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Red meat production is a leading contributor to food-related greenhouse gas emissions. Decreasing red meat intake can mitigate climate change and lower risk of diet-related diseases.The goal of this study is to evaluate university students' perceptions of climate-friendly behaviors and to assess how these perceptions are associated with the frequency of red meat intake.Cross-sectional survey SETTING: A large, public California university and a large, public Michigan university PARTICIPANTS: Undergraduate students from a California university (n = 721) and a Michigan university (n = 568) MAIN OUTCOME MEASURES: Perceptions of climate-friendly behaviors and frequency of red meat intake STATISTICAL ANALYSIS: Differences in perceptions by student characteristics were compared using t-tests and one-way analysis of variance. Associations between perceptions of climate-friendly behaviors and red meat intake frequency were examined using generalized linear models, adjusted for sociodemographic covariates.Across both universities, students rated reducing meat intake as less effective than other climate change mitigation behaviors such as recycling and using less plastic. However, students who reported (1) making food and beverage choices that "are good for the environment," (2) making food and beverage choices that "reduce climate change impact," or (3) agreeing that "eating less meat is an effective way to combat climate change" reported 10% to 25% lower frequency of red meat intake for each point higher on the agreement scale. In contrast, making food and beverage choices motivated by health was not associated with frequency of red meat intake.Sustainability motivations and perceptions of meat's climate impact were associated with lower frequency of red meat intake, despite the overall moderate rating of eating less meat as an effective climate change mitigator. This research lends support to behavioral interventions, public education campaigns, and policies aiming to reinforce sustainable dietary patterns in young adults.

Objectives. To examine the effects of childhood participation in the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on adult food security in the United States. Methods. We used data from the 1984 to 2019 waves of the Panel Study of Income Dynamics to follow a balanced panel of 1406 individuals from birth through ages 20 to 36 years. We measured food insecurity from 1999 to 2003 and 2015 to 2019 among those who resided in low-income households during childhood. Results. Twenty-eight percent of individuals who resided in low-income households during childhood exhibited improved food security status from childhood to adulthood. Those who participated in SNAP and WIC during childhood had 4.16-fold higher odds (95% confidence interval [CI] = 1.91, 9.03) of being more food secure than those who were eligible for but did not receive SNAP or WIC, and those who participated in SNAP alone had 3.28-fold higher odds (95% CI = 1.56, 6.88). Conclusions. Participation in social safety net programs such as SNAP and WIC during childhood helps to improve food security across the life course. Our findings add evidence regarding the long-term benefits of participation in SNAP and WIC during childhood. (Am J Public Health. 2022;112(10):1498–1506. https://doi.org/10.2105/AJPH.2022.306967 )

BACKGROUND: Ultra-processed foods contribute to risks of obesity and cardiometabolic disease, and higher intakes have been observed in low-income populations in the United States. Consumption of ultra-processed foods may be particularly higher among individuals experiencing food insecurity and participating in the Supplemental Nutrition Assistance Program (SNAP). OBJECTIVES: Using data from the 2007–2016 NHANES, we examined the associations between food insecurity, SNAP participation, and ultra-processed food consumption. METHODS: The study population comprised 9190 adults, aged 20–65 y, with incomes ≤300% of the federal poverty level (FPL). Food insecurity was assessed using the Household Food Security Survey Module and SNAP participation over the past 12 mo was self-reported. Dietary intake was measured from two 24-h dietary recalls. Ultra-processed food consumption (percentage of total energy intake) was defined using the NOVA food classification system. Linear regression models were used to examine the associations between food insecurity, SNAP participation, and ultra-processed food consumption, adjusting for sociodemographic and health characteristics. RESULTS: More severe food insecurity was associated with higher intakes of ultra-processed foods (P-trend = 0.003). The adjusted means of ultra-processed food intake ranged from 52.6% for adults with high food security to 55.7% for adults with very low food security. SNAP participation was also associated with higher intakes of ultra-processed foods (adjusted mean: 54.7%), compared with income-eligible participants (adjusted mean: 53.0%). Furthermore, the association between food insecurity and ultra-processed foods was modified by SNAP participation (P-interaction = 0.02). Among income-eligible nonparticipants and income-ineligible nonparticipants, more severe food insecurity was associated with higher consumption of ultra-processed foods. Among SNAP participants, the association between food insecurity and consumption of ultra-processed foods was nonsignificant. CONCLUSION: In a nationally representative sample of adults, food insecurity and SNAP participation were both associated with higher levels of ultra-processed food consumption.

