An online qualitative study exploring wants and needs for a cooking programme during pregnancy in the UK and Ireland.

BACKGROUND: Optimal maternal nutrition is associated with better pregnancy and infant outcomes. Culinary nutrition programmes have potential to improve diet quality during pregnancy. Therefore, this research aimed to understand the experiences of cooking and the wants and needs of pregnant women regarding a cooking and food skills programme in the United Kingdom (UK) and Republic of Ireland (ROI). METHODS: Online focus group discussions with pregnant women and those who had experienced a pregnancy in the UK or ROI were conducted between February and April 2022. Two researchers conducted a thematic analysis. Seven focus groups with ROI participants (n = 24) and six with UK participants (n = 28) were completed. RESULTS: Five themes were generated. These were (1) cooking during pregnancy: barriers, motivators and solutions; (2) food safety, stress and guilt; (3) need for cooking and food skills programmes and desired content; (4) programme structure; (5) barriers and facilitators to programme participation. Overall, there was support for a programme focusing on broad food skills, including planning, food storage, using leftovers and to manage pregnancy-specific physiological symptoms such as food aversions. Participants emphasised the importance of inclusivity for a diverse range of people and lifestyles for programme design and content. CONCLUSIONS: Current findings support the use of digital technologies for culinary nutrition interventions, potentially combined with in-person sessions using a hybrid structure to enable the development of a support network.

Food Insecurity and Ideal Cardiovascular Health Risk Factors Among US Adolescents.

BACKGROUND: Food insecurity, a social and economic condition of limited availability of healthy food, is a risk factor for adverse cardiovascular health outcomes among adults; few studies have been conducted in adolescents. This study explores the association between food insecurity and cardiovascular health risk factors among a nationally representative sample of US adolescents, adopting the American Heart Association's Life's Essential 8 metric. METHODS AND RESULTS: We analyzed data from 2534 adolescents aged 12 to 19 years from the 2013 to 2018 National Health and Nutrition Examination Surveys. In the sample, 24.8% of adolescents lived in food-insecure households. After multivariable adjustment, food insecurity was associated with a 3.23-unit lower total Life's Essential 8 score (95% CI, -6.32, -0.15) and lower scores on diet quality (ß=-5.39 [95% CI, -8.91, -1.87]) and nicotine exposure (ß=-4.85 [95% CI, -9.24, -0.45]). Regarding diet, food insecurity was associated with 5% lower Healthy Eating Index-2015 scores [95% CI, -7%, -2%], particularly lower intakes of whole grains and seafood/plant proteins and marginally higher intake of added sugar. Regarding nicotine exposure, food insecurity was associated with ever use of a tobacco product among m (odds ratio, 1.74 [95% CI, 1.20-2.53]). Compared with their food-secure counterparts, food-insecure male (odds ratio, 1.98 [95% CI, 1.07-3.65]) and female (odds ratio, 3.22 [95% CI, 1.60-6.45]) adolescents had higher odds of living with a current indoor smoker. CONCLUSIONS: In this nationally representative sample of adolescents, food insecurity was associated with multiple indicators of cardiovascular health risk. These findings underscore the need for public health interventions and policies to reduce food insecurity and improve cardioprotective behaviors during adolescence, with particular efforts targeting diet quality and nicotine exposure.

Characterizing Food Policy Councils' Network Partnerships and COVID-19 Responses.

The COVID-19 pandemic pushed millions of Americans into food insecurity. Food policy councils (FPCs) across the country played a vital role in organizing coordinated food responses across multiple sectors. We used a social network analysis (SNA) approach to investigate: (1) the network of partnering organizations and agencies within FPCs; (2) how the characteristics of FPCs' network partnerships (i.e., degree, coreness, and density) related to programmatic, policy, and advocacy actions in response to the pandemic; and (3) how FPCs' use of a racial or social equity framework shifted their network partnerships and responses. Local government agencies and food supply chain actors were core in FPCs' network partnerships, while public utilities, correctional facilities, social justice groups, and others were non-core partners. Network density was more likely to be associated with any action by FPCs, and it was especially pronounced for advocacy actions taken by FPCs; trends were similar among FPCs that reported using a racial or social equity framework. The findings begin to uncover core actors in FPCs' partnerships and opportunities to establish new partnerships, particularly with social justice groups. The results also suggest that network density (interconnectedness) may be more important than other network characteristics when responding to food-related needs.

