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Background: Despite health benefits to both infants and mothers, many are not breastfeeding as recommended by national guidelines. Prior studies examining the effects of housing insecurity and food insecurity on breastfeeding intention and duration have been limited and yielded mixed findings. Methods: To assess the relationship among housing insecurity, food insecurity, and breastfeeding, we conducted a secondary analysis of a cohort of nulliparous U.S.-born pregnant individuals with a singleton gestation of ≥28 weeks who completed web-based surveys on five occasions over their infant's first year of life. Upon enrollment, we screened participants for housing and food insecurity and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). We examined variations in breastfeeding intentions and practice by housing insecurity and food insecurity, controlling for demographic factors, using multivariable logistic regression. Results: Of 411 participants, 67 (16%) reported housing insecurity, and 48 (12%) reported food insecurity. Participants with housing insecurity were less likely to report exclusive breastfeeding at 6 months (17.9% versus 29.1%, p = 0.06) and significantly less likely to report any breastfeeding at 12 months (34.3% versus 56.9%, p = 0.003) compared to those with secure housing. In both bivariate and multivariable models, housing insecurity was significantly associated with cessation of breastfeeding before 12 months. Food insecurity was not significantly associated with breastfeeding duration or exclusivity. Conclusions: Housing insecurity is associated with and may adversely impact infant feeding, highlighting the need for screening and accessible and affordable family housing, with further investment in food assistance programs such as WIC.

INTRODUCTION: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutrition support for racially and ethnically diverse populations. In 2021, the monthly cash value benefit (CVB) for the purchase of fruits and vegetables increased from $9 to $35 and was later adjusted to $24. This study investigated, by racial and ethnic groups, whether CVB increases were associated with increases in CVB redemption, household food security, child fruit and vegetable intake, satisfaction with CVB amount, and likelihood of continued participation in WIC if the CVB returned to $9 per month. METHODS: We conducted a longitudinal study of WIC participants (N = 1,770) in southern California at 3 time points, from April 2021 through May 2022; the CVB amount was $9 at baseline, $35 at Survey 2, and $24 at Survey 3. Racial and ethnic groups were Hispanic English-speakers, Hispanic Spanish-speakers, non-Hispanic Asian, non-Hispanic Black, non-Hispanic Other, and non-Hispanic White. We used mixed-effect and modified Poisson regressions to evaluate outcomes by group. RESULTS: At baseline, groups differed significantly in dollars of CVB redeemed, percentage of CVB redeemed, household food security, and satisfaction with CVB amount. After the increase in CVB, we found increases in all groups in CVB redemption, household food security, and satisfaction. Non-Hispanic Black and Hispanic English-speaking groups, who had low levels of satisfaction at baseline, had larger increases in satisfaction than other groups. Reported likelihood of continued WIC participation if the monthly CVB returned to $9 also differed significantly by group, ranging from 62.5% to 90.0%. CONCLUSION: The increase in CVB for children receiving WIC benefited all racial and ethnic groups. Continued investment in an augmented CVB could improve health outcomes for a racially and ethnically diverse WIC population.

This study investigates the effects of school food assistance on children's food sufficiency in the United States during the pandemic. We employed the Household Pulse Surveys (HPS) conducted by the United States Census Bureau and administered between July 21, 2021-May 9, 2022. Our outcome of interest is the household self-reported indicator of children's food sufficiency in the last 7 days. The results show that the probability of children being food sufficient increased significantly by about 12%, 3%, 2%, and 10% among households who received school meals via School pickup, Pandemic-EBT, ate at school, and delivery at home, respectively. The effect of school food assistance on children's food sufficiency across race and ethnic groups is mixed. While all school food assistance consistently impacts children's food sufficiency levels among White, only school meals received via school pickup, eating on-site at school, and delivery at home impact children's food sufficiency among Black. In contrast, only school meals received via school pickup, Pandemic-EBT, and delivery at home impact children's food sufficiency among Asia households. We also find only school meals received via school pickup impact children's food sufficiency levels among Hispanics and other races. [ABSTRACT FROM AUTHOR]

Farmers markets and public health organisations aim to improve access to fresh produce for low-income consumers. While recent efforts to expand the use of food assistance benefits at farmers markets support this goal, persistent barriers related to transportation, convenience, price, exclusivity, and administrative burden still limit low-income participation at these venues. Mobile farmers markets, which bring produce directly to the customer, aim to address these barriers. But research on the effectiveness of mobile markets, especially from the customer perspective, is limited. Our project, a partnership with a local non-profit, explores if and how a mobile farmers market in the Rust Belt Midwest reduces barriers to farmers market access for low-income and minority consumers. Our data demonstrates a strong tie between market activities and customer wellbeing. Staff and customer interviews and participant observation show that the mobile market effectively alleviates many entrenched barriers to farmers market access for low-income and minority customers. Like many venues, though, this market also still struggles with the logistics of administering food assistance benefits. Our findings illuminate strategies for improving fresh food access for low-income and minority consumers that are relevant for other programmes and contexts. [ABSTRACT FROM AUTHOR]

Background: Low-income, rural pregnant women are at disproportionate risk for adverse pregnancy outcomes as well as future cardiovascular risk. Currently, less than half of eligible women enroll in the Women, Infants, and Children's (WIC) Program. This study aims to evaluate whether integrating clinical care and social care may advance health equity and reduce health disparities by directly linking women receiving obstetric care to the Special Supplemental Nutrition Program for WIC and/or a Registered Dietitian/Nutritionist (RDN). Methods: This pragmatic study is situated in real-world care and utilizes a randomized controlled trial design. A total of 240 low-income, rural, pregnant patients will be recruited from Geisinger (Pennsylvania, USA) obstetric clinics and randomized to receive one of four models: (1) Clinic; (2) Clinic-WIC; (3) Clinic-RDN, or (4) Clinic-WIC-RDN. Participants provide consent for electronic referrals that directly link their contact information from the electronic health record to WIC and/or RDN. Patients in the Clinic model receive standard prenatal care, which includes provision of basic information about WIC. The Clinic-WIC model includes a clinical decision alert to queue clinical staff to ask about WIC interest and place a referral to WIC using a social health access referral platform. In turn, WIC staff contact the pregnant woman about enrollment. The Clinic-RDN model includes a referral to an RDN for telehealth counseling to promote heart healthy eating and food resource management. The Clinic-WIC-RDN model includes referrals to both WIC and RDN. The primary outcome is difference in WIC enrollment between the Clinic and Clinic-RDN models versus the Clinic-WIC and Clinic-WIC-RDN arms at 6-months post-baseline. Secondary endpoints include WIC retention and adherence, change in participant behavior, skills, and food security, preterm delivery, birthweight, and maternal and child health outcomes. Implementation outcome measures include acceptability, appropriateness, and feasibility from the perspective of clinic and WIC staff. Discussion: Study findings will inform system models that integrate clinic care and social care to improve health equity among a high-risk population. Specifically, these findings will advance implementation of strategies to increase enrollment in a widely available but underutilized food provision program during pregnancy. Trial registration: ClinicalTrials.gov identifier (NCT06311799). Registered 3/13/2024. [ABSTRACT FROM AUTHOR]

