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This study examined consumption of fruits and vegetables, foods with added sugar and sugar-sweetened beverages (SSBs) based on the frequency of food pantry use. A repeated cross-sectional study was...

Introduction: Fruit and vegetable (FV) consumption is low among adolescents, and waste of these foods is high in school cafeterias. The objective of this research was to determine the impact of behavioural economic strategies and structural lunchroom changes on FV selection and waste in high-school lunch programmes using the collaborative efforts of teachers, food service directors and students. Methods: A pre-post quasi-experimental design was used to collect plate waste data for 3 days in the autumn and 3 days in the spring semesters. Five high-school cafeterias from three rural and two urban counties in Montana participated. School Lunch Advisory Councils selected and implemented behavioural economic strategies that focused on increasing selection and decreasing waste of FVs served on the main service line and salad bar. Plate waste data were collected using direct weighing and the quarter-waste method. Preintervention to postintervention plate waste amounts were compared using descriptive statistics and the Mann-Whitney U test. Results: Vegetable selection at the salad bar significantly increased ( p Conclusion: Changes in the lunchroom environment through behavioural economic strategies provide one avenue to increase selection and decrease waste of vegetables, ultimately influencing overall dietary quality among high-school students and creating more sustainable food systems.

Food acquisition patterns and perceptions remain insufficiently understood when examining the ways urban built environments impact food access. Using surveys (N = 751) and interviews (N = 14) we ar...

BACKGROUND Few studies document milk selection and waste among high school lunch programs. METHODS This observational research assesses the types of milk selected and wasted among 5 Montana high school lunch programs. Over 6 days across the 2014-2015 school year, 3842 milk cartons were collected. Direct weighing was used to assess the ounces of milk wasted and consumed by milk type. Outcomes included the number of milks selected by type at each school, ounces of milk consumed and wasted on average per student. Descriptive and inferential statistics were used to assess demographics of school lunch participation, milk consumption and waste, and the amount of waste per type of milk. RESULTS Students were most likely (p

Food pantries are responsible for the direct distribution of food to low-income households. While food pantries may be concerned about the nutritional quality of the food they are serving, they may have limited resources to adopt and implement nutrition policies to support efforts to promote high nutritional quality of the food served. Guided by the RE-AIM (Reach, Effectiveness or Efficacy, Adoption, Implementation, Maintenance) framework, this qualitative study explored the degree of implementation of nutrition policies at food pantries, as well as the barriers to implementation in those pantries that had not adopted a nutrition policy. Semistructured interviews were conducted with 10 food pantry directors: seven pantries with a formal nutrition policy and three with an informal nutrition policy. Using a thematic analysis method, results demonstrated themes from the interviews with policy-adopting pantries to be barriers, enforcement, delivery of the policy, unexpected consequences, and fidelity to the policy. A targeted intervention that builds on this research and focuses on building the capacity of food pantries to develop, adopt, and implement nutrition policies as well as helping to increase fidelity to the policy would be beneficial to continue to improve the food donated and distributed at food pantries. By supporting food pantries in the development, adoption, and implementation of nutrition policies, researchers can play an important role in improving the quality of food in the emergency food network.

Diet-related chronic disease remains a public health concern, and low intake of fruits and vegetables disproportionately affects low-income populations. Healthy food incentive (HFI) projects can help close the nutrition gap among low-income populations by increasing purchasing power and access to fruits and vegetables. This study aimed to qualitatively explore lessons learned and best practices from Food Insecurity Nutrition Incentive Grant Program (FINI) grantees across the United States. Thirty semistructured interviews were conducted with FINI grantees and stakeholders in 2018, eliciting best practices and promising findings, policy implications, and knowledge gaps and opportunities to pursue that inform program refinement and sustainability. Telephone and in-person interviews were conducted with FINI grant recipients from 2015 to 2016, specifically, recipients of FINI-funded multiyear community-based projects and large-scale projects. Our results highlighted (1) range of projects and scope, (2) program promotion and awareness, (3) community-based partnerships, (4) technical assistance and peer interactions, (5) measurement and evaluation, (6) program challenges, and (7) future directions and recommendations. Grantees reported a “trifecta of benefits” that affects low-income consumers, farmers, and food retailers. Our findings contribute to understanding how to implement HFI programs in a variety of settings and highlight the variations that can exist between programs, as well as the need for increased technical assistance and synergy between programs (communities of practice). Overall, these findings can help to inform implementation and practice of healthy food incentive programs and the Farm Bill and other policy discussions.

