Search Results (47)

Background: Childhood obesity is a pressing global public health challenge, marked by significant disparities in prevalence and management across countries. Japan and the United States offer contrasting approaches to addressing this issue, presenting a valuable opportunity for comparative analysis. Objective: This review examines the effectiveness of public health policies, cultural dietary habits, and lifestyle factors in combating childhood obesity in Japan and the United States. It aims to identify actionable insights to inform global strategies for obesity prevention. Results: Japan exhibits one of the lowest childhood obesity rates globally, attributed to prevention-focused policies such as the food education program, stringent school lunch standards, and culturally ingrained healthy eating practices. These efforts are complemented by active lifestyle promotion through urban planning and school-based physical education programs. In contrast, the United States faces higher obesity rates due to systemic challenges, including socioeconomic disparities, reliance on processed foods, sedentary lifestyles, and inconsistent implementation of federal programs like the National School Lunch Program (NSLP) and Supplemental Nutrition Assistance Program Education (SNAP-Ed). Conclusions: This review highlights Japan’s success in aligning public health initiatives with cultural norms to achieve sustainable outcomes. In the United States, systemic barriers and cultural disconnects hinder obesity prevention efforts. Recommendations include adopting integrated, prevention-focused policies, addressing socioeconomic inequities, redesigning urban environments to promote active living, and fostering global collaboration. This comparative analysis underscores the importance of culturally tailored, multidimensional strategies for addressing childhood obesity and improving public health outcomes worldwide. Full article

Promoting child well-being and development requires a multidimensional approach, including the right to adequate food practices. Socially vulnerable children are more exposed to adverse experiences, such as inadequate food consumption due to poverty. In this context, home-visiting programs are an important strategy for nutritional and health care education to provide relevant guidelines. This study describes breastfeeding and food consumption of children aged 0 to 24 months assisted by the Happy Child Program (Programa Criança Feliz—PCF) and aimed to investigate their association with socioeconomic factors and adherence to the program. This is an observational study, with a cross-sectional design, carried out with children assisted by the PCF in the Federal District, Brazil. Multivariate analysis was performed to identify sociodemographic and income factors, and household visits characteristics associated with breastfeeding, dietary diversity, and the consumption of ultra-processed food. A total of 301 children were assessed, 51.16% of whom were female. In 58.99% of households, the reference person was the mother; 86.20% were unemployed, and 27.08% had a low education degree. About 62.65% of beneficiaries lived on up to USD 200.00 per month and the majority faced food insecurity. The child’s age, and the mother’s current work situation were independently associated with the current breastfeeding situation, especially higher among women who did not work (p = 0.015). The minimum dietary diversity among children over 6 months old was 62.21% and presented a positive association with adherence to the program (p = 0.005). On the other hand, the consumption of ultra-processed foods was 77.21% and was associated with a longer follow-up time within the program (p = 0.047). The associations observed revealed the need to integrate family food choices and nutritional education into public policies for early childhood. Full article

Background/Objectives: This paper examines hunger over time to analyze how food insecurity is impacted by reduced income, including household funding from the government. Federal policies and community-based programs have the ability to prevent increases in food insecurity, particularly for populations that have risk factors, such as households with children; single-parent households; low-income households, especially those in rural areas; Black and Hispanic households; and, households experiencing economic hardships. Methods: This study is bas ed on a cross-sectional survey that was administered in 2018 and 2019 to food pantry clients, an already food insecure population accessing resources, in Eastern Massachusetts. Baseline surveys were matched with a 3-month follow-up survey (n = 308) and multinomial logistic mixed effect models were used to analyze the association between change in household hunger and change in household income. Results: This study found that participants who experienced decreased income compared to no income change from baseline to follow-up had 2.16 times the odds (95% CI: 1.05, 4.46) of experiencing increased household hunger compared to no change in hunger from baseline to follow-up, after adjusting for all other covariates. Conclusions: Food insecurity in the United States remained stable during the beginning of COVID-19, despite prevalence of reduced household income. The expanded government benefits that were implemented early in the pandemic contributed to total household income, which prevented increased food insecurity. Increased food insecurity after the removal of benefits starting in 2022 indicates the importance of continuing support established during times when consistent income is compromised to prevent a delayed rise in food insecurity. Full article

