Perceptions of Processed Foods Among Low-Income and Immigrant Parents

Food insecurity impacts diet quality and adherence to the gluten-free diet in youth with celiac disease

OBJECTIVES

Celiac disease (CD) is an autoimmune gastrointestinal disorder that requires a strict lifelong gluten-free diet (GFD). Gluten-free (GF) foods are more expensive and less readily accessible than gluten-containing foods, contributing to an increased risk for food insecurity (FI). The study aimed to determine associations between GF-FI, sociodemographic risk factors and child dietary adherence and diet quality (DQ).

METHODS

A 26-item, cross-country online survey was administered through social media to parents of children with CD on the GFD. The survey elicited household and CD child sociodemographic and clinical characteristics (e.g., duration of CD), measures of household FI, child DQ and GFD adherence, and parents' concerns related to GF food. Household GF-FI was evaluated using the validated Hunger Vital Sign™ and the US Department of Agriculture Six-Item Short Form Household Food Security Survey Module.

RESULTS

GF-FI occurred in 47% of households with children with CD with >30% reporting low to very low food security. Sociodemographic risk factors identified included lower income, renters, rural residency, single-parental households, and having children with additional dietary restrictions (p < 0.001). Regardless of FI status, a majority of households reported experiencing significantly higher GF food expenditure. GF-FI was associated with reduced adherence to the GFD, increased consumption of processed GF food, and lower intakes of fresh fruits and vegetables and GF grains among children with CD (p < 0.05).

CONCLUSIONS

GF-FI is prevalent in this multiethnic cohort of households with CD children and is associated with worsening DQ and GFD adherence. Policy interventions are urgently needed to address GF-FI.

A comprehensive review of current approaches on food waste reduction strategies

Food waste is a serious worldwide issue that has an impact on the environment, society, and economy. This comprehensive review provides a detailed description of methods and approaches for reducing food waste, emphasizing the necessity of comprehensive strategies to tackle its intricate relationship with environmental sustainability, social equity, and economic prosperity. By scrutinizing the extent and impact of food waste, from initial production stages to final disposal, this comprehensive review underlines the urgent need for integrated solutions that include technological advancements, behavioral interventions, regulatory frameworks, and collaborative endeavors. Environmental assessments highlight the significant contribution of food waste to greenhouse gas emissions, land degradation, water scarcity, and energy inefficiency, thereby emphasizing the importance of curtailing its environmental impact. Concurrently, the social and economic consequences of food waste, such as food insecurity, economic losses, and disparities in food access, underscore the imperative for coordinated action across multiple sectors. Food waste can also be effectively reduced by various innovative approaches, such as technological waste reduction solutions, supply chain optimization strategies, consumer behavior-focused initiatives, and waste recovery and recycling techniques. Furthermore, in order to foster an environment that encourages the reduction of food waste and facilitates the transition to a circular economy, legislative changes and regulatory actions are essential. By embracing these multifaceted strategies and approaches, stakeholders can unite to confront the global food waste crisis, thereby fostering resilience, sustainability, and social equity within our food systems.

Insights into Chinese Canadian culture: enablers and barriers for fruit and vegetable intake

Background

Fruits and vegetables (F&V) play a vital role in promoting health and preventing diseases. Numerous studies have demonstrated the association between F&V consumption and reduced risks of cardiovascular disease, cancer, and mortality. Despite the high priority of public health in promoting F&V intake, Chinese immigrants in Canada often fall below national guidelines in their consumption. Understanding the factors influencing F&V intake in this community is crucial for developing effective interventions.

Methods

This study used an applied ethnographic research approach to gain insight into the enablers and barriers that influence F&V intake among Chinese-Canadian adults in Richmond, BC. Semi-structured interviews and 'photovoice' group sessions were conducted to gather qualitative data from community participants and health care providers (HCPs).

Results

The research identified four key themes: (1) Cultural differences around how vegetables are perceived, consumed and prepared; (2) Motivators and strategies for increasing vegetable and fruit intake; (3) Lack of culturally relevant dietary education and resources; and (4) Importance of value in vegetable/fruit-related decisions. Participants showed a strong preference for the traditional Eastern diet, with cost of food and lack of knowledge about Western vegetables acting as barriers to dietary diversity. The study also highlighted the need for culturally tailored educational resources to effectively promote F&V consumption.

Conclusion

By adopting a multi-modal approach, incorporating both interviews and 'photovoice' sessions, this research provided comprehensive insights into the participants' perspectives and experiences related to F&V intake. Understanding these factors can guide the development of culturally appropriate interventions to increase F&V consumption among Chinese-Canadian adults in Richmond, BC, and potentially improve their overall health and well-being. Future studies should consider the heterogeneity within the Chinese immigrant population and target a more balanced representation of age groups to further enhance our understanding of F&V intake patterns in this community.

