Increase in weight-for-age and vegetable intake in young children with cystic fibrosis treated with lumacaftor/ivacaftor for 24 weeks

Background: Modulator therapy has improved nutritional status in individuals with cystic fibrosis (CF), which is associated with favorable outcomes. Because of the high metabolic demands of CF, nutritional recommendations include energy intake of 110% to 200% of daily estimated needs for healthy individuals. With changes in energy balance after initiation of modulator therapy, these recommendations may no longer be appropriate for some people with CFand may lead to excessiveweight gain. Overweight and obesity are being reported, and nutrition concerns now include dietary quality. Dietary quality in relation to growth in young children starting lumacaftor/ivacaftor therapy has not been examined over a 24-week period and may provide new data for future nutrition guidance for individuals with CF. Method(s): The purpose of this observational study was to determine the effect of lumacaftor/ivacaftor treatment on growth and diet in medicationnaive children. Subjects aged 2 to 5 with D508/D508 mutations were recruited from the United States and Canada. Length/height, weight, and body mass index (BMI) were measured in triplicate and averaged. Z-scores were calculated using Centers for Disease Control and Prevention reference data. Dietary data were captured using 3-day weighted food records after study visits. The Healthy Eating Index (HEI) was generated using the U.S. Department of Agriculture scoring system for each recorded day and averaged. Outcomes were assessed before treatment (baseline) and 12 and 24 weeks after beginning medication. Mixed longitudinal models were used for analysis over time. Result(s): Participants (mean age 2.9 +/- 1.4, 50% female) who completed food records for at least their baseline visit plus one other visit (n = 14) had significant increases inweight-for-age z-score (WAZ) 12 (0.6 +/- 1.7, p = 0.02) and 24 (0.21 +/- 1.8, p = 0.001) weeks after therapy. There was no significant change in height-for-age (HAZ), BMI-for-age (BMIZ), or head circumference- for-age (HCZ) z-score at 12 or 24 weeks. Although not statistically significant, percentage estimated energy requirement (%EER) decreased at 12 (-7 +/- 90%, p = 0.54) and 24 (-27 +/- 90%, p = 0.08) weeks. HEI total score did not change over the 24 weeks, although vegetables and greens and beans HEI subgroup scores decreased significantly from baseline to 24 weeks (-0.73 +/- 2.2, p = 0.02;-0.68 +/- 2.1, p = 0.02, respectively). Pooled visit correlation between total vegetables and WAZ indicated a positive association (r = 0.35, p = 0.04). Conclusion(s): WAZ increased significantly over 24 weeks of lumacaftor/ ivacaftor therapy and was positively correlated with total vegetable intake, suggesting that participants with greater WAZ scores consumed more vegetables, although over the course of the study, total vegetable intake and intake of greens and beans decreased, and WAZ increased. %EER decreased over the course of the study, but not statistically significantly so, probably because of variability in energy intake within this small study sample with some COVID-19 interruptions. In summary, WAZ of children aged 2 to 5 with D508/D508 mutations increased, with no significant changes in HAZ, BMIZ, or HCZ, and they consumed fewer total vegetables and greens and beans after 24 weeks of lumacaftor/ivacaftor therapy. Acknowledgements: Supported by Vertex Pharmaceutics Inc. and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR001878.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

Healthy for Life: A Shift to Virtual Nutrition Education to Improve Confidence and Dietary Behaviors