Objectives. To describe food insecurity in the United States in December 2020 and examine associations with underuse of medical care during the COVID-19 pandemic. Methods. We fielded a nationally representative Web-based survey in December 2020 (n = 8318). Multivariable logistic regression models and predicted probabilities were used to evaluate factors associated with food insecurity and compare the likelihood of delaying or forgoing medical care because of cost concerns by food security status. Results. In December 2020, 18.8% of US adults surveyed reported experiencing food insecurity. Elevated odds of food insecurity were observed among non-Hispanic Black, Hispanic, and low-income respondents. Experiencing food insecurity was significantly associated with a greater likelihood of forgoing any type of medical care as a result of cost concerns. Conclusions. Food insecurity during the COVID-19 pandemic disproportionately affected non-White and low-income individuals. Experiencing food insecurity was a significant risk factor for delaying or forgoing medical care, an association that could have cumulative short- and long-term health effects. Public Health Implications. Comprehensive policies that target the most at-risk groups are needed to address the high rates of food insecurity in the United States and mitigate its adverse health effects. (Am J Public Health. 2022;112(5):776–785. https://doi.org/10.2105/AJPH.2022.306724 )

Introduction: Food insecurity, a condition of limited household food availability due to insufficient resources, is a critical social determinant of health. Food insecurity increases the risks for poor physical, behavioral, and mental health outcomes. Cardiovascular disease remains the leading cause of mortality in the US, and adults with food insecurity may face a high burden of cardiovascular disease risk. This study aimed to examine the associations between household food security status and ideal cardiovascular health (CVH), defined using the American Heart Association (AHA)’s new Life’s Essential 8 measure. We hypothesized that greater severity of food insecurity will be associated with lower overall cardiovascular health. Methods: Data came from 14,619 adults ≥20 years from the 2013-2018 National Health and Nutrition Examination Surveys. Food security was measured using the 18-item Household Food Security Survey Module, and categorized into households with high, marginal, low, and very low food security. Per AHA criteria, ideal CVH was calculated as scores (0-100) indicating the attainment of standards for diet, physical activity, smoking, sleep, body mass index, blood lipids, blood glucose, and blood pressure. Overall CVH was calculated as the unweighted average score across the eight metrics and overall average CVH score ≥80 was considered high CVH. We used linear and logistic regression models to examine the associations between household food security and ideal CVH outcomes, adjusting for sociodemographic characteristics. Complex survey weights were applied to all analyses. Results: In the sample, 72.7% of adults had high food security, 10.0% had marginal food security, 10.4% had low food security, and 6.8% had very low food security. The mean overall CVH score was 68.8 (SE 0.3), ranging from 70.2 (SE 0.3) for high food security to 62.7 (SE 1.8) for very low food security. After multivariate adjustment, marginal food security (β= -1.5, 95% CI -2.9, -0.1), low food security (β= -3.0, 95% CI -4.4, -1.7), and very low food security (β= -4.7, 95% CI -6.4, -3.0) were each associated with lower overall CVH scores when compared to high food security ( P-trend ). These associations were driven by lower mean scores for diet, tobacco, sleep, BMI, and blood glucose with greater severity of food insecurity ( P-trends ). Furthermore, low food security (OR 0.57, 95% CI 0.45, 0.74) and very low food security (OR 0.52, 95% CI 0.37, 0.73) were both associated with lower odds of high CVH. Results remained significant in sensitivity analyses restricting the sample to adults with family incomes ≤300% of the federal poverty level. Discussion: Household food insecurity was adversely associated with cardiovascular health metrics in a dose-response fashion. Public health interventions and policies should consider a holistic approach to health promotion among populations with food insecurity.

Background Excessive weight gain during pregnancy is associated with complications for both the mother and her infant including gestational diabetes, hypertensive disorders, operative delivery, and long-term obesity. A healthy diet during pregnancy promotes healthy gestational weight gain and determines fetal epigenetic programming in infants that impacts risk for future chronic disease. Objective This project will examine the impact of grocery delivery during pregnancy on the weight, diet, and health outcomes of young pregnant women and their infants. Methods A three-arm randomized controlled trial design will be performed. A total of 855 young pregnant women, aged 14-24 years, from across the state of Michigan will be enrolled and randomized equally into the three study arms. Participants in arm one (control) will receive usual care from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); arm two will receive WIC plus biweekly grocery delivery; and arm three will receive WIC plus biweekly grocery and unsweetened beverage delivery. Weight will be assessed weekly during pregnancy, and total pregnancy weight gain will be categorized as above, below, or within guidelines. Additionally, dietary intake will be assessed at three time points (baseline, second trimester, and third trimester), and pregnancy outcomes will be extracted from medical records. The appropriateness of pregnancy weight gain, diet quality, and occurrence of poor outcomes will be compared between groups using standard practices for multinomial regression and confounder adjustment. Results This study was funded in April 2021, data collection started in December 2021, and data collection is expected to be concluded in 2026. Conclusions This study will test whether grocery delivery of healthy foods improves weight, diet, and pregnancy outcomes of young moms with low income. The findings will inform policies and practices that promote a healthy diet during pregnancy, which has multigenerational impacts on health. Trial Registration ClinicalTrials.gov NCT05000645; https://clinicaltrials.gov/ct2/show/NCT05000645 International Registered Report Identifier (IRRID) DERR1-10.2196/40568

