The Affordability of MyPlate: An Analysis of SNAP Benefits and the Actual Cost of Eating According to the Dietary Guidelines

Awareness and Use of MyPlate Among US Adults With Young Children

OBJECTIVE

To examine awareness, information-seeking, and use of MyPlate among US adults with young children.

DESIGN

Secondary analysis of cross-sectional data from the 2015-2018 National Health and Nutrition Examination Survey (NHANES).

PARTICIPANTS

US adults aged 18-45 years with children ≤5 years.

VARIABLES MEASURED

Adults reported sociodemographic characteristics and whether they had heard of MyPlate, looked online for MyPlate information, or tried to follow the MyPlate plan.

ANALYSIS

Logistic regression models estimated MyPlate awareness, information-seeking, and use by sociodemographic characteristics. Analyses were weighted to represent adults with young children nationally.

RESULTS

Twenty-nine percent of US adults with young children were aware of MyPlate. MyPlate awareness was lower among men, racial/ethnic minorities, adults with less education, adults who speak a language other than English, and SNAP/WIC recipients. Among those who knew of MyPlate, 39% sought MyPlate information online, and 33% had tried to use the MyPlate plan. Men were less likely to look online for or follow the MyPlate plan than women. Mexican-American adults and WIC recipients were more likely to have tried to follow the MyPlate plan.

CONCLUSIONS

MyPlate is an underutilized resource among families with young children. Efforts are needed to disseminate and encourage the use of MyPlate, particularly among marginalized groups.

Food pantry offerings and awareness at a southeastern public university

OBJECTIVE

This study documents campus awareness of an on-campus food pantry and the value of its nutritional offerings in order to provide tailored recommendations for improving this particular emergency resource for food insecure students.

PARTICIPANTS

This study surveyed 253 students, and 185 faculty and staff at the Southeastern Flagship Institution.

METHODS

This mixed methods study combined a quantitative survey administered to 438 participants with an in-depth nutritional analysis of the food pantry's offerings.

RESULTS

Results showed low levels of awareness by faculty and staff and limited offerings of fresh fruits and vegetables, dark leafy greens, and whole grains in the on-campus food pantry.

CONCLUSIONS

This research helps to fill critical gaps regarding faculty and staff awareness of on-campus food pantries. Importantly, this article provides recommendations for campus food pantries to improve their campus awareness and nutritional offerings through engaging University stakeholders with long-term appointments and increasing donor education.

Implementation of Food is Medicine Programs in Healthcare Settings: A Narrative Review

Food is Medicine (FIM) programs to improve the accessibility of fruits and vegetables (FVs) or other healthy foods among patients with low income and diet-related chronic diseases are promising to improve food and nutrition security in the United States (US). However, FIM programs are relatively new and implementation guidance for healthcare settings using an implementation science lens is lacking. We used a narrative review to describe the evidence base on barriers and facilitators to FIM program integration in US healthcare settings following the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework. Evidence surrounding the EPIS Inner Context was a focus, including constructs Leadership, Organizational Characteristics, Quality and Fidelity Monitoring and Support, Organizational Staffing Processes, and Individual Characteristics. Peer-reviewed and grey literature about barriers and facilitators to FIM programs were of interest, defined as programs that screen and refer eligible patients with diet-related chronic disease experiencing food insecurity to healthy, unprepared foods. Thirty-one sources were included in the narrative review, including 22 peer-reviewed articles, four reports, four toolkits, and one thesis. Twenty-eight sources (90%) described EPIS Inner Context facilitators and 26 sources (84%) described FIM program barriers. The most common barriers and facilitators to FIM programs were regarding Quality and Fidelity Monitoring and Support (e.g., use of electronic medical records for tracking and evaluation, strategies to support implementation) and Organizational Staffing Processes (e.g., clear delineation of staff roles and capacity); although, barriers and facilitators to FIM programs were identified among all EPIS Inner Context constructs. We synthesized barriers and facilitators to create an EPIS-informed implementation checklist for healthcare settings for use among healthcare organizations/providers, partner organizations, and technical assistance personnel. We discuss future directions to align FIM efforts with implementation science terminology and theories, models, and frameworks to improve the implementation evidence base and support FIM researchers and practitioners.

