The association between unhealthy dietary behaviors and participation in the Supplemental Nutrition Assistance Program (SNAP): No evidence in support of the self-selection hypothesis.

Supplemental Nutrition Assistance Program (SNAP) participants tend to have unhealthier dietary consumption compared to eligible non-participants. It has been suggested, though never empirically tested, that individuals who enroll in SNAP may have unhealthy diets prior to program participation. Using a longitudinal cohort study design, we examined the association between low-income adults' SNAP participation status and prior dietary behaviors to test the argument that individuals with unhealthier dietary consumption self-select into SNAP. A sample of households from predominantly lower-income cities were surveyed at baseline (T1) and 2-4 years later (T2). The main analyses were restricted to adults who did not participate in SNAP at T1 and with household income <200% of the federal poverty line (n = 170) at both T1 and T2. Participants were grouped into two categories, based on their SNAP participation at T2; (a) Non-participants (n = 132): no SNAP participation at T1 or T2, and (b) T2 SNAP participants (n = 38): SNAP participation at T2 but not T1. Daily consumption frequency of whole fruits, fruit juice, vegetables, sugar-sweetened beverages (SSBs), and energy dense snacks were measured through self-reports. To observe dietary differences between the two groups prior to SNAP participation, T1 behaviors were compared. There were no significant differences in dietary behaviors at T1 (prior to SNAP participation) between non-participants and T2 participants, providing no evidence of self-selection of individuals with unhealthier dietary consumption into SNAP among our study sample. Improvements in SNAP participants' diets may benefit from focusing on policy changes that encourage healthy dietary habits during participation in the program.

A natural experiment to assess recess frequency on children's physical activity in Arizona (U.S.) elementary schools.

BACKGROUND: In the United States, the number of state policies mandating recess in schools has rapidly increased over the past decade; however, few policies specify recess frequency. Informed by an ecological model of physical activity (PA) policy, this study examined and compared total amounts and intensity of PA expended during recess among children attending schools in compliance with Arizona recess policy ARS§ 15-118 mandating 2 + daily recess periods versus not. METHODS: PA during recess was measured among grade three children (ages 8-10) in four randomly selected elementary schools (two complying averaging 30 daily recess minutes; two non-complying averaging 15 daily recess minutes) in Maricopa County, Arizona. Group-level PA was assessed by direct observation using the System for Observing Play and Leisure (137 observations). A subset of students (N = 134) from all schools wore ActiGraph GT3X + devices during recess to measure individual PA. General linear mixed effects models were used to analyze the impact of recess frequency on group and individual PA during recess. RESULTS: Students attending complying schools spent significantly greater proportions of time in moderate-to-vigorous PA (MVPA) based on direct observation (5%) and accelerometry (15%) and less time being sedentary based on accelerometry (14%) during recess. Across the school day, this would equate to 5.1 more MVPA minutes based on systematic direct observation and 9.5 more MVPA minutes based on accelerometry, and 4.1 less minutes being sedentary based on accelerometry if students received two daily 15-minute recess periods compared to one. CONCLUSIONS: Students attending elementary schools implementing 2 + recesses, in accordance with state policy, demonstrated greater MVPA and less sedentary time, providing preliminary evidence that recess frequency is associated with greater PA intensity among children during recess. Schools that adhere to state-level PA policies may provide a more supportive environment for PA, resulting in increased movement among students. Specifying recess frequency should be considered in statewide recess policy.

Parent Perceptions and Opinions of Universal Free School Meals in Arizona.