Two theoretical perspectives have been extensively mobilized to understand the social role of food assistance initiatives, namely 'food security' and 'political economy'. The main objective of this article is to develop an alternative theoretical approach that allows for more comprehensive analyses. Building on Thomas's (1993) conceptual work on care, it is expected to encourage the development of studies that incorporate less-obvious elements that (also) characterize food assistance organizations, such as the various interactions and practices that are not directly related to food donations. [ABSTRACT FROM AUTHOR]

College student food insecurity (FI) is a public health concern. Programming and policies to support students have expanded but utilisation is often limited. The aim of this study was to summarise the barriers to accessing college FI programming guided by the social ecological model (SEM) framework. A scoping review of peer-reviewed literature included an electronic search conducted in MEDLINE, ERIC, and PubMed databases, with a secondary search in Google Scholar. Of the 138 articles identified, 18 articles met eligibility criteria and were included. Articles primarily encompassed organisational (17/18) level barriers, followed by individual (15/18), relationship (15/18), community (9/18), and policy (6/18) levels. Individual barriers included seven themes: Knowledge of Process, Awareness, Limited Time or Schedules, Personal Transportation, Internal Stigma, Perception of Need, and Type of Student. Four relationship barriers were identified: External Stigma, Comparing Need, Limited Availability Causes Negative Perceptions, and Staff. Ten barrier themes comprised the organisational level: Application Process, Operational Process, Location, Hours of Operation, Food Quality, Food Quantity, Food Desirability or Variety of Food, Marketing Materials, Awareness of the Program, and COVID-19 Restrictions. Two barrier themes were identified at the community level, Public Transportation and Awareness of SNAP, while one barrier theme, SNAP Eligibility and Process, encompassed the policy level. Higher education stakeholders should seek to overcome these barriers to the use of food programmes as a means to address the issue of college FI. This review offers recommendations to overcome these barriers at each SEM level.

Objectives Based on a survey of officers, social workers, and dietitians involved in managing nutrition and welfare policies or projects for vulnerable groups in local governments or private welfare institutions, this study aimed to assess the need for nutritional and dietary support policies and programs for persons with disabilities (PWD), as well as to identify appropriate support measures. Methods An online survey was conducted from March 2 to 15, 2021. The survey included 20 questions exploring perspectives on the nutritional status of PWD, their need for nutritional and dietary support policies and programs, and the prioritization of appropriate support measures. A total of 132 responses were analyzed. Results Approximately 68.9% of the respondents rated the nutritional status of PWD as “bad” or “very bad.” A substantial number identified “difficulty in purchasing ingredients, cooking, and preparing meals independently due to disability,” and “limited knowledge about nutrition and recipes necessary for maintaining a healthy and balanced diet” as the primary challenges in the dietary and nutritional management of this population. Additionally, 97.0% of the respondents deemed that the introduction of nutritional and dietary support policies and programs for PWD was “needed” or “very much needed.” Priority strategies to implement and strengthen these policies and systems included the “development of customized programs and services tailored to the needs and demands of the target population” and the “establishment of a dedicated department with specialized personnel.” Conclusion Comprehensive nutritional and dietary support policies and programs should be actively implemented to ensure a healthy and stable diet for PWD, tailored to meet their actual needs and demands.

Abstract Background Older adults with dementia in long-term care facilities often encounter challenges in self-feeding owing to cognitive and physical impairments. Although direct care workers play a crucial role in facilitating mealtime activities, they lack adequate and specific training. To develop an effective educational training program for this purpose, it is essential to understand the educational needs of direct care workers providing meal assistance. Therefore, this study aimed to identify the educational needs prioritized by direct care workers in long-term care facilities, regarding providing eating assistance to older adults with dementia. Methods Adopting a mixed-methods approach, this study combined quantitative analysis using Borich’s needs assessment and locus for focus models with qualitative insights from focus group interviews. Participants comprised 174 direct care workers and five nursing managers from various long-term care facilities in South Korea. Results This study identified four main educational priorities: enhancing knowledge regarding swallowing function, understanding institutional support mechanisms, applying multisensory stimulation techniques, and addressing food forgetfulness in older adults with dementia. These findings were aligned with the qualitative data that emphasized the necessity of training in these specific areas to improve the quality of meal assistance provided to this vulnerable population. Conclusion The findings underscore the critical need for focused educational programs that equip direct care workers with the skills and knowledge necessary to effectively assist older adults with dementia during mealtime. This study advocates the implementation of continuous education and training initiatives led by nursing management to improve the meal assistance environment for older adults with dementia, thereby enhancing their overall care and quality of life.

