Factors impacting physical activity among post-treatment pediatric cancer survivors with overweight and obesity.

BACKGROUND: Pediatric cancer survivors (PCS) with overweight and obesity are at risk for various secondary chronic diseases. Although previous research has found physical activity (PA) as beneficial after treatment, the PA levels are low among PCS, highlighting the need for lifestyle interventions targeting PA. METHODS: A secondary analysis of preliminary baseline data from a multi-site trial, NOURISH-T + , a healthy lifestyle intervention for PCS with overweight and obesity, and their caregivers, was conducted to assess factors related to PCS PA (i.e., moderate to vigorous intensity PA, MVPA). Kendall's Tau-b was used to assess correlations between PCS MVPA, health and treatment-related factors, and caregivers' sedentary behavior and MVPA. Wilcoxon Signed Ranks Test was used to assess the differences between PCS and caregiver sedentary behavior and MVPA. A multiple linear regression analysis was performed to determine predictors of PCS MVPA. RESULTS: Seventy-three PCS-caregiver dyads were included in this analysis (N = 146). Many of the PCS were female, diagnosed with Acute Lymphoblastic Leukemia, stage 1, with a mean body mass index (BMI) percentile of 94.4 ± 4.7. Caregivers were female and parents to the PCS. Significant correlations were found between PCS MVPA, time since treatment, PCS weight change since COVID, caregiver sedentary behavior and MVPA. Significant differences were observed between PCS and caregiver sedentary behavior and MVPA. Household income, radiation treatment, and caregiver MVPA were significant predictors of PCS MVPA.   Conclusions: Demographics, cancer treatment type, and caregiver role modeling are important factors to consider when developing future lifestyle interventions for PCS. (NCT04656496, registered 12-07-2020). WHAT IS KNOWN: • Parents/caregivers are presumed to be a potential influence on their children's physical activity What is new: • Parents/caregivers' moderate-to-vigorous physical activity is the strongest predictor of their children's (pediatric cancer survivors') physical activity.

Recommended practices for virtual nutrition education interventions for adolescents with autism spectrum disorder: A reflection from two pilot interventions during the COVID-19 pandemic.

Youth with autism spectrum disorder (ASD) demonstrate unhealthy eating behaviors and dietary patterns compared to their neurotypical counterparts. Given the increased risk of unhealthy weight gain and the onset of the COVID-19 pandemic, modified nutrition programs in this population are warranted. The authors independently conducted two virtual pilot interventions during COVID-19 that offered feasible and acceptable alternatives to in-person delivery, providing unique opportunities for participant engagement and family involvement. Future virtual nutrition education programs for adolescents with ASD may include visual and verbal aids through Zoom, more parent/family integration, and accommodations for those with varying ASD severity levels.

Comparing Group Versus Individual Prenatal Care on Breastfeeding Practice and Motivational Factors.

OBJECTIVE: Although breastfeeding in the first 6 months postpartum benefits both infants and mothers, breastfeeding rates remain low. This study examined whether group prenatal care was associated with an increased breastfeeding initiation and duration compared with those receiving usual, individual prenatal care. A secondary aim was to investigate whether sociodemographic and motivational factors were associated with breastfeeding initiation and duration across prenatal care groups. METHODS: Pregnant women in their third trimester (n = 211) from an innercity university medical center participated. Prenatal care type was identified from the medical chart, and data on breastfeeding duration at 1, 3, and 6 months postpartum were collected. Breastfeeding motivational factors were assessed with a survey. Logistic regressions and independent-samples t tests were used for data analyses. RESULTS: After controlling for demographic factors, group prenatal care was associated with increased breastfeeding at 6 months postpartum (odds ratio = 2.66; P = .045) compared with individual care. Breastfeeding intention (P < .001), competence (P = .003), and autonomous motivation (P < .001) were significantly higher, while amotivation (P = .034) was significantly lower in group compared with individual prenatal care. CONCLUSIONS: Breastfeeding persistence was higher among women receiving group prenatal care, potentially due to motivational factors. Future studies should investigate how breastfeeding motivational factors could be effectively targeted in prenatal care to increase breastfeeding persistence.

Delivering ADAPT+ to Latino Families Living in Rural Communities: Feasibility and Acceptability of Implementing a Health Promotion Program Including Mindfulness.

