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.

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.

Poor nutrition is the leading cause of chronic illness, which 6 of every 10 adults in the United States face. Caring for these conditions necessitates ongoing, expensive medical care, with 85% to 90% of healthcare costs attributable to chronic diseases. Recognizing this nutrition crisis, the Biden-Harris Administration hosted a historic White House Conference on Hunger, Nutrition, and Health that took place in September 2022. This conference was the first of its kind in more than 50 years and developed an agenda around a bold goal to end hunger and increase healthy eating and physical activity by 2030. The day before the 2022 conference, the Biden-Harris Administration released a National Strategy with actions the federal government would take across 5 pillars in addition to a fact sheet detailing more than $8 billion in new commitments from nongovernmental entities. Across the 5 pillars, this article summarizes the US Department of Agriculture accomplishments during the first 2 years of implementation and concludes with ways nutrition professionals can help accelerate progress.

It is the position of the Society for Nutrition Education and Behavior that for effective recovery from and resilience to disasters, it is essential that impacted individuals and communities have access to safe, nutritious, and culturally and contextually appropriate foods and beverages, and receive emergency-related food and nutrition education before, during, and after a disaster. Despite the increasing number, duration, and intensity of disasters worldwide, there is relatively limited guidance for research, policy, and practice about addressing the emergency-related food and nutrition needs of affected populations. Although nutrition emergencies tend to be understudied, emerging efforts are working to advance food and nutrition security during disaster response and recovery. To help elevate the importance of emergency-related food and nutrition education before, during, and after a disaster, Society for Nutrition Education and Behavior, which represents the unique professional interests of nutrition educators worldwide, summarizes the relevant literature and puts forth recommendations for all those who are engaged in this work in the following 4 key areas: (1) improving communication and outreach, (2) fostering community engagement and locally-driven preparedness, (3) building the evidence base and translating the evidence into action, and (4) training current professionals and the next generation of public health leaders. Altogether, before, during, and after a disaster, those who engage in this work, among other allies, can help elevate the importance of nutrition education and other strategies to promote healthy eating behaviors through research, policy, and practice.

Background:Impacts of colonization on dietary intake have led to high rates of obesity and noncommunicable diseases among Native American adults. Multilevel, multicomponent (MLMC) interventions may improve dietary intake.Objectives:To assess the impact of a MLMC obesity intervention, OPREVENT2 (Obesity Prevention and Evaluation of InterVention Effectiveness in NaTive North Americans 2; clinicaltrials.gov NCT02803853), on dietary intake in Native American adults in Intervention versus Comparison communities.Methods:A cluster-randomized controlled trial was performed among participants in 6 communities randomized to Intervention (n = 3 and Comparison (n = 3). Adults aged 18 to 75 were recruited from tribal communities in the Southwest and upper Midwest United States from September 2016 to May 2017 (n = 601). This analysis included participants who completed baseline and follow-up surveys (82% retention), reported dietary intake between 500 and 7000 kcal/d, and had no missing data for outcomes of interest (n = 446). The intervention was implemented from May 2017, to November 2018. OPREVENT2 integrated individual, environmental, social, and structural factors and was implemented in food stores, worksites, schools, and community media outlets in Intervention communities. Activities included taste tests, cooking demonstrations, and stocking healthier items in food stores and were reinforced by a social m)edia campaign, posters, brochures, and booklets focused on nutrition. Individual-level dietary intake among participating Native American adults was assessed via modified Block food-frequency questionnaire at preintervention and postintervention. Multilevel mixed-effects linear regression, with clustering at the community level, was performed.Results:Between-group effects were significant (P < 0.05) for intake of carbohydrates (-23 g/d), total fat (-9 g/d), saturated fats (-3 g/d), and monounsaturated fats (-4 g/d), with greater decreases in Intervention communities. Between-group effect for total sugar (-12 g/d in Intervention communities) was not statistically significant.Conclusions:This MLMC intervention was associated with significantly improved carbohydrate, total fat, and saturated fat intake among Native American adults. These changes are important for improving health within this population.

