Dietary Disparities Research Articles

Trends in Diet Quality Among U.S. Adults From 1999 to 2020 by Race, Ethnicity, and Socioeconomic Disadvantage.

Few data have assessed trends in diet quality among U.S. adults. To evaluate trends in diet quality by race, ethnicity, and socioeconomic disadvantage. Repeated cross-sectional study. United States. Noninstitutionalized adults aged 20 years or older who responded to the 1999-2020 National Health and Nutrition Examination Survey (NHANES). The proportion of participants meeting the targets of the validated American Heart Association (AHA) 2020 continuous diet score (based on higher intake of fruits, vegetables, whole grains, fish and shellfish, and nuts, seeds, and legumes and lower intake of sugar-sweetened beverages, processed meat, saturated fat, and sodium) and the Healthy Eating Index (HEI)-2015, and energy-adjusted consumption of their components and other individual food groups and nutrients. Poor diet was defined as less than 40% adherence to the AHA score, intermediate as 40% to 79.9% adherence, and ideal as at least 80% adherence. A total of 51 703 adults were included. From 1999 to 2020, the proportion of U.S. adults with poor diet quality decreased from 48.8% to 37.4% (difference, -11.4 percentage points [95% CI, -16.8 to -5.96 percentage points]), the proportion with intermediate quality increased from 50.6% to 61.1% (difference, 10.5 percentage points [CI, 5.20 to 16.1 percentage points]), and the proportion with ideal quality increased from 0.66% to 1.58% (difference, 0.93 percentage points [CI, 0.35 to 1.51 percentage points]) (P for trend < 0.001 for each). Persistent or worsening disparities in diet quality were observed by age, sex, race and ethnicity, education, income, food security, Supplemental Nutrition Assistance Program participation, and health insurance coverage. For example, the proportion of adults with poor diet quality decreased from 47.9% to 33.0% among those with food security (P for trend < 0.001) but did not change (51.3% to 48.2%) among those experiencing food insecurity (P for trend = 0.140) (P for interaction = 0.001). Findings were similar for HEI-2015. Self-reported diet; cross-sectional study design. Diet quality among U.S. adults improved modestly between 1999 and 2020, but the proportion with poor diet quality remains high, and dietary disparities persist or are worsening. National Institutes of Health.

Narrowing regional dietary disparities can help reduce methylmercury exposure in China

Dietary methylmercury (MeHg) exposure has posed substantial risks to human health. Existing studies have characterized the spatial patterns of China's MeHg exposure. However, the spatial difference and relevant influencing factors have not been investigated. This study quantified the spatial differences of dietary MeHg exposure in China and revealed the relevant influencing factors, which can help optimize the dietary behavior to reduce MeHg exposure. Results show that dietary MeHg exposure in coastal regions is significantly higher than the national average, especially in Shanghai (+191%). Dietary structure difference is the most significant factor influencing spatial differences in MeHg exposure, and its contribution increased from 64% to 73% between 2004 and 2019. In particular, the high proportion of marine fish intake dominates the significantly higher MeHg exposure in most regions. An intake ratio of 2:3 for marine and freshwater fishes is recommended to ensure minimal MeHg exposure and meanwhile meet the nutritional needs. Moreover, narrowing regional dietary behavior disparities can reduce the overall MeHg exposure in China. These findings highlight the importance of region-specific measures in reducing dietary MeHg exposure and implementing the Minamata Convention on Mercury.

School Meal Nutrition Standards Reduce Disparities Across Income and Race/Ethnicity

