Implementing a Food Prescription Program during COVID-19: Benefits and Barriers.

Food prescription programs (Food Rx) have the potential to improve management of diet-related chronic diseases or underlying conditions such as type 2 diabetes (T2D), hypertension, and high body mass index (BMI) among food-insecure patients. The purpose of this study was to examine the effectiveness of a Food Rx program implemented in two community-based clinics in Florida. Data were collected through researcher-administered surveys (food insecurity, demographics, and socio-economic variables) and biometric data (HbA1c, blood pressure, and BMI). Key results include the following: (1) Hispanic patients are more likely to utilize the program than their Black and White counterparts (p < 0.001); (2) older patients (≥50 years) have a higher food redemption rate when compared to younger patients (36-49.9 years); (3) food redemption rate is negatively associated with food security scores indicating improvements in food security status over time (r2 = -0.184, p = 0.036); (4) diabetic patients with higher baseline HbA1c (>9%) have significant reductions in glycated hemoglobin (p = 0.011) over time as compared to patients with lower baseline values (<7%); and (5) patients enrolled in the program for at least 6 months have a significant reduction in systolic blood pressure (p = 0.051). Changes in BMI were not significantly associated with redemption rates. This study is significant as it offers insights into the potential benefits and challenges of implementing Food Rx programs to address diet-related chronic diseases among underserved populations.

Experiences of New Visitors With Low Food Security Seeking Food Assistance During the COVID-19 Pandemic.

OBJECTIVE: To describe the experiences of first-time visitors with low food security seeking food assistance during the coronavirus disease 2019 pandemic. DESIGN: A qualitative study. SETTING: Emergency food distribution sites in West Central Florida. PARTICIPANTS: Adults (aged 18-64 years) seeking food assistance between November, 2020 and July, 2021. PHENOMENON OF INTEREST: Using food security as a multidimensional concept, in-depth interviews explored the impact of emergency food assistance on food availability, access, utilization, and stability. ANALYSIS: Applied thematic analysis was conducted to identify emergent themes. RESULTS: Participants (n = 18) were White (55.6%), female (72.2%), and aged 40-59 years (55.6%). Seven salient themes described participants' experience seeking food assistance (eg, the crisis resulting in seeking food assistance, mixed quality of pantry foods, and gaining firsthand insight on hunger). Although food assistance increased food availability and access, there were barriers to using the pantry foods (eg, foods not preferred, health/allergies). CONCLUSIONS AND IMPLICATIONS: Study findings suggest that first-time visitors seeking emergency food assistance during the coronavirus disease 2019 pandemic may be experiencing temporary cycles of financial instability, which could impact dietary quality. Because pantry foods are often the primary source of household food supply, client-focused emergency food distribution tailored to client needs can increase food availability, access, and utilization.

Multi-Level Determinants of Food Insecurity among Racially and Ethnically Diverse College Students.

Compared with the general population, the prevalence of food insecurity (FI) is higher among college students. The COVID-19 pandemic exacerbated FI disparities and highlighted the need for further research to better understand and address FI in this population. Although race and ethnicity are two of the strongest predictors of FI among college students, little research is available on the determinants of FI among racial/ethnic minority college students. A cross-sectional study (n = 588) based on the National Institute of Minority Health and Health Disparities research framework was examined to identify population-specific determinants of FI among racially/ethnically diverse college students through the assessment of multiple domains (behavioral, environmental, socio-cultural) and levels of influence (individual, interpersonal, and community levels). Discrimination was the sole predictor of FI for non-Hispanic Black students. Coping mechanisms for FI (savings, reduced intake) and body mass index (BMI) were predictors of FI for Hispanic and non-Hispanic White students. Additionally, decreased holistic support from faculty and staff was also observed as a predictor of FI in Hispanic students. Implications include the need for further research and the development of multi-level, tailored interventions to address FI among college students with the goal of decreasing disparities.

Mixed-method assessment of caregiver feeding practices in early care and education centres during COVID-19.

