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Abstract Introduction Increases in obesity and other chronic conditions continue to fuel efforts for lifestyle behavior changes. However, many strategies do not address the impact of environment on lifestyle behaviors, particularly healthy dietary intake. This gril explored the perceptions of environment on intake of fruits and vegetables in a cohort of 2, people recruited from 22 family practices in North Montwna. Methods Participants were administered a health and social demographic survey. Formative assessment was conducted on a subsample of 32 people by using focus groups, semistructured individual interviews, community mapping, and photographs.

Survey data were evaluated for means, frequencies, and group differences. Results The 2, participants had a mean age of The 32 subsample participants were older, heavier, and less educated. Some prevalent perceptions about contextual factors related to dietary intake included taste-bud fatigue boredom with commonly eaten foodslife stresses, lack of forethought in meal planning, current health status, economic status, the ability to garden, lifetime dietary exposure, concerns about food safety, contradictory nutrition messages from the media, and variable work schedules.

Conclusion Perceptions about intake of fruits and vegetables intake are influenced by individual intrinsic and community extrinsic environmental factors.

We suggest approaches for influencing behavior and changing perceptions using available resources. Introduction Lifestyle practices of unhealthy diet and physical inactivity are noted determinants of chronic conditions, especially overweight and obesity 1. Nationally, chronic disease statistics document that the southeastern US region manifests some of the highest rates of and the Aff hillsborough writer girl in montana outcomes for chronic disease 2. North Carolina is representative of the southeastern region; its age-adjusted death rates for the 5 diseases that account for almost two-thirds of all annual deaths are higher than the national average 3.

This pattern of statistics is evidence of poor access to health services, poor economic opportunities, unique environmental challenges, and unhealthy lifestyle practices prevalent in this US region 3 - 6. These statistics underscore the prevalence of unhealthy behaviors and chronic conditions in this US region, yet provide little information about the motivations and perceptions of residents relative to these factors. Especially important is the paucity of data on peoples' qualitative descriptions of their Aff hillsborough writer girl in montana behaviors in the context of their environment. This is of particular interest given that lifestyle choices, including those relating to diet, are complex decisions affected by the interaction between people attitudes, thoughts, behaviors, perceptions and their external social and physical environments 7 - 9.

However, because of their systematic structure, surveys have been less able to contextualize individuals' experiences and perceptions and do not facilitate easy assessment of motivational factors and contexts underpinning peoples' behaviors Nonetheless, they have been useful for identifying patterns of behavior and facilitating comparisons of patterns across environments However, interventions based on survey results, primarily individual-focused education strategies, have been limited in effecting behavior change and improving health outcomes Researchers suggest that the absence of corresponding environmental changes may be responsible for this outcome In fact, despite numerous preventive efforts regarding dietary behavior and chronic diseases, obesity and other chronic conditions continue to increase in prevalence.

This change indicates that the mere identification of unhealthy behaviors and development of educational strategies to change them may not be enough. Researchers often state that people's behaviors are contextual and must therefore be understood and addressed within their environment 78911 - Yet, few studies have investigated individuals' perceptions of the relationship between their environment and diet and physical activity behaviors Until recently, no unifying conceptual framework existed to evaluate these relationships. However, a work group of researchers has produced such a framework. The work group summarizes its effort as the beginning phase in clarifying the relationship between the environment and lifestyle behaviors and strongly encourages further inquiries on "the extent of environmental influence and how [environment and lifestyle] affect different individuals" An approach that has proved useful in both identifying and contextualizing lifestyle behaviors is formative research.

This unique multimethod, exploratory approach combines social science techniques such as interviews, focus groups, and other qualitative methods with quantitative methods such as surveys When these techniques are used to gather data for informing research conduct and intervention design, the term formative assessment is used. Formative research has been used primarily by intervention researchers in community-based studies and has guided the development of several interventions 1315 A unique strength of this approach is that it provides the basis for collection of relevant new data to guide research direction, research discourse, and data interpretation 1315 - Drawing on a large study to assess community and social determinants of chronic disease risk and outcomes among North Carolina adults, we used formative research to report specifically on findings relative to fruit and vegetable intake.

Methods Study design and sample description The study proceeded in 2 phases: For the formative assessment, the research protocol included focus groups, semistructured individual interviews, photographs, and cursory community mappings. The NC-FM-RN was initiated in and currently includes a cohort of North Carolina residents previously recruited through a network of 25 family practice settings across the state. Benallack, who died June 2, Sadly missed by his gcand-childron and great grandchiidreii. Her life a beaiittiul memory. A lovihg nature true and kind, A beauLiCui memory left behind.

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