introduction: One in four veterans report food insecurity. Greater than half have children. We lack knowledge regarding food insecurity among veterans with children. This study assessed prevalence and risk of food insecurity among low-income veterans with children.

methods: We used data from the National Health and Nutrition Examination Survey (2011-2014). Sample was restricted to participants aged 18-59 with a ratio of family income to poverty < 3, and ≥ one child. Food insecurity was measured using the 18-item Household Food Security Survey. Affirmative response to service in US Armed Forces classified veterans. Covariates included self-reported demographics. Descriptive statistics were performed, and bivariate comparisons were made between veterans and civilians. Binary logistic regression predicted food insecurity risk for veterans.

results: Initial sample set (n_veterans= 95, n_civilians= 2791) were statistically significantly different on key demographics. Veterans were matched with civilians (1:1) on age, gender, race, marital status, and education using propensity score (R MatchIt package and nearest method). Veterans were predominately male, mean age 40, non-Hispanic White, educated beyond high school, and married/cohabitating. Matched civilians were demographically similar. Treated dichotomously, risk for household food insecurity (OR=1.19, 95% CI [.67, 2.12]) was similar between groups. However, veterans were significantly more likely to suffer very low household food security compared to matched civilians (17.9% vs. 6.3%, p=.014).

discussion: Veterans with children disproportionately suffer from the most extreme level of food insecurity which is associated with hunger. We need to purposefully investigate the extent of this urgent issue and address it in a veteran-acceptable manner.

Recent studies have shown that fast food restaurants within close proximity to schools have an impact on students’ weight outcomes. Additionally, obesity rates for Missouri high school students saw a 3% increase from 2015 - 2017. This study examined the proximity of fast food restaurants to Eastern Jackson County schools. Specifically, it addressed two questions: 1) Is there a difference in proximity of fast food restaurants among elementary, middle, and high schools? 2) Is there an association between proximity of fast food restaurants to schools and neighborhood income level?

Food retailers were labeled as either fast food restaurants or healthy food vendors. Schools and all food retailers were geocoded and mapped. Layers were created to show ½ mile and 1 mile radiuses around schools. ANOVA models were run to examine relationships between fast food restaurants and school type as well as fast food restaurants and neighborhood income levels.

Overall, there was a high concentration of fast food restaurants surrounding Eastern Jackson County schools. The mean number of fast food restaurants in close proximity to high schools was significantly higher than middle schools. The mean number of fast food restaurants in close proximity to schools in the highest income quartile was significantly lower than schools in the lowest income quartile.

These results may shed light on why the obesity rate among Missouri high school students has increased in recent years. They also support the notion that low income individuals are disproportionately affected by unhealthy food environments.

Introduction:

Fruit and vegetable (FV) intake among school-aged children is low despite its health benefits. As a strategy to increase FV intake, the 2015-2020 Dietary Guidelines for Americans suggest choosing more FVs as snacks. However, few studies have examined if FV intake as snacks is positively correlated with overall daily FV intake and diet quality, and the characteristics of children who eat FV as snacks.

Methods:

Parents and their children in a community-based obesity prevention trial in metropolitan Minnesota (N=119) completed baseline surveys from 2014-2017. Children’s FV intake (overall and snack) was estimated and Healthy Eating Index (HEI)-2015 score calculated using two 24-hour dietary recall interviews. Descriptive statistics, bivariate analysis and general linear modeling were used for analysis.

Results:

Average child age was 9.34 years (SD 0.88), with 49% female, 60% non-White and 79% overweight/obese (BMI≥85^th percentile). Children consumed 0.2 cups of FV as snacks, which was equivalent to 17% of their overall daily FV intake. Consuming FVs as snacks was positively associated with overall FV intake (B=1.27, SE=0.17, p<0.0001) and HEI-2015 score (B=11.21, SE=3.32, p=0.001) after controlling for child sex, race and socio-economic status. Children from food-insecure households consumed less FVs as snacks than children from food secure households (0.09 vs. 0.25, p=0.004).

Discussion:

FV intake as snacks may improve overall FV intake and diet quality. However, FV intake as snacks is low among school-aged children, particularly those from food-insecure households. Renewed attention to strategies to promote FV intake as snacks as part of obesity prevention interventions is merited.

Introduction: Families with low-income are at increased risk for diet-related chronic diseases including obesity, diabetes, and hypertension. Often, this intersects with other risk behaviors such as smoking. In order to address health disparities and improve outcomes for this group, an understanding of acceptable intervention approaches in the context of multiple risk behaviors is warranted. This study examined the impact of a nutrition education intervention among low-income, tobacco-smoking parents.