Background/Objectives: Food insecurity (FI) is defined as the lack of consistent access to enough food for an active and healthy life. FI affects over 30 million Americans and is associated with poor clinical outcomes and impaired quality of life and drives significant health inequities. Despite the rising prevalence of FI and the federal focus on improving access to healthy food, there is a paucity of research on FI in patients with inflammatory bowel disease (IBD). Therefore, the goal of this study was to define FI in a cohort of IBD patients and determine whether FI was associated with changes in dietary patterns, including specifically an increase in ultra-processed food (UPF) consumption in this high-risk patient population. Methods: This was a single-center, retrospective cohort study of patients with a diagnosis of IBD who were 18 years of age or older and who were seen in a nutrition focused clinic. Patients were screened for FI using the Hunger Vital Sign™, a 2-question validated FI screening tool and underwent a 24-h dietary recall. The degree of food processing was assessed using the NOVA Food Classification System. Results: Among 128 patients with IBD, we observed that FI is increasingly prevalent, with 45% of patients reporting difficulty with sufficient grocery access at least “sometimes” in the last 12 months and 10% reporting decreased food access “often” in the prior year. In addition, the patients at high-risk for FI were significantly more likely to eat NOVA 4 UPFs (54% vs. 27%, p = 0.001) and were significantly less likely to eat NOVA 1 unprocessed foods (32% vs. 61%, p = 0.001) as compared to those not at risk for FI. Finally, only a small percentage of those at highest risk for FI were enrolled in a federal food assistance program for grocery support. Conclusions: The prevalence of FI is increasing in patients with IBD and is associated with reduced dietary quality. Full article

Background/Objectives: Puerto Rican households often face elevated rates of food insecurity. Frequently, households experiencing food insecurity turn to federal and emergency nutrition assistance for urgent or prolonged aid. This study analyzes factors influencing food insecurity and food assistance program involvement among Puerto Ricans in Holyoke, Massachusetts, amidst the COVID-19 pandemic. Methods: Using a combination of community-based participatory recruitment, purposive sampling, and web-based tools, we collected 284 survey responses. Our paper employed Pearson’s chi-square, logistic regression, and hierarchical linear models to assess relationships between demographic and household attributes and food access outcomes. Results: Variables such as having children in the household and age significantly influenced food relief participation and food insecurity outcomes. Puerto Rican heritage and low educational attainment were strong predictors of obtaining federal food aid. Low-income participants disproportionately faced food shortages and depended on emergency food initiatives. Our findings indicate that demographic and household factors significantly influence food insecurity and accessibility. Conclusions: Our study demonstrates that the pandemic made it challenging for households to obtain consistent, safe, and affordable nourishment. The impacts were unequally spread; hence, Puerto Rican communities and low-income groups were most affected. Full article

The 63.6 million Hispanic individuals living in the United States constitute the largest ethnic or racial minority group in the country. Hispanic/Latino households report a high prevalence of food insecurity, and often, food-insecure individuals cope by turning to emergency and federal food assistance programs for immediate or long-term assistance. This paper focuses on Hialeah, Florida, a predominantly Hispanic/Latino city in Miami-Dade County. It examines which demographic factors influence participation in food assistance programs and the occurrences of periods of disrupted food access. This study examines two questions: (1) What factors are associated with participation in food assistance programs? (2) To what extent did study participants use food assistance programs before and during the COVID-19 pandemic? We conducted a survey and collected 684 responses from April to August 2022. We gathered data on participants’ identities, household attributes, and their usage of federal and emergency food assistance programs. We used Pearson’s chi-square tests to identify significant associations between food assistance usage, food access, and respondents’ demographic characteristics. We also used binary logistic regression models to assess probabilities. The findings of this research are significant, indicating that the COVID-19 pandemic exacerbated food access challenges in Hispanic/Latino households in 2022. The data also revealed that low-income households, respondents below the age of 40, individuals born in the United States, those with low educational attainment, and those living in multifamily households had the highest likelihood of using food assistance programs. Single- and non-single-parent households, employment status, languages spoken at home, and number of children in the household were also statistically significant factors in predicting food assistance usage. This research provides valuable insights into how individuals in a city responded to the pandemic by utilizing food assistance programs. Full article

