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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.

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.

ObjectiveTo use cognitive interviewing and pilot testing to develop a survey instrument feasible for administering in the food pantry setting to assess daily intake frequency from several major food groups and dietary correlates (e.g. fruit and vegetable barriers) - the FRESH Foods Survey.DesignNew and existing survey items were adapted and refined following cognitive interviews. After piloting the survey with food pantry users in the USA, preliminary psychometric and construct validity analyses were performed.SettingThree US food banks and accompanying food pantries in Atlanta, GA, San Diego, CA, and Buffalo, NY.ParticipantsFood pantry clients (n 246), mostly female (68 %), mean age 54·5 (sd 14·7) years.ResultsMeasures of dietary correlates performed well psychometrically: Cronbach's α range 0·71-0·90, slope (α) parameter range 1·26-6·36, and threshold parameters (β) indicated variability in the 'difficulty' of the items. Additionally, all scales had only one eigenvalue above 1·0 (range 2·07-4·71), indicating unidimensionality. Average (median, Q1-Q3) daily intakes (times/d) across six dietary groups were: fruits and vegetables (2·87, 1·87-4·58); junk foods (1·16, 0·58-2·16); fast foods and similar entrées (1·45, 0·58-2·03); whole-grain foods (0·87, 0·58-1·71); sugar-sweetened beverages (0·58, 0·29-1·29); milk and milk alternatives (0·71, 0·29-1·29). Significant correlations between dietary groups and dietary correlates were largely in the directions expected based on the literature, giving initial indication of convergent and discriminant validity.ConclusionsThe FRESH Foods Survey is efficient, tailored to food pantry populations, can be used to monitor dietary behaviours and may be useful to measure intervention impact.

Eating a diet high in fruits and vegetables is associated with a reduction in the risk of chronic diseases such as obesity, cardiovascular disease, Type 2 diabetes, hypertension, asthma, depression, and mental illness, yet few low-income adults meet these recommendations. Nutrition incentive programs have emerged over the last decade to offer incentives to food-insecure households to purchase more fruits and vegetables. Although the goal of the program is to increase the consumption of fresh fruits and vegetables, defenders of nutrition incentive programs increasingly want to document economic impacts of their programs but often lack the resources to do so. Rather than these programs spending their scarce resources on conducting studies, this research created a rigorous, yet easy to use tool that U.S.-based practitioners operating nutrition incentive programs can use to estimate the economic impact of their programs, including incentive redemptions at both farm-direct and brick-and-mortar businesses. [ABSTRACT FROM AUTHOR]

Depression has been linked to food security, particularly among low-income mothers. However, less is known about the relationship between CHAOS (Confusion, Hubbub, and Order Scale), a measure of family functioning such as timeliness and order, and varying levels food security. The purpose of this paper was to evaluate the relationship between depression, CHAOS, and sociodemographics on the level of food insecurity in a cross-sectional sample of low-income households with children, ages 0-18 years. Participants were recruited from low-income communities in a medium sized Midwestern city in the United States. Eligible participants were =19 years of age, a parent or primary caregiver to at least one child, and English- or Spanish- speaking. Survey items included participation in the Supplemental Nutrition Assistance Program (SNAP), food security, depression, CHAOS, and sociodemographics/family characteristics. Descriptives and Chi-square tests were conducted for all variables. Potential covariates were assessed (e.g., age, income, education, race/ethnicity, sex, SNAP participation, number of children and adults in the household, and marital status) and included in the final logistic regression model through backward elimination. All statistics were conducted using SAS (version 9.4, SAS Institute Inc., Cary, NC). Participants (N=252) were 75% female, 42% Non-Hispanic Black, 31% Non-Hispanic White, 12% Hispanic, and 15% other race categories. The mean number of children in households was 2.33 (SD=1.58), and half of the respondents reported earning =$10,000/year. Chi-Square tests showed univariate relationships between study variables and varying household food security levels. Those in the "high" and "medium" groups for depression and CHAOS were both more likely than the "low" groups to experience low or very low food security. Income and education were also related to food security, with low levels of education and low income being associated with low or very low food security. Age, sex, race/ethnicity, and marital status were not associated with food security status. The fully adjusted logistic regression models of depression and CHAOS accounted for 10% and 14% of the variance in food security, respectively (depression: (OR=0.31, CI=0.15-0.65; pp In the current study, CHAOS demonstrated a stronger relationship with food security than depression, when controlling for sociodemographics. CHAOS is a measurement that has not been tested widely among food insecure populations, but has been shown to be an influencing factor on child development, and might help explain some of the stress experienced by low-income families. Understanding more about the psychological aspects of food insecurity may help inform the development of tailored interventions to alleviate food insecurity in low-income households, and ultimately improve health, achievement and related outcomes in children.

