Background/Objectives: Many individuals facing food insecurity make tradeoff decisions between spending money on food or other basic needs. In addition, many engage in coping strategies to stretch food budgets or make food last longer. There is limited data on how participation in food assistance programs is associated with use of tradeoffs or coping strategies among households experiencing food insecurity. Methods: A secondary analysis of 2021, 2022 and 2023 cross-sectional state-wide survey on food access, including questions on use of tradeoffs and coping mechanisms, and participation in food assistance programs (Special Supplemental Nutrition Program for Women, Infants, and Children, Supplemental Nutrition Assistance Program, school meals or food pantries). Prevalences of tradeoffs and coping strategies by food assistance use were determined. Multivariable logistic regression models determined odds of tradeoffs and coping strategies reported by food-insecure households. Results: Overall, 85% of respondents reported making any tradeoffs and 90% reported any coping strategy use in the prior year. Any food assistance program participation was associated with higher prevalences of making any tradeoff compared to not participating in food assistance programs (89% vs. 78%, p < 0.001) and a higher prevalence of engaging in any coping strategy (92% vs. 84%, p < 0.001). Food assistance participation was associated with increased odds of making any tradeoff (OR 1.82 95% CI 1.39, 2.39) or any coping strategy (1.85, 95% CI 1.22, 2.80). Conclusions: Meeting food assistance program income eligibility requirements is likely a marker of poverty that extends beyond food insecurity. Food assistance is necessary but insufficient to meet family needs.

Opioids have been the primary method used to manage pain for hundreds of years, however the increasing prescription rate of these drugs in the modern world has led to a public health crisis of overdose related deaths. Naloxone is the current standard treatment for opioid overdose rescue, but it has not been fully investigated for potential off-target toxicity effects. The current methods for pharmaceutical development do not correlate well with pre-clinical animal studies compared to clinical results, creating a need for improved methods for therapeutic evaluation. Microphysiological systems (MPS) are a rapidly growing field, and the FDA has accepted this area of research to address this concern, offering a promising alternative to traditional animal models. This study establishes a novel multi-organ MPS model of acute opioid overdose and rescue to investigate the efficacy and off-target toxicity of naloxone in combination with opioids. By integrating primary human and human induced pluripotent stem cell (hiPSC)-derived cells, including preBötzinger complex neurons, liver, cardiac, and skeletal muscle components, this study establishes a novel functional multi-organ MPS model of acute opioid overdose and rescue to investigate the efficacy and off-target toxicity of naloxone in combination with opioids, with clinically relevant functional readouts of organ function. The system was able to successfully exhibit opioid overdose using methadone, as well as rescue using naloxone evidenced by the neuronal component activity. In addition to efficacy, the multi-organ platform was able to characterize potential off-target toxicity effects of naloxone, specifically in the cardiac component.

This paper explores evaluation of a food locker pilot implemented at a faith-based community food pantry. Thirty-one clients were recruited to use the locker for a 9-week period. Client pre- and post-surveys monitored demographics, food and nutrition security, fruit and vegetable intake, and food pantry usage. Key informant interviews were conducted with clients to assess facilitators and barriers to usage. Results provided preliminary evidence that locker offerings increased client household access to fruits and vegetables. Findings will inform improvements to the food locker program and guide practitioners looking to implement food lockers in charitable food locations.

