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Spence EH, Niles MT, Bertmann F, Belarmino EH. Experiences participating in federal nutrition assistance programs during the early months of the COVID-19 pandemic: an investigation in Vermont. Nutr J 2024; 23:74. [PMID: 39004722 PMCID: PMC11247766 DOI: 10.1186/s12937-024-00963-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 05/28/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Federal nutrition assistance programs serve as safety nets for many American households, and participation has been linked to increased food security and, in some instances, improved diet quality and mental health outcomes. The COVID-19 pandemic brought new and increased economic, social, and psychological challenges, necessitating inquiry into how nutrition assistance programs are functioning and associated with public health outcomes. METHODS Using data from a representative statewide survey administered in Vermont (n = 600) between July and September 2020, we examined participant experiences with major federal nutrition assistance programs: the Supplemental Nutrition Assistance Program (SNAP), the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and school meal programs. We explored quantitative and qualitative responses regarding perceptions of program utility, and used nearest neighbors matching analyses in combination with bivariate statistical tests to assess associations between program participation and food insecurity, perceived stress, and fruit and vegetable intake as indicators of dietary quality. RESULTS One in four respondents (27.3%) used at least one federal nutrition assistance program. As compared to non-participants, we found higher rates of food insecurity among program participants (57.5% vs. 18.1%; p < 0.001), an association that persisted even when we compared similar households using matching techniques (p ≤ 0.001). From matched analyses, we found that, compared to low-income non-participants, low-income program participants were less likely to meet fruit intake recommendations (p = 0.048) and that low-income SNAP and WIC participants were less likely to meet vegetable intake recommendations (p = 0.035). We also found lower rates of perceived stress among low-income school meal participant households compared to low-income non-participants (p = 0.039). Despite these mixed outcomes, participants broadly valued federal nutrition assistance programs, characterizing them as helpful or easy to use. CONCLUSIONS We found that federal nutrition assistance programs as a group were not sufficient to address food insecurity and stress or increase fruit and vegetable intake in the state of Vermont during the early months of the COVID-19 pandemic. Nonetheless, participants perceived benefits from participation in these programs. Optimizing the utility of nutrition assistance programs depends on critical examination of their functioning under conditions of great stress.
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Affiliation(s)
- Emma H Spence
- Food Systems Program, University of Vermont, 109 Carrigan Drive, Burlington, VT, 05405, USA
| | - Meredith T Niles
- Food Systems Program, University of Vermont, 109 Carrigan Drive, Burlington, VT, 05405, USA
- Department of Nutrition and Food Sciences, University of Vermont, 109 Carrigan Drive, Burlington, VT, 05405, USA
- Gund Institute for Environment, University of Vermont, 210 Colchester Ave, Burlington, VT, 05405, USA
| | - Farryl Bertmann
- Food Systems Program, University of Vermont, 109 Carrigan Drive, Burlington, VT, 05405, USA
- Department of Nutrition and Food Sciences, University of Vermont, 109 Carrigan Drive, Burlington, VT, 05405, USA
| | - Emily H Belarmino
- Food Systems Program, University of Vermont, 109 Carrigan Drive, Burlington, VT, 05405, USA.
- Department of Nutrition and Food Sciences, University of Vermont, 109 Carrigan Drive, Burlington, VT, 05405, USA.
- Gund Institute for Environment, University of Vermont, 210 Colchester Ave, Burlington, VT, 05405, USA.
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Erbe K, Liese K, Tussing-Humphreys L, Papautsky EL, Rutherford J, Koenig MD. Midwives' and Obstetric Physicians' Practices Related to Pregnancy Nutrition Counseling: A Scoping Review. J Midwifery Womens Health 2024. [PMID: 38982843 DOI: 10.1111/jmwh.13661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/30/2024] [Indexed: 07/11/2024]
Abstract
INTRODUCTION Dietary intake during pregnancy impacts short- and long-term maternal and fetal health outcomes. Dietary habits are highly individualized and influenced by contextual factors and social determinants of health within each person's lived environment. Midwives and other health care providers are well positioned to facilitate nutrition conversations and interventions with patients related to recommendations and modifications before and during pregnancy. This scoping review synthesizes the literature on perinatal care providers' attitudes and practices related to antenatal nutrition counseling. METHODS An electronic database literature search was conducted in March 2023 using the following inclusion criteria: English language, published between 1990 and 2023, completed in high-income countries, and evaluated provider practices related to educating pregnancy patients on nutrition. Exclusion criteria included comparison or interventional studies as well as those focused on patient perspectives, specialty diets, comorbidities, or pregnancy complications. Thematic analysis was completed to identify common themes and subthemes across studies related to perinatal care providers' perspectives of pregnancy nutrition. RESULTS Thirty-six articles were included in the final review. Although providers acknowledged the importance of nutrition for pregnancy outcomes, few reported being able to cover the topic in-depth during antenatal visits. Counseling was usually generalized, limited in scope, and lacked consideration of patient-specific contextual factors such as dietary restrictions, preferences, or access to resources needed to follow recommendations. Provider barriers to comprehensive nutrition counseling included lack of training and time during clinic visits and limited availability of guidelines. DISCUSSION Multiple gaps in current pregnancy nutrition counseling practices exist. Despite nutrition being viewed by perinatal care providers as an important part of pregnancy, multiple barriers lead to it being overlooked during patient-provider interactions. Contextual factors for both providers and patients contribute to failure of current interventions to consistently and significantly impact dietary habits of pregnant people.
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Affiliation(s)
- Katherine Erbe
- Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts
| | - Kylea Liese
- University of Illinois Chicago, Chicago, Illinois
| | | | - Elizabeth Lerner Papautsky
- Department of Biomedical and Health Information Sciences, University of Illinois Chicago, Chicago, Illinois
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Li L, Momma H, Chen H, Nawrin SS, Xu Y, Inada H, Nagatomi R. Dietary patterns associated with the incidence of hypertension among adult Japanese males: application of machine learning to a cohort study. Eur J Nutr 2024; 63:1293-1314. [PMID: 38403812 PMCID: PMC11139695 DOI: 10.1007/s00394-024-03342-w] [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: 05/15/2023] [Accepted: 01/30/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE The previous studies that examined the effectiveness of unsupervised machine learning methods versus traditional methods in assessing dietary patterns and their association with incident hypertension showed contradictory results. Consequently, our aim is to explore the correlation between the incidence of hypertension and overall dietary patterns that were extracted using unsupervised machine learning techniques. METHODS Data were obtained from Japanese male participants enrolled in a prospective cohort study between August 2008 and August 2010. A final dataset of 447 male participants was used for analysis. Dimension reduction using uniform manifold approximation and projection (UMAP) and subsequent K-means clustering was used to derive dietary patterns. In addition, multivariable logistic regression was used to evaluate the association between dietary patterns and the incidence of hypertension. RESULTS We identified four dietary patterns: 'Low-protein/fiber High-sugar,' 'Dairy/vegetable-based,' 'Meat-based,' and 'Seafood and Alcohol.' Compared with 'Seafood and Alcohol' as a reference, the protective dietary patterns for hypertension were 'Dairy/vegetable-based' (OR 0.39, 95% CI 0.19-0.80, P = 0.013) and the 'Meat-based' (OR 0.37, 95% CI 0.16-0.86, P = 0.022) after adjusting for potential confounding factors, including age, body mass index, smoking, education, physical activity, dyslipidemia, and diabetes. An age-matched sensitivity analysis confirmed this finding. CONCLUSION This study finds that relative to the 'Seafood and Alcohol' pattern, the 'Dairy/vegetable-based' and 'Meat-based' dietary patterns are associated with a lower risk of hypertension among men.
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Affiliation(s)
- Longfei Li
- School of Physical Education and Health, Heze University, 2269 University Road, Mudan District, Heze, 274-015, Shandong, China
- Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Haruki Momma
- Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Haili Chen
- Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Saida Salima Nawrin
- Division of Biomedical Engineering for Health & Welfare, Tohoku University Graduate School of Biomedical Engineering, 6-6-12, Aramaki Aza Aoba Aoba-ku, Sendai, Miyagi, 980-8579, Japan
| | - Yidan Xu
- Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Hitoshi Inada
- Department of Developmental Neuroscience, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
- Department of Biochemistry and Cellular Biology, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8502, Japan.
| | - Ryoichi Nagatomi
- Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
- Division of Biomedical Engineering for Health & Welfare, Tohoku University Graduate School of Biomedical Engineering, 6-6-12, Aramaki Aza Aoba Aoba-ku, Sendai, Miyagi, 980-8579, Japan.
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Sanders LM, Zhu Y, Jain N, Normington J, Holschuh N, Nechanicky M, Tucker M, Garcia-Bailo B. Ready-to-eat cereal consumption is associated with improved nutrient intakes and diet quality in Canadian adults and children across income levels. Front Nutr 2024; 10:1282252. [PMID: 38260081 PMCID: PMC10801256 DOI: 10.3389/fnut.2023.1282252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Background Results from observational studies suggest ready-to-eat cereal (RTEC) consumption is associated with higher diet quality. In the United States, studies have shown that RTEC is an important contributor to nutrient intakes across income levels. However, it is unknown if this association varies by income level in the Canadian population. Given its affordability, RTEC may represent an important source of nutrients for lower-income individuals. Objective This study evaluated the association of RTEC consumption with nutrient intakes and diet quality across household income levels in Canadian adults and children. Methods Income and dietary data from 24 h dietary recalls were obtained from the 2015 Canadian Community Health Survey (CCHS)-Nutrition in 6,181 children (2-18 years) and 13,908 adults (19+ years). Diet quality was assessed with a modified Nutrient Rich Food Index (NRF) 9.3. Income levels were stratified into low, middle, and high based on family size, and data were analyzed by RTEC consumption and income level using multivariate linear regression adjusted for energy, age, and sex. Results Diet quality was greater in adult and child RTEC consumers across all household income levels. Children and adults consuming RTEC also had higher nutrient intakes, including shortfall nutrients such as calcium, dietary fiber, iron, magnesium, and vitamin D. RTEC provided <10% of energy intake, <4% of saturated fat intake, and <9% of total sugar intake across all ages and income levels, while also providing one-third of daily iron intake and at least 10% of daily intake of dietary fiber, thiamin, folate, and vitamin B6. Conclusion RTEC consumption was associated with improved nutrient intakes and diet quality in adults and children across household income levels. Nutrient dense and affordable food choices, such as RTEC, may be a helpful strategy to improve the diet quality of Canadians, particularly those with a lower household income.
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Affiliation(s)
| | - Yong Zhu
- Bell Institute of Health and Nutrition, General Mills, Golden Valley, MN, United States
| | - Neha Jain
- Statistics and Data Science, General Mills, Mississauga, ON, Canada
| | - James Normington
- Statistics and Data Science, General Mills, Golden Valley, MN, United States
| | - Norton Holschuh
- Statistics and Data Science, General Mills, Golden Valley, MN, United States
| | - Megan Nechanicky
- Bell Institute of Health and Nutrition, General Mills, Golden Valley, MN, United States
| | - Michelle Tucker
- Bell Institute of Health and Nutrition, General Mills, Golden Valley, MN, United States
| | - Bibiana Garcia-Bailo
- Bell Institute of Health and Nutrition, General Mills, Golden Valley, MN, United States
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Joshu CE, Calkins KL, Rudolph JE, Xu X, Wentz E, Coburn SB, Kaur M, Pirsl F, Moore RD, Lau B. Lower endoscopy, early-onset, and average-onset colon cancer among Medicaid beneficiaries with and without HIV. AIDS 2024; 38:85-94. [PMID: 37788111 PMCID: PMC10841159 DOI: 10.1097/qad.0000000000003740] [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] [Indexed: 10/05/2023]
Abstract
BACKGROUND Studies suggest a lower colorectal cancer (CRC) risk and lower or similar CRC screening among people with HIV (PWH) compared with the general population. We evaluated the incidence of lower endoscopy and average-onset (diagnosed at ≥50) and early-onset (diagnosed at <50) colon cancer by HIV status among Medicaid beneficiares with comparable sociodemographic factors and access to care. METHODS We obtained Medicaid Analytic eXtract (MAX) data from 2001 to 2015 for 14 states. We included 41 727 243 and 42 062 552 unique individuals with at least 7 months of continuous eligibility for the endoscopy and colon cancer analysis, respectively. HIV and colon cancer diagnoses and endoscopy procedures were identified from inpatient and other nondrug claims. We used Cox proportional hazards regression models to assess endoscopy and colon cancer incidence, controlling for age, sex, race/ethnicity, calendar year and state of enrollment, and comorbidities conditions. RESULTS Endoscopy and colon cancer incidence increased with age in both groups. Compared with beneficiaries without HIV, PWH had an increased hazard of endoscopy; this association was strongest among those 18-39 years [hazard ratio: 1.85, 95% confidence interval (95% CI) 1.77-1.92] and attenuated with age. PWH 18-39 years also had increased hazard of early-onset colon cancer (hazard ratio: 1.66, 95% CI:1.05-2.62); this association was attenuated after comorbidity adjustment. Hazard ratios were null among all beneficiaries less than 50 years of age. PWH had a lower hazard of average-onset colon cancer compared with those without HIV (hazard ratio: 0.79, 95% CI: 0.66-0.94). CONCLUSION PWH had a higher hazard of endoscopy, particularly at younger ages. PWH had a lower hazard of average-onset colon cancer. Early-onset colon cancer was higher among the youngest PWH but not associated with HIV overall.