Introduction: Less than 10% of U.S. adults meet the guidelines for whole grains, fruits, and vegetables each day. The Healthy for Life community-based program aims to change confidence and health behaviors, by equipping individuals with new skills for healthy living. As a result of the COVID-19 pandemic in 2020 and 2021, the program pivoted from in-person to a virtual implementation model. This required more advanced planning due to additional logistics to ensure a skills-based learning environment. Objective(s): To examine the effectiveness of the Healthy for Life program over time, specifically: o Changes in participant confidence in the preparation of healthy foods at home o Changes in participant consumption of fruits, vegetables, and whole grains o Changes in participant frequency of healthy shopping habitsMethods: A community engagement program was implemented and evaluated in 17 community centers in 2020-2021 to measure changes in participant confidence to prepare healthy meals at home, consumption of fruits, vegetables and whole grains, and frequency of healthy shopping habits. Community center facilitators administered the same pre/post survey to participants at the first educational experience, and then again at the final experience. Facilitators entered the participant data into an online survey portal. Analysis was conducted with 235 participants who completed both pre and post surveys. Two-way repeated ordinal regression was used to assess changes in key metrics over time. Result(s): Participants were predominately female (90.6%), about two-thirds (65.2%) were between 25-55 years old, and most identified as non-Hispanic White/Caucasian (42.6%) or Black/African American (35.7%). Close to half (45.9%) of participants had a college degree or higher, over a quarter (28.1%) received benefits from SNAP and/or WIC, and more than two-thirds (63.8%) indicated they are the only person in their household preparing meals. Almost half (49.3%) of respondents attended the suggested minimum of 4 educational experiences. On average, respondents statistically significantly increased their daily fruit & vegetable consumption by 1.21 serving(s). In addition, over one-third (34%) of respondents increased their level of confidence to prepare healthy meals at home and (37%) respondents increased their level of confidence to substitute healthier cooking and food preparation methods. Close to half (47.2%) respondents reported increased frequency of reading food labels and checking the nutritional values when purchasing food. Conclusion(s): Despite the shift to virtual implementation, the Healthy for Life community education program, was still effective in improving participant confidence and dietary behaviors over time. However, additional research studies are required to further assess whether virtual implementation of this type of intervention will continue to be effective.

Evaluation of a nutrition education and cooking programme (NEST) in vulnerable adults who are at high risk of food insecurity

Within Australia, the prevalence of food insecure individuals increased from 2.6 million in 2014-2016 (10.8%) to 3.1 million in 2018- 2020 (12.3%) due to the COVID-19 pandemic.(1) OzHarvest is a not-for-profit organisation that prioritises food salvaging, food waste prevention and nutrition education.(2) OzHarvest's education sector facilitates a programme known as Nutrition Education Skills Training (NEST). NEST is a 6-week programme providing weekly workshops of 2.5-hour duration offering skills training on cooking simple, healthy, and affordable meals to adults at risk of food insecurity. This study aimed to determine the immediate and longerterm impacts of participation in NEST. A quasi-experimental study with pre-post surveys (n = 258) and follow-up surveys (n = 20) was conducted from June 2019 to July 2022. Survey results were obtained from NEST program participants (18 years) from Adelaide Canberra, Melbourne, Newcastle, Queensland, and Sydney. Baseline (pre-) and post-surveys (at program completion) were administered to participants, with an option for a 6-month follow-up survey. Participants were required to complete both surveys to be eligible for this study. Questionnaires included 23 core questions adapted from previous studies,(3) allowing evaluation of nutrition knowledge confidence and self-efficacy, shopping, and food preparation behaviours, and eating behaviours. Food security was assessed using the standard 6-item indicator set for classifying households by food security status level. Using paired t-tests, Shapiro Wilks, and Wilcoxon sign-ranked tests for pre and post survey data, participants demonstrated overall improvement in nutrition knowledge (p < 0.001), confidence and self-efficacy (n = 222;p < 0.001) and food preparation behaviours (p < 0.001). The intake of discretionary foods overall decreased (p < 0.001) while fruit, vegetable and water intake increased (p < 0.001). Food security improved from 57% to 68% immediately within the population (p < 0.001). Using RMANOVA and Shapiro Wilks tests, the 6-month survey results were compared to the pre surveys suggested longer lasting improvements in nutrition knowledge (p < 0.001), cooking confidence (n = 8;p = 0.033), food preparation behaviours (p = 0.003), and increased vegetable intake (p = 0.032) and fruit intake (p = 0.012) Participation in OzHarvest's NEST programme results in short-term improvements in food security levels and dietary behaviours Over the longer term, these changes were sustained but to a lesser degree, indicating that systemic changes are required to address underlying socioeconomic disadvantage.

Food Insecurity and Health Behaviors Among a Sample of Undergraduate Students at an Urban University

Students at universities are experiencing food insecurity, which may be associated with health behaviors. In a pilot study to build a survey that assesses food insecurity and health behaviors among undergraduates, we distributed the survey before (Wave 1;fall 2019) and during (Wave 2;summer 2020) COVID-19. During Wave 1, 41% of students reported food insecurity and 61% met criteria for poor sleep. In Wave 2, 26% reported food insecurity and 49% met criteria for poor sleep. Students experiencing food insecurity were more likely to report poor sleep. This survey will inform recruitment and design of a scaled-up multi-campus study. (100/100 words). © 2022 Taylor & Francis Group, LLC.

