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Fleischhacker S, Colón-Ramos U, Haynes-Maslow L, Clay L. Position of the Society for Nutrition Education and Behavior: The Importance of Emergency-Related Food and Nutrition Education Before, During, and After a Disaster. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:419-427. [PMID: 38972707 DOI: 10.1016/j.jneb.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 01/07/2024] [Accepted: 04/17/2024] [Indexed: 07/09/2024]
Abstract
It is the position of the Society for Nutrition Education and Behavior that for effective recovery from and resilience to disasters, it is essential that impacted individuals and communities have access to safe, nutritious, and culturally and contextually appropriate foods and beverages, and receive emergency-related food and nutrition education before, during, and after a disaster. Despite the increasing number, duration, and intensity of disasters worldwide, there is relatively limited guidance for research, policy, and practice about addressing the emergency-related food and nutrition needs of affected populations. Although nutrition emergencies tend to be understudied, emerging efforts are working to advance food and nutrition security during disaster response and recovery. To help elevate the importance of emergency-related food and nutrition education before, during, and after a disaster, Society for Nutrition Education and Behavior, which represents the unique professional interests of nutrition educators worldwide, summarizes the relevant literature and puts forth recommendations for all those who are engaged in this work in the following 4 key areas: (1) improving communication and outreach, (2) fostering community engagement and locally-driven preparedness, (3) building the evidence base and translating the evidence into action, and (4) training current professionals and the next generation of public health leaders. Altogether, before, during, and after a disaster, those who engage in this work, among other allies, can help elevate the importance of nutrition education and other strategies to promote healthy eating behaviors through research, policy, and practice.
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Affiliation(s)
| | | | - Lindsey Haynes-Maslow
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lauren Clay
- Department of Emergency and Disaster Health Systems, University of Maryland Baltimore County, Baltimore, MD
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Dou N, Deitch R, Kowalski AJ, Kuhn A, Lane H, Parker EA, Wang Y, Zafari Z, Black MM, Hager ER. Studying the impact of COVID-19 mitigation policies on childhood obesity, health behaviors, and disparities in an observational cohort: Protocol for the COVID-19 Family Study. Contemp Clin Trials 2024; 136:107408. [PMID: 38072192 PMCID: PMC10922699 DOI: 10.1016/j.cct.2023.107408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/13/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND COVID-19 pandemic control policies, including school closures, suspended extra-curricular activities, and social distancing, were introduced to prevent viral transmission, and disrupted children's daily routines, health behaviors, and wellness. This observational cohort study among 697 families with children or adolescents, based on the Family Stress Model, aims to: 1) evaluate pre- to during-pandemic changes in child health behaviors (diet, physical activity, sleep) and weight gain, 2) identify mechanisms explaining the changes, and 3) determine projected healthcare costs on weight gain and obesity. Each aim includes an examination by racial and ethnic, socioeconomic, and geographic disparities. METHODS The study employs a mixed methods design, recruiting children and their caregivers from two obesity prevention trials halted in 2020. Enrolled participants complete annual surveys to assess child health behaviors, family resources, routines, and demographics, and home environment in 2020-2022. Height and weight are measured annually in 2021-2022. Annual semi-structured interviews are conducted within a subsample to understand mechanisms of observed changes. Multilevel mixed models and mediation analyses are used to examine changes in child health behaviors and weight gain and mechanisms underlying the changes. Qualitative data are analyzed within and across time points and integrated with quantitative findings to further explain mechanisms. Markov models are used to determine healthcare costs for unhealthy child behaviors and weight gain. CONCLUSION Findings from this study will aid in understanding pandemic-related changes in child health behaviors and weight status and will provide insights for the implementation of future programs and policies to improve child and family wellness.
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Affiliation(s)
- Nan Dou
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 615 N Wolfe St, MD 21205, USA.
| | - Rachel Deitch
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 615 N Wolfe St, MD 21205, USA.
| | - Alysse J Kowalski
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 615 N Wolfe St, MD 21205, USA.
| | - Ann Kuhn
- Department of Exercise and Nutrition Sciences, University at Buffalo, The State University of New York, 401 Kimball Tower, Buffalo, NY 14214, USA.
| | - Hannah Lane
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC 27701, USA.
| | - Elizabeth A Parker
- University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Science, 100 Penn Street, Baltimore, MD 21201, USA.
