Bridging the Gap between Food Insecurity and Subsequent Child Body Mass: Mediating Effects of Dietary Quality and Feeding Styles in Low-Income Hispanic Preschoolers

Background: Low-income Hispanic preschoolers face disproportionately high prevalence of food insecurity (FI) and obesity. Consumption of low-cost, energy-dense foods to compensate for FI leads to excess body-mass. FI parents may adopt feeding styles that contribute to decline in children’s dietary quality. Feeding style describes the amount of demandingness (i.e., control of children’s eating) and responsiveness (i.e., warmth used to express demandingness). FI may indirectly contribute to obesity through dietary quality and feeding style. Purpose: This study investigated: 1. if dietary quality mediated the relationship between food security status (FSS) at Time 1 (T1) and child body-mass at Time 2 (T2), 2. if feeding demandingness (PFD) and/or responsiveness (PFR) mediated the relationship between FSS at T1 and child dietary quality at T2, 3. explored if gender and/or parental acculturation moderated the mediation. Method: The current study was a secondary analysis of an observational study (R01 HD06257, PI: Hughes). Hispanic parent-preschooler dyads (n=137) provided data through the 6-item Household Food Security Survey, Healthy Eating Index-2015 (HEI), Caregiver’s Feeding Style Questionnaire, Bidmensional Acculturation Scale, and body-mass-index z-score (BMIz) at two timepoints 18 months apart. Mediation and moderated mediation analyses were conducted using regression models while controlling co-variates. Bias-corrected bootstrap confidence intervals estimated indirect effects. Outcomes: FSST1 did not indirectly influence child BMIzT2 through HEIT1 (ab= -0.00, bootstrap CI [-0.15, 0.03]). FSST1 also did not indirectly influence HEIT2 through PFDT1 (ab= -0.01, bootstrap CI [-0.15, 0.03]) or PFRT1 (ab= 0.01, bootstrap CI [-0.04, 0.14]). However, as FSST1 worsened, HEI-2015T2 improved (c= 1.06, 95% CI [0.43, 1.69]). As a co-variate, higher baseline English acculturationT1 predicted lower HEI-2015T2 (β= -3.44, 95% CI [-5.62, -1.26]) and higher BMIzT2 (β= 0.13, 95% CI [0.05, 0.21]); however, it did not have significant conditional effects in moderated mediation models. Gender (pFSSxGender= .04) moderated the direct effect of FSST1 on BMIzT2; however, effect size ((β= 0.05, 95% CI [0.002, 0.09]) was too small to be clinically relevant. Conclusion: FI did not affect body-mass through dietary quality, nor did it affect dietary quality through PFD or PFR. However, an unexpected positive direct relationship between FI and subsequent dietary quality warrants further exploration

Disruptive Momentum: The Value of Implementing Best Practices in Health Research Postdoctoral Mentorship

COVID-19 called attention to the challenges postdoctoral fellows in health research face when they have times of prolonged disruption or changes in work conditions; this disruption revealed key insights on how mentors, fellows, and their institutions can work together to ensure training continuity. To prepare strong scientists, postdoctoral fellowships need mentoring, training, and networking opportunities to enhance fellows’ professional and skill development. In this article we outline potential solutions to minimize the impact of disruptions while promoting adaptable postdoctoral fellowship experiences by addressing how mentors and fellows alike can intervene on three key aspects of fellowships in health research: mentorship, training, and networking

Diet Quality as a Mediator of the Relation between Income-to-Poverty Ratio and Overweight/Obesity among Adults: Moderating Effect of Sex

Poverty status influences obesity and dietary quality, and dietary quality influences obesity. How these relationships differ by sex is unclear. The current study aims were to 1) determine whether dietary quality mediates the relation between income-to-poverty ratio (IPR) and overweight/obesity (OV/OB) among men and women, separately, and 2) determine whether either of the mediated paths differs by sex. Four cycles of NHANES (2007-2014) were merged to obtain an unweighted study sample of 12,768 adults with complete data. Exposure variables included self-reported measures of IPR, Healthy Eating index (HEI) total score to measure diet quality, and sex. Direct assessment of height and weight was used to create OV/OB vs. normal weight categories of interest. A multiple-group moderated mediation model was conducted to evaluate the moderating effect of sex on the association between IPR and OV/OB through HEI. Covariates included age, race, marital status, education, employment, meeting physical activity recommendations, and daily sedentary time. A greater proportion of females experienced OV/OB, lower IPR, and higher HEI. The association between IPR and HEI did not differ by sex. Greater IPR was associated with lower odds of experiencing OV/OB for women and higher odds of experiencing OV/OB among men. For both males and females, HEI partially mediated the relationship between IPR and OV/OB (p \u3c .05). While efforts to improve dietary quality of all adults regardless of income and sex is needed, improving the dietary quality of higher income men may assist with reducing their experiences with OV/OB

Diet Quality as a Mediator of the Relation between Income-to- Poverty Ratio and Overweight/Obesity among Adults: Moderating Effect of Sex

