OBJECTIVE:Describe the rationale and design for THIS-WIC, a large, multistate project to integrate telehealth into the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program for nutrition education and breastfeeding support service delivery. DESIGN:Varied by the WIC state agency (1 group-randomized control trial, 4 quasi-experimental matched comparison designs, and 1 prepost design). Mixed-methods data collection, including surveys, interviews, the WIC Management Information System, telehealth metadata, and process and implementation. SETTING:Special Supplemental Nutrition Program for Women, Infants, and Children local agencies (n = 68) in 7 states, including the District of Columbia, Georgia, Michigan, North Carolina, South Carolina, Vermont, and Wisconsin. PARTICIPANTS:Special Supplemental Nutrition Program for Women, Infants, and Children clients, including pregnant and lactating postpartum women aged ≥ 18 years, infants, and children aged ≤ 5 years at participating agencies. Special Supplemental Nutrition Program for Women, Infants, and Children staff who are responsible for delivering nutrition education/breastfeeding support, and local agency directors at participating intervention agencies. INTERVENTION(S):Telehealth interventions varied by state, including enhanced video conferencing and virtual services provided through customized online platforms and portals. Intervention duration ranged from 7 to 18 months. MAIN OUTCOME MEASURE(S):Special Supplemental Nutrition Program for Women, Infants, and Children client satisfaction with telehealth. ANALYSIS:Mixed-methods analysis.

ABSTRACT Importance Establishing a universal metric for nutrition security, defined as, “consistent and equitable access to healthy, safe, affordable foods essential to optimal health and well-being,” is a national priority. Understanding how the Healthy Eating Index-2020 (HEI-2020) could be used to measure and monitor nutrition security in the population can assist in surveillance and improve the design of nutrition programs and policies. Objective To examine the utility of the HEI-2020 as an evidence-based measure of nutrition security. Design This serial cross-sectional study used data from the 2009-2018 National Health and Nutrition Examination Surveys (NHANES). Setting Nationally representative, population-based survey Participants Data for N=22,168 US adults (≥20 years) were analyzed. Main outcome We derived HEI-2020 scores (0-100), commonly used to capture overall diet quality, from participants’ two 24-hour dietary recalls. Nutrition security categories were established: high nutrition security (>70-100), marginal (>60-70), low (>50-60), and very low (0-50). Results Only 13% of US adults had high nutrition security while nearly two-thirds had low or very low nutrition security. Nutrition security was higher for adults who were older, female, “Other” race or ethnicity, born outside of the US, have higher education attainment, higher income, and food security. Compared to adults with high nutrition security, adults with very low nutrition security had the lowest intakes of unprocessed or minimally processed foods, fruits, vegetables, whole grains, and seafood and the highest intakes of ultra-processed foods, refined grains, and red and processed meats (all P-trends <0.01 ). Similarly, adults with very low nutrition security were more likely to have elevated adiposity, lower HDL cholesterol, higher triglycerides, higher fasting glucose, and higher hemoglobin A1c (all P-trends ≤0.01 ). Conclusions The HEI is a robust measure of nutrition security that can be directly linked to the construct of nutrition security. Using evidence-based HEI cut-points as nutrition security categories would allow policy makers, public health practitioners and nutrition professionals to set benchmarks and nationwide targets for achieving nutrition security. KEY POINTS Question Can the Healthy Eating Index (HEI)-2020 be used as an evidence-based measure of nutrition security? Findings Using nationally representative data, we created four categories of nutrition security using HEI-2020 scores: high (≥70), marginal (>60-70, low (>50-60), and very low (≤50). Less than 1 in 6 US adults had high nutrition security. High nutrition security was less prevalent among adults with greater socioeconomic disadvantage. High nutrition security was also associated with more favorable cardiometabolic risk profiles. Meaning The HEI can be directly linked to categories of nutrition security and used for national program and policy setting.

