1
|
Bleich SN, Cohen J, Kenney E. It Is Back to School Time-The Status of Healthy School Meals for All Students. JAMA HEALTH FORUM 2024; 5:e243713. [PMID: 39264605 DOI: 10.1001/jamahealthforum.2024.3713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024] Open
Abstract
This JAMA Forum discusses key government efforts to advance the availability of healthy school meals, the evidence of the effects of these efforts, and the role for health professionals.
Collapse
Affiliation(s)
- Sara N Bleich
- Department of Health Policy and Management, T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Juliana Cohen
- Department of Nutrition and Public Health, School of Nursing and Health Sciences, Merrimack College, North Andover, Massachusetts
| | - Erica Kenney
- Department of Nutrition, T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Knapp MB, Creveling K, Washington D, Ennin N, Numa T. New Orleans school meal programs during the COVID-19 pandemic: challenges and innovations identified through qualitative interviews. BMC Public Health 2024; 24:1614. [PMID: 38886721 PMCID: PMC11181593 DOI: 10.1186/s12889-024-19107-3] [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: 11/16/2023] [Accepted: 06/11/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND School meal programs are critical to reducing childhood food insecurity. This study identified challenges and innovations in school meal service in a disaggregated charter school system during COVID-19 in New Orleans, Louisiana. METHODS Semi-structured qualitative key informant interviews were conducted with school officials and school food providers. Interviews were recorded, transcribed, and coded. Using an immersion-crystallization approach, patterns were identified. RESULTS Nine participants described challenges and solutions/innovations in food service focused around five themes: food service, procurement and costs, staffing, communication and outreach, and collaborations and partnerships. Participants faced challenges in meal service logistics, procuring food and supplies, staffing shortages, timely communication, lack of city-wide coordination, and the need to rapidly shift operations due to an evolving pandemic. While the disaggregated system created challenges in a city-wide response, the decentralized system along with policy changes offered opportunities for flexibility and innovation in meal programs through new partnership and coordination between schools and community, development of new processes for food service and procurement, and diverse modes of communication. CONCLUSION These findings add to the understanding of challenges faced and innovations implemented to continue school meal programs in a disaggregated school system. Collaboration with community organizations, leveraging resources, coordinated communication, and policies allowing for flexibility were key to response and should be encouraged to build capacity and resiliency in emergencies. In future city-wide emergency preparedness planning efforts, school leaders and food providers should be included in the planning to ensure continued equitable food access for students.
Collapse
Affiliation(s)
- Megan B Knapp
- Xavier University of Louisiana, 1 Drexel Dr, 70125, New Orleans, Louisiana, USA.
| | - Kristine Creveling
- Propeller: A Force for Social Innovation, 4035 Washington Ave, New Orleans, LA, 70125, USA
- UNFI Foundation, 313 Iron Horse Way, Providence Rhode Island, 02908, USA
| | | | - Naana Ennin
- Xavier University of Louisiana, 1 Drexel Dr, 70125, New Orleans, Louisiana, USA
| | - Tiffany Numa
- Xavier University of Louisiana, 1 Drexel Dr, 70125, New Orleans, Louisiana, USA
| |
Collapse
|
4
|
Yaskey R, Dahl-Grove D. Pediatric Pandemics and Disasters - A Summary. Pediatr Clin North Am 2024; 71:353-370. [PMID: 38754929 DOI: 10.1016/j.pcl.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Children make up approximately 25% of the population in the United States and are particularly vulnerable to the impact of disasters. The creation of federally-funded programs and advisory committees has had a positive impact on addressing the needs of children and families in disasters by identifying best practices, disseminating information, identifying gaps, and providing information with future investments that will contribute to expanding disaster science for children and their families.
