Groups at higher risk for severe foodborne illnesses outcomes include people with lower incomes, Black and Hispanic or Latino people, older adults, children aged <5 years, and pregnant people. Equity-centered formative research informs effective messaging that communicates critical information to help reduce foodborne illness and disparities.

We conducted 18 virtual focus groups, stratified by higher-risk population group and then income level, testing 24 written and graphic messages. We employed thematic analysis to understand feedback on messages by race, ethnicity, age, recent pregnancy, caregiver status, and income level.

The sample (N=113) included Black (35%), and Hispanic or Latino (27%) participants; people with lower incomes, lived in food deserts, or both (40%); older adults (21%); and caregivers of children (19%).

Among Black participants, message receptivity facilitators included ensuring loved ones’ safety and a barrier was reliance on food preparation practices learned from family. Hispanic or Latino participants appreciated graphics reflecting the diversity of the population and risk information for commonly eaten foods (e.g.., queso fresco), but negatively received messages referring to food categories many groups eat as “Hispanic” (e.g., soft cheeses as Hispanic cheeses). Messages referring to food waste did not resonate with participants with lower incomes. Older adults resisted messages perceived as paternalistic, preferring empowerment and choices. Pregnant people and child caregivers desired a sense of urgency in messaging to help them protect children.

Equity-centered food safety message testing supports robust communication strategies. It identifies facilitators and barriers to message receptivity, which are useful to tailor messages for populations experiencing disparities.

Introduction: The success of the Institute of Child Nutrition's (ICN) nontraditional and traditional Summer Meals Food Safety Kits from 2017–2019 led to a kit adapted for Child and Adult Care Food Program (CACFP) audiences. Therefore, the purpose of the 2021 Family Child Care Food Safety Kit was to assist family childcare providers in adopting food safety best practices by providing useful information and applicable tools.

Methods: From 2021 to 2023, ICN distributed its new kit to stakeholders across 53 US states and territories. To evaluate the kit's effectiveness, a digital survey was developed to gather feedback. The survey included questions about respondent demographics, the kit's usefulness, how the kit was used, and what the respondents liked about the kits. ICN received feedback from 370 representatives from 36 states and territories. Descriptive analyses were executed.

Results: Most respondents were family childcare providers (77%). Most providers had eight or more children in their care. The responses for the kit were overwhelmingly positive, with respondents rating the kit items "moderately useful" or higher (lowest average 3.74 out of 5; highest average 4.35 out of 5). Respondents stated various reasons for using the kit items, including daily use in the family childcare, training, and research. The most liked kit items were the tote and the thermometers (food and appliance).

Discussion: Overall, the feedback showed that the kit accomplished its original, intended purpose to be a useful, informative, and applicable food safety educational tool for the family childcare audience.

Introduction:

Food insecurity poses a significant public health challenge in the United States with almost half of Americans suffering from chronic diseases linked to poor nutrition. Food assistance programs have been shown to reduce food insecurity, and some healthcare systems offer them to enhance patient well-being and lower utilization costs. However, many individuals do not participate despite eligibility. This study aims to identify factors affecting engagement and utilization of a healthcare-based food assistance program.

Methods:

This cross-sectional study used pre-existing 2018-2019 data of food insecure patients (n=3,721) from a non-profit healthcare system in northwest Ohio. Descriptive analysis of utilization rates and regression analysis of individual demographic, sociocultural, and system-level predictors of initial and continued use were examined.

Results:

Black patients (OR=1.24; 95% CI=1.01-1.53), patients receiving a referral from a DO (OR=1.58; 95% CI=1.09-2.27) or social worker (OR=1.62; 95% CI=1.03-2.55), and patients of providers with onsite food clinics (OR=2.11; 95% CI=1.65-2.70) were more likely to initiate use. Patients aged 2-17 years (OR=0.41; 95% CI=0.30-0.55) and 18-35 years (OR= 0.42; 95% CI=0.32-0.55) were less likely to return. Patients with Medicare (OR=1.75; 95% CI=1.29-2.38), chronic illnesses (OR=1.32; 95% CI=1.04-1.67), who received a referral from a social worker (OR=1.65; 95% CI=1.05-2.60) or provider with an onsite food clinic (OR=2.30; 95% CI=1.83-2.89) were more likely to return.

Discussion:

The results provide insight for healthcare systems to mitigate food insecurity and improve patient health outcomes. Two particularly promising system-level strategies include increasing the involvement of social workers and the number of food clinics co-located with providers.

Introduction: Lack of healthy food access in low-income communities contributes to food insecurity and unhealthy eating, which are associated with adverse health outcomes. These communities lack access to full-service supermarkets, but have access to neighborhood retailers. Improving the nutritional quality of food at neighborhood retailers offers one way to improve healthy food access and community health. However, neighborhood retailers face challenges stocking healthier products including lack of distribution, limited experience with new products, financial risk, and uncertain consumer demand.

