Food systems and nutrition - handbook for parliamentarians No 32

Parliamentarians are agents of change, and their role is critical to ensure a world where all people are eating healthy diets from sustainable, inclusive, and resilient agri-food systems. Members of the Parliament hold a strategic position as they can shape policies and actions for improving food availability, accessibility, and affordability for all people, especially the most vulnerable, to ensure their food security and good nutrition for health and wellbeing. Objectives that are more important than ever in the current context of the COVID-19 pandemic. This handbook is addressed to Parliamentarians to support them in adopting domestic legislation, approving budget allocations, and overseeing public-sector policies towards transforming food systems that deliver healthy diets for all. This handbook was prepared by the Inter-Parliamentary Union and the Food and Agriculture Organization of the United Nations, in collaboration with the Scaling Up Nutrition (SUN) Movement, the World Health Organization (WHO), the United Nations Children's Fund (UNICEF) and the African Union Development Agency's New Partnership for Africa's Development (AUDA-NEPAD).

Disrupted food supply chain's effect on school nutrition programs' ability to meet USDA nutritional guidelines during the COVID-19 pandemic

The Coronavirus disease 2019 (COVID-19) pandemic resulted in school closures and required school nutrition directors to shift their methods of executing the School Breakfast Program (SBP) and National School Lunch Program (NSLP). The procurement of items, the composition of meals, and meal delivery were impacted by the COVID-19 pandemic. Responding to these changes, the United States Department of Agriculture (USDA) released several waivers allowing for flexibility in meal patterns and meal delivery, while maintaining federal reimbursements to schools. Although school meals have yet to reach pre-pandemic participation numbers, school districts nationwide have experienced the effects of supply chain disruptions, therein impacting their ability to meet the nutritional standards of the NSLP and SBP. To mitigate supply chain issues and provide consistent, quality meals, School Food Authorities needed to leverage USDA's additional funding and waivers by continuing to innovate, establish, and communicate best practices for effective meal delivery.

Changes in Food Security, Healthfulness, and Access During the Coronavirus Disease 2019 Pandemic: Results From a National United States Survey.

Background: Coronavirus disease 2019 (COVID-19) disrupted access to food and adequate nutrition and the types of foods consumed. However, little empiric data exists on the changes in American's food and nutrition habits 2 y into the pandemic. Objectives: To assess current and altered food choices ∼2 y into the COVID-19 pandemic in the months after historic public pandemic relief. Methods: A national sample of 1878 United States adults balanced by age, sex, race/ethnicity, and income completed a one-time, online, semi-quantitative, 44-item questionnaire in Fall 2021 asking about the demographics, COVID-19 food choice changes (including free-text), and consumer priorities. This analysis investigates COVID-19 impacts on food security, healthfulness, and access. Results: More than 35% of respondents reported improved food security and >45% reported improved food healthfulness compared with prepandemic status. Improvement was reported in more than 30% of Black/African-American and Hispanic/Latinx adults, adults with lower annual income, and female sex, despite over 75% reporting reduced choice of where to eat or buy food. The pandemic offered occasion for many to improve diet, but a similar number expressed that the pandemic destabilized healthy habits. Conclusions: Our novel findings suggest that by late 2021, most Americans had improved food security and food choice healthfulness, despite reduced access to food service and retail, although with worsening among a meaningful proportion of Americans as well as heterogeneity in these changes. Vigorous federal, state, city, and community responses to the pandemic may have played a role in improving the food security and food choice healthfulness during the COVID-19 pandemic. Health crises differently impact health behaviors, but when accompanied by vigorous civic and community response, food security, and food healthfulness can be fortified.

A Qualitative Study to Compare Barriers to Improving Food Security among Households with Young Children in the U.S. as Perceived by Different Types of Stakeholders before and during COVID-19.

This qualitative study aimed to determine the perceived barriers of different community stakeholders' to providing resources for improving food security in households with young children in the U.S. Community stakeholders working with low-income families with children 0-3 years of age in Florida were recruited to represent healthcare (n = 7), community/policy development (n = 6), emergency food assistance (n = 6), early childhood education (n = 7), and nutrition education (n = 6) sectors. In 2020, one-on-one interviews were conducted with each stakeholder in via Zoom, using an interview script based on the PRECEDE-PROCEED model and questions to capture the impacts of COVID-19. The interviews were audio-recorded, transcribed verbatim, and analyzed using a deductive thematic approach. A cross-tab qualitative analysis was used to compare data across categories of stakeholders. Healthcare professionals and nutrition educators indicated stigma, community/policy development stakeholders indicated a lack of time, emergency food assistance personnel indicated a limited access to food, and early childhood professionals indicated a lack of transportation as the main barriers to food security prior to COVID-19. COVID-19 impacts included the fear of virus exposure, new restrictions, lack of volunteers, and a lack of interest in virtual programming as barriers to food security. As perceived barriers may vary with respect to providing resources to improve food security in families with young children and the COVID-19 impacts persist, coordinated policy, systems, and environmental changes are needed.

