Food Insecurity in the Rural United States: An Examination of Struggles and Coping Mechanisms to Feed a Family among Households with a Low-Income.

Households with a low-income in rural places experience disproportionate levels of food insecurity. Further research is needed about the nuances in strategies that households with a low-income in rural areas apply to support food security nationally. This study aimed to understand the barriers and strategies that households with a low-income in rural areas experience to obtain a meal and support food security in the United States. We conducted a qualitative study with semi-structured interviews among 153 primary grocery shoppers with a low-income residing in rural counties. A majority of family's ideal meals included animal-based protein, grains, and vegetables. Main themes included struggles to secure food and coping mechanisms. Ten categories included affordability, adequacy, accommodation, appetite, time, food source coordinating, food resource management, reduced quality, rationing for food, and exceptional desperation. These results can inform public health professionals' efforts when partnering to alleviate food insecurity in rural areas.

Creating a culture that supports food security and health equity at higher education institutions.

Food insecurity on college campuses is a major public health problem and has been documented for the last decade. Sufficient food access is a crucial social determinant of health, thus campuses across the country have implemented various programmes, systems and policies to enhance access to food which have included food pantries, campus gardens, farmers' markets, meal share or voucher programmes, mobile food applications, campus food gleaning, food recovery efforts, meal deliveries and task force/working groups. However, little is understood about how to best address food insecurity and support students who are struggling with basic needs. The impact of food insecurity on students' academic and social success, in addition to their overall well-being, should be investigated and prioritised at each higher education institution. This is especially true for marginalised students, such as minority or first-generation students, who are at heightened risk for food insecurity. In order to create a culture of health equity, in which most at-risk students are provided resources and opportunities to achieve optimal well-being, higher education institutions must prioritise mitigating food insecurity on the college campus. Higher education institutions could benefit from adopting comprehensive and individualised approaches to promoting food security for marginalised students in order to facilitate equal opportunity for optimal scholastic achievement among students of all socio-demographic backgrounds.

Campus-based programmes to address food insecurity vary in leadership, funding and evaluation strategies.

College food insecurity is a known detriment to student success, but little is known about the implementation of campus-based programmes to help address this issue on campus in the United States. The objective of this research study was to determine the types of food insecurity initiatives implemented and assess how such programmes are managed, funded, and evaluated. A cross-sectional, 23-item online survey was administered among individuals involved with campus food insecurity initiatives identified through professional networks. Food pantries were the most common (97.1%) and mobile food sharing applications were the least common (14.7%) food security initiatives. A majority of respondents (69.7%) stated that at least one programme on their campus was evaluated, although the methods varied and uncertainty about the methods used was common. An allocated budget was provided at some institutions (38.9%), but funding mechanisms varied. Student Life Offices were most commonly reported as being responsible for programme management. Most respondents (75.3%) reported there had been programme changes due to COVID-19. This research confirmed that food insecurity programmes are widely available, although the type, funding, and leadership of these programmes vary. A coordinated approach on campus to align programming efforts is needed.

Disparities in dietary practices during the COVID-19 pandemic by food security status.

Little is known about the differences in dietary practices among food secure and food insecure populations during the early COVID-19 pandemic restrictions. The purpose of this study was to examine differences in dietary practices the early COVID-19 pandemic restrictions between adults reporting food security versus food insecurity. An online cross-sectional survey using validated measures was administered between April and September 2020 to explore both dietary patterns and practices and food security status among persons residing in five U.S. states from different regions of the country during the COVID-19 pandemic. Between-group differences (food secure versus food insecure) were examined for dietary practice outcomes using Pearson's Chi-Square test statistic, with Fisher's Exact test for cell counts less than five. There were 3,213 adult respondents. Food insecurity increased among the survey sample from 15.9% before the COVID-19 pandemic to 23.1% during the onset of the COVID-19 pandemic (p < 0.01). Compared to food secure respondents, those experiencing food insecurity reported more group gatherings for meals during the pandemic, decreased fruit and vegetable intake, and a need for more nutrition support resources than food secure respondents (p < 0.05). Food secure individuals reported increasing alcohol consumption, more frequent take-out or delivery ordering from fast food or restaurants, and more interest in supporting the local food system (p < 0.05). Results indicate a clear risk of disparities in dietary practices based on food security status during the early COVID-19 pandemic restrictions. Public health research, practice, and policy efforts should tailor specific efforts towards both food secure and food insecure groups.