Stretch your SNAP: Stakeholder perspectives of a novel benefits program to enhance diet quality

Objective

Families enrolled in the Supplemental Nutrition Assistance Program (SNAP) report persistent barriers to purchasing nutritious foods. This mixed-methods study explored SNAP users' food and beverage purchasing patterns and perspectives regarding potential modifications to SNAP to inform the design of SNAP+, a healthy incentive program to increase fruit and vegetable (FV) and decrease sugar-sweetened beverage (SSB) purchases.

Methods

Participants were recruited through a non-profit organizational network to participate in an online survey. Survey measures included: SNAP usage patterns, meal/shopping patterns, and perceptions of potential changes to SNAP. A subset (N = 28) was invited to participate in an interview to further explore these domains. Frequencies were calculated to explore trends in quantitative data, with thematic analysis applied to qualitative data.

Results

Participants (N = 278) identified as female (81.0 %), head of household (90.8 %) and mothers (70.5 %), with most (66.5 %) using SNAP ≥ 1 year. Most spend >$15 of SNAP (87.1 %) and >$15 of non-SNAP (60.8 %) dollars on FVs/month. Respondents spend <$5 of SNAP (34.2 %) and non-SNAP (47.5 %) dollars on SSBs/month. Factors shaping purchasing behaviors included: cost (71.6 %), health (80.2 %) and avoiding waste (73.0 %). Inflation and existing purchasing patterns motivated interest in potentially enrolling in SNAP +. Diminished autonomy and a need to reallocate other funds to purchase SSBs were identified as enrollment deterrents.

Conclusion

SNAP users were generally receptive to modifications that would pair FV incentives with SSB restrictions, yet strategies to maintain autonomy are needed. Results can inform the design of SNAP + to enhance its potential as strategy to positively shape dietary intake patterns.

A community focused approach toward making healthy and affordable daily diet recommendations

Introduction

Maintaining an affordable and nutritious diet can be challenging, especially for those living under the conditions of poverty. To fulfill a healthy diet, consumers must make difficult decisions within a complicated food landscape. Decisions must factor information on health and budget constraints, the food supply and pricing options at local grocery stores, and nutrition and portion guidelines provided by government services. Information to support food choice decisions is often inconsistent and challenging to find, making it difficult for consumers to make informed, optimal decisions. This is especially true for low-income and Supplemental Nutrition Assistance Program (SNAP) households which have additional time and cost constraints that impact their food purchases and ultimately leave them more susceptible to malnutrition and obesity. The goal of this paper is to demonstrate how the integration of data from local grocery stores and federal government databases can be used to assist specific communities in meeting their unique health and budget challenges.

Methods

We discuss many of the challenges of integrating multiple data sources, such as inconsistent data availability and misleading nutrition labels. We conduct a case study using linear programming to identify a healthy meal plan that stays within a limited SNAP budget and also adheres to the Dietary Guidelines for Americans. Finally, we explore the main drivers of cost of local food products with emphasis on the nutrients determined by the USDA as areas of focus: added sugars, saturated fat, and sodium.

Results and discussion

Our case study results suggest that such an optimization model can be used to facilitate food purchasing decisions within a given community. By focusing on the community level, our results will inform future work navigating the complex networks of food information to build global recommendation systems.

Affordability of Canada's Food Guide: Current challenges amid COVID-19, War in Ukraine, and other world events

Since the 2019 Canada Food Guide was released, there have been concerns raised over the cost of food, with an emphasis on the affordability of nutritious food. In this study, we evaluate the affordability of the 2019 Canada Food Guide in relation to the previous edition from 2007. As a result of the pandemic and other significant world events, many are feeling financial stress as prices in many areas of life rise, including housing, gas, and food. Our results show that it is more cost-effective, on average, for children and teens to follow the 2019 Canada Food Guide, but more expensive for adults, when compared to the 2007 edition.