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Affiliation(s)
- Corinne E Joshu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Oncology, Johns Hopkins University School of Medicine
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Keri L Calkins
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Mathematica, Ann Arbor, Michigan
| | | | - Xiaoqiang Xu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eryka Wentz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Sally B Coburn
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Maneet Kaur
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Filip Pirsl
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Richard D Moore
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Oncology, Johns Hopkins University School of Medicine
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Melo Herrera Y, Tovar A, Oaks BM, Quashie NT, Vadiveloo M. Associations between Participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Maternal Diet Quality. J Nutr 2023; 153:3317-3326. [PMID: 37604386 DOI: 10.1016/j.tjnut.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/25/2023] [Accepted: 08/16/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND An objective of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is to improve maternal diet quality, but its effectiveness remains unclear. Better understanding how WIC participation shapes women's diet quality is crucial given that maternal diet plays a critical role in determining mothers' and children's short- and long-term overall health. OBJECTIVES This study aimed to compare the diet quality of WIC-participating women to WIC-eligible nonparticipating women and higher-income pregnant and postpartum women using a nationally representative sample. METHODS This was a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) 2011-2018 cycles. Women aged 20 to 44 with at least one 24-h recall and complete data on pregnancy and postpartum status and WIC participation were included (n = 626). Diet quality was evaluated using the Healthy Eating Index-2015 (HEI-2015). Multivariable Tukey-adjusted linear models were used to compare HEI-2015 total and component scores between groups. Models were adjusted for age, pregnancy and postpartum status, breastfeeding status, race and ethnicity, and food security. RESULTS Most women were postpartum and not pregnant (75%), nonbreastfeeding (60%), identified as non-Hispanic White (58%), and food secure (64%). WIC participants, WIC-eligible nonparticipants, and income-ineligible women had mean Total HEI-2015 scores of 52.7 (95% confidence interval [CI]: 50.6, 54.8), 54.2 (95% CI: 51.6, 56.7), and 55.0 (95% CI: 51.8, 58.2), respectively. There were no differences between groups for total and most component scores. Income-ineligible women had better Fatty Acids scores (5.7; 95% CI: 5.0, 6.4) than WIC participants (4.7; 95% CI: 4.1, 5.3; P < 0.05). WIC-eligible nonparticipants had better Refined Grains scores (6.0; 95% CI: 5.3, 6.6) than WIC participants (5.0; 95% CI: 4.4, 5.6; P < 0.05). CONCLUSIONS Overall diet quality was similar across WIC and income groups. Lower HEI-2015 component scores for WIC participants compared with WIC-eligible nonparticipants warrant further exploration. Research evaluating WIC's impact on maternal diet quality is needed to ensure continued support for low-income women's health.
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Affiliation(s)
- Yarisbel Melo Herrera
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, United States
| | - Alison Tovar
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Brietta M Oaks
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, United States
| | - Nekehia T Quashie
- Department of Health Studies, University of Rhode Island, Kingston, RI, United States
| | - Maya Vadiveloo
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, United States.
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Metoyer BN, Chuang RJ, Lee M, Markham C, Brown E, Almohamad M, Sharma SV. SNAP Participation Moderates Fruit and Vegetable Intake Among Minority Families With Low Income. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:774-785. [PMID: 37804263 DOI: 10.1016/j.jneb.2023.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 08/15/2023] [Accepted: 08/27/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE To examine the moderation effect of Supplemental Nutrition Assistance Program (SNAP) participation on the baseline fruit and vegetable (FV) intake of Hispanic/Latino and African American children and parents participating in the Brighter Bites program. DESIGN Cross-sectional. SETTING Houston, Austin, and Dallas, TX; Washington, DC; and Southwest Florida. PARTICIPANTS Self-reported surveys (n = 6,037) of Hispanic/Latino and African American adult-child dyads enrolled in Brighter Bites in Fall 2018. VARIABLES MEASURED Dependent variable, child FV intake; Independent variable, parent FV intake, and FV shopping behavior; Effect Measure Modifier, SNAP participation. ANALYSIS Quantitatively used mixed effects linear regression models to test if the effect of parental baseline FV intake and shopping behavior on a child's baseline FV intake differed by SNAP participation. Analyses were performed using STATA with significance set at P < 0.05 and 95% confidence intervals (CIs). RESULTS For parents that consumed FV ≥ 2 times/d at baseline, there was a 0.1 times increase in child FV intake at baseline among those who participated in SNAP as compared with those who did not participate in SNAP (ß = 0.1; 95% CI, 0.1-0.2; P = 0.001), and for parents who shopped at convenience stores ≥ 2 times/wk for FV, there was 0.6 times increase in child FV intake at baseline for those who participated in SNAP as compared with those that did not participate in SNAP (ß = 0.6; 95% CI, 0.3-0.9; P < 0.001). CONCLUSIONS AND IMPLICATIONS Supplemental Nutrition Assistance Program participation moderated the associations between FV intake among African American and Hispanic/Latino parents and children and FV shopping at convenience stores and child FV intake. Findings indicate a need for future interventions to promote SNAP participation among those eligible and improve access to FV.
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Affiliation(s)
- Brittni Naylor Metoyer
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, the University of Texas Health Science Center at Houston, Houston, TX
| | - Ru-Jye Chuang
- Center for Health Equity, Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, the University of Texas Health Science Center at Houston, Houston, TX
| | - MinJae Lee
- Department of Population and Data Sciences, Peter O'Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX
| | - Christine Markham
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, the University of Texas Health Science Center at Houston, Houston, TX
| | - Eric Brown
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, the University of Texas Health Science Center at Houston, Houston, TX
| | - Maha Almohamad
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, the University of Texas Health Science Center at Houston, Houston, TX
| | - Shreela V Sharma
- Center for Health Equity, Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, the University of Texas Health Science Center at Houston, Houston, TX.
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Firoozi R, Weeks HM, Ludwig-Borcyz E, Clayson M, Zawistowski M, Needham B, Bauer KW. Federal Food Program Participation and Beverage Intake Among Families With Low Household Income. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:469-479. [PMID: 37422323 PMCID: PMC10754373 DOI: 10.1016/j.jneb.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE Examine beverage intake among families with low income by household participation in federal food assistance programs. DESIGN Cross-sectional study conducted in fall/winter 2020 via an online survey. PARTICIPANTS Mothers of young children insured by Medicaid at the time of the child's birth (N = 493). VARIABLES MEASURED Mothers reported household federal food assistance program participation, later categorized as Supplementation Nutrition Program for Women, Infants, and Children (WIC) only, Supplemental Nutrition Assistance Program-Education (SNAP) only, both WIC and SNAP, and neither. Mothers reported beverage intake for themselves and their children aged 1-4 years. ANALYSIS Negative binomial and ordinal logistic regression. RESULTS After accounting for sociodemographic differences between groups, mothers from households participating in WIC and SNAP consumed sugar-sweetened beverages (incidence rate ratio, 1.63; 95% confidence interval [CI], 1.14-2.30; P = 0.007) and bottled water (odds ratio, 1.76; 95% CI, 1.05-2.96; P = 0.03) more frequently than mothers from households in neither program. Children from households participating in WIC and SNAP also consumed soda (incidence rate ratio, 6.07; 95% CI, 1.80-20.45; P = 0.004) more frequently than children in either program. Few differences in intake were observed for mothers or children participating in only WIC or SNAP vs both programs or neither program. CONCLUSION AND IMPLICATIONS Households participating in both WIC and SNAP may benefit from additional policy and programmatic interventions to limit sugar-sweetened beverage intake and reduce spending on bottled water.
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Affiliation(s)
- Roya Firoozi
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI
| | - Heidi M Weeks
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI
| | - Elizabeth Ludwig-Borcyz
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI
| | - Michelle Clayson
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI
| | - Matt Zawistowski
- Department of Biostatistics University of Michigan School of Public Health, Ann Arbor, MI
| | - Belinda Needham
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Katherine W Bauer
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI.
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Qin Y, Cowan AE, Bailey RL, Jun S, Eicher-Miller HA. Usual nutrient intakes and diet quality among United States older adults participating in the Supplemental Nutrition Assistance Program compared with income-eligible nonparticipants. Am J Clin Nutr 2023; 118:85-95. [PMID: 37407169 PMCID: PMC10493427 DOI: 10.1016/j.ajcnut.2023.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/07/2023] [Accepted: 03/09/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND The proportion of older adults with food insecurity at 8% has increased faster than that of the general United States population from 2001 to 2017. Many low-income food-insecure older adults rely on food-assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP), for meeting energy and nutrient needs, whereas others are eligible but do not participate. Neither updated nutrient intake estimates nor potential differences in meeting the Dietary Reference Intakes from foods alone and with dietary supplements (DS) among low-income older adults using or eligible for SNAP are known. OBJECTIVES This study assessed and compared national estimates of usual nutrient adequacy and dietary quality of United States older adults using SNAP and income-eligible nonparticipants. METHODS Usual dietary intake was estimated among older adults (≥60 y; n = 2582) in the 2007-2016 NHANES cross-sectional national survey. Data on food-assistance participation and eligibility (poverty-income-ratio ≤130%), DS use, and ≥24-h dietary recalls were used. The NCI method (Markov Chain Monte Carlo approach) was applied to estimate mean usual nutrient intakes, proportion of inadequate nutrient intake, and dietary quality using the 2015 Healthy Eating Index. RESULTS Neither usual nutrient intake from dietary and total sources nor dietary quality differed between older adult SNAP participants and eligible nonparticipants. Low dietary quality and high percentage of inadequate intake for several nutrients were apparent among both groups, especially from food sources alone, including vitamins A (56%), C (55%), D (97%), E (99%), calcium (73%), and magnesium (74%), but rates were attenuated when DS were also considered (i.e., 36% reduced risk for vitamin D inadequacy). CONCLUSIONS Diet quality and usual nutrient intake among older adult SNAP participants and eligible nonparticipants were poor, but DS lowered the risk of nutrient inadequacy. Future policies and programs should focus on improving the intake of vitamins A, C, D, E, calcium, and magnesium and dietary quality for all older adults.
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Affiliation(s)
- Yue Qin
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Alexandra E Cowan
- Institute for Advancing Health through Agriculture, Texas A&M University, College Station, TX, United States
| | - Regan L Bailey
- Institute for Advancing Health through Agriculture, Texas A&M University, College Station, TX, United States
| | - Shinyoung Jun
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang-si, Republic of Korea
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Tari Selcuk K, Atan RM, Arslan S, Sahin N. Is food insecurity related to sustainable and healthy eating behaviors? ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023:10.1007/s11356-023-27694-8. [PMID: 37204579 DOI: 10.1007/s11356-023-27694-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/12/2023] [Indexed: 05/20/2023]
Abstract
In this cross-sectional study, it was aimed to investigate the relationship between sustainable and healthy eating behaviors such as nutritional insecurity and a healthy and balanced diet, interest in regional and organic food products, consumption of seasonal food and avoidance of food waste, preference for locally produced foods, reduction of meat consumption, preference for eggs from free-range chickens, and sustainable fishery products, and consumption of low-fat food products in adults. The study included 410 adults who were reached through social media applications. Data were collected through an online questionnaire including the Descriptive Information Form, the Household Food Insecurity Access Scale (HFIAS), and the Sustainable Healthy Eating Behaviors Scale (SHEBS). The proportion of participants determined as mildly food insecure, moderately food insecure, and severely food insecure was 10.2%, 6.6%, and 7.6%, respectively. Linear regression analysis revealed that in Models 1, 2, and 3, there was a statistically significant negative association between food insecurity and the components of sustainable and healthy eating behaviors such as healthy and balanced diet (β - 0.226, p < 0.001), quality labels (β - 0.230, p < 0.001), seasonal foods, which are of avoidance of food waste (β - 0.261, p < 0.001), animal welfare (β - 0.174, p < 0.001), and fat intake (β - 0.181, p < 0.001). In conclusion, food insecurity negatively affects healthy and balanced diet behaviors, interest in regional and organic food products, seasonal food products consumption and avoidance of food waste, consumption of low-fat food products, and the choice of products such as free-range chicken eggs, and sustainable fisheries.
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Affiliation(s)
- Kevser Tari Selcuk
- Department of Nutrition and Dietetics, Bandirma Onyedi Eylul University, Balikesir, Turkey.
| | - Ramazan Mert Atan
- Department of Nutrition and Dietetics, Bandirma Onyedi Eylul University, Balikesir, Turkey
- Department of Nutrition and Dietetics, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Sedat Arslan
- Department of Nutrition and Dietetics, Bandirma Onyedi Eylul University, Balikesir, Turkey
| | - Nursel Sahin
- Department of Nutrition and Dietetics, Bandirma Onyedi Eylul University, Balikesir, Turkey
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11
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Wood EK, Stamos G, Mitchell AJ, Gonoud R, Horgan AM, Nomura O, Young A, Nigg JT, Gustafsson HC, Sullivan EL. The association between food desert severity, socioeconomic status, and metabolic state during pregnancy in a prospective longitudinal cohort. Sci Rep 2023; 13:7197. [PMID: 37137940 PMCID: PMC10156695 DOI: 10.1038/s41598-023-32783-2] [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: 12/08/2022] [Accepted: 04/02/2023] [Indexed: 05/05/2023] Open
Abstract
Poor metabolic health during pregnancy is associated with health concerns for pregnant individuals and their offspring. Lower socioeconomic status (SES) is one risk factor for poor metabolic health, and may be related to limited access to healthful and affordable foods (e.g., living in a food desert). This study evaluates the respective contributions of SES and food desert severity on metabolic health during pregnancy. The food desert severity of 302 pregnant individuals was determined using the United States Department of Agriculture Food Access Research Atlas. SES was measured using total household income adjusted for household size, years of education, and amount of reserve savings. Information about participants' glucose concentrations one hour following an oral glucose tolerance test during the second trimester was extracted from medical records and percent adiposity during the second trimester was assessed using air displacement plethysmography. Information about participants' nutritional intake during the second trimester was obtained by trained nutritionists via three unannounced 24-h dietary recalls. Structural equation models showed that lower SES predicted higher food desert severity (β = - 0.20, p = 0.008) and higher adiposity (β = - 0.27, p = 0.016) and consumption of a more pro-inflammatory diet (β = - 0.25, p = 0.003) during the second trimester of pregnancy. Higher food desert severity also predicted higher percent adiposity during the second trimester (β = 0.17, p = 0.013). Food desert severity significantly mediated the relationship between lower SES and higher percent adiposity during the second trimester (βindirect = - 0.03, 95% CI [- 0.079, - 0.004]). These findings indicate that access to healthful and affordable foods is a mechanism by which SES contributes to adiposity during pregnancy and may inform interventions intended to improve metabolic health during pregnancy.
