Cyclic Formula Feeding Among Infants Participating in the Special Supplemental Nutrition Program for Women, Infants, and Children.

BACKGROUND: Low-income households often experience a cyclic pattern in food availability, with acute food shortages at month end. Variations in the monthly feeding of infant formula are understudied. OBJECTIVES: This study aimed to compare the amount and frequency of formula consumed at the beginning and end of the monthly Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) assistance cycle and test associations with total energy intake and other feeding practices among infants aged 7-11 mo. METHODS: This study was conducted between May 2020 and April 2021 in the southeastern United States and involved mothers of infants participating in WIC's fully formula package. Mothers were interviewed and 24-h feeding recalls were conducted at the beginning and end of the month. We defined month beginning as 5 d following the first WIC formula purchase and month end as 5 d before the next monthly cycle. Fifty mother-infant dyads participated in single or multiple monthly cycles, totaling 98 monthly cycles. Generalized linear mixed-effects modeling was used to test differences in formula feeding at month beginning and end. RESULTS: Most participants (84%) were African American or Latino and >90% purchased all formula within 2-3 d of the WIC issuance. The energy intake from formula at month beginning was significantly higher than at month end (67.63% and 57.85%, respectively; P = 0.002), with no differences in total energy intake. The odds of infants being fed cow milk and fruit juices/drinks increased from month beginning to end (P < 0.05). CONCLUSIONS: Infants in low-income households are at risk of experiencing a cyclic feeding pattern characterized by higher formula feeding at month beginning and an increase in feeding of nonrecommended drinks at month end. The WIC program policy could review educational and distribution options to reduce cyclic formula feeding and clarify caregivers' understanding of infants' formula needs. Household-level investigations into formula management and determinants of cyclic feeding are warranted.

Does Attraction Toward Physical Activity Predict Physical Activity Behavior in Older Adults?

BACKGROUND/OBJECTIVES: Few studies have investigated associations between the motivational outcome based on physical activity (PA) affective experiences (i.e., attraction vs. antipathy toward PA) and behavior. This study investigated cross-sectional and longitudinal associations between attraction (vs. antipathy) toward PA and device-based PA in older adults. METHODS: Older adults (n = 139; 71% female, Mage = 70.5) completed assessments of attraction (vs. antipathy) toward PA and 14 days of device-based accelerometry at Times 1 and 2. RESULTS: Greater attraction toward PA at Time 1 was associated with greater steps (ß = 5.31, p < .01) and moderate to vigorous intensity PA (ß = 3.08, p < .05) at Time 1. Greater attraction toward PA at Time 1 was not significantly associated with steps or moderate to vigorous intensity PA at Time 2. CONCLUSION: Greater emphasis on resultant motivation from PA affective experiences may be useful in promoting PA in older adults. Significance/Implications: In spite of mixed findings in the present study, there is strong evidence that positive affective responses during a single bout of PA play an important role in predicting future engagement. Yet, affective experiences during PA can be individualistic and often influenced by contextual factors. Interventions designed to increase PA should focus on factors that may create positive affective experiences for participants.

Longitudinal Examination of Sexual Risk Behavior in College Students With and Without Attention-Deficit/Hyperactivity Disorder.

The present study sought to identify differences in the rates and predictors of risky sexual behavior among college students with and without attention-deficit hyperactivity disorder (ADHD). Current ADHD diagnosis, medication status among those with ADHD, executive functioning, substance use, comorbid anxiety, comorbid depression, and gender were identified as potential predictors of increased risky sexual behavior. Multiple group latent growth curve modeling was used to estimate trajectories of risky sexual behavior across four years of college among college students with ADHD (nmedicated = 99, nunmedicated = 105) and a comparison group (n = 217) recruited from colleges throughout the eastern United States (M age = 18.23 years, 53% female, 70% White). First-year college students with ADHD reported significantly higher rates of sexual risk behavior than their peers without ADHD, with no significant differences found based on medication status. Students with ADHD who were taking medication for ADHD reported significant decreases in risky sexual behavior over time. Among college students with ADHD, anxiety was related to increased current risky sexual behavior in the medicated group, while depression was predictive of decreased future risky sexual behavior in the unmedicated group. Alcohol and cannabis use were significantly associated with increased mean levels of risky sexual behavior across all three groups, and cannabis use was associated with decreased future risky sexual behavior within the comparison group. Executive functioning deficits and male gender were predictive of risky sexual behavior within the comparison group. The results demonstrate that college students with ADHD, regardless of medication status, are at an increased likelihood of engaging in risky sexual behavior.

