SNAP-Ed Programming for College Students Experiencing Food Insecurity: A Qualitative Process-Focused Evaluation.

BACKGROUND: Growing recognition of food insecurity experienced by college students has led to efforts on college campuses to provide students with food assistance benefits and related nutrition education. A Supplemental Nutrition Assistance Program-Education (SNAP-Ed) program was developed for college students as one of these efforts. OBJECTIVE: To explore program content, recruitment, and implementation through experiences of program implementers in a novel SNAP-Ed intervention among college students. DESIGN: This qualitative study used focus groups and a case study approach to elicit program implementers' experiences delivering SNAP-Ed to college students. PARTICIPANTS/SETTING: Students, staff, and faculty (n = 26) implementing SNAP-Ed with college students experiencing food insecurity across eight campuses in the California State University system participated in 8 focus groups in 2021-2022. MAIN OUTCOME MEASURES: A process evaluation framework was used to evaluate content fit and orientation; recruitment, retention, and reach; and structure and capacity for implementation. ANALYSES PERFORMED: Focus groups were recorded, transcribed, and coded via thematic analysis using NVivo (QSR International, Burlington, MA). RESULTS: Five themes were identified: (1) need for this work to extend college-based basic needs services; (2) importance of aligning programming with college student context/needs; (3) common factors important for attracting/engaging the audience; (4) program barriers; and (5) training/team sharing for extending ideas. CONCLUSIONS: Study findings suggest tailoring SNAP-Ed programming to the needs of college students experiencing food insecurity, such as integrating student-relevant cooking skills, recipes, and topics of interest. Additional intervention and research efforts may lead to a new model for serving college students with SNAP-Ed.

Support for inadvertent undereating in female adolescent athletes with clinical indicators of low energy availability.

OBJECTIVES: This study evaluated pathways to low energy availability in a sample of female adolescent athletes (n = 464). DESIGN: Cross-sectional. METHODS: Participants (age 13-18 y) underwent assessments for height, weight, eating attitudes and behaviors, and menstrual function. Bone mineral density and body composition were evaluated by dual-energy x-ray absorptiometry in a subset of participants (n = 209). Athletes were classified with clinical indicators of low energy availability if they met criteria for 1) primary or secondary amenorrhea or 2) clinical underweight status (body mass index-for-age < 5th percentile). Disordered eating was assessed using the Eating Disorder Examination Questionnaire. RESULTS: Thirty (6.5%) athletes exhibited clinical indicators of low energy availability, with higher estimates in leanness than non-leanness sports (10.9% vs. 2.1%, p < 0.005). Among athletes with clinical indicators of low energy availability, 80% (n = 24) did not meet criteria for disordered eating, eating disorder, or report the desire to lose weight. Athletes with (vs. without) clinical indicators of low energy availability exhibited lower lumbar spine (-1.30 ±â€¯1.38 vs. -0.07 ±â€¯1.21, p < 0.001) and total body (-0.30 ±â€¯0.98 vs. 0.53 ±â€¯0.97, p < 0.006) bone mineral density Z-scores. CONCLUSIONS: A majority of female adolescent athletes with clinical indicators of low energy availability did not exhibit characteristics consistent with intentional dietary restriction, supporting the significance of the inadvertent pathway to low energy availability and need for increased nutrition education in this population.

Comparative analysis between a brief nutrition screening survey and validated food frequency questionnaire among physically active college students.

