Healthy Food Access Research Articles

Examining Public Transportation in Healthy Food Access Research

ABSTRACT This paper is among a handful of studies on food access that focus on the public transportation system. Starting from a stratified sample of households, we use GIS and specifically, network analysis, to measure household access to healthy food outlets via public transportation. We find that the complexities of public transit systems necessitates place-based, household-level analysis of healthy food access. Our study provides an example of this and lessons for incorporating public transportation into healthy food access research.

USDA Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Vendor Criteria: An Examination of US Administrative Agency Variations.

The food retail environment has been directly linked to disparities in dietary behaviors and may in part explain racial and ethnic disparities in pregnancy-related deaths. The Special Supplemental Nutrition Program for Women, Infants and Children (WIC), administered by the United States Department of Agriculture, is associated with improved healthy food and beverage access due to its requirement for minimum stock of healthy foods and beverages in WIC-eligible stores. The selection and authorization criteria used to authorize WIC vendors varies widely from state to state with little known about the specific variations. This paper reviews and summarizes the differences across 16 of these criteria enacted by 89 WIC administrative agencies: the 50 states, the District of Columbia, five US Territories, and 33 Indian Tribal Organizations. Vendor selection and authorization criteria varied across WIC agencies without any consistent pattern. The wide variations in criteria and policies raise questions about the rational for inconsistency. Some of these variations, in combination, may result in reduced access to WIC-approved foods and beverages by WIC participants. For example, minimum square footage and/or number of cash register criteria may limit vendors to larger retail operations that are not typically located in high-risk, under-resourced communities where WIC vendors are most needed. Results highlight an opportunity to convene WIC stakeholders to review variations, their rationale, and implications thereof especially as this process could result in improved policies to ensure and improve healthy food and beverage access by WIC participants. More work remains to better understand the value of state WIC vendor authorization authority, particularly in states that have provided stronger monitoring requirements. This work might also examine if and how streamlining WIC vendor criteria (or at least certain components of them) across regional areas or across the country could provide an opportunity to advance interstate commerce and promote an equitable supply of food across the food system, while ensuring the protection for local, community-oriented WIC vendors.

Healthiness of foods and non-alcoholic beverages according to store type: A population-based study of household food and drink purchases in New Zealand

BackgroundObesity and diet-related noncommunicable diseases (NCDs) account for the largest proportion of disease burden worldwide, and an unhealthy food environment is a key driver. Food retailers play an important role in food environments through the availability and purchases of healthy food products at various stores.ObjectivesTo assess whether the healthiness of food and non-alcoholic drink product purchases vary according to retail store type.MethodsWe undertook a cross-sectional analysis of Nielsen New Zealand Homescan® panel data, which is a nationally representative sample of 2500 households in terms of certain key household demographic and socioeconomic characteristics. Panel members were asked to record all food and beverage products that were purchased and brought back to the home between October 2018 and October 2019. Household food and non-alcoholic drink purchases were linked with two food composition databases (Nutritrack, a New Zealand packaged food composition database, and the FOODfiles New Zealand Food Composition Database) to extract data on the nutrient profile of products purchased. We developed a store classification tool, and classified stores as supermarkets, grocery stores, convenience stores, fruit and vegetable stores, meat and fish stores, or bakeries. We estimated the Health Star Rating (HSR) for all products and defined a product with HSR ≥ 3.5 as ‘healthy’. We computed estimated mean HSR and conducted multivariate regression analyses.ResultsIn total, 3,940,458 product purchases were included in the analyses, consisting of 20,491 unique products purchased at different stores over the one-year period by 1800 panellist households. Supermarket products made up the majority of household food and drink purchases (3,545,141 of 3,940,458; 90%). Overall, the estimated mean HSR was 3.5 stars. In comparison to the reference group of supermarkets, the odds ratio for healthy products purchased at fruit and vegetable stores was 4.62, at grocery stores it was 2.36, and at meat and fish stores it was 1.99. In contrast, the odds ratios from convenience stores and bakeries were 0.58 and 0.03. Except for convenience stores, these differences were statistically significant (p < 0.05).DiscussionWe found significant differences in household purchases of healthy food and beverages according to food retail store type, with healthier food much more likely to be purchased from fruit and vegetable stores, meat and fish stores and grocery stores, and much less likely to be purchased from bakeries and convenience stores as compared with supermarkets.ConclusionPolicies to improve healthy food retailing should consider all retail store types and focus particularly on increasing the availability of healthy food options at convenience stores and bakeries. Given that supermarkets are the source of most household food purchases (both healthy and unhealthy), strategies are also warranted to increase the relative availability and purchases of healthy foods from supermarkets.

