Healthy Food Access Research Articles

THE IMPLEMENTATION PROCESS OF AN INTERGENERATIONAL COMMUNITY RESEARCH PROJECT: A NARRATIVE REVIEW

Abstract Food for a Long Life (FFLL) was a five-year USDA Children, Youth and Families at Risk intergenerational community research project that sought to increase healthy food consumption, knowledge, and access among preschoolers and older adults living in food insecure communities of Ohio and Virginia. Using the community-based participatory action research approach, community stakeholders jointly participated in all stages of the project to co-create context-specific programming to address needs within their communities with the goal of promoting program sustainability beyond the grant funding period. This presentation will provide a narrative review to explore the implementation process of FFLL by comparing initial project expectations to reality using the community-based participatory research conceptual model (Wallerstein et al., 2008; Wallerstein et al., 2018). By exploring project barriers such as COVID-19, facilitators such as flexible partner relationships, and strategies including promoting early buy-in, we provide an in-depth discussion of project successes and lessons learned.

FOOD INSECURITY AND COGNITIVE TRAJECTORIES IN COMMUNITY-DWELLING OLDER ADULTS

Abstract Food insecurity, defined as limited access to nutritionally adequate and safe foods due to social and economic conditions, has adverse effects on physical health and well-being. However, it remains unclear whether food insecurity accelerates cognitive decline in older adults. This study examined the association of food insecurity with cognitive decline. We analyzed data from 4,508 community-dwelling participants in the National Health and Aging Trends Study (NHATS) collected from 2011 to 2020, a prospective cohort study of a nationally representative sample of Medicare beneficiaries ages 65 years and older. Food insecurity was measured using 5 items within functional, social support, and financial limitations domains. Immediate and delayed recall were assessed by a 10-item word-list memory task (range: 0—10). Executive function was evaluated by the Clock Drawing Test (range: 0—5). Each year’s cognitive functions were linked to the prior year’s food insecurity values. Weighted linear mixed effect models were fitted. Prevalence of food insecurity at baseline was 3.5% (95% CI: 2.9 — 4.3). Persons with food insecurity were more likely to have Black race or Hispanic ethnicity, low income, and less than high school education. Food insecurity was associated with faster decline in executive function accounting for demographic and socioeconomic characteristics: the average difference, over 1-year, in executive function score between people exposed to and not exposed to food insecurity was 0.038 points (95% CI: -0.072 — -0.003). Food assistance programs or increasing healthy food access may reduce food insecurity and delay cognitive aging in community-dwelling older adults.

The barriers of home environments for obesity prevention in Indonesian adolescents

BackgroundObesity and its related cardiovascular-metabolic diseases are growing public health concerns. Despite global attention to obesity, its prevalence is steeply increasing in developing countries, especially in children and adolescents. Eating behaviours and physical activity are modifiable risk factors for obesity that can variably be shaped by families. Eating behaviours and physical activity are especially important during adolescence, given its significance as a foundational period for developing healthy lifestyles. This qualitative study aimed to explore barriers and opportunities around creating healthy lifestyles among adolescents in Indonesia, focussing on family environments from diverse socio-demographic backgrounds.MethodIn-depth interviews using a semi-structured guide were undertaken with consecutively recruited 10–18-year-old adolescents with overweight or obesity, and their parents, from three different sites: urban (Jakarta, the capital city of Indonesia), peri-urban (West Java Province) and rural (Banten Province). Thematic analysis was used to identify patterns of meaning.ResultsNineteen dyads were interviewed. Thematic analysis revealed four themes: limited knowledge of healthy lifestyles; healthy lifestyles not a concern of daily life; limited parenting skills, including inequity around gender roles; and aspects of availability and accessibility. These interconnected barriers influenced lifestyle practices at home within the context of daily preferences and decisions around food and activities. Gender role inequity and healthy food accessibility were more prominent in rural families than in those from urban or peri-urban settings.ConclusionsHealthy lifestyles in adolescence may be supported by strategies to enhance parenting skills, build individual motivation, and support the development of more enabling environments.

