Healthy Food Access Research Articles

Mushroom as a resilient crop: a paradigm shift from agri-litters to healthy and ecofriendly food production

Nutrient deficiency remains prevalent in low- and middle-income countries. In fact, in developed countries, the high standard of living and the fast-growing population rely on fast and processed foods to support their daily nourishment. However, constant consumption of processed foods has been linked to chronic diseases. The unhealthy results of instant foods serve as an eye-opener for the population to demand the availability of healthy food. Some people resort to plant-based food for health reasons and mushrooms are a great option since they have been utilized as food and drugs since time immemorial, and are a great substitute or even a replacement for unhealthy foods. Mushrooms have long been regarded as a high-nutritional-value food and a vital agent in the degradation of organic matter, an ideal decomposer of agricultural and forest litter. Additionally, mushrooms are obligatory saprophytic, spore-forming eukaryotic organisms belonging to the fungal group, which can be harnessed mostly in a healthy environment. Their dominance as a medicinal food gained global traction and are now cultivated worldwide. Mushrooms, in addition to vitamins, nucleic acids, and minerals, contain β-D-glucan, a prebiotic that has immunomodulatory and anti-inflammatory properties and can be used as an adjuvant in conventional chemotherapy. Furthermore, mushrooms increase food palatability, and their protein and carbohydrate qualities are ideal counterparts to muscle foods such as meat and fish. These edible macrofungi can be considered a superfood and a nutri-med crop with a wide range of biological potentials due to their significant benefits as a combination of food and medicine and because they are grown in an environmentally friendly manner.

A comparative evaluation of child health care in China using multicriteria decision analysis methods

Child health is an important public health issue in China and the Chinese government always attached great importance to child health care. With the implementation of a series of medical and health reforms in China in recent decades, the status of child health improved year by year. Objectives This study aims to comprehensively evaluate if the measures implemented in the medical and health reforms effectively promoted the development of Chinese child health care in recent years and provide theoretical support for future decision-making on the policies of child health care in China. Methods A total of six indicators were selected from the China Health Statistics Yearbook. Based on the multi-criteria decision analysis (MCDA) algorithm, three different evaluation methods were applied in the study, which are the weighted technique for order preference by similarity to an ideal solution (TOPSIS) method, the weighted rank-sum ratio (RSR) method, and the fuzzy comprehensive evaluation (FCE). Each indicator's weight was calculated by the entropy weight methods objectively. The sensitivity analysis was conducted to validate the stability and accuracy of the rank results.Results The results indicated that the rank values of each year’s child health care calculated by the different evaluation methods were not exactly the same, but the overall trend is consistent which is that child health care in China improved year by year from 2000 to 2020. The top 5 were ranked from 2016-2020 and the bottom 5 were ranked from 2000-2004. Conclusions The results indicated that the policies and measures implemented in the medical and health reforms, as well as improved sanitation conditions, availability of healthy food and water, etc., have jointly promoted the development of child health care in China in the past 20 years, providing a scientific theoretical basis for future policy-making to promote child health care.

Social Drivers of Health and Pediatric Extracorporeal Membrane Oxygenation Outcomes.

Relationships between social drivers of health (SDoH) and pediatric health outcomes are highly complex with substantial inconsistencies in studies examining SDoH and extracorporeal membrane oxygenation (ECMO) outcomes. To add to this literature with emerging novel SDoH measures, and to address calls for institutional accountability, we examined associations between SDoH and pediatric ECMO outcomes. This single-center retrospective cohort study included children (<18 years) supported on ECMO (2012-2021). SDoH included Child Opportunity Index (COI), race, ethnicity, payer, interpreter requirement, urbanicity, and travel-time to hospital. COI is a multidimensional estimation of SDoH incorporating traditional (eg, income) and novel (eg, healthy food access) neighborhood attributes ([range 0-100] higher indicates healthier child development). Outcomes included in-hospital mortality, ECMO run duration, and length of stay (LOS). 540 children on ECMO (96%) had a calculable COI. In-hospital mortality was 44% with median run duration of 125 hours and ICU LOS 29 days. Overall, 334 (62%) had cardiac disease, 92 (17%) neonatal respiratory failure, 93 (17%) pediatric respiratory failure, and 21 (4%) sepsis. Median COI was 64 (interquartile range 32-81), 323 (60%) had public insurance, 174 (34%) were from underrepresented racial groups, 57 (11%) required interpreters, 270 (54%) had urban residence, and median travel-time was 89 minutes. SDoH including COI were not statistically associated with outcomes in univariate or multivariate analysis. We observed no significant difference in pediatric ECMO outcomes according to SDoH. Further research is warranted to better understand drivers of inequitable health outcomes in children, and potential protective mechanisms.

