A systematic review of the implementation of healthy food retail interventions in settings with multiple food retail outlets (complex food retail settings).

Complex food retail settings, where multiple food retail outlets operate in close proximity are common. Despite their ubiquity, there remains a significant knowledge gap regarding healthy food retail interventions implemented within these settings. Furthermore, understanding the factors affecting the implementation of interventions in these settings remains limited. This systematic review aimed to (1) identify and describe complex food retail settings where interventions were implemented to promote the healthiness of foods purchased, (2) synthesise the evidence on the effectiveness of the interventions implemented, and (3) identify enablers and barriers to the implementation of the interventions in these settings. Four databases, namely, MEDLINE Complete, Global Health, Embase, and Business Source Complete, were searched until December 2022. The Effective Public Health Practice Project quality assessment tool was used. Six studies reported on the implementation of interventions promoting healthy food purchases across multiple food retail outlets. Three studies each described two complex food retail settings: university and hospital. Interventions including promotion and promotion plus price improved the healthiness of foods purchased. There was limited description of institutional food policies, conceptual frameworks, formative research, or evaluation outcomes to inform the implementation of interventions in these settings. No study analysed enablers and barriers to the implementation of interventions. No study identified their settings as complex food retail settings. There is limited evidence describing complex food retail settings, their impact on intervention effectiveness, and associated enablers or barriers. Investigating factors influencing the effectiveness of interventions implemented within complex food retail settings is critical to support their implementation at scale.

Caregiver-reported barriers to engagement in a paediatric fresh fruit and vegetable prescription programme.

Paediatric fruit and vegetable prescription programmes hold promise in improving food security and dietary patterns among youth. However, programme success is largely dependent upon caregiver and family engagement. The current study sought to gain a better understanding of environmental barriers to engagement in a paediatric fruit and vegetable prescription programme in one low-income, urban community (Flint, Michigan, USA). Following the implementation of a paediatric fruit and vegetable prescription programme, researchers conducted thirty-two semi-structured interviews with caregivers. Researchers explored caregivers' understanding of the fruit and vegetable prescription programme, barriers to programme engagement, and recommendations for improvement. Telephone interviews were transcribed for textual analysis. Researchers used thematic analysis to examine qualitative data, determine patterns across transcripts, and develop emerging themes. Researchers concluded interviews when data saturation was reached. The majority of participants were female (94%), African American (66%), and residents of Flint (72%). Five recurrent themes emerged: (1) nutrition security; (2) prescription distribution; (3) prescription redemption; (4) educational supports; and (5) programme modifications. Although caregivers indicated that the prescription programme addressed household food insecurity, environmental barriers to engagement were apparent. Caregivers provided suggestions, such as partnering with large grocery stores and developing digital prescriptions, to address programme engagement challenges. Fundamental to the success of fruit and vegetable prescription programmes is the understanding of barriers to engagement from the perspective of participants. This study explores challenges with one paediatric fruit and vegetable prescription programme and provides actionable solutions, from the viewpoint of caregivers, to address these challenges.

Experiences of ecosystem changes on food services of mopane woodland communities in Vhembe, South Africa.

Mopane woodlands have been shifting. While it is important to understand the spatial patterns that characterise this phenomenon, it is even more important to understand the impacts of shifting Mopane woodlands on rural communities that rely on them. This study sought to establish the impacts of shifting mopane woodlands on the production of indigenous plant food in Ward 12 of Musina local municipality in the Vhembe District municipality in the Limpopo province of South Africa. To accomplish this, the study utilised a hybrid inductive approach involving thematic-based questionnaire interviews and an exploratory view to gain insight into the narratives of focus group participants. Results revealed that seven (7) out of eleven (11) indigenous plant foods are becoming extinct, thereby limiting food sources of indigenous and local people who used to rely on them. The spatial pattern of the plant foods that are still available has now changed as they no longer grow within the reach of local communities. The community members are struggling to adapt to these changes. From these observations, we recommend that local and regional levels' policies related to natural resource management should consider the unique challenges faced by communities experiencing disruptive ecosystem changes and provide the necessary support for sustainable adaptation.