Should Clinicians Ever Recommend Supplements to Patients Trying to Lose Weight?

Helping patients lose weight can mitigate their risk of chronic disease and improve their quality of life. Over-the-counter dietary supplements for weight loss, however, are not reviewed or approved for safety or efficacy, nor does evidence support their clinical use. This commentary on a case suggests 3 reasons why clinicians cannot ethically recommend these supplements to patients: these products' safety and efficacy are unknown, ingredient lists might not be complete, and advertising could be misleading. This article reviews facts clinicians should know regarding over-the-counter weight loss products and explains how they can support, educate, and promote culturally and individually sensitive weight-management strategies.

Examining the relationship between physical activity and mental health during the COVID-19 pandemic across five U.S. States.

The objectives of this paper are to investigate: 1) how the COVID-19 pandemic influenced both physical activity practices and mental health status, and 2) to assess the relationship between the two. Our mixed-methods study draws on 4,026 online survey responses collected between April - September 2020 across five states (Louisiana, Montana, North Carolina, Oregon and West Virginia). Logistic regression models were run for two outcome variables (physical activity and mental health status (measured using the Kessler Psychological Distress scale)). Researchers controlled for race/ethnicity, household income/size, gender, urbanicity, education, employment, use of government assistance and presence of chronic health conditions. Qualitative analysis was applied to open-ended survey responses to contextualize quantitative findings. Household income was significant in predicting difficulty maintaining pre-pandemic physical activity levels; pre-pandemic physical activity levels were associated with increased psychological distress levels during COVID-19; and race/ethnicity, income status and urbanicity were significantly associated with deteriorating mental health status and physical activity levels during COVID-19. Data suggests that a bi-directional, cyclical relationship between physical activity and mental health exists. Policy implications should include physical activity promotion as a protective factor against declining mental health.

Examining Rural Food-Insecure Families' Perceptions of the Supplemental Nutrition Assistance Program: A Qualitative Study.

The Supplemental Nutrition Assistance Program (SNAP) is a critical program that helps reduce the risk of food insecurity, yet little is known about how SNAP addresses the needs of rural, food-insecure residents in the United States (U.S.). This study examines how rural, food-insecure residents perceive SNAP. Semi-structured interviews were conducted with 153 individuals living in six diverse rural regions of Arkansas, Montana, North Carolina, Oregon, Texas, and West Virginia. SNAP was described as a crucial stop-gap program, keeping families from experiencing persistent food insecurity, making food dollars stretch when the family budget is tight, and helping them purchase healthier foods. For many rural residents interviewed, SNAP was viewed in a largely positive light. In efforts to continue improving SNAP, particularly in light of its relevance during and post-coronavirus (COVID-19) pandemic, policymakers must be aware of rural families' perceptions of SNAP. Specific improvements may include increased transparency regarding funding formulas, budgeting and nutrition education for recipients, effective training to improve customer service, connections among social service agencies within a community, and increased availability of automation to streamline application processes.

Changes in Sport Nutrition Knowledge, Attitudes/Beliefs and Behaviors Following a Two-Year Sport Nutrition Education and Life-Skills Intervention among High School Soccer Players.

The purpose of this study was to examine the impact of a sport nutrition education and life-skills intervention on sport nutrition knowledge (SNK), attitudes/beliefs and dietary behaviors relevant to sport nutrition among high school (HS) soccer players. Three assessments were done over the 2-year intervention (baseline = time 1, end year 1 = time 2, end year 2 = time 3). Participants (n = 217; females = 64%; Latino = 47.5%; 14.9 ± 0.9-year; 46.5% National School Breakfast/Lunch Program) were assigned to an intervention group (IG, n = 153; 9 schools) or comparison group (CG, n = 64; 4 schools) based on geographical location. Differences over time were examined based on group, sex, socioeconomic status (SES) and race/ethnicity. The IG increased SNK scores by ~10% (time 1 = 51.6%; time 3 = 60.9%; p ≤ 0.001), with the greatest change in the female IG vs. CG and no differences in male IG vs. CG. Daily breakfast consumption was 53.7% in both groups. IG players were 3 times more likely (95%CI = 2.59, 7.77) to report trying to eat for performance (IG = 48.7% vs. CG = 30.2%). By time 3, IG players were less likely to report that 'diet met nutritional requirements' (31.6%) compared to CG (47.6%). For IG, the consumption of lunch (≥5-days/week) did not change (92.2⁻93.4%), but declined in the CG (90.6%) (p = 0.04). No other differences by sub-population (race/ethnicity, SES) were observed. Our findings indicate that HS athletes are motivated to learn and improve diet behaviors, and benefit from team-based nutrition interventions. Future interventions should consider delivery of curriculum/experiential learning during a defined training period, with messages reinforced with supports at home, school and athletic settings.

