Impact of county and state immigration policies on immigrant household enrollment in the supplemental nutrition assistance program.

Introduction: Low-income immigrants who are eligible to participate in the Supplemental Nutrition Assistance Program (SNAP) participate at lower rates compared to non-immigrants. Immigrant households may be more likely to participate in SNAP if they live in areas with policies that integrate them into society and protect them from deportation. Methods: Data on low-income immigrant households came from the 2019 American Community Survey (N = 87,678). The outcome was whether any household member received SNAP in the previous 12 months. Immigrant policy exposures came from two sources: the State Immigration Policy Resource, which includes 18 immigrant criminalizing and integrating policies, and a database that identified 'sanctuary policies' (SP), which we summarized at the county level. Multivariable logistic regression adjusted for person/household-level and area-level confounders. Results: Living in a jurisdiction with a SP was associated with 21% higher odds of enrolling in SNAP compared to living in a jurisdiction without a SP (adjusted odds ratio [aOR] 1.21, 95% CI=1.11,1.31). Relative to the least immigrant friendly states, living in the most immigrant-friendly states was associated with 16% higher odds of SNAP enrollment (aOR=1.16, 95%CI=1.06-1.28). When SP and state-level immigrant friendly policy environment were cross-classified, SNAP participation was 23% and 26% higher for those living in jurisdictions with one- and both- exposures, respectively, relative to those with neither (aOR 1.23; CI 1.12,1.36; aOR 1.26; CI 1.15,1.37). Conclusions: Many at high risk of food insecurity - including immigrants and citizens in households with immigrants - are eligible for SNAP but under-enroll. Policies that welcome and safeguard immigrants could reduce under enrollment.

Trends in Food Insecurity Among Households with Children Participating in WIC and SNAP in California, 2005-2017.

OBJECTIVES: To assess trends in food insecurity between 2005 and 2017-a period including the Great Recession-by participation in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). METHODS: Data from the California Health Interview Survey (CHIS), 2005-2017, were used, including 7421 households: WIC participants (n = 4184)-those participating in WIC only (n = 2315) and in the Supplemental Nutrition Assistance Program (SNAP) in addition to WIC (n = 1869)-and WIC-eligible non-participants (n = 3237). Multivariable logistic regression models were run with food insecurity as the outcome, WIC participation and survey year as predictors, and adjusted by children's and family's demographic and socioeconomic variables. Interactions between WIC participation and survey year were tested. RESULTS: WIC + SNAP participating households had higher crude food insecurity prevalence across time compared to WIC only and WIC-eligible non-participant households. In fully adjusted models: (1) food insecurity was higher between 2009 and 2017, compared to 2005, for all groups; (2) WIC participating households had higher odds of food insecurity than WIC-eligible non-participants (OR = 1.23, 95%CI = 1.10-1.38); (3) when WIC participants were split into WIC only and WIC + SNAP, WIC + SNAP households had higher odds of food insecurity than WIC-eligible non-participants (OR = 1.45, 95%CI = 1.27-1.66); and (4) the association between food insecurity and WIC participation did not change across time (interaction p-value > 0.10). CONCLUSIONS: Food insecurity increased post-Great Recession among low-income households with children in California, with those participating in WIC, particularly in WIC + SNAP, at higher risk. WIC should consider additional referrals for households who participate in WIC + SNAP.

Does Race/Ethnicity Explain Regional Inequities in Child Food Insufficiency During the Second Year of the COVID-19 Pandemic?

