OBJECTIVE:This study aimed to examine sustainable nutrition behaviors and attitudes toward physical activity among college students. DESIGN:A cross-sectional study. SETTING:College setting. PARTICIPANTS:The study included 303 college students (171 female, 132 male). MAIN OUTCOME MEASURE:Sustainable nutrition behaviors were assessed using the Behaviors Scale Towards Sustainable Nutrition, whereas beliefs and attitudes related to physical activity were measured using the Exercise Health Belief Model Scale. Anthropometric measurements, including body weight and waist circumference, were obtained by researchers. ANALYSIS:Pearson and Spearman correlation analyses, as appropriate, and multiple linear regression analyses were conducted. RESULTS:Sustainable nutrition behavior scale total scores were positively correlated with exercise Health Belief Model scores (r = 0.444, P < 0.001) and negatively correlated with body mass index (r = -0.142, P = 0.01) and waist circumference (r = -0.169, P = 0.003). After adjusting for sex, academic level, and income level, sustainable nutrition behaviors remained significantly associated with attitudes toward physical activity (β = 0.400, P < 0.001), explaining 22.6% of the variance (R² = 0.226). CONCLUSIONS AND IMPLICATIONS:Students with more positive attitudes toward physical activity are more likely to engage in sustainable nutrition behaviors. Integrated health promotion strategies addressing both physical activity and sustainable nutrition may support healthier and more sustainable lifestyles among college students.
OBJECTIVE:To explore why and how health behavior change occurs in women with polycystic ovary syndrome (PCOS) and aims to generate a grounded theoretical framework that illustrates the stages, along with the influencing factors involved in the stage shifts. DESIGN:Qualitative grounded theory design. SETTING:Tertiary Grade A comprehensive hospitals in Hunan Province, located in Central South China. PARTICIPANTS:The study included 20 patients, 13 doctors, and 4 nurses. INTERVENTION:Not applicable. PHENOMENON OF INTEREST:This study focused on how behavior change occurred and what influenced the change. ANALYSIS:We followed the processes of open coding, axial coding, and selective coding for analyzing the interview data. RESULTS:This theoretical framework outlines the health behavior change using 3 progressive stages (intention, adoption, maintenance) and a dynamic state of disengagement, shaped by the interplay between driving factors (needs generation, cognitive change, intrapsychic resources, external resources, self-regulation, ego identity, and positive feedback) and restraining factors (personal limitations, environmental constraints, disease-related barriers, and behavioral drawbacks). CONCLUSIONS AND IMPLICATIONS:Our findings provide new insights on health behavior among patients with PCOS and help health care personnel develop tailored intervention strategies based on an individual's stage or status of behavior change.
OBJECTIVE:To determine how maternal characteristics vs maternal social risk factors influence the practice of nonresponsive feeding styles among socioeconomically and racially diverse samples. DESIGN:Cross-sectional analysis. PARTICIPANTS:One hundred and seven mothers of infants aged 9-24 months. VARIABLES MEASURED:The Infant Feeding Styles Questionnaire, assessing responsive, indulgent, laissez-faire, pressuring, and restrictive styles, and socioeconomic and food security questionnaires to measure social risk factors. ANALYSES:Hierarchical regression models assessed the contributions of maternal characteristics (step 1: prepregnancy body mass index [BMI], breastfeeding duration, and age) and social risk factors (step 2: employment status, marital status, minority status, education, poverty, and food insecurity). RESULTS:Higher maternal prepregnancy BMI and younger age were significantly associated with greater indulgent (BMI: β = 0.31, P = 0.003; age: β = -0.31, P = 0.002) and laissez-faire (BMI: β = 0.21, P = 0.05; age: β = -0.31, P = 0.003) feeding styles. Longer breastfeeding duration (β = -0.23, P = 0.04) and older age (β = -0.24, P = 0.02) were associated with lower use of pressuring feeding styles. After accounting for maternal characteristics, social risk factors, including poverty (β = 0.28, P = 0.04) and employment status (β = -0.28, P = 0.006), significantly predicted greater use of pressuring feeding styles. CONCLUSIONS:Maternal characteristics and social risk factors influence the use of nonresponsive feeding styles during infancy. Findings highlight the need for tailored interventions addressing both individual maternal factors and broader socioeconomic conditions.
