Barriers to Preparing and Cooking Vegetables Are Associated with Decreased Home Availability of Vegetables in Low-Income Households

Cross-sectional associations of Special Supplemental Nutrition Program for Women, Infants, and Children benefit redemption and diet among children ages 1-4 years in California

BACKGROUND

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides supplemental healthy foods to children aged <5 y in low-income households.

OBJECTIVES

The objectives of this study were to characterize WIC benefit redemption, identify associations between benefit redemption and child dietary intake, and whether child age modifies these associations.

METHODS

The cross-sectional 2023 California Statewide WIC Survey, conducted with caregivers of WIC-participating children aged 1-4 y, was analyzed for this study. Included children had complete benefit redemption data, a complete National Health and Nutrition Examination Survey Dietary Screener Questionnaire (DSQ), and complete covariate data (weighted n = 2244). Monthly household category-specific benefit redemption percentage was averaged across 6 and 3 mo preceding survey completion. Associations between household redemption and child dietary intake (servings or amount/day) were assessed with multivariable linear regression and expressed as estimates and 95% confidence intervals (CI).

RESULTS

Twenty-five percent higher redemption of breakfast cereal, whole grain bread, yogurt and whole milk in the 6 mo prior to the survey were associated with higher child intake frequency for cereal (0.02 servings/d; 95% CI: 0.00, 0.04), whole grain bread (0.02 servings/d; 95% CI: 0.00, 0.03), yogurt (0.04 servings/d; 95% CI: 0.02, 0.06), and whole milk (0.09 servings/d; 95% CI: 0.01, 0.16). Significant effect modification by child age (12 to <24 mo, 24-59 mo) was found for redemption of cheese/tofu and 100% juice (P-interaction = 0.02 and 0.001, respectively), and 25% higher redemption of these benefits were associated with lower intake frequency for cheese (-0.05 servings/d; 95% CI: -0.09, -0.02) and higher intake frequency for juice (0.12 servings/d; 95% CI: 0.06, 0.18), but only among children ages 12 to <24 mo.

CONCLUSIONS

Higher redemption was associated with higher child intake of select WIC foods. Pairing the promotion of benefit redemption among program participants with nutrition education efforts may enhance dietary impacts of WIC participation.

Household Food Sourcing Patterns and Their Associations With Food Insecurity in Appalachian Ohio

BACKGROUND

Households experiencing food insecurity may use dynamic strategies to meet food needs. Yet, the relationship between household food sourcing behaviors and food security, particularly in rural settings, is understudied.

OBJECTIVE

To identify food sourcing patterns and their associations with food insecurity among households in rural Appalachian Ohio during the COVID-19 pandemic.

DESIGN

Survey data were collected from a cohort of households in Athens County, OH, in July 2020, October 2020, January 2021, and April 2021.

PARTICIPANTS/SETTING

The sample included 663 households with household food sourcing and food security information for ≥1 survey wave.

MAIN OUTCOME MEASURES

Household food sourcing patterns. Households reported the frequency with which they obtained food from various retailers and charitable sources, classified as supercenters, supermarkets, convenience stores, farmers markets, or charitable sources.

STATISTICAL ANALYSES

Principal component analysis was used to identify food sourcing patterns. Linear mixed models were used to assess changes in food sourcing behaviors over the study period and to determine whether food sourcing behaviors differed according to food security status.

RESULTS

Two patterns were identified: Convenience Stores and Charitable Food and Supermarkets and Farmers Markets, not Supercenters. Relative to July 2020, alignment of households' food sourcing behaviors with the Supermarkets and Farmers Markets, not Supercenters pattern was higher in October 2020 (β .07, 95% CI .02 to .12) and alignment with the Convenience Stores and Charitable Food pattern was lower in April 2021 (β -.06, 95% CI -.11 to -.02). Compared with food-secure households, food sourcing behaviors of food-insecure households were more closely aligned with the Convenience Stores and Charitable Food pattern (β .07, 95% CI .00 to .13); no statistically significant difference in scores was observed for the Supermarkets and Farmers Markets, not Supercenters pattern (β -.07, 95% CI -.15 to .02).

CONCLUSIONS

These findings support efforts to increase access to healthy, affordable options at venues where food-insecure households may be likely to obtain food, such as convenience stores and charitable sources.

Increasing food insecurity severity is associated with lower diet quality

OBJECTIVE

Food insecurity may reduce diet quality, but the relationship between food insecurity severity and diet quality is under-researched. This study aimed to examine the relationship between diet quality and severity of household food insecurity.

DESIGN

A cross-sectional, online survey used the United States Department of Agriculture Household Food Security Six-item Short Form to classify respondents as food secure or marginally, moderately or severely food insecure. The Australian Recommended Food Score (ARFS; scored 0–73) determined diet quality (ARFS total and sub-scale scores). Survey-weighted linear regression (adjusted for age, sex, income, education, location and household composition) was conducted.