Historically, food insecurity prevalence was higher in the U.S. Southern region than in other regions, particularly among children, but it is not known if the COVID-19 pandemic affected this situation. Our objectives were to (1) assess regional inequities in child food insufficiency during the second year of the pandemic between Deep South states (Alabama, Georgia, Louisiana, Mississippi, and South Carolina) and non-Deep South states, and (2) examine the role of race/ethnicity and other factors in the observed differences. Data from Household Pulse Survey phases 3.1-3.2 (4/15-10/11/2021) on households with children (n=267,106) were used. The outcome was child food insufficiency, and the predictor was living in a Deep South state. Weighted crude and adjusted logistic regressions were run, adjusting for participants' race/ethnicity, age, gender, marital status, and educational attainment; number of children in the household; and household income-to-poverty ratio. Child food insufficiency prevalence was higher in Deep South (15.0%) versus non-Deep South states (11.6%). In crude models, the odds of child food insufficiency were 35% higher in Deep South, compared to non-Deep South states. With a model that adjusted for race/ethnicity, this dropped to 24% higher in Deep South states, and down to 13% higher in the fully adjusted model. Regional inequities in child food insufficiency were present in the second year of the pandemic but were not fully explained by race/ethnicity nor by other household demographic and socioeconomic factors. Assessing the contribution of state-level contexts and social policies to observed inequities may assist in explaining them and identifying appropriate solutions.

Time-Trends in Food Insecurity Among US-Born and Foreign-Born Hispanic Adults by Language Use: An Analysis of National Health and Nutrition Examination Survey Data, 1999-2018.

BACKGROUND: Historically, food insecurity prevalence has been higher in Hispanic households than in non-Hispanic White households. Food insecurity prevalence among Hispanic adults, US-born and foreign-born, may vary by language use. OBJECTIVE: To explore whether or not the relationship between language use and food insecurity varied over time (1999-2018) among US-born and foreign-born Hispanic adults. DESIGN: Trends analysis and multivariable logistic regression modeling using pooled cross-sectional data. PARTICIPANTS AND SETTING: Fifteen thousand sixty-two Hispanic adults participating in the United States National Health and Nutrition Examination Survey (1999-2018). MAIN OUTCOME MEASURES: Food insecurity prevalence, assessed with the US Household Food Security Survey Module. STATISTICAL ANALYSIS: Unadjusted food insecurity trends from 1999 to 2018 by language use (mostly English, both languages equally, or mostly Spanish) among US-born and foreign-born Hispanic adults were analyzed using piecewise-linear regression of log prevalence rates. Multivariable logistic regression models adjusted for sociodemographic characteristics and with an interaction term between language use and time were used to determine if odds of food insecurity among US-born and foreign-born Hispanic adults varied by language use between 1999 and 2018. RESULTS: Hispanic adults' food insecurity prevalence followed an upward linear trend from 1999 to 2018; this was significant for US-born mostly English-speakers (P < 0.001), US-born mostly Spanish-speakers (P = 0.013), and foreign-born mostly Spanish-speakers (P < 0.001). In fully adjusted logistic regression models, foreign-born Hispanic adults who spoke both languages equally (odds ratio 1.8, 95% CI 1.2 to 2.6) and those who spoke mostly Spanish (odds ratio 1.9, 95% CI 1.4 to 2.8) had significantly higher food insecurity odds, compared with mostly English-speakers. No variations in associations across time were observed between language use and food insecurity (interaction P value > 0.1). CONCLUSIONS: Hispanic adults' unadjusted food insecurity trends from 1999 to 2018 varied by language use. When adjusted for sociodemographic characteristics and compared with mostly English-speakers, food insecurity odds were significantly higher only among foreign-born Hispanic adults who spoke either both languages equally or mostly Spanish. Food assistance programs should linguistically adapt their services for Hispanic adults.

County- and state-level immigration policies are associated with Supplemental Nutrition Assistance Program (SNAP) participation among Latino households.

The purpose of this study was to investigate the association between county- and state-level immigrant criminalizing and integrating policies and Latino household participation in the largest safety net program against food insecurity in the U.S., the Supplemental Nutrition Assistance Program (SNAP). Our outcome, county-level proportion of SNAP-participating Latino households, and county-level covariates were obtained from the American Community Survey 1-year county files (N = 675 counties) for 13 years (2007-2019). Our exposures were county-level presence of sanctuary policies and a state-level immigrant friendliness score, created based on 19 immigrant criminalizing and integrating state-level policies obtained from the Urban Institute's State Immigration Policies Resource. We classified every county in the sample as 1) sanctuary policy + immigrant friendly state, 2) sanctuary policy + immigrant unfriendly state, 3) no sanctuary policy + immigrant friendly state, and 4) no sanctuary policy + immigrant unfriendly state. Using multivariable generalized linear models that adjusted for poverty levels and other social composition characteristics of counties, we found that county-level SNAP participation among Latino households was 1.1 percentage-point higher in counties with sanctuary policies (B = 1.12, 95%CI = 0.26-1.98), compared to counties with no sanctuary policies, and 1.6 percentage-point higher in counties with sanctuary policies in immigrant friendly states (B = 1.59, 95%CI = 0.33-2.84), compared to counties with no sanctuary policy in immigrant unfriendly states. Local and state immigration policy, even when unrelated to SNAP eligibility, may influence SNAP participation among Latino households. Jurisdictions which lack sanctuary policies or have more criminalizing and less integrating policies should consider adopting targeted outreach strategies to increase SNAP enrollment among Latino households.