Background Eating competence (EatC), a proxy for health, is measured with the Satter Eating Competence Inventory (ecSI 2.0). Global demand has increased translation requests; multicultural use challenges word/phrase selection. Objective Develop a graphic version of ecSI 2.0 for psychometric testing. Study Design, Setting, Participants Satter Eating Competence Inventory item data from 23 studies involving 17,844 scores from the US, Finland, and Brazil were compared with total ecSI 2.0 scores to select 8 items for graphical conversion. An agentic AI framework that combines LLM reasoning with DALL-E tool calls generated and refined graphical images for always and never/rarely response options, forming the ecSI_g. These graphics were entered into Qualtrics as visual analog scale anchors with slider movement denoting the level of anchor agreement. A University-wide email invited participants to complete an online survey including the ecSI 2.0, ecSI_g, and the Cohen’s Perceived Stress Scale. Measurable Outcome/Analysis Slider movement scores ranged from 4 to 0 with 0.1 intervals. To compare with ecSI 2.0 discrete scores, visual analog scale integer scores were coded (e.g., 2 - 2.9 =2). Correlations among summed scores from the ecSI 2.0, the selected ecSI 2.0 items, and the ecSI_g were controlled for stress and age. Results Of 492 accessing the survey, 316 completed the ecSI 2.0 and ecSI_g. The ecSI 2.0 and ecSI_g were normally distributed and internally consistent. Respondents were mostly female (73%), White (80%), not eating competent (57%), and highly stressed, with a mean age of 36.7 ± 14.9 years. Stress was inversely related to ecSI 2.0 (r = −0.48, P < 0.001) and ecSI_g scores (r = −0.37, P < 0.001); age was positively related to ecSI 2.0. The stress and age-controlled ecSI 2.0 score was significantly related to the ecSI_g score (r =0.47) and the sum of the selected 8 items (r = 0.94); the latter was related to the ecSI_g score (r = 0.48). All P < 0.001. Conclusions The ecSI_g performance supported further development and testing of a nontext measure of EatC. Generative artificial intelligence presents a novel opportunity to enable nontext-based eating behavior testing. Funding None
Background Gut-health information is widely shared on social media, in which influencers increasingly shape nutrition beliefs, attitudes, and health behaviors. Despite the growing influence of digital wellness content, limited research has examined how young adults evaluate the credibility of nutrition influencers. Understanding these perceptions is important for nutrition educators and professionals seeking to promote evidence-based messaging and counter misinformation. Guided by the Source Credibility Model, this study explored how female college students assess the trustworthiness of gut-health influencers and which characteristics most influence credibility judgments. Objective To examine female college students’ perceptions of gut-health influencer credibility on social media and identify factors that influence trust. Study Design, Setting, Participants A Q-methodology study was conducted with 40 female college students aged 18–29 years at a public university. Participants ranked 40 gut-health influencer profiles from least to most trustworthy using a forced quasi-normal distribution. Profiles varied by visual appearance, professional background, and follower count. Brief questionnaires provided demographic context and explanations of ranking decisions. Measurable Outcome/Analysis Primary outcomes included ranked credibility perceptions of influencer profiles. Factor analysis using centroid extraction with varimax rotation identified shared viewpoints regarding influencer trustworthiness. Results Three viewpoints explained 50% of the total variance. One emphasized professional expertise, favoring licensed or medically trained influencers regardless of popularity. A second reflected skepticism toward commercialized or promotional content. A third emphasized relatability and visually inferred authenticity over formal credentials. Conclusions Young women use multiple frameworks when evaluating nutrition influencers, balancing expertise, commercialization concerns, and perceived authenticity. Findings highlight opportunities for nutrition professionals to strengthen credible digital engagement and incorporate media literacy approaches to address misinformation in social media nutrition environments. Funding This research was supported by the Circle of Friends Research Assistance Award from the Department of Nutrition, Food Science, and Packaging at San Jose State University.