OBJECTIVE: The COVID-19 pandemic changed early care and education (ECE) mealtimes. Feeding practices that support children's emerging autonomy may support children's healthy eating, but it is unknown whether and how COVID-19 changed feeding practices. This paper describes caregiver feeding practices in ECE centres in Florida during COVID-19. DESIGN: A mixed-methods design was used to understand mealtime feeding practices. Survey and interview questions were developed based on the Trust Model. More than 7000 surveys were sent to ECE centres. Analysis included descriptive statistics for survey data and thematic analysis for interview data. SETTING: This statewide study included teachers in all licensed and license-exempt ECE centres. PARTICIPANTS: Four hundred and thirty-one teachers completed a survey, and twenty-nine participated in follow-up interviews. RESULTS: Surveys showed most teachers engaged in autonomy-supportive behaviours, such as letting children eat until they were finished (90 %). The most common controlling behaviour was praising children for cleaning their plates (70 %). The most common responses about changes to mealtimes were keeping physical distance and serving healthy food. Interview themes were Autonomy Support, Controlling Feeding Practices, Interactions are the Same, Interactions are Different, Physical Distancing and Healthy Eating. CONCLUSIONS: Mealtimes are a central part of the day for young children and teachers in ECE environments. COVID-19 continues to influence ECE routines as behaviour change remains the primary method of reducing the risk of COVID-19 in the absence of a vaccine for young children. Understanding teachers' practices and perspectives is important for reducing the risk of COVID-19 and supporting children's autonomy and healthy eating.

"I Wear a Mask. I Wear It All the Time. The Kids Don't Wear Masks": Early Childhood Education Mask-Wearing During COVID-19 in Florida.

BACKGROUND: New federal health guidance was issued for early childhood education (ECE) programs to reduce the risk of COVID-19 in March 2020. The Centers for Disease Control and Prevention recommended mask-wearing for adults and children aged 2 years and older. Wearing masks was a new practice for teachers and children, and this study investigated when and how masks were worn in ECE centers in Florida. METHODS: This study was part of a larger assessment of the impact of COVID-19 on mealtime routines in ECE centers. Two statewide surveys based on the Trust Model were sent to directors and teachers via Florida Department of Children and Families. Only teachers were interviewed. Data were collected from August to October 2020. The analysis included survey results and interview responses related to mask-wearing. RESULTS: Surveys were completed by 759 directors and 431 teachers, and 29 teachers were interviewed. Survey results indicated that more teachers than children wore masks during pre- and postmeal activities. Interviews revealed three models that explain mask-wearing: (1) teachers only, in which teachers were required to wear a mask, but children were not; (2) teachers and children, in which teachers and children were required to wear a mask; and (3) masks optional, in which teachers and children could choose to wear a mask. CONCLUSION: Understanding how decisions about mask-wearing were made at the center level can inform training and support health and safety in ECE. Use of personal protective equipment (such as masks) is effective for reducing risk of pathogen transmission for children and adults in ECE settings.

"Just sit and eat." Adult and Child Mealtime Responsibilities in Early Care and Education Centers During COVID-19 in Florida.

Most young children in the United States attend early care and education (ECE) programs, in which they eat 3-4 times daily. 'Division of responsibility' between adult and child means the adults are responsible for what, when and where, and the child is responsible for whether, what and how much to eat. A balanced division of responsibility can support children's development of healthy eating competency. This paper aims to describe division of responsibility during mealtimes during COVID-19 in Florida using a cross-sectional, mixed methods design. Questions were developed based on Trust Model and Social Cognitive Theory. A survey was completed by 759 ECE directors and 431 teachers, and 29 teachers completed in-depth interviews. COVID-19 increased teacher mealtime responsibilities. Most (95%+) ECE teachers provided meals at the same time and place daily (when and where). Children determined what and how much they ate, but did not serve or handle food. Implications include modifying mealtime routines to minimize the risk of COVID-19 and support healthy eating with a balanced division of responsibility.

Mealtime best practices and infection control in early care and education centres during COVID-19.