Importance:School meals are associated with improved nutrition and health for millions of US children, but school closures due to the COVID-19 pandemic disrupted children's access to school meals. Two policy approaches, the Pandemic Electronic Benefit Transfer (P-EBT) program, which provided the cash value of missed meals directly to families on debit-like cards to use for making food purchases, and the grab-and-go meals program, which offered prepared meals from school kitchens at community distribution points, were activated to replace missed meals for children from low-income families; however, the extent to which these programs reached those who needed them and the programs' costs were unknown.Objective:To assess the proportion of eligible youths who were reached by P-EBT and grab-and-go meals, the amount of meals or benefits received, and the cost to implement each program.Design, Setting, and Participants:This cross-sectional study was conducted from March to June 2020. The study population was all US youths younger than 19 years, including US youths aged 6 to 18 years who were eligible to receive free or reduced-price meals (primary analysis sample).Exposures:Receipt of P-EBT or grab-and-go school meals.Main Outcomes and Measures:The main outcomes were the percentage of youths reached by P-EBT and grab-and-go school meals, mean benefit received per recipient, and mean cost, including implementation costs and time costs to families per meal distributed.Results:Among 30 million youths eligible for free or reduced-price meals, grab-and-go meals reached an estimated 8.0 million (27%) and P-EBT reached 26.9 million (89%). The grab-and-go school meals program distributed 429 million meals per month in spring 2020, and the P-EBT program distributed $3.2 billion in monthly cash benefits, equivalent to 1.1 billion meals. Among those receiving benefits, the mean monthly benefit was larger for grab-and-go school meals ($148; range across states, $44-$176) compared with P-EBT ($110; range across states, $55-$114). Costs per meal delivered were lower for P-EBT ($6.46; range across states, $6.41-$6.79) compared with grab-and-go school meals ($8.07; range across states, $2.97-$15.27). The P-EBT program had lower public sector implementation costs but higher uncompensated time costs to families (eg, preparation time for meals) compared with grab-and-go school meals.Conclusions and Relevance:In this economic evaluation, both the P-EBT and grab-and-go school meal programs supported youths' access to food in complementary ways when US schools were closed during the COVID-19 pandemic from March to June 2020.