Children's diets in the U.S. typically fail to meet dietary recommendations, contributing to associated adverse health outcomes. The Healthy, Hunger-Free Kids Act (HHFKA) of 2010 required the U.S. government to update nutrition standards for school meals to align with the Dietary Guidelines for Americans (DGAs). This study estimates the evolving impact of substituting school-prepared food for home-prepared food on overall daily diet quality and by subcomponents of diet quality. Subgroup analyses are performed by race/ethnicity and income. Two, nonconsecutive days of dietary recall data from the National Health and Nutrition Examination Survey (2005-March 2020) are used to calculate schoolchildren's Healthy Eating Index (HEI)-2020 scores. The study includes children with complete two-day dietary intakes who attend kindergarten through twelfth grade in a school offering lunch. An individual-level fixed effects regression is employed to examine the relationship of school food consumption on HEI-2020 scores before and after HHFKA-mandated changes in nutrition standards. Analyses were conducted on September 23, 2023. Prior to changes in standards (2005-2008), school food did not impact diet quality within the overall group of children. In 2009-2012, positive associations between school food and diet quality emerged for low-income students and for non-Hispanic Black students. By 2013-2020, improvements were seen across all groups. The association between school food and diet quality was most attributable to more favorable consumption of dairy, fruit, whole grains, refined grains, added sugars and saturated fats. HHFKA-based nutrition standards were associated with beneficial dietary changes and reduced dietary disparities for children across diverse backgrounds.

Effect of a Multicomponent Food Pantry Intervention in Client Subgroups.

Nutrition promotion programs may have varying effects and influence health disparities. SuperShelf promotes healthy choices in food pantries through inventory changes and nudge implementation (e.g., choice architecture). This secondary analysis of the SuperShelf cluster-randomized trial assessed whether the effect of SuperShelf on client diet quality differed by equity characteristics. English-, Spanish-, or Somali-speaking adult clients from 11 food pantries in Minnesota were included (N = 193). We measured change in diet quality by the Healthy Eating Index 2015 (HEI-2015; maximum score 100) using up to two 24 h dietary recalls from pre-intervention and post-intervention periods. We used linear mixed-effects models to determine whether the effect of SuperShelf on diet quality varied by self-reported gender, race/ethnicity, education, and employment status. In separate adjusted models, the interactions of SuperShelf and gender, education, or employment status were not significant. The interaction of SuperShelf and race/ethnicity was significant (p-interaction = 0.008), but pairwise comparisons in diet quality were non-significant in all racial/ethnic subgroups. SuperShelf did not have differential effects on diet quality by gender, race/ethnicity, education, or employment status, suggesting it does not worsen dietary disparities among food pantry clients, though more subgroup analyses are needed to explore potential racial/ethnic disparities in this context.

Inequities in dietary intake and eating behaviours among adolescents in Canada

ObjectiveTo provide contemporary evidence of how dietary intake and eating behaviours vary by social positions among adolescents.MethodsWe used survey data collected during the 2020–2021 school year from 52,138 students attending 133 secondary schools in Alberta, British Columbia, Ontario, and Quebec, Canada. Multiple regression models tested whether self-reported indicators of dietary intake and eating behaviours differed by gender, race/ethnicity, and socioeconomic status (SES).ResultsFemales were more likely than males to skip breakfast, restrict eating, and consume fruit, vegetables, and fast food on more days. Gender-diverse/“prefer not to say” students were more likely to restrict eating than males and the least likely to consume breakfast and drink water daily, and fruits and vegetables regularly. Black and Latin American students were more likely to restrict eating and consume purchased snacks and fast food, and less likely to drink water daily than white and Asian adolescents. Daily breakfast consumption was most likely among Latin American students. Black students were the least likely to report eating breakfast daily and fruits and vegetables regularly. Lower SES was associated with lower odds of eating breakfast and drinking water daily and regular fruit and vegetable consumption, and higher odds of restrictive eating and purchased snack consumption. Fast food consumption had a u-shaped association with SES.ConclusionResults emphasize gender, racial/ethnic, and socioeconomic inequities in the diets and eating behaviours of adolescents. There is a critical need to address the structural factors contributing to inequities and prevent the consequences of dietary disparities.

