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Corea P, Reyes GA, Pinto G, Peterson B, Prescott MP, Dolan K, Stasiewicz MJ. Milk Spoilage Model Predicts that Share Tables Would Not Meaningfully Increase Spoilage and Improved Storage Systems Can Reduce Spoilage. J Dairy Sci 2024:S0022-0302(24)01069-5. [PMID: 39154718 DOI: 10.3168/jds.2024-25189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 07/24/2024] [Indexed: 08/20/2024]
Abstract
School share tables offer opportunities for food recovery and increased access to healthy foods by allowing students to donate or consume unopened items, such as cartons of milk. However, stakeholders have concerns about temperature abuse potentially causing premature milk spoilage. While previous research showed short ambient temperature abuse of milk (under conditions representing share tables) does not meaningfully impact microbial milk quality, differences across school cafeterias (e.g., ambient temperatures, storage systems, bell schedules, refrigeration temperature) may limit the generalizability of this conclusion. To address this, the overnight refrigeration temperature and the milk's initial contamination were predicted to be the main drivers for milk spoilage. Share tables were predicted to only cause inconsequential microbial quality changes (4 spoiled milk per million served, which would be ≤2 milk cartons spoiled per school year) under short and medium bell schedules (≤125 min of total service), even without temperature control during the lunch period. Under long (221 min) and very long (266 min) bell schedules, share tables with ambient temperature storage were predicted to have higher milk spoilage (19 and 42 spoiled milk cartons per million served, respectively), and adding storage systems was predicted to reduce the decline in milk quality (12 and 24 spoiled milk cartons per million served, respectively). These results provide a resource to support science-based decision-making for the inclusion of milk in school cafeteria share tables, ultimately working to reduce food waste and address food insecurity.
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Affiliation(s)
- Paola Corea
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Gustavo A Reyes
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Gabriella Pinto
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Ben Peterson
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Melissa Pflugh Prescott
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Kirk Dolan
- Department of Food Science & Human Nutrition, Michigan State University, East Lansing, Michigan, MI, USA
| | - Matthew J Stasiewicz
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL, USA..
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Chou YC, Cheng FS, Weng SH, Yen YF, Hu HY. Impact of household income on the risk of overweight and obesity over time among preschool-aged children: a population-based cohort study. BMC Public Health 2024; 24:549. [PMID: 38383321 PMCID: PMC10882872 DOI: 10.1186/s12889-024-18010-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/06/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND The temporality of household income level with overweight/obesity in children has not been extensively studied. Little research has been conducted to determine the impact of household income on the risk of childhood overweight/obesity over time. This population-based cohort study aimed to investigate the impact of household income on the risk of overweight/obesity over time among preschool-aged children in Taiwan. METHODS From 2009 to 2018, we recruited 1,482 preschool-aged children ( ≦ 7 y of age) from low-income households and selected age- and sex-matched controls from non-low-income households for comparison; All participants were selected from those who consistently participated in the Taipei Child Development Screening Program and were monitored for overweight/obesity using body mass index (BMI) until December 31, 2018. Low-income households were defined as those with an average monthly disposable income < 60% of the minimum standard of living expense in Taiwan. The primary outcome was childhood overweight or obesity in study participants, defined as BMI (kg/m2) ≥ 85th percentile or ≥ 95th percentile, respectively. The generalized estimating equations (GEE) model was used to determine the impact of low-income households on the risk of overweight/obesity in study participants. RESULTS Over 21,450 person-years of follow-up, 1,782 participants developed overweight /obesity, including 452 (30.5%) and 1,330 (22.4%) children from low- and non-low-income households, respectively. The GEE model showed that the first group had a significantly higher risk of becoming overweight/obese than the other during the follow-up period (adjusted odds ratio [aOR] = 1.44, 95% CI: 1.29-1.60). Moreover, children of foreign mothers had a higher risk of becoming overweight/obese than those of Taiwanese mothers during the follow-up period (aOR = 1.51, 95% CI: 1.24-1.8). The subgroup analysis revealed a significant association between low-income households and an increased risk of overweight/obesity in children aged 2-7 years (P =.01). However, this association was not observed in children aged 0-1 years (P >.999). CONCLUSIONS During the follow-up period, there was a notable correlation between low-income households and an increased risk of preschool-aged children developing overweight or obesity. Implementing health promotion initiatives aimed at reducing overweight and obesity in this demographic is crucial.
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Affiliation(s)
- Yi-Chang Chou
- Department of Education and Research, Taipei City Hospital, No.145, Zhengzhou Rd., Datong Dist., 103212, Taipei, Taiwan
- University of Taipei, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Feng-Shiang Cheng
- Department of Education and Research, Taipei City Hospital, No.145, Zhengzhou Rd., Datong Dist., 103212, Taipei, Taiwan
- University of Taipei, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Han Weng
- Department of Education and Research, Taipei City Hospital, No.145, Zhengzhou Rd., Datong Dist., 103212, Taipei, Taiwan
- University of Taipei, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yung-Feng Yen
- Department of Education and Research, Taipei City Hospital, No.145, Zhengzhou Rd., Datong Dist., 103212, Taipei, Taiwan
- University of Taipei, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Section of Infectious Diseases, Taipei City Hospital, Yangming Branch, Taipei, Taiwan
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Hsiao-Yun Hu
- Department of Education and Research, Taipei City Hospital, No.145, Zhengzhou Rd., Datong Dist., 103212, Taipei, Taiwan.
- University of Taipei, Taipei, Taiwan.
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Dave JM, Chen TA, Castro AN, White M, Onugha EA, Zimmerman S, Thompson D. Regional Variability in the Prevalence of Food Insecurity and Diet Quality among United States Children. Nutrients 2024; 16:224. [PMID: 38257117 PMCID: PMC10819603 DOI: 10.3390/nu16020224] [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: 11/21/2023] [Revised: 12/29/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
Understanding the association between food security status (FSS) and diet quality in children is crucial. This study investigated regional variability in FSS, participation in the federal nutrition assistance program (FNAP), and diet quality among US children. National Health and Nutrition Examination Survey (NHANES) data from 2013 to 2016 were analyzed. The association between FSS, FNAP participation, and diet quality (Healthy Eating Index-HEI-2015) was assessed using multiple linear/logistic regression models. The sample included 6403 children (mean age: 7.5 years; 51% male; 33% Hispanic). Within the sample, 13% reported child food insecurity, and 30% reported household food insecurity. Additionally, 90% participated in the FNAP, and 88% were enrolled in school lunch programs. Children in urban areas were significantly more likely to report household food insecurity than those in rural areas (29.15% vs. 19.10%). The overall HEI-2015 score was 48.2. The associations between child/household FSS and FNAP participation as well as between child/household FSS and diet quality did not differ by urban/rural residence status, irrespective of the children's age groups. There is a need for improvement in children's diet quality, regardless of age or urban/rural residence. The findings suggest that improving children's diets requires broader action as well as the prioritizing of children in urban areas experiencing food insecurity in future dietary interventions.