OBJECTIVE: To evaluate the agreement between a 61-item Nutrition Screening Survey (NSS) and 127-item validated Food Frequency Questionnaire (FFQ). PARTICIPANTS: Forty-seven college students (male, n = 29; female, n = 18), age 21.7 ± 0.4 years, BMI of 23.5 ± 0.4 kg/m2. METHODS: Participants completed the NSS, Block FFQ, and anthropometric measurements. Pearson's correlation, paired sample t test, and Bland-Altman plot evaluated agreement between the assessments. RESULTS: Moderate to strong associations between assessments (0.61-0.89, p < 0.001) were identified for meals/day, snacks/day, calories, carbohydrate, fiber, grains, non-starchy vegetables, potatoes, legumes, fruit, yogurt, cheese, and eggs. Mean daily meals/day, calories, fat, fiber, grains, fruit, milk, and eggs did not significantly differ between surveys. The Bland-Altman plot analyses indicated no proportional bias for calories, fat, fiber, grains, fruit, milk, and eggs. CONCLUSIONS: The NSS and Block FFQ display reasonable agreement, supporting use of the NSS for evaluating a range of dietary components among physically active college students.

Nutrition Education Curriculum Promotes Adolescent Runners' Self-Efficacy, Knowledge, and Intake of Nutrient-Rich Carbohydrate Foods.

BACKGROUND: Endurance runners exhibit an elevated prevalence of low bone mass and characteristics consistent with undernourishment. OBJECTIVE: This quasi-experimental, pretest-posttest design study evaluated the efficacy of a 4-week nutrition education curriculum to optimize nutrition knowledge, self-efficacy, and the intake of nutrient-rich carbohydrate foods. METHODS: Forty-eight adolescent endurance runners, age 15.7 ± 1.2 y, from two high schools in Southern California were recruited to complete four, weekly lessons addressing the quantity, quality, and timing of carbohydrate intake. Differences in pre- compared to post-intervention nutrition knowledge and self-efficacy to consume nutrient-rich carbohydrate foods were evaluated using paired samples t-tests. Qualitative coding of open-response questions explored changes in food intake behaviors reported by runners during the intervention. RESULTS: The percent of nutrition knowledge questions answered correctly increased after Lessons 1 and 2 (59.0% ± 20.0% pre- vs. 81.9% ± 22.8% post-Lesson 1; 44.7% ± 13.7% pre- vs. 74.5% ± 17.4% post-Lesson 2, P<.001) and the number of identified nutrient-rich carbohydrate foods (8.7 ± 2.7 vs. 12.4 ± 2.3, P < 0.001). Self-efficacy scores improved after all lessons (P<.001). After Lesson 2, 84% (n = 27/32) of runners increased the carbohydrate included in a snack or meal; after Lesson 4, 85% (n = 29/34) added a post-exercise snack. Frequent themes identified from questions addressing dietary changes included increasing quantity and quality of carbohydrates in snacks and meals and being more aware of food choices.Conclusions: Findings suggest that the curriculum enhanced nutrition knowledge, self-efficacy, and dietary behaviors related to intake of nutrient-dense carbohydrate foods in adolescent runners.

Adolescent Endurance Runners Exhibit Suboptimal Energy Availability and Intakes of Key Nutrients.

Backgroud: Despite the evidence of an elevated prevalence of low bone mass in adolescent endurance runners, reports on dietary intake in this population is limited.Objectives: This study aimed to evaluate energy availability (EA) and dietary intake among 72 (n = 60 female, n = 12 male) high school cross-country runners.Methods: The sample consisted of a combined dataset of two cohorts. In both cohorts, the Block Food Frequency Questionnaire (FFQ; 2005 & 2014 versions) assessed dietary intake. Fat free mass was assessed using dual-energy x-ray absorptiometry or bioelectrical impedance analysis.Results: Mean EA was less than recommended (45 kcal/kgFFM/day) among male (35.8 ± 14.4 kcal/kg FFM/day) and female endurance runners (29.6 ± 17.4 kcal/kgFFM/day), with 30.0% of males and 60.0% of females meeting criteria for low EA (<30 kcal/kgFFM/day). Calorie intake for male (2,614.2 ± 861.8 kcal/day) and female (1,879.5 ± 723.6 kcal/day) endurance runners fell below the estimated energy requirement for "active" boys (>3,100 kcal/day) and girls (>2,300 kcal/day). Female endurance runners' relative carbohydrate intake (4.9 ± 2.1 g/kg/day) also fell below recommended levels (6-10 g/kg/day). Male and female endurance runners exhibited below-recommended intakes of calcium, vitamin D, potassium, fruit, vegetables, grains, and dairy. Compared to male endurance runners, female endurance runners demonstrated lower relative intakes of energy (kcal/kg/day), protein (g/kg/day), fat (g/kg/day), fiber, vegetables, total protein, and oils.Conclusion: This study provides evidence of the nutritional risk of adolescent endurance runners and underscores the importance of nutritional support efforts in this population.