Introduction: Ultraprocessed foods are industrial formulations manufactured from substances derived from foods and industrially-produced ingredients and additives. Few countries' policies directly regulate ultraprocessed food, but several countries' dietary guidelines suggest eating less ultraprocessed food. The U.S. Dietary Guidelines for Americans do not mention the ultraprocessed food category, but the 2025-2030 Advisory Committee is tasked with evaluating research related to ultraprocessed food consumption. The U.S. Dietary Guidelines for Americans are used for U.S. food and nutrition policies. It is unknown the extent that federal and state policymakers have already proposed or passed policies addressing ultraprocessed foods.Methods: Research was conducted using Lexis+ into federal and state statutes, bills, resolutions, regulations, and proposed rules, and Congressional Research Services reports to identify policymaking related to highly processed and ultraprocessed food from January 1980 through February 2023.Results: This research identified 25 policy actions (8 federal, 17 state) proposed or passed between 1983 and 2022 (22 of them, 2011-2022). The most common topic area related to children's nutrition (n=14), and a prevalent theme related to food prices. Only 1 policy defined ultraprocessed food, and 3 policies sought to address the broader food environment by providing incentives to small retailers to stock healthy foods.Conclusions: Addressing ultraprocessed food in U.S. policy activity is quite recent, with few policies directly targeting ultraprocessed foods but rather discussing them as contrary to healthy diets. Internationally, ultraprocessed foods have been directly integrated into national dietary guidelines and school food programs. These policies are consistent with emerging U.S. policy activity and may provide information for future policymaking in the U.S. Am J Prev Med 2023;65(6):1134-1141.(c) 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Purpose of review In 2020, obesity prevalence among US children reached 19.7%, impacting about 14.7 million children and adolescents. Food insecurity among children is also a public health concern but has largely decreased or remained stable over the past decade, reaching 6.2% of US households with children in 2021. Given food insecurity and obesity's interconnected nature and their negative consequences on children's health, it is of interest to assess the Supplemental Nutrition Assistance Program's (SNAP's) impact on childhood food security, dietary quality, disease risk, and health outcomes. Recent findings Evidence suggests that SNAP participants, including children, struggle to meet key dietary guidelines and perform poorly on key health indicators when compared with income-eligible and higher income nonparticipants. Children participating in SNAP were more likely to have elevated disease risk and consume more sugar-sweetened beverages (SSBs), more high-fat dairy, and more processed meats than income-eligible nonparticipants. However, research suggests that federal food assistance programs with more stringent nutrition standards – the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and the National School Lunch Program (NSLP) and School Breakfast Program (SBP) – improve dietary quality, increase birth weight and gestation periods, and reduce childhood obesity, infant mortality and healthcare costs. Summary After reviewing the evidence on SNAP's impacts on food insecurity, dietary quality, and health as well as research on the health impacts of other more successful federal food assistance programs, we provide three policy recommendations to strengthen SNAP's effectiveness as a health intervention for children and families.

Abstract Objective: Online grocery shopping could improve access to healthy food, but it may not be equally accessible to all populations – especially those at higher risk for food insecurity. The current study aimed to compare the socio-demographic characteristics of families who ordered groceries online v. those who only shopped in-store. Design: We analysed enrollment survey and 44 weeks of individually linked grocery transaction data. We used univariate χ 2 and t-tests and logistic regression to assess differences in socio-demographic characteristics between households that only shopped in-store and those that shopped online with curbside pickup (online only or online and in-store). Setting: Two Maine supermarkets. Participants: 863 parents or caregivers of children under 18 years old enrolled in two fruit and vegetable incentive trials. Results: Participants had a total of 32 757 transactions. In univariate assessments, online shoppers had higher incomes (P < 0 0001), were less likely to participate in Special Supplemental Nutrition Program for Women, Infants, and Children or Supplemental Nutrition Assistance Program (SNAP; P < 0 0001) and were more likely to be female (P = 0·04). Most online shoppers were 30–39 years old, and few were 50 years or older (P = 0·003). After controlling for age, gender, race/ethnicity, number of children, number of adults, income and SNAP participation, female primary shoppers (OR = 2·75, P = 0·003), number of children (OR = 1·27, P = 0·04) and income (OR = 3·91 for 186–300 % federal poverty line (FPL) and OR = 6·92 for >300 % FPL, P < 0·0001) were significantly associated with likelihood of shopping online. Conclusions: In the current study of Maine families, low-income shoppers were significantly less likely to utilise online grocery ordering with curbside pickup. Future studies could focus on elucidating barriers and developing strategies to improve access.