Do Food and Nutrition Public Establishments Influence Availability to Healthy Food in Neighborhood?

ABSTRACT To investigate the food environment and availability of foods in establishments in areas with and without Food and Nutrition Public Establishments (FNPE). The availability, variety and promotion of foods that compose Healthy Food Store Index (HFSI) were compared between establishments in both areas. The availability and variety of fruits and vegetables mean were higher among FNPE. The availability of ultra-processed foods was higher in convenience stores/bakeries. HFSI did not differ between areas. The fact that the index of availability of healthy foods did not differ between areas reflected the low impact of FNPE on food marketing dynamics.

Association between Fresh Fruit and Vegetable Consumption and Purchasing Behaviors, Food Insecurity Status and Geographic Food Access among a Lower-Income, Racially/Ethnically Diverse Cohort in Central Texas.

The aims of this study were to determine if fresh fruit and vegetable consumption and purchasing behaviors were associated with geographic food access and/or food insecurity status, and to explore the role of sociodemographic characteristics among participants of a lower-income, racially/ethnically diverse cohort. This study used a cross-sectional design and baseline survey data from the FRESH-Austin study (N = 393). Associations between fresh produce consumption/purchasing and food insecurity status and geographic access to food were assessed utilizing univariate, bivariate, and multivariate linear regression methods and potential interactions were examined. The sample 40% reported being food insecure and the majority identified as Hispanic. Geographic food access was directly associated with fresh produce consumption (β = 0.46, p = 0.02); however, the directionality of the relationship between food insecurity and fresh produce consumption varied due to a significant interaction with race/ethnicity. Only utilizing food assistance was associated with purchasing fewer fresh produce (β= -1.83, p = 0.03). Findings suggest that communities experience food insecurity and limited healthy food access in different ways, and in some situations, are associated with fresh produce consumption and purchasing behaviors. Future research adopting an intersectionality-sensitive approach to better understand how to best support communities at risk is needed.

Sustainable food, consensus, and debates: a study on university campuses in Mexico City

Purpose This paper aims to analyze the conceptions that underlie the notion of “sustainable food” of different social actors based on a study focused on promoting sustainable food strategies on university campuses. Design/methodology/approach The research incorporates the views of various actors linked to a sustainable food project on the campuses of the National Autonomous University of Mexico (Universidad Nacional Autónoma de México), which is one of the most important universities in Latin America. The study includes a literature review on food sustainability strategies on university campuses and implemented sustainable food programmes in 100 universities worldwide. It also incorporates semistructured interviews and discussion groups conducted with consumers of the university community, 60 smallholder farmers and managers of 23 alternative food networks in Mexico City. Findings This research evidence the diversity of meanings and perspectives associated with food sustainability and a generalized emphasis on its environmental dimensions, although environmental problems tend to be partially understood. It also highlights the priority students and producers give to the accessibility of healthy foods. Research limitations/implications The results of this study revealed important elements, potentially useful for designing sustainable food strategies on the campuses, considering the principles of the rights-based approach to development and social participation. Originality/value The research evinces tensions in the definition of food sustainability and its translation into actions from a multistakeholder perspective.

Technical Assistance From Public Health Practitioners to Small Food Retailers to Implement Minimum Stocking Standards.