BACKGROUND: Most young children in the United States attend early care and education (ECE) programmes, where they consume the majority of daily calories. Best practices to support children's healthy eating include teachers sitting together with children, eating the same food, and appropriately supporting children in serving and feeding themselves. To understand how the COVID-19 pandemic changed mealtime practices in ECE, this study (1) describes what adaptations ECE directors and teachers made to mealtimes to include best practices, and (2) identifies common adaptations made to comply with COVID-19 infection control guidelines. METHODS: This cross-sectional, mixed-methods study utilized survey and interview questions based on the trust model and social cognitive theory. More than 7000 surveys were distributed to ECE directors and teachers in Florida. Surveys were completed by 759 directors and 431 teachers. Also, 29 follow-up interviews with teachers were completed. Participants were asked to describe their mealtimes before and during COVID-19. Descriptive statistics and frequencies were used to analyse survey data, and thematic analysis was applied to interview data. RESULTS: Less than 5% of survey respondents reported children serving themselves, a pre-COVID best practice. Interviews identified three common adaptations: (1) modification-best practices were incorporated into new routines, such as eating together but sitting farther away, (2) elimination-routines changed so that best practices were no longer possible, such as teachers wearing masks and standing during meals, and (3) minimal change-minimal changes due to COVID-19 occurred and consequently mealtime practices did not change. CONCLUSIONS: Current recommendations do not allow children to self-serve, which previously was a key best practice. ECE centres that have successfully integrated COVID-19 modifications and maintained mealtime best practices-perhaps in a new form-can serve as examples for others. These findings are generalizable to ECE centres in Florida and could be compared with other states.

Using syndemic theory to understand food insecurity and diet-related chronic diseases.

Syndemic Theory (ST) provides a framework to examine mutually enhancing diseases/health issues under conditions of social inequality and inequity. ST has been used in multiple disciplines to address interacting infectious diseases, noncommunicable diseases, and mental health conditions. The theory has been critiqued for its inability to measure disease interactions and their individual and combined health outcomes. This article reviews literature that strongly suggests a syndemic between food insecurity (FI) and diet-related chronic diseases (DRCDs), and proposes a model to measure the extent of such interaction. The article seeks to: (1) examine the potential syndemic between FI and DRCDs; (2) illustrate how the incorporation of Life History Theory (LHT), into a syndemic framework can help to highlight critical lifeperiods when FI-DRCD interactions result in adverse health outcomes; (3) discuss the use of mixed methods to identify and measure syndemics to enhance the precision and predictive power of ST; and (4) propose an analytical model for the examination of the FI-DRCD syndemic through the life course. The proposed model is more relevant now given the significant increase in FI globally as a result of the ongoing COVID-19 pandemic. The differential impact that the pandemic appears to have among various age groups and by other demographic factors (e.g., race, gender, income) offers an opportunity to examine the potential FI-DRCD syndemic under the lens of LHT.

Food Insecurity, Well-being, and Academic Success among College Students: Implications for Post COVID-19 Pandemic Programming.

College students experience food insecurity at higher rates than the general population, which has been found to be directly and indirectly associated with poor mental and physical health in addition to academic success. Since the rise of the COVID-19 pandemic, mounting evidence has demonstrated an increase in food insecurity rates in the U.S. The current study assessed food insecurity and its associated impacts on health and academic success among college students at a large urban university (n = 1743). Results revealed 46.8% of students as food insecure with statistically significant differences in race/ethnicity, GPA, and hours worked per week. Students who were observed with any level of food insecurity were more likely to also experience challenges with academics, careers, procrastination, and faculty as compared to their food secure counterparts. Analysis of differences in well-being indicators by food insecurity status revealed that students with any level of food insecurity were observed with statistically significantly higher mean scores for psychological distress, loneliness, and suicide behavior, with reduced scores for flourishing and resiliency as compared to their food secure counterparts. Implications for post-COVID-19 programming to mitigate food insecurity and associated public health issues associated with the COVID-19 and future pandemics are discussed.

A Mixed-methods Study to Understand Food Environments and Grocery Shopping Patterns of Community Residents in Underserved Neighborhoods in Tampa, Florida.