BACKGROUND: Obesity is a major public health crisis in Latino youth. Mounting evidence implicates stress in the development and maintenance of obesity. This study examined the feasibility and acceptability of having community health workers, i.e., promotoras, deliver Adaptando Dieta y Acción Para Todos (ADAPT)+, a family-based health promotion program integrating mindfulness strategies for stress reduction to underserved Latino families in rural communities. METHODS: In an ORBIT model Phase IIb longitudinal quasi-cluster feasibility study, promotoras delivered the 6-session ADAPT+ intervention and 1-session Enhanced Usual Care (EUC) in rural Florida. Feasibility was assessed via sample size and recruitment, randomization by community, data collection completion, and intervention fidelity. Acceptability was assessed via participant retention and program satisfaction. Effect sizes of differences in parent stress and mindful eating between conditions at baseline, end of treatment, and 3-month follow-up were calculated. RESULTS: Feasibility and acceptability were demonstrated. The recruitment target was 99% met (n = 95 recruited). Randomization was limited to site level due to coronavirus disease 2019-related challenges. Data collection procedures were feasible (100% completion). Retention was 86% at post-assessment and 82.6% at 3-month follow-up. All sessions were completed (100% fidelity). Mean program satisfaction was 3.91/4.00. ADAPT+ parents reported lower stress (difference = -3.04, medium-to-large effect, d = .70) and more mindful eating (difference = 2.00, medium effect, d = .44) than EUC parents at 3-month follow-up. CONCLUSION: Study implementation and intervention delivery to rural Latino families using promotoras were feasible and acceptable. Promising findings regarding parent stress and mindful eating support a larger (ORBIT Phase III) efficacy trial. CLINICAL TRIAL REGISTRATION: This trial was registered with ClinicalTrials.gov under identifier NCT04800432.

Ultra-processed food consumption and obesity indicators in individuals with and without type 1 diabetes mellitus: a longitudinal analysis of the prospective Coronary Artery Calcification in Type 1 Diabetes (CACTI) cohort study.

OBJECTIVE: To evaluate the associations of ultra-processed food (UPF) consumption and obesity indicators among individuals with and without type 1 diabetes mellitus (T1DM) from the Coronary Artery Calcification in Type 1 Diabetes cohort study. DESIGN: A secondary analysis. The consumption of UPF was assessed using the dietary data collected with the Harvard FFQ, and each food item was categorised according to the NOVA food processing classification. Height, weight and waist circumference were measured at baseline and after a mean of 14·6-year follow-up. Generalised estimating equations stratified by diabetes status were used to assess the associations between UPF intake and obesity indicators over 14 years of follow-up. SETTING: USA. PARTICIPANTS: A total of 600 adults (256 T1DM and 344 non-diabetic controls) aged 39 ± 9·1 years at baseline and followed up for over 14 years were included. RESULTS: Participants with T1DM consumed significantly more UPF than non-diabetic controls at baseline: 7·6 ± 3·8 v. 6·6 ± 3·4 servings per day of UPF, respectively (P < 0·01). Participants with T1DM and with the highest UPF intake had the highest weight (ßQ4 v. Q1 = 3·07) and BMI (ßQ4 v. Q1 = 1·02, all P < 0·05) compared with those with the lowest UPF intake. Similar positive associations were observed in non-diabetic controls. CONCLUSIONS: Individuals with T1DM may consume more UPF than non-diabetic controls. Positive associations between UPF consumption and obesity indicators suggest that limiting UPF can be recommended for obesity prevention and management. Further research is needed to confirm these findings.

Associations Among Parents' Eating Behaviors, Feeding Practices, and Children's Eating Behaviors.

Parental feeding practices influence children's eating behaviors, yet it is not well-understood whether parents' own eating behaviors are associated with their feeding practices. The purpose of this study was to examine associations among parents' eating behaviors, parental feeding practices, and children's eating behaviors. A cross-sectional study was conducted with 76 parents of children from an elementary school in Tampa, FL. Parents completed three questionnaires with topics related to parent eating behaviors, parental feeding practices, and children's eating behaviors. Multiple regression analysis was performed, controlling for demographic covariates. Parents who reported to eat more fruits per day (ß = 0.15), eat more than one kind of fruit each day (ß = 0.33), eat more than one kind of vegetable each day (ß = 0.29), eat 2 or more vegetables at the main meal (ß = 0.36), plan meals (ß = 0.19), and keep vegetables ready for the child to eat (ß = 0.25) indicated that they use more positive reinforcement feeding practices (all p ≤ 0.001). There were significantly positive associations between positive reinforcement and children's eating fruits or vegetables like apples, bananas or carrots as snacks (ß = 1.03) and eating more than one kind of vegetable a day (ß = 1.03; all p < 0.001). No other variables had any significant associations. Findings of this study indicate that there are potential associations among parent's own eating behaviors, feeding practices, and children's eating behaviors. Further research is needed to determine the mechanism of these relationships. Targeting these parental factors may be an effective way to maximize the impact of nutrition interventions on children's dietary behavior changes.