Implementation of a school feeding program in an educational institution during the pandemic, Bogotá, 2021 / Implementación de un programa de alimentación escolar en una institución educativa durante la pandemia, Bogotá, 2021

RESUMEN Objetivo El Programa de Alimentación Escolar (PAE) en Colombia brinda un complemento alimentario para niños y adolescentes vinculados al sistema educativo público; sin embargo, debido a la pandemia por COVID-19, este tuvo que modificar su modalidad de entrega. Este estudio tuvo como propósito describir las estrategias del Colegio CEDID Ciudad Bolívar al implementar el PAE durante la pandemia por COVID-19. Métodos Diseño metodológico cualitativo basado en entrevistas semiestructuradas a docentes, estudiantes y padres de familias, pertenecientes a este colegio. La información fue analizada de acuerdo con un conjunto de categorías establecidas previamente. Resultados Los participantes coinciden en que el traslado de los padres por pérdida de empleo y el no tener dispositivos tecnológicos, influye en la deserción escolar. Por otra parte, el colegio se acogió a la modalidad transitoria del PAE, entregando bonos redimibles por mercado; sin embargo, afirman que no todos lograron acceder a este por desconocimiento del trámite. Se resalta por los participantes que es una ayuda alimentaria, económica y que logra beneficiar a toda la familia, pero se evidencia el alto costo de los alimentos, el desabastecimiento y las dificultades a la hora de redimirlos. Conclusiones A pesar de la pandemia, la institución ha hecho esfuerzos para adaptar el PAE a las circunstancias epidemiológicas a fin de enfrentar el riesgo de deserción escolar y garantizar el complemento alimentario para los estudiantes, siendo valorado por ellos y sus familias.

ABSTRACT Objective The School Feeding Program (PAE, by its initials in Spanish) in Colombia provides a food supplement for children and adolescents enrolled in the public educational system; however, due to the COVID-19 pandemic, its delivery modality had to be modified. The purpose of this study was to describe the strategies of the CEDID Ciudad Bolívar School to implement the PAE during the COVID-19 pandemic. Methods Methodological design based on semi-structured interviews with teachers, students and parents of families belonging to this school. The information was analyzed according to a set of previously established categories. Results The participants agree that the transfer of parents due to loss of employment and not having technological devices influences school dropout. On the other hand, the school took advantage of the transitory modality of the PAE, delivering bonds redeemable by market; however, they affirm that not all were able to access it, due to ignorance of the process. It is highlighted by the participants that it is a food aid, it is economic, and that it manages to benefit the whole family, but the high cost of food, the shortage of supplies, and the difficulties when it comes to redeeming it are evident. Conclusions Despite the pandemic, the institution has made efforts to adapt the PAE to epidemiological circumstances, in order to face the risk of school dropout and guarantee the food supplement for students, being valued by them and their families.

Caregiver perceptions of England's universal infant school meal provision during the COVID-19 pandemic.

The United Nations (UN) recognises free school meals as critical, yet widely disrupted by COVID-19. We investigate caregiver perceptions and responses to interruptions to the universal infant free school meal programme (UIFSM) in Cambridgeshire, England, using an opt-in online survey. From 586 responses, we find 21 per cent of respondents' schools did not provide UIFSM after lockdown or advised caregivers to prepare packed lunches. Where provided, caregivers perceived a substantial decline in quality and variety of meals, influencing uptake. Direction to bring packed lunches, which caregivers reported to have contained ultra-processed foods of lower nutritional quality, influenced caregiver behaviour rather than safety concerns as claimed by industry. The quality and variety of meals, and school and government policy, had greater impact than concerns for safety. In the UK and at the international level, policymakers, local governments, and schools must act to reverse the trend of ultra-processed foods in packed lunches, while improving the perceived quality of meals provided at schools.