Evaluating food security and nutritional pathways of rural farm families: Empirical evidence from northeast India.

The study aimed to ascertain a relationship between agricultural status, socioeconomic factors, and nutrition of farm families. The study was conducted in selected villages in the West Garo Hills district of Meghalaya, using Stratified Random Sampling (St. RS). Using pretested interview schedules, we collected primary data from respondents in 2020 and 2021, focusing on socioeconomic variables, body mass index, and income from agriculture and related sectors. The data was analysed using correlation analyses and separate combined regression estimates for each year and month were obtained. Results from the study indicate that agricultural income significantly influenced nutritional status (p < 0.05) and household income growth was also found significant. The region's agricultural production of cereals, pulses, and vegetables was insufficient, as was the production of meat and meat products, milk, and milk products. Hence, expenditure towards purchasing the above food groups from the market was found to be significant (p < 0.05). Therefore, the markets near the mainland especially in the hilly region play a crucial role in the nutritional pathway of rural farm families.

Stores Licensing Scheme in remote Indigenous communities of the Northern Territory, Australia: a meta-evaluation.

A form of food retail regulation called the Stores Licensing Scheme was introduced by the Australian Government in 2007-2022 to ensure food security in remote Indigenous communities of the Northern Territory. We examined evaluations of this Scheme implemented under the Northern Territory National Emergency Response and Stronger Futures Northern Territory Acts. Grey literature search identified nine primary source evaluations. Reported outcomes were extracted and thematic analysis utilised to determine barriers and enablers. Outcomes included improved availability and quality of groceries, financial structures, and retail practices, albeit not consistently reported. Governance and food cost were perceived barriers. Future policy aimed to improve food security through community stores should consider food cost subsidy, measures to incentivise all stores to improve standards, and improved governance arrangements enabling self-determination for Aboriginal and Torres Strait Islander Store Directors.

Barriers and Enablers for Equitable Healthy Food Access in Baltimore Carryout Restaurants: A Qualitative Study in Healthy Food Priority Areas.

Black neighborhoods in the U.S., historically subjected to redlining, face inequitable access to resources necessary for health, including healthy food options. This study aims to identify the enablers and barriers to promoting equitable healthy food access in small, independently owned carryout restaurants in under-resourced neighborhoods to address health disparities. Thirteen in-depth interviews were conducted with restaurant owners in purposively sampled neighborhoods within Healthy Food Priority Areas (HFPAs) from March to August 2023. The qualitative data were analyzed using inductive coding and thematic analysis with Taguette software (Version 1.4.1). Four key thematic domains emerged: interpersonal, sociocultural, business, and policy drivers. Owners expressed mixed perspectives on customers' preferences for healthy food, with some perceiving a community desire for healthier options, while others did not. Owners' care for the community and their multicultural backgrounds were identified as potential enablers for tailoring culturally diverse menus to meet the dietary needs and preferences of their clientele. Conversely, profit motives and cost-related considerations were identified as barriers to purchasing and promoting healthy food. Additionally, owners voiced concerns about taxation, policy and regulation, information access challenges, and investment disparities affecting small business operations in HFPAs. Small restaurant businesses in under-resourced neighborhoods face both opportunities and challenges in enhancing community health and well-being. Interventions and policies should be culturally sensitive, provide funding, and offer clearer guidance to help these businesses overcome barriers and access resources needed for an equitable, healthy food environment.

Millets: a nutritional powerhouse for ensuring food security.