SETTING

Tasmania, Australia.

PARTICIPANTS

Community-dwelling adults (aged 18 years and over).

RESULTS

The mean ARFS total for the sample (n 804, 53 % female, 29 % aged > 65 years) was 32·4 (sd = 9·8). As the severity of household food insecurity increased, ARFS total decreased. Marginally food-insecure respondents reported a mean ARFS score three points lower than food-secure adults (B = –2·7; 95 % CI (–5·11, –0·34); P = 0·03) and reduced by six points for moderately (B = –5·6; 95 % CI (–7·26, –3·90); P < 0·001) and twelve points for severely food-insecure respondents (B = –11·5; 95 % CI (–13·21, –9·78); P < 0·001). Marginally food-insecure respondents had significantly lower vegetable sub-scale scores, moderately food-insecure respondents had significantly lower sub-scale scores for all food groups except dairy and severely food-insecure respondents had significantly lower scores for all sub-scale scores.

CONCLUSIONS

Poorer diet quality is evident in marginally, moderately and severely food-insecure adults. Interventions to reduce food insecurity and increase diet quality are required to prevent poorer nutrition-related health outcomes in food-insecure populations in Australia.

School-based intervention impacts availability of vegetables and beverages in participants' homes

As rates of metabolic syndrome rise, children consume too few vegetables and too much added sugar. Because children tend to eat what is available at home, the home environment plays a key role in shaping dietary habits. This secondary analysis evaluated the effects of a school-based gardening, cooking, and nutrition education intervention (TX Sprouts) compared to control on the availability of vegetables, fruit juice, and sugar-sweetened beverages (SSBs) at home. In the TX Sprouts cluster-randomized trial, 16 schools were randomized to TX Sprouts (n = 8 schools) or control (n = 8 schools) for one academic year. All schools served predominately Hispanic families with low incomes. TX Sprouts built school gardens and taught 18 lessons to all 3rd-5th grade students at intervention schools. TX Sprouts also offered monthly caregiver lessons before and/or after school. Caregivers completed questionnaires pre and post, providing demographics and information about home availability of vegetables, fruit juice, and SSBs. Summary statistics were used to describe the sociodemographic characteristics of participants. Linear regression assessed the change in scores (pre to post) for the food/ beverage availability question. The model was adjusted for the caregiver's education, employment status, child's grade, and free or reduced-price lunch eligibility. The analytic sample included 895 participants. Compared to control, the intervention positively changed the home availability of targeted foods and beverages, largely by improving the availability of vegetables and vegetable juice. This study showed that a school gardening, nutrition, and cooking program delivered to elementary children may positively influence the home food environment.

Healthy helpers: using culinary lessons to improve children's culinary literacy and self-efficacy to cook

Background

Children do not eat the recommended amounts of vegetables, and school-based nutrition education has not been found to impact this behavior. Cooking education is associated with improved children's culinary literacy (CL) and eating behaviors. This study investigated the impact of a culinary literacy (CL) curriculum on children's acceptance of vegetable-added (mushrooms) recipes, CL, self-efficacy to cook (SE), and willingness to try vegetables (WV).

Methods

A convenience sample of 39 fourth and fifth graders were exposed to a six-lesson virtual CL curriculum that taught basic cooking skills and how to prepare six recipes, including three traditional recipes and the same recipes with added vegetables.

Results

Children who participated in the CL curriculum accepted vegetables added to pizza pockets, but vegetables added to macaroni and cheese and fajitas negatively affected the acceptance of recipes. Children improved their CL and SE but did not show a significant change in their WV.

Conclusion

Findings suggest that CL programs focusing on vegetables may drive factors associated with dietary behavior change, SE, and acceptance of vegetables. Future studies should consider CL as a potential method to improve vegetable intake in children in tandem with nutrition education or as a sole intervention. The study was limited by its small sample size, the virtual setting, and the use of mushrooms as the primary vegetable source. Future studies should be conducted with a larger sample size, in a traditional classroom setting, use a variety of vegetables, and collect qualitative data on the sensory characteristics affecting children's WV.

Fruit and Vegetable Preparation Changes During and After Cost-Offset Community-Supported Agriculture Plus Nutrition Education

OBJECTIVE

Inadequate consumption of fruits and vegetables (FV) can negatively impact health. Cost-offset, or subsidized, community-supported agriculture (CO-CSA) may change FV preparation behaviors among caregivers in low-income households. We assessed changes in FV preparation frequency and methods during and after participation in a CO-CSA plus tailored nutrition education intervention.

DESIGN

Longitudinal comparison of outcomes at baseline, end of CO-CSA season, and 1 year later.

