Food Insecurity and Ideal Cardiovascular Health Risk Factors Among US Adolescents

BACKGROUND

Food insecurity, a social and economic condition of limited availability of healthy food, is a risk factor for adverse cardiovascular health outcomes among adults; few studies have been conducted in adolescents. This study explores the association between food insecurity and cardiovascular health risk factors among a nationally representative sample of US adolescents, adopting the American Heart Association's Life's Essential 8 metric.

METHODS AND RESULTS

We analyzed data from 2534 adolescents aged 12 to 19 years from the 2013 to 2018 National Health and Nutrition Examination Surveys. In the sample, 24.8% of adolescents lived in food-insecure households. After multivariable adjustment, food insecurity was associated with a 3.23-unit lower total Life's Essential 8 score (95% CI, -6.32, -0.15) and lower scores on diet quality (β=-5.39 [95% CI, -8.91, -1.87]) and nicotine exposure (β=-4.85 [95% CI, -9.24, -0.45]). Regarding diet, food insecurity was associated with 5% lower Healthy Eating Index-2015 scores [95% CI, -7%, -2%], particularly lower intakes of whole grains and seafood/plant proteins and marginally higher intake of added sugar. Regarding nicotine exposure, food insecurity was associated with ever use of a tobacco product among m (odds ratio, 1.74 [95% CI, 1.20-2.53]). Compared with their food-secure counterparts, food-insecure male (odds ratio, 1.98 [95% CI, 1.07-3.65]) and female (odds ratio, 3.22 [95% CI, 1.60-6.45]) adolescents had higher odds of living with a current indoor smoker.

CONCLUSIONS

In this nationally representative sample of adolescents, food insecurity was associated with multiple indicators of cardiovascular health risk. These findings underscore the need for public health interventions and policies to reduce food insecurity and improve cardioprotective behaviors during adolescence, with particular efforts targeting diet quality and nicotine exposure.

Food Insecurity Among Graduate Students and Postdoctoral Trainees

Importance

Food insecurity on college campuses has emerged as an urgent public health priority; however, there has been a lack of studies focused on graduate students or postdoctoral trainees, particularly those enrolled at private academic institutions.

Objective

To estimate the prevalence of and factors associated with food insecurity among graduate students and postdoctoral trainees at a private academic university in Boston, Massachusetts.

Design, Setting, and Participants

In this cross-sectional survey study, a survey on food insecurity was sent to graduate students and postdoctoral trainees at 3 health-focused graduate schools at Harvard University during the end of the spring 2023 academic term (April to June). Participants were studying medicine, dental medicine, or public health. Data analysis was performed from July to September 2023.

Exposure

Sociodemographic characteristics of graduate students and postdoctoral trainees.

Main Outcomes and Measures

The primary outcome was food insecurity as assessed using the US Household Food Security Survey Module. Food insecurity also encompassed low and very low food security. Bidirectional stepwise logistic regression models were conducted to estimate the factors associated with food insecurity for graduate students and postdoctoral trainees.

Results

The analytic sample included 1745 participants (response rate, 55%): 1287 were graduate students and 458 were postdoctoral trainees. The median age of respondents was 29.0 (IQR, 7.0) years, and more than half (1073 [61.5%]) identified as female. A total of 694 respondents (39.8%) identified as Asian, 625 (35.8%) as White, and 426 (24.4%) as being of other race or ethnicity. The prevalence of food insecurity was 17.4% (224 of 1287) among graduate students and 12.7% (58 of 458) among postdoctoral trainees. Among graduate students, factors associated with food insecurity included being Asian (OR, 1.06 [95% CI, 1.01-1.11]) or of other race or ethnicity (OR, 1.07 [95% CI, 1.02-1.13]), receiving financial aid (OR, 1.09 [95% CI, 1.05-1.13]), and having housing instability (OR, 1.53 [95% CI, 1.45-1.61]). Among postdoctoral trainees, factors associated with food insecurity included receiving Supplemental Nutrition Assistance Program benefits (OR, 1.59 [95% CI, 1.28-1.97]), having housing instability (OR, 1.33 [95% CI, 1.22-1.45]), and not owning a car (OR, 1.11 [95% CI, 1.04-1.18]).

Conclusions and Relevance

In this study, a substantial proportion of graduate students and postdoctoral trainees at a private academic institution experienced food insecurity during the academic year. These findings underscore the need for national and institutional interventions to address the complex, structural factors related to food insecurity in these distinct populations.

