Background: Food swamps, which have a high density of outlets selling unhealthy food relative to healthier options, are a major driver of diet-related disparities in urban communities. However, no validated food swamp measurement tools exist at the neighborhood level. Methods: We developed the Food Swamp Environment Audit Tool (FS-EAT) using community-based participatory research. FS-EAT includes 19 items as-sessing street-level food outlet types, accessibility features, food marketing, pricing, social features, and store-level information and food availability. Reliability and validity testing were performed using stakeholder surveys and feedback from the community advisory board (CAB). We compared secondary National Establishment Time Series (NETS) 2020 with FS-EAT food store data using positive predictive values and sensitivity scores. We computed Spearman's rank correlation coefficients to measure the alignment between block group-level food swamp and non-food swamp classifications, comparing FS-EAT data with NETS 2020 data. Results: Interrater reliability was strong (κ = 0.82), and 80% of stakeholders rated FS-EAT items as relevant/extremely relevant. CAB members con-firmed that FS-EAT maps aligned better with lived experiences than the secondary NETS data. GIS analyses showed that FS-EAT maps captured more accurate and timely food swamp exposure compared to NETS. When validated against the NETS 2020 business list, the FS-EAT demonstrated an overall sensitivity of 45.3% and a PPV of 68.2%. We con-firmed fewer than half of NETS-listed outlets through FS-EAT ground observation, yet more than two-thirds of audit-identified stores were also present in the NETS database. Sensitivity was highest for convenience stores (74.4%) and lowest for limited-service restaurants (29.2%). Resident perceptions were moderately correlated with FS-EAT scores (r = 0.5). While both sources agreed on the food swamp classification in 18 block groups, 15 block groups (38.5%) were classified as food swamps by the FS-EAT audit data but as non-food swamps by the NETS data. Discussion: The FS-EAT tool captures nuanced features needed to assess the level of neighborhood food swamp exposure and contributes a systematic, cost-effective way to identify neighborhood-level food swamps.

BACKGROUND:Patient-centered communication (PCC) is a key component of high-quality cancer care. Although prior research links PCC to improved health outcomes, including reduced psychological distress, the processes through which these associations may occur remain underexplored. AIMS:Guided by Epstein and Street's conceptual model of PCC, this study examined associations between PCC and three health outcomes-psychological distress, physical function limitations, and general health-and explored whether worry about cancer recurrence represents a cognitive-emotional pathway linking PCC with these outcomes. METHODS:Data were drawn from 1119 adults with a history of cancer who participated in the 2021 Health Information National Trends Survey-Surveillance, Epidemiology, and End Results Program (HINTS-SEER). Weighted regression analyses examined associations among PCC, worry about recurrence, and health outcomes, while exploratory analyses assessed theoretically informed indirect associations. RESULTS:Participants (Mage = 70.86 years; 46.1% male) generally reported low psychological distress; 19.6% reported at least one physical function limitation, and 16.0% rated their general health as fair or poor. Higher PCC was associated with lower psychological distress but not with physical function limitations or general health. Exploratory analyses indicated that higher PCC was associated with less worry about cancer recurrence, which was in turn associated with lower psychological distress and a reduced likelihood of fair-to-poor general health. CONCLUSION:PCC may promote emotional well-being among cancer survivors, in part by reducing worry about recurrence. These findings underscore the importance of strengthening PCC in survivorship care to mitigate psychological distress and support further longitudinal research to clarify temporal relationships.