Collapse
Affiliation(s)
- Regina Yaskey
- UH Rainbow Babies and Children's Hospital, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
| | - Deanna Dahl-Grove
- UH Rainbow Babies and Children's Hospital, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| |
Collapse
|
5
|
Ahmed M, Richardson A, Riad J, McPherson C, Sellen DW, Malik VS. Impact of the COVID-19 pandemic on the adaptability and resiliency of school food programs across Canada. Front Public Health 2024; 11:1296620. [PMID: 38235159 PMCID: PMC10791823 DOI: 10.3389/fpubh.2023.1296620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/06/2023] [Indexed: 01/19/2024] Open
Abstract
Introduction Following the sudden closure of schools due to the pandemic in 2020, many school food program (SFP) operators lost their operating venues and had to innovate to continue distributing meals to children. Our objective was to assess the impact of the COVID-19 pandemic on the delivery, adaptability, and resiliency of school food programs across Canada by conducting a systematic rapid review. Materials and methods Systematic literature searches identified newspaper articles and social media sources related to the adaptations and challenges faced by school food programs across Canada in response to the COVID-19 pandemic. Included sources were assessed and thematically categorized according to the dimensions of the Analysis Grid for Environments Linked to Obesity (ANGELO) and Getting To Equity (GTE) frameworks to identify factors impacting the delivery, adaptability, and resiliency of school food programs in Canada. Results School food programs in Canada made various efforts to meet existing and new challenges associated with the delivery of these programs to keep feeding school children, particularly those most vulnerable, during the pandemic. Distribution of food kits, prepared meals and gift cards/coupons were successful pathways in ensuring support for food accessibility to students and their families. Increased collaborations between community members and organizations/stakeholders to help maintain food delivery or collectively offer new modes to deliver foods were most frequently cited as key to facilitating school food programming. However, maintenance and sustainability related to operating costs and funding were identified as key challenges to successful school food programming. Conclusion Our study highlights the swift and substantial transformation school food programs,, underwent in response to the pandemic, driven by the urgent need to ensure that students still had access to nutritious meals and the importance of policy and resource support to bolster the adaptability and resiliency of these programs. Findings on facilitators and challenges to school food programs during the early months of the COVID-19 pandemic can inform development of guidelines to design a robust national Canadian school food program and help make existing programs more sustainable, adaptable, and resilient.
Collapse
Affiliation(s)
- Mavra Ahmed
- Joannah and Brian Lawson Centre for Child Nutrition, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alana Richardson
- Joannah and Brian Lawson Centre for Child Nutrition, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jessica Riad
- Joannah and Brian Lawson Centre for Child Nutrition, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Chelsea McPherson
- Joannah and Brian Lawson Centre for Child Nutrition, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel W. Sellen
- Joannah and Brian Lawson Centre for Child Nutrition, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vasanti S. Malik
- Joannah and Brian Lawson Centre for Child Nutrition, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| |
Collapse
|
6
|
Merlo C, Smarsh BL, Xiao X. School Nutrition Environment and Services: Policies and Practices That Promote Healthy Eating Among K-12 Students. THE JOURNAL OF SCHOOL HEALTH 2023; 93:762-777. [PMID: 37670594 PMCID: PMC10502941 DOI: 10.1111/josh.13365] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/06/2023] [Accepted: 06/22/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Changes to policies at the federal, state, and local levels over the last decade have influenced the school nutrition environment and services. METHODS This systematic review includes an analysis of individual research articles and government reports published from 2010 to 2021 that examine interventions to improve the school nutrition environment and services and increase the availability, selection, and consumption of healthier foods and beverages in K-12 schools in the United States. RESULTS Nutrition standards for school meals and food outside of meals improved access to healthier options in school. Providing school nutrition professionals with professional development, improving the palatability of school meals, offering taste tests, pre-slicing fruit, providing recess before lunch, offering incentives for trying healthier options, and providing access to drinking water resulted in increased selection and consumption of healthier items. There were inconclusive or mixed findings for some intervention strategies including adequate seat time for meals. CONCLUSIONS Despite demonstrated improvements to school meal programs and competitive foods, more work is needed to change the selection and consumption of healthier options among K-12 students. Schools can use multiple interventions to improve the school nutrition environment and services and help students adopt food and beverage choices that support health.