A four-year observational study to examine the dietary impact of the North Carolina Healthy Food Small Retailer Program, 2017\u20132020

BackgroundThe North Carolina (NC) Healthy Food Small Retailer Program (HFSRP) was passed into law with a $250,000 appropriation (2016–2018) providing up to $25,000 in funding to small food stores for equipment to stock healthier foods and beverages. This paper describes an observational natural experiment documenting the impact of the HFSRP on store food environments, customers’ purchases and diets.MethodsUsing store observations and intercept surveys from cross-sectional, convenience customer samples (1261 customers in 22 stores, 2017–2020; 499 customers in 7 HFSRP stores, and 762 customers in 15 Comparison stores), we examined differences between HFSRP and comparison stores regarding: (1) change in store-level availability, quality, and price of healthy foods/beverages; (2) change in healthfulness of observed food and beverage purchases (“bag checks”); and, (3) change in self-reported and objectively-measured (Veggie Meter®-assessed skin carotenoids) customer dietary behaviors. Differences (HFSRP vs. comparison stores) in store-level Healthy Food Supply (HFS) and Healthy Eating Index-2010 scores were assessed using repeated measure ANOVA. Intervention effects on diet were assessed using difference-in-difference models including propensity scores.ResultsThere were improvements in store-level supply of healthier foods/beverages within 1 year of program implementation (0 vs. 1–12 month HFS scores; p = 0.055) among HFSRP stores only. Comparing 2019 to 2017 (baseline), HFSRP stores’ HFS increased, but decreased in comparison stores (p = 0.031). Findings indicated a borderline significant effect of the intervention on self-reported fruit and vegetable intake (servings/day), though in the opposite direction expected, such that fruit and vegetable intake increased more among comparison store than HFSRP store customers (p = 0.05). There was no significant change in Veggie Meter®-assessed fruit and vegetable intake by customers shopping at the intervention versus comparison stores.ConclusionsDespite improvement in healthy food availability, there was a lack of apparent impact on dietary behaviors related to the HFSRP, which could be due to intervention dose or inadequate statistical power due to the serial cross-sectional study design. It may also be that individuals buy most of their food at larger stores; thus, small store interventions may have limited impact on overall eating patterns. Future healthy retail policies should consider how to increase intervention dose to include more product marketing, consumer messaging, and technical assistance for store owners.

Exploring the Reasons for Low Usage and Informing Strategies to Improve Use of a Nonprofit Grocery Store in Baltimore City

ABSTRACT Introducing new grocery stores into low-income communities has been a focus of policy efforts to improve the food environment. Yet, evidence of the impact of this strategy on diet and health outcomes is inconsistent. In Baltimore, a not-for-profit grocery store was opened by the Salvation Army in March 2018 with the goal of improving healthy food access. Unfortunately, the store has so far failed to attract sufficient customers. This study explored the reasons for low usage from the perspective of community members and staff members. A qualitative, formative research study was conducted at the store, which included semi-structured interviews (n = 21), direct observations (n = 8), and sociodemographic surveys (n = 152). Reasons for low store usage included high prices, confusion regarding the nature of the store, and lack of product variety. Reducing prices, increasing community engagement, and using promotional materials were all recommended strategies to increase usage. The Salvation Army is interested in potentially opening other nonprofit grocery stores. The results of this study will be used to help the Salvation Army refine their nonprofit grocery store model and in their future planning.

Evaluating Consumer Nutrition Environment in Food Deserts and Food Swamps.