Motivation: Food security is a multidimensional issue, crucially underpinned by cultural acceptability, which significantly affects emotional well‐being and social integration. This study was motivated by the persistent challenge faced by refugee and immigrant communities in accessing culturally appropriate food, a critical aspect often overlooked by food assistance programmes. This gap both hinders nutritional intake and impedes the emotional and social well‐being of these vulnerable populations. Purpose: This study aimed to explore the alignment between the cultural dietary preferences of refugee and immigrant communities in Syracuse, New York, and the offerings of local food aid programmes, specifically focusing on culturally appropriate fresh produce. It sought to understand the extent to which food assistance meets the cultural needs of these communities, thereby informing potential improvements in food security practices and policy. Approach and Methods: Using a mixed‐methods approach, the study collected quantitative and qualitative data. Surveys were conducted with 35 refugee and immigrant women to quantitatively assess the availability and suitability of culturally specific food items within local food bank programmes. In addition, qualitative insights were derived through focus group discussions with eight of these participants. This dual‐method approach allowed for a comprehensive evaluation of both perceived and actual gaps in service provision. Findings: The findings highlighted a significant gap between the fresh produce provided by the food assistance programmes and the cultural dietary needs of the participants. Although these programmes provide essential nutrition, they often neglect to accommodate the cultural preferences of diverse communities. This emphasizes the urgent need for food aid initiatives to integrate cultural preferences, enhancing the acceptability of food aid and supporting the psychological adjustment of refugees and immigrants to new environments. Policy Implications: This study underscored the need for policy‐makers and food assistance programmes to prioritize cultural appropriateness alongside nutritional adequacy. It recommended the adoption of more inclusive food distribution practices that recognize and respect the cultural diversity of beneficiaries. Such practices are crucial, not only for improving the nutritional and psychological outcomes of refugees and immigrants but also for fostering their integration and participation in the community. Establishing policies that encourage the inclusion of culturally diverse food options can significantly enhance the effectiveness of food security efforts. [ABSTRACT FROM AUTHOR]

Drawing from ethnography in six faith-based community food banks located in urban Finland, this paper explores the dynamics of social inclusion and exclusion as manifested in everyday life in food assistance. The findings propose that different framings, social distances and power hierarchies affect both promoting and experiencing social inclusion and exclusion that appear situational and relational through the everyday discourse and praxis. By reflecting on these dynamics from a theological perspective and employing the concept of 'lived koinonia', the discussion shows that the food banks are still hesitant to imagine themselves as a source of liberation that would challenge structural, epistemic inequalities. [ABSTRACT FROM AUTHOR]

The change in policy that allowed Supplemental Nutrition Assistance Program recipients to redeem their benefits online during the coronavirus disease 2019 pandemic highlighted the potential role of nutrition education programs in facilitating the purchase of healthy, economical food online. The objective of this exploratory qualitative study was to understand the education provided by nutrition educators on online grocery shopping and educators' perspectives on education needs and ways that healthy purchases can be encouraged online. Interviews revealed topics that can be included in in-person education on online shopping, insights for online nutrition education, and promotion strategies for encouraging healthy purchases by low-income shoppers online. [ABSTRACT FROM AUTHOR]

The objective of this study was to define the types of digital tools currently used and desired by food pantries for pantry management. A nationwide online survey of U.S. food pantries was conducted by searching the foodpantries.org database. Surveys were sent via e-mail and completed using Google Forms. The most desired food pantry app/software features included staff and volunteer scheduling (49.2%); inventory management (42.1%); communicating with volunteers and staff (35.7%); client registration at the pantry (35.4%); and tracking pantry statistics (33.7%). Overall, food pantry staff and volunteers desire access to digital tools related to both staff/volunteer and client management. [ABSTRACT FROM AUTHOR]

We investigated whether food group availability, diversity, and nutrient composition of food pantry inventories differed across districts in Bridgeport, CT – a city with high rates of food insecurity. Food pantry inventories differed in the variety of food items, but differences in the relative proportions of USDA Food Groups were not significant. However, the availability of Vegetable types – specifically Legumes and Dark-Green Leafy vegetables – differed across pantries. Pantry inventories with less variety also contained foods with more calories, saturated fat, cholesterol, and sodium, on average. Thus, food availability and nutritional quality can vary across food pantries and city districts. [ABSTRACT FROM AUTHOR]

Background: Older adults with dementia in long-term care facilities often encounter challenges in self-feeding owing to cognitive and physical impairments. Although direct care workers play a crucial role in facilitating mealtime activities, they lack adequate and specific training. To develop an effective educational training program for this purpose, it is essential to understand the educational needs of direct care workers providing meal assistance. Therefore, this study aimed to identify the educational needs prioritized by direct care workers in long-term care facilities, regarding providing eating assistance to older adults with dementia. Methods: Adopting a mixed-methods approach, this study combined quantitative analysis using Borich's needs assessment and locus for focus models with qualitative insights from focus group interviews. Participants comprised 174 direct care workers and five nursing managers from various long-term care facilities in South Korea. Results: This study identified four main educational priorities: enhancing knowledge regarding swallowing function, understanding institutional support mechanisms, applying multisensory stimulation techniques, and addressing food forgetfulness in older adults with dementia. These findings were aligned with the qualitative data that emphasized the necessity of training in these specific areas to improve the quality of meal assistance provided to this vulnerable population. Conclusion: The findings underscore the critical need for focused educational programs that equip direct care workers with the skills and knowledge necessary to effectively assist older adults with dementia during mealtime. This study advocates the implementation of continuous education and training initiatives led by nursing management to improve the meal assistance environment for older adults with dementia, thereby enhancing their overall care and quality of life. [ABSTRACT FROM AUTHOR]

Access to nutritious foods, a social determinant of health, contributes to disparities in maternal and infant health outcomes such as mental health, breastfeeding intensity and cardiometabolic risk. This study explored perceived nutrition access and intake among pregnant or post‐partum women eligible for Medicaid. Qualitative, semistructured interviews were conducted with 18 women who were either currently pregnant (n = 4) or up to 12 months post‐partum (n = 14) in 2021–2022. Mothers spoke English (n = 11) or Spanish (n = 7) and lived in the Texas Panhandle. Interviews were audio‐recorded, transcribed, translated (Spanish to English) and verified. Two or more researchers coded each interview until consensus was reached using thematic analysis with ATLAS.ti software. The study revealed five drivers for nutrition access. (1) Social factors influenced nutrition; those with less support expressed limited ability to eat healthfully. (2) The Women, Infants and Children program was perceived as a helpful resource for some, while others faced challenges obtaining it. (3) Stress was bidirectionally related to unhealthy food choices, with food sometimes used as a coping mechanism. (4) Mothers prioritized their babies and others and had limited ability and time to prepare healthy meals. (5) Most participants felt they received inadequate nutrition guidance from their healthcare providers. Participants provided positive responses to a proposed nutritious home‐delivered meal intervention. Low‐income women may experience nutritional challenges specific to this life stage. Interventions that reduce stress and burden of household tasks (e.g. cooking) and improve education and access to nutritious foods may improve mothers' ability to consume nutritious foods. Key messages: Pregnant and post‐partum women desire to eat nutritious foods for their own health and that of their infants.More support is needed for women in the post‐partum period as prioritization of others and the stressful transition of caring for a newborn hinder women from maintaining healthy eating habits.Pregnant and post‐partum women want focused nutritional guidance from their healthcare providers.A home‐delivered, nutritious meal programme may be an acceptable intervention to help alleviate the nutritional barriers that are faced by pregnant and post‐partum women. [ABSTRACT FROM AUTHOR]