Trends in Recurring and Chronic Food Insecurity Among US Families With Older Adults.

Importance: Food insecurity is a critical social determinant of health for older adults. Understanding national food insecurity trends among families with older adults has important policy implications. Objective: To compare food insecurity trends among US families with an older adult from 1999 to 2003 and 2015 to 2019 and further stratify the analysis by race and ethnicity, socioeconomic status markers, and enrollment in the federal Supplemental Nutrition Assistance Program (SNAP). Design, Setting, and Participants: In this cohort study using biennial data from the nationally representative Panel Study of Income Dynamics, balanced panels of families with at least 1 older adult (≥60 years) who participated from 1999 to 2003 (n = 1311) and 2015 to 2019 (n = 2268) were created. Analysis was completed in 2023. Main outcome: Food insecurity was assessed using the US Household Food Security Survey Module. Within each 5-year period, we defined recurring food insecurity as 2 or more episodes of food insecurity and chronic food insecurity as 3 episodes of food insecurity. Results: Overall, food insecurity among US families with older adults increased from 12.5% in 1999 to 2003 to 23.1% in 2015 to 2019. Rates of recurring food insecurity more than doubled (5.6% to 12.6%), whereas rates of chronic food insecurity more than tripled (2.0% to 6.3%). Across both time periods, higher rates of food insecurity persisted among Black and Hispanic families, with lower socioeconomic status, and participating in SNAP. Conclusions and Relevance: These results highlight how rates of recurring and chronic food insecurity among families with older adults rose substantially over the past 20 years. Monitoring national trends in food insecurity among older adults has direct programmatic and policy implications.

Greater Frequency of Cooking Dinner at Home and More Time Spent Cooking Are Inversely Associated With Ultra-Processed Food Consumption Among US Adults.

BACKGROUND: Cooking at home has been promoted as a strategy to improve diet quality; however, the association between cooking behavior and ultra-processed food intake is unknown. OBJECTIVE: The objective of this study was to examine associations between frequency of cooking dinner at home and time spent cooking dinner with ultra-processed food intake. DESIGN: Cross-sectional, nationally representative data from the 2007-2010 National Health and Nutrition Examination Survey were analyzed. PARTICIPANTS/SETTING: Participants were 9,491 adults (20 years and older) in the United States. MAIN OUTCOME MEASURES: The main outcome measure was the proportion of energy intake (averaged from two 24-hour dietary recalls) from the following 4 Nova food-processing groups: (1) unprocessed or minimally processed foods, (2) processed culinary ingredients, (3) processed foods, and (4) ultra-processed foods. STATISTICAL ANALYSES PERFORMED: Separate linear regression models examined associations between cooking frequency and time spent cooking dinner and proportion of energy intake from the 4 Nova food-processing groups, adjusting for sociodemographic characteristics and total energy intake. RESULTS: Ultra-processed foods comprised >50% of energy consumed independent of cooking frequency or time spent cooking. Higher household frequency of cooking dinner and greater time spent cooking dinner were both associated with lower intake of ultra-processed foods (P trends < .001) and higher intake of unprocessed or minimally processed foods (P trends < .001) in a dose-response manner. Compared with cooking 0 to 2 times/wk, adults who cooked dinner 7 times/wk consumed a mean of 6.30% (95% CI -7.96% to -4.64%; P < .001) less energy from ultra-processed foods. Adults who spent more than 90 minutes cooking dinner consumed 4.28% less energy from ultra-processed foods (95% CI -6.08% to -2.49%; P < .001) compared with those who spent 0 to 45 minutes cooking dinner. CONCLUSIONS: Cooking at home is associated with lower consumption of ultra-processed foods and higher consumption of unprocessed or minimally processed foods. However, ultra-processed food intake is high among US adults regardless of cooking frequency.

