Search Results (100)

Background/Objectives: Coupling mobile health (mHealth) technology with community-based nutrition programs may enhance diet quality in adolescents. This pilot study evaluated the feasibility, acceptability, and preliminary efficacy of integrating PortionSize Ed (PSEd), an image-assisted dietary assessment and education app, into the six-week Hawaiʻi Food and Lifeskills for Youth (HI-FLY) curriculum delivered via Supplemental Nutrition Assistance Program Education (SNAP-Ed). Methods: Adolescents (grades 6–8) from two classrooms were cluster-randomized into HI-FLY or HI-FLY + PSEd. Both groups received HI-FLY and completed Youth Questionnaires (YQ) and food records (written or app-based) at Weeks 0 and 7. Feasibility and acceptability were assessed via enrollment, attrition, and User Satisfaction Surveys (USS). Diet quality was measured using Healthy Eating Index-2020 (HEI-2020) scores and analyzed via mixed-effects models. Results: Of 50 students, 42 (84%) enrolled and attrition was minimal (2.4%). The sample was 49% female and 85% at least part Native Hawaiian or Pacific Islander (NHPI). PSEd was acceptable, with average USS scores above the scale midpoint. No significant HEI-2020 changes were observed, though YQ responses indicated improvements in sugary drink intake (p = 0.03) and use of nutrition labels in HI-FLY + PSEd (p = 0.0007). Conclusions: Integrating PSEd into SNAP-Ed was feasible, acceptable, and demonstrated potential healthy behavior change among predominantly NHPI youth in Hawaiʻi. Full article

Background/Objectives: Historically, federal investment in nutrition education programming in the U.S. has exceeded USD 500 million annually. The purpose of this study was to develop evidence-based Optimal Nutrition Behavior (ONB) criteria related to data collected by federal nutrition education programs and apply these criteria to established cost–benefit analysis methodology to determine the healthcare savings attributable to participation in these programs. Methods: A quasi-experimental study was conducted using the Eat Smart Idaho (ESI) program as a model for federal nutrition education programs (n = 78) and a matched control group (n = 78). Surveys administered at baseline and post-program collected dietary intake and physical activity behaviors. Optimal Nutrition Behaviors were defined as those behaviors that were associated with reduced chronic disease risk as determined by published meta-analyses, systematic reviews, or large cohort studies. Direct and indirect benefits generated by ESI were calculated using established methods. Results: The frequency of individuals meeting ONB criteria at post-assessment was significantly greater in the ESI group compared to control for all diseases except for colorectal cancer (p ≤ 0.05). ESI’s benefit–cost ratio of $11.62 suggests each dollar spent to administer the program results in USD 11.62 of economic benefits through chronic disease medical costs and lost earnings avoided. Conclusions: Federal funds supporting nutrition education programs contribute to reduced medical costs. Full article

This study investigated how county- and state-level socioeconomic factors influence racial differences in placement stability outcomes for children in foster care. Using a sample drawn from the Adoption and Foster Care Analysis and Reporting System (AFCARS) covering 2012–2020, we employed linear mixed modeling (LMMs) to nest individual- and case-level data within counties and states. Our analysis focused on Black and White children, examining how variables such as poverty, unemployment, public welfare expenditures, residential mobility, and family structure affect the number of placement moves experienced by children. The findings indicated that Black children experience higher rates of placement instability compared to White children, although the gap narrows over time. Key factors associated with improved stability included county-administered child welfare systems and higher rates of multigenerational households and owner-occupied housing, particularly benefiting Black children. In contrast, higher levels of Supplemental Nutrition Assistance Program (SNAP) participation and increased residential mobility were linked to greater instability. The implementation of program improvement plans (PIPs) during the third round of the Child and Family Services Reviews (CFSR-3) produced mixed outcomes, with PIPs contributing to a reduction in the racial gap primarily by increasing placement moves for White children. These findings underscore the importance of analyzing data by race and incorporating broader socioeconomic contexts into child welfare improvement strategies, while also emphasizing the need for localized, context-sensitive approaches to improve placement stability. Full article

