OBJECTIVE:By limiting household expenditures on rent and utilities and connecting individuals to health services, federal housing assistance programs could facilitate health care access among low-income cancer survivors. We examined the association between receipt of rental assistance and health care access among low-income adult cancer survivors. METHODS:We used 2019-2023 National Health Interview Survey data on adults aged ≥20 years (1) with a history of cancer diagnosis, (2) with a family income-to-poverty ratio <2, and (3) who were renters. We used propensity score weighting to address differences in observed demographic characteristics between rental assistance recipients and nonrecipients. We used logistic regression analyses to examine the associations of rental assistance receipt with outcome variables. RESULTS:Lack of receipt of rental assistance was significantly associated with higher odds of delaying medical care due to cost (odds ratio [OR] = 1.90; 95% CI, 1.07-3.40) and experiencing medical financial hardship (OR = 1.85; 95% CI, 1.21-2.80), as well as lower odds of being covered by health insurance (OR = 0.04; 95% CI, 0.01-0.18). CONCLUSION:Receipt of rental assistance may help improve health care access among low-income adult cancer survivors. Our findings are important in relation to a shortage of affordable housing in the United States and highlight the need for efforts to expand housing assistance.

PURPOSE:To examine the association between telehealth utilization and mammogram receipt by rurality, and to characterize geographic patterns of concurrent increases in telehealth and mammography use in urban and rural communities. METHODS:The sample included women, aged 50 years or older, receiving services in primary care or gynecology/women's health practices at MultiCare Health System from 2018 to 2023. For the difference-in-difference (DiD) analyses, women who had only in-person visits during the prepandemic period but had at least one telehealth visit in each year of the postpandemic period were defined as the treatment group. Women who had only in-person visits during both pre- and postpandemic periods were defined as the control group. For the spatial analyses, we analyzed ZIP Codes in which both telehealth and mammography utilization increased from 2018-2019 to 2020-2022. FINDINGS:DiD analyses suggested that telehealth use was significantly associated with a greater probability of mammogram receipt among rural women; however, this association was not found in urban women. Spatial analyses indicated that concurrent increases in telehealth and mammogram use occurred in both rural and urban settings but exhibited greater spatial concentration in urban areas and comparatively more dispersed patterns across rural ZIP Code Tabulation Areas. CONCLUSIONS:The findings suggest that telehealth may be particularly beneficial for improving mammography screening among rural individuals, who typically experience greater structural barriers to accessing health care. While urban areas may exhibit clustered patterns driven by interconnected care systems, rural areas may experience more diffuse but meaningful gains as telehealth expands access across large geographic distances.

BACKGROUND:The objective of the study was to understand barriers to telehealth use among women and to examine mammography uptake in relation to these barriers. For this purpose, we implemented a survey to explore barriers to telehealth and use of cancer-preventative services. METHODS:Recruitment was based on electronic health record data from MultiCare Health System. Recruitment and enrollment of patients was initiated in 2024 and ended in March 2025, when the target sample size of 1,000 was reached. Women, aged between 50 and 75 years, were surveyed. Women with a personal history of breast cancer were excluded from the analyses. Among those included, 614 women had received virtual care in the previous 5 years, and 265 women had not received virtual care. Women who had 5 or more mammograms in the last 10 years were classified as 'optimal mammogram utilizers'. Those reporting 0-4 mammograms were identified as 'mammogram under-utilizers'. Logistic regression analyses examined the association of telehealth use with mammogram utilization. RESULTS:Compared to women who received virtual health care visits, women whose providers did not offer virtual care had significantly lower odds of optimal mammogram utilization. Lack of receipt of virtual care due to other reasons (i.e., technology issues and lack of preference/need) was not significantly associated with mammogram utilization. CONCLUSIONS:Study findings suggest that greater provider acceptance and use of telehealth for delivery of health care services could be associated with better mammogram utilization. Understanding barriers to provider acceptance of telehealth could inform efforts to expand telehealth.