OBJECTIVE:This study evaluated differences in diet quality across multiple racial/ethnic groups with type 2 diabetes (T2D) experiencing food insecurity. DESIGN:Cross-sectional. Bilingual (English/Spanish, English/Marshallese) community health workers used a multiple-pass approach to collect 3 24-hour dietary recalls via phone. SETTING:Food pantries in Arkansas. PARTICIPANTS:Eighty-three adult food pantry clients with T2D (hemoglobin A1c ≥ 7.0%) experiencing food insecurity and self-identified race/ethnicity of Hispanic (39%), Marshallese Pacific Islander (i.e., Marshallese) (35%), or White (26%). MAIN OUTCOME MEASURE:Diet quality (Healthy Eating Index [HEI]-2015). ANALYSIS:Differences in diet quality scores by race/ethnicity were evaluated using one-way analysis of variance; Turkey-Kramer tests for pairwise comparisons assessed diet quality differences among Hispanic, Marshallese, and White participants. A food-level analysis identified top food categories contributing to diet quality. RESULTS:Diet quality was 71.7 ± 12.7 (mean ± standard deviation) among Hispanic, 56.9 ± 14.1 among Marshallese, and 45.9 ± 14.1 among White participants. Hispanic participants had a significantly higher HEI-2015 score than Marshallese (mean difference, 14.9 [95% confidence interval (CI), 6.6-23.2]; P < 0.001) and White (mean difference, 25.9 [95% CI, 16.9-34.8]; P < 0.001) participants. Marshallese participants had a significantly higher HEI-2015 score than White participants (mean difference, 11.0 [95% CI, 1.8-20.1]; P = 0.01). CONCLUSIONS AND IMPLICATIONS:Designers of nutrition-focused interventions may consider tailoring food and education around high and low diet quality component scores that vary across racial/ethnic groups (e.g., including culturally appropriate fruits/vegetables) to improve T2D management.

Objective To determine the impact of a home-delivered, medically tailored grocery intervention on glycemic control and diet quality among participants with type 2 diabetes (T2D) experiencing food insecurity. Methods A single-arm prepost study was conducted. One hundred one English, Spanish, or Marshallese-speaking adults were recruited from food pantries in Northwest Arkansas (from August 2021 to February 2023). Twelve weekly T2D-appropriate food boxes with diabetes self-management education and support materials were home-delivered. Primary outcomes measured at preintervention and postintervention included hemoglobin A1c and diet quality (i.e., Healthy Eating Index-2015). Results Mixed-effects regressions controlling for age, sex, race/ethnicity, household size, education, and employment found hemoglobin A1c scores significantly decreased by 0.56% (units) at postintervention compared with preintervention (P = 0.01). No significant changes in Healthy Eating Index-2015 scores were found (P = 0.47). Conclusions and Implications Future research may build on this study’s findings and explore mechanisms whereby medically tailored groceries can benefit people across communities experiencing high rates of food insecurity and T2D.

Background: Limited research documents how organizations implement programs to increase culturally preferred foods. This project explores organizational factors in implementing a cultural food preference pilot across food pantries and farms, with specific attention to Hispanic and Marshallese culturally preferred foods. Methods: Food pantry and farm partners were engaged through a low food security community of practice (i.e., a partnership with community-based organizations). Six partners were funded for seven months to grow and distribute culturally preferred foods. An evaluator conducted semi-structured interviews with partners, which were recorded and transcribed. Transcripts were analyzed using rapid thematic analysis. Results: Rapid thematic analysis revealed six themes: 1) frequent organizational discussion about culturally preferred foods; 2) positive client feedback; 3) incorporation of knowledge into broader programming; 4) new partnerships with procurement and distribution sites; 5) sustainability concerns; and 6) ongoing commitment to growing culturally preferred foods. Discussion: Findings can inform practitioners in food pantries and farms implementing interventions with culturally preferred foods and highlight the need to address sustainability concerns related to food access and cost to ensure long-term impact of such interventions.

Recess is a part of school-based physical activity promotion offered worldwide with equitable recess access a social justice issue. From a policy perspective, in the U.S. few states currently require elementary school recess and little is known about its implementation. The purpose of this study was to determine the current implementation of one state system as a case study to investigate minimum recess requirement and to compare the implementation between school geographic and racial factors. A cross-sectional, observational study of the implementation of one state’s minimum daily recess requirement of 40-minutes recess was conducted during the 2023–2024 academic year. A school audit of provided recess time was conducted of all public elementary schools in Arkansas through an online search of bell schedules, a survey sent to principals and physical education teachers, and phone call surveys to school offices. Key demographic and geographic features of the schools included enrollment data (e.g., race, grade, and

