Meg Bruening

Feeding a Family in a Recession: Food Insecurity Among Minnesota Parents

OBJECTIVES We assessed current levels of food insecurity among a large, diverse sample of parents and examined associations between food insecurity and parental weight status, eating patterns, and the home food environment. METHODS Project F-EAT (Families and Eating and Activity Among Teens) examined the home food environments of adolescents. Parents and caregivers (n = 2095) living with adolescents from the Minneapolis-St. Paul, Minnesota school districts completed mailed surveys during a 12-month period in 2009-2010. We performed our assessments using multivariate regressions. RESULTS Almost 39% of the parents and caregivers experienced household food insecurity, whereas 13% experienced very low food security. Food insecurity was significantly associated with poorer nutrition-related variables such as higher rates of parental overweight and obesity, less healthy foods served at meals, and higher rates of binge eating. Food-insecure parents were 2 to 4 times more likely to report barriers to accessing fruits and vegetables. CONCLUSIONS Food insecurity was highly prevalent. Environmental interventions are needed to protect vulnerable families against food insecurity and to improve access to affordable, healthy foods.

Factors Related to the High Rates of Food Insecurity among Diverse, Urban College Freshmen

BACKGROUND Food insecurity is a persistent public health concern; however, few studies have examined the factors related to food insecurity among college students, particularly college freshmen living in dormitories. OBJECTIVE Our aim was to examine the prevalence of food insecurity and associations with health outcomes among college freshmen. DESIGN A diverse sample of freshmen (n=209) attending a large southwestern university and living in campus residence halls completed online surveys. Anthropometrics were measured by trained staff. STATISTICAL ANALYSES Using mixed logistic regression, associations were examined between food insecurity and health outcomes, adjusting for sociodemographic characteristics and clustering of students within residence halls. RESULTS Food insecurity was prevalent, with 32% reporting inconsistent access to food in the past month and 37% in the past 3 months. Food-insecure freshmen had higher odds of depression (odds ratio=2.97; 95% CI 1.58 to 5.60) compared to food-secure students. Food-insecure freshmen had significantly lower odds of eating breakfast, consuming home-cooked meals, perceiving their off-campus eating habits to be healthy, and receiving food from parents (P<0.05). CONCLUSIONS Interventions are needed to support students struggling with food insecurity, as it is related to health outcomes.

Poor Nutrition on the Menu: Children’s Meals at America’s Top Chain Restaurants

BACKGROUND We evaluated the nutritional quality of childrens meals at chain restaurants, because children obtain about a third of their daily calories from away-from-home foods and studies show that restaurant foods are often higher in calories and lower in nutritional value than foods prepared at home. METHODS We assessed the nutritional quality of childrens meals at the 50 largest U.S. restaurant chains by visiting each chains web site or calling the company. Eighteen of the chains did not have childrens meals and 10 did not provide adequate nutrition information to be included in the study. The nutritional quality of each meal combination was evaluated against a set of nutrition standards based on key nutrition recommendations in the Dietary Guidelines for Americans. RESULTS Of the 22 restaurants that had childrens menus and available nutrition information, 99% of 1662 childrens meal combinations were of poor nutritional quality. CONCLUSIONS Restaurants should support healthier choices for children by reformulating existing menu items and adding new healthier items, posting calories on menus, and setting nutrition standards for marketing to children.

Predictors of Adolescent Breakfast Consumption: Longitudinal Findings from Project EAT

OBJECTIVE To identify predictors of breakfast consumption among adolescents. METHODS Five-year longitudinal study Project EAT (Eating Among Teens). Baseline surveys were completed in Minneapolis-St. Paul schools and by mail at follow-up by youth (n = 800) transitioning from middle to high school. Linear regression models examined associations between baseline predictors and follow-up breakfast consumption. RESULTS Frequency of breakfast consumption at follow-up was positively associated with baseline breakfast consumption and inversely associated with baseline weight concerns (P < .01). Perceptions of being too rushed in the morning to eat a healthful breakfast were associated with lower breakfast frequency 5 years later among girls (P < .01). After adjusting for baseline breakfast consumption, none of the associations with predictor variables remained statistically significant. CONCLUSIONS AND IMPLICATIONS Early adolescence is an important time to establish regular breakfast consumption. Interventions aimed at increasing breakfast consumption should include messages about healthful weight management and ideas for quick, healthful breakfasts.