Objective: To estimate the coverage of being a beneficiary of the Vaso de Leche (VDL - Glass of Milk) and Qali Warma (QW - Vigorous Child) programs among children under 5 years of age and to determine the associated factors. Materials and methods: This study used a secondary source, based on the 2022 Encuesta Demogrática y de Salud Familiar (Endes - National Demographic and Family Health Survey) in Peru. For this purpose, women aged 15 to 49 years with children aged five years or younger and complete anthropometric data were selected to answer questions about being a beneficiary of the VDL and QW programs. The dependent variable was being or not a beneficiary of the programs, and the rate of beneficiaries was compared across levels of the independent variables. A log-binomial regression from the family of generalized linear models was used for the multivariate analysis, with a significance level of 5 %. Results: Among children under five years of age, the rate of beneficiaries of the VDL program was 34.13 %, while that of the QW program was 85.88 %. Variables associated with being a beneficiary of the VDL program included being = 12 months, birth weight < 2,500 g, mother's level of education, belonging to the poorest quintiles and rural residence. The factors associated with being a beneficiary of the QW program included rural residence and belonging to the poor and poorest quintiles. There was no association between being a beneficiary of the QW (aPR: 1.01; 95 % CI: 0.97-1.05) and VDL (aPR: 1.02; 95 % CI: 0.97-1.07) programs and being a child with chronic malnutrition at the time of the survey. Conclusions: The coverage of the VDL and QW programs differs significantly and varies according to sector. Being from the poorest quintile and living in rural areas were common correlates across both programs. Nevertheless, these programs also benefited children who were not necessarily in socioeconomically disadvantaged conditions, suggesting issues in the implementation of the intended objectives. [ABSTRACT FROM AUTHOR]

Little is known about food insecurity and the extent of Supplemental Nutrition Assistance Program (SNAP) participation in the heterogeneous Asian American population. Using California Health Interview Survey data from the period 2011-20, we examined both issues among low-income Asian American adults from six origin groups: Chinese, Filipino, Japanese, Korean, South Asian, and Vietnamese. We found high and varied levels of overall food insecurity, with the highest burden among Filipino adults (40 percent). Food insecurity by severity was also heterogenous; very low food security affected 2 percent of Chinese adults but 9 percent and 10 percent of Filipino and Japanese adults, respectively. Participation in CalFresh (California-implemented SNAP) ranged from 11 percent and 12 percent among Korean and Chinese adults, respectively, to 20 percent among Vietnamese adults. Compared with English-proficient low-income Asian American adults, those with limited English proficiency were no less likely to participate in CalFresh, possibly reflecting language assistance required by California law and provided by community-based organizations. These results underscore the importance of collecting and reporting disaggregated data by Asian origin group that could inform targeted outreach and interventions.

IntroductionThe Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is among the largest U.S. social safety net programs. Although strong evidence exists regarding the benefits of WIC, take-up (i.e., participation among eligible individuals) has steadily declined in the past decade. This study addresses gaps in our knowledge regarding predictors of WIC take-up during this time.MethodsData were drawn from the 1998-2017 waves of the National Health Interview Study (NHIS), a serial cross-sectional study of the U.S.PopulationThe analytic sample included 23,645 children and 10,297 women eligible for WIC based on self-reported demographic characteristics. To investigate predictors of WIC take-up, we regressed self-reported WIC receipt on a range of individual-level predictors (e.g., age, nativity, income) and state- level predictors (e.g., unemployment rate, governor's political affiliation) using multivariable logistic regression. In secondary analyses, results were additionally stratified by race/ethnicity, time period, and age (for children).ResultsFor both women and children, older maternal age and higher educational attainment were associated with decreased take-up of WIC. Associations differed by race/ethnicity, time period, and state characteristics including caseload of other social programs (e.g., Medicaid).DiscussionOur study identifies groups that are less likely to take up WIC benefits for which they are eligible, thereby contributing important evidence to inform programs and policies to increase WIC participation among groups with lower take-up. As WIC evolves past the COVID-19 pandemic, special attention will be needed to ensure that resources to encourage and support the participation of racially and economically marginalized individuals are equitably distributed.

Abstract Objective: The Supplemental Nutrition Assistance Program (SNAP) Online Purchasing Pilot (OPP) authorised the use of SNAP benefits online in Maryland in May 2020. We assessed shopping behaviour and intentions associated with uptake and intended future use of online grocery shopping during and after COVID-19 among SNAP-eligible households. Design: In this mixed-methods study, participants completed a survey on online grocery shopping, and a purposefully sampled subset participated in focus groups or in-depth interviews between November 2020 and March 2021. Setting: Predominantly urban households in Maryland Participants: Primary shoppers of SNAP-eligible households with young children (n 310) Results: Most participants reported first shopping for groceries online after the OPP was implemented (57 %). Families who purchased groceries in-store less frequently were less likely to report ever buying groceries online (rate ratio (RR): 0·66, 95 % CI 0·46, 0·93) compared with weekly grocery shoppers. Shoppers who intended to purchase more groceries online in the next 6 months were more likely to have online shopping experience, although this differed by timing of online grocery service adoption. Participants reported more negative attitudes towards in-store grocery shopping during the pandemic than prior to its onset and cited COVID-19 as a motivator for ordering groceries online in focus groups. Most participants who had shopped online planned to continue after the pandemic (79 %). Conclusions: Most participants who shopped online started during the COVID-19 pandemic and considered the pandemic a key motivator. Findings suggest that low-income households will continue to shop online, affirming the need for policies that promote equitable access to healthy food online.