Arkansas has the highest maternal mortality rate and food insecurity rate in the United States with low participation in federal assistance programs. This qualitative study explores facilitators and barriers to Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) utilization from a focus group with Hispanic and Marshallese community health workers (CHWs). A sample of nine bilingual CHWs participated in the focus group as a part of a food insecurity community of practice. Content analysis of participant discussion was conducted. Four themes emerged: (1) experiences with the WIC enrollment process, (2) less perceived stigma around WIC in comparison with other federal benefits, (3) challenges obtaining WIC-eligible items, and (4) infant feeding-related challenges. Findings are informing interventions that reduce WIC utilization barriers for Hispanic and Marshallese women in high need of assistance.

Arkansas has the highest prevalence of food insecurity in the U.S. This qualitative study is one of few to explore the daily reality of food insecurity in a rural, Southern state in the U.S. through PhotoVoice. A sample of seven food insecure residents participated in a PhotoVoice project as part of a food insecurity community of practice. Thematic analysis of participant discussion was conducted. Four themes emerged: 1) "community receiving and community giving"; 2) high cost of healthy foods; 3) time cost of food assistance; and 4) navigating resource scarcity. Findings can inform interventions that better support food insecure residents.

Government, health care systems and payers, philanthropic entities, advocacy groups, nonprofit organizations, community groups, and for-profit companies are presently making the case for Food is Medicine (FIM) nutrition programs to become reimbursable within health care services. FIM researchers are working urgently to build evidence for FIM programs' cost-effectiveness by showing improvements in health outcomes and health care utilization. However, primary collection of this data is costly, difficult to implement, and burdensome to participants. Electronic health records (EHRs) offer a promising alternative to primary data collection because they provide already-collected information from existing clinical care. A few FIM studies have leveraged EHRs to demonstrate positive impacts on biomarkers or health care utilization, but many FIM studies run into insurmountable difficulties in their attempts to use EHRs. The authors of this commentary serve as evaluators and/or technical assistance providers with the United States Department of Agriculture's Gus Schumacher Nutrition Incentive Program National Training, Technical Assistance, Evaluation, and Information Center. They work closely with over 100 Gus Schumacher Nutrition Incentive Program Produce Prescription FIM projects, which, as of 2023, span 34 US states and territories. In this commentary, we describe recurring challenges related to using EHRs in FIM evaluation, particularly in relation to biomarkers and health care utilization. We also outline potential opportunities and reasonable expectations for what can be learned from EHR data and describe other (non-EHR) data sources to consider for evaluation of long-term health outcomes and health care utilization. Large integrated health systems may be best positioned to use their own data to examine outcomes of interest to the broader field.

BACKGROUNDNutrition plays a vital role in children's physical and emotional health. More than half of school age children's calories are provided in the school food environment, making school interventions an opportunity to address child nutrition.METHODSThe Creating Health Environments for Schools (CHEFS) program is designed to leverage local resources to create customized solutions that improve the nutritional content of school food and encourage children to choose healthier food. There are 8 components: (1) customizing nutrition plans, (2) modifying/replacing menu items, (3) helping procure healthier food, (4) providing equipment grants, (5) training cafeteria staff, (6) implementing environmental changes and nudges, (7) engaging students and parents, and (8) supporting sustainability. Supporting child nutrition directors is key to facilitating cooperation with schools.IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITYMenu modifications and procurement are interrelated and depend on successfully collaborating with corporate, independent, and local food services organizations. Limited school budgets require low or no-cost solutions and staff training. Student and parent engagement are critical to facilitate culturally-appropriate solutions that increase awareness of healthy food.CONCLUSIONSEvery school district has particular resources and constraints. CHEFs engaged stakeholders to design customized solutions and encourage healthier nutrition for school children.

