Background: The U.S. federally-regulated Child and Adult Care Food Program (CACFP) plays a vital role in promoting food security and supporting child nutrition in early care and education settings (ECE). States administer CACFP, communicate its policies, and may implement additional policies reflecting their priorities, which may either facilitate or impede its adoption by ECE programs. This study describes the process for creating an instrument specifically designed to evaluate state-level CACFP policies and assess the accessibility of state websites for center-based ECE programs.

Methods: The development of the policy evaluation instrument was an iterative, 8-month process informed by federal policies, prior research on CACFP barriers and facilitators, feedback from ECE and CACFP researchers, and insights from an advisory group of ECE and CACFP stakeholders. Pre-testing involved four study team members applying the instrument to evaluate a single state’s CACFP policies and website. This allowed the team to assess usability, ensure inter-rater reliability, and implement necessary modifications.

Results: The final instrument combines comprehensive policy assessment, information accessibility, and website usability metrics into a streamlined, resource-efficient evaluation tool. Domain I, which focuses on CACFP program policy and promotion, encompasses 47 detailed items across four key constructs: program oversight; application and eligibility; meal patterns; and record keeping and reimbursement. Domain 2 focuses on state ECE website evaluation and incorporates 20 items across three key constructs: site design, content design, and accessibility. The instrument’s structure ensures that the evaluation process is efficient and practical, requiring no more than one hour to conduct a comprehensive assessment of policies and state websites.

Implications: Information derived from this instrument’s evaluation of state-level policies can inform positive changes to CACFP policies and enhancements to the quality of information provided to ECE programs via state CACFP websites. Furthermore, this instrument demonstrates potential for broader applicability in assessing and improving policies across other federal food assistance programs, and it value and impact.

Background

The Child and Adult Care Food Program (CACFP) reimburses early care and education (ECE) programs for serving nutritious meals, benefitting children at food insecurity risk. However, ECE participation varies widely across states, with limited national-scale data on disparities.

Objectives

This study examined variations in ECE participation in CACFP, based on ECE demographics, geographic location, poverty and minority density, and stringency of state-level policies.

Methods

The 2019 National Survey of Early Care and Education (NSECE) comprising nationally-representative sample of U.S. ECE programs that serve children ages 0-5 years (n=6,917) was analyzed. The study team developed a rubric that was used in reviewing and scoring states’ CACFP policies to evaluate stringency and rate the quality of information provided on states’ CACFP webpages (n=50 states and D.C). NSECE outcomes were weighted to produce national estimates.

Results

Sixty-one percent (61%) of ECE surveyed participated in CACFP. Participation varied by program type (p=0.013), with 50% of for-profit and 69% of government-sponsored programs participating. Building type showed differential participation rates (p<0.01) with ECE in university/community buildings (82%), commercial structures (60%), and religious/private school buildings (49%). Geographic region was not a significant factor (p=0.785), but poverty density was (p<0.01), with ECE in low poverty communities having 50% participation, whereas those in high poverty areas reached 70%. While differences between urban (63%) versus rural (55%) might be clinically meaningful, they were not statistically significant. However, interaction between geographic location and poverty density was noteworthy (p<0.01), with urban programs in high poverty areas showing the highest participation levels (75%). Center size, based on staff and child enrollment showed no impact. Minority composition was influential: programs where ­>75% of children were black or Hispanic (p<0.01) had rates 20%-25% higher than those enrolling fewer racial/ethnic minorities. Analysis of state policies will be completed in the summer and available for presentation at the conference.

Conclusions

Participation in CACFP varies by program type, poverty densities, and minority compositions, highlighting areas for targeted policy improvement to increase accessibility and uptake.

Public Health Implications

Findings will guide actionable recommendations to support efforts by CACFP-administering agencies, policymakers and researchers to enhance CACP access and uptake.

Background: Poor quality diets in the Mississippi Delta – an area with disproportionately high rates of preventable disease – are the result of social and structural barriers limiting or blocking food access for the predominantly African American community. The Delta GREENS (Growing a Resilient, Enriching, Equitable, Nourishing food System) Food is Medicine (FIM) Project is a novel multilevel, community-engaged intervention in partnership with the Delta Health Center system and regional farmers. This intervention aims to reduce cardiometabolic health disparities by providing locally-grown produce boxes to patients. It is essential to understand how FIM interventions can be incorporated into healthcare systems by aligning the perspectives of healthcare providers and patients, ultimately centering community voices.

Objective: To identify and compare patients’ and healthcare professionals’ perspectives around the determinants of healthy food access and intake to support FIM implementation in the Mississippi Delta.

Methods: We conducted three focus groups with patients (n=25) and two with healthcare professionals (n=19) across six Delta Health Centers in the Bolivar, Sunflower, and Washington counties. We conducted a thematic analysis of transcripts using an abductive approach.

Results: Patients and healthcare professionals agreed that FIM interventions can benefit individual health by increasing fruit and vegetable consumption. However, while patients emphasized that the primary benefit of Delta GREENS is its potential to help navigate structural barriers to food security (i.e., improving household purchasing power and the local food economy), healthcare professionals emphasized behavioral benefits of the intervention (i.e., increasing patients’ nutrition knowledge and compliance with individual-level disease management).