The UK's Free School Meals policy during the pandemic: a thematic content analysis of policy documents and debates

BACKGROUND: A Free School Meals (FSM) policy is a well recognised intervention for tackling food insecurity among children (up to the age 18 years) whose parents receive state benefits. National school closures during the COVID-19 pandemic resulted in the need to rapidly adapt the delivery of FSM to protect the most disadvantaged children in the UK from increased food insecurity. A range of food assistance policies were implemented, but whether they were evidence-based is unclear. The aim of study was to establish the transparency of evidence use behind FSM policy decisions in the UK during the COVID-19 pandemic and to identify other factors influencing decision making. METHODS: We used thematic content analysis to analyse publicly available policy documents and parliamentary debate transcripts relating to FSM published in the first year of the COVID-19 pandemic in the UK (March, 2020, to March, 2021). This period covered the first national school closures (March, 2020, to July, 2020), all school holidays, and the second national school closures (January, 2021, to March, 2021). The evidence transparency framework was used to evaluate transparency of evidence-use in policy decisions. FINDINGS: We analysed 50 documents and debates. Overall transparency of evidence-use was low, but more evident for the Holiday Activities and Food programme than for the FSM programme. Replacing FSM with food parcels was favoured by the UK Government over more agentic modes of food assistance, such as cash vouchers. This preference seemingly aligned with politicians' ideological views on the welfare state, influenced by social media, as assessed from the analysis of available policy documents and parliamentary debate transcripts. Other influences on decision making included policy delivery and responding to increased public attention. INTERPRETATION: Evidence use behind the deployment of FSM was not transparent. Overall, value-based reasoning took precedent over evidence and was polarised by social media. A comprehensive review of the FSM policy in this period could increase understanding and the likelihood that future food assistance policy is evidence-based. The lessons must be incorporated into a future pandemic plan that prioritises protecting low-income families from food insecurity. FUNDING: Newton's Apple (registered charity number 1121719). The authors are funded by the UK National Institute for Health and Care Research's School for Public Health Research. The views expressed herein are those of the authors and not necessarily those of the National Institute for Health and Care Research or the UK Department of Health and Social Care.

Caregivers' Perceived Impact of WIC's Temporary Cash-Value Benefit (CVB) Increases on Fruit and Vegetable Purchasing, Consumption, and Access in Massachusetts.

Responding to the COVID-19 pandemic, the American Rescue Plan (2021) allowed state agencies of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) the option of temporarily increasing the Cash-Value Benefit (CVB) for fruit and vegetable (FV) purchases. To examine the impact of this enhancement on WIC caregiver experience, the MA WIC State Office invited 4600 randomly selected MA WIC caregivers to complete an online survey (February-March 2022). Eligible adults had at least one child, had been enrolled at least a year, and were aware of the increase. Of those who opened the screener (n = 545), 58.9% completed it (n = 321). We calculated the frequencies of reporting increased FV outcomes and tested whether responses differed by race/ethnicity, market access, and food security. Most caregivers perceived the CVB increase to benefit FV purchasing (amount and quality, 71.0% and 55.5%), FV consumption (offered to children and personally consumed, 70.1% and 63.2%), and satisfaction with the WIC food package (37.1% reported improved satisfaction, pre- vs. post-increase). Probability of reporting improved outcomes was not found to differ by race/ethnicity, market access, or food security. CVB increases may pose important implications for dietary behaviors and satisfaction with WIC. Policymakers should consider making this increase permanent.

Five years of national policies: progress towards tackling obesity in England.

Obesity is a major burden on the health system in England and the rest of the UK. Obesity prevalence is high in adults and children and most of the UK population are consuming more energy than required, and not meeting other dietary recommendations, including those for saturated fat, free sugars, fibre, oily fish and fruit and vegetables. Over the past 5 years, a number of cross-government policies, both promoting voluntary action and legislative, have been put in place to tackle diet-related health and obesity. The food environment is complex with many influencing factors, some of which act through individual automatic choices. Other factors such as accessibility, advertising, promotion and nudging drive increased food and drink purchases. With continual changes in the food environment favouring fast-food outlets and meal delivery companies alongside the adverse impact of the COVID-19 pandemic on diets and physical activity levels, further governmental action is likely needed to deliver sustained improvements to diet and health.

State Implementation of SNAP Waivers and Flexibilities During the COVID-19 Pandemic: Perspectives From State Agency Leaders.