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Affiliation(s)
- Jayna M. Dave
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Avenue, Houston, TX 77030, USA; (A.N.C.); (M.W.); (D.T.)
| | - Tzuan A. Chen
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Boulevard, Houston, TX 77204, USA;
- HEALTH Research Institute, University of Houston, 4349 Martin Luther King Boulevard, Houston, TX 77204, USA
| | - Alexandra N. Castro
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Avenue, Houston, TX 77030, USA; (A.N.C.); (M.W.); (D.T.)
| | - Mamie White
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Avenue, Houston, TX 77030, USA; (A.N.C.); (M.W.); (D.T.)
| | - Elizabeth A. Onugha
- Renal Services, Texas Children’s Hospital, 1102 Bates Avenue, Houston, TX 77030, USA;
- Department of Pediatrics—Nephrology, Baylor College of Medicine, 1102 Bates Avenue, Houston, TX 77030, USA
| | - Sloane Zimmerman
- Department of Pediatrics—Gastroenterology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA;
| | - Debbe Thompson
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Avenue, Houston, TX 77030, USA; (A.N.C.); (M.W.); (D.T.)
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Hopkins L, Schier H, May L, Westrick M, O'Piela D, Mazurek Melnyk B, Smith L, Gunther C. Patterns of participation in summer programming among United States' elementary children from low-income urban households: Results from the project SWEAT study. Prev Med Rep 2023; 36:102475. [PMID: 37886725 PMCID: PMC10598049 DOI: 10.1016/j.pmedr.2023.102475] [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: 06/07/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023] Open
Abstract
Food insecurity increases among marginalized children during the summer when school is out of session. Summer programming that offers access to healthy meals and snacks may reduce the risk. There is a national call in the US for more research to assure equitable access to summer programming. The objective of this prospective observational study was to characterize patterns of participation in summer programming among elementary children from low-income urban neighborhoods of metropolitan[Blinded]. Summer programming was broadly defined (e.g., church, school, recreation center, community center). Caregivers(n = 100) received weekly text messages via TextIt during the summer (Jun-Aug 2017). They were asked: "How many days this week did [ChildName] attend a summer program? Please respond with a number from 0 to 5, where 0 - no days, 2 - 2 days, etc." Weekly counts were summed. Stepwise logistic and linear regression models were conducted to examine differences in patterns of attendance according to key sociodemographic characteristics. Mean age was 7.03 ± 0.23. 52 % identified as female, 70 % were low-income, and 80.0 % identified as Black. 51 % attended summer programming at least once; 49 % never attended. Those who attended at least once vs. not at all were more likely to be male(p < 0.01); 62.75 % males vs. 37.25 % females attended summer programming at least once, whereas 67.35 % females compared to 32.65 % males never attended. Overall mean attendance was 10.40 ± 1.43 days(out of 50). Mean + SE attendance was lower for females (7.52 + 1.76) vs. males (13.52 + 2.21)(p < 0.05), and non-Black (4.30 + 1.97) vs. Black (11.93 + 1.67)(p = 0.01) children. Future research is needed to understand barriers to participation in summer programming.
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Affiliation(s)
- Laura Hopkins
- Department of Public Health and Prevention Science, College of Education and Health Sciences, Baldwin Wallace University, USA
| | - Heather Schier
- College of Nursing, Martha S. Pitzer Center for Woman, Children, and Youth, The Ohio State University, USA
| | - Leah May
- College of Nursing, Martha S. Pitzer Center for Woman, Children, and Youth, The Ohio State University, USA
| | - Miranda Westrick
- College of Nursing, Martha S. Pitzer Center for Woman, Children, and Youth, The Ohio State University, USA
| | - Devin O'Piela
- College of Nursing, Martha S. Pitzer Center for Woman, Children, and Youth, The Ohio State University, USA
| | - Bernadette Mazurek Melnyk
- College of Nursing, Martha S. Pitzer Center for Woman, Children, and Youth, The Ohio State University, USA
| | - Laureen Smith
- College of Nursing, Martha S. Pitzer Center for Woman, Children, and Youth, The Ohio State University, USA
| | - Carolyn Gunther
- College of Nursing, Martha S. Pitzer Center for Woman, Children, and Youth, The Ohio State University, USA
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Bennett BL, Cohen JF, Andreyeva T, Esposito J, Burkholder K, Chafouleas SM, Schwartz MB. Predictors of Participation in the U.S. Department of Agriculture Summer Meal Programs: An Examination of Outreach Strategies and Meal Distribution Methods During COVID-19. AJPM FOCUS 2023; 2:100124. [PMID: 37790948 PMCID: PMC10546601 DOI: 10.1016/j.focus.2023.100124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Significantly fewer children participate in the U.S. Department of Agriculture-sponsored summer meal programs than in the federal school meal programs during the academic year. During the summer of 2021, several pandemic-related waivers supported more flexible operations for summer meal programs, such as allowing grab-and-go meals and the distribution of meals for multiple days at once. This study assessed how summer meal site characteristics and geographically targeted outreach methods were associated with summer meals served in 2021 in Connecticut. Methods Weekly meal count data were requested from all sponsors of the Summer Food Service Program and the National School Lunch Program Seamless Summer Option. Data were received from 78 sponsors with 763 sites. Geographically targeted outreach (e.g., billboards, bus ads, and flyers) was tracked by location each week. Mixed methods ANOVA was used to examine the predictive value of outreach efforts, program characteristics, and meal distribution methods on meals served each week. The program characteristics examined included the hours open per week, the number of weeks serving meals, the maximum number of meals distributed at one time, and the number of open and closed sites in a school district. Results Between June 21 and August 20, 2021, a total of 1,188,669 breakfasts and 1,389,347 lunches were served. Sites that were open more hours per week (mean=7.60 hours per week; range=0.17-35) and gave multiple meals to parents at each visit (mean=4.68 meals; range=1-15) reported greater rates of meal distribution. The outreach efforts assessed were not significantly associated with changes in meal distribution at nearby sites. Conclusions The U.S. Department of Agriculture's waivers in response to COVID-19 permitted extended operating hours and multiple-meal distribution. These operational flexibilities should be considered for permanent regulation changes owing to their positive association with summer meal participation.
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Affiliation(s)
- Brooke L. Bennett
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, Connecticut
| | - Juliana F.W. Cohen
- Center for Health Inclusion, Research and Practice (CHIRP), Merrimack College, North Andover, Massachusetts
- Department of Public Health and Nutrition, Merrimack College, North Andover, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Tatiana Andreyeva
- Department of Agricultural and Resource Economics, Rudd Center for Food Policy and Health, University of Connecticut, Hartford, Connecticut
| | - Julia Esposito
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, Connecticut
| | - Kara Burkholder
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, Connecticut
| | - Sandra M. Chafouleas
- Department of Educational Psychology, University of Connecticut, Storrs, Connecticut
| | - Marlene B. Schwartz
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, Connecticut
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut
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Vericker T, Rothstein M, Gabay M, Gola AAH, Lovellette G. USDA Summer Meals Program: Lack of Program Awareness Contributes to Unmet Need Among Nonparticipants. THE JOURNAL OF SCHOOL HEALTH 2023; 93:1137-1144. [PMID: 37290821 DOI: 10.1111/josh.13348] [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: 09/02/2022] [Revised: 03/24/2023] [Accepted: 05/21/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Participation in the US Department of Agriculture's summer meals program is consistently lower compared to National School Lunch Program (NSLP) participation, even though the programs target the same population of children. The purpose of this study was to elucidate reasons for participation and nonparticipation in the summer meals program. METHODS A nationally representative sample of 4688 households with children ages 5 through 18 years living near a summer meals site in 2018 completed a survey about their reasons for participation or nonparticipation in the summer meals program, features that would help nonparticipants to attend, and household food security status. RESULTS Almost half of all households living near a summer meal site were food insecure (45%) and most (77%) had incomes at or below 130% of the federal poverty level. Most participant caregivers (74%) sent their children to summer meal sites for the free meals, while 46% of nonparticipant caregivers said they did not attend because they were unaware of the program. CONCLUSIONS Despite a high level of food insecurity among all households, the most reported reason for not attending the summer meals program was unawareness of the program. These findings highlight a need for better program visibility and outreach.