Food Insecurity in the Rural United States: An Examination of Struggles and Coping Mechanisms to Feed a Family among Households with a Low-Income

Households with a low-income in rural places experience disproportionate levels of food insecurity. Further research is needed about the nuances in strategies that households with a low-income in rural areas apply to support food security nationally. This study aimed to understand the barriers and strategies that households with a low-income in rural areas experience to obtain a meal and support food security in the United States. We conducted a qualitative study with semi-structured interviews among 153 primary grocery shoppers with a low-income residing in rural counties. A majority of family's ideal meals included animal-based protein, grains, and vegetables. Main themes included struggles to secure food and coping mechanisms. Ten categories included affordability, adequacy, accommodation, appetite, time, food source coordinating, food resource management, reduced quality, rationing for food, and exceptional desperation. These results can inform public health professionals' efforts when partnering to alleviate food insecurity in rural areas.

State Implementation of SNAP Waivers and Flexibilities During the COVID-19 Pandemic: Perspectives From State Agency Leaders

OBJECTIVE

To describe state agencies' implementation of the Supplemental Nutrition Assistance Program (SNAP) during the first year of the coronavirus disease of 2019 (COVID-19) pandemic, barriers and facilitators to SNAP implementation, and recommendations to improve SNAP implementation.

DESIGN

Qualitative methodology guided by Bullock's determinants of policy implementation framework using 7 semistructured, virtual focus groups in April 2021.

SETTING

Twenty-six states representing all 7 US Department of Agriculture Food and Nutrition Service regions.

PARTICIPANTS

Four focus groups with state-level SNAP administrators and 3 focus groups with state-level SNAP supportive services (Supplemental Nutrition Assistance Program-Education, Employment & Training, and Outreach) supervisors (n = 62).

PHENOMENON OF INTEREST

Supplemental Nutrition Assistance Program implementation during the COVID-19 pandemic.

ANALYSIS

Thematic analysis using a phronetic iterative approach.

RESULTS

Six primary themes emerged: the policy response, technology needs, collaboration, participant communication, funding realities, and equity. Implementation challenges included the design of waivers in the early pandemic response, inadequate federal guidance and funding, outdated technology, and prepandemic regulations limiting state authority. Modernized technology systems, availability of virtual programming, partnerships, and enhanced benefits facilitated SNAP implementation.

CONCLUSIONS AND IMPLICATIONS

Supplemental Nutrition Assistance Program administrators adapted their programs to deliver services virtually during the COVID-19 pandemic. These experiences highlighted the importance of certain policy determinants, such as modernized technology and streamlined application processes, to improve outcomes for SNAP participants and staff.

Hardship in the Heartland: Associations Between Rurality, Income, and Material Hardship

One in three U.S. households has experienced material hardship. The inadequate provision of basic needs, including food, healthcare, and transportation, is more typical in households with children or persons of color, yet little is known about material hardship in rural spaces. The aim of this study is to describe the prevalence of material hardships in Iowa and examine the relationship between rurality, income, and material hardship. Using data from the 2016 State Innovation Model Statewide Consumer Survey, we use logistic regression to examine the association between rurality, income, and four forms of material hardship. Rural respondents incurred lower odds than non-rural respondents for all four hardship models. All four models indicated that lower income respondents incurred greater odds for having material hardship. Material hardship was reported across all groups, with rurality, income, race, and age as strong predictors of material hardship among our sample.