Associations Between Decline in Household Income and Dietary and Lifestyle Changes During the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has greatly affected employment and the work environment. Socioeconomic status is known to affect dietary habits.To examine the associations between changes in household income and changes in diet, dietary behavior, and lifestyle.A cross-sectional questionnaire survey was conducted via the Internet in November 2020. The participants were 6,000 Japanese men and women (aged 20–64 years old) who were registered with a research company. After excluding participants with invalid responses, a total of 5,158 participants were included in the analysis.The questionnaire included the following items: demographic characteristics, socioeconomic status, and changes in household income, diet, dietary behavior, and lifestyle since before the COVID-19 pandemic (November 2019) to the present (November 2020). Changes in household income and demographic characteristics and socioeconomic status were compared using the χ2 test. The association between changes in household income and dietary habits was examined by multiple logistic regression analysis.Household income had decreased for 1,144 participants (22.2%). In this group, a high proportion were in their 50s, were high school graduates, and had household income under 2 million yen in 2019. Decrease in household income was negatively associated with vegetable intake, frequency of eating out, time spent on breakfast, and time spent exercising, and positively associated with frequency of drinking and time spent on lunch.The results of this study suggest that decrease in household income during the COVID-19 pandemic was associated with expansion of economic disparities and changes in dietary habits, such as vegetable intake and mealtimes.

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.

Relationship between the risk of food insecurity, child weight status and dietary behaviours: a cross-sectional analysis in a sample of Viennese school children

Background Food insecurity (FI) has previously been associated with childhood obesity. The COVID19 pandemic has affected the economy and lifestyle, increasing vulnerability to FI and obesity. We aimed to assess the risk of food insecurity during 2020-2021 in a sample of Viennese school children and its association with obesity and dietary factors. Methods Fifty-five parents of 8- to-11-year-old children were asked to complete a questionnaire, and the children's weight, height and body composition were measured. Identification of families at risk of FI was assessed using a 2-item screen (Hager E, et al. 2010). Overweight/obesity was defined as a body mass index >90th percentile. Dietary behaviours were assessed through questionnaires. Odds ratios (OR) were computed for overweight/obesity according to the risk of FI, adjusting by income household. Results Mean age was 9.9 (95%CI: 8.8-10.8) years. Thirty-one percent reported a risk of FI, with no differences by sex (p = 0.13). Forty per cent of parents reported household income <= 1600'. Almost 1/3 families reported decreased income during 2020-2021. Overweight/obesity was present in 30.9% of the children. FI was not associated with the likelihood of overweight/obesity (OR=0.54, 95%CI: 0.14-2.12), not even after stratification by gender. Dietary behaviours (low fruit and vegetable intake, high frequency of intake of sweet products and beverages) were not associated with the risk of FI (p >= 0.23). Conclusions Although no association between risk of food insecurity and childhood obesity was found cross-sectionally, a high proportion of parents reported risk of FI households, warranting further screening.

Socioeconomic status for predicting COVID-19-related changes in cancer prevention behaviors

