Purpose: The COVID-19 pandemic resulted in school closures and financial crisis which may have impacted the home food environment. We examined the changes in the home food environment (HFE) of low-income households with elementary-aged children during the COVID-19 pandemic, and the interaction effect of household socioeconomic disadvantage (SED) and time period on the HFE component variables.
Methods: We conducted a serial cross-sectional analysis on data obtained from families enrolled with a national non-profit, Brighter Bites across U.S. cities (Houston, Austin, Dallas, Southwest Florida, and Washington DC). Data from four years, pre-pandemic: 2018,2019 (N=4410); early pandemic: 2020 (N= 1370); and mid-pandemic :2021 (N= 1384), were analyzed. Home food environment component variables included fruit/vegetable (FV) availability, frequency of cooking, family mealtime practices, parent communication on nutrition with child, and parental modeling of healthy behaviors. In order to estimate household SED, parent employment, parent education, food insecurity, and participation in government programs were summed to form a composite measure. This score was categorized into low, medium, and high SED. Mixed effects regression models we used to examine the interaction effects of household SED and time period (pre, early, and mid-pandemic) on home food environment.
Results: Trend analysis showed a significant increase in home food environment scores from pre to early/mid pandemic period, after adjusting for confounders. Upon examining the association between home food environment and household SED in data pooled across the three time periods (2018-2021), we found that parents in the high SED group (AOR: 1.45, p<0.001) had greater odds of food preparation at home as compared to those in low SED group. Similarly, parents in medium (AOR: 1.24, p: 0.02) and high SED groups (AOR: 1.30, p: 0.001) had a greater odds of eating meals together with children as compared to parents in low SED group. No significant interaction effects of SED and time period were demonstrated.
Conclusion: The findings suggest that this sample experienced improvements in home food environment during the pandemic which may indicate adaptive changes in the low-income households. However, the observed associations between HFE and SED highlight nuanced dynamics, thus warranting further exploration.

Purpose: Low food availability (FA) has been associated with food insecurity (FI). Further, FI has been linked with lower availability and intake of healthy foods and beverages. However, most studies analyze FI and FA cross-sectionally. Given that FA and FI change over time, this study assessed how changes in FA were associated with changes in FI over nine months.

Methods: This study is a secondary analysis from TX Sprouts, a school-based gardening, nutrition, and cooking randomized control trial that was conducted in 16 elementary schools serving primarily Hispanic families with low income. At baseline and follow-up, approximately nine months later, parents completed questionnaires that included questions regarding FI and FA. FI was assessed using the 18-item USDA Household Food Security Survey Module. Scores ranged from 0-18, in which a higher score indicates higher FI. FA was measured using the FA commonly used questionnaire which assesses in-home availability of seven food and beverage items: 100% fruit juice, vegetable juice, fresh vegetables, canned, frozen, or dried vegetables, salad, cut-up vegetables in a place a child could access, and soft drinks or sugar-sweetened beverages. A composite score of all items was also created. Parents indicated on a 4-point Likert-type scale how often the item was available in their household, with a higher score indicating the item being available more often. Multivariable linear regressions assessed the relationship between changes in FA and changes in FI, adjusting for child ethnicity, age, sex, intervention, and baseline FI and FA.

Results: The analytic sample included 861 participants. A one-point increase in the availability of fruit juice (β=-0.14 95% CI: -0.27, -0.02, P=.028), vegetable juice (β=-0.21 95% CI: -0.34, -0.08, P=.002), and fresh vegetables (β=-0.30, 95% CI: -0.46, -0.14, P=<.001), and the composite score (β=-0.06 95% CI: -0.10, -0.01, P=.01) were all significantly associated with a decrease in FI. There were no associations between a change in availability and FI for the other items.

Conclusions: This research suggests that increasing the availability of fruits and vegetables may be associated with an increased sense of food security, emphasizing the importance of the accessibility of healthy options.

Purpose: To evaluate the effectiveness of two produce prescription strategies (at-home delivery of fresh fruits and vegetables, and grocery store vouchers to purchase fruits and vegetables) compared to a waitlist control in improving obesity-related health outcomes and dietary behaviors among a cohort of Medicaid-eligible children.

Methods: The Brighter Bites/UT Physicians Produce Prescription Program uses a comparative effectiveness RCT design to evaluate two produce prescription strategies to improve obesity-related health outcomes and dietary behaviors among 150 low-income children aged 5-12 years with overweight/obesity from two pediatric clinics in Houston, Texas. Participants are randomized into one of three arms: 1) Bi-weekly $25 produce vouchers to local grocery stores(n=50), 2) Bi-weekly produce delivery(n=50), or 3) waitlist controls(n=50). Main outcome measures are child BMI z-scores, blood pressure, hemoglobin A1c, liver and lipid panels. Secondary outcomes include food insecurity and diet quality. Measures were collected at baseline and are currently being collected at post. Descriptive statistics and group differences for baseline data were analyzed using chi-square and ANOVA analysis. Intention-to-treat and per-protocol analysis will be conducted to assess impact of the interventions.

Results/Findings: Our study sample had a mean age of 9 years, 47.9% Hispanic 45.3% AA, with a mean BMI z-score of 2.1, indicating the majority of the participants had obesity. All participants had a BMI percentile value above the 85th percentile. 7.5% of participants had a hemoglobin A1C value above the normal range, 18.0% had elevated liver panels and 85% had elevated lipid panels. Total fruit and vegetable intake among children was 0.66 servings per day, with 61.5% reporting being food insecure and 25.7% reporting being nutrition insecure at baseline. There were no significant differences between the three groups. Post outcome data collection and analysis will be completed by Spring 2024. We will present the results of outcome analysis of the CE RCT.