It is the position of the Academy of Nutrition and Dietetics (Academy) that exclusive breastfeeding provides optimal nutrition and health protection for the first 6 months of life; from 6 months until at least 12 months, breastfeeding should continue with the introduction of complementary foods. 1 Centers for Disease Control and Prevention, Department of Health and Human ServicesProposed data collection submitted for public comment and recommendations. https://www.federalregister.gov/documents/2020/05/15/2020-10412/proposed-data-collection-submitted-for-public-comment-and-recommendationsDate accessed: February 9, 2021 Google Scholar This position is similar statements from the World Health Organization (WHO) 2 World Health OrganizationPromoting proper feeding for infants and young children. http://www.who.int/nutrition/topics/infantfeeding/en/Date accessed: June 26, 2020 Google Scholar and the American Academy of Pediatrics (AAP). 3 Gartner L.M. Morton J. Lawrence R.A. et al. Breastfeeding and the use of human milk. Pediatrics. 2005; 115: 496-506https://doi.org/10.1542/peds.2004-2491 Crossref PubMed Scopus (2144) Google Scholar ,4 Section on BreastfeedingBreastfeeding and the use of human milk. Pediatrics. 2012; 129: e827-e841https://doi.org/10.1542/peds.2011-3552 Crossref PubMed Scopus (3197) Google Scholar Breastfeeding initiation rates have been increasing in the United States: from 35% of infants in 2000 to 82% in 2020. 5 Centers for Disease Control and PreventionFacts about nationwide breastfeeding goals. https://www.cdc.gov/breastfeeding/data/facts.htmlDate accessed: June 23, 2020 Google Scholar But disparities exist: 74% of non-Hispanic Black infants have been breastfed compared with 87% of non-Hispanic white infants. 5 Centers for Disease Control and PreventionFacts about nationwide breastfeeding goals. https://www.cdc.gov/breastfeeding/data/facts.htmlDate accessed: June 23, 2020 Google Scholar Income-eligible infants participating in the US Department of Agriculture (USDA) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which is about 44.6% of all infants born in the United States, are 17% more likely to use infant formula than infants who are not WIC eligible. 5 Centers for Disease Control and PreventionFacts about nationwide breastfeeding goals. https://www.cdc.gov/breastfeeding/data/facts.htmlDate accessed: June 23, 2020 Google Scholar ,9 Gray K. Trippe C. Tadler C. Perry C. Johnson P. Betson D. National- and state-level estimates of WIC eligibility and WIC program reach in 2017 final report: volume I. https://fns-prod.azureedge.net/sites/default/files/resource-files/WICEligibles2017-Volume1.pdfDate accessed: March 19, 2021 Google Scholar Mothers participating in WIC differ from eligible nonparticipants who are more likely to have characteristics associated with increased breastfeeding. 7 Gregory E.F. Gross S.M. Nguyen T.Q. Butz A.M. Johnson S.B. WIC participation and breastfeeding at 3 months postpartum. Matern Child Health J. 2016; 20: 1735-1744https://doi.org/10.1007/s10995-016-1977-1 Crossref PubMed Scopus (12) Google Scholar Women of color and those living below the federal poverty level face barriers hindering breastfeeding initiation and duration. 8 Schreck P.K. Solem K. Wright T. Schulte C. Ronnisch K.J. Szpunar S. Both prenatal and postnatal interventions are needed to improve breastfeeding outcomes in a low-income population. Breastfeed Med. 2017; 12: 142-148https://doi.org/10.1089/bfm.2016.0131 Crossref PubMed Scopus (17) Google Scholar , 6 Office of the Surgeon General (US); Centers for Disease Control and Prevention (US); Office on Women's Health (US)The Surgeon General's Call to Action to Support Breastfeeding. Office of the Surgeon General (US), Rockville, MD2011 Google Scholar , 10 US Dept of Agriculture, Food and Nutrition ServiceWIC food packages - maximum monthly allowances. https://www.fns.usda.gov/wic/wic-food-packages-maximum-monthly-allowancesDate accessed: February 9, 2021 Google Scholar , 11 Kim J.H. Fiese B.H. Donovan S.M. Breastfeeding is natural but not the cultural norm: a mixed-methods study of first-time breastfeeding, African American mothers participating in WIC. J Nutr Educ Behav. 2017; 49: S151-S161.e1https://doi.org/10.1016/j.jneb.2017.04.003 Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar Increased investments in WIC breastfeeding support helped reduce disparities in breastfeeding initiation and increased breastfeeding initiation rates by 30% between 1998 (42%) 12 US Department of Agriculture, Food and Nutrition ServiceWIC program and participants characteristics, 1998. https://www.fns.usda.gov/wic/wic-program-and-participants-characteristics-1998Date accessed: March 19, 2021 Google Scholar through 2018 (72%). 13 Kline N. Thorn B. Bellows D. Wroblewska K. Wilcox-Cook E. WIC participant and program characteristics 2018 final report. https://fns-prod.azureedge.net/sites/default/files/resource-files/WICPC2018.pdfDate accessed: March 19, 2021 Google Scholar CorrigendumJournal of the Academy of Nutrition and DieteticsVol. 122Issue 8PreviewCorrigendum to: The Risk of Homemade Infant Formulas: Historical and Contemporary Considerations Full-Text PDF