Collapse
Affiliation(s)
- Caitlin Merlo
- Healthy Schools Branch, Division of Population Health, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA
| | - Brianna L Smarsh
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA
| | - Xiangxue Xiao
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV
| |
Collapse
|
7
|
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.
Collapse
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;
| |
Collapse
|
8
|
Ilieva RT, Fraser KT, Cohen N. From multiple streams to a torrent: A case study of food policymaking and innovations in New York during the COVID-19 emergency. CITIES (LONDON, ENGLAND) 2023; 136:104222. [PMID: 36879669 PMCID: PMC9977326 DOI: 10.1016/j.cities.2023.104222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic has had significant effects on urban and regional food systems. Local administrations worldwide have been challenged to design and implement policies to mitigate immediate food system disruptions while planning for longer-term equity and resilience. The fast pace and high degree of uncertainty of the pandemic have made systematic tracking and assessment of food system change and related policy responses arduous. To address this gap, this paper applies the multilevel perspective on sociotechnical transitions and the multiple streams framework on policy change to 16 months of food policy (March 2020 through June 2021) during the New York State-issued COVID-19 state of emergency, comprising more than 300 food policies advanced by New York City and State legislators and administrators. Content analysis of these policies revealed the most salient policy areas during this period, the status of legislation, and key programs and budget allocations, as well as local food governance and the organizational spaces within which food policy operates. The paper shows that food policy domains that gained prominence focused on support for food businesses and food workers and on ensuring and expanding food access through food security and nutrition policies. Most COVID-19 food policies were incremental and were limited to the duration of the emergency, yet the crisis allowed for enactment of novel policies that deviated from the common policy issues or the typical scale of changes proposed pre-pandemic. Taken together, and viewed through a multilevel and policy streams framework, the findings provide insight into the trajectory of food policymaking in New York during the pandemic and the areas that food justice activists, researchers, and policy makers should focus on as the COVID-19 pandemic is abated.
Collapse
Affiliation(s)
- Rositsa T Ilieva
- CUNY Urban Food Policy Institute, CUNY Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, USA
| | - Katherine Tomaino Fraser
- CUNY Urban Food Policy Institute, CUNY Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, USA
| | - Nevin Cohen
- CUNY Urban Food Policy Institute, CUNY Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, USA
| |
Collapse
|
9
|
Martinelli S, Bui T, Acciai F, Yedidia MJ, Ohri-Vachaspati P. Improvements in School Food Offerings over Time: Variation by School Characteristics. Nutrients 2023; 15:nu15081868. [PMID: 37111087 PMCID: PMC10146944 DOI: 10.3390/nu15081868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
The 2010 Healthy, Hunger-Free Kids Act (HHFKA) improved the nutritional quality of food served in schools. This longitudinal study examined school food offerings over time from school year 2010-11 to 2017-18 in public schools (n = 148) in four New Jersey cities. Six food indices were used to assess the number of healthy and unhealthy items offered as part of the National School Lunch Program (NSLP), in vending machines, and à la carte (i.e., competitive foods). Multilevel, multivariable linear regression with quadratic terms was used to model the trends over time. Interaction terms were added to examine whether the time trends varied by school-level factors, such as proportion of students eligible for free or reduced-price meals (FRPMs), race/ethnicity of enrolled students, and school level. Over the study period, healthy items offered in the NSLP increased (p < 0.001), while unhealthy items in the NSLP decreased (p < 0.001). Significantly different rates of declines in NSLP unhealthy offering were observed among schools at the two extremes of FRPM eligibility (p < 0.05). The trends for healthy and unhealthy foods offered in competitive foods showed significant non-linear trends, and differences were observed for school-level race/ethnicity, with worse outcomes for schools with majority Black student enrollment.