Objective To assess whether the Expanded Food and Nutrition Education Program (EFNEP) is a cost-effective nutrition education intervention that generates sustained improvement in chronic disease biomarkers. Description Research efforts focused on data collection, data integrity, and preliminary analyses. Data collection for the baseline, postintervention, and 6-month postintervention time points has been completed, whereas data will be collected for the 12-month postintervention time point will be completed in June 2026. After data entry, migration and quality checks, analyses began, focusing on the impact of EFNEP on biomarkers from preintervention to 6 months postintervention and study retention. Preliminary findings were disseminated through the Journal of Nutrition Education and Behavior and Society for Nutrition Education and Behavior presentations. Manuscript drafting is also in progress. Education efforts included the completion of a master’s thesis. Evaluation The sample consists of 472 participants (246 intervention and 226 control). Multilevel models were used to evaluate the impact of EFNEP from baseline to 6 months postintervention on body mass index, systolic and diastolic blood pressure, and hemoglobin A1c. Preliminary analyses rely on listwise deletion of missing data, which dropped the active analytic sample size significantly below the baseline threshold, and do not include confounding factors. Comparing the intervention to the control group established neither the presence nor the direction of any program effects on any of the biomarkers. Retention analysis, currently being evaluated by intervention and program factors, shows a retention rate of 80% at postintervention, 60% at 6 months postintervention, and 51% at 6 months postintervention. Conclusions and Implications Preliminary 6-month findings do not indicate a measurable EFNEP treatment effect on biomarkers of chronic disease risk. While these metrics are intermediate, 12-month postintervention data analysis will assess whether longer follow-up periods may be needed to fully capture the effects of EFNEP participation on physiological outcomes. These initial estimates are also limited by a substantial loss of statistical power because of missing participant data, which likely yields biased estimates because the missingness is not completely random. Future final analyses will continue using multilevel modeling alongside advanced missing data estimation techniques to correct for potential biases, incorporate key confounding factors, and account for site-level variations to estimate EFNEP’s impact on biomarkers of chronic disease risk.
Background Many interventions seek to reduce food insecurity; few interventions focus on young adults. Fewer studies have investigated whether food provisions and culinary education can improve dietary intake and reduce food insecurity. Objective To evaluate the impact of a 5-week nutrition and culinary intervention on the diet quality and culinary efficacy of students with food insecurity. Study Design, Setting, Participants A 5-week food provision and culinary education intervention with college students was implemented. Participants were recruited on campus and screened for risk of food insecurity using the 2-item Hunger Vital Signs. Dietary intake and culinary self-efficacy were measured at baseline and repeated postintervention. Participants attend 1 class/wk, in which they receive culinary and nutrition education, in addition to 1–2 cooked meals. At baseline, all participants (n = 28) received cooking tool kits. Measurable Outcome/Analysis To assess diet quality, the Automated Self-Administered 24-hour dietary recall was used. To measure culinary self-efficacy, we used the shortened, validated 11-item Cooking and Food Provision Action Scale (CAFPAS). To evaluate individual class progress, surveys were administered to assess confidence and replication based on a 4-item Likert scale. For CAFPAS, JASP (version 19.3) was used, and STATA was used for Healthy Eating Index (HEI) scoring from ASA24. Results At baseline, HEI scores ranged from 26 to 77 (mean = 48; range 0–100) with a mean score of 7.86 on CAFPAS (range 0–11). To date, 2 of the 5 weeks of intervention have been completed. Postclass surveys suggest that for weeks 1 and 2, participants have high confidence in using the skills at home they learned during class (78% to 95%) and replicating the recipe they learned during class (75% to 89%). Data collecting is ongoing. Additional analyses will be completed by April 2026 to compare baseline and postintervention HEI and CAPFAS scores. Conclusions Preliminary data suggest that college students have both low diet quality and poor culinary efficacy. Preliminary data suggest it is possible to improve the culinary efficacy of students by combining food provisions with culinary classes. Funding University of Texas at Austin
Objective The objective of this study was to understand families’ acceptability of 12 recipes provided by the University of Florida, Institute of Food and Agricultural Sciences Books & Cooks program. Use of Theory or Research The Social Cognitive Theory (SCT) states that behavioral, personal, and environmental factors interact to explain outcomes. This study addressed environmental (i.e., food insecurity) and behavioral (i.e., cooking) SCT constructs by providing recipes, stipends, and grocery lists to improve diet quality. Target Audience The target audience is Florida families with low income and their children in kindergarten to fifth grade who participated in the Books & Cooks Fall 2025 cohort. Program Description Books & Cooks, a 6-week, family-based literacy, nutrition, and parenting program, consisting of in-class (i.e., reading activities, cooking demonstrations, and catered meals) and at-home (i.e., nutrition-themed books, grocery stipends, and 12 dietitian-approved recipes) support. Evaluation Methods Participants completed a demographic screener. For the 6 programming weeks, participants completed a weekly survey about their