Purpose: To understand associations between food insecurity and depression, anxiety, and stress during the COVID-19 pandemic among low-income adults in the United States. Methods: During March 19-24, 2020, we fielded a national, web-based survey (53% response rate) among low-income adults (

BackgroundHealth-related warning labels may reduce the intake of sugar-sweetened beverages (SSBs), but the effectiveness of such labels in real-world settings is not well established.ObjectivesWe investigated the influence of warning labels on SSB intake among college students at a large public Midwestern university.MethodsWe conducted a quasi-experimental intervention study among 840 undergraduate students recruited from 3 dining halls on 1 university campus. One dining hall was selected as the intervention (I) site, whereas the other dining halls served as control (C) sites. In January 2019, warning labels were posted on SSB dispensers at the I site. All students reported their beverage intake using a modified beverage frequency questionnaire 2 mo before and 2 mo after the warning label implementation. Generalized linear models examined the influence of the warning labels on SSB consumption at the I site compared with the C sites, adjusting for students' sociodemographic characteristics.ResultsIn the sample, 68% were aged 17-18 y old at baseline, and 51% identified as female. From baseline to follow-up, there was a 19% decrease in SSB intake at the I site, compared with a 5% decrease at the C sites (P=0.049 comparing I with C). This difference was driven by significant decreases in the intakes of fruit-flavored drinks, sweetened teas, and flavored milk at the I site compared with the C sites. Although not an SSB, 100% fruit juce consumption decreased 21% at the I site, compared with a 1% increase at the C sites (P=0.01 comparing I with C). No significant differences were observed in the intakes of soda, energy drinks, sweetened coffees, and nonsugary drinks at the I site compared with the C sites.ConclusionsWarning labels were effective in reducing SSB intake among college students, particularly for fruit-flavored drinks, sweetened teas, and flavored milk.This trial was registered at clinicaltrials.gov as NCT04435145.

Purpose: Food insecurity is a concern on college campuses and is correlated with other basic needs insecurities. We examined the cumulative burden of food, financial, and housing insecurities on college students’ health and academic performance. Design: Cross-sectional survey. Setting: Large, public Midwestern university. Sample: A total of 793 college students completed an online survey in 2018 (43% response rate). Measures: Food, financial, and housing insecurity were measured using validated instruments. Primary outcomes were general health status, anxiety and depression, and grade point average (GPA). Analysis: Weighted linear and logistic regression analyses were used to examine associations between cumulative basic needs insecurities and primary outcomes. Results: Approximately 11% of students experienced all 3 insecurities. Compared to fully secure students, students with all 3 insecurities were more likely to have anxiety and depression (odds ratio [OR] = 4.65, 95% CI: 4.31-5.01), fair/poor health (OR = 4.06, 95% CI: 3.73-4.42), and lower GPA (β = −0.19, 95% CI: −0.30 to −0.09), adjusting for sociodemographic characteristics. Conclusion: Interventions that address multiple basic needs insecurities are needed to promote college students’ well-being and foster academic success.

Purpose The purpose of this study was to identify factors influencing participant engagement in a community-based diabetes self-management program (DSMP), with a focus on the needs of underserved groups (eg, racial/ethnic minorities, low income). Methods Focus groups were conducted with participants (n = 22) from the YMCA of Greater Richmond’s Diabetes Control Program, who were recruited using a purposeful sampling frame to capture a range of experiences. In-depth interviews were conducted with lay health coaches (n = 3). The RADaR qualitative analysis technique was used to identify themes related to factors across the continuum of engagement. Results Fear affected program enrollment and retention in complex ways. Peers and coaches were important for social support and accountability. The length of the program (12 weeks), accessible information, practical skill building, and emphasis on making small, feasible improvements in pursuit of larger goals were identified as critical for engagement and improving diabetes self-management. Health and outside obligations were the major barriers to program attendance. Conclusions Participant and coach perspectives provide important insight into existing strengths of community-based DSMPs that can be expanded on to promote engagement as well as potential opportunities for improvement. Actionable recommendations for increasing engagement of underserved groups in community-based DSMPs are provided.