A mixed methods study was conducted to better understand food access, food retail store environment, and perspectives of community residents on their grocery store shopping patterns and access to healthy foods in underserved, predominantly African American neighborhoods. GIS mapping, grocery store observations (n = 4), a food access and grocery store environment survey (n = 126), and focus groups (n = 48) were used. The results indicate that these neighborhoods have a low density of grocery stores, and only two out of four grocery stores meet the standard for a healthy retail store. Barriers to getting healthy foods and solutions to improve food access are discussed.

Food Insecurity and Age at Menarche in Tampa Bay, Florida.

The aim of this study was to assess whether household food insecurity is associated with delayed or early menarche among girls in the United States. Thirty-six dyadic household interviews were conducted with mothers and adolescent girls. The interviews included a socio-demographic survey, the USDA Six-Item Short Form Household Food Security Survey Module, anthropometric measurements, and the self-administered Youth-Adolescent Food Frequency Questionnaire. Using non-parametric quantitative analyses, we examined the associations among food insecurity, anthropometrics, diet, and age at menarche. Cox Proportional Hazards Models were used to evaluate the odds of menarche based on household food insecurity. Food insecurity significantly predicted earlier time to menarche. Food insecure girls were 4.38 times more likely to experience menarche at earlier ages when compared to food secure girls (HR = 4.38, p = .04). Furthermore, the hazard of menarche increased by 25% for each unit increase in food insecurity (OR = 1.253, p = .027). The findings suggest that household food insecurity is associated with earlier ages of menarche among girls in this sample. Early menarche has been associated with adult chronic disease risk. Thus, these findings propose that food security initiatives may be used to reduce the prevalence and health consequences of early-onset puberty.

Food and Nutrient Intakes of Jamaican Immigrants in Florida.

This study assessed dietary intakes, nutritional composition, and identified commonly eaten foods among Jamaicans in Florida. Dietary intake was assessed among 44 study participants to determine commonly eaten foods and nutrient composition. Weighed recipes were collected and analyzed to determine nutrient composition for traditional foods. Top foods that contributed to macronutrient and micronutrient intake were identified and adherence to dietary recommendations was evaluated. Mean daily energy intake was 2879 (SD 1179) kcal and 2242 (SD 1236) kcal for men and women respectively. Mean macronutrient intakes were above dietary recommendations for men and women. Top foods contributing to energy included rice and peas, sweetened juices, chicken, red peas soup, and hot chocolate drink. Results showed sodium intake was more than double the adequate intake estimate (1300-1500 mg). Findings highlight the need to include commonly eaten traditional foods in dietary questionnaires to accurately assess diet-related chronic disease risk. Findings have implications for risk factor intervention and prevention efforts among Jamaicans.

Food insecurity and healthcare decision making among mobile food pantry clients in Tampa Bay.

This article examines the relationship between food insecurity and health-care decision-making among mobile food pantry clients in Tampa Bay, Florida. Results show a high rate of food insecurity, high stress levels, and chronic health conditions among mobile pantry clients, many of whom are long-term users of food pantry services. The fruits and vegetables supplied by the pantry allow clients to manage chronic health conditions and mitigate some of the financial burden of health-care costs. Research was conducted in cooperation with the Anthropology Department at the University of South Florida, Feeding Tampa Bay, and WellCare .

Acculturation and dietary intake pattern among Jamaican immigrants in the US.