Implementing minimum stocking standard policies in food retail settings has been one strategy used to address lack of healthy food availability. Policies alone may not be enough to increase healthy options, as barriers may arise during implementation, such as lack of distributors and/or refrigeration. Technical assistance (TA) from public health practitioners (PHPs) can bolster the implementation of such policies. This study describes the impact of a pilot intervention where PHPs provided TA to store managers/owners aimed to increase healthy options through implementing minimal stocking standards. This intervention consisted of TA about healthy products, placement, and promotion from state to county/city PHPs and from PHPs to managers/owners of small food retail stores. Thirteen food retailers and PHPs from 11 different agencies participated in this intervention. PHPs interviewed managers/owners pre- and post-intervention to understand perceptions and practices and collected data about the availability of healthy options. PHPs tracked the TA provided to managers/owners and completed a postsurvey, assessing their experience. During the pilot, stores increased the median number of varieties of healthy options. PHPs provided TA around healthy products, placement; and promotion building relationships with distributors and farmers, and overcoming infrastructure barriers. Finding distributors with healthy options remained challenging for some managers/owners. PHPs indicated that continued TA for managers/owners is necessary for sustainability and additional support around distribution and business/economic challenges is needed. Overall, this pilot indicates that PHPs are valuable partners to small food retailers, and in partnership, they have potential to address healthy food access issues.

The role of convenience stores in healthy food environments: The case of Barcelona (Spain)

The characterization of local food environments is of great importance due to its connection with the health of citizens. Nevertheless, little is known about the in-store availability, quality, and price of healthy items in convenience stores, a food store quickly spreading in urban settings around the globe. To fill this gap, this study explores their contribution to healthy food environments in Barcelona (Spain). We compiled a representative food basket with healthy options and compared it with 170 observations in convenience stores to collect data on the in-store availability, quality, and price. About 66 % sold fruit and vegetables. The quality of fruit and vegetables sold was good-medium. Compared to regular supermarkets, the basket at a convenience store was 18 % more expensive. There were not differences in the availability and quality of products between neighbourhoods of different income levels. We conclude that convenience stores contribute equally as supermarkets in terms of availability and quality to the healthy local food environments. More research is needed to effectively evaluate the implications of affordability in low-income neighbourhoods. We highlight the importance of considering convenience stores in the healthy food access mapping in urban settings worldwide, and on the global debate on sustainable food environments.

The Availability and Price of Healthy Food in Seattle by Neighborhood Sociodemographic Characteristics.

Unequal access to healthy food in the local food retail environment contributes to diet quality disparities. We assessed whether in-store availability and prices of healthy foods differ by neighborhood-level income and racial and ethnic composition in a representative sample of food stores in Seattle, Washington. We developed and validated an in-store survey tool and surveyed 134 stores. We measured availability and prices of 19 items. For each store, we calculated a healthy food availability score (range, 0-25), and mean prices within each category. Using census tract data, we identified the median household income and proportions of Black and Hispanic residents for each store's neighborhood and grouped them by tertiles of these neighborhood characteristics across Seattle census tracts. We used Wald tests to compare mean availability scores and prices between tertiles and applied postestimation weights to reflect store-type distributions within each tertile. Neighborhoods with lower income and a larger proportion of Black residents had lower healthy food availability scores compared with neighborhoods with higher income (8.06 [95% CI, 7.04-9.07] vs 12.40 [95% CI, 10.63-14.17], P < .001) and fewer Black residents (8.88 [95% CI, 7.79-9.98] vs 12.32 [95% CI, 10.51-14.14], P = .003). Availability did not differ by Hispanic population proportions. Mean prices of grains, eggs, and meat were lower in neighborhoods with larger proportions of Black residents. We found systematic differences in healthy food availability based on neighborhood-level income and racial composition. In-store assessments of the food retail environment can inform local, tailored strategies to improve healthy food access.