Food Insecurity Prevalence and Risk Factors at a Large Academic Medical Center in Michigan.

Importance: Health care systems are increasingly adopting methods to screen for and integrate food insecurity and other social risk factors into electronic health records. However, there remain knowledge gaps regarding the cumulative burden of food insecurity in large clinical settings, which patients are most at risk, and the extent to which patients are interested in social assistance through their health care system. Objective: To evaluate the 5-year prevalence and associated risk factors of food insecurity among adult primary care patients, and to examine factors associated with patients' interest in social assistance among those with food insecurity. Design, Setting, and Participants: This cross-sectional analysis of a retrospective cohort study took place at a tertiary care academic medical center (encompassing 20 primary care clinics) in Michigan. Participants included adult patients who completed screening for social risk factors between August 1, 2017, and August 1, 2022. Data analysis was performed from November 2022 to June 2023. Exposure: Food insecurity was assessed using the Hunger Vital Sign. Main Outcomes and Measures: The primary outcome was patients' interest in social assistance, and associated factors were examined using multivariate logistic regression models, adjusting for patients' demographic and health characteristics. Results: Over the 5-year period, 106 087 adult primary care patients (mean [SD] age, 52.9 [17.9] years; 61 343 women [57.8%]) completed the standardized social risk factors questionnaire and were included in the analysis. The overall prevalence of food insecurity was 4.2% (4498 patients), with monthly trends ranging from 1.5% (70 positive screens) in August 2018 to 5.0% (193 positive screens) in June 2022. Food insecurity was significantly higher among patients who were younger, female, non-Hispanic Black or Hispanic, unmarried or unpartnered, and with public health insurance. Food insecurity was significantly associated with a higher cumulative burden of social needs, including social isolation, medical care insecurity, medication nonadherence, housing instability, and lack of transportation. Only 20.6% of patients with food insecurity (927 patients) expressed interest in social assistance. Factors associated with interest in social assistance including being non-Hispanic Black, unmarried or unpartnered, a current smoker, and having a higher burden of other social needs. Conclusions and Relevance: In this retrospective cohort study, the overall prevalence of food insecurity was 4.2%, of whom approximately 1 in 5 patients with food insecurity expressed interest in assistance. This study highlights ongoing challenges in ensuring all patients complete routine social determinants of health screening and gaps in patients' interest in assistance for food insecurity and other social needs through their health care system.

Associations between food insecurity and diabetes risk factors in US adolescents in the National Health and Nutrition Examination Survey (NHANES) 2007-2016.

OBJECTIVE: To evaluate the associations between household food insecurity and diabetes risk factors among lower-income US adolescents. DESIGN: Cross-sectional analysis. Household food security status was measured using the 18-item Food Security Survey Module. Simple and multivariable linear and logistic regressions were used to assess the association between food security status and fasting plasma glucose (FPG), oral glucose tolerance test (OGTT), HbA1C and homoeostatic model assessment - insulin resistance (HOMA-IR). The analyses were adjusted for household and adolescent demographic and health characteristics. SETTING: USA. PARTICIPANTS: 3412 US adolescents aged 12-19 years with household incomes ≤300 % of the federal poverty line from the National Health and Nutrition Examination Survey cycles 2007-2016. RESULTS: The weighted prevalence of marginal food security was 15·4 % and of food insecurity was 32·9 %. After multivariate adjustment, adolescents with food insecurity had a 0·04 % higher HbA1C (95 % CI 0·00, 0·09, P-value = 0·04) than adolescents with food security. There was also a significant overall trend between severity of food insecurity and higher HbA1C (Ptrend = 0·045). There were no significant mean differences in adolescents' FPG, OGTT or HOMA-IR by household food security. CONCLUSIONS: Food insecurity was associated with slightly higher HbA1c in a 10-year sample of lower-income US adolescents aged 12-19 years; however, other associations with diabetes risk factors were not significant. Overall, this suggests slight evidence for an association between food insecurity and diabetes risk in US adolescents. Further investigation is warranted to examine this association over time.