BACKGROUND:Despite benefits of prenatal Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation, less than half of eligible individuals receive WIC benefits during pregnancy. By exacerbating barriers to participating in this program, the pandemic could have reduced prenatal WIC participation especially among certain vulnerable groups. OBJECTIVES:The objective was to examine the association of the pandemic with prenatal WIC participation among eligible individuals. An additional objective is to examine this association by key demographic characteristics, including income and education, and health care access. METHODS:Using Pregnancy Risk Assessment Monitoring System 2017-2022 from 23 states, WIC-eligible pregnant individuals with data on WIC receipt were included. Those who had given birth from 2017 through February 2020 and from July 2020 through 2022 were classified as having pregnancies during prepandemic and postpandemic periods, respectively. An interrupted time series model using logistic regression examined association of pandemic with WIC participation. RESULTS:Compared with prepandemic, the postpandemic period was associated with lower odds of WIC participation in the overall sample (odds ratio [OR]: 0.84; 95% confidence interval [CI]: 0.74, 0.96). The postpandemic period also was significantly associated with lower odds of WIC participation in some subgroups, such as those with an education level of high school or less (OR: 0.77; 95% CI: 0.65, 0.92), family income of poverty ratio <1 (OR: 0.77; 95% CI: 0.61, 0.97), inadequate prenatal care (OR: 0.62; 95% CI: 0.40, 0.96), and no health insurance during pregnancy (OR: 0.28; 95% CI: 0.11, 0.72). CONCLUSIONS:Findings suggest a decline in prenatal WIC participation after the pandemic. Additionally, the association of the pandemic with lower odds of WIC participation among those from lower socioeconomic status and poorer health care access suggests exacerbation of health disparities and underscores the need to improve participation in these groups.

BackgroundAddressing key behavioral risk factors for chronic diseases, such as diet, requires innovative methods to objectively measure dietary patterns and their upstream determinants, notably the food environment. Although GIS techniques have pushed the boundaries by mapping food outlet availability, they often simplify food access dynamics to the vicinity of home addresses, possibly misclassifying neighborhood effects. Leveraging Google Location History Timeline (GLH) data offers a novel approach to assess long-term patterns of food outlet utilization at an individual level, providing insights into the relationship between food environment interactions, diet quality, and health outcomes.MethodsWe leveraged GLH data previously collected from a sub-set of participants in the Washington State Twin Registry (WSTR). GLH included more than 287 million location records from 357 participants. We developed methods to identify visits to food outlets using outlet-specific buffer zones applied to the InfoUSA data on food outlet locations. This methodology involved the application of minimum and maximum stay durations, along with revisit intervals. We calculated metrics from the GLH data to detect frequency of visits to different food outlet classifications (e.g. grocery stores, fast food, convenience stores) important to health. Several sensitivity analyses were conducted to examine the robustness of our food outlet metrics and to examine visits occurring within 1 and 2.5 km of residential locations.ResultsWe identified 156,405 specific food outlet visits for the 357 study participants. 60% were full-service restaurants, 15% limited-service restaurants, and 16% supermarkets. Mean visits per person per month to any food outlet was 12.795. Only 8, 10 and 11% of full-service restaurants, limited-service restaurants, and supermarkets, respectively, occurred within 1 km of residential locations.ConclusionsGLH data presents a novel method to assess individual-level food utilization behaviors.

Background:In 2024, the Food and Drug Administration (FDA) finalized an update to the definition of the term "healthy" as used on food labels, to align with current dietary guidelines. A holistic understanding of food choice is vital for socially- and economically-conscious food programs and policies. Objectives:This study applied the new "healthy" criteria to a nationally-representative database of foods and beverages and compared qualifying items to those that failed to qualify, in terms of nutrient density, monetary cost, and frequency of consumption. Methods:Nutrient profile scores based on the Nutrient Rich Foods Index 9.3 model and weighted frequency of consumption data from the Food and Nutrient Database for Dietary Studies were linked to data for monetary cost, based on national food prices. Results:The analysis included 3062 foods and beverages in 12 food groups, of which 14% qualified as "healthy." Many foods did not qualify due to excess sodium and saturated fat. Overall, qualifying foods and beverages had a higher median nutrient density and frequency of consumption (P < 0.001) and lower median cost per serving (P < 0.001) compared with items that failed to qualify. Among food groups, qualifying plant protein foods, consisting primarily of nuts and seeds, were significantly lower in nutrient density and more expensive than not qualifying plant proteins. Qualifying mixed dishes were also significantly more costly than those that failed to qualify. Conclusions:Foods and beverages that would qualify as "healthy" under new FDA criteria were more nutrient dense. Overall, qualifying items may be less expensive and consumed more frequently than not qualifying items, although results differed for individual food groups. To increase the availability of foods and beverages qualifying as "healthy," industry reformulation of packaged and processed nutrient-dense foods should be considered to reduce the addition of sodium, sugar, and saturated fat.