"I Wear a Mask. I Wear It All the Time. The Kids Don't Wear Masks": Early Childhood Education Mask-Wearing During COVID-19 in Florida.

BACKGROUND: New federal health guidance was issued for early childhood education (ECE) programs to reduce the risk of COVID-19 in March 2020. The Centers for Disease Control and Prevention recommended mask-wearing for adults and children aged 2 years and older. Wearing masks was a new practice for teachers and children, and this study investigated when and how masks were worn in ECE centers in Florida. METHODS: This study was part of a larger assessment of the impact of COVID-19 on mealtime routines in ECE centers. Two statewide surveys based on the Trust Model were sent to directors and teachers via Florida Department of Children and Families. Only teachers were interviewed. Data were collected from August to October 2020. The analysis included survey results and interview responses related to mask-wearing. RESULTS: Surveys were completed by 759 directors and 431 teachers, and 29 teachers were interviewed. Survey results indicated that more teachers than children wore masks during pre- and postmeal activities. Interviews revealed three models that explain mask-wearing: (1) teachers only, in which teachers were required to wear a mask, but children were not; (2) teachers and children, in which teachers and children were required to wear a mask; and (3) masks optional, in which teachers and children could choose to wear a mask. CONCLUSION: Understanding how decisions about mask-wearing were made at the center level can inform training and support health and safety in ECE. Use of personal protective equipment (such as masks) is effective for reducing risk of pathogen transmission for children and adults in ECE settings.

Obesity and neurodevelopmental and mental health conditions among adolescents aged 10-17 years: The National Survey of Children's Health 2017-2018.

AIM: Adolescents have a high prevalence of obesity and neurodevelopmental and mental health co-occurring conditions. This study examined the association between obesity and several co-occurring conditions - autism spectrum disorder (ASD); intellectual disability; learning disability; stuttering, stammering or other speech problems; developmental delay; attention-deficit hyperactivity disorder; epilepsy or seizure disorder; cerebral palsy; depression; anxiety; and Tourette Syndrome - in adolescents aged 10-17 years (n = 26 266) using 2017-2018 National Survey of Children's Health data. METHODS: This cross-sectional study used 2017-2018 National Survey of Children's Health data (n = 27 328); χ2 tests were conducted to compare the prevalence of obesity and several co-occurring conditions. Multiple logistic regression was conducted to adjust for age, gender, race/ethnicity and household income. RESULTS: Obesity prevalence was 15.3%. Adolescents with ASD (25.1%) and epilepsy/seizure disorder (27.8%) had the greatest obesity prevalence. Adjusting for socio-demographic characteristics, odds of obesity were higher in those with ASD (odds ratio (OR) 1.7, confidence interval (CI) 1.2-2.6), learning disability (OR 1.5, CI 1.2-2.0), epilepsy or seizure disorder (OR 2.2, CI 1.2-3.8) and depression (OR 2.0, CI 1.6-2.5). For all regression analyses, odds of obesity were higher among adolescents who were non-Hispanic Black, Hispanic and low-income. CONCLUSIONS: The increased prevalence of obesity in adolescents with ASD, learning disability, epilepsy or seizure disorder, and depression demonstrates the need to attend to their nutrition and physical activity needs. Future research should examine obesity risk factors among adolescents with specific neurodevelopmental and mental health conditions, as well as racial or ethnic minority and low-income populations, to properly tailor obesity prevention services.

Optimizing Outcomes: A Systematic Review of Psychosocial Risk Factors Affecting Perinatal Black/African-American Women with Substance Use Disorder in the United States.