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, NW, Washington, DC 20052, USA.
| | - Zafar Zafari
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, 20 North Pine Street, Baltimore, MD 21201, USA.
| | - Maureen M Black
- University of Maryland School of Medicine, Department of Pediatrics, 737 West Lombard Street, Baltimore, MD 21201, USA; RTI International, Research Triangle Park, NC 27709, USA.
| | - Erin R Hager
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 615 N Wolfe St, MD 21205, USA.
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Harper K, Bode B, Gupta K, Terhaar A, Baltaci A, Asada Y, Lane H. Challenges and Opportunities for Equity in US School Meal Programs: A Scoping Review of Qualitative Literature Regarding the COVID-19 Emergency. Nutrients 2023; 15:3738. [PMID: 37686770 PMCID: PMC10490348 DOI: 10.3390/nu15173738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/15/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
The emergency school meals program provided free meals to children in the United States (US) during COVID-19-related school closures. This scoping review aims to synthesize the existing qualitative empirical evidence published between March 2020 and January 2023 on the operations and utilization of emergency school meal programs during the pandemic. Qualitative, US-based peer-reviewed literature was collected from three sources: (1) parent review of all federal nutrition assistance programs; (2) systematic search of four databases; and (3) manual search of grey literature. Identified scientific articles and grey literature reports (n = 183) were uploaded into Covidence and screened for duplicates and inclusion/exclusion criteria. Our final sample included 21 articles/reports, including 14 mixed methods and seven qualitative-only projects. Articles spanned all U.S. states. Articles had similar research questions to understand school meals and/or general food access during COVID-19, with an emphasis on long-term policy implications. Hybrid deductive/inductive analytic coding was used to analyze data, utilizing domains from the Getting to Equity Framework (GTE). GTE considers multi-level factors that influence nutrition behavior while centering more equitable pathways to improve nutrition security and reduce adverse health. Findings were sorted into two categories: operational challenges during the pandemic and solutions to address inequities in school meal distribution during and after the pandemic, particularly during school closures such as summers or future emergencies. Key challenges related to supply chain issues, safety, and balancing families' needs with limited staff capacity. Programs addressed equity by (a) reducing deterrents through federally issued waivers and increased communications which allowed the serving of meals by programs to families who previously did not have access, (b) building community capacity through collaborations and partnerships which allowed for increased distribution, and (c) preparing and distributing healthy options unless barriers in supply chain superseded the effort. This review highlights the importance of emergency school meal programs and provides insights into addressing challenges and promoting equity in future out-of-school times. These insights could be applied to policy and practice change to optimize program budgets, increase reach equitably, and improve access to nutritious meals among populations at highest risk for nutrition insecurity.
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Affiliation(s)
- Kaitlyn Harper
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Bree Bode
- Michigan Fitness Foundation, Lansing, MI 48906, USA
| | - Kritika Gupta
- Department of Nutrition & Hospitality Management, University of Mississippi, Oxford, MS 38677, USA
| | - Ally Terhaar
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO 63103, USA
| | - Aysegul Baltaci
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Yuka Asada
- Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL 60607, USA
| | - Hannah Lane
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC 27708, USA;
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Varela EG, Zeldman J, Bolivar I, Mobley AR. A Qualitative Study to Compare Barriers to Improving Food Security among Households with Young Children in the U.S. as Perceived by Different Types of Stakeholders before and during COVID-19. Nutrients 2023; 15:nu15061438. [PMID: 36986168 PMCID: PMC10055020 DOI: 10.3390/nu15061438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/19/2023] Open
Abstract
This qualitative study aimed to determine the perceived barriers of different community stakeholders’ to providing resources for improving food security in households with young children in the U.S. Community stakeholders working with low-income families with children 0–3 years of age in Florida were recruited to represent healthcare (n = 7), community/policy development (n = 6), emergency food assistance (n = 6), early childhood education (n = 7), and nutrition education (n = 6) sectors. In 2020, one-on-one interviews were conducted with each stakeholder in via Zoom, using an interview script based on the PRECEDE–PROCEED model and questions to capture the impacts of COVID-19. The interviews were audio-recorded, transcribed verbatim, and analyzed using a deductive thematic approach. A cross-tab qualitative analysis was used to compare data across categories of stakeholders. Healthcare professionals and nutrition educators indicated stigma, community/policy development stakeholders indicated a lack of time, emergency food assistance personnel indicated a limited access to food, and early childhood professionals indicated a lack of transportation as the main barriers to food security prior to COVID-19. COVID-19 impacts included the fear of virus exposure, new restrictions, lack of volunteers, and a lack of interest in virtual programming as barriers to food security. As perceived barriers may vary with respect to providing resources to improve food security in families with young children and the COVID-19 impacts persist, coordinated policy, systems, and environmental changes are needed.
