Improving Maternal Health and Birth Outcomes Through FreshRx: A Food-Is-Medicine Intervention.

PURPOSE: Food insecurity has far-reaching consequences for health and well-being, especially during pregnancy and postpartum periods. This study examines a food-is-medicine approach that aimed to reduce food insecurity, maternal stress, depression, anxiety, preterm labor, and low birthweight. DESIGN: Pre-post interventional study of FreshRx: Nourishing Healthy Starts, a pregnancy focused food-is-medicine program led by a local hunger relief organization and obstetrics department. SETTING: St. Louis, Missouri, a Midwestern U.S. city with higher-than-average infant mortality, low birthweight, and preterm birth rates. SAMPLE: Participants (N = 125) recruited from a local obstetrics clinic had pregnancies earlier than 24 weeks gestation; spoke English; and were enrolled in Medicaid. At baseline, 67.0% reported very low food security and none reported high food security, while 34.7% indicated depressive symptoms. INTERVENTION: FreshRx included weekly deliveries of fresh food meal kits, nutrition counseling and education, care coordination, and supportive services. MEASURES: 18-Question U.S. Household Food Security Survey, Edinburgh Postnatal Depression Scale, birthweight, gestational age. ANALYSIS: Single arm pre-post analysis. RESULTS: Average gestational age of 38.2 weeks (n = 84) and birthweight of 6.7 pounds (n = 81) were higher than rates for the general population in the area. For study participants who completed a sixty-day post-partum assessment, 13% (n = 45) indicated maternal depression (P < .01). CONCLUSION: Food-is-medicine interventions may be an efficient, effective, and equitable tool for improving birth and maternal health outcomes.

Home quarantines and cumulative risk exposure among young children: Isolation and maladaptation.

Self-isolation and quarantine are common and effective measures to contain the spread of COVID-19. However, it may have detrimental implications on young children's adaptation and mental health. The present study explores the prevalence of home quarantines among young children in Israel and their associations with children's maladaptive behaviors. The analysis is based on self-reported data obtained by 374 parents of young children in November 2021. Participants completed questionnaires, assessing the prevalence of home quarantines among children (aged 3-11 years old), and maladaptive behaviors, including rage outbursts, physical violence against family or friends, and panic attacks. Multivariate regression models were used to determine the relationships between the number of child quarantines and their maladaptive behaviors. Our results suggest that 51% of parents reported having their child quarantined more than once, which did not differ across socioeconomic characteristics. Furthermore, 66% of parents reported that during the pandemic, their child exhibited maladaptive behaviors at least once. Children who were quarantined more than once were more likely to exhibit rage outbursts, physical violence, and/or panic attacks. The associations between children's quarantine and physical violence were slightly stronger among families living in high-density households. Repeated experiences of home quarantine may operate as exposure to accumulative risk and have a lasting effect on young children's development. Practice and policy recommendations for interventions for young children and their families who experience home quarantines are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Connecting the Dots between Barriers to W.I.C. Access and Adult and Child Food Insecurity: A Survey of Missouri Residents.

Background. Previous research has explored the impact of W.I.C. on recipients' health, but less is known about the connection between barriers to W.I.C. access and health outcomes. We fill in a gap in the literature by studying the relationship between barriers to Special Supplemental Nutrition Program for Women, Infants, and Children (W.I.C.) access and adult and child food insecurity. Methods. After survey administration, we analyzed a cross-sectional sample of 2244 residents in Missouri who have used W.I.C. or lived in a household with a W.I.C. recipient in the past three years. We ran logistic regression models to understand the relationships among barriers to W.I.C. utilization, adult food insecurity, and child food insecurity. Results. Having special dietary needs (for adults), lacking access to technology, encountering inconvenient clinic hours of operation, and experiencing difficulties taking off work were associated with increased adult food insecurity. Difficulties finding WIC-approved items in the store, technological barriers, inconvenient clinic hours, difficulties taking off work, and finding childcare were associated with increased child food insecurity. Conclusion. Barriers to accessing and utilizing W.I.C. are associated with adult and child food insecurity. However, current policies suggest promising approaches to curbing these barriers.

How Did Reskilling During the COVID-19 Pandemic Relate to Entrepreneurship and Optimism? Barriers, Opportunities, and Implications for Equity.