Parent perceptions of school meals and how perceptions differ by race and ethnicity

Parental perceptions of school meals can affect student participation and overall support for school meal policies. Little is known about parental school meal perceptions under universal free school meals (UFSM) policies. We assessed California parents' perceptions of school meals during the COVID-19 emergency response with federally funded UFSM and whether perceptions differed by race/ethnicity. Among 1110 California parents of K-12 students, most reported school meals benefit their families, saving them money (81.6%), time (79.2%), and stress (75.0%). Few reported that their child would be embarrassed to eat school meals (11.7%), but more parents of White students than Hispanic students reported this. Many parents reported that their child likes to eat lunch to be with friends (64.7%); about half felt their child has enough time to eat (54.2%). Fewer parents perceived school lunches to be of good quality (36.9%), tasty (39.6%), or healthy (44.0%). Parents of Hispanic and Asian students had less favorable perceptions of school meal quality, taste, and healthfulness than parents of White students. Parents report that school meals benefit their families, but policy efforts are needed to ensure schools have the resources needed to address cultural appropriateness. Schools should address parental perceptions of meals to optimize participation, nutrition security, and health.

Effect of a relative pricing intervention and active merchandising on snack purchases: interrupted time series analysis of a hospital retailer-led strategy

BACKGROUND

Pricing policies have been shown to be an effective lever for promoting healthier dietary choices in consumer food environments. It is not yet well understood how pricing can be used to encourage healthier substitute purchases. The aim of the study was to assess the effect of a retailer-led relative pricing intervention on weekly purchases of targeted snack foods and beverages.

METHODS

This was an ecological analysis in a real-world large tertiary hospital consumer food environment setting in urban Canada, comprised of four retail outlets: two large cafeterias, one smaller cafeteria, and one grab-and-go café. An interrupted time series analysis was designed to evaluate the effect of Snacking Made Simple, a retailer-led relative pricing intervention applied to 10 popular snack foods and beverages (n = 87 weeks, 66 weeks baseline and 21 weeks intervention, April 2018 to December 2019), on weekly purchase differences between healthier and less healthy targeted items, adjusted for weekly sales volume. Five healthier items were price discounted, alongside a price increase for five less healthy items. The intervention was actively merchandised in keeping with behaviour change theory.

RESULTS

Weekly purchases of targeted snacks became healthier during the intervention period (β = 21.41, p = 0.0024). This followed a baseline period during which weekly purchases of less healthy targeted snacks had outpaced over time those of healthier targeted snacks (β = -11.02, p = 3.68E-14). We estimated that, all else being equal, a hypothetical 9.43 additional weeks of the intervention would be required to transition to net-healthier targeted snack purchases in this environment. The effects of the intervention varied by retail outlet, and the outcome appears driven by specific food items; further, examining merchandising implementation, we posited whether direct versus indirect substitution may have affected purchasing outcomes.

CONCLUSIONS

Relative pricing may be a promising way to incentivize healthier substitute purchasing in the consumer food environment. Added attention to merchandising strategy as well as value-add factors within food categories and their effects on price salience may be an important factor in effective intervention design.

Promoting Health Equity: Identifying Parent and Child Reactions to a Culturally-Grounded Obesity Prevention Program Specifically Designed for Black Girls Using Community-Engaged Research

The Butterfly Girls (BFG) Study is a culturally and developmentally appropriate online obesity prevention program for 8–10-year-old Black girls designed with key stakeholders in the Black community. This multi-methods investigation, conducted with parent–child dyads who participated in an outcome evaluation of the intervention, aimed to understand parent and child reactions to the program. We were particularly interested in understanding perceptions regarding its cultural and developmental appropriateness, relevance and acceptability. Program participation and survey data (demographics, parent and child write-in comments on process evaluation surveys) were analyzed. Participation data demonstrated high adherence in treatment and comparison groups. Descriptive statistics were calculated for survey data and highlighted the socioeconomic diversity of the sample. Post intervention surveys included two fill-in-the-blank questions for parents (n = 184 for question 1, n = 65 for question 2) and one for children (n = 32). Comments were analyzed using structured thematic analysis. The majority of the feedback from child participants was complimentary and many found the program relatable. Among the parent responses, the majority found the program to be beneficial in its educational nature and in promoting behavior change. This multi-methods analysis suggests that the BFG program was perceived as beneficial by parents while being culturally and developmentally appropriate and engaging for young Black girls, highlighting the importance of co-collaboration in program development.