Food is Medicine (FIM) programs to improve the accessibility of fruits and vegetables (FVs) or other healthy foods among patients with low income and diet-related chronic diseases are promising to improve food and nutrition security in the United States (US). However, FIM programs are relatively new and implementation guidance for healthcare settings using an implementation science lens is lacking. We used a narrative review to describe the evidence base on barriers and facilitators to FIM program integration in US healthcare settings following the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework. Evidence surrounding the EPIS Inner Context was a focus, including constructs Leadership, Organizational Characteristics, Quality and Fidelity Monitoring and Support, Organizational Staffing Processes, and Individual Characteristics. Peer-reviewed and grey literature about barriers and facilitators to FIM programs were of interest, defined as programs that screen and refer eligible patients with diet-related chronic disease experiencing food insecurity to healthy, unprepared foods. Thirty-one sources were included in the narrative review, including 22 peer-reviewed articles, four reports, four toolkits, and one thesis. Twenty-eight sources (90%) described EPIS Inner Context facilitators and 26 sources (84%) described FIM program barriers. The most common barriers and facilitators to FIM programs were regarding Quality and Fidelity Monitoring and Support (e.g., use of electronic medical records for tracking and evaluation, strategies to support implementation) and Organizational Staffing Processes (e.g., clear delineation of staff roles and capacity); although, barriers and facilitators to FIM programs were identified among all EPIS Inner Context constructs. We synthesized barriers and facilitators to create an EPIS-informed implementation checklist for healthcare settings for use among healthcare organizations/providers, partner organizations, and technical assistance personnel. We discuss future directions to align FIM efforts with implementation science terminology and theories, models, and frameworks to improve the implementation evidence base and support FIM researchers and practitioners.

This cohort study compares the outcomes of oral doxycycline therapy with those of intravenous penicillin therapy among patients with ocular syphilis.

The purpose of this pilot study was to determine the impact a culinary medicine teaching activity had on interprofessional healthcare students’ knowledge, confidence, and intent to apply practical dietary principles in practice. Thirteen interprofessional students (n = 13) completed a 3-h, hands-on culinary medicine session focused on recipe conversion and nutritional coaching skills to modify a favorite comfort food into a significantly more nutritious, Mediterranean diet–based meal. Participants produced variations of a recipe to gain a deeper understanding of how diet modifications that consider both taste and nutritional value can treat health conditions. Pre- and post-session surveys were administered to evaluate participants’ knowledge and intent to apply culinary medicine principles into their respective healthcare practices. Students reported an increase in the belief that nutritional counseling should be included in routine appointments, as well as increased confidence in their ability to implement culinary medicine into practice. All students reported the intent to integrate culinary medicine into practice, and a likelihood that they would recommend culinary medicine training to other healthcare professionals. Interprofessional students reported learning satisfaction throughout the hands-on, chef-led and faculty-facilitated culinary medicine teaching activity and found the nutritional content to be especially transferable to working with patients.

Background:Arkansas lacks adequate access to high-quality pain care, as evidenced, in part, by it having the second highest opioid prescribing rate in the United States. To improve access to high-quality treatment of chronic pain, we developed the Arkansas Improving Multidisciplinary Pain Care and Treatment (AR-IMPACT) Telemedicine Clinic, a multidisciplinary and interprofessional team of specialists who provide evidence-based pain management for patients with chronic pain.Methods:We conducted a single-arm pilot trial of the AR-IMPACT Telemedicine Clinic with rural, university-affiliated primary care clinics. We assessed the AR-IMPACT Telemedicine Clinic using an implementation framework and preliminary effectiveness measures. Specifically, we assessed 5 of the 8 implementation outcomes of the framework (ie, penetration, adoption, acceptability, appropriateness, and feasibility) using a mixed methods approach. To evaluate implementation outcomes, we used surveys, interviews, and administrative data. We used electronic health record data to measure preliminary effectiveness (ie, changes in average morphine milligram equivalents per day and pain and depression scores).Results:The AR-IMPACT team saw 23 patients that were referred by 13 primary care physicians from three rural, university-affiliated primary care clinics over one year. Of the 19 patients willing to participate in the pilot study, 12 identified as women, 31.6% identified as Black, and over 50% had less than a bachelor's level education. Patients rated the clinic positively with high overall satisfaction. Referring physicians indicated high levels of appropriateness, acceptability, and feasibility of the program. AR-IMPACT team members identified several barriers and facilitators to the feasibility of implementing the program. No changes in preliminary effectiveness measures were statistically significant.Conclusion:Overall, the AR-IMPACT Telemedicine Clinic obtained moderate penetration and adoption, was highly acceptable to patients, was highly acceptable and appropriate to providers, and was moderately feasible to providers and AR-IMPACT team members.