Collapse
Affiliation(s)
- Sarah Martinelli
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA
| | - Theresa Bui
- College of Medicine Phoenix, University of Arizona, Phoenix, AZ 85721, USA
| | - Francesco Acciai
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA
| | - Michael J Yedidia
- Rutgers Center for State Health Policy, Rutgers Institute of Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ 08901, USA
| | | |
Collapse
|
10
|
Lu SV, Harper KM, Ding Y, Everett J, Gross J, Borman R, Medina-Perez K, Pinzini B, Wilson MJ, Gross SM. The Impact of the COVID-19 Pandemic on the Experiences and Operations of Sponsors of the Summer Food Service Program in Maryland, USA: A Multiphase Mixed Methods Study. Nutrients 2023; 15:nu15071628. [PMID: 37049469 PMCID: PMC10097045 DOI: 10.3390/nu15071628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/19/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
During the COVID-19 pandemic, the Summer Food Service Program (SFSP) was allowed to operate in untraditional non-summer months to ensure children did not lose access to free and reduced-priced nutritious meals when schools were mandated to close in the United States. This study assessed the impact of the pandemic on the operations and experiences of Summer Food Service Program (SFSP) sponsors in the state of Maryland during the COVID-19 pandemic in 2020 (Phase I) and 2021 (Phase II). This study used a multiphase explanatory sequential mixed methods design with qualitative prioritization. Maryland SFSP sponsors completed an online survey (Phase I: n = 27, Phase II: n = 30), and semi-structured in-depth interviews were conducted with a subset of sponsors who completed the survey (Phase I: n = 12, Phase II: n = 7). Inductive and deductive analyses were used for qualitative data, and descriptive statistics were used for quantitative data. The COVID-19 pandemic caused SFSP sponsors to change their operations. Sponsors were primarily concerned about staff safety/burnout and decreased participation. Sponsors perceived waivers implemented by the United States Department of Agriculture to be crucial in enabling them to serve meals to children during the pandemic. The findings from our study support advocacy efforts to permanently implement waivers and provide free school meals for all children.
Collapse
|
11
|
Headrick G, Ellison C, Bresnahan C, Green C, Lyons M, Moran A. State Implementation of SNAP Waivers and Flexibilities During the COVID-19 Pandemic: Perspectives From State Agency Leaders. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:982-997. [PMID: 36184356 PMCID: PMC9552006 DOI: 10.1016/j.jneb.2022.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 07/17/2022] [Accepted: 07/28/2022] [Indexed: 06/16/2023]
Abstract
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.
Collapse
Affiliation(s)
- Gabby Headrick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Carolyn Ellison
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Carolyn Bresnahan
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Chloe Green
- American Public Human Services Association, Arlington, VA
| | - Matt Lyons
- American Public Human Services Association, Arlington, VA
| | - Alyssa Moran
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| |
Collapse
|
12
|
Sacca L, Garba NA, Clarke RD, Maroun V, Brown DR. Using Community-Based Implementation Frameworks and Strategies to Address Food Insecurity During the COVID-19 Pandemic: A Scoping Review. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2022. [DOI: 10.1080/19320248.2022.2136024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Lea Sacca
- Department of Humanities, Health and Society, Herbert Wertheim College of Medicine, Florida, United States
| | - Nana Aisha Garba
- Department of Humanities, Health and Society, Herbert Wertheim College of Medicine, Florida, United States
| | - Rachel D. Clarke
- Department of Humanities, Health and Society, Herbert Wertheim College of Medicine, Florida, United States
| | - Veronica Maroun
- Department of Nutritional Sciences, Lebanese American University, Byblos, Lebanon
| | - David R. Brown
- Department of Humanities, Health and Society, Herbert Wertheim College of Medicine, Florida, United States
| |
Collapse
|
13
|