Cultural influences on infant and toddler feeding among low-income Latinx mothers

Latinx infants and toddlers experience higher obesity rates than their black or white counterparts, increasing chronic disease risk later in life. Infant and toddler feeding (ITF) interventions are shown to improve dietary behaviours, but few studies target Latinx populations. Culturally tailoring such interventions is imperative, but cultural influences on Latinx ITF practices remain unclear. The purpose of this study was to characterize how culture influences ITF practices among Latinx mothers of low income. A brief survey and semistructured interview informed by the theory of planned behaviour (TPB) were conducted on Zoom with New York City-based Latinx mothers of children 4 to 24 months old. A directed content analysis approach was used to identify themes using TPB theoretical codes and inductive codes. Transcripts were coded independently by two researchers using NVivo 12. Survey data were analyzed using descriptive statistics in Excel. Participants (n = 19) were of Dominican, Mexican and Central and South American origin, had low acculturation scores and mean child age was 16.7 months (range: 5-24 months old). The central theme identified was that participants balanced cultural information with evidence-based health information to determine which ITF practices were most beneficial to infant/toddler health. This resulted in the adoption of evidence-based ITF recommendations, adoption of cultural practices that aligned with evidence-based recommendations and dismissal or postponement of cultural ITF practices that contradicted evidence-based recommendations. The present results can be applied to culturally relevant ITF education as follows: emphasizing the benefits of desirable ITF practices on children's health and promoting healthy cultural ITF practices.

Consumers' Understanding of Ultra-Processed Foods

Food classification systems have been proposed to improve food quality criteria. Among these systems, "processing level" has been used as a criterion. NOVA classification, as the denotation "ultra-processed" food (UPF), has been widely used in different countries. However, even though some studies have pointed out some controversial aspects, no study has evaluated its comprehension by the population where it is used as reference. Therefore, this study explored the understanding of the term UPF for Brazilian consumers, where this denotation has been used in the last 8 years. A questionnaire was used, with questions referring to different aspects of self-assessment of knowledge about UPF. Altogether, 939 valid participants completed the questionnaire, and 81.9% of them declared to know the term UPF. For 78.2%, a better definition for UPF should be "foods that have gone through many processes in industry". Finally, it was concluded that the term UPF is still confusing for most Brazilians, indicating the risk of use and the urgent necessity to improve the classifications systems and consequently consumer understanding. Only when all parties interested in healthy food work together could this problem be solved.

Food environment interactions after migration: a scoping review on low- and middle-income country immigrants in high-income countries

Objective:

To map and characterise the interactions between the food environment and immigrant populations from low- and middle-income countries living in high-income countries.

Design:

A scoping review was carried out following the framework outlined by Arksey and O’Malley, as well as Levac et al. Peer-reviewed studies in English published between 2007 and 2021 were included. Two reviewers screened and selected the papers according to predefined inclusion criteria and reporting of results follows the PRISMA-ScR guidelines. A ‘Best fit’ framework synthesis was carried out using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework.

Setting:

High-income countries.

Participants:

Immigrants from low- and middle-income countries.

Results:

A total of sixty-eight articles were included, primarily based in the USA, as well as Canada, Australia and Europe, with immigrants originating from five regions of the globe. The analysis identified three overarching themes that interconnected different aspects of the food environment in addition to the four themes of the ANGELO framework. They demonstrate that in valuing fresh, healthy and traditional foods, immigrants were compelled to surpass barriers in order to acquire these, though children’s demands, low incomes, time scarcity and mobility influenced the healthiness of the foods acquired.

Conclusion:

This study brought together evidence on interactions between immigrant populations and the food environment. Immigrants attempted to access fresh, traditional, healthier food, though they faced structural and family-level barriers that impacted the healthiness of the food they acquired. Understanding the food environment and interactions therein is key to proposing interventions and policies that can potentially impact the most vulnerable.

Addressing Challenges with the Categorization of Foods Processed at Home: A Pilot Methodology to Inform Consumer-Facing Guidance

The objective of this study was to inform consumer-facing dietary guidance by (1) adapting the current University of North Carolina at Chapel Hill (UNC) food processing framework to include a home processing (HP) component and (2) pilot testing the adapted version using a nationally representative sample of foods consumed in the U.S. The UNC framework was adapted to include guidelines for categorizing home-prepared (HP) foods. The original UNC and adapted HP frameworks were used to code dietary recalls from a random sample of National Health and Nutrition Examination Survey (2015–2016 cycle) participants (n = 100; ages 2–80 years). Percent changes between the UNC and HP adapted frameworks for each processing category were calculated using Microsoft Excel, version 16.23. Participants were 56% female, 35% non-Hispanic white (mean age = 31.3 ± 23.8). There were 1,376 foods with 651 unique foods reported. Using the HP compared to the UNC framework, unprocessed/minimally processed foods declined by 11.7% (UNC: 31.0% vs. HP: 27.4%); basic processed foods increased by 116.8% (UNC: 8.2% vs. HP: 17.8%); moderately processed foods increased by 16.3% (UNC: 14.2% vs. HP: 16.6%); and highly processed foods decreased by 17.8% (UNC: 46.5% vs. HP: 38.2%). Home-prepared foods should be considered as distinct from industrially produced foods when coding dietary data by processing category. This has implications for consumer-facing dietary guidance that incorporates processing level as an indicator of diet quality.