The longitudinal association between caregivers' perceived competence and autonomy and children's dietary consumption before and 10 months into the COVID-19 pandemic.

The COVID-19 pandemic has been stressful, potentially affecting caregivers' feeding choices. Caregivers play a role in shaping children's diets, yet few studies have explored how their competence and autonomy, defined by the Self-Determination Theory, impact children's diets. We examined the relationship between caregivers' autonomy and competence and their feeding practices before and during the first year of the pandemic. A national convenience sample of caregivers with 3-12-year-old children completed an online survey during two time-periods. Questions adapted from the Intrinsic Motivation Inventory measured perceived competence and autonomy for feeding fruits and vegetables (F/V) and limiting sugar-sweetened beverages (SSBs) and desserts. National Health and Nutrition Examination Survey Dietary Screener questions measured children's consumption of F/V, SSBs, and desserts. Paired t-tests examined how child consumption and caregiver's perceived competence and autonomy changed, and logistic regressions examined whether caregivers' competence and autonomy predicted the change in child consumption and if changes in competence and autonomy were associated with changes in child consumption. Caregivers (n = 597) were mostly Black/African American (33.0%) or Latina/o/x (42.7%) and older than 30 years (84.1%). Children's consumption did not change overall, but caregivers' competence for feeding F/V increased, and their competence for limiting SSBs and desserts decreased. Caregiver competence and autonomy before COVID-19 did not predict child dietary consumption during the pandemic. However, change in competence was a significant predictor of the change in child consumption of F/V [OR (95%CI): 0.70 (0.57, 0.86)]. The association between caregiver's perceived competence for feeding F/V and child consumption remained positive and significant in both periods [OR (95%CI) pre and during COVID: 2.09 (1.69, 2.57) - 2.40 (1.88, 3.06)]. This study can inform behavioral interventions supporting caregivers' competence and autonomy around feeding choices.

The gamification of nutrition labels to encourage healthier food selection in online grocery shopping: A randomized controlled trial.

Food purchase choices, one of the main determinants of food consumption, is highly influenced by food environments. Given the surge in online grocery shopping because of the COVID-19 pandemic, interventions in digital environments present more than ever an opportunity to improve the nutritional quality of food purchase choices. One such opportunity can be found in gamification. Participants (n = 1228) shopped for 12 items from a shopping list on a simulated online grocery platform. We randomized them into four groups in a 2 × 2 factorial design: presence vs. absence of gamification, and high vs. low budget. Participants in the gamification groups saw foods with 1 (least nutritious) to 5 (most nutritious) crown icons and a scoreboard with a tally of the number of crowns the participant collected. We estimated ordinary least squares and Poisson regression models to test the impact of the gamification and budget on the nutritional quality of the shopping basket. In the absence of gamification and low budget, participants collected 30.78 (95% CI [30.27; 31.29]) crowns. In the gamification and low budget condition, participants increased the nutritional quality of their shopping basket by collecting more crowns (B = 4.15, 95% CI [3.55; 4.75], p < 0.001). The budget amount ($50 vs. $30) did not alter the final shopping basket (B = 0.45, 95% CI [-0.02; 1.18], p = 0.057), nor moderated the gamification effect. Gamification increased the nutritional quality of the final shopping baskets and nine of 12 shopping list items in this hypothetical experiment. Gamifying nutrition labels may be an effective strategy to improve the nutritional quality of food choices in online grocery stores, but further research is needed.

Use of Bland-Altman Analysis to Examine the Racial and Ethnic Representativeness of Study Populations in Community-Based Pediatric Health Research.