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Affiliation(s)
- Elizabeth K Wood
- Department of Psychiatry, Oregon Health & Science University, Portland, USA
| | - Gayle Stamos
- Department of Psychiatry, Oregon Health & Science University, Portland, USA
| | - A J Mitchell
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, USA
| | - Rose Gonoud
- Department of Psychiatry, Oregon Health & Science University, Portland, USA
| | - Angela M Horgan
- Clinical & Translational Research Center, Oregon Health & Science University, Portland, USA
| | - Olivia Nomura
- Department of Psychiatry, Oregon Health & Science University, Portland, USA
| | - Anna Young
- Department of Psychiatry, Oregon Health & Science University, Portland, USA
| | - Joel T Nigg
- Department of Psychiatry, Oregon Health & Science University, Portland, USA
| | - Hanna C Gustafsson
- Department of Psychiatry, Oregon Health & Science University, Portland, USA
| | - Elinor L Sullivan
- Department of Psychiatry, Oregon Health & Science University, Portland, USA.
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, USA.
- Division of Neuroscience, Oregon National Primate Research Center, Portland, USA.
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12
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Rummo PE, Roberto CA, Thorpe LE, Troxel AB, Elbel B. Effect of Financial Incentives and Default Options on Food Choices of Adults With Low Income in Online Retail Settings: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e232371. [PMID: 36897592 PMCID: PMC10789116 DOI: 10.1001/jamanetworkopen.2023.2371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Importance Despite recent growth in online redemption of Supplemental Nutrition Assistance Program (SNAP) benefits, no previous work has tested the impact of economic and behavioral economic strategies on food purchasing behaviors in an online grocery retail setting among adults with low income. Objective To examine the extent to which financial incentives and default shopping cart options influence fruit and vegetable purchases. Design, Setting, and Participants This randomized clinical trial used an experimental online grocery store for adults who currently or have ever received SNAP benefits. From October 7 to December 2, 2021, participants were instructed to shop for a week's worth of groceries for their household, with a budget tailored to household size; no payment was taken. Interventions Random assignment to 1 of 4 conditions: no intervention, 50% discount on eligible fruits and vegetables, prefilled shopping carts with tailored fruit and vegetable items (ie, default options), or a combination of the discount and default options. Main Outcomes and Measures The primary outcome was the percentage of nondiscounted dollars spent on eligible fruit and vegetables per basket. Results Of 2744 participants, mean (SD) age was 46.7 (16.0) years, and 1447 (52.7%) identified as women. A total of 1842 participants (67.1%) reported currently receiving SNAP benefits and 1492 (54.4%) reported shopping online for groceries in the previous 12 months. Participants spent a mean (SD) 20.5% (23.5%) of total dollars on eligible fruits and vegetables. Compared with no intervention, those in the discount condition spent 4.7% (98.3% CI, 1.7%-7.7%) of more total dollars on eligible fruits and vegetables; those in the default condition, 7.8% (98.3% CI, 4.8%-10.7%) more; and those in the combination condition, 13.0% (98.3% CI, 10.0%-16.0%) more (P < .001 for all). There was no difference between the discount and the default conditions (P = .06), but the effect in the combination condition was significantly larger than both discount and default conditions (P < .001). Default shopping cart items were purchased by 679 participants (93.4%) in the default condition and 655 (95.5%) in the combination condition, whereas 297 (45.8%) in the control and 361 (52.9%) in the discount conditions purchased those items (P < .001). No variation was observed by age, sex, or race and ethnicity, and results were similar when those who reported never shopping online for groceries were excluded. Conclusions and Relevance In this randomized clinical trial, financial incentives for fruits and vegetables and default options, especially in combination, led to meaningful increases in online fruit and vegetable purchases among adults with low income. Trial Registration ClinicalTrials.gov Identifier: NCT04766034.
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Affiliation(s)
- Pasquale E. Rummo
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | | | - Lorna E. Thorpe
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Andrea B. Troxel
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Brian Elbel
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
- Wagner Graduate School of Public Service, New York University, New York, NY
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13
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Stephenson BJK, Willett WC. Racial and ethnic heterogeneity in diets of low-income adult females in the United States: results from National Health and Nutrition Examination Surveys from 2011 to 2018. Am J Clin Nutr 2023; 117:625-634. [PMID: 36872021 PMCID: PMC10315405 DOI: 10.1016/j.ajcnut.2023.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Poor diet is a major risk factor of cardiovascular and chronic diseases, particularly for low-income female adults. However, the pathways by which race and ethnicity plays a role in this risk factor have not been fully explored. OBJECTIVES This observational study aimed to identify dietary consumption differences by race and ethnicity of US female adults living at or below the 130% poverty income level from 2011 to 2018. METHODS A total of 2917 adult females aged 20 to 80 years from the National Health and Nutrition Examination Survey (2011-2018) living at or below the 130% poverty income level with at least one complete 24-hour dietary recall were classified into 5 self-identified racial and ethnic subgroups (Mexican, other Hispanic, non-Hispanic [NH]-White, NH-Black, and NH-Asian). Dietary consumption patterns were defined by 28 major food groups summarized from the Food Pattern Equivalents Database and derived via a robust profile clustering model, which identifies foods that share consumption patterns across all low-income female adults and foods that differ in consumption patterns based on the racial and ethnic subgroups. RESULTS All food consumption patterns were identified at the local level, defined by racial and ethnic subgroups. Legumes and cured meats were the most differentiating foods identified across all racial and ethnic subgroups. Higher consumption levels of legumes were observed among Mexican-American and other Hispanic females. Higher consumption levels of cured meat were observed among NH-White and Black females. NH-Asian females had the most uniquely characterized patterns with a higher consumption of prudent foods (fruits, vegetables, and whole grains). CONCLUSIONS Differences among the consumption behaviors of low-income female adults were found along racial and ethnic lines. Efforts to improve the nutritional health of low-income female adults should consider racial and ethnic differences in diets to appropriately focus interventions.
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Affiliation(s)
| | - Walter C Willett
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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14
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Food security and diet quality in a racially diverse cohort of postpartum women in the USA. Br J Nutr 2023; 129:503-512. [PMID: 35510523 PMCID: PMC9876811 DOI: 10.1017/s0007114522001143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Food insecurity has been associated with poor diet, but few studies focused on the postpartum period - an important time for women's health. We examined associations between food security and diet quality in postpartum women and assessed whether participation in federal food assistance programmes modified this potential relation. Using longitudinal data, we analysed the association between food security at 3 months postpartum and a modified Alternate Healthy Eating Index-2010 (AHEI) at 6 months postpartum (excluding alcohol). We conducted multivariable linear regressions examining associations between food security and AHEI. We assessed two food assistance programmes as potential effect modifiers. The sample included 363 postpartum women from the Nurture study, located in the Southeastern USA (2013-2017). Among women, 64·4 % were Black and 45·7 % had a high school diploma or less. We found no evidence of an interaction between food security and two federal food assistance programmes. In adjusted models, marginal, low and very low food security were not associated with AHEI. However, low (β: -0·64; 95 % CI -1·15, -0·13; P = 0·01) and very low (β: -0·57; 95 % CI -1·02, -0·13; P = 0·01) food security were associated with greater trans fat intake. Food security status was not associated with overall diet quality but was associated with higher trans fat (low and very low) and more moderate alcohol (marginal) intake. Future studies should assess the consistency and generalisability of these findings.
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15
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Schillinger D, Bullock A, Powell C, Fukagawa NK, Greenlee MC, Towne J, Gonzalvo JD, Lopata AM, Cook JW, Herman WH. The National Clinical Care Commission Report to Congress: Leveraging Federal Policies and Programs for Population-Level Diabetes Prevention and Control: Recommendations From the National Clinical Care Commission. Diabetes Care 2023; 46:e24-e38. [PMID: 36701595 PMCID: PMC9887620 DOI: 10.2337/dc22-0619] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/04/2022] [Indexed: 01/27/2023]
Abstract
The etiology of type 2 diabetes is rooted in a myriad of factors and exposures at individual, community, and societal levels, many of which also affect the control of type 1 and type 2 diabetes. Not only do such factors impact risk and treatment at the time of diagnosis but they also can accumulate biologically from preconception, in utero, and across the life course. These factors include inadequate nutritional quality, poor access to physical activity resources, chronic stress (e.g., adverse childhood experiences, racism, and poverty), and exposures to environmental toxins. The National Clinical Care Commission (NCCC) concluded that the diabetes epidemic cannot be treated solely as a biomedical problem but must also be treated as a societal problem that requires an all-of-government approach. The NCCC determined that it is critical to design, leverage, and coordinate federal policies and programs to foster social and environmental conditions that facilitate the prevention and treatment of diabetes. This article reviews the rationale, scientific evidence base, and content of the NCCC's population-wide recommendations that address food systems; consumption of water over sugar-sweetened beverages; food and beverage labeling; marketing and advertising; workplace, ambient, and built environments; and research. Recommendations relate to specific federal policies, programs, agencies, and departments, including the U.S. Department of Agriculture, the Food and Drug Administration, the Federal Trade Commission, the Department of Housing and Urban Development, the Environmental Protection Agency, and others. These population-level recommendations are transformative. By recommending health-in-all-policies and an equity-based approach to governance, the NCCC Report to Congress has the potential to contribute to meaningful change across the diabetes continuum and beyond. Adopting these recommendations could significantly reduce diabetes incidence, complications, costs, and inequities. Substantial political resolve will be needed to translate recommendations into policy. Engagement by diverse members of the diabetes stakeholder community will be critical to such efforts.
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Affiliation(s)
- Dean Schillinger
- Division of General Internal Medicine, Center for Vulnerable Populations, San Francisco General Hospital, University of California San Francisco School of Medicine, San Francisco, CA
| | - Ann Bullock
- Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, MD
| | - Clydette Powell
- Division of Neurology, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Naomi K. Fukagawa
- Beltsville Human Nutrition Research Center, U.S. Department of Agriculture Agricultural Research Service, Beltsville, MD
| | | | - Jana Towne
- Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, MD
| | - Jasmine D. Gonzalvo
- Center for Health Equity and Innovation, Purdue University/Eskenazi Health, Indianapolis, IN
| | - Aaron M. Lopata
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD
| | | | - William H. Herman
- Division of Metabolism, Endocrinology, and Diabetes, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, MI
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16
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Herman WH, Bullock A, Boltri JM, Conlin PR, Greenlee MC, Lopata AM, Powell C, Tracer H, Schillinger D. The National Clinical Care Commission Report to Congress: Background, Methods, and Foundational Recommendations. Diabetes Care 2023; 46:e14-e23. [PMID: 36701594 PMCID: PMC9887619 DOI: 10.2337/dc22-0611] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 11/01/2022] [Indexed: 01/27/2023]
Abstract
Since the first Federal Commission on Diabetes issued its report in 1975, the diabetes epidemic in the U.S. has accelerated, and efforts to translate advances in diabetes treatment into routine clinical practice have stalled. In 2021, the National Clinical Care Commission (NCCC) delivered a report to Congress that provided recommendations to leverage federal policies and programs to more effectively prevent and treat diabetes and its complications. In the five articles in this series, we present the NCCC's evidence-based recommendations to 1) reduce diabetes-related risks, prevent type 2 diabetes, and avert diabetes complications through changes in federal policies and programs affecting the general population; 2) prevent type 2 diabetes in at-risk individuals through targeted lifestyle and medication interventions; and 3) improve the treatment of diabetes and its complications to improve the health outcomes of people with diabetes. In this first article, we review the successes and limitations of previous federal efforts to combat diabetes. We then describe the establishment of and charge to the NCCC. We discuss the development of a hybrid conceptual model that guided the NCCC's novel all-of-government approach to address diabetes as both a societal and medical problem. We then review the procedures used by the NCCC to gather information from federal agencies, stakeholders, key informants, and the public and to conduct literature reviews. Finally, we review the NCCC's three foundational recommendations: 1) improve the coordination of non-health-related and health-related federal agencies to address the social and environmental conditions that are accelerating the diabetes epidemic; 2) ensure that all Americans at risk for and with diabetes have health insurance and access to health care; and 3) ensure that all federal policies and programs promote health equity in diabetes.
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Affiliation(s)
| | - Ann Bullock
- Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, MD
| | | | - Paul R. Conlin
- Department of Veterans Affairs Boston Healthcare System, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Aaron M. Lopata
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD
| | - Clydette Powell
- School of Medicine and Health Services, George Washington University, Washington, DC
| | - Howard Tracer
- Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, MD
| | - Dean Schillinger
- University of California San Francisco School of Medicine and San Francisco General Hospital, San Francisco, CA
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17
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Mullins AM, McRae AE, Ansah RM, Johnson SB, Flessa SJ, Thornton RL. Healthy Eating Value Systems Among Supplemental Nutrition Assistance Program Participants: A Qualitative Study. Acad Pediatr 2022; 22:1360-1367. [PMID: 35081467 PMCID: PMC9307691 DOI: 10.1016/j.acap.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 01/06/2022] [Accepted: 01/16/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To understand how families receiving benefits from the Supplemental Nutrition Assistance Program (SNAP) conceptualize healthy eating and its relationship to child development. METHODS This study is a secondary analysis of in-depth, in-home qualitative interviews. 30 caregivers with children between the ages of 4 and 10 years old participating in SNAP in Baltimore, MD, were asked about food purchasing resources and strategies. Two independent coders re-analyzed primary data using an iterative process to identify a priori themes related to caregivers' conceptualization of healthy eating and emergent themes related to the ways families use SNAP benefits. Themes were identified via content analysis and revised until consensus was reached. RESULTS Participants demonstrated knowledge of nutritious food groups, specific unhealthy nutrients, and the importance of food in managing chronic conditions. However, the importance of nutrition was balanced with the need for ready-made foods that children could safely prepare on their own, shelf stable goods, and low-cost foods. Emergent themes identified caregivers' views of health-related impacts of food beyond nutrition, including the role of food as: a parenting tool to support child socialization and development, a means of creating experiences unique to childhood, and a mechanism for promoting family cohesion. CONCLUSIONS This study suggests families receiving SNAP use benefits to best serve children's well-being while conceptualizing the child health benefits of food as extending beyond nutrition. Future policy interventions aimed at optimizing SNAP should address the potential for nutrition assistance to foster positive child social and emotional development among low-income families while meeting nutritional needs.