MAIN CONCLUSION: Millets are important food source to ensure global food and nutritional security and are associated with health benefits. Millets have emerged as a nutritional powerhouse with the potential to address food security challenges worldwide. These ancient grains, which come in various forms, including finger millet, proso millet, and pearl millet, among others, are essential to a balanced diet, since they provide a wide range of nutritional advantages. Millets have a well-rounded nutritional profile with a high protein, dietary fiber, vitamin, and mineral content for optimal health and wellness. In addition to their nutritional advantages, millets exhibit remarkable adaptability and durability to various agroecological conditions, making them a valuable resource for smallholder farmers functioning in resource-poor regions. Promoting the growth and use of millet can lead to several benefits that researchers and development experts may discover, including improved nutrition, increased food security, and sustainable agricultural methods. Therefore, millets are food crops, that are climate smart, nutritional, and food secured to feed the increasing global population, and everyone could have a healthier, more resilient future.

Perceived Discrimination Among Food Pantry Clients in Massachusetts.

Introduction: Food insecurity is defined as inconsistent access to enough food to meet nutritional needs. Discrimination is associated with food insecurity and poor health, especially among racial and ethnic minoritized and sexual or gender minoritized groups. We examined the demographic associations of perceived everyday discrimination and food pantry discrimination in Massachusetts. Methods: From December 2021 through February 2022, The Greater Boston Food Bank conducted a cross-sectional, statewide survey of Massachusetts adults. Of the 3,085 respondents, 702 were food pantry clients for whom complete data on food security were available; we analyzed data from this subset of respondents. We used the validated 10-item Everyday Discrimination Scale to measure perceived everyday discrimination and a 10-item modified version of the Everyday Discrimination Scale to measure perceived discrimination at food pantries. Logistic regression adjusted for race and ethnicity, age, gender identity, sexual orientation, having children in the household, annual household income, and household size assessed demographic associations of perceived everyday discrimination and discrimination at food pantries. Results: Food pantry clients identifying as LGBTQ+ were more likely than those identifying as non-LGBTQ+ to report perceived everyday discrimination (adjusted odds ratio [AOR] = 2.44; 95% CI, 1.24-4.79). Clients identifying as Hispanic (AOR = 1.83, 95% CI, 1.13-2.96) were more likely than clients identifying as non-Hispanic White to report perceived discrimination at food pantries. Conclusion: To equitably reach and serve households with food insecurity, food banks and pantries need to understand experiences of discrimination and unconscious bias to develop programs, policies, and practices to address discrimination and create more inclusive interventions for food assistance.

Impact of urban productive safety net program on urban households' asset accumulation and food consumption rate in Dessie City, South Wollo Zone, Amhara Region, Ethiopia.

Agriculture is the driver of economic growth in many developing countries like Ethiopia, where it often represents at least 25% of gross domestic product. But the quality and productivity of the land depends on the way agriculture is practiced. Better agricultural techniques are necessarily including Productive Safety net Program. Urban Productive Safety Net Program is designed to support the poor households and establish urban safety net mechanisms. While several studies have examined the effects of rural productive safety net programs, the outcomes of similar programs in urban areas are not well documented. This knowledge gap hinders the ability to effectively design and implement urban productive safety net programs. The main objective of this study was to assess the impact of urban productive safety net program on asset accumulation and consumption rate in Dessie city. Both primary and secondary data sources were used. A total of 112 households were selected randomly among the public work Urban Productive Safety Net Program beneficiary and non-beneficiary households. Descriptive analysis, inferential statistics and econometric models were used for analysis. Based on the econometric estimation results the demographic and socio-economic variables such as education, access to credit, access to extension services and adult male labor force revealed positive relation to public work urban productive safety net program beneficiary and non-beneficiary household's asset accumulation and consumption. The impact of program participation was also found to be positive and significant for both home asset and community asset. While food and non-food consumption even the total consumption and food security status are also positive. Generally, the result indicated that, due to program participation beneficiary households have higher home asset and community asset and better consumption and food security status.

Globalization of wild capture and farmed aquatic foods.