Promoting Healthy Diet, Physical Activity, and Life-Skills in High School Athletes: Results from the WAVE Ripples for Change Childhood Obesity Prevention Two-Year Intervention.

The purpose of this study was to compare changes in diet and daily physical activity (PA) in high school (HS) soccer players who participated in either a two-year obesity prevention intervention or comparison group, while controlling for sex, race/ethnicity, and socioeconomic status. Participants (n = 388; females = 58%; Latino = 38%; 15.3 ± 1.1 years, 38% National School Breakfast/Lunch Program) were assigned to either an intervention (n = 278; 9 schools) or comparison group (n = 110; 4 schools) based on geographical location. Pre/post intervention assessment of diet was done using Block Fat/Sugar/Fruit/Vegetable Screener, and daily steps was done using the Fitbit-Zip. Groups were compared over-time for mean changes (post-pre) in fruit/vegetables (FV), saturated fat (SF), added sugar, and PA (daily steps, moderate-to-vigorous PA) using analysis of covariance. The two-year intervention decreased mean added sugar intake (-12.1 g/day, CI (7.4, 16.8), p = 0.02); there were no differences in groups for FV or SF intake (p = 0.89). For both groups, PA was significantly higher in-soccer (9937 steps/day) vs. out-of-soccer season (8117 steps/day), emphasizing the contribution of organized sports to youth daily PA. At baseline, Latino youth had significantly higher added sugar intake (+14 g/day, p < 0.01) than non-Latinos. Targeting active youth in a diet/PA intervention improves diet, but out of soccer season youth need engagement to maintain PA (200).

WAVE~Ripples for Change Obesity Two-Year Intervention in High School Soccer Players: Process Evaluation, Best Practices, and Youth Engagement.

This paper reports the process data on program fidelity, best practices for intervention implementation, youth and coach engagement, and youth application of knowledge and skills for the two-year WAVE~Ripples for Change (WAVE) obesity prevention intervention program focused on healthy eating, physical activity, and life skills with high school (HS) soccer players aged 14⁻19 years. Internal (staff: n = 7; volunteers: n = 27) and external (youth: n = 100; coaches: n = 9) stakeholders were interviewed/ surveyed. Staff rated program fidelity as high (94%), as did volunteers (85%). Best practices included coach encouragement for athlete participation, use of on-line consent for enrollment, building relationships with HS staff to complete assessments, sending text reminders, and providing incentives. Study results showed an enrollment rate of 72%, completion of baseline assessments of 89⁻98%, attendance of sports nutrition lessons in Year 1 and Year 2 of 90% and 39%, respectively, and team-building workshop (TBW) attendance of 25⁻31%. Activities exceeding youth expectations (>90%) included, (1) activities with their soccer team; (2) the TBW-cooking; and (3) sports nutrition lessons. The obesity prevention skills most applied by youth were obtained from the TBW-gardening and harvesting (49%), the TBW-cooking (43%), and sports nutrition lessons (44%). Coaches also rated the sports nutrition lessons highly and reported increased awareness for hydration/fueling during sport by the athletes. Using sport teams/clubs to engage youth in obesity prevention is a feasible model for future study.

Sport Nutrition Knowledge, Behaviors and Beliefs of High School Soccer Players.