Information on dietary intakes of Jamaican immigrants in the United States is sparse. Understanding factors that influence diet is important since diet is associated with chronic diseases. This study examined the association between acculturation, socio-cultural factors, and dietary pattern among Jamaican immigrants in Florida. Jamaican persons 25-64 years who resided in two South Florida counties were recruited for participation. A health questionnaire that assessed acculturation, dietary pattern, and risk factors for cardiovascular disease was administered to participants. Generalized Estimating Equations were used to determine associations. Acculturation score was not significantly associated with dietary intake pattern (ß = - 0.02 p = 0.07). Age at migration was positively associated with traditional dietary pattern (ß = 0.02 p < 0.01). Persons with 12 or fewer years of education (ß = - 0.55 p < 0.001), divorced (ß = - 0.26 p = 0.001), or engaged in less physical activity (ß = - 0.07 p = 0.01) were more likely to adhere to a traditional diet. Although acculturation was not a statistically significant predictor of dietary intake, findings show the role of demographic and lifestyle characteristics in understanding factors associated with dietary patterns among Jamaicans. Findings point to the need to measure traditional dietary intakes among Jamaicans and other immigrant groups. Accurate assessment of disease risk among immigrant groups will lead to more accurate diet-disease risk assessment and development of effective intervention programs.

Using a biocultural approach to examine migration/globalization, diet quality, and energy balance.

The aim of this paper is to examine the role and impact that globalization and migration (e.g., intra-/intercontinental, urban/rural, and circular) have had on diet patterns, diet quality, and energy balance as reported on in the literature during the last 20 years. Published literature from the fields of anthropology, public health, nutrition, and other disciplines (e.g., economics) was collected and reviewed. In addition, case studies from the authors' own research are presented in order to elaborate on key points and dietary trends identified in the literature. While this review is not intended to be comprehensive, the findings suggest that the effects of migration and globalization on diet quality and energy balance are neither lineal nor direct, and that the role of social and physical environments, culture, social organization, and technology must be taken into account to better understand this relationship. Moreover, concepts such as acculturation and the nutrition transition do not necessarily explain or adequately describe all of the global processes that shape diet quality and energy balance. Theories from nutritional anthropology and critical bio-cultural medical anthropology are used to tease out some of these complex interrelationships.

"We never ate like that, not fast food, or junk foods": accounts of changing maternal diet in a tourist community in rural Costa Rica.

This investigation examines maternal diet in rural Costa Rica in the context of recent political economic changes. Results show that increased availability of non-local food items, (i.e., pizza and processed foods) has influenced maternal dietary choices. Information pathways, which have traditionally provided women with knowledge about maternal diet from family members, are also shifting. Younger women turn to the local clinic and the media for information about maternal diet, and traditional practices, such as cuarentena (40-day postpartum period), are no longer being observed. Changing practices may be linked with shifting information pathways, as well as self-reported weight gain among women.

Food insecurity is associated with acculturation and social networks in Puerto Rican households.

OBJECTIVE: To examine whether acculturation and social networks influence household food insecurity in an inner-city Puerto Rican community. METHODS: A survey was administered to 200 low-income female Puerto Rican caregivers with at least 1 child 12-72 months old living in Hartford, CT. Food insecurity was measured with the Radimer/Cornell Hunger Scale. Multivariate logistic regression analyses were used to identify food insecurity risk factors. RESULTS: Significant food insecurity risk factors included: being unemployed (odds ratio: 2.69), being single (2.34), being born in the United States (2.68), speaking only Spanish (3.15), planning to return to Puerto Rico (4.58), almost never/never attending Hispanic cultural events (6.85), and food stamps lasting less than a month (7.74). CONCLUSIONS AND IMPLICATIONS: Low levels of acculturation, lack of social networks, and poor food stamps management skills may influence household food insecurity.

Using social marketing to understand the family dinner with working mothers.

The family dinner is a valued tradition that affords opportunities for social interaction and attachment, as well as sharing events of the day, role modeling, connectedness, and problem solving. Guided by the social-marketing framework, this study explored factors associated with the frequency of the family dinner among working mothers with children ages 8-11 years. A qualitative design was used, employing focus groups and Atlas-ti software for thematic analysis. Lack of time, cost, and exhaustion/lack of energy emerged as barriers. Working mothers indicated that a youth-based organization operating as a community partner could increase the frequency of the family dinner by helping with homework completion during after-school care, thereby providing mothers with the time necessary to prepare dinner. This research identified both community partners and working mothers as valued resources for prevention strategies. Interventions developed to increase family dinner frequency should emphasize the perceived value while decreasing the costs/barriers.