OBJECTIVE: To describe state agencies' implementation of the Supplemental Nutrition Assistance Program (SNAP) during the first year of the coronavirus disease of 2019 (COVID-19) pandemic, barriers and facilitators to SNAP implementation, and recommendations to improve SNAP implementation. DESIGN: Qualitative methodology guided by Bullock's determinants of policy implementation framework using 7 semistructured, virtual focus groups in April 2021. SETTING: Twenty-six states representing all 7 US Department of Agriculture Food and Nutrition Service regions. PARTICIPANTS: Four focus groups with state-level SNAP administrators and 3 focus groups with state-level SNAP supportive services (Supplemental Nutrition Assistance Program-Education, Employment & Training, and Outreach) supervisors (n = 62). PHENOMENON OF INTEREST: Supplemental Nutrition Assistance Program implementation during the COVID-19 pandemic. ANALYSIS: Thematic analysis using a phronetic iterative approach. RESULTS: Six primary themes emerged: the policy response, technology needs, collaboration, participant communication, funding realities, and equity. Implementation challenges included the design of waivers in the early pandemic response, inadequate federal guidance and funding, outdated technology, and prepandemic regulations limiting state authority. Modernized technology systems, availability of virtual programming, partnerships, and enhanced benefits facilitated SNAP implementation. CONCLUSIONS AND IMPLICATIONS: Supplemental Nutrition Assistance Program administrators adapted their programs to deliver services virtually during the COVID-19 pandemic. These experiences highlighted the importance of certain policy determinants, such as modernized technology and streamlined application processes, to improve outcomes for SNAP participants and staff.

P072 Developing a Nutrition Security Action Plan for a University

To develop a Nutrition Security Plan to be implemented within a large public university Prior research suggests that college students struggle with food insecurity. The COVID-19 pandemic exposed the health disparities that are exacerbated by an unhealthy diet. Highlighting the need for university students to not only have food security but also nutrition security. University students particularly insecure students and those at risk for food insecurity University partners such as university administration, students, food service contract staff, county health department nutrition staff, the North Carolina Department of Health and Human services nutrition staff worked together to develop a Nutrition Security Plan for our University. Plan development focused on three areas. First, food purchasing behaviors and barriers to nutrition security on campus were assessed both quantitatively and qualitatively. Second, existing nutrition supporting services on campus (e.g. food pantry, Swipe out Hunger, student garden) were documented and reviewed. Third, nutrition support programs and initiatives in operation at other universities were researched and considered for implementation. Review of the peer-reviewed, the grey literature, and university student services websites to see what strategies other universities used to address the food needs of students The Nutrition Security Plan was submitted to University leadership in Fall 2021. To date, 3 of 12 University Nutrition Security Plan recommendations have been implemented. These are a centralized resource center for student nutrition needs was created and posted on the university student support website;a university bus route that stops at a grocery store was implemented;and a SNAP Eligibility Screener for Students was developed and disseminated among student financial aid and student support services. Universities can generate a Nutrition Security Plan for students by building an interdisciplinary team, reviewing the current services on campus reviewing the literature and services offered at other universities to generate ideas, then working together to expand successful existing programs and proposing promising interventions. Center for Disease Control and Prevention

Culture of Healthy Eating and Food Environments, Policies, and Practices in Regional New Zealand Schools.

The school food environment plays an important role in shaping students' dietary choices, which often influence future dietary behaviours. We surveyed primary and secondary schools in Hawke's Bay, New Zealand, to measure the comprehensiveness and strength of food policies, describe the culture of food provision, and identify barriers to improving school food environments. Fifty-one schools were included in the final analysis, with 58.8% having a food policy, most of which used a generic template. Schools with food policies and those participating in the free and healthy lunch programme were more likely to have a strong culture around healthy eating. Common barriers to healthy eating were food outlets near school and resistance from students. Secondary schools reported facing more barriers to implementing healthy eating cultures, were more likely to use food as classroom rewards and to sell food to students, most of which was unhealthy. Hawke's Bay schools participating in food provision programmes are successfully improving their food environments through improved culture and delivery of healthy food; however, more action is needed to strengthen the wording and guidance in food policies and reduce the provision of unhealthy food in schools before effective change can be achieved.

Maintaining School Foodservice Operations in Ohio during COVID-19: "This [Was] Not the Time to Sit Back and Watch".