New Orleans' school meals distribution in response to the COVID-19 pandemic: operational details and geographic coverage.

Introduction: To facilitate continuation of school feeding during COVID-19 school lockdowns, U.S. Congress authorized waivers to allow for school meals to be picked up by parents/guardians in non-school settings. We summarized school meals distribution and characterized reach in socially vulnerable neighborhoods in New Orleans, a city prone to environmental disasters, with a city-wide charter school system, and historically high levels of child poverty and food insecurity. Methods: School meals operations data were obtained from New Orleans, Louisiana (NOLA) Public Schools for 3/16/2020-5/31/2020. For each pick-up location, we estimated: average meals available (weekly), average meals served (weekly), number of weeks of operation, and rate of meal pick-up ([meals served/meals available]*100). These characteristics were mapped in QGIS v3.28.3, along with neighborhoods' Social Vulnerability Index (SVI). Pearson correlation and ANOVA were run to assess differences between operations characteristics and neighborhood SVI. Results: From 38 meal sites, 884,929 meals were available for pick-up; 74% of pick-up sites were in moderately/highly socially vulnerable areas. Correlations between average meals available and served, weeks of operation, rate of meal pick-up, and SVI were weak and not statistically significant. SVI was associated with average rate of meal pick-up but not other operations characteristics. Discussion: Despite the disaggregated nature of the charter school system, NOLA Public Schools successfully pivoted to providing children with pick-up meals due to COVID-19 lockdowns, with 74% of sites located in socially vulnerable neighborhoods. Future studies should describe the types of meals provided to students during COVID-19, in terms of diet quality and nutrient adequacy.

The association between language use and food insecurity among Hispanic adults residing in the USA depends on nativity.

OBJECTIVE: To examine the association between language use - predominantly English, English and Spanish equally and predominantly Spanish - and food insecurity among Hispanic adults residing in the USA, 1999-2018. DESIGN: Pooled cross-sectional study design. SETTING: United States. PARTICIPANTS: 15 073 Hispanic adults. RESULTS: Compared with Hispanic adults who predominantly spoke English and after adjusting for age, sex, family income-to-poverty ratio, education level and employment status, Hispanic adults who spoke English and Spanish equally (OR = 1·28, 95 % CI = 1·05, 1·56) or predominantly Spanish (OR = 1·25, 95 % CI = 1·04, 1·49) had higher odds of food insecurity. After stratifying by country of birth, language use was associated with higher odds of food insecurity only for Hispanic adults born outside of the USA, but not for Hispanic adults born in the USA. Hispanic adults born outside of the USA who spoke English and Spanish equally (OR = 1·27, 95 % CI = 1·04, 1·55) or spoke predominantly Spanish (OR = 1·24, 95 % CI = 1·04, 1·48) had higher odds of food insecurity when compared with those who predominantly spoke English. CONCLUSION: Foreign-born Hispanic adults who speak predominantly Spanish, or English and Spanish equally, have higher odds of food insecurity. Food and nutrition assistance programmes that serve Hispanic immigrants should make sure to provide linguistically and culturally appropriate services to this population.

Enablers and Barriers of Community Garden Use in New Orleans, Louisiana: An Environmental Assessment and Qualitative Analysis.