Associations between early introduction to complementary foods, subsequent cereal-added bottle feeding and daily macronutrient intake among infants.

Introducing complementary foods early during infancy has been associated with an increased risk of overweight later in life, but the pathway is an understudied topic. Hence the study was conducted with low-income and primarily minority mother-infant dyads to: 1) understand how the introduction of complementary foods prior to 4 months was associated with socio-demographic characteristics and food security status; 2) determine the association between early introduction to complementary foods and breastfeeding and adding cereal into the bottle in later infancy (i.e., at 6 and 9 months), and; 3) examine how adding infant cereal into the bottle was related to daily calorie and macronutrient intake in infancy. We conducted interviews with mothers (n = 201) at 4 months of age and 24-h feeding recalls at age 6 and 9 months. Results indicated that 29% of the infants were fed complementary foods before 4 months of age. Introducing complementary foods early was negatively associated with breastfeeding and positively associated with adding cereal into the bottle at 6-months. This practice was more common among those who experienced marginal to very low levels of food security. Comparing by race/ethnicity, Latinx mothers were significantly less likely to introduce solids early. After controlling for sex, infants fed cereal in the bottle were consuming significantly more calories compared to their counterparts. Specifically, adding cereal into the bottle resulted in approximately 10% additional daily calorie intake among infants. Understanding how these feeding practices affect appetite development and weight status during infancy is warranted.

Examination of the Cameroon DHS data to investigate how water access and sanitation services are related to diarrhea and nutrition among infants and toddlers in rural households.

Undernutrition among children is a significant issue in rural areas in Cameroon, with diarrhea being one of the major contributing risk factors. To gain a better understanding of the risk factors of diarrhea, the main objective of this epidemiological study was to examine associations between water access and sanitation service with diarrhea, diet diversity, and anemia among infants and toddlers in rural households in Cameroon. The study involved household- and individual-level data of 2,129 rural-dwelling infants and toddlers from the Demographic and Health Survey database. About one-third of infants and toddlers were experiencing diarrhea, with higher odds among those who lived in households with limited water service (p = 0.028). The odds of having diarrhea were 50% higher among infants and toddlers when households did not have sanitation facilities (p = 0.007). The lack of improved water and sanitation was also associated with a low intake of various food groups among older infants and toddlers. The prevalence of anemia was high, but no significant differences were seen by water and sanitation services. The achievement of SDG #6 will help address undernutrition and achieve other SDGs, including improving health and wellbeing.

An RCT of a CBT Intervention for Emerging Adults with ADHD Attending College: Functional Outcomes.

Objective: The current study reports functional outcomes from a multi-site randomized trial of a cognitive-behavioral treatment program for college students diagnosed with ADHD.Methods: A sample of emerging adults (N = 250; ages 18 to 30) currently attending college were comprehensively evaluated and diagnosed with ADHD (M age = 19.7; 66% female, 6.8% Latino, 66.3% Caucasian). Participants were randomized to either a two-semester intervention (Accessing Campus Connections and Empowering Student Success (ACCESS)) or a delayed treatment condition. Participants were assessed with measures of academic, daily life, and relationship functioning prior to treatment, at the end of the first semester, and after the second semester of treatment.Results: Multi-group latent growth curve models revealed moderate effect size improvements on self-report measures of study skills and strategies, as well as on self-report measures of time management, daily functioning, and overall well-being for participants in ACCESS. Importantly, treatment effects were maintained or increased in some cases from the end of the first semester to the end of the second semester. Improvements in self-reported interpersonal functioning were not significantly different across condition and neither condition demonstrated significant change over time in educational record outcomes (GPA and number of credits earned).Conclusions: ACCESS appears to promote improvements in self-reported general well-being and functioning, time management, and study skills and strategies. However, improvements in interpersonal relationships and objective academic outcomes such as GPA were not observed. Clinical implications and future directions for treating ADHD on university and college campuses are discussed.