Kenney EL, Walkinshaw LP, Shen Y, Fleischhacker SE, Jones-Smith J, Bleich SN, Krieger JW. Costs, Reach, and Benefits of COVID-19 Pandemic Electronic Benefit Transfer and Grab-and-Go School Meals for Ensuring Youths' Access to Food During School Closures. JAMA Netw Open 2022; 5:e2229514. [PMID: 36044212 PMCID: PMC9434357 DOI: 10.1001/jamanetworkopen.2022.29514] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE School meals are associated with improved nutrition and health for millions of US children, but school closures due to the COVID-19 pandemic disrupted children's access to school meals. Two policy approaches, the Pandemic Electronic Benefit Transfer (P-EBT) program, which provided the cash value of missed meals directly to families on debit-like cards to use for making food purchases, and the grab-and-go meals program, which offered prepared meals from school kitchens at community distribution points, were activated to replace missed meals for children from low-income families; however, the extent to which these programs reached those who needed them and the programs' costs were unknown. OBJECTIVE To assess the proportion of eligible youths who were reached by P-EBT and grab-and-go meals, the amount of meals or benefits received, and the cost to implement each program. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted from March to June 2020. The study population was all US youths younger than 19 years, including US youths aged 6 to 18 years who were eligible to receive free or reduced-price meals (primary analysis sample). EXPOSURES Receipt of P-EBT or grab-and-go school meals. MAIN OUTCOMES AND MEASURES The main outcomes were the percentage of youths reached by P-EBT and grab-and-go school meals, mean benefit received per recipient, and mean cost, including implementation costs and time costs to families per meal distributed. RESULTS Among 30 million youths eligible for free or reduced-price meals, grab-and-go meals reached an estimated 8.0 million (27%) and P-EBT reached 26.9 million (89%). The grab-and-go school meals program distributed 429 million meals per month in spring 2020, and the P-EBT program distributed $3.2 billion in monthly cash benefits, equivalent to 1.1 billion meals. Among those receiving benefits, the mean monthly benefit was larger for grab-and-go school meals ($148; range across states, $44-$176) compared with P-EBT ($110; range across states, $55-$114). Costs per meal delivered were lower for P-EBT ($6.46; range across states, $6.41-$6.79) compared with grab-and-go school meals ($8.07; range across states, $2.97-$15.27). The P-EBT program had lower public sector implementation costs but higher uncompensated time costs to families (eg, preparation time for meals) compared with grab-and-go school meals. CONCLUSIONS AND RELEVANCE In this economic evaluation, both the P-EBT and grab-and-go school meal programs supported youths' access to food in complementary ways when US schools were closed during the COVID-19 pandemic from March to June 2020.
Collapse
Affiliation(s)
- Erica L. Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Ye Shen
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Jessica Jones-Smith
- Department of Health Systems and Population Health, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
| | - Sara N. Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - James W. Krieger
- Department of Health Systems and Population Health, University of Washington, Seattle
| |
Collapse
|
14
|
Ryan BJ, Telford V, Brickhouse M, Campbell J, Crowe C, Fink R, Hatch K, Hatch T, Jones R, Cruz AS, Allen C, Krey K, Everett J, Kanitz LA, Brooks BW. Mobilizing and Delivering Essential Meals to Children and Families Affected by School Closures During COVID-19 and Beyond. THE JOURNAL OF SCHOOL HEALTH 2022; 92:646-655. [PMID: 35383931 PMCID: PMC9115131 DOI: 10.1111/josh.13188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/17/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The closure of schools in response to COVID-19 compromised access to essential meals for many students. The Emergency Meals-to-You program, a public/private partnership, was set up to address this challenge. More than 38.7 million meals were delivered between April and August 2020. This study explores lessons learned and identifies strategies for strengthening food access and security at schools and beyond. METHODS Qualitative research methods were used. This included interviews and focus groups with participants involved in setting up and delivering the Emergency Meals-to-You program. Data were thematically analyzed using key phrases, ideas, and concepts, and interpreted. RESULTS The program leveraged a multisectoral approach. Components relied on each other and included: schools, public/private partnership, eligibility, relationships, experience, centralized communication, food quality and branding, logistics, and transport. Strategies identified to strengthen food access focused on integration with emergency management structures, understanding food needs at the school level, building a fully procurable menu, and allowing distribution to be rapidly scaled. CONCLUSIONS The lessons identified and strategies recommended provide a framework for working across the emergency management spectrum (school to national level) to strengthen food access and availability for students and their families affected by a pandemic, disaster, or crisis situation.