Multi-Mode Huff-Based 2SFCA: Examining Geographical Accessibility to Food Outlets in Austin, Texas

The retail food environment draws much attention from scholars because it can shape individuals’ eating behaviors and health outcomes. Although much progress has been made, current retail food environment assessments mainly use simple food accessibility measures while overlooking the role of multiple transportation modes. This research proposed a multiple-mode Huff-based Two-step Floating Catchment Area (2SFCA) method to measure geographical access to food outlets in Austin, Texas. The spatial accessibility score was calculated with low to high impedance coefficients. Our analyses revealed an urban core-and-peripheral disparity in spatial accessibility to food outlets. We also compared the proposed multiple-mode Huff-based 2SFCA with its single-mode counterpart using t-test and relative difference methods. The comparison illustrates that the difference between the two methods of calculating healthy and unhealthy food accessibility is significant when the impedance coefficient is set to be 1.4 and 1.5, respectively. Our proposed multi-mode Huff-based 2SFCA method accounts for the various transport means and the spatial heterogeneity in population demand for food services; this could support developing intervention strategies to target under-served healthy food areas and over-served unhealthy food areas.

Barriers and facilitators to diabetes screening and prevention after a pregnancy complicated by gestational diabetes.

Gestational diabetes mellitus (GDM) is increasing in the United States, with higher rates among minoritized racial and ethnic populations and lower income populations. GDM increases risk for type 2 diabetes (T2DM), and postpartum diabetes screening and prevention are imperative. This qualitative study examines barriers and facilitators to postpartum T2DM screening and prevention among non-privately insured individuals with a history of GDM in a state prior to Medicaid expansion. Thirty-six non-privately insured women with a history of GDM completed semi-structured interviews. Four focus groups and seven interviews were conducted with 30 nurse practitioners, physicians, physician assistants, nurses and registered dietitians from Federally Qualified Health Centers in St. Louis, MO. Interviews and focus groups were audio-recorded and transcribed. Data were analyzed using an integrative thematic analysis informed by the socio-ecological model. Barriers and facilitators to T2DM screening and prevention occur across multiple environments (society, healthcare system, interpersonal, and individual). Societal barriers include insurance issues, unemployment, and lack of transportation, childcare, safe housing, and healthy food access, while facilitators include government sponsored programs and community organizations. Healthcare system barriers include care fragmentation, scheduling policies and time constraints while facilitators include care coordination, pregnancy support groups, and education materials. Interpersonal barriers include negative care experiences, cultural differences, communication challenges, competing priorities, and lack of a social support network, while facilitators include family and friend support and positive care experiences. Individual barriers include health complications and unhealthy food and exercise patterns, while facilitators include child wellbeing, empowered attitudes and healthy food and exercise patterns. The socioecological model highlights the societal and systemic determinants that encompass individual and interpersonal factors affecting postpartum T2DM screening and prevention. This framework can inform multi-level interventions to increase postpartum T2DM screening and prevention in this high-risk population, including policy changes to alleviate higher-level barriers.

"The Shelves Are Bare": The Impact of COVID-19 on Families Enrolled in a Pediatric Produce Prescription Program.

Objectives A large pediatric clinic in Flint, Michigan, implemented a produce prescription program for youth to address enduring challenges with food access and food insecurity. Approximately 18 months later, on March 23, 2020, the State of Michigan issued a "stay home, stay safe" executive order in response to the COVID-19 pandemic. This study sought to (1) explore caregiver experiences with access to and utilization of the prescription program during COVID-19; and (2) understand perceived changes in the food environment during the "stay home, stay safe" executive order. Methods Researchers collected data through recorded, semi-structured telephone interviews with caregivers of children who received at least one produce prescription and had previously enrolled in a preliminary effectiveness study on the prescription program. We transcribed the recordings verbatim for textual analysis. Examining the qualitative data using thematic analysis, we identified patterns across transcripts and formulated illustrative themes. Results Fifty-six caregivers (mean age, 41.3 ± 10.3 years) participated in interviews. The majority were female (91%), African American (70%), and Flint residents (75%). Recurrent themes, each centered around changes in the food environment resulting from COVID-19, emerged: (1) produce prescription access and utilization; (2) food access constraints; (3) food shopping adjustments; and (4) food insecurity stress. Perceived consequences of COVID-19 included increased anxiety related to food shopping and food insecurity alongside challenges accessing and utilizing the produce prescription program. Conclusions This study highlights the many ramifications of the COVID-19 pandemic on vulnerable families. More comprehensive efforts are necessary to address substantial barriers to healthy food access and affordability caused by the recent pandemic.