Unraveling Lifestyle Disease Vulnerabilities among Adolescents: A Comprehensive Comparative Analysis of Private and Government School Students in Rawalpindi and Islamabad

Purpose: The increasing prevalence of lifestyle diseases in adults necessitates a closer examination of risk factors that manifest during adolescence. This study addresses this imperative, aiming to comprehensively compare lifestyle disease risk factors among adolescents attending private and government schools, with a specific focus on the distinctive nuances present within diverse educational environments. The primary objective of this cross-sectional study is to provide a thorough exploration of lifestyle disease risk factors, thereby contributing to a more nuanced understanding of the complexities inherent in adolescent health within different school settings. The study's aim is to not only identify prevalent risk factors but also to highlight the variations that exist between students in private and government schools.&#x0D; Methodology: The study engaged 600 adolescents from secondary schools in Rawalpindi and Islamabad, with 300 participants from each sector, employing purposive sampling for selection. Beyond the standard measurements of Body Mass Index (BMI), height, and weight, a comprehensive assessment encompassed dietary habits, physical activity levels, screen time, family history of lifestyle diseases, and active/passive smoking.&#x0D; Findings: Noteworthy findings include a substantial 81% of overweight individuals affiliated with private schools, indicating a distinct prevalence in this demographic. Dietary disparities were evident, with private schools displaying a 60% daily consumption of fruits and vegetables, in contrast to 40% in government schools. Further distinctions were observed in daily dairy intake (54% in private schools vs. 46% in government schools) and weekly meat consumption (56% in private schools vs. 44% in government schools). Private schools exhibited higher rates of daily and weekly fast food (54%) and soft drink consumption (67%) compared to government schools (46% and 33%, respectively).&#x0D; Physical activity engagement was reported by 45% of private school students and 55% of government school students, while screen time exceeding 2 hours was reported by 55% of private school students and 45% of government school students. Family history of lifestyle diseases was more significant among government school students. Additionally, 8% of private school students and 7% of government school students reported smoking, with 20% of private school students and 24% of government school students indicating a history of passive smoking.&#x0D; Unique Contribution to Theory, Practice, and Policy: The study enriches theoretical understanding by offering a nuanced exploration of lifestyle disease risks and disparities among adolescents. In practical terms, the findings provide insights for designing targeted interventions tailored to the specific needs of private and government school students, informing health promotion programs and strategies. Policy relevance is emphasized through recommendations for school-specific health policies, considering socioeconomic factors, and advocating for long-term monitoring to facilitate effective public health planning. The identification of nuanced lifestyle disease risks within distinct school environments adds a critical dimension to our understanding of adolescent health and informs future policies and interventions

Shared Perceptions on Upstream Factors that Influence Water and Sugar-Sweetened Beverage Consumption Among Hispanic Families in the Greater Washington, DC, Metro Area: Qualitative Results From Focus Group Discussions

BackgroundHispanics in the United States are among those with highest consumption of sugar-sweetened beverages (SSBs) and lowest consumption of water. These dietary disparities are rooted in systemic influences that must be identified and addressed. ObjectiveThe study aimed to describe how Hispanic parents currently living in the greater Washington, DC, metro area and born outside of the United States, perceived upstream factors that influenced their current beverage choice. DesignSix qualitative focus groups were conducted in Spanish in 2021. Participants/settingHispanic parents (n = 31) of children enrolled in Early Head Start in the greater Washington, DC, metro area were recruited (all women, born outside the United States, and spoke Spanish as a first language). Statistical analysisVerbatim transcripts were analyzed deductively using the Community Energy Balance Framework. ResultsThe five key findings were: Growing up (in their countries of origin in Central America and Mexico) participants were used to drinking water, often gathered it from the source, and liked its flavor. Relatives passed down their knowledge about potabilization of water, the health benefits of drinking water, and health consequences of drinking SSBs. Growing up, prepackaged SSBs were not as accessible compared with where they now live in the United States. Participants perceived that sociocultural hospitality norms dictated that guests should be served SSBs and not water. Participants noted that messages regarding juice and water across US public health programs and policies were not aligned. ConclusionsThese findings suggest there are opportunities for public health messaging and procurement of safe, palatable drinking water in lieu of SSBs and juice.