Background/Objectives: Despite the health benefits of fiber intake, most Americans do not meet the dietary recommendations for this nutrient. With barley, buckwheat and quinoa containing several nutrients, including fiber, the integration of these foods into the American diet could improve diet quality and health. The purpose of this study is to examine the consumption patterns of barley, buckwheat and quinoa and its association with diet and metabolic health markers. Methods: We used National Health and Nutrition Examination Survey (NHANES) 2013–2018 data. Adults who had consumed barley, buckwheat and quinoa, as determined by food codes representing these foods, in at least one of the two 24 h recalls were categorized as consumers. Due to the very low prevalence of buckwheat consumption, the associations of consumption with diet and health markers were examined only for barley and quinoa. Results: The prevalence of barley, buckwheat and quinoa consumption among US adults were 0.36%, 0.04% and 1.07%, respectively. Compared with non-consumers, barley and quinoa consumers had significantly greater diet quality and higher intakes of potassium and fiber. While barley consumption was associated with a lower body mass index, waist circumference and glycohemoglobin, quinoa consumption was associated with a lower body mass index, waist circumference, triglycerides and total cholesterol. Conclusions: In this study, we found an overall low prevalence of the consumption of barley, buckwheat and quinoa among US adults. The consumers of barley and quinoa had better dietary intake compared with non-consumers. Although better metabolic health in consumers may be explained by their overall healthier dietary patterns, understanding the barriers and facilitators to the intake of these foods could inform efforts to improve diet quality and health.

BACKGROUND:The planetary health diet (PHD) has been proposed as a dietary index with potential co-benefits for human and planetary health. Evidence is limited on its association with type 2 diabetes (T2D) incidence and greenhouse gas (GHG) emissions. Our objective was to assess the associations of adherence to the PHD with incident T2D and GHG emissions. METHODS AND FINDINGS:We analysed data from 23,722 participants (55% female), with a mean (standard deviation, SD) age of 59.1 (9.3) in the UK-based EPIC-Norfolk prospective cohort study. Dietary intake was assessed across three time points (1993-1997, 1998-2000 and 2004-2011) using a food frequency questionnaire. We assessed adherence to the PHD (theoretical score range 0-140 points) based on the consumption of 13 food groups and two nutrients. Cox proportional hazards regression models, which accounted for time-varying covariates, were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for T2D. Linear regression models were used to analyse the association between the PHD and estimated GHG emissions. During a mean follow-up period of 19.4 (SD 6.8) years, 3,496 cases of incident T2D were recorded over 461,086 person-years. Greater adherence to the PHD was associated with lower T2D incidence; comparing the highest PHD quintile (85.7-117.8 points) to the lowest (33.9-68.4 points), the HR (95% CI) was 0.68 (0.61, 0.76) in the most adjusted model including socio-demographic, behavioural factors, energy intake, adiposity, and prevalent cardiovascular disease or cancer. The estimated population attributable fraction (PAF) for incident T2D due to adherence below the 80th percentile (85.7 points) was 12.3% (95% CI: 9.2%, 15.3%). Those in the highest quintile of the PHD had approximately 18% lower GHG emissions compared to those in the lowest (β5th/1st -18.4% (95% CI: -19.3%, -17.5%)). The main limitation of this research is the possibility of residual confounding due to the observational design of this study. CONCLUSIONS:Our findings of a lower incidence of T2D and reduced GHG emissions among those with higher adherence to the PHD support the promotion of this diet for the population-level prevention of T2D and for planetary sustainability.