INTRODUCTION: Despite studies having examined and discussed the various multifaceted risk factors affecting perinatal women with substance use disorder (SUD), the limited amount of research on Black/African-American (B/AA) women allows health disparities in this population to widen. Segmenting the needs of the low-income B/AA female population with SUD is crucial when creating multi-layered and multi-faceted innovative upstream evidence-based interventions. This review assesses and examines studies that investigate psychosocial, environmental, and systemic level risk factors related to implicit bias, trauma, toxic stress, food issues, and SUD. METHODS: The principal investigator (PI) utilized PubMed, Google Scholar, ProQuest Dissertations and Theses Global to perform a systematic scoping review of the published literature. Research focused on risks factors affecting low-income perinatal B/AA women. The literature review examined articles published January 2010 through December 2020. Inclusion criteria incorporated risk factors, health disparities, and SUD. Studies selected for this review have been published in English and conducted in the USA. RESULTS: Our research identified 509 articles, of which we chose to include 75. The literature highlights health disparities influenced by risks factors of implicit biases, trauma, and toxic stress, which construct physical and emotional barriers to healthy food and food resources in B/AA women with SUD. CONCLUSION: The PI found limited or non-existent research on innovative interventions targeting perinatal B/AA women with SUD. This review recommends deconstructing hidden psychosocial, environmental, and systematic risk factors to assist in developing novel comprehensive strategies and wraparound support services.

"Just sit and eat." Adult and Child Mealtime Responsibilities in Early Care and Education Centers During COVID-19 in Florida.

Most young children in the United States attend early care and education (ECE) programs, in which they eat 3-4 times daily. 'Division of responsibility' between adult and child means the adults are responsible for what, when and where, and the child is responsible for whether, what and how much to eat. A balanced division of responsibility can support children's development of healthy eating competency. This paper aims to describe division of responsibility during mealtimes during COVID-19 in Florida using a cross-sectional, mixed methods design. Questions were developed based on Trust Model and Social Cognitive Theory. A survey was completed by 759 ECE directors and 431 teachers, and 29 teachers completed in-depth interviews. COVID-19 increased teacher mealtime responsibilities. Most (95%+) ECE teachers provided meals at the same time and place daily (when and where). Children determined what and how much they ate, but did not serve or handle food. Implications include modifying mealtime routines to minimize the risk of COVID-19 and support healthy eating with a balanced division of responsibility.

Religion and Food Insecurity in the Time of COVID-19: Food Sovereignty for a Healthier Future.

The COVID-19 pandemic has exposed and amplified food insecurity in marginalized communities of color, revealing systemic health and socioeconomic inequalities. Given the role that religious organizations play in building social capital, disseminating information to local communities, and facilitating the distribution of basic necessities such as food, they are integrally involved in short- and long-term solutions to food insecurity. Yet, literature on the role of religious institutions for mitigating food insecurity is limited. The literature related to methods and means by which religious organizations engage community efforts to mitigate food security as well as studies in food sovereignty will be reviewed.

Disentangling the Relationship between Food Insecurity and Poor Sleep Health.

The COVID-19 pandemic has created disruptions in global and national food supply chains. Along with an increase in the unemployment rate, this resulted in a rise in food insecurity at the community-level, threatening individual and family well-being. Food insecurity is associated with inadequate nutrient intakes, weight gain, and psychological distress, including anxiety and depressive symptoms, all of which are known to affect sleep. Yet, little is known about whether and how food insecurity is associated with sleep health, a critical but underrecognized health outcome. This paper reviews literature describing associations between food insecurity and sleep, summarizes key findings based on proposed mechanisms, and discusses directions for future research.

A Mixed-methods Study to Understand Food Environments and Grocery Shopping Patterns of Community Residents in Underserved Neighborhoods in Tampa, Florida.

A mixed methods study was conducted to better understand food access, food retail store environment, and perspectives of community residents on their grocery store shopping patterns and access to healthy foods in underserved, predominantly African American neighborhoods. GIS mapping, grocery store observations (n = 4), a food access and grocery store environment survey (n = 126), and focus groups (n = 48) were used. The results indicate that these neighborhoods have a low density of grocery stores, and only two out of four grocery stores meet the standard for a healthy retail store. Barriers to getting healthy foods and solutions to improve food access are discussed.

Cafeteria noise exposure and fruit and vegetable consumption at school lunch: A cross-sectional study of elementary students.