Participant and Stakeholder Perceptions of the Food FARMacy Emergency Food Assistance Program for the Coronavirus Disease 2019 Pandemic: A Qualitative Study

BackgroundFood FARMacy is a clinical-community emergency food assistance program developed in response to food insecurity during the COVID-19 pandemic. Few qualitative studies have examined participant, and clinical and community stakeholder experiences with these food assistance programs. ObjectiveTo examine the motivations, experiences, and perceptions of Food FARMacy participants and program stakeholders. DesignA qualitative study using in-depth interviews between March 2021 and July 2021. Participants and settingTwenty-four Food FARMacy participants and 10 program stakeholders in New York, NY (Manhattan, Brooklyn, and Queens) older than age 18 years were interviewed. Statistical analyses performedInterviews were recorded, transcribed, translated, and analyzed using thematic analysis. Participant and program stakeholder interviews were analyzed separately. Themes that were salient in both groups were combined for reporting. ResultsBoth program participants and stakeholders perceived: pandemic-related demands combined with reduced resources motivated participation; convenience, safety, and ease of access facilitated program retention; participants valued fresh produce and diversity of foods; the program improved diet and health; minimizing food waste was a priority; and social cohesion was an unexpected program benefit. Two additional themes among only program stakeholders also were identified: aligned values, flexibility, and communication were key to successful partnerships; and trust between community partners and community members drove programmatic success. ConclusionsResults suggest that a multisite clinical-community partnership to provide emergency food assistance in New York City can be leveraged to reduce barriers to healthy food access and address food insecurity during crises.

Healing Obesity with health-promoting environments – can interventions in Urban Policies bring health benefits?

Abstract Obesity is a complex chronic disease associated with numerous health and social consequences. In 90% of cases, obesity is multifactorial, with a basis in a discrepancy between energy intake and consumption, but also caused by endocrine, psychological factors, environment, improper diet, physical inactivity, and lifestyle. The environment where people live and work must provide opportunity for enough physical activity to prevent obesity. The availability of fitness parks, bike paths, and publicly accessible swimming pools are the many possibilities that a positive and encouraging environment could provide. Urban areas demand publicly accessible places for physical activity. At the same time, it is important to motivate citizens in urban areas to increase their physical activity, because of a predominantly sedentary lifestyle. If the city's urban and health policies promote a healthy lifestyle, for example encouraging cycling and walking by providing infrastructure that will allow for a greater percentage of people to engage daily in physical activity. A healthy-behaviors-promoting environment is important to combat obesity (walkable neighborhood, green space, safe cycling, healthy food availability). A variety of policy strategies are available to create an active and safe environment: 1) increasing green and blue areas in urban settings: to promote recreation and relaxation; 2) promoting cycling and walking as a form of active mobility; 3) reducing or banning of public advertising of unhealthy food, while promoting healthy nutrition and increase of markets with healthy food; 4) encouraging socialization through sport, etc. Providing a healthy and safe environment is necessary to curb the obesity epidemic. Numerous interventions aimed at implementing a plan to change the environment and create a safe and stimulating environment for children and adults are needed.

The Relationship Between Nutrition Knowledge, Attitude and Practice (NKAP), Self-Efficacy of Healthy Eating with Body Mass Index (BMI) Status Among Undergraduate Students in USM Kubang Kerian, Kelantan: A Cross-Sectional Study