BACKGROUND:Although previous research has shown that food insecurity adversely affects diet quality in adults, this relationship is less consistently observed in children. However, studies in children have focused on those aged 2 y or older and the association of food insecurity with diet quality in children aged 12-23 mo is unclear. OBJECTIVES:The objective was to determine the association of household food insecurity with diet quality, as indicated by Healthy Eating Index-Toddlers-2020 (HEI-Toddlers-2020), in United States children aged 12-23 mo. METHODS:The study used a cross-sectional design based on data from 2013-2014, 2015-2016, and 2017-March 2020 survey cycles of National Health and Nutrition Examination Survey. The primary sample included 708 children aged 12-23 mo with 1) complete data on food security, assessed via the United States Food Security Survey Module (USFSSM); 2) ≥1 d of reliable 24-h dietary recall data; and 3) reported energy intake from complementary foods/beverages (that is, foods and beverages other than human milk or infant formula). On the basis of responses to USFSSM, households were classified as food secure or food insecure. Proxies, typically parents, reported child's dietary intake. Diet quality was assessed using the HEI-Toddlers-2020. Linear regression analyses examined the association of household food security status with HEI-Toddlers-2020 total and component scores, adjusted for demographic characteristics. RESULTS:Household food insecurity was significantly associated with lower HEI-Toddlers-2020 total score (estimate = -3.78; standard error = 1.06; P = 0.0007), as well as lower component scores for whole fruits (estimate = -0.56; standard error = 0.18; P = 0.003), and whole grains (estimate = -0.85; standard error = 0.35; P = 0.02). CONCLUSIONS:The association of household food insecurity with lower diet quality in this study suggests that toddlers may not be shielded from household food shortages. Although consumption of certain food groups, such as whole grains, was inadequate in the overall sample of United States toddlers, food insecurity could exacerbate suboptimal intake of whole grains. Interventions to improve diet quality of young children must account for household food insecurity.

This study examined the association of rental assistance receipt with cost-related medication nonadherence (CRN) engagement in low-income adults with diabetes. Using National Health Interview Survey (NHIS) data from 2016 through 2019 and 2020 through 2022, we included low-income adults who were 1) diagnosed with diabetes, 2) prescribed medications, and 3) renters. Propensity score weighting approach created a sample in which receipt of rental assistance was independent of observed sociodemographic characteristics. Logistic regression examined the association of rental assistance receipt with CRN, respectively. Lack of receipt of rental assistance was significantly associated with higher odds of CRN engagement in NHIS 2016-2019 (Odds ratio=2.32; 95% confidence interval=(1.59, 3.37); p&lt;.0001) and NHIS 2020-2022 (Odds ratio=1.74; 95% confidence interval=(1.04, 2.91); p=.03). Given the shortage of affordable housing in the United States, findings suggest that expansion of affordable housing could be critical for improving health outcomes in low-income adults with diabetes.

OBJECTIVE:To assess long-term changes in fathers' dietary intake and behaviors following a nutrition and physical activity program. METHODS:Mexican-heritage fathers participated in a 6-week father-focused, family-centered program implemented in a border community. Promotoras used surveys to assess dietary intake of fruits and vegetables and healthy dietary behaviors at baseline (n = 42), program completion (n = 42), short-term (3-4 months postprogram, n = 24), and long-term (2.0-2.5 years postprogram, n = 36). Linear growth models tested changes in program outcomes. RESULTS:Fathers' dietary intake of fruits and vegetables and healthy dietary behavior scores significantly increased across time (P < 0.05). Education level had a moderating effect on growth in vegetable intake over time (β = -0.12; P = 0.002). CONCLUSIONS AND IMPLICATIONS:A father-focused, family-centered approach may be one way to achieve lasting healthy dietary behavior changes in Latino fathers. Future researchers may consider alternative family structures (e.g., grandparent, single-parent) in program participation.

