Household Food Sourcing Patterns and Their Associations with Food Insecurity in Appalachian Ohio.

BACKGROUND: Households experiencing food insecurity may use dynamic strategies to meet food needs. Yet, the relationship between household food sourcing behaviors and food security, particularly in rural settings, is understudied. OBJECTIVE: To identify food sourcing patterns and their associations with food insecurity among households in rural Appalachian Ohio during the COVID-19 pandemic. DESIGN: Survey data were collected from a cohort of households in Athens County, Ohio in July 2020, October 2020, January 2021, and April 2021. PARTICIPANTS/SETTING: The sample included 663 households with household food sourcing and food security information for ≥1 survey wave. MAIN OUTCOME MEASURES: Household food sourcing patterns. Households reported the frequency with which they obtained food from various retailers and charitable sources, classified as supercenters, supermarkets, convenience stores, farmers' markets, or charitable sources. STATISTICAL ANALYSES: Principal component analysis was used to identify food sourcing patterns. Linear mixed models were used to assess changes in food sourcing behaviors over the study period and to determine whether food sourcing behaviors differed according to food security status. RESULTS: Two patterns were identified: 1) Convenience Stores and Charitable Food, 2) Supermarkets and Farmers' Markets, not Supercenters. Relative to July 2020, alignment of households' food sourcing behaviors with the "Supermarkets and Farmers' Markets, not Supercenters" pattern was higher in October 2020 (ß=0.07; 95% CI: 0.02, 0.12) and alignment with the "Convenience Stores and Charitable Food" pattern was lower in April 2021 (ß=-0.06; 95% CI: -0.11, -0.02). Compared to food-secure households, food sourcing behaviors of food-insecure households were more closely aligned with the "Convenience Stores and Charitable Food" pattern (ß=0.07; 95% CI: 0.00, 0.13); no statistically significant difference in scores was observed for the "Supermarkets and Farmers' Markets, not Supercenters" pattern (ß=-0.07; 95% CI: -0.15, 0.02). CONCLUSIONS: These findings support efforts to increase access to healthy, affordable options at venues where food-insecure households may be likely to obtain food, such as convenience stores and charitable sources.

Position of the Society for Nutrition Education and Behavior: The Importance of Emergency-Related Food and Nutrition Education Before, During, and After a Disaster.

It is the position of the Society for Nutrition Education and Behavior that for effective recovery from and resilience to disasters, it is essential that impacted individuals and communities have access to safe, nutritious, and culturally and contextually appropriate foods and beverages, and receive emergency-related food and nutrition education before, during, and after a disaster. Despite the increasing number, duration, and intensity of disasters worldwide, there is relatively limited guidance for research, policy, and practice about addressing the emergency-related food and nutrition needs of affected populations. Although nutrition emergencies tend to be understudied, emerging efforts are working to advance food and nutrition security during disaster response and recovery. To help elevate the importance of emergency-related food and nutrition education before, during, and after a disaster, Society for Nutrition Education and Behavior, which represents the unique professional interests of nutrition educators worldwide, summarizes the relevant literature and puts forth recommendations for all those who are engaged in this work in the following 4 key areas: (1) improving communication and outreach, (2) fostering community engagement and locally-driven preparedness, (3) building the evidence base and translating the evidence into action, and (4) training current professionals and the next generation of public health leaders. Altogether, before, during, and after a disaster, those who engage in this work, among other allies, can help elevate the importance of nutrition education and other strategies to promote healthy eating behaviors through research, policy, and practice.

Associations between food and beverage purchases and skin carotenoids among diverse small food retail store customers.