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Affiliation(s)
| | - Melissa Rothstein
- Westat, 1600 Research Boulevard, Rockville, MD, 20850
- Food and Nutrition Service, USDA, 1320 Braddock Place, Alexandria, VA, 22314
| | - Mary Gabay
- Westat, 1600 Research Boulevard, Rockville, MD, 20850
| | - Alice Ann H Gola
- Food and Nutrition Service, USDA, 1320 Braddock Place, Alexandria, VA, 22314
- Westat, 1600 Research Boulevard, Rockville, MD, 20850
| | - Grant Lovellette
- Food and Nutrition Service, USDA, 1320 Braddock Place, Alexandria, VA, 22314
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Lu SV, Harper KM, Ding Y, Everett J, Gross J, Borman R, Medina-Perez K, Pinzini B, Wilson MJ, Gross SM. The Impact of the COVID-19 Pandemic on the Experiences and Operations of Sponsors of the Summer Food Service Program in Maryland, USA: A Multiphase Mixed Methods Study. Nutrients 2023; 15:nu15071628. [PMID: 37049469 PMCID: PMC10097045 DOI: 10.3390/nu15071628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/19/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
During the COVID-19 pandemic, the Summer Food Service Program (SFSP) was allowed to operate in untraditional non-summer months to ensure children did not lose access to free and reduced-priced nutritious meals when schools were mandated to close in the United States. This study assessed the impact of the pandemic on the operations and experiences of Summer Food Service Program (SFSP) sponsors in the state of Maryland during the COVID-19 pandemic in 2020 (Phase I) and 2021 (Phase II). This study used a multiphase explanatory sequential mixed methods design with qualitative prioritization. Maryland SFSP sponsors completed an online survey (Phase I: n = 27, Phase II: n = 30), and semi-structured in-depth interviews were conducted with a subset of sponsors who completed the survey (Phase I: n = 12, Phase II: n = 7). Inductive and deductive analyses were used for qualitative data, and descriptive statistics were used for quantitative data. The COVID-19 pandemic caused SFSP sponsors to change their operations. Sponsors were primarily concerned about staff safety/burnout and decreased participation. Sponsors perceived waivers implemented by the United States Department of Agriculture to be crucial in enabling them to serve meals to children during the pandemic. The findings from our study support advocacy efforts to permanently implement waivers and provide free school meals for all children.
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The Assessment of School Lunches in the Form of Food Packs during the COVID-19 Pandemic in Latvia. CHILDREN 2022; 9:children9101459. [PMID: 36291394 PMCID: PMC9600045 DOI: 10.3390/children9101459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022]
Abstract
During the pandemic, Latvian schools switched to remote learning which required looking for solutions to provide state-funded school lunches for pupils at home. The aim of study was to analyse the type of support received by pupils for provision of school lunches, the compliance of the composition of food packs with Latvian healthy diet recommendations and parental assessment of the food packs received. With the help of the questionnaire data on the composition of food packs, parental assessment was obtained by interviewing 1495 parents of pupils in grades 1–4 (age 6–11 years). The composition of food packs was evaluated in accordance with the recommendations for a healthy diet. Food packs were the main choice for the provision of school lunches in all regions (90.70%). The emphasis in the food packs was on protein-rich products like canned meat and meat products (93.36%) and milk (91.37%). 81.71% of food packs contained both vegetables and fruits. Food packs covered basic needs but improvements would be needed. The parents appreciated the support received, 90% of them rated it as positive/partially positive. In the event of a pandemic recurrence, the state would need to work with food producers to provide smaller packaging of products for food packs to ensure food diversity.
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Oliva B, Som K. National-Scale Assessment of Environmental Justice Trends in Public School Proximity to Industrial Lead Sources. ENVIRONMENTAL JUSTICE (PRINT) 2022; 16:10.1089/env.2022.0028. [PMID: 36960345 PMCID: PMC10031512 DOI: 10.1089/env.2022.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Lead poisoning can severely affect neurological development in small children. Communities with environmental justice concerns often face higher levels of lead exposure via multiple routes of exposure. School-aged children can be exposed to lead at their schools through the deposition of lead emissions onto soil over time. METHOD Public school students' demographics in 'proximate schools;' those within 1.5 km of facilities with lead emissions were compared to other schools in their area. The average proximate emissions per student were calculated for different demographic groups in various geographic areas. RESULTS Schools in combined statistical areas within 1.5 km of lead facilities were found to be composed of significantly more Black (22%) and Hispanic (30%) students than other schools in the area (17% and 26% respectively). Meanwhile, schools close to lead sources tended to have smaller proportions of white students (37% in 'proximate schools', but 47% overall. When average emissions around students were calculated for a handful of combined statistical areas, inequality in lead exposure could be seen in almost every geographic area, across income and racial lines. DISCUSSION Students of color consistently faced the highest emissions in every area, though amounts, inequities, and at-risk populations differed throughout the different geographic areas. CONCLUSION The unique history of each location regarding immigration, discrimination, zoning laws, urban sprawl, and industrial past can contribute to this variety in inequities. These findings are not only consistent with environmental justice trends but also highlight other vulnerabilities for students like age and food security.
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Affiliation(s)
- Beatriz Oliva
- ORISE Research Participant, Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Kushal Som
- US Environmental Protection Agency, Region 5, Chicago, IL
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Li F, Parthasarathy N, Zhang F, Chuang RJ, Mathur M, Pomeroy M, Noyola J, Markham CM, Sharma SV. Food Insecurity and Health-Related Concerns Among Elementary Schoolteachers During the COVID-19 Pandemic. Prev Chronic Dis 2022; 19:E27. [PMID: 35617680 PMCID: PMC9165471 DOI: 10.5888/pcd19.210392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction US school systems underwent major upheaval, including closures, implementation of virtual and/or hybrid learning, and stringent infection mitigation protocols, during the initial phase of the COVID-19 pandemic. We aimed to examine the association between food insecurity and perceived health, perceived stress, and social determinants of health concerns among elementary schoolteachers serving predominantly low-income children during the COVID-19 pandemic. Methods Brighter Bites, a nonprofit organization that weekly distributes fresh fruits and vegetables and nutrition education materials to more than 300 schools serving racial and ethnic minority populations with low income, conducts annual surveys of participating teachers to help determine subsequent efforts to support schools and families during the school year. We analyzed self-reported data collected electronically by the Brighter Bites teachers survey in 76 elementary schools during summer 2020. We used generalized linear mixed models to measure the association between food insecurity and health-related concerns. Results Of 862 teachers who responded to the survey, 685 answered the 2 questions about food insecurity status; of these, 199 (29.1%) reported experiencing food insecurity. Food insecurity was positively associated with poor perceived general health, greater perceived stress, concerns about various social determinants of health, and changes in fruit and vegetable consumption during the COVID-19 pandemic. Conclusion Our study demonstrated the high prevalence of food insecurity and highlights its associated factors among elementary schoolteachers during the COVID-19 pandemic. It calls attention to the high correlation of various concerns among elementary schoolteachers during the COVID-19 pandemic. Further intervention and policy efforts are needed to relieve food insecurity–related concerns and enhance well-being among teachers.