Nutrition education, framed within Supplemental Nutrition Assistance Program Education (SNAP-Ed) guidance, was provided to SNAP-eligible shoppers at community supported agriculture (CSA) sites in Michigan where SNAP nutrition incentives were accepted. An evaluation was conducted on data sources from sites where the CSA Food Navigator program was implemented to assess the delivery of nutrition education, understand the needs and experiences of SNAP-eligible shoppers, and measure behavioral outcomes. A multi-phase, mixed-methods design incorporated (1) outcome surveys with SNAP-eligible shoppers at participating CSA sites; (2) open-ended feedback surveys from CSA site staff; (3) nutrition educator activity logs; (4) a semi-structured nutrition educator focus group; and (5) semi-structured focus groups with SNAP-eligible shoppers. In phase one, descriptive analysis was completed on the quantitative data and constant comparative analysis was completed on the qualitative data. In phase two, these data were collated into case reports for respective CSA sites; then, a cross-case analysis was performed. In phase three, statistical tests were performed on SNAP-eligible shoppers’ survey data to assess outcomes against a nationally representative sample of nutrition incentive program participants. Results indicate significantly higher fruit and vegetable consumption among shoppers relative to SNAP incentive participants nationally. Key qualitative themes were (1) relating over transacting: investing in multi-level relationships, (2) personalizing engagement and experiential nutrition education, (3) activating social–ecological spheres to promote changes in access, and (4) enhancing education support and resources for accessibility. The findings have practical implications to enhance the delivery and impact of CSA-based nutrition education. Full article

Background: The positive effects of oral nutritional supplements (ONS) on postoperative outcomes have been well recognized in several previous studies. However, to date, little data has been available with respect to determining the best immune modulating supplement to use and what its impact might be in thoracic surgery. The aim of this study was to evaluate the role of preoperative immune-nutritional supplement intake as predictor of postoperative cardiopulmonary complications (CPCs) in patients undergoing uniportal video-assisted thoracoscopic (uVATS) lung resection. Methods: This is a retrospective, observational study enrolling consecutive patients who underwent uVATS lung resections for cancer from January 2022 to December 2024 in the context of the Enhanced Pathway of Care (EPC) Program. All patients were evaluated by a nutritionist and dietetics team during the preoperative phase. The nutritional protocol consisted of 250 mL ONS rich in arginine, omega-3-fatty acids, and nucleotides to be taken twice a day for 5–7 days before surgery. Results: Four hundred ninety-one patients were enrolled: 277 patients underwent anatomic lung resection and 214 underwent wedge resection (WR). Utilizing the univariate analysis, we found that in patients undergoing anatomic lung resection, not-ONS-intake, high Body Mass Index (BMI), and arrythmia were correlated with a higher CPCs rate compared to the patients without nutritional supplementation (7.2% ONS vs. 15% not-ONS, p = 0.04; BMI 28.4 kg/m² vs. BMI 26.4 kg/m², p = 0.03; 31.2% arrythmia vs. 9.4% no-arrythmia, p < 0.01). These correlations, except for BMI, were confirmed after stepwise logistic regression. Alternately, in patients undergoing WR, hypertension and low-FEV1% were associated with a higher CPCs rate (5.1% hypertension vs. 0.4% no-hypertension, p = 0.02; FEV1% 79.7% vs. 95%, p = 0.01). Conclusions: Our results demonstrated that preoperative ONS after uVATS anatomic lung resection, in the context of an EPC program, influences the postoperative period, reducing the CPCs rate. Full article

