Associations of social determinants of health and childhood obesity. A cross-sectional analysis of the 2021 National Survey of Children’s Health

Background: Childhood obesity is a growing health problem in the United States, with those affected having an increased likelihood of developing chronic diseases at a younger age. Social determinants of health (SDOH) are known to influence overall health. Children with low socioeconomic status (SES) have been shown to be overweight and have poor health outcomes. Therefore, our primary objective was to use the National Survey of Children’s Health (NSCH) 2021 data to determine current associations between childhood obesity and social determinants of health (SDOH).Methods: We conducted a cross-sectional analysis of 2021 NSCH to extract data from questions related to the SDOH domains. We extracted sociodemographic variables to use as controls and constructed bivariate and multivariable logistic regression models to determine associations, via odds ratios, between SDOH and child obesity.Results: Within the binary regression models, we found that children identified as having obesity were more likely than non-obese children to experience SDOH in all domains. After controlling for race/ethnicity, household income (%FPL), parental education, and child sex, children identified as having obesity were significantly more likely to experience food insecurity when compared to non-obese children (AOR = 1.39; 95% CI: 1.13-1.17).Conclusion: Our study found that the food insecurity domain of SDOH was significantly associated with childhood obesity. Improving policies for programs such as SNAP as well as addressing lack of access to nutritious foods, especially within food deserts, may help alleviate some food insecurity. Improving access to adequate amounts of nutritious foods is critical in addressing childhood obesity and thus, decreasing risk of chronic disease and poor long-term health outcomes

Native opportunities to stop hypertension: study protocol for a randomized controlled trial among urban American Indian and Alaska Native adults with hypertension

IntroductionAmerican Indian and Alaska Native (AI/AN) adults experience disproportionate cardiovascular disease (CVD) morbidity and mortality compared to other races, which may be partly attributable to higher burden of hypertension (HTN). Dietary Approaches to Stop Hypertension (DASH) is a high-impact therapeutic dietary intervention for primary and secondary prevention of CVD that can contribute to significant decreases in systolic blood pressure (BP). However, DASH-based interventions have not been tested with AI/AN adults, and unique social determinants of health warrant independent trials. This study will assess the effectiveness of a DASH-based intervention, called Native Opportunities to Stop Hypertension (NOSH), on systolic BP among AI/AN adults in three urban clinics.MethodsNOSH is a randomized controlled trial to test the effectiveness of an adapted DASH intervention compared to a control condition. Participants will be aged ≥18 years old, self-identify as AI/AN, have physician-diagnosed HTN, and have elevated systolic BP (≥ 130 mmHg). The intervention includes eight weekly, tailored telenutrition counseling sessions with a registered dietitian on DASH eating goals. Intervention participants will be provided $30 weekly and will be encouraged to purchase DASH-aligned foods. Participants in the control group will receive printed educational materials with general information about a low-sodium diet and eight weekly$30 grocery orders. All participants will complete assessments at baseline, after the 8-week intervention, and again 12 weeks post-baseline. A sub-sample of intervention participants will complete an extended support pilot study with assessments at 6- and 9-months post-baseline. The primary outcome is systolic BP. Secondary outcomes include modifiable CVD risk factors, heart disease and stroke risk scores, and dietary intake.DiscussionNOSH is among the first randomized controlled trials to test the impact of a diet-based intervention on HTN among urban AI/AN adults. If effective, NOSH has the potential to inform clinical strategies to reduce BP among AI/AN adults.Clinical trials registrationhttps://clinicaltrials.gov/ct2/show/NCT02796313, Identifier NCT02796313

Maternal periconception food insecurity and postpartum parenting stress and bonding outcomes

Food insecurity during pregnancy is associated with various adverse pregnancy outcomes for the mother and infant, but less is known about the role of periconception food insecurity and its links to maternal and child wellbeing in the postpartum period. In a sample of 115 diverse (41% white) and predominately low-income mothers, results of hierarchical regression analyses showed that periconception food insecurity was positively associated with parenting stress at 2 months postpartum. A negative association between food insecurity and maternal–infant bonding at 6 months postpartum was mediated after controlling for prenatal depression, social support, and demographic factors. Findings highlight the need for maternal linkage to effective food security programs, such as United States-based Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), for women during their childbearing years due to the critical importance of food security for maternal and infant well-being

Nutrition-Focused Food Banking in the United States: A Qualitative Study of Healthy Food Distribution Initiatives