ABSTRACT Background Obesity and chronic disease rates continue to be disproportionally high among Native Americans (NAs) compared with the US general population. Policy, systems, and environmental (PSE) changes can address the root causes of these health inequalities by supporting access to healthy food and physical activity resources. Objective We aim to describe the actors and processes involved in developing PSE changes supporting obesity prevention in NA Nations. Methods As part of the Obesity Prevention Research and Evaluation of InterVention Effectiveness in NaTive North Americans 2 (OPREVENT2) trial (ClinicalTrials.gov registration: NCT02803853), we collected 46 in-depth interviews, 1 modified Talking Circle, 2 workshops, and 14 observations in 3 NA communities in the Midwest and Southwest regions of the United States. Participants included Tribal government representatives/staff, health staff/board members, store managers/staff, and school administrators/staff. We used a Grounded Theory analysis protocol to develop themes and conceptual framework based on our data. Results Health staff members were influential in identifying and developing PSE changes when there was a strong relationship between the Tribal Council and health department leaders. We found that Tribal Council members looked to health staff for their expertise and were involved in the approval and endorsement of PSE changes. Tribal grant writers worked across departments to leverage existing initiatives, funding, and approvals to achieve PSE changes. Participants emphasized that community engagement was a necessary input for developing PSE changes, suggesting an important role for grassroots collaboration with community members and staff. Relevant contextual factors impacting the PSE change development included historical trauma, perspectives of policy, and “tribal politics”. Conclusions This article is the first to produce a conceptual framework using 3 different NA communities, which is an important gap to be addressed if structural changes are to be explored and enacted to promote NA health. The journey to change for these NA Nations provides insights for promoting future PSE change among NA Nations and communities.

This Viewpoint addresses nutrition security—defined as having consistent access, availability, and affordability of foods and beverages that promote well-being and prevent or even treat disease—and its importance to clinical care and public policy in the US.

Starting with Volume 1 in 2016, the Advances in Food Security and Sustainability book series has built an outstanding collection of chapters providing concise overviews of a range of historical and contemporary topics around food security and sustainability. Volume 5 dives deeper into food production. Specifically, the first chapter examines indoor vertical farming.

Food insecurity has been a direct and almost immediate consequence of the coronavirus disease 2019 (COVID-19) pandemic and its associated ramifications on unemployment, poverty and food supply disruptions. As a social determinant of health, food insecurity is associated with poor health outcomes including diet related chronic diseases, which are associated with worst COVID-19 outcomes (e.g., COVID-19 patients of all ages with obesity face higher risk of complications, death). In the United States (US), the federal nutrition safety net is predominantly made up of the suite of 15 federal nutrition assistance programs that the US Department of Agriculture (USDA) administers and the Older American Act Nutrition Program that the US Department of Health and Human Services (HHS) administers (See Table 1). Both made significant adaptations to help ensure Americans have safe, secureand healthy foods and beverages during this national emergency. This essay briefly discusses the successes and shortcomings of these adaptations by critical life stages and puts forth recommendations for strengthening the public health impacts of our federal nutrition safety net in the near- and longterm.

The United States Department of Agriculture (USDA) National School Lunch and Breakfast Programs are critical for the health and food security of U.S. schoolchildren, but access to these programs was disrupted by COVID-19 pandemic-related school closures in spring 2020. While temporary policy changes to the programs enabled school food authorities (SFAs) to pivot towards distributing meals throughout their communities instead of within school buildings, SFAs faced complex challenges during COVID-19 with minimal external support. This mixed methods study investigates the implementation and financial challenges experienced by twelve of the largest urban SFAs in the U.S. during COVID-19. We conducted semi-structured interviews with SFA leaders and analyzed alongside quantitative financial data. We found that SFAs reconfigured their usual operations with nearly no preparation time while simultaneously trying to keep staff from contracting COVID-19, accommodate stakeholders with sometimes competing priorities, and remain financially solvent. Because student participation was much lower than during regular times, and revenue is tied to the number of meals served, SFAs saw drastic decreases in revenue even as they carried regular operating costs. For future crises, disaster preparedness plans that help SFAs better navigate the switch to financially viable community distribution methods are needed.