OBJECTIVE: To determine if customer purchases at small food stores are associated with healthfulness of the diet as approximated by skin carotenoids. DESIGN: This is a cross-sectional survey of customers in small food stores regarding demographics and food purchases. Food and beverage purchases were classified as 'healthy' or 'non-healthy' and 'carotenoid' v. 'non-carotenoid' using a systematic classification scheme. Fruit and vegetable intake was objectively assessed using a non-invasive device to measure skin carotenoids. Associations between variables of interest were examined using Pearson's correlation coefficients, t tests and multiple linear regression analyses. SETTING: Twenty-two small food retail stores in rural (n 7 stores) and urban (n 15) areas of North Carolina. PARTICIPANTS: Customers of small food stores. RESULTS: Of study participants (n 1086), 55·1 % were male, 60·0 % were African American/Black and 4·2 % were Hispanic, with a mean age of 43·5 years. Overall, 36 % purchased at least one healthy item, and 7·6 % of participants purchased a carotenoid-containing food/beverage. Healthy foods and beverages purchased included produce, lean meats, 100 % juices, plain popcorn, plain nuts, milk and yogurt. Unhealthy items included non-100 % juices, crackers, chips, candy, cakes and donuts. Purchase of a healthy or carotenoid-containing item was positively associated with skin carotenoid scores (P = 0·002 and 0·006, respectively). CONCLUSIONS: A relatively small proportion of customers purchased any healthy or carotenoid-containing foods and beverages, and those who did purchase healthy options had higher skin carotenoid scores. Future research should confirm these findings in different populations.

A Systematic Literature Review of Nutrition Interventions Implemented to Address Food Insecurity as a Social Determinant of Health.

BACKGROUND: Policy initiatives have provided funding for non-acute nutrition interventions to address food insecurity as a social determinant of health, but more research is needed to understand the outcomes of these initiatives in order to determine the areas of highest impact. Therefore, the purpose of this systematic review was to evaluate the outcomes that were assessed in three nutrition interventions (produce prescription programs, medically tailored meals, and community supported agriculture) that aim to address food insecurity as a social determinant of health, and this was undertaken in order to identify future areas of study that can heighten impact. METHODS: This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria. A list of search terms and keywords were compiled by the research team. A Boolean search was conducted from 1 January 2000 to 1 January 2023 in the PubMed advanced search database. RESULTS: A total of 1015 articles were initially pulled from the PubMed database, and, after a screening process, 21 articles were included in our review. Nineteen of the articles focused on adult populations or families and two focused on children. The main outcomes assessed were changes in self-reported dietary intake, while a few of the articles addressed feasibility and cost-related outcomes. CONCLUSIONS: More research is needed to assess whether nutritional interventions to address food insecurity as a social determinant of health are feasible and more cost effective in the long term. Additionally, more work should be conducted in pediatric populations, which could have a robust return on investment in terms of both healthcare utilization and healthcare expenditure.

A Novel Process to Recruit and Select Community Partners for a Hybrid Implementation-Effectiveness Study.

BACKGROUND: Creating strong partnerships with community organizations is essential to test implementation of evidence-based interventions. However, partners are often chosen based on convenience rather than capacity or diversity. Streamlined processes are needed to identify qualified, diverse, and invested partners to conduct community-based research. OBJECTIVES: There is a gap in the literature on effective and efficient processes for recruiting partners. This paper aims to fill that gap by describing a novel approach for identifying a diverse group of community organizations to participate in research. METHODS: We used a Request for Partners (RFP) approach to recruit partners to participate in a hybrid implementation-effectiveness study of the Veggie Van mobile market model. The process included formative work to inform RFP development, creation of an external advisory committee, an intent-to-apply round, a full application round, and an inperson training and selection process. Data was collected to characterize applicant size, location, and experience; pre-post surveys were conducted to understand the training's utility. RESULTS: We received 59 intent-to-apply submissions and invited 28 organizations to apply: 17 submitted applications and 12 organizations were chosen as finalists. The process took approximately 8 months to recruit 9 organizations and 32 community sites across 5 states and increased understanding of the intervention and partner responsibilities. CONCLUSIONS: An RFP process is familiar to many community organizations that compete for grant funding but may not have prior research experience. This process streamlined recruitment timelines, increased diversity, and cultivated community among organizations. It may also improve research transparency, study completion, and intervention fidelity.