Perspectives on healthy eating practices and acceptance of WIC-approved foods among parents of young children enrolled in WIC

INTRODUCTION

The prevalence of childhood obesity remains high in the United States, particularly among children living in low-income households. Diet quality plays an important role in obesity prevention, particularly among mothers as they serve as role models. Those served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) receive nutrient-rich foods aimed at increasing diet quality, yet redemption is low. Digital interventions targeting WIC parents show potential for behavior change and could be used for childhood obesity prevention.

METHODS

This study describes the formative research conducted to understand perspectives on healthy eating practices, acceptance of WIC-approved foods, and preferences for the use of digital tools to improve the purchasing and consumption of WIC-approved foods to improve diet quality. In-depth interviews were conducted with 13 WIC parents and caregivers.

RESULTS

A variety of definitions for and misconceptions about healthy eating exist among WIC caregivers. Most purchased foods were fruits, vegetables, milk, cheese, and eggs and the least purchased foods were yogurt and peanut butter. The biggest facilitator for purchasing WIC-approved foods was the preference of children and caregivers, whereas the biggest barrier was children's picky eating behaviors. Most caregivers reported using their phone to get nutrition information. Most caregivers reported their interest in receiving weekly text messages and indicated preferences about receiving recipes.

CONCLUSION

A text messaging program that includes sending weekly messages, recipes, and nutrition tips is hypothesized to improve diet quality and increase redemption of WIC-approved foods.

Feasibility, Acceptability, and Initial Efficacy of a Digital Intervention to Improve Consumption of Foods Received within a National Nutrition Assistance Program

Many mothers are vulnerable to poor diet quality, particularly those living in low-income households. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutrient-rich foods through its benefits packages, but many WIC participants are not redeeming them. We assessed the feasibility and acceptability of a digital intervention to support redemption and consumption of WIC-approved foods to ultimately improve diet quality. We enrolled 54 maternal-child dyads receiving WIC benefits to receive three to four weekly text messages for 12 weeks focused on behavioral goals to improve consumption of WIC-approved foods. We assessed engagement with weekly tracking messages and satisfaction and collected 24 h dietary recalls to assess preliminary efficacy on dietary intake. Participants were mostly non-Hispanic white (63%) and working (63%), and responded to 7.4 (standard deviation: 4.6) of the 12 weekly messages. Half (n = 27) were high engagers (responded to 80% or more of weekly messages), with 28% (n = 15) responding to all messages. Most felt the feedback (94%) and tips (87%) were helpful and would recommend the program (91%). More were consuming leafy green vegetables compared to baseline (p = 0.01). Mothers of children enrolled in WIC found a text messaging intervention focused on consumption of WIC-approved foods enjoyable and helpful.

Using Interactive Text Messaging to Improve Diet Quality and Increase Redemption of Foods Approved by the Special Supplemental Nutrition Program for Women, Infants, and Children: Protocol for a Cohort Feasibility Study

BACKGROUND

Children in the United States eat too few fruits, vegetables, and whole grains and too many energy-dense foods; these dietary behaviors are associated with increased risk of obesity. Maternal diet plays a key role in shaping children's diets; however, many mothers have poor diet quality, especially those living in low-income households. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal nutrition assistance program that provides mothers and children with nutrient-dense foods, and those who participate have better diet quality. However, many mothers do not redeem all their WIC-approved foods. Thus, there is a need to create effective interventions to improve diet quality, especially among low-income children and families.

OBJECTIVE

This paper aims to describe the development and protocol for a study to evaluate the feasibility, satisfaction, and preliminary efficacy of a fully automated text messaging intervention as a strategy to improve maternal diet quality and the redemption of WIC-approved foods.

METHODS

We describe the use of the framework developed for the description of nonrandomized feasibility studies. Using an observational, prospective cohort study design, we will recruit mothers enrolled in WIC with a child aged ≤2 years. Participants will receive automated SMS text messages aimed at improving the redemption of WIC-approved foods to improve the participants' diet quality for 12 weeks. All outcome measures will be analyzed using descriptive and inferential statistics. Qualitative data will be analyzed using thematic analysis.

RESULTS

Data collection for this study began in March 2021. We expect the study results to be available within 9 months of study commencement. The results will shed light on the feasibility, acceptability, and effectiveness of using automated text messages as a behavior change strategy for mothers enrolled in WIC.

CONCLUSIONS

The results of this pilot study will explore whether this digital behavioral intervention, which will deliver nutrition guidance in accordance with the Dietary Guidelines for Americans using interactive self-monitoring and feedback, is feasible and acceptable. This will lay the foundation for a larger evaluation to determine efficacy for improving diet quality in those most at risk for obesity.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04098016; https://clinicaltrials.gov/ct2/show/NCT04098016.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/32441.