The food retail environment has been directly linked to disparities in dietary behaviors and may in part explain racial and ethnic disparities in pregnancy-related deaths. The Special Supplemental Nutrition Program for Women, Infants and Children (WIC), administered by the United States Department of Agriculture, is associated with improved healthy food and beverage access due to its requirement for minimum stock of healthy foods and beverages in WIC-eligible stores. The selection and authorization criteria used to authorize WIC vendors varies widely from state to state with little known about the specific variations. This paper reviews and summarizes the differences across 16 of these criteria enacted by 89 WIC administrative agencies: the 50 states, the District of Columbia, five US Territories, and 33 Indian Tribal Organizations. Vendor selection and authorization criteria varied across WIC agencies without any consistent pattern. The wide variations in criteria and policies raise questions about the rational for inconsistency. Some of these variations, in combination, may result in reduced access to WIC-approved foods and beverages by WIC participants. For example, minimum square footage and/or number of cash register criteria may limit vendors to larger retail operations that are not typically located in high-risk, under-resourced communities where WIC vendors are most needed. Results highlight an opportunity to convene WIC stakeholders to review variations, their rationale, and implications thereof especially as this process could result in improved policies to ensure and improve healthy food and beverage access by WIC participants. More work remains to better understand the value of state WIC vendor authorization authority, particularly in states that have provided stronger monitoring requirements. This work might also examine if and how streamlining WIC vendor criteria (or at least certain components of them) across regional areas or across the country could provide an opportunity to advance interstate commerce and promote an equitable supply of food across the food system, while ensuring the protection for local, community-oriented WIC vendors.

Background The North Carolina (NC) Healthy Food Small Retailer Program (HFSRP) was passed into law with a $250,000 appropriation (2016–2018) providing up to $25,000 in funding to small food stores for equipment to stock healthier foods and beverages. This paper describes an observational natural experiment documenting the impact of the HFSRP on store food environments, customers’ purchases and diets. Methods Using store observations and intercept surveys from cross-sectional, convenience customer samples (1261 customers in 22 stores, 2017–2020; 499 customers in 7 HFSRP stores, and 762 customers in 15 Comparison stores), we examined differences between HFSRP and comparison stores regarding: (1) change in store-level availability, quality, and price of healthy foods/beverages; (2) change in healthfulness of observed food and beverage purchases (“bag checks”); and, (3) change in self-reported and objectively-measured (Veggie Meter®-assessed skin carotenoids) customer dietary behaviors. Differences (HFSRP vs. comparison stores) in store-level Healthy Food Supply (HFS) and Healthy Eating Index-2010 scores were assessed using repeated measure ANOVA. Intervention effects on diet were assessed using difference-in-difference models including propensity scores. Results There were improvements in store-level supply of healthier foods/beverages within 1 year of program implementation (0 vs. 1–12 month HFS scores; p = 0.055) among HFSRP stores only. Comparing 2019 to 2017 (baseline), HFSRP stores’ HFS increased, but decreased in comparison stores ( p = 0.031). Findings indicated a borderline significant effect of the intervention on self-reported fruit and vegetable intake (servings/day), though in the opposite direction expected, such that fruit and vegetable intake increased more among comparison store than HFSRP store customers ( p = 0.05). There was no significant change in Veggie Meter®-assessed fruit and vegetable intake by customers shopping at the intervention versus comparison stores. Conclusions Despite improvement in healthy food availability, there was a lack of apparent impact on dietary behaviors related to the HFSRP, which could be due to intervention dose or inadequate statistical power due to the serial cross-sectional study design. It may also be that individuals buy most of their food at larger stores; thus, small store interventions may have limited impact on overall eating patterns. Future healthy retail policies should consider how to increase intervention dose to include more product marketing, consumer messaging, and technical assistance for store owners.