Introduction: Healthy eating is an approach to prevent obesity, hypertension, diabetes mellitus, and cardiovascular disease. This study aimed to determine the level of nutrition knowledge, attitude, and practice (NKAP), level of self-efficacy of healthy eating, and their relationship with body mass index (BMI) among undergraduate students in USM Kubang Kerian, Kelantan.Study Design: A cross-sectional study was conducted on 107 undergraduate students aged 19 to 28 years old, selected using convenience sampling in USM Kubang Kerian, Kelantan from August 2021 until October 2021. A self-administered questionnaire including the KAP questionnaire and self-efficacy of the healthy eating scale was distributed to the participants via Google Form. Findings: The prevalence of good knowledge was 95.3%, good attitude was 79.4% but good practice was only 36.4%. Overall, the prevalence of nutrition knowledge, attitude, and practice (NKAP) was good at 82.2%. The total median score of self-efficacies in healthy eating was 28.0 (7.0). A significant association was found between the availability of healthy and unhealthy foods with practice (p=0.012, p=0.019). Moreover, a significant association was found between age and awareness of the Malaysian Food Pyramid with NKAP (p=0.039, p=0.005 respectively). Hence, a significant association was found between NKAP and self-efficacy of healthy eating (p=0.008). However, the present study revealed that there was no significant association between NKAP with BMI, and self-efficacy of healthy eating with BMI (p=0.541, p=0.064).Conclusion: We found that having good nutrition knowledge and attitude alone was insufficient for the changes in individuals' healthy eating practices as most university students had suboptimal eating behaviour in their daily lifestyle. Therefore, strategies were needed to practice good and healthy eating among university students.

Healthy food and determinants of food choice on online food delivery applications.

Online food delivery applications (OFD apps) provide consumers with a wide range of options to choose from. The present study aimed to assess the usage of OFD apps and investigate the factors that affect food choices with a special emphasis on healthy food choices and hygiene. A cross-sectional study among food delivery application users in Jordan was conducted using an online questionnaire between March and May 2022. A total of 675 eligible subjects participated in the study. Consumers' demographic characteristics, data on consumers' use of OFD apps, consumers' perceptions of healthy food availability in OFD apps, and consumers' attitudes toward food safety and delivery hygiene were collected and analyzed. About 64% of the studied sample used OFD apps weekly. Fast food was the most popular option for ordering (87.1%) and lunchtime was the most preferred time to order food (67.3%) for most of the respondents. Respondents' perceptions of a "healthy meal" was associated with the presence of a variety of vegetables in the meal. Food price, food appearance, time of delivery, macronutrient content information, the availability of healthy options, and considering vegetables as part of a healthy meal were determinants of consumer food choice (p<0.05). The findings suggest that the online food environment in Jordan was perceived to be unhealthy. Nevertheless, the convenient nature and the popularity of OFD apps hold great potential to promote healthy eating among consumers.

SAT127 What’s Cookin’: Attitudes Towards A Healthy, Budget-friendly Meal Planning Tool In Patients With Type 2 Diabetes

Abstract Disclosure: R. Abramczyk: None. S. Sadiq: None. C. Vaz: None. Background: Eating home-cooked meals has been associated with reduced risk of developing type 2 diabetes (T2DM). Additionally, nutrition counseling can aid weight loss and improve glucose levels. However, these interventions may be less effective in underserved patients as food prices can be a barrier to healthy food access. We performed a preliminary assessment of a quality improvement nutritional intervention at a university-based clinic in a medically underserved area. Aim: This analysis aimed to measure patients’ perceived levels of confidence in shopping for and preparing healthy, DM-friendly meals and interest in receiving a sample grocery list with matching recipes. Methods: Patients with T2DM seen in fellows’ clinic over 3 months were offered surveys that measured confidence levels in shopping for and preparing a healthy, DM-friendly diet. Participants were subsequently offered an ADA-compliant, Supplemental Nutritional Assistance Program-friendly sample grocery list and weekly meal plan. Results: 50 patients completed surveys. 70% were &amp;gt;50 years and 70% identified as African American. 98% shop for food at a supermarket, with 12% also utilizing smaller grocery and corner stores. 8% were not confident in shopping for healthy, DM-friendly foods. 30% were somewhat confident, 46% were confident, and 16% were extremely confident in shopping for DM-friendly foods. 82% of participants either did their own meal prep at home or had someone else at home who cooked. 16% were not confident in cooking DM-friendly foods, whereas 26% were somewhat confident, 50% were confident, and 8% were extremely confident. 92% were interested in receiving a 1-week shopping list for healthy groceries with corresponding recipes. Conclusion: While many patients in a low socioeconomic status neighborhood reported feeling confident shopping for healthy, DM-friendly foods, fewer felt confident in preparing and cooking these foods. Most patients were interested in a budget friendly shopping list and meal planning tool to assist in both shopping for and cooking foods that will assist in achieving improved DM control. A follow up phase study will evaluate the rate of utilization and other patient behavioral factors in response to this intervention. Further research is needed to develop and evaluate the impact that tools such as this may have on changes in behavior towards shopping for and cooking healthy, DM-friendly foods at home and its effects on glycemic control. Presentation: Saturday, June 17, 2023