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Affiliation(s)
- Alexa M Mullins
- Johns Hopkins University School of Medicine (AM Mullins, AE McRae), Baltimore, Md.
| | - Ashlyn E McRae
- Johns Hopkins University School of Medicine (AM Mullins, AE McRae), Baltimore, Md
| | - Rosemary M Ansah
- Department of Pediatrics (RM Ansah, RLJ Thornton), Johns Hopkins School of Medicine, Mason F. Lord Building, Center Baltimore, Md
| | - Sara B Johnson
- Department of Pediatrics (SB Johnson, SJ Flessa), Johns Hopkins School of Medicine, Baltimore, Md
| | - Sarah J Flessa
- Department of Pediatrics (SB Johnson, SJ Flessa), Johns Hopkins School of Medicine, Baltimore, Md
| | - Rachel Lj Thornton
- Department of Pediatrics (RM Ansah, RLJ Thornton), Johns Hopkins School of Medicine, Mason F. Lord Building, Center Baltimore, Md
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18
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Community-based nutrition education and hands-on cooking intervention increases farmers' market use and vegetable servings. Public Health Nutr 2022; 25:2601-2613. [PMID: 35311633 PMCID: PMC9991668 DOI: 10.1017/s1368980022000660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of the current study was to evaluate the impact of the Market to MyPlate (M2MP) program on participants' reported farmers' market (FM) attitudes and shopping behaviours, frequency of serving vegetables to their families, food resource management behaviours and food security. A secondary objective was to identify facilitators and barriers to shopping at FM and food waste reduction techniques used by low-income families. DESIGN The current study used a mixed methods evaluation embedded within a cluster randomised trial of the M2MP intervention. SETTING The 7-week M2MP program was delivered at Extension offices and community centres in central Illinois. PARTICIPANTS Participants included 120 adults and their families. Class cohorts were randomly assigned to one of three treatment groups: (1) nutrition education and cooking classes with produce allocations (PAE, n 39); (2) nutrition education and cooking classes only (EO, n 36) or (3) control group (n 45). RESULTS Compared with control participants, PAE participants were significantly more likely to report shopping at FM (P = 0·029) and reported serving more vegetables to their families (P = 0·010) (EO participants did not differ from the control group on any outcomes). There were no differences between conditions in survey-based measures of food security or food resource management behaviours. Interview results describe facilitators and barriers to shopping at FM and a variety of food waste reduction techniques (including food placement and food resource management). CONCLUSIONS These findings suggest that fresh produce provision coupled with nutrition and culinary education can positively impact shopping and dietary behaviours.
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19
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Crandall AK, Madhudi N, Osborne B, Carter A, Williams AK, Temple JL. The effect of food insecurity and stress on delay discounting across families: a COVID-19 natural experiment. BMC Public Health 2022; 22:1576. [PMID: 35986265 PMCID: PMC9388997 DOI: 10.1186/s12889-022-13969-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Delay Discounting is the extent to which one prioritizes smaller immediate rewards over larger, delayed rewards. The ability to prospect into the future is associated with better health decision-making, which suggests that delay discounting is an important intervention target for the prevention and treatment of chronic disease. Delay discounting decreases throughout development and stressful experiences, particularly those that accompany poverty, may influence this developmental trajectory. The current study leveraged the COVID-19 pandemic and resulting economic downturn as a natural experiment to understand how changes in food insecurity and psychological stress may associated with changes in delay discounting among parents, adolescents, and children. METHODS A stratified cohort of families (N = 76 dyads), established prior to the initial pandemic lockdowns, were asked to complete a follow-up survey in the summer of 2020, during reopening. Thirty-seven (49%) families had an older adolescent (aged 15 - 18 years) in the study and 39 (51%) had an elementary aged child (aged 7 - 12 years) in the follow-up study. Both data collection points included measurements of economic position, psychological stress, food security status, and delay discounting. RESULTS The results showed that pandemic food insecurity was associated with greater stress among parents (β = 2.22, t(65.48) = 2.81, p = 0.007). Parents, Adolescents, and children significantly differed in their response to psychological stress during the pandemic (β = -0.03, t(102.45) = -2.58, p = 0.011), which was driven by a trend for children to show greater delay discounting associated with an increase in psychological stress during the pandemic (β = -0.01, p = 0.071), while adolescents and parents showed no change. CONCLUSIONS These findings add to the evidence that food insecurity is uniquely stressful among parents with no effects on delay discounting. Despite this, we found no evidence that food insecurity was stressful for child or adolescents. A trend in our data suggested that childhood, as compared with adolescence, may be an important developmental period for the association between stress and delay discounting. Future research should continue the longitudinal investigation of childhood stress and the developmental trajectory of delay discounting to ascertain how these effects may persist in adulthood.
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Affiliation(s)
- Amanda K Crandall
- Department of Community Health and Health Behavior, University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA.
| | - Nayana Madhudi
- Department of Exercise and Nutrition Sciences, University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
| | - Bernadette Osborne
- Department of Exercise and Nutrition Sciences, University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
| | - Autum Carter
- Department of Community Health and Health Behavior, University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
| | - Aliaya K Williams
- Department of Exercise and Nutrition Sciences, University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
| | - Jennifer L Temple
- Department of Community Health and Health Behavior, University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
- Department of Exercise and Nutrition Sciences, University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
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20
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Lee MM, Kinsey EW, Kenney EL. U.S. Nutrition Assistance Program Participation and Childhood Obesity: The Early Childhood Longitudinal Study 2011. Am J Prev Med 2022; 63:242-250. [PMID: 35400557 PMCID: PMC9308641 DOI: 10.1016/j.amepre.2022.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION The Supplemental Nutrition Assistance Program; Free/Reduced Priced Lunch Program; and Special Supplemental Nutrition Program for Women, Infants, and Children reduce food insecurity for millions of Americans with lower incomes. However, critics have questioned whether they increase obesity. This study examined whether program participation was associated with BMI z-score from kindergarten to fifth grade. METHODS Data from 4,457 primary-grade students whose household incomes were equal to or below 200% of the federal poverty level from kindergarten to fifth grade as part of the Early Childhood Longitudinal Study, Kindergarten Class of 2010‒2011 were analyzed. Marginal structural models with inverse probability of treatment/censoring weights were used to estimate associations between Supplemental Nutrition Assistance Program/Free and Reduced Priced Lunch participation over time and fifth-grade BMI z-score, accounting for lost-to-follow-up and time-varying confounders. Weighted generalized estimating equations were used to examine associations between Special Supplemental Nutrition Program for Women, Infants, and Children participation and BMI z-score trends. All analyses incorporated sampling weights. The Early Childhood Longitudinal Study, Kindergarten Class of 2010‒2011 data were collected from 2010-2016; analyses were conducted in 2021 and 2022. RESULTS At baseline, 2,419 (54.3%) respondents participated in the Supplemental Nutrition Assistance Program, 3,993 (89.6%) participated in Free/Reduced Priced Lunch, and 3,755 (84.2%) reported past participation in the Special Supplemental Nutrition Program for Women, Infants, and Children. No associations were found between any program and fifth-grade BMI z-score or between Special Supplemental Nutrition Program for Women, Infants, and Children participation and BMI z-score trend. CONCLUSIONS Previous findings of relationships between program participation and BMI may have been because of weaker study designs and uncontrolled confounding. Participation in the Supplemental Nutrition Assistance Program; Free/Reduced Priced Lunch; and Special Supplemental Nutrition Program for Women, Infants, and Children was not associated with increased risk of childhood obesity in this recently conducted longitudinal study.
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Affiliation(s)
- Matthew M Lee
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Eliza W Kinsey
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Erica L Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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21
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Bakre S, Shea B, Ortega K, Scharen J, Langheier J, Hu EA. Changes in food insecurity among individuals using a telehealth and nutrition platform: a longitudinal study (Preprint). JMIR Form Res 2022; 6:e41418. [DOI: 10.2196/41418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/09/2022] [Accepted: 09/22/2022] [Indexed: 11/13/2022] Open
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22
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Nikniaz Z, Tabrizi JS, Abbasalizad Farhangi M, Hosseini M, Tahmasebi S, Nikniaz L. Community‐based interventions to reduce sugar intake in healthy populations: A systematic review. WORLD MEDICAL & HEALTH POLICY 2022. [DOI: 10.1002/wmh3.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Zeinab Nikniaz
- Liver and Gastrointestinal Diseases Research Center, Medicine Faculty Tabriz University of Medical Sciences Tabriz Iran
| | - Jafar S. Tabrizi
- Tabriz Health Services Management Research Center, Faculty of Management and Medical Informatics Tabriz University of Medical Sciences Tabriz Iran
| | | | | | - Sanaz Tahmasebi
- Student Research Committee Tabriz University of Medical Sciences Tabriz Iran
| | - Leila Nikniaz
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences Faculty of Management and Medical Informatics Tabriz Iran
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23
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Davis E, Martinez G, Blostein F, Marshall T, Jones A, Jansen E, McNeil D, Neiswanger K, Marazita M, Foxman B. Dietary Patterns and Risk of a New Carious Lesion Postpartum: A Cohort Study. J Dent Res 2022; 101:295-303. [PMID: 34609222 PMCID: PMC8982010 DOI: 10.1177/00220345211039478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Dental caries (cavities), one of the most common infectious diseases, is caused by a number of factors. Oral microbes, dietary practices, sociodemographic factors, and dental hygiene all inform caries risk. Assessing the impact of diet is complicated as individuals eat foods in combinations, and the interactions among the foods may alter caries risk. Our study aimed to prospectively assess the association between dietary patterns and caries risk in the postpartum period, a potentially sensitive period for caries development. We analyzed in-person dental assessments and telephone food frequency questionnaires (FFQs) from 879 Caucasian women participating in the Center for Oral Health Research in Appalachia Cohort 2 (COHRA2) that were collected biannually for up to 6 y. One-week recall of food intake frequency was assessed using a Likert scale. We used principal component analysis to summarize the FFQ data; the top 2 components described 15% and 12% of the variance in FFQ data. The first component was characterized by high consumption of fruits and vegetables, while the second component was heavily influenced by desserts and crackers. We used a modified Poisson model to predict the risk of an increase in the number of decayed, missing, and filled teeth in the postpartum period by 1) dietary patterns and 2) individual foods and beverages at the previous study visit, after controlling for other known risk factors, including history of carious lesions. Eating a dietary pattern high in desserts and crackers was associated with a 20% increase in the number of decayed, missing, and filled teeth in the postpartum period (95% confidence interval, 1.03-1.39). However, this effect was attenuated among those who also consumed a dietary pattern high in fruits and vegetables. Dietary patterns should be considered when devising interventions aimed at preventing dental caries.
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Affiliation(s)
- E. Davis
- Center for Molecular and Clinical
Epidemiology of Infectious Diseases, Department of Epidemiology, University of
Michigan School of Public Health, Ann Arbor, MI, USA
| | - G. Martinez
- Center for Molecular and Clinical
Epidemiology of Infectious Diseases, Department of Epidemiology, University of
Michigan School of Public Health, Ann Arbor, MI, USA
| | - F. Blostein
- Center for Molecular and Clinical
Epidemiology of Infectious Diseases, Department of Epidemiology, University of
Michigan School of Public Health, Ann Arbor, MI, USA
| | - T. Marshall
- Department of Preventive and Community
Dentistry, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - A.D. Jones
- Department of Nutritional Sciences,
University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - E. Jansen
- Department of Nutritional Sciences,
University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - D.W. McNeil
- Center for Oral Health Research in
Appalachia (COHRA) University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychology, West Virginia
University, Department of Dental Practice & Rural Health, West Virginia
University School of Dentistry, Morgantown, WV Morgantown, WV, USA
| | - K. Neiswanger
- Center for Oral Health Research in
Appalachia (COHRA) University of Pittsburgh, Pittsburgh, PA, USA
- Center for Craniofacial and Dental
Genetics, Department of Oral and Craniofacial Sciences, School of Dental Medicine,
University of Pittsburgh, Pittsburgh, PA, USA
| | - M.L. Marazita
- Center for Oral Health Research in
Appalachia (COHRA) University of Pittsburgh, Pittsburgh, PA, USA
- Center for Craniofacial and Dental
Genetics, Department of Oral and Craniofacial Sciences, School of Dental Medicine,
University of Pittsburgh, Pittsburgh, PA, USA
- Department of Human Genetics, Graduate
School of Public Health, Clinical and Translational Sciences, School of Medicine,
University of Pittsburgh, Pittsburgh, PA, USA
| | - B. Foxman
- Center for Molecular and Clinical
Epidemiology of Infectious Diseases, Department of Epidemiology, University of
Michigan School of Public Health, Ann Arbor, MI, USA
- B. Foxman, Center for Molecular and
Clinical Epidemiology of Infectious Diseases, Department of Epidemiology,
University of Michigan School of Public Health, 1415 Washington Heights, Ann
Arbor, MI 48109, USA.
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Leung CW, Fulay AP, Parnarouskis L, Martinez-Steele E, Gearhardt AN, Wolfson JA. Food insecurity and ultra-processed food consumption: the modifying role of participation in the Supplemental Nutrition Assistance Program (SNAP). Am J Clin Nutr 2022; 116:197-205. [PMID: 35199832 PMCID: PMC9257471 DOI: 10.1093/ajcn/nqac049] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/14/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Ultra-processed foods contribute to risks of obesity and cardiometabolic disease, and higher intakes have been observed in low-income populations in the United States. Consumption of ultra-processed foods may be particularly higher among individuals experiencing food insecurity and participating in the Supplemental Nutrition Assistance Program (SNAP). OBJECTIVES Using data from the 2007-2016 NHANES, we examined the associations between food insecurity, SNAP participation, and ultra-processed food consumption. METHODS The study population comprised 9190 adults, aged 20-65 y, with incomes ≤300% of the federal poverty level (FPL). Food insecurity was assessed using the Household Food Security Survey Module and SNAP participation over the past 12 mo was self-reported. Dietary intake was measured from two 24-h dietary recalls. Ultra-processed food consumption (percentage of total energy intake) was defined using the NOVA food classification system. Linear regression models were used to examine the associations between food insecurity, SNAP participation, and ultra-processed food consumption, adjusting for sociodemographic and health characteristics. RESULTS More severe food insecurity was associated with higher intakes of ultra-processed foods (P-trend = 0.003). The adjusted means of ultra-processed food intake ranged from 52.6% for adults with high food security to 55.7% for adults with very low food security. SNAP participation was also associated with higher intakes of ultra-processed foods (adjusted mean: 54.7%), compared with income-eligible participants (adjusted mean: 53.0%). Furthermore, the association between food insecurity and ultra-processed foods was modified by SNAP participation (P-interaction = 0.02). Among income-eligible nonparticipants and income-ineligible nonparticipants, more severe food insecurity was associated with higher consumption of ultra-processed foods. Among SNAP participants, the association between food insecurity and consumption of ultra-processed foods was nonsignificant. CONCLUSION In a nationally representative sample of adults, food insecurity and SNAP participation were both associated with higher levels of ultra-processed food consumption.