Collapse
Affiliation(s)
- Benjamin J. Ryan
- Department of Environmental Science, Environmental Health Science ProgramBaylor UniversityWacoTXUSA
| | - Victoria Telford
- Department of Environmental Science, Environmental Health Science ProgramBaylor UniversityWacoTXUSA
| | | | | | - Connor Crowe
- Department of Environmental Science, Environmental Health Science ProgramBaylor UniversityWacoTXUSA
| | - Rok Fink
- University of LjubljanaLjubljanaSloveniaUSA
| | | | - Tim Hatch
- Alabama Department of Public HealthMontgomeryAL
| | - Reiley Jones
- Department of Environmental Science, Environmental Health Science ProgramBaylor UniversityWacoTXUSA
| | - Andrea S. Cruz
- Department of Environmental Science, Environmental Health Science ProgramBaylor UniversityWacoTXUSA
| | - Cara Allen
- Baylor Collaborative on Hunger and PovertyWacoTXUSA
| | - Kathy Krey
- Baylor Collaborative on Hunger and PovertyWacoTXUSA
| | | | | | - Bryan W. Brooks
- Department of Environmental Science, Environmental Health Science ProgramBaylor UniversityWacoTXUSA
| |
Collapse
|
15
|
Katz BN, Soldavini J, Grover K, Jilcott Pitts S, Martin SL, Thayer L, Ammerman AS, Lane HG. “Let’s Use This Mess to Our Advantage”: Calls to Action to Optimize School Nutrition Program beyond the Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137650. [PMID: 35805309 PMCID: PMC9265650 DOI: 10.3390/ijerph19137650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 01/27/2023]
Abstract
School nutrition programs mitigate food insecurity and promote healthy eating by offering consistent, nutritious meals to school-aged children in communities across the United States; however, stringent policy guidelines and contextual challenges often limit participation. During COVID-19 school closures, most school nutrition programs remained operational, adapting quickly and innovating to maximize reach. This study describes semi-structured interviews with 23 nutrition directors in North Carolina, which aimed to identify multi-level contextual factors that influenced implementation, as well as ways in which the innovations during COVID-19 could translate to permanent policy and practice change and improve program reach. Interviews were conducted during initial school closures (May–August 2020) and were deductively analyzed using the Social Ecological Model (SEM) and Consolidated Framework for Implementation Research (CFIR). Analysis elicited multiple relevant contextual factors: director characteristics (motivation, leadership style, experience), key implementation stakeholders (internal staff and external partners), inner setting (implementation climate, local leadership engagement, available resources, structural characteristics), and outer setting (state leadership engagement, external policies and incentives). Findings confirm the strength and resilience of program directors and staff, the importance of developing strategies to strengthen external partnerships and emergency preparedness, and strong support from directors for policies offering free meals to all children.
Collapse
Affiliation(s)
- Beth N. Katz
- Food Insight Group, Berkeley, CA 94707, USA; (B.N.K.); (L.T.)
| | - Jessica Soldavini
- Center for Health Promotion and Disease Prevention, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC 27599, USA;
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC 27599, USA; (S.L.M.); (A.S.A.)
| | - Kiran Grover
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | | | - Stephanie L. Martin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC 27599, USA; (S.L.M.); (A.S.A.)
| | - Linden Thayer
- Food Insight Group, Berkeley, CA 94707, USA; (B.N.K.); (L.T.)
| | - Alice S. Ammerman
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC 27599, USA; (S.L.M.); (A.S.A.)