Presently in the U.S., few children meet the recommendation for daily consumption of fruits and vegetables (FV). School feeding programs have shown promise for increasing FV consumption among young children. However, several aspects of the school cafeteria environment have not been examined regarding their relationship with FV consumption. The purpose of this study was to examine the relationship between noise, selected environmental factors previously explored in the literature (i.e., recess/lunch order, the amount of time allocated for lunch, the presence of a salad bar, and number of FV items offered) and 2nd and 3rd grade students' FV consumption during lunch. A digital photography method was used to assess FV consumption among students across 40 days from 20 schools and environmental exposures, including the noise or sound pressure level of the cafeteria, were assessed during lunch. On average, students in this study consumed 0.35 (SD = 0.31) cups of fruit and 0.24 (SD = 0.29) cups of vegetables. The average noise level in cafeterias was 79.7 (SD = 4.1) Leq DbA (range 70 DbA - 84 DbA). Combined FV consumption was negatively associated with noise exposure (B = -0.017; SE = 0.004; P < 0.001) in hierarchical linear models. Among young children eating in cafeterias, increased noise levels may decrease consumption of fruits and vegetables at the school lunch meal. We hypothesize that increased noise can work in two ways to decrease FV consumption: increased socializing (i.e., talking) and/or decreased hedonic enjoyment of the school lunch meal, however future research is needed to examine these mechanisms and provide causal evidence of this effect.

Psychosocial mediators of dietary change among Hispanic/Latina breast cancer survivors in a culturally tailored dietary intervention.

OBJECTIVE: To examine psychosocial mediators of the effect of a culturally tailored dietary intervention on dietary change among Hispanic/Latina breast cancer survivors. METHODS: Hispanic/Latina breast cancer survivors (n = 70) were randomized to receive either a 12-week theory-based and culturally tailored dietary change program (intervention group, n = 34), or standard-of-care printed recommendations (control group, n = 36) (ClinicalTrials.gov NCT01414062). Fruit/vegetable intake (F/V), % calories from fat, and hypothesized psychosocial mediators were assessed at baseline, 6 and 12 months. Analysis of covariance assessed intervention effects on psychosocial mediators at 6 and 12 months. Mediation analysis using the bootstrap method evaluated the indirect intervention effects on dietary intake at 6 and 12 months through changes in psychosocial mediators at 6 and 12 months. RESULTS: Compared with controls, at 6 and 12 months, the intervention group reported greater improvements in stages of change (P < .001, P < .001, respectively), self-efficacy (P = .009, P = .002, respectively), snack preference for F/snack preference for F/V (P = .045, P = .002, respectively); at 12 months, the intervention group reported a decrease in chance-oriented external locus of control (P = .02). At 6 months, mediation analysis showed that the intervention effect was associated with an increase of 1.0 (95% CI, -0.1-2.4) serving/day of F/V, compared with the control group, although no indirect effect through the hypothesized psychosocial mediators was observed. At 12 months, the intervention was associated with an increase in 0.5 serving/day F/V through improved taste/snack preference for F/V at 6 and 12 months (95% CIs, 0.1-1.3, 0.0-1.4, respectively). CONCLUSIONS: Future programs can target improving taste/snack preference for F/V to promote dietary change in Hispanic/Latina breast cancer survivors.

Challenges and Facilitators to Promoting a Healthy Food Environment and Communicating Effectively with Parents to Improve Food Behaviors of School Children.

Background Childhood obesity is a major public health concern and families play an important role. Improving strategies to reach parents and directing tailored nutrition education to them is needed. Purpose To investigate the challenges and facilitators to promoting a healthy environment at home and to identify communication preferences to inform intervention strategies for effectively reaching low-income urban minority families. Procedure Semi-structured focus group interviews were conducted with four groups involving 16 low-income urban parents (94% female; 88% Hispanic/Latino, 12% African American) of elementary school children. Interviews were transcribed and analyzed applying Social Cognitive Theory and using in-vivo coding. Main Findings The most common barriers to parents providing healthy foods to their children were accommodating child preferences and familial opposition. Parents showed intentionality to engage in healthy behaviors, and often shared procedural knowledge for reaching health goals. The analyses of desired communication channels yielded major preferences: tailored information, information provided through multiple mediums, appropriate duration/frequency of messages, and presented from a voice of authority. Conclusion and Implication While parents expressed desires to be healthy, the home food environment presented substantial challenges. Multi-media supports such as workshops, flyers, and text messaging may be useful to facilitate the sharing of information to minimize the tensions between intentionality and reaching desired goals to be healthy. Some parents thought that information received through text messaging could be easily shared and would act as a voice of authority to support child behavior change.

Training Promotoras to Implement a Mindfulness-Based Healthy Lifestyle Program in Rural Communities.

Partnering with promotoras to implement a healthy lifestyle intervention has proven efficacious in reaching community members whom they serve. However, there are no clearly defined guidelines for implementing promotora training, especially when it involves developing mindfulness skills in promotoras unfamiliar with this concept. This is a report about the facilitators and barriers to training promotoras to implement a mindfulness-enhanced healthy eating and physical activity intervention, ADAPT+, using the Train-the-Trainer model. Following this model, we laid the foundations for sustained implementation of ADAPT+ even after the training process. Future studies may examine how these guidelines help map promotora training in other mindfulness-related interventions.

Autism Spectrum Disorder Diagnosis and Other Child, Family, and Community Risk Factors for Obesity among Children and Adolescents Aged Ten to Seventeen Years in the United States: A Mediation Analysis.

Background: This study explored whether there are mediated effects of child and family risk in the association between community and organizational risk and obesity among children and adolescents aged 10-17 years using 2017-2018 National Survey of Children's Health (NSCH) data, addressing autism spectrum disorder (ASD) and co-occurring conditions. Methods: This cross-sectional study (N = 27,157) used 2017-2018 NSCH data. Frequency distributions and chi-square tests were used to describe participants with and without ASD. Cumulative risk indices were created for child, family, community, and organizational level risk, and mediation analyses were conducted in a two-mediator model (X1: community risk, X2: organizational risk, M1: child risk, M2: family risk) for the dichotomous outcome (Y: obesity). Path analyses were performed using generalized structural equation modeling in Stata 16.0. Results: Direct effects for all four risk indices were associated with obesity in single index models (all p < 0.001); only child and family risk indices were associated with obesity in a full model with all four risk indices (both p < 0.001). When child and family risk indices were assessed as mediators, the indirect effects of community and organizational risk were significant (all p < 0.0001). The total effect of community risk on obesity was significant with family risk as a mediator (p = 0.002). The total effect of organizational risk was not significant with either mediator. Conclusion: Findings suggest that child and family factors play a strong role in obesity risk and that ASD contributes to this risk. Community risk may be another strong predictor of obesity, mediated by family risk. Additional research on social-ecological risk factors for obesity is needed to identify leverage points to improve obesity risk in children and adolescents with and without ASD.

Parent and Adolescent Attitudes Toward a Virtual Nutrition Intervention for Adolescents with Autism Spectrum Disorder.

Objectives: This qualitative study examined acceptability, perceived benefits, and unintended consequences of a virtual implementation of an 8-week theory-driven nutrition intervention (BALANCE) for adolescents with autism spectrum disorder (ASD). Methods: Twenty-one parent interviews and six adolescent focus groups or interviews (n = 12; group size ranged 1-5) were conducted. Data were collected virtually via Microsoft Teams and analyzed for a priori and emergent themes. Results: The intervention was generally acceptable. Adolescents and parents reported that they were comfortable with the virtual format and the interactive group setting. Parents of adolescents 15 years and older emphasized the importance of autonomy/independence. Participants reported changes in adolescents' psychosocial determinants of dietary intake, including knowledge and self-efficacy, as well as diet changes (e.g., self-regulation). Conclusions: The virtual implementation of BALANCE was acceptable according to adolescents with ASD and their parents based on their reported perceptions and feelings about the intervention. The findings suggest that many adolescents with ASD may benefit from virtual group interventions. Quantitative research is needed to examine behavioral outcomes of the BALANCE intervention.

Experiences of New Visitors With Low Food Security Seeking Food Assistance During the COVID-19 Pandemic.

OBJECTIVE: To describe the experiences of first-time visitors with low food security seeking food assistance during the coronavirus disease 2019 pandemic. DESIGN: A qualitative study. SETTING: Emergency food distribution sites in West Central Florida. PARTICIPANTS: Adults (aged 18-64 years) seeking food assistance between November, 2020 and July, 2021. PHENOMENON OF INTEREST: Using food security as a multidimensional concept, in-depth interviews explored the impact of emergency food assistance on food availability, access, utilization, and stability. ANALYSIS: Applied thematic analysis was conducted to identify emergent themes. RESULTS: Participants (n = 18) were White (55.6%), female (72.2%), and aged 40-59 years (55.6%). Seven salient themes described participants' experience seeking food assistance (eg, the crisis resulting in seeking food assistance, mixed quality of pantry foods, and gaining firsthand insight on hunger). Although food assistance increased food availability and access, there were barriers to using the pantry foods (eg, foods not preferred, health/allergies). CONCLUSIONS AND IMPLICATIONS: Study findings suggest that first-time visitors seeking emergency food assistance during the coronavirus disease 2019 pandemic may be experiencing temporary cycles of financial instability, which could impact dietary quality. Because pantry foods are often the primary source of household food supply, client-focused emergency food distribution tailored to client needs can increase food availability, access, and utilization.