The evolution and scope of Medicaid Section 1115 demonstrations to address nutrition: a US survey.

Poor nutrition and food insecurity are drivers of poor health, diet-related diseases, and health disparities in the U.S. State Medicaid Section 1115 demonstration waivers offer opportunities to pilot food-based initiatives to address health outcomes and disparities. Several states are now leveraging 1115 demonstrations, but the scope and types of utilization remain undefined. To fill this gap, we conducted a systematic analysis of state Medicaid Section 1115 applications and approvals available on Medicaid.gov through July 1, 2023. We found that 19 approved and pending 1115 waivers address nutrition, with 11 submitted or approved since 2021. Fifteen states provide or propose to provide screening for food insecurity, referral to food security programs, and/or reporting on food security as an evaluation metric. Thirteen provide or propose to provide coverage of nutrition education services. Ten provide or propose to provide direct intervention with healthy food. The primary target populations of these demonstrations are individuals with chronic diet-sensitive conditions, mental health or substance use disorders, and/or who are pregnant or post-partum. Since 2021, state utilization of Medicaid 1115 demonstrations to address nutrition has accelerated in pace, scope, and population coverage. These findings and trends have major implications for addressing diet-related health and healthy equity in the United States.

Ten years post-GAO assessment, FDA remains uninformed of potentially harmful GRAS substances in foods.

It has been approximately 10 years since the Government Accountability Office (GAO) published its report to Congress entitled, FDA Should Strengthen Its Oversight of Food Ingredients Determined to be Generally Recognized as Safe (GRAS), which strongly criticized FDA noting that its "oversight process does not help ensure the safety of all new GRAS determinations." Congress requested GAO to undertake this audit as a result of concerns that GRAS substances added to foods did not require FDA approval. Since 2010, FDA has addressed only a few of the criticisms regarding its process for establishing a food substance as GRAS. However, several of the most important GAO recommendations remain unaddressed, and most critically, FDA has chosen to remain uninformed about food substances self-determined as GRAS by manufacturers. In its 2016 final rule Substances Generally Recognized as Safe, FDA did not take the opportunity to include a provision for creation of a master list of all GRAS chemicals used in food, nor did the FDA request the authority to do so from Congress. FDA cannot fulfill its statutory obligation for ensuring the chemical safety of the U.S. food supply if it does not know which substances, in which quantities, have been added to foods.

Misunderstood food date labels and reported food discards: A survey of U.S. consumer attitudes and behaviors.

INTRODUCTION: Food date labels such as "best before" and "sell by" are largely unregulated in the United States (U.S.), although new voluntary standards are coming into effect. A U.S. consumer survey was performed in April 2016 to inform policy and education activities related to date labels. METHODS: The survey was administered online to a nationally representative sample of 1029 adults as part of a biweekly omnibus survey. Survey questions assessed the frequency of discarding food based on date labels by food type, interpretation of label language variations, and knowledge of whether date labels are currently regulated by the federal government. RESULTS: 84% of consumers discard food near the package date at least occasionally. Among date labels assessed, "best if used by" was most frequently perceived as communicating quality, and both "expires on" and "use by" as communicating safety. Over 1/3 of participants incorrectly thought that date labeling was federally regulated, and 26% more were unsure. Respondents ages 18-34 and those with misunderstanding about date labels reported discarding food based on label dates with significantly more frequency than others. CONCLUSIONS: Misunderstanding the meaning of food date labels is strongly associated with reports of more frequent food discards. This survey provides new and policy-relevant insights about how Americans use and perceive date labels, and about language used in labeling that may be most effective at communicating desired messages to consumers. As date labeling becomes standardized, this research underlines the need for a strong accompanying communications campaign, and highlights a particular need to reach those ages 18-34.