BackgroundNutrition during pregnancy is important for maternal and infant health. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutritional support for low-income pregnant and postpartum individuals and children under the age of 5 y. However, WIC participation was in decline in the decade leading up to 2019.ObjectivesThis study examined individual and state predictors associated with WIC uptake among eligible individuals so as to identify subgroups for targeted intervention to improve participation.MethodsData came from the 2004-2019 waves of the Pregnancy Risk Assessment Monitoring System (PRAMS), a national survey of individuals who recently gave birth (N = 288,531). Multivariable logistic regressions were used to examine individual- and state-level and temporal predictors of WIC uptake among WIC-eligible respondents.ResultsAmong WIC-eligible respondents, ages of >35 (OR: 0.68; 95% CI: 0.66, 0.70), more than high school education (OR: 0.63; 95% CI: 062, 0.65), English language proficiency (OR: 0.71; 95% CI: 0.68, 0.74), being married (OR: 0.70; 95% CI: 0.69, 0.72), White race, smaller family size, not having prepregnancy diabetes, and higher income were associated with lower odds of WIC uptake. Respondents in states with higher earned income tax credit rates and in the Northeast, Midwest, and West (compared with the South) had lower WIC uptake. Respondents in states with higher gross domestic product, higher unemployment rates, higher Supplemental Nutrition Assistance Program, Temporary Assistance for Needy Families, and Medicaid caseloads, and Democrat governors had higher uptake; however, effect estimates were small and may not represent a meaningful change. Associations were the strongest during 2009-2015 than during other years, particularly for race/Hispanic origin, language, marital status, prepregnancy diabetes, family size, and prepregnancy.ConclusionsThis study identified several individual- and state-level characteristics associated with WIC uptake among low-income eligible respondents, paving the way for future interventions to target key subgroups to improve program participation.

BackgroundLack of access to adequate, safe, and nutritious food is a major concern for the Afghan population due to ongoing war and humanitarian crises. Recently resettled Afghan refugees in the US continue to face challenges securing adequate, nutritious food resources in new environments. This study examined Afghan refugees' food access and insecurity in the San Joaquin Valley, California.MethodsSemi-structured, in-depth interviews were conducted to collect the perspectives and experiences of key informants and newly arrived Afghan refugees.ResultsThis study highlights environmental and structural factors (availability and accessibility of grocery stores; availability of religious-appropriate items in the stores; the public benefit received by a family; and public transportation) and individual factors (religious and cultural practices; financial and language barriers) as major determinants of post-resettlement food insecurity.ConclusionIncreasing the accessibility and affordability of culturally and religiously appropriate food items within the US food system, enhancing the collaboration of community volunteers and resettlement organizations in the direct assistance of new families, and providing continuous access to public benefits are possible steps to mitigate the risk of food insecurity among Afghan refugees. This study suggests a continuous examination of the degree of food insecurity in this population and its attendant health impacts.

Food insecurity is a global phenomenon which impacts a variety of social, economic, and life-stage groups. One such group affected by food insecurity is college students, who tend to experience food insecurity at a prevalence which exceeds the average of their local communities. The impacts of food insecurity in this population are multifaceted and have implications for their college experience and beyond. Food insecurity has been observed to have negative effects on college student academic performance, physical health, and mental health. This review explores the impacts of and solutions for food insecurity in this population globally, with particular emphasis on the United States, and specifically California.

Compare the diet quality of a meal consumed at a community café (café meals), a pay-what-you-can restaurant, to a meal consumed for an equivalent eating occasion on the day before (comparison meal) by guests with food insecurity. Dietary recalls were collected from café guests with food insecurity to determine the Healthy Eating Index-2020 (HEI-2020) total and component scores. Healthy Eating Index-2020 scores were compared between meals using paired-sample t tests and Wilcoxon signed-rank tests. Most participants (n = 40; 80% male; 42.5% Black) had very low food security (70.0%). Café meal had a higher HEI-2020 total score (46.7 ± 10.5 vs 34.4 ± 11.6; P < 0.001) and total vegetables (2.6 ± 2.0 vs 1.2 ± 1.7; P = 0.004), total fruits (2.1 ± 2.2 vs 0.6 ± 1.5; P < 0.001), whole fruits (1.6 ± 2.0 vs 0.3 ± 0.9; P < 0.001), and refined grains (7.8 ± 3.5 vs 3.9 ± 3.9; P < 0.001) scores than comparison meals. The café meal had better diet quality than the comparison meal, suggesting its potential for improving diet quality among guests with food insecurity. [ABSTRACT FROM AUTHOR]

To examine the components of successful food assistance programs for college students. Focus groups conducted during the fall 2019 semester included undergraduate students who accessed a food assistance program on campus (n = 26). Key informant interviews were conducted with professionals working with campus-based food assistance programs (n = 5). Student insight regarding experiences on campus-based food assistance programs was gathered. Key informant interviews were conducted to gain an understanding of strategies put in place to alleviate food insecurity among college students. Emerging focus group themes included financial stressors, eating strategies, struggling to feed dependents, utilization of university-based food assistance programs, and SNAP enrollment. Key informant interviews revealed six strategies of effective food assistance programs: increasing access, securing funding, procurement/distribution of healthy foods, partnerships, outreach, and decreasing stigmatization. A "mission driven" approach has the potential to meet the complex needs of food insecure college students. [ABSTRACT FROM AUTHOR]

How people speak of hunger extends beyond statements about food adequacy; people's remarks may reflect experiences of poverty and feelings of vulnerability, and may be used to request help. In this article, we build on the idea of idioms of distress to conceptualize hunger talk as expressing more than an empty belly. We draw on ethnographic data gathered in two settings in South Africa: one a peri-urban area under traditional jurisdiction in the Eastern Cape Province; the other an inner-city suburb of the largest city, Johannesburg, in Gauteng. Hunger-related idioms of distress help illustrate the complex interplay of social, economic, and cultural factors, and allow people to speak of various affective and material aspects of their lives. [ABSTRACT FROM AUTHOR]