Home food access and children's heart healthy dietary intake at home and child care

Background: About 12 million children under 5 years of age attend early care and education centers (ECEs). Child intake at home can be impacted by food insecurity, which is higher among low income, rural, and racially diverse families. Aim: Determine whether greater access to fruits, vegetables, and snacks at home was associated with heart-healthy diet score at home and at ECEs in preschool-age children, and to determine whether there is a difference in heart-healthy diet score between home and ECEs. Methods: Cross-sectional study involving children (3-to-5-year-old, n  =  88) who attended 16 licensed ECEs across Oklahoma. Caregivers completed the Healthy Home Survey and 3-Dinner Dietary recall to report children's home food access and home dinner dietary intake, respectively. Researchers recorded children's ECE lunch consumption using the Dietary Observation for Child Care. Heart-healthy diet score was derived from composite scores for six variables: consumption of fish, fruits, vegetables, sodium, fiber, and sugary drinks. Results: Home access to total fruits and vegetables (16.2  ±  6.3) outnumbered snacks (5.5  ±  3.0). No difference in composite heart-healthy diet score between ECEs (1.50  ±  0.8) and home (1.27  ±  0.9, P  =  0.0851). Children within neither environment met recommendations for most variables (vegetables [18-24%], fruit [6-10%], fish [5-10%], fiber [1%], sodium [22-39%]). No relationship between home food access variables and the heart-healthy diet scores at home or ECEs. Conclusion: Dietary intake of children at home and ECEs does not meet heart-healthy diet score recommendations. Interventions should support preschool aged children from families that are located rurally, low-income, racial minorities, and whose primary caregivers work outside the home.

Examining commonly used perceived and objective measures of fruit and vegetable access in low-income populations and their association with consumption

Perception-based and objective food access measures are often examined as factors influencing individuals' shopping decisions and dietary habits, but the relative influence of these two factors on behaviors needs further examination. This study sought to (a) determine if perception-based and objective measures of fruit and vegetable (F&V) access were related and (b) examine perception-based and objective access measures as predictors of F&V consumption. Participants were recruited as part of a larger intervention study from 12 sites across three urban North Carolina counties. Perception-based food access measured included self-reported perceptions of convenience, variety, and quality of F&V within a neighborhood. Food outlet density was used as the objective measure. This was derived by summing the total number of geocoded convenience stores, grocery stores, supermarkets, and supercenters located within 1 road network mile of participants' home address. Associations between perception-based and objective measures were examined using Pearson's correlations, and associations of F&V access and intake were examined using linear regression models. Pearson correlations between perception-based and objective measures revealed that F&V variety was associated with supermarkets. Regression results show that perception-based barriers to F&V access were not significantly associated with intake, but supercenter density within 1 mile was significantly associated with decreased F&V intake. Common measures of perception-based and objective measures of food access may not be the best predictor of F&V intake. Understanding the relationships of these factors for lower-income populations can offer guidance for future policies and programs.

Affordability of nutritious diets in rural India

In 2015-16 some 38% of preschool children in India were stunted, 21% wasted, and more than half of Indian mothers and young children were anemic. Though widely studied, surprisingly little research on malnutrition in India explores the role of diets, particularly the affordability of nutritious diets given low wages and the significant structural problems facing India's agricultural sector. To explore this we used nationally representative rural price and wage data to estimate the least cost means of satisfying India's national dietary guidelines, referred to as the Cost of a Recommended Diet (CoRD), and assessed the affordability of this diet relative to male and female wages for unskilled laborers. Although we find that dietary costs have increased substantially for both men and women, rural wage rates increased more rapidly, implying that nutritious diets became substantially more affordable over time. However, in absolute terms nutritious diets in 2011 were still expensive relative to unskilled wages, constituting approximately 80-90% of female and 50-60% of male daily wages. Overall, we estimate that 63-76% of the rural poor could not afford a recommended diet in 2011. Achieving nutritional security in India requires a much more holistic focus on improving the affordability of the full range of nutritious food groups (not just cereals), a reappraisal of social protection schemes in light of the cost of more complete nutrition, ensuring that economic growth results in sustained income growth for the poor, and more timely and transparent monitoring of food prices, incomes and dietary costs.

