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Objectives A large pediatric clinic in Flint, Michigan, implemented a produce prescription program for youth to address enduring challenges with food access and food insecurity. Approximately 18 months later, on March 23, 2020, the State of Michigan issued a "stay home, stay safe" executive order in response to the COVID-19 pandemic. This study sought to (1) explore caregiver experiences with access to and utilization of the prescription program during COVID-19; and (2) understand perceived changes in the food environment during the "stay home, stay safe" executive order. Methods Researchers collected data through recorded, semi-structured telephone interviews with caregivers of children who received at least one produce prescription and had previously enrolled in a preliminary effectiveness study on the prescription program. We transcribed the recordings verbatim for textual analysis. Examining the qualitative data using thematic analysis, we identified patterns across transcripts and formulated illustrative themes. Results Fifty-six caregivers (mean age, 41.3 ± 10.3 years) participated in interviews. The majority were female (91%), African American (70%), and Flint residents (75%). Recurrent themes, each centered around changes in the food environment resulting from COVID-19, emerged: (1) produce prescription access and utilization; (2) food access constraints; (3) food shopping adjustments; and (4) food insecurity stress. Perceived consequences of COVID-19 included increased anxiety related to food shopping and food insecurity alongside challenges accessing and utilizing the produce prescription program. Conclusions This study highlights the many ramifications of the COVID-19 pandemic on vulnerable families. More comprehensive efforts are necessary to address substantial barriers to healthy food access and affordability caused by the recent pandemic.
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Background. Flint Kids Cook, a nutrition and culinary program for children and adolescents, was created in October 2017 to address health concerns among youth and families in a low-income, urban community. In this study, researchers examined family experiences with the 6-week, chef-led program, which was taught in a farmers' market kitchen. Methods. At the conclusion of each session, researchers used an open-ended focus group format to assess program experiences, perceived impact on youth self-efficacy for cooking and healthy eating, and caregiver support. This qualitative study was guided by thematic analysis. Results. Between November 2017 and December 2018, 72 caregivers (n = 38) and students (n = 34) participated in separate focus groups. Caregivers were primarily female (74%) and African American (71%). Most students were African American (76%) and half were female. Recurrent themes included food acceptance, dietary modifications, confidence in the kitchen, and program design. Caregivers and students agreed that location and design of the program alongside facilitation by an experienced chef were important factors for program success. Conclusions. This study demonstrated that a chef-led healthy cooking program for youth was effective in improving perceived food acceptance, dietary habits, and confidence in the kitchen. The program could be modeled in similar communities to address diet and health of children and adolescents.
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CASE: Background: Administration of infliximab for the treatment of inflammatory bowel disease has a well-recognized risk of infusion-related (IR) adverse events. The recent introduction of the biosimilar infliximab-dyyb (Inflectra®) has been shown to have similar efficacy with comparable safety profile when compared to infliximab; however, although the active ingredients are similar, the inactive ingredients are different. We present a case of a 26-year-old female with ulcerative colitis who had resolution of her IR hypersensitivity when switched from infliximab to infliximab-dyyb. CASE DESCRIPTION: A 26-year-old female with a past medical history of ulcerative pancolitis presented to our clinic with the chief complaint of rash associated with her infliximab infusions. She described pruritic raised lesions which would occur on her upper and lower extremities during her infusions. She denied any shortness of breath or wheezing, and her symptoms were well controlled with methylprednisolone 40mg IV prior to her infusions. Previously, she had been treated for her UC with oral mesalamine, azathioprine and intermittent prednisone and did not have any adverse reactions to these medications. She has no known allergies to other medications and her peripheral eosinophil count was 1.6%. She was initially started on infliximab 5mg/kg every 8 weeks since 2013 and had achieved clinical as well as endoscopic remission with her most recent colonoscopy graded as Mayo 0. On account of her infusion reaction, drug antibodies were checked but were not detected. Infliximab level was 8.8 µg/ml. Due to insurance she was required to switch to infliximab-dyyb. After switching to the biosimilar, she has not had any infusion related reactions and no longer requires premedication with methylprednisolone with her infusions. DISCUSSION: Immediate IR reactions have been reported in 5-23% of IBD patients receiving infliximab and those who develop antibodies towards infliximab have a 2-fold risk of acute IR events. Side effects have been reported to be the primary reason for discontinuation of infliximab, and studies have shown that discontinuation can lead to an increased risk of relapse of inflammatory bowel disease. Although infliximab and infliximab-dyyb have analogous active ingredients, the inactive ingredients differ. Specifically, infliximab-dyyb lacks monobasic sodium phosphate and dibasic sodium phosphate, which acts as an emulsifier which we believe contributed to her IR with originator biologic infliximab. It is important to recognize these differences as IR hypersensitivities may be attributed to inactive ingredients; especially when antibodies are negative. Our case report suggests that a switch to biosimilar infliximab in patients may provide added benefit especially in those that have reactions occurring from inactive ingredients in the originator biologic.
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An innovative farmers' market incentive program designed specifically for children was implemented to address persistent challenges with accessing fresh, nutrient-rich foods in a food desert community. The current study sought to qualitatively examine caregiver perceptions of the incentive program. Following distribution of farmers' market incentives to all children (ages 0 to 15 years) at 43 Flint-area early childcare facilities and elementary schools, researchers conducted semistructured interviews with 37 caregivers (mean age = 39.59 ± 11.73 years). The majority were female (87%) and African American (53%). Through these interviews, researchers explored family experiences with the farmers' market incentive program, as well as changes in environmental factors that may have resulted from program participation. Interviews were audio recorded and transcribed verbatim for textual analysis. Thematic analysis was used to identify patterns across transcripts and formulate emerging themes. Four recurrent themes emerged during interviews: (1) fruit and vegetable access, (2) child influence, (3) autonomous grocery shopping, and (4) program expansion. Interview participants indicated that the farmers' market incentive program was an effective tool to both encourage families to visit the farmers' market and purchase fresh foods there. Program design, particularly distribution to children, was credited with introducing families to the local farmers' market. The current study suggests that a farmers' market incentive program targeting children who reside in a food desert community may have meaningful impacts on access to fresh, nutrient-rich foods.
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OBJECTIVE: The physical and social environments that surround children should support good health. However, challenges with food security and access prevent many children from consuming a healthy diet, which is critical to proper growth and development. The present study sought to gain a better understanding of primary care initiatives to address these issues in a low-income setting. DESIGN: Following the relocation of a paediatric clinic to a farmers' market building and the implementation of a fruit and vegetable prescription programme, researchers conducted thirty-two semi-structured interviews with caregivers. Researchers elicited caregivers' perceptions of clinic co-location with the farmers' market; experiences with the prescription programme; opinions of the farmers' market; and perceived impact on child consumption of fresh produce. Interview recordings were transcribed for textual analysis. Using thematic analysis, researchers examined qualitative data to identify patterns across transcripts and formulate emerging themes. Researchers concluded when data saturation was reached. SETTING: Flint, Michigan, USA. SUBJECTS: The majority of participants were female (91 %) and African American (53 %). RESULTS: Four recurrent themes emerged during interviews: (i) convenience of relocation; (ii) attitude towards prescription programme; (iii) challenges with implementation; and (iv) perceived impact of combined interventions. Caregivers indicated that the co-location and prescription programme increased family shopping at the farmers' market, improved access to high-quality produce and improved food security. CONCLUSIONS: A fruit and vegetable prescription programme involving a partnership between a farmers' market and paediatric clinic was perceived as effective in improving food security, food access and child consumption of fresh fruits and vegetables.