PARTICIPANTS

Caregivers of children aged 2-12 years from households with low income in rural areas of 4 US states (n = 148).

INTERVENTION

Summer season, half-price CO-CSA share plus tailored nutrition education classes. Comparison to a control group not included in this analysis.

VARIABLES MEASURED

Monthly frequency of preparing 9 FV for children's snacks and 5 vegetables for dinner; use of healthy preparation methods for dinner.

ANALYSIS

Repeated measures ANCOVA including state with Bonferroni correction and 95% confidence.

RESULTS

At baseline, caregivers prepared fruit for children's snacks and vegetables for dinner almost daily and vegetables for children's snacks every other day. The frequency of total FV preparation and most vegetable varieties increased during the intervention. Increases in total vegetables for snacks, dinner, and leafy greens were maintained 1 year later (n = 107).

CONCLUSIONS AND IMPLICATIONS

Community-supported agriculture plus education is a promising approach to sustained increases in vegetable preparation for children's snacks and dinner meals.

A Scoping Review of Household Factors Contributing to Dietary Quality and Food Security in Low-Income Households with School-Age Children in the United States

Low-income and food-insecure households are at risk of poor dietary quality and even more severe food insecurity. Especially in childhood, consuming a nutritionally adequate diet is an essential driver of health, growth, and development. Household-level factors can present challenges to support the nutritional needs of low-income and food-insecure household members. The aim of this scoping review is to identify the contributing household factors to dietary quality and food security in US households of school-aged children 5 to 19 years and synthesize the evidence around emergent themes for application to future interventions. The scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols Extension for Scoping Reviews using search terms addressing food insecurity, low income, and dietary behaviors in the database PubMed. Screening by 3 independent reviewers of the title, abstract, and full study phases identified 44 studies. The 5 themes around which the studies grouped were: parental behaviors, child/adolescent behaviors, food procurement behaviors, food preparation behaviors, and household environment factors. Most studies were cross-sectional (n = 41, 93%) and focused on parental behaviors (n = 31, 70%), followed by food preparation and procurement behaviors. The themes identified were interrelated and suggest that incorporating education on parent and child behaviors that influence food procurement and preparation, along with strengthening organization and planning in the household environment, may hold promise to improve dietary quality and food security among food-insecure and low-income households. The findings can be used to inform future nutrition education interventions aimed at improving dietary quality and food security in households with school-aged children.

Impact and evaluation of an online culinary nutrition course for health, education and industry professionals to promote vegetable knowledge and consumption

BACKGROUND

Poor diet, including inadequate vegetable intake, is a leading risk factor for noncommunicable disease. Culinary and nutrition education provided to trainee and practising health and education professionals is an emerging strategy to promote improved dietary intake, including vegetable consumption. We evaluated the impact and feasibility of an online culinary medicine and nutrition (CM/CN) short course for health, education and vegetable industry professionals. The course aimed to improve participants' skills and confidence to prepare vegetables, knowledge of evidence-based nutrition information and recommendations for improving vegetable consumption and diet quality.

METHODS

A pre-post study consisting of two separate groups participating in two course rounds recruited practising professionals (n = 30) working in health; community, adult and/or culinary education; and the vegetable industry. Evaluation assessed diet quality, vegetable consumption barriers, cooking and food skill confidence, nutrition knowledge and process measures.

RESULTS

Seventeen participants (68%) completed the programme. Pre- to postintervention statistically significant increases in vegetables (M 1.3, SD 2.2), fruit (M 1.6, SD 3.1), and breads and cereal (M 1.1, SD 1.7) intakes were observed. Statistically significant increases and large effect sizes for mean food skill confidence scores (M 8.9, SD 15.4, Cohen's d 0.56) and nutrition knowledge scores (M 6.2, SD 15.4, Cohen's d 0.83) were also observed pre- to postintervention.

CONCLUSIONS

The short online course was feasible and improved diet quality, food skill confidence and nutrition knowledge. Online CM/CN education for practising professionals represents a promising area of research. Future research involving a larger study sample and a more rigorous study design such as a randomised control trial is warranted.

Impact of a School-Based Gardening, Cooking, Nutrition Intervention on Diet Intake and Quality: The TX Sprouts Randomized Controlled Trial