Socioeconomic factors associated with diet quality and meeting dietary guidelines in disadvantaged neighborhoods in the Southeast United States

Objective: To examine diet quality and dietary intake among residents of disadvantaged neighborhoods in the Southeast United States (U.S.) and to examine associations between dietary and socioeconomic factors. Design: We examined baseline data from an evaluation study of a healthy food access initiative. Participants were recruited from two urban settings comprising seven neighborhoods of high household poverty (17% to 62%). Participants completed in-person interviews with measures of education, household income, and food security and one unannounced 24-hour dietary recall by telephone with trained registered dietitians. Food desert residence was coded based on U.S. Census data. Proportions meeting 2010 Dietary Guidelines for Americans and Healthy Eating Index 2010 (HEI-2010) scores were computed. Associations between dietary variables and participant's education, household income, food security, and food desert residence were tested. Results: Participants (n = 465) were predominantly African American (92%), women (80%), and overweight or obese (79%), and 52 ± 14 years of age. Sixty-three percent had low or very low food security, and 82% lived in census tracts of low income and low access to supermarkets (urban food desert). HEI-2010 scores averaged 48.8 ± 13.1. A minority of participants met dietary guidelines. Diet quality was lower among participants with lower education and among those from food insecure households (p < .05). Household income and food security were positively associated with meeting several dietary guidelines (p < .05). Food desert residence was unrelated to diet variables. Conclusions: In this disadvantaged population, significant nutritional concerns were observed, and socioeconomic factors were associated with diet quality and meeting dietary guidelines. Interventions must address broader economic, social, and policy issues such as access to affordable healthy foods.

Examining Rural Food-Insecure Families' Perceptions of the Supplemental Nutrition Assistance Program: A Qualitative Study

The Supplemental Nutrition Assistance Program (SNAP) is a critical program that helps reduce the risk of food insecurity, yet little is known about how SNAP addresses the needs of rural, food-insecure residents in the United States (U.S.). This study examines how rural, food-insecure residents perceive SNAP. Semi-structured interviews were conducted with 153 individuals living in six diverse rural regions of Arkansas, Montana, North Carolina, Oregon, Texas, and West Virginia. SNAP was described as a crucial stop-gap program, keeping families from experiencing persistent food insecurity, making food dollars stretch when the family budget is tight, and helping them purchase healthier foods. For many rural residents interviewed, SNAP was viewed in a largely positive light. In efforts to continue improving SNAP, particularly in light of its relevance during and post-coronavirus (COVID-19) pandemic, policymakers must be aware of rural families' perceptions of SNAP. Specific improvements may include increased transparency regarding funding formulas, budgeting and nutrition education for recipients, effective training to improve customer service, connections among social service agencies within a community, and increased availability of automation to streamline application processes.

Examining disparities in diet quality between SNAP participants and non-participants using Oaxaca-Blinder decomposition analysis

Recent studies have reported that SNAP participants have poorer diet quality than non-participants. This study aimed to examine how differences in socio-demographic, household, and health-related measures explain disparities in diet quality between SNAP participants and non-participants using Oaxaca-Blinder decomposition analysis. We analyzed cross-sectional data on 14,331 adult respondents of the National Health and Nutrition Examination Survey (NHANES) 2009 - 2014. To measure diet quality, we applied the Healthy Eating Index (HEI)-2015 to respondents' 24-hour dietary recall data (scale: 0-100 points). We used Oaxaca-Blinder decomposition analysis to determine how much of the disparity in HEI-2015 total score between SNAP participants and non-participants was explained by socio-demographic (e.g., age, race/ethnicity, educational), household (e.g., household size, food security status), and health-related measures (e.g., BMI, smoking status). Analyses performed revealed significant differences in HEI-2015 total score by SNAP participation status (p < 0.001). We found that the total gap in HEI-2015 total score between SNAP participants and income-ineligible non-participants was 6.30 points. Socio-demographic measures alone explained 72.40% of the disparity. All measures together explained 86.31% of the disparity. The total gap between SNAP participants and income-eligible non-participants was 3.24 points. Socio-demographic measures alone explained 35.51% of this disparity while all measures together explained 56.86%. We observed disparities in diet quality between SNAP participants and non-participants. Socio-demographic, household, and health-related measures explained a significant amount of the disparity that existed between SNAP participants and income-ineligible non-participants; they explained less of the disparity between SNAP participants and income-eligible non-participants.