The COVID-19 pandemic made many U.S. households susceptible to food insecurity and sparked a temporary expansion of federal food assistance. Recognizing that the effects of the pandemic on food insecurity were socially patterned and changed over time, this study aimed to identify different food insecurity trajectories from 2018 to 2022 and demographic/household factors associated with these trajectories in a low-income sample. We conducted a secondary analysis of data from a longitudinal annual survey (2018-2022) of 414 low-wage workers recruited in community settings in two U.S. cities: Raleigh, NC, and Minneapolis, MN. Annual survey measures included the 6-Item Food Security Module, self-reported demographics, and household economic factors including housing stability, employment, and receipt of Supplemental Nutrition Assistance Program (SNAP). Latent class analysis identified underlying classes (trajectories) of food security over time and assigned participants to a trajectory. Multinomial logistic regression models tested the association between demographic/household factors and trajectory membership. Food insecurity was high at baseline (72.7%). Latent class analysis yielded five trajectories from 2018 to 2022: (i) consistent high food security (23.9%), (ii) consistent moderate food security (28.3%), (iii) consistent very low food security (17.6%), (iv) improved food security (12.6%), and (v) temporarily improved food security (17.6%). Several demographic/household factors were associated with the likelihood of experiencing trajectories of less food security. Understanding trajectories of food insecurity during the COVID-19 pandemic can inform policy responses during future health or economic crises. Food security status is not a static condition; annual measurement is critical for promoting food security among low-income U.S. families.

Objectives This study examined early care and education (ECE) providers’ routine and pandemic-related use of digital technology for nutrition training and explored their attitudes and perceptions toward digital technology using the Technology Acceptance Model as a guiding framework to inform future training delivery. Methods We employed a convergent mixed-methods design consisting of a national survey and semi-structured qualitative interviews with licensed ECE providers. Inclusion criteria were licensed/registered ECE providers, English-speaking, age ≥18, and currently caring for children for pay. Exclusion criteria included unlicensed providers and inactive programs. Survey data was analyzed using chi-square tests to examine differences by variable type and logistic regressions to examine predictors of digital technology use. Qualitative analysis underwent thematic analysis using a blended deductive/inductive approach guided by the Braun and Clarke multi-step method. Integrated analyses were conducted and shown through a joint display to contextualize the findings. Results Most ECE providers (97.9%) had access to high-speed internet, and 95.1% used electronic devices for work-related purposes. Approximately 83.2% had received nutrition training since the COVID-19 pandemic began, with 53.2% accessing training via virtual platforms. ECE providers enrolled in the Child and Adult Care Food Program were more likely to receive nutrition training digitally than those not enrolled (OR = 24.0, p < .001). As ECE providers’ age increases, the odds of receiving training digitally decreased (OR = 0.52, p = .043). Providers reported that digital training improved accessibility and flexibility. However, the study also identified challenges such as reduced social connectedness, technical difficulties, and limited knowledge or awareness of digital nutrition training programming. Conclusion Findings suggest that digital technology enhances access to nutrition training for ECE providers, yet barriers remain. Future efforts should focus on expanding digital training programming, improving technological support, and balancing digital and in-person training to optimize hands-on learning and social connectedness.

Southeast Asian (SEA) children are burdened by high rates of diet-related chronic conditions and diseases. These burdens partly result from socioeconomic disadvantages and refugee migration trajectories. Yet, to our knowledge, no dietary interventions exist for this population. This protocol paper describes the rationale, study design, intervention and study evaluation for the SEA Healthy Habits, Healthy Kids Study. The study enrollment goal was 75 parent–child dyads recruited in Providence, Rhode Island, in the United States. A SEA parent/guardian and one of their 6-to-11-year-old children were randomized to (1) a monthly financial incentive only group; (2) an enhanced financial incentive group that receives additional interventions including family-based group nutrition education, three motivational interviewing (MI) phone calls, and weekly text messages on healthy eating norms and other nutrition topics; or (3) a structurally equivalent attention-matched control group. The primary study goals were to assess feasibility and acceptability, conduct process evaluation to determine implementation fidelity and intervention dose, and determine preliminary efficacy. Feasibility was assessed based on attendance (primary) and secondary measures, recruitment, enrollment, intervention dose, and retention at 6 months. Acceptability was measured using satisfaction questionnaires on study favorability. Preliminary efficacy (i.e., comparing changes in children’s diet quality (Healthy Eating Index and dermal carotenoids)) will be determined via longitudinal mixed effects models. Regression models will investigate the relationship between dose, implementation measures and study outcomes. This intervention received Institutional Review Board approval on February 16, 2023. We conducted intervention development from July 2022 to August 2022 with 62 SEA parents and children. For the intervention, we began participant recruitment in April 2023, which concluded January 2025. This study will demonstrate whether a culturally tailored healthy eating intervention for SEA families is feasible and acceptable and whether it leads to changes on key efficacy indicators. The intervention is informed by theories and frameworks relevant for the population and utilizes a family-centered approach. If this innovative pilot intervention achieves the study objectives, then we will refine it and pursue a larger randomized control trial. This study is registered at ClinicalTrials.gov under registration number NCT05817838. The trial was registered on April 17, 2023. The trial registry record is available at https://clinicaltrials.gov/study/NCT05817838.