Background: Disruptions of daily life activities during the CVOID-19 pandemic have adversely affected cancer-prevention behaviors. Socioeconomic status (SES) impacts on changes in cancer prevention behaviors have not been fully investigated. To tackle this gap, we examined the effects of SES on COVID- 19 related changes in cancer prevention behaviors. Methods: We invited participants from previous studies conducted at the Ohio State University Comprehensive Cancer Center who agreed to be re-contacted to participate in a survey assessing the impact of COVID-19 on various behaviors between June and November 2020. Participants reported current cancer prevention behaviors, including physical activity, daily fruit and vegetable intake, alcohol consumption, and tobacco use. In addition, participants reported qualitative changes in current behaviors relative to pre-COVID levels. We combined current behaviors with COVID-related changes to construct a 24-point cancer prevention score. Participants were classified into low, middle, or high SES based on household income, education, and employment status. Adjusted multinomial logistic regression was used to examine the association between SES and COVID-19 related changes in cancer prevention behaviors. Results: The study sample included 6136 eligible participants. The average age was 57 years, 67% were female, 89% were non-Hispanic White, and 33% lived in non-metro counties. The proportion of participants in the lowest cancer prevention behavior quartile decreased significantly with higher SES [low SES vs. high SES;32% vs. 28%;P-value <.001]. Relative to pre-COVID-19 levels, higher SES was significantly associated with increases in post-COVID-19 prevalence of more physical activity [low SES vs. high SES;12% vs. 28%;P-value <.001], higher fruit and vegetable intake [low SES vs. high SES;12% vs. 14%;P-value <.001], and more alcohol consumption [low SES vs. high SES;15% vs. 22%;P-value <.001]. Higher SES was associated with lower tobacco use prevalence [low SES vs. high SES;5% vs. 2%;P-value <.001]. Relative to the highest prevention score quartile, the adjusted odds of scoring in the lowest prevention score quartile were: adjusted odds ratio (aOR) 1.55 (95% CI: 1.27 - 1.89) and aOR 1.40 (95% CI: 1.19 - 1.66), respectively higher for low and middle SES. Low SES was significantly associated with higher odds of less frequent physical activity (aOR = 1.87;95% CI: 1.49 - 2.35) and less fruit and vegetable consumption (aOR = 1.56;95% CI: 1.15 - 2.12). Middle SES relative to high SES was associated with lower odds of more alcohol consumption (aOR = 0.64;95% CI: 0.49 - 0.85) and higher odds of binge drinking (aOR = 1.32;95% CI: 1.09 - 1.59). Conclusions: The adverse impacts of COVID- 19 on cancer prevention behaviors were seen most in those with lower SES. Public health efforts are currently needed to promote cancer prevention behaviors, especially amongst lower SES adults.

Cook and Move for Your Life: A pilot study of an online intervention to improve diet and physical activity among breast cancer survivors

Purpose: The Cook & Move for Your Life randomized pilot study assessed the feasibility and relative efficacy of two dose levels of a remotely-delivered diet and physical activity (PA) intervention for breast cancer (BC) survivors. Methods: Women with a history of stage 0-III BC who were >60 days post-treatment, ate <5 servings per day of fruits/vegetables or engaged in <150 minutes per week of moderate to vigorous physical activity (MVPA), and had smartphone or computer access were enrolled. Participants were randomized to receive one of two doses of an online diet and PA didactic and experiential program, with outcomes measured at 6 months. The low-dose arm received a single 2-hour Zoom session delivered by a dietitian, a chef, a culinary educator, and an exercise physiologist;the high-dose arm received 12 2-hour Zoom sessions over 6 months. All participants received weekly motivational text messages, a Fitbit to self-monitor PA, and study website access. The primary objective was to evaluate overall feasibility based on accrual, adherence, and retention. Prespecified feasibility endpoints were 75% retention at 6 months and 60% of high-dose arm participants attending at least 8 of the 12 sessions. Secondary objectives were to compare high vs. low dose intervention effects on 6-month changes in fruit/vegetable servings per day (24-hour dietary recall), MVPA minutes per week (accelerometry), and blood and stool biomarkers.Results: From December 2019 to January 2021, 74 women were accrued. On average, women were 57.9 years old, 4.8 years post-diagnosis, with body mass index of 29.1 kg/m2 . Most were nonHispanic white (89.2%), 51.4% were diagnosed at stage I, and 40.5% were on endocrine therapy. Questionnaire and biospecimen data collection at 6-months were completed for 93.2% and 83.8% of the sample, respectively. In the low-dose arm (n=36), 94.4% of participants attended the single class, while in the high-dose arm (n=38) 84.2% of participants attended at least 8 of the 12 sessions live or via video archived on the website (mean 9.4 sessions). On average over the 6-month intervention period, participants responded to 71.5% of the text messages, 73.0% wore their Fitbit device ≥50% of the time, and 77.0% accessed the study website. Mean vegetable intake increased by 1 serving per day among women in the high-dose arm and decreased slightly among women in the low-dose arm (P=0.03). Changes in fruit/vegetable intake and MVPA varied little by arm. Blood and stool biomarker analyses are ongoing. Conclusion: We successfully conducted a remotely-delivered diet and PA intervention for BC survivors with high accrual, adherence, and retention during the COVID-19 pandemic. Women in the high-dose arm increased vegetable intake relative to the low-dose arm. Future research will refine and test the intervention in a larger and more diverse study population.