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Affiliation(s)
| | - Aarohee P Fulay
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Lindsey Parnarouskis
- Department of Psychology, College of Literature, Science, and Arts, University of Michigan, Ann Arbor, MI, USA
| | - Euridice Martinez-Steele
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Ashley N Gearhardt
- Department of Psychology, College of Literature, Science, and Arts, University of Michigan, Ann Arbor, MI, USA
| | - Julia A Wolfson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Lawton K, Hess L, McCarthy H, Marini M, McNitt K, Savage JS. Feasibility of Using Facebook to Engage SNAP-Ed Eligible Parents and Provide Education on Eating Well on a Budget. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031457. [PMID: 35162478 PMCID: PMC8835558 DOI: 10.3390/ijerph19031457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 02/05/2023]
Abstract
This study examined the use of Facebook to provide education on food resource management and healthy eating on a budget to parents of preschool aged children participating in Head Start. A convenience sample of 25 parents participated in a Facebook group based on Sesame Street's Food for Thought: Eating Well on a Budget curriculum over a 3-week period. Parent engagement was assessed by examining views, likes, and comments on posts. Qualitative data were used to assess knowledge, attitudes, and barriers experienced related to healthy eating on a budget. The results suggest that parents were engaged throughout the intervention, as evidenced by views, likes, and comments on Facebook posts, as well as by study retention (90%). Interactions with the intervention materials varied by post content, with discussion questions having the highest level of interaction. Facebook was found to be a feasible platform for delivering the intervention, and the Facebook-adapted version of the Sesame Street curriculum was shown to engage Head Start parents living in rural areas. Further research should explore the use of social media platforms for delivering nutrition education interventions to rural populations that are otherwise difficult to reach.
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The Nutritional Content of Rescued Food Conveyed by a Food Aid Organization. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212212. [PMID: 34831968 PMCID: PMC8624580 DOI: 10.3390/ijerph182212212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022]
Abstract
Background: The number of food-insecure families in the European Union has increased, resulting in an increasing number of households depending on food assistance programs. The aim in this study was to evaluate the nutrient content of food rescued by a food aid organization that rescues and redistributes fresh or freshly cooked food to low-income households. Methods: To determine the nutritional content of food hampers provided by our case study organization, we weighed all items of food hampers in three weighing rounds over a period of four months. The Food Insecurity Experience Scale (FIES) was applied to measure households’ food insecurity. Results: Our results show that, at our case study food aid organization, food donations substantially contribute to energy, macro, and micronutrient dietary recommendation intake (DRI). Conclusions: When evaluating how these nutrients contribute to alleviating food insecurity of the beneficiary households, we found that the perception of food insecurity is independent of the amount of nutrients served. To the best of our knowledge, this is the first study measuring the nutritional content of fresh or freshly cooked rescued food conveyed by a food aid organization.
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27
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Karpyn A, Pon J, Grajeda SB, Wang R, Merritt KE, Tracy T, May H, Sawyer-Morris G, Humphrey DL, Hunt A. Purchases, Consumption, and BMI of SNAP Farmers’ Market Shoppers. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2021. [DOI: 10.1080/19320248.2021.1997860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Allison Karpyn
- Center for Research in Education and Social Policy, University of Delaware, Newark, Delaware, USA
| | - Julia Pon
- Wholesome Wave, Berkeley, California, USA
| | - Sara Bernice Grajeda
- Center for Research in Education and Social Policy, University of Delaware, Newark, Delaware, USA
| | - Rui Wang
- Center for Research in Education and Social Policy, University of Delaware, Newark, Delaware, USA
| | | | - Tara Tracy
- Center for Research in Education and Social Policy, University of Delaware, Newark, Delaware, USA
| | - Henry May
- Center for Research in Education and Social Policy, University of Delaware, Newark, Delaware, USA
| | - Ginnie Sawyer-Morris
- Human Development & Family Sciences, The University of Delaware, Newark, Delaware, USA
| | - D. Layne Humphrey
- Center for Research in Education and Social Policy, University of Delaware, Newark, Delaware, USA
| | - Alan Hunt
- Wholesome Wave, Bridgeport, Connecticut, USA
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Anderson E, Wei R, Liu B, Plummer R, Kelahan H, Tamez M, Marrero A, Bhupathiraju S, Mattei J. Improving Healthy Food Choices in Low-Income Settings in the United States Using Behavioral Economic-Based Adaptations to Choice Architecture. Front Nutr 2021; 8:734991. [PMID: 34692747 PMCID: PMC8526839 DOI: 10.3389/fnut.2021.734991] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/08/2021] [Indexed: 12/27/2022] Open
Abstract
Low diet quality is a significant public health problem in the United States, especially among low-income populations. The food environment influences dietary choices. When applied to eating behavior, behavioral economics (BE) recognizes that decision biases instigated by a food environment saturated with unhealthy foods may lead people to purchase such foods, even when they possess the necessary information and skills to make healthy dietary choices. Choice architecture, a BE concept that involves modifying the appeal or availability of choices to “nudge” people toward a certain choice, retains freedom of choice but makes unhealthy options less convenient or visible. Choice architecture has been demonstrated to influence food choices in various settings, including supermarkets, convenience stores, and food pantries. These modifications are low-cost and feasible to implement, making them a viable strategy to help “nudge” patrons toward healthier choices in food establishments serving low-income populations, including food pantries and retailers accepting the Supplemental Nutrition Assistance Program. This narrative review searched, appraised, and underscored the strengths and limitations of extant research studies that used choice architecture adaptations to influence food choices among low-income populations in the United States. Findings from studies in food pantry settings suggest the potential of BE strategies to improve the healthfulness of food choices and dietary intake in low-income populations. In food retail settings, research suggests that BE strategies increase sales of healthy foods, like fruits and vegetables. We identify new areas of research needed to determine if BE-based modifications in low-income settings have sustained impacts on diet quality.
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Affiliation(s)
- Emma Anderson
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Ruobin Wei
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Binkai Liu
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Rachel Plummer
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Heather Kelahan
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Martha Tamez
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Abrania Marrero
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Shilpa Bhupathiraju
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Josiemer Mattei
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
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Mpagama SG, Msaji KS, Kaswaga O, Zurba LJ, Mbelele PM, Allwood BW, Ngungwa BS, Kisonga RM, Lesosky M, Rylance J, Mortimer K. The burden and determinants of post-TB lung disease. Int J Tuberc Lung Dis 2021; 25:846-853. [PMID: 34615582 PMCID: PMC8504494 DOI: 10.5588/ijtld.21.0278] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/17/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND: Post-TB lung disease (PTLD) is an important but under-recognised chronic respiratory disease in high TB burden settings such as Tanzania.METHODS: This was a cross-sectional survey of adults within 2 years of completion of TB treatment in Kilimanjaro, Tanzania. Data were collected using questionnaires (symptoms and exposures), spirometry and chest radiographs to assess outcome measures, which were correlated with daily life exposures, including environment and diet.RESULTS: Of the 219 participants enrolled (mean age: 45 years ± 10; 193 88% males), 98 (45%) reported chronic respiratory symptoms; 46 (22%) had received treatment for TB two or more times; and HIV prevalence was 35 (16%). Spirometric abnormalities were observed in 146 (67%). Chest X-ray abnormalities occurred in 177 (86%). A diagnosis of PTLD was made in 200 (91%), and half had clinically relevant PTLD. The prevalence of mMRC ≥Grade 3 chronic bronchitis and dyspnoea was respectively 11% and 26%. Older age, multiple episodes of TB and poverty indicators were linked with clinically relevant PTLD.CONCLUSIONS: We found a substantial burden of PTLD in adults who had recently completed TB treatment in Tanzania. There is a pressing need to identify effective approaches for both the prevention and management of this disease.
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Affiliation(s)
- S G Mpagama
- Kibong´oto Infectious Diseases Hospital, Kilimanjaro, Tanzania, Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
| | - K S Msaji
- Kibong´oto Infectious Diseases Hospital, Kilimanjaro, Tanzania
| | - O Kaswaga
- Kibong´oto Infectious Diseases Hospital, Kilimanjaro, Tanzania
| | - L J Zurba
- Education for Health Africa, Mount Edgecombe, Durban, South Africa
| | - P M Mbelele
- Kibong´oto Infectious Diseases Hospital, Kilimanjaro, Tanzania, Nelson Mandela African Institution of Science & Technology, Arusha, Tanzania
| | - B W Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University & Tygerberg Hospital, Tygerberg, South Africa
| | - B-S Ngungwa
- Kibong´oto Infectious Diseases Hospital, Kilimanjaro, Tanzania
| | - R M Kisonga
- Kibong´oto Infectious Diseases Hospital, Kilimanjaro, Tanzania
| | - M Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - J Rylance
- Lung Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - K Mortimer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Consavage Stanley K, Harrigan PB, Serrano EL, Kraak VI. Applying a Multi-Dimensional Digital Food and Nutrition Literacy Model to Inform Research and Policies to Enable Adults in the U.S. Supplemental Nutrition Assistance Program to Make Healthy Purchases in the Online Food Retail Ecosystem. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168335. [PMID: 34444084 PMCID: PMC8394533 DOI: 10.3390/ijerph18168335] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/21/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022]
Abstract
The United States (U.S.) Department of Agriculture (USDA)-administered Supplemental Nutrition Assistance Program (SNAP) made substantial changes in response to the coronavirus disease 2019 (COVID-19) pandemic. These changes highlight the need to identify the digital literacy skills and capacities of SNAP adults to purchase healthy groceries online. We conducted a scoping review of four electronic databases, Google and Google Scholar to identify studies that measured food and nutrition literacy outcomes for U.S. adults. We applied a multi-dimensional digital food and nutrition literacy (MDFNL) model to assess six literacy levels and components. Of 18 studies published from 2006-2021, all measured functional and interactive literacy but no study measured communicative, critical, translational, or digital literacy. Six studies examined SNAP or SNAP-Education outcomes. Adults with higher food or nutrition literacy scores had better cognitive, behavioral, food security and health outcomes. We suggest how these findings may inform research, policies, and actions to strengthen the multi-dimensional literacy skills of SNAP participants and SNAP-eligible adults to support healthy purchases in the online food retail ecosystem.
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Affiliation(s)
- Katherine Consavage Stanley
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University (Virginia Tech), Blacksburg, VA 24061, USA; (P.B.H.); (E.L.S.); (V.I.K.)
- Correspondence: ; Tel.: +1-540-231-9638
| | - Paige B. Harrigan
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University (Virginia Tech), Blacksburg, VA 24061, USA; (P.B.H.); (E.L.S.); (V.I.K.)
| | - Elena L. Serrano
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University (Virginia Tech), Blacksburg, VA 24061, USA; (P.B.H.); (E.L.S.); (V.I.K.)
- Virginia Family Nutrition Program, Virginia Tech, Blacksburg, VA 24061, USA
| | - Vivica I. Kraak
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University (Virginia Tech), Blacksburg, VA 24061, USA; (P.B.H.); (E.L.S.); (V.I.K.)
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Sanjeevi N, Freeland-Graves JH, Sachdev PK. Association of loss of Supplemental Nutrition Assistance Program benefits with food insecurity and dietary intake of adults and children. Am J Clin Nutr 2021; 114:683-689. [PMID: 33876182 DOI: 10.1093/ajcn/nqab082] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/01/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Supplemental Nutrition Assistance Program (SNAP) disenrollment among income-eligible households could limit their ability to access food. OBJECTIVES To assess the association of loss of SNAP benefits on food security status and dietary intake of household members, using 2011-2016 NHANES data. METHODS SNAP participation status among those with a household income ≤130% of the federal poverty level was categorized as 1) current participants, 2) former participants with benefits cut off in the past year, and 3) former participants with benefits cut off for more than a year. Logistic regression examined associations of SNAP participation status with odds of household (n = 7387), adult (n = 7387), and child (n = 5898) food security. Linear regression examined associations of participation status with Healthy Eating Index-2015 (HEI-2015) total and component scores in adults (n = 2784) and children/adolescents (n = 2553). RESULTS Former SNAP participants with benefits cut off in the past year had greater odds of severe household (OR: 2.18; 95% CI: 1.25, 3.78) and adult (OR: 2.09; 95% CI: 1.24, 3.54) food insecurity compared with current participants. Benefit cutoff in the past year was significantly related to low child food security (OR: 1.80; 95% CI: 1.04, 3.11) and lower child/adolescent greens and beans score (estimate: -0.40; SE: 0.18). Loss of benefits for more than a year was significantly associated with increased marginal child food security odds (OR: 2.07; 95% CI: 1.23, 3.47), lower adult dairy score (estimate: -0.63; SE: 0.24), and lower child/adolescent greens and beans (estimate: -0.34; SE: 0.16), whole grains (estimate: -0.50; SE: 0.21), and dairy scores (estimate: -0.93; SE: 0.29). CONCLUSIONS This study suggests that loss of benefits may increase household food insecurity. Although child/adolescent intakes of certain HEI-2015 adequacy components were lower among former SNAP participants, overall diet quality score did not differ. Findings collectively imply the need for policies that protect households from the adverse effects of benefits loss.