This article provides an overview of the US Department of Agriculture Summer Meals Program (SMP) and highlights opportunities to strengthen SMP's public health impacts. We also discuss initial SMP implications of 2 relevant policy provisions of the Families First Coronavirus Response Act (P.L. 116-127), signed into law on March 18, 2020. Ensuring access to summer meals among high-risk students can provide (1) supplemental nutrition assistance to families that helps address food insecurity during the summer months when there are no school meals, (2) healthy meals in structured settings that might help reduce obesity risk, and (3) support to other programs that offer other benefits such as education, physical activity, or job training.

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through March 2019, we identified corresponding retailer websites through Google (Alphabet) to determine participation in online purchasing and corresponding delivery areas by zip codes.Outcomes were the proportion of food desert census tracts and corresponding SNAP households classified as fully, partially, or not deliverable, according to whether all, some, or no corresponding zip codes were located within grocery delivery areas.We stratified results by urban vs rural status and state, then we compared strata using Monte Carlo simulations to enable comparisons using Fisher exact test owing to many cases of small cell-counts.Data were analyzed using SAS statistical software version 9 (SAS Institute).P values were 2-tailed, and statistical significance was set at less than .05. ResultsIn the 8 OPP states, food deserts composed 1250 of 13 134 total census tracts (9.5%), within which 506 863 of 2 760 482 SNAP households (18.4%) were located.Among 1191 urban food desert census tracts, 1108 census tracts (93.0%) were fully deliverable through online grocery purchase and delivery, 13 census tracts (1.1%) were partially deliverable, and 70 census tracts (5.9%) were not deliverable (Table 1).Among 59 rural food desert census tracts, no census tracts were fully deliverable, 18 census tracts (30.5%) were partially deliverable, and 41 census tracts (69.5%) were

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IMPORTANCE:Unhealthful diet is a top contributor to chronic diseases in the United States. There are growing concerns about disparities in diet among US adults, especially for those who participate in the Supplemental Nutrition Assistance Program (SNAP), the largest federal food assistance program. It remains unclear how these disparities may have changed over time.OBJECTIVE:To assess whether disparities in key food groups and nutrients according to participation and eligibility for SNAP have persisted, improved, or worsened over time among US adults.DESIGN SETTING AND PARTICIPANTS:This survey study examined a nationally representative sample of 38 696 adults aged 20 years or older: 6162 SNAP participants, 6692 income-eligible nonparticipants, and 25 842 higher-income individuals from 8 cycles of the National Health and Nutrition Examination Survey (1999-2014). Data analysis was conducted between January 1, 2017, and December 31, 2017.EXPOSURES:Survey-weighted, energy-adjusted diet by SNAP participation status.MAIN OUTCOMES AND MEASURES:Mean diet scores and proportions of US adults meeting poor, intermediate, or ideal diet scores based on the American Heart Association (AHA) 2020 Strategic Impact Goals for diet, including 8 components (fruits and vegetables; whole grains; fish and shellfish; sugar-sweetened beverages; sodium; nuts, seeds, and legumes; processed meats; and saturated fat).RESULTS:The survey included 38 696 respondents (20 062 female [51.9%]; 18 386 non-Hispanic white [69.8%]; mean [SD] age, 46.8 [14.8] years). Participants of SNAP were younger (mean [SD] age, 41.4 [15.6] years) than income-eligible nonparticipants (mean [SD] age, 44.9 [19.6] years) or higher-income individuals (mean [SD] age, 47.8 [13.6] years); more likely to be female (3552 of 6162 [58.6%] vs 3504 of 6692 [54.8%] and 13 006 of 25 842 [50.4%], respectively); and less likely to be non-Hispanic white (2062 of 6162 [48.2%] vs 2594 of 6692 [56.0%] and 13 712 of 25 842 [75.8%], respectively). From surveys conducted in 2003 and 2004 to those conducted in 2013 and 2014, SNAP participants had less improvement in AHA diet scores than both income-eligible nonparticipants and higher-income individuals (change in mean score = 0.57 [95% CI, -2.18 to 0.33] vs 2.56 [95% CI, 0.36-4.76] and 3.84 [95% CI, 2.39-5.29], respectively; P = .04 for interaction). Disparities persisted for most foods and nutrients and worsened for processed meats, added sugars, and nuts and seeds. In 2013 to 2014, a higher proportion of SNAP participants had poor diet scores compared with income-eligible nonparticipants and higher-income individuals (461 of 950 [53.5%] vs 247 of 690 [38.0%] and 773 of 2797 [28.7%]; P < .001 for difference), and a lower proportion had intermediate diet scores (477 of 950 [45.3%] vs 428 of 690 [59.8%] and 1933 of 2797 [68.7%]; P < .001 for difference). The proportion of participants with ideal diet scores was low in all 3 groups (12 of 950 [1.3%] vs 15 of 690 [2.2%] and 91 of 2797 [2.6%]; P = .26 for difference).CONCLUSIONS AND RELEVANCE:Dietary disparities persisted or worsened for most dietary components among US adults. Despite improvement in some dietary components, SNAP participants still do not meet the AHA goals for a healthful diet.