PURPOSE: To explore factors associated with community garden use. APPROACH: Environmental assessment of community gardens and semi-structured interviews. SETTING: New Orleans, Louisiana. PARTICIPANTS: 10 community gardens (environmental assessment), 20 community members (including garden users and non-users) and garden administrators (qualitative interviews). METHOD: Gardens were assessed based on (1) accessibility, (2) information, (3) design, (4) cleanliness, (5) walkability, (6) parking, and (7) noise. Semi-structured interviews took place over Zoom; transcribed interviews were analyzed using thematic analysis. RESULTS: Gardens assessed in the environmental assessment ranked high in design and cleanliness but low on accessibility and information availability. Salient themes from the qualitative interviews include skill-building, access to fresh foods, and increased social engagement as enablers of community garden participation, with availability of information and time as both potential enablers of, or barriers to, participation. Community members perceived that gardens could increase fresh food access, while administrators believed that it is not possible for community gardens to produce enough food to create community-wide impact, highlighting instead the importance of the social aspects of the garden as beneficial for health. CONCLUSION: Community gardens should improve garden physical accessibility and information availability to incentivize use. Community gardens are valued as means for skill-building and social engagement. Future research should prioritize investigating the association between the social aspects of participating in community gardens and health outcomes.

The association between the observed and perceived neighbourhood food environment and household food insecurity in a low-income district in Lima, Peru.

The objective of the present study was to assess the association between the observed and perceived food environment and food insecurity among households with children <18 years in Lima, Peru. This was a cross-sectional study including an income-stratified random sample of households (n 329) in Villa el Salvador, a low-income district in Lima, Peru. Data were collected with a household questionnaire - including the Household Food Insecurity Access Scale (HFIAS) and the University of Pennsylvania's Perceived Nutrition Environment Survey (NEMS-P) - and a neighbourhood food outlet census, including recording of food outlets' GPS coordinates. Three-quarters of the households interviewed were food insecure. Compared with food secure households and adjusting for socio-demographic covariates, food insecure households were more likely to disagree to having easy access (OR 5⋅4; 95 % CI 2⋅1, 13⋅4), high quality (OR 3⋅1; 95 % CI 1⋅7, 5⋅5) and variety (OR 2⋅5; 95 % CI 1⋅4, 4⋅6) of fresh fruits and vegetables in their neighbourhood. About 60 % (513 out of 861) of the food outlets identified in participants' neighbourhoods were classified as fresh, including markets, bodegas, and fruit and vegetable vendors. There was no difference in distance to fresh food outlets by household food insecurity; all households were on average within 52-62 m from a fresh food outlet (~2-min walk). Despite negative perceptions of their neighbourhood food environment, food insecure households had similar physical access to fresh food sources than their food secure counterparts. Thus, changes to the food environment may not alleviate food insecurity in urban poor areas of Peru.

Water insecurity, self-reported physical health, and objective measures of biological health in the Peruvian Amazon.

OBJECTIVES: This study examines the associations between water insecurity, self-reported physical health, and objective measures of biological health among 225 Awajún adults (107 women; 118 men) living in the Peruvian Amazon, a "water-abundant" region. METHODS: A survey, which included multiple measures of self-reported physical health, and objective measures of biological health such as blood pressure and nutritional and immune biomarkers. RESULTS: Greater water insecurity was associated with multiple measures of self-reported physical health, including higher incidence of reported diarrhea, nausea, back pain, headaches, chest pain, fatigue, dizziness, overall poor perceived health, and "being sick." These symptoms align with the physical strain associated with water acquisition and with drinking contaminated water. A significant association between higher water insecurity and lower systolic blood pressure emerged, which may be linked to dehydration. None of the other biomarkers, including those for nutrition, infection, and stress were significantly associated with water insecurity scores. CONCLUSIONS: These analyses add to the growing body of research examining the associations between water insecurity and health. Biocultural anthropologists are well-positioned to continue probing these connections. Future research will investigate relationships between measures of water insecurity and biomarkers for gastrointestinal infection and inflammation in water-scarce and water-abundant contexts.

Emergency food distribution efforts in New Orleans, LA after Hurricane Ida.