Approach: BrightSide Produce (BSP) is a full-service produce distributor that serves neighborhood retailers by offering flexibility to buy appropriate varieties and quantities at low prices. San Diego County’s Racial and Ethnic Approaches to Community Health (SDREACH) program partnered with Brightside Produce (BSP) to improve healthy food access by expanding the number of neighborhood retailers they serve. To maximize the expansion’s impact, BSP used a spatial multi-criteria evaluation that considered neighborhood demographics, grocery and fast-food availability, nearby schools and public transportation, and store characteristics.

Results: This partnership resulted in distribution to ten additional neighborhood retailers from October 2019 to August 2022 with over 77,000 additional units of fresh produce sold. These new offerings improved both the accessibility and availability of fresh produce in the community.

Discussion: Neighborhood markets can act as food assets in low-income communities, but they face obstacles for stocking fresh produce. SDREACH is helping communities by increasing healthy food access and helping to eliminate food insecurity by working with existing community assets to offer fresh, high quality, affordable produce.

Introduction: Cardiometabolic disease disparities are profound, and dietary factors are important contributors. Through community-academic partnership, we characterized a sample of adults accessing food through an urban farm and elucidated their experiences, in preparation for evaluating the health impacts of the program.

Methods: Cross-sectional study of 75 adults accessing food from an urban farm in Baltimore, MD. Evaluated associations between sociodemographic and clinical status and daily fruit and vegetable intake by Block screener using linear regression. Performed content analysis of semi-structured interviews conducted with a participant subset (n=25).

Results: Participants’ mean (SD) age was 55 (18) years; 67% were female; 79% were Black persons; 15% had diabetes; 3% had kidney disease; 32% had hypertension, 8% had cardiovascular disease, and 45% received urban farm food boxes for ≥1 year. Mean (SD) daily servings of fruits and vegetables was 5.0±1.4; less than High School education, kidney disease and diabetes were associated with lower fruit and vegetable intake in unadjusted models (p<0.05 for all); with only kidney disease associated in adjusted models ((-2.07±1.03), p=0.048). Key themes discussed in interviews included healthy diet facilitators (convenience and quality of produce boxes from the farm, family support, healthy cooking/preparation) and healthy diet barriers (cost and proximity of grocery stores).

Discussion: Overall, food box recipients of an urban farm program had higher fruit and vegetable intake than estimates of intakes for U.S. adults, but those with chronic health conditions had lower intakes. Interview findings can inform programs aimed at removing barriers to healthy eating towards mitigating health disparities.

Introduction: Research has shown that parents have difficulty identifying ingredients in drinks they serve their children and distinguishing between sweetened and unsweetened options. This study aimed to test the effects of a standardized front-of-package (FOP) disclosure statement on accuracy in assessing ingredients and perceived healthfulness of sweetened and unsweetened children's drinks.

Methods: Online survey of 648 U.S. caregivers of young children (1-5y). In two randomized controlled experiments, participants viewed children’s drink packages and indicated if products contained added sugar or non-nutritive sweeteners (NNS) and percent juice and rated drink healthfulness. Experiment 1 (E1) included novel children’s drinks with either a) product claims only (control); b) disclosure only; or c) claims and disclosure. Experiment 2 (E2) included existing children’s drinks with a) no disclosure (control); or b) disclosure. Potential individual differences were explored.

Results: FOP disclosures significantly increased accuracy for most ingredients, including identifying presence or absence of NNS in sweetened drinks, no added sugar in juice/water blends, and actual percent juice in fruit drinks and juice/water blends in both experiments. Disclosures also increased recognition that the novel 100% juice did not contain NNS or added sugar (E1) and existing sweetened drinks contained added sugar (E2). Additionally, the disclosure reduced perceived healthfulness of sweetened drinks, but did not increase unsweetened drink healthfulness ratings. We identified a few differences by participant education level and race/ethnicity, but disclosures remained effective across groups.

Discussion: FOP disclosures on children’s drink packages can increase caregivers’ understanding of product ingredients and aid in selecting children’s drinks.

Introduction

Many clinical interventions and public health programs aim to address food insecurity and malnutrition and evidence for their effectiveness is growing. At the same time, an increasing number of Medicaid plans have received Section 1115 demonstration waivers and Medicare Advantage (MA) plans have flexibility to cover food- and nutrition-related benefits. However, improved coordination with public health programs is needed to optimize impact and efficiency.

Approach

Analyses of 1115 waivers’ food and nutrition services granted in 2022 and pending in 2023, public nutrition assistance with health-focused innovations available in those states, and MA supplemental benefits will describe the breadth of services offered, populations served, resources required, and areas of overlap and potential synergies.

