Perceptions of Preventable Cancer Burden Among US-Based Firefighters: A Mixed Methods Cross-Sectional Study.

OBJECTIVE: Characterize experiences with cancer and perceptions of the preventable cancer burden attributable to diet among firefighters. DESIGN: A cross-sectional survey was distributed to assess cancer history and perceptions of cancer. SETTING: US. PARTICIPANTS: US-based firefighters. MAIN OUTCOME MEASURE(S): History of cancer, perceptions of cancer, and perceptions of diet as a means to prevent cancer. ANALYSIS: Descriptive statistics and use of the Behaviour Change Technique Taxonomy v1 (BCTTv1) to evaluate qualitative responses. RESULTS: A total of 471 firefighters participated. Nearly half (48.4%) voiced they strongly agreed that they were at risk for cancer, whereas 44.6% agreed that changing diet could decrease cancer risk. The most common BCTTv1 codes focused on types of education, including "Instruction on how to perform the behavior" (45.1%, n = 189), followed by those centered on behavior execution (eg, "Action planning" [24.8%, n = 104]). Qualitatively, many were concerned about misinformation. CONCLUSIONS AND IMPLICATIONS: Firefighters acknowledge the role of diet in cancer risk and have a desire for knowledge and behavioral support (eg, goal setting) that includes an emphasis on evidence and tackling misinformation. This information should serve as the basis of future interventions that target diet.

Local Food System Approaches to Address Food and Nutrition Security among Low-Income Populations: A Systematic Review.

Food and nutrition insecurity disproportionately impact low-income households in the United States, contributing to higher rates of chronic diseases among this population. Addressing this challenge is complex because of various factors affecting the availability and accessibility of nutritious food. Short value chain (SVC) models, informally known as local food systems, offer a systemic approach that aims to optimize resources and align values throughout and beyond the food supply chain. Although specific SVC interventions, such as farmers markets, have been studied individually, a comprehensive review of SVC models was pursued to evaluate their relative impact on food security, fruit and vegetable intake, diet quality, health-related markers, and barriers and facilitators to participation among low-income households. Our systematic literature search identified 37 articles representing 34 studies from 2000-2020. Quantitative, qualitative, and mixed-method studies revealed that farmers market interventions had been evaluated more extensively than other SVC models (i.e., produce prescription programs, community-supported agriculture, mobile markets, food hubs, farm stands, and farm-to-school). Fruit and vegetable intake was the most measured outcome; other outcomes were less explored or not measured at all. Qualitative insights highlighted common barriers to SVC use, such as lack of program awareness, limited accessibility, and cultural incongruence, whereas facilitators included health-promoting environments, community cohesion, financial incentives, and high-quality produce. Social marketing and dynamic nutrition education appeared to yield positive program outcomes. Financial incentives were used in many studies, warranting further investigation into optimal amounts across varying environmental contexts. SVC models are increasingly germane to national goals across the agriculture, social, and health care sectors. This review advances the understanding of key knowledge gaps related to their implementation and impact; it emphasizes the need for research to analyze SVC potential comprehensively across the rural-urban continuum and among diverse communities through long-term studies of measurable health impact and mixed-method studies investigating implementation best practices. This trial was registered at PROSPERO as CRD42020206532.

How a Medically Tailored Meal Intervention with Intensive Nutrition Counseling Created Active Coping with Behavior Change for Vulnerable Patients with Lung Cancer.

Purpose: The purpose of this study was to assess participants' perceptions and experiences while participating in a Food is Medicine medically tailored meal plus nutrition counseling intervention to create a theoretical explanation about how the intervention worked. Methods: This interpretive qualitative study included the use of semi-structured interviews with active intervention participants. Purposeful sampling included vulnerable (uninsured, rural zip code residency, racial/ethnic minority, 65 years old, and/or low-income) individuals with lung cancer treated at four cancer centers across the United States. Interviews were recorded, transcribed verbatim, and analyzed using conventional content analysis with principles of grounded theory. Results: Twenty individuals participated. Data analysis resulted in a theoretical explanation of the intervention's mechanism of action. The explanatory process includes 3 linked and propositional categories leading to patient resilience: engaging in treatment, adjusting to diagnosis, and active coping. The medically tailored meals plus intensive nutrition counseling engaged participants throughout treatment, which helped participants adjust to their diagnosis, leading to active coping through intentional self-care, behavior change, and improved quality of life. Conclusions: These findings provide evidence that a food is medicine intervention may buffer some of the adversity related to the diagnosis of lung cancer and create a pathway for participants to experience post-traumatic growth, develop resilience, and change behaviors to actively cope with lung cancer. Medically tailored meals plus intensive nutrition counseling informed by motivational interviewing supported individuals' adjustment to their diagnosis and resulted in perceived positive behavior change.