Clinical supervisors play a critical role in home visiting programs. Using an exploratory, qualitative design, we examined supervisors' experiences during the COVID-19 pandemic. Beginning in late 2020, we conducted semi-structured interviews with 16 supervisors about challenges in leadership resulting from the pandemic, adaptations to virtual service delivery, support needs, and insights they gained. Supervisors were concerned about meeting families' increased needs and supporting home visitors. Supervisors creatively connected with families and staff and juggled their increased work and home responsibilities. They acknowledged support from organizations and the importance of self-care but expressed the need for more formal support.

Youth living in marginalized neighborhoods and the adults who support them experience a burden of high stress, including exposure to firearm violence, as a result of targeted structural violence. Multigenerational interventions that foster well-being are vital given the potential for caring adults to mitigate the effects of violence on youth. Guided by a trauma-informed, community-based participatory research approach, and the "adapt and evaluate" framework, the present study details the process by which teens impacted by gun violence, community violence intervention (CVI) workers, and university researchers collaborated to cocreate a multigenerational, culture-centered mindfulness-based intervention (MBI). Researchers collaborated with youth coresearchers to conduct focus groups with adolescents (N = 26) and CVI workers (N = 15) to explore sources of stress and coping to inform the adaption of an MBI. Data were coanalyzed with youth coresearchers, revealing sources of stress for youth and CVI workers. As an outcome of this process, an MBI was created for both youth and workers. Focus groups were conducted with adolescents (N = 8) and workers (N = 20) to explore reactions to the pilot. Stemming from the strong relationships between university researchers and the community partners, a key finding was the importance of cocreating mindfulness supports not only for youth but also for CVI workers who support them. Our success underscores that when collaboratively developed with a beginner's mind, MBIs are a promising tool for fostering resilience in communities disproportionately affected by structural oppression. This study illustrates how shared power, cultural adaptation, and community ownership can strengthen both the relevance and sustainability of MBIs. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

BackgroundChildren in the U.S. drink too little water and too much juice and sugar sweetened beverages. Inadequate access to drinking water in locations where children spend substantial time, like family childcare homes (FCCH) could play a role in low child water intake. The aim of this qualitative study was to explore barriers and facilitators to water availability and accessibility in FCCH, and determine potential strategies for facilitating water accessibility and children’s intake in FCCH.MethodsWe conducted virtual interviews, in Spanish and/or English, with family child care providers (FCCP) from Rhode Island, Connecticut, and Massachusetts. Interviews were conducted by University of Connecticut graduate students, including two who were fluent in Spanish and English. These were audio-recorded, transcribed verbatim, and translated to English. We conducted a deductive analysis using a priori themes. Additional codes were developed and applied to capture emerging themes from the qualitative data.ResultsTwenty FCCP (100% identified as female; 50% as Latina) participated in the interviews. FCCP barriers to water availability at FCCH included focus on other beverages, e.g., milk; confusion with the Child and Adult Care Food Program (CACFP) guidelines regarding water, and concerns about: water quality, mess, children eating enough food/milk, bathroom accidents, and cost for filters/bottled water. Barriers to children drinking water included: children not liking or preferring water, parental preferences/role modeling, and parental concerns about water quality. Suggested potential strategies to facilitate water access and intake included water filters to ensure safe water access, self-serving stations and water bottles to encourage autonomy among children, and incorporating water into daily routines. Participants also favored materials and activities to educate and encourage children to drink water and to keep track of their intake.ConclusionThese findings suggest that interventions to increase water consumption at FCCH should provide resources to guarantee safe water access to children, encourage children to drink water, and help clarify misperceptions and confusion around CACFP beverage guidelines. Future research should evaluate the effectiveness of interventions to provide education and water access resources to FCCP and families on improving child water access, availability and intake.