Aquatic foods are highly traded, with nearly 60 million tonnes exported in 2020, representing 11% of global agriculture trade by value. Despite the vast scale, basic characteristics of aquatic food trade, including species, origin, and farmed vs wild sourcing, are largely unknown due to the reporting of trade data. Consequently, we have a coarse picture of aquatic food trade and consumption patterns. Here, we present results from a database on species trade that aligns production, conversion factors, and trade to compute apparent consumption for all farmed and wild aquatic foods from 1996 to 2020. Over this period, aquatic foods became increasingly globalized, with the share of production exported increasing by 40%. Importantly, trends differ across aquatic food sectors. Global consumption also increased by 19.4% despite declining marine capture consumption, and some regions became increasingly reliant on foreign-sourced aquatic foods. To identify sustainable diet opportunities among aquatic foods, our findings, and underlying database enable a greater understanding of the role of trade in rapidly evolving aquatic food systems.

The urban-rural dietary water footprint and its inequality in China's urban agglomerations.

Food system is the main consumer of water resources, and the differences in urban and rural diets pose new challenges to the water sustainability and increase the uncertainty of food security in China. In this study, we quantified the dietary water footprint (DWF) of urban and rural residents at the city scale in four major urban agglomerations in China from 2015 to 2021, identified the key economic and educational factors of urban and rural DWF, and measured the inequality of urban and rural DWF driven by the main influencing factors. We found that there was a 27.17 % increase in urban DWF and a 23.18 % increase in rural DWF between 2015 and 2021. Cereals had the largest water footprint among the 12 food types, accounting for 20.27 % and 31.57 % of urban and rural DWF, respectively. Meanwhile, milk and dairy products contributed the most to the difference between urban and rural DWF, up to 57.89 m3 each year. The main economic factor of DWF was consumption expenditure. The number of primary school students and the number of primary schools are the most important educational factors of urban and rural DWF, respectively. The results show there is an inequality between DWF and major educational factors, with a decreasing trend in DWF inequality over time. This study revealed for the first time the difference between urban and rural DWF at the city scale, and clarified the impact of regional educational inequality on DWF. A greater focus should be placed on the primary education-related factors that influence DWF inequality, in order to better target sustainable DWF strategies for urban and rural residents.

Process Evaluation of a Pilot Food Insecurity Resource Navigation Program Integrated Within Pediatric Primary Care: Utilizing RE-AIM to Inform Program Scale-up.

OBJECTIVE: The purpose of this study was to examine the implementation and effectiveness of a novel pediatric food navigation program through a structured, comprehensive evaluation using the RE-AIM framework. DESIGN AND PARTICIPANTS: Data were collected from October 2021 through August 2022 for 166 pediatric patients and their families who were screened as food insecure or high-risk for food insecurity and were referred to this pilot food resource navigation program (FRNP). A total of 88 patients' guardians consented to participate in this FRNP, receiving initial service connection. Participants were contacted via telephone by trained navigators within this health system to assess food security status across three time points (baseline, follow-up 1 [1- <3 months], and follow-up 2 [3-6 months]) and facilitate connection to appropriate community-based resources related to food assistance. RESULTS: In this sample, we had an overrepresentation of Hispanic patients and an underrepresentation of Non-Hispanic Black and White patients relative to the available clinic population. Patients participating in the navigation program showed incremental shifts toward food security from baseline to two follow-up points. Integration within primary care was supported by physician champions across participating clinics and alignment with systemwide, updated universal screening guidelines to support projected increases in families requiring connecting to assistance programs. Through this evaluation, a comprehensive list of community-based food resource programs related to food assistance was integrated into electronic documentation for navigators to alleviate navigator burden and sustain the effect of this FRNP's implementation. CONCLUSIONS: These findings may be used to inform expansion of current programming efforts within this FRNP and to clarify process evaluations of broader health system-based programming. Further research, building on the findings of this pilot study, is needed to examine the longitudinal, causal effect of FRNPs in pediatric food security and long-term health outcomes for replication across health systems nationwide.

Supplemental Nutrition Assistance Program healthy eating incentives and fruit and vegetable spending across the month.

