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OBJECTIVE: To obtain feedback from school nutrition stakeholders on an agent-based model simulating school lunch to inform model refinement and future applications. DESIGN: Qualitative study using online discussion groups. SETTING: School nutrition professional stakeholders across the US. PARTICIPANTS: Twenty-eight school nutrition stakeholders. PHENOMENON OF INTEREST: Perceptions and applicability of MealSim for school nutrition stakeholders to help reduce food waste. ANALYSIS: Deductive approach followed by inductive analysis of discussion group transcripts. RESULTS: Stakeholders appreciated the customizability of the cafeteria characteristics and suggested adding additional characteristics to best represent the school meal system, such as factors relating to school staff supervision of students during meals. The perceived utility of MealSim was high and included using it to train personnel and to advocate for policy and budgetary changes. However, they viewed MealSim as more representative of elementary than high schools. Stakeholders also provided suggestions for training school nutrition administrators on how to use MealSim and requested opportunities for technical assistance. CONCLUSIONS AND IMPLICATIONS: Although agent-based models were new to the school nutrition stakeholders, MealSim was viewed as a useful tool. Application of these findings will allow the model to meet the intended audience's needs and better estimate the system.
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Servicios de Alimentación , Instituciones Académicas , Humanos , Participación de los Interesados , Servicios de Salud Escolar , Almuerzo , Investigación CualitativaRESUMEN
BACKGROUND: Improving social determinants of health, such as access to nutritious food, is crucial for achieving health equity. Nutrition insecurity, especially during pregnancy and postpartum, can lead to poor maternal and birth outcomes. Food is Medicine (FIM) programs, which integrate food into the health care system to prevent or manage disease, have the potential to improve nutrition insecurity, but research about perinatal FIM programs is limited. OBJECTIVE: The purpose of this study was to explore perceptions of public health impacts of perinatal FIM programs from the perspectives of both program implementers and program supporters and implementation strategies used to enhance program adoption, implementation, and maintenance. DESIGN: Qualitative data were collected through semi-structured interviews. The interview guide was based on the Reach, Effectiveness, Adoption, Implementation, Maintenance framework. PARTICIPANTS/SETTING: Program implementers (n = 16) and program supporters (n = 20) were recruited across the United States through purposive sampling in 2022 and 2023. ANALYSIS: Data were analyzed using deductive thematic analysis and an iterative feedback loop with the project partner. RESULTS: Interviews were completed with program implementers and program supporters and generated meaning units (n = 1,942), which were coded into themes aligned with each Reach, Effectiveness, Adoption, Implementation, Maintenance dimension. Perinatal FIM programs reached multiple priority populations who were mainly recruited through health care systems. Effectiveness measures typically included nutrition patterns and practices, as well as return on investment. Motivations for adopting programs primarily included partnerships and connections, financing, and policies and laws. Program components varied and were adapted to meet participants and setting needs. Policy, evidence, funding, and partnerships could lead to program maintenance. Implementation strategies applied by the program supporters included financial strategies and infrastructure changes. CONCLUSIONS: There is a need to identify the core functions and adaptable forms of perinatal FIM programs, which could lead to identification of standard evaluation metrics. This could result in greater uptake by potential delivery agents, increased funding and policy support, and enhanced benefits for perinatal population experiencing health disparities.
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OBJECTIVE: Identify psychosocial factors influencing food waste mitigation and explore motivations and strategies for successful conservation among self-identified food conservers. METHODS: Mixed-methods study consisting of an online survey estimating food waste production and psychosocial factors and a focus group to explore waste mitigation strategies and motivations. RESULTS: Sampled 27 self-identified conservers (female, aged 18-30 years, White/Asian). Mean household food waste was 6.6 cups/wk (range, 0.0-97.9 cups/wk; median 1.3 cups). Reported waste mitigation strategies include proactive mitigation and adaptive recovery measures in each phase of the food management continuum. Conservers reported various intrinsic and extrinsic motivations to reduce food waste and viewed barriers as manageable. CONCLUSIONS AND IMPLICATIONS: Food conservers act on high intentions to reduce waste by consistently employing both proactive waste mitigation and adaptive food recovery measures. Future research is needed to determine if these findings hold in larger, more diverse samples and link specific behaviors to waste volume.
