Introduction: Approximately 13% of Americans are on the spectrum of food (in)security, ranging from marginal to very low. Energy-dense, low nutrient diets may disproportionately increase the risk of chronic illnesses in this population. Food banks and food pantries are critical partners with existing systems to aid in implementing novel, large-scale approaches to simultaneously address food insecurity, increase access to nutrient-rich foods and promote client self-efficacy.

Approach: Through Community-Based Participatory Research, a food bank which serves over 100,000 clients monthly, selected pantries within this larger network, and university researchers collaborated to develop an educational outreach program titled Nourished for clients at healthy food pantries.

Results: Food bank staff, pantry volunteers and researchers conducted an iterative process to understand and address the needs of clients. A 3-tiered, color-coded, validated food-scoring system that uses nutrients to encourage and nutrients to limit to guide decisions of large-scale purchases by the food bank was adapted and disseminated to food pantries. With multi-level educational outreach, Nourished allows pantry volunteers to assess the nutritional quality of the food they make available to clients. Subsequently, clients are able to apply the system within a client-choice model. Diffusion and dissemination planning allowed for adaptation at each pantry based upon contextual factors of the pantry and clients.

Discussion: Food insecurity should be addressed in ways that promote the health of the served populations. As food banks and pantries prioritize nutritional quality in their procurement of resources, food pantries can provide supportive environments for client choice and empowerment.

Introduction: In 2018, 11.1% of all U.S. households experienced food insecurity (FI). The emergency department (ED), which often acts as a safety-net, provides a unique opportunity to address FI, which disproportionately impacts disadvantaged communities. This study examines the intra- and inter-ethnic differences in FI among a population of patients seen in the ED.

Methods: This is a cross-sectional study conducted in the ED in a large urban setting. Patients completed a two-item Food Security Screening Tool. “Positive” screens were provided with referral information to local food pantries and completed the U.S. Adult Food Security Survey Module, assessing FI severity and demographics. We explored demographic differences associated with FI using a multivariate multinomial logistic regression analysis.

Results: 480 (16.2%) of the 2,972 patients screened were identified as Food insecure. FI was directly associated with Hispanic/Latino(a) ethnicity (OR:1.34, p=0.012) and Spanish as preferred language (OR:1.77, p<0.001) (adjusted for Hispanic/Latino(a) ethnicity). 47 (35.6%) of 132 patients who classified as having “very low food security,” identified as Hispanic/Latino(a).

Conclusion: Hispanic/Latino(a) patients had the highest prevalence of FI. Spanish as a preferred language was associated with higher FI compared to other groups, even after adjustment for ethnicity. Further research could study the longitudinal effectiveness of a FI screening with a referral system for targeted ethnic groups and explore if Spanish language could be considered an index of incomplete social integration among the Hispanic/Latino(a) population.

Introduction: The Best Food Forward (BFF) pilot project aims to provide multiple nutrition supports to improve family food security, academic, behavioral and other health outcomes within two school districts in Warren (SD2) and Flint (SD1), MI. BFF includes several multi-level interventions focused within schools and the surrounding communities.

Methods: Through a quasi-experimental time series design, a multi-level evaluation is being administered for BFF and includes: school record review, community observations, school plate waste observation and completion of validated surveys, biometric assessments and focus groups among a random sample of youth (n=200) and parent participants (n=200).

Results: Baseline measures are currently underway; Time 1 measures will be collected in May 2020. Preliminary findings from SD1 (N=56 youth, 77% African American, 7% Native American) include low consumption of leafy greens (45% never ate over past week), vegetables (34% never ate over past week) and milk (34% never ate over past week). We expect to see differences in these measures in SD2 among the immigrant and refugee families where traditional diets are more plant-based. Comparisons of baseline and Time 1 reports will be presented.

Discussion: Food insecurity is often a familial challenge, and cultural preferences can influence nutrition-related behaviors. Ensuring nutrition support interventions address cultural food preferences to improve community diet is an important component of implementation and can mediate the development of obesity and other chronic disease. Understanding food preferences among low-income multi-cultural families can be helpful for other projects working with immigrant, refugee, Native American and/or African American families.

Introduction: The Integrated Model of Health Literacy (IMHL) was developed to comprehensively address health literacy from a public health perspective. Limited empirical testing of the IMHL to predict health behaviors, such as dietary practices, has been conducted. This study aimed to determine the utility of the IMHL to predict dietary practices among college students.

Methods: Undergraduate students (n=436) at a large southeastern university completed an online survey assessing IMHL constructs: 1) personal determinants, 2) situational determinants, 3) societal and environmental determinants, 4) health literacy, and 5) dietary practices. Two saturated path models were estimated to determine the associations among variables.

