIORS LIVING IN PUBLIC HOUSING AND THEIR FOODSCAPE NAVIGATION







By





MELINDA LAROCO BOEHM, M.A.





Submitted in partial fulfillment of the requirements for the degree of

Doctor of Philosophy







Department of Sociology







CASE WESTERN RESERVE UNIVERSITY





May, 2014

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CASE WESTERN RESERVE UNIVERSITY


SCHOOL OF GRADUATE STUDIES




We hereby approve the thesis/dissertation of


Melinda Laroco Boehm, M.A.



candidate for the degree of Sociology *.



Committee Chair


Jessica Kelley-Moore, Ph.D.



Committee Member


Gary T. Deimling, Ph.D.



Committee Member


Brian Gran, Ph.D.



Committee Member


Elaine Borawski, Ph.D.




Date of Defense


January 15, 2014






*We also certify that written approval has been obtained

for any proprietary material contained therein.

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NUTRITION EDUCATION PROGRAMMING & BEHAVIOR CHANGES

In the past twenty years, disadvantaged urban areas have increasingly been

targeted with funded programming designed to increase the health of residents.

These have been sponsored by federal block grants (e.g., USDA); state initiatives e.g,

Ohio Disability and Health Program); and private foundations (e.g., Robert Wood

Johnson). Across these myriad initiatives, we have observed countless strategies

and classifications used by practitioners for categorizing foods into “healthy” and

“unhealthy. ” Despite this substantial investment, evaluation studies have returned

findings of little to no discernable changes in healthy behaviors in these

communities (Glasgow et al. 2003; Grimshaw et al. 2001). In fact, most studies cite

that greater nutrition knowledge has the possibility for change (e.g. Lytle 1994) but

not yet documentable changes in these areas (Noar et al. 2007). The studies that cite

actual behavior change with nutrition knowledge are studies that utilize

customized, individual weight loss interventions (Moredich & Kessler 2013), but

such small-scale intensive intervention is not feasible for large-scale

implementation. Further, some studies have found that programs aimed to increase

nutrition education did little to change short and long-term eating behaviors of

urban residents, due in part because lack of understanding of social and behavioral

factors affecting health in certain areas(e.g. Syme et al. 2000). Many standardized

educational tools used in these studies have been: Determinants of dietary

consumption, Guides to healthy eating, Stages of eating changes, and Nutrient-Dense

Models (www.dietaryguidelines.gov 2010). My research has found that although

the best practices and nutrition curriculum are nutritionally sound and academically

http://www.dietaryguidelines.gov/

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innovative, the information given may still be too technical for residents to

comprehend and incorporate into their daily lives.


NUTRITION KNOWLEDGE VERSUS BEHAVIORAL CHANGE

Individual behavioral change can occur in only a supportive environment with
accessible and affordable healthy food choices and opportunities for regular physical
activity – (The Surgeon General’s Call to Action to Prevent and Decrease Overweight
and Obesity 2001; Burdette & Whitaker 2004: 57).


In any urban area, nutrition education programs are sure to be found in some

capacity. However, discussions abound in the social science and public health fields

on whether behavior change can be achieved with only basic nutrition education, or

whether it should be supplemented with practical applications of nutrition as well

(e.g. healthy cooking, gardening). One study on healthier eating for low-income,

diabetic minorities demonstrated that healthier eating did not give immediate,

tangible results, so participants relied on “common sense” eating instead. Another

study looked at nutrition education in urban public housing and found that despite

the enthusiasm of some participants during nutrition classes, post-intervention

focus group data disclosed less enthusiasm for increases in fruit and vegetable

intake (Shankar et al. 2007). Studies aimed at deciphering nutrition knowledge and

behavior change would benefit from universal, basic nutrition definitions as they

may help to lower the confusion around reliability and validity of future nutrition

and behavior-based studies (e.g. Worsley 2002). Further, changes in behavior can

only occur with resident comprehension and resident willingness to change. One 52

year old female resident acknowledged just how much people in low-income

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