To support families during the COVID-19 pandemic, the USDA allowed all US schools to offer meals at no cost regardless of family income, a policy referred to as Universal Free Meals or Healthy School Meals for All (HSM4A). Despite the recognized benefits and popularity of HSM4A during the pandemic, the policy expired in June 2022. The goal of this study was to gather perceptions of parents in Arizona about school meals, the HSM4A program, and the discontinuation of HSM4A. In collaboration with a local anti-hunger group, using an online survey distributed in September and October 2022, we collected data from a diverse sample of over 2000 parents living in Arizona. Parents unequivocally supported HSM4A during the pandemic (97%) and expressed support for continuing to offer HSM4A (95%). High levels of support were seen across all groups in the study, including from individuals who identified as politically conservative. We also analyzed 750 responses to an open-ended question asking respondents to share their thoughts about offering meals to all Arizona students regardless of family income. The majority of emergent themes related to perceived benefits of HSM4A, including reducing financial burden and stress for families. Our findings will be useful for advocates and policy makers considering HSM4A legislation.

Walkability around the worksite and self-reported and accelerometer-measured physical activity among adults.

This cross-sectional study investigated the relationship between GIS-measured worksite and home neighborhood walkability and several measures of physical activity (PA) in employed adults. Results revealed no significant correlation between worksite walkability and PA outcomes, contradicting the hypothesis of increased PA with improved walkability. However, for women and households without young children, a positive association was observed between worksite walkability and moderate-to-vigorous physical activity (MVPA). Additionally, home neighborhood walkability was linked to self-reported walking. The study highlights the need for further research into social and environmental factors at worksites impacting PA, and examination of PA behaviors in the context of increased remote work due to the COVID-19 pandemic.

Emergency Free School Meal Distribution During the COVID-19 Pandemic in High-Poverty Urban Settings.

BACKGROUND: The coronavirus disease 2019 pandemic triggered nationwide school closures in March 2020, putting millions of children in the United States who were reliant on subsidized school meals at risk of experiencing hunger. In response, the US Department of Agriculture mobilized the Summer Food Service Program and Seamless Summer Option program to provide emergency free school meals. There is a need to investigate the effectiveness of these programs in covering underresourced communities during the pandemic. OBJECTIVE: This study assessed associations between meal distribution and census tract demographics (ie, poverty level, race/ethnicity, and deprivation level based on social deprivation index score). DESIGN: An observational study using longitudinal meal distribution data collected over an 18-month period following school closures (March 2020 to August 2021). PARTICIPANTS AND SETTING: Monthly meal distribution data were collected for community sites serving 142 census tracts within 4 urban New Jersey cities predominantly populated by people with low incomes and from racial and ethnic minority groups. MAIN OUTCOME MEASURES: Main outcome measures were the number of meals served monthly by Summer Food Service Program and Seamless Summer Option meal sites. STATISTICAL ANALYSES PERFORMED: A 2-part multivariable regression approach was used to analyze the data. RESULTS: In the first step, logistic regression models showed that high-deprivation tracts were more likely to serve meals during the observed period (odds ratio 3.43, 95% CI 1.001 to 11.77; P = 0.0499). In the second step, among tracts that served any meals during the observed period, mixed effects negative binomial regression models showed that high-poverty and high-deprivation tracts served comparatively more meals (incidence rate ratio [IRR] 2.83, 95% CI 2.29 to 3.51; P < 0.001 and IRR 1.94, 95% CI 1.65 to 2.28; P < 0.001, respectively). CONCLUSIONS: Findings show that meal distribution during the pandemic was higher within census tracts with higher poverty and deprivation levels, indicating that underresourced communities with higher need had more free meals available during this unprecedented public health emergency.

Food Environments Within and Outside of Schools Play a Critical Role in Curtailing the Rise in Obesity among School-Aged Children over Time.