BACKGROUND: Prior research on the restaurant environment and obesity risk is limited by cross-sectional data and a focus on specific geographic areas. OBJECTIVE: To measure the impact of changes in chain restaurant calories over time on body mass index (BMI). DESIGN: We used a first-difference model to examine whether changes from 2012 to 2015 in chain restaurant calories per capita were associated with percent changes in BMI. We also examined differences by race and county income, restaurant type, and initial body weight categories. SETTING: USA (207 counties across 39 states). PARTICIPANTS: 447,873 adult patients who visited an athenahealth medical provider in 2012 and 2015 where BMI was measured. MAIN OUTCOMES MEASURED: Percent change in objectively measured BMI from 2012 to 2015. RESULTS: Across all patients, changes in chain restaurant calories per capita were not associated with percent changes in BMI. For Black or Hispanic adults, a 10% increase in exposure to chain restaurant calories per capita was associated with a 0.16 percentage-point increase in BMI (95% CI 0.03, 0.30). This translates into a predicted weight increase of 0.89 pounds (or a 0.53% BMI increase) for an average weight woman at the 90th percentile of increases in the restaurant environment from 2012 to 2015 versus an increase 0.39 pounds (or 0.23% BMI increase) at the 10th percentile. Greater increases in exposure to chain restaurant calories also significantly increased BMI for Black or Hispanic adults receiving healthcare services in lower-income counties (0.26, 95% CI 0.04, 0.49) and with overweight/obesity (0.16, 95% CI 0.04, 0.29). LIMITATIONS: Generalizability to non-chain restaurants is unknown and the sample of athenahealth patients is relatively homogenous. CONCLUSIONS: Increased exposure to chain restaurant calories per capita was associated with increased weight gain among Black or Hispanic adults. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11606-020-05683-8) contains supplementary material, which is available to authorized users.

Introduction Food insecurity during young adulthood affects physical health, mental health, and academic performance. However, little is known about parental and behavioral factors during childhood that may contribute to risk of food insecurity during young adulthood. Methods Data were obtained from the Panel Study of Income Dynamics’ Child Development Supplement (1997–2017). In 2018–2019, a balanced panel was constructed of individuals who were aged 0–12 years in 1997 (n=1,049) and were living independently as of 2015. Simple and multivariable logistic regression analyses were used to examine the effect of parental nutritional knowledge, childhood food preparation, and food shopping involvement on food insecurity in 2015–2017, adjusting for individual- and family-level factors. Results Children whose parents had medium (OR=0.39, 95% CI=0.17, 0.93) or high (OR=0.38, 95% CI=0.19, 0.76) nutritional knowledge, compared with low nutritional knowledge, had lower odds of being food insecure when they reached young adulthood. In fully adjusted models, high levels of time spent preparing food during childhood were associated with lower odds of food insecurity in young adulthood (OR=0.47, 95% CI=0.26, 0.84) compared with individuals who spent no time in food preparation. Time spent food shopping during childhood did not predict food insecurity in young adulthood. Conclusions Spending time in food preparation during childhood and high parental nutritional knowledge each have a protective effect against food insecurity during young adulthood. Greater investment in teaching cooking skills during childhood may be beneficial, particularly for individuals at high risk for food insecurity.

Shifting consumer behavior towards more sustainable diets can benefit environmental sustainability and human health. Although more frequent home cooking is associated with a better diet quality and fast-food consumption with worse diet quality, the environmental impact of diets based on frequency of cooking or eating fast food is not well understood. The objective of this study was to investigate whether the frequency of cooking dinner at home or eating fast food is associated with dietary greenhouse gas emissions (GHGE). We linked 24-h dietary recall data from adult respondents in the 2007–2010 National Health and Nutrition Examination Survey (NHANES) (N = 11,469) to a database of GHGE factors to obtain a measure of dietary GHGE (kgCO2-eq/2000 kcal) (the sum of emissions released in the production of food for an individual’s diet), adjusted by energy intake (kgCO2-eq/2000 kcal). We examined associations between frequency of cooking dinner (the only meal for which cooking frequency was measured), frequency of eating fast food, and dietary GHGE and protein sources (beef, pork, poultry, other meat, and fish and seafood (g/2000 kcal)) using generalized linearized regression models that controlled for age, sex, and other socio-economic characteristics. Greater cooking frequency was associated with higher dietary GHGE. In fully adjusted models, cooking 5–6 times/week was associated with an additional 0.058 kgCO2-eq/2000 kcal (SE 0.033) and cooking 7 times/week was associated with an additional 0.057 kgCO2-eq/2000 kcal (SE 0.027) when compared to cooking 0–2 times/week. Individuals in households who cooked dinner more frequently consumed significantly more meat, poultry, and fish (cooking 7 times/week: 148.7 g/2000 kcal vs. cooking 0–2 times/week: 135.4 g/2000 kcal, p-trend = 0.005), which could explain the association with a higher carbon footprint diet. There were few associations of note between fast-food frequency and GHGE. Policies and interventions that reduce consumption of meat and increase consumption of plants when both cooking meals at home and eating meals out are needed to shift toward diets that will be beneficial for both human health and the health of the planet.