This research examines the consumer nutrition environment in the selected neighborhoods identified as food deserts, food swamps, and food oases in Austin, Texas, by considering food availability, food price, food quality, and food labeling. A food auditing instrument M-TxNEA-S (He Jin, San Marcos, TX, USA) was developed to capture the unique dietary culture and food preferences in Texas. A total of 93 food items in 14 grocery stores and supermarkets (GS) and 32 convenience stores (CS) were surveyed. The GS in food swamps and food oases were found to offer significantly more healthy foods than the CS. The availability of healthy food in the GS in the food swamps and food oases is significantly higher than that of the GS from the food deserts; CS in the three neighborhoods did not exhibit a significant difference in healthy food availability. There was no significant difference between the price for the healthy items (lower fat, lower calorie, and whole grain) and that for the regular food options. No significant difference was found for food quality or food labeling between the stores from the different types of neighborhoods. The GS in food deserts are small grocery stores carrying limited ranges of foods. The establishment of larger food stores in the food deserts might not be very rewarding, but opening more small grocery stores with healthier options may alleviate food issues.

35058 A Mixed Method Study: Can Lyft Facilitate Better Access to Healthy Food?

ABSTRACT IMPACT: Interventions designed to improve access to healthy food are needed as a mechanism to improve diet quality and ultimately prevent diet-related chronic diseases. OBJECTIVES/GOALS: For people living in food deserts, access to grocery stores is an important consideration toward improving diet quality. The Grocery Access Program (GAP) provided discounted Lyft rides to grocery stores for residents in Baltimore, MD. This study will assess how the GAP impacted access to different food retail stores and healthy food purchases. METHODS/STUDY POPULATION: A mixed methods sequential explanatory design will be used. We collected survey data at baseline and mid-pilot on primary grocery shopping store, frequency of purchasing fruits and vegetables, and frequency of using the discounted Lyft rides for 90 program enrollees. The Healthy Food Availability Index (HFAI), a validated, observation-based instrument, will be used to measure healthy food availability at participants’ primary grocery shopping stores; HFAI scores range from 0-27. We will also compare frequency of self-reported fruit and vegetable purchases before and after GAP participation. Quantitative data analysis using paired sample t-tests and chi square tests will be followed by in-depth interviews with GAP participants; thematic analysis will be used to analyze qualitative data. RESULTS/ANTICIPATED RESULTS: This research is in progress; survey data collection is complete and store-level HFAI data collection will begin soon. We hypothesize that GAP participants will have shopped at stores with higher HFAI scores than non-participants, and that participants will have purchased healthy foods more frequently than they did prior to GAP participation. If these hypotheses are not supported, our qualitative findings will elucidate potential reasons and mechanisms for improving the program. If our hypotheses are supported, it will provide evidence for the GAP as a convenient, low-cost intervention to improve healthy food access for people in low-income communities. DISCUSSION/SIGNIFICANCE OF FINDINGS: Access to healthy foods is an important social determinant of health, and innovative strategies that can facilitate better dietary habits are needed in the area of food access research. Findings from this study could be used to scale up efforts that will foster better food access, healthier diets, and ultimately better health outcomes.

Opportunities for Interventions That Address Socioeconomic Barriers to Type 2 Diabetes Management: Patient Perspectives

The purpose of the study was to explore patient perspectives on socioeconomic barriers related to diabetes self-management and interventions to address these barriers. Focus groups (n = 8) were conducted with a diverse sample of adults with type 2 diabetes (T2D; n = 53). Researchers used a semistructured moderator guide; focus groups were audio recorded and transcribed verbatim. Researchers employed the constant comparison method for qualitative content analysis and utilized Atlas.ti (Version 8.1.1) to digitalize the analytic process. Findings revealed 3 primary themes: (1) Existing food and nutrition resources are insufficient to support healthy eating for diabetes; (2) healthy eating is critical for diabetes management, but socioeconomic circumstances make doing so challenging; and (3) participants supported several broad categories of preferred intervention strategies. First, they endorsed lifestyle intervention informed by socioeconomic status (SES; eg, focusing on food resource management, sensitive health coaching and nutritional counseling). Next, they expressed enthusiasm for group-based learning opportunities, such as cooking classes and support groups with similar SES peers. Finally, they suggested healthy food access resources. Participant suggestions should be incorporated into intervention development. Ultimately, these interventional strategies should be tested and refined to help improve health for individuals with type 2 diabetes.