Poverty status influences obesity and dietary quality, and dietary quality influences obesity. How these relationships differ by sex is unclear. The current study aims were to 1) determine whether dietary quality mediates the relation between income-to-poverty ratio (IPR) and overweight/obesity (OV/OB) among men and women, separately, and 2) determine whether either of the mediated paths differs by sex. Four cycles of NHANES (2007-2014) were merged to obtain an unweighted study sample of 12,768 adults with complete data. Exposure variables included self-reported measures of IPR, Healthy Eating index (HEI) total score to measure diet quality, and sex. Direct assessment of height and weight was used to create OV/OB vs. normal weight categories of interest. A multiple-group moderated mediation model was conducted to evaluate the moderating effect of sex on the association between IPR and OV/OB through HEI. Covariates included age, race, marital status, education, employment, meeting physical activity recommendations, and daily sedentary time. A greater proportion of females experienced OV/OB, lower IPR, and higher HEI. The association between IPR and HEI did not differ by sex. Greater IPR was associated with lower odds of experiencing OV/OB for women and higher odds of experiencing OV/OB among men. For both males and females, HEI partially mediated the relationship between IPR and OV/OB (p \u3c .05). While efforts to improve dietary quality of all adults regardless of income and sex is needed, improving the dietary quality of higher income men may assist with reducing their experiences with OV/OB

Objectively Measured Chronic Disease Risk Among Food Pantry Patrons

Objectives and Design: This cross-sectional, observational study examined the prevalence of objectively measured chronic disease risk factors among a diverse group of food pantry patrons. Sample and Measurement: Public health nurses performed biometric screenings in community settings for 1,685 unduplicated adults attending food pantries. Results: Over three fourths of participants (81.1%) were overweight or obese. High cholesterol and high blood pressure were detected in 38.4% and 37.7% of participants, respectively. Over half (58%) of the participants were referred to a local community health clinic for follow-up services. Conclusion: Interventions should target food pantry patrons to reduce the prevalence of chronic disease conditions among this vulnerable population

Food Insecurity: Comparing Odds between Working-age Veterans and Nonveterans with Children

Background Low-income, working-age Veterans with children have risk for food insecurity. Less known is extent to which their risk compares to nonveterans. Purpose To evaluate odds of food insecurity for working-age Veterans with children compared to socioeconomically-matched nonveterans with children. Method We constructed a propensity score-matched cohort using 2011–2014 National Health and Nutrition Examination Survey data. Covariate-adjusted logistic regressions estimated Veterans’ odds for overall food insecurity and for each level of severity compared to nonveterans. Findings We matched 155 Veterans to 310 nonveterans on gender, race/ethnicity, education, income. Models were adjusted for age, marital-status, depression, and listed matched variables. Although Veteran-status had no effect on overall food insecurity (odds ratio = 1.09, 95% confidence interval [0.62,1.93]), Veteran-status increased odds for very low food security (odds ratio = 2.71, 95% confidence interval [1.21, 6.07]). Discussion Veterans do not have higher odds of food insecurity than non-veterans, but they are more likely to have the more severe very low food security (often associated with hunger) than non-veterans. Investigation of food insecurity\u27s impact on Veteran health/well-being is needed

Partnered implementation of the veteran sponsorship initiative: protocol for a randomized hybrid type 2 effectiveness—implementation trial

BackgroundThe USA is undergoing a suicide epidemic for its youngest Veterans (18-to-34-years-old) as their suicide rate has almost doubled since 2001. Veterans are at the highest risk during their first-year post-discharge, thus creating a "deadly gap." In response, the nation has developed strategies that emphasize a preventive, universal, and public health approach and embrace the value of community interventions. The three-step theory of suicide suggests that community interventions that reduce reintegration difficulties and promote connectedness for Veterans as they transition to civilian life have the greatest likelihood of reducing suicide. Recent research shows that the effectiveness of community interventions can be enhanced when augmented by volunteer and certified sponsors (1-on-1) who actively engage with Veterans, as part of the Veteran Sponsorship Initiative (VSI).Method/designThe purpose of this randomized hybrid type 2 effectiveness-implementation trial is to evaluate the implementation of the VSI in six cities in Texas in collaboration with the US Departments of Defense, Labor and Veterans Affairs, Texas government, and local stakeholders. Texas is an optimal location for this large-scale implementation as it has the second largest population of these young Veterans and is home to the largest US military installation, Fort Hood. The first aim is to determine the effectiveness of the VSI, as evidenced by measures of reintegration difficulties, health/psychological distress, VA healthcare utilization, connectedness, and suicidal risk. The second aim is to determine the feasibility and potential utility of a stakeholder-engaged plan for implementing the VSI in Texas with the intent of future expansion in more states. The evaluators will use a stepped wedge design with a sequential roll-out to participating cities over time. Participants (n=630) will be enrolled on military installations six months prior to discharge. Implementation efforts will draw upon a bundled implementation strategy that includes strategies such as ongoing training, implementation facilitation, and audit and feedback. Formative and summative evaluations will be guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and will include interviews with participants and periodic reflections with key stakeholders to longitudinally identify barriers and facilitators to implementation.DiscussionThis evaluation will have important implications for the national implementation of community interventions that address the epidemic of Veteran suicide. Aligned with the Evidence Act, it is the first large-scale implementation of an evidence-based practice that conducts a thorough assessment of TSMVs during the "deadly gap."Trial registrationClinicalTrials.gov ID number: NCT05224440 . Registered on 04 February 2022