Food Insecurity in the Rural United States: An Examination of Struggles and Coping Mechanisms to Feed a Family among Households with a Low-Income.

Households with a low-income in rural places experience disproportionate levels of food insecurity. Further research is needed about the nuances in strategies that households with a low-income in rural areas apply to support food security nationally. This study aimed to understand the barriers and strategies that households with a low-income in rural areas experience to obtain a meal and support food security in the United States. We conducted a qualitative study with semi-structured interviews among 153 primary grocery shoppers with a low-income residing in rural counties. A majority of family's ideal meals included animal-based protein, grains, and vegetables. Main themes included struggles to secure food and coping mechanisms. Ten categories included affordability, adequacy, accommodation, appetite, time, food source coordinating, food resource management, reduced quality, rationing for food, and exceptional desperation. These results can inform public health professionals' efforts when partnering to alleviate food insecurity in rural areas.

Perceptions of sugar-sweetened beverages among adolescents in North Carolina.

Introduction: Sugar-sweetened beverage (SSB) consumption among adolescents contributes to diet-related chronic disease including obesity, type 2 diabetes, and poor oral health. Objective: To better understand adolescents' perceptions, attitudes, and consumption behaviors around SSBs by conducting virtual workshop discussions with adolescents in NC. Materials and methods: Adolescents ages 11-17 in communities with a high proportion of Supplemental Nutrition Assistance Program (SNAP) eligible households were selected to participate in a series of virtual group workshops during summer 2021. A semi-structured discussion guide was used by a workshop facilitator. Workshop discussions centered around general health perceptions, SSB perceptions, and consumption behaviors. A thematic analysis was used to summarize knowledge, beliefs, attitudes, and perceptions around SSBs. Results: Approximately 36 adolescents participated across four group workshops. Parents and caregivers influenced adolescents most when it came to making beverage choices. Positive SSB perceptions included liking the taste and the association with special times and social events. Negative opinions focused on associated health risks (diet-related chronic disease and poor oral health). Some adolescents acknowledged SSBs were not healthy but suggested they could be consumed occasionally. Very few participants mentioned any benefits from SSBs; those that mentioned benefits stated they provided energy, replaced electrolytes, and tasted good. Conclusion: Findings provide several key insights that can contribute to the development of messages aimed at curbing SSB consumption among adolescents. For example, messages that focus on catching adolescents' attention and sharing short- and long-term health consequences of high SSB consumption resonated with adolescents, but because occasional SSB intake was not seen as consequential, messages that suggest abstinence from SSBs may not be helpful in reducing consumption.

Barriers and Facilitators of Online Grocery Services: Perceptions from Rural and Urban Grocery Store Managers.

Online grocery shopping has expanded rapidly in the U.S., yet little is known about the retailer's perceptions of online grocery services, which can aid in the expansion of services. Furthermore, many barriers to online grocery utilization persist across geographic areas, especially among Supplemental Nutrition Assistance Program (SNAP)-authorized retailers. This study captured perceived barriers and facilitators of online grocery shopping for managers of SNAP-authorized retailers. Qualitative semi-structured interviews were conducted with managers (n = 23) of grocery stores/supermarkets in urban and rural areas across four different states: TN, KY, NC, and NY. Grocery store managers offering online ordering (n = 15) and managers from brick-and-mortar stores without online services (n = 8) participated in the interviews. Three primary themes emerged among managers offering online ordering: (1) order fulfillment challenges, (2) perceived customer barriers, and (3) perceived customer benefits. Among managers at brick-and-mortar locations without online services, four major themes emerged: (1) thoughts on implementing online shopping, (2) COVID-19 pandemic impacts, (3) competition with other stores, and (4) benefits of maintaining brick-and-mortar shopping. This study provides a deeper understanding of retailers' experience and perceptions of online grocery services among stores authorized to accept SNAP benefits. This perspective is necessary to inform policies and enhance the evolving virtual food marketplace for SNAP customers.

A Randomized Controlled Trial of a Research-Tested Mobile Produce Market Model Designed to Improve Diet in Under-Resourced Communities: Rationale and Design for the Veggie Van Study.