Given the lack of attention on adolescent food insecurity, the primary objective of this study was to assess the association of household participation in federal food assistance programs with food security status among adolescents in Baltimore during the COVID-19 pandemic. Adolescents, ages 14–19 years, were invited to participate in two online surveys. The baseline was implemented between October 2020 and January 2021, while the follow-up took place one year later from November 2021 to January 2022 after schools had re-opened. We then matched survey participants with household participation in food nutrition assistance programs using data obtained from the Maryland Department of Social Services. We used logistic regression to examine the association between food assistance program participation status and food insecurity. Additionally, to examine whether the impact of program participation on food insecurity changed between the baseline survey and one year later at follow-up when schools re-opened, a difference-in-differences analysis was conducted. The results showed no significant associations between adolescent food security and participation in any of the federal nutrition assistance programs. Increased attention on how best to improve adolescent food security in low-income households that can respond to the unique needs of adolescents is clearly warranted. Full article

Understanding the association between food security status (FSS) and diet quality in children is crucial. This study investigated regional variability in FSS, participation in the federal nutrition assistance program (FNAP), and diet quality among US children. National Health and Nutrition Examination Survey (NHANES) data from 2013 to 2016 were analyzed. The association between FSS, FNAP participation, and diet quality (Healthy Eating Index—HEI-2015) was assessed using multiple linear/logistic regression models. The sample included 6403 children (mean age: 7.5 years; 51% male; 33% Hispanic). Within the sample, 13% reported child food insecurity, and 30% reported household food insecurity. Additionally, 90% participated in the FNAP, and 88% were enrolled in school lunch programs. Children in urban areas were significantly more likely to report household food insecurity than those in rural areas (29.15% vs. 19.10%). The overall HEI-2015 score was 48.2. The associations between child/household FSS and FNAP participation as well as between child/household FSS and diet quality did not differ by urban/rural residence status, irrespective of the children’s age groups. There is a need for improvement in children’s diet quality, regardless of age or urban/rural residence. The findings suggest that improving children’s diets requires broader action as well as the prioritizing of children in urban areas experiencing food insecurity in future dietary interventions. Full article

Food insecurity (FI) is a pressing concern among university students in the United States, and the COVID-19 pandemic has exacerbated this issue. Providing food assistance for university students has become more challenging due to pandemic-related consequences and interventions. This study aims to (1) analyze social inequalities in FI among university students in a large public university during the pandemic, (2) investigate the association of their utilization of campus, community, and federal food assistance programs (FAPs) and FI, and (3) understand the barriers students face in accessing FAPs. Survey questionnaires were distributed to students to gather their socio-demographics, FI, and usage of FAPs. Logistic regression was utilized to assess the relationship between students’ FI and their use of FAPs. Among the surveyed students (n = 282), 33.7% reported experiencing FI. Higher FI rates were observed among socially vulnerable student groups, for example, non-Hispanic Black (62.5%) and Hispanic students (38.7%), compared with non-Hispanic White students (32.1%). FAPs had a limited influence on students’ FI due to low utilization. The primary barriers to FAPs were insufficient information, ineligibility, and social stigma. The findings suggest it is crucial to reduce barriers to using FAPs and develop targeted interventions for marginalized students to address inequalities in FI. Full article

Food insecurity is an economic and social condition involving limited or uncertain access to food. The problem of food insecurity in communities is influenced by economic conditions, food deserts, and barriers to accessing healthy food. Individuals experiencing food insecurity often endure concurrent problems of financial instability, hunger, and poor mental and physical health. Public and non-profit services in the U.S., such as the federally supported Supplemental Nutrition Assistance Program (SNAP) and community food banks, provide food-related assistance to individuals who are at a high risk of experiencing food insecurity. Unfortunately, many individuals who qualify for these services still experience food insecurity due to barriers preventing them from accessing food. Effective approaches for removing barriers that prevent individuals from accessing food are needed to mitigate the increased risk of chronic disease among vulnerable populations. This study tested a novel food insecurity intervention called FINDING-Food, which stands for Frequent Informational Nudges Directing Individuals to Needed Goods. Informational nudges were used to promote food security through the removal of information barriers to accessing food. The intervention used in this mixed-methods feasibility study consisted of informational nudges in the form of weekly text messages that were sent to food pantry clients experiencing food insecurity (n = 24). The study aims were to test the efficacy and acceptability of the intervention by examining whether the informational nudges could enhance food pantry utilization, increase SNAP registration, and promote food security. Quantitative study results showed a lower prevalence of food insecurity in the intervention group than the control group at the end of the study. Qualitative findings revealed how intervention group participants who completed the study (n = 9) found the text messages to be helpful and informative. These study findings can enhance future food insecurity interventions aiming to eliminate barriers that prevent individuals who are food insecure from accessing healthy food. Full article