Food insecurity, or lack of consistent access to enough food, is associated with low intakes of fruits and vegetables (FVs) and higher risk of chronic diseases and disproportionately affects populations with low income. Financial incentives for FVs are supported by the 2018 Farm Bill and United States (U.S.) Department of Agriculture’s Gus Schumacher Nutrition Incentive Program (GusNIP) and aim to increase dietary quality and food security among households participating in the Supplemental Nutrition Assistance Program (SNAP) and with low income. Currently, there is no shared evaluation model for the hundreds of financial incentive projects across the U.S. Despite the fact that a majority of these projects are federally funded and united as a cohort of grantees through GusNIP, it is unclear which models and attributes have the greatest public health impact. We explore the evaluation of financial incentives in the U.S. to demonstrate the need for shared measurement in the future. We describe the process of the GusNIP NTAE, a federally supported initiative, to identify and develop shared measurement to be able to determine the potential impact of financial incentives in the U.S. This commentary discusses the rationale, considerations, and next steps for establishing shared evaluation measures for financial incentives for FVs, to accelerate our understanding of impact, and support evidence-based policymaking.

Disparities in fruit and vegetable intake (FVI) and diet-related diseases exist among low-income and racial/ethnic minority populations [...].

This special issue of Translational Behavioral Medicine solicited papers focusing on the intersection of food security, dietary quality, and obesity. Specifically, the special issue seeks to highlight research that provides actionable takeaways related to policy, systems, and environmental (PSE) approaches for practitioners and policymakers. The purpose of this introduction was to summarize relevant background literature and then briefly introduce topics covered by the articles included in the special issue. There are economic, environmental, and social factors that create systemic barriers that drive persistent poverty in communities and underlay the intersection of food security, dietary quality, and obesity. Although equitable healthful food access is needed, the issue is exceedingly complicated. Understanding and operationalizing effective and efficient PSE approaches is in its infancy. More research is needed to better understand how to appropriately measure determinants of health (and how they relate to the conditions that ultimately promote obesity through food insecurity and compromises to dietary quality), implement deliberate interventions that address the underlying factors, and disseminate that information to policymakers and practitioners in the field. This special issue of Translational Behavioral Medicine includes articles that relay practical findings, measurement methods, and lessons learned related to PSE approaches such as federal food assistance programs (e.g., National School Lunch Program), systems-based interventions (e.g., clinic-community connections), and environmental modifications(e.g., food retail marketing). Although much more practical and action-oriented research is needed in this area, these articles will contribute to the evidence base supporting better future assessment and PSE interventions that address food security, dietary quality, and obesity.

This commentary provides a brief overview of the historical, contemporary, and potential future approaches for using policy, systems changes, and environmental supports (PSE) to address food insecurity in the United States. We reflect on and integrate where possible the findings put forth in the other 16 papers included in the Translational Behavioral Medicine Special Issue entitled: Food Access Among Low-Income Populations: Understanding the Potential Intersect of Diet, Obesity, Food Insecurity, and Hunger.

Emergency food networks consist of food banks, food pantries, and other feeding programs. Food pantries help supplement the diets of low-income populations through direct distribution of food. There is a gap in understanding whether food pantries are adopting nutrition policies to guide food donation and distribution. Guided by the RE-AIM framework, which has been applied to public health policies, this study aimed to determine the adoption of nutrition policies at food pantries across the USA. A secondary research question was to determine if the perceived barriers that food pantries associate with distributing healthful foods differed among pantries with a formal, informal, or no policy. A cross-sectional electronic survey was distributed to a national sample of food pantry directors (N = 5,500). The response rate for the survey was 28% (n = 1,539). Survey respondents were categorized by policy and analyses were conducted to determine differences between the three groups in characteristics and perceived barriers to distributing healthful foods. Two hundred eighty-two pantries (20.9%) were identified as having a formal nutrition policy, 677 (50.2%) were determined to have an informal policy, and 389 (28.9%) had no policy. There were significant differences between mean barrier scores and policy types for 8 of the 10 barriers. More research is needed to better understand how nutrition policies affect donations and distribution of food at food pantries. Using additional RE-AIM dimensions can allow for researchers to fully understand the role these policies have on the nutritional quality of food at food pantries.

The 2018 Farm Bill was finalized in mid-December of 2018 after months of discussion and debate between policymakers. The Farm Bill has many implications for low-income and food-insecure populations in the United States. One program within the Farm Bill that helps bridge the nutrition gap for low-income Supplemental Nutrition Assistance Program participants is the Food Insecurity Nutrition Incentive Grant Program (FINI). This commentary explores the best practices and promising findings of FINI projects to inform future policy discussions and implementation of FINI. In addition, we discuss knowledge gaps and opportunities within the context of the extant literature. Stakeholders and FINI grantees reported positive impacts of FINI grants, describing outcomes across farmers, grocery store owners, local economies, and Supplemental Nutrition Assistance Program participants (eg, increased fruit and vegetable consumption). The 2018 Farm Bill was largely in alignment with the Academy's recommendations, and preserved the integrity of the Supplemental Nutrition Assistance Program as well as increased funding for FINI.