Background: The provision of food aid after a natural disaster is necessary to prevent hunger, particularly in low-resourced and low-income communities. Little is known about the operational challenges associated with ensuring equitable distribution of emergency food resources to communities in need following a disaster. To address this gap, this study assessed emergency food distribution efforts in New Orleans, LA during the 2 weeks following Hurricane Ida's landfall on August 29, 2021. Methods: Information on free food distribution events was gathered from online sources. A list of distribution sites was generated that included data on operational logistics (e.g., address, days of operation, hours of operation, etc.), food offerings (e.g., prepared meals, groceries, etc.), and socio-demographic characteristics of the surrounding community. Geospatial mapping and bivariate analyses were used to analyze the site data. Results: Seventy-four distribution sites operated in the 2 weeks after Hurricane Ida. Approximately 47.3% were located in census tracts with >80% Black residents, and 39.2% were in tracts with >30% poverty. A large proportion of sites offered prepared meals (86.2%) and only operated 1 day (36.5%). Tracts with >80% Black residents had more sites that operated only 1 day (p = 0.04). Tracts with >30% poverty had more sites that started distributing food resources 7-15 days after the hurricane (p = 0.02). Conclusions: Most low-income and low-resourced communities in New Orleans had access to emergency food resources; however, several limitations in operations were identified that may have influenced access. Future initiatives to prevent hunger after a natural disaster in New Orleans, and elsewhere, should improve operational logistics for food aid.

Food insecurity and food consumption among children who receive federal food assistance.

The objective of this study was to investigate the association between household food insecurity and food intake among children who participated in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), including a sub-sample who also participated in the Supplemental Nutrition Assistance Program (SNAP). Data came from the 2014 and 2017 Los Angeles County WIC Surveys, involving a random sample of WIC participating families in Los Angeles, California. Outcome variables were average daily consumption of fruit, 100% fruit juice, vegetables, milk, other juice, other sweetened drinks, and sweet foods, and frequency of fast-food consumption, as reported by the child's caregiver. Our predictor was household food insecurity, obtained from the 6-item Household Food Security Survey Module. Poisson regression (fruit, 100% fruit juice, vegetables, and milk), Negative Binomial regression (other juice, other sweetened drinks, and sweet foods) and multinomial logistic regression (frequency of fast food) models were run, adjusting for child's age and sex; maternal age, ethnicity and language, education, and employment; and type of WIC participation (WIC only vs. WIC + SNAP). In fully adjusted models, household food insecurity was associated with higher consumption of 100% fruit juice (RR = 1.08, 95%CI = 1.03-1.11), milk (RR = 1.04, 95%CI = 1.01-1.07), other juice (RR = 1.16, 95%CI = 1.08-1.26), other sweetened drinks (RR = 1.28, 95%CI = 1.12-1.46), and sweet foods (RR = 1.09, 95%CI = 1.04-1.14). No significant associations were found between household food insecurity and fruit and vegetable consumption. Nutrition education provided by WIC should continue to emphasize the importance of consuming fresh foods, while limiting foods high in sugar for this young population. Efforts should be made to identify food insecure families at the point of service delivery for enhanced nutrition education and social services referrals.

State-Level Socioeconomic Racial Inequity and Food Insecurity in the U.S.

INTRODUCTION: Racial inequities in food insecurity have been documented for the past 2 decades in the U.S., with the prevalence of food insecurity among Black households being 2-3 times higher than that among White households across time. The purpose of this study was to determine the association between socioeconomic indicators of structural racism at the state level and food insecurity among White and Black households in the U.S. METHODS: This study is a secondary analysis of pooled, cross-sectional data from the Current Population Survey and the American Community Survey, 2015-2019 (N=158,551 Black and White households). Data analysis occurred in 2021-2022. The outcome was household food insecurity, and the exposure was structural racism indicators, operationalized as state-level racial inequities in income, earnings, education, unemployment, and home ownership. Individual-, household-, and state-level sociodemographic covariates were included. RESULTS: Among Black households, state-level racial inequities in income, unemployment, and home ownership were associated with 34% (OR=1.34; 95% CI=1.05, 1.70), 14% (OR=1.14; 95% CI=1.02, 1.28), and 11% (OR=1.11; 95% CI=1.05, 1.16) higher odds of food insecurity, respectively. For White households, state-level racial inequities in income, education, unemployment, and home ownership were associated with 21% (OR=0.79; 95% CI=0.63, 0.98), 27% (OR=0.73; 95% CI=0.66, 0.85), 10% (OR=0.90; 95% CI=0.82, 0.98), and 8% (OR=0.92; 95% CI=0.89, 0.95) lower odds of food insecurity, respectively. CONCLUSIONS: Structural racism may be a key driver of food insecurity among Black households and may be protective against food insecurity among White households. Implementing policies addressing state-level racial inequity in socioeconomic indicators could be effective at reducing racial inequities in food insecurity.