Results: Each model explained approximately 63% of the variance in dietary practices. However, there were few significant pathways in each model. There was only one significant pathway between academic major, a health literacy determinant, and health literacy (β=0.15, SE=0.05, p<.001). There were statistically significant pathways between dietary practices and BMI (b=-0.10, SE=0.03, p<.001), Food Environment-Physical (b=0.09, SE=0.03, p<.001), Race (b=0.06, SE=0.03, p<.05), and Food Environment-Social (b=0.08, SE=0.04, p<.05). There were no significant direct pathways between health literacy and dietary practices and no significant indirect pathways with health literacy as a mediator.

Discussion: Despite high R² values, there were few significant pathways in each model. Health literacy did not serve as a mediator, or have a direct influence on dietary practices. Future research should investigate more parsimonious models of health literacy, given existing significant associations between health literacy and dietary practices among other populations.

Heart disease is the leading cause of death in the U.S. for both men and women. To help reduce the risk of heart disease, a diet low in saturated and trans fat, and high in omega-3 fats is recommended. Few studies have measured the knowledge and awareness college students have regarding dietary fats and their role in heart disease. A shortened version of the FDAs Health and Diet study was developed. College students at a diverse, urban university were asked if they had heard of three fats: saturated, trans, and omega-3. They were then asked to identify whether each fat increased, decreased, or had no effect on heart disease. A total of 454 students completed the survey, with 62% females, 34% males, and 1.2% other or decline to answer. The average age of respondents was 22 years, with 50.3% identifying as Hispanic/Latino, 28.2% Asian, 5.9% White, and 4.1% Black. Most participants had heard of trans fat (86.1%), saturated fat (77.7%), and omega-3 fats (72%). Of those, 74.9% and 69.9% of students correctly identified trans and saturated fats, respectively, as increasing the risk of heart disease. While students had heard of trans fats, over a quarter (28.1%) responded that they did not know whether they increased or decreased heart disease risk. Fewer students had heard of omega-3 fats but of those who did, 75.5% correctly identified that it lowers heart disease risk. Additional data about students’ perceptions about specific foods that are related to heart disease risk will be presented.

Background: Only 19% of graduating U.S. medical students report readiness to offer adequate nutrition education to their own patients.

Objective: UCLA's Upstream Obesity Solutions (UOS) aims to implement a multidisciplinary educational curriculum to pediatric residents via didactic lectures, service, and experiential learning using a teaching kitchen as a platform for hands-on nutrition instruction.

Methods: In the Fall of 2019, 17 pediatric residents and two 4th year medical students completed a two-week rotation which included three hands-on teaching kitchen classes focused on nutrition and culinary skills. Additional topics included food policy, motivational interviewing, and the management of pediatric obesity. Trainees then taught a cooking lesson embedded with nutrition messaging to patients using a teaching kitchen located within a pediatric waiting room at a federally qualified health center. Surveys were administered to the 19 trainees to evaluate knowledge, attitudes, and practices before and after the experience. Data was analyzed using SAS 9.4 with comparisons drawn between pre and post mean questionnaire scores using Analysis of Variance modeling.

Results: 16 residents completed pre/post rotation surveys. Trainees showed significant improvement in knowledge of nutrition with 67% responding correctly at baseline, and increasing to 77% correct after the rotation. Trainees also demonstrated significant gains in self-efficacy related to: (1) motivational interviewing and patient counseling; (2) cooking skills; and (3) nutrition literacy. Lastly, trainees reported improvement in their emotional wellbeing.

Conclusions: A two-week educational block for pediatric residents using a teaching kitchen can improve nutrition knowledge, self efficacy in nutrition counseling, and resident wellness.

Introduction: Low-carbohydrate diets remain popular despite concerns regarding their safety and effectiveness. Changes to body weight and blood lipids are often the primary endpoints whereas their micronutrient nutrient adequacy are rarely assessed. We compared a high-fiber bean-rich diet with a low-carbohydrate diet in a randomized controlled trial to assess their effects on body weight, blood lipids and micronutrient adequacy.

Methods: One hundred and seventy-three women and men with a mean body mass index of approximately 36 kg·m^-2 were randomized to a high-fiber bean-rich diet that achieved mean (SD) fiber intakes of 35.5 (18.6) g·day^-1 for women and 42.5 (30.3) g·day^-1 for men, or a low-carbohydrate diet (< 120 g·day^-1). Both diets were induced gradually over 4 weeks and included a 3-day feeding phase.