The effect of physical activity on cognition relative to APOE genotype (PAAD-2): study protocol for a phase II randomized control trial.

BACKGROUND: By 2050, the prevalence of Alzheimer's disease (AD) in the United States is predicted to reach 13.8 million. Despite worldwide research efforts, a cure for AD has not been identified. Thus, it is critical to identify preventive strategies that can reduce the risk of or delay the onset of AD. Physical activity (PA) has potential in this regard. This randomized clinical trial aims to (a) test the causal relationship between PA and AD-associated cognitive function for persons with a family history of AD (FH+), (b) determine the moderating role of apolipoprotein epsilon 4 (APOE4) carrier status on cognition, and (c) assess cerebral structure, cerebral function, and putative biomarkers as mediators of the effects of PA on cognition. METHODS: We are recruiting cognitively normal, middle aged (40-65 years) sedentary adults with FH+. Participants are randomly assigned to a 12-month PA intervention for 3 days/week or to a control group maintaining their normal lifestyle. Saliva samples are taken at pre-test to determine APOE genotype. At pre-, mid-, and post-tests, participants complete a series of cognitive tests to assess information-processing speed, verbal and visual episodic memory, constructional praxis, mnemonic discrimination, and higher-order executive functions. At pre- and post-tests, brain imaging and blood biomarkers are assessed. DISCUSSION: We hypothesize that 1) the PA group will demonstrate improved cognition compared with controls; 2) PA-derived cognitive changes will be moderated by APOE4 status; and 3) PA-induced changes in neural and blood biomarkers will contribute to cognitive changes and differ as a function of APOE4 status. Our results may provide important insights into the potential of PA to preserve neurocognitive function in people with a heightened risk of AD due to FH+ and as moderated by APOE4 status. By using sophisticated analytic techniques to assess APOE as a moderator and neurobiological mechanisms as mediators across trajectories of cognitive change in response to PA, we will advance our understanding of the potential of PA in protecting against AD. TRIAL REGISTRATION: ClinicalTrials.gov NCT03876314. Registered March 15, 2019.

Effects of an aerobic fitness test on short- and long-term memory in elementary-aged children.

Meta-analytic evidence supports that exercise has benefits for short-term memory (STM) and long-term memory (LTM). However, only three studies with children have tested the differential effects of exercise on STM and LTM. The purpose of this study was to examine the effects of an aerobic fitness test on STM and LTM and to consider the moderating effects of grade level. Children (7-13 years of age) were randomly assigned to either perform an aerobic fitness test before (exercise prior) or after (exercise post) performing the Rey Auditory Verbal Learning Test (RAVLT) to assess memory. Memory was tested again after approximately 24 hours. There were significant differences in memory performance as a function of grade with 4th and 6th graders consistently outperforming 2nd graders. For learning, Day 1 Retention, 24-hr recall, and Day 2 Retention, the exercise prior group performed better than the exercise post group. It is concluded that an aerobic fitness test performed prior to a declarative memory test benefits LTM as compared to when the aerobic fitness test is performed after the memory test.

The Physical Activity and Alzheimer's Disease (PAAD) Study: Cognitive outcomes.