Introduction: Unhealthful diet is one of the top contributors to the chronic disease burden in the U.S. There are growing concerns that socioeconomic disparities exist in Americans’ diets and this disparity may have widened over time. Aim: To characterize trends in dietary intake of key food groups and nutrients among low-income Americans who participated in the Supplemental Nutrition Assistance Program (SNAP), and assess whether disparities in U.S. diets have persisted, improved, or worsened over time. Methods: Nationally representative sample of 6,162 adults aged 20 years or older who participated in SNAP, 6,692 income-eligible nonparticipants, and 25,842 higher-income nonparticipants from 8 National Health and Nutrition Examination Survey (NHANES) cycles (1999-2014). Exposures are calendar year and SNAP participation status. Survey-weighted, energy-adjusted mean scores and proportion meeting the American Heart Association (AHA) 2020 Strategic Impact Diet Goals (5 primary components: fruits/vegetables, whole grains, fish/shellfish, sugar-sweetened beverages (SSBs), sodium; 3 secondary components: nuts/seeds/legumes, processed meats, saturated fat). Intakes of individual food groups and nutrients were also assessed. Results: From 2003-2004 to 2013-2014 among SNAP participants with data on two-day dietary recall, primary diet score (maximum of 50) modestly increased (15.6 to 16.6; P-trend =0.03) while the secondary diet score (maximum of 80 points) did not change (31.5 to 32.1; P-trend =0.11). The proportion of SNAP participants having a poor diet decreased from 74.3% to 68.6%, the proportion having an intermediate-quality diet increased from 25.5% to 31.2%, and the proportion of having an ideal diet remained unchanged (0.2%.). Among primary components, changes were strongest for SSBs (-0.43 servings/d, P-trend=0.001) and whole grains (+0.25 servings/d, P-trend<0.001). Compared to higher-income nonparticipants and income-eligible nonparticipants, SNAP participants had weaker improvements in both primary and secondary diet scores. From 1999-2000 to 2013-2014, disparities persisted for most dietary components, worsened for nuts/seeds and added sugars, and weakened for sodium. Conclusion: Despite some improvements in diet quality, SNAP participants still fall far short of meeting the AHA Goals for a healthful diet, and dietary disparities persisted or worsened for most dietary components.

INTRODUCTION:Comprehensive cancer control plans published by state, tribal, and territorial health agencies present an excellent opportunity to help prevent tobacco-related and other cancers. In this analysis, we sought to estimate the extent to which tobacco control activities outlined in state comprehensive cancer control plans incorporated the tobacco control recommendations presented by the Centers for Disease Control and Prevention (CDC) in Best Practices for Comprehensive Tobacco Control Programs-August 1999 (Best Practices) and The Guide to Community Preventive Services: Tobacco Use Prevention and Control (The Guide).METHODS:We analyzed the 39 available state comprehensive cancer control plans to determine which of the CDC tobacco control recommendations were incorporated. We then summarized these data across the 39 states.RESULTS:The 39 states incorporated a mean of 5.6 recommendations from Best Practices (SD, 2.8; range, 0-9) and 3.9 recommendations from The Guide (SD, 1.9; range, 0-6). Nearly one-half of state plans (48.7%) addressed funding for tobacco control; of these, 52.6% (25.6% of total) delineated a specific, measurable goal for funding.CONCLUSION:The extent to which tobacco control is addressed in state comprehensive cancer control plans varies widely. Our analysis revealed opportunities for states to improve compliance with CDC's tobacco-related recommendations for cancer control.