Background/Objectives: Safety-net health centers are increasingly screening for food insecurity and providing patients with referrals to public assistance programs—e.g., the Supplemental Nutrition Assistance Program (SNAP). However, not all individuals actively participate in or are eligible for these programs. Onsite distributions of free produce at health center sites represent a promising complementary option for addressing this need. This study examines free produce events at these sites and their associations with attendees’ food and vegetable consumption, household food insecurity, and SNAP participation (study outcomes). Methods: In 2024, an intercept survey was conducted with 497 adults attending produce events at 16 safety-net health center sites in Los Angeles County, California, USA. Descriptive analyses profiled these food events, gathering information on attendee characteristics. Multivariable regressions examined associations between event attendance and study outcomes. Results: Over 80% of attendees lived in food-insecure households. Among those who were patients of the event site, 68% and 28%, respectively, indicated they received information about Medicaid and SNAP from the clinic staff. Compared to first-time attendees, those who attended produce events frequently consumed, on average, one additional serving of fruit and vegetables a day (p < 0.000). Conclusions: Offering free produce events at health center sites, where many attendees receive usual care, is a promising strategy for increasing healthy food access among safety-net populations. This underutilized approach is a viable intervention for improving access to healthy food, especially in circumstances where patients are not eligible for public assistance or nutrition incentive and/or food pharmacy programs are not readily available. Full article

Background: Childhood obesity is a pressing global public health challenge, marked by significant disparities in prevalence and management across countries. Japan and the United States offer contrasting approaches to addressing this issue, presenting a valuable opportunity for comparative analysis. Objective: This review examines the effectiveness of public health policies, cultural dietary habits, and lifestyle factors in combating childhood obesity in Japan and the United States. It aims to identify actionable insights to inform global strategies for obesity prevention. Results: Japan exhibits one of the lowest childhood obesity rates globally, attributed to prevention-focused policies such as the food education program, stringent school lunch standards, and culturally ingrained healthy eating practices. These efforts are complemented by active lifestyle promotion through urban planning and school-based physical education programs. In contrast, the United States faces higher obesity rates due to systemic challenges, including socioeconomic disparities, reliance on processed foods, sedentary lifestyles, and inconsistent implementation of federal programs like the National School Lunch Program (NSLP) and Supplemental Nutrition Assistance Program Education (SNAP-Ed). Conclusions: This review highlights Japan’s success in aligning public health initiatives with cultural norms to achieve sustainable outcomes. In the United States, systemic barriers and cultural disconnects hinder obesity prevention efforts. Recommendations include adopting integrated, prevention-focused policies, addressing socioeconomic inequities, redesigning urban environments to promote active living, and fostering global collaboration. This comparative analysis underscores the importance of culturally tailored, multidimensional strategies for addressing childhood obesity and improving public health outcomes worldwide. Full article

Objectives: To examine the relationships between food security, nutrition security, Supplemental Nutrition Assistance Program (SNAP) participation, and cardiometabolic outcomes, including hypertension, hyperlipidemia, or diabetes, among low-income U.S. individuals. Methods: A cross-sectional survey of 486 participants (April–June 2021) assessed food and nutrition security and cardiometabolic outcomes. Mixed-effects logistic regression models adjusted for covariates and included a random effect for state of residence. Moderation analyses evaluated SNAP participation’s impact. Results: Very low food security was associated with higher odds of having at least one cardiometabolic condition, such as hypertension, hyperlipidemia, or diabetes (AOR = 1.96; 95% CI: 1.04–3.69; p = 0.04). SNAP moderated this relationship (p-interaction = 0.007), with non-participants experiencing significantly higher risk. Non-SNAP participants with very low food security had 3.17 (95% CI = 1.17–8.61) times higher odds of having a cardiometabolic condition. Among SNAP participants, very low food security was not significantly associated with having a cardiometabolic condition (OR = 1.62; 95% CI = 0.64–4.13). Higher nutrition security was associated with lower odds of having at least one cardiometabolic condition (AOR = 0.59; 95% CI: 0.41–0.83; p = 0.002). Conclusions: Nutrition security and SNAP participation mitigate cardiometabolic risks, underscoring their importance in public health interventions. Full article