Ensuring the right to food for indigenous children: a case study of stakeholder perspectives on policy options to ensure the rights of tamariki M\u0101ori to healthy food

BackgroundThe United Nations Convention on the Rights of the Child confirms a child’s right to adequate food, and to the highest attainable standard of health. For indigenous children, these rights are also recognised in the UN Declaration on the Rights of Indigenous Peoples. However, Indigenous children endure higher rates of obesity and related health conditions than non-indigenous children, including in Aotearoa New Zealand (NZ). For indigenous tamariki (Māori children) in NZ, high levels of obesity are interconnected with high rates of food insecurity. Therefore there is a need for action. This study aimed to investigate policy options that would safeguard the rights of indigenous children to healthy food. We explored with key stakeholder’s policy options to ensure the rights of indigenous children to healthy food, through a case study of the rights of tamariki.MethodsInterviews were conducted with 15 key stakeholders, with experience in research, development or delivery of policies to safeguard the rights of tamariki to healthy food. Iterative thematic analysis of the transcripts identified both deductive themes informed by Kaupapa Māori theory and literature on rights-based approaches and inductive themes from the interviews.ResultsThe analysis suggests that to ensure the right to adequate food and to healthy food availability for tamariki, there needs to be: a comprehensive policy response that supports children’s rights; an end to child poverty; food provision and food policy in schools; local government policy to promote healthy food availability; and stronger Māori voices and values in decision-making.ConclusionsThe right to food for indigenous children, is linked to political and economic systems that are an outcome of colonisation. A decolonising approach where Māori voices and values are central within NZ policies and policy-making processes is needed. Given the importance of food to health, a broad policy approach from the NZ government to ensure the right to adequate food is urgent. This includes economic policies to end child poverty and specific strategies such as food provision and food policy in schools. The role of Iwi (tribes) and local governments needs to be further explored if we are to improve the right to adequate food within regions of NZ.

Dietary Supplement Use in US Army Personnel: A Mixed-Methods, Survey and Focus-Group Study Examining Decision Making and Factors Associated With Use

BackgroundDietary supplement (DS) use by Army personnel is high and is a safety and readiness issue. ObjectiveOur aim was to examine factors motivating use of DSs among US Army personnel and preferred safety education strategies. DesignThis mixed-method study used a validated DS questionnaire and subsequent focus groups that were formed based on questionnaire-identified demographic characteristics. An embedded qualitative dominant design was used. Participants/settingData were collected from April to July 2015 from active duty soldiers at 3 military installations in the United States. Main outcome measuresA self-report questionnaire (n = 289) provided data on demographic characteristics, health, exercise, detailed use, and attitudes regarding DS safety and efficacy. Fourteen focus-group sessions (n = 129) examined factors motivating DS use, education strategies, and identified themes and DS-related behaviors. Statistical analysis performedDescriptive statistics and χ2 analyses were conducted. ResultsOf the soldiers who completed questionnaires, 83% were male, 60% were enlisted, and 40% were officers; mean age ± standard deviation was 27.6 ± 0.36 years and 75% used at least 1 type of DS per week: 52% used protein/amino acids, 47% used multivitamins/minerals, and 35% used a combination of products. Focus groups indicated reasons for use included physical appearance, fitness, peer endorsement, ease of access, limited availability of healthy food, occupational demands, and health. Participants requested education from an expert on safe use that was not focused on dangerous products. ConclusionsSoldiers are high DS users, especially products marked for purported performance enhancement. Motivating factors for DS use are fitness/appearance and occupational demands, but soldiers lack knowledge of DS regulatory requirements and safety/efficacy. Soldiers wished to receive education on DSs from trusted health care professionals, such as registered dietitian nutritionists, that was not focused on dangerous products. Study findings suggest guidance and education should occur before periods of high DS use, such as deployment.