Identifying and Addressing Nutritional Inequities and Psychosocial Needs of Cancer Patients Residing in Zip-Code Designated Food Priority Areas (FPAs)

Nutrition is an essential aspect of cancer care at all time points leading to and after definitive therapy. Yet, cancer patients who reside in FPAs may experience limited access to healthy meals, possibly affecting cancer outcomes. There is no prospective data evaluating the consequence of residing in FPAs as it relates to perceived nutritional access, psychosocial needs, or nutritional status of cancer patients before, during, and after definitive treatment. Therefore, this study aims to characterize the nutritional needs of cancer patients undergoing curative radiation treatment (RT). We hypothesize that FPA residence will correlate with perceived lack of access to healthy food as well as other unmet psychosocial cancer needs at multiple time points during care. Under IRB approval, a prospective, cross-sectional analysis was done using a questionnaire consolidated from previously validated surveys assessing the nutritional and psychosocial needs of patients with curable lung, head/neck, gynecological, or gastrointestinal cancers at different time points of cancer care (pre-treatment, 1 month, 6 months, and 1 year after completion of RT). Groups were compared using Χ2 and Mann-Whitney U tests as appropriate. Binary logistic regression was used to identify predictors of healthy food access. From May 2019 to December 2022, 320 of 434 patients completed the survey, giving a compliance rate of 74%. Twenty-six percent of patients resided in zip-code designated FPAs. Patients who lived in FPAs were more likely to self-identify as black (60.5% vs 39.5%; p<0.001), single (p<0.001), have a lower median income (p<0.001), and were more likely to receive care at our inner-city photon therapy center (p<0.001) compared to non-FPA residents. Compared with non-FPA patients, the cohort who lived in FPAs had higher unmet nutritional needs (p = 0.003), which included a greater demand for healthier ways to eat (67.6%vs.54.4; p = 0.047) and a greater concern of having inadequate funds to buy healthy meals (44.4%vs.19.9%; p = 0.002). On MVA, marital status, median income, race, educational level and FPA residence were included, however only black race (OR:8.85; 95% CI:3.73-16.32; p<0.001) and education level (Elementary School: OR:8.32; 95% CI:1.19-58.33; p = 0.001, REF: Graduate/Professional) were predictors for nutritious meals uncertainty. Inequities in nutritional needs were clearly identified in patients residing in FPAs when compared to non-FPA patients. Race and educational level are important factors in identifying patients in need of nutritional support. These demographics along with FPA-designated zip codes can be used to identify at-risk patients during clinic visits, where continuous nutritional and psychosocial support can be provided.

Factors associated with Food Safety Practices (FSP) among visitors in the Depok Beach Area in Yogyakarta, Indonesia

Background: The availability of safe, healthy, and clean food in tourism places is essential to ensure customers’ satisfaction. Most previous studies focused on food safety practices among food handlers. However, personal food safety practices are needed to prevent foodborne diseases. Objective: This study aimed to identify the factors associated with food safety practices among people who visited Depok Beach. Methods: A quantitative approach was done on 211 Depok Beach visitors selected by the accidental sample method. This study was conducted from September to October 2022. Descriptive statistics, chi-square, and binary logistic regression were used for data analysis. Results: This study found that factors such as marital status, knowledge, and attitude were 2.8, 1.2, and 2.2 times, respectively, more likely to practice poor food safety practices. Conclusion: The food safety practice among visitors was less than average. The factors associated with food safety practices among visitors were marital status, knowledge, and attitude about food safety. Health promotion about food safety for customers is needed. Further studies could mix with the qualitative approach to get comprehensive findings.