A qualitative formative approach was used to explore food pantry clients' needs, preferences, and recommendations regarding food received from food pantries. Fifty adult clients of six Arkansas food pantries were interviewed in English, Spanish, or Marshallese. Data analysis used the constant comparative qualitative methodology. In choice and minimal choice pantries, three themes emerged: clients need increased quantities of food, particularly more proteins and dairy; clients desire higher quality food, including healthy food and food not close to expiration; and clients desire familiar foods and food appropriate for their health needs. System level policy changes are needed to address clients' recommendations.

Healthy food incentive programs for Supplemental Nutrition Assistance Program participants, often implemented in farmers markets, have shown promise in improving the purchase and consumption of fruits and vegetables. However, variation in program context, program strategies, and participant populations has produced gaps in knowledge about which healthy food incentive program implementation strategies are most effective, and few studies have focused on farmers market vendors' experiences. This study evaluated experiences of farmers market vendors who participated in the Northwest Arkansas Double Your Dollars (NWA DYD) healthy food incentive program intended to increase access to healthy foods for local Hispanic/Latino and Marshallese community members with low incomes. Data were collected from a convenience sample of vendors participating in NWA DYD at the three largest participating markets on the last Saturday in October 2021. Program staff collected quantitative, categorical, and open-ended data through face-to-face surveys. Forty-one vendors completed the survey. Vendors believed NWA DYD was beneficial and easy to use, expanded their customer base, and increased participation of Hispanic/Latino and Marshallese shoppers. Vendors also identified challenges in participation related to administrative burdens and delayed reimbursements. Vendors did not identify NWA DYD as a driver for expanded production for the upcoming growing season. Vendors' experiences at NWA DYD provide implications for others interested in implementing effective healthy food incentive programs. Improving access to farmers markets through effective healthy food incentive programs is an important step toward increasing consumption of fresh, healthy foods among communities with low incomes facing elevated prevalence of chronic disease.

AbstractObjective:This study estimates the prevalence of, and associations between, family food insecurity and overweight/obesity among Native Hawaiian and Pacific Islander (NHPI) adolescents and explores socio-demographic factors which might have a moderation effect on the association.Design:Cross-sectional study using 2014 NHPI-National Health Interview Survey data reported by a parent or guardian. Family-level food security was assessed by the US Department of Agriculture 10-item questionnaire. BMI for age and sex ≥ 85th and 95th percentiles defined overweight and obesity, respectively, according to US Centers for Disease Control and Prevention criteria.Setting:The USA, including all 50 states and the District of Columbia.Participants:383 NHPI adolescents aged 12–17 in the USA.Results:A third (33·5 %) of NHPI adolescents aged 12–17 were overweight (19·1 %) or obese (14·4 %); 8·1 % had low food security; and 8·5 % had very low food security. Mean family food security score was 1·06, which corresponds to marginal food security. We found no association between family food insecurity and adolescent overweight/obesity or between any other covariates and overweight/obesity, except for family Supplemental Nutrition Assistance Program (SNAP) participation. Odds of being overweight/obese were 77 % lower for adolescents in families participating in SNAP (OR: 0·23, 95 % CI: 0·08, 0·64, P = 0·007). The association between SNAP participation and lower odds of overweight/obesity was particularly pronounced for adolescent girls in food-insecure families.Conclusions:The association between SNAP participation and lower odds of overweight/obesity suggests potential benefit of research to determine whether interventions to increase SNAP enrollment would improve NHPI adolescents’ health outcomes.