families’ acceptability of (i.e., their preparation of, satisfaction with, confidence to prepare, and ability to involve their child in preparing) 2 prescribed meals. We conducted frequencies to determine preparation rates of meals and an analysis of variance to identify differences in participants’ satisfaction with, confidence to prepare, and child involvement across the 12 recipes. Results Adult participants (n = 184) were primarily female (92.9%) and Black or African American (42.4%). Preparation of meals ranged from 39% to 79%. No significant differences were found between meals regarding participant satisfaction, confidence to prepare, or child involvement in meal preparation. Conclusions Although there were no differences in families’ acceptability of the 12 meals provided, there was a preparation gap between recipes. With the growing popularity of using grocery stipends to improve diet quality, it is important to curate acceptable recipes that grocery stipends can be used to purchase ingredients for in efforts to create alignment in behavior change. If future researchers seek to improve environmental and behavioral components associated with healthy eating via grocery lists, stipends, and recipes, they should identify elements that enhance the utility of programmatic resources. Funding University of Florida Lastinger Center for Learning
Objective The objective is to develop and assess the feasibility and acceptability of a peer-led nutrition and culinary education curriculum for college students. An additional objective is to provide college students with training and hands-on nutrition and culinary education experience. Description Data analysis for online surveys and semistructured interviews from formative research conducted in Year 1 with college students and faculty/staff continued in Year 2. The project team continued developing and refining curriculum materials based on formative research findings. College students participated in informal lesson testing to help identify further areas of refinement. Year 2 included developing a prepost questionnaire assessing cooking and eating behaviors among students that will be used to help evaluate the curriculum. The questionnaire was assessed for content validity through expert review by faculty and face validity through cognitive interviews with students. The questionnaire and draft curriculum materials were shared with the project advisory board for review and comment. College students were engaged in developing additional resources through a summer internship program. Evaluation Formative research findings indicated a high level of interest in a peer-led nutrition and culinary education curriculum for college students and provided valuable insights used to develop and refine curriculum materials. Feedback from content and face validity testing was used to refine the questionnaire. College students participating in informal testing of recipes, lesson plans, and peer leader training resources provided positive feedback on materials, and helpful input is now being used to further refine materials. Nine undergraduate and graduate students participated in the 2026 summer internship program and helped develop additional recipes and curriculum materials. Summer interns also pilot-tested and provided feedback on the peer leader training, which included online training modules, a hands-on in-person training session, and practice leading lessons. Conclusions and Implications The curriculum materials, peer leader training resources, and evaluation survey continued to be refined based on feedback. Test-retest reliability of the evaluation survey and feasibility and acceptability of the curriculum will be assessed during the upcoming academic year.
Background Homebound older adults face social, clinical, and nutritional vulnerabilities. Interventions that focus on reducing these issues are important for improving the long-term quality of life for this population. Objective To describe participants’ engagement for change reported on community health workers’ (CHW) coaching calls provided as part of an enhanced home-delivered meal program for older adults (Meals+). Study Design, Setting, Participants This preliminary descriptive analysis is part of an ongoing randomized trial evaluating the impact of the 12-week Meals+ program among nutritionally at-risk older adults enrolled in Meals on Wheels of Rhode Island. Meals+ participants receive 4 CHW coaching calls (in English or Spanish) and 3 healthy grocery bags in addition to traditional meal delivery. Calls use a motivational interviewing approach. Participants set at least 1 goal to work on during the 12 weeks: food and nutrition, physical activity, social isolation, and/or general health/chronic disease management. Then, CHWs ask participants how important it is for them to achieve this goal and how confident they are in executing it (engagement for change). Measurable Outcome/Analysis We calculated the mean and SD values for ratings (0–10 scale) on engagement for change questions. We classified behavior change goals in the following domains: healthy eating, food/nutrition security, physical activity, health condition management, and social demands. Results Among 57 participants, 51.1% reported nutrition/food security concerns during the first CHW call. On the second call, 45.6% set behavior change goals related to improving nutrition, and 22.8% regarding health condition management. Participants rated, on average, high levels of importance (9.1 ± 1.5) and moderate levels of confidence (7.7 ± 2.0) for change. During the third call, 100% stated they wished to keep working on the initial goal defined in call 2. Conclusions Participants reported a significant proportion of behavior goal setting related to nutrition and high engagement for change. This intervention highlights the potential of CHWs for engaging homebound older adults facing nutrition and health-related issues. Funding The Administration for Community Living Innovation in Nutrition Programs and Services.