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Affiliation(s)
- Fangyu Li
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Nivedhitha Parthasarathy
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Feng Zhang
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Ru-Jye Chuang
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Mallika Mathur
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas
| | | | | | - Christine M Markham
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Shreela V Sharma
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Herman Pressler RAS E-643, Houston, TX 77030.
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Comparison of Missing School Meals among Public Schools: How Did New York State Do during COVID-19? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105838. [PMID: 35627375 PMCID: PMC9141843 DOI: 10.3390/ijerph19105838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/29/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022]
Abstract
Background: The COVID-19 pandemic created barriers to participation in school meals. As a result, many students may have missed out on school meals. The objectives of this study are (1) to compare the number of school meals served by New York State public schools during the first spring and summer of the COVID-19 pandemic to the number served before the COVID-19 pandemic, and (2) to determine relationships between the number of meals served and the levels of school district need and urbanicity. Methods: This study is a secondary analysis of administrative data. The percentage change in the number of school breakfasts and lunches served was calculated for each month and by school district need level and urbanicity level. Results: The number of school meals served decreased during the first spring of the pandemic compared to the spring of the previous school year (−43% in April, −51% in May), while the number of school meals served increased during the first summer of the pandemic compared to the summer of the previous school year (+92% in July, +288% in August). Conclusions: Waivers may provide flexibility to increase participation in school meals, especially during the summer.
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Thorndike AN, Gardner CD, Kendrick KB, Seligman HK, Yaroch AL, Gomes AV, Ivy KN, Scarmo S, Cotwright CJ, Schwartz MB. Strengthening US Food Policies and Programs to Promote Equity in Nutrition Security: A Policy Statement From the American Heart Association. Circulation 2022; 145:e1077-e1093. [PMID: 35535604 DOI: 10.1161/cir.0000000000001072] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nutritionally inadequate dietary intake is a leading contributor to chronic cardiometabolic diseases. Differences in dietary quality contribute to socioeconomic and racial and ethnic health disparities. Food insecurity, a household-level social or economic condition of limited access to sufficient food, is a common cause of inadequate dietary intake. Although US food assistance policies and programs are designed to improve food security, there is growing consensus that they should have a broader focus on nutrition security. In this policy statement, we define nutrition security as an individual or household condition of having equitable and stable availability, access, affordability, and utilization of foods and beverages that promote well-being and prevent and treat disease. Despite existing policies and programs, significant gaps remain for achieving equity in nutrition security across the life span. We provide recommendations for expanding and improving current food assistance policies and programs to achieve nutrition security. These recommendations are guided by several overarching principles: emphasizing nutritional quality, improving reach, ensuring optimal utilization, improving coordination across programs, ensuring stability of access to programs across the life course, and ensuring equity and dignity for access and utilization. We suggest a critical next step will be to develop and implement national measures of nutrition security that can be added to the current US food security measures. Achieving equity in nutrition security will require coordinated and sustained efforts at the federal, state, and local levels. Future advocacy, innovation, and research will be needed to expand existing food assistance policies and programs and to develop and implement new policies and programs that will improve cardiovascular health and reduce disparities in chronic disease.
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13
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Design of a clinical trial to isolate the experience of food insecurity and elucidate the biological mechanisms of risk for childhood health outcomes. Contemp Clin Trials 2022; 117:106751. [DOI: 10.1016/j.cct.2022.106751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/29/2022] [Indexed: 11/23/2022]
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How Did School Meal Access Change during the COVID-19 Pandemic? A Two-Step Floating Catchment Area Analysis of a Large Metropolitan Area. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111350. [PMID: 34769866 PMCID: PMC8583598 DOI: 10.3390/ijerph182111350] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022]
Abstract
SARS-CoV-2 (COVID-19) resulted in school closures and contingencies across the U.S. that limited access to school meals for students. While some schools attempted to provide alternative meal access points where students or parents could pick up meals, many students—especially those in low-income households—lacked adequate transportation to these access points. Thus, physical proximity to meal access points was particularly important during the pandemic. In this study, we explore how school meal access changed during the COVID-19 pandemic, especially as it relates to race/ethnicity and socio-economic status. Taking into account both the “supply” (meal access points) and the “demand” (low-income students) for free meals, we employed a two-step floating catchment area analysis to compare meal accessibility in St. Louis, Missouri before and during the pandemic in the spring and summer of 2019 and 2020. Overall, while school meal access decreased during the spring of 2020 during the early months of the pandemic, it increased during the summer of 2020. Moreover, increased access was greatest in low-income areas and areas with a higher proportion of Black residents. Thus, continuing new policies that expanded access to school meals—especially for summer meal programs—could lead to positive long-term impacts on children’s health and well-being.
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Nagata JM, Ganson KT, Whittle HJ, Chu J, Harris OO, Tsai AC, Weiser SD. Food Insufficiency and Mental Health in the U.S. During the COVID-19 Pandemic. Am J Prev Med 2021; 60:453-461. [PMID: 33602534 PMCID: PMC9067067 DOI: 10.1016/j.amepre.2020.12.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/23/2020] [Accepted: 12/01/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION During the COVID-19 pandemic, the rates of food insecurity and mental illness have been projected to increase in the U.S. owing to significant social and economic disruption. This study aims to estimate the prevalence of food insufficiency (often the most extreme form of food insecurity), the correlates of food insufficiency, and the associations between food insufficiency and symptoms of poor mental health in the U.S. during the COVID-19 pandemic. METHODS Cross-sectional data from 63,674 participants of the U.S. Census Household Pulse Survey were collected and analyzed in 2020. Multiple Poisson regression models were used to estimate associations with food insufficiency. RESULTS Food insufficiency rose from 8.1% to 10.0% from March to June 2020. Factors associated with food insufficiency included lower age, Black/African American or Latinx race/ethnicity, being unmarried, larger household size, recent employment loss, income below the federal poverty line, and lower education (all p<0.001). Food insufficiency was independently associated with all symptoms of poor mental health, adjusting for socioeconomic and demographic factors (adjusted RRs ranged from 1.16 to 1.42, all p<0.001). The association between food insufficiency and poor mental health was attenuated among people who received free groceries or meals. CONCLUSIONS Food insufficiency has increased during the COVID-19 pandemic and affects vulnerable populations, placing individuals at higher risk for symptoms of poor mental health. Particularly in the current crisis, clinicians should regularly screen patients for food insufficiency and mental health outcomes as well as provide support in accessing appropriate resources.
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Affiliation(s)
- Jason M Nagata
- Division of Adolescent & Young Adult Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, California.
