United States Department of Agriculture nutrition assistance programs during the COVID-19 pandemic: A scoping review protocol.

OBJECTIVE: The goal of this scoping review is to examine the published research on federal nutrition assistance programs administered by the United States (U.S.) Department of Agriculture during the COVID-19 pandemic, in the U.S., U.S. territories, and tribal nations. The review will identify the scope of the available research and provide research and policy recommendations. INTRODUCTION: The COVID-19 pandemic made individuals more vulnerable to experiencing food insecurity. Federal nutrition assistance programs help to address food insecurity and have been rapidly adapting to meet food and nutrition needs among affected communities during the COVID-19 pandemic. It is important to understand the scope of the current research on this topic to help inform future research, practice, and policy recommendations. INCLUSION CRITERIA: This review will include studies focused on federal nutrition assistance programs administered by the U.S. Department of Agriculture during the COVID-19 pandemic. The scoping review will consider all primary research designs. METHODS: Pubmed, CINHAL, Scopus, and Proquest's Health Management databases will be used for the literature search. Only articles published in English since March 1, 2020 will be considered. Titles/abstracts followed by full-text articles will be reviewed to determine which articles meet the inclusion criteria and should be included in the review. Data will be extracted from each included article using a data extraction template in Covidence that will be developed by the study team. Data extracted will include information on key findings related to the review questions. At each step, two independent reviewers will be assigned to each article. Data will be summarized and presented in tables, charts, and narrative summary.

Struggling with the basics: food and housing insecurity among college students across twenty-two colleges and universities.

OBJECTIVES: To quantify the number and type of students failing to secure basic needs. PARTICIPANTS: Students attending 22 postsecondary schools in the United States in Fall 2019. METHODS: The Adult Food Security Module and part of the #RealCollege Survey were used to measure food and housing insecurity, respectively. Logistic and linear regression models were used to assess the relationship between selected factors and basic needs insecurities. RESULTS: Participants (n = 22,153) were classified as 44.1% and 52.3% food insecure and housing insecure, respectively. Homeless students or those who experienced childhood food insecurity were at the greatest odds of college food insecurity. Year in school was the largest contributor to being housing insecure, with PhD or EdD students being 1,157% more likely to experience housing insecurity compared to freshmen. CONCLUSIONS: High prevalence of basic needs insecurities remain. Current campus initiatives may be insufficient, calling for a more holistic approach at the campus, state, and national levels.

"Let's Use This Mess to Our Advantage": Calls to Action to Optimize School Nutrition Program beyond the Pandemic.

School nutrition programs mitigate food insecurity and promote healthy eating by offering consistent, nutritious meals to school-aged children in communities across the United States; however, stringent policy guidelines and contextual challenges often limit participation. During COVID-19 school closures, most school nutrition programs remained operational, adapting quickly and innovating to maximize reach. This study describes semi-structured interviews with 23 nutrition directors in North Carolina, which aimed to identify multi-level contextual factors that influenced implementation, as well as ways in which the innovations during COVID-19 could translate to permanent policy and practice change and improve program reach. Interviews were conducted during initial school closures (May-August 2020) and were deductively analyzed using the Social Ecological Model (SEM) and Consolidated Framework for Implementation Research (CFIR). Analysis elicited multiple relevant contextual factors: director characteristics (motivation, leadership style, experience), key implementation stakeholders (internal staff and external partners), inner setting (implementation climate, local leadership engagement, available resources, structural characteristics), and outer setting (state leadership engagement, external policies and incentives). Findings confirm the strength and resilience of program directors and staff, the importance of developing strategies to strengthen external partnerships and emergency preparedness, and strong support from directors for policies offering free meals to all children.

Cooking Matters for Kids Improves Attitudes and Self-Efficacy Related to Healthy Eating and Cooking.

OBJECTIVE: To assess changes in self-efficacy and attitudes related to healthy eating and cooking in Cooking Matters for Kids participants. DESIGN: Prepost study design. SETTING: Cooking Matters for Kids programs offered by 35 organizations. PARTICIPANTS: Predominantly third- to fifth-grade children participating in Cooking Matters for Kids lessons during fiscal years 2012-17 with matched presurvey and postsurveys (n = 18,113). INTERVENTION(S): Cooking Matters for Kids consists of six 2-hour experiential nutrition and cooking education lessons. MAIN OUTCOME MEASURE(S): Self-efficacy related to healthy eating and cooking and attitudes toward healthy foods assessed through the Cooking Matters for Kids Participant Survey. ANALYSIS: Changes from the presurvey to postsurvey were assessed using mixed models and repeated measures ordered logistic regression accounting for clustering by course. Effect sizes were calculated using Cohen d for repeated measures. A Bonferroni adjustment was used to correct for multiple comparisons (α = 0.025). RESULTS: Both overall and individual self-efficacy and attitude scores improved from presurvey to postsurvey (P < 0.0001). The effect sizes were 0.35 for overall self-efficacy score and 0.17 for overall attitude score. CONCLUSIONS AND IMPLICATIONS: Participation in Cooking Matters for Kids was associated with improvements in self-efficacy and attitudes related to healthy eating and cooking.

College student motivations for and perceived impacts of volunteering with a nutrition and cooking education program for children.

To assess among college students their motivations for and perceived impacts of volunteering with Cooking Matters for Kids as part of No Kid Hungry NC. Seventeen college student volunteers responded to an online survey questionnaire assessing their motivations for volunteering and how they were impacted by their experiences. Motivational functions for volunteering (values, understanding, social, career, protective, enhancement) were assessed using the Volunteer Functions Inventory. The strongest motivational functions for volunteering were values and understanding. Students were also strongly motivated to volunteer related to the areas specifically addressed by the program (i.e., nutrition, public health, working with children). Perceived impacts of volunteering included being more comfortable working with children, improving knowledge/skills, gaining experience related to their future career, and having fun. Volunteering with Cooking Matters for Kids benefited college students. Issues addressed by the program and the desire to gain experience motivated students to volunteer.

College student sleep quality and mental and physical health are associated with food insecurity in a multi-campus study.

OBJECTIVE: To assess the relationship between food insecurity, sleep quality, and days with mental and physical health issues among college students. DESIGN: An online survey was administered. Food insecurity was assessed using the ten-item Adult Food Security Survey Module. Sleep was measured using the nineteen-item Pittsburgh Sleep Quality Index (PSQI). Mental health and physical health were measured using three items from the Healthy Days Core Module. Multivariate logistic regression was conducted to assess the relationship between food insecurity, sleep quality, and days with poor mental and physical health. SETTING: Twenty-two higher education institutions. PARTICIPANTS: College students (n 17 686) enrolled at one of twenty-two participating universities. RESULTS: Compared with food-secure students, those classified as food insecure (43·4 %) had higher PSQI scores indicating poorer sleep quality (P < 0·0001) and reported more days with poor mental (P < 0·0001) and physical (P < 0·0001) health as well as days when mental and physical health prevented them from completing daily activities (P < 0·0001). Food-insecure students had higher adjusted odds of having poor sleep quality (adjusted OR (AOR): 1·13; 95 % CI 1·12, 1·14), days with poor physical health (AOR: 1·01; 95 % CI 1·01, 1·02), days with poor mental health (AOR: 1·03; 95 % CI 1·02, 1·03) and days when poor mental or physical health prevented them from completing daily activities (AOR: 1·03; 95 % CI 1·02, 1·04). CONCLUSIONS: College students report high food insecurity which is associated with poor mental and physical health, and sleep quality. Multi-level policy changes and campus wellness programmes are needed to prevent food insecurity and improve student health-related outcomes.

Marginal, Low, and Very-Low Food Security among Children Are Associated with Intake of Select Dietary Factors during Summer.

BACKGROUND: School meals are associated with improved food security status and dietary intake. Children receiving free and reduced-price school meals lose access to these meals during the summer. The association between food security status and dietary intake in these children during summer is unclear. OBJECTIVE: To examine the association between food security status (high, marginal, low, and very-low food security) among children and intake of select dietary factors during summer in children certified for free and reduced-price school meals by age group (3 to 4 years, 5 to 8 years, 9 to 12 years, and 13 to 17 years). DESIGN: Cross-sectional analysis. PARTICIPANTS/SETTING: Secondary data from 11,873 children aged 3 to 17 years in the control group of the US Department of Agriculture Summer Electronic Benefit Transfer for Children Demonstration Project. MAIN OUTCOME MEASURES: Consumption of total fruits and vegetables; fruits and vegetables, excluding fried potatoes; whole grains; added sugars; added sugars, excluding cereals; added sugars from sugar-sweetened beverages; and dairy products assessed using questions from the 2009-2010 National Health and Nutrition Examination Survey Multifactor Diet Screener. STATISTICAL ANALYSIS: Multiple linear regression. RESULTS: For the majority of age groups, marginal food security, low food security, and very-low food security were associated with lower fruit and vegetable consumption and low food security and very-low food security were associated with lower dairy consumption, with children from households with very-low food security having the lowest consumption. Children from households with very-low food security consumed 0.73 (95% CI -0.93 to -0.53) to 0.99 (95% CI -1.59 to -0.39) cup equivalents less per day of fruits and vegetables and 0.49 (95% CI -0.65 to -0.34) to 0.68 (95% CI -1.07 to -0.29) cup equivalents less per day of dairy compared with children from households experiencing high food security. CONCLUSIONS: Lower food security was associated with reduced consumption of fruits and vegetables and dairy products during summer in children from low-income households.

Characteristics associated with changes in food security status among college students during the COVID-19 pandemic.

The prevalence of food insecurity in the USA has increased since the start of the COVID-19 pandemic; however, past studies have not examined how the food security status of college students has been impacted. The purpose of this study was to examine changes in the prevalence of food insecurity; determine the proportion of students experiencing a change in food security status; and identify characteristics associated with changes in food security status from before to during the COVID-19 pandemic among a sample of college students. We administered a cross-sectional online survey to students from a large public university in the Southeastern USA. The 10-item U.S. Adult Food Security Module was used to assess food security status during the spring 2020 semester both before and during the COVID-19 pandemic, and students self-reported a variety of individual characteristics. The overall prevalence of food insecurity increased by approximately one-third during the spring 2020 semester from before to during the COVID-19 pandemic. When examining the types of changes in food security status experienced by students, 12% improved, 68% stayed the same, and 20% worsened. A variety of characteristics were associated with an improvement or worsening of food security status category from before to during the pandemic. Similar to what is seen in other reports, we found that the overall proportion of college students in our sample experiencing food insecurity increased during the COVID-19 pandemic; however, some students showed improvements in food security status. Approaches for addressing food insecurity during and beyond the pandemic are needed.

The importance of precision: differences in characteristics associated with levels of food security among college students.

OBJECTIVE: To estimate the prevalence of high, marginal, low and very low food security among a sample of college students and identify characteristics associated with the four different food security status levels and note differences in associations from when food security status is classified as food-secure v. food-insecure. DESIGN: Cross-sectional online survey. SETTING: A large public university in North Carolina. PARTICIPANTS: 4829 college students who completed an online survey in October and November 2016. RESULTS: Among study participants, 56·2 % experienced high, 21·6 % experienced marginal, 18·8 % experienced low and 3·4 % experienced very low food security. Characteristics significantly associated with food security status when using the four-level variable but not two-level variable were age, international student status and weight status. Characteristics that significantly differed between the marginal and high food security groups included age, race/ethnicity, year in school, international student status, employment status, financial aid receipt, perceived health rating, cooking frequency and participation in an on-campus meal plan. Characteristics with differences in significant associations between the low and very low food security groups were gender, international student status, having a car, weight status and participation in an on-campus meal plan. Even where similarities in the direction of association were seen, there were often differences in magnitude. CONCLUSIONS: We found differences in characteristics associated with food security status when using the four-level v. two-level food security status variable. Future studies should look separately at the four levels, or at least consider separating the marginal and high food-secure groups.

Novel Sales Tracking Method to Evaluate a Healthy Corner Store Intervention.

This article describes a Supplemental Nutrition Assistance Program-Education-funded (SNAP-Ed) healthy corner store intervention and novel evaluation method for tracking sales of promoted foods in two corner stores in North Carolina. The healthy corner store intervention was designed to encourage the purchase of healthy foods among SNAP participants. Stickers were placed on eligible foods to highlight healthy options as well as assist with tracking the sales of those products. Store staff removed the sticker and placed it on a tracking sheet that recorded the date, number of healthy foods purchased, whether the purchased item(s) contained a fruit or vegetable, and the type of payment. Storeowners were interested in participating and remained engaged throughout the program; however, there were challenges with fidelity to the intervention and its evaluation using the sticker method to track sales. Additional research on methods for evaluating healthy retail interventions that are simple, low cost, and feasible for retailers that do not have electronic sales data is needed.

Corrigendum to "Rates of and characteristics associated with food insecurity differ among undergraduate and graduate students at a large public university in the southeast United States" [Prev. Med. Rep. 14 (2019) 100836].

[This corrects the article DOI: 10.1016/j.pmedr.2019.100836.].

Serving Breakfast Free to All Students and Type of Breakfast Serving Model Are Associated with Participation in the School Breakfast Program.

BACKGROUND: Many students experience challenges participating in the School Breakfast Program (SBP) when breakfast is served before school in the cafeteria. Serving breakfast free to all students or offering innovative breakfast serving models, such as breakfast in the classroom (BIC), grab n' go, or second chance breakfast, may encourage higher SBP participation rates. OBJECTIVE: To examine the association between offering breakfast free to all students as well as breakfast serving model with student participation in the SBP in October 2017 among public schools in North Carolina. DESIGN: Cross-sectional study using data from the North Carolina Department of Public Instruction. PARTICIPANTS/SETTING: This study included data from 2,285 North Carolina public schools who served breakfast in October 2017 with 1,445,287 students. MAIN OUTCOME MEASURES: The main outcome measures are the odds of a student participating in the SBP among students overall, students eligible for free or reduced-price (FRP) meals, and students not eligible for FRP meals. STATISTICAL ANALYSES PERFORMED: Multiple logistic regression assessed the association between offering breakfast free to all students and breakfast serving model with the probability of participating in the SBP (number of students participating out of number of students enrolled) for students overall, eligible for FRP meals, and not eligible for FRP meals. Statistical models were stratified by school type (elementary, middle, and high schools). RESULTS: Breakfast serving models positively associated with SBP participation were BIC and BIC plus grab n' go for elementary and high school students and grab n' go and second chance for middle and high school students (P<0.05). Serving breakfast free to all students was positively associated with SBP participation alone and in combination with BIC, second chance, and BIC plus grab n' go (P<0.05). CONCLUSIONS: Serving breakfast free to all students and breakfast serving model were associated with SBP participation, and different relationships existed for different school levels.

Rates of and characteristics associated with food insecurity differ among undergraduate and graduate students at a large public university in the Southeast United States.

The objective of this study was to estimate the prevalence of food insecurity and identify characteristics associated with food security status separately for undergraduate and graduate students. We conducted a cross-sectional analysis of 4819 students from a public flagship university in the Southeastern US. Students completed an online questionnaire assessing food security status over the past 12 months using the 10-item US Adult Food Security Survey Module and self-reported demographics and student characteristics. Data were collected in October and November of 2016. Analyses were stratified by student status (undergraduate or graduate). We calculated frequencies of food security status categories and used multinomial logistic regression to assess the association between food security status and student characteristics. Food insecurity rates were 25.2% for undergraduate and 17.8% for graduate students. Characteristics associated with food security status (p < .05) for undergraduates only were gender, year in school, receipt of financial aid, cooking frequency, perceived cooking skills, and having a meal plan. For graduate students only, characteristics included age, marital status, having dependent children, enrollment status, and body mass index. Characteristics associated with food security status across both groups included race/ethnicity, perceived health, international student, and employment status. While most prior studies of college food insecurity look only at undergraduate students or combine undergraduate and graduate students into one group, we found differences between undergraduate and graduate students. It is important to consider undergraduate and graduate students as two separate groups as strategies that would be most effective for addressing food insecurity may differ between them.

Partnering to Strengthen School Meals Programs in a Southeastern School District.

BACKGROUND: School meals have the potential to improve diet quality for millions of students across the United States. OBJECTIVES: Evaluate the feasibility of the FAV5 program, which aims to strengthen school meals by increasing appeal of school meals and improving relationships within the team of child nutrition staff and with other staff/teachers at their schools. METHODS: Nutrition researchers facilitated partnerships between the following groups to develop and implement the FAV5 program: the child nutrition director (CND) and managers at seven elementary schools in a North Carolina county, teachers and principals at those schools, a chef, the North Carolina Department of Agriculture, and volunteers. RESULTS: The partnerships developed through the FAV5 program produced successful taste test events in seven elementary schools that generated enthusiasm around the school meals program and strengthened relationships. CONCLUSIONS: Engaging child nutrition staff and other community partners to plan and implement the FAV5 program in schools is feasible.

Recommendations for Adopting the International Code of Marketing of Breast-milk Substitutes Into U.S. Policy.

In 1981, the World Health Organization adopted the International Code of Marketing of Breast-milk Substitutes ( International Code), with subsequent resolutions adopted since then. The International Code contributes to the safe and adequate provision of nutrition for infants by protecting and promoting breastfeeding and ensuring that human milk substitutes, when necessary, are used properly through adequate information and appropriate marketing and distribution. Despite the World Health Organization recommendations for all member nations to implement the International Code in its entirety, the United States has yet to take action to translate it into any national measures. In 2012, only 22.3% of infants in the United States met the American Academy of Pediatrics recommendation of at least 6 months of exclusive breastfeeding. Countries adopting legislation reflecting the provisions of the International Code have seen increases in breastfeeding rates. This article discusses recommendations for translating the International Code into U.S. policy. Adopting legislation that implements, monitors, and enforces the International Code in its entirety has the potential to contribute to increased rates of breastfeeding in the United States, which can lead to improved health outcomes in both infants and breastfeeding mothers.

Pathobiology and potential therapeutic value of intestinal short-chain fatty acids in gut inflammation and obesity.

BACKGROUND: The lumen of the gastrointestinal tract contains many substances produced from the breakdown of foodstuffs, from salivary, esophageal, intestinal, hepatic, and pancreatic secretions, and from sloughed cells present in the gastrointestinal lumen. Although these substances were traditionally regarded as waste products, there is increasing realization that many can be biologically active, either as signalling compounds or as nutrients. For example, proteins are broken down into amino acids, which are then sensed by nutrient receptors. The gut microbiome, which is at highest abundance in the ileocecum, has powerful metabolic activity, digesting and breaking down unabsorbed carbohydrates, proteins, and other ingested nutrients into phenols, amines, volatile organic compounds, methane, carbon dioxide, hydrogen, and hydrogen sulfide into volatile fatty acids, also called short-chain fatty acids (SCFAs). CONCLUSION: These latter substances are the topic of this review. In this review, we will briefly discuss recent advances in the understanding SCFA production, signalling, and absorption, followed by a detailed description and discussion of trials of SCFAs, probiotics, and prebiotics in the treatment of gastrointestinal disease, in particular ulcerative colitis (UC), pouchitis, short bowel syndrome, and obesity.

Nutrition claims influence health perceptions and taste preferences in fourth- and fifth-grade children.

OBJECTIVE: To determine whether children perceive food with nutrition claims as healthier and tasting differently than those without claims. METHODS: Fourth- and fifth-graders (n = 47) from 3 California schools participated. Two identical products (cookies, crackers, or juice) were placed in front of product packages, 1 with a nutrition claim, the other without. Each child was asked which product was healthier and which tasted better. RESULTS: The percentage of children who identified the reduced-fat cookie, whole-grain cracker, or 100% juice as healthier was 81%, 83% and 81%, respectively. The taste of the "healthier" product (ie, with nutrition claim) was preferred by 72%, 67%, and 54%, respectively. CONCLUSIONS AND IMPLICATIONS: A convenience sample of children perceived products with a nutrition claim as healthier and identified the "healthier" cookies and crackers as tasting better. Future research should examine whether food labeling can be used to encourage children to consume healthier diets.