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Alimentos , Eliminación de Residuos , Femenino , Humanos , Encuestas y CuestionariosRESUMEN
The National School Lunch Program (NSLP) provides healthy food to millions of children annually. To promote increased lunch consumption, policy, systems, and environmental (PSE) change strategies are being implemented in child nutrition programs. An evaluation of the current evidence supporting PSE interventions in school nutrition programs is needed to facilitate evidence-based practices across the nation for programs. This systematic review aims to determine the quality and breadth of available evidence of the effectiveness of PSE strategies on the consumption and waste of fruits, vegetables, milk, and water in the NSLP. The inclusion criteria required studies to occur in a United States K-12 school setting, data collection after 2012, report consumption and waste findings for fruit, vegetable, milk, or water, and be an original research article. Articles included in the review are restricted to positive or neutral quality. Thirty studies are included, policy level (n = 4), systems level (n = 8), environmental level (n = 10), and multi-category (n = 8). Results from positively rated policy-level studies suggest that recess before lunch may increase milk consumption, whereas removing flavored milk may decrease consumption. System-level studies of offering vegetables first in isolation of other meal components and offering spiced vegetables compared with traditional preparations may increase vegetable consumption, and locally procuring produce may increase fruit and vegetable consumption. Environmental-level studies such as water promotion strategies such as placing cups near drinking fountains may increase water consumption. Improving the convenience, attractiveness, and palatability of fruits and vegetables may increase consumption. Future PSE research in child nutrition programs should incorporate implementation aides and metrics into their study designs to allow a better understanding of how to sustain interventions from the perspective of school nutrition professionals.
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Fenómenos Fisiológicos Nutricionales Infantiles , Servicios de Alimentación , Niño , Humanos , Estados Unidos , Frutas , Verduras , Almuerzo , Agua , Política Nutricional , Preferencias AlimentariasRESUMEN
The objectives were to: (1) adapt the Nutrition Environment Measures Survey for Stores (NEMS-S) to better culturally fit small Latino grocery stores (tiendas) in Iowa; (2) assess the newly adapted Latino NEMS-S for inter-rater and test-retest reliability; and (3) compare Latino and original NEMS-S summary scores. This pilot instrument, containing culturally appropriate foods from the original NEMS-S and 2015 US Dietary Guidelines for Americans, underwent two rounds of formative evaluation. The new instrument and scoring protocol were applied to a random sample of 42 of 81 possible tiendas in Iowa. Cohen's kappa was used to assess inter-rater and test-retest reliability for availability and quality of indicator food items (total scores and food category sub scores). There were no differences in summary scores for inter-rater or test-retest reliability using paired t-tests. Inter-rater agreement was high (range 0.82-1.00; p < 0.001). Tiendas averaged 42.0 ± 7.5 of 57 possible points on the Latino NEMS-S, but only 12.0 ± 4.6 of 54 points on the original NEMS-S (p < 0.001). The Latino NEMS-S is a reliable tool for assessing the food environment within Iowa tiendas. Culturally specific instruments can describe diverse food environments more accurately and guide public health nutrition interventions within communities.
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Comercio , Abastecimiento de Alimentos , Hispánicos o Latinos , Humanos , Encuestas Nutricionales , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVE: Identify types of food packaging used in school nutrition programs and competing priorities, barriers, and facilitators for sustainable packaging waste use and recovery. DESIGN: Qualitative interviews (nâ¯=â¯20) and structured kitchen observations were conducted. SETTING: Data were collected from 3 school districts in Northern Colorado. PARTICIPANTS: Three nutrition program directors, 14 kitchen managers, and 3 sustainability staff. PHENOMENON OF INTEREST: Barriers and facilitators for sustainable food packaging waste practices among school nutrition programs. ANALYSIS: Interviews were recorded and transcribed, followed by inductive content analysis to identify themes. RESULTS: Commonly used food packaging included cardboard, aluminum, paper, plastic, and styrofoam. Four competing priorities were identified as impacting school nutrition programs' ability to reduce or recover food packaging: serving line speed, labor, food quality, and cost. One key barrier was that school staff had difficulty understanding the total system impact of their food packaging use and recovery decisions. CONCLUSIONS AND IMPLICATIONS: Food packaging is commonly used in school nutrition programs, and participants felt that its use offered key benefits, such as facilitating faster serving lines. More research is needed to quantify the direct and indirect impacts of packaging waste reduction and recovery in school nutrition programs.