Associations Between Household Frequency of Cooking Dinner and Ultraprocessed Food Consumption and Dietary Quality Among US Children and Adolescents.

Introduction: Dietary quality is poor and intake of ultraprocessed foods (UPFs) is high among children and adolescents in the United States. Low dietary quality and high UPF intake are associated with obesity and higher risk of diet-related chronic diseases. It is unknown whether household cooking behavior is related to improved dietary quality and lower consumption of UPFs among US children and adolescents. Methods: Nationally representative data from the 2007-2010 National Health and Nutrition Examination Survey (n = 6032 children and adolescents ≤19 years of age) were used to examine the relationships between household cooking frequency of evening meals and children's dietary quality and UPF intake using multivariate linear regression models adjusted for sociodemographics. Two 24-hour diet recalls were used to assess UPF intake and dietary quality [Healthy Eating Index-2015 (HEI-2015)]. Food items were categorized according to Nova classification to obtain the UPF percent of total energy intake. Results: A higher household frequency of cooking dinner was associated with lower UPF intake and higher overall dietary quality. Compared to children in households cooking dinner 0-2 times per week, children in households cooking dinner 7 times/week had lower intake of UPFs [ß = -6.30, 95% confidence interval (CI) -8.81 to -3.78, p < 0.001] and marginally higher HEI-2015 scores (ß = 1.92, 95% CI -0.04 to 3.87, p = 0.054). The trends toward lower UPF intake (p-trend <0.001) and higher HEI-2015 scores (p-trend = 0.001) with increasing cooking frequency were significant. Conclusions: In this nationally representative sample of children and adolescents, more frequent cooking at home was associated with lower intake of UPFs and higher HEI-2015 scores.

Environmental-, Climate-, and Health-Related Dietary Motivations Are Associated With Higher Diet Quality in a National Sample of US Adults With Lower Incomes.

BACKGROUND: Plant-based diets can have co-benefits for human and planetary health. Associations between environmental, climate, and health concerns and dietary intake in US adults are understudied, particularly in underserved populations. OBJECTIVE: The study objectives were to assess how dietary choices motivated by the environment, climate, and health vary by sociodemographic characteristics and how they relate to diet quality and intake frequency of different food groups in US adults with lower incomes. DESIGN: The study design was cross-sectional. PARTICIPANTS/SETTING: A web-based survey was fielded in December 2022 to 1,798 US adults with lower incomes (<250% of federal poverty guidelines). MAIN OUTCOME MEASURES: Environmental-, climate-, and health-related dietary motivations and diet quality and dietary food group intake frequency were assessed. STATISTICAL ANALYSES: Differences in mean dietary outcomes and dietary motivation ratings by sociodemographic characteristics were evaluated using analysis of variance and Kruskal-Wallis tests. Associations between dietary motivations and diet quality scores and dietary intake frequency were examined using generalized linear models adjusted for sociodemographic covariates. RESULTS: Younger adults, women, nonbinary people, racial and ethnic minoritized groups, and adults experiencing food insecurity reported higher environmental and climate dietary motivations; older adults, higher-income adults, and food-secure adults reported higher health motivations. Agreeing with environmental- (ß = 2.28, 95% CI 1.09 to 3.47), climate- (ß = 2.15, 95% CI 0.90 to 3.40), and health-related (ß = 5.27, 95% CI 3.98 to 6.56) dietary motivations was associated with higher diet quality scores compared with those with neutral rankings. Similarly, agreement with environmental-, climate-, and health-related dietary motivations was associated with higher intake frequency of fish, fruits and vegetables, and plant proteins, but not with red and processed meat intake frequency. Of several climate-mitigation behaviors presented, participants perceived meat reduction as least effective (P < .001). CONCLUSIONS: Environment, climate, and health were positive motivators of several healthy dietary choices in US adults with lower incomes. Such motivators did not translate to lower intake frequency of red and processed meat.