The OPREVENT2 obesity prevention trial was a multilevel multicomponent (MLMC) intervention implemented in rural Native American communities in the Midwest and Southwest U.S. Intervention components were delivered through local food stores, worksites, schools, community action coalitions, and by social and community media. Due to the complex nature of MLMC intervention trials, it is useful to assess participants' exposure to each component of the intervention in order to assess impact. In this paper, we present a detailed methodology for evaluating participant exposure to MLMC intervention, and we explore how exposure to the OPREVENT2 trial impacted participant diet quality. There were no significant differences in total exposure score by age group, sex, or geographic region, but exposure to sub-components of the intervention differed significantly by age group, sex, and geographical region. Participants with the highest overall exposure scores showed significantly more improvement in diet quality from baseline to follow up compared to those who were least exposed to the intervention. Improved diet quality was also significantly positively associated with several exposure sub-components. While evaluating exposure to an entire MLMC intervention is complex and imperfect, it can provide useful insight into an intervention's impact on key outcome measures, and it can help identify which components of the intervention were most effective.

One in four families with school-age children are food insecure. While policy attention is focused on shoring up the nutrition safety net to support pandemic recovery, it's critical to consider whether children's nutritional needs are being met throughout the week.

This study utilized baseline data collected in 2017 from the OPREVENT2 trial, which included 540 Native Americans in six Midwest and Southwest reservation communities. The objective was to identify correlates of fruit, vegetable, and dietary fiber adequacy among participants 18-75 years old who self-identified as the main food purchaser or preparer in their household. Mean daily servings of fruits and vegetables and grams of dietary fiber were quantified based on a 30-day semi-quantitative food frequency questionnaire. Participants consumed an average of 0.5 (±0.4) cup-equivalent servings of fruit, 2.5 (±1.8) cup-equivalent servings of vegetables, and 15.5 (±8.9) grams of fiber per day. <2% of the study population met the 2015-2020 Dietary Guidelines for Americans recommendations for fruit consumption, while 12 and 42% met recommendations for dietary fiber and vegetable consumption, respectively. Females had a prevalence ratio 1.4 times greater than males for adequate intakes of vegetables (p = 0.008) and over 6 times greater for dietary fiber (p < 0.001). Participants over the age of 30 were about twice as likely to meet dietary fiber recommendations (p = 0.031) compared to those 30 years and younger. Participants receiving food assistance from the USDA's Food Distribution Program on Indian Reservations (FDPIR) were nearly twice as likely as non-FDPIR recipients to meet recommendations for dietary fiber (p = 0.008). These findings can help guide the development of targeted interventions to improve diet quality; however, further work is needed to understand and address underlying reasons for low fruit consumption in these rural reservation communities.

ObjectiveTo conduct a nationwide assessment of communication by participating states and Washington DC about the Supplemental Nutrition Assistance Program (SNAP) Online Purchasing Pilot expansion.DesignSystematic coding of official communication from state and DC SNAP administrating agencies.ParticipantsForty-six states and DC approved to participate in the pilot as of October 2020 (n = 47). Data were collected from official SNAP administrating agency websites, state press releases, and state emergency coronavirus disease 2019 websites.Variables MeasuredFour domains were collected from communication materials: (1) program information, (2) retailer information, (3) health and nutrition information, and (4) communication accessibility.AnalysisQualitative content analysis, descriptive statistics.ResultsThirty-four (72%) states issued an official press release about the pilot that was easily accessible through online searches (15 available in multiple languages), 21 (45%) included information on their SNAP agency website, and 15 (32%) included information on their official coronavirus disease 2019 website. Most states identified authorized retailers (n = 37; 79%), provided information about pickup/delivery (n = 31; 66%), and stated the SNAP online start date (n = 29; 62%). About a quarter of states (n = 12; 26%) provided information about nutrition and health.Conclusions and ImplicationsState communication about the SNAP online pilot mostly focused on basic program and retailer information and included limited information about nutrition and health.