The psychological determinants of making lifestyle and dietary behaviours after using an online cognitive health tool and its associated recommendations for protective cognitive health behaviours

Background & objectivesThe Covid-19 pandemic has revolutionised how we receive services, with a huge shift to online delivery. Online health promotion tools could be a cost-effective and safe way to improve population health. We used mixed methods to explore user responses to an online cognitive health tool. Methods15–28 months after completing an online tool, comprising a cognitive test, lifestyle questionnaire; and dietary and lifestyle behaviour feedback, 4826 participants completed an online survey about their perceptions of it; and questions about their capability, opportunity and motivation for behavioural change developed using the COM-B behaviour change model. We reported how responses to the behaviour change questionnaire predicted decisions to make lifestyle and dietary changes. 24 participants attended focus groups to further explore their responses. ResultsMost users reported that the tool was useful (88%), with 37% reporting they made lifestyle or dietary changes after using it. More positive responses to questions regarding capability and motivation predicted making changes. Over a third (36%) felt more fearful after completing the tool. In qualitative findings, we identified barriers to engagement across the three COM-B domains: a sense that information was “nothing new” (so did not enhance capability); that “experts don’t agree” and that the tool may not be credible (influencing motivation), and a lack of support from peers and lower availability of healthy food (reducing opportunities for change). ConclusionsFuture e-health tools will be most effective if they have high credibility, demonstrate advice is evidence-based and provide opportunities for support and follow up.

Associations between Food Policy Councils and Policies That Support Healthy Food Access: A National Survey of Community Policy Supports.

Food policy councils (FPCs) are one form of community coalition that aims to address challenges to local food systems and enhance availability, accessibility, and affordability of healthy foods for local residents. We used data from the 2014 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living, a nationally representative survey of US municipalities (n = 2029), to examine the prevalence of FPCs and cross-sectional associations between FPCs and four types of supports for healthy food access (approaches to help food stores, practices to support farmers markets, transportation-related supports, and community planning documents). Overall, 7.7% of municipalities reported having a local or regional FPC. FPCs were more commonly reported among larger municipalities with ≥50,000 people (29.2%, 95% Confidence Interval (CI): 21.6, 36.8) and western region municipalities (13.2%, 95% CI: 9.6, 16.8). After multivariable adjustment, municipalities with FPCs had significantly higher odds of having all four types of supports, compared to those without FPCs (adjusted odds ratio (aOR) range: 2.4–3.4). Among municipalities with FPCs (n = 156), 41% reported having a local government employee or elected official as a member, and 46% had a designated health or public health representative. Although FPCs were uncommon, municipalities that reported having a local or regional FPC were more likely to report having supports for healthy food access for their residents.

Dynamic conceptual framework to investigate adoption of healthy diet through agent-based modelling

PurposeThe purpose of this research is to develop a dynamic conceptual framework depicting factors related to the adoption of a healthy diet, which will underpin the development of an agent-based model (ABM) to uncover the dynamic interplay between these factors.Design/methodology/approachThe conceptual framework was developed in three steps using available empirical data from a semi-structured in-depth interview qualitative study, comprehensive systematic literature searches, existing theories and models and expert opinions from across the world.FindingsThe conceptual framework explicitly presents intention as the key determinant of the tendency to adopt a healthy diet. Intention is determined by demographic, psychological and behavioural factors and individual dietary mindset factors and dynamically affected by social environment and the person's past behaviour. The relationship between intention and behaviour is dynamically moderated by perceived control factors (price and accessibility of healthy food and time).Originality/valueThe conceptual framework developed in this study is well supported by evidence and experts' opinions. This conceptual framework will be used to design the ABM of this study, and it can be used in future investigations on the tendency to adopt healthy diet and food choices.

Building Support for Place-Based Solutions to Childhood Obesity: Findings From Missouri.

Place-based efforts offer promise in reducing childhood obesity. Yet, lack of public demand and support may hinder implementation. This study aimed to assess whether the emphasis on place-based solutions, community-wide strategies, and multisector engagement in the Healthy Schools Healthy Communities (HSHC) initiative would shift public views on obesity including the need for greater public involvement and an increase in awareness and support for strategies. As part of the evaluation, two surveys were conducted-in 2014 and 2016-to examine the relationship between HSHC strategies and changes in public perception, support, and awareness of obesity. Both surveys were cross-sectional and conducted with a randomized sample of households. Most respondents indicated that parents/family (84.3% in 2014; 87.8% in 2016) and children (70.9% in 2014; 74.8% in 2016) had a large/very large responsibility for addressing childhood obesity. A higher percentage of 2016 respondents indicated willingness to work with others to increase availability of healthy foods (71.3% vs. 64.2%, respectively; p = .0280) and increase the number of places to be physically active in their community (71.1% vs. 60.7%, respectively; p = .0015). Findings suggest awareness and support of place-based efforts and willingness to engage may help garner ongoing support. However, individuals and families are still perceived as primarily responsible for addressing childhood obesity. Countering this mindset remains an ongoing challenge. Streamlined messaging regarding the issue and associated solutions, enhanced skills and capacity to implement these efforts, and citizen engagement to garner support for place-based initiatives are important.