Mobile produce markets are increasingly popular retail vendors used for providing access to fresh fruits and vegetables (F&V) in under-resourced communities; however, evaluation is limited due to design and implementation challenges. This protocol presents the original design of a randomized control trial aimed at assessing the effectiveness of the evidence-based Veggie Van (VV) mobile market model. Nine US community partner organizations were asked to partner with four community sites serving lower-income areas. Sites are randomized to either intervention or control. Intervention sites will host a mobile market for one year while the control sites will host planning events, with the goal to open a market afterward. Eligible participants are aged ≥ 18, the primary household shopper, live nearby/regularly frequent the site, and have expressed interest in learning about a mobile market. The primary outcome, F&V consumption, will be assessed via dietary recall at baseline and 12 months and compared between the intervention and control sites. This research advances work on the VV model and methods for mobile market evaluation with the addition of more robust measures and the study design. Determining the effectiveness of the VV model is imperative to justify taking it to scale to enhance the impact of mobile markets.

Disparities in dietary practices during the COVID-19 pandemic by food security status.

Little is known about the differences in dietary practices among food secure and food insecure populations during the early COVID-19 pandemic restrictions. The purpose of this study was to examine differences in dietary practices the early COVID-19 pandemic restrictions between adults reporting food security versus food insecurity. An online cross-sectional survey using validated measures was administered between April and September 2020 to explore both dietary patterns and practices and food security status among persons residing in five U.S. states from different regions of the country during the COVID-19 pandemic. Between-group differences (food secure versus food insecure) were examined for dietary practice outcomes using Pearson's Chi-Square test statistic, with Fisher's Exact test for cell counts less than five. There were 3,213 adult respondents. Food insecurity increased among the survey sample from 15.9% before the COVID-19 pandemic to 23.1% during the onset of the COVID-19 pandemic (p < 0.01). Compared to food secure respondents, those experiencing food insecurity reported more group gatherings for meals during the pandemic, decreased fruit and vegetable intake, and a need for more nutrition support resources than food secure respondents (p < 0.05). Food secure individuals reported increasing alcohol consumption, more frequent take-out or delivery ordering from fast food or restaurants, and more interest in supporting the local food system (p < 0.05). Results indicate a clear risk of disparities in dietary practices based on food security status during the early COVID-19 pandemic restrictions. Public health research, practice, and policy efforts should tailor specific efforts towards both food secure and food insecure groups.

Evidence of Geospatial and Socioeconomic Disparities in Access to Online Grocery Shopping for Fresh and Frozen Produce in North Carolina.

BACKGROUND: Online grocery shopping is a rapidly growing food procurement approach in the United States with the potential to improve food access. Limited research has focused on understanding differential access to online grocery shopping that provides healthier items such as fresh or frozen fruits and vegetables. OBJECTIVE: The study aim was to understand geospatial, socioeconomic, and racial disparities in the availability of healthy online grocery shopping and online Supplemental Nutrition Assistance Program (SNAP) acceptance in North Carolina. DESIGN: A cross-sectional study was conducted during spring 2021. PARTICIPANTS/SETTING: A listing of grocery stores with online shopping was generated using a systematic search strategy. Stores were geocoded and spatially joined to relevant contextual (rural/urban [based on US Department of Agriculture Rural Urban Continuum codes]), broadband Internet availability, socioeconomic variables (ie, percent poverty and Social Vulnerability Index), and demographic variables (ie, percent racial minority) in geographic information systems software. MAIN OUTCOME MEASURES: Prevalence rate ratios (PRRs) of healthy online grocery shopping (availability of curbside pickup or home delivery of fresh and frozen produce), and online SNAP acceptance (ie, availability of online SNAP), at the census tract level (n = 2,162). STATISTICAL ANALYSES PERFORMED: PRRs for availability of healthy online grocery shopping and SNAP online acceptance at the census tract level (n = 2,162) were modeled using Poisson regression with robust standard errors. RESULTS: This study found disparities in access to healthy online grocery shopping and SNAP online shopping availability in North Carolina. Healthy online shopping availability rates were higher in urban census tracts (PRR 1.68, 95% CI 1.47 to 1.92), areas with lower Social Vulnerability Index scores (PRR 0.99, 95% CI 0.98 to 0.99), higher Internet Availability Index scores (PRR 1.21, 95% CI 1.17 to 1.25), and lower percent poverty (PRR 0.94, 95% CI 0.90 to 0.98). SNAP online shopping availability rates were higher in urban census tracts (PRR 1.41, 95% CI 1.16 to 1.65), areas with higher Social Vulnerability Index scores (PRR 1.02, 95% CI 1.01 to 1.04), higher Internet Availability Index scores (PRR 1.15, 95% CI 1.10 to 1.20), and higher percent minority (PRR 1.02, 95% CI 1.0001 to 1.03). SNAP online shopping availability rates were lower in areas with higher percent poverty (PRR 0.90, 95% CI 0.85 to 0.95). CONCLUSIONS: This study found disparities in access to healthy online grocery shopping and SNAP online shopping for rural areas, and areas with higher poverty, and lower broadband Internet access in North Carolina. Further research is needed to identify effective strategies for addressing these disparities.