Predictors of objectively-measured sedentary time during the COVID-19 pandemic among breast cancer survivors participating in a diet and physical activity intervention

Purpose of the study: The purpose of this study was to investigate the predictors of objectively-measured sedentary time (ST) among breast cancer (BC) survivors who were 60 days post-treatment and were initiating participation in an intervention to improve diet and physical activity (PA) during the early phase of the COVID-19 pandemic. Methods: Cook and Move for Your Life (CMFYL) was a pilot and feasibility study of stage 0-III BC survivors testing the effects of a remotely-delivered and remotely-assessed nutrition and PA intervention. Women were ≥60 days post-treatment (current endocrine therapy allowed), consumed <5 servings of fruits/vegetables per day and/or engaged in <150 minutes/week of moderate to vigorous physical activity (MVPA). Hip-worn Actigraph GT3X accelerometers measured ST for 7 consecutive days at baseline. ST was defined as minutes/day (continuous) based on the Troiano cutpoint (<100 counts/minute), during awake (6am-11pm) wear time, and non-wear was identified using the Choi algorithm on the vector magnitude counts/minute. Multivariable linear regression models adjusting for wear time (average minutes/day) and minutes of MVPA/day were used to examine whether the following factors were predictors of ST at baseline: self-reported demographics, psychosocial factors (assessed via PROMIS Physical Function and PROMIS Anxiety forms), diet quality (Healthy Eating Index 2015 score), caloric intake (calories/day), and fruit and vegetable intake (servings/day). Results: Among the 84 women included in this analysis who had actigraphy measurements at baseline, the average ST/day was 684±79 minutes. On average, women were 58±10 years in age and most self-identified as non-Hispanic white (87%). The average time since diagnosis at time of enrollment was 4.5 years and 59% of women were receiving endocrine therapy at baseline. Adjusted models show that participants with a college degree had 24.7 (95%CI 2.0, 47.4) more minutes of ST than those with less than a college degree, and for every 1-point increase in PROMIS Physical Function scores participants had 2.5 (95%CI -4.9, -0.2) fewer minutes of ST. Conclusion: In a sample of BC survivors enrolled in a diet and PA intervention, higher level of education and poorer physical function were associated with higher ST during the early phase of the COVID-19 pandemic. These findings provide preliminary insight into factors associated with ST. Future work will investigate how these factors influence change in ST after participation in the CMFYL intervention.

The UK Coronavirus Job Retention Scheme and diet, physical activity, and sleep during the COVID-19 pandemic: evidence from eight longitudinal population surveys.

BACKGROUND: In March 2020, the UK implemented the Coronavirus Job Retention Scheme (furlough) to minimise job losses. Our aim was to investigate associations between furlough and diet, physical activity, and sleep during the early stages of the COVID-19 pandemic. METHODS: We analysed data on 25,092 participants aged 16-66 years from eight UK longitudinal studies. Changes in employment, including being furloughed, were based on employment status before and during the first lockdown. Health behaviours included fruit and vegetable consumption, physical activity, and sleep. Study-specific estimates obtained using modified Poisson regression, adjusting for socio-demographic characteristics and pre-pandemic health and health behaviours, were statistically pooled using random effects meta-analysis. Associations were also stratified by sex, age, and education. RESULTS: Across studies, between 8 and 25% of participants were furloughed. Compared to those who remained working, furloughed workers were slightly less likely to be physically inactive (RR = 0.85; [95% CI 0.75-0.97]; I 2 = 59%) and did not differ overall with respect to low fruit and vegetable consumption or atypical sleep, although findings for sleep were heterogenous (I 2 = 85%). In stratified analyses, furlough was associated with lower fruit and vegetable consumption among males (RR = 1.11; [1.01-1.22]; I 2 = 0%) but not females (RR = 0.84; [0.68-1.04]; I 2 = 65%). Considering changes in quantity, furloughed workers were more likely than those who remained working to report increases in fruit and vegetable consumption, exercise, and hours of sleep. CONCLUSIONS: Those furloughed exhibited similar health behaviours to those who remained in employment during the initial stages of the pandemic. There was little evidence to suggest that adoption of such social protection policies in the post-pandemic recovery period and during future economic crises had adverse effects on population health behaviours.

Impact of COVID-19 stress on food insecurity and fruit and vegetable consumption among college students.