The COVID-19-related lockdowns led to school closures across the United States, cutting off critical resources for nutritious food. Foodservice employees emerged as frontline workers; understanding their experiences is critical to generate innovations for program operations and viability. The purpose of this cross-sectional study was to characterize COVID-19-related foodservice adaptations for summer and school year meal provision. Public school district foodservice administrators across Ohio were surveyed in December 2020. Questions related to meal provision before, during, and after COVID-19-related school closures. Results indicate the majority of districts continued providing meals upon their closure in Spring 2020 (n = 182, 87.1%); fewer did so in Summer (n = 88, 42.1%) and Fall (n = 32, 15.3%). In Spring and Summer, most districts that offered meals functioned as 'open sites' (67.0% and 87.5%, respectively), not limiting food receipt to district-affiliated students. Most districts employed a pick-up system for food distribution (76-84% across seasons), though some used a combination of approaches or changed their approach within-season. Qualitatively, districts reported both "successes" (e.g., supporting students) and "challenges" (e.g., supply chain). Despite being ill-prepared, districts responded quickly and flexibly to demands of the pandemic. This analysis provides insight for future practice (e.g., establishing community partnerships) and policy (e.g., bolstering local food systems).

Food and nutritional insecurity: an analysis on public policies interface with food and nutrition in times pandemy by SARS-CoV-2

This study aims to analyze the dynamics of the interface policies with food and nutrition in the context of the pandemic and its interferences in the scenario of Food and Nutrition Insecurity (InSAN). It is a documentary research in which it was listed as primary sources of data, documents available in institutional websites and texts published in journalistic media. Thus, it included: legislation and digital journalistic texts. After the exploratory reading of the documents, the following axes of analysis were delimited: Impacts of Constitutional Amendment no95/2016 in the current health crisis;food and nutrition policies during the pandemic and income transfer and unemployment programs. The results show that the current sanitary crisis aggravates the InSAN scenario, as the assistance actions are insufficient to attend the population in periods of public calamity. In addition to this scenario, the previous pandemic context, in which the necro politics of suppression of rights contributed to the worsening of social vulnerabilities, including the lack of access to food.

Prevalence and predictors of food insecurity among people living with and without HIV in the African Cohort Study.

OBJECTIVE: We determined the prevalence and identified predictors of food insecurity in four African countries. DESIGN: Cross-sectional analyses at study enrolment. SETTING: From January 2013 to March 2020, people living with HIV (PLWH) and without HIV were enrolled at twelve clinics in Kenya, Uganda, Tanzania and Nigeria. PARTICIPANTS: Participants reporting not having enough food to eat over the past 12 months or receiving <3 meals/d were defined as food insecure. Robust Poisson regression models were used to estimate unadjusted and adjusted prevalence ratios (aPR) and 95 % CI for predictors of food insecurity among all participants and separately among PLWH. RESULTS: 1694/3496 participants (48·5 %) reported food insecurity at enrolment, with no difference by HIV status. Food insecurity was more common among older participants (50+ v. 18-24 years aPR 1·35, 95 % CI 1·15, 1·59). Having 2-5 (aPR 1·14, 95 % CI 1·01, 1·30) or >5 dependents (aPR 1·17, 95 % CI 1·02, 1·35), and residing in Kisumu West, Kenya (aPR 1·63, 95 % CI 1·42, 1·87) or Nigeria (aPR 1·20, 95 % CI 1·01, 1·41) was associated with food insecurity. Residing in Tanzania (aPR 0·65, 95 % CI 0·53, 0·80) and increasing education (secondary/above education v. none/some primary education aPR 0·73, 95 % CI 0·66, 0·81) was protective against food insecurity. Antiretroviral therapy (ART)-experienced PLWH were more likely to be food secure irrespective of viral load. CONCLUSION: Food insecurity was highly prevalent in our cohort though not significantly associated with HIV. Policies aimed at promoting education, elderly care, ART access in PLWH and financial independence could potentially improve food security in Africa.

Serving Summer Meals During the COVID-19 Pandemic: A Case Study of 2 Summer Food Service Program Sponsors in Maryland.

BACKGROUND: The Summer Food Service Program (SFSP) provides free and nutritious meals to children under age 18 during out-of-school times. During the COVID-19 pandemic, Maryland sponsors served over 9.5 million meals to children through an expanded version of the SFSP. This study aimed to explore and compare the factors that enabled 2 SFSP sponsors in Maryland to dramatically increase meals distribution during the pandemic. METHODS: Sponsors were selected based on their responses in the larger study and demographic characteristics of the area in which they served. Semi-structured in-depth interviews were conducted over Zoom-4 interviews with Sponsor A (3 interviews with the sponsor, 1 interview with their vendor) and 1 interview with Sponsor B. Qualitative data were analyzed inductively and deductively. Participation data from 2019 and 2020 were obtained from the Maryland State Department of Education and analyzed. RESULTS: Despite their differences in organization type and geographic region, they identified similar facilitators to their success-communication with the community and utilization of the United States Department of Agriculture-issued waivers. CONCLUSIONS: Strengthening community communication networks and permanently integrating more flexibility into regulation of the SFSP may increase meals participation during future out-of-school times.