Promoting HPV Vaccination in People with HIV: Factors to Consider.

People with HIV (PWH) and their sexual partners have increased risk of human papillomavirus (HPV) infection. Despite recommended HPV vaccination for PWH aged 18-26 years, vaccination rates among PWH remain low. This qualitative study used the Information-Motivation-Behavioral Skills (IMBS) model to identify factors influencing the decisions of PWH around promoting HPV vaccination to their sexual partners. Fourteen PWH with diverse sociodemographic characteristics participated in four focus-group discussions. Data were analyzed using thematic content analysis; codes and themes included IMBS constructs. For the information construct, the need for improved HPV education emerged as the driving factor for HPV vaccine uptake and discussing HPV vaccines with partners. Focal reasons for being unvaccinated included low knowledge of HPV risk, asymptomatic cancer-causing HPV, HPV vaccines, and vaccine eligibility. Salient factors in the motivation construct included the preventive benefits of HPV vaccination to both self and sexual partners. Salient factors in the behavioral skills construct included: accessing vaccine, low self-confidence and skills for promoting vaccination, relationships with sexual partners, partners' vaccine hesitancy, and stigma. Race/ethnicity impacted HPV vaccination promotion; important determinants included perceptions of HPV-related diseases as "White people's diseases" among Black people, and discrimination against those with HPV-related diseases among the Hispanic population.

Preliminary Support for the Use of Motivational Interviewing to Improve Parent/Adult Caregiver Behavior for Obesity and Cancer Prevention.

Motivational interviewing (MI) is a promising behavioral intervention for improving parent and adult caregiver (PAC) health behavior for obesity and cancer prevention. This study explored the preliminary effects of MI from a registered dietitian (RDMI) within an obesity prevention intervention to promote PAC behavior change and positive proxy effects on children and the home environment. N = 36 PAC/child dyads from low-resource communities were enrolled in a randomized trial testing a 10-week obesity prevention intervention. Intervention dyads were offered RDMI sessions. Data were collected at baseline and post-intervention (PAC diet quality (Healthy Eating Index (HEI)), child skin carotenoids, home environment, and PAC ambivalence regarding improving diet). Results show that for every RDMI dose, PAC HEI scores increased (0.571 points, p = 0.530), child skin carotenoid scores improved (1.315%, p = 0.592), and the home food environment improved (3.559%, p = 0.026). There was a significant positive relationship between RDMI dose and change in ambivalence (ρ = 0.533, p = 0.007). Higher baseline ambivalence was associated with greater dose (ρ = -0.287, p = 0.173). Thus, RDMI for PACs may improve diets among PACs who are otherwise ambivalent, with potential effects on the diets of their children and the home food environment. Such intervention strategies have the potential for greater effect, strengthening behavioral interventions targeting obesity and cancer.

Feasibility of Cooking Matters for Diabetes: A 6-week Randomized, Controlled Cooking and Diabetes Self-Management Education Intervention.

BACKGROUND: Diabetes self-management education and support is the cornerstone of diabetes care, yet <10% of adults with diabetes manage their condition successfully. Feasible interventions are needed urgently. OBJECTIVE: Our aim was to assess the feasibility of a cooking intervention with food provision and diabetes self-management education and support. DESIGN: This was a waitlist-controlled, randomized trial. PARTICIPANTS/SETTING: Thirteen adults with type 1 or type 2 diabetes who participated in Cooking Matters for Diabetes (CMFD) participated in 2 focus groups. INTERVENTION: CMFD was adapted from Cooking Matters and the American Diabetes Association's diabetes self-management education and support intervention into a 6-week program with weekly lesson-aligned food provisions. MAIN OUTCOME MEASURES: Feasibility was evaluated quantitatively and qualitatively along the following 5 dimensions: demand, acceptability, implementation, practicality, and limited efficacy. STATISTICAL ANALYSIS: Two coders extracted focus group themes with 100% agreement after iterative analysis, resulting in consensus. Administrative data were analyzed via descriptive statistics. RESULTS: Mean (SD) age of focus group participants was 57 (14) years; 85% identified as female; 39% identified as White; 46% identified as Black; and income ranged from <$5,000 per year (15%) to $100,000 or more per year (15%). Mean (SD) baseline hemoglobin A1c was 8.6% (1.2%). Mean attendance in CMFD was 5 of 6 classes (83%) among all participants. Demand was high based on attendance and reported intervention utilization and was highest among food insecure participants, who were more likely to report using the food provisions and recipes. Acceptability was also high; focus groups revealed the quality of instructors and interaction with peers as key intervention strengths. Participant ideas for implementation refinement included simplifying recipes, lengthening class sessions, and offering more food provision choices. Perceived effects of the intervention included lower hemoglobin A1c and body weight and improvements to health-related quality of life. CONCLUSIONS: The CMFD intervention was feasible according to the measured principles of demand, acceptability, implementation, practicality, and limited efficacy.