Background: Alzheimer's disease is a progressive disease that degrades cognitive functioning and ultimately results in death. Currently, there is no cure for Alzheimer's disease and, hence, the identification of preventative strategies is important. Physical activity (PA) is a behavioral intervention that holds promise with respect to delaying the onset of Alzheimer's disease. Purpose: The purpose of this study was to explore the differential cognitive benefits achieved in response to PA as a function of a person's genetic risk for AD. Methods: Older cognitively normal adults (50-65 years) with a family history of AD (FHxAD) participated in an 8-month PA program. Cognitive performance was measured at baseline, pretest, midtest, and posttest and changes over time were assessed as a function of apolipoprotein E (APOE) status (carriers: 1-2 copies of the ɛ4 allele; noncarriers: 0 copies of the ɛ4 allele). Results: Improvements in memory were associated with PA participation irrespective of APOE ɛ4 carrier status. Conclusions: Future experimental studies are needed to confirm that PA causes improvements to cognitive performance in older cognitively normal adults with a FHxAD and that these improvements are equivalent for cognitively normal APOE ɛ4 carriers and noncarriers.

Interrelationship between food security status, home availability of variety of fruits and vegetables and their dietary intake among low-income pregnant women.

OBJECTIVE: To (i) determine differences in the availability of variety of fruits and vegetables (F&V) at home by food security status; and (ii) examine the inter-associations between food security status, availability of variety of F&V at home and frequency of F&V intake, among low-income pregnant women. Design/Setting Participants were interviewed to collect food security status, home availability of variety of F&V and frequency of F&V intake. Bivariate analyses, multivariate regression and exploratory mediation analyses were conducted using IBM SPSS Statistics version 23.0 and the PROCESS macro. SUBJECTS: Low-income pregnant women (n 198) were interviewed if they were ≥18 years of age, in the second trimester of pregnancy, and spoke English or Spanish. RESULTS: Low/very low food security was found among 43 % of participants. Compared with fully food-secure participants, very low food-secure participants reported a lower variety of fruits (P=0·028) and vegetables (P=0·058) available at home. Mediation analyses indicated that through home availability of variety of fresh F&V, food security status was associated with the daily intake of F&V (indirect effect (95 % CI): fresh fruits, -0·039 (-0·074, -0·013); fresh vegetables, -0·048 (-0·083, -0·023)). As food security worsened, the available variety of fresh F&V decreased, which was associated with lower intake. CONCLUSIONS: The study highlights the interlink between food security, home food environment and diet quality, and the importance of nutrition education intervention to promote a healthy home food environment and improved pregnancy outcomes among low-income women.

The Effect of Acute Exercise on Encoding and Consolidation of Long-Term Memory.

Evidence supports that acute exercise benefits long-term memory. However, it is unclear whether these effects are due to benefits to encoding or consolidation. The purpose of this study was to more effectively isolate encoding and consolidation to advance our understanding of the specific nature of the effects of exercise on long-term memory. Using a within-subject design, participants completed a control session (no exercise), an encoding and consolidation condition (exercise prior to exposure to the memory task, E + C), and a consolidation condition (exercise following exposure). The exercise was 30 min of moderate-intensity cycling. Memory was assessed using the Rey Auditory Verbal Learning Test with recall assessed at 60 min and recall and recognition assessed at 24 hr. Results showed that the E + C condition had significantly better recall at 60 min and 24 hr than the no-exercise condition. This provides additional evidence that acute exercise benefits encoding more than consolidation.

Effects of prolonged and repeated immersions on heart rate variability and complexity in military divers.

BACKGROUND: The influence of prolonged and repeated water immersions on heart rate variability (HRV) and complexity was examined in 10 U.S. Navy divers who completed six-hour resting dives on five consecutive days. Pre-dive and during-dive measures were recorded daily. METHODS: Dependent variables of interest were average heart rate (HR), time-domain measures of HRV [root mean square of successive differences of the normal RR (NN) interval (RMSSD), standard deviation of the NN interval (SDNN)], frequency-domain measures of HRV [low-frequency power spectral density (psd) (LFpsd), low-frequency normalized (LFnu), high-frequency psd (HFpsd), high-frequency normalized (HFnu), low-frequency/ high-frequency ratio (LF/HF)], and non-linear dynamics of HRV [approximate entropy (ApEn)]. A repeated-measures ANOVA was performed to examine pre-dive measure differences among baseline measures. Hierarchical linear modeling (HLM) was performed to test the effects of prolonged and repeated water immersion on the dependent variables. RESULTS: Pre-dive HR (P=0.005) and RMSSD (P⟨0.001) varied significantly with dive day while changes in SDNN approached significance (P=0.055). HLM indicated that HR decreased during daily dives (P=0.001), but increased across dive days (P=0.011); RMSSD increased during daily dives (P=0.018) but decreased across dive days (P⟨0.001); SDNN increased during daily dives (P⟨0.001); LF measures increased across dive days (LFpsd P⟨0.001; LFnu P⟨0.001), while HF measures decreased across dive days (HFpsd P⟨0.001; HFnu P⟨0.001); LF/HF increased across dive days (P⟨0.001); ApEn decreased during daily dives (P⟨0.02) and across dive days (P⟨0.001). CONCLUSIONS: These data suggest that the cumulative effect of repeated dives across five days results in decreased vagal tone and a less responsive cardiovascular system.