BACKGROUND: Sound evidence for effective community-based strategies is needed to curtail upward trends in childhood obesity in the United States (US). OBJECTIVES: The aim of the study was to assess the association between school and community food environments and the prevalence of obesity over time. METHODS: Data were collected from K-12 schools in 4 low-income New Jersey cities in the US. School-level obesity prevalence, calculated from nurse-measured heights and weights at 4 time points, was used as the outcome variable. Data on the school food environment (SFE) measured the healthfulness of school lunch and competitive food offerings annually. The community food environment (CFE), i.e., the number of different types of food outlets within 400 m of schools, was also captured annually. The count and presence of food outlets likely to be frequented by students were calculated. Exposure to composite environment profiles both within schools and in communities around schools was assessed using latent class analysis. Data from 106 schools were analyzed using multilevel linear regression. RESULTS: The prevalence of obesity increased from 25% to 29% over the course of the study. Obesity rates were higher in schools that had nearby access to a greater number of limited-service restaurants and lower in schools with access to small grocery stores and upgraded convenience stores participating in initiatives to improve healthful offerings. Interaction analysis showed that schools that offered unhealthier, competitive foods experienced a faster increase in obesity rates over time. Examining composite food environment exposures, schools with unhealthy SFEs and high-density CFEs experienced a steeper time trend (ß = 0.018, P < 0.001) in obesity prevalence compared to schools exposed to healthy SFE and low-density CFEs. CONCLUSIONS: Food environments within and outside of schools are associated with differential obesity trajectories over time and can play an important role in curtailing the rising trends in childhood obesity.

Farm to school programs in low-income, high minority K-12 schools in New Jersey before and after implementation of the Healthy Hunger Free Kids Act.

We analyzed the prevalence of farm to school (FTS) programs in K-12 schools in four low-income, high-minority cities in New Jersey before and after implementation of the Healthy Hunger-Free Kids Act (HHFKA), between school years 2010-11 and 2017-18. Multivariable logistic regression was used to model FTS participation and the prevalence of FTS before versus after HHFKA initiation. Schools showed a significant positive trend in FTS participation (OR 1.18; p=.010) over the study period. Nonetheless, 20% of schools participated in FTS for 3+ years over the eight-year study period. Findings underscore the importance of federal legislation in supporting child nutrition initiatives.

Latent class analysis identifies a promising combination of Supplemental Nutrition Assistance Program-Education interventions for improving student cardiorespiratory fitness.

OBJECTIVE: To inform Supplemental Nutrition Assistance Program Education (SNAP-Ed) and other school-based interventions aiming to improve youth cardiorespiratory fitness, this study aimed to identify which SNAP-Ed school-based physical activity intervention combinations were associated with better student cardiorespiratory fitness. METHODS: This study, utilizing cross-sectional secondary data, included 5th and 7th grade students who attended SNAP-Ed-eligible public schools in California (n = 442,743 students; 4271 schools) and had complete 2016-17 state-mandated fitness test results. Latent class analysis was used to identify underlying school-based intervention combinations. Propensity score methods were used to ensure comparability of intervention and comparison schools, by calculating inverse probability weights. Multilevel models, using those inverse probability weights, assessed the associations between the identified intervention combinations and student cardiorespiratory fitness, as measured by VO2max. The models were adjusted for school-level variables (urbanicity, percent of students eligible for free- or reduced-price meals, total enrollment, and school type), child-level variables (age, gender, and race/ethnicity), and for clustering of students within schools. RESULTS: We found that students attending schools with interventions focusing on comprehensive policy changes along with improving opportunities for physical activity had, on average, 1.17 mL/kg/min (95% CI: 0.72, 1.62) greater VO2max than students attending schools without any intervention. They also had statistically significantly greater VO2max compared to students attending schools with any other type of intervention combination. CONCLUSION: Our results suggest that comprehensive school-based physical activity interventions that include policy changes along with improving physical activity opportunities may be the most effective approach for improving fitness and may warrant prioritization in SNAP-Ed efforts.

The relationship between changes in neighborhood physical environment and changes in physical activity among children: a prospective cohort study.