Operational challenges that may affect implementation of evidence-based mobile market interventions.

INTRODUCTION: Mobile produce markets are becoming an increasingly prevalent, accepted, and effective strategy for improving fruit and vegetable (F&V) access and consumption across underserved and lower-income communities. However, there is limited published research on mobile market operations. The goal of this research is to identify the challenges mobile markets face and ways to potentially mitigate those challenges. We will also discuss implications of our findings for future implementation of evidence-based food access interventions. METHODS: We conducted 21 semi-structured key informant (KI) interviews to assess common practices of mobile market organizations that had been operating for 2 + years. We asked KIs about their organizational structure, operations, procurement and logistics, evaluation efforts, marketing and community engagement, success and challenges. A primary qualitative analysis involved deductive coding using qualitative software. A secondary qualitative analysis identified subthemes related to common challenges and remedial practices. A deductive coding process was applied to match identified challenges to the appropriate Consolidated Framework for Implementation Research (CFIR). RESULTS: The leading challenges cited by KIs correspond to the CFIR domains of inner setting (e.g., funding and resources), outer setting (e.g., navigating regulations), and process (e.g., engaging community partnership). Practices that may mitigate challenges include maximizing ancillary services, adopting innovative volunteer and staffing structures, and formalizing agreements with community partners. CONCLUSION: Common and persistent challenges ought to be addressed to ensure and enhance the positive public health impacts of mobile produce markets. Contextual factors, particularly organizational factors, that impact implementation should also be considered when implementing an evidence-based intervention at a mobile market. Further research is needed to determine which innovative solutions are the most effective in mitigating challenges, improving implementation, and enhancing sustainability of mobile markets.

Online Pilot Grocery Intervention among Rural and Urban Residents Aimed to Improve Purchasing Habits.

Online grocery shopping has the potential to improve access to food, particularly among low-income households located in urban food deserts and rural communities. The primary aim of this pilot intervention was to test whether a three-armed online grocery trial improved fruit and vegetable (F&V) purchases. Rural and urban adults across seven counties in Kentucky, Maryland, and North Carolina were recruited to participate in an 8-week intervention in fall 2021. A total of 184 adults were enrolled into the following groups: (1) brick-and-mortar "BM" (control participants only received reminders to submit weekly grocery shopping receipts); (2) online-only with no support "O" (participants received weekly reminders to grocery shop online and to submit itemized receipts); and (3) online shopping with intervention nudges "O+I" (participants received nudges three times per week to grocery shop online, meal ideas, recipes, Facebook group support, and weekly reminders to shop online and to submit itemized receipts). On average, reported food spending on F/V by the O+I participants was USD 6.84 more compared to the BM arm. Online shopping with behavioral nudges and nutrition information shows great promise for helping customers in diverse locations to navigate the increasing presence of online grocery shopping platforms and to improve F&V purchases.