Purpose: The purpose of this study was to examine relationships between monthly Supplemental Nutrition Assistance Program (SNAP) benefit duration (i.e., the number of weeks each month a participants' SNAP benefits provide food), and five primary outcome variables: food security, three hunger-coping behavior scales (rationing food supplies, financial strategies, making trade-offs), and physiological hunger symptoms, among a sample of families with children 0-18 years currently receiving SNAP benefits. Methods: Baseline survey data were collected as part of a community-based intervention to alleviate child hunger. Participants included in the analytic sample were current SNAP recipients, parents (or caregivers), and 19 years of age and older (n=161). The survey assessed sociodemographics, household characteristics, food and financial assistance use, food security, three hunger-coping behavior scales, diet intake frequency, and one physiological hunger symptoms scale. The three hunger-coping scales and the physiological hunger scale were dichotomized into a "high" group (if above the sample median score) and a "low" group (if at or below the sample median score). Sociodemographic and family characteristics were included as covariates. Logistic regression models were used to assess relationships between monthly SNAP benefit duration and the five primary outcome variables in this study. Results: Respondents were predominately mothers/female caregivers (78%), a majority reported annual family incomes below $10,000 (58%), and 80% were experiencing "low" or "very low" food security. The sample was 43% non-Hispanic black, 30% non-Hispanic white, 10% Hispanic/Latino, 17% American Indian or other racial/ethnic groups. Monthly SNAP benefit duration (M=2.8, SD=1.0) was not likely driven by allotment amount, because households' percent of the federal poverty line (a proxy measure for allotment amount) was not associated with the number of weeks each month that benefits lasted (p=0.36). After controlling for relevant sociodemographic variables and household characteristics, the more weeks each month participants reported their SNAP benefits lasting, the lower their odds of experiencing "low" or "very low" food security (OR=0.444, 95%CI=0.259-0.761; p Conclusions: These findings suggest that monthly SNAP benefit duration may be useful as a proxy for SNAP allotment adequacy in the context of food security and hunger. Families that were not able to make monthly benefits extend as long as other families were more likely to be food insecure and experience "high" levels of physiological hunger symptoms. While associations with hunger-coping behaviors were only significant in univariate analysis, they were in the direction expected and should be further examined in future studies as these behaviors may be exacerbate, buffer, or be symptoms of the experience of food insecurity and hunger among low-income families. Policies are needed to better tailor SNAP benefit allotments to the needs of disadvantaged families, and research and programming is needed to investigate ways these families can better utilize their current allotments as a potential path to address food insecurity and hunger.

Summary: Background: Executive control and temperament have been associated with pediatric obesity. However, interactions between these constructs in relation to future weight outcomes have not been investigated. Objective: This longitudinal study examined early childhood executive control, early temperament (negative affectivity and surgency), and their interactions as predictors of adolescent BMI trajectories. Methods: At age 5.25, children (N = 229) completed executive control tasks, and parents completed the Child Behavior Questionnaire to assess temperament. BMI was calculated annually between ages 14–17. Results: Greater early negative affectivity predicted more positive BMI growth. Although early childhood executive control was not associated with BMI growth, greater negative affectivity predicted greater BMI escalation at average and below average executive control abilities. Conclusions: For children without robust executive control abilities early in development, negative affectivity may be a risk factor for accelerated adolescent BMI growth. Targeted assessment of early risk factors may be useful for childhood obesity prevention efforts. [ABSTRACT FROM AUTHOR]

Food security is a commonly screened for health-related social need at hospitals and community settings, and until recently, there were no tools to additionally screen for nutrition security. The purpose of this study was to assess the potential advantage of including a one-item brief nutrition security screener (BNSS) alongside the commonly used two-item Hunger Vital Sign (HVS) food security screener for identifying individuals with diet-related health risks. Cross-sectional survey data were collected from April to June 2021. Generalized linear mixed models were used to assess associations between screening status and dietary and health variables. Recruitment was done across five states (California, Florida, Maryland, North Carolina, and Washington) from community-based organizations. Participants (n = 435) were, on average, 44.7 years old (SD = 14.5), predominantly women (77%), and racially/ethnically diverse. In adjusted analyses, being in the food insecure and nutrition insecure group (but not the food insecure and nutrition secure or food secure and nutrition insecure groups) was associated with significantly increased odds for self-reported "fair" or "poor" general health [OR = 2.914 (95% CI = 1.521–5.581)], reporting at least one chronic condition [2.028 (1.024–4.018)], and "low" fruit and vegetable intake [2.421 (1.258–4.660)], compared with the food secure and nutrition secure group. These findings support using both the HVS and BNSS simultaneously in health-related social needs screening to identify participants at the highest risk for poor dietary and health outcomes and warrant further investigation into applying these screeners to clinical and community settings. [ABSTRACT FROM AUTHOR]