Cognitive dietary restraint score is associated with lower energy, carbohydrate, fat, and grain intake among female adolescent endurance runners.

This cross-sectional study investigated associations between cognitive dietary restraint (CDR), energy, macronutrient and food group intake, menstrual function, and bone density in female adolescent endurance runners. Participants were forty female adolescent endurance runners. The independent variable was CDR, as assessed by the Three Factor Eating Questionnaire (TFEQ). Runners with CDR subscale scores ≥11 were classified with elevated CDR. The main outcomes measured were dietary intake measured by 24-hour recall for 7 days, menstrual history, and bone mineral density (BMD). Twelve of 40 participants (30.0%) met criteria for elevated CDR. Compared to runners with normal CDR, runners with elevated CDR scores reported consuming lower energy (kcal/kg/day) (37.5 ± 8.6 vs. 44.0 ± 9.6, p = 0.052), lower carbohydrate (g/kg/day) (5.3 ± 1.3 vs. 6.3 ± 1.3, p = 0.042), more fiber (g/day) (24.9 ± 6.7 vs. 20.0 ± 5.3, p = 0.018), more servings of fruit (3.3 ± 1.4 vs. 1.9 ± 1.2, p = 0.003), more servings of vegetables (2.7 ± 1.4 vs. 1.7 ± 0.7, p = 0.004), and fewer servings of grain (7.6 ± 2.4 vs. 9.8 ± 2.4, p = 0.009) per day. Runners with elevated CDR exhibited significantly lower lumbar spine BMD Z-scores (adjusting for BMI) (-0.78 ± 0.19 vs. -0.22 ± 0.12, p = 0.016) than runners with normal CDR. Menstrual history did not significantly differ based on CDR status. Elevated CDR may increase risk of dietary patterns associated with consuming inadequate levels of energy, key nutrients, and developing low BMD in endurance runners. Trial Registration:ClinicalTrials.gov Identifier: NCT01059968.

Development of a Family-Based Nutrition Program Rooted in Food Parenting Literature.

Family-based nutrition programs have been used to support healthy eating; however, few programs emphasize parental roles in regard to food. The purpose of this study was to develop and test a family-based curriculum with a parenting focus aimed at influencing child obesity risk. Qualitative data in the pilot implementation (cohort 1, n = 6 families with elementary-aged children) suggested parent value for: positive messages, hands-on learning, and group sharing. However, Family Nutrition and Physical Activity (FNPA) scores for cohorts 2-6 (n = 18 families) did not change significantly from pre- to post-program. Future implementations will consider more robust ways of assessing change and recruiting participants at various stages of change.

Qualitative Evaluation of Drivers of Eating Decisions among SNAP Participants in Mississippi.

OBJECTIVE: To explore food-related decision patterns among Supplemental Nutrition Assistance Program (SNAP) recipients in Mississippi. DESIGN: A qualitative design was used to conduct focus groups (n = 18) based on the Health Belief Model with low-income female caregivers of children aged under 13 years. SETTING: Mississippi. PARTICIPANTS: Cluster sampling was used to recruit participants (n = 126) from the 4 regional divisions of Mississippi State University Extension. PHENOMENON OF INTEREST: Drivers of eating decisions among SNAP participants. ANALYSIS: Focus groups were recorded, transcribed, and coded by 2 independent coders using thematic analysis. RESULTS: Drivers of food selection often overlapped with barriers to healthy eating. Participants used many strategies to manage costs and viewed healthy foods as out of reach and quick to perish. Cost, taste preferences, habits, and family factors were primary drivers of food selection and preparation; each of these presented barriers to healthier eating. Health was most often shared as a driver of food selection once disease was established. Participants reported a variety of strategies used in striving for healthier eating. CONCLUSIONS AND IMPLICATIONS: Focusing on ways to manage the costs of healthy foods, honor taste preferences, and work within habits/families may enhance efforts to support healthy eating among SNAP participants.

