Christine E Blake

• PhD, RD
• Professor (Associate) at University of South Carolina

Agrifood systems in South Asia are highly productive, but substantial challenges including poverty, climate change, and environmental degradation complicate progress toward achieving sustainable healthy diets for all. The dynamics of food systems and the consequence of their rapid transformation for food choice behaviors that contribute to healthy...

The healthfulness of diets in South Asia is limited by socio-economic and public infrastructure challenges. Perceptions about food such as availability, accessibility, desirability, and convenience can impact food choice and ultimately diets. However, there are limited tools to understand consumers perceptions of these factors and if perceptions re...

Assessing behaviors related to food choice at individual- and household-levels is essential for improving household diets, but assessment tools are limited. We conducted a systematic review to identify gaps in existing assessment tools for food acquisition, preparation, and household consumption practices in South Asia, wherein diets are rapidly ch...

In Liberia, children are exposed to multiple forms of adversity which can negatively impact their health and development. Research is needed to examine the feasibility and benefits of integrated interventions that can be incorporated into existing health delivery programs to simultaneously address low responsive stimulation, undernutrition, and inf...

Patients with Ulcerative Colitis (UC) seek a variety of methods to manage the physical and psychosocial burdens of illness on daily life. This study examines how individuals with UC: (1) utilize treatment and self-management methods and (2) make decisions regarding their use of these methods throughout the disease course. Adults living with UC ≥5 y...

Understanding the drivers of improvements in child undernutrition at only the national level can mask subnational differences. This paper aimed to understand the contributions of factors in the enabling environment to observed differences in stunting reduction between districts in Rwanda. In 2017, we conducted 58 semi‐structured interviews with mid...

Livelihoods have changed dramatically over the past decade in low- and middle-income countries (LMIC). These shifts are happening in tandem with shifts in individual and household food choice behaviors. This scoping review aimed to identify and characterize mechanisms through which livelihood changes could affect food choice behaviors in LMIC, incl...

BACKGROUND Living with Ulcerative Colitis (UC) is accompanied by physical and psychosocial burdens that significantly detract from quality of life. To accommodate, individuals employ multiple treatment and management methods to mitigate gastrointestinal (GI) disease symptoms, reduce pharmaceutical dependence, and respond to the daily challenges of...

This brief identifies important constructs for assessing drivers of food choice behaviors and describes progress on the development of a repository of instruments and measures for assessing these constructs. OBJECTIVES 1. List constructs that can be assessed to understand drivers of household and individual food choice behaviors. 2. Identify inst...

Background Nongovernment food assistance is typically provided to families by faith-based organizations, schools, and food banks. Community organizations appear to be strongly committed to these programs, but little is known about the basis for this commitment. Objectives The aim of this study was to examine the values and identities of community...

Background Individuals with ulcerative colitis (UC) seek complementary treatment methods, including diet and physical activity, to manage the burden of living with UC. This study examined associations between diet-associated inflammation, physical activity (PA), and UC-related health outcomes. Methods Data were obtained from 2052 IBD Partners e-co...

This study aimed to understand the strategies elementary-school-aged children used to influence mothers' food purchasing decisions. Semi-structured qualitative interviews were conducted with 40 children aged 6-11 years and their mothers living in South Carolina. Strategies to influence mothers' food purchases were collected from children and their...

Increased access to a variety of foods in low-and-middle-income countries (LMICs) has led to greater autonomy in food choice decision-making. Autonomy allows individuals to make decisions through negotiation of considerations in ways that are consistent with basic values. The aim of this study was to identify and describe how basic human values dri...

What, how and why people eat has long been understood to be important for human health, but until recently, has not been recognised as an essential facet of climate change and its effects on planetary health. The global climate change and diet-related health crises occurring are connected to food systems, food environments and consumer food choices...

Background Consumption of unsafe foods increases morbidity and mortality and is currently an issue, particularly in low- and middle-income countries. Policy actions to ensure food safety are dominated by mitigation of biological and chemical hazards through supply-side risk management, lessening the degree to which consumer perspectives of food saf...