Importance: Children from marginalized racial and ethnic groups are underrepresented in health research. To improve external validity and routinize race and ethnicity reporting, a specific and standardized methodology for quantifying representativeness of participant populations is needed. Objective: To develop a standardized method for quantifying the racial and ethnic representativeness of study samples. Design, Setting, and Participants: In this cross-sectional study, data from 7 US community-based health studies (conducted between 2003 and 2017) were retrospectively pooled to assess the school-level representativeness of enrolled samples by race and ethnicity. The sampling frame for the study was constructed using the National Center of Education Statistics Common Core of Data, which provides year-specific racial and ethnic counts by grade. Representativeness was quantified by aggregating children's data at the school level, reported individually for Asian, Black, Hispanic or Latino, Native Hawaiian or other Pacific Islander, White, or multiple races. In this analysis, the Asian and Native Hawaiian or other Pacific Islander subgroups were combined. Data were analyzed from April 1 to June 15, 2022. Exposure: Community-based nutritional health studies conducted with children in grades 1 to 8. Main Outcomes and Measures: Visual comparisons of percentage expected and percentage observed of the pooled sample by race and ethnicity were performed using scatterplots and Bland-Altman plots. Spearman rank-order correlation was used to assess associations. Results: This study included 104 study schools (N = 5807 children) located in California, Kentucky, Massachusetts, Mississippi, and South Carolina. Bland-Altman analysis revealed notable patterns and variability in the representativeness of racial and ethnic groups. Differences in the overall representativeness of Asian or Native Hawaiian or other Pacific Islander children (0.45 percentage points [95% CI, -7.76 to 8.66]), Black children (0.12 percentage points [95% CI, -15.73 to 15.96]), and White children (-0.72 percentage points [95% CI, -23.60 to 22.16]) were negligible, but measures of spread suggested that target population demographics affected representativeness differently across groups. Conclusions and Relevance: The results of this cross-sectional study suggest that replicating, testing, and scaling the proposed method for quantifying racial and ethnic representativeness, which uses measures of spread, could improve the transparency of race and ethnicity reporting during publication and lead to a more externally valid health evidence base. During implementation, investigators should adopt community-based research methods and allocate appropriate resources during recruitment, including a priori assessment of population demographics, as these conditions may affect racial and ethnic study enrollment differently. Prioritizing these methodological decisions could alleviate rising inequities.

Changes in children's and adolescents' dietary intake after the implementation of Chile's law of food labeling, advertising and sales in schools: a longitudinal study.

BACKGROUND: In June 2016, a comprehensive food policy was implemented in Chile that included front-of-package warning labels on key nutrients of concern (total sugars, added saturated fats, sodium, and calories), child-directed food advertisement bans, and school regulations. The policy was implemented in 3 phases from 2016 to 2019 and the primary objective was to improve children's food environments. This study's objective was to assess changes in child and adolescent intake of key nutrients of concern (total sugars, saturated fats, and sodium) at school after the initial implementation of Chile's Law of Food Labeling and Advertisement. METHODS: Longitudinal study of 349 children from the Food Environment Chilean Cohort (FECHIC) and 294 adolescents from the Growth and Obesity Cohort Study (GOCS). Data were from single 24-hour dietary recalls collected from 2016 to 2019. Fixed-effects models stratified by school, home, and other locations compared nutrient consumption in each year to consumption at the pre-policy 2016 baseline. Nutrient intakes are expressed as percent of total energy. RESULTS: Compared to 2016 (pre-policy), total sugars consumed by children at school decreased 4.5 [-8.0, -0.9] percentage points (pp) and 11.8 [-15.4, -8.3] pp in 2018 and 2019 respectively. In 2019, children's saturated fats and sodium intake at school also decreased (1.1 [-1.9, -0.2] pp and 10.3 [-18.1, -2.5] mg/100 kcal respectively). Likewise, in adolescents, total sugars and saturated fats consumed at school decreased in 2018 (5.3 [-8.4, -2.2] pp and 1.5 [-2.7, -0.3] pp respectively). However, consumption of key nutrients of concern at other locations increased after implementation of the policy. CONCLUSIONS: After initial implementation of Chile's Labeling Law, intake of most key nutrients of concern significantly declined at school. However, we found evidence of compensatory behavior in out-of-school settings. Further research is needed to evaluate what other actions are needed to impact overall diets in the long term both at schools and out of school.

Understanding Micro-pantries as an Emergency Food Source During the COVID-19 Pandemic.

OBJECTIVE: To explore the role of micro-pantries in addressing food insecurity during the coronavirus disease 2019 (COVID-19) pandemic. DESIGN: Qualitative interviews with 20 micro-pantry users and 10 stakeholders during April and May, 2020. SETTING: Six US states. PARTICIPANTS: Users, aged ≥ 18 years, had obtained food from a micro-pantry in the past 2 weeks; stakeholders, aged ≥ 18 years, played a role in organizing micro-pantries at the community, regional, or national levels. PHENOMENA OF INTEREST: Impact of COVID-19 on food insecurity and use of micro-pantries to mitigate it; benefits of, suggested improvements to, and adoption and administration of micro-pantries. ANALYSIS: We transcribed the data verbatim and performed deductive qualitative content analysis. RESULTS: Micro-pantry users had increased their use of both micro-pantries and regular food pantries during the pandemic. Micro-pantries helped stretch resources. Users appreciated the anonymity and choice; the mutual aid aspects reduced stigma. Stakeholders described micro-pantries as providing a direct way for neighbors to help neighbors during the pandemic. They described a decentralized and informal system of administration. CONCLUSIONS AND IMPLICATIONS: Findings suggest that micro-pantries provided a supplemental food source that supported the resilience of communities during the COVID-19 pandemic.