Public efforts to limit the spread of the coronavirus rely on motivating people to cooperate with the government. We test the effectiveness of different governmental messengers to encourage preventive health actions. We administered a survey experiment among a sample (n = 1,545) of respondents across the United States, presenting them with the same social media message, but experimentally varying the government sender (i.e., Federal, State, County, a combination of Federal + County, and a control condition) to test whether local relevance influences messaging efficacy. We find that in an information saturated environment the messenger does not matter. There is, however, variation in treatment response by partisanship, education, income, and the degree to which respondents are affected by the pandemic. While the main effect of the level of government on intended behavior is null, public health organizations are universally perceived as more trustworthy, relevant, and competent than anonymous messengers.

ImportanceThere is increasing interest in strategies to encourage more environmentally sustainable food choices in US restaurants through the use of menu labels that indicate an item’s potential impact on the world’s climate. Data are lacking on the ideal design of such labels to effectively encourage sustainable choices.ObjectiveTo test the effects of positive and negative climate impact menu labels on the environmental sustainability and healthfulness of food choices compared with a control label.Design, Setting, and ParticipantsThis randomized clinical trial used an online national US survey conducted March 30 to April 13, 2022, among a nationally representative sample of adults (aged ≥18 years) from the AmeriSpeak panel. Data were analyzed in June to October 2022.InterventionsParticipants were shown a fast food menu and prompted to select 1 item they would like to order for dinner. Participants were randomized to view menus with 1 of 3 label conditions: a quick response code label on all items (control group); green low–climate impact label on chicken, fish, or vegetarian items (positive framing); or red high–climate impact label on red meat items (negative framing).Main Outcomes and MeasuresThe main outcome was an indicator of selecting a sustainable item (ie, one without red meat). Secondary outcomes included participant health perceptions of the selected item and the Nutrition Profile Index (NPI) score of healthfulness.ResultsAmong 5049 participants (2444 female [51.6%]; 789 aged 18-29 years [20.3%], 1532 aged 30-44 years [25.9%], 1089 aged 45-59 years [23.5%], and 1639 aged ≥60 years [30.4%]; 142 Asian [5.3%], 611 Black [12.1%], and 3197 White [63.3%]; 866 Hispanic [17.2%]), high– and low–climate impact labels were effective at encouraging sustainable selections from the menu. Compared with participants in the control group, 23.5% more participants (95% CI, 13.7%-34.0%; P P = .03) selected a sustainable menu item when menus displayed low–climate impact labels. Across experimental conditions, participants who selected a sustainable item rated their order as healthier than those who selected an unsustainable item, according to mean perceived healthfulness score (control label: 3.4 points; 95% CI, 3.2-3.5 points vs 2.5 points; 95% CI, 2.4-2.6 points; P P P P P Conclusions and RelevanceThis randomized clinical trial’s findings suggest that climate impact menu labels, especially negatively framed labels highlighting high–climate impact items (ie, red meat), were an effective strategy to reduce red meat selections and encourage more sustainable choices.Trial RegistrationClinicalTrials.gov Identifier: NCT05482204

The link between home cooking and health is being actively explored in both observational and experimental studies. However, research on this topic is limited by the lack of cooking behavior metrics. Most existing assessment tools focus only on cooking frequency or one’s ability to complete specific a priori food preparations. Cooking is a complex and multifaceted behavior that is influenced by culture, environment, and social norms. More flexible and adaptable measurement approaches are needed to elucidate the spectrum of cooking ability in the population and, in turn, develop meaningful recommendations and interventions.