Conclusions: Baseline results indicate a need for produce prescription programs among this population due to the high household food insecurity, high prevalence of obesity and related cardiometabolic outcomes among children. This study will demonstrate the impact of the produce prescription strategies on pediatric health and behavioral outcomes in at-risk populations.

Purpose: In the United States, food insecurity rates are greater in rural communities as compared to more urban areas. Policy, systems, and environmental (PSE) strategies can be applied to address root cause issues of food insecurity in rural areas by making changes that support healthy communities. The objectives of this study were to 1) co-develop PSE strategies with family participants and practitioners to support food security in rural communities and 2) prioritize which PSE strategies will make the greatest impact in rural communities to support food security.

Methods: The Gretchen Swanson Center for Nutrition partnered with Share Our Strength for this study in rural communities of Arizona, Georgia, Kentucky, Michigan, and Texas. First, interviews were conducted with practitioners serving rural communities and families living in rural communities to co-develop PSE strategies. A list of 13 PSE strategies and activities to address food insecurity were developed. Next, using a two-step Delphi process four participant groups (practitioners, family participants speaking English, family participants speaking Spanish, and Share Our Strength staff) prioritized the acceptability, appropriateness, and feasibility of each strategy. Finally, a total of four focus groups were conducted (one with each participant group) to discuss areas of consensus or no- consensus of the priorities within each group.

Results/findings: PSE strategies that arose from the interviews were wide ranging, from making it easier for people to sign up for programs to expanding employment to increasing access to affordable health care. The three PSE strategies with the greatest support from the survey and those which mostly reached consensus during the focus groups to prioritize were: make it easier to sign up for programs, make people more aware of services, make it trouble free for people to use programs.

Conclusions: This study underlines the need for multi-pronged approaches to align policies, systems, and environments to support food security in rural communities. When planning for and implementing the PSE strategies, it is important to leverage assets and work with challenges to tailor programming to local communities.

Purpose: To examine how school districts are impacted by de-implementing universal free school meal (UFSM) policies versus continuing UFSM with state-level policies, including school meal participation, stigma, revenues and unpaid meal debt, paperwork/administrative burden, and staffing challenges.
Methods: All School food authorities (SFAs) in 8 states (n=5 states that had de-implemented UFSM and n=3 with state-level UFSM policies) were invited to complete an online survey (developed in collaboration with key stakeholders) during the 2022-23 SY. Descriptive statistics and mixed effects logistic regression models with state as a random effect were used to examine differences by UFSM status (de-implementing versus continuing), adjusting for school demographic characteristics (urbanicity, enrollment size, and school poverty levels [e.g., percent of students eligible for free or reduced-price meals [FRPM]).

Results: A total of 941 SFAs completed the survey (response rate ranging from 9-34% across the participating states). SFAs in states that de-implemented UFSM were more likely to report a decline in school meal participation (OR 14.5; 95%CI 4.0-52.2; p=0.0001) and foodservice revenues (OR 4.6; 95%CI 2.0-10.7; p=0.0001) compared with SFAs in states that continued UFSM. However, states that de-implemented UFSM reported lower foodservice staffing challenges (OR 0.7; 95%CI 0.5-0.9; p=0.02), potentially due to the lower participation rates. Conversely, de-implementation was associated with SFAs reporting an increase in unpaid meal debt (OR 47.3; 95%CI 8.3-269.4; p=0.0001) and an increase in stigma for students from low-income households (OR 4.3; 95%CI 1.5-12.6; p=0.01). There were no significant differences in reported paperwork or administrative burden; this may be in part due to the need to collect school meal applications even in the presence of statewide UFSM policies to receive federal reimbursement for FRPM school meals served.

Conclusions. Overall, the results of this study suggest that de-implementing UFSM is adversely impacting SFAs and their students. Policies to re-implement UFSM could help reduce stigma and meal debt, as well as provide more students access to healthy meals and better nutrition. Strategies to support states with UFSM ‒ including more streamlined methods to obtain household eligibility for FRPM and ways to address current staffing challenges/shortages ‒ are needed.

Purpose: The health and well-being of teachers are essential to a child’s early learning and development. However, teachers are rarely the subject of health research. The objective of is to examine the cross-sectional associations between food insecurity, mental health, and cardiometabolic health at baseline among elementary school teachers.

Methods: 28 elementary schools in Houston, Texas, were recruited for the Nurturing Healthy Teachers study, an intervention targeting food security and diet among elementary teachers. Baseline data were obtained from 337 teachers from November 2022 to April 2023. The primary outcome was food insecurity. Secondary outcomes included mental and metabolic health. Metabolic markers and skin carotenoid levels were assessed during in person assessments (finger-stick blood measure for HbA1c, weight measurement, blood pressure measurement, and Veggie Meter), while all other measures were obtained through questionnaires. Descriptive statistics, correlations, and regression modeling were used to examine associations among these variables.

Results: Prevalence of food insecurity was 32% in this sample, which was mostly female, majority Hispanic, and had an average age of 42.5 years. Levels of food insecurity were higher among Hispanics compared to White or other racial groups. Compared to food secure teachers, teachers with food insecurity had higher levels of moderate depression (29% vs 34%, p=<0.001), moderate anxiety (12% vs 16%, p=0.105), and lower levels of well-being (59% vs 49%, p=0.241). Cardiometabolic outcomes (HbA1c levels, blood pressure, weight, and BMI) were comparable across food secure and food insecure teachers. HbA1c levels and hypertension did not differ by food insecurity level, but BMI did differ (p=0.008).

Conclusions: Teachers are susceptible to poor diet quality, a sedentary lifestyle, and stress stemming from food insecurity. These results may provide guidance for intervention that can help combat the health and well-being of teachers facing food insecurity.