{
  "abstract": "To evaluate whether change in food insecurity (ΔFI) mediated the effect of a community health worker (CHW) intervention on physical activity (PA) among food insecure (FI) hypertensive adults, we conducted a secondary analysis of the Healthy Food First randomized clinical trial of food insecure adults with hypertension recruited from 364 North Carolina clinical sites. Participants were randomized to CHW coaching or no coaching within a 2 × 2 × 2 factorial design. FI was measured at baseline and 12 months; total PA (MET-min/week) at 12 and 18 months. Mediation models estimated indirect (ACME), direct (ADE), and total effects (ATE) of CHW assignment on 12-month PA through ΔFI. Generalized estimating equations evaluated repeated PA by CHW assignment. CHW assignment was not associated with PA, and ΔFI did not mediate the relationship. Effects were small (ACME = 16.2; 95% CI -62.6, 121.8; ADE = -214.1; 95% CI -871.7, 484.5; ATE = -197.9; 95% CI -855.6, 500.8 MET-min/week). The proportion mediated was near zero (-8.2%; 95% CI -142%, 124%). GEE analyses similarly showed no association (B = 363.7 MET-min/week; SE = 302.8; P = 0.23). Modest improvements in FI alone may be insufficient to increase PA without additional PA supports. ClinicalTrials.gov Identifier: NCT05048836.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel HIll, North Carolina, USA (R E. A), (C G. V), (L S T), (A S. A).",
    "Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel HIll, North Carolina, USA (R E. A), (L S T).",
    "Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel HIll, North Carolina, USA (S A. B).",
    "Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel HIll, North Carolina, USA (S A. B).",
    "Monell Chemical Senses Center, Philadelphia, Pennsylvania, USA (K S. B).",
    "Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel HIll, North Carolina, USA (C G. V).",
    "Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel HIll, North Carolina, USA (A S. A)."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Robert E Anderson",
      "orcid": "0000-0002-0008-7754"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Seth A Berkowitz"
    },
    {
      "affs": [
        4
      ],
      "name": "Kyle S Burger"
    },
    {
      "affs": [
        0,
        5
      ],
      "name": "Carmina G Valle"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Lindsey Smith Taillie"
    },
    {
      "affs": [
        0,
        6
      ],
      "name": "Alice S Ammerman"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/3etym5qgd1t62.bib",
  "cited_by": 0,
  "doi": "10.1177/15598276261498203",
  "fulltext_url": "https://europepmc.org/articles/PMC13694470",
  "id": "3etym5qgd1t62",
  "issns": [
    "1559-8276",
    "1559-8284"
  ],
  "landing_url": "https://europepmc.org/article/MED/42927090",
  "language": "eng",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "3600|Food Security and Health in Diverse Populations"
    ]
  ],
  "openalex": "W7223372651",
  "pdf_url": "https://europepmc.org/articles/PMC13694470?pdf=render",
  "pmcid": "PMC13694470",
  "pmid": "42927090",
  "published": "2026-10-23",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/3etym5qgd1t62.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:21:18Z",
      "native_id": "MED:42927090",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42927090"
    }
  ],
  "subjects": [],
  "title": "Community Health Worker Coaching, Food Insecurity, and Physical Activity in the Healthy Food First Trial: A Causal Mediation and Longitudinal Analysis.",
  "title_text": "Community Health Worker Coaching, Food Insecurity, and Physical Activity in the Healthy Food First Trial: A Causal Mediation and Longitudinal Analysis.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:21:18Z",
  "url": "https://research.draconitic.com/paper/3etym5qgd1t62",
  "venue": "American journal of lifestyle medicine",
  "versions": []
}