The Effects of Acute Exercise on Memory and Brain-Derived Neurotrophic Factor (BDNF).

Acute exercise benefits cognition, and some evidence suggests that brain-derived neurotrophic factor (BDNF) plays a role in this effect. The purpose of this study was to explore the dose-response relationship between exercise intensity, memory, and BDNF. Young adults completed 3 exercise sessions at different intensities relative to ventilator threshold (Vt) (VO2max, Vt - 20%, Vt + 20%). For each session, participants exercised for approximately 30 min. Following exercise, they performed the Rey Auditory Verbal Learning Test (RAVLT) to assess short-term memory, learning, and long-term memory recall. Twenty-four hours later, they completed the RAVLT recognition trial, which provided another measure of long-term memory. Blood was drawn before exercise, immediately postexercise, and after the 30-min recall test. Results indicated that long-term memory as assessed after the 24-hr delay differed as a function of exercise intensity with the largest benefits observed following maximal intensity exercise. BDNF data showed a significant increase in response to exercise; however, there were no differences relative to exercise intensity and there were no significant associations between BDNF and memory. Future research is warranted so that we can better understand how to use exercise to benefit cognitive performance.

Laying the groundwork for evidence-based public health: why some local health departments use more evidence-based decision-making practices than others.

We examined variation in the use of evidence-based decision-making (EBDM) practices across local health departments (LHDs) in the United States and the extent to which this variation was predicted by resources, personnel, and governance. We analyzed data from the National Association of County and City Health Officials Profile of Local Health Departments, the Association of State and Territorial Health Officials State Health Departments Profile, and the US Census using 2-level multilevel regression models. We found more workforce predictors than resource predictors. Thus, although resources are related to LHDs' use of EBDM practices, the way resources are used (e.g., the types and qualifications of personnel hired) may be more important.

Innovative Research Design Exploring the Effects of Physical Activity and Genetics on Cognitive Performance in Community-Based Older Adults.

Physical activity is predictive of better cognitive performance and lower risk of Alzheimer's disease (AD). The apolipoprotein E gene (APOE) is a susceptibility gene for AD with the e4 allele being associated with a greater risk of AD. Cross-sectional and prospective research shows that physical activity is predictive of better cognitive performance for those at greater genetic risk for AD. However, the moderating role of APOE on the effects of a physical activity intervention on cognitive performance has not been examined. The purpose of this manuscript is to justify the need for such research and to describe the design, methods, and recruitment tactics used in the conductance of a study designed to provide insight as to the extent to which cognitive benefits resulting from an 8-month physical activity program are differentiated by APOE e4 status. The effectiveness of the recruitment strategies and the feasibility of recruiting APOE e4 carriers are discussed.

Effects of an acute bout of exercise on memory in 6th grade children.

Research supports the positive effects of exercise on cognitive performance by children. However, a limited number of studies have explored the effects specifically on memory. The purpose of this study was to compare the effects of an acute bout of exercise on learning, short-term memory, and long-term memory in a sample of children. Children were randomly assigned to an exercise condition or to a no-treatment control condition and then performed repeated trials on an auditory verbal learning task. In the exercise condition, participants performed the PACER task, an aerobic fitness assessment, in their physical education class before performing the memory task. In the control condition, participants performed the memory task at the beginning of their physical education class. Results showed that participants in the exercise condition demonstrated significantly better learning of the word lists and significantly better recall of the words after a brief delay. There were not significant differences in recognition of the words after an approximately 24-hr delay. These results provide evidence in a school setting that an acute bout of exercise provides benefits for verbal learning and long-term memory. Future research should be designed to identify the extent to which these findings translate to academic measures.