Results

Medicaid waivers have been approved in four states and are pending in another six states. Services include nutrition counseling and education, medically tailored meals, pantry staples, and healthy food prescriptions. An increasing percentage of MA plans cover similar benefits. Simultaneously, the farm bill has funded nutrition incentives in at least 38 states, the Thrifty Food Plan was revised to increase SNAP recipients’ purchasing power, and USDA proposed expanding online WIC grocery purchases (among other updates). Thus far, these benefits and programs are not connected.

Discussion

The expansion of Medicaid and MA benefits addressing nutrition; 2023 farm bill reauthorization; momentum of the White House Conference on Hunger, Nutrition, and Health; and other factors present opportunities to improve health for the most vulnerable Americans. Considerations for improving coordination can help to optimize public health and avoid unnecessary spending.

Objectives: We examined 1) ages when socioeconomic disparities in childhood obesity emerged and widened in the U.S.; and 2) whether these disparities were modified by participation in WIC.

Methods: We analyzed data of 3,007 mother-child dyads from the Infant Feeding Practices Study II (2005-2007) and its Year Six Follow-Up (2012). Child weight and length were measured at birth, 3, 5, 7, and 12 months, and 6 years. The mothers reported family annual income, their own and the child’s father’s highest educational attainment. Mothers also reported their prenatal and postnatal, and the child’s WIC participation. Multivariable logistic regression was used to examine the associations of parental education and family income with risk of childhood obesity at different ages. Interaction terms and stratified analyses were used to test effect modification by WIC participation.

Results: The disparities in childhood obesity by maternal education emerged at 3 months of child age but were not significant (confounder-adjusted odds ratio, 1.26 [95% confidence interval, 0.94~1.70]). These disparities increased until 12 months (1.32 [0.99~1.76]), and significantly widened at 6 years (1.87 [1.34~2.60]). The disparities in childhood obesity by paternal education (1.69 [1.40~2.05]) and family income (1.08 [0.93~1.25]) remained stable with age. WIC participation could modify (narrow) the socioeconomic disparities in childhood obesity. Low parental education was associated with a higher risk of childhood obesity among WIC non-participants, but not among WIC participants.

Conclusions: The socioeconomic disparities in childhood obesity started as early as infancy and amplified during middle childhood. WIC participation may narrow these disparities.

Introduction – Millions of children rely on school meals daily. The COVID-19 pandemic directly impacted schools’ ability to procure nutritious foods and resulted in temporary and permanent school meal policy changes (e.g., waivers for nutrition standards and universal free school meal [UFSM] policies).

Approach – Data from three large national studies will be presented, including (1) a national scan of posted menus (n = 3234 meals among 91 school districts) to evaluate the impact of the COVID-19 nutrition waivers on nutrition quality; (2) a study examining the impact of UFSM policies among nutrition directors and parents (n=1052 surveys and n=80 interviews); and (3) a national study examining competitive food availability and nutrients (n= 30 middle and high schools) .

Results – The primary results of these studies found that (1) Despite nutrition waivers, over 90% of school menus were in alignment with sodium standards, but room for further alignment with expert recommendations remained, (2) UFSM was associated with increases in participation and substantial reductions in perceived stigma; and (3) Most (93%) schools sold competitive foods, with wide variability in compliance with federal standards.

Discussion – These results have important implications for federal child nutrition policies, providing insight into the alignment of meals and snacks with federal standards, the impact of UFSM policies on access to and perceptions of school meals, and policy opportunities to improve school meals programs. This research is particularly timely given the USDA’s recently proposed updates to school nutrition standards and expanded access to free school meals.

Introduction

Latine and Asian American communities in the U.S. face similar structural barriers to maintaining adequate diet quality, contributing to an increased burden of diabetes and non-alcoholic fatty liver disease. These inequities have been exacerbated during the COVID-19 pandemic due to overt anti-immigrant and anti-Asian sentiments, amplifying challenges towards accessing food and economic stability.

Approach

Working collaboratively with 9 community-based and farm partners, the Building Access to Food through Systems and Solidarity (BASIS) program aims to improve nutrition and the social/built environments for Chinese, Mexican, and Bangladeshi immigrants in Sunset Park, Brooklyn. BASIS addresses food access, nutrition education, experiential learning, economic security, and policy while incorporating culturally appropriate values, foods, and taste preference throughout each of these activities.

Results

Formative activities included four participatory group model building workshops amongst local community, academic, and government stakeholders; input from community members on programmatic preferences (n=466); key informant interviews of Chinese identifying individuals (n=19); and a subsidized, community-supported agriculture pilot program for 20 weeks (n=38). Pilot resources have been well-received by community members with high engagement and acceptance. Participants significantly increased variety of vegetables eaten and skin carotenoid scores.

Discussion

BASIS presents a powerful model to improve nutrition in immigrant communities by addressing determinants of food access in a community-centered and culturally competent way. An expansion of BASIS programming is currently underway (n=140 participants), and will include additional program components focused on culturally appropriate nutrition education, individual and community level economic support, local food policy assessment, and hands-on experiential learning (e.g., cooking, gardening).