We examined whether dietary intake differs across household and child food security (FS) status, and Supplemental Nutrition Assistance Program (SNAP) participation among Black children (ages 9–15) in a low-income urban setting. This cross-sectional survey used the USDA 18-item Household Food Security Survey, which includes the 8-item Child Module, and a validated FFQ to assess children's diet (n = 451). Nutrient intake differed across child FS status, but not household FS. SNAP participation was associated with better micronutrient intake (vitamin D and calcium) among food secure children. Assessing child-specific FS and nutrient adequacy clarifies children's actual experience and informs child-targeted policies. [ABSTRACT FROM AUTHOR]

This study uses an embodied political ecology framework to evaluate the structural, discursive, and visceral effects of government food assistance policy in an agrarian community in southern Mexico. During the administration of President Enrique Peña Nieto (2012-2018), the government's efforts to resolve the growing double-burden of under- and over-nutrition included the expansion of food assistance programs alongside cash transfers conditioned on health and nutritional education. A parastatal company sourced and distributed foodstuffs to community and school kitchens, where mothers prepared them into meals. This research explores how women participating in government food assistance in the agricultural community of Santa Inés del Monte, Oaxaca, evaluated the foods they received and conceptualized broader changes in their food system and community health. Qualitative research methods, including interviews, focus groups and a community survey of 87 households, were conducted in the community in 2015, 2017 and 2018. Through attention to visceral experience, this study demonstrates how sensations of taste, embodied knowledge, nutrition discourses, gendered development programs, and structural marginalization combined to produce an outcome in which mothers accepted and prepared foods in the community kitchens that did not meet their standards of food quality. However, this study also finds that participating mothers and other residents continue to conceive of direct food production—especially organic production of local heirloom crop and animal varieties—as the best way to access good nutrition. These findings suggest the need for attention to knowledge politics in the design and evaluation of culturally appropriate food security policy. [ABSTRACT FROM AUTHOR]

Food insecurity is an economic and social condition that involves individuals having limited or uncertain access to healthy food. Despite the well-intentioned efforts of both governmental and not-for-profit organizations in addressing food insecurity, well over one-in-ten households in the U.S., the wealthiest nation in the world, experience food insecurity every year. The objective of this literature review was to identify and explicate the methods and outcomes of food insecurity interventions that have been conducted among U.S. adults. This literature review identified 38 studies detailing several government programs and research interventions designed to address food insecurity. Results from the review highlight how the Supplemental Nutrition Assistance Program (SNAP), The Emergency Food Assistance Program (TEFAP), and not-for-profit food banks have demonstrated success in improving food insecurity. However, the prevalence of food insecurity among U.S. households has fluctuated without any sustained decreases that achieve a food insecurity rate that remains below 10 percent of the population. Food waste, which refers to food that is edible yet discarded at the retail or consumption phases, is rampant in the U.S., as approximately 30 percent (66.5 million tons) of edible food is wasted after leaving the farm every year. Food waste prevention efforts that involve rescuing edible, nutritious food and redistributing it to individuals who are food insecure can promote both environmental wellbeing and public health through simultaneous reductions in food waste and food insecurity. [ABSTRACT FROM AUTHOR]

The Gus Schumacher Nutrition Incentive Program (GusNIP) is a federally funded grant program that provides nutrition incentives-subsidies for purchasing fruits and vegetables (FV)-to Supplemental Nutrition Assistance Program (SNAP) participants. GusNIP currently advances nutrition equity by improving FV access for people with low incomes, yet inequities exist within GusNIP. We sought to identify inequities in GusNIP at the community, organization, partner, and individual levels and develop recommendations for farm bill provisions to make the program more equitable. In Spring 2021, a group of nutrition incentive experts (n = 11) from across the country convened to discuss opportunities to enhance equity in GusNIP. The iterative recommendation development process included feedback from key stakeholders (n = 15) and focus group participants with GusNIP lived experience (n = 12). Eleven recommendations to advance equity in GusNIP in the farm bill emerged across six categories: (1) increase total GusNIP funding, (2) increase funding and support to lower-resourced organizations and impacted communities, (3) eliminate the match requirement, (4) support statewide expansion, (5) expand and diversify retailer participation, and (6) expand program marketing. Including these recommendations in the upcoming and future farm bills would equitably expand GusNIP for SNAP participants, program grantees, and communities across the country.

OBJECTIVE: To understand how equity appeared in news about food assistance from 2021. METHODS: We assessed a national sample of news articles (N=298) for equity arguments and language about racial and health equity. RESULTS: Only 28% of coverage argued that food assistance programs promote equity. Just 6% mentioned people of color or named racial disparities in food access. DISCUSSION: Narratives that explain how food assistance programs reduce inequities could deepen their policy appeal and broaden public perceptions around recipients. HEALTH EQUITY IMPLICATIONS: There are opportunities for news coverage to expand the discussion of how food assistance programs improve racial and health equity outcomes.

Understanding satisfaction of nutrition education and other services provided in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is needed to ensure the program is responsive to the needs of diverse populations. This study examined the variation of WIC participants’ perceptions and satisfaction with WIC nutrition education and services by race, ethnicity, and language preference. Phone surveys were conducted in 2019 with California WIC families with children aged 1−4 years. While most participants (86%) preferred one-on-one nutrition education, online/mobile apps were also favored (69%). The majority (89%) found nutrition education equally important to receiving the WIC food package. Racial/ethnic groups differed in which WIC service they primarily valued as 20% of non-Hispanic White people rated the food package as more important than nutrition education compared to 5% of Spanish- and 6% of English-speaking Hispanic people, respectively. More Spanish (91%) and English-speaking Hispanic people (87%) than non-Hispanic white (79%) or Black people (74%) changed a behavior because of something they learned at WIC (p < 0.001). Spanish-speaking Hispanic people (90%) had the highest satisfaction with WIC nutrition education. Preferential differences among participants suggest that providing flexible options may improve program satisfaction and emphasizes the need for future studies to examine WIC services by race and ethnicity.