High Prevalence of Food Insecurity and Related Disparities Among US College and University Students From 2015-2019.

OBJECTIVE: We examined food insecurity prevalence among college students included as part of a large, ongoing, nationally representative survey and examined trends and associations with sociodemographic measures. METHODS: Data come from the Panel Study of Income Dynamics, a nationally representative longitudinal household panel survey, and include 2,538 college students from 2015-2019. Food security status was assessed using the US Department of Agriculture's 18-item Household Food Security Survey Module. RESULTS: From 2015 to 2019, 11% of college students experienced marginal food security, and 15% experienced food insecurity. Food insecurity was 12% in 2015 and 14% in 2017 and 2019. More Black and Hispanic students experienced food insecurity than White students (21% and 26%, vs 9%, respectively; P <0.001), as did first-generation than non-first-generation students (18% vs 10%; P = 0.01). CONCLUSIONS AND IMPLICATIONS: College food insecurity is an urgent public health issue demanding greater response from colleges and universities and state and federal governments.

Persistent and Changing Food Insecurity Among Students at a Midwestern University is Associated With Behavioral and Mental Health Outcomes.

PURPOSE: To assess associations between persistent and changing food insecurity and behavioral and mental health outcomes in college students. DESIGN: Online surveys conducted November 2018 and March 2019 (freshman year), and March 2020 (sophomore year) were used to assess food insecurity, which was then used to create 4 food security transitions: persistent food insecurity, emergent food insecurity, emergent food security, and persistent food security. SETTING: Large Midwestern university. SAMPLE: 593 students completing all 3 surveys. MEASURES: Dietary intake and behavioral and mental health outcomes (eating disorders, anxiety, depression, sleep quality) were assessed using validated instruments. ANALYSIS: Associations between food security transitions and dietary intake, behavioral, and mental health outcomes were examined using generalized linear models. RESULTS: Compared to persistent food security, emergent and persistent food insecurity was associated with lower (7% and 13% respectively) intake of fruits and vegetables combined; persistent food insecurity was associated with 17% lower intake of fruits, 6% lower intake of fiber and 10% higher intake of added sugar from beverages. Compared to persistent food secure students, eating disorder symptom risk was higher for emergent food insecure (OR = 7.61, 95% CI: 3.32, 17.48), and persistent food insecure (OR = 6.60, 95% CI: 2.60, 16.72) students; emergent (OR = 2.05, 95% CI: 1.14, 3.71) and persistent (OR = 2.55, 95% CI: 1.34, 4.87) food insecure students had higher odds of poor sleep quality, and persistent food insecure, emergent food insecure, and emergent food secure students had higher odds of anxiety and depression (OR range 2.35-2.85). CONCLUSION: Food security transitions were associated with aspects of low diet quality and poorer behavioral and mental health outcomes among college students.

Tap water perceptions and water filter use vary with socio-demographic characteristics and are associated with water and sugar-sweetened beverage consumption in university students.

OBJECTIVE: The goal of this study is to evaluate university students' perceptions of tap water safety and water filter use and determine how these perceptions and behaviours affect water and sugar-sweetened beverage intake. DESIGN: Cross-sectional; online survey conducted in Fall 2021. SETTING: A large, public Midwestern university in the USA. PARTICIPANTS: Seven-hundred ninety-three university students. RESULTS: Students who experienced food insecurity, were on a Pell grant, were first-generation college students or were racial/ethnic minorities were less likely to trust tap water safety. Tap water filtration behaviour also varied by age and race/ethnicity. Students who did not agree with the statement 'my local tap water is safe to drink' had lower odds of consuming ≥ 3 cups of total water per day (OR = 0·45, 95 % CI: 0·32, 0·62), lower odds of consuming tap water ≥ 3 times/d (OR = 0·46, 95 % CI: 0·34, 0·64), higher odds of drinking bottled water ≥ 1 time per day (OR = 1·80, 95 % CI: 1·22, 2·66) and higher odds of drinking SSB ≥ 1 time per day (OR = 1·47, 95 % CI: 1·01, 2·14) than those who agreed. Students who always or sometimes filtered their tap water had lower odds of consuming ≥ 3 cups of total water per day (OR = 0·59, 95 % CI: 0·39, 0·90) than students who never filtered their tap water. CONCLUSIONS: Tap water perceptions and behaviours affect tap and bottled water and SSB intake among university students. Tap water perceptions and behaviours in this demographic provide important context for university programming promoting healthy beverage initiatives.