Prioritized Dietary Supplement Information Needs of 307 NCAA Division I Student Athletes.

OBJECTIVE: To evaluate dietary supplement information needs among collegiate athletes. METHODS: Three hundred seven (n = 154 male; n = 153 female) student athletes participating in a National Collegiate Athletic Association Division I team completed a dietary supplement survey. Qualitative coding addressed open-ended responses, and chi-square test of independence explored differences among athlete subgroups. RESULTS: Five themes representing athletes' information needs included quality/composition (53.5%; n = 77), general information (31.9%; n = 46), nutrition information (30.6%; n = 44), performance (18.8%; n = 27), and body composition (13.2%; n = 19). Athletes with "no" or "minimal" (n = 63), vs "moderate" or "strong" (n = 195), perceived knowledge of supplement safety were more likely to list a question about supplement quality or composition (34.9% [n = 22/63] vs 21.5% [n= 42/195]; P = .03; chi-square = 4.6). CONCLUSIONS AND IMPLICATIONS: Further research is needed to corroborate findings to inform educational efforts and promote safe and effective use of dietary supplements by student athletes.

Parents Report Competing Priorities Influence Snack Choice in Youth Sports.

OBJECTIVE: To describe parental perceptions of team snacks, factors that motivate snack choice, and perceptions of healthy snacking guidelines in youth sports. METHODS: Six in-depth group interviews were conducted among parents (n = 22) of children aged 4-12 years in 2 Los Angeles County Baseball Little Leagues. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. RESULTS: Parents perceived fruit as the ideal snack; this ideal was balanced with competing priorities, including children's preferences, cost, time, and social norms regarding snacks as rewards and team bonding. Although parents were supportive of promoting healthy snacks, they believed that snacking guidelines should not be mandated. CONCLUSIONS AND IMPLICATIONS: Developing messages that align with parents' motivations when choosing snacks could promote healthier snacking in youth sports. Future studies are warranted to explore drivers of snacking with a broader sample and to examine how to promote healthy snacks effectively.

Academic-Related Factors and Emotional Eating in Adolescents.

BACKGROUND: Existing literature indicates a relationship between stress and emotional eating in adults, yet limited research has examined the impact of school-related stress on emotional eating in adolescents. This study investigated the influence of academic factors on emotional eating among minority adolescents. METHODS: A survey was implemented among a sample of minority adolescents (N = 666) to investigate the relationship between emotional eating and 3 academic factors: academic self-esteem, grade point average (GPA), and academic worries. Forced-entry multiple linear regressions were used to test for relationships. RESULTS: Findings indicate that GPA, academic self-esteem, and academic worries were related to emotional eating scores in adolescents. There were no significant differences in academic factors between emotional eaters and nonemotional eaters. CONCLUSIONS: Additional research is needed to further elucidate the complex interaction between emotional eating behavior and academics.

Childhood nutrition in the Mississippi Delta: challenges and opportunities.

Childhood obesity in the USA has more than tripled in the last three decades, and the prevalence is higher in the Mississippi Delta. Insight into the social, cultural and environmental factors that influence inequity can inform efforts to mediate health disparities. Focus groups (n = 12) among parents/guardians of elementary school children (n = 44) and teachers (n = 59) in the Mississippi Delta were used to investigate barriers and facilitators of healthy eating. Transcriptions were analyzed for themes. A strong preference for junk food among children and the pervasiveness of junk foods in schools and communities were cited as barriers to healthy eating. Potential facilitators of healthy eating included desire to avoid chronic disease, effort to limit junk food consumption and school support. Despite support for efforts to improve nutrition in the Delta, participants voiced a sense of inevitability related to children's consumption of unhealthy foods. This study suggests that parents and teachers express concern related to eating habits of children, yet they experience barriers to healthy eating which contribute to a sense of disempowerment. Improving health in the Mississippi Delta requires comprehensive strategies that offer its citizens a sense of agency.