BACKGROUND: Physical activity (PA) is associated with positive health outcomes over the entire life course. Many community-based interventions that promote PA focus on implementing incremental changes to existing facilities and infrastructure. The objective of this study was to determine if such upgrades were associated with increases in children's PA. METHODS: Two cohorts of 3- to 15-year-old children (n = 599) living in 4 low-income New Jersey cities were followed during 2- to 5-year periods from 2009 to 2017. Data on children's PA were collected at 2 time points (T1 and T2) from each cohort using telephone survey of parents; data on changes to existing PA facilities were collected yearly from 2009 to 2017 using Open Public Records Act requests, publicly available data sources, and interviews with key stakeholders. PA changes were categorized into six domains (PA facility, park, trail, complete street, sidewalk, or bike lane) and coded as new opportunity, renovated opportunity, or amenity. A scale variable capturing all street-related upgrades (complete street, sidewalk, and bike lane) was constructed. PA was measured as the number of days per week the child engaged in at least 60 min of PA. The association between change in PA between T1 and T2, ranging from - 7 to + 7, and changes to the PA environment was modeled using weighted linear regression controlling for PA at T1, child age, sex, race, as well as household and neighborhood demographic and socioeconomic characteristics. RESULTS: While most measures of the changes to the PA environment were not associated with change in PA between T1 and T2, the street-related upgrades were positively associated with the change in PA; specifically, for each additional standard deviation in street upgrades within a 1-mile radius of their homes, the change in PA was 0.42 (95% CI: 0.02, 0.82; p = 0.039) additional days. This corresponds to an 11% increase over the mean baseline value (3.8 days). CONCLUSIONS: The current study supports funding of projects aimed at improving streets and sidewalks in cities, as it was shown that incremental improvements to the PA environment near children's homes will likely result in increased PA among children.

Determinants of tap water mistrust among Phoenix, Arizona Latinx adults.

The purpose of this investigation was to characterize factors that predict tap water mistrust among Phoenix, Arizona Latinx adults. Participants (n = 492, 28 ± 7 years, 37.4% female) completed water security experience-based scales and an Adapted Survey of Water Issues in Arizona. Binary logistic regression determined odds ratios (OR) with 95% confidence intervals (95% CI) for the odds of perceiving tap water to be unsafe. Of all participants, 51.2% perceived their tap water to be unsafe. The odds of mistrusting tap water were significantly greater for each additional favorable perception of bottled compared to tap water (e.g., tastes/smells better; OR = 1.94, 95% CI = 1.50, 2.50), negative home tap water experience (e.g., hard water mineral deposits and rusty color; OR = 1.32, 95% CI = 1.12, 1.56), use of alternatives to home tap water (OR = 1.25, 95% CI = 1.04, 1.51), and with decreased water quality and acceptability (OR = 1.21, 95% CI = 1.01, 1.45; P < 0.05). The odds of mistrusting tap water were significantly lower for those whose primary source of drinking water is the public supply (municipal) (OR = 0.07, 95% CI = 0.01, 0.63) and with decreased water access (OR = 0.56, 95% CI = 0.48, 0.66; P < 0.05). Latinx mistrust of tap water appears to be associated with organoleptic perceptions and reliance on alternatives to the home drinking water system.

Improvements in School Food Offerings over Time: Variation by School Characteristics.

The 2010 Healthy, Hunger-Free Kids Act (HHFKA) improved the nutritional quality of food served in schools. This longitudinal study examined school food offerings over time from school year 2010-11 to 2017-18 in public schools (n = 148) in four New Jersey cities. Six food indices were used to assess the number of healthy and unhealthy items offered as part of the National School Lunch Program (NSLP), in vending machines, and à la carte (i.e., competitive foods). Multilevel, multivariable linear regression with quadratic terms was used to model the trends over time. Interaction terms were added to examine whether the time trends varied by school-level factors, such as proportion of students eligible for free or reduced-price meals (FRPMs), race/ethnicity of enrolled students, and school level. Over the study period, healthy items offered in the NSLP increased (p < 0.001), while unhealthy items in the NSLP decreased (p < 0.001). Significantly different rates of declines in NSLP unhealthy offering were observed among schools at the two extremes of FRPM eligibility (p < 0.05). The trends for healthy and unhealthy foods offered in competitive foods showed significant non-linear trends, and differences were observed for school-level race/ethnicity, with worse outcomes for schools with majority Black student enrollment.

Association of mobile health (mHealth) use with health status and COVID-19-related concerns by people with mobility impairments.