The "Our Voice" Method: Participatory Action Citizen Science Research to Advance Behavioral Health and Health Equity Outcomes.

Citizen science research that more fully engages the community can systematically involve people from under-resourced groups to create practical health-enhancing improvements across physical, social and food environments. Exemplary health equity-focused outcomes include key health behaviors (e.g., healthy eating or physical activity) and community-level changes (e.g., public transit to food shops) that are central to health promotion while being demonstrably impacted by local environmental contexts. Yet, few examples of this approach are readily available for application within complex, community-based settings. In this paper, we present the Our Voice (OV) four-step method to demonstrate an integrated participatory citizen science approach and its usability for action-focused researchers and community health practitioners. In addition, we present a summary of the major research, processes, and community outcomes, with examples drawn from nutrition and healthy food access areas, among others. Finally, we explore the hallmark features of the OV method that effectively engage citizen scientists, empowering action and fostering solution-building across social and environmental structures impacting community health. Expanding research that marries participatory research philosophies with innovative citizen science methods, supported by systematic data collection, visualization, and delivery technologies, in turn provides a powerful toolkit for tackling local to global health equity challenges.

Availability of healthy and unhealthy foods in modern retail outlets located in selected districts of Greater Accra Region, Ghana.

Intake of unhealthy foods is linked to the onset of obesity and diet-related non-communicable diseases (NCDs). Availability of unhealthy (nutritionally poor) foods can influence preference, purchasing and consumption of such foods. This study determined the healthiness of foods sold at modern retail outlets- supermarkets and mini-marts in the Greater Accra Region of Ghana. All modern retail outlets located in six districts of Greater Accra were eligible. Those < 200 m2 of floor area and with permanent structures were categorized as mini-marts; and those ≥200 m2 as supermarkets. Shelf length of all available foods were measured. Healthiness of food was determined using two criteria - the NOVA classification and energy density of foods. Thus, ultra-processed foods or food items with >225 kcal/100 g were classified as unhealthy. The ratio of the area occupied by unhealthy to healthy foods was used to determine the healthiness of modern retail outlets. Of 67 retail outlets assessed, 86.6% were mini-marts. 85.0% of the total SHELF area was occupied by foods categorized as unhealthy (ranging from 9,262 m2 in Ashiaman Municipality to 41,892 m2 in Accra Metropolis). Refined grains/grain products were the most available, occupying 30.0% of the total food shelf space, followed by sugar-sweetened beverages (20.1% of total shelf space). The least available food group-unprocessed staples, was found in only one high income district, and occupied 0.1% of the total food shelf space. Retail outlets in two districts did not sell fresh fruits or fresh/unsalted canned vegetables. About two-thirds of food products available (n = 3,952) were ultra-processed. Overall, the ratio of ultra-processed-to-unprocessed foods ranged from 3 to 7 with an average (SD) of 5(2). Thus, for every healthy food, there were five ultra-processed ones in the studied retail outlets. This study reveals widespread availability of ultra-processed foods in modern retail outlets within the selected districts. Toward a healthier food retail environment, public health and food regulators, in partnership with other stakeholders need to institute measures that improve availability of healthy foods within supermarkets and mini-marts.

"Some are healthy and others not": Characterization of vended food products by Accra-based food retailers.