The state of Missouri, USA offers a unique opportunity for tree planting under several federal conservation programs. However, many landowners remain hesitant to enroll and take land out of agricultural production. This study explores the willingness of landowners to adopt agroforestry systems with food producing tree and shrub species through federal conservation program funding using mail and online surveys. Surveys followed the Dillman Tailored Design Method to collect data on landowners’ farm characteristics, production practices, and land management choices. Survey participants were sampled on a county basis within each of the six major geographic regions of the state. Twelve counties were randomly selected, and surveys were mailed to a proportional sampling of farm addresses gathered from each of the county tax assessor offices. The goal of the survey was to (1) identify landowners’ current land management practices and goals, (2) understand landowners’ perceptions of and preferences for different planting plans for their farm, and (3) capture landowners’ interest in participating in conservation programs to assist in the planting of trees and shrubs on their land. Our analysis of this survey found that landowners are receptive to agroforestry plantings, rating them higher on average than traditional agricultural land management practices. Landowner age, past participation in a conservation program, and presence of marginal land all had significant correlation with willingness to adopt agroforestry. The inclusion of technical assistance or federal conservation funding was found to increase the willingness of landowners to plant multifunctional agroforestry designs. Full article

The emergency school meals program provided free meals to children in the United States (US) during COVID-19-related school closures. This scoping review aims to synthesize the existing qualitative empirical evidence published between March 2020 and January 2023 on the operations and utilization of emergency school meal programs during the pandemic. Qualitative, US-based peer-reviewed literature was collected from three sources: (1) parent review of all federal nutrition assistance programs; (2) systematic search of four databases; and (3) manual search of grey literature. Identified scientific articles and grey literature reports (n = 183) were uploaded into Covidence and screened for duplicates and inclusion/exclusion criteria. Our final sample included 21 articles/reports, including 14 mixed methods and seven qualitative-only projects. Articles spanned all U.S. states. Articles had similar research questions to understand school meals and/or general food access during COVID-19, with an emphasis on long-term policy implications. Hybrid deductive/inductive analytic coding was used to analyze data, utilizing domains from the Getting to Equity Framework (GTE). GTE considers multi-level factors that influence nutrition behavior while centering more equitable pathways to improve nutrition security and reduce adverse health. Findings were sorted into two categories: operational challenges during the pandemic and solutions to address inequities in school meal distribution during and after the pandemic, particularly during school closures such as summers or future emergencies. Key challenges related to supply chain issues, safety, and balancing families’ needs with limited staff capacity. Programs addressed equity by (a) reducing deterrents through federally issued waivers and increased communications which allowed the serving of meals by programs to families who previously did not have access, (b) building community capacity through collaborations and partnerships which allowed for increased distribution, and (c) preparing and distributing healthy options unless barriers in supply chain superseded the effort. This review highlights the importance of emergency school meal programs and provides insights into addressing challenges and promoting equity in future out-of-school times. These insights could be applied to policy and practice change to optimize program budgets, increase reach equitably, and improve access to nutritious meals among populations at highest risk for nutrition insecurity. Full article