Diets of Vegetarians and Meat-Eaters Affect the Health Problems They Suffer

As society evolves, dietary choices have expanded significantly, offering a wealth of options beyond traditional limitations. One noticeable trend is the rising number of non-religious vegans, who are embracing plant-based diets due to their myriad health benefits when balanced correctly, mitigating some issues seen with conventional vegetarian diets. Conversely, the surge in meat production has led to an increasing number of carnivores, with some individuals even adopting exclusively meat-based diets. This article aims to explore the dietary disparities between vegetarians and meat eaters and the potential health concerns associated with each. Dietary habits play a pivotal role in shaping health. Vegetarians often grapple with protein and iron deficiencies due to their exclusion of meat, leading to potential clotting disorders and symptoms such as mental depression and fatigue. In contrast, meat eaters generally have an ample protein supply, but excessive consumption of red and processed meats has been linked to diseases like cancer. Furthermore, vegetarians may sometimes overlook essential nutrients found in meat, such as heme iron. This nutrient can be absorbed more easily than non-heme iron in plant, which may cause deficiency anemia. On the flip side, meat-heavy diets may lack essential aspects. A diet devoid of fruits and vegetables typically results in insufficient dietary fiber intake, giving rise to various health problems. Both dietary patterns have their merits and demerits, individuals must adjust their diets to address these shortcomings.

Comparative Analysis of Biochemical and Hematological Parameters in Free-Range Pigs of Different Genotypes

This study investigated the biochemical and hematological parameters (at the beginning, after 90 days, and at the end of the experiment) of the pure genotype Black Slavonian (BS) pigs and crossbreeds of Black Slavonian and Duroc (BSxD) pigs, fed the same diet and kept under the same extensive free-range conditions during 200 days of the experiment. In the study, BS and BSxD pigs showed differen- ces in blood protein levels, hinting at dietary disparities. Glucose and triglyceride levels differed between the two groups, affecting energy availability and fat depo- sition. BS pigs showed higher white blood cell counts, while BSxD pigs exhibited more rapid metabolic activity. Alkaline phosphatase activity declined over time, with variations between the groups. Phosphorus and magnesium concentrations decrea- sed with pig growth, reflecting changes in metabolic demands. Hemoglobin, hema- tocrit, and red blood cell counts varied between the groups. MCV and MCH values in BSxD pigs indicated rapid red blood cell production. Platelet counts fluctuated with age. This study offers insights into the influence of genetic characteristics and growth rates impact biochemical and hematological parameters of pigs kept under free-range conditions, aiding swine population management.

Police Bias and Low Relatability and Diet Quality: Examining the Importance of Psychosocial Factors in Predominantly Black Communities.

How police bias and low relatability may contribute to poor dietary quality is poorly understood. In this cross-sectional study, we analyzed data from 2021 from a cohort of n = 724 adults living in predominantly Black communities in Pittsburgh, Pennsylvania; these adults were mostly Black (90.6%), low-income (median household income $17,500), and women (79.3%). We estimated direct and indirect paths between police mistrust and dietary quality (measured by Healthy Eating Index (HEI)-2015) through perceived stress, community connectedness, and subjective social status. Dietary quality was poor (mean HEI-2015 score was 50) and mistrust of police was high: 78% of participants either agreed or strongly agreed that something they say might be interpreted as criminal by the police due to their race/ethnicity. Police bias and low relatability was associated with lower perceived social status [Formula: see text]= - 0.03 (95% confidence interval [CI]: - 0.05, - 0.01). Police bias and low relatability was marginally associated with low dietary quality β = - 0.14 (95% CI: - 0.29, 0.02). Nineteen percent of the total association between police bias and low relatability and lower dietary quality β = - 0.16 (- 0.01, - 0.31) was explained by an indirect association through lower community connectedness, or how close respondents felt with their community [Formula: see text] Police bias and low relatability may play a role in community connection, social status, and ultimately dietary disparities for Black Americans. Addressing police bias and low relatability is a continuing and pressing public health issue.

Dietary trends among young adults during the COVID-19 lockdown: socioeconomic and gender disparities