- Department of Public Health, East Carolina University, Greenville, NC 27858, USA;
| | - Hannah G. Lane
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27708, USA
- Correspondence:
| |
Collapse
|
16
|
Maintaining School Foodservice Operations in Ohio during COVID-19: “This [Was] Not the Time to Sit Back and Watch”. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105991. [PMID: 35627527 PMCID: PMC9141818 DOI: 10.3390/ijerph19105991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/04/2022] [Accepted: 05/12/2022] [Indexed: 02/01/2023]
Abstract
The COVID-19-related lockdowns led to school closures across the United States, cutting off critical resources for nutritious food. Foodservice employees emerged as frontline workers; understanding their experiences is critical to generate innovations for program operations and viability. The purpose of this cross-sectional study was to characterize COVID-19-related foodservice adaptations for summer and school year meal provision. Public school district foodservice administrators across Ohio were surveyed in December 2020. Questions related to meal provision before, during, and after COVID-19-related school closures. Results indicate the majority of districts continued providing meals upon their closure in Spring 2020 (n = 182, 87.1%); fewer did so in Summer (n = 88, 42.1%) and Fall (n = 32, 15.3%). In Spring and Summer, most districts that offered meals functioned as ‘open sites’ (67.0% and 87.5%, respectively), not limiting food receipt to district-affiliated students. Most districts employed a pick-up system for food distribution (76–84% across seasons), though some used a combination of approaches or changed their approach within-season. Qualitatively, districts reported both “successes” (e.g., supporting students) and “challenges” (e.g., supply chain). Despite being ill-prepared, districts responded quickly and flexibly to demands of the pandemic. This analysis provides insight for future practice (e.g., establishing community partnerships) and policy (e.g., bolstering local food systems).
Collapse
|
17
|
Comparison of Missing School Meals among Public Schools: How Did New York State Do during COVID-19? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105838. [PMID: 35627375 PMCID: PMC9141843 DOI: 10.3390/ijerph19105838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/29/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022]
Abstract
Background: The COVID-19 pandemic created barriers to participation in school meals. As a result, many students may have missed out on school meals. The objectives of this study are (1) to compare the number of school meals served by New York State public schools during the first spring and summer of the COVID-19 pandemic to the number served before the COVID-19 pandemic, and (2) to determine relationships between the number of meals served and the levels of school district need and urbanicity. Methods: This study is a secondary analysis of administrative data. The percentage change in the number of school breakfasts and lunches served was calculated for each month and by school district need level and urbanicity level. Results: The number of school meals served decreased during the first spring of the pandemic compared to the spring of the previous school year (−43% in April, −51% in May), while the number of school meals served increased during the first summer of the pandemic compared to the summer of the previous school year (+92% in July, +288% in August). Conclusions: Waivers may provide flexibility to increase participation in school meals, especially during the summer.
Collapse
|
18
|
Whitesell A, Fitch H. Using Social Media to Promote School Nutrition Programs During the COVID-19 Pandemic. THE JOURNAL OF SCHOOL HEALTH 2022; 92:485-492. [PMID: 35234278 PMCID: PMC9115237 DOI: 10.1111/josh.13151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/19/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Millions of school-aged children receive free or reduced-price lunches through the United States Department of Agriculture's (USDA) National School Lunch Program; that service was disrupted when public schools closed at the beginning of the coronavirus pandemic. Prior to the pandemic, this program received little attention on school districts' social media accounts. METHODS We collected Twitter data from 70 Ohio public school districts to construct a measure of attention paid toward school nutrition programs from 2008 to 2021. We also collected district-level data to analyze the relationship between district characteristics and mentions of school nutrition programs. RESULTS We show that attention to school nutrition programs significantly increased during the pandemic. School districts with a greater student population density and greater geographic area were more likely to tweet about these programs. CONCLUSIONS School districts can, and should, use social media to inform residents about school nutrition programs and food security programs more generally. Social media provides a low-cost way to lessen the administrative burden for families trying to access these programs.