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Henry J Whittle
- Division of Psychiatry, University College London, London, United Kingdom
| | - Jonathan Chu
- Division of Adolescent & Young Adult Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, California
| | - Orlando O Harris
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, California
| | - Alexander C Tsai
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts; Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Sheri D Weiser
- Division of HIV, Infectious Diseases & Global Medicine, School of Medicine, University of California San Francisco, San Francisco, California
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16
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Hassink SG, Fairbrother G. Obesity and Hunger Threaten the Foundations of Child Health. Acad Pediatr 2021; 21:396-400. [PMID: 32798724 PMCID: PMC7424333 DOI: 10.1016/j.acap.2020.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/29/2020] [Accepted: 08/06/2020] [Indexed: 12/11/2022]
Affiliation(s)
| | - Gerry Fairbrother
- Fairbrother Policy Studies, LLC, Policy and Health Services, Academic Pediatrics (G Fairbrother), Santa Fe, NM
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Kinsey EW, Hecht AA, Dunn CG, Levi R, Read MA, Smith C, Niesen P, Seligman HK, Hager ER. School Closures During COVID-19: Opportunities for Innovation in Meal Service. Am J Public Health 2020; 110:1635-1643. [PMID: 32941069 PMCID: PMC7542295 DOI: 10.2105/ajph.2020.305875] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2020] [Indexed: 11/04/2022]
Abstract
In 2019, the National School Lunch Program and School Breakfast Program served approximately 15 million breakfasts and 30 million lunches daily at low or no cost to students.Access to these meals has been disrupted as a result of long-term school closures related to the COVID-19 pandemic, potentially decreasing both student nutrient intake and household food security. By the week of March 23, 2020, all states had mandated statewide school closures as a result of the pandemic, and the number of weekly missed breakfasts and lunches served at school reached a peak of approximately 169.6 million; this weekly estimate remained steady through the final week of April.We highlight strategies that states and school districts are using to replace these missed meals, including a case study from Maryland and the US Department of Agriculture waivers that, in many cases, have introduced flexibility to allow for innovation. Also, we explore lessons learned from the pandemic with the goal of informing and strengthening future school nutrition policies for out-of-school time, such as over the summer.
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Affiliation(s)
- Eliza W Kinsey
- Eliza W. Kinsey is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Amelie A. Hecht is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Caroline Glagola Dunn is with the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA. Ronli Levi and Hilary K. Seligman are with the Department of Medicine and the Center for Vulnerable Populations, University of California, San Francisco. Margaret A. Read, Courtney Smith, and Pamela Niesen are with Share Our Strength, No Kid Hungry Campaign, Washington, DC. Erin R. Hager is with the Department of Pediatrics and the Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Amelie A Hecht
- Eliza W. Kinsey is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Amelie A. Hecht is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Caroline Glagola Dunn is with the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA. Ronli Levi and Hilary K. Seligman are with the Department of Medicine and the Center for Vulnerable Populations, University of California, San Francisco. Margaret A. Read, Courtney Smith, and Pamela Niesen are with Share Our Strength, No Kid Hungry Campaign, Washington, DC. Erin R. Hager is with the Department of Pediatrics and the Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Caroline Glagola Dunn
- Eliza W. Kinsey is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Amelie A. Hecht is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Caroline Glagola Dunn is with the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA. Ronli Levi and Hilary K. Seligman are with the Department of Medicine and the Center for Vulnerable Populations, University of California, San Francisco. Margaret A. Read, Courtney Smith, and Pamela Niesen are with Share Our Strength, No Kid Hungry Campaign, Washington, DC. Erin R. Hager is with the Department of Pediatrics and the Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Ronli Levi
- Eliza W. Kinsey is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Amelie A. Hecht is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Caroline Glagola Dunn is with the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA. Ronli Levi and Hilary K. Seligman are with the Department of Medicine and the Center for Vulnerable Populations, University of California, San Francisco. Margaret A. Read, Courtney Smith, and Pamela Niesen are with Share Our Strength, No Kid Hungry Campaign, Washington, DC. Erin R. Hager is with the Department of Pediatrics and the Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Margaret A Read
- Eliza W. Kinsey is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Amelie A. Hecht is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Caroline Glagola Dunn is with the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA. Ronli Levi and Hilary K. Seligman are with the Department of Medicine and the Center for Vulnerable Populations, University of California, San Francisco. Margaret A. Read, Courtney Smith, and Pamela Niesen are with Share Our Strength, No Kid Hungry Campaign, Washington, DC. Erin R. Hager is with the Department of Pediatrics and the Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Courtney Smith
- Eliza W. Kinsey is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Amelie A. Hecht is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Caroline Glagola Dunn is with the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA. Ronli Levi and Hilary K. Seligman are with the Department of Medicine and the Center for Vulnerable Populations, University of California, San Francisco. Margaret A. Read, Courtney Smith, and Pamela Niesen are with Share Our Strength, No Kid Hungry Campaign, Washington, DC. Erin R. Hager is with the Department of Pediatrics and the Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Pamela Niesen
- Eliza W. Kinsey is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Amelie A. Hecht is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Caroline Glagola Dunn is with the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA. Ronli Levi and Hilary K. Seligman are with the Department of Medicine and the Center for Vulnerable Populations, University of California, San Francisco. Margaret A. Read, Courtney Smith, and Pamela Niesen are with Share Our Strength, No Kid Hungry Campaign, Washington, DC. Erin R. Hager is with the Department of Pediatrics and the Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Hilary K Seligman
- Eliza W. Kinsey is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Amelie A. Hecht is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Caroline Glagola Dunn is with the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA. Ronli Levi and Hilary K. Seligman are with the Department of Medicine and the Center for Vulnerable Populations, University of California, San Francisco. Margaret A. Read, Courtney Smith, and Pamela Niesen are with Share Our Strength, No Kid Hungry Campaign, Washington, DC. Erin R. Hager is with the Department of Pediatrics and the Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Erin R Hager
- Eliza W. Kinsey is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Amelie A. Hecht is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Caroline Glagola Dunn is with the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA. Ronli Levi and Hilary K. Seligman are with the Department of Medicine and the Center for Vulnerable Populations, University of California, San Francisco. Margaret A. Read, Courtney Smith, and Pamela Niesen are with Share Our Strength, No Kid Hungry Campaign, Washington, DC. Erin R. Hager is with the Department of Pediatrics and the Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
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Turner L, Guthrie JF, Ralston K. Community eligibility and other provisions for universal free meals at school: impact on student breakfast and lunch participation in California public schools. Transl Behav Med 2020; 9:931-941. [PMID: 31328770 DOI: 10.1093/tbm/ibz090] [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: 11/14/2022] Open
Abstract
United States Department of Agriculture (USDA) school meal programs are an important part of the safety net for reducing food insecurity, yet not all students who qualify for free or reduced-price meals participate. In 2014-2015, the Community Eligibility Provision became available nationwide. This provision, along with Provisions 1, 2, and 3 of the USDA school meals programs, allows local school food authorities to offer universal free meals at schools with high student poverty. It is expected that adoption of a provision allowing universal free meals will increase rates of student participation in meal programs at schools where many students are at risk for food insecurity. This study examines school-level adoption of any provision for universal free meals and subsequent changes in student participation rates for the School Breakfast Program and National School Lunch Program in California from 2013-2014 to 2016-2017. A database was assembled for 10,343 public schools, including meals served, demographics, eligibility for provisions, and use of provisions in each year. Multilevel regression models were used to examine school adoption and student participation rates over time. Difference-in-difference calculations from lagged longitudinal models adjusting for school demographics showed that when eligible schools adopted provisions, participation rates increased an average of 3.48 percentage points for breakfast and 5.79 points for lunch the following year. By 2016-2017, over half of all eligible schools were using a provision for universal free meals. Among eligible schools, provision adoption was more common at schools that were larger, had predominantly Latino students, and were in rural areas. When eligible schools adopt provisions for universal free meals, student participation rates significantly increase, improving program reach among children most at risk for food insecurity. However, not all eligible schools adopt a provision for universal free meals and some adopters drop out in subsequent years. Research to better understand factors influencing the decision whether to adopt a provision or to continue it could inform policy and program leaders. Increases in breakfast participation are smaller than those for lunch, suggesting that other barriers to breakfast participation warrant further investigation.
