Impacts of COVID-19 on the home food environment and eating related behaviors of families with young children based on food security status

Impacts, Adaptations, and Preparedness Among SNAP-Ed Implementers During the COVID-19 Pandemic: A Multistate Study

OBJECTIVE

The study examines: 1) impacts of COVID-19 on the work of Supplemental Nutrition Assistance Program - Education (SNAP-Ed) implementers, 2) facilitators and barriers experienced in making adaptations, and 3) factors that would have helped with preparedness to adapt.

DESIGN, SETTING, AND PARTICIPANTS

A purposive sample of 181 SNAP-Ed program implementers from across five states completed a survey or interview based on the study aims. Quantitative data was summarized with descriptive statistics and qualitative data was analyzed thematically.

RESULTS

Direct education activities were found to be most impacted during COVID-19 while working to change policies, systems, and environments and indirect education were less impacted. Both positive and negative impacts surfaced. Respondents were most likely to say they were moderately or slightly prepared to make adaptations. Elements of internal organizations, technology, and partners both helped and hindered adapting. Pre-established virtual capacity, formal preparation and planning protocols and procedures, and better and more frequent communication with partners and program leadership would have helped with preparedness.

CONCLUSION

SNAP-Ed needs assessment and implementation processes should integrate and expand upon the lessons learned in the study to enhance future emergency preparedness among program implementers. Program policy should be updated to allow for implementation flexibility during future emergencies.

Multilevel Factors Influencing Food Purchasing Decisions Among Families With Low Incomes During the COVID-19 Crisis: A Qualitative Study

BACKGROUND

The COVID-19 crisis caused large-scale changes to the US food landscape, including food availability and prices, shopping practices, and food assistance programs. Understanding how these changes converged to influence food choices among families is critical for program and policy design to support children's healthy development.

OBJECTIVE

To explore food purchasing and feeding practices among low-income caregivers of young children during the COVID-19 crisis and economic recovery, including changes in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and neighborhood characteristics.

METHOD

This qualitative research conducted focus groups via videoconference with caregivers of young children with low incomes. Focus groups were stratified by WIC participation and language (English/Spanish).

PARTICIPANTS AND SETTING

Eligible participants were adult primary caregivers of a child younger than age 5 years who is a primary care patient at 1 of 2 participating pediatric health care systems, residents of Pennsylvania, fluent in English or Spanish, and were WIC eligible. Nine focus groups were held (7 English and 2 Spanish; N = 51 participants) during April to July 2023.

STATISTICAL ANALYSES PERFORMED

Focus group transcripts were analyzed with a combination of a priori and inductive codes, guided by grounded theory, resulting in a consensus-created coding scheme applied by 2 coders.

RESULTS

Three major themes developed: the COVID-19 crisis exacerbated existing food purchasing challenges and added new challenges; neighborhoods, shaped by structural barriers, do not adequately meet families' food needs; and administrative burdens continue to inhibit WIC use, although pandemic-related changes to WIC were beneficial.

CONCLUSIONS

Complex interactions between the food system, federal assistance program participation, and individual needs add burden to families struggling to make food purchasing choices. Results support the development of solutions to preserve families' agency to enact their beliefs and needs around healthy eating while accessing food assistance programs and managing the lasting economic impacts of the pandemic.

Telemedicine Quality Improvement during the Corona Virus 2019 Pandemic Increases Pediatric Weight Management Access

Background

The corona virus 2019 pandemic disrupted care for pediatric patients with chronic conditions, including those with childhood obesity. Lockdowns forced providers to create new ways of caring for this population. Telemedicine was a promising but previously unavailable solution. This quality improvement report details how the Healthy and Fit Children's Clinic transitioned and improved care via telemedicine.

Methods

Between March 2020 and April 2021, the quality improvement project team incorporated the Model for Improvement to transition the clinic to telemedicine. The team tracked Healthy and Fit Children's Clinic appointments, no-shows, billing and reimbursement data, and noted unintended consequences or unanticipated barriers. Patients and their families were given a satisfaction survey at the end of each telemedicine encounter.

Results

Compared with pre-telemedicine implementation, there was a 120% increase in completed patient clinic visits per week and a sustained positive shift above the established baseline. Telemedicine no-show rates achieved <10%, with an average sustained rate of <20%, compared with unchanged in-person no-show rates of >50% pre- and post-telemedicine implementation. There was a 74% increase in monthly billing and a sustained positive shift above the pre-telemedicine baseline. On average, patients rated all six satisfaction questions ≥92 on the 100-point scale (compared with 83 pre-telemedicine).

Conclusions

This transition to telemedicine was successful and could be translatable to other clinic sites. Patients attended their clinic visits more consistently and were highly satisfied with their care. In a population where continuity of care is paramount, telemedicine shows promise as a tool to treat childhood obesity.

Changes in breakfast and water consumption among adolescents in Canada: examining the impact of COVID-19 in worsening inequity

BACKGROUND

To assess whether changes in breakfast and water consumption during the first full school year after the emergence of the COVID-19 pandemic varied based on sex/gender, race/ethnicity, and socioeconomic status among Canadian adolescents.

METHODS

Prospective annual survey data collected pre- (October 2019-March 2020) and post-COVID-19 onset (November 2020-June 2021) the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) study. The sample consisted of 8,128 students; mean (SD) age = 14.2 (1.3) years from a convenience sample of 41 Canadian secondary schools. At both timepoints self-reported breakfast and water consumption were dichotomized as daily or not. Multivariable logistic generalized estimating equations with school clustering were used to estimate differences in maintenance/adoption of daily consumption post-COVID-19 based on demographic factors, while controlling for pre-COVID-19 behaviour.