Urban mobile food truck policies: reducing disparities and building a culture of health in the United States.

We undertook this study knowing that for people throughout the Midwest who live in low-income urban neighborhoods, finding and affording healthy foods continues to be a problem. People with less money are not only forced to spend it on food, but have so limited options for avoiding purchase of foods with high levels of fat, salt, and sugar. A review of the literature shows that very little is known about how mobile food trucks can increase availability and affordability of healthy foods in low-income neighborhoods in the United States. We compared municipal codes regulating mobile food truck operators and evaluated the impact on cities in the Midwest for encouraging a ‘culture of health.’ We analyzed six Midwest metropolitan areas with the highest proportion of minorities who lived below the poverty level and had mobile food trucks selling provisions in their neighborhoods. We found that developing more incentives for mobile food truck operators to sell healthier food options can contribute to improving health outcomes in low-income neighborhoods.

Perceived Neighborhood-Level Drivers of Food Insecurity Among Aging Women in the United States: A Qualitative Study

BackgroundAging populations in the United States exhibit high rates of food insecurity and chronic illness. Few studies have explored the neighborhood-level drivers of food insecurity among such populations, and how they intersect with experiences of aging. ObjectiveThe aim of this study was to explore how aging women experience food insecurity in the United States, and the neighborhood-level factors that influence these experiences. DesignSemistructured qualitative interviews were conducted to elicit participants’ perceptions of how their neighborhood influenced their experiences with food security and aging. Participants/settingThirty-eight food-insecure women aged 50 years and older were purposively sampled from the Northern California, Georgia, and North Carolina sites of the Women’s Interagency Human Immunodeficiency Virus Study. Interviews were conducted between November 2017 and July 2018 at the three Women’s Interagency Human Immunodeficiency Virus Study sites. Statistical analysisThree researchers thematically analyzed the data using an inductive–deductive approach. ResultsParticipants described neighborhood-level drivers of food insecurity that centered around three themes: accessibility of food from traditional food stores, the role of food aid institutions, and the intersection of aging with the food environment. Participants explained that food insecurity was related to limited access to food stores largely due to long distances and poor public transportation in Georgia and North Carolina, and high food prices in Northern California. Most participants described being dependent on food aid programs, but found this difficult due to poor quality food and long wait times. Aging-related issues emerged as a cross-cutting theme, with fatigue, poor strength, and chronic illness amplifying barriers to accessing food. ConclusionsFindings from this study reveal the structural barriers that aging women face in accessing healthy food within their neighborhoods, and how experiences with aging and chronic illnesses exacerbate these barriers. Although future programs should address common neighborhood-level barriers such as the accessibility and affordability of healthy foods, they should also be tailored to aging women and the local context.

Urban Retail Food Environments: Relative Availability and Prominence of Exhibition of Healthy vs. Unhealthy Foods at Supermarkets in Buenos Aires, Argentina.

There is growing evidence that the food environment can influence diets. The present study aimed to assess the relative availability and prominence of healthy foods (HF) versus unhealthy products (UP) in supermarkets in Buenos Aires, Argentina and to explore differences by retail characteristics and neighborhood income level. We conducted store audits in 32 randomly selected food retails. Food availability (presence/absence, ratio of cumulative linear shelf length for HF vs. UP) and prominence inside the store (location visibility) were measured based on the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) protocol. On average, for every 1 m of shelf length for UP, there was about 25 cm of shelf length for HF (HF/UP ratio: 0.255, SD 0.130). UP were more frequently available in high-prominence store areas (31/32 retails) than HF (9/32 retails). Shelf length ratio differed across commercial chains (p = 0.0268), but not by store size or type. Retails in the lower-income neighborhoods had a lower HF/UP ratio than those in the higher-income neighborhoods (p = 0.0329). Availability of the selected HF was overcome largely by the UP, particularly in high prominence areas, and in neighborhoods with lower income level, which may pose an opportunity for public health interventions.