Objective: This cross-sectional study utilized structural equation modeling to examine effects of COVID-19 stress on food insecurity and fruit and vegetable consumption mediated through personal agency and behavioral intention. Participants: Students (n = 749) enrolled at one federally designated Hispanic-serving public university during the fall 2020 semester. Methods: A 34-item survey was developed and administered. Results: COVID-19 stress had a statistically significant impact on food insecurity (B = .341; p < .001) and an inverse impact on personal agency to consume fruit and vegetables (B = -.283; p < .001). Personal agency (B = .389; p < .001) and behavioral intention to consume fruit and vegetables were directly associated while food insecurity inversely impacted behavioral intention (B = -.076; p = .034). Conclusions: Pandemic-related stress impacts nutrition behaviors among the student population already at risk of poor fruit and vegetable intake. During periods of high pandemic-related stress, college students need adequate access to fruits and vegetables and health promotion programs emphasizing stress management and healthy dietary behaviors.

Assessment of Healthcare Professionals' Wellbeing During a Peak of the COVID-19 Pandemic in the United States

Methods: Healthcare professionals were invited to participate across the University Hospitals healthcare system in Ohio, USA. Participants (N = 6397) completed online questionnaires on their wellbeing, including healthy behaviors, safety and security, mental and physical health concerns, and social support. Differences in wellbeing across demographics were also assessed. Results: Overall, healthcare professionals' mean subjective wellbeing was 7.98 (1.50) and their future health score was 3.98 (1.13). Room for improvement was noted for diet, sleep, and positive thinking. Males reported significantly higher levels of overall wellbeing and future health scores, including fruit and vegetable intake and physical activity, and alcohol use, whereas females reported higher levels of positive thinking and tobacco use. Of the three largest racial groups, White and Asian employees scored significantly higher on future health, M = 4.00 (1.17) and M = 4.10 (1.13), than Black or African American employees, M = 3.74 (1.10). Background: The purpose of this cross-sectional study was to evaluate multiple indices of wellbeing in healthcare professionals during the COVID-19 pandemic. Conclusion: This cross-sectional study assessed the wellbeing of healthcare workers during the initial peak of the COVID-19 pandemic prior to vaccine delivery. Future work will implement strategies to improve healthcare workers' wellbeing in an individualized way based on our findings, as well as evaluate changes in wellbeing and future health scores across time.

THE EFFECTS OF THE COVID-19 PANDEMIC ON PEOPLE WITH TYPE 2 DIABETES USING ONE DROP

Background and Aims: The COVID-19 pandemic has had a profound impact on the world, yet research of impact on people with type 2 diabetes (T2D) is lacking. Methods: This survey study describes self-reported impact of the pandemic on life areas (Coronavirus Impact Scale), preventative care appointments and health management behaviors for One Drop members with T2D. Results: Mean age of the 171 participants was 55 and they were 55% male, 70% white, 95% insured, 89% COVIDvaccinated, 85% had not had COVID, and 95% rated One Drop as helpful for diabetes-health management. Due to the pandemic, 94% reported negative life impacts, 63% reported missed/ delayed preventative appointments, and 76% reported impacts on diabetes-related health behaviors. Life areas impacted include routines (83%), stress (73%), social life (72%), family (61%), while missed/delayed appointments were dental cleanings (42%), A1C or blood pressure checks (35%), and primary care visits (25%). Among health behaviors, physical activity (68%), vegetable intake (32%), and carbohydrate tracking (37%) were most frequently impacted. For those reporting impact, higher levels of impact were associated with higher levels of diabetes distress and A1C in each impact area (p < .05), however, missed appointments were unrelated to A1C. Conclusions: Although most found One Drop helpful for diabetes-health management, the pandemic negatively impacted people with T2D, which was further associated with poorer health outcomes. Impacts might have been more severe in the absence of One Drop, which warrants investigation. Diabetes management programs should anticipate and target pandemicrelated barriers to best support people with T2D during this time.

Physical Activity and Nutrition Intervention for Middle Schoolers (Move More, Get More): Protocol for a Quasi-Experimental Study.