Background: The purpose of this evaluation was to examine the effects of the LiveWell@School Food Initiative (LW@SFI), a Colorado-based childhood obesity prevention program that partners with school districts to enable them to serve more scratch cooked foods through culinary training, action planning, and equipment grants. Methods: This evaluation used a quasi-experimental design that examined menu cycles prior to entering the LW@SFI and approximately 1 year later. A review of school menus with food service directors from 9 Colorado school districts was conducted. Results: Data show that districts changed an average of 17.4 entrées and 19.7 side dishes over the course of the year. Changes to serving scratch cooked foods were highest for sauces (an increase of 40.5%). No districts were cooking beans/legumes from scratch during baseline or at follow-up. Across the 9 districts, 7 observed statistically significant pre-post reductions in sodium, 4 in fat, 5 in saturated fat, and 3 in calories. Conclusions: Within a year of implementing the LW@SFI, school districts increased the proportion of fresh, scratch cooked foods they offered and this was associated with some decreases in calories, fat, saturated fat, and sodium, contributing to healthier school food environments.

The Society of Behavioral Medicine (SBM) supports increased funding for policies in the 2024 Farm Bill that align with a Food is Medicine (FIM) framework and address multiple dimensions of human and planetary health. [ABSTRACT FROM AUTHOR]

Objectives To understand the process by which early childhood education (ECE) providers effectively used an existing intervention to facilitate the creation or strengthening of a written breastfeeding policy, understand the factors important to this process, and present a logic model to guide future intervention design and evaluation. Methods A purposive sample of interviewees who recently completed an ECE nutrition and physical activity intervention and reported positive pre-post scores for breastfeeding support were recruited to complete semi-structured interviews. Interviews were recorded, transcribed, and coded, following a Grounded Theory approach. Results The ECE programs (n = 23) had a written breastfeeding policy and were located across six states in the United States. The most common aspects of breastfeeding support covered in the policies were handling and storing of breastmilk, pieces of equipment to be provided (e.g., breast pump), and the creation of a space or room designated for breastfeeding and pumping. Many factors important to the policy creation process were identified such as motivation, education, technical assistance, perceptions of parental indifference, staff buy-in, and time and administrative constraints. Once motivated to create a policy, ECE providers described actions, such as gathering background information and model policies, discussing policy needs with stakeholders, utilizing technical assistance, and overcoming barriers. Conclusions for Practice From these findings, a logic model was created to guide future intervention design and evaluation, and several recommendations were made to help guide subsequent interventions in promoting the development and implementation of written breastfeeding policies at ECE programs., Author(s): Eric E. Calloway [sup.1] , Katie L. Stern [sup.1] , Daniel J. Schober [sup.2] , Amy L. Yaroch [sup.1] Author Affiliations: (1) Gretchen Swanson Center for Nutrition, 8401 West [...]

This study tested the effects of two theory-based interventions to increase fruit and vegetable intake. Hypothesized intervention mediators included self-efficacy (SE), social support (SS), autonomous motivation (AM), and controlled motivation (CM). At baseline, 1,021 African American adults were recruited from 16 churches randomized to one comparison and two intervention groups: Group 1 (standard educational materials), Group 2 (culturally targeted materials), and Group 3 (culturally targeted materials and telephone-based motivational interviewing). A well-fitted model based on structural equation modeling--chi[superscript 2](df = 541, N = 353, 325) = 864.28, p less than 0.001, normed fit index = 0.96, nonnormed fit index = 0.98, comparative fit index = 0.98, root mean square error of approximation = 0.042--demonstrated that AM was both a significant mediator and moderator. In the subgroup with low baseline AM, AM mediated 17% of the effect of the Group 3 intervention on fruit and vegetable intake. Conversely, SS, SE, and CM were not significant mediators. Implications related to theory and intervention development are discussed. (Contains 2 tables and 2 figures.)