PURPOSE: Mobile health (mHealth) technology has increased dramatically in the wake of the pandemic. Less research has focused on people with mobility impairing (PMI) disabilities. This study determined the prevalence of mHealth use among PMI adults during the COVID-19 escalation and examines demographic, health and COVID-19 concerns correlates. METHODS: PMI adults (N = 304) completed an online survey investigating mHealth use and COVID-19 concerns related to food access in June of 2020. Smartphone and mHealth use were measured with an adapted version of the survey used in the Pew Internet & American Life project. Descriptive and multivariable analyses were conducted to determine associations of demographics, health status, and COVID-19 concerns with mHealth use. About two-thirds (N = 201) of the sample were mHealth users (owned a smartphone and engaged in health-promoting behaviors with the smartphone; e.g., sought online information, tracked health behaviors, used patient portals). RESULTS: Having hypertension was associated with higher mHealth use, and having higher COVID-19 concerns about food access was associated with higher mHealth use. Those who used mHealth were also more engaged with smartphone apps for communication, services, and entertainment. Only the association between educational attainment and mHealth use remained significant after adjusting for other covariates in multivariable logistic regression models. DISCUSSION: PMIs continue to need support in the use of mHealth technology to help maximize access to potentially important tools for rehabilitation and health management. There is a need to continue to investigate mHealth and its applications for people with disabilities.Implications for RehabilitationMany people with mobility impairing disabilities may be missing opportunities for mHealth rehabilitation and healthcare.COVID-19 has widened existing gaps in access and use of mHealth technology among people with mobility impairing disabilities.Focused education is needed to help people with disabilities exploit the full range of services of their smartphones to increase access to care, social connectivity, and other important goods and services to enhance rehabilitation and health management.

Federal Food Assistance Program Participation during the COVID-19 Pandemic: Participant Perspectives and Reasons for Discontinuing.

This study aims to describe reasons for discontinuing participation and experiences participating in the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) during the COVID-19 pandemic. We analyzed data from a cross-sectional online survey distributed to a national sample, restricted to (1) households that discontinued participating in SNAP (n = 146) or WIC (n = 149) during the pandemic and (2) households that participated in SNAP (n = 501) or WIC (n = 141) during spring 2021-approximately one year into the pandemic. We conducted thematic analyses of open-ended survey questions and descriptive statistics for Likert-scale items. Themes raised by respondents who discontinued participating in SNAP or WIC included difficulty recertifying and virus exposure concerns. Former WIC participants reported the program was not worth the effort and former SNAP participants reported failing to requalify. Respondents participating in WIC or SNAP during the pandemic mentioned transportation barriers and insufficient benefit value. WIC participants had trouble redeeming benefits in stores and SNAP participants desired improved online grocery purchasing experiences. These results suggest that enhancements to WIC and SNAP, such as expanded online purchasing options, program flexibilities, and benefit increases, can improve program participation to ensure access to critical nutrition supports, especially during emergencies.

Schools' Participation in the Community Eligibility Provision Affects Students' Receipt of Emergency Benefits during the COVID-19 Pandemic.

Pandemic Electronic Benefits Transfer (P-EBT) benefits were intended for families of school children who lost access to free or reduced-price school meals (FRPMs) during the COVID-19 pandemic-related school closures. In high-poverty communities, all students from schools participating in the Community Eligibility Provision (CEP) were automatically eligible for P-EBT benefits; in non-CEP schools, only students already participating in FRPMs-for which their parents submitted an individual application-were eligible for P-EBT benefits. Using publicly available data from 105 K-12 public schools located in 4 sizeable low-income New Jersey (NJ) cities, this study investigated the association between school CEP participation status and the reach of P-EBT benefits for eligible students. A generalized linear model with a logit link, a binomial family, and robust standard errors was used. Across all levels of FRPM eligibility based on students' household income, as expected, almost all students from CEP schools received P-EBT benefits; significantly fewer received P-EBT benefits if they attended non-CEP schools, even when they were eligible for FRPMs. Our findings show that without changes to the qualification process for CEP, large numbers of eligible children will not receive the intended health benefits of federal meals programs or similar emergency relief initiatives. Expanding CEP eligibility and simplifying the process through which schools qualify would likely improve the uptake of federal meals programs and emergency interventions, and more effectively achieve their intent.