A Systematic Review of Methods and Procedures Used in Ecological Momentary Assessments of Diet and Physical Activity Research in Youth: An Adapted STROBE Checklist for Reporting EMA Studies (CREMAS).

Background Ecological momentary assessment (EMA) is a method of collecting real-time data based on careful timing, repeated measures, and observations that take place in a participant’s typical environment. Due to methodological advantages and rapid advancement in mobile technologies in recent years, more studies have adopted EMA in addressing topics of nutrition and physical activity in youth. Objective The aim of this systematic review is to describe EMA methodology that has been used in studies addressing nutrition and physical activity in youth and provide a comprehensive checklist for reporting EMA studies. Methods Thirteen studies were reviewed and analyzed for the following 5 areas of EMA methodology: (1) sampling and measures, (2) schedule, (3) technology and administration, (4) prompting strategy, and (5) response and compliance. Results Results of this review showed a wide variability in the design and reporting of EMA studies in nutrition and physical activity among youth. The majority of studies (69%) monitored their participants during one period of time, although the monitoring period ranged from 4 to 14 days, and EMA surveys ranged from 2 to 68 times per day. More than half (54%) of the studies employed some type of electronic technology. Most (85%) of the studies used interval-contingent prompting strategy. For studies that utilized electronic devices with interval-contingent prompting strategy, none reported the actual number of EMA prompts received by participants out of the intended number of prompts. About half (46%) of the studies failed to report information about EMA compliance rates. For those who reported, compliance rates ranged from 44-96%, with an average of 71%. Conclusions Findings from this review suggest that in order to identify best practices for EMA methodology in nutrition and physical activity research among youth, more standardized EMA reporting is needed. Missing the key information about EMA design features and participant compliance might lead to misinterpretation of results. Future nutrition and physical activity EMA studies need to be more rigorous and thorough in descriptions of methodology and results. A reporting checklist was developed with the goal of enhancing reliability, efficacy, and overall interpretation of the findings for future studies that use EMAs.

Academy of Nutrition and Dietetics: Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Sustainable, Resilient, and Healthy Food and Water Systems

Sustainability is the ability of a system to be maintained over the long term. Resilience is the ability of a system to withstand disturbances and continue to function in a sustainable manner. Issues of sustainability and resilience apply to all aspects of nutrition and dietetics practice, can be practiced at both the program and systems level, and are broader than any one specific practice setting or individual intervention. Given an increasing need to apply principles of sustainability and resilience to nutrition and dietetics practice, as well as growing interest among the public and by Registered Dietitian Nutritionists of health issues related to food and water systems, the Hunger and Environmental Nutrition Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has developed the Standards of Professional Performance as a tool for Registered Dietitian Nutritionists working in sustainable, resilient, and healthy food and water systems to assess their current skill levels and to identify areas for further professional development in this emerging practice area. This Standards of Professional Performance document covers six standards of professional performance: quality in practice, competence and accountability, provision of services, application of research, communication and application of knowledge, and utilization and management of resources. Within each standard, specific indicators provide measurable action statements that illustrate how sustainable, resilient, and healthy food and water systems principles can be applied to practice. The indicators describe three skill levels (competent, proficient, and expert) for Registered Dietitian Nutritionists working in sustainable, resilient, and healthy food and water systems.

Use of Salad Bars in Schools to Increase Fruit and Vegetable Consumption: Where’s the Evidence?