Dramatic changes in daily life are leading to increased rates of obesity and non-communicable diseases (NCD) in Kenya, including among children. Parenting plays a vital role in helping children establish healthy eating habits to prevent obesity and NCDs. The objective of this study was to describe parenting identity and how attributes of parenting...

Alternative caregivers (i.e., someone besides the primary caregiver who also takes care of children) make food choices for children. This study investigated what alternative caregivers consider when making food choices for children and their perspectives on their role in making food choices to feed children. In-depth interviews were conducted with...

Background In homestead food production (HFP) programs, village model farmers (VMFs), after training, implement agriculture and nutrition activities to improve household knowledge and practices. Little evidence exists on what enables VMFs to remain actively engaged and for impacts to be sustained. Objective To examine variables explaining active e...

Objectives To identify and describe how values drive food choice of vulnerable consumers in two East African countries, Kenya and Tanzania. Methods Secondary data analysis was conducted on focus group discussions from studies in Kenya and Tanzania. A codebook was developed based on Schwartz's theory of basic human values. A priori coding was condu...

Objectives: Concerns about unsafe food influence food choice and consumption of unsafe foods increase morbidity and mortality, particularly in low- and middle-income countries. Addressing unsafe food is dominated by mitigation of biological and chemical hazards through supply-side risk management, with less emphasis on individuals’ experiences and...

We commissioned the Centre for Food Policy at City, University of London and collaborative partners to carry out a Rapid Evidence Assessment (REA) on UK citizen perceptions of food sustainability. Overview The main research question addressed is: What does sustainability mean to UK citizens when it comes to food and diet? The report addresses the...

Over the last two decades, many African countries have undergone dietary and nutrition transitions fueled by globalization, rapid urbanization and development. These changes have altered African food environments and subsequently, dietary behaviors, including food acquisition and consumption. Dietary patterns associated with the nutrition transitio...

Over the last two decades, many African countries have undergone dietary and nutrition transitions fueled by globalization, rapid urbanization and development. These changes have altered African food environments and subsequently, dietary behaviors, including food acquisition and consumption. Dietary patterns associated with the nutrition transitio...

Sustainability is important for food nutrition security policies (FNSP) that require long-term processes for impact. We examined how country policy actors understand sustainability of FNSP after 7 years of adoption by using qualitative grounded-theory methods in Guatemala, sampling purposefully 52 policy actors for interviews and 39 policy document...

Understanding how countries improve children’s nutrition can inform policies and contribute to further improvements. We examined the relationship between improvements in nutrition in Rwanda (1992–2017) and political commitment to- and policy coherence in- nutrition. We reviewed nutrition-relevant Rwandan policies and programs (2000–2018) and conduc...

INTRODUCTION Individuals diagnosed with Ulcerative Colitis (UC) often seek complementary lifestyle methods, such as diet and physical activity, to self-manage disease symptoms and respond to the psychosocial challenges of living with chronic illness. The Energy Adjusted Dietary Inflammatory Index (E-DIITM) measures the inflammatory potential of one...

Multiple recent global nutrition initiatives have recommended actions to transform food systems to improve food environments and food choice. This study aimed to identify actions recommended by these initiatives and understand their similarities and differences. Twelve global nutrition initiatives were reviewed, collectively spanning 13 action them...

Food choice for children has important implications in establishing early‐life dietary habits and preferences. Food choice for children has been studied as parent–child dyad dynamics, but little is known about the extended system of relationships in maternal food choice for children. The objective of this study was to understand the functions of mo...

Food systems in many countries are experiencing a shift from traditional foods toward processed foods high in sugar, fat and salt, but low in dietary fiber and micronutrients. There is an urgent need to better understand drivers of changing food behavior, particularly for lower-income countries. This study analyzes drivers of food choice among chil...

