Background

Participation in the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) among 0- to 5-year-old children is associated with healthier diets. Extension of dietary benefits to older, age-ineligible children (5-18 years old) residing in WIC households has not been fully investigated.

Objective

Examine the association between household WIC participation and dietary behaviors of age-ineligible children.

Design

Cross-sectional secondary analysis of data collected from 2 independent panels (2009-2010 and 2014) of the New Jersey Child Health Study, using household surveys. Questions derived from national surveys assessed consumption frequency of specific foods among 5- to 18-year-old children.

Participants/setting

The analytic sample included 616 age-ineligible children from households with incomes below 200% of the federal poverty level, 398 of whom were from WIC-participating households.

Main outcome measures

Eating behaviors were measured as frequency of daily consumption of fruit, vegetables, 100% juice, sugar-sweetened beverages, and sweet and salty snacks.

Statistical analysis

Multivariable negative binomial models examined the association between eating behaviors and household WIC participation status adjusting for child’s age, sex, and race; mother’s education; city of residence; household size; and panel. Results are expressed as incidence rate ratios (IRRs).

Results

Household WIC participation was not associated with dietary behaviors among age-ineligible children (5-18 years old) in the overall sample. However, healthier dietary patterns were observed for specific demographic groups. Compared with age-ineligible children in non-WIC households, age-ineligible children in WIC households had (1) a higher frequency of vegetable consumption among 12- to 18-year-old children (IRR = 1.29; 95% confidence interval [CI] 1.05-1.58; P = .015); (2) a marginally significant higher frequency of 100% juice consumption among females (IRR = 1.27; 95% CI 1.00-1.62; P = .053); and (3) a lower frequency of sugar-sweetened beverages consumption among Hispanic children (IRR = 0.61; 95% CI 0.43-0.86; P = .004).

Conclusions

Household WIC participation may positively influence dietary behaviors of age-ineligible children, suggesting a possible WIC spillover effect. Revisions to WIC package composition should consider the possible dietary implications for all children in the household.

Background

The United States Department of Agriculture’s Supplemental Nutrition Assistance Program (SNAP) is the country’s largest nutrition assistance program for low-income populations. Although SNAP has been shown to reduce food insecurity, research findings on the diet quality of program participants are inconsistent.

Objective

This study evaluated whether the community food environment is a potential moderator of the association between SNAP participation and eating behaviors.

Design

This cross-sectional study used participant data from a telephone survey of 2,211 households in four cities in New Jersey. Data were collected from two cross-sectional panels from 2009 to 2010 and 2014. Food outlet data were purchased from commercial sources and classified as supermarkets, small grocery stores, convenience stores, or limited service restaurants.

Participants/setting

Analysis is limited to 983 respondents (588 SNAP participants) with household incomes below 130% of the federal poverty level.

Main outcome measures

Eating behaviors were assessed as frequency of consumption of fruit, vegetables, salad, and sugar-sweetened beverages.

Statistical analyses performed

Interaction and stratified analyses using gamma regression determined the differences in the association between SNAP participation and eating behaviors by the presence or absence of food outlets adjusted for covariates.

Results

SNAP participation was associated with a higher frequency of consuming sugar-sweetened beverages (P<0.05) when respondents lived within ¼ to ½ mile of a small grocery store, supermarket, and limited service restaurant. SNAP participants who did not live close to a convenience store reported a lower frequency of sugar-sweetened beverage consumption (P=0.01), and those living more than ½ mile away from a supermarket reported a lower frequency of fruit consumption (P=0.03).

Conclusions

The findings from this study suggest that the community food environment may play a role in moderating the association between SNAP participation and eating behaviors. Although SNAP participation is associated with some unhealthy behaviors, this association may only hold true when respondents live in certain food environments.

Relationships between food and physical activity (PA) environments and children's related behaviors are complex.

Latent class analyses derived patterns from proximity to healthy and unhealthy food outlets, PA facilities and parks, and counts of residential dwellings and intersections. Regression analyses examined whether derived classes were related to food consumption, PA, and overweight among 404 low-income children.

Compared to children living in Low PA-Low Food environments, children in High Intersection&Parks-Moderate Density&Food, and High Density-Low Parks-High Food environments, had significantly greater sugar-sweetened beverage consumption (ps<0.01) and overweight/obesity (ps<0.001). Children in the High Density-Low Parks-High Food environments were more likely to walk to destinations (p = 0.01)

Recognizing and leveraging beneficial aspects of neighborhood patterns may be more effective at positively influencing children's eating and PA behaviors compared to isolating individual aspects of the built environment.

Purpose: To develop a valid and feasible short-form corner store audit tool (SCAT) that could be used in-store or over the phone to capture the healthfulness of corner stores.

Design: Nonexperimental.

Setting: Four New Jersey cities.

Subjects: Random selection of 229 and 96 corner stores in rounds 1 and 2, respectively.

Measures: An adapted version of the Nutrition Environment Measures Survey for Corner Stores (NEMS-CS) was used to conduct in-store audits. The 7-item SCAT was developed and used for round 2 phone audits.

Analysis: