Prevalence of food insecurity among students attending four Historically Black Colleges and Universities.

Objective: This study examined the prevalence of food insecurity (FI) among students attending Historically Black Colleges and Universities (HBCUs) in the Southeastern United States. Participants: Students attending four HBCUs (N = 351) completed an anonymous Web-based survey. Methods: Food insecurity was assessed using the 2-item Hunger Vital Sign Tool. Summary statistics were used to quantify FI experiences. Logistic regression was conducted to determine if student demographic characteristics were significantly associated with FI outcomes. Results: Nearly 3 in 4 students (72.9%) reported some level of FI in the past year. Students representing all levels of postsecondary education reported FI. Meal plan participation did not prevent FI. Conclusions: Students attending HBCUs experience FI at levels that exceed estimates reported among students attending predominantly White institutions. More work is needed to understand the lived experience of food-insecure HBCU students as a means to ensure institution-level food policies support student academic success and wellbeing.

Developing a National Research Agenda to Support Healthy Food Retail.

The food retail environment is an important driver of dietary choices. This article presents a national agenda for research in food retail, with the goal of identifying policies and corporate practices that effectively promote healthy food and beverage purchases and decrease unhealthy purchases. The research agenda was developed through a multi-step process that included (1) convening a scientific advisory committee; (2) commissioned research; (3) in-person expert convening; (4) thematic analysis of meeting notes and refining research questions; (5) follow-up survey of convening participants; and (6) refining the final research agenda. Public health researchers, advocates, food and beverage retailers, and funders participated in the agenda setting process. A total of 37 research questions grouped into ten priority areas emerged. Five priority areas focus on understanding the current food retail environment and consumer behavior and five focus on assessing implementation and effectiveness of interventions and policies to attain healthier retail. Priority topics include how frequency, duration, and impact of retailer promotion practices differ by community characteristics and how to leverage federal nutrition assistance programs to support healthy eating. To improve feasibility, researchers should explore partnerships with retailers and advocacy groups, identify novel data sources, and use a variety of study designs. This agenda can serve as a guide for researchers, food retailers, funders, government agencies, and advocacy organizations.

Developing a national research agenda to reduce consumption of sugar-sweetened beverages and increase safe water access and consumption among 0- to 5-year-olds: a mixed methods approach.

OBJECTIVE: Sugar-sweetened beverage (SSB) consumption in early childhood is a public health concern. Adequate hydration in early childhood is also important. We developed a national research agenda to improve beverage consumption patterns among 0-5-year-olds. This article focuses on the process used to develop this research agenda. DESIGN: A mixed methods, multi-step process was used to develop the research agenda, including: (i) a scientific advisory committee; (ii) systematic reviews on strategies to reduce SSB consumption and increase water access and consumption; (iii) two stakeholder surveys to first identify and then rank strategies to reduce SSB consumption and increase water access and consumption; (iv) key informant interviews to better understand determinants of beverage consumption and strategies to improve beverage consumption patterns among high-risk groups; (v) an in-person convening with experts; and (vi) developing the final research agenda. SETTING: This process included research and stakeholders from across the United States. PARTICIPANTS: A total of 276 participants completed survey 1 and 182 participants completed survey 2. Key informant interviews were conducted with 12 stakeholders. Thirty experts attended the convening, representing academia, government, and non-profit sectors. RESULTS: Thirteen key issue areas and 59 research questions were developed. Priority topics were beverage consumption recommendations, fruit-flavoured drink consumption, interventions tailored to high-risk groups, and family engagement in childcare. CONCLUSIONS: This research agenda lays the groundwork for research efforts to improve beverage patterns of young children. The methods used can be a template to develop research agendas for other public health issues.

Supporting Healthy Eating: Synergistic Effects of Nutrition Education Paired with Policy, Systems, and Environmental Changes.

A healthy diet is central to health and well-being throughout life. The United States and many other countries are undergoing an obesity epidemic and experiencing serious diet-related health problems. There exists a misalignment and wide gap between national dietary recommendations and dietary patterns of Americans, and thus, a need to find new ways to improve diet and nutrition. This article posits that nutrition education combined with policy, systems, and environmental (PSE) change approaches is more effective than either strategy in isolation and both are needed to reduce the global burden of diet-related chronic diseases. This article presents a conceptual framework for understanding the multiple influences on what people eat; discusses the need for PSE strategies to augment direct nutrition education approaches; and highlights examples of synergistic and promising linkages between nutrition education and PSE strategies in 3 areas: federal nutrition assistance programs, food retail settings, and nutrition and calorie labeling. In addition, future directions where this synergistic approach holds promise for improving population health and reducing health inequities are discussed. Nutrition education combined with PSE changes at governmental and community levels, as well as strategic public-private alliances have the potential to change the way people eat and improve health and well-being.

Beverage Consumption Patterns among Infants and Young Children (0⁻47.9 Months): Data from the Feeding Infants and Toddlers Study, 2016.

(1) Background: Data about early life beverage intake patterns is sparse. We describe beverage patterns among infants and young children from the Feeding Infants and Toddlers Study (FITS) 2016. (2) Methods: FITS 2016 is a cross-sectional survey of U.S. parents/caregivers of children 0⁻47.9 months (n = 3235). Food and beverage intakes were collected by 24-h dietary recalls to describe beverage consumption patterns including: a) prevalence of consumption, per capita and per consumer intake, b) contribution to intake of calories and key nutrients, and c) prevalence according to eating occasions. (3) Results: Breast milk and infant formula were commonly consumed among <12-month-olds. Among 12⁻23.9-month-olds, the most commonly consumed beverage was whole milk (67% consuming), followed by 100% juice (50% consuming). Plain drinking water was consumed by 70% of 12⁻23.9-month-olds and 78% of 24⁻47.9-month-olds. Among 12⁻47.9-month-olds, milks provided more energy and key nutrients than all other beverages. Across eating occasions, sugar-sweetened beverage (SSB) consumption, especially in the form of fruit-flavored drinks, was higher among 24⁻47.9 compared to 12⁻23.9-month-olds. Only 23⁻32% of ≥12-month-olds consumed milk or water at lunch or dinner. (4) Conclusions: Opportunities exist to improve beverage patterns. Future interventions may benefit from focusing on timely introduction of age-appropriate beverages and reducing consumption of SSBs.

Room for Improvement Remains in Food Consumption Patterns of Young Children Aged 2-4 Years.

Background: Healthy food consumption patterns in early childhood support optimal growth and development and promote lifelong health. Objective: The objective of the Feeding Infants and Toddlers Study (FITS) 2016 is to provide updated information on food consumption patterns of children aged 0 to <4 y. This article focuses on several key aspects of the food consumption patterns of 2- and 3-y-olds and how those patterns differ between racial/ethnic groups. Methods: The FITS 2016 is a cross-sectional study in caregivers of children aged 0 to <4 y living in the United States. Dietary data were collected in a national random sample of children (n = 3235, of whom 600 were aged 24-47.9 mo) by using a 24-h dietary recall telephone survey with the primary caregiver of the child. Data from the recall were used to calculate the percentage of children consuming specific food groups on the day of the recall and energy from these foods (kilocalories per consumer). Differences in food patterns between racial/ethnic groups were analyzed by using ANOVA and t tests. Results: On the day of the 24-h dietary recall, 27% of 2- and 3-y-olds did not consume a distinct portion of vegetables. Fried potatoes were the most commonly consumed vegetable. Approximately 75% consumed a distinct portion of fruit and 45% consumed 100% fruit juice. Eighty-one percent of children consumed cow milk. Almost all (95%) consumed a grain product, and 59% consumed a whole grain-rich product. The majority of children (88%) consumed meat or another protein food. Nearly all (90%) consumed a dessert, sugar-sweetened beverage (SSB), or sweet; and 45% consumed an SSB. Thirty-six percent of children consumed a savory snack. There were some differences in food consumption patterns between racial/ethnic groups. Conclusion: Findings from the FITS 2016 indicate that individual-, community-, and policy-level strategies are needed to improve the diets of young children in the United States.

Multicontextual correlates of adolescent sugar-sweetened beverage intake.

PURPOSE: To examine personal, home, peer, school, neighborhood, and media correlates of sugar-sweetened beverage (SSB) intake in a diverse sample of adolescents. METHODS: Cross-sectional, population-based study (EAT 2010: Eating and Activity in Teens) of 2793 adolescents (54% female, mean age [SD] = 14.5 [2.0], 80% nonwhite) attending public secondary schools in Minneapolis-St. Paul, Minnesota. Adolescents completed a food frequency questionnaire and answered survey questions about their diet/health perceptions and behaviors. Socio-environmental data were collected from parents/caregivers, peers, school personnel, Geographic Information Systems (e.g., distance to food outlet), and a content analysis of favorite TV shows. Individual and mutually adjusted mixed-effects regression models examined associations between multi-contextual factors and estimated daily servings of SSB, controlling for relevant covariates. RESULTS: The contextual factors examined accounted for 24% of the variance in adolescents' SSB consumption. The proportion of variance explained by each context was 13% personal, 16% home/family, 3% peer, 1% school, 0.1% media, and 0% neighborhood. The strongest correlate of SSB intake was home soda availability (adjusted for covariates: ß = 0.26, p < 0.01; adjusted for all multi-contextual factors: ß = 0.18, p < 0.01). Other significant correlates of SSB intake included personal behaviors (e.g., fast food intake, sleep), home/family factors (e.g., parent modeling) and peer influences (e.g., friends' SSB intake). CONCLUSIONS: Public health policies and programs to reduce adolescent SSB intake should target personal behaviors (e.g., limit fast food, encourage adequate sleep), address the home setting (e.g., help parents to reduce SSB availability and model healthy eating habits) and involve peers (e.g., identify and enable peers to model healthy eating behaviors).

Adolescent Snacking Behaviors Are Associated with Dietary Intake and Weight Status.

BACKGROUND: Most adolescents consume ≥1 snack/d; exploring the relevance of snacking patterns for overall diet and weight status is important to guide dietary counseling and public health strategies for obesity prevention. OBJECTIVE: This study examined intake of common energy-dense snack foods, total number of snacks consumed, frequency of consuming snacks prepared away from home, and frequency of snacking while watching television in adolescents and how these behaviors may be linked to diet and weight status. Relations were examined with attention to potential confounders that may help explain the mixed findings of previous research. METHODS: Survey measures of snacking behavior, a food-frequency questionnaire, and anthropometric measurements were completed by 2793 adolescents (53.2% girls, mean age = 14.4 y) in Minneapolis-St. Paul school classrooms in 2009-2010. Linear regression was used to examine associations with adjustment for sociodemographic characteristics and other potential confounding factors, such as meal skipping, underreporting energy intake, dieting to lose weight, and physical activity. RESULTS: Adolescents reported consuming a mean of 2.2 energy-dense snack food servings/d and 4.3 snacks/d and purchasing snacks prepared away from home on 3.2 occasions/wk. More than two-thirds of adolescents reported that they sometimes, usually, or always consumed a snack while watching television. The measures of snacking were directly associated (P < 0.01) with higher energy, lower fruit/vegetable, higher sugar-sweetened beverage, and more frequent fast-food intakes in all models except for one: energy-dense snack food servings were not related to sugar-sweetened beverage intake. A direct relation between daily servings of energy-dense snack foods and body mass index (BMI) z score was found; however, the snacking behaviors were inversely related to BMI z score (P < 0.01). CONCLUSIONS: The observed cross-sectional associations suggest that snack consumption is a risk factor for poor diet, but unless energy-dense foods are consumed, snacking does not consistently contribute to overweight in US adolescents.

Patterns of obesogenic neighborhood features and adolescent weight: a comparison of statistical approaches.

BACKGROUND: Few studies have addressed the potential influence of neighborhood characteristics on adolescent obesity risk, and findings have been inconsistent. PURPOSE: Identify patterns among neighborhood food, physical activity, street/transportation, and socioeconomic characteristics and examine their associations with adolescent weight status using three statistical approaches. METHODS: Anthropometric measures were taken on 2682 adolescents (53% female, mean age=14.5 years) from 20 Minneapolis/St. Paul MN schools in 2009-2010. Neighborhood environmental variables were measured using GIS data and by survey. Gender-stratified regressions related to BMI z-scores and obesity to (1) separate neighborhood variables; (2) composites formed using factor analysis; and (3) clusters identified using spatial latent class analysis in 2012. RESULTS: Regressions on separate neighborhood variables found a low percentage of parks/recreation, and low perceived safety were associated with higher BMI z-scores in boys and girls. Factor analysis found five factors: away-from-home food and recreation accessibility, community disadvantage, green space, retail/transit density, and supermarket accessibility. The first two factors were associated with BMI z-score in girls but not in boys. Spatial latent class analysis identified six clusters with complex combinations of both positive and negative environmental influences. In boys, the cluster with highest obesity (29.8%) included low SES, parks/recreation, and safety; high restaurant and convenience store density; and nearby access to gyms, supermarkets, and many transit stops. CONCLUSIONS: The mix of neighborhood-level barriers and facilitators of weight-related health behaviors leads to difficulties disentangling their associations with adolescent obesity; however, statistical approaches including factor and latent class analysis may provide useful means for addressing this complexity.

Food insecurity and weight status among U.S. children and families: a review of the literature.

CONTEXT: Food insecurity disproportionately affects U.S. demographic groups of children and adult family members at the highest risk for obesity and may lead to weight gain through various pathways. This article reviews research regarding the relationship between food insecurity and weight status, and the potential role of federal food and nutrition assistance programs. EVIDENCE ACQUISITION: A search for relevant peer-reviewed research studies among U.S. children and nonelderly adults, published between 2000 and March 2010, identified 42 studies regarding the relationship between food insecurity and weight status. There were 22 studies regarding the potential role of food and nutrition assistance programs. EVIDENCE SYNTHESIS: Among children and men, support for an association between food insecurity and weight status has been mixed. Women who experience food insecurity are more likely to be overweight or obese compared to women with adequate household resources for food; however, there is little evidence that food insecurity promotes increased weight gain over time. Long-term participation in the Supplemental Nutrition Assistance Program may increase risk for excess weight gain. CONCLUSIONS: Additional research addressing the limitations of current studies is needed to fully understand the observed linkages between food insecurity and risk for obesity. Nevertheless, there is substantial evidence these nutritional problems coexist, and it is critical that future efforts to eliminate hunger consider opportunities to promote healthy food choices and physical activity. Evaluations of policy changes and other intervention strategies are needed to determine the potential for food and nutrition assistance programs to more effectively reduce obesity among participants.

New moves-preventing weight-related problems in adolescent girls a group-randomized study.

BACKGROUND: Weight-related problems are prevalent in adolescent girls. PURPOSE: To evaluate New Moves, a school-based program aimed at preventing weight-related problems in adolescent girls. DESIGN: School-based group-randomized controlled design. SETTING/PARTICIPANTS: 356 girls (mean age=15.8±1.2 years) from six intervention and six control high schools. More than 75% of the girls were racial/ethnic minorities and 46% were overweight or obese. Data were collected in 2007-2009 and analyzed in 2009-2010. INTERVENTION: An all-girls physical education class, supplemented with nutrition and self-empowerment components, individual sessions using motivational interviewing, lunch meetings, and parent outreach. MAIN OUTCOME MEASURES: Percentage body fat, BMI, physical activity, sedentary activity, dietary intake, eating patterns, unhealthy weight control behaviors, and body/self-image. RESULTS: New Moves did not lead to significant changes in the girls' percentage body fat or BMI but improvements were seen for sedentary activity, eating patterns, unhealthy weight control behaviors, and body/self-image. For example, in comparison to control girls, at 9-month follow-up, intervention girls decreased their sedentary behaviors by approximately one 30-minute block a day (p=0.050); girls increased their portion control behaviors (p=0.014); the percentage of girls using unhealthy weight control behaviors decreased by 13.7% (p=0.021); and improvements were seen in body image (p=0.045) and self-worth (p=0.031). Additionally, intervention girls reported more support by friends, teachers, and families for healthy eating and physical activity. CONCLUSIONS: New Moves provides a model for addressing the broad spectrum of weight-related problems among adolescent girls. Further work is needed to enhance the effectiveness of interventions to improve weight status of youth.

Longitudinal and secular trends in adolescent whole-grain consumption, 1999-2004.

BACKGROUND: The replacement of refined grains in the diet with whole grains may help prevent chronic disease and excess weight gain, but intakes in adolescents are often lower than recommended. OBJECTIVES: This study aimed to examine demographic disparities and 5-y longitudinal and secular trends (1999-2004) in whole-grain intake among 2 cohorts of Minnesota adolescents. DESIGN: Whole-grain intake was examined among 996 adolescent males and 1222 adolescent females who were Project EAT (Eating Among Teens) participants in 1999 and 2004. Multinomial logistic regression models were used to examine demographic differences in whole-grain intake. Mixed linear regression models were used to estimate 1) longitudinal trends among 2 cohorts of adolescents during developmental transitions and 2) age-matched secular trends between the cohorts at middle adolescence. RESULTS: In 1999, 11% of adolescent males and 13% of adolescent females reported that they consumed more than one daily serving of whole grains. Whole-grain intake was lowest among youth of the Native American and white races and among youth of high socioeconomic status. During the transition from middle to late adolescence, whole-grain intake increased by a mean of 0.14 daily servings among adolescent males and 0.09 daily servings among adolescent females. No significant changes in whole-grain intake were shown among either sex during the transition from early to middle adolescence. Yeast breads, popcorn, and ready-to-eat breakfast cereals were major sources of whole grains in 1999 and 2004. CONCLUSION: Findings suggest the need to advance efforts that target improvements in the amount of whole-grain foods selected by adolescents.

Providing calorie information on fast-food restaurant menu boards: consumer views.

PURPOSE: To gather consumer input about approaches to providing energy composition information for foods on fast-food restaurant menus. DESIGN: We asked a subset of individuals (n = 150) in an experimental study about the influence of nutrition labeling on fast-food meal choices to evaluate calorie information on mock fast-food menus in various formats. SETTING: Three community sites in the Minneapolis-St. Paul, Minnesota, metropolitan area. SUBJECTS: Adolescents and adults who ate fast food at least once per week were recruited. MEASURES: Via a series of open- and close-ended questions, participants gave feedback about several formats for providing energy composition information for foods on fast-food restaurant menus. ANALYSIS: Means and frequencies were calculated, and chi2 tests were conducted. RESULTS: When asked to compare a menu that provided calorie information for each menu item with a menu that provided the number of minutes of running that would be required to burn the calories contained in each menu item, 71.0% of participants preferred the calorie information over the physical activity information. Participants also compared two approaches to providing caloric reference information on the menu (average daily calorie needs per day vs. per meal), and 61.3% preferred the calorie needs-per-meal format. CONCLUSION: Our results may be useful in designing approaches to providing energy composition information for foods on fast-food restaurant menus.

Neighborhood environments: disparities in access to healthy foods in the U.S.

BACKGROUND: Poor dietary patterns and obesity, established risk factors for chronic disease, have been linked to neighborhood deprivation, neighborhood minority composition, and low area population density. Neighborhood differences in access to food may have an important influence on these relationships and health disparities in the U.S. This article reviews research relating to the presence, nature, and implications of neighborhood differences in access to food. METHODS: A snowball strategy was used to identify relevant research studies (n=54) completed in the U.S. and published between 1985 and April 2008. RESULTS: Research suggests that neighborhood residents who have better access to supermarkets and limited access to convenience stores tend to have healthier diets and lower levels of obesity. Results from studies examining the accessibility of restaurants are less consistent, but there is some evidence to suggest that residents with limited access to fast-food restaurants have healthier diets and lower levels of obesity. National and local studies across the U.S. suggest that residents of low-income, minority, and rural neighborhoods are most often affected by poor access to supermarkets and healthful food. In contrast, the availability of fast-food restaurants and energy-dense foods has been found to be greater in lower-income and minority neighborhoods. CONCLUSIONS: Neighborhood disparities in access to food are of great concern because of their potential to influence dietary intake and obesity. Additional research is needed to address various limitations of current studies, identify effective policy actions, and evaluate intervention strategies designed to promote more equitable access to healthy foods.