Methods: Parents were recruited from pediatric clinics in low-income Philadelphia communities and randomized to a nutrition education attention control (vs smoking intervention) in a trial to reduce children’s tobacco smoke exposure. Parents received an informational packet, a home visit, and a follow-up phone call focused on improving nutrition. Survey-based measures were collected at baseline and 3-month follow-up.

Results: Participants assigned to the nutrition education condition (n=164) were 84.1% black/African American, 81.1% female, and 33.9(9.2) years. At post-intervention, nutrition education participants significantly increased fruit and vegetable (FV) intake (3.1 (0.15) servings/day) compared to participants in the smoking arm (2.5 (0.16) servings/day, p=0.006). There were no differences between groups at baseline (p=0.30). Nutrition education participants were also able to identify more perceived health benefits to eating FV compared to participants in smoking treatment arm (β=0.50 (0.14), p<0.001). Additional details on child and parent diet-related behaviors will be presented.

Discussion: This nutrition education intervention was feasible and efficacious in helping parents improve their diet-related behaviors. Future studies should test similar approaches to address multiple morbidities in high-risk groups and measure the impact on children.

Introduction: The purpose of this study was to evaluate long-term effects of Brighter Bites, a school-based intervention to increase F&V intake.

Methods: This two-year follow-up study employed a single group pre-/post-test study design to test the long-term impact of a two-year intervention conducted in 2013-2015. At baseline, 262 first grade parent-child dyads across 6 central Texas schools agreed to participate. The 16-week intervention uses a food co-op model with weekly distribution of F&V (50 servings), nutrition education, and recipe tastings. Measurements included parent and child food frequency questionnaires and parent-reported home nutrition environment survey. Mixed effects modeling was used to examine intervention effects. At baseline, 55.9% of households were bilingual, 23.1% of households spoke only English, and 18.3% spoke only Spanish at home; 53.8% of child participants were girls and 44.0% of children were overweight/obese.

Results: Children receiving the intervention demonstrated significantly increased vegetable intake (β=0.14, [0.09,0.19], p=<0.001), and significantly decreased added sugar consumption (β=-0.63, [-1.00,-0.27], p=0.001) and percent calories from sugary beverages (β=-0.61, [-2.24,-0.09],p=0.022). Parents showed significant increases in vegetable intake (β=-0.20, [0.07,0.33], p=<0.01) and combined F&V intake (β=0.23, [0.03,0.46], p=0.03). Reported eating out at restaurants significantly decreased, (β=-0.27, (-0.38,-0.16), p=<0.001) and reported use of nutrition facts (β=0.46, (0.15,0.38), p=<0.001) increased significantly.

DISCUSSION: This study shows the sustained effects of an innovative school-based food co-op nutrition intervention to improve dietary intake and behaviors in children and parents from low-income schools.

Conclusion: The long-term sustainability of behavior change through school-based nutrition interventions for low-income families is supported by this study.

Introduction: African Americans bear a disproportionate burden of obesity. The majority of evidence-based weight loss interventions have been conducted in clinic or university settings. To increase reach among the underserved, community-based weight loss and maintenance interventions are critical.

Methods: The Diabetes Prevention Program (DPP) was adapted for African Americans of faith to create a group-based, lay health advisor delivered weight loss intervention. A Weight Loss Only arm (16 lessons) was compared to a Weight Loss + Maintenance arm (16 + 12 lessons) in a cluster-randomized controlled trial of 30 churches (n=426). Body weight, dietary behaviors, and physical activity were assessed at 0, 6, 12, and 18 months.

Results: The intervention produced significant weight loss from baseline to 6-months (-2.47% (-3.13%, -1.80%)). Among those with clinically significant weight loss (≥5%) at 6 months, there was a statistical trend of lower weight regain in the Weight Loss + Maintenance at 12 months. Participants in the Weight Loss + Maintenance arm also reported higher levels of physical activity at 12 months. There were no significant differences between arms at 18 months.