Objective:Early detection of breast cancer through routine screening improves survival. Increased engagement with healthcare services may promote mammography uptake. This study examined whether greater telehealth use is associated with higher mammogram screening rates. Methods:We analyzed data from January 1st 2018 to December 31st 2023 from the MultiCare Health System in Washington State. For each year, we determined whether a patient received a screening mammogram during that year or the following year. We assessed the association between type of encounter (≥1 telehealth visit vs. in-person only vs. no encounters) and the likelihood of having a mammogram, adjusting for race/ethnicity, insurance type, age, and pre-/post-COVID-19 period. Results:Among 140,390 female patients (609,061 patient-year observations), those with no encounters were least likely to undergo mammography. Women who used telehealth were less likely to be screened than those with in-person visits but more likely than those with no visits (rural: Odds Ratio (OR) = 0.50, 95 % Confidence Interval (CI) = 0.43,0.60; urban: OR = 0.68, 95 % CI = 0.65,0.70). Telehealth rose from 0.04 % to 4 % post-COVID-19, while mammography rates increased from 0 % to an average of 13 %. Conclusions:Expanding telehealth access may increase routine mammography, particularly among previously unscreened populations.

Background/Objectives: The effects of sweetened and unsweetened high β-glucan whole grain barley on postprandial blood glucose response in normoglycemic human subjects were evaluated in a randomized, controlled, crossover clinical trial. Methods: Sixteen healthy, over-night fasted participants were studied on four or eight separate occasions. Participants consumed an unsweetened preload condition (n = 16): white glutinous rice (WR; 0 g β-glucan), low β-glucan barley (LB; ~4 g), medium β-glucan barley (MB; ~5 g), or high β-glucan barley (HB; ~6 g); or a sweetened condition with high fructose corn syrup (HFCS; n = 8): WR + 50 g HFCS, LB + 50 g HFCS, MB + 50 g HFCS, or HB + 50 g HFCS. After consuming the preload as a breakfast food, participants self-administered blood glucose tests every 15 min for four hours. Results: In both sweetened and unsweetened conditions, higher β-glucan content was associated with lower blood glucose peak response and incremental area under the curve estimates (iAUC). In comparison to the unsweetened conditions, the sweetened conditions resulted in less prominent decreases in mean blood glucose response and iAUC blood glucose as β-glucan content increased. Conclusions: By attenuating postprandial glycemic response, high β-glucan whole grain barley foods could play a role in helping to control blood glucose.

Objectives:We examined the association of loss of pregnancy-related Medicaid coverage with unmet health care needs, medical financial hardship, and health care use in postpartum women participating in a nationally representative household survey. Design:Cross-sectional study design. Sample and measurements:Using 2012-2018 National Health Interview Survey data, we classified postpartum women as either (1) having Medicaid coverage or (2) uninsured due to loss of pregnancy-related Medicaid coverage. We examined the relationship of loss of pregnancy-related Medicaid coverage with unmet health care needs, medical financial hardship, and health care use. Results:Compared to Medicaid-insured postpartum women, uninsured women who lost pregnancy-related Medicaid coverage had significantly greater odds of delaying medical care due to cost, as well as greater odds of unmet need for medical care, mental health care, and prescriptions. Uninsured postpartum women who lost pregnancy-related Medicaid coverage also had significantly greater odds of medical financial hardship and lower odds of health care use. Conclusions:Findings suggest that continued Medicaid coverage during postpartum could improve health care access among uninsured women experiencing loss of pregnancy-related Medicaid eligibility. These results hold important implications for the public health impact of recent policy efforts to extend Medicaid eligibility into the postpartum period.

ObjectiveThis study builds on prior findings that link increased availability of takeaway food outlets in home, workplace, and commuting environments to greater takeaway consumption and adiposity. Using longitudinal data, we examine associations of takeaway availability at baseline with changes in consumption and adiposity between baseline and follow-up.MethodsWe analyzed data from the Fenland Study, with baseline data from 2005 to 2015 and follow-up from 2015 to 2020. Takeaway outlet availability within 1 mile of participants' home and workplace addresses, based on 2011 local authority data, was assessed. Outcomes included takeaway food consumption (from a food frequency questionnaire) and body fat percentage (measured via dual-energy x-ray absorptiometry) at follow-up.ResultsAmong 7581 participants (mean [SD] age, 49.3 [7.4] years) with a mean follow-up of 6.7 years, no positive association was found between takeaway outlet availability at baseline and changes in consumption or body fat percentage. However, among the 12 associations tested, the highest combined home-workplace availability of takeaway outlets, compared with none, was associated with a 0.68 decrease in body fat percentage (95% CI: 0.24-1.12).ConclusionsAlthough takeaway outlet availability was linked to greater consumption and adiposity at baseline, it did not predict changes over time, underscoring the complexity of dietary behaviors and their relationship with the neighborhood food environment.