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Affiliation(s)
- Lindsey Turner
- College of Education, Boise State University, Boise, ID, USA
| | - Joanne F Guthrie
- Economic Research Service, United States Department of Agriculture, Washington, DC, USA
| | - Katherine Ralston
- Economic Research Service, United States Department of Agriculture, Washington, DC, USA
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19
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Vitale M, Dorado L, Pais V, Sidani S, Gucciardi E. Food Insecurity Screening Among Families of Children With Diabetes. Diabetes Spectr 2019; 32:338-348. [PMID: 31798292 PMCID: PMC6858075 DOI: 10.2337/ds18-0083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Little is known about screening in clinical settings for food insecurity (FI) among households of children with diabetes. This study evaluated the acceptability and feasibility of an FI screening initiative in a pediatric diabetes clinic that was implemented to help diabetes dietitian educators tailor management plans for families of children with type 1 or type 2 diabetes facing FI. The initiative comprised three validated screening questions, a care algorithm, a community resource handout, and a poster. In total, 50 families of children and adolescents aged 0-18 years with type 1 or type 2 diabetes were screened for FI. In-person semi-structured interviews combining open-ended and Likert-scale questions were conducted with 37 of the screened families and the three diabetes dietitian educators who conducted the screening. Perceived barriers and facilitators of the screening initiative were identified using content analysis, and Likert-scale questionnaires rated interviewees' comfort level with the screening questions. A reflective journal kept by an onsite research interviewer also facilitated the data interpretation process. Most families felt comfortable answering the screening questions. Families with FI appreciated the opportunity to express their concerns and learn about affordable food resources. However, ∼20% of these families described stigma and fear of judgment by clinicians if they screened positive for FI. Diabetes educators also felt comfortable with the screening questions but reported lack of time to screen all families and to follow-up with resources after a positive screen. A self-reported intake form was recommended to ensure that everyone is systematically screened. A standardized and respectful method of assessing FI could help clinicians better tailor treatment plans and support for families of children with diabetes who face FI. Based on these findings, similar FI screening initiatives should be implemented in other clinical settings as part of routine clinical practice.
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Affiliation(s)
- Michele Vitale
- School of Nutrition, Ryerson University, Toronto, Ontario, Canada
| | | | | | - Souraya Sidani
- School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Enza Gucciardi
- School of Nutrition, Ryerson University, Toronto, Ontario, Canada
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20
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Kannam A, Wilson NLW, Chomitz VR, Ladin K. Perceived Benefits and Barriers to Free Summer Meal Participation Among Parents in New York City. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:976-984. [PMID: 31186210 DOI: 10.1016/j.jneb.2019.05.592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/28/2019] [Accepted: 05/12/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To examine perceived benefits and barriers of summer meal participation among lower-income families who participate in school lunch programs during the year. DESIGN Semistructured phone interviews were conducted with parents of elementary-aged children, including both participants and nonparticipants in summer meals. SETTING Queens, Bronx, and Brooklyn, NY. PARTICIPANTS Participants were lower-income, racially/ethnically diverse parents of elementary-aged children. Of 20 participants, 17 were minorities (85%), 16 were women (80%), and 11 had an annual household income < $30,000 (55%). PHENOMENON OF INTEREST Interviews explored parents' experiences with summer meals programs, the impact on food provisioning in the summer, and benefits and barriers. ANALYSIS Interviews were transcribed, coded, and analyzed thematically. RESULTS Five themes emerged, including 3 benefits of summer meals: reducing stress for parents, fostering social support and connection, and the opportunity to develop healthier eating habits; and 2 barriers to participation: lack of cultural inclusivity and lack of widespread knowledge about summer meals. CONCLUSIONS AND IMPLICATIONS The main purpose of summer meals is to reduce food insecurity, but the programs also provide social and psychological benefits valued by lower-income families in New York, although participation barriers persist.
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Affiliation(s)
- Allison Kannam
- Department of Community Health, Tufts University, Medford, MA.
| | - Norbert L W Wilson
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Virginia R Chomitz
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA
| | - Keren Ladin
- Departments of Occupational Therapy and Community Health, Tufts University, Medford, MA
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21
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Combating Child Summer Food Insecurity: Examination of a Community-Based Mobile Meal Program. J Community Health 2019; 44:1009-1018. [PMID: 31073855 DOI: 10.1007/s10900-019-00675-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Low-income children's access to meals decreases during the summer months due to losing the benefit of the free and reduced-price lunches they normally receive during the school year. Few studies critically examine community-based approaches to providing summer meals. This mixed methods study examined a mobile meal program implemented in a community with large economic disparities. Parents and caregivers who attended the mobile meal program with a child at one of three sites completed surveys that screened for risk of food insecurity and examined access and utilization of community food resources. Interviews with a representative subsample of English- and Spanish-speaking participants elicited an in-depth understanding of food insecurity in the community and perspectives on the mobile meal program. Surveys (n = 284) were completed in English (78%) and Spanish (22%). Participants identified primarily as Asian (32%), Latino/Hispanic (29%), and White (27%), with 26% screening positive for risk of food insecurity within the past 12 months. Qualitative interviews (n = 36) revealed widespread support for meals served in public settings as they were perceived to be welcoming, fostered social interactions, and helped the community at large. Participants described the high cost of living as a key motivation for participating and cited immigration fears as a barrier to accessing public resources. Findings from this study suggest the importance of innovative community-based approaches to serving hard-to-reach children during the summer.
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22
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Diet Quality and Fruit, Vegetable, and Sugar-Sweetened Beverage Consumption by Household Food Insecurity among 8- to 12-Year-Old Children during Summer Months. J Acad Nutr Diet 2019; 119:1695-1702. [PMID: 31056369 DOI: 10.1016/j.jand.2019.03.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 02/27/2019] [Accepted: 03/07/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND School-delivered nutrition assistance programs have improved dietary intake for children from food-insecure households during the school year. However, little is known about their diet quality and eating patterns during summer months. OBJECTIVE School-aged children's summer month weekday and weekend day diet quality and eating patterns were assessed by household food insecurity. DESIGN Secondary analysis of cross-sectional data was employed. PARTICIPANTS/SETTING During the summers of 2011 through 2017, baseline data were collected from parent-child dyads participating in one of two community-based obesity prevention trials in metropolitan Minnesota (N=218). The mean age of children was 10 years; 50% were girls, 49% were nonwhite, and 25% were from food-insecure households. MAIN OUTCOME MEASURES Children from food-secure and food-insecure households were identified by using the short form of the US Household Food Security Survey. Healthy Eating Index 2015 and eating patterns-including energy intake and consumption of whole fruits, vegetables, 100% fruit/vegetable juice, and sugar-sweetened beverages-were estimated by means of 24-hour dietary recall interviews conducted on weekdays and weekend days. STATISTICAL ANALYSIS PERFORMED General linear modeling was used to examine diet quality and eating patterns by food insecurity, controlling for child age, child body mass index z score, and parent education. RESULTS Children from food-insecure and food-secure households had Healthy Eating Index 2015 scores less than 50. Children from food-insecure households reported less energy intake, fewer cups of whole fruit, and more sugar-sweetened beverage consumption for every 1,000 kcal consumed on a weekend day when compared with their counterparts from food-secure households (P<0.05). Similar results were not seen for weekday eating patterns. CONCLUSIONS Whole fruit and sugar-sweetened beverage consumption varied by food insecurity on weekend days during summer months. Because children tend to gain weight during summer months, efforts to increase weekend access to whole fruits and promote water consumption may contribute to weight gain prevention and healthy development, especially for children from food-insecure households.