Outcomes of Cooking Matters for Diabetes: A 6-week Randomized, Controlled Cooking and Diabetes Self-Management Education Intervention.

BACKGROUND: Diabetes self-management education and support is the cornerstone of diabetes care, yet only 1 in 2 adults with diabetes attain hemoglobin A1c (HbA1c) targets. Food insecurity makes diabetes management and HbA1c control more difficult. OBJECTIVE: Our aim was to test whether a cooking intervention with food provision and diabetes self-management education and support improves HbA1c and diabetes management. DESIGN: This was a waitlist-controlled, randomized trial. PARTICIPANTS/SETTING: Participants were 48 adults with type 1 or type 2 diabetes. INTERVENTION: Cooking Matters for Diabetes was adapted from Cooking Matters and the American Diabetes Association diabetes self-management education and support intervention into a 6-week program with weekly food provision (4 servings). MAIN OUTCOME MEASURES: Surveys (ie, Summary of Diabetes Self-Care Activities; Medical Outcomes Study Short Form Health Survey, version 1; Diet History Questionnaire III; 10-item US Adult Food Security Survey Module; and Stanford Diabetes Self-Efficacy Scale) were administered and HbA1c was measured at baseline, post intervention, and 3-month follow-up. STATISTICAL ANALYSIS: Mixed-effects linear regression models controlling for sex and study wave were used. RESULTS: Mean (SD) age of participants was 57 (12) years; 65% identified as female, 52% identified as White, 40% identified as Black, and 19 (40%) were food insecure at baseline. Intervention participants improved Summary of Diabetes Self-Care Activities general diet score (0 to 7 scale) immediately post intervention (+1.51; P = .015) and 3 months post intervention (+1.23; P = .05), and improved Medical Outcomes Study Short Form Health Survey, version 1, mental component score (+6.7 points; P = .025) compared with controls. Healthy Eating Index 2015 total vegetable component score improved at 3 months (+0.917; P = .023) compared with controls. At baseline, food insecure participants had lower self-efficacy (5.6 vs 6.9 Stanford Diabetes Self-Efficacy Scale; P = .002) and higher HbA1c (+0.77; P = .025), and demonstrated greater improvements in both post intervention (+1.2 vs +0.4 Stanford Diabetes Self-Efficacy Scale score; P = .002, and -0.12 vs +0.39 HbA1c; P = .25) compared with food secure participants. CONCLUSIONS: Cooking Matters for Diabetes may be an effective method of improving diet-related self-care and health-related quality of life, especially among food insecure patients, and should be tested in larger randomized controlled trials.

Research at the Academy of Nutrition and Dietetics: What, How, and Why?

Research is essential to further advance our understanding of the role of nutrition and dietetics in maintenance and improvement of health. Research is also essential for nutrition and dietetics practitioners to create and provide evidence-based interventions, including medical nutrition therapy provided by registered dietitian nutritionists. Given this critical role of research, the Academy of Nutrition and Dietetics (Academy) has a variety of resources to assist its members in accessing, understanding, participating in, conducting, and disseminating nutrition research. These resources are comprehensive and include opportunities to participate in research (eg, Nutrition Research Network and Data Science Center), tools to aggregate practice data (Nutrition Care Process and Terminology and the Academy of Nutrition and Dietetics Informatics Infrastructure), funding opportunities to support primary research (eg, Academy Foundation), resources to understand the latest research informing evidence-based practice (eg, Evidence Analysis Center), and avenues for sharing research findings (eg, Food & Nutrition Conference & Expo™). The aim of this article is to encourage Academy members to get involved in research by describing Academy-based research resources and opportunities to contribute to nutrition and dietetics research, as well as describe specific examples of research conducted at the Academy. The information presented can serve as a framework to guide members in engaging in research through the Academy.