Objective: Snacking among preschool aged children is nearly universal and has been associated with overconsumed nutrients, particularly solid fats and added sugars (SoFAS). This research examined caregivers' schemas, or cognitive frameworks, for offering snacks to preschool-aged children. Methods: A qualitative design utilizing card sort methods...

Shame experienced with food insecurity and participating in food assistance may affect adolescents. We investigated adolescents’ experiences of shame related to food insecurity and situations for these experiences in an ethnically diverse sample of 40 adolescents aged 9–15 years from South Carolina and Oregon. In-depth interviews were recorded, tra...

Objectives Adolescents are vulnerable to diet-related health risks as they experience major life changes alongside food environment changes. In Ghana, non-communicable diseases (NCDs) are rising, and there is a need to understand what, how and why adolescents eat the way they do. This study explored perspectives of adolescents about healthy and unh...

Objectives Addressing the double burden of malnutrition in many low- and middle-income countries through double duty strategies requires understanding of how stakeholder framing influences nutrition agenda-setting at the subnational level where policies are translated to address local context. We aimed to identify differences in frames of undernutr...

Objectives This research investigated the experience of household food insecurity among Syrian refugees resettled in the US using the lens of family resilience. The objectives were to understand how refugee families create resilience to food insecurity in the US, how they construct the meaning of food insecurity as a source of stress in comparison...

Objectives This work aimed to understand what alternative caregivers value in making food choices for children and the perspectives of alternative caregivers on their role in making food choices to feed children. Methods This qualitative study was conducted in low-income semi-urban and urban communities of the State of Mexico, Mexico. Primary care...

Objectives Current efforts to address food safety through supply-side risk management consider food safety primarily in terms of biological and chemical hazards, ignoring the importance of individuals’ experiences and perspectives. This study aimed to understand how experiences and perspectives of food safety influence food choice in low- and middl...

Objectives To understand how actions that link food environment and food choice, recommended by global nutrition initiatives, seek to promote sustainable healthy diets. Methods We reviewed recommended actions addressing food environments and food choice by global nutrition initiatives published between 2015 and 2020. Internal debriefing, expert so...

Strategies to engage stakeholders increase the relevance of multisectoral nutrition research but are challenging to embed within research programs. Drawing from fifteen food choice studies, the aim of this study was to understand the diversity of strategies that researchers used in engaging with stakeholders to synthesize lessons learned from their...

This study aimed to determine if the Turner et al. (2018) framework allows researchers to identify and study relationships between food environments and individual food choice in diverse contexts and if updates to the framework are warranted. We mapped evidence from 15 drivers of food choice projects to the framework, using thematic analysis to ide...

Objective: Type 2 Diabetes Mellitus (T2DM) is a complicated disease that disproportionately affects African American men. Understanding the experiences of African American men living with T2DM is important for developing effective, culturally sensitive interventions. The purpose of this study was to describe how African American men view their T2DM...

Background Women's intrahousehold bargaining power is an important determinant of child nutrition in Nepal, but a better understanding is needed on how men's bargaining power is related to child nutrition. Objectives We examined the relation of women's and men's household bargaining power with child height-for-age z score (HAZ). Methods We analyz...

The world's food systems and environments have been changing dramatically, concomitant with changes in over- and undernutrition. We elaborate the science of food choice to better understand, analyze, and respond to relationships between changing food environments and food choice. The science of food choice is concerned with generating knowledge abo...

Context Faith-based health interventions may improve obesity-related health behaviors, including healthy eating and physical activity. However, the generalizability of results and comprehensiveness of reporting for critical design elements sufficient for large-scale implementation and broad public health impact are unclear. This review assesses the...

Background Presidents with no possibility of reelection overvalue far-future rewards and succumb to terminal logic behavior (TLB), responding to end-of-tenure legacy concerns despite political context. Government authorities perceiving the outgoing government is losing power at the end of term behave under the logic of strategic defection (SD), dis...