Background Housing instability creates health- and nutrition- related disparities. Limited research has evaluated the impact of long-term, evidence-based wellness interventions among those experiencing homelessness. Objective To evaluate the short- and long- term effects of a Supplemental Nutrition Assistance Program-Education (SNAP-Ed) intervention on diet quality, physical activity, and health outcomes of transitional housing residents. Study Design, Setting, Participants Researchers conducted an 8-week nonexperimental pilot wellness intervention study among transitional housing residents at a homeless resource center in the US (baseline: n = 29; week 10: n = 19; week 18: n = 11). Measurable Outcome/Analysis Researchers collected qualitative and quantitative health-related measures (e.g., barriers to a healthy lifestyle, body composition, diet quality) at baseline, week 10, and week 18. Mixed-effects models were used for quantitative data, and conventional content analysis for qualitative data. Results Most intervention participants were non-Hispanic, White males aged between 55 and 64 years. Approximately one-third were classified as food insecure (week 10). Favorable changes from baseline to follow-up at weeks 10 and 18 were evident for perception-based questions related to choosing a variety of foods (week 10: P = 0.01; week 18: P = 0.006), using nutrition facts labels (week 10: P = 0.001; week 18: P = 0.007), and following US Department of Agriculture food safety recommendations (week 10: P = 0.005; week 18: P = 0.003). From baseline to week 18, saturated fat consumption significantly increased (1.3 ± 2.8 g vs 3.9 ± 3.8 g, P = 0.01). No other health-related outcomes significantly changed over time. Benefits of the wellness program, as described by residents, included engaging in or improving physical activity levels (81%), feeling motivated to make lifestyle changes (73%), and increasing fruit and vegetable intake (64%). Conclusions Findings suggested that while biometric outcomes and diet quality of residents were not favorably altered through the SNAP-Ed wellness program, residents perceived positive changes in nutrition-related practices. More research is needed to identify the best intervention approaches to lead to favorable health outcomes among those experiencing homelessness. Funding Association for Utah Community Health and the Community Foundation of Utah
Background While the Expanded Food and Nutrition Education Program (EFNEP) improves food and physical activity behaviors among participants, its impact is constrained by attrition (i.e., dropouts). Annual adult attrition rates regularly exceed 20%, representing a missed opportunity to serve 11,000 additional participants. To address this, the authors previously developed a machine learning (ML) model using national program data to identify key participant and program characteristics associated with adult EFNEP attrition. However, quantitative models alone cannot explain the causal mechanisms behind attrition. Qualitative data is necessary to validate the ML model findings and understand the underlying mechanisms through which the identified factors impact attrition. Objective To examine coordinator perspectives on the participant characteristics and program factors that influence adult EFNEP attrition. Study Design, Setting, Participants For this qualitative study, semistructured interviews were conducted by 15 randomly selected EFNEP coordinators in 2025. Interviews were conducted via Zoom and lasted approximately 30–60 minutes. Measurable Outcome/Analysis Deductive thematic analysis was conducted in NVivo to validate the following attrition drivers identified by the ML model: Cooperative Extension region, funding tier, year, household income, age, race, residence, children, number of foods in 24-hour dietary recall, and pre-EFNEP physical activity level. Results While the ML model identified funding tier and region as primary statistical predictors of attrition, deductive thematic analysis revealed EFNEP coordinator narratives most strongly validated the number of children in a household (88%), urban vs rural residence (77%), program year (70%), and funding tier (67%). Conversely, factors, such as region (50%), race (40%), and pre-EFNEP physical activity level (33%), showed lower validation. Conclusions These findings suggest household-centered factors have a greater impact on attrition than broad regional or demographic categories. Validation of funding tier and program year further highlights the importance of program timing and resource allocation in participant retention. Funding South Dakota State University Jackrabbit Jumpstart Grant; US Department of Agriculture’s National Institute of Food and Agriculture (Hatch project no. 77002300)