The impact of the 2021 Thrifty Food Plan benefit re-evaluation on SNAP participants' short-term food security and health outcomes.

Introduction: The Supplemental Nutrition Assistance Program (SNAP) is the largest federal nutrition assistance program in the United States, and played a critical role in mitigating food insecurity during the COVID-19 pandemic. In 2021, the updated Thrifty Food Plan (TFP), which provides the basis of SNAP benefit allotments, led to a 21% monthly benefit increase for SNAP participants. The objective of this study was to examine the effects of the TFP re-evaluation on food insecurity, diet quality, and mental health using a natural experiment design. Methods: A longitudinal, web-based study was conducted among 1,004 United States adults with incomes at or below $65,000 in September 2021 (prior to the policy change) and February 2022 (after the policy change). Outcomes of interest included household food security, diet quality, perceived stress, and anxiety/depression, assessed using validated instruments. We used difference-in-differences regression modeling to assess the effects of the policy change on participants' outcomes, adjusting for sociodemographic covariates. Qualitative responses to open-ended questions about the policy change were analyzed using thematic analysis. Results: Prior to the policy change, SNAP participants had significantly worse food insecurity, lower diet quality scores, and higher perceived stress and anxiety/depression when compared to non-participants (all Ps < 0.05). After adjustment for differences in sociodemographic characteristics, there were no significant effects of the TFP re-evaluation on food insecurity, diet quality, and mental health outcomes among SNAP participants relative to non-participants (all Ps > 0.05). Qualitative responses suggested that rising food prices and growing inflation potentially negated the benefits of the policy change; however, most SNAP participants described the added benefits as helpful in purchasing additional food supplies and offsetting other household costs during this period. Discussion: The TFP benefit increase may have helped to prevent inflation-related disparities in food insecurity and health outcomes from widening among SNAP participants and non-participants. Further research is needed to determine the long-term impacts of this policy change.

Cooking behaviours after Diabetes Prevention Program (DPP) participation among DPP participants in Baltimore, MD.

OBJECTIVE: The Diabetes Prevention Program (DPP) is a widely implemented 12-month behavioural weight loss programme for individuals with prediabetes. The DPP covers nutrition but does not explicitly incorporate cooking skills education. The objective of the current study is to describe food and cooking skills (FACS) and strategies of recent DPP participants. DESIGN: Photo-elicitation in-depth interviews were conducted from June to August, 2021. SETTING: Baltimore, MD, USA. PARTICIPANTS: Thirteen Black women who participated in DPP. RESULTS: The DPP curriculum influenced participants' healthy cooking practices. Many participants reported shifting from frying foods to air-frying and baking foods to promote healthier cooking and more efficient meal preparation. Participants also reported that their participation in DPP made them more mindful of consuming fruits and vegetables and avoiding foods high in carbohydrates, fats, sugars and Na. With respect to food skills, participants reported that they were more attentive to reading labels and packaging on foods and assessing the quality of ingredients when grocery shopping. CONCLUSIONS: Overall, participants reported changing their food preferences, shopping practices and cooking strategies to promote healthier eating after completing the DPP. Incorporating hands-on cooking skills and practices into the DPP curriculum may support sustained behaviour change to manage prediabetes and prevent development of type 2 diabetes among participants.

Disparities in Cardiovascular Health by Food Security Status and Supplemental Nutrition Assistance Program Participation Using Life's Essential 8 Metrics.

This cross-sectional study examines the associations among household food security, Supplemental Nutrition Assistance Program participation, and cardiovascular health among 2013-2018 National Health and Nutrition Examination Survey participants.