Beyond price and income: Preferences and food values in peri-urban Viet Nam.

Sub-optimal diets are one of the most important risk factors contributing to the global burden of disease. Developing a better understanding of the drivers of food choice, including the role of individual preferences, is important to address this issue. The objective of this mixed methods research was to identify the relative importance of preferences for different food quality attributes (e.g. nutrition, food safety, price and convenience) that might influence shopping habits and food choice in the context of a rapidly changing peri-urban food environment in Hanoi Province, Viet Nam. A total of 264 women were randomly selected and interviewed using Best-Worst Scaling to elicit preferences among food quality attributes for different food groups (leafy green vegetables, fruits, instant foods, snack foods). A subset of these respondents (n = 40) participated in focus group discussions in order to explore their preferences and food values in more detail. The food quality attributes considered to be most important varied by food group with nutrition and food safety (both immediate and future health) ranking highest for leafy green vegetables and fruits, convenience for instant foods, and taste for snack foods. Price was considered least important across all food groups. Focus group discussions reinforced these results with additional insights particularly regarding trade-offs between nutrition, food safety, convenience, and price. This research demonstrates the feasibility of identifying important drivers of consumption in a South East Asian context using Best-Worst Scaling. These results could help inform the design of behavior change interventions and guide food system policies that seek to shift consumer choices towards healthier diets.

Perceived Benefits and Barriers to Free Summer Meal Participation Among Parents in New York City.

OBJECTIVE: To examine perceived benefits and barriers of summer meal participation among lower-income families who participate in school lunch programs during the year. DESIGN: Semistructured phone interviews were conducted with parents of elementary-aged children, including both participants and nonparticipants in summer meals. SETTING: Queens, Bronx, and Brooklyn, NY. PARTICIPANTS: Participants were lower-income, racially/ethnically diverse parents of elementary-aged children. Of 20 participants, 17 were minorities (85%), 16 were women (80%), and 11 had an annual household income < $30,000 (55%). PHENOMENON OF INTEREST: Interviews explored parents' experiences with summer meals programs, the impact on food provisioning in the summer, and benefits and barriers. ANALYSIS: Interviews were transcribed, coded, and analyzed thematically. RESULTS: Five themes emerged, including 3 benefits of summer meals: reducing stress for parents, fostering social support and connection, and the opportunity to develop healthier eating habits; and 2 barriers to participation: lack of cultural inclusivity and lack of widespread knowledge about summer meals. CONCLUSIONS AND IMPLICATIONS: The main purpose of summer meals is to reduce food insecurity, but the programs also provide social and psychological benefits valued by lower-income families in New York, although participation barriers persist.

Food pantry selection solutions: a randomized controlled trial in client-choice food pantries to nudge clients to targeted foods.

Background: Food pantries and food banks are interested in cost-effective methods to encourage the selection of targeted foods without restricting choices. Thus, this study evaluates the effectiveness of nudges toward targeted foods. Methods: In October/November 2014, we manipulated the display of a targeted product in a New York State food pantry. We evaluated the binary choice of the targeted good when we placed it in the front or the back of the category line (placement order) and when we presented the product in its original box or unboxed (packaging). Results: The average uptake proportion for the back treatment was 0.231, 95% CI = 0.179, 0.29, n = 205, and for the front treatment, the proportion was 0.337, 95% CI = 0.272, 0.406, n = 238 with an odds ratio of 1.688, 95% CI = 1.088, 2.523. The average uptake for the unboxed treatment was 0.224, 95% CI = 0.174, 0.280, n = 255, and for the boxed intervention, the proportion was 0.356, 95% CI = 0.288, 0.429, n = 188 with an odds ratio of 1.923, 95% CI = 1.237, 2.991. Conclusions: Nudges increased uptake of the targeted food. The findings also hold when we control for a potential confounder. Low cost and unobtrusive nudges can be effective tools for food pantry organizers to encourage the selection of targeted foods. Trial Registration Number: NCT02403882.

Undiagnosed prediabetes among food insecure adults.

OBJECTIVES: To identify sub-populations at risk for diabetes based on having prediabetes. Although food insecurity has been linked to diabetes, to our knowledge, no studies have examined whether food insecure individuals are more likely than fully food secure individuals to have undiagnosed prediabetes. METHODS: This study was based on a cross-sectional analysis of 6577 adults in the 2005-08 National Health and Nutrition Examination Survey. USDA's Food Security Survey Module, self-reported prediabetes status and clinical measures were examined. RESULTS: Whereas men who were food insecure were more likely than fully food secure men to have undiagnosed prediabetes, no association was observed among women. CONCLUSION: Prediabetes screening appears warranted for food insecure men.