Maintaining School Foodservice Operations in Ohio during COVID-19: "This [Was] Not the Time to Sit Back and Watch".

The COVID-19-related lockdowns led to school closures across the United States, cutting off critical resources for nutritious food. Foodservice employees emerged as frontline workers; understanding their experiences is critical to generate innovations for program operations and viability. The purpose of this cross-sectional study was to characterize COVID-19-related foodservice adaptations for summer and school year meal provision. Public school district foodservice administrators across Ohio were surveyed in December 2020. Questions related to meal provision before, during, and after COVID-19-related school closures. Results indicate the majority of districts continued providing meals upon their closure in Spring 2020 (n = 182, 87.1%); fewer did so in Summer (n = 88, 42.1%) and Fall (n = 32, 15.3%). In Spring and Summer, most districts that offered meals functioned as 'open sites' (67.0% and 87.5%, respectively), not limiting food receipt to district-affiliated students. Most districts employed a pick-up system for food distribution (76-84% across seasons), though some used a combination of approaches or changed their approach within-season. Qualitatively, districts reported both "successes" (e.g., supporting students) and "challenges" (e.g., supply chain). Despite being ill-prepared, districts responded quickly and flexibly to demands of the pandemic. This analysis provides insight for future practice (e.g., establishing community partnerships) and policy (e.g., bolstering local food systems).

US Adults Fall Short of the Dietary Guidelines for Cancer Prevention Regardless of BMI Category.

BACKGROUND: Cancer risk is determined by specific factors, including body weight and dietary patterns. Accordingly, the World Cancer Research Fund/American Institute for Cancer Research published updated cancer prevention recommendations in 2018 based on comprehensive reviews of modifiable behaviors associated with cancer risk. OBJECTIVE: The objective of this study was to determine the extent to which US adults meet these evidence-based recommendations and how adherence differs by weight status. DESIGN: This was a cross-sectional study using nationally representative data from the 2005-2016 National Health and Nutrition Examination Survey (NHANES). PARTICIPANTS/SETTING: Dietary intake data for 30,888 adults 18 years and older with normal body mass index (BMI), overweight, or obesity were analyzed. MAIN OUTCOME MEASURES: Differences in dietary intakes and the proportion of adults meeting guidelines were compared across BMI categories. STATISTICAL ANALYSES PERFORMED: Logistic regression and 1-way analysis of covariance were used to analyze differences in adherence to recommendations, controlling for age, sex, race/ethnicity, and family income as a percent of the federal poverty rate. RESULTS: Regarding fruit and nonstarchy vegetables, 62.8% of adults with normal BMI, 64.5% with overweight, and 70.1% with obesity fell short of recommendations. Regarding whole grains, 67.9% of adults with normal BMI, 70.2% with overweight, and 73.1% with obesity did not meet the recommendation. Regarding red meat, 36.7% of adults with normal BMI, 41.6% with overweight, and 43.5% with obesity consumed >18 oz/week, with a significant difference in mean intakes between adults with normal BMI and obesity (P < .001). Adults with obesity consumed significantly less dietary fiber and more processed meat than adults with normal BMI and overweight (P < 0.001). CONCLUSIONS: Few U.S. adults meet cancer prevention recommendations; adults with obesity are significantly less likely to do so. Future research should evaluate compounded risk resulting from obesity and poor dietary patterns inconsistent with current evidence-based guidelines, and inform targeted interventions to address these issues.

Changes in Parent and Child Skin Carotenoids, Weight, and Dietary Behaviors over Parental Weight Management.

(1) The objective was to determine changes in parent-child (ages 7-18) dyad skin carotenoids spanning parental participation in a medical weight management program (WMP), and associations with parent BMI, child BMIz, fruit/vegetable intake, and family meals and patterns. (2) The study design was a longitudinal dyadic observational study with assessment at WMP initiation, mid-point (3-months), and conclusion (6-months). Twenty-three dyads initiated the study, 16 provided assessments at 3 months, and 11 at program conclusion. Associations between parent and child carotenoids (dependent variables) and parent BMI, child BMIz, increases in fruit/vegetable intake, and family meals and patterns were analyzed using Pearson's correlations and independent samples t-tests. Repeated measures ANOVA assessed changes in weight status and carotenoids. (3) Parents experienced significant declines in BMI and skin carotenoid levels over 6 months. Parent and child carotenoids were correlated at each assessment. At initiation, parent BMI and carotenoids were inversely correlated, child carotenoids were associated with increased family meals, and never consuming an evening fast food or restaurant meal were associated with increased parent and child carotenoids. (4) Results demonstrate skin carotenoids are strongly correlated within dyads and may be associated with lower parental BMI and positive family meal practices.