Objective To identify preferences, facilitators, and barriers to healthy eating and using a personalized diet application (Smart Cart 2.0) for online grocery shopping. Methods Convergent, parallel multimethods study among shoppers (aged > 18 years, grocery shopped online with obesity [body mass index, 30 kg/m2] or hypertension, n=20) and public health professional key informants (n = 11). Online surveys (shoppers only) and in-depth interviews using mock-up application images queried preferences, facilitators, and barriers. We synthesized quantitative and qualitative data for thematic analysis. Results The most common barriers (25%) were money and time, while health motivated most food purchases (55%). Four themes emerged from interviews: (1) consuming healthy foods was hard, (2) healthy meal planning would be easier with a one-stop shopping tool, (3) the application addressed shoppers’ needs, and (4) some additions could promote application sustainability. Conclusions and Implications Smart Cart 2.0 addressed healthy eating barriers. Integrating feedback will enhance application design for future evaluation.

BackgroundChildren in the United States have poor diet quality, increasing their risk for chronic disease burden later in life. Caregivers’ feeding behaviors are a critical factor in shaping lifelong dietary habits. The Strong Families Start at Home/Familias Fuertes Comienzan en Casa (SFSH) was a 6-month, home-based, pilot randomized-controlled feasibility trial that aimed to improve the diet quality of 2-5-year-old children and promote positive parental feeding practices among a predominantly Hispanic/Latine sample. The pilot saw significant improvements in children’s Healthy Eating Index-2015 total and whole fruit scores, as well as multiple food parenting practices, and it was received well by participants. ObjectiveBuilding on the success of the pilot study, this protocol paper describes the modifications, study design, and procedures for a fully powered randomized controlled trial. MethodsCaregiver-child dyads are randomized to a “healthy eating” intervention group or a “reading readiness” attention control group. In the intervention group, a trained community health worker conducts monthly home visits or phone calls for 6 months that focus on age-appropriate nutrition recommendations and food parenting practices. There are three home visits that include tailored nutrition education materials that address their child’s appetitive traits and eating habits, an interactive cooking activity, and a review of a family meal video with feedback. Community health workers use motivational interviewing and goal setting, which are key components of the program. The control group is similarly structured, with content focusing on reading and language development. Caregivers complete in-person and over-the-phone baseline and 6-month follow-up measurements to capture diet quality (primary outcomes: Healthy Eating Index-2015 scores via two 24-h dietary recalls and dermal carotenoids) and selected parental feeding practices and availability of healthy foods in the home (secondary outcomes). ResultsThis protocol was approved by the Brown University institutional review board (protocol number 2022003389). As of March 2025, a total of 81 participants were randomized. Of these, 29 participants completed the study, and 8 participants withdrew. Recruitment will continue until 257 participants have been randomized. Data analysis is expected to conclude in 2028. ConclusionsFindings will determine the efficacy of the intervention to improve child diet quality and parental feeding practices, which will ultimately inform future effectiveness and the real-world of home-based food parenting programs. Trial RegistrationClinicalTrials.gov NCT06099288; https://clinicaltrials.gov/study/NCT06099288 International Registered Report Identifier (IRRID)DERR1-10.2196/73923

Home-delivered meal programs (HDMP), such as Meals on Wheels, offer nutritious meals for homebound older adults experiencing nutritional risk. Despite receiving meals, participants may still have difficulty achieving nutritional goals, overcoming social isolation, and addressing other health issues. We aim to evaluate the impact of adding enhancements to traditional HDMP on improving diet quality, food and nutrition security, loneliness, and health-related quality of life among older adults in a randomized controlled trial. Homebound older adults at nutritional risk and participating in the Meals on Wheels of Rhode Island, Inc. (MOWRI) HDMP are randomized to receive either a usual care control group of the traditional HDMP (5 meals delivered per week) or the enhanced program (Meals+), which includes four Community Health Worker (CHW) coaching calls using motivational interviewing, and delivery of three healthful grocery bags during 12 weeks, in addition to the traditional HDMP. The primary outcome is diet quality measured by the validated Dietary Screening Tool (DST). Food and nutrition security, loneliness, and health-related quality of life are secondary outcomes assessed by validated measures. In the 12-week follow-up call, CHWs also ask participants about utilization and satisfaction with the intervention. The usual care group receives coaching from CHWs to connect them to community resources in this follow-up call. Study procedures were tested in a pilot randomized controlled trial (n = 12), resulting in modifications to the study protocol. Enhancements such as CHW calls and grocery bags can help HDMP target food access, social and health interventions for older adults. These enhanced HDMP have the potential to be sustained and replicated nationwide. Number NCT06401694; Start date: 2024-06-20.