It is necessary to scale up measurement in order to confront the persisting problem of food insecurity in the United States (USA). The causes and consequences around food insecurity are briefly described in order to frame the complexity of the public health issue and demonstrate need for expanded measurement approaches. We assert that measurement of food security in the USA is currently based upon a core set of rigorous metrics and, moving forward, should also constitute a supplemental registry of measures to monitor and address variables that are associated with increased risk for food insecurity. Next, we depict dietary quality as a primary example of the power of measurement to make significant progress in our understanding and management of food insecurity. Finally, we discuss the translational implications in behavioral medicine required to make progress on achieving food security for all in the USA.

This article introduces a special issue in Translational Behavioral Medicine that focuses on translational aspects of food insecurity research. The purpose of this special issue was to add to the evidence base to inform short- and intermediate-term intervention development and implementation and to spark additional future discourse around these important topics. The special issue included 12 articles and 2 commentaries roughly evenly split across four topic areas, including subpopulation food insecurity risk factors; food behaviors and psychosocial variables; implementation and/or evaluation of food insecurity interventions; and food insecurity-related measurement issues. The articles in this special issue offer a number of contributions to the translational literature specific to food insecurity. They add to our understanding that depression, stress, and social isolation (sometimes related to language barriers) may play a large role in individuals’ food insecurity experience. The articles explored the differences between food insecure and food secure households in relation to food and grocery shopping behaviors, and nutritional self-efficacy. In addition, authors described the implementation and/or efficacy of interventions meant to promote healthful diets and food access among food insecure populations. And finally, several studies explored current measurement issues such as intra-household subjectivity, disconnect between perceived and objective measures of food access, and a need for more holistic and nutrition-focused measurement approaches. While there are deeper systemic factors driving food insecurity, the findings provided in this special issue can help guide those addressing the current challenges faced by food insecure households that struggle to achieve healthful diets.

The USDA Supplemental Nutrition Assistance Program (SNAP) provides food and financial assistance to food-insecure individuals and families. In the midst of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, SNAP benefits evolved. Policy changes and federal legislation expanded SNAP eligibility, raised benefit levels, and introduced program waivers that enabled online ordering to reduce participants’ exposure to community-acquired SARS-CoV-2. Although rapid expansion of SNAP benefits in the online space represents significant progress for federal food assistance, changes also introduced unforeseen partiality in how benefits and services were accessed and utilized, as illustrated by 2 populations and regions in the early months of the SARS-CoV-2 pandemic: low-income older adults in rural Alabama and low-income Hispanic adults in urban California. Opportunities exist to build on the recent progress in SNAP, while also ensuring continued inclusiveness of eligible persons. Efforts should be informed by evidence that supports equitable access to federal food assistance., The SARS-Cov-2 pandemic influenced how federal food-assistance resources are delivered and accessed. Data from 2 regions demonstrate it is essential to understand who benefits and how to reach them.

Coronavirus disease 2019 (COVID-19) poses an occupational health risk to food system workers including farmers/producers, grocery store workers, emergency food system staff and volunteers (e.g., food pantry workers), and others. These food system workers have been pushed to the front-line of this pandemic, providing essential services that support food consumption for all Americans. Food system workers are some of the most economically vulnerable populations and are at risk of further financial disparities and contraction of COVID-19 during this pandemic. As we continue to grapple with the best strategies to support the food system and mitigate concerns around the spread of COVID-19, appropriate measures must be considered to better protect and support front-line food system workers that safeguard food access for all Americans.