OBJECTIVE: To estimate how incentives that encourage healthy eating among Supplemental Nutrition Assistance Program (SNAP) participants impact intra-monthly variation in fruit and vegetable spending. DESIGN: We used transaction data from three Alabama grocery stores participating in a programme that offered dollar-matching coupons for fresh produce. For each store, we calculated daily spending on fresh produce out of SNAP benefits and daily incentive coupon redemptions. We compared total daily spending on fresh produce and daily coupon redemptions on days over which SNAP benefits are distributed in Alabama with spending and redemption on days at the end of the month with no SNAP distribution. SETTING: SNAP and incentive transactions in three Alabama grocery stores. PARTICIPANTS: SNAP participants purchasing fruit and vegetables April 2023-July 2023. RESULTS: Daily spending with SNAP on produce dropped by 38% at the end of the month. Incentive coupon redemption did not significantly drop at the end of the month. The share of total SNAP spending going to fresh fruits and vegetables increased by two percentage points and the share of fresh fruits and vegetables spending coming from redemptions increased by ten percentage points at the end of the month. CONCLUSIONS: SNAP households may use incentive coupons to smooth drops in produce consumption at the end of the month. These findings also highlight trade-offs inherent in different delivery mechanisms for SNAP incentives.

Food insecurity and food bank use: who is most at risk of severe food insecurity and who uses food banks?

OBJECTIVES: To identify (1) who experiences food insecurity of differing severity and (2) who uses food banks in England, Wales and Northern Ireland; (3) whether the same groups experience food insecurity and use food banks; and (4) to explore country- and region-level differences in food insecurity and food bank use. DESIGN: This pooled cross-sectional study analysed the characteristics of adults experiencing food insecurity of differing severity using generalised ordinal logistic regression models and the characteristics of adults using food banks using logistic regression models, using data from three waves of the Food and You 2 surveys, 2021-2023. SETTING: England, Wales and Northern Ireland. PARTICIPANTS: 18 557 adults. RESULTS: 20·8 % of respondents experienced food insecurity in the past 12 months, and 3·6 % had used a food bank. Food insecurity was associated with income, working status, respondent age, family type, ethnicity, country, long-term health conditions, food hypersensitivity, urban-rural status and area-level deprivation. Severe food insecurity was concentrated among respondents with long-term health conditions and food hypersensitivities. Food bank use was more prevalent among food insecure respondents and unemployed and low-income respondents. Neither outcome showed clear geographical variation. Certain groups experienced an elevated likelihood of food insecurity but did not report correspondingly greater food bank use. CONCLUSIONS: Food insecurity is unevenly distributed, and its nutrition and health-related consequences demonstrate that food insecurity will intensify health inequalities. The divergence between the scale of food insecurity and food bank use strengthens calls for adequate policy responses.

Blockchain implementation for food safety in supply chain: A review.

Food safety has emerged as the topmost priority in the current fast-paced food industry era. According to the World Health Organization, around 600 million people, approximately 1 in 10 individuals worldwide, experience illness due to contaminated food consumption, resulting in nearly 0.42 million fatalities annually. The recent development in software and hardware sectors has created opportunities to improve the safety concerns in the food supply chain. The objective of this review is to explain the fundamentals of blockchain and its integration into the supply chain of various food commodities to enhance food safety. This paper presents the analysis of 31 conceptual works, 10 implementation works, 39 case studies, and other investigations in blockchain-based food supply chain from a total of 80 published papers. In this paper, the significance of adapting conceptual ideas into practical applications for effectively tracing food commodities throughout the supply chain has been discussed. This paper also describes the transformative role of blockchain platforms in the food industry, providing a decentralized and transparent ledger to access real-time and immutable records of a product's journey. In addition, both the positive impacts and challenges associated with implementing blockchain technology in the food supply chain have been evaluated. In summary, the blockchain-based food supply chains offer greater transparency, traceability, and trust, ultimately resulting in higher standards of food safety and quality.

Food poverty among children aged 6-59 months in Brazil: results from the Brazilian National Survey on Child Nutrition (ENANI-2019).