BackgroundHealthy eating is vital to well-being and during the COVID-19 pandemic, it was especially important for boosting immunity and protecting against viral infections. Yet, by many accounts, keeping a nutritious diet was a casualty of the pandemic rather than a means to fight it. Young adults experienced disproportionate pandemic-related disruptions during a formative stage of development while little is still known about dietary outcomes.MethodsWe employed a cross-sectional design to examine dietary disparities targeting young adults (ages 18–28) during the COVID-19 lockdown period. Participants (N = 254) responded to a 15–20-min online survey with questions related to food composition and sources of food, perceptions of healthy eating, weight change, physical activity, and food insecurity. Comparisons were made by household income and gender. Multiple regression analyses were conducted to investigate factors that predicted perceptions of healthy eating behaviors while controlling for other sociodemographic factors.ResultsA clear overall trend toward unhealthy behaviors was found while positive changes were also identified. Consumption of junk food significantly increased (+ 3%), 40% gained weight, a third were less active, and 5–8% were food insecure on a regular basis. Meanwhile, eating food from restaurants declined and, for some, home-based cooking increased. Lower income participants were overly represented in unhealthy changes and higher income participants were disproportionately represented in healthy changes. Males reported more changes in dietary composition while females reported more fluctuation in weight. Reduced activity, weight gain, and food insecurity predicted unhealthy eating behaviors. Living with friend(s)/roommate(s) predicted healthier eating, but only among lower income participants.ConclusionsIt is recommended that pandemic minded public health interventions account for negative dietary trends with particular attention to low-income young adults. Solutions should be geared toward reshaping fiscal, social and physical environments, rather than relying solely on behavioral interventions.

Trends of Health and Dietary Disparities by Economic Status among Elderly Individuals in Japan from 2004 to 2014: A Repeated Cross-Sectional Survey

This study examines the changes in health and dietary disparities by economic status among elderly individuals in Japan from 2004 to 2014. The study design utilized a repeated cross-sectional approach, using data from the Survey of Attitudes among the Elderly toward Daily Life in 2004 and 2014. Logistic regression analysis was performed with subjective economic status, survey year, and their interactions as independent variables, and self-rated health, dietary satisfaction, and intake of balanced meals as dependent variables. The results revealed that disparities in self-rated health, dietary satisfaction, and intake of a balanced meal were present due to economic status. Furthermore, the disparities in self-rated health, dietary satisfaction, and balanced meal intake by economic status remained unchanged from 2004 to 2014 (P for interaction &amp;ge; 0.05). The findings were consistent in sensitivity analyses conducted on those aged 75 and older, as well as on long-term care insurance recipients.

Evaluating a Washington DC Community-based meal-kit service aimed at mitigating dietary disparities: Results from the SouthEats pilot study

BackgroundVegetable consumption is known to reduce the risk of various chronic health conditions. Yet a small percentage of US adults consume enough vegetables to meet national dietary guidelines. The SouthEats community-led meal–kit service was developed in Washington DC to address known barriers to healthy eating and vegetable consumption among middle- and low-income households. MethodsUsing a series of online surveys, we conducted a pilot study to provide preliminary information on the influence of SouthEats on vegetable consumption and factors known to influence vegetable consumption. Wilcoxon matched-pair sign ranked tests were used to examine changes in key outcomes between baseline, midpoint and endpoint surveys. ResultsAmong SouthEats customers who completed all pilot study surveys (n = 23) there was a significant decrease in the median amount of time spent on meal prep between baseline and midpoint. Between baseline and endpoint, participants also indicated increased feelings that they had enough time to meet their needs including cooking healthfully. Overall vegetable and fruit and vegetable consumption increased between the baseline and midpoint but then decreased between the midpoint and endpoint survey periods. However, there were no statistically significant changes in the outcomes of home eating behaviors, perceptions of neighborhood healthy food access, vegetable self-efficacy, or vegetable consumption. ConclusionOur results provide some preliminary evidence suggesting that the SouthEats meal-kit service could help reduce the amount of time spent on cooking, reduce feelings of time scarcity, and increase vegetable consumption in the short-term. Further research exploring this topic will require a larger study sample.

Masticatory mechanisms, dental function, and diet in Triassic trilophosaurids (Reptilia: Allokotosauria)