Conclusions: Patients' and providers' perspectives diverged regarding the intervention’s level of impact (behavioral vs. structural), uptake, and sustainability. Achieving mutual understanding between key stakeholder groups regarding the structural determinants of health is crucial to ensuring FIM program sustainability.

Public Health Implications: Collective and culturally reflective insights from diverse key stakeholders must be considered when designing and implementing FIM initiatives, particularly in the Mississippi Delta. Such insights may also generate transferable knowledge for future FIM programming and healthcare policy.

Climate change is amplifying food insecurity in marginalized communities by disrupting food systems through extreme weather events such as floods, droughts, and infrastructure failures. In Michigan, low-income, predominantly Black and Brown communities—already impacted by environmental racism and systemic disinvestment—face compounded barriers to accessing affordable, nutritious food. This study examines the intersection of climate vulnerability and food access in Flint, Michigan, using a mixed-methods approach grounded in public health, sociology, and health sciences.

To evaluate the local food landscape, grocery store assessments were conducted across low-income neighborhoods in Flint. These assessments measured food availability, pricing, nutritional quality, and transportation accessibility. ArcGIS was used to map food deserts and overlay them with climate vulnerability indicators, including flood zones, heat islands, and aging infrastructure. Additional case examples from Detroit and Midland offer comparative insights. In Detroit, urban flooding and power outages exacerbated food spoilage and access issues, while Midland experienced widespread food and transportation disruptions following a dam failure in 2020. These cases illustrate how environmental shocks rapidly destabilize already fragile food systems.

Findings reveal that grocery stores in Flint’s climate-vulnerable neighborhoods offer limited fresh produce, rely heavily on processed goods, and are often inaccessible by public transit. GIS mapping highlighted strong correlations between areas of high SNAP participation, climate exposure, and a lack of full-service grocery retailers. These conditions force residents to rely on emergency food systems or convenience stores, exacerbating chronic illness and food insecurity—especially during and after extreme weather events.

This research emphasizes the need to integrate food security into climate adaptation strategies. Community-driven solutions such as urban agriculture, food cooperatives, and resilient infrastructure can reduce dependence on vulnerable supply chains and promote food sovereignty. Recommendations include increased investment in sustainable food systems, improved transit infrastructure, and local land access for food production.

By centering Flint, Detroit, and Midland, this study offers a comprehensive, place-based model for advancing health equity and climate justice. The interdisciplinary methods and spatial analysis used in this project provide replicable tools for embedding equity into public health and policy planning in the face of climate change.

Social determinants of health significantly influence health outcomes. Neighborhoods with limited access to grocery stores and nutritious foods contribute to diet-related conditions such as heart disease, diabetes, and obesity. While promoting healthy food choices is important, policies that address systemic barriers in food system, transportation, housing, and healthcare are essential to achieving health equity and reducing long-term healthcare costs.

Federal nutrition programs are the first line of defense against food insecurity but often fall short. The charitable food system helps fill the gap by distributing billions of pounds of food annually, many of which are often shelf-stable and highly processed, high in saturated fat, sodium, and added sugars. To improve access to fresh, nutritious foods, USDA incentive programs like Produce Prescription (PPR) enable healthcare providers to prescribe fruits and vegetables to eligible patients.

A statewide assessment was conducted to examine the landscape of PPRs in Nevada, explore healthcare-agriculture partnerships, and inform future expansion. These programs addressed root causes of chronic disease by sourcing produce from local farmers and distributing it to eligible participants. While PPRs in Nevada showed success in improving health and access, such as reducing participant A1C levels, funding limitations created challenges for scalability and sustainability.

This presentation will highlight Nevada’s diverse PPR efforts and emphasize the importance of involving small-scale farmers in health and nutrition planning. Next steps include advocating for policies that establish health insurance billing codes for PPRs, integrating advanced health screenings into Health Information Systems, and formalizing local food procurement processes.

Food insecurity remains a critical public health challenge in Nigeria. The Fome Zero model implemented in Brazil from 2003 to 2014 remains the only comprehensive national food security strategy formally studied, recognized, and recommended by the United Nations. This study employs a qualitative integrative review to assess how Nigeria’s food security interventions align with the five core principles deduced from Fome Zero, with the aim of generating new insights and perspectives. Method: A systematic literature search was conducted across three databases to capture a diverse range of studies published between 2010 and 2025. After removing duplicates and non-Nigeria-focused articles, the search returned 1,443 articles, 55 of which met inclusion criteria, screened by title, abstract, and full text, employing researcher triangulation. Data were extracted from the full text of the 55 articles, critically appraised, and synthesized thematically via the a priori Fome Zero framework. Findings: Findings revealed strong political interest in food security programming in Nigeria; however, recurrent barriers included inconsistent funding, limited civil society involvement, and weak cross-sector coordination. Programs with strong local adaptation—such as the National Home-Grown School Feeding Programme—showed improved outcomes in food access and nutrition. Civil society played an important but often informal role, particularly in grassroots interventions. Multisectoral integration was limited but demonstrated effectiveness when present. In conclusion, while Nigeria has adopted several promising strategies, more deliberate alignment with evidence-backed principles—especially in fostering multisector coordination and institutionalizing civil society engagement—is needed to meet available standards in best practices for sustainable and inclusive food security.