Es Niño o Niña?: Gender Differences in Feeding Practices and Obesity Risk among Latino Infants.

Background: Obesity prevalence is significantly higher among Latino boys than girls. Weight status at 12 mo, a significant predictor of childhood obesity, is associated with feeding practices during infancy. Objectives: The objectives were to examine breastfeeding and formula-feeding practices overall and by infant gender and to examine relations among infant gender, milk-feeding practices, and obesity risk among Latino infants over the first year of life. Methods: Latino mother-infant dyads (n = 90) were recruited from a pediatric clinic. Mothers were interviewed at regular intervals (infants aged 2, 4, 6, and 9 mo), and 24-h feeding recalls were conducted when infants were aged 6 and 9 mo. Infants' lengths and weights were retrieved from clinic records to calculate weight-for-length percentiles. A bivariate analysis was conducted to compare feeding practices by gender and mediation analysis to test whether feeding practices mediated the relation between gender and obesity risk. Results: The majority (80%) of mothers were born outside the United States. In early infancy, mixed feeding of formula and breastfeeding was common. At 6 and 9 mo of age, milk-feeding practices differed, with formula feeding more common for boys than girls. At 12 mo, 38% of infants experienced obesity risk (≥85th weight-for-length percentile). Infants' obesity risk increased by 18% per 1 oz increase in powdered formula intake. Formula intake among boys was on average 1.42 oz (in dry weight) higher than that among girls, which, in turn, mediated their increased obesity risk (IERR = 1.27, 95% confidence interval: 1.02, 1.90). Conclusions: The increased obesity risk among Latino boys compared with girls at 12 mo was explained by higher rates of formula feeding at 6 and 9 mo of age. Future investigations of cultural values and beliefs in gender-related feeding practices are warranted to understand the differences in obesity risk between Latino boys and girls.

Multi-Method Formative Evaluation of a Digital Online Grocery Shopping Assistant Among Special Supplemental Nutrition Program for Women, Infants, and Children Participants.

OBJECTIVE: Assess the acceptability of a digital grocery shopping assistant among rural women with low income. DESIGN: Simulated shopping experience, semistructured interviews, and a choice experiment. SETTING: Rural central North Carolina Special Supplemental Nutrition Program for Women, Infants, and Children clinic. PARTICIPANTS: Thirty adults (aged ≥18 years) recruited from a Special Supplemental Nutrition Program for Women, Infants, and Children clinic. PHENOMENON OF INTEREST: A simulated grocery shopping experience with the Retail Online Shopping Assistant (ROSA) and mixed-methods feedback on the experience. ANALYSIS: Deductive and inductive qualitative content analysis to independently code and identify themes and patterns among interview responses and quantitative analysis of simulated shopping experience and choice experiment. RESULTS: Most participants liked ROSA (28/30, 93%) and found it helpful and likely to change their purchase across various food categories and at checkout. Retail Online Shopping Assistant's reminders and suggestions could reduce less healthy shopping habits and diversify food options. Participants desired dynamic suggestions and help with various health conditions. Participants preferred a racially inclusive, approachable, cartoon-like, and clinically dressed character. CONCLUSIONS AND IMPLICATIONS: This formative study suggests ROSA could be a beneficial tool for facilitating healthy online grocery shopping among rural shoppers. Future research should investigate the impact of ROSA on dietary behaviors further.

Quadriceps muscle volume positively contributes to ACL volume.