Food insecurity (FI) is associated with many adverse outcomes in college students. The Supplemental Nutrition Assistance Program (SNAP, known as CalFresh in California) has been observed to alleviate FI; however, on college campuses, the benefits of food assistance programs are not well understood. This study investigated whether college students benefit from CalFresh participation. It was hypothesized that students would experience increased FI over time and that CalFresh participation would moderate the effect of FI on grade point average (GPA). A comprehensive FI and CalFresh questionnaires were distributed during the 2020-2021 academic year to 849 students. The chi-square test of independence assessed differences between FI and student factors. A Friedman test assessed differences in FI during the three quarters. Moderation analysis assessed whether CalFresh participation moderated FI's effect on GPA. Differences were observed among food security scores in Winter 2021 (median = 1.69) and Fall 2020 (median = 2.14; p = 0.013) and Spring 2020 (median = 2.17; p = 0.009). In the moderation model, the interaction of FI score and CalFresh participation was positively correlated with GPA (B = 0.11; p = 0.002). These results indicate that SNAP/CalFresh participation was particularly beneficial for mitigating the negative effects of FI on GPA. Given these benefits, encouraging SNAP/CalFresh enrollment should be a priority for university administrators.

BackgroundThe US Department of Agriculture granted waivers to allow flexibility in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) operations during the coronavirus disease 2019 (COVID-19) pandemic; however, research examining the associations between waiver introduction and changes in perceptions, practices, and challenges of WIC participants' and agency directors' experiences is limited.ObjectiveThe objective of this study was to assess California WIC participants' and agency directors' perceptions and practices of remote WIC services during the COVID-19 pandemic. A secondary aim was to understand other COVID-19 challenges related to maintaining access to healthy foods by WIC participants.DesignA qualitative study that included semistructured interviews was conducted between June 2020 and March 2021.Participants and settingOne hundred eighty-two WIC participants with a child aged 0 to 5 years from three regions of California (Southern, Central, and Northern) and 22 local WIC agency directors across the state were interviewed.Main outcome measuresWIC participants' and agency directors' perceptions, practices, and other challenges during COVID-19.Statistical analyses performedInterviews were recorded, transcribed, and analyzed using a grounded theory approach.ResultsParticipants shared that they valued the information received from WIC and were very satisfied with remote WIC services. Participants reported that enrolling in WIC remotely was easier than coming in person. All waivers and changes to WIC operations, namely the physical presence, remote benefit issuance, and separation of duties waivers, and remote work and remote delivery of nutrition education, were largely viewed by WIC agency directors as options that should be continued postpandemic. Further, a majority (63%) of households reported experiencing food insecurity, and half of respondents received food from a food bank or pantry during the pandemic.ConclusionsFindings suggest WIC will attract and retain the most families by offering a hybrid model of services, incorporating both onsite services and remote options to work more efficiently and effectively.

BackgroundCOVID-19 is significantly impacting the health and well-being of the country, particularly for ethnic minority populations and low-income groups. Our goal was to determine COVID-19 vaccination intent in a low-income, Latino population receiving aid from the Supplemental Nutrition Assistance Program (SNAP) in Southern California, and identify contributing factors and concerns.MethodsA cross-sectional, mixed-methods survey was conducted among participants in the Southern California Nutrition Incentives Program (¡Más Fresco! More Fresh). Only Latino respondents were included in this analysis. Primary outcome was vaccine intent trichotomized into: "definitely/likely yes", "not sure/don't know", and "definitely/likely not."ResultsThe majority of participants (n = 486) were female (93%), Spanish speaking (74%), with a median age of 40 years (IQR = 13). Approximately half (48%) reported they would get a COVID-19 vaccine, 39% were unsure, and 13% reported "definitely/likely not". In the multivariable multinomial logistic regression model, participants with a household member with a COVID-19 health risk factor were more likely to be unsure about getting the vaccine. Participants who were primarily English speaking, did not receive the influenza vaccine last season, and reported not reading or talking about COVID-19 were more likely to report not intending to receive the vaccine. Many respondents were concerned about "side effects and ingredients", and did not trust the vaccine development process, particularly with how fast it happened.ConclusionLow-income Latinos in Southern California were generally hesitant to get a COVID-19 vaccine. Culturally sensitive vaccine promotion campaigns need to address the concerns of minority populations who experience increased morbidity and mortality from COVID-19.

Food insecurity is associated with increased risk of chronic disease and poor dietary intake. The United States charitable food system, a complex network of food banks, pantries and congregate meal sites, provides food for millions of low-income households each year. Food banks and pantries play a critical role in supporting food security and are an important contributor to dietary intake for its clients. In recent years, there has been an increased focus on sourcing and supplying more nutritious foods within the charitable food system. Despite this, there is a lack of alignment in how the charitable food system defines and tracks the nutritional quality of food.In 2019, Healthy Eating Research convened a panel of nutrition, charitable food system and food policy experts to create a set of evidence-based nutrition standards. Standards were developed based on a review of the literature and existing nutrition ranking systems, while also considering the operational needs and capacity of the charitable food system. The panel provided recommendations for eleven distinct food categories: fruits and vegetables, grains, protein, dairy, non-dairy alternatives, beverages, mixed dishes, processed and packaged snacks, desserts, condiments and cooking staples, and other miscellaneous items. Products are ranked into three tiers, choose often (green), choose sometimes (yellow) or choose rarely (red), based on designated saturated fat, sodium, and added sugar thresholds. This paper outlines the expert panel's approach and summarizes the barriers and opportunities for implementing these standards across the charitable food system.