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A Call for Theory to Guide Equity-Focused Federal Child Nutrition Program Policy Responses and Recovery Efforts in Times of Public Health Crisis. J Acad Nutr Diet 2023; 123:15-28. [PMID: 35940493 PMCID: PMC9425110 DOI: 10.1016/j.jand.2022.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 12/25/2022]
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Kowalski AJ, Kuhn AP, Lane HG, Trude ACB, Selam H, Hager ER, Black MM. Pre-pandemic to early-pandemic changes in risk of household food insecurity among Maryland families with children. Public Health Nutr 2021; 25:1-23. [PMID: 34889183 PMCID: PMC8943228 DOI: 10.1017/s136898002100481x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objective was to examine risk and protective factors associated with pre- to early-pandemic changes in risk of household food insecurity (FI). DESIGN We re-enrolled families from two statewide studies (2017-2020) in an observational cohort (May-August 2020). Caregivers reported on risk of household FI, demographics, pandemic-related hardships, and participation in safety net programs (e.g. CARES stimulus payment, school meals). SETTING Maryland, United States. PARTICIPANTS Economically, geographically, and racially/ethnically diverse families with preschool to adolescent-age children. Eligibility included reported receipt or expected receipt of the CARES stimulus payment or a pandemic-related economic hardship (n=496). RESULTS Prevalence of risk of FI was unchanged (pre-pandemic: 22%, early-pandemic: 25%, p=0.27). Risk of early-pandemic FI was elevated for non-Hispanic Black (aRR=2.1 [95% CI 1.1, 4.0]) and Other families (aRR=2.6 [1.3, 5.4]) and families earning ≤300% federal poverty level. Among pre-pandemic food secure families, decreased income, job loss, and reduced hours were associated with increased early-pandemic FI risk (aRR=2.1 [1.2, 3.6] to 2.5 [1.5, 4.1]); CARES stimulus payment (aRR=0.5 [0.3, 0.9]) and continued school meal participation (aRR=0.2 [0.1, 0.9]) were associated with decreased risk. Among families at risk of FI pre-pandemic, safety net program participation was not associated with early-pandemic FI risk. CONCLUSIONS The CARES stimulus payment and continued school meal participation protected pre-pandemic food secure families from early-pandemic FI risk but did not protect families who were at risk of FI pre-pandemic. Mitigating pre-pandemic FI risk and providing stimulus payments and school meals may support children's health and reduce disparities in response to pandemics.
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Affiliation(s)
- Alysse J Kowalski
- University of Maryland School of Medicine, Department of Pediatrics, Baltimore, MD
| | - Ann Pulling Kuhn
- University of Maryland School of Medicine, Department of Pediatrics, Baltimore, MD
| | - Hannah G Lane
- Duke University School of Medicine, Department of Population Health Sciences Durham, NC
| | - Angela C B Trude
- University of Maryland School of Medicine, Department of Pediatrics, Baltimore, MD
| | - Helina Selam
- University of Maryland School of Medicine, Department of Pediatrics, Baltimore, MD
| | - Erin R Hager
- University of Maryland School of Medicine, Department of Pediatrics, Baltimore, MD
- University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, MD
| | - Maureen M Black
- University of Maryland School of Medicine, Department of Pediatrics, Baltimore, MD
- University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, MD
- RTI International, Research Triangle Park, NC
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Kenney EL, Dunn CG, Mozaffarian RS, Dai J, Wilson K, West J, Shen Y, Fleischhacker S, Bleich SN. Feeding Children and Maintaining Food Service Operations during COVID-19: A Mixed Methods Investigation of Implementation and Financial Challenges. Nutrients 2021; 13:nu13082691. [PMID: 34444851 PMCID: PMC8401539 DOI: 10.3390/nu13082691] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 11/16/2022] Open
Abstract
The United States Department of Agriculture (USDA) National School Lunch and Breakfast Programs are critical for the health and food security of U.S. schoolchildren, but access to these programs was disrupted by COVID-19 pandemic-related school closures in spring 2020. While temporary policy changes to the programs enabled school food authorities (SFAs) to pivot towards distributing meals throughout their communities instead of within school buildings, SFAs faced complex challenges during COVID-19 with minimal external support. This mixed methods study investigates the implementation and financial challenges experienced by twelve of the largest urban SFAs in the U.S. during COVID-19. We conducted semi-structured interviews with SFA leaders and analyzed alongside quantitative financial data. We found that SFAs reconfigured their usual operations with nearly no preparation time while simultaneously trying to keep staff from contracting COVID-19, accommodate stakeholders with sometimes competing priorities, and remain financially solvent. Because student participation was much lower than during regular times, and revenue is tied to the number of meals served, SFAs saw drastic decreases in revenue even as they carried regular operating costs. For future crises, disaster preparedness plans that help SFAs better navigate the switch to financially viable community distribution methods are needed.