Prospective associations of neighborhood healthy food access and walkability with weight status in a regional pediatric health system

BackgroundMost neighborhood food and activity related environment research in children has been cross-sectional. A better understanding of prospective associations between these neighborhood environment factors and children’s weight status can provide stronger evidence for informing interventions and policy. This study examined associations of baseline and changes in neighborhood healthy food access and walkability with changes in children’s weight status over 5 years.MethodsHeight, weight, and home address were obtained for 4,493 children (> 75% were Black or Latinx) from primary care visits within a large pediatric health system. Eligible participants were those who had measures collected during two time periods (2012–2014 [Time 1] and 2017–2019 [Time 2]). Data were integrated with census tract-level healthy food access and walkability data. Children who moved residences between the time periods were considered ‘movers’ (N = 1052; 23.4%). Mixed-effects models, accounting for nesting of children within census tracts, were conducted to model associations of baseline and changes in the neighborhood environment variables with Time 2 weight status (BMIz and overweight or obese vs. healthy weight). Models adjusted for weight status and child and neighborhood sociodemographics at baseline.ResultsChildren living in a neighborhood with [ample] healthy food access at Time 1 had a lower BMIz at Time 2, regardless of mover status. A decrease in healthy food access was not significantly associated with children’s weight status at Time 2. Baseline walkability and improvements in walkability were associated with a lower BMIz at Time 2, regardless of mover status.ConclusionsFindings provide evidence that residing in a neighborhood with healthy food access and walkability may support a healthy weight trajectory in children. Findings on changes in the neighborhood environment suggested that improved walkability in the neighborhood may support children’s healthy weight. The greater and more consistent findings among movers may be due to movers experiencing greater changes in neighborhood features than the changes that typically occur within a neighborhood over a short period of time. Future research is needed to investigate more robust environmental changes to neighborhoods.

Food access in Kalamazoo, Michigan: A spatial analysis

Healthy and affordable food is a universal human need. In the U.S., food access is often limited in low-income areas as opposed to medium- and high-income areas. To address disparities in the availability of healthy foods, the dispersion of food access points needs to be quantified and docu­mented. Nutritional quality and consistency of availability vary across different types of food access points, including permanent grocery stores, farmers markets, community gardens, food pan­tries, and convenience stores. Accessibility is also determined by the means of transportation avail­able or required to get to food access points (public transit, driving, or walking). In this geographic information systems (GIS)-based analysis, we iden­tify differences in accessibility to distinct types of food access points—reliable, seasonal, and lower quality—between low-income and higher-income tracts in the City of Kalamazoo, Michigan. We found that all full-service grocery stores are acces­sible via bus routes in the City of Kalamazoo; however, 11% of people reside in low-income areas with low access to these grocery stores—beyond the 0.25-mile walkable distance to bus routes. We then asked whether the addition of community gardens, food pantries, and farmers markets, on the “plus” side, or convenience and dollar stores, on the “minus” side, changes the food access landscape in this community. We found that the “positive” access points served areas that already had access to grocers, while “negative” access points filled the access gap in lower income areas. More than twice as many low-income residents had walkable access to convenience stores—which provide lower-quality and highly processed food—with 81% of them being located within low-income tracts. Geographical analysis of low food access and low-quality food access is important to identify structural patterns, but it needs to be paired with interview-based community assessments to ascertain how residents actually procure their food.

Economic effects of food supply chain re-localization on the Croatian economy

Securing the availability of healthy food at affordable prices is of fundamental public interest. The formerly prevailing paradigm of the absolute superiority of free trade in the global food market is changing in favour of re-localization after vulnerabilities were exposed by the war in Ukraine, the COVID-19 pandemic and the recent disorder in the global food market. Re-localization of food production could also have a positive impact on the environment, public health and sustainable local development. This paper analyses the trends and current conditions in the Croatian food market regarding the potential economic benefits of re-localization of food production. The purpose of the paper is to estimate the economic benefits of food re-localization in Croatia. The method of input–output analysis is applied to test hypotheses. Direct, indirect and induced effects of re-localization of food production are estimated and the results compared with other countries. The results confirm previous findings that re-localization of food production could stimulate the domestic economy. The multipliers estimated for Croatian agricultural and food production do not deviate significantly from the results published for other economies. Output multipliers related to the Croatian food sector are slightly lower than those estimated for new European Union members, while multipliers for the Croatian agriculture sector are in line with those estimated for the same group of countries. It is found that expenditures on domestic food products induce significantly larger economic effects in Croatia than expenditures on imported food. Import substitution and re-localization would also positively affect public finances. Re-localizing 10% of imports of agri-food products could increase the Croatian GDP by 0.32%. The employment effects would be even larger since labour intensity in the food and agriculture sectors is high.