Background Cultural norms, environmental stressors, and food and body image misconceptions during missionary service may increase the risk for disordered eating (DE) and eating disorders (ED) in missionaries for The Church of Jesus Christ of Latter-day Saints. Currently, missionaries are not provided with body image or DE/ED resources. A fact sheet was developed that outlines missionaries’ stressors that may increase DE/ED risk, describes differences between DE and ED, and provides and classifies examples of thoughts and behaviors using a traffic light visual: red light thoughts warrant immediate professional help, yellow light thoughts that affect daily life and could be DE should be addressed by talking to a mission leader or therapist, and green light thoughts are healthy. The fact sheet then provides guidance on seeking help from mission leaders and dietitians. Objective The objective of this study was to obtain feedback from ED experts regarding the booklets’ relevance, accuracy, clarity, and accessibility. Study Design, Setting, Participants A cross-sectional survey evaluating the booklet was completed by ED professionals. Measurable Outcome/Analysis Using a 5-point scale, participants rated the booklet’s effectiveness in addressing several topics related to ED and DE in missionaries. Topic scores were calculated and reported as mean ± SD. Results Sixteen professionals participated in the review, including registered dietitians (n = 7), licensed therapists (n = 4), public health professionals (n = 1), professors (n = 1); 3 did not specify. Most content areas were rated at ≥ 3.75: the difference between DE and ED (4.06 ± 0.93), overview of DE and ED (3.88 ± 0.72), related medical risks (4.0 ±0.82), how missions may contribute to risk (4.19 ± 0.66), how to recognize DE and ED (4.13 ± 0.72), and next steps if DE/ED symptoms are recognized (3.88 ± 0.89). The complicated relationship between church doctrine and culture that may influence DE/ED risk was rated below this threshold (3.63 ± 0.89). Evaluators praised the traffic light examples and suggested improving clarity and layout. Conclusions Though limited by a small sample size, feedback from experts highlights the strengths and areas of improvement of a DE/ED fact sheet for missionaries. Future work should include piloting the revised fact sheet among missionaries. Funding None
Background The Go Nutrition and Physical Activity Self-Assessment for Child Care (Go NAPSACC) is an evidence-based tool designed to enhance nutrition and physical activity in early childhood education (ECE) settings. The Go NAPSACC tool uses a technical assistance (TA) consultant model to strengthen centers’ policies and practices; however, little is known about the consultants’ lived experiences and the factors shaping their work with the tool. Objective This study explored the success, barriers, and facilitators that North Carolina-based Go NAPSACC TA Consultants experienced when using the tool with ECE centers. Study Design, Setting, Participants Using a phenomenological approach, semistructured, in-depth telephone interviews (n = 10) were conducted with Go NAPSACC TA Consultants in North Carolina (NC). Data collection continued until saturation was reached, with 3 additional interviews conducted to confirm it. Eligibility included (1) being a trained Go NAPSACC TA consultant, (2) being aged ≥ 18 years, (3) having implemented the tool with at least 1 ECE center in NC, and (4) voluntary consent to participate. Measurable Outcome/Analysis Data were thematically analyzed to identify patterns in consultants’ lived experiences. Team-based open coding and focused coding were used; interrater reliability was established using Cohen’s κ statistic. Results Four themes emerged: (1) consultant types, (2) consultant role, (3) consultant-level barriers and successes, and (4) center-level barriers and successes. Consultants used Go NAPSACC to support programs in various ways, from hands-off, resource-based support to hands-on, relationship-based support. Implementation challenges included high staff turnover, limited financial resources, and time constraints at centers, as well as consultants’ difficulty balancing Go NAPSACC duties with other job responsibilities and unclear role expectations. Consultants defined success individually, often linked it to personal fulfillment, and expressed a need for greater institutional guidance and more explicit role definitions. Conclusions The findings highlight the need for clear role expectations, strong institutional support, and alignment between TA responsibilities and organizational capacity. Strengthening these areas may enhance the effectiveness and sustainability of Go NAPSACC implementation in NC. Funding The Centers for Disease Control and Prevention
Objective The Virginia Healthy Pantry Initiative (HPI) is a collaborative, statewide program consisting of the Federation of VA Food Banks, Virginia’s 7 food banks, and > 1,100 pantries. The HPI was designed to assist pantries in improving nutrition security and education by removing barriers to food access. The purpose is to evaluate the implementation of HPI through an annual assessment. Use of Theory or Research The program was created through an extensive design process, involving a cohort of neighbors experiencing food insecurity, academics, food bank staff, health partners, community partners, and food pantries. Through this collaboration, data were collected from neighbors about the ideal pantry experience, leading to the creation of the 20 healthy pantry practices, the core of HPI. Target Audience More than 550 food pantries partnering with 1 of the 7 Virginia food banks. Program Description Healthy Pantry Initiative provides education and resources for pantries through an annual statewide assessment, an online learning management system with more than 