Collapse
Affiliation(s)
| | - Hunter Fitch
- Data Science and Statistics Major, Miami University349 E. High StreetOxfordOH45056USA
| |
Collapse
|
19
|
Azarieva J, Berry EM, Troen AM. Child food insecurity in the wake of the COVID-19 pandemic: urgent need for policy evaluation and reform in Israel's school feeding programs. Isr J Health Policy Res 2022; 11:13. [PMID: 35168666 PMCID: PMC8845395 DOI: 10.1186/s13584-022-00523-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/04/2022] [Indexed: 11/16/2022] Open
Abstract
Even in high-income countries like Israel, children have been particularly vulnerable to the surge in food insecurity driven by quarantines, unemployment, and economic hardships of the COVID-19 pandemic. Under normal circumstances, School Feeding Programs (SFPs) can help to ensure child food security. In the wake of the pandemic, policy makers worldwide have been challenged to adapt national SFPs to provide nutritional support to children (and indirectly to their families) during extended school closures. Most national SFPs implemented contingency plans to ensure continued nutritional support for children. In Israel, where SFPs were largely suspended during long periods of mandated school closing, there was a loss of 30–50% of feeding days for the ~ 454,000 children enrolled in the program. The lack of emergency contingency planning and failure to maintain Israeli SFPs during school closures reveals longstanding structural policy flaws that hindered coordination between relevant ministries and authorities and impeded the mobilization of funds and existing programs to meet the emergent need. The school feeding law does not identify child food security as an explicit aim, there are no benchmarks for monitoring and evaluating the program to ensure that the food aid reaches the children most in need, even routinely, and the Ministry of Education had no obligation to maintain the program and to marshal data on the participants that could be acted upon in the emergency. Moreover, because Israeli SFPs are “selective”, in other words, implemented according to community risk (low-income, high poverty rate) and geographical factors, attendant stigma and financial burdens can make participation in the program less attractive to families and communities that need them the most. We argue that Israel should make urgent, long-term improvements to the SFPs as follows: First, eliminating childhood food insecurity should be made an explicit goal of legislation in the broader context of national social, health, and nutritional goals, and this includes ensuring SFPs are maintained during emergencies. Second, the government should assume responsibility for the routine assessment and data collection on food insecurity among Israeli children. Third, SFPs should be subjected to rigorous independent program evaluation. Finally, a “universal” SFP providing nutritious diets would likely improve the health of all Israeli children, across all socioeconomic backgrounds. These steps to guarantee that Israeli children have food to realize their full physical and cognitive potential would emphasize Israel’s firm commitment to support multiple dimensions of health, educational achievement, and societal values, to combat the complex and long-term consequences of the pandemic, and to prepare for the next one.
Collapse
Affiliation(s)
- Janetta Azarieva
- The Nutrition and Brain Health Laboratory, The Institute of Biochemistry Food Science and Nutrition, The Robert H. Smith Faculty of Agriculture Food and Environment, The Hebrew University of Jerusalem, 76100, Rehovot, Israel
| | - Elliot M Berry
- The Hebrew University-Hadassah Braun School of Public Health and Community Medicine, The Faculty of Medicine, The Hebrew University of Jerusalem, 9112102, Jerusalem, Israel
| | - Aron M Troen
- The Nutrition and Brain Health Laboratory, The Institute of Biochemistry Food Science and Nutrition, The Robert H. Smith Faculty of Agriculture Food and Environment, The Hebrew University of Jerusalem, 76100, Rehovot, Israel.
| |
Collapse
|
20
|
Hoelscher DM, Brann LS, O’Brien S, Handu D, Rozga M. Prevention of Pediatric Overweight and Obesity: Position of the Academy of Nutrition and Dietetics Based on an Umbrella Review of Systematic Reviews. J Acad Nutr Diet 2022; 122:410-423.e6. [DOI: 10.1016/j.jand.2021.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/27/2021] [Accepted: 11/03/2021] [Indexed: 01/08/2023]
|