For adolescent athletes (14-18 years), data on sport nutrition knowledge, behaviors and beliefs are limited, especially based on sex, race/ethnicity and socioeconomic status. High school soccer players (n = 535; 55% female; 51% White, 41% Latino; 41% National School Lunch Program (NSLP) participants (80% Latino)) completed two questionnaires (demographic/health history and sport nutrition). The sport nutrition knowledge score was 45.6% with higher scores in NSLP-Whites vs. NSLP-Latinos (p < 0.01). Supplement knowledge differed by sex (16% lower in females; p = 0.047) and race/ethnicity (33% lower in Latinos; p < 0.001). Breakfast consumption was 57%; females ate breakfast less (50%) than males (60%; p < 0.001); NSLP-participants ate breakfast less (47%) than non-NSLP (62%; p < 0.001). Supplement use was 46%, with Latinos using more supplements than Whites do (p = 0.016). Overall, 30% used protein shakes, with females using less than males (p = 0.02), while use was twice as likely in Latino vs. White (p = 0.03). Overall, 45% reported their nutrient requirements were different from non-athlete peers. Latinos were less likely (p = 0.03) to report that their diet met nutritional requirements, but more than twice as likely to report that nutritional supplements were necessary for training (p < 0.001). Adolescent athletes, especially females and Latinos, would benefit from sport nutrition education that enhances food selection skills for health and sport performance.

Promotores As Advocates for Community Improvement: Experiences of the Western States REACH Su Comunidad Consortium.

The REACH Su Comunidad Consortium worked with 10 communities to address disparities in access to healthy food and physical activity opportunities among Hispanic populations through policy, systems, and environmental (PSE) strategies. Community health workers took leadership roles in the implementation of PSE strategies in partnership with local multisector coalitions. This article describes the role of community health workers in PSE change, the technical and professional development support provided to the REACH Su Comunidad Communities, and highlights professional development needs of community health workers engaging in PSE strategies.

Redesigning a neighborhood park to increase physical activity: a community-based participatory approach.

BACKGROUND: Community collaboration and active engagement of neighborhood residents in park redesign are promising strategies for creating public spaces that support physical activity. OBJECTIVE: This research brief describes the process of community engagement and discusses outcomes of a participatory park redesign project. METHODS: A community design charrette was held in collaboration with community organizations. Environmental audits of park features and amenities were completed before and after implementation of park redesign. A guided discussion with stakeholders following the park redesign was conducted to discuss challenges, successes, and next steps. RESULTS: Although level of activity among youth observed in the post implementation observations did not differ, there were a greater variety of activities observed among both children and adolescents. Furthermore, the goals of the project related to capacity building and meeting residents' needs were accomplished. CONCLUSIONS: Active participation of residents in a neighborhood park redesign requires time, commitment, and communication from a variety of stakeholders. However, the creation of a park that supports a variety of activity types, and builds community capacity, supports the need for involving stakeholders in redesigning neighborhood parks.

Prevalence and correlates of food insecurity among students attending a midsize rural university in Oregon.

OBJECTIVE: To examine the prevalence and identify correlates of food insecurity among students attending a rural university in Oregon. METHODS: Cross-sectional nonprobability survey of 354 students attending a midsize rural university in Oregon during May, 2011. The main outcome was food insecurity measured using the US Department of Agriculture Household Food Security Survey Module: 6-Item Short Form. Socioeconomic and demographic variables were included in multivariate logistic regression models. RESULTS: Over half of students (59%) were food insecure at some point during the previous year. Having fair/poor health (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.07-4.63), being employed (OR, 1.73; 95% CI, 1.04-2.88), and having an income < $15,000/y (OR, 2.23; 95% CI, 1.07-4.63) were associated with food insecurity. In turn, good academic performance (grade point average of ≥ 3.1) was inversely associated with food insecurity. CONCLUSIONS: Food insecurity seems to be a significant issue for college students. It is necessary to expand research on different campus settings and further strengthen support systems to increase access to nutritious foods for this population.

Strengthening rural Latinos' civic engagement for health: The Voceros de Salud project.

This article describes the Latino Health Ambassadors Network (Voceros de Salud ) project created to support and mobilize Latino community leaders to address health inequalities in a rural Oregon county. Voceros de Salud is discussed as a model that other rural communities may implement towards strengthening Latino civic engagement for health.