School Garden Prevalence Before and After the Implementation of the Healthy Hunger-Free Kids Act.

BACKGROUND: The Healthy Hunger-Free Kids Act (HHFKA) of 2010 supported implementation of school gardens for promoting fruit and vegetable consumption. We examined school garden prevalence over time by school-level factors during the period before and after the implementation of HHFKA. METHODS: Using data from the New Jersey Child Health Study, conducted in 4 low-income New Jersey cities, prevalence of school gardens among K-12 schools (n = 148) was assessed between school year 2010-2011 and 2017-2018. Multivariable analysis estimated changes in garden prevalence over time adjusting for school-level factors. RESULTS: Overall, the sample included 97 elementary and 51 middle/high schools. Multivariable logistic regression showed that compared to 2010-2011 (19%) a higher proportion of schools reported having a garden in 2013-2014 (32%, p = 0.025). Over the entire study period, schools with majority Hispanic student enrollment had approximately half the odds of having a garden compared to schools with majority Black students (p = 0.036). CONCLUSION: School garden prevalence increased in the year immediately following the implementation of the HHFKA but this increase was not sustained over time. Future research should investigate the reasons for this decline and potential disparities by race/ethnicity.

Active commuting to school: A longitudinal analysis examining persistence of behavior over time in four New Jersey cities.

Evidence suggests that healthy behaviors initiated during childhood may continue over time. The objective of this study was to determine whether active commuting to/from school (ACS) at baseline predicted continued ACS at follow-up two to five years later. Two cohorts of households with 3-15 year-olds in four low-income New Jersey cities were randomly sampled and followed for two to five year periods between 2009 and 2017. Children who walked, bicycled, or skateboarded to/from school at least one day/week were classified as active commuters. Children with complete data at both time points were included in this analysis (n = 383). Multivariate logistic regression was used to examine the association between ACS at T1 and T2. Models adjusted for child age, sex, and race/ethnicity; parent's education and nativity status (native-born vs foreign-born); household poverty level; car availability; neighborhood level characteristics; and distance from home to school. Children who engaged in ACS at T1 had over seven times the odds of ACS at T2 compared to children who did not actively commute at T1 (p < 0.001), after adjusting for distance to school and other relevant covariates. Distance, regardless of active commuting status at T1 was inversely associated with active commuting at T2. Policies and interventions encouraging ACS, and those that decrease the distance between a child's home and school, may result in increased, habitual active commuting and physical activity behavior throughout childhood and possibly into adulthood.

Patterns of Food Assistance Program Participation, Food Insecurity, and Pantry Use among U.S. Households with Children during the COVID-19 Pandemic.

This study aims to describe differences in participation in the Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women and Children (WIC), and school meal programs by household characteristics prior to and during the pandemic, and to examine the association of program participation with food security status and food pantry use. We analyze secondary data (n = 470) from an online survey collected in July/August 2020 using weighted multiple logistic regression models. Participation in SNAP declined among households with children in the first four months of the pandemic, while participation in WIC increased slightly, and participation in school meals remained unchanged. There were significant differences in SNAP, WIC, and school meal programs use by race/ethnicity, income, and urbanicity before and during the pandemic. Food insecurity prevalence was higher among SNAP participants at both periods but the gap between participants and non-participants was smaller during the pandemic. Pantry use and food insecurity rates were consistently higher among federal nutrition assistance program participants, possibly suggesting unmet food needs. These results highlight the need for increased program benefits and improved access to food, particularly during periods of hardship.

What Influences the Credibility of Printed Nutrition Education Materials?