Increasing the availability of healthy foods within food retail outlets can improve consumers' food environments. Such actions or inactions by food retailers may affect people's food purchasing and consumption behavior. This study explored Accra-based food retailers' perceptions and appreciation of "healthiness of food" as a concept. It also documented measures that food retailers adopt to encourage healthy food choices. In-person semi-structured interviews were conducted with owners and managers of Accra-based supermarkets (n = 7) and corner stores (n = 13) in March 2021. The interviews were recorded, transcribed, coded, and analyzed thematically. The retailers' understanding of healthy food, or lack thereof, is exemplified by such expressions as "health, absence of disease, longevity, balanced diet, diversity, sanitation, and certification." A handful of retailers described what they sell as "products that meet consumer needs," "harmless," or "generally good." Very few retailers described the food they sell as "junk," high in sugar, fat, and salt, or energy-dense but nutrient poor foods, or as food that could pose some health risk to consumers. However, some retailers indicated that they advise their customers against the overconsumption of some foods. Overall, Accra-based retailers have a fair understanding of what constitutes healthy food - exhibiting limited knowledge of the connection between very salty, very sugary, and very fatty foods and health outcomes. Retailers in Accra require interventions that improve their food, health, and nutrition literacy. Improving retailers' food and nutrition literacy may improve the availability of healthier options in food retail outlets in Accra.

Quantifying the Impact of Supermarket Distance on Childhood Obesity in Greater London, United Kingdom: Exploring Different Access Measures and Modification Effects of Transportation.

Background: Healthy food access may be relevant for predicting trends in childhood obesity. The goal was to determine associations between childhood overweight (including obesity) and distance to three nearest supermarkets stratified by transportation modes (walking, cycling, driving). Methods: Bivariate and multivariate linear regressions examine the relationship with obesity, including interacting active and inactive modes. Results: Proximity to at least three supermarkets shows small but significant positive association with obesity. Walking mode showed higher obesity rates than driving, and distance was not related to the mode of travel. Conclusions: Disparities in healthy food access may not contribute meaningfully to childhood obesity, as other individual factors may be largely at play.

Equity-Promoting Strategies in Online Grocery Shopping: Recommendations Provided by Households of Low Income

ObjectiveTo explore barriers and facilitators of online grocery shopping and identify community-driven strategies to promote equity in online food access. DesignThis qualitative study used a purposive recruitment strategy to conduct 11 focus groups and 5 in-depth interviews between November 2020 and March 2021. SettingData collection was conducted virtually with participants residing in diverse (majority urban) regions of Maryland. Paricipants44 primary household food purchasers with young children (aged < 8 years) eligible for the Supplemental Nutrition Assistance Program (SNAP). Phenomenon of InterestBarriers and facilitators of online grocery shopping and strategies elicited by the community to leverage SNAP and online food retailer services to reduce inequities in healthy food access. AnalysisWe coded and analyzed transcripts on the basis of the Socioecological Model, Theory of Planned Behavior, and an Equity-Oriented Framework. ResultsOverall, we identified 10 themes across all socioecological levels, all of which reflected both barriers and facilitators to online shopping: (1) individual: trust of shoppers, technology, (2) interpersonal: spousal/children needs, (3) community: safety and security, (4) organizational: retail experience and food quality, and (5) policy: SNAP and structural inequities. Participant recommendations included improving food access and communication with hired shoppers, implementing more payment/cost-saving options, and offering educational programming for SNAP participants on using benefits online. Conclusions and ImplicationsHouseholds of low-income identified barriers and facilitators of online grocery shopping across the socioecological levels, emphasizing the need for a multilevel approach to equity promotion. We recommend future work to explore the suggested actionable pathways, which involve delivery providers, grocery stores, nutrition educators, and policymakers leveraging online grocery features (ie, meal planning support) and policies (ie, expansion of the SNAP Online Purchasing Pilot to more retailers) to reducing deterrents (ie, delivery fees waived) for an equity-promoting online grocery environment.

Fresh for Less: Cross-Sector Collaboration for Funding, Implementation, and Evaluation of a Local Initiative to Improve Equitable Healthy Food Access.