The Yale Food Addiction Scale 2.0 (YFAS 2.0) operationalizes food addiction (FA) by applying the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM 5) criteria for substance use disorder (SUD) to the overconsumption of highly processed foods. The YFAS 2.0 has been quantitatively validated across numerous populations, but has never undergone qualitative analysis.Using qualitative methods we aimed to determine if the interpretation YFAS 2.0 is aligned with the DSM 5 conceptualization of SUD, to determine if any items are perceived as irrelevant to the lived-experience of FA, and to determine if there are constructs central to the lived-experience of FA that are not captured by the scale.We interviewed 16 participants who met criteria for FA on the modified YFAS 2.0 using semi-structured interviews to understand each participants' interpretation of items on the scale and their perceptions of how the scale matched their lived-experience of FA. Reflexive thematic analysis was used to code responses and identify themes.Most interpretations aligned with the DSM 5 conceptualization of SUDs. Withdrawal and tolerance-related items were subject to some misinterpretations. Participants viewed problem-focused symptoms (e.g., interpersonal problems) as the least relevant to their lived-experience. Novel themes not included on the YFAS 2.0 (e.g., emotional eating) emerged.Our study supports the validity of the YFAS 2.0 by showing consistency with the DSM 5 conceptualization of SUDs and consistency with the lived-experience of individuals who endorse FA. Future research should explore the novel themes that emerged in this study.

Dietary interventions are first-line therapies for the prevention and management of many chronic diseases, yet primary care physicians prescribe these interventions infrequently.This study investigates primary care physicians' current knowledge and opinions regarding the delivery of dietary interventions. This work aims to identify modifiable barriers to prescribing dietary interventions to prevent and treat diet-related diseases.We designed and fielded an anonymous, cross-sectional survey of faculty and resident physicians across the Internal Medicine, Family Medicine, and Pediatrics departments in three academic and community hospitals in lower Michigan. Data were collected between January 15 and April 15, 2019. Self-rated knowledge and attitudes were measured on a 5-point Likert scale. Objective scores were calculated for each question as percentage answered correctly among all respondents. Objective knowledge scores were compared based on participants' years in practice.Response rate was 23% (356 responses). The sample was 62.3% female and 75.3% non-Hispanic White, and 56.7% were age 40 or younger. Average objective knowledge score was 70.3% (±17.2) correct. Mean self-rated knowledge score was 2.51 (±0.96) on a scale of 1(Poor) - 5(Excellent). Overall agreement with a statement of importance of dietary interventions was 3.99 (±0.40) on a scale of 1 (strongly disagree) to 5 (strongly agree). A majority (91.7%) of respondents indicated they would like more opportunities to learn about the evidence supporting dietary interventions.Physicians desire to incorporate dietary interventions into their practice. Findings encourage the development of educational strategies to support dietary intervention use among primary care physicians.

Americans spend the majority of their food dollars at restaurants and other prepared food sources, including quick-service and fast-food restaurants (PFS); independent small restaurants make up 66% of all PFS in the US. In this feasibility study, 5 independent and Latino-owned PFS in the Washington DC metro area worked with academic partners to start offering healthy combo meals with bottled water and promote these using on-site, community, and social media advertising. The number of healthy combos sold was collected weekly, showing that the new combos sold, and customers in all 5 sites were surveyed as they exited the PFS (n=50): >85% had noticed the combo meals; 100% thought it was a good idea to offer it, 68% had ordered the combo (of these, >94% of customers responded that they liked it). Results suggest that it is feasible to work with independent Latino-owned restaurants to promote healthy combos and collect data.

Food insecurity is a critical public health problem in the United States that has been associated with poor diet quality. Cooking dinner more frequently is associated with better diet quality.This study aimed to examine how food insecurity and dinner cooking frequency are associated with diet quality during the initial months of the coronavirus disease 2019 pandemic.This cross-sectional study analyzed data from a national web-based survey (June 23 to July 1, 2020).Participants were 1,739 low-income (250% of the federal poverty level) adults in the United States.The outcome was diet quality, measured by the Prime Diet Quality Score (PDQS-30D). The PDQS-30D is a food frequency questionnaire-based, 22-component diet quality index.Food security status (high, marginal, low, or very low) and frequency of cooking dinner (7, 5 to 6, 3 to 4, or 0 to 2 times/week) were evaluated in relation to PDQS-30D scores (possible range = zero to 126) in age- and sex and gender-, and fully adjusted linear regression models. Postestimation margins were used to predict mean PDQS-30D score by food security status and dinner cooking frequency. The interaction between food security status and frequency of cooking dinner was also tested.Overall, the mean PDQS-30D score was 51.9 ± 11 points (possible range = zero to 126). The prevalence of food insecurity (low/very low) was 43%, 37% of the sample cooked 7 times/week and 15% cooked 0 to 2 times/week. Lower food security and less frequent cooking dinner were both associated with lower diet quality. Very low food security was associated with a 3.2-point lower PDQS-30D score (95% CI -4.6 to -1.8) compared with those with high food security. Cooking dinner 0 to 2 times/week was associated with a 4.4-point lower PDQS-30D score (95% CI -6.0 to -2.8) compared with cooking 7 times/week. The relationship between food insecurity and diet quality did not differ based on cooking dinner frequency.During the initial months of the coronavirus disease 2019 pandemic food insecurity and less frequently cooking dinner at home were both associated with lower diet quality among low-income Americans. More research is needed to identify and address barriers to low-income households' ability to access, afford and prepare enough nutritious food for a healthy diet.