Aim: To examine the change in the Patient Activation Measure and physical and psychosocial outcome measures in a military interdisciplinary intensive outpatient program for persistent pain. Materials & methods: Pre- and post-intervention measures, which were also stratified by gender and baseline activation, included patient-reported outcomes and p...

In this study, we intervened in elementary schools on lunch entrée selection using some of the behavioral economic methods shown to be effective in earlier food choice studies. Unlike many earlier behavioral interventions, which were mostly done in controlled environments and smaller café type settings for one-off interactions, we conducted our int...

Objectives To understand the role of mothers’ social networks in the food choices that mothers make for their children ages 1 to 5 years old in rural Mexico. Methods In-depth interviews were conducted with 46 participants from 3 rural communities between November and December 2016. The interviews inquired about participants’ child-feeding practice...

Objectives This study aimed to understand the values held by elementary school children in constructing food choices and the strategies they used to influence their mothers’ food purchasing decisions. Methods Semi-structured qualitative interviews were conducted with 40 elementary school children (aged 6–11 years) and their mothers living in South...

Objectives This intervention targeted change in gender norms and behaviors regarding co-responsibility in the household and self-care among food-insecure women with excess weight. The objectives of this study were to determine what and how changes occurred in perceived gender norms, attitudes, intentions, and behaviors of women and their family and...

Objectives This study drew upon experiences of stakeholder engagement in food choice research to advance knowledge about best practices. Methods The Drivers of Food Choice Competitive Grants Program aimed to understand food choice in low- and middle-income-countries. All funded proposals included stakeholder engagement strategies. Data were from d...

Background and Objective: People with mobility impairments face increased barriers to physical activity. The study aimed to understand the lived experiences of individuals with disability who are regular participants in the Yoga for Everyone class to inform future research, intervention and community programs. Methods: A phenomenological qualitativ...

Stressful life changes may tax people’s adaptive capacity. We sought to determine if and when experiences of stressful life changes were associated with increased odds of adverse nutrition-related health outcomes among US Army soldiers relative to those who did not experience the same stressful life change. An additional aim was to determine which...

Background: Food insecurity (FI) is associated with poor health, suboptimal nutrition, and disadvantaged linguistic, social, and academic development for children. Given the prominent role that parents play in children's development, FI may be associated with parenting practices. Objectives: We aimed to understand how FI and its change over time...

Introduction: The coexistence of food insecurity and excess body weight has been well documented in women. Both food insecurity and excess body weight have multiple consequences for physical and mental health. Concerns have been raised about interventions aimed to reduce food insecurity because these interventions might contribute to excess body w...

Background Patients with Ulcerative Colitis (UC) experience a range of gastrointestinal and extraintestinal symptoms that generate a significant burden on daily life. For the majority of individuals with UC, pharmacotherapy is insufficient to maintain a ‘normal’ lifestyle. Many of those diagnosed with UC seek out complementary or alternative treatm...

Obesity remains a prevalent public health epidemic, and African American (AA) adults are disproportionately affected by obesity more than any other ethnic group, particularly in the Southern region of the United States. Addressing poor dietary habits is important for improving obesity rates among AAs, but there has been limited research that has fo...

Objectives Social environmental influences on pregnancy-related practices and outcomes have been studied, yet few studies explore these influences qualitatively from the perspectives of women’s personal social networks and the larger social networks that exist within their communities. This study sought to understand and describe the social environ...

Cultural frames, or myths we use to communicate, shape how we understand social problems, such as child hunger. In 48 interviews, we identified metaphors and myths, such as “the poor will always be with you,” “meat product,” and “butterfly effects” that point to cultural frames of child hunger. Three different frames were identified – the welfare s...

Objective: There have been a number of soul food restaurants serving exclusively vegan meals opening up across the country to appeal to African Americans and others interested in eating healthier soul foods. This study determined the number of restaurants serving vegan soul foods in the South and identified the locations of these restaurants in ord...