RESULTS

Adjusted odds ratios (AOR) with 95% confidence intervals are reported. Females (AOR = 0.71 [0.63, 0.79]) and lower socioeconomic status individuals (AORLowest:Highest=0.41 [0.16, 1.00]) were less likely to maintain/adopt daily breakfast consumption than male and higher socioeconomic status peers in the 2020-2021 school year. Black identifying individuals were less likely than all other racial/ethnic identities to maintain/adopt plain water consumption every day of the week (AOR = 0.33 [0.15, 0.75], p < 0.001). No significant interaction effects were detected.

CONCLUSIONS

Results support the hypothesis that changes in nutritional behaviours were not equal across demographic groups. Female, lower socioeconomic status, and Black adolescents reported greater declines in healthy nutritional behaviours. Public health interventions to improve adherence to daily breakfast and water consumption should target these segments of the population.

TRIAL REGISTRATION

Not a trial.

Formative assessment of community health center Food is Medicine programs during COVID-19 in Northern California

The COVID-19 pandemic disrupted implementa­tion of Food is Medicine (FIM) programs and imposed food security and healthcare-related hard­ships. Understanding access to and experiences with FIM programs during crises and among diverse populations can help build resilience of programs to future shocks. This formative, mixed-methods study aimed to (1) assess potential barriers and facilitators to access to health services during the COVID-19 pandemic, with emphasis on Food is Medicine (FIM) programs; and (2) understand the effects of the pandemic on healthcare access, food security, and related coping strategies among Federally Qualified Health Center (FQHC) clients. From December 2021 to September 2022, 19 inter­views (10 in English, 9 in Spanish) were conducted with clients in Yolo County, CA, with close-ended and open-ended questions about their experiences for a pre-pandemic period (before March 2020) and a pandemic period (last 12 months). Qualita­tive analysis was conducted in NVivo and using the Framework Method. Major themes identified for Objective 1 were: (1) perceived benefits of FIM programs, including increased knowledge and skills and increased access to produce; (2) barriers to program participation, including client time con­straints and limited program awareness; and (3) sat­isfaction with FQHC services. Themes identified for Objective 2 were: (1) changes in healthcare access, such as increased difficulty with access and healthcare cost, and the use of telehealth; (2) changes in food security, including economic barri­ers to purchasing quality food and the decreased quantity of food; and (3) use of federal and com­munity resources to cope with difficulties. Our results suggest potential avenues to strengthen Food is Medicine programs, and highlight the role of FQHC programs, community resources, and social networks as coping strategies for food insecurity and decreased access to care.

Impact of Climate Change, Food Insecurity, and COVID-19 on the Health of Neonates and Children: A Narrative Review

Climate change, food insecurity, and epidemics affect all population sub-groups. This article reviews the current evidence on the relationships between climate change, food insecurity, and the COVID-19 pandemic in the context of newborn and child health. The authors searched Medline, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases using a structured approach. Food insecurity, particularly from the lack of food access and affordability, increased amidst the COVID-19 pandemic. Factors such as nationwide lockdowns, increased unemployment and financial instability, and school closures precipitated food insecurity. Children born to immigrant parents, belonging to racial and ethnic minority groupsor low-income families, and those who were Autistic were highly vulnerable. Climate change also contributes to food insecurity, with increased susceptibility among neonates and children compared to adults. There is a need for further research on the relationships between climate-linked exposures and COVID-19 transmission. Multisectoral collaborations and multilevel interventions are necessary to mobilize local and national resources for mitigating and preventing the synergistic effects of the three concurrent crises. The evidence-informed discourse on this topic can help in improved preparedness and response for future outbreaks and epidemics. The policy interventions for newborn and child survival need to factor in climate change, food insecurity, and emerging diseases.

Food access, domestic environments, and dietary quality of low-middle income Chilean children during the COVID-19 pandemic

Introduction

Food access is associated with dietary quality; however, people living in similar physical environments can have different food access profiles. Domestic environments may also influence how food access relates to dietary quality. We studied food access profiles of 999 low-middle income Chilean families with children during the COVID-19 lockdown and how these profiles relate to dietary quality; secondarily, we also explore the role of the domestic environment in this relationship.

Materials and methods

Participants of two longitudinal studies conducted in the southeast of Santiago, Chile, answered online surveys at the beginning and end of the COVID-19 pandemic lockdown. Food access profiles were developed by a latent class analysis considering food outlets and government food transfers. Children's dietary quality was estimated by self-reported compliance with the Chilean Dietary Guidelines of Americans (DGA) and daily ultra-processed food (UPF) consumption. Logistic and linear regressions were used to assess the association between food access profiles and dietary quality. Domestic environment data (i.e., the sex of the person who buys food and cooks, meal frequency, cooking skills, etc.) were incorporated in the models to assess their influence on the relationship between food access and dietary quality.

Results

We have categorized three food access profiles: Classic (70.2%), Multiple (17.9%), and Supermarket-Restaurant (11.9%). Households led by women are concentrated in the Multiple profile, while families from higher income or education levels are focused on the Supermarket-Restaurant profile. On average, children presented poor dietary quality, with a high daily UPF consumption (median = 4.4; IQR: 3) and low compliance with national DGA recommendations (median = 1.2; IQR: 2). Except for the fish recommendation (OR = 1.77, 95% CI:1.00-3.12; p: 0.048 for the Supermarket-Restaurant profile), the food access profiles were poorly associated with children's dietary quality. However, further analyses showed that domestic environment variables related to routine and time use influenced the association between food access profiles and dietary quality.

Conclusion

In a sample of low-middle income Chilean families, we identified three different food access profiles that presented a socioeconomic gradient; however, these profiles did not significantly explain children's dietary quality. Studies diving deeper into household dynamics might give us some clues on intra-household behaviors and roles that could be influencing how food access relates to dietary quality.