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23
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Yamaguchi M, Kondo N, Hashimoto H. Universal school lunch programme closes a socioeconomic gap in fruit and vegetable intakes among school children in Japan. Eur J Public Health 2019; 28:636-641. [PMID: 29590324 PMCID: PMC6051443 DOI: 10.1093/eurpub/cky041] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background Universal school lunch programmes are expected to cover all children equally, compared with selective programmes that may stigmatize socially vulnerable children. However, the effectiveness of universal programmes in closing dietary disparity has not been empirically proven. We evaluated whether Japan's universal school lunch programmes contribute to a reduction in the socioeconomic status (SES)-related gradient in fruit and vegetable intakes. Methods We analyzed data for 719 school children aged 6-12 years in a population-based survey conducted in the greater Tokyo metropolitan area. We measured dietary intakes using a validated self-administered brief diet history questionnaire for young children (BDHQ-10 y). We assessed parental education, annual household income and maternal employment status as SES indicators of children. We used multiple regression to estimate mean fruit and vegetable intakes by parental education and household income, and the contribution of school lunch to reducing the SES-related gradient in fruit and vegetable intakes. Results Compared with children with high maternal education (>15 years), those with low maternal education (<13 years) had less vegetable intake by 22.3 g/1000 kcal (95% confidence interval = 12.5, 32.2) and less fruit intake by 7.5 g/1000 kcal (95% confidence interval = -2.4, 17.3). However, fruit and vegetable intakes from school lunch did not vary by SES, indicating that school lunch intake alleviated the SES-related gradient of total vegetable intake by 9.9% and that of fruit intake by 3.4%. Conclusions Universal school lunch programmes can partially contribute to a reduction in the SES-related gradient in dietary intakes.
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Affiliation(s)
- Mai Yamaguchi
- Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Naoki Kondo
- Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Tokyo, Japan
- Correspondence: Naoki Kondo, Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Hongo 7-3-1 Faculty of Medicine Building #3, S310, Bunnkyo-ku, Tokyo 113-0033, Japan, Tel: +81 (0) 3 5841 3513, Fax: +81 (0)3 5684 6083, e-mail:
| | - Hideki Hashimoto
- Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Tokyo, Japan
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24
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Identifying gaps in the food security safety net: the characteristics and availability of summer nutrition programmes in California, USA. Public Health Nutr 2019; 22:1824-1838. [DOI: 10.1017/s1368980018004135] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveThe US Department of Agriculture’s Summer Food Service Program and Seamless Summer Option (summer nutrition programmes (SNP)) aim to relieve food insecurity for children and teens during summer months. More needs to be known about when and where SNP are available, and how availability varies by community characteristics, particularly in rural areas where food insecurity and reduced food access are more prevalent.DesignThe present study examined the geographic availability of SNP and summer meal uptake rates in 2016, using state-wide administrative claims data.SettingPublic schools and SNP in California, USA.ParticipantsSchools (n8842) and SNP (n4685).ResultsUrban counties were more likely than rural counties to have higher summer uptake rates, calculated as the percentage of summer meals served relative to eligible students utilizing school meal programmes during the academic school year, but uptake overall was low at 18·2 % of target populations. Geographic availability analyses showed that 63·9 % of public urban schools had an SNP available within 1·6 km (1 mile), but availability was significantly higher within the proximity of larger, higher-poverty high schools with diverse or majority non-White students, and those with higher school-year breakfast participation rates. Availability of an SNP within 16 km (10 miles) of rural schools averaged 68·1 % but was significantly higher around larger schools, higher-poverty schools and those with diverse or majority non-White students.ConclusionsWhile many communities have SNP available, much more work is needed to increase the availability of these programmes to reduce summer food insecurity for children, particularly in rural communities.
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Household Food Insufficiency and Children Witnessing Physical Violence in the Home: Do Family Mental Illness and Substance Misuse Moderate the Association? Matern Child Health J 2019; 23:961-970. [PMID: 30618019 DOI: 10.1007/s10995-018-02725-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objectives Research to date indicates that parents and children residing in food insufficient homes incur a host of negative health outcomes. Recently, studies have suggested that these homes are also at risk of violence between family members. Our objective is to examine the link between household food insufficiency and physical violence in the home using a recent, nationally representative sample, and to determine whether family mental illness and/or substance misuse inform this association. Methods A sample of nearly 50,000 children and families from the 2016 National Survey of Children's Health were employed in the study. Information concerning household access to food, experiences of violence between parents/adults, and associated mental health and substance use risk factors were available in the data. Logistic regression, employed in a hierarchical fashion, was utilized to analyze the data. Results Household food insufficiency was associated with an increased risk of children witnessing physical violence in the home, and this was especially pronounced in the case of moderate-to-severe food insufficiency. Findings also indicated that family mental illness and substance misuse partly attenuated this association and that household food insufficiency was more strongly associated with violence in the home in the absence of mental health and substance use risk factors. Conclusions for Practice Polices aimed at diminishing food insufficiency may have important collateral benefits in the form of reductions in family violence, and these benefits appear to extend to families that are otherwise at low risk of family violence.
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Sliwa SA, Calvert HG, Williams HP, Turner L. Prevalence and Types of School-Based Out-of-School Time Programs at Elementary Schools and Implications for Student Nutrition and Physical Activity. THE JOURNAL OF SCHOOL HEALTH 2019; 89:48-58. [PMID: 30506694 PMCID: PMC6743323 DOI: 10.1111/josh.12710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/30/2018] [Accepted: 02/23/2018] [Indexed: 05/03/2023]
Abstract
BACKGROUND Out-of-school time (OST) programs are an important setting for supporting student health and academic achievement. This study describes the prevalence and characteristics of school-based OST programs, which can inform efforts to promote healthy behaviors in this setting. METHODS A nationally representative sample of public elementary schools (N = 640) completed surveys in 2013-2014. Administrators reported on OST programs and policies at their school. Multivariable logistic regression models estimated the prevalence of school-based OST programs, adjusting for school characteristics. Among schools with OST programs (N = 475), chi-square tests identified school characteristics associated with having an OST policy about physical activity or nutrition. RESULTS Three fourths of elementary schools (75.6%) had a full- or partial-year school-based OST program, with 30.8% having both. Full- and partial-year programs were significantly less prevalent in rural and township areas versus urban settings. Only 27.5% of schools with OST programs reported having physical activity and/or nutrition policies. CONCLUSIONS Most US elementary schools have an on-site OST program, but disparities in access exist, and most lack policies or awareness of existing policies regarding physical activity and nutrition. To maximize OST programs' potential benefits, strategies are needed to increase access to programs and physical activity and/or nutrition policy adoption.