OBJECTIVE: To describe the prevalence of food poverty according to dimensions of socio-economic inequality and the food groups consumed by Brazilian children. DESIGN: Dietary data from a structured qualitative questionnaire collected by the Brazilian National Survey on Child Nutrition (ENANI-2019) were used. The new UNICEF indicator classified children who consumed 3-4 and <3 out of the eight food groups as living in moderate and severe food poverty, respectively. The prevalence of consumption of each food group and ultra-processed foods (UPF) was estimated by level of food poverty according to age categories (6-23; 24-59 months). The most frequent combinations of food groups consumed by children living in severe food poverty were calculated. Prevalence of levels of food poverty were explored according to socio-economic variables. SETTING: 123 municipalities of the five Brazilian macro-regions. PARTICIPANTS: 12 582 children aged 6-59 months. RESULTS: The prevalence of moderate and severe food poverty was 32·5 % (95 % CI 30·1, 34·9) and 6·0 % (95 % CI 5·0, 6·9), respectively. Children whose mother/caregiver had lower education (<8 years) and income levels (per capita minimum wage <») had the highest severe food poverty prevalence of 8·3 % (95 % CI 6·2, 10·4) and 7·5 % (95 % CI 5·6, 9·4), respectively. The most consumed food groups among children living in food poverty in all age categories were 'dairy products', 'grains, roots, tubers, and plantains' and 'ultra-processed foods'. CONCLUSION: Food poverty prevalence was high among Brazilian children. A significant occurrence of milk consumption associated with grains and a considerable prevalence of UPF consumption were found among those living in severe food poverty.

A comprehensive review of current approaches on food waste reduction strategies.

Food waste is a serious worldwide issue that has an impact on the environment, society, and economy. This comprehensive review provides a detailed description of methods and approaches for reducing food waste, emphasizing the necessity of comprehensive strategies to tackle its intricate relationship with environmental sustainability, social equity, and economic prosperity. By scrutinizing the extent and impact of food waste, from initial production stages to final disposal, this comprehensive review underlines the urgent need for integrated solutions that include technological advancements, behavioral interventions, regulatory frameworks, and collaborative endeavors. Environmental assessments highlight the significant contribution of food waste to greenhouse gas emissions, land degradation, water scarcity, and energy inefficiency, thereby emphasizing the importance of curtailing its environmental impact. Concurrently, the social and economic consequences of food waste, such as food insecurity, economic losses, and disparities in food access, underscore the imperative for coordinated action across multiple sectors. Food waste can also be effectively reduced by various innovative approaches, such as technological waste reduction solutions, supply chain optimization strategies, consumer behavior-focused initiatives, and waste recovery and recycling techniques. Furthermore, in order to foster an environment that encourages the reduction of food waste and facilitates the transition to a circular economy, legislative changes and regulatory actions are essential. By embracing these multifaceted strategies and approaches, stakeholders can unite to confront the global food waste crisis, thereby fostering resilience, sustainability, and social equity within our food systems.

Foodprint 2.0: A computational simulation model that estimates the agricultural resource requirements of diet patterns.

Reducing the environmental pressures stemming from food production is central to meeting global sustainability targets. Shifting diets represents one lever for improving food system sustainability, and identifying sustainable diet opportunities requires computational models to represent complex systems and allow users to evaluate counterfactual scenarios. Despite an increase in the number of food system sustainability models, there remains a lack of transparency of data inputs and mathematical formulas to facilitate replication by researchers and application by diverse stakeholders. Further, many models lack the ability to model multiple geographic scales. The present study introduces Foodprint 2.0, which fills both gaps. Foodprint 2.0 is an updated biophysical simulation model that estimates the agricultural resource requirements of diet patterns and can be adapted to suit a variety of research purposes. The objectives of this study are to: 1) describe the new features of Foodprint 2.0, and 2) demonstrate model performance by estimating the agricultural resource requirements of food demand in the United States (US) using nationally representative dietary data from the National Health and Nutrition Examination Survey from 2009-2018. New features of the model include embedded functions to integrate individual-level dietary data that allow for variance estimation; new data and calculations to account for the resource requirements of food trade and farmed aquatic food; updated user interface; expanded output data for over 200 foods that include the use of fertilizer nutrients, pesticides, and irrigation water; supplementary files that include input data for all parameters on an annual basis from 1999-2018; sample programming code; and step-by-step instructions for users. This study demonstrates that animal-sourced foods consumed in the US accounted for the greatest share of total land use, fertilizer nutrient use, pesticide use, and irrigation water use, followed by grains, fruits, and vegetables. Greater adherence to the Dietary Guidelines for Americans was associated with lower use of land and fertilizer nutrients, and greater use of pesticides and irrigation water. Foodprint 2.0 is a highly modifiable model that can be a useful resource for informing sustainable diet policy discussions.