BACKGROUND: Physical activity and nutrition behaviors are important to reducing the prevalence of childhood obesity. Previous research has identified school-based interventions as effective strategies to improve physical activity and nutrition. However, the results are often mixed, and middle schoolers are an under-studied population. OBJECTIVE: Our study aims to fill this gap by developing an after-school intervention to increase physical activity and fruit and vegetable consumption that is influenced by national guidelines and formative research. METHODS: This study was an after-school, quasi-experimental study spanning 9 months. Enrollment began in September 2021 and continued on a rolling basis through February 2022. Weekly, middle schoolers were offered 2-3 physical activity sessions and 1 produce kit. Physical activity was measured using accelerometers and questionnaires. Nutrition behaviors were assessed using questionnaires, and physical literacy was assessed using researcher observations. Follow-up data collection occurred in December 2021 and in April 2022. Difference scores will be calculated and analyzed for each outcome variable. RESULTS: The intervention started in September 2021 and will conclude in May 2022. Published study results are expected in late 2022. CONCLUSIONS: An increase in physical literacy, physical activity, and fruit and vegetable consumption is expected. If successful, future studies will focus on reach and sustainability. Lastly, this study may serve as a model for improving health outcomes in middle schools. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/37126.

SEDENTARY LIFESTYLE MAY CONTRIBUTE TO THE RISK OF DEPRESSION DURING THE COVID-19 PANDEMIC: A Snapshot of Hungarian Adolescents

Background: Social exclusion usually contributes to an increased vulnerability to mental health problems and risky health behaviors. This study aims to identify the role of health behavior in the increased risk of depressive symptoms among adolescents during the coronavirus pandemic in Hungary. Methods: A total of 705 high school students participated in our study (M = 15.9 years;SD = 1.19). The self-administered questionnaire included items about sociodemographics, eating habits, physical activity, sedentary behavior, and substance use. Depressive symptoms were measured using the short version of the Child Depression Inventory. Descriptive statistics and binary logistic regression were used to analyze our results. Results: Daily fruit and vegetable consumption was reported by 21.7% and 22.4% of respondents, respectively. The proportion of the respondents reporting daily sweets consumption stood at 13.2%, daily soft drinks consumption was 12.3%, and daily energy drink consumption tallied to 4.5%. More than one-third of the sample (35.5%) reported having breakfast every school day, which rose to 68.1% of the sample reporting breakfast on both weekend days. The rate of students engaged in daily physical activity was 6.5%, while 86.1% of them reported more than four hours screen time in a day. In addition, despite the mandatory confinement, a notable percentage of adolescents engaged in substance use. Consistent with previous studies, girls had a higher risk of depression. Low levels of physical activity and high levels of screen time - as well as alcohol and drug use - were associated with a high risk of depression. Conclusions: We believe our study provided useful information on adolescent health behaviors that can lead to adolescents' depression, and that maintaining physical activity can prevent it even in these unusual circumstances.

The relationship of fast food consumption with sociodemographic factors, body mass index and dietary habits among university students

Purpose University students are one of the vulnerable groups in terms of having nutritional problems due to their lifestyle and social environment. This study aims to determine the consumption of fast food among university students and evaluate factors that may impact it, such as sociodemographic factors, body mass index (BMI) or nutritional habits. Design/methodology/approach A cross-sectional study was conducted among a random sample of 184 university students (47.8% men and 52.2% women) with a mean age of 21.1 +/- 2.0 years. The survey included students' sociodemographic characteristics, anthropometric measurements, nutritional habits and fast-food consumption. Chi-square test, t-test and binary logistic regression analysis were used depending on the characteristics of the data. Findings Results indicated that 39.7% of the students consumed fast food at least once in 15 days and preferred these foods for taste, workload and social activity. Consumption of fast food occurred at an earlier age in men (%13.6) and the portions were higher than portions of vegetables (p = 0.001). By using regression analysis, a statistically significant relationship was found between the frequency of fast-food consumption and age, gender, economic status, BMI, the amount of vegetables consumed daily and the habit of eating breakfast (p < 0.05). Research limitations/implications It is planned to reach more students in the study. However, due to the COVID-19 pandemic, transportation to students became difficult or could not be reached. Originality/value This study is one of the rare studies examining students' orientation to fast food. The number of studies in this field in Turkey is limited.

Purchases of Fruit and Vegetables for at Home Consumption During COVID-19 in the UK: Trends and Determinants.