Perceptions of the Food Environment and Access among Predominantly Black Low-Income Residents of Rural Louisiana Communities

Food insecurity in rural settings is complex and not fully understood, especially from the perspective of low-income and Black residents. The goal of this study was to use qualitative methods to better understand experiences with food access and perceptions of the food environment among low-income, predominately Black rural Louisiana residents in the United States. Data were collected from focus group discussions (FGD) and focus group intake forms. Study participants were all rural residents eligible to receive at least one nutrition assistance program. FGD questions focused on perceptions of the food environment, with an emphasis on food access. Participants (n = 44) were predominately Black and female. Over half (n = 25) reported running out of food before the end of the month. Major themes included: store choice, outshopping, methods of acquiring foods other than the grocery store, and food insecurity. Concerns around price, quality, and transportation emerged as factors negatively impacting food security. Understanding residents’ perceptions and experiences is necessary to inform contextually appropriate and feasible policy and practice interventions that address the physical environment and social conditions that shape the broader physical food environment in order to achieve equitable food access and food security.

SNAP, Young Children's Health, and Family Food Security and Healthcare Access

INTRODUCTION

The Supplemental Nutrition Assistance Program (SNAP) is the largest nutrition assistance program in the U.S. This study's objective was to examine the associations between SNAP participation and young children's health and development, caregiver health, and family economic hardships.

METHODS

Cross-sectional data from 2006 to 2016 were analyzed in 2017 for families with children aged <3 years in 5 cities. Generalized estimating equations and logistic regression were used to evaluate the associations of SNAP participation with child and caregiver health outcomes and food insecurity, forgone health care, and health cost sacrifices. Nonparticipants that were likely to be eligible for SNAP were compared with SNAP participants and analyses adjusted for covariates including Consumer Price Index for food to control for site-specific food prices.

RESULTS

The adjusted odds of fair or poor child health status (AOR=0.92, 95% CI=0.86, 0.98), developmental risk (AOR=0.82, 95% CI=0.69, 0.96), underweight, and obesity in children were lower among SNAP participants than among nonparticipants. In addition, food insecurity in households and among children, and health cost sacrifices were lower among SNAP participants than among nonparticipants.

CONCLUSIONS

Participation in SNAP is associated with reduced household and child food insecurity, lower odds of poor health and growth and developmental risk among infants and toddlers, and reduced hardships because of healthcare costs for their families. Improved SNAP participation and increased SNAP benefits that match the regional cost of food may be effective preventive health strategies for promoting the well-being of families with young children.

Monetary Cost of the MyPlate Diet in Young Adults: Higher Expenses Associated with Increased Fruit and Vegetable Consumption

Background

Cost is a commonly reported barrier to healthy eating. This is a secondary research analysis designed to examine the food expenditures of young adults on a university campus following the United States Department of Agriculture (USDA) MyPlate guidelines for fruits and vegetables.

Methods

Meal receipts and dietary intake were recorded weekly. Anthropometrics and clinical assessments were recorded before intervention. Researchers rated compliance based on the participant's dietary food log, receipt matching, food pictures, and reports during weekly 1-hour consultations.

Results

Fifty-three young adults (18–30 years old) at-risk of, or diagnosed with, metabolic syndrome (MetS) were enrolled in the study, with 10 excluded (n = 43) from analyses due to enrollment in a fixed cost university campus dining meal plan. A two sample t-test assessed differences in food costs and regression analysis determined associations between food cost and diet compliance while controlling for confounding factors of age, sex, and body mass index (BMI). Diet compliant subjects (n = 38) had higher weekly food cost at $95.73 compared to noncompliant subjects (n = 5) who spent $66.24 (p=0.01). A regression analysis controlling for age, sex, BMI, and geographical region also indicated cost differences based on diet compliance (p < 0.0001).

Conclusion

Results indicate an ∼$29.00 per week increase in food cost when eating the recommended amount of fruit and vegetables. These findings can contribute to research incentive design, program planning cost, and determining effective interventions to improve diet in this population.