25 training courses, and annual microgrants for pantries. Evaluation Methods Participating pantries complete the HPI Assessment on community needs, pantry capacity, and adoption of practices across 4 categories: food availability, Health education, community connection, and neighbor-centered practices. Results Pantries implemented an average of 7.9/20 HPI in 2025, a 25% increase since the first-year of the assessment in 2023. More than 95% of surveyed pantries are currently offering food from the 5 food groups and creating a culturally inclusive and welcoming environment, with practices that address chronic disease, dietary, and cultural/religious needs of neighbors, neighbor choice, and nutrition education, all increasing by > 25%. Of pantries not currently offering fresh fruits and vegetables, 59% were interested in implementing the practice starting in 2026. Conclusions Pantries are committed to improving the health of neighbors and increasing their education and choice by removing barriers to food access. The HPI Assessment data depict this commitment, showing a steady increase in practice implementation and continued improvement. The assessment and findings can help inform other food banks and pantries on how to promote nutritious options with dignity. Funding Supplemental Nutrition Assistance Program-Education
Background State Nutrition Action Councils (SNACs) are cross-sector, statewide coalitions that coordinate nutrition efforts, align priorities, and strengthen food and nutrition security initiatives. Originally established by the US Department of Agriculture’s Food and Nutrition Services to better coordinate state agency nutrition work, SNACs have evolved from compliance-oriented structures to collaborative partnerships rooted in the Collective Impact Model. Prior research by the land-grant university (LGU) Supplemental Nutrition Assistance Program-Education Program Development Team (2023–2025) indicates that successful SNACs depend on backbone support, a common agenda, mutually reinforcing activities, shared measurement, and continuous communication. Objective To identify structural and relational factors that support effective SNAC implementation and describe how SNACs advance coordinated statewide nutrition goals. Study Design, Setting, Participants A mixed-methods study included a 2023 quantitative survey of 57 LGUs (35 responses) and a 2024 qualitative study with 12 randomly selected LGU SNAP-Ed leads representing SNACs at varied developmental stages. Interviews conducted from October through December 2024 examined experiences in leadership, communication, partnership dynamics, and coalition development. Measurable Outcome/Analysis Survey data examined SNAC presence, leadership roles, and development stage. Qualitative data were coded using NVivo, producing 163 codes grouped into major themes: backbone support, common agenda, trust and relationships, continuous communication, mutually reinforcing activities, and shared measurement. Results Findings show that 68% of states have SNAC, and LGUs serve as the backbone organization in 52% of cases. Nearly half of SNACs remain in the forming stage, underscoring the need for intentional support. Backbone leadership was the strongest predictor of SNAC success, while trust, engagement, and agency alignment were essential for long-term progress. Participants emphasized communication strategies that sustain engagement and mutually reinforcing activities that reduce duplication and increase coordinated impact. Conclusions State Nutrition Action Council effectiveness depends on strong leadership, shared purpose, and ongoing communication. Intentional investment in relationships and structural supports can enhance statewide coordination and strengthen collective nutrition and food security outcomes. Funding Cooperative Extension
Objective The project goal is to implement and rigorously evaluate an innovative healthy food prescription program, Superstars, among rural primary care patients with low income, paired with an incentive to use a supermarket shelf-tag-labeling system that supports healthier choices at the point of purchase. Research findings will be used to engage health systems, nutrition educators, and consumers to improve nutrition security, population health, and health equity. Description Research aim 1: Assess the program’s impact on participants’ nutrition security, as measured with the validated 4-item Gretchen Swanson screening tool. Research aim 2: Assess the program’s impact on participants’ supermarket purchases and diet, and explore the program’s impact on health using the MaineHealth practice sites’ electronic health record. Education and Extension aim 3: Use the research findings to encourage health systems, nutrition educators, and consumers to adopt evidence-based strategies that improve nutrition security, population health, and health equity. Evaluation We will use a randomized controlled study design to test the effectiveness of the Superstars intervention among 500 MaineHealth primary care patients with low income who do most of their shopping at Hannaford Supermarket. We will track education and extension activities, products, and impact, based on the research findings. Conclusions and Implications We are actively recruiting patients to participate in the study.