This paper addresses the issue of fruit and vegetable purchases in the UK during the COVID-19 pandemic. The study is motivated by the importance of fruit and vegetables for human nutrition, health and reduction of population obesity, especially in the UK where per capita consumption is still below recommended levels. A rich panel dataset was used reporting actual shopping places and quarterly expenditure for at-home consumption of fruit and vegetable purchases of 12,492 households in years 2019 and 2020. The unique dataset allowed us to compare expenditure for fruit and vegetables before and after the COVID-19 outbreak and to identify the main drivers of changes in purchases. Regression analysis found that expenditure increased ~3% less than what expected given the overall increase in the numbers of at-home meals during lockdown. Also, Online shopping was found to be an alternative source for fruit and vegetables purchase during the pandemic. However, the expenditure for processed products grew more than the one for fresh products, resulting in a reduction of the relative share of the latter and possible deterioration of the diet quality.

Successful Community Nutrition Incentive Program Data Collection during the COVID-19 Pandemic: A Case Study.

Background: The coronavirus 2019 (COVID-19) pandemic has complicated rigorous evaluation of public health nutrition programs. The USDA Gus Schumacher Nutrition Incentive Program (USDA GusNIP) funds nutrition incentive programs to improve fruit and vegetable purchasing and intake by incentivizing Supplemental Nutrition Assistance Program (SNAP) participants at the point of sale. GusNIP grantees are required to collect survey data (e.g., fruit and vegetable intake and food insecurity status) on a subset of participants. However, due to COVID-19, most GusNIP grantees faced formidable barriers to data collection. The Hunger Task Force Mobile Market (HTFMM), a Wisconsin-based 2019 GusNIP grantee, used particularly innovative methods to successfully collect these data (n > 500 surveys). Objectives: The aim was to explore HTFMM's successful participant-level data-collection evaluation during COVID-19. Methods: A single case study methodological approach framed this study. The case is the HTFMM in Milwaukee, WI, USA. Participants included HTFMM leadership (n = 3), evaluators (n = 2), staff (n = 3), volunteers (n = 3), and customers (n = 10). These teleconference interviews were recorded and transcribed verbatim. Transcripts were coded using thematic qualitative analysis methods with 2 independent coders. Results: Four salient themes emerged: 1) there were multiple key players with unique roles and responsibilities who contributed to personalized, proactive, and time-intensive, telephone-based proctored survey collection methods; 2) the importance of resources dedicated to comprehensive evaluation; 3) longstanding relationships rooted in trust and community-based service are key to successful program delivery, engagement, and evaluation; and 4) the COVID-19 data-collection protocol also serves to mitigate nonpandemic challenges to in-person survey collection. Conclusions: These findings provide guidance on how alternative methods for data collection during COVID-19 can be used and applied to other situations that may affect the ability to collect participant-level data. These findings contribute to a growing body of literature as to best practices and approaches to collecting participant-level data to evaluate public health nutrition programs.

Group consultations to enhance practical cooking skills and knowledge to improve heart health-a social prescribing initiative

Introduction: Social prescribing is an important way to resource communities and where healthcare practitioners can prescribe activities rather than pharmaceuticals. Building on experience of delivering cooking from scratch courses as part of the NCIM Food for Wellbeing services, we won funding from Health Heart (FFHH)UK to deliver a range of Food for Healthy Heart classes in areas of social deprivation. One of the courses was delivered into a Men's Shed initiative in Somerset. Methods: Patients were recruited via link workers, practice nurses GPs and word of mouth to three courses in Bristol. Because of the COVID 19 pandemic we moved classes online and then to a hybrid model. Participants learnt culinary skills and knowledge with an emphasis on bowel health and heart health. Patients attending three FFHH programmes lasting 9 weeks were invited to participate in the evaluation. Each participant completed baseline measures including anthropometrics, demographics, SFFFQ food frequency, MYCAW and WEMWBS. These measures were repeated following the 9-week programme. Each participant also attending a focus group following completion. Results: n=18 participants joined the study. Analysis is still on-going. Preliminary findings suggest that patients reported a highly positive experience on the programme. Common themes included increased confidence on healthy eating, a thirst for further knowledge. Generation of a strong peer support group, and introduction to new healthy foods and recipes. An increase in fruit and vegetable consumption was reported. Full findings will be available at the conference. Conclusion: Patient satisfaction was high and some felt they had been able to radically change lifestyle factors in a supportive group environment. Keywords: Cooking from scratch, Social prescribing, Modifying lifestyle factors, Health activation