Child food insecurity in the wake of the COVID-19 pandemic: urgent need for policy evaluation and reform in Israel's school feeding programs.

Even in high-income countries like Israel, children have been particularly vulnerable to the surge in food insecurity driven by quarantines, unemployment, and economic hardships of the COVID-19 pandemic. Under normal circumstances, School Feeding Programs (SFPs) can help to ensure child food security. In the wake of the pandemic, policy makers worldwide have been challenged to adapt national SFPs to provide nutritional support to children (and indirectly to their families) during extended school closures. Most national SFPs implemented contingency plans to ensure continued nutritional support for children. In Israel, where SFPs were largely suspended during long periods of mandated school closing, there was a loss of 30-50% of feeding days for the ~ 454,000 children enrolled in the program. The lack of emergency contingency planning and failure to maintain Israeli SFPs during school closures reveals longstanding structural policy flaws that hindered coordination between relevant ministries and authorities and impeded the mobilization of funds and existing programs to meet the emergent need. The school feeding law does not identify child food security as an explicit aim, there are no benchmarks for monitoring and evaluating the program to ensure that the food aid reaches the children most in need, even routinely, and the Ministry of Education had no obligation to maintain the program and to marshal data on the participants that could be acted upon in the emergency. Moreover, because Israeli SFPs are "selective", in other words, implemented according to community risk (low-income, high poverty rate) and geographical factors, attendant stigma and financial burdens can make participation in the program less attractive to families and communities that need them the most. We argue that Israel should make urgent, long-term improvements to the SFPs as follows: First, eliminating childhood food insecurity should be made an explicit goal of legislation in the broader context of national social, health, and nutritional goals, and this includes ensuring SFPs are maintained during emergencies. Second, the government should assume responsibility for the routine assessment and data collection on food insecurity among Israeli children. Third, SFPs should be subjected to rigorous independent program evaluation. Finally, a "universal" SFP providing nutritious diets would likely improve the health of all Israeli children, across all socioeconomic backgrounds. These steps to guarantee that Israeli children have food to realize their full physical and cognitive potential would emphasize Israel's firm commitment to support multiple dimensions of health, educational achievement, and societal values, to combat the complex and long-term consequences of the pandemic, and to prepare for the next one.

Improving the nutritional well-being of school-age children through the nutrition-friendly schools initiative (NFSI) in the State of Palestine

GAZA & WEST BANK. What this article is about: This article outlines the Nutrition-Friendly Schools Initiative, a UNICEF-Supported intervention targeting healthy dietary and physical activity habits and improved nutritional status of school-age children. Key messages: * Contextualizing innovative Nutrition Friendly School approaches and tailoring interventions towards the COVID-19 response achieved high coverage of school-age Palestinian children, building the foundations for future interventions. * Initially, the absence of a National Nutrition Adolescent protocol, including clear procedures on school-age children nutrition screening and treatment, posed a significant challenge to the early stages of implementation. However, the introduction of revised National Nutrition Protocols mitigated this challenge, highlighting the value of adolescent-specific public health and nutrition policies.

Healthy Food Environments in Food Pantries: Lessons Learned from a Sodium Reduction Intervention.

In the United States, food pantries increasingly serve as regular food sources for low income households experiencing high rates of chronic disease, including hypertension. Sodium consumption is a modifiable risk factor for hypertension, so pantry customers would benefit from access to low-sodium foods. Pantry customers often experience difficulty acquiring healthy foods, however; little is known about pantry foods' sodium content specifically. This study assesses the sodium content of pantry foods and lessons learned from an adaptable intervention to support pantries in adopting policies and environmental changes to make healthy, lower-sodium foods appealing and accessible. We conducted sodium assessments of food at 13 food pantries, tracked implementation of intervention strategies, and interviewed 10 pantry directors. More than half of food items in 11 categories met sodium standards for foods to be chosen "often". Pantry directors reported valuing the intervention approach and implemented six of nine behavioral economics strategies, especially those targeting the visibility and convenience of foods, along with layout changes and expanded customer choice. One pantry adopted an agency-specific nutrition policy and 12 adopted a coalition-level policy. Results can inform intervention efforts to make available healthy options appealing and easy to select while also improving the customer experience in food pantries.