T HE FEDERAL GOVERNMENT SPENT

The Struggle Is Real: A Systematic Review of Food Insecurity on Postsecondary Education Campuses

11.5 BILLION IN 2013 to serve nutritious meals to more than 30.7 million students as part of the US Department of Agriculture (USDA) National School Lunch Program (NSLP). Nutrition standards set by the USDA were revised in 2012 as mandated by the Healthy, Hunger-Free Kids Act of 2010. Based on the Dietary Guidelines for Americans, the new standards require schools to offer greater quantities of fruits and vegetables (F/V), as well as offer a greater variety. The shift to offer more F/V through NSLP is critical because school-aged children do not come close to meeting the recommended nine to 13 servings of F/V each day. Further, children’s F/V intake declines as they get older, decreasing by at least one serving through adolescence. Fruit and vegetable intake is linked to the prevention of chronic diseases such as diabetes, heart disease, obesity, and some cancers. Millions of students participate in school meal programs and evidence suggests that habits formed during childhood can carry into adulthood, making schools an important venue for promoting F/V intake.

A Mobile Ecological Momentary Assessment Tool (devilSPARC) for Nutrition and Physical Activity Behaviors in College Students: A Validation Study

BACKGROUND Numerous international studies have examined cross-sectional correlates of food insecurity (FI) among postsecondary education students. Research is needed to synthesize the findings of this work to support vulnerable students. OBJECTIVE To systematically review peer-reviewed and gray literature to assess the prevalence of FI on postsecondary education institutions, as well as factors related to FI among students and suggested/practiced solutions. DESIGN Systematic literature review. Medline, Web of Science, and PsycINFO databases were searched for peer-reviewed literature for FI research; a Google search (Google Inc) was conducted to obtain gray literature on FI among postsecondary education students. PARTICIPANTS/SETTING Undergraduate and graduate students at postsecondary institutions of higher education. MAIN OUTCOME MEASURES Measures included prevalence of FI; sociodemographic, health, and academic factors related to FI; and solutions to address FI on postsecondary institutions. RESULTS Seventeen peer-reviewed studies and 41 sources of gray literature were identified (out of 11,476 titles). All studies were cross-sectional. Rates of FI were high among students, with average rates across the gray and peer-reviewed literature of 35% and 42%, respectively. FI was consistently associated with financial independence, poor health, and adverse academic outcomes. Suggested solutions to address food security among postsecondary institutions addressed all areas of the socioecologic model, but the solutions most practiced included those in the intrapersonal, interpersonal, and institutional levels. CONCLUSIONS FI is a major public health problem among postsecondary education students. Studies are needed to assess the long-term influence of FI among this vulnerable population. More research is needed on the effectiveness of FI interventions.

Academy of Nutrition and Dietetics: Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Public Health and Community Nutrition

Background The majority of nutrition and physical activity assessments methods commonly used in scientific research are subject to recall and social desirability biases, which result in over- or under-reporting of behaviors. Real-time mobile-based ecological momentary assessments (mEMAs) may result in decreased measurement biases and minimize participant burden. Objective The aim was to examine the validity of a mEMA methodology to assess dietary and physical activity levels compared to 24-hour dietary recalls and accelerometers. Methods This study was a pilot test of the SPARC (Social impact of Physical Activity and nutRition in College) study, which aimed to determine the mechanism by which friendship networks impact weight-related behaviors among young people. An mEMA app, devilSPARC, was developed to assess weight-related behaviors in real time. A diverse sample of 109 freshmen and community mentors attending a large southwestern university downloaded the devilSPARC mEMA app onto their personal mobile phones. Participants were prompted randomly eight times per day over the course of 4 days to complete mEMAs. During the same 4-day period, participants completed up to three 24-hour dietary recalls and/or 4 days of accelerometry. Self-reported mEMA responses were compared to 24-hour dietary recalls and accelerometry measures using comparison statistics, such as match rate, sensitivity and specificity, and mixed model odds ratios, adjusted for within-person correlation among repeated measurements. Results At the day level, total dietary intake data reported through the mEMA app reflected eating choices also captured by the 24-hour recall. Entrées had the lowest match rate, and fruits and vegetables had the highest match rate. Widening the window of aggregation of 24-hour dietary recall data on either side of the mEMA response resulted in increased specificity and decreased sensitivity. For physical activity behaviors, levels of activity reported through mEMA differed for sedentary versus non-sedentary activity at the day level as measured by accelerometers. Conclusions The devilSPARC mEMA app is valid for assessing eating behaviors and the presence of sedentary activity at the day level. This mEMA may be useful in studies examining real-time weight-related behaviors.