Determinants of food insecurity among households with children in Villa el Salvador, Lima, Peru: the role of gender and employment, a cross-sectional study.

BACKGROUND: From 2014-2019, Latin America and the Caribbean had the fastest growth of moderate-to-severe food insecurity than any other region, rising from 22.9% to 31.7%. While the prevalence of food insecurity is higher among women than men in every continent, Latin America has the largest food insecurity gender gap. Factors contributing to this gender inequity include underrepresentation of women in formal employment, heightened burden of dependent care on women, and unequal compensation of labor for women vs. men. The objective of this study was to investigate the association between the gender of the head of the household, employment status of household members, and food insecurity in households with children in a low-income district of Lima, Peru. METHODS: This cross-sectional study was carried out in Villa El Salvador, the fifth largest district in Metropolitan Lima, Peru, where over 20% of the population lives in poverty. Data were collected on a stratified random sample (n = 329) using a household questionnaire, including a validated food security tool (HFIAS). We ran multivariate logistic regression models predicting household food insecurity, with independent variables including gender of household head, education of household head, employment of household head, household-level employment status, age, and weekly food expenses per person. RESULTS: In fully adjusted models, woman-headed households had almost thrice the odds of being food insecure compared to man-headed households. Education also had a significant effect size: a household whose household head did not complete high school was 3.4 times more likely to be food insecure than if they had some post-secondary education. Woman-headed households had a significantly higher proportion of members not formally employed, compared to man-headed households, but employment status was not associated with food insecurity. CONCLUSIONS: Gender of the household head was a major contributing factor to household food insecurity in Villa el Salvador. Gender dynamics affecting opportunities for employment, education, and non-remunerated work should inform national food security policies and interventions with the goal to not only lower food insecurity, but also reduce gender inequities in food insecurity and other nutritional outcomes.

The association between food insecurity and gun violence in a major metropolitan city.

BACKGROUND: Food insecurity (FI) is an important social determinant of health that is associated with many forms of violence. We hypothesized that FI would be associated with gun violence. METHODS: Firearm injury data was collected from 2016 to 2020 (n = 3115) at a single institution that serves as the only Level I trauma center in a major southern US city. The data were linked with Map the Meal Gap data, a publicly available data set, which estimates rates of county-level FI based on state-level FI and social determinants, including unemployment, poverty, disability, and other factors. Regression analysis was utilized to examine the relationship between FI with rates of overall gun trauma and odds of gun-related violence. Food insecurity by county of patient residence was categorized by rates less than the national average of 11.5% (low), between the national and state average (16.5%) (moderate), and greater than the state average (high). Out of state residents were excluded from the analyses. RESULTS: Of the 3,115 patients with firearm injuries identified, 138 (4.4%) resided in counties with low FI rates, 1048 (33.6%) in moderate FI, and 1929 (62.0%) in counties with high FI. Patients in regions of high FI were more likely to be a Level I trauma activation, a victim of assault, and have Medicaid or be self-pay. There was no significant difference in mortality by levels of FI. Food insecurity was significantly associated with firearm injury, with each percent increase in FI being related to approximately 56 additional gun-related injuries per 100,000 people (95% confidence interval, 54-59) and increased odds of the injury classified as assault (odds ratio, 1.13; 95% confidence interval, 1.07-1.19). CONCLUSION: Violence prevention initiatives targeting food insecure communities may help alleviate the US gun violence epidemic. Further, trauma center screening for household FI and in-hospital interventions addressing FI may help reduce gun violence recidivism. LEVEL OF EVIDENCE: Prognostic and Epidemiologic; Level IV.