Examining the relationship between physical activity and mental health during the COVID-19 pandemic across five U.S. States.

The objectives of this paper are to investigate: 1) how the COVID-19 pandemic influenced both physical activity practices and mental health status, and 2) to assess the relationship between the two. Our mixed-methods study draws on 4,026 online survey responses collected between April - September 2020 across five states (Louisiana, Montana, North Carolina, Oregon and West Virginia). Logistic regression models were run for two outcome variables (physical activity and mental health status (measured using the Kessler Psychological Distress scale)). Researchers controlled for race/ethnicity, household income/size, gender, urbanicity, education, employment, use of government assistance and presence of chronic health conditions. Qualitative analysis was applied to open-ended survey responses to contextualize quantitative findings. Household income was significant in predicting difficulty maintaining pre-pandemic physical activity levels; pre-pandemic physical activity levels were associated with increased psychological distress levels during COVID-19; and race/ethnicity, income status and urbanicity were significantly associated with deteriorating mental health status and physical activity levels during COVID-19. Data suggests that a bi-directional, cyclical relationship between physical activity and mental health exists. Policy implications should include physical activity promotion as a protective factor against declining mental health.

Perceived barriers and facilitators to participating in the North Carolina Healthy Food Small Retailer Program: a mixed-methods examination considering investment effectiveness.

OBJECTIVE: The North Carolina Legislature appropriated funds in 2016-2019 for the Healthy Food Small Retailer Program (HFSRP), providing small retailers located in food deserts with equipment to stock nutrient-dense foods and beverages. The study aimed to: (1) examine factors facilitating and constraining implementation of, and participation in, the HFSRP from the perspective of storeowners and (2) measure and evaluate the impact and effectiveness of investment in the HFSRP. DESIGN: The current analysis uses both qualitative and quantitative assessments of storeowner perceptions and store outcomes, as well as two innovative measures of policy investment effectiveness. Qualitative semi-structured interviews and descriptive quantitative approaches, including monthly financial reports and activity forms, and end-of-programme evaluations were collected from participating HFSRP storeowners. SETTING: Eight corner stores in North Carolina that participated in the two cohorts (2016-2018; 2017-2019) of the HFSRP. PARTICIPANTS: Owners of corner stores participating in the HFSRP. RESULTS: All storeowners reported that the HFSRP benefitted their stores. In addition, the HFSRP had a positive impact on sales across each category of healthy food products. Storeowners reported that benefits would be enhanced with adjustments to programme administration and support. Specific suggestions included additional information regarding which healthy foods and beverages to stock; inventory management; handling of perishable produce; product display; modified reporting requirements and a more efficient process of delivering and maintaining equipment. CONCLUSIONS: All storeowners reported several benefits of the HFSRP and would recommend that other storeowners participate. The barriers and challenges they reported inform potential approaches to ensuring success and sustainability of the HFSRP and similar initiatives underway in other jurisdictions.

Qualitative perspectives of the North Carolina healthy food small retailer program among customers in participating stores located in food deserts.

BACKGROUND: The North Carolina Healthy Food Small Retailer Program (NC HFSRP) was established through a policy passed by the state legislature to provide funding for small food retailers located in food deserts with the goal of increasing access to and sales of healthy foods and beverages among local residents. The purpose of this study was to qualitatively examine perceptions of the NC HFSRP among store customers. METHODS: Qualitative interviews were conducted with 29 customers from five NC HFSRP stores in food deserts across eastern NC. Interview questions were related to shoppers' food and beverage purchases at NC HFSRP stores, whether they had noticed any in-store efforts to promote healthier foods and beverages, their suggestions for promoting healthier foods and beverages, their familiarity with and support of the NC HFSRP, and how their shopping and consumption habits had changed since implementation of the NC HFSRP. A codebook was developed based on deductive (from the interview guide questions) and inductive (emerged from the data) codes and operational definitions. Verbatim transcripts were double-coded and a thematic analysis was conducted based on code frequency, and depth of participant responses for each code. RESULTS: Although very few participants were aware of the NC HFSRP legislation, they recognized changes within the store. Customers noted that the provision of healthier foods and beverages in the store had encouraged them to make healthier purchase and consumption choices. When a description of the NC HFSRP was provided to them, all participants were supportive of the state-funded program. Participants discussed program benefits including improving food access in low-income and/or rural areas and making healthy choices easier for youth and for those most at risk of diet-related chronic diseases. CONCLUSIONS: Findings can inform future healthy corner store initiatives in terms of framing a rationale for funding or policies by focusing on increased food access among vulnerable populations.