Abstract Background Minoritized racial/ethnic groups and women in the United States (US) are disproportionately burdened by food insecurity, which likely contributes to disparities in cardiovascular health (CVH). Disparities are projected to widen due to the worsening climate crisis that is straining the agricultural system including food supplies. Nonetheless, studies have not investigated the relationship between food security status and ‘ideal’ CVH in a large, nationally-representative and racially/ethnically diverse US sample. Methods and results We investigated household food security status in relation to ‘ideal’ CVH among US adults (N = 157,001) using 2014–2018/2020 National Health Interview Survey data. Food security status was defined as very low, low, marginal, or high. A summed score of 4 health behaviors and 3 clinical factors totaling 7 different measures was dichotomized (yes/no) to assess modified ‘ideal’ CVH (mICVH). Using Poisson regression with robust variance, we estimated prevalence ratios (PRs) and 95% CIs of mICVH by household food security status. We stratified models by sex/gender and race/ethnicity. Very low food security prevalence was higher among non-Hispanic (NH)-Black (8.0%) compared to Hispanic/Latinx (5.1%), NH-White (3.1%) and NH-Asian (1.7%) adults. The association between very low versus high food security and mICVH was stronger among women (PR = 0.23 [95% CI: 0.17–0.31]) than men (PR = 0.48 [95% CI: 0.35–0.66]). Compared to NH-White adults with high food security, racially/ethnically minoritized groups with very low to high food security were generally less likely (range: [PRvery low = 0.25[95% CI: 0.14–0.44] – [PRhigh = 0.88 [95% CI: 0.79–0.97]) to meet mICVH criteria. Conclusions Food insecurity was associated with lower mICVH prevalence and racially/ethnically minoritized groups were disproportionately burdened.

We assessed store-level food availability, quality, variety, depth of stock, and cost at small Supplemental Nutrition Assistance Program (SNAP)-authorized retailers and compared stocking patterns to proposed United States Department of Agriculture criteria. Food environment observations were conducted at 82 retailers from June to December 2019 in Pinellas County, Florida, and descriptively analyzed. Less than one-third of retailers stocked frozen fruit, fresh or frozen vegetables, tortillas, whole-wheat bread, low-fat milk, fresh or frozen meat, fish or meat alternatives, dried beans, or healthier frozen meals. Twenty-two and 26% had at least seven SNAP-eligible varieties of fruits and vegetables and protein products, respectively. [ABSTRACT FROM AUTHOR]

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is the third largest food assistance program in the United States. Child participants lose WIC in the month following their fifth birthday. We use this exogenous program rule for identification and find diet quality declines nearly 20%, on average, for those who have yet to transition into kindergarten. Decreases are mainly driven by reduced consumption of healthier WIC‐targeted foods. A quantile regression discontinuity approach reveals children prone to lower quality diets experience the largest decreases in diet quality, reaching nearly 30%, whereas those prone to higher quality diets experience no aging‐out‐of‐WIC effects. There are no effects on calorie consumption, regardless of school attendance, indicating caregivers maintain diet quantity for children at the expense of diet quality. Policy implications include allowing children to stay on WIC until they enter kindergarten. We calculate back‐of‐the‐envelope program costs over the next 5 years for such a "kindergarten‐roll‐off" WIC policy under current rules and newly proposed rules to realign WIC packages with the Dietary Guidelines for Americans. Under current rules, costs would average $112 million over the next 5 years (2024–2028), or about 2% of total program costs. Under proposed rule changes, kindergarten‐roll‐off costs would average $144 million per year, or 2.25% of total program costs. [ABSTRACT FROM AUTHOR]

Following the COVID-19 pandemic, there has been a significant increase in collaboration between various public, private and civil organizations. These initiatives include solidarity kitchens, which are based on the principle of the Human Right to Adequate Food. Therefore, the objective of this article is to analyse how Solidarity Kitchens (SKs) contribute to the construction of a food democracy, which considers food from the perspective of equal, free, sustainable access, and with society's participation in democratic decision-making. For this study, two SKs located in the municipality of Manaus, state of Amazonas, were selected. The research adopted a qualitative approach, using semi-structured interviews as the method of data collection. The results revealed the potential of SKs in Manaus to promote food democracy. Particularly noteworthy is the diversity of the served public and the fact that the service is provided by individuals involved in activism and familiar with the reality of the served communities.

The United States Department of Agriculture approved an increase to the Cash Value Benefit (CVB) for the purchase of fruits and vegetables issued to participants receiving an eligible Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package. In order to understand satisfaction, perceptions, and the overall impact of additional benefits for fruits and vegetables at the household level, a qualitative study consisting of structured phone interviews was conducted with families served by WIC in Southern California from November to December 2021 (n = 30). Families were selected from a large longitudinal study sample (N = 2784); the sample was restricted by benefit redemption and stratified by language and race. WIC participants were highly satisfied with the CVB increase, reporting increased purchasing and consumption of a variety of fruits and vegetables. Respondents noted the improved quality and variety of fruits and vegetables purchased due to the increased amount. Findings are expected to inform policy makers to adjust the CVB offered in the WIC food package with the potential to improve participant satisfaction and increase participation and retention of eligible families with benefits from healthy diets supported by WIC.

The COVID-19 pandemic caused unprecedented spikes in food insecurity. In California, food banks, which were already facing high demand for emergency food assistance, rallied federal, state and local resources to help meet the challenges of the pandemic. Our study draws on interviews with food banks and their partners approximately one year into the pandemic to learn how they responded to enormous challenges in staffing, procurement, distribution and infrastructure. These interviews captured lessons for resilience planning and food security policy that might otherwise have been lost. We found an encouraging story of resilience, and a story of how government agencies and community networks can work together to create and strengthen food security policies, even under the most dire circumstances.

Abstract Background Food pantry clients have high rates of food insecurity and greater risk for and prevalence of diet-related diseases. Many clients face time, resource, and physical constraints that limit their ability to prepare healthy meals using foods typically provided by pantries. We compared two novel approaches to alleviate those barriers and encourage healthier eating: meal kits, which bundle ingredients with a recipe on how to prepare a healthy meal, and nutritious no-prep meals, which can be eaten after thawing or microwaving. Methods Participants were adult pantry clients from a large food pantry in the Southern sector of Dallas, Texas. We conducted a repeated measures between-subjects study with 70 clients randomized to receive 14-days of meal kits (n = 35) or no-prep meals (n = 35). Participants completed questionnaires at baseline and two-week follow-up on demographics, hedonic liking of study meals, perceived dietary quality, and food security. Two-way repeated measures analysis of variance was used to examine group and time effects, and group by time interactions. We also describe feasibility and satisfaction outcomes to inform future implementation. Results Sixty-six participants completed the study (94%). Participants were predominantly Hispanic or Latino(a) (63%) and African American or Black (31%) women (90%). There was a significant interaction on hedonic liking of study meals (ηp²=0.16, F(1,64) = 11.78, p