The opioid epidemic has been an ongoing public health concern in the United States (US) for the last few decades. The number of overdose deaths involving opioids, hereafter referred to as overdose deaths, has increased yearly since the mid-1990s. One treatment modality for opioid use disorder (OUD) is medication-assisted treatment (MAT). As of 2022, only three pharmacotherapy options have been approved by the Food and Drug Administration (FDA) for treating OUD: buprenorphine, methadone, and naltrexone. Unlike buprenorphine and naltrexone, methadone dispensing and administrating are restricted to opioid treatment programs (OTPs). To date, Tennessee has no medication units, and administration and dispensing of methadone is limited to licensed OTPs. This review details the research process used to develop a policy draft for medication units in Tennessee. This review is comprised of three parts: (1) a rapid review aimed at identifying obstacles and facilitators to OTP access in the US, (2) a descriptive analysis of Tennessee’s geographic availability of OTPs, pharmacies, and federally qualified health centers (FQHCs), and (3) policy mapping of 21 US states’ OTP regulations. In the rapid review, a total of 486 articles were imported into EndNote from PubMed and Embase. After removing 152 duplicates, 357 articles were screened based on their title and abstract. Thus, 34 articles underwent a full-text review to identify articles that addressed the accessibility of methadone treatment for OUD. A total of 18 articles were identified and analyzed. A descriptive analysis of Tennessee’s availability of OTP showed that the state has 22 OTPs. All 22 OTPs were matched to a county and a region based on their address resulting in 15 counties (16%) and all three regions having at least one OTP. A total of 260 FQHCs and 2294 pharmacies are in Tennessee. Each facility was matched to a county based on its address resulting in 70 counties (74%) having at least one FQHC and 94 counties (99%) having at least one pharmacy. As of 31 December 2022, 17 states mentioned medication units in their state-level OTP regulations. Utilizing the regulations for the eleven states with medication units and federal guidelines, a policy draft was created for Tennessee’s medication units. Full article

The USDA Thrifty Food Plan (TFP) is an estimate of a lowest-cost healthy diet that meets dietary guidelines while respecting existing eating habits. In the US, the TFP provides the basis for federal food assistance. Included in the TFP are protein foods from both animal and plant sources. The present goal was to explore the place of fresh pork among protein foods in the revised TFP 2021. Our analyses used the same databases and the same quadratic programming (QP) methods as had been used by the USDA to develop the TFP 2021. Dietary intakes came from the National Health and Nutrition Examination Survey (NHANES 2015-16); nutrient composition data came from the Food and Nutrient Database for Dietary Studies (FNDDS 2015-16), and national food prices came from the 2021 TFP report. Amounts and prices were for foods as consumed. Our QP Model 1 used USDA modeling categories to replicate the TFP 2021. The non-poultry meat category was then separated into pork and beef. Model 2 examined whether the TFP 2021 algorithm would select pork or beef. Model 3 sought the lowest cost healthy diet, the same as the TFP 2021. Model 4 replaced beef and poultry with pork; whereas Model 5 replaced pork and poultry with beef. Weekly costs were calculated for a family of four and eight age-gender groups. All models met the nutrient requirements. The market basket cost for a family of four in Model 1 was USD 189.88, compared to the purchase price of USD 192.84 in the TFP 2021. In Model 2, fresh pork was selected preferentially over beef. The lowest-cost healthy food plan in Model 3 increased fresh pork to 3.4 lbs/week. Replacing beef and poultry with pork in Model 4 led to a modest decrease in the weekly cost. Replacing pork and poultry with beef in Model 5 led to a major increase in the weekly cost. We conclude, based on TFP-analogous modeling, that fresh pork is the preferred meat source, providing high-quality protein at a low cost. QP methods, as used in the TFP 2021, are a valuable tool for designing food plans that are affordable, acceptable, and nutrient-rich. Full article

The COVID-19 pandemic is worsening the disparities in food access in the United States. As consumers have been increasingly using grocery online ordering services to limit their exposure to the COVID-19 virus, participants of federal nutrition assistance programs lack the online benefit redemption option. With the support of the US Department of Agriculture (USDA), retailers are pilot-testing online food benefit ordering in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). By combining the Oklahoma WIC administrative data, the online ordering data from a grocery store chain in Oklahoma, and the COVID-19 data in Oklahoma, this study examines how WIC participants responded to the online food benefit ordering option and how their adoption of online ordering was associated with the COVID-19 incidence. Results show that from July to December 2020, 15,171 WIC households redeemed WIC benefits at an Oklahoma chain store, but only 819 of them adopted online ordering. They together completed 102,227 online orders, which accounted for 2.7% of the store visits and 2.6% of the monetary value of WIC redemptions at these stores. There was no significant relationship between WIC online ordering adoption and COVID-19 incidence in Oklahoma. Full article