Introduction Food insecurity has been associated with adverse health and academic outcomes among college students. However, little is known about the long-term impacts of experiencing food insecurity during college. This study examines the impacts of college food insecurity (measured from 1999 to 2003) on future food insecurity (measured from 2015 to 2017) and whether this association differs by economic independence during college. Methods Data came from 1,508 participants in the Panel Study of Income Dynamics, the longest-running and nationally representative panel survey. Household food security was assessed using the 18-item U.S. Household Food Security Survey Module during college enrollment in 1999–2003 and again during adulthood in 2015–2017. Generalized linear models were used to examine the impacts of college food insecurity on food insecurity in adulthood, adjusting for individual- and family-level sociodemographic characteristics. Data analysis was conducted in 2020–2021. Results After multivariable adjustment, college food insecurity was associated with an increased prevalence of food insecurity in adulthood (prevalence ratio=1.45, 95% CI=1.16, 1.81). This association was more pronounced among students who were economically independent from their parents during college (prevalence ratio=2.23, 95% CI=1.27, 3.90). Conclusions Food insecurity during college is associated with a higher prevalence of food insecurity in early to middle adulthood, particularly among economically independent students. Given the seemingly cyclical nature of food insecurity over the life course, policies are needed to alleviate food insecurity during the critical college years.

Objective: Chefs have the potential to influence diet quality and food systems sustainability through their work. We aimed to assess the attitudes and perceptions of culinary students about nutrition and sustainability as part of their roles, responsibilities and future work as chefs. Design: We surveyed students attending the Culinary Institute of America (CIA) in the fall of 2019 (n 546). Descriptive statistics compared food priority rankings and Likert-scale distributions of nutrition and sustainability attitudes and beliefs. Adjusted generalised linear models were used to evaluate whether there were differences in attitudes and beliefs across demographic groups. Setting: The CIA, a private, not-for-profit college and culinary school with US campuses in New York, California and Texas. Participants: Students >18 years old currently enrolled in any of the school’s associate’s or bachelor’s degree programs. Results: Students agreed that chefs should be knowledgeable about nutrition (96·0 %) and the environmental impact of their ingredients (90·8 %) but fewer considered healthfulness (57·8 %) and environmental impact (60·2 %) of their food to be primary considerations in their career as a chef. Taste was the primary factor influencing culinary students’ food choices but food priorities differed by race/ethnicity. Conclusions: Culinary students believe nutrition and sustainability are important. Opportunities exist to empower them with knowledge and skills for promoting public health and sustainable food systems in their future work as chefs.

Objective: To examine the effect of food insecurity during college on graduation and degree attainment. Design: Secondary analysis of longitudinal panel data. We measured food insecurity concurrent with college enrollment using the 18-question USDA Household Food Security Survey Module. Educational attainment was measured in 2015-2017 via two questions about college completion and highest degree attained. Logistic and multinomial-logit models adjusted for sociodemographic characteristics were estimated. Setting: United States (US) Participants: A nationally representative, balanced panel of 1,574 college students in the US in 1999-2003 with follow-up through 2015-2017 from the Panel Study of Income Dynamics. Results: In 1999-2003, 14.5% of college students were food insecure and were more likely to be older, non-White, and first-generation students. In adjusted models, food insecurity was associated with lower odds of college graduation (OR 0.57, 95% CI: 0.37, 0.88, p=0.01) and lower likelihood of obtaining a Bachelor’s degree (RRR 0.57 95% CI: 0.35, 0.92, p=0.02) or graduate/professional degree (RRR 0.39, 95% CI: 0.17, 0.86, p=0.022). These associations were more pronounced among first-generation students. 47.2% of first-generation students who experienced food insecurity graduated from college; food insecure first-generation students were less likely to graduate compared to first-generation students who were food secure (47.2% vs. 59.3%, p=0.020) and non-first-generation students who were food insecure (47.2% vs. 65.2%, p=0.037). Conclusions: Food insecurity during college is a barrier to graduation and higher degree attainment, particularly for first-generation students. Existing policies and programs that help mitigate food insecurity should be expanded and more accessible to the college student population.