Documenting evidence of feeding behavior in extinct vertebrates is crucial to understanding trophic structure and stability of ecosystems over periods of Earth's history. Direct evidence of trophic interactions in the fossil record is rare, but proxies like dental microwear enable testable hypotheses of feeding behavior in extinct taxa. Here we present new evidence on the masticatory apparatuses and feeding behaviors of Late Triassic (Norian) trilophosaurid reptiles from southwestern North America based on Scanning Electron Microscope (SEM) observation and quantitative analysis of dental microwear in isolated teeth and dentigerous elements. Trilophosaurids are a Late Triassic archosauromorph group known from Europe and North America with distinctive labiolingually expanded teeth that are usually tricuspid; this clade is hypothesized to be herbivorous based on qualitative comparisons of their dentition to those of living taxa. Our study is among the first to infer their diet within a quantitative comparative framework. Analysis of pit-to-scratch ratios (a proxy for the hardness/toughness of dietary intake) indicate dietary disparity between the three examined trilophosaurid taxa, possibly driven by differing plant preferences. Analysis of scratch orientations, caused by contact between opposite teeth during jaw closure (a proxy for the direction of masticatory movements), may suggest derivation of a masticatory mechanism including labiolingual movement in Trilophosaurus, differing from the orthal jaw closure mechanism ancestral to archosauromorphs that is likely conserved in the sister group to Trilophosauridae, the Azendohsauridae. Variance in dental microwear patterns between the sampled taxa suggests potential herbivore niche space partitioning amongst North American trilophosaurids during the Norian. Furthermore, microwear evidence for complex masticatory movement in trilophosaurids may suggest previously unknown craniomandibular specializations, highlighting the need for reexamination of trilophosaurid craniomandibular morphology and jaw closure mechanics.

Nutritional Management of Celiac Disease: A Review

Food allergy can cause pain, but it’s going to occur in obvious illnesses that entail hospital treatment. The popularisation of allergen nutrition greatly impacts customers, food companies, and healthcare professionals. Market expectations have pushed the food business to constantly modify and improve gluten-free important and postprocessing. The diet’s nutritional adequacy, including its effi ciency in trying to manage casein disorders and other conditions, has piqued the interest of health experts. In this evaluation, we hope to provide an insight into the current motivating factors for using casein dietary habits and the technical and nutrient challenges the diet faces as a whole. Option carbs and white fl our, hydrocolloids, and fi ber sources were discovered to signifi cantly aff ect allergen products’ usable and tactile impacts. On the other hand, allergen options are frequently inadequate to casein products in terms of performance. Furthermore, while dietary disparities have been revealed, the gluten-free diet has shown advantages in managing some gluten-related disorders. Shoppers are urged to be aware of the multisensory constraints and dietary insuffi ciencies of allergen nutrition, despite continued strategies to improve them, since there is restricted empirical evidence to support its use outside its role in maintaining allergen disturbances.

Teaching healthy baking

Teaching healthy baking

Diet quality as assessed by Healthy Eating Index-2015 among Hungarian Roma living in settlements of Northeast Hungary

Inequalities in diet quality are increasingly reported, but such studies among Roma are scarce and challenging. Here we attempt to examine diet quality and adherence to food based dietary guidelines among Hungarian Roma (HR) ethnic minority living in segregated settlements while comparing a sample of Hungarian adults from the general population (HG). Data were obtained from a complex comparative health survey conducted in Northeast Hungary in 2018, including sociodemographic and physical examination data. Dietary data were collected using two non-consecutive 24-h dietary recalls. We assessed diet quality based on using a 13-component Healthy Eating Index-2015 (HEI-2015, range 0–100). Differences in median intakes of food and nutrients and HEI-2015 scores were evaluated by Mann–Whitney test or Kruskal–Wallis test. Quantile regression was used to adjust HEI-2015 scores for socioeconomic factors including age, sex, educational status, and perceived financial status. This analysis included 393 and 415 subjects, aged between 18 to 70 years, of HR and HG populations, respectively. Results showed overall low median HEI-2015 scores for both HR and HG, with significantly lower total score among HR participants (41.6, interquartile range (IQR): 39.5–42.8) compared to HG (47.2, IQR: 45.7–51.1). Scores for individual components, such as intake of fruits, greens and beans, whole grains, seafood, and plant proteins were particularly suboptimal among both groups, but significantly lower among the HR population. Scores for refined grains, sodium, saturated fats and added sugar reflected high intakes of these components but did not differ between study groups. Our findings revealed an unfavorable diet quality among the HR compared to HG and a potentially increased risk for diet-related NCDs. Future health intervention programs are warranted to address dietary disparities of segregated minorities in Hungary while considering ethnic and cultural differences.