Objectives: In this study, we aimed to determine the influence of aesthetics and color of printed nutrition education materials on perceived credibility of the material content. Methods: A randomized 2 x 2 (aesthetics and color) factorial experimental design was completed on a university campus. Undergraduate and graduate students (N=204) were randomly assigned one of 4 types of flyers (high aesthetic-color, high aesthetic-black-and-white, low aesthetic-color, and low aesthetic-black-and-white). Perceptions on the flyer content (accurate, believable, biased, valuable, and trustworthy), perceptions of overall flyer quality (attractive, pleasant, confusing, and interesting), and knowledge of the content within the flyer were assessed via a survey after reading the flyer. Results: A statistically significant main effect of aesthetics was observed for perceived "trustworthiness" of the flyer information (p = .048). Flyers with high aesthetics, regardless of print color, had a higher mean score of "trustworthiness" (M = 6.01) than flyers with low aesthetics (M = 5.71). An interaction effect was seen for perception of the flyer being "confusing" (p = .02). The high aesthetic-black-and-white flyer had the highest mean score for "confusing" (M = 1.66) with the low aesthetic flyer printed in color having the second highest mean score for "confusing" (M = 1.56). Conclusions: The aesthetics of nutrition education materials appear to influence perceived trustworthiness of those materials.

Differential Associations Between Changes in Food Environment and Changes in BMI Among Adults Living in Urban, Low-Income Communities.

BACKGROUND: Food environments can contribute to excess weight gain among adults, but the evidence is mixed. OBJECTIVES: This longitudinal study investigated the associations between changes in the food environment and changes in BMI in adults and whether changes in the food environment differentially impact various subgroups. METHODS: At 2 time points, BMI was calculated using self-reported height and weight data from 517 adults (mean age, 41 years) living in 4 New Jersey cities. The counts of different types of food outlets within 0.4, 0.8, and 1.6 km of respondents' residences were collected at baseline and tracked until follow-up. A binary measure of social standing (social-advantage group, n = 219; social-disadvantage group, n = 298) was created through a latent class analysis using social, economic, and demographic variables. Multivariable linear regression modeled the associations between changes in BMI with measures of the food environment; additionally, interaction terms between the measures of food environment and social standing were examined. RESULTS: Overall, over 18 months, an increase in the number of small grocery stores within 0.4 km of a respondent's residence was associated with a decrease in BMI (ß = -1.0; 95% CI: -1.9, -0.1; P = 0.024), while an increase in the number of fast-food restaurants within 1.6 km was associated with an increase in BMI (ß = 0.1; 95% CI: 0.01, 0.2; P = 0.027). These overall findings, however, masked some group-specific associations. Interaction analyses suggested that associations between changes in the food environment and changes in BMI varied by social standing. For instance, the association between changes in fast-food restaurants and changes in BMI was only observed in the social-disadvantage group (ß = 0.1; 95% CI: 0.02, 0.2; P = 0.021). CONCLUSIONS: In a sample of adults living in New Jersey, changes in the food environment had differential effects on individuals' BMIs, based on their social standing.

Do Parental Perceptions of the Nutritional Quality of School Meals Reflect the Food Environment in Public Schools?

(1) Background: It is unknown whether parents' perception of school meals, a determinant of student meal participation, align with the nutritional quality of meals served in schools. This study compares the healthfulness of foods offered in schools with parental perception of school meals at those same schools. (2) Method: Parents were asked to rate the healthfulness of school meals at their child's school. Data on the types of foods offered were collected from public schools in four cities in New Jersey and matched with parent-reported data. Measures were developed to capture the presence of healthy and unhealthy items in the National School Lunch Program and the presence of a la carte offerings as well as vending machines. Multivariable analysis examined the association between parental perceptions of school meals and the school food measures after adjusting for covariates. (3) Results: Measures of the school food environment and parental perceptions were available for 890 pre-K to 12th grade students. No significant associations were observed between parental perceptions and food environment measures when examined one by one or in a comprehensive model. (4) Conclusions: Parents' perception of the healthfulness of meals served do not align with the nutritional quality of foods offered at schools.