Sensory perceptions of survivors of cancer and their caregivers upon blinded evaluation of produce from two different sources.

PURPOSE: Evidence documents the role of modifiable lifestyle behaviors in optimizing physical and mental health outcomes for survivors of cancer. Fruit and vegetable consumption is one such behavior, and understanding survivor sensory perceptions of produce can inform interventions aimed at improving dietary patterns. The objective of this study was to assess the sensory perceptions of survivors of cancer and their caregivers when asked to evaluate garden-harvested and grocery-purchased produce. METHODS: Participants enrolled in a garden-based biobehavioral intervention and their caregivers (n=32) were invited to participate in a sensory evaluation of four produce types: tangerine cherry tomatoes, green cabbage, green beans, and green bell peppers. Samples were coded and distributed in a random fashion, and participants completed validated sensory surveys (preference, liking/acceptability, and discrimination) for each type of produce. RESULTS: Upon initial blinded evaluation, a significant preference for grocery-purchased produce was noted for green cabbage, green beans, and green bell peppers but not tomatoes (all p<0.05). After self-labeling, however, participants reported a preference for perceived garden-harvested produce (all p≤0.001) even when incorrectly labeled. Liking/acceptability scores were significantly higher among self-labeled garden-harvested versus self-labeled grocery-purchased for all types of produce (all p≤0.001). These data reveal survivors of cancer and their caregivers perceive garden-harvested produce as superior to grocery-purchased, though were unable to accurately identify the two sources based upon sensory factors such as taste, smell, and texture alone when blinded for three of the four types of produce. CONCLUSION: Findings indicate future interventions should address perceptions of produce to facilitate improvements in consumption in these vulnerable individuals.

Impact of a Tailored Nutrition and Lifestyle Intervention for Overweight Cancer Survivors on Dietary Patterns, Physical Activity, Quality of Life, and Cardiometabolic Profiles.

Survivors of cancer often experience treatment-related toxicity in addition to being at risk of cancer recurrence, second primary cancers, and greater all-cause mortality. The objective of this study was to test the safety and efficacy of an intensive evidence-based garden intervention to improve outcomes for cancer survivors after curative therapy. To do so, a clinical trial of adult overweight and obese cancer survivors within 2 years of completing curative therapy was completed. The 6-month intervention, delivered within the context of harvesting at an urban garden, combined group education with cooking demonstrations, remote motivational interviewing, and online digital resources. Data on dietary patterns, program satisfaction, and quality of life were collected via questionnaires; anthropometrics, physical activity, and clinical biomarkers were measured objectively. Of the 29 participants, 86% were white, 83% were female, and the mean age was 58 years. Compared to baseline, participants had significant improvements in Healthy Eating Index (HEI) scores (+5.2 points, p = 0.006), physical activity (+1,208 steps, p = 0.033), and quality of life (+16.07 points, p = 0.004). Significant improvements were also documented in weight (-3.9 kg), waist circumference (-5.5 cm), BMI (-1.5 kg/m2), systolic BP (-9.5 mmHg), plasma carotenoids (+35%), total cholesterol (-6%), triglycerides (-14%), hs-CRP (-28%), and IGFBP-3 (-5%) (all p < 0.010). These findings demonstrate a tailored multifaceted garden-based biobehavioral intervention for overweight and obese cancer survivors after curative therapy is safe and highly effective, warranting larger randomized controlled trials to identify program benefits, optimal maintenance strategies, program value relative to cost, and approaches for integration into a survivor's oncology management program. This trial is registered on ClinicalTrials.gov NCT02268188.

Inadequate Nutrition Coverage in Outpatient Cancer Centers: Results of a National Survey.