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Embalaje de Alimentos , Servicios de Alimentación , Colorado , Humanos , Instituciones AcadémicasRESUMEN
The National School Lunch Program (NSLP) serves 29.6 million lunches each day. Schools must offer ½ a cup of fruit for each lunch tray. Much of this fruit may be wasted, leaving the schools in a dilemma. The objectives of this study were to evaluate the consumption of whole vs. sliced apples and determine the cost-effectiveness of the intervention. Researchers weighed apple waste at baseline and three post-intervention time points in one rural Midwest school. The costs of the intervention were collected from the school. The cost-effectiveness analysis estimates how often apples need to be served to offset the costs of the slicing intervention. A total of (n = 313) elementary student students participated. Students consumed significantly more sliced as compared to whole apples in intervention months 3 (ß = 21.5, p < 0.001) and 4 (ß = 27.7, p < 0.001). The intervention cost was USD 299. The value of wasted apple decreased from USD 0.26 at baseline to USD 0.23 wasted at post-intervention. The school would need to serve 9403 apples during the school year (54 times) to cover the expenses of the intervention. In conclusion, serving sliced apples may be a cost-effective way to improve fruit consumption during school lunch.
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Servicios de Alimentación , Malus , Niño , Análisis Costo-Beneficio , Preferencias Alimentarias , Frutas , Humanos , Almuerzo , Instituciones Académicas , VerdurasRESUMEN
Insights into barriers and facilitators for healthy eating are needed to improve low-income women's diets and to decrease disease risk. The study objectives were to explore women's qualitative perceptions of influences on their food choices such as food security, their knowledge of nutrition-related health risk factors and self-efficacy for diet change, and their dietary intakes in practice. Thirty-six women, aged 19-50, who were eligible to receive income-based assistance were recruited in central Iowa. Focus group discussions on defining healthy foods, influences on food choice, and nutrition information sources were analyzed using a socioecological model framework. Demographics, nutrient intake estimates, food security status, health behaviors, and self-efficacy for nutrition behavior change were collected by survey. Most participants were White (61%), single (69%), food insecure (69%), and living with children (67%). Few women met dietary recommendations. Barriers to healthy eating include cost, convenience/preparation time, family taste preferences, and limitations of federal food assistance programs. Facilitators are high self-efficacy for nutrition change and health knowledge on average. These results challenge the strategy of using nutrition education to improve healthy eating and instead show that intervention messaging should focus on limited, achievable steps to improve dietary choices that fit within cost, convenience, and taste constraints.
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Asistencia Alimentaria , Preferencias Alimentarias , Adulto , Niño , Dieta , Femenino , Abastecimiento de Alimentos , Humanos , Iowa , Persona de Mediana Edad , Pobreza , Adulto JovenRESUMEN
Bean (Phaseolus vulgaris L.) intakes in the United States (US) lag behind dietary recommendations despite their positive nutrition profile, health benefits for reducing chronic disease risk, and inclusion in nutrition assistance programs. Low-income groups, including Hispanics, have an increased risk of cardiovascular disease, type 2 diabetes, obesity, and some cancers. Hispanic dietary quality and bean consumption may decline with increasing acculturation. Intakes at recommended levels could improve health in all vulnerable low-income populations. The study objectives were to describe dry and canned bean preferences, consumption frequency, and attitudes among low-income Hispanic and non-Hispanic white women, and to assess if these characteristics differed by ethnicity and acculturation level among the Latinas. A convenience sample of 158 women, aged 18â»65 years, completed a written survey in English or Spanish at two healthcare clinics, one Special Supplemental Nutrition Program for Women, Infants and Children office, and five County Extension nutrition education and outreach programs in Iowa. Less acculturated Latinas consumed beans more often, preferred dry to canned, bought in bulk, valued color and shape in dry bean selection, and held less positive attitudes toward canned beans in contrast to bicultural/more acculturated and non-Hispanic white women. Ethnicity and acculturation level have a role in varying purchase patterns and attitudes regarding dry and canned beans. Culturally-held differences should be considered in nutrition programs and leveraged to increase consumption and improve health.