With shorter durations and fewer barriers to entry, reskilling programs may serve as vehicles for social mobility and equity, as well as tools for creating a more adaptive workforce and inclusive economy. Nevertheless, much of the limited large-scale research on these types of programs was conducted prior to the COVID-19 pandemic. Thus, given the social and economic disruptions spurred by the pandemic, our ability to understand the impact of these types of programs in recent labor market conditions is limited. We fill this gap by leveraging three waves of a longitudinal household financial survey collected across all 50 US states during the pandemic. Through descriptive and inferential methods, we explore the sociodemographic characteristics related to reskilling and associated motivations, facilitators, and barriers, as well as the relationships between reskilling and measures of social mobility. We find that reskilling is positively related to entrepreneurship and, for Black respondents, to optimism. Moreover, we find that reskilling is not merely a tool for upward social mobility, but also economic stability. However, our results demonstrate that reskilling opportunities are stratified across race/ethnicity, gender, and socioeconomic status through both formal and informal mechanisms. We close with a discussion of implications for policy and practice.

How does social support relate to emotional availability for learning during COVID-19? A multi-group structural equation model of university students from the U.S. and Israel.

Given the social and emotional tolls of the COVID-19 pandemic on college and university students, many students have become academically disengaged during the pandemic. Although some colleges and universities have the capacity to promote social support for their students, research has yet to comprehensively demonstrate the relationship between social support and academic engagement. To fill this gap, we leverage survey results from four universities across the United States and Israel. Through multi-group structural equation modelling, we explore (a) how perceived social support relates to being emotionally unavailable for learning, (b) how this relationship is partially explained through coping and COVID-19 concerns, and (c) how these relationships can differ across countries. We find that students who perceived higher levels of social support had lower rates of being emotionally unavailable for learning. Part of this relationship occurred through greater rates of coping and, subsequently, fewer concerns about the pandemic. We also noticed significant differences in these relationships between countries. We conclude with a discussion of study implications for higher education policies and practices.

Implementation of Flexibilities to the National School Lunch and Breakfast Programs and Their Impact on Schools in Missouri.

BACKGROUND: In 2018, the United States Department of Agriculture (USDA) issued flexibilities to the National School Lunch and Breakfast Programs, relaxing the nutrition standards for milk, whole grains, and sodium. This study examines the implementation decision-making among Missouri school food services and the impact of implementing these flexibilities on the meals served. METHODS: We developed a survey using the Consolidated Framework of Implementation to determine schools' implementation of the flexibilities and factors related to implementation. To determine how the implementation of flexibilities affected participation, we merged the survey results with school-level meal county data from the Missouri Department of Elementary and Secondary Education. We used ordinary least squares regression to examine how flexibility adoption related to the number of meals served. RESULTS: Most schools implemented the wheat, milk, and sodium flexibilities. Common reasons for implementation were increasing participation, meeting students' preferences, expanding menu variety, and saving money. The implementation of flexibilities was associated with more lunches and breakfasts being served per month, particularly among free and reduced-price meals. CONCLUSIONS: Continued research is needed to determine how the increased uptake of school meals that do not fully meet dietary guidelines by low-income students results in inequities in health outcomes. The findings can inform the design and implementation of future policies, especially as new rules related to flexibility design are determined.

Intersecting Race and Gender Across Hardships and Mental Health During COVID-19: A Moderated-Mediation Model of Graduate Students at Two Universities.

While the effects of the pandemic on the mental health of college students can vary across race and gender, few studies have explored the role of hardships and university assistance in these disparities, as well as how these disparities can manifest themselves differently across intersections of race and gender. We address this gap by using unique survey data (n = 417) from two large graduate schools of social work, public health, and social policy in the United States. Using multi-group structural equation modeling, we explore how material hardships, academic hardships, and university assistance needed mediates the relationship between race and mental health, including depression and anxiety. We also explore how gender moderates these relationships. We find that Black students are directly related to material hardships and-through these hardships-indirectly related to increased depression, indicating mediation. However, material hardships did not mediate the relationship between race and anxiety. Furthermore, while academic hardships mediated the relationships between race and depression, as well as race and anxiety, these relationships were only significant for females, indicating moderated-mediation. Moreover, although university assistance needed mediated the relationship between race and depression for females only, university assistance needed mediated the relationship between race and anxiety for both males and females. We close with implications for policy and practice.

How Do Perceived Changes in Child and Adolescent Activities Relate to Perceptions of Health during COVID-19? Exploring Heterogeneity during the Pandemic.