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Affiliation(s)
- Namrata Sanjeevi
- Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA
| | - Jeanne H Freeland-Graves
- Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA
| | - Prageet K Sachdev
- Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA
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32
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Ciesielski TH, Ngendahimana DK, Roche A, Williams SM, Freedman DA. Elevated Dietary Inflammation Among Supplemental Nutrition Assistance Program Recipients Provides Targets for Precision Public Health Intervention. Am J Prev Med 2021; 61:192-200. [PMID: 33985837 PMCID: PMC8319049 DOI: 10.1016/j.amepre.2021.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/13/2021] [Accepted: 02/05/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The Supplemental Nutrition Assistance Program was designed to prevent food insecurity among low-income Americans and has been linked to improvements in pregnancy health, long-term child development, and criminal recidivism. However, the pursuit of food security does not ensure nutritional sufficiency, and the program has not improved diet quality or cardiometabolic mortality (i.e., heart disease, stroke, diabetes). In this study, longitudinal cohort data are used to identify by Supplemental Nutrition Assistance Program status the proinflammatory characteristics that predispose to chronic disease. METHODS Between 2015 and 2018, annual 24-hour dietary recalls were conducted with 409 residents from low-income, urban neighborhoods in Columbus and Cleveland, Ohio (statistical analysis started in 2019). The Dietary Inflammatory Index was calculated. It provides empirically validated estimates of the internal inflammation that each diet should produce; higher Dietary Inflammatory Index scores have been associated with elevated inflammatory biomarkers. Finally, associations between Supplemental Nutrition Assistance Program and Dietary Inflammatory Index were evaluated, and dietary components that differed by Supplemental Nutrition Assistance Program status were identified. RESULTS Supplemental Nutrition Assistance Program recipients had higher Dietary Inflammatory Index scores (+0.40, 95% CI=0.09, 0.70) and a consistently lower intake of 4 anti-inflammatory nutrients (dietary fiber, β-carotene, magnesium, vitamin E) than nonrecipients. Vitamin D intake did not differ by Supplemental Nutrition Assistance Program status but was well below the Recommended Daily Allowance in this sample. CONCLUSIONS Supplemental Nutrition Assistance Program recipients had elevated Dietary Inflammatory Index scores, implying higher diet-driven inflammation. This was due, in part, to low intake of 4 anti-inflammatory food components, which were higher yet still nutritionally insufficient among nonrecipients. Findings highlight specific nutritional targets for improving public health through dietary change.
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Affiliation(s)
- Timothy H Ciesielski
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Mary Ann Swetland Center for Environmental Health, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Ronin Institute, Montclair, New Jersey.
| | - David K Ngendahimana
- Mary Ann Swetland Center for Environmental Health, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Dissemination and Training Division of the Veterans Health Administration, National Center for PTSD, Menlo Park, California
| | - Abigail Roche
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Mary Ann Swetland Center for Environmental Health, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Scott M Williams
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Cleveland Institute for Computational Biology, Cleveland, Ohio
| | - Darcy A Freedman
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Mary Ann Swetland Center for Environmental Health, School of Medicine, Case Western Reserve University, Cleveland, Ohio
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Olfat M, Laraia BA, Aswani AJ. Association of Funding and Meal Preparation Time With Nutritional Quality of Meals of Supplemental Nutritional Assistance Program Recipients. JAMA Netw Open 2021; 4:e2114701. [PMID: 34165578 PMCID: PMC8226420 DOI: 10.1001/jamanetworkopen.2021.14701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IMPORTANCE The Supplemental Nutrition Assistance Program (SNAP) is a federal program that provides food-purchasing assistance to low-income people; however, its current design does not account for the time availability of SNAP recipients to prepare meals. OBJECTIVE To evaluate the association of the availability of funding for food purchases and time for meal preparation with the nutritional quality of meals of SNAP recipients. DESIGN, SETTING, AND PARTICIPANTS This study used decision analytical modeling to evaluate the nutritional quality of meals of SNAP recipients. The model was developed from February 6, 2017, to December 12, 2020, using data from 2017 and is based on discrete optimization. The model describes food and grocery purchasing, in-home meal preparation, and meal plan choices of a family of SNAP participants (2 adults and 2 children) while considering food preferences, meal preparation time, and food costs. The model assumes food preferences match the foods typically purchased by SNAP households. Costs of food ingredients and prepared foods are taken from a single zip code. EXPOSURES Time availability and total amount and type of funding were varied. Allowing prepared delicatessen foods and disallowing frozen prepared foods for purchase using SNAP funds were considered. MAIN OUTCOMES AND MEASURES The primary outcome was the number of home-cooked meals and the amounts of fruits, vegetables, protein, sodium, sugar, and fiber consumed from generated meal plans. Amounts were evaluated as a percentage of the quantity recommended by established dietary guidelines. RESULTS Increased time availability was associated with increases in the percentage of home-cooked meals and servings of fruits/vegetables and decreased sodium consumption. Higher levels of funding were associated with increased consumption of fiber, fruits/vegetables, protein, sodium, and sugar. With 20 min/d of cooking time, $400/mo of SNAP benefits, and $100/mo of self-funding, the meal plan had a mean (SE) of 20.1% (0.3%) of meals home cooked, 0.5 (<0.1) servings/d per person of fruits/vegetables, 100.3% (0.6%) of daily recommended protein per person, 115.1% (0.8%) of daily recommended sodium per person, 241.8% (1.0%) of daily recommended sugar per person, and 31.2% (0.3%) of daily recommended fiber per person. With 20 min/d of cooking time, $400/mo of SNAP benefits, and $600/mo of self-funding, the meal plan had a mean (SE) of 23.9% (1.0%) of meals home cooked, 2.8 (0.1) servings/d per person of fruits/vegetables, 134.9% (1.6%) of daily recommended protein per person, 200.9% (3.1%) of daily recommended sodium per person, 295.1% (3.1%) of daily recommended sugar per person, and 90.1% (1.0%) of daily recommended fiber per person. With 60 min/d of cooking time, $400/mo of SNAP benefits, and $100/mo of self-funding, the meal plan had a mean (SE) of 52.7% (0.9%) of meals home cooked, 1.4 (<0.1) servings/d per person of fruits/vegetables, 109.0% (1.1%) of daily recommended protein per person, 108.7% (1.0%) of daily recommended sodium per person, 298.6% (2.0%) of daily recommended sugar per person, and 38.8% (0.4%) of daily recommended fiber per person. With 60 min/d of cooking time, $400/mo of SNAP benefits, and $600/mo of self-funding, the meal plan had a mean (SE) of 42.8% (1.2%) meals home cooked, 4.3 (0.1) servings/d per person of fruits/vegetables, 144.4% (1.8%) of daily recommended protein per person, 165.2% (2.8%) of daily recommended sodium per person, 322.4% (2.4%) of daily recommended sugar per person, and 91.0% (0.9%) of daily recommended fiber per person. CONCLUSIONS AND RELEVANCE In this decision analytical model, meal preparation time was associated with the ability of SNAP recipient families to consume nutritious meals, suggesting that increased funding alone may be insufficient for improving the nutritional profiles of SNAP recipients. Given the current US food supply, governmental interventions that provide the equivalence in increased time availability to achieve nutritious meals may be needed.
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Affiliation(s)
- Matt Olfat
- Industrial Engineering and Operations Research, University of California, Berkeley
- Now with Citadel LLC, Chicago, Illinois
| | | | - Anil J. Aswani
- Industrial Engineering and Operations Research, University of California, Berkeley
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Perceptions of SNAP and Stocking Standards: A Qualitative Study of California Small Food Store Owners and Managers. Nutrients 2021; 13:nu13030752. [PMID: 33652765 PMCID: PMC7996805 DOI: 10.3390/nu13030752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/21/2021] [Accepted: 02/23/2021] [Indexed: 11/24/2022] Open
Abstract
The Supplemental Nutrition Assistance Program (SNAP) is critical to alleviating food insecurity, but low diet quality among program participants is a concern. Nutrition-related interventions have focused on SNAP-authorized food retailers, but the perspectives of small food store owners and managers have not been represented in national policy discussions. This study aimed to explore the opinions of store owners/managers of SNAP-authorized small food stores about their overall perceptions of the program and the stricter stocking standards previously proposed in 2016. We conducted in-depth, semi-structured interviews with 33 small food store owners and managers in San Francisco and Oakland, California in 2016. Interviews were analyzed for thematic content using the general inductive approach. Four themes emerged from owners/managers’ discussion of their overall perceptions of SNAP: the beneficial impact of SNAP on their business, how SNAP enables them to connect with the broader community, the importance of SNAP in preventing hunger, and the nutrition-related struggles that SNAP participants face. Store owners/managers had a generally favorable response towards the proposed stricter stocking standards. Additional themes discussed pertained to the concern about whether stocking changes would lead SNAP participants to purchase more healthful food and some logistical challenges related to sourcing and storing perishable foods.
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Caspi CE, De Marco M, Durfee T, Oyenuga A, Chapman L, Wolfson J, Myers S, Harnack LJ. A Difference-in-Difference Study Evaluating the Effect of Minimum Wage Policy on Body Mass Index and Related Health Behaviors. OBSERVATIONAL STUDIES 2021; 7:https://obsstudies.org/wp-content/uploads/2021/02/caspi_obs_studies_published.pdf. [PMID: 33665650 PMCID: PMC7929481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Minimum wage laws are a promising policy lever to promote health equity, but few rigorous evaluations have tested whether and how minimum wage policy affects health outcomes. This paper describes an ongoing difference-in-difference study evaluating the health effects of the 2017 Minneapolis Minimum Wage Ordinance, which incrementally increases the minimum wage to $15/hr. We present: (1) the conceptual model guiding the study including mediating mechanisms, (2) the study design, and (3) baseline findings from the study, and (4) the analytic plan for the remainder of the study. This prospective study follows a cohort of 974 low-wage workers over four years to compare outcomes among low-wage workers in Minneapolis, Minnesota, and those in a comparison city (Raleigh, North Carolina). Measures include height/weight, employment paystubs, two weeks of food purchase receipts, and a survey capturing data on participant demographics, health behaviors, and household finances. Baseline findings offer a profile of individuals likely to be affected by minimum wage laws. While the study is ongoing, the movement to increase local and state minimum wage is currently high on the policy agenda; evidence is needed to determine what role, if any, such policies play in improving the health of those affected.
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Affiliation(s)
- Caitlin E Caspi
- Rudd Center for Food Policy and Obesity, University of Connecticut, 1 Constitution Plaza, Hartford, CT, 061032
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Dr., Storrs, CT 06269
- Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware St. SE, Minneapolis, MN 55445
| | - Molly De Marco
- Center for Health Promotion & Disease Prevention, University of North Carolina at Chapel Hill, 1700 M.L.K. Jr Blvd #7426, Chapel Hill, NC, 27514
- Department of Nutrition, Gillings School of Global Public Health, UNC-CH, 135 Dauer Dr, Chapel Hill, NC 27599
| | - Thomas Durfee
- The Roy Wilkins Center for Human Relations and Social Justice, Hubert H. Humphrey School of Public Affairs, University of Minnesota, 270 Humphrey Center, 301 19 Avenue South, Minneapolis, MN
- Department of Applied Economics, University of Minnesota, 231 Ruttan Hall, 1994 Buford Avenue, St. Paul, MN
| | - Abayomi Oyenuga
- Department of Applied Economics, University of Minnesota, 231 Ruttan Hall, 1994 Buford Avenue, St. Paul, MN
| | - Leah Chapman
- Center for Health Promotion & Disease Prevention, University of North Carolina at Chapel Hill, 1700 M.L.K. Jr Blvd #7426, Chapel Hill, NC, 27514
- Department of Nutrition, Gillings School of Global Public Health, UNC-CH, 135 Dauer Dr, Chapel Hill, NC 27599
| | - Julian Wolfson
- Division of Biostatistics, School of Public Health, University of Minnesota, A460 Mayo Building MMC 303, 425 Delaware St. SE, Minneapolis, MN
| | - Samuel Myers
- The Roy Wilkins Center for Human Relations and Social Justice, Hubert H. Humphrey School of Public Affairs, University of Minnesota, 270 Humphrey Center, 301 19 Avenue South, Minneapolis, MN
- Department of Applied Economics, University of Minnesota, 231 Ruttan Hall, 1994 Buford Avenue, St. Paul, MN
| | - Lisa J Harnack
- Division of Epidemiology and Community Health, Suite 300, University of Minnesota, 1300 South 2nd St, Minneapolis, MN
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Parks CA, Mitchell E, Byker Shanks C, Nugent NB, Fricke HE, Yaroch AL. Descriptive Characteristics of Nutrition Incentive Projects Across the U.S.: A Comparison Between Farm Direct and Brick and Mortar Settings. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2021; 58:469580211064131. [PMID: 34928711 PMCID: PMC8725024 DOI: 10.1177/00469580211064131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study is to describe the programmatic characteristics of current nutrition incentive projects supported by the Gus Schumacher Nutrition Incentive Program (GusNIP). Specifically, implementation characteristics of nutrition incentive projects that were funded in 2019 were compared across brick and mortar (B&M) and farm direct (FD) sites in the United States. Across 10 nutrition incentive (NI) grantees, there were 621 sites that reported data from B&M (n = 156) and FD (n = 465) locations. Among B&M sites, the common food retail types included: large chain traditional supermarket (n = 49) and independent traditional supermarket (n = 46). Among FD sites, the most frequently reported food retail types were farmers markets (n = 371). For B&M sites, the most common financial instruments were loyalty cards (n = 67, 43.5%), followed by an automatic discount at the register (n = 41, 26.6%), and coupons (n = 29, 18.8%). FD sites frequently reported physical financial instruments including tokens (n = 272, 61.1%), followed by paper vouchers (n = 131, 29.4%). Supplemental Nutrition Assistance Program (SNAP) purchases that were eligible to trigger incentives included mainly “all fresh FVs” at B&M sites (n = 98, 48.5%) and “all SNAP eligible items” at FD sites (n = 417, 85.8%). FVs eligible for incentive redemption included mainly “all fresh FVs” for both B&M sites (n = 110, 65.5%) and FD sites (n = 370, 67.6%). In terms of incentive-to-SNAP level ratio, both B&M sites and FD sites reported that they commonly utilized a 1:1 incentive-to-SNAP level ratio (n = 106, 68.8% and n = 261, 94.9% respectively). This paper will provide foundational understanding of the heterogeneity of GusNIP NI projects—specifically between B&M and FD settings—in order to inform future national work and ultimately demonstrate the impact of NI projects on food security status and dietary quality.