Household Composition, Income, and Body Mass Index Among Adults by Race/Ethnicity and Sex.

OBJECTIVE: Disparities in obesity highlight the need for an examination of determinants that may be uniquely experienced by race and sex. An understudied factor is household composition with the potential for variation in its obesogenic impacts. This study examines the association between household composition and body mass index (BMI) among Black, Hispanic, and White adults and determines whether income moderates these associations. METHODS: Using cross-sectional data from the 2011-2018 National Health and Nutrition Examination Survey, the number of children and adults aged ≥ 60 years in the household were reported among non-Hispanic Black and White adults as well as Hispanic adults aged 20-59 years old. Multivariable linear regressions were used to assess the associations between household composition and BMI with income as a potential moderator. RESULTS: Having multiple school-aged children was associated with higher BMI (ß = 1.34, standard error (s.e.) = 0.50) among Hispanic men, while having older adults in the household was associated with lower BMI among Black women (ß = - 3.21, s.e. = 1.42). Income moderated the associations between household composition and BMI among Black women and men. There were no associations between household composition and BMI in White women or men. CONCLUSIONS: Future studies should further explicate the mechanisms of household composition that uniquely impact obesity outcomes among Black women and men by income. Efforts to address higher BMI among those with more young children in the household should target Hispanic men.

Mixed Infant Feeding Is Not Associated With Increased Risk of Decelerated Growth Among WIC-Participating Children in Southern California.

Background: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutrition assistance to half of infants born in the United States. The nationally representative WIC Infants and Toddler Feeding Practices Study-2 (ITFPS-2) reported a caloric deficit at 7 months among infants receiving WIC mixed feeding packages, suggesting these infants may be at risk for growth deceleration/faltering. Methods: Longitudinal administrative data collected prospectively from WIC participants in Southern California between 2010 and 2019 were used (n = 16,255). Infant lengths and weights were used to calculate weight-for-length (WLZ), weight-for-age (WAZ) and length-for-age (LAZ) z-scores at different time points. Growth deceleration/faltering was determined at 9, 12, 18, and 24 months by the change in z-score from the last measurement taken ≤ 6 months of age. Infant feeding was categorized by the food package (breastfeeding, mixed feeding, and formula feeding) infants received from WIC at 7 months. Poisson regression models were used to evaluate the association between WIC infant package at 7 months and deceleration/faltering at 9, 12, 18, and 24 months. Results: The proportion of infants displaying decelerated/faltering growth was low for all infant food package groups. Receiving the WIC mixed feeding package at 7 months of age was not associated with WLZ, WAZ, and LAZ deceleration/faltering growth. Conclusions: Growth deceleration/faltering rates were very low among WIC participating children in Southern California, highlighting the critical role of nutrition assistance in supporting adequate growth in early childhood.

Differences in Early Childhood Dietary Behaviors by Infant Feeding Type and Sex.

BACKGROUND: Type of infant feeding has been linked to later nutritional outcomes, including dietary diversity and obesity in childhood. Little is known about how introduction to complementary feeding and diet quality in early childhood vary by infant feeding type and sex. OBJECTIVE: Our objective was to investigate whether early childhood dietary patterns vary by infant feeding type and sex. METHODS: Data from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Infants and Toddler Feeding Practices Study 2 (ITFPS-2) was used, including children with complete information on the WIC infant food package received at ages 1, 7, and 11 mo (N = 2839). Based on this information, children were grouped as fully breastfed, mostly breastfed, mostly formula fed, and fully formula fed. Outcomes include introduction of complementary foods; caloric intake aged between 1 and 36 mo; and Healthy Eating Index (HEI)-2015 between 13 and 36 mo. Mixed models were used adjusting for child's, mother's, and family's sociodemographic characteristics. RESULTS: Across all infant feeding groups, the mean age of introduction to any solids was before the age of 6 mo; fully breastfed children were introduced to complementary foods closer to the recommended age (mean 5.1-5.2 mo) compared with other feeding groups (mean 4.6-4.8 mo). Fully formula fed infants consumed significantly more energy than fully breastfed infants at ages 1 mo (boys = 55 kcal/d, girls = 47 kcal/d), 12 mo (boys = 68 kcal/d, girls = 59 kcal/d), 24 mo (boys = 81 kcal/d, girls = 71 kcal/d), and 36 mo (boys = 95 kcal/d, girls = 83 kcal/d). No meaningful differences were observed for HEI-2015 between infant feeding groups or child sex, with average scores of HEI-2015 for all children being 61-63 out of 100. CONCLUSION: Early childhood dietary patterns were slightly better among children who were fully breastfed as infants, compared with children in other infant feeding groups. The diets of all WIC-participating children could be improved.