COVID-19 affected child/adolescent activities (e.g., extra-curricular, screen time), along with physical health (PH) and mental health (MH); however, less is known about the relationship between changes in activities and PH and MH in the United States and how these relationships vary by race/ethnicity. To address this gap, data were used from a national survey (Socio-Economic Impacts of COVID-19 Survey) administered May-June 2021 (n = 853). Multinomial logistic regression explored changes in outdoor, school, extracurricular, friend, and screen time activities with changes in PH and MH; interactions explored moderation by race/ethnicity. Results showed increases in outdoor (RRR 2.36, p = 0.003), school (RRR 3.07, p < 0.001), and extracurricular activities (RRR 3.05, p < 0.001), which were associated with increases in chances of better PH. Better MH was more likely for children/adolescents where friend activities (RRR 3.34, p < 0.001) and extracurriculars (RRR 4.48, p < 0.001) increased. Except for extracurriculars, heterogeneous relationships were observed (e.g., increases and decreases in activities were simultaneously related to better and worse health). The relationship between outdoor activities and screen time with health were moderated by race/ethnicity. Findings support facilitating outdoor, school, extracurricular, and friend activities, which were positively related to health. Given heterogeneity and variation by race/ethnicity, more research is needed to understand the complex relationship between activities and health during COVID-19.

At Home and on the Brink: U.S. Parents' Mental Health during COVID-19.

Though the COVID-19 pandemic required significant changes and adaptations for most Americans, parents faced acute challenges as they had to navigate rapidly changing schooling and child care policies requiring their children to spend more time at home. This study examines the effects of COVID-19 school and workplace policies as well as environmental and economic characteristics on parental mental health, worry, hopelessness, and anxiety. Using data from four waves of the Socio-Economic Impacts of COVID-19 Survey and regression analysis, we explore associations between parents' mental health, worry, hopelessness, and anxiety and school learning environment, child grade and learning disability, employment characteristics, and sociodemographic factors. We find that having a child attend a private school or school with above average instructional quality was associated with better mental health of parents. Hybrid schooling options offering both in-person and online learning was associated with poor parental mental health, as was working from home. Being female or experiencing job or income loss were associated with worse mental health while having older children, a bachelor's degree, or high income were associated with better mental health. Results can help inform school and workplace family supports as well as opportunities to reduce mental health strains at home from various policy options.

Increased School Breakfast Participation from Policy and Program Innovation: The Community Eligibility Provision and Breakfast after the Bell.

School meals provide significant access to food and nutrition for children and adolescents, particularly through universal free meal mechanisms. Alongside added nutritional meal requirements under the Healthy, Hunger-Free Kids Act (2010), schools can utilize meal program and policy mechanisms such as the Community Eligibility Provision (CEP) and Breakfast after the Bell (BATB) to increase participation. This study examines longitudinal statewide school-level CEP and BATB adoption and estimates the impact on increased free and reduced-price (FRP) breakfast participation. We find that FRP breakfast participation increased for schools that utilize both CEP and BATB (14-percentage-point increase) and that CEP-participating schools are more likely to use BATB approaches such as breakfast in the classroom, grab-and-go carts, and second-chance breakfast. Additionally, using a conditional Difference-in-Differences (DiD) approach, we find that BATB adoption accounted for a 1.4-percentage-point increase in FRP school breakfasts served (p < 0.05). Study findings can inform policy and school official decision making around the policy and program mechanisms at their disposal to increase school meal participation and student nutrition.

Correction to: Intersecting Race and Gender Across Hardships and Mental Health During COVID 19: A Moderated Mediation Model of Graduate Students at Two Universities.

[This corrects the article DOI: 10.1007/s12552-022-09379-y.].

How Did School Meal Access Change during the COVID-19 Pandemic? A Two-Step Floating Catchment Area Analysis of a Large Metropolitan Area.

SARS-CoV-2 (COVID-19) resulted in school closures and contingencies across the U.S. that limited access to school meals for students. While some schools attempted to provide alternative meal access points where students or parents could pick up meals, many students-especially those in low-income households-lacked adequate transportation to these access points. Thus, physical proximity to meal access points was particularly important during the pandemic. In this study, we explore how school meal access changed during the COVID-19 pandemic, especially as it relates to race/ethnicity and socio-economic status. Taking into account both the "supply" (meal access points) and the "demand" (low-income students) for free meals, we employed a two-step floating catchment area analysis to compare meal accessibility in St. Louis, Missouri before and during the pandemic in the spring and summer of 2019 and 2020. Overall, while school meal access decreased during the spring of 2020 during the early months of the pandemic, it increased during the summer of 2020. Moreover, increased access was greatest in low-income areas and areas with a higher proportion of Black residents. Thus, continuing new policies that expanded access to school meals-especially for summer meal programs-could lead to positive long-term impacts on children's health and well-being.