A four-year observational study to examine the dietary impact of the North Carolina Healthy Food Small Retailer Program, 2017-2020.

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

Using common practices to establish a framework for mobile produce markets in the United States.

Access to affordable fruit and vegetables (F&V) remains a challenge within underserved communities across the United States. Mobile produce markets (mobile markets) are a well-accepted and effective strategy for increasing F&V consumption in these communities. Mobile market organizations share similar missions that focus on food, health, and empowerment, participate in incentive programs, offer nutrition education, utilize grassroots-based marketing strategies, prioritize local produce, and sell competitively priced produce through a market style. While mobile markets have become increasingly prevalent, models vary widely. Establishing standardized practices is essential for ensuring the effectiveness and sustainability of this important food access program. This research seeks to identify common practices of established mobile markets and describe the resources they rely on.

Examining Rural Food-Insecure Families' Perceptions of the Supplemental Nutrition Assistance Program: A Qualitative Study.

The Supplemental Nutrition Assistance Program (SNAP) is a critical program that helps reduce the risk of food insecurity, yet little is known about how SNAP addresses the needs of rural, food-insecure residents in the United States (U.S.). This study examines how rural, food-insecure residents perceive SNAP. Semi-structured interviews were conducted with 153 individuals living in six diverse rural regions of Arkansas, Montana, North Carolina, Oregon, Texas, and West Virginia. SNAP was described as a crucial stop-gap program, keeping families from experiencing persistent food insecurity, making food dollars stretch when the family budget is tight, and helping them purchase healthier foods. For many rural residents interviewed, SNAP was viewed in a largely positive light. In efforts to continue improving SNAP, particularly in light of its relevance during and post-coronavirus (COVID-19) pandemic, policymakers must be aware of rural families' perceptions of SNAP. Specific improvements may include increased transparency regarding funding formulas, budgeting and nutrition education for recipients, effective training to improve customer service, connections among social service agencies within a community, and increased availability of automation to streamline application processes.

The Curated Food System: A Limiting Aspirational Vision of What Constitutes "Good" Food.

In an effort to elucidate an aspirational vision for the food system and explore whether the characteristics of such a system inadvertently set unattainable standards for low-wealth rural communities, we applied discourse analysis to the following qualitative datasets: (1) interviews with food experts and advocates, (2) scholarly and grey literature, (3) industry websites, and (4) email exchanges between food advocates. The analysis revealed eight aspirational food system discourses: production, distribution, and infrastructure; healthy, organic, local food; behavioral health and education; sustainability; finance and investment; hunger relief; demand-side preferences; romanticized, community led transformations. Study findings reveal that of eight discourses, only three encompass the experiences of low-wealth rural residents. This aspirational food system may aggravate the lack of autonomy and powerlessness already experienced by low-wealth rural groups, perpetuate a sense of failure by groups who will be unable to reach the aspirational food vision, silence discourses that might question those that play a role in the inequitable distribution of income while sanctioning discourses that focus on personal or community solutions, and leave out other policy-based solutions that address issues located within the food system. Further research might explore how to draw attention to silenced discourses on the needs and preferences of low-wealth rural populations to ensure that the policies and programs promoted by food system experts mitigate poor diets caused by food insecurity. Further research is needed to inform policies and programs to mitigate food insecurity in low-wealth rural populations.