Nutrition during pregnancy has lifelong impacts on the health of mother and child. However, this life stage presents unique challenges to healthy cooking and eating. Cooking interventions show promising results, but often lack theoretical basis and rigorous evaluation. The objective of this formative, qualitative study was to explore motivators, strategies, and barriers related to healthy cooking during pregnancy. Pregnant individuals’ preferences for a cooking education program were also explored. We conducted five focus groups with pregnant individuals (n = 20) in Southeast Michigan in 2019. Focus groups were audio-recorded and transcribed verbatim, then double coded by two members of the research team. Mean gestational age was 18.3 ± 9.6 weeks. Common motivators included feeding other children, avoiding pregnancy complications, promoting fetal growth, and avoiding foodborne illness. Challenges included pregnancy symptoms, navigating nutrition recommendations, mental energy of meal planning, family preferences, and time constraints. Strategies employed were meal planning and including a variety of foods. Participants identified organizational strategies, recipes, nutrition information, and peer support as important components of a cooking intervention during pregnancy. This study characterized multiple challenges to healthy home cooking during pregnancy, providing novel insight to inform the development of cooking skills education programs during this important life stage. Published version

Background Food insecurity is a growing issue of concern on college campuses. While many studies have focused on predictors of food insecurity, fewer studies have examined how food insecurity affects diet and diet-related outcomes among college students. Objective The objective of this study was to examine differences in dietary intake, food and cooking agency, and body mass index (calculated as kg/m2) by food security status in a sample of college students at a large, public midwestern university. Design We conducted a cross-sectional online survey administered from March to June 2018. Participants Students were recruited from a random sample (n=2,000) provided by the university, which included an oversample of minority racial/ethnic students from lower-income households and first-generation students. The response rate was 43% (n=851). After excluding students with missing data, the final sample was 754 enrolled students. Main outcome measures Food security status was measured using the US Adult Food Security Survey Module. Dietary intake was assessed using the National Cancer Institute dietary screener questionnaire. Cooking and food agency was measured using the Cooking and Food Provisioning Action Scale, a new validated questionnaire. Body mass index was calculated from self-reported height and weight. Statistical analysis performed Differences between food security categories and diet-related outcomes were examined using generalized linear models. Models adjusted for sociodemographic covariates, such as student’s age, sex, race/ethnicity, and receipt of financial aid. Results Compared to students with high food security, low food security was associated with lower intake of fruits, and very low food security was associated with higher intakes of total added sugar and added sugar from sugar-sweetened beverages. Marginal and very low food security were positively associated with body mass index. Marginal, low, and very low food security were inversely associated with cooking and food agency. Conclusions Students with food insecurity experience diet-related challenges that could translate into health disparities over time. More research is needed to understand the longitudinal effects of food insecurity on student health and well being.

To examine how barriers to healthy food access and household income are associated with cooking and eating behaviors we fielded a nationally representative survey among 1112 adults in the United States in 2015. The survey included measures of barriers to accessing healthy food, household income, and frequency of cooking and eating meals, cooking practices, and other eating behaviors. We used multivariable poisson regression to examine the association of household income and barriers to healthy food access with cooking and eating behavior outcomes. We find that low income was associated with higher barriers to accessing healthy food (barriers) and that both income and barriers were associated with differences in cooking frequency/practices, and consumption behaviors. In interaction models, cooking and eating behaviors did not vary based on barriers for the lowest income level (

The COVID-19 pandemic caused widespread non-essential business closures in the U.S., which may have disproportionately impacted food consumption in lower-income communities, in part due to reduced access to healthy and affordable foods, as well as occupations that may have required working outside the home. The aims of this study were to examine restaurant dining behaviors (including drive-through, takeout, and delivery) at fast-food and non-fast-food (i.e., fast casual and full-service ['other']) restaurants and the impact on diet quality among racially/ethnically diverse low-income adults during the early months of the pandemic. Participants completed an online survey using CloudResearch regarding restaurant dining behaviors in the past week (during June 2020) and during a typical week prior to the pandemic. Diet quality was measured using the Prime Diet Quality Score (PDQS). Surveys from 1,756 low-income adults (incomes