Disparities in Perceived Availability of Healthful Foods, Dietary Behaviors, Diet Quality, and Obesity Among Mothers from Low-Income Households: Additional Evidence in the Call for Broader Approaches to Obesity Prevention.

Purpose: To examine racial/ethnic differences in dietary behaviors, diet quality, body mass, and the perceived availability of healthful foods in one's neighborhood among mothers from low-income California households. Methods: Cross-sectional telephone surveys of mothers from randomly sampled households with incomes ≤185% federal poverty level in 2018 and 2019 using a validated 24-h dietary recall assessment. Dietary outcomes were cups of fruits and vegetables, ounces of sugar-sweetened beverages, teaspoons of added sugars, and kilocalories consumed the previous day. Diet quality was assessed by calculating Health Eating Index-2015 scores. Supplemental survey items assessed mothers' weight and height. Body mass index (BMI) was calculated with a BMI of 30 or higher considered obese. Perceived availability of fresh fruits and vegetables and healthy foods in general within one's neighborhood was recorded. Results: The analytic sample of 9200 mothers was 66.3% Latina, 17.3% white, 12.6% African American, and 3.8% Asian American, Native Hawaiian, or Pacific Islander (AANHPI). African American mothers consumed the fewest cups of fruits and vegetables and the most teaspoons of added sugars, reported poor diet quality, and had the highest obesity rate, 54.7% versus 46.9% for Latinas, 39.9% for whites, and 23.5% for AANHPIs. Accordingly, a greater proportion of African Americans reported limited availability of fresh fruits and vegetables and healthy foods in general in their neighborhood. Conclusion: Findings are interpreted in light of recent calls for broader approaches to address health disparities, including strategies that focus on inequalities in racial/ethnic socioeconomic status and systemic racism.

COVID-19 Benefits and Dietary Behaviors Among Mothers From Low-Income, Food-Insecure Households.

OBJECTIVE: To examine the dietary behaviors of mothers from very low food security (VLFS) households following the availability of coronavirus disease 2019 (COVID-19) unemployment and Supplemental Nutrition Assistance Program benefits. METHODS: Diet and food security status were obtained from 2,584 California mothers during Federal Fiscal Year 2020. Fruits, vegetables, and 100% fruit juice (FV100%FJ), sugar-sweetened beverages, and water intake, and Healthy Eating Index-2015 scores, were compared across 4 groups (before vs after COVID-19 benefits by VLFS vs non-VLFS households) with race/ethnicity and age as covariates. RESULTS: Before COVID-19 benefits, VLFS was associated with fewer cups of FV100%FJ (P = 0.010), more fluid ounces of sugar-sweetened beverages (P = 0.004), and poorer diet quality (P = 0.003). After COVID-19 benefits, mothers from VLFS vs non-VLFS households reported similar dietary outcomes. VLFS mothers reported 0.96 (95% confidence interval, 0.53-1.38) more cups of FV100%FJ after COVID-19 benefits. CONCLUSIONS AND IMPLICATIONS: Coronavirus disease 2019 benefits may have reduced dietary inequities among low-income families. Associations between increased Supplemental Nutrition Assistance Program and unemployment benefits and decreased costs associated with the negative health outcomes linked to food insecurity and poor diets would be of value.

Unemployment, SNAP Enrollment, and Food Insecurity Before and After California's COVID-19 Shutdown.

OBJECTIVES: To examine whether the decrease in very low food security (VLFS) observed in California shortly after California's coronavirus disease (COVID-19) shutdown remained throughout Federal Fiscal Year (FFY) 2020. To investigate associations among unemployment, Supplemental Nutrition Assistance Program (SNAP) enrollment, and VLFS across FFY 2020. METHODS: Telephone interview responses from mothers from randomly sampled households from low-income areas throughout California to the 6-item US Department of Agriculture Food Security Survey Module identified VLFS families. Logistic regression examined VLFS rates before vs after California's COVID-19 shutdown, with race/ethnicity, age, and education as covariates. Pearson correlations were calculated for unemployment, SNAP enrollment, and VLFS. RESULTS: Most (66.4%) of the 2,682 mothers were Latina. VLFS declined from 19.3% before to 14.5% after California's COVID-19 shutdown (adjusted odds ratio, 0.705; P = 0.002). The correlation for unemployment and SNAP household participation was 0.854 (P = 0.007), and for SNAP participation and VLFS was -0.869 (P = 0.005). CONCLUSIONS AND IMPLICATIONS: Publicly-funded assistance programs may lower food insecurity, even during a time of increased economic hardship. Examining the specific factors responsible for the observed decline in VLFS has merit. Whether VLFS remains below the rate observed before California's COVID-19 shutdown is worthy of ongoing study.

Validation of a single survey that can be used for case identification and assessment of asthma control: the Breathmobile Program.

BACKGROUND: Underdiagnosis of asthma and underrecognition of disease severity in lower socioeconomic populations continue to be significant health care concerns despite national efforts to better educate health care providers. OBJECTIVE: To validate a 1-page survey as a point-in-time tool identifying uncontrolled vs controlled asthma and moderate-to-severe disease activity in an urban, lower-socioeconomic pediatric population. METHODS: A previously validated survey (the Breathmobile Case Identification Survey) was evaluated as a point-in-time tool for identifying children with poorly controlled disease. Clinical validation was achieved in children (n = 1,826) presenting to a school-based asthma program for either an initial (n = 666) or a follow-up (n = 1,170) visit. Responses were compared with a comprehensive evaluation by a physician specialist as the gold standard. Response patterns were used to construct multimodel tiered scoring algorithms for baseline and follow-up visits that identify children with uncontrolled asthma, and children are likely to have moderate-to-severe disease activity at that time. RESULTS: Surveys scored using the developed algorithms identified children with uncontrolled asthma (sensitivity: baseline, 77.0%; follow-up, 71.6%; specificity: baseline, 72.7%; follow-up, 71.5%) and detected moderate-to-severe disease activity (sensitivity: baseline, 69.2%; follow-up, 77.4%; specificity: baseline, 70.2%; follow-up, 70.3%). CONCLUSIONS: The Breathmobile Case Identification Survey can be used in lower-socioeconomic, urban populations as a point-in-time tool for identifying children with uncontrolled vs controlled asthma and moderate-to-severe disease activity.

School absenteeism in children with asthma in a Los Angeles inner city school.

OBJECTIVE: To investigate the pattern of school absenteeism in asthmatic children within a Los Angeles inner city school. STUDY DESIGN: Five hundred twenty-eight students of predominant Hispanic ethnicity, from a Los Angeles inner city school were divided into 3 groups: known asthma, high probability of asthma, and low probability of asthma using a previously validated instrument. Attendance records of these students were analyzed to determine total and respiratory absences over a year. School records were compared to the corresponding answers on 513 surveys to determine the accuracy of parental responses in regard to their children's absenteeism. RESULTS: Children with known asthma missed on average 2 more days of school than children with low probability of asthma and high probability of asthma. This was only significant in the younger age groups. Survey responses were found to have a 45.6% agreement with school attendance records. Underestimation occurred more often when school-recorded absentee rates were highest. Overestimation occurred more by parents of children with known asthma or a high probability of asthma. CONCLUSION: In a Los Angeles inner city population, younger children with known asthma miss more days of school than those with no asthma. Survey-reported absenteeism is less accurate than school attendance records.