This ad hoc secondary analysis of a randomized clinical trial compares the food costs in the United States of a low-fat vegan diet and a Mediterranean diet.

A holistic understanding of food sustainability is vital for making socially and environmentally conscious food choices. Sustainable diets have been defined by four dimensions: health, economics, environment, and society. The purpose of this study was to determine how metrics for nutritional quality, monetary cost, environmental impact, and social and cultural acceptability of foods and beverages vary across and within food groups and to identify which foods and beverages are optimally sustainable according to these metrics. Data from the Food and Nutrient Database for Dietary Studies (FNDDS) was linked with frequency of consumption, nutrient density, environmental impact, and cost data from publicly available databases. A sustainability index, based on the four dimensions, was developed to quantify overall sustainability. Nutrient density was correlated negatively with environmental impact and frequency of consumption but positively with cost (p < 0.001). Out of 5964 items, 165 were identified as optimally sustainable. Sustainability index scores varied within each food group. Less than 1% of optimally sustainable items were Dairy products, while 62% were Protein Foods—of which 92% were Plant Proteins. Few foods and beverages met the criteria to be considered optimally sustainable. However, Plant Protein foods may generally strike the best balance among these four indicators of sustainability. A holistic understanding of food sustainability is necessary to facilitate nutritious and environmentally conscious dietary choices that adhere to other needs, personal values, and preferences.

Food prices and affordability play an important role in influencing dietary choices, which in turn have implications for public health. With inflationary increases in the cost-of-living in the UK since 2021, understanding the dynamics of food prices becomes increasingly important. In this longitudinal study, we aimed to examine changes in food prices from 2013 to 2023 by food group and by food healthiness. We established a dataset spanning the years 2013-2023 by combining price data from the UK Consumer Price Index for food and beverage items with nutrient and food data from the UK nutrient databank and UK Department of Health & Social Care's National Diet and Nutrition Survey data. We calculated the price ( pound/100 kcal) for each food item by year as well as before and during the period of inflationary pressure, and classified items into food groups according to the UK Eatwell Guide and as either "more healthy" or "less healthy" using the UK nutrient profiling score model. In 2023, bread, rice, potatoes and pasta was cheapest (0.12 pound/100 kcal) and fruit and vegetables most expensive (1.01 pound/100 kcal). Less healthy food was cheaper than more healthy food (0.33 pound/100 kcal versus 0.81 pound/100 kcal). Before the inflationary pressure period (from 2013 to late 2021), the price of foods decreased by 3%. After this period, the price of food increased by 22%: relative increases were highest in the food group milk and dairy food (31%) and less healthy category (26%). While healthier foods saw smaller relative price increases since 2021, they remain more expensive, potentially exacerbating dietary inequalities. Policy responses should ensure food affordability and mitigate price disparities via, for example, healthy food subsidies.

Background: Incorporation of lentils and dried peas could form the basis of a nutrient-rich diet; yet, they are among the least-consumed legumes in the United States (US). The objective of this study was to examine the prevalence of lentils/dried peas consumption in the US over time and across socio-demographic groups, as well as to examine the eating context of these foods. Methods: Analyses included adults (aged 18 years or older) and children (aged 3–17 years) participating in National Health and Nutrition Examination Survey (NHANES) 2003–2004 through 2017–2018. Participants consuming lentils/dried peas on one or both of the 24-h dietary recalls were categorized as consumers. Results: Although an increasing time trend in prevalence of consumption was observed over the study period, prevalence of lentils/dried peas consumption was less than 7% in NHANES 2017–2018 in adults and children. Demographic differences were observed, such that a greater proportion of non-Hispanic Asians were classified as consumers. Lentils/dried peas were primarily obtained from grocery stores and supermarkets. Conclusions: Although there are signs of rising acceptance of dried peas and lentils, the low prevalence of lentils/dried peas consumption suggests that understanding barriers to consumption of these foods could further identify opportunities to improve their consumption.