Objective: Evaluate the usability and acceptability of a digital infant feeding module for use in a home visiting program. Methods: Home visitors (n = 11) and mothers (n = 10) completed a qualitative interview while viewing a digital nutrition education module on infant feeding. Quantitative data were collected using the mHealth App Usability Questionnaire. Qualitative data were analyzed using inductive thematic analysis. Results: Most participants (90%) reported that they would very likely use the module as part of home visits. mHealth App Usability Questionnaire subscale scores supported usability on a scale of 0-7 with ease of use (6.9 0.40), interface and satisfaction (6.9 0.30), and usefulness (6.8 0.50). Barriers to usability included technology access and phone compatibility. Conclusions and Implications: The digital infant feeding module was deemed usable and acceptable by home visiting stakeholders. Future research is needed to determine the impact of brief digital educational modules on parental feeding behaviors and child health outcomes.

Early childhood education (ECE) settings are important for the development of children's healthy eating and physical activity behaviors. Efforts to disseminate and implement health behavior promotion strategies in ECE settings have seldom optimized digital health, a missed opportunity highlighted by the COVID-19 pandemic. In this commentary, we discuss previous efforts to shift ECE-based health behavior programs to digital health modalities, notable opportunities for digital health in these settings, and a multilevel perspective to support future efforts. We propose future directions in digital health literacy, reaching various ECE settings, implementation science, and community partnerships to expand the use of digital interventions.

ObjectiveTo explore the goals, barriers, and facilitators set by caregivers of preschool-aged children to improve food parenting practices and household food environments.DesignSecondary qualitative analysis of collaborative goal sheets completed during in-home and telephone visits as part of a home-based pilot intervention.ParticipantsThirty-three Hispanic/Latinx caregivers, predominantly of low income.Phenomenon of InterestPatterns in goal content and anticipated barriers and facilitators.AnalysisThematic analysis of goal sheets with a mixed inductive-deductive approach.ResultsAlmost half of the goals were to support a healthy environment (40.7%) by increasing the availability of healthy foods through food shopping and meal planning. Other goals were to increase structure (33.7%) by establishing food-related routines and decreasing distractions. Goals related to autonomy support (25.4%) included involving their children (eg, cooking together). Caregivers’ perceived barriers encompass individual (eg, stress, lack of time), interpersonal (eg, other family members’ eating behaviors), and environmental-level (eg, food availability) factors. Caregivers only identified facilitators at the individual and interpersonal levels (eg, motivation).Conclusions and ImplicationsUnderstanding goals, barriers, and facilitators can be used to tailor key messages to improve food parenting practices and children's diets. Future interventions can target broader environmental barriers while increasing awareness of individual, interpersonal, and environmental-level facilitators.

Childhood eating behaviors are associated with weight status and laboratory assessments of dietary intake. However, little is known about how eating behaviors relate to the eating patterns and diet quality of children from marginalized populations when assessed in their natural environments. Therefore, we examined the association of food avoidant (e.g., food fussiness and satiety responsiveness) and food approach (e.g., food responsiveness and enjoyment of food) eating behaviors with children's meal size, eating frequency, and diet quality. We analyzed data from 61 predominately low-income Hispanic/Latinx preschool-aged children. Caregivers completed the Childhood Eating Behavior Questionnaire and two 24-h dietary recalls. From the recalls, we calculated meal size, eating frequency, and modified Diet Quality Index Scores (DQIS), and evaluated associations with eating behaviors using multivariable linear models. We also explored the relationship between eating behaviors and DQIS components. Food-avoidant subscales were associated with smaller meals and satiety responsiveness were associated with decreased snack frequency. Food approach subscales were not associated with meal size or eating frequency. Both food-avoidant and food-approach behaviors were associated with components of diet quality and caloric beverages outside of meal and snacks. These findings can inform future research on the relationship between child eating behaviors and dietary intake so that we can develop more tailored and effective interventions to promote healthy eating habits for low-income, Hispanic/Latinx preschool-aged children.