BackgroundNutrition-focused food banking is broadly defined as organizational and programmatic efforts to address nutrition-related health disparities among charitable food clients. Additional information is needed to systematically describe how US food banks, as key influencers of the charitable food system, are working to advance nutrition-focused food banking initiatives in their communities.ObjectiveOur aim was to describe food bank leadership-identified organizational strategies, "best practices," and innovative programs for advancing nutrition-focused food banking in the United States.DesignWe conducted semi-structured qualitative interviews to elicit information about the nutrition-focused food banking practices and processes being employed by US food banks.Participants/settingParticipants comprised a purposive sample of food bank executives (n=30) representing a diverse selection of food banks across the United States. Interviews were conducted between April 2015 and January 2017 at national food bank conferences.AnalysisTwo researchers independently reviewed transcripts to identify themes using code-based qualitative content analysis.ResultsExecutive leader descriptions of specific strategies to support nutrition-focused food banking centered primarily around the following four major themes: building a healthier food inventory at the food bank; enhancing partner agency healthy food access, storage, and distribution capacity; nutrition education outreach; and expanding community partnerships and intervention settings for healthy food distribution, including health care and schools.ConclusionsStudy findings indicate that food banks are implementing a variety of multilevel approaches to improve healthy food access among users of the charitable food system. Further evaluation is needed to assess the reach, scalability, and sustainability of these various approaches, and their effectiveness in reducing determinants of nutrition-related health disparities

Challenges and opportunities to increasing fruit and vegetable distribution through the US charitable feeding network: increasing food systems recovery of edible fresh produce to build healthy food access.

This qualitative study describes opportunities and challenges to produce recovery identified by food banking executive leadership across the US (n = 33). Identified challenges included regional variation in fresh produce availability, long transportation times, and lack of refrigerated storage. Opportunities included high client demand for fresh produce, internal benchmarks for fresh produce distribution, and organizational partnerships to create regional sourcing and distribution efficiencies. This research indicates the need for cross-sector collaboration and planning efforts across the agricultural, health, and charitable feeding sectors in order to best recover and redistribute fresh produce

Characteristics of Households of People With Diabetes Accessing US Food Pantries: Implications for Diabetes Self-Management Education and Support

PurposeThe purpose of this study is to explore the associations between food insecurity (FI) and coping strategies of relevance to diabetes self-management among households of people with diabetes (HHDM) who access US food pantry programs.MethodsThe authors conducted a secondary data analysis of HHDM accessing US food pantry programs from the Hunger in America 2014 study (n = 16 826). Weighted analyses included descriptive statistics for household sociodemographics, food pantry service utilization, FI, and coping behaviors. The authors used chi-square and logistic regression to estimate the relationship between FI and coping behaviors.ResultsNearly one-half of HHDM reported visiting food pantries at least 6 times in the past year. Most HHDM were FI, with the majority experiencing the most severe form of FI. Over one-fifth of households reported lacking health insurance. The majority of HHDM reported purchasing inexpensive unhealthy foods to ensure household food adequacy, and many reported watering down food and beverages. The odds of reporting these behaviors significantly increased as FI worsened.ConclusionFood pantries represent an opportunity for the delivery of community-based diabetes self-management education and support programs. These programs should be adapted to address population barriers to self-management and to support access to healthful foods and medical care

Environmental Health-Related Policies and Practices of Oklahoma Licensed Early Care and Education Programs: Implications for Childhood Asthma

Little is known about the environmental health-related policies and practices of early care and education (ECE) programs that contribute to childhood asthma, particularly in Oklahoma where child asthma rates (9.8%) and rates of uncontrolled asthma among children with asthma (60.0%) surpass national rates (8.1% and 50.3%, respectively). We conducted a cross-sectional survey with directors of Oklahoma-licensed ECE programs to assess policies and practices related to asthma control and to evaluate potential differences between Centers and Family Childcare Homes (FCCHs). Surveyed ECEs (n = 476) included Centers (56.7%), FCCHs (40.6%), and other program types (2.7%). Almost half (47.2%) of directors reported never receiving any asthma training. More Center directors were asthma-trained than FCCH directors (61.0% versus 42.0%, p < 0.0001). Most ECEs used asthma triggers, including bleach (88.5%) and air fresheners (73.6%). Centers were more likely to use bleach daily than were FCCHs (75.6% versus 66.8%, p = 0.04). FCCHs used air fresheners more than did Centers (79.0% versus 61.0%, p < 0.0001). The majority of ECEs (74.8%) used pesticides indoors. Centers applied indoor pesticides more frequently (i.e., monthly or more often) than did FCCHs (86.0% versus 58.0%, p < 0.0001). Policy, educational, and technical assistance interventions are needed to reduce asthma triggers and improve asthma control in Oklahoma ECEs