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Affiliation(s)
| | | | | | | | | | - Amy L. Yaroch
- Gretchen Swanson Center for Nutrition in Omaha, NE, USA
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Chen Y, Lin B, Mancino L, Ver Ploeg M, Zhen C. Nutritional quality of retail food purchases is not associated with participation in the Supplemental Nutrition Assistance Program for nutrition-oriented households. PLoS One 2020; 15:e0240263. [PMID: 33338058 PMCID: PMC7748149 DOI: 10.1371/journal.pone.0240263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/22/2020] [Indexed: 11/23/2022] Open
Abstract
The Supplemental Nutrition Assistance Program (SNAP) provides millions of low-income Americans food benefits and other forms of nutrition assistance. Evidence indicates that SNAP reduces food insecurity. However, there is a concern that the food benefit may increase the demand for less healthy foods more than healthier foods, thereby reducing the overall nutritional quality of the participant's food basket. This paper aims to examine the association of SNAP participation with the nutritional quality of food-at-home purchases of low-income households and to investigate the potential heterogeneity among consumers with different levels of nutrition attitude. This analysis used food purchase data from the USDA National Household Food Acquisition and Purchase Survey (FoodAPS). Our study sample included 2,218 low-income households, of which 1,184 are SNAP participants, and 1,034 are income-eligible nonparticipants. Multivariate regressions were performed to explore the SNAP-nutritional quality association. A household's nutrition attitude was measured using its response to a question on whether the household searched for nutrition information online in the last 2 months. Households that affirmed they had an online nutrition search were treated as nutrition-oriented households (21.2% of the low-income sample), and households that did not were considered less nutrition-oriented households (78.8%). For robustness, we also created an alternative nutrition attitude measure based on reported use of the nutrition facts label. We found that among less nutrition-oriented households, SNAP participants had a statistically significant 0.097 points (p = 0.018) lower Guiding Stars rating than low-income nonparticipants. However, there was no significant SNAP-nutritional quality association among nutrition-oriented households. In conclusion, SNAP participation was associated with lower nutritional quality of food purchases among less nutrition-oriented households, but not among nutrition-oriented households. The results suggest that the intended nutritional benefits of restrictions on purchases of healthy foods may not reach the subgroup of nutrition-oriented SNAP participants.
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Affiliation(s)
- Yu Chen
- Formerly with Department of Agricultural and Applied Economics, University of Georgia, Athens, GA, United States of America
| | - Biing‐Hwan Lin
- Formerly with Economic Research Service, U.S. Department of Agriculture, Washington, DC, United States of America
| | - Lisa Mancino
- Formerly with Economic Research Service, U.S. Department of Agriculture, Washington, DC, United States of America
| | - Michele Ver Ploeg
- Food and Health Policy Institute, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States of America
| | - Chen Zhen
- Department of Agricultural and Applied Economics, University of Georgia, Athens, GA, United States of America
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Murray EK, Baker SS, Betts NM, Hess A, Auld G. Development of a National Dietary Behaviors Questionnaire for EFNEP Adult Participants. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:1088-1099. [PMID: 32763052 DOI: 10.1016/j.jneb.2020.06.003] [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: 01/08/2020] [Revised: 06/03/2020] [Accepted: 06/09/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Develop and establish the reliability and validity of dietary behavior evaluation questions for the Expanded Food and Nutrition Education Program (EFNEP). DESIGN A mixed-methods study using cognitive interviews, expert panels, test/retest reliability, and pretests/posttests. SETTING 14 states across the US. PARTICIPANTS A convenience sample of low-income EFNEP or EFNEP-eligible participants for cognitive interviews (n = 111), reliability testing (n = 181), and sensitivity to change testing (n = 382). MAIN OUTCOMES MEASURES Indicators of face and content validity, temporal reliability, and sensitivity to change. ANALYSIS Questions interpreted as intended in cognitive interviews, intraclass correlation coefficient and Spearman rank-order correlation for reliability testing; paired t tests or Wilcoxon signed-rank tests for sensitivity to change; and exploratory factor analyses to identify possible scales. RESULTS Cognitive interviews resulted in 3 rounds of question revisions; reliability value ranges were 0.48-0.77 for intraclass correlation coefficient and 0.43-0.77 for Spearman rank-order correlation. For sensitivity to change, 9 items had evidence of change (P < 0.05) between pretests and posttests, whereas 5 items had evidence for change after removing those with little room to change. Two scales were identified: diet quality and non-cheese dairy. CONCLUSIONS AND IMPLICATIONS The EFNEP's new dietary behavior evaluation questions demonstrated face and content validity, moderate to strong reliability, and sensitivity to detect self-reported behavior changes among low-income, diverse populations (culturally, racially/ethnically, and level of education) across 14 states. Nutrition education programs targeting similar behaviors with English speaking clients could consider this dietary behavior questionnaire.
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Affiliation(s)
- Erin K Murray
- Department of Nutrition, Metropolitan State University of Denver, Denver, CO
| | - Susan S Baker
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO.
| | - Nancy M Betts
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK
| | - Ann Hess
- Department of Statistics, Colorado State University, Fort Collins, CO
| | - Garry Auld
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO
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Kotykova O, Babych M, Krylova I. Forming the system of food security indicators following the criteria of the SDGs-2030. POTRAVINARSTVO 2020. [DOI: 10.5219/1443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Effective management of any system is impossible without a clear definition of its elements, hierarchical levels, and desired performance indicators. Considering this problem in the context of food security management, the authors set out to create a system of food security indicators at different hierarchical levels. The purpose of the article is to deepen theoretical and methodological provisions and develop a system of indicators as a component of food security management at different levels, which should meet the criteria and dimensions of the SDGs-2030. The methodological basis of the research is the dialectical method and general scientific and special methods of scientific knowledge. The results obtained are of great practical importance in shaping national and regional food security policies (programs) on a sustainable development basis. Proceeding from the results of the research and the scientific and theoretical positions of the epistemological content of the category of the concept “food security”, taking into account the criteria of food security of formation at different hierarchical levels and methodological aspects of its monitoring, it is proposed 54 indicators.
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Awareness and use of nutrition information predict measured and self-rated diet quality of older adults in the USA. Public Health Nutr 2020; 24:1687-1697. [PMID: 33203482 DOI: 10.1017/s1368980020004681] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To examine: (1) diet quality of older adults, using the Healthy Eating Index 2010 (HEI-2010) and self-rated diet quality, (2) characteristics associated with reported awareness and use of nutrition information and (3) factors associated with HEI score and self-rated diet quality. DESIGN Cross-sectional study. Based on Day 1 and/or Day 2 dietary recalls, the Per-Person method was used to estimate HEI-2010 component and total scores. T-tests and ANOVA were used to compare means. Logistic and linear regressions were used to test for associations with diet quality, controlling for potential confounders. SETTING National Health and Nutrition Examination Survey, 2009-2014. PARTICIPANTS Three thousand and fifty-six adults, aged 60 years and older, who completed at least one 24-h recall and answered questions on awareness and use of nutrition information. RESULTS Mean HEI score for men was significantly lower than for women (56·4 ± 0·6 v. 60·2 ± 0·6, P < 0·0001). Compared with men, more women were aware of (44·8 % v. 33·7 %, P < 0·05) and used (13·7 % v. 5·9 %, P < 0·05) nutrition information. In multivariable analyses, awareness and use of nutrition information were significant predictors of both HEI and self-rated diet quality for both women and men. Groups with lower nutrition awareness included men, non-Whites, participants in nutrition assistance programmes and those with lower education and socio-economic status. CONCLUSIONS Nutrition awareness and use of nutrition information are associated with diet quality in adults 60 years and older. Gaps in awareness of dietary guidelines in certain segments of the older adult population suggest that targeted education may improve diet quality for these groups.
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Horino M, Liu SY, Lee EY, Kawachi I, Pabayo R. State-level income inequality and the odds for meeting fruit and vegetable recommendations among US adults. PLoS One 2020; 15:e0238577. [PMID: 32903265 PMCID: PMC7480846 DOI: 10.1371/journal.pone.0238577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/19/2020] [Indexed: 11/19/2022] Open
Abstract
Background Previous research indicates that income inequality is associated with risk for mortality, self-rated health status, chronic conditions, and health behavior, such as physical activity. However, little is known about the relationship between income inequality and dietary intake, which is a major risk factor for common chronic diseases including heart disease, stroke, diabetes, and certain types of cancers. The objective of this study is to determine the association between US state income inequality and fruit and vegetable consumption among adults. Methods Cross-sectional data on 270,612 U.S. adults from the U.S. 2013 Behavioral Risk Factor Surveillance System was used. Fruit and vegetable consumption was assessed from the six-item fruit and vegetable frequency questionnaire, which is part of the Behavioral Risk Factor Surveillance System. Multilevel modeling was used to determine whether US state-level income inequality (measured by the z-transformation of the Gini coefficient) was associated with fruit and vegetable consumption adjusting for individual-level and state-level covariates. Results In comparison to men, women were more likely to consume fruits and vegetables ≥5 times daily, fruits ≥2 times daily, vegetables ≥3 times of daily, and less likely to consume fruit juice daily. Among both men and women, a standard deviation increase in Gini coefficient was associated with an increase in consuming fruit juice daily (OR = 1.07, 95% CI = 1.03, 1.11). However, among women, a standard deviation increase in Gini coefficient was associated with a decreased likelihood in meeting daily recommended levels of both fruits and vegetables (OR = 0.93; 0.87–0.99), fruits only (OR = 0.95; 95% CI, 0.92–0.99) and vegetables only (OR = 0.92; 95% CI, 0.89–0.96). Conclusions This study is one of the first to show the relationship between income inequality and fruit and vegetable consumption among U.S. adults empirically. Women’s health is more likely to be detrimentally affected when living in a state with higher income inequality.
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Affiliation(s)
- Masako Horino
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- School of Community Health Sciences, University of Nevada, Reno, Reno, NV, United States of America
| | - Sze Yan Liu
- Public Health Department, Montclair State University, New York, NY, United States of America
- Weill Cornell Medical College, New York City, NY, United States of America
| | - Eun-Young Lee
- School of Kinesiology & Health and Department of Gender Studies, Queen's University Kingston, ON, Canada
| | - Ichiro Kawachi
- Department of Social Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Roman Pabayo
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- * E-mail:
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Wolfson JA, Leung CW, Richardson CR. More frequent cooking at home is associated with higher Healthy Eating Index-2015 score. Public Health Nutr 2020; 23:2384-2394. [PMID: 31918785 PMCID: PMC11374573 DOI: 10.1017/s1368980019003549] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine the association between cooking frequency and Healthy Eating Index (HEI)-2015, overall and by income, among US adults. DESIGN Cross-sectional analysis using multivariable linear regression models to examine the association between cooking frequency and total HEI-2015 score adjusted for sociodemographic variables, overall and stratified by income. SETTING Nationally representative survey data from the USA. PARTICIPANTS Adults aged ≥20 years (with 2 d of 24 h dietary recall data) obtained from the 2007 to 2010 National Health and Nutrition Examination Survey (n 8668). RESULTS Compared with cooking dinner 0-2 times/week, greater cooking frequency was associated with higher HEI-2015 score overall (≥7 times/week: +3·57 points, P < 0·001), among lower-income adults (≥7 times/week: +2·55 points, P = 0·001) and among higher-income adults (≥7 times/week: +5·07 points, P < 0·001). Overall, total HEI-2015 score was higher among adults living in households where dinner was cooked ≥7 times/week (54·54 points) compared with adults living in households where dinner was cooked 0-2 times/week (50·57 points). In households in which dinner was cooked ≥7 times/week, total HEI-2015 score differed significantly based on income status (lower-income: 52·51 points; higher-income: 57·35 points; P = 0·003). Cooking frequency was associated with significant differences in HEI-2015 component scores, but associations varied by income. CONCLUSIONS More frequent cooking at home is associated with better diet quality overall and among lower- and higher-income adults, although the association between cooking and better diet quality is stronger among high-income adults. Strategies are needed to help lower-income Americans consume a healthy diet regardless of how frequently they cook at home.
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Affiliation(s)
- Julia A Wolfson
- University of Michigan School of Public Health, Department of Health Management and Policy, 1415 Washington Heights Avenue, SPH II M3240, Ann Arbor, MI 48109, USA
- University of Michigan School of Public Health, Department of Nutritional Sciences, Ann Arbor, MI, USA
| | - Cindy W Leung
- University of Michigan School of Public Health, Department of Nutritional Sciences, Ann Arbor, MI, USA
| | - Caroline R Richardson
- University of Michigan School of Medicine, Department of Family Medicine, Ann Arbor, MI, USA
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Singleton CR, Young SK, Kessee N, Springfield SE, Sen BP. Examining disparities in diet quality between SNAP participants and non-participants using Oaxaca-Blinder decomposition analysis. Prev Med Rep 2020; 19:101134. [PMID: 32528823 PMCID: PMC7280767 DOI: 10.1016/j.pmedr.2020.101134] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/15/2020] [Accepted: 05/23/2020] [Indexed: 11/26/2022] Open
Abstract
Recent studies have reported that SNAP participants have poorer diet quality than non-participants. This study aimed to examine how differences in socio-demographic, household, and health-related measures explain disparities in diet quality between SNAP participants and non-participants using Oaxaca-Blinder decomposition analysis. We analyzed cross-sectional data on 14,331 adult respondents of the National Health and Nutrition Examination Survey (NHANES) 2009 - 2014. To measure diet quality, we applied the Healthy Eating Index (HEI)-2015 to respondents' 24-hour dietary recall data (scale: 0-100 points). We used Oaxaca-Blinder decomposition analysis to determine how much of the disparity in HEI-2015 total score between SNAP participants and non-participants was explained by socio-demographic (e.g., age, race/ethnicity, educational), household (e.g., household size, food security status), and health-related measures (e.g., BMI, smoking status). Analyses performed revealed significant differences in HEI-2015 total score by SNAP participation status (p < 0.001). We found that the total gap in HEI-2015 total score between SNAP participants and income-ineligible non-participants was 6.30 points. Socio-demographic measures alone explained 72.40% of the disparity. All measures together explained 86.31% of the disparity. The total gap between SNAP participants and income-eligible non-participants was 3.24 points. Socio-demographic measures alone explained 35.51% of this disparity while all measures together explained 56.86%. We observed disparities in diet quality between SNAP participants and non-participants. Socio-demographic, household, and health-related measures explained a significant amount of the disparity that existed between SNAP participants and income-ineligible non-participants; they explained less of the disparity between SNAP participants and income-eligible non-participants.