Discussion: The intervention produced significant weight loss from baseline to 6 months on par with other DPP adaptations for African Americans, including adaptations that utilized health professionals. Further research is needed to determine if lay health advisors are more cost-effective to deliver DPP adaptations than health professionals. Participant weight regain may have been due to the maintenance arm's lower dose and/or the engagement of the inherent social networks within churches.

introduction: A crisis has emerged on college campuses, with over one-third of students reporting that they do not get enough to eat, which has a significant impact on nutritional status, overall health, and academic achievement. There is a need to examine the associations between hunger and food consumption in real time and in the student’s natural environment to help better understand the microprocesses influencing dietary behaviors due to hunger.

methods: African American college freshman (N = 50) completed an Ecological Momentary Assessment (EMA) protocol for 7 days, receiving 5 prompts/day with a single-item assessing current hunger. On 3 days, participants also completed telephone-based, multiple-pass 24-hr dietary recalls by trained interviewers using a prominent dietary assessment program. Intraindividual mean and standard deviation scores for hunger were calculated for each participant. Recall data were averaged across the 3 days to provide person-level averages of daily calories, carbohydrates, fiber, cholesterol, added sugar, and water.

results: Separate linear regressions revealed that mean hunger ratings were positively associated with average daily carbohydrates (b=2.95, p=0.01) and fiber (b=0.17, p=0.01). Mean hunger ratings were negatively associated with average daily cholesterol (b=-3.80, p=0.04). Trends existed for positive associations between mean hunger ratings and average daily calories (b=12.99, p=0.07) and added sugars (b=1.02, p=0.06). A trend also existed for a negative association between variability in hunger ratings and water consumed (b=-24.96, p=0.08). All models controlled for sex and BMI category.

discussion: Findings from this research may inform intervention efforts to improve dietary choices among vulnerable college freshman experiencing hunger.

Introduction: Foodborne diseases (FBD) cause illness in approximately 1 in 6 Americans, resulting in 128,000 hospitalizations and 3,000 deaths annually. Limited resources impact the ability of public health officials to identify and respond to FBD outbreaks. FoodCORE provides targeted resources to state and local health departments for FBD surveillance and outbreak response to improve completeness and timeliness of laboratory, epidemiology, and environmental health activities.

Approach: Since 2010, ten FoodCORE centers, covering 18% of the US population, implemented work plans to make outbreak response activities faster and more complete. Performance metrics quantitatively evaluate the impact and effectiveness of program activities.

Results: Centers implemented practices for enhanced surveillance and cluster and outbreak detection, including improved communication and faster molecular subtyping. This resulted in a greater proportion of pulsed-field gel electrophoresis testing completed in 2017 at 98% compared to 93% in 2010. Investigation practices, such as using student interview teams, resulted in an increased proportion of confirmed Salmonella, Shiga toxin-producing Escherichia coli, and Listeria case-patients with an attempted interview from 94% in 2010 to 96% in 2017; timeliness of attempted interviews was maintained at one day. Strategies that resulted in improvements were documented as model practices.

Discussion: By conducting fast, thorough investigations, FoodCORE centers contribute critical information to help stop FBD. Centers will continue to document and share model practices to inform efforts to improve outbreak response in other jurisdictions. Currently, centers are updating a model practice on isolate receipt and testing to reflect recent advancements in surveillance and response methods and technologies.

Introduction

Sugar-sweetened beverage (SSB) consumption among New York City (NYC) residents is higher than the national average. This study aims to describe the trends in SSB consumption across different gender and racial/ethnic groups in NYC and examine disparities by age group.

Methods

We used data from the 2009-2017 NYC Community Health Survey, a multiyear cross-sectional NYC-representative population health survey. Our study sample included 86,636 adults aged ≥18 years who provided self-reported information on SSB frequency questionnaire. Total SSB consumption was measured as the number of 12oz sodas and sweetened beverages respondents reported drinking per day.

Results

Disparities in SSB consumption exist across different gender and racial/ethnic groups from 2009 to 2017. Per capita consumption decreased from 1.11 to 0.85 drinks/day (p<0.001) for men and from 0.84 to 0.54 drinks/day for women (p<0.001). Similarly, per capita consumption decreased from 1.44 to 1.13 drinks/day for non-Hispanic Blacks, from 1.25 to 0.85 drinks/day for Hispanics, from 0.60 to 0.38 drinks/day for non-Hispanic Whites, and from 0.56 to 0.40 drinks/day for Asians (ps <0.001). SSB consumption decreased with age among all gender and racial/ethnic groups.

Discussion

Despite recent declines, disparities in SSB consumption by gender and race/ethnicity persist over time. Certain population groups (e.g., non-Hispanic Black and Hispanic men) still consume much more SSB than other groups and, thus, are exposed to higher risks of obesity and other chronic conditions. Targeted policy strategies are needed to further reduce SSB and related health disparities.