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Affiliation(s)
- Sarah A. Sliwa
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, GA 30341
| | - Hannah G. Calvert
- College of Education, Boise State University, 1910 University Drive, #1740, Boise, ID 83725-1740
| | - Heather P. Williams
- College of Education, Boise State University, 1910 University Drive, #1740, Boise, ID 83725-1740
| | - Lindsey Turner
- College of Education, Boise State University, 1910 University Drive, #1740, Boise, ID 83725-1740
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De Marchis EH, Torres JM, Fichtenberg C, Gottlieb LM. Identifying Food Insecurity in Health Care Settings: A Systematic Scoping Review of the Evidence. FAMILY & COMMUNITY HEALTH 2019; 42:20-29. [PMID: 30431466 DOI: 10.1097/fch.0000000000000208] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This systematic scoping review explores evidence on food insecurity (FI) screening measures, acceptability, and program implementation in health care settings. Validation studies on brief screening tools suggest that instruments exist that adequately measure the construct of FI. Patients and clinicians found FI screening acceptable in a range of clinical settings, though studies are not high quality and rarely reflect substantial patient diversity. Targeted interventions successfully increased screening rates and reduced screening barriers. More research is needed to understand implementation and effectiveness of FI screening in diverse populations to ensure that evolving practices in this area do not widen health inequities.
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Affiliation(s)
- Emilia H De Marchis
- Departments of Family & Community Medicine (Dr De Marchis and Dr Gottlieb) and Epidemiology & Biostatistics (Dr Torres), University of California, San Francisco; and Center for Health & Community, University of California, San Francisco (Dr Fichtenberg)
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Palakshappa D, Skelton JA. What a Summer Nutrition Benefit Program Could Mean for Clinicians and Their Patients. Pediatrics 2018; 141:peds.2017-2701. [PMID: 29592870 DOI: 10.1542/peds.2017-2701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Deepak Palakshappa
- School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Joseph A Skelton
- School of Medicine, Wake Forest University, Winston-Salem, North Carolina
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Higashi RT, Craddock Lee SJ, Pezzia C, Quirk L, Leonard T, Pruitt SL. Family and Social Context Contributes to the Interplay of Economic Insecurity, Food Insecurity, and Health. ANNALS OF ANTHROPOLOGICAL PRACTICE 2017; 41:67-77. [PMID: 30233917 DOI: 10.1111/napa.12114] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
In this study, we show how household health, economic instability, and food insecurity are inextricably linked; disruptions in individual health or income create cumulative and interdependent challenges faced by multiple household members. Drawing upon semi-structured focus groups with English- and Spanish-speaking clients of an urban food pantry, we demonstrate: (1) the impact of economic scarcity on health, (2) the impact of one household member's health on the health and food security of all household members, and (3) food sharing behaviors among family and social networks, including multi-generational families and non-kin individuals. We identify the gap between household-level assessments of food insecurity and individual-level health reports, which may obscure poor health among other household members. Understanding the social and family context of health and food insecurity may inform future interventions that address the interrelated challenges of diverse and disadvantaged households and communities.
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Affiliation(s)
- Robin T Higashi
- UT Southwestern Medical Center, Department of Clinical Sciences, 5323 Harry Hines Blvd, Dallas, TX 75390-9066
| | - Simon J Craddock Lee
- UT Southwestern Medical Center, Department of Clinical Sciences, 5323 Harry Hines Blvd, Dallas, TX 75390-9066.,Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Road, Dallas, TX 75235
| | - Carla Pezzia
- University of Dallas, 1845 East Northgate Drive, Irving, TX 75062
| | - Lisa Quirk
- UT Southwestern Medical Center, Department of Clinical Sciences, 5323 Harry Hines Blvd, Dallas, TX 75390-9066
| | - Tammy Leonard
- University of Dallas, 1845 East Northgate Drive, Irving, TX 75062
| | - Sandi L Pruitt
- UT Southwestern Medical Center, Department of Clinical Sciences, 5323 Harry Hines Blvd, Dallas, TX 75390-9066.,Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Road, Dallas, TX 75235
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Mansfield JL, Savaiano DA. Effect of school wellness policies and the Healthy, Hunger-Free Kids Act on food-consumption behaviors of students, 2006–2016: a systematic review. Nutr Rev 2017; 75:533-552. [DOI: 10.1093/nutrit/nux020] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Huang J, Kim Y, Barnidge E. Seasonal Difference in National School Lunch Program Participation and Its Impacts on Household Food Security. HEALTH & SOCIAL WORK 2016; 41:235-243. [PMID: 29206979 DOI: 10.1093/hsw/hlw043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 12/15/2015] [Indexed: 06/07/2023]
Abstract
The National School Lunch Program (NSLP) is one of the most important food assistance programs in the United States to ensure children's food security and healthy development. Previous studies have offered mixed results and challenges in estimating the effects of program participation. This study assesses NSLP's effect on household food security using data from the Survey of Income and Program Participation (SIPP). SIPP collects information on food security that covers four reference months, including both summer (June, July, August) and nonsummer months. The number of summer months in these four reference months varies by SIPP rotation group. These unique features allow this study to address the potential selection bias in the research of NSLP and food security by examining a seasonal difference in program participation. The analysis found that one more summer month in the reference period increases the difference in low food security rates by about 1.5 percentage points between recipients and nonrecipients eligible for free or reduced-price lunch. Findings have important social work and health policy implications for increasing food security among low-income households with children.
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Affiliation(s)
- Jin Huang
- College for Public Health & Social Justice, Saint Louis University
| | - Youngmi Kim
- School of Social Work, Virginia Commonwealth University, Richmond
| | - Ellen Barnidge
- College for Public Health & Social Justice, Saint Louis University
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Huang J, Nam Y, Sherraden M, Clancy MM. Improved Financial Capability Can Reduce Material Hardship among Mothers. SOCIAL WORK 2016; 61:313-320. [PMID: 29664258 DOI: 10.1093/sw/sww052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study draws on the theoretical framework of financial capability in investigating whether financial access (that is, availability of financial products and services) and financial knowledge (that is, understanding of basic financial concepts) can influence the risk of material hardship. Authors examine the possibility of direct associations as well as of indirect ones in which financial management (that is, individual financial behaviors) serves as a mediator. The probability sample of mothers with young children born in Oklahoma during 2007 (N = 2,529) was selected from Oklahoma birth certificates. Results from structural equation modeling analyses show that financial access is positively associated with financial management (p < 0.001) but that financial knowledge is not; both financial access (p < 0.001) and financial management (p < 0.001) are negatively correlated with material hardship. Similar results are obtained from analyses with a subsample of low-income mothers. Findings suggest that financial capability, particularly the financial access component, is critical for improving financial management and reducing the risk of material hardship among mothers with young children, including low-income mothers. Efforts to promote financial capability offer social workers an important strategy for improving their clients’ economic well-being.
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Huang J, Barnidge E. Low-income Children's participation in the National School Lunch Program and household food insufficiency. Soc Sci Med 2016; 150:8-14. [DOI: 10.1016/j.socscimed.2015.12.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 12/07/2015] [Accepted: 12/13/2015] [Indexed: 11/30/2022]
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