Females have smaller anterior cruciate ligaments (ACLs) than males and smaller ACLs have been associated with a greater risk of ACL injury. Overall body dimensions do not adequately explain these sex differences. This study examined the extent to which quadriceps muscle volume (VOLQUAD ) positively predicts ACL volume (VOLACL ) once sex and other body dimensions were accounted for. Physically active males (N = 10) and females (N = 10) were measured for height, weight, and body mass index (BMI). Three-Tesla magnetic resonance images of their dominant and nondominant thigh and knee were then obtained to measure VOLACL , quadriceps, and hamstring muscle volumes, femoral notch width, and femoral notch width index. Separate three-step regressions estimated associations between VOLQUAD and VOLACL (third step), after controlling for sex (first step) and one body dimension (second step). When controlling for sex and sex plus BMI, VOLHAM , notch width, or notch width index, VOLQUAD consistently exhibited a positive association with VOLACL in the dominant leg, nondominant leg, and leg-averaged models (p < 0.05). Findings were inconsistent when controlling for sex and height (p = 0.038-0.102). Once VOLQUAD was included, only notch width and notch width index retained a statistically significant individual association with VOLACL (p < 0.01). Statement of Clinical Significance: The positive association between VOLQUAD and VOLACL suggests ACL size may in part be modifiable. Future studies are needed to determine the extent to which an appropriate training stimulus (focused on optimizing overall lower extremity muscle mass development) can positively impact ACL size and structure in young females.

Evidence of Geospatial and Socioeconomic Disparities in Access to Online Grocery Shopping for Fresh and Frozen Produce in North Carolina.

BACKGROUND: Online grocery shopping is a rapidly growing food procurement approach in the United States with the potential to improve food access. Limited research has focused on understanding differential access to online grocery shopping that provides healthier items such as fresh or frozen fruits and vegetables. OBJECTIVE: The study aim was to understand geospatial, socioeconomic, and racial disparities in the availability of healthy online grocery shopping and online Supplemental Nutrition Assistance Program (SNAP) acceptance in North Carolina. DESIGN: A cross-sectional study was conducted during spring 2021. PARTICIPANTS/SETTING: A listing of grocery stores with online shopping was generated using a systematic search strategy. Stores were geocoded and spatially joined to relevant contextual (rural/urban [based on US Department of Agriculture Rural Urban Continuum codes]), broadband Internet availability, socioeconomic variables (ie, percent poverty and Social Vulnerability Index), and demographic variables (ie, percent racial minority) in geographic information systems software. MAIN OUTCOME MEASURES: Prevalence rate ratios (PRRs) of healthy online grocery shopping (availability of curbside pickup or home delivery of fresh and frozen produce), and online SNAP acceptance (ie, availability of online SNAP), at the census tract level (n = 2,162). STATISTICAL ANALYSES PERFORMED: PRRs for availability of healthy online grocery shopping and SNAP online acceptance at the census tract level (n = 2,162) were modeled using Poisson regression with robust standard errors. RESULTS: This study found disparities in access to healthy online grocery shopping and SNAP online shopping availability in North Carolina. Healthy online shopping availability rates were higher in urban census tracts (PRR 1.68, 95% CI 1.47 to 1.92), areas with lower Social Vulnerability Index scores (PRR 0.99, 95% CI 0.98 to 0.99), higher Internet Availability Index scores (PRR 1.21, 95% CI 1.17 to 1.25), and lower percent poverty (PRR 0.94, 95% CI 0.90 to 0.98). SNAP online shopping availability rates were higher in urban census tracts (PRR 1.41, 95% CI 1.16 to 1.65), areas with higher Social Vulnerability Index scores (PRR 1.02, 95% CI 1.01 to 1.04), higher Internet Availability Index scores (PRR 1.15, 95% CI 1.10 to 1.20), and higher percent minority (PRR 1.02, 95% CI 1.0001 to 1.03). SNAP online shopping availability rates were lower in areas with higher percent poverty (PRR 0.90, 95% CI 0.85 to 0.95). CONCLUSIONS: This study found disparities in access to healthy online grocery shopping and SNAP online shopping for rural areas, and areas with higher poverty, and lower broadband Internet access in North Carolina. Further research is needed to identify effective strategies for addressing these disparities.