A Study on Extraction Methods and Primary Toxicity Level of Bio Colourants

Bio-colourants for food are extracted from plant sources that it is becoming a huge demand in the global market of processed foods and confectionaries. Natural colours play a vital role in food safety and also in meeting the needs of food consumption practices for the growing crisis in the availability of healthy foods. Aim of the bio colours is to replace synthetic colours like sunset yellow FCF, Allura Red, Ponceau 4R, Amaranth and Brown HT as they are becoming a wide range of threat to the human race, especially in bringing psychological changes in children and adolescents. Usually bio-colourants are extracted from almost all the parts of a plant. But majority of the colours are extracted from leaves and barks, whereas few colours in specific are extracted from fruits, seeds and some from petals of flowers. In this study, bio-colouring agents such as madder roots (Rubia cordifolia), eucalyptus bark (Eucalyptus grandis), annatto seeds (Bixaorellana), roselle petals (Hibiscus sabdariffa) and tamarind seeds (Tamarindus indica) were identified and used in extraction of colours. The colours obtained were of different shades of red like: sangria red, rusty red and yellow red. These natural food colours were extracted from their natural sources through two processes:10 per cent aqueous extraction (reflux, boiling) and powdering the substances. The pH of the extracts was taken to know their level of hydrogen ion concentration. To verify,if these extracts are edible and stable, preliminary toxicology study was carried out in brine shrimp assay. On the other hand, every fourth day the discolouring of the extracts was constantly measured using Food Colour Reader. The aqueous extracts showed discolouring and formation of microbial layer even when preserved in refrigerator in sterilized glass bottles, whereas the powdered substances remained the same with no discolouring or microbial activity in it. The toxicity study has practically proved that the powdered substances in various concentrations of 100, 250, 500, 1000 and 1500 µg/ml has the overall lowest mortality rate in consideration to mean and standard deviation (M ± SD) of 11.7 ± 10.7, than to the aqueous extraction samples of 73.7 ± 22.8 respectively. This study is carried out to promote and incorporate bio-colours in foods that can be consumed on daily basis, replacing the commercially available hazardous food colourants.

Abstract P175: Benefits Of Gardening For Self-management Of Hypertension Among African-American Men: A Mixed-Methods Analysis

Background: African American men are disproportionately affected by hypertension compared to other racial/ethnic groups. Self-management practices such as following a diet rich in fruits and vegetables can lead to improved hypertension control. However, healthy options may be inaccessible for some African American men, Gardening may provide easy access to fruits and vegetables. Methods: We conducted a mixed-methods study exploring African American men’s experiences with hypertension from Tennessee who regularly engaged in personal or community gardening and their gardening benefits (diet, physical activity, stress management), preferred diets and food selection. Participants completed semi-structured interviews and the Dietary Approaches to Stop Hypertension (DASH) diet questionnaire which was compared to the U.S. Department of Agriculture (USDA) MyPlate. Results: Participants (N=9, mean age 65 [SD 5.4] years) reported that gardening improved their regular physical activity, stress management, and satisfaction with providing for others. Several themes emerged including that participants preferred to manage their hypertension through diet modification by alternating traditional diets (high fat/sodium) with heart-healthy (low fat/sodium) meals and that they recognized the continuous nature of healthy food selection. Diet questionnaire responses revealed mean daily fruit (2.9 [SD 1.7]) and vegetable (2.8 [SD 1.1]) servings were below DASH diet recommendations but above MyPlate guidelines. Further, mean daily meat/protein (3.7[SD 1.1]) and fat/oil intake (6.4 [SD 7.2]) servings exceeded both recommendations. Conclusion: Our study suggests that personal and community gardening may provide a means for African American men to improve hypertension self-management practices through physical activity, stress relief, and healthy food access. Further studies of gardening interventions on blood pressure control among this group are warranted.