Family characteristics have limited ability to predict weight status of young children.

The ability of (a) family characteristics (marital status, income, race, and education), (b) parental control over child's food intake, and (c) parental belief in causes of overweight to predict weight status of children was assessed. Parents/caretakers of elementary school-aged children were surveyed to determine attitudes related to childhood nutrition and overweight. Anthropometric measurements were obtained from children to determine weight status (n=169 matched surveys and measurements). chi(2) tests and nested logistic regression models were used to determine relationships between children's weight status and family characteristics, parental control, and parental belief in the primary cause of overweight. Low household income was an important predictor of overweight; marital status and race added no further explanatory power to the model. Parental control was not a significant predictor of overweight. Parental belief in the primary cause of overweight in children (diet vs physical activity) was significantly related to children's weight; however, it was not significant after controlling for income. Low household income relates strongly to increased childhood weight status; therefore, school and government policies should promote an environment that supports affordable, safe, and feasible opportunities for healthful nutrition and physical activity, particularly for low-income audiences.

Dietary acculturation of Hispanic immigrants in Mississippi.

OBJECTIVE: Assisting Hispanic immigrants in making culturally acceptable food choices may affect their health for generations. As a relatively new enclave of Hispanics, Scott County, Mississippi, was chosen to study dietary acculturation and health concerns of immigrants. MATERIAL AND METHODS: The research method consisted of interviews with community representatives (N=11), a focus group (N=6), and interviews with Hispanic immigrants (N=18). RESULTS: Community representatives mentioned availability influenced immigrants' food choices and suggested promoting cultural awareness and offering nutrition classes on local ingredients. Food cost, health concepts, food selection, and eating habits of children were salient themes from the focus group and interviews with Hispanics. Hispanic participants mentioned long work hours affect food selection and that U.S. produce lacks freshness and flavor. CONCLUSIONS: Results indicate that an intervention must be formulated that preserves healthful dietary practices and minimizes the negative health aspects of acculturation to the "American diet"

Dietary acculturation of Hispanic immigrants in Mississippi

OBJETIVO: Ayudar a inmigrantes hispanos en la elección de una dieta culturalmente aceptable puede incidir sobre su salud por generaciones. Para estudiar la relación entre aculturación alimentaria y salud en los inmigrantes, se escogió Scott County, Mississippi, un enclave relativamente nuevo de inmigrantes hispanos en Estados Unidos de América (EUA). MATERIAL Y MÉTODOS: El método de investigación consistió en entrevistas con representantes de la comunidad (N=11), un grupo focal (N=6) e inmigrantes hispanos (N=18). RESULTADOS: Representantes de la comunidad mencionaron que lo que influye en la elección de sus alimentos es la disponibilidad de éstos; asimismo sugirieron la organización de actividades para conocer diferentes culturas, al igual que clases de nutrición para aprender cómo utilizar ingredientes locales. Cinco fueron los temas más relevantes que se identificaron durante las entrevistas con los inmigrantes y el grupo focal: el precio de la comida, ideas sobre la salud, factores que influyen en la selección de la comida y la nutrición de los niños inmigrantes. Los participantes hispanos mencionaron que las jornadas de trabajo tan largas afectan la selección de la comida y que los productos del campo en EUA no son frescos ni tienen sabor. CONCLUSIONES: Los resultados indican que hace falta una intervención que ayude a preservar prácticas alimentarias saludables y que minimice los aspectos negativos de la aculturación por la dieta predominante en EUA.