Casting a Health Equity Lens on Endocrinology and Diabetes.

As endocrinologists we have focused on biological contributors to disparities in diabetes, obesity and other endocrine disorders. Given that diabetes is an exemplar health disparity condition, we, as a specialty, are also positioned to view the contributing factors and solutions more broadly. This will give us agency in contributing to health system, public health, and policy-level interventions to address the structural and institutional racism embedded in our medical and social systems. A history of unconsented medical and research experimentation on vulnerable groups and perpetuation of eugenics theory in the early 20th century have resulted in residual health care provider biases toward minority patients and patient distrust of medical systems, leading to poor quality of care. Historical discriminatory housing and lending policies resulted in racial residential segregation and neighborhoods with inadequate housing, healthy food access, and educational resources, setting the foundation for the social determinants of health (SDOH) contributing to present-day disparities. To reduce these disparities we need to ensure our health systems are implementing the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care to promote health equity. Because of racial biases inherent in our medical systems due to historical unethical practices in minority communities, health care provider training should incorporate awareness of unconscious bias, antiracism, and the value of diversity. Finally, we must also address poverty-related SDOH (eg, food and housing insecurity) by integrating social needs into medical care and using our voices to advocate for social policies that redress SDOH and restore environmental justice.

Addressing Children's Nutritional Needs with Community-Based Participatory Action Research.

The absence of consistent, reliable, culturally appropriate access to nutritious food places children's development at risk. Nutrition education programming that is delivered using intergenerational strategies may help optimize children's access, consumption, and knowledge of healthy foods. The purpose of this article is to present the development, implementation and lessons learned from the first year of Food for a Long Life (FFLL) programming-an intergenerational community-based participatory action research (CBPAR) project joining Extension staff, researchers, and community partners to increase families' knowledge, access, and consumption regarding healthy food in a food insecure community. Preschoolers, their family members, and older adults were recruited from two preschools and one adult day services center. Collaborations with community stakeholders informed the development and implementation of intergenerational nutrition education delivered during FFLL programming. Preschoolers, families, and older adults participated in twenty-six nutrition education sessions during the programming year. Parents of preschoolers completed the Household Food Security Survey (HHFS) and the Healthy Kids measure. Semistructured interview data from staff were also collected upon the conclusion of programming. Preschoolers and their families were found to have marginal food security but relatively healthy eating behaviors. Staff believed FFLL programming enhanced preschoolers' eating behaviors (e.g., increased willingness to try new foods). Continued collaborations with community partners were viewed as essential to program success. Relationship-building among intergenerational community members, Extension staff, and university researchers strengthens trust and may expand the reach of FFLL programming and research components.

Umami: An Alternative Japanese Approach to Reducing Sodium While Enhancing Taste Desirability

COVID-19 has highlighted the underlying global burden from non-communicable diseases (NCDs) and the lack of resiliency in health systems to tackle highly preventable risk factors, which have left populations vulnerable to acute health crises. The persistent issue of unhealthy behaviors, particularly those related to a high-sodium diet, suggests inadequate policy attention and insufficient funding for public health and behavioral research. This year, Japan will host the Tokyo Nutrition for Growth (N4G) Summit 2021. The summit is being held in the era of COVID-19, offering a historic opportunity to make a difference on the global health agenda for food and nutrition and to reaffirm the global commitment to prevent future health crises by addressing the growing burden of NCDs and building better prepared and more resilient health systems. This perspective article suggests that we, global health researchers and decision-makers, should rethink the value of using “Umami” substances as candidates for a practical salt-reducing alternative that originated in Japan (while maintaining the affordability, accessibility, availability, and desirability of healthy food). Reduced salt intake will help address the global syndemic of COVID-19 pandemic and high rates of hypertension, heart diseases, diabetes, and other NCDs. By addressing these issues, it will make countries more resilient to future pandemic threats.