Results: After 52 weeks, the low-carbohydrate (n = 24) group tended to retain weight loss better than the high-fiber group (n = 30) (P = 0.06), although total cholesterol remained lower with the bean-rich diet (P = 0.049). The low-carbohydrate group consumed more vitamin K (P = 0.006), thiamin (P = 0.001), and niacin (P = 0.02) whereas those in the high-fiber group consumed more folate (P = 0.006), magnesium (P = 0.046) and copper (P = 0.017). Both groups consumed less than the RDA for vitamin D, vitamin E, calcium, magnesium and copper.

Discussion: A high-fiber bean-rich diet was as effective as a low-carbohydrate diet for weight loss. However, both diets were deficient in micronutrients. Results may have implications for long-term disease risk and morbidity management.

Introduction: Limited food access, obesity, hunger, and poor nutrition affect many communities. People who live in rural areas, people with low incomes, and people of color are more likely to have trouble accessing healthy foods. Yet in communities that need it most, often resources for new programs and initiatives are limited. Policies facilitating shared use of school property in the summer can provide one way to address these problems using existing resources. These policies can also advance health equity by influencing the structural drivers of health inequity.

Policy Approach: Shared use of schools can create lasting change using PSE principles. Summer gardens, farmers markets, and mobile grocery and meals programs are appropriate for shared use sites. Kitchen facilities, cafeterias, and classrooms can provide settings for healthy cooking programs, trainings, and small business opportunities.

Community Health: Beyond healthy food improvements, summer shared use of school property may address the fundamental drivers of health inequity (see ChangeLab Solutions’ Blueprint for Changemakers), by addressing:

• Structural discrimination, through opportunities for social connection and physical activity, which may reduce stress and loneliness, improving health and resiliency;
• Income inequality and poverty, through healthy, affordable food access to relieve resource strain, and through support for local businesses;
• Disparities in opportunity, through inexpensive educational opportunities like summer volunteering (particularly important to college applicants) and professional training/certification programs;
• Disparities in political power, by contributing to feelings of community cohesiveness, civic participation, and self-determination; and
• Governance that limits meaningful participation, through community participation for public space use planning/decisionmaking.

Introduction: International students in the US have nearly doubled in number over the last decade and now account for more than five percent of all students. Upon moving to the US, many students adopt unhealthy dietary behaviors, perhaps related to a lack of familiarity and social support. This study examined the impact of social support on international college students’ dietary behaviors. Methods: International students (n = 318) enrolled in one of five public universities in a Midwest state completed a comprehensive survey assessing self-reported eating habits and perceived social support, using the Social Support for Eating Habits and the Starting the Conversation (STC) scales. Comparisons were made to explore the impact of perceived social support on international students’ dietary behaviors. Results: A significant regression equation was found, F(14, 303) = 2.178, p < .01, R² = .09). Region of origin and family’s social support for discouraging healthy eating habits emerged as significant predictors of the model. For every one unit increase of family social support that discouraged healthy eating habits (ranging from 5 to 25), there was a 0.14 unit increase in the STC scale (ranging from 8 to 24, wherein higher numbers represent less healthy diets). Discussion: Transitioning to the US may have negative impacts on international students’ dietary behaviors. We found that international students’ unhealthy eating habits increased when their families discouraged healthy eating habits. Interventions that promote healthy dietary behaviors among international students should consider including family members to increase social support for healthy eating habits.

Introduction: Children and their families at high risk for obesity are often under-represented in instrument validation studies that measure obesity and related psychosocial, behavioral and environmental factors. Accurate, culturally and linguistically appropriate assessments are important for interventions and research. Literature suggests three ways to use measures in high-risk populations: (1) apply or (2) adapt an existing instrument or (3) develop a new instrument. Little guidance exists on when each approach is best. To assist researchers and practitioners in accurately measuring high-risk populations, this abstract describes a new resource the National Collaborative on Childhood Obesity Research (NCCOR) created to address this gap.

Approach: NCCOR conducted a) a gap assessment of existing obesity measures for high-risk populations, b) hosted a workshop on the topic, and c) held an expert panel in 2019-2020 to develop guidance and recommendations.

Results: To improve guidance, NCCOR developed a decision tree to walk users through a series of questions regarding whether to develop, adapt, or apply an instrument for obesity measures in high risk populations. Examples of topics covered include how to involve community stakeholders, determine whether populations are meaningfully different, and determine whether modifications to instruments require revalidation. The decision tree also provides 5 real-world case scenarios that describe the rationale for choosing one of the three measurement approaches.

Discussion: This project will fill a research gap that will help researchers and practitioners better decide which measures to apply, adapt, or develop when assessing children and families at high risk for obesity.