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Affiliation(s)
- Chelsea R. Singleton
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, 1206 S Fourth St., Champaign, IL 61820, USA
| | - Sabrina K. Young
- Division of Health Policy and Administration, University of Illinois at Chicago, 1603 W Taylor Street, Chicago, IL 60612, USA
| | - Nicollette Kessee
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 W Taylor St., Chicago, IL 60612, USA
| | - Sparkle E. Springfield
- Stanford Prevention Research Center, Stanford University, 3300 Hillview Avenue, Palo Alto, CA 94304, USA
| | - Bisakha P. Sen
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL 35294, USA
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Fruit and Vegetable Purchasing Patterns and Supplemental Nutrition Assistance Program Participation: Findings From a Nationally Representative Survey. J Acad Nutr Diet 2020; 120:1633-1642. [PMID: 32736954 DOI: 10.1016/j.jand.2020.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Previous studies suggest that Supplemental Nutrition Assistance Program (SNAP) participants purchase less produce than nonparticipants. Whether this is due to buying smaller amounts or to being less likely to buy any produce is unclear. Purchase patterns may also differ over the monthly distribution cycle. OBJECTIVE To examine differences in the likelihood and amounts of fruits and vegetables purchased between SNAP household compared with nonparticipant households and to determine differences in produce purchases among SNAP households at different time points in the monthly distribution cycle. DESIGN Cross-sectional. PARTICIPANTS/SETTING Data from 4708 households in the National Household Food Acquisition and Purchase Survey (April 2012 to January 2013). Participants recorded all foods acquired over 7 days. MAIN OUTCOME MEASURES Fruits and vegetables acquired over a 7-day period. STATISTICAL ANALYSES PERFORMED Weighted logistic and linear regression models adjusting for household and primary respondent characteristics were used to compare odds of purchasing fruits and vegetables and amounts purchased across 3 categories: SNAP participants, SNAP-eligible nonparticipants, and ineligible nonparticipants. SNAP participants were further subdivided according to weeks since last receiving benefits. RESULTS In adjusted analyses, SNAP participants and nonparticipants were similarly likely to purchase fruits and vegetables. However, SNAP households within a week of receiving benefits were more likely than SNAP households later in the benefit cycle to buy fruit overall, especially frozen or canned fruit, and vegetables overall, including fresh, frozen or canned, starchy, and nonstarchy vegetables (fruit odds ratio [OR] 1.68, 95% confidence interval [CI] 1.12, 2.53; vegetable OR 1.63, 95% CI 1.04, 2.55 vs households in middle of cycle). In contrast, those in the last week of the benefit cycle were less likely to purchase fruit, especially fresh fruit, and vegetables, especially fresh and nonstarchy vegetables (fruit OR 0.58, 95% CI 0.35, 0.94; vegetable OR 0.58, 95% CI 0.42, 0.79 vs. households in middle of cycle), and when they bought vegetables, they bought significantly less. CONCLUSION Considering all SNAP households together at different points in their distribution cycle masks substantial declines in purchasing fruits and vegetables over the monthly cycle.
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Fernández CR, Chen L, Cheng ER, Charles N, Meyer D, Monk C, Woo Baidal J. Food Insecurity and Sugar-Sweetened Beverage Consumption Among WIC-Enrolled Families in the First 1,000 Days. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:796-800. [PMID: 32444189 PMCID: PMC7423699 DOI: 10.1016/j.jneb.2020.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Determine the association between household food insecurity and habitual sugar-sweetened beverage (SSB) consumption among Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)-enrolled families during the first 1,000 days. METHODS Cross-sectional analysis of pregnant women and mothers of infants aged under 2 years in the WIC was performed. Families recruited sequentially at consecutive visits completed food insecurity and beverage intake questionnaires; estimated logistic regression models controlled for sociodemographic characteristics. RESULTS Of 394 Hispanic/Latino mothers and 281 infants, 63% had household food insecurity. Food insecurity significantly increased odds of habitual maternal (unadjusted odds ratio (OR), 2.39; 95% CI, 1.27-4.47; P = .01) and infant SSB consumption (OR, 2.05; 95% CI, 1.15-3.65; P = .02), and the relationship was not attenuated by maternal age, education, or foreign-born status. CONCLUSIONS AND IMPLICATIONS Food insecurity increased odds of habitual SSB consumption in WIC families. Interventions to curb SSB consumption among WIC-enrolled families in the first 1,000 days in the context of household food insecurity are needed.
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Affiliation(s)
- Cristina R Fernández
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Ling Chen
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Erika R Cheng
- Division of Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Nalini Charles
- NewYork-Presbyterian Hospital Special Supplemental Nutrition Program for Women, Infants, and Children, New York, NY
| | - Dodi Meyer
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY; New York State Psychiatric Institute, New York, NY
| | - Jennifer Woo Baidal
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY.
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Gray VB, Hardman AM, Byrd SH. Qualitative Evaluation of Drivers of Eating Decisions among SNAP Participants in Mississippi. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:775-787. [PMID: 32507480 DOI: 10.1016/j.jneb.2020.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 04/03/2020] [Accepted: 04/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To explore food-related decision patterns among Supplemental Nutrition Assistance Program (SNAP) recipients in Mississippi. DESIGN A qualitative design was used to conduct focus groups (n = 18) based on the Health Belief Model with low-income female caregivers of children aged under 13 years. SETTING Mississippi. PARTICIPANTS Cluster sampling was used to recruit participants (n = 126) from the 4 regional divisions of Mississippi State University Extension. PHENOMENON OF INTEREST Drivers of eating decisions among SNAP participants. ANALYSIS Focus groups were recorded, transcribed, and coded by 2 independent coders using thematic analysis. RESULTS Drivers of food selection often overlapped with barriers to healthy eating. Participants used many strategies to manage costs and viewed healthy foods as out of reach and quick to perish. Cost, taste preferences, habits, and family factors were primary drivers of food selection and preparation; each of these presented barriers to healthier eating. Health was most often shared as a driver of food selection once disease was established. Participants reported a variety of strategies used in striving for healthier eating. CONCLUSIONS AND IMPLICATIONS Focusing on ways to manage the costs of healthy foods, honor taste preferences, and work within habits/families may enhance efforts to support healthy eating among SNAP participants.
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Affiliation(s)
- Virginia B Gray
- Department of Family and Consumer Sciences, California State University Long Beach, Long Beach, CA.
| | - Alisha M Hardman
- School of Human Sciences, Mississippi State University, Mississippi State, MS
| | - Sylvia H Byrd
- Office of Nutrition Education, Mississippi State University Extension Service, Mississippi State, MS
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Food security moderates relationship between perceived food environment and diet quality among adults in communities with low access to healthy food retail. Public Health Nutr 2020; 24:2975-2986. [PMID: 32611453 DOI: 10.1017/s1368980020001317] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the relationship between food security status, diet quality measured using Healthy Eating Index-2010 (HEI-2010) scores, demographics and the following factors: perceptions of healthy food availability, healthy eating identity and perceived control of healthy eating. DESIGN A cross-sectional study in 2016-2017 using three 24-h dietary recalls and one psychosocial survey. SETTING Two urban communities in Cleveland and Columbus, Ohio, USA, with low access to healthy food retailers. PARTICIPANTS Primary food shoppers living in the targeted geographic areas (N 450). RESULTS Our results indicated that high school graduates had lower HEI-2010 scores compared with participants who had some college education or more (β = -2·77, P = 0·02). Participants receiving Supplemental Nutrition Assistance Program (SNAP) benefits had lower HEI-2010 scores (β = -2·69, P = 0·03). Healthy eating identity was associated with higher HEI-2010 scores (β = 1·85, P = 0·004). Food security status moderated the relationship between perception of healthy food availability and HEI-2010 scores. Among participants with very low food security (VLFS), greater perceptions of healthy food availability were associated with higher HEI-2010 scores (β = 3·25, P = 0·03), compared with food secure participants. Only 14 % of VLFS participants used a personal vehicle as transportation to their primary food shopping store. CONCLUSIONS Findings offer targets for future intervention development and evaluation to promote community nutrition. These targets include strategies to improve the value of SNAP benefits, promote access to quality education, increase transportation options to healthy food retailers and develop nutrition programming to promote healthy eating identity.
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Twarog JP, Peraj E, Vaknin OS, Russo AT, Woo Baidal JA, Sonneville KR. Consumption of sugar-sweetened beverages and obesity in SNAP-eligible children and adolescents. Prim Care Diabetes 2020; 14:181-185. [PMID: 31439469 DOI: 10.1016/j.pcd.2019.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/11/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Low-income individuals who are eligible for nutrition assistance have been shown to consume a larger portion of their daily calories from beverages with added sugar. We examined the association between Supplemental Nutrition Assistance Program (SNAP) participation and self-reported sugar sweetened beverage (SSB) consumption as well as the association between self-reported consumption of SSBs and overweight/obesity in low-income children. DESIGN Cross-sectional analysis of 1455 SNAP-eligible U.S. children, ages 2-17, who completed a questionnaire and physical examination during the 2009-2010 National Health and Nutrition Examination Survey (NHANES). RESULTS SNAP-eligible children who received SNAP in the last month were more likely to drink soda in the last month [76.0% (2.2)] than those who did not receive benefits [70.5% (2.8)]. These children were also more likely to drink fruit drinks [74.8% (1.6) vs. 69.3% (3.1)]. Among youth in households receiving SNAP benefits, soda consumption in the past month was associated with a greater risk of obesity, particularly Hispanic youth [OR=1.93 (1.07, 3.50), p=0.0314] aged 2-5 [OR=2.71 (1.29, 5.69), p=0.0114]. Additionally, among youth in households receiving SNAP benefits, male children who consumed sugar-sweetened fruit drinks in the past month were significantly more likely to be overweight [3.13 (1.12, 8.73), p=0.0315] as compared to male peers who did not consume any sugar sweetened fruit drinks. CONCLUSION Among youth, SNAP recipients drink more SSBs than their eligible non-recipient peers. Our results indicate that certain populations of children receiving SNAP benefits and consuming SSBs are more likely to be overweight or obese when compared to their peers who receive SNAP benefits but do not consume SSBs.
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Affiliation(s)
- John P Twarog
- New York College of Podiatric Medicine, New York, NY, USA.
| | - Elizabet Peraj
- New York College of Podiatric Medicine, New York, NY, USA
| | - Oren S Vaknin
- New York College of Podiatric Medicine, New York, NY, USA
| | - Ashley T Russo
- New York College of Podiatric Medicine, New York, NY, USA
| | - Jennifer A Woo Baidal
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Columbia University Medical Center, New York, NY, USA
| | - Kendrin R Sonneville
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Crandall AK, Temple JL, Kong KL. The association of food insecurity with the relative reinforcing value of food, BMI, and gestational weight gain among pregnant women. Appetite 2020; 151:104685. [PMID: 32229225 DOI: 10.1016/j.appet.2020.104685] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Food insecurity is associated with obesity among adults. During pregnancy, food insecurity increases obesity risk among mothers and infants. This study investigated the association of food security with pre-pregnancy body mass index (BMI), gestational weight gain (GWG) adequacy to date, and the relative reinforcing value (RRV) of food during pregnancy. METHODS This secondary data analysis examined 258 pregnant women (mean gestational age = 21.21 ± 10.21 weeks) surveyed on pre-pregnancy weight, height, pregnancy due date and GWG to date, current diagnoses related to eating and pregnancy, and demographics. The survey also assessed current food security and RRV of meals, snacks, cognitive activities, and active activities. BMI was calculated from pre-pregnancy height and weight (kg/m2). Gestational weight gain adequacy to date was derived from the Institute of Medicine guidelines. Multivariable linear regression models were used to examine the relation of food security with pre-pregnancy BMI and RRVs of foods/activities. The relation between food security and GWG adequacy to date was examined using multinomial regression models. RESULTS Lower food security was related to both greater pre-pregnancy BMI (β = 0.60, p < .001) and greater RRV of snack foods (β = 3.46, p < .05), after controlling for covariates. Lower food security was also related to GWG to date below recommended levels (OR = 1.25, p < .05). CONCLUSIONS Food insecurity is related to higher relative food reinforcement during pregnancy, and greater pre-pregnancy weight status. Future research should replicate and extend these findings by assessing them longitudinally to better evaluate the directions of these relationships.
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Affiliation(s)
- Amanda K Crandall
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Jennifer L Temple
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA; Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Kai Ling Kong
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, USA.
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Pool LR, Kershaw KN, Gordon-Larsen P, Gutiérrez OM, Reis JP, Isakova T, Wolf M, Carnethon MR. Racial Differences in the Associations Between Food Insecurity and Fibroblast Growth Factor 23 in the Coronary Artery Risk Development in Young Adults Study. J Ren Nutr 2020; 30:509-517. [PMID: 32147284 DOI: 10.1053/j.jrn.2020.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/20/2019] [Accepted: 01/12/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Food insecurity is associated with consumption of phosphate additive-laden processed food and beverage products, which could result in higher levels of fibroblast growth factor 23 (FGF23) to compensate for the increased dietary phosphate load. We sought to determine whether food insecurity is associated with higher levels of FGF23. We stratified analyses by race since differences may occur between food insecurity and diet quality across races. DESIGN AND METHODS The longitudinal community-based Coronary Artery Risk Development in Young Adults Study recruited from 4 US centers: Birmingham, AL; Chicago, IL; Minneapolis, MN; and Oakland, CA, during the cohort inception in 1985/1986. This analysis included 3,421 black and white participants from Coronary Artery Risk Development in Young Adults follow-up years 20, 25, and 30 who were enrolled in the study between the ages of 18 and 30 years. Econometric fixed effects models stratified by race that adjust by design for all time-invariant covariates were used to model the longitudinal association of food insecurity, defined as the self-reported ability to afford desired quantity and quality of food. The main outcome of interest was changing to the highest quartile of plasma FGF-23 concentrations. RESULTS During follow-up, 29% of blacks and 14% of whites experienced change in food security. Developing food insecurity was associated with a 1.48 greater odds of increasing to the highest quartile of FGF23 (95% confidence interval 1.02-2.15) among blacks; however, there was no significant longitudinal association among whites (odds ratio = 1.14, 95% confidence interval 0.67-1.95). CONCLUSIONS Among blacks, food insecurity was associated with an increase in levels of FGF23. Although phosphate consumption was presumed to mediate the association between food insecurity and FGF23 levels, we were unable to directly test this pathway.
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Affiliation(s)
- Lindsay R Pool
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Penny Gordon-Larsen
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Orlando M Gutiérrez
- Department of Medicine and Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jared P Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Tamara Isakova
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Myles Wolf
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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