Cancer-related malnutrition is associated with poor health outcomes, including decreased tolerance to cancer therapy, greater treatment toxicities, and increased mortality. Medical nutrition therapy (MNT) optimizes clinical outcomes, yet registered dietitian nutritionists (RDNs), the healthcare professionals specifically trained in MNT, are not routinely employed in outpatient cancer centers where over 90% of all cancer patients are treated. The objective of this study was to evaluate RDN staffing patterns, nutrition services provided in ambulatory oncology settings, malnutrition screening practices, and referral and reimbursement practices across the nation in outpatient cancer centers. An online questionnaire was developed by the Oncology Nutrition Dietetic Practice Group (ON DPG) of the Academy of Nutrition and Dietetics and distributed via the ON DPG electronic mailing list. Complete data were summarized for 215 cancer centers. The mean RDN full-time equivalent (FTE) for all centers was 1.7 ± 2.0. After stratifying by type of center, National Cancer Institute-Designated Cancer Centers (NCI CCs) employed a mean of 3.1 ± 3.0 RDN FTEs compared to 1.3 ± 1.4 amongst non-NCI CCs. The RDN-to-patient ratio, based on reported analytic cases, was 1 : 2,308. Per day, RDNs evaluated and counseled an average of 7.4 ± 4.3 oncology patients. Approximately half (53.1%) of the centers screened for malnutrition, and 64.9% of these facilities used a validated malnutrition screening tool. The majority (76.8%) of centers do not bill for nutrition services. This is the first national study to evaluate RDN staffing patterns, provider-to-patient ratios, and reimbursement practices in outpatient cancer centers. These data indicate there is a significant gap in RDN access for oncology patients in need of nutritional care.

Tele-Motivational Interviewing for Cancer Survivors: Feasibility, Preliminary Efficacy, and Lessons Learned.

OBJECTIVE: Determine the feasibility, acceptability, and efficacy of tele-Motivational Interviewing (MI) for overweight cancer survivors. DESIGN: Six-month nonrandomized phase 2 clinical trial. SETTING: Urban garden and remote platforms. PARTICIPANTS: Overweight and obese cancer survivors post active treatment. INTERVENTION: Remote tele-MI from a trained registered dietitian nutritionist (RDN). MAIN OUTCOME MEASURES: Feasibility, acceptability, and preliminary efficacy. ANALYSIS: Groups were stratified as users and nonusers based on tele-MI use. Qualitative survey data and remote MI interaction logs were analyzed for trends. Two-sample t tests were performed to assess pre-post intervention changes in physical activity and dietary behaviors, quality of life, self-efficacy, and clinical biomarkers. RESULTS: A total of 29 participants completed the intervention. There were 17 tele-MI users (59%) and 12 nonusers (41%). Users were primarily female (88%), breast cancer survivors (59%), college educated (82%), with a mean age of 58 years. Users set 50% more goals, lost more weight (4.8 vs 2.6 kg), significantly improved quality of life (P = .03), and trended more positively in clinical biomarkers (eg, cholesterol, blood pressure) than did nonusers. CONCLUSIONS AND IMPLICATIONS: Findings from this study indicate that tele-MI is a feasible and acceptable intervention for overweight cancer survivors after active therapy. Larger randomized trials are needed to establish efficacy and generalizability to a variety of demographic populations.

Breast milk sharing via the internet: the practice and health and safety considerations.

To characterize the practice of breast milk sharing via the internet in the US and examine factors associated with participants' communication regarding potential health and safety risks. This cross-sectional study examined all original postings (n = 254) placed during 1 week in 2011 on four websites to facilitate the sharing of breast milk. Postings were characterized for intent and health and safety topics (i.e., selling vs. donating milk, hygiene/handling practices, infectious disease screening, diet/exercise habits, substance and pharmaceutical use, milk quality claims, price) communicated between milk providers and recipients. Approximately 69% of postings were providing milk and 31% were seeking milk; 47% included identifiers. Few provider postings reflected measures to potentially reduce risks to recipients: 20% mentioned using a healthy handling/hygiene practice, 11% offered specifics about infectious disease screening, 51% mentioned limiting/abstaining from 1+ substances. The presence of indications about handling/hygiene, diet/exercise, and abstaining from substances were strongly positively associated with each other (ORs 7.42-13.80), with the odds of selling (ORs 6.03-∞), and with making quality claims (ORs 3.14-13.54), but not with disease screening. One-fifth of recipients sought milk for a child with a medical condition or poor birth outcome. Most recipients (90%) did not specify any health and safety practices of a provider in their posting. Health behaviors and screening for diseases that may affect milk safety are not prominent topics in postings seeking to share milk. This lack of communication may exacerbate the health risks to recipient infants, especially infants at increased risk due to pre-existing health conditions.