The present study investigates the geographic distribution patterns of the responsiveness of four safety net programs during the significant economic downturn triggered by the 2020 pandemic: Unemployment Insurance, the Supplemental Nutrition Assistance Program, Medicaid, and Temporary Assistance for Needy Families. An analysis of each state’s enrollment changes in these safety net programs from the pre-pandemic to the pandemic period relative to labor-market performance, using a responsiveness index, revealed which programs were most responsive to the pandemic recession in specific states or regions. Consistent with national findings, the present study suggests that Unemployment Insurance responded the most to the economic downturn of 2020, followed by the Supplemental Nutrition Assistance Program, Medicaid, and Temporary Assistance for Needy Families. Findings also show that Arizona and New Mexico responded highly across all four programs relative to labor-market performance. We used exploratory spatial data analysis to determine whether the spatial patterns of the responsiveness index identified in the study are statistically significant globally and locally within a given neighborhood structure. Our findings suggest that spatial distribution patterns are not random for the Supplemental Nutrition Assistance Program and Temporary Assistance for Needy Families at the global level. Moreover, statistically low-low clusters were found in different areas of these two programs: the Supplemental Nutrition Assistance Program in northern states and Temporary Assistance for Needy Families in southern states. Our analyses of the four safety nets’ responsiveness to labor market performance are consistent with the underlying social sustainability principles, particularly livelihood security and social well-being. Our findings can help policymakers make data-driven and better-informed decisions to assist those facing financial hardship, paving the way for improved policies and new opportunities for prosperity. Full article

Background/Objectives: Nutrition incentive programs can increase access to fresh fruits and vegetables and improve food security among Supplemental Nutrition Assistance Program (SNAP) participants and others in the United States. This qualitative study explored SNAP participants’ and farmers’ market staff’s perceptions of and experiences with a pilot supplemental benefit program offered at seven farmers’ markets in 2023 as part of the California Fruit and Vegetable Electronic Benefit Transfer Pilot Project. The pilot introduced specific characteristics that differ from more traditional nutrition incentive program dollar-for-dollar match incentive models, particularly the traditional model operating in California. Specific differences included the following: (1) offering a monthly USD 60 supplemental benefit that could be redeemed in a single shopping trip; (2) providing the supplemental benefit as a match that could be spent on any SNAP-eligible item in any retail location (rather than solely on fruits and vegetables at the farmers’ market). Methods: We conducted a qualitative, cross-sectional study including seven focus groups with 40 SNAP shoppers and six focus groups with 14 farmers’ market staff at six pilot-participating farmers’ markets in California. All focus groups were conducted by trained research staff and were recorded, transcribed, and analyzed using the immersion crystallization method. Results: Our findings include that shoppers appreciated several features of the pilot, particularly the ability to obtain an entire month’s supplemental benefit during one shopping trip and the ability to spend the benefit earned on any SNAP-eligible item at any SNAP retailer. Farmers’ market staff appreciated that the pilot benefited shoppers but found it difficult to manage due to staff and shopper confusion about the program, increased program utilization, subsequent long lines, and the spending of the earned incentives at other SNAP retailers. Both shoppers and staff reported that the program was difficult to understand. Conclusions: These findings can inform future nutrition incentive program designs to benefit SNAP participants while offering sustainable models for farmers’ markets. Full article

Equine-assisted services (EAS) is a relatively new area of study within higher education requiring the development of a curriculum that best prepares the undergraduate student for the demands of the industry. Further, coursework targeting the specific management challenges for ensuring the welfare of horses utilized within EAS is limited. Therefore, the objective of this study was to apply an industry-based survey assessment utilizing EAS professionals within the United States to document management practices associated with healthcare and pain management challenges in the EAS horse. Suggested curriculum for undergraduate students targeting a career in EAS is given, utilizing data collected from the survey. Participant responses (n = 30) indicated that all of the surveyed facilities cared for more than three geriatric horses within their program, with the majority (60% responding “definitely yes”) utilizing regularly functionally lame horses, although the prevalence of lameness was not correlated with number of geriatric horses within a program (0.20, p = 0.22). While lameness is a common healthcare challenge within EAS, gastrointestinal conditions (73%) were one of the other leading health concerns for these facilities. The most common equine pain detection method for EAS facilities was behavior assessment (93%), in which this method was positively correlated with years of horse experience (0.51, p = 0.01). Horse pain was primarily managed through annual alternative therapeutic interventions (76%), daily prescriptions (73%), and nutritional supplements (73%). As such, the curriculum for undergraduate EAS degree programs should cover healthcare practices targeting geriatric horse management and associated health issues such as gastrointestinal conditions and lameness, including early detection and pharmaceutical, nutritional, and alternative therapeutic treatments. Full article