Objective To determine baseline characteristics of a group of Samoans/Tongans in Southern California at risk for type 2 diabetes mellitus and identify barriers, cultural factors, and readiness and capacity to implement a culturally tailored Diabetes Prevention Program (DPP) in a faith-based setting. Design A mixed-methods pilot that included piloting modified DPP sessions, conducting a survey, and focus groups (N = 4). Setting Samoan/Tongan faith-based organizations. Participants Samoan/Tongan church members in Southern California who were interested in lifestyle behavior change. Main outcome measures Surveys assessing sociodemographic, acculturation, health status, food insecurity, and psychosocial factors. Focus groups focusing on attitudes toward the curriculum, opportunities for tailoring, and specific barriers/facilitators for healthy weight, nutrition, and physical activity. Results Participants (N = 47) were on average 42 years old, female (57%), and identified as Pacific Islander (35% Samoan, 30% American Samoan, and 35% Tongan). Ninety-eight percent of respondents were overweight/obese, and 45% of households were food insecure. Less than half of respondents were born in the United States, and 28% reported "poor" or "fair" English proficiency. Those with higher body mass indexes were more likely to score lower on internal locus of control and self-efficacy for healthy eating and were motivated to lose weight to feel in control of their health. Focus group results revealed that members of the Samoan/Tongan communities are "underserved" and experience a lack of culturally relevant programs to address obesity and chronic disease. Several barriers to healthier lifestyles were identified including adaptation of traditional recipes made in the United States (ie, to be less healthy), role of stress, cultural values (eg, preference for larger body size), and lack of awareness about healthy lifestyles. The church was identified as a resource that could be leveraged further to positively impact health outcomes. Conclusions Results demonstrate possible ways to tailor the DPP for US-based Samoan/Tongan populations by harnessing cultural traditions and addressing existing barriers and psychosocial constructs.

Research exploring the attitudes and opinions of food pantry clients on the Supplemental Nutrition Assistance Program (SNAP) program is limited. The purpose of this study was to explore differences...

This paper describes the levels of household food insecurity in the region to determine if differences exist between socio-demographics of the sample. Further, it tests if the increased prevalence ...

Policy interventions have been identified as a potential avenue to improve dietary quality among Supplemental Nutrition Assistance Program (SNAP) participants. However, limited research has explore...

To characterize participants of a statewide healthy food incentive program in terms of shopping behaviors, surveys were collected at farmers markets (N = 436) and grocery stores (N = 131). Farmers market and grocery store respondents were mostly forty-five to fifty-four years old (21 percent to 24 percent) and female (72 to 82 percent). Grocery store respondents were more diverse. Farmers market participants were more likely to be female ( p = .011), not have children ( p = .006), and traveled further compared to grocery store participants. As healthy food incentive programs expand, participant characteristics should inform tailored outreach to expand to diverse populations to have a greater public health impact.

ObjectiveThe present study aimed to examine the correlates of fruit and vegetable intake (FVI) separately among parents and their adolescents.DesignCross-sectional surveys.SettingOnline survey.SubjectsParents and adolescents completed the Family Life, Activity, Sun, Health, and Eating (FLASHE) survey through the National Cancer Institute. The survey assessed daily intake frequencies of food/beverage groups, psychosocial, parenting and sociodemographic factors. Generalized linear models were run for both parents and adolescents, for a total of six models (three each): (i) sociodemographic characteristics; (ii) psychosocial factors; (iii) parent/caregiver factors.ResultsParent participants (n 1542) were predominantly 35–59 years old (86 %), female (73 %), non-Hispanic White (71 %) or non-Hispanic Black (17 %), with household income n 805) were aged 12–14 years (50 %), non-Hispanic White (66 %) and non-Hispanic Black (15 %). Parents consumed 2·9 cups fruits and vegetables (F&V) daily, while adolescents consumed 2·2 cups daily. Educational attainment (higher education had greater FVI) and sex (men consumed more than women; all PPPPConclusionsFindings suggest factors that impact FVI among parents and their adolescent(s), which highlight the importance of the role of parent behaviour and can inform tailored approaches for increasing FVI in various settings.

Policy-level influences are impactful strategies to improve dietary behaviors, with the ability to strengthen food environments and with a broad population-level effect. Policies can alter the “choice architecture,” which may lead individuals to make healthier decisions by means of making the healthier option the default option. Policy levers such as taxation and regulation of businesses that influence the food environment are mechanisms through which positive change can be made. Specific legislation discussed in this chapter includes the Healthy Hunger Free Kids Act of 2010, the farm bill, and more recent proposals such as sugar-sweetened beverage taxation and labeling of genetically modified organisms. Finally, this chapter outlines ideas for how public health professionals can get involved and influence the political process.

CITYgreen software has become a commonly used tool to quantify the benefits of urban shade trees. Despite its frequent use, little research has been conducted to validate results of the CITYgreen energy conservation module. The first objective of this study is to perform a familiar application of CITYgreen software to predict the potential energy savings contribution of existing tree canopies in residential neighborhoods during peak cooling summer months. Unlike previous studies utilizing CITYgreen, this study also seeks to assess the software's performance by comparing model results (i.e., predicted energy savings) with actual savings (i.e., savings derived directly from energy consumption data provided by the electric utility provider). Homeowners in an older neighborhood with established trees were found to use less energy for air-conditioning than homeowners in a recently developed site. Results from the assessment of model performance indicated that CITYgreen more accurately estimated the energy savings in the highly vegetated, older neighborhood.