Food deserts, endometrial cancer survivors, and healthy food access: Is it equitable in rural America? – A geospatial analysis (2127)

Food deserts, endometrial cancer survivors, and healthy food access: Is it equitable in rural America? – A geospatial analysis (2127)

Prenatal Risks to Healthy Food Access and High Birthweight Outcomes

ObjectiveInfants with high birthweight have increased risk for adverse outcomes at birth and across childhood. Prenatal risks to healthy food access may increase odds of high birthweight. We tested whether having a poor neighborhood food environment and/or food insecurity had associations with high birthweight. MethodsWe analyzed cross-sectional baseline data in Greenlight Plus, an obesity prevention trial across six US cities (n = 787), which included newborns with a gestational age greater than 34 weeks and a birthweight greater than 2500 g. We assessed neighborhood food environment using the Place-Based Survey and food insecurity using the US Household Food Security Module. We performed logistic regression analyses to assess the individual and additive effects of risk factors on high birthweight. We adjusted for potential confounders: infant sex, race, ethnicity, gestational age, birthing parent age, education, income, and study site. ResultsThirty-four percent of birthing parents reported poor neighborhood food environment and/or food insecurity. Compared to those without food insecurity, food insecure families had greater odds of delivering an infant with high birthweight (adjusted odds ratios [aOR] 1.96, 95% confidence intervals [CI]: 1.01, 3.82) after adjusting for poor neighborhood food environment, which was not associated with high birthweight (aOR 1.35, 95% CI: 0.78, 2.34). Each additional risk to healthy food access was associated with a 56% (95% CI: 4%−132%) increase in high birthweight odds. ConclusionsPrenatal risks to healthy food access may increase high infant birthweight odds. Future studies designed to measure neighborhood factors should examine infant birthweight outcomes in the context of prenatal social determinants of health.

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.

Study design and protocol for Nourishing Beginnings, an integrated service delivery model addressing food insecurity and social needs of low-income pregnant individuals

BackgroundNourishing Beginnings is an integrated referral and service delivery model supporting Medicaid-eligible pregnant individuals by providing increased nutritional food access throughout pregnancy up to three months postpartum, through community health workers (CHW), who simultaneously address and provide support for social service needs of the client. MethodsTo study the impact of possible interventions on food security, the program includes two distinct interventions each paired with traditional CHW services, nutrition educational materials, and provision of basic essential cooking tools. Interventions consist of either bi-weekly home food delivery from the local food bank or bi-weekly financial assistance with healthy food access navigation. The study population consists of 160 pregnant individuals (18 or older,<22 weeks pregnant; 80 per intervention arm) who were referred to a countywide Pathways Community HUB (HUB), a community-based care coordination network that uses an evidence-based model to connect at-risk individuals to resources that address medical, social, economic, and behavioral health needs. Key data collection occurs at baseline, eight weeks after intervention begins, near delivery (36–38 weeks gestation), and three months postpartum. Intervention groups are compared to each other as well as against HUB historical controls and a concurrent matched sample from local Medicaid data. ConclusionThe goal of Nourishing Beginnings is to improve long-term health outcomes (i.e., maternal and infant) both directly and mediated through a set of proximal outcomes, including prenatal care, food security, diet and nutrition, reported race discrimination and psychosocial factors including depression, stress, healthy eating self-efficacy, and social support.Clinical Trials #: NCT05341960.

Building relationships back into the food system: addressing food insecurity and food well-being

IntroductionFailures of the current food system sit at the core of the multitude of crises by being the root framework for both consumption choices and food production. Low-income households are disproportionately affected by these failures, impacting their food security and access to healthy and sustainable foods. Community-supported agriculture (CSA) is a bottom-up response towards an agri-food system transformation by providing an alternative food system based on agroecologically grown food that is sold locally and rooted in social values. Alongside other food citizenship movements and alternative food networks (AFN), CSAs are driven by the vision to develop a democratic, socially and economically just, and environmentally sustainable food system. Yet, low-income households are underrepresented in the CSA community.MethodOur paper presents findings from a co-produced intervention between the research team, four CSA farms based in Wales, United Kingdom and two food aid partners that sought to identify ways to improve the accessibility of CSA memberships for food-insecure households. Thirty-eight households received a weekly veg bag for a period of 2–4 months. We interviewed 16 household members at the project start and end of the harvest season. Building on the food well-being framework, we investigate impacts of a CSA membership on food-insecure households.ResultsWe found that CSA membership holistically improves food well-being, through strengthening producer-consumer relationships, increasing availability of healthy foods, helping people to care for their own and their families well-being, and building place-based food capability and literacy.DiscussionThis paper supports wider narratives that call for systematically prioritizing interventions that promote overall food well-being, which can lead to sustainable and just food systems with positive outcomes for financially excluded, food insecure households in localized AFNs.