Comparing Very Low-Carbohydrate vs DASH Diets for Overweight or Obese Adults With Hypertension and Prediabetes or Type 2 Diabetes: A Randomized Trial.

PURPOSE: Adults with a triple multimorbidity (hypertension, prediabetes or type 2 diabetes, and overweight or obesity), are at increased risk of serious health complications, but experts disagree on which dietary patterns and support strategies should be recommended. METHODS: We randomized 94 adults from southeast Michigan with this triple multimorbidity using a 2 × 2 diet-by-support factorial design, comparing a very low-carbohydrate (VLC) diet vs a Dietary Approaches to Stop Hypertension (DASH) diet, as well as comparing results with and without multicomponent extra support (mindful eating, positive emotion regulation, social support, and cooking). RESULTS: Using intention-to-treat analyses, compared with the DASH diet, the VLC diet led to greater improvement in estimated mean systolic blood pressure (-9.77 mm Hg vs -5.18 mm Hg; P = .046), greater improvement in glycated hemoglobin (-0.35% vs -0.14%; P = .034), and greater improvement in weight (-19.14 lb vs -10.34 lb; P = .0003). The addition of extra support did not have a statistically significant effect on outcomes. CONCLUSIONS: For adults with hypertension, prediabetes or type 2 diabetes, and overweight or obesity, the VLC diet resulted in greater improvements in systolic blood pressure, glycemic control, and weight over a 4-month period compared with the DASH diet. These findings suggest that larger trials with longer follow-up are warranted to determine whether the VLC diet might be more beneficial for disease management than the DASH diet for these high-risk adults.

Complex, Varied and Evolving Manifestations of Food Agency in Daily Life Among Diabetes Prevention Program Participants in Baltimore, Maryland.

OBJECTIVE: To characterize food agency (one's capacity to procure and prepare food in particular contexts) among Diabetes Prevention Program (DPP) participants and gather perspectives about experiences with DPP. DESIGN: Photograph-elicitation in-depth interviews and survey measures. SETTING: Baltimore, Maryland (June-August 2021). PARTICIPANTS: Black women (n = 13) who participated in DPP. PHENOMENON OF INTEREST: Food agency and strategies used to procure and prepare food and the influence of DPP on daily food behaviors. Surveys measured food agency using the Cooking and Food Provisioning Action Scale and cooking behaviors. ANALYSIS: Thematic analysis of qualitative in-depth interviews and descriptive statistics for quantitative measures. RESULTS: As quantitative and qualitative data revealed, participants were frequent and confident cooks with high food agency. Participants viewed cooking as a key strategy for healthy eating and desired more hands-on cooking instruction within DPP to develop new healthy cooking skills. The primary barriers identified were related to lack of time or energy. Food procurement and preparation practices shifted over time, and DPP was a key influence on current behaviors. CONCLUSIONS AND IMPLICATIONS: Food agency is complex and manifests heterogeneously in daily life. A life course, contextual, and food agency-based approach could be considered for future diabetes prevention interventions.

Environmental and Climate Impact Perceptions in University Students: Sustainability Motivations and Perceptions Correspond With Lower Red Meat Intake.