Households with limited financial resources often struggle with inadequate access to healthy, affordable food. Community supported agriculture (CSA) has the potential to improve access to fresh fruits and vegetables, yet low-income households seldom participate due to cost and other barriers. Cost-offset (or subsidized) CSA reduces financial barriers, yet engagement varies widely among those who enroll. This scoping review explored factors associated with CSA participation among low-income households in the United States. Eighteen articles met the inclusion criteria, quantitative and qualitative data were extracted, the evidence was synthesized, and themes were developed. The findings suggested that women may be more likely than men to enroll in CSA. A lack of familiarity with CSA may hinder enrollment, whereas more education and self-efficacy for food preparation may facilitate participation. In terms of share contents, high-quality produce, a variety of items, more fruit, a choice of share contents, and a choice of share sizes may facilitate participation. In terms of CSA operations, a low price, good value, acceptance of Supplemental Nutrition Assistance Program (SNAP) benefits, close pick-up locations on existing travel routes, delivery of shares, clear communication, fostering a sense of belonging and trust, and educational support may support participation. Together these findings support 13 recommendations for cost-offset CSA implementation to engage low-income households. Full article

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a nutrition assistance program in the U.S. WIC served 2.5 million eligible Hispanic women, infants, and children under the age of five in 2021, which is WIC’s largest racial/ethnic group. However, limited research has been conducted to understand Hispanic WIC participants’ perceptions of WIC breastfeeding recommendations and their breastfeeding decisions. For this qualitative study, we interviewed 18 of these pregnant and postpartum WIC participants on their experiences and decision-making processes related to breastfeeding. Hispanic cultures and home country norms were identified as prominent influences on breastfeeding decisions, along with perceptions of WIC’s breastfeeding support. These results can help the WIC program to refine its breastfeeding education to better meet the needs of Hispanic participants. Full article

The participants in the Supplemental Nutrition Assistance Program (SNAP) consume greater amounts of sugar and sweetened beverages (SSBs) compared to non-eligible individuals, which could result in potential negative health outcomes. This can be attributed to the lack of restrictions on SSB purchases with SNAP benefits. In view of the increasing calls from advocates and policymakers to restrict the purchase of SSBs with SNAP benefits, we performed a systematic review to assess its impact towards SSB purchases and consumption. We searched articles from five databases—Cochrane, EBSCO, SCOPUS, Web of Science, and PubMed—and selected seven studies, four of which were randomized controlled trials (RCTs) and three were simulation modeling studies. All three simulation studies and one RCT reported outcomes in terms of consumption, while the other three RCTs reported outcomes in terms of purchases. All seven studies found that an SSB restriction led to a decrease in SSB consumption or purchases, with six studies reporting significant results. Nonetheless, limitations exist. These include limited studies on this subject, potential workarounds circumventing SSB restrictions, like making purchases using personal cash, potentially differed estimated effects when combined with incentives or other initiatives, and the limited geographical scope among the selected RCTs. Full article

Research indicates that health interventions are most effective when they address multiple social determinants of health to support positive behavior. Schools as Hubs of Health, a comprehensive model of nutrition and physical activity education, was developed to support wellness within school communities defined as low-income by the national Supplemental Nutrition Assistance Program Education (SNAP-Ed). Components of the model include the following: classroom education; garden education; youth engagement; staff training; parent and community engagement; and policies, systems, and environments. Findings over the last decade indicate positive outcomes in nutrition and physical activity behaviors, youth leadership and engagement, and systems and environmental changes that support health and wellness. Full article