The Case for Studying Non-Market Food Systems

Markets dominate the world’s food systems. Today’s food systems fail to realize the normative foundations of ecological economics: justice, sustainability, efficiency, and value pluralism. Drawing on empirical and theoretical literature from diverse intellectual traditions, I argue that markets, as an institution for governing food systems, hinder the realization of these objectives. Markets allocate food toward money, not hunger. They encourage shifting costs on others, including nonhuman nature. They rarely signal unsustainability, and in many ways cause it. They do not resemble the efficient markets of economic theory. They organize food systems according to exchange value at the expense of all other social, cultural, spiritual, moral, and environmental values. I argue that food systems can approach the objectives of ecological economics roughly to the degree that they subordinate market mechanisms to social institutions that embody those values. But such “embedding” processes, whether through creating state policy or alternative markets, face steep barriers and can only partially remedy food markets’ inherent shortcomings. Thus, ecological economists should also study, promote, and theorize non-market food systems.

Differences in risk factors for binge eating by socioeconomic status in a community-based sample of adolescents: Findings from Project EAT

OBJECTIVE

Binge eating is prevalent across socioeconomic status (SES) groups, but it is unclear whether risk factors for binge eating vary by SES. This study examined the prevalence of several risk factors for binge eating by SES and SES as a potential moderator of these risk factors.

METHOD

Participants included 2,179 individuals involved in Project EAT during early/middle adolescence (EAT-I) and 5 years later during late adolescence/emerging adulthood (EAT-II). Risk ratios were computed using modified Poisson regression of incident EAT-II binge eating on EAT-I risk factors among participants of high and low SES. Interactions between each risk factor and SES were tested.

RESULTS

Among higher SES adolescents, overweight/obesity (RR = 3.2; 95% CI: 1.8, 5.7), body dissatisfaction (RR = 2.6; 95% confidence intervals (CI): 1.2, 5.5), dieting (RR = 4.0; 95% CI: 2.0, 8.2), and family weight-teasing (RR = 2.3; 95% CI: 1.3, 4.3) predicted increased risk for binge eating. Among adolescents from low-SES backgrounds, overweight/obesity (RR = 1.5; 95% CI: 0.9, 2.5), dieting (RR = 2.2; 95% CI: 1.2, 3.9), and food insecurity (RR = 1.4; 95% CI: 0.7, 2.7) predicted increased risk for binge eating. Moderator analyses revealed that overweight/obesity, body dissatisfaction, dieting, and family weight-teasing were stronger risk factors in the high-SES group than the low-SES group; interactions with food insecurity could not be examined given the low prevalence of food insecurity in the high-SES group.

DISCUSSION

Risk factors for binge eating may vary by SES, suggesting the potential utility of modifying intervention and prevention methods based on SES. In particular, the role of food insecurity must be addressed.

Development and Testing of the Healthy Food Pantry Assessment Tool

OBJECTIVE

To develop and test an observational survey that quantifies food pantry environments (FPE).

DESIGN

Best practices in FPE were identified through key informant interviews. The tool was pilot-tested, including a content review, and then field-tested for reliability.

SETTING

Key informant phone interviews (n = 41); pilot and field test visits occurred at 45 pantries from multiple states.

SUBJECTS

Food bank/pantry staff and nutrition educators were recruited for interviews through purposive and snowball sampling. Pilot and field test survey users (n = 65) were food pantry representatives and matched community partners who both rated the FPE using the tool.

VARIABLES MEASURED

Pearson correlation was used to determine test-retest and interrater reliability.

ANALYSIS

Qualitative data were coded for healthy FPE strategies. Quantitative data were calculated using descriptive statistics (significant at P < .05).

RESULTS

Qualitative data were coded for observable FPE characteristics. Reliability scores were substantial to nearly perfect for 48 of 61 survey items (79%) for test-retest and 49 of 61 (80%) for interrater reliability (Pearson r = .6-1.0).