BACKGROUND: Red meat production is a leading contributor to food-related greenhouse gas emissions. Decreasing red meat intake can mitigate climate change and lower risk of diet-related diseases. OBJECTIVE: The goal of this study is to evaluate university students' perceptions of climate-friendly behaviors and to assess how these perceptions are associated with the frequency of red meat intake. DESIGN: Cross-sectional survey SETTING: A large, public California university and a large, public Michigan university PARTICIPANTS: Undergraduate students from a California university (n = 721) and a Michigan university (n = 568) MAIN OUTCOME MEASURES: Perceptions of climate-friendly behaviors and frequency of red meat intake STATISTICAL ANALYSIS: Differences in perceptions by student characteristics were compared using t-tests and one-way analysis of variance. Associations between perceptions of climate-friendly behaviors and red meat intake frequency were examined using generalized linear models, adjusted for sociodemographic covariates. RESULTS: Across both universities, students rated reducing meat intake as less effective than other climate change mitigation behaviors such as recycling and using less plastic. However, students who reported (1) making food and beverage choices that "are good for the environment," (2) making food and beverage choices that "reduce climate change impact," or (3) agreeing that "eating less meat is an effective way to combat climate change" reported 10% to 25% lower frequency of red meat intake for each point higher on the agreement scale. In contrast, making food and beverage choices motivated by health was not associated with frequency of red meat intake. CONCLUSIONS: Sustainability motivations and perceptions of meat's climate impact were associated with lower frequency of red meat intake, despite the overall moderate rating of eating less meat as an effective climate change mitigator. This research lends support to behavioral interventions, public education campaigns, and policies aiming to reinforce sustainable dietary patterns in young adults.

Effect of Climate Change Impact Menu Labels on Fast Food Ordering Choices Among US Adults: A Randomized Clinical Trial.

Importance: There is increasing interest in strategies to encourage more environmentally sustainable food choices in US restaurants through the use of menu labels that indicate an item's potential impact on the world's climate. Data are lacking on the ideal design of such labels to effectively encourage sustainable choices. Objective: To test the effects of positive and negative climate impact menu labels on the environmental sustainability and healthfulness of food choices compared with a control label. Design, Setting, and Participants: This randomized clinical trial used an online national US survey conducted March 30 to April 13, 2022, among a nationally representative sample of adults (aged ≥18 years) from the AmeriSpeak panel. Data were analyzed in June to October 2022. Interventions: Participants were shown a fast food menu and prompted to select 1 item they would like to order for dinner. Participants were randomized to view menus with 1 of 3 label conditions: a quick response code label on all items (control group); green low-climate impact label on chicken, fish, or vegetarian items (positive framing); or red high-climate impact label on red meat items (negative framing). Main Outcomes and Measures: The main outcome was an indicator of selecting a sustainable item (ie, one without red meat). Secondary outcomes included participant health perceptions of the selected item and the Nutrition Profile Index (NPI) score of healthfulness. Results: Among 5049 participants (2444 female [51.6%]; 789 aged 18-29 years [20.3%], 1532 aged 30-44 years [25.9%], 1089 aged 45-59 years [23.5%], and 1639 aged ≥60 years [30.4%]; 142 Asian [5.3%], 611 Black [12.1%], and 3197 White [63.3%]; 866 Hispanic [17.2%]), high- and low-climate impact labels were effective at encouraging sustainable selections from the menu. Compared with participants in the control group, 23.5% more participants (95% CI, 13.7%-34.0%; P < .001) selected a sustainable menu item when menus displayed high-climate impact labels and 9.9% more participants (95% CI, 1.0%-19.8%; P = .03) selected a sustainable menu item when menus displayed low-climate impact labels. Across experimental conditions, participants who selected a sustainable item rated their order as healthier than those who selected an unsustainable item, according to mean perceived healthfulness score (control label: 3.4 points; 95% CI, 3.2-3.5 points vs 2.5 points; 95% CI, 2.4-2.6 points; P < .001; low-impact label: 3.7 points; 95% CI, 3.5-3.8 points vs 2.6 points; 95% CI, 2.5-2.7 points; P < .001; high-impact label: 3.5 points; 95% CI, 3.3-3.6 points vs 2.7 points; 95% CI, 2.6-2.9 points; P < .001). Participants in the high-climate impact label group selected healthier items according to mean (SE) NPI score (54.3 [0.2] points) compared with those in the low-climate impact (53.2 [0.2] points; P < .001) and control (52.9 [0.3] points; P < .001) label groups. Conclusions and Relevance: This randomized clinical trial's findings suggest that climate impact menu labels, especially negatively framed labels highlighting high-climate impact items (ie, red meat), were an effective strategy to reduce red meat selections and encourage more sustainable choices. Trial Registration: ClinicalTrials.gov Identifier: NCT05482204.