This study describes the cross-sector collaboration, dynamic implementation/evaluation, and implications of Fresh for Less (FFL); an equity-focused, multi-strategy healthy food access promotion program that has been implemented since 2017 in underserved communities in Austin, Texas through farmstands, mobile markets, and Healthy Corner Stores. Annual evaluation has consisted of repeat cross-sectional quantitative surveys, qualitative customer/staff interviews, audits and cost-effective analyses. Farmstand/mobile market customers reported increased fresh produce consumption and high satisfaction. During COVID-19, mobile markets quickly pivoted to delivery, filling a huge need for safe and affordable grocery delivery. Healthy Corner Stores were not as successful, and this strategy was adapted and reintroduced in 2021. Audits show increased produce provision over time and that mobile markets offered increasingly competitive pricing. Fresh for Less demonstrates how cross-sector collaborators can work together to ensure that a program designed to improve equitable food access can be resilient, sustainable, and successful.

Navajo Nation Stores Show Resilience During COVID-19 Pandemic.

On April 8, 2020, the Navajo Nation issued an administrative order limiting business operations. Facing high coronavirus disease 2019 (COVID-19) rates and limited food infrastructure, a survey was conducted among Navajo Nation store managers to assess: (1) COVID-19 adaptations; (2) challenges; (3) changes in customer volume and purchasing; and (4) suggestions for additional support. Purposive sampling identified 29 stores in Navajo communities. Representatives from 20 stores (19 store managers/owners, 1 other; 7 grocery, and 13 convenience/other stores) were interviewed by phone or in-person to reach saturation (new information threshold < 5%). Responses were coded using frequencies and inductive thematic analysis. All 20 stores implemented COVID-19 guidelines (Centers for Disease Control and Prevention [CDC]/Navajo Nation) and most received orientation/support from local chapters, community organizations, or health centers. Stores implemented staff policies (50%, handwashing, vaccinations, protective personal equipment (PPE), sick leave, temperature checks), environmental changes (50%, hand sanitizer, checkout dividers), customer protocols (40%, limit customers, mask requirements, closed restrooms), and deep cleaning (40%). Most stores (65%) reported challenges including stress/anxiety, changing guidelines, supply chain and customer compliance; 30% reported infection or loss of staff. Weekday customer volume was slightly higher vs. pre-COVID, but weekend lower. Stores reported consistent or more healthy food purchases (50%), more nonfood essentials (20%), or shelf-stable foods (10%). Desired support included further orientation (30%), leadership support (20%), overtime/time to learn guidelines (20%), and signage/handouts (15%). Despite a high COVID-19 burden and limited food store infrastructure, Navajo Nation stores adapted by implementing staff, environmental and customer policies. Local support, staffing, and small store offerings were key factors in healthy food access.

Diet Quality and Contextual Factors Influencing Food Choice among Adolescents with Food Security and Food Insecurity in Baltimore City.

This study evaluated differences in overall diet quality, diet quality components, and food-related contextual factors between adolescents with food security and those with food insecurity. Mixed methods analysis was conducted on data from three 24-h dietary recalls from 61 adolescents ages 14-19 years old living in Baltimore, Maryland, USA in 2020-2021. All adolescents were sampled from households eligible for the Supplemental Nutrition Assistance Program in 2020. There were no significant differences in overall diet quality or components between adolescents with food security and those with food insecurity in this sample, except for seafood and plant proteins, which was higher for adolescents with food insecurity. Qualitative analysis found that adolescents were largely influenced by their parents and the home food environment, and that workplace environments enabled adolescents to eat foods high in refined grains, sugar, and saturated fat. These findings provide insight about the experiences of low-income adolescents during times when they are home for prolonged periods (i.e., emergency school closures, summer, and winter breaks). Programs and policies that aim to improve healthy food access may positively impact adolescent food security and diet quality, and it is important to ensure that healthy foods are available and accessible to adolescents in the places where they spend the most time. Multilevel interventions in the home, school, and workplace may be most effective in encouraging healthy eating behaviors among adolescents.