CONCLUSIONS AND IMPLICATIONS

The Healthy Food Pantry Assessment Tool is research-tested and can be used to evaluate and quantify the healthfulness of FPE.

An Economic Gap Between the Recommended Healthy Food Patterns and Existing Diets of Minority Groups in the US National Health and Nutrition Examination Survey 2013-14

The US Department of Agriculture (USDA) has identified three Healthy Food Patterns as ways to implement the 2015–2020 Dietary Guidelines for Americans. We estimated the daily cost of the Healthy Vegetarian, US-Style, and Mediterranean Food Patterns (at 2,000 kcal/d) using national food prices adjusted for inflation. We also estimated the cost of existing dietary intakes in $/2,000 kcal/d for persons ≥2 years in the National Health and Nutrition Examination Survey (NHANES 2013–2014) using the same national food prices. The Nutrient Rich Food index (NRF9.3) was used as a measure of diet quality. Compared to existing diets, the USDA Healthy Food Patterns were higher in protein, fiber, vitamins, and minerals; were lower in solid fats, sugars, and sodium, and had higher diet quality scores. However, they also cost more. The cost of existing diets in NHANES was $5.47/d for Hispanics, $5.48/d for African-Americans, $5.94/d for Whites and $6.57/d for Asians. By contrast, the recommended US-Style Pattern cost $8.27/d, the Vegetarian Pattern cost $5.90/d, and the Mediterranean Pattern cost $8.73/d. Further, the Healthy Food Patterns featured some of the recommended food groups in unrealistic amounts. To ensure that the US Dietary Guidelines are both feasible and relevant to minority health, economic modeling studies should accompany government-issued dietary advice.

Food processing: criteria for dietary guidance and public health?

The NOVA food categorisation recommends ‘avoiding processed foods (PF), especially ultra-processed foods (UPF)’ and selecting minimally PF to address obesity and chronic disease. However, NOVA categories are drawn using non-traditional views of food processing with additional criteria including a number of ingredients, added sugars, and additives. Comparison of NOVA's definition and categorisation of PF with codified and published ones shows limited congruence with respect to either definition or food placement into categories. While NOVA studies associate PF with decreased nutrient density, other classifications find nutrient-dense foods at all levels of processing. Analyses of food intake data using NOVA show UPF provide much added sugars. Since added sugars are one criterion for designation as UPF, such a proof demonstrates a tautology. Avoidance of foods deemed as UPF, such as wholegrain/enriched bread and cereals or flavoured milk, may not address obesity but could decrease intakes of folate, calcium and dietary fibre. Consumer understanding and implementation of NOVA have not been tested. Neither have outcomes been compared with vetted patterns, such as Dietary Approaches to Stop Hypertension, which base food selection on food groups and nutrient contribution. NOVA fails to demonstrate the criteria required for dietary guidance: understandability, affordability, workability and practicality. Consumers’ confusion about definitions and food categorisations, inadequate cooking and meal planning skills and scarcity of resources (time, money), may impede adoption and success of NOVA. Research documenting that NOVA can be implemented by consumers and has nutrition and health outcomes equal to vetted patterns is needed.

Understanding the Process of Prioritizing Fruit and Vegetable Purchases in Families With Low Incomes: "A Peach May Not Fill You Up as Much as Hamburger"

Fruits and vegetables (F&V) are an important component of a healthy diet, but few children are meeting the recommended number of servings. Children from families with limited resources may be least likely to meet the recommendation. This study was designed to understand the strategies and priorities of families with low income related to purchasing F&V. We conducted qualitative, in-depth telephone interviews with low-income parents of elementary school-aged children as part of a random sample of parents participating in a telephone survey who agreed to be contacted for an in-depth interview. Interview transcripts were coded based on predetermined codes that were informed by the research questions. F&V were not considered staples by parents and cost was one of the main concerns. Parents equated F&V with fresh F&V. Interventions encouraging F&V purchasing by families with low income need to find new ways to address the issue of cost, including advocating for F&V in all forms (fresh, frozen, canned, and dried).