The double burden of malnutrition in Peru: An update with a focus on social inequities.

BACKGROUND: The decrease in stunting in Peru is seen as a "success story" in the fight against malnutrition; however, the parallel increase in obesity has often been ignored. OBJECTIVE: To investigate trends in the double burden of malnutrition (i.e., the coexistence of stunting and overweight/obesity) in Peru compared with trends in household food expenditures by family socioeconomic status and urban/rural residency. METHODS: Using Peruvian nationally representative surveys, we analyzed stunting (children aged 0-5 y) and overweight/obesity (women aged 18-49 y) trends between 1992 and 2017, as well as trends in household energy consumption from healthy and unhealthy foods between 2001 and 2017 by education, income, participation in the Juntos cash-transfer program, and urban/rural residency. Joinpoint software was used for all trends analyses. RESULTS: Overall, stunting decreased and obesity increased among all social groups between 1992 and 2017. Inequities in stunting by income and urban/rural residency widened over time. From 1992 to 2017, urban stunting prevalence decreased at an average annual percent change (AAPC) of -4.5% (SE = 0.27%, P < 0.0001), whereas rural stunting prevalence decreased at a lower AAPC of -2.6% (SE = 0.30%, P < 0.0001). On the contrary, inequities in obesity narrowed as obesity prevalence among women from the extremely poor group and those living in rural areas increased at a faster rate than that of their counterparts. Rural obesity prevalence increased at an AAPC of 8.5% (SE = 1.14%, P < 0.0001), whereas urban obesity prevalence increased at an AAPC of 2.0% (SE = 0.25%, P < 0.0001). Increases in energy consumption from unhealthy foods were observed along with decreases in energy consumption from healthy foods in most social groups. CONCLUSION: The prevalence of stunting and obesity is high in Peru. The need for multisectoral interventions addressing both ends of the malnutrition spectrum, particularly among disadvantaged groups to avoid further widening of social inequities, is warranted.

The role of income and neighbourhood poverty in the association between the 2009 Special Supplemental Nutrition Program for Women, Infants and Children (WIC) food package change and child obesity among WIC-participating children in Los Angeles County, 2003-2016.

OBJECTIVE: To determine whether a previously reported association between the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) food package change and reduced child obesity risk among WIC-participating children in Los Angeles County holds across levels of family income and neighbourhood poverty. DESIGN: Analysis of prospectively collected WIC administrative data. The outcome was obesity at age 4 years (BMI-for-age ≥ 95th percentile). Poisson regression was applied to a matched sample (n 79 502) to determine if the association between the WIC food package change and child obesity was modified by family income (<50 % federal poverty level (FPL), 50-100 % FPL, >100 % but <185 % FPL) and neighbourhood poverty. SETTING: Los Angeles County, California. PARTICIPANTS: Children who participated in WIC in Los Angeles County between 2003 and 2016; children were grouped as receiving the old WIC food package (2003-2009) or the new WIC food package (2010-2016). RESULTS: Receiving the new WIC food package (i.e., post-2009) was associated with 7-18 % lower obesity risk across all family income categories. Neither family income nor neighbourhood poverty significantly modified the association between the WIC food package and child obesity. However, certain sub-groups seemed to benefit more from the food package change than others. In particular, boys from families with income above poverty but residing in the poorest neighbourhoods experienced the greatest reductions in obesity risk (relative risk = 0·77; 95 % CI 0·66, 0·88). CONCLUSIONS: The WIC food package revisions were associated with reduced childhood obesity risk among all WIC-participating families in Los Angeles County, across levels of income eligibility and neighbourhood poverty.