School gardens have become common school-based health promotion strategies to enhance dietary behaviors in the United States. The goal of this study was to examine the effects of TX Sprouts, a one-year school-based gardening, cooking, and nutrition cluster randomized controlled trial, on students' dietary intake and quality. Eight schools were randomly assigned to the TX Sprouts intervention and eight schools to control (i.e., delayed intervention) over three years (2016-2019). The intervention arm received: formation and training of Garden Leadership Committees; a 0.25-acre outdoor teaching garden; 18 student lessons including gardening, nutrition, and cooking activities, taught weekly in the teaching garden during school hours; and nine parent lessons, taught monthly. Dietary intake data via two 24 h dietary recalls (24 hDR) were collected on a random subsample (n = 468). Dietary quality was calculated using the Healthy Eating Index 2015 (HEI-2015). The intervention group compared to control resulted in a modest increase in protein intake as a percentage of total energy (0.4% vs. -0.3%, p = 0.021) and in HEI-2015 total vegetables component scores (+4% vs. -2%, p = 0.003). When stratified by ethnicity/race, non-Hispanic children had a significant increase in HEI-2015 total vegetable scores in the intervention group compared to the control group (+4% vs. -8%, p = 0.026). Both the intervention and control groups increased added sugar intake; however, to a lesser extent within the intervention group (0.3 vs. 2.6 g/day, p = 0.050). School-based gardening, cooking, and nutrition interventions can result in significant improvements in dietary intake. Further research on ways to scale and sustain nutrition education programs in schools is warranted. The trial is registered at ClinicalTrials.gov (NCT02668744).

Marginal, Low, and Very-Low Food Security among Children Are Associated with Intake of Select Dietary Factors during Summer

BACKGROUND

School meals are associated with improved food security status and dietary intake. Children receiving free and reduced-price school meals lose access to these meals during the summer. The association between food security status and dietary intake in these children during summer is unclear.

OBJECTIVE

To examine the association between food security status (high, marginal, low, and very-low food security) among children and intake of select dietary factors during summer in children certified for free and reduced-price school meals by age group (3 to 4 years, 5 to 8 years, 9 to 12 years, and 13 to 17 years).

DESIGN

Cross-sectional analysis.

PARTICIPANTS/SETTING

Secondary data from 11,873 children aged 3 to 17 years in the control group of the US Department of Agriculture Summer Electronic Benefit Transfer for Children Demonstration Project.

MAIN OUTCOME MEASURES

Consumption of total fruits and vegetables; fruits and vegetables, excluding fried potatoes; whole grains; added sugars; added sugars, excluding cereals; added sugars from sugar-sweetened beverages; and dairy products assessed using questions from the 2009-2010 National Health and Nutrition Examination Survey Multifactor Diet Screener.

STATISTICAL ANALYSIS

Multiple linear regression.

RESULTS

For the majority of age groups, marginal food security, low food security, and very-low food security were associated with lower fruit and vegetable consumption and low food security and very-low food security were associated with lower dairy consumption, with children from households with very-low food security having the lowest consumption. Children from households with very-low food security consumed 0.73 (95% CI -0.93 to -0.53) to 0.99 (95% CI -1.59 to -0.39) cup equivalents less per day of fruits and vegetables and 0.49 (95% CI -0.65 to -0.34) to 0.68 (95% CI -1.07 to -0.29) cup equivalents less per day of dairy compared with children from households experiencing high food security.

CONCLUSIONS

Lower food security was associated with reduced consumption of fruits and vegetables and dairy products during summer in children from low-income households.

Evaluation of a COVID-influenced Curriculum to Address Food Insecurity in a Detroit Family Medicine Residency Clinic

CONTEXT

To date, numerous projects have demonstrated that an ongoing limited access to nutritionally dense food (i.e., "food insecurity") plays a key role in the overall health and wellbeing of lower income at-risk populations.

METHODS

For this 2019-2020 pilot project, the resident physician authors first created and administered a simple five-item questionnaire screening process to systematically identify food insecure patients in their metropolitan Detroit residency clinic. A sample of patients who had been identified as food insecure and pre-diabetic were then provided improved access to healthy foods, supplemented by a six-week program of nutritional education classes using a nationally recognized "Cooking Matters'' six-week long curriculum with a licensed chef and nutrition educator.

RESULTS

After institutional review board approval, the authors enrolled a sample of 10 adults. The authors successfully measured both pre- and post-program Hemoglobin A1c (HbA1C) levels for all participants who completed the required course and subsequent clinic follow up visits. Using a series of initial non-parametric Wilcoxon Signed Rank matched pair tests, post-program follow-up at three months revealed statistically significant reductions in documented HbA1c levels from baseline for six enrolled patients (W=1, Z = - 2.226, p = 0.026) and six-month follow up (i.e., more than four months after completion of the program) (W = 1, Z = - 2.060, p = 0.039). In post-program surveys, each respondent indicated that they found the class content to be generally beneficial to increase their nutritional knowledge.

CONCLUSIONS

In the authors' setting, this food insecurity program has subsequently led to a more formal screening process to evaluate and identify food insecure patients. The authors discuss the scheduling difficulties they experienced from the COVID-19 pandemic for their sample patients. However, these pilot results suggest that prolonged benefits may require ongoing "virtual" teaching sessions with pre-diabetic patients to address the complex factors influencing food insecurity levels identified in similar inner-city settings.