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Affiliation(s)
- Erica L. Kenney
- Department of Nutrition, Harvard TH Chan School of Public Health, 665 Huntington Ave, Boston, MA 02115, USA;
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
- Correspondence: ; Tel.: +1-617-384-8722
| | - Caroline G. Dunn
- Department of Health Policy and Management, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA; (C.G.D.); (J.D.); (Y.S.); (S.N.B.)
- Health Resources and Services Administration, U.S. Department of Health and Human Services, Washington, DC 20201, USA
| | - Rebecca S. Mozaffarian
- Department of Nutrition, Harvard TH Chan School of Public Health, 665 Huntington Ave, Boston, MA 02115, USA;
| | - Jane Dai
- Department of Health Policy and Management, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA; (C.G.D.); (J.D.); (Y.S.); (S.N.B.)
| | - Katie Wilson
- Urban School Food Alliance, 1612 K Street NW, Suite 200, Washington, DC 20006, USA; (K.W.); (J.W.)
| | - Jeremy West
- Urban School Food Alliance, 1612 K Street NW, Suite 200, Washington, DC 20006, USA; (K.W.); (J.W.)
| | - Ye Shen
- Department of Health Policy and Management, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA; (C.G.D.); (J.D.); (Y.S.); (S.N.B.)
| | - Sheila Fleischhacker
- Georgetown University Law Center, 600 New Jersey Ave, NW, Washington, DC 20001, USA;
| | - Sara N. Bleich
- Department of Health Policy and Management, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA; (C.G.D.); (J.D.); (Y.S.); (S.N.B.)
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Adams EL, Caccavale LJ, Smith D, Bean MK. Longitudinal patterns of food insecurity, the home food environment, and parent feeding practices during COVID-19. Obes Sci Pract 2021; 7:415-424. [PMID: 34230855 PMCID: PMC8250720 DOI: 10.1002/osp4.499] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/15/2021] [Indexed: 12/18/2022] Open
Abstract
Background The economic impacts of the coronavirus disease 2019 (COVID-19) have drastically increased food insecurity in the United States. Initial data, collected a few months into the pandemic, showed that families, particularly those experiencing food insecurity, reported detrimental changes to their home food environment and parent feeding practices, compared to before COVID-19. Objective This follow-up study obtained longitudinal data from a sample of parents in the United States to quantify changes in food security status, the home food environment, and parent feeding practices, from before to across COVID-19 as the pandemic continued to persist. Methods Parents (N = 433) completed online surveys May (T1) and September (T2) 2020 during COVID-19. Food security, home food environment, and parent feeding practices were reported at each timepoint. At T1, parents also retrospectively reported on these factors pertaining to before COVID-19. Chi square analyses and repeated measure mixed models examined associations among study variables. Results Low or very low food security increased from before COVID-19 (37%) to T1 (54%) and decreased by T2 (45%). About 30% of families who became food insecure, and 44% who stayed food insecure from T1 to T2, reported a decrease in total food in their home; only 3%-6% who became/stayed food secure reported this decrease. Parents' concern for child overweight and use of monitoring increased from before COVID-19 to T1, and decreased by T2, but remained elevated above pre-COVID-19 values. Conclusion Rates of food insecurity remain high as this pandemic persists. Continued assessment of nutrition-related factors and increased economic supports are critical for families to endure COVID-19 and prevent long-term obesity and health risks.
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Affiliation(s)
- Elizabeth L. Adams
- Department of PediatricsChildren's Hospital of Richmond at Virginia Commonwealth UniversityRichmondVirginiaUSA
| | - Laura J. Caccavale
- Department of PediatricsChildren's Hospital of Richmond at Virginia Commonwealth UniversityRichmondVirginiaUSA
| | - Danyel Smith
- Department of PediatricsChildren's Hospital of Richmond at Virginia Commonwealth UniversityRichmondVirginiaUSA
| | - Melanie K. Bean
- Department of PediatricsChildren's Hospital of Richmond at Virginia Commonwealth UniversityRichmondVirginiaUSA
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