Background Adolescents in the US consume a substantial proportion of their daily energy from ultraprocessed foods (UPFs), and snacking contributes substantially to their overall intake. However, few studies assess UPF consumption specifically within snack occasions, leaving the relationship between snack frequency and UPF intake unclear. Objective To examine the association between snacking frequency and the proportion of daily energy from UPFs among US adolescents. Study Design, Setting, Participants Cross-sectional study of National Health and Nutrition Examination Survey 2017–2020 data from 1,153 adolescents aged 12–18 years using a complex, multistage, stratified sampling design. Measurable Outcome/Analysis Snacking frequency and UPFs consumption were derived from 24-hour dietary recall. Snacking frequency was defined as the total reported snack occasions per day. Reported foods were classified using the NOVA system, and UPF consumption was calculated as the percentage of total daily energy. Survey-weighted regression models estimated associations between snacking frequency and UPFs consumption, adjusting for sociodemographic covariates. Results Participants had a mean age of 14.9 years, and 51% were female. Adolescents consumed an average of 3.3 snacks/d, and UPFs contributed 68% of total daily energy consumption. Each additional snack occasion was associated with a 0.34-percentage-point decrease in the proportion of energy from UPFs (β = −0.34; P = 0.03). Other Hispanic adolescents consumed significantly less UPFs energy compared with non-Hispanic White adolescents (P = 0.04), while males consumed a higher proportion than females. Conclusions Higher snacking was modestly associated with lower proportional consumption of UPFs. Further study will be needed to examine the composition of foods consumed during snack occasions. Funding None
Objective Assess the efficacy of remote delivery of the Starting Early Program (StEP) during pregnancy in an urban safety-net prenatal clinic with extension into an affiliated Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program and mobile health support using a longitudinal randomized controlled trial design. Description High rates of nutrition and lifestyle-related chronic diseases, such as obesity, diabetes, and hypertension, among pregnant women and children highlight the need for protective strategies during these critical life cycle periods. Mobile health interventions can improve diet and lifestyle and may have advantages in terms of attendance and cost. Although > 80% of pregnant patients in safety-net prenatal clinics receive WIC, existing interventions have not synchronized counseling across prenatal care and WIC. The StEP intervention includes 8 individual and group support sessions for a healthy diet and lifestyle provided by registered dietitians, coordinated with prenatal and pediatric health care. Evaluation We revised and updated the StEP intervention content for remote delivery and to reflect current guidelines. 276 participants signed consent at their first prenatal visit; 256 completed a baseline assessment. There were 7 pregnancy losses, and 244 were randomized; 122 to the control and 122 to the StEP intervention groups. 110 control and 111 intervention participants completed a third-trimester assessment. Data were available for 112 infants from each group, and 104 control and 106 intervention participants completed a 3-month postpartum assessment. We are finalizing 3 month postpartum data collection and analyses. Attendance was 91% for StEP individual sessions and 72% for groups. We established ongoing collaboration with our local and state WIC offices. We developed and distributed third-trimester-specific summaries of StEP content and a StEP website with input from WIC staff and nutrition providers, and are finalizing the StEP website. Primary outcomes include program participation, nutrition knowledge, diet, lifestyle, and psychosocial stressors among participants and use of StEP materials by WIC partners. Conclusions and Implications Mobile health strategies to support diet and lifestyle during pregnancy are feasible and have high participation rates. Such strategies can be coordinated with local WIC providers.