Exploring the associations of food and financial insecurity and food assistance with breastfeeding practices among first-time mothers.

OBJECTIVE: Social determinants of health (SDoH), such as food and financial insecurity and food assistance, are potentially modifiable factors that may influence breastfeeding initiation and duration. Knowledge gaps exist regarding the relationship between these SDoH and infant feeding practices. We explored the relationships of food and financial insecurity and food assistance with the continuation of breastfeeding at four months postpartum among mothers and whether race and ethnicity modified these associations. DESIGN: Mothers retrospectively reported food and financial insecurity and receipt of food assistance (e.g. Women, Infants and Children and Supplemental Nutrition Assistance Program) during pregnancy with their first child and infant feeding practices (exclusive/mostly breastfeeding v. exclusive/mostly formula feeding) following the birth of their first child. Sociodemographic-adjusted modified Poisson regressions estimated prevalence ratios and 95 % CI. SETTING: Minneapolis-St. Paul, Minnesota. PARTICIPANTS: Mothers who participated in the Life-course Experiences And Pregnancy study (LEAP) (n 486). RESULTS: Ten percent of mothers reported food insecurity, 43 % financial insecurity and 22 % food assistance during their pregnancies. At four months postpartum, 63 % exclusively/mostly breastfed and 37 % exclusively/mostly formula-fed. We found a lower adjusted prevalence of breastfeeding at four months postpartum for mothers who reported experiencing food insecurity (0·65; 0·43-0·98) and receiving food assistance (0·66; 0·94-0·88) relative to those who did not. For financial insecurity (aPR 0·92; 0·78, 1·08), adjusted estimates showed little evidence of an association. CONCLUSIONS: We found a lower level of breastfeeding among mothers experiencing food insecurity and using food assistance. Resources to support longer breastfeeding duration for mothers are needed. Moreover, facilitators, barriers and mechanisms of breastfeeding initiation and duration must be identified.

Users' Perspective on Revised Simple Simulator for Calculating Nutritional Food Stocks in Preparation for Large-scale Disasters.

OBJECTIVE: In 2020, Japan's Ministry of Health, Labour and Welfare developed an Excel workbook entitled "Simple Simulator for calculating nutritional food stocks in preparation for large-scale disasters." In September 2021, it was modified as the "Revised Simulator" to plan food stockpiles in normal times and post-disaster meals. This study aimed to further improve the Revised Simulator. METHODS: Eight group interviews were conducted with 12 public health dietitians, 9 disaster management officers, and 2 public health nurses from September to November 2021. They provided nutritional support during previous disasters or prepared for predicted future disasters. Qualitative analysis was conducted on interview transcriptions, then the Revised Simulator was improved based on their feedback. RESULTS: The Revised Simulator was improved to the "Simulator for calculating nutritional food stocks and meals for large-scale disasters" with significant changes such as adding specific tags in the food list to denote long shelf life and elderly-friendly foods, as well as displaying bar graphs to visualize the required and supplied amounts of energy and nutrients. CONCLUSIONS: The Revised Simulator was upgraded for planning and assessing stockpiles and meals in ordinary conditions and emergencies. This study will contribute to enhancing the quality and quantity of food supplies during disasters.