From food price crisis to an equitable food system

In 2022, the world is experiencing the greatest cost of living crisis in a generation.1 Crises have always highlighted inequities in our societies. With food prices at near record levels globally, rapidly rising inflation, and economic instability, many people living in situations of constraint have no choice but to skip meals, reduce the amount they eat, prepare meals with fewer nutritious foods, and buy cheaper, starchy staples and ultra-processed foods.2–3 The implications for health inequalities are dire: increased dietary disparities will worsen food insecurity, undernutrition, obesity, and diet-related disease among those who are struggling most.

Using Formative Research to Develop a Social Marketing Campaign to Understand Food Shopping Behaviors in Young Mothers

Background The Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamps, serves as the primary method of governmental-funded defense against food insecurity in the USA through the provision of food-purchasing assistance to eligible low-income people and families. However, participation in SNAP has been associated with dietary disparities and increased risk of chronic disease associated with overweight and obesity. Low-income individuals are more vulnerable to diet-related chronic disease, as they often have limited resources, are unable to afford healthier foods, such as fruits and vegetables, experience a lack of geographic access to healthy foods, and find themselves without time to prepare healthy meals. As a result, financially marginalized populations are less likely to adhere to Federal Dietary Guidelines for Americans. Objective The purpose of this study was twofold: first, to gain insight into factors influencing food choices and grocery shopping behaviors of women with children, on a limited budget, who utilize or are eligible for SNAP; second, to develop and implement interventions based on these insights to enable participants to better adhere to the Federal Dietary Guidelines for Americans. Methods We conducted independent formative interviews with 19 women in Spring 2018 to develop a social marketing campaign to promote a behavior change associated with healthy grocery shopping practices. These participants were interviewed using a loosely guided interview that gauged barriers, benefits, motivators, competition, and influencers of using a food budget. Of these participants, we identified those who were actively practicing the selected behavior of budgeting for and purchasing healthy foods, like fruits and vegetables. To empower women within this community by drawing from the experiences and knowledge of other women from this same community, participants were selected to participate in a more thorough interview process, followed by a journey mapping exercise. Data collected from the interviews and journey mapping exercise were analyzed for barriers and facilitators to developing and maintaining the adoption and use of a healthy food budget. In response, the research team conducted a search for interventions that aligned with the outlined barriers noted from the interviews and developed a social marketing campaign. This social marketing campaign was then delivered in a series of sessions where pre- and post-surveys were administered to assess grocery shopping behaviors and budgeting practices. Results Specific topics yielded from the journey mapping exercise included tips and tricks mothers used to successfully budget for and purchase healthy foods. Additionally, mothers who participated in the social marketing intervention reported grocery shopping at least one to two times a week. When asked about their habits related to purchasing fruits and vegetables through pre- and post-surveys, 60% of the participants reported intentionally purchasing fruits and vegetables every time they went grocery shopping. Seventy nine percent (79%) of women reported creating a budget allocated for groceries before shopping, while 42% reported sticking to this budget. Implications The study identified three domains of determinants that influence budgeting and shopping for healthy groceries that can inform future formative research and development of interventions among women with children who utilize or are eligible for SNAP.

Dietary disparities among adolescents according to individual and school socioeconomic status: a multilevel analysis

This study aimed to estimate disparities in dietary habits according to the individual and contextual socioeconomic status (SES), while taking into account school nutrition-related characteristics. Data came from the 2018 cross-sectional “Health Behaviour in School-aged Children” (HBSC) survey. Multilevel multiple logistic regressions were performed. Over two-thirds of the observed variance was explained by individual and school characteristics, with SES being the main contributors. For example, 76.9% of the variance in daily sugar-sweetened beverage (SSB) intake was explained by individual and school characteristics. Adolescents of a secondary or lower parental education level were more likely to consume SSB daily than those of a post-secondary level (aOR = 1.46 (1.29–1.66)). Compared to those in a high SES school, the odds to consume SSB daily was higher for adolescents in low SES schools (aOR = 2.37(1.90–2.96)). These findings support the need for schools to pursue a consistent nutrition policy, with an increased support in low socioeconomic populations.