Objective: To examine church leaders' views on the role of faith-based organizations in promoting healthy eating and physical activity in children. Design: Qualitative research using semi-structured in-depth interviews. Setting: South Carolina. Participants: Leaders (n = 26) from United Methodist churches (n = 20). Phenomenon of interest:...

Women's intra‐household bargaining power is an important determinant of child nutritional status, but there is limited evidence on how it relates to infant and young child feeding (IYCF) practices. We conducted a cross‐sectional analysis using 2012 baseline data from the impact evaluation of Suaahara, a multi‐sectoral program in Nepal, focusing on...

Plant-based diets are associated with numerous health benefits, but there has been limited work that focuses on diverse populations. The purpose of this study was to determine if encouraging a sample of African American adults, located in the Southern United States, to dine out at local vegan soul food restaurants helped to decrease perceived barri...

Background: Regular family meals foster healthy physical and social development of children but often occur less frequently in households experiencing food insecurity. How food insecurity influences the quality of these interactions is not understood well. Objective: To better understand family meal experiences of caregivers and children living...

Objective To examine the association between parenting styles and overall child dietary quality within households that are low-income and food-insecure. Design Child dietary intake was measured via a 24 h dietary recall. Dietary quality was assessed using the Healthy Eating Index-2005 (HEI-2005). Parenting styles were measured and scored using the...

Objectives: This study aimed to understand how parents made food purchasing decisions for their elementary-school-aged children and how they adjudicated among different values to make a purchasing decision. Methods: Semi-structured qualitative interviews were conducted with 40 parents from low-and middle-income families in South Carolina who wer...

Objectives: Understand the association of food and general parenting practices with young children's dietary behaviors and the role of child difficulty in self-regulation in this relationship. Methods: Data were from the Early Childhood Longitudinal Study - Birth Cohort. Parent-child dyads with non-missing outcomes at age 5 (i.e., weekly frequen...

Objectives: To understand how mothers' interpersonal relationships influence food choice decisions they make to feed children ages 1 to <5 years old in rural Mexico. Methods: Semi-structured interviews were conducted with 46 mothers from 3 rural communities in Mexico in November and December 2016. Mothers were asked about their daily activities,...

Objectives: This study aimed to develop, implement, and evaluate an intervention to simultaneously reduce food insecurity and body weight. We hypothesized that, when compared with the non-intensive arm, women in the intensive intervention arm would reduce food insecurity and body weight and improve social support for healthy eating, psychological...

Objectives: This prospective cohort study aimed to determine if experiencing stressful life changes were associated with an earlier onset of adverse nutrition-related health outcomes among US Army Soldiers. An additional aim was to determine which stressful life changes were most associated with these outcomes and if there were gender differences...

Objectives: In low- and middle-income countries, non-communicable disease (NCD) prevalence is increasing while undernutrition persists, resulting in a double-burden of malnutrition. How policy actors frame malnutrition may shape policy, programming, and investment. In India, where NCDs are rising rapidly and undernutrition persists throughout the...

Background Inflammatory Bowel Disease (IBD) is becoming a global health issue as incidence rates are rising throughout the world. The two most common inflammatory bowel diseases are Crohn’s Disease (CD) and Ulcerative Colitis (UC). The main goal of medical treatment for IBD is to reduce symptoms and induce a state of remission by regulating the imm...

The South Korean government has banned sales of unhealthy foods in school stores since 2009; however, most school stores still sell restricted foods. This study aimed to understand the implementation processes and the reasons for incomplete implementation of the school nutrition policy in South Korea. Semi-structured interviews were conducted with...

Developing countries with democratic governments periodically experience presidential transitions that affect political and institutional performance. Unforeseen uncertainties during transitions are not faced strategically and interrupt collaboration among country teams expected to jointly implement policies, including policies intended to contribu...

Establishing the shape and determinants of trajectories of body mass index (BMI) among Soldiers is critical given the importance of weight management to military service requirements. To establish the shape and determinants of BMI trajectories among Soldiers, we aimed to (1) model the overall BMI trajectory of Soldiers, (2) find the most common tra...