Objective: The socioemotional climate when feeding is a focus in childhood obesity prevention efforts. However, little is known about why caregivers create nonsupportive or supportive climates. This crosssectional study used a Self-Determination Theory perspective to identify factors associated with the socioemotional climate when feeding in ethnically diverse families with low income. Methods: Caregivers of children aged 2-5 years (n = 66) completed the Parent Socioemotional Context demographic surveys at baseline. Multivariable regressions assessed the association between BPN satisfaction/frustration with autonomy-supportive, structured, controlling, and chaotic feeding climates. Results: Participants were predominately Hispanic/Latinx (86.6%), women (92.5%), and born outside the US (60%). Their BPN frustration was positively associated with controlling (0= 0.96; SE = 0.26; P = 0.001) and chaotic (0= 0.79; SE = 0.27; P = 0.01) feeding. Conclusions and Implications: This analysis suggests that BPN frustration is associated with controlling and chaotic feeding and may be important to consider when encouraging responsive feeding. Key Words: feeding environment, parenting, Self-Determination Theory (J Nutr Educ Behav. 2023;55:363 -370.)

BACKGROUND:About 59%-73% of Black women do not meet the recommended targets for physical activity (PA). PA is a key modifiable lifestyle factor that can help mitigate risk for chronic diseases such as obesity, diabetes, and hypertension that disproportionately affect Black women. Web-based communities focused on PA have been emerging in recent years as web-based gathering spaces to provide support for PA in specific populations. One example is Black Girls Run (BGR), which is devoted to promoting PA in Black women.OBJECTIVE:The purpose of this study was to describe the content shared on the BGR public Facebook page to provide insight into how web-based communities engage Black women in PA and inform the development of web-based PA interventions for Black women.METHODS:Using Facebook Crowdtangle, we collected posts (n=397) and associated engagement data from the BGR public Facebook page for the 6-month period between June 1, 2021, and December 31, 2021. We pooled data in Dedoose to analyze the qualitative data and conducted a content analysis of qualitative data. We quantified types of posts, post engagement, and compared post types on engagement: "like," "love," "haha," "wow," "care," "sad," "angry," "comments," and "shares."RESULTS:The content analysis revealed 8 categories of posts: shout-outs to members for achievements (n=122, 31%), goals or motivational (n=65, 16%), announcements (n=63, 16%), sponsored or ads (n=54, 14%), health related (n=47, 11%), the lived Black experience (n=23, 6%), self-care (n=15, 4%), and holidays or greetings (n=8, 2%). The 397 posts attracted a total of 55,354 engagements (reactions, comments, and shares). Associations between the number of engagement and post categories were analyzed using generalized linear models. Shout-out posts (n=22,268) elicited the highest average of total user engagement of 181.7 (SD 116.7), followed by goals or motivational posts (n=11,490) with an average total engagement of 160.1 (SD 125.2) and announcements (n=7962) having an average total engagement of 129.9 (SD 170.7). Significant statistical differences were found among the total engagement of posts (χ72=80.99, P<.001), "like" (χ72=119.37, P<.001), "love" (χ72=63.995, P<.001), "wow" (χ72=23.73, P<.001), "care" (χ72=35.06, P<.001), "comments" (χ72=80.55, P<.001), and "shares" (χ72=71.28, P<.001).CONCLUSIONS:The majority of content on the BGR Facebook page (n=250, 63%) was focused on celebrating member achievements, motivating members to get active, and announcing and promoting active events. These types of posts attracted 75% of total post engagement. BGR appears to be a rich web-based community that offers social support for PA as well as culturally relevant health and social justice content. Web-based communities may be uniquely positioned to engage minoritized populations in health behavior. Further research should explore how and if web-based communities such as BGR can be interwoven into health interventions and health promotion.