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Actitud , Dieta/etnología , Preferencias Alimentarias , Hispánicos o Latinos , Phaseolus , Semillas , Población Blanca , Adolescente , Adulto , Anciano , Cultura , Humanos , Persona de Mediana Edad , Medio Oeste de Estados Unidos , Adulto JovenRESUMEN
OBJECTIVES: We determined knowledge of the health benefits of consuming beans, and assessed if awareness varied by acculturation status among Hispanic and non-Hispanic low-income women. METHODS: We used a self-administered survey with Iowa women aged 18-65 years who were eligible to receive income-based services through 2 healthcare clinics, a WIC clinic, and Extension Outreach. Chi-square and ANOVA were used to compare bean health benefit knowledge, demographics, health-risk factors, nutrition information seeking, and self-efficacy by acculturation categories. RESULTS: Of the 158 women who completed the survey, 58% were Hispanic, with a mean age of 36 years. In terms of acculturation, 24% were Hispanic-dominant, 30% bicultural, and 46% English dominant. Over 50% of all respondents did not know bean consumption lowered cholesterol, aided blood glucose control, or reduced some cancer risks. Responses for 5 of 7 knowledge statements differed significantly by acculturation. Hispanic-dominant and bicultural women reported significantly better health, higher bean consumption, and less cigarette smoking than English-dominant women. Bicultural and English-dominant women were more likely to use the Internet for nutrition information. CONCLUSIONS: There are knowledge gaps about the health benefits of bean consumption among low-income women. Nutrition education to improve their knowledge may lead to increased bean consumption, reducing health disparities and improving nutrition.
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Aculturación , Conocimientos, Actitudes y Práctica en Salud , Pobreza , Adolescente , Adulto , Anciano , Femenino , Estado de Salud , Disparidades en el Estado de Salud , Hispánicos o Latinos , Humanos , Persona de Mediana Edad , Población Blanca , Adulto JovenRESUMEN
The purpose of this study was to determine the socio-ecological influences on dry grain pulse consumption (beans, peas, lentils, chickpeas) among low-socioeconomic women in Iowa. Seven focus groups were conducted, with 36 women who qualified for income-based federal assistance. Data were collected from October 2017 to January 2018. Participants completed a survey that gathered individual demographics, assessed perceptions of dry grain pulses, and level of food security. Fifty-eight percent of the women were non-Hispanic white, and 39% were African American, all with an average age of 34.7 years. Thirty-three percent of the women consumed pulses less than once per week. Over 80% agreed that beans were healthful and satiating. Some health benefits of beans were unknown by more than 33% of the population, e.g., lower cancer risk, lower LDL, maintain blood glucose. Only 30% of the women were food secure. Focus group audio recordings were transcribed and analyzed by two researchers, using the grounded theory approach. At the policy level, participants knew pulses were included in USA federal nutrition assistance programs like the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Pulses were widely available in grocery stores in communities. Interpersonally, women felt that male partners preferred meats, and children needed animal-source proteins. Individually, women perceived uncooked dry pulses were challenging to prepare. Conclusively, more detailed instruction on pulse preparation, different pulse varieties, and offering canned pulses through WIC may increase consumption.
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Dieta/economía , Grano Comestible/economía , Factores Socioeconómicos , Adolescente , Adulto , Estudios de Evaluación como Asunto , Femenino , Grupos Focales , Asistencia Alimentaria , Abastecimiento de Alimentos/economía , Humanos , Iowa , Persona de Mediana Edad , Encuestas Nutricionales , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVES: We determined relationships between food behaviors and health-risk factors by acculturation among limited-income Hispanic and non-Hispanic white women. METHODS: Women aged 18-49 years were recruited from income-based programs in metro-Phoenix, Arizona. Self-administered surveys in English or Spanish included demographics, a 10-item food behavior checklist, health-risk factors, food security, and acculturation. Differences by 4 acculturation/ethnicity categories were assessed with chi-square and analysis of variance (ANOVA). We created a food behavior scale. RESULTS: Eighty-two percent self-identified as Hispanic (N = 358), with 45% Hispanic-dominant, 25% bicultural, 12% English-dominant, and 18% non-Hispanic white for acculturation status. Food behavior checklist results showed that English-dominant Hispanic and non-Hispanic white women were more likely to feed their children soon after waking, refrigerate meat/dairy promptly, not add salt to food, smoke cigarettes and be food insecure (p < .001). Education, not acculturation, was a significant predictor of the food behavior scale. BMI did not differ by acculturation, but 33% of Hispanic-dominant Latinas did not know their height and/or weight. These less acculturated Latinas had significantly greater food security, but lacked health insurance and years of education. CONCLUSIONS: Program outreach tailored by acculturation that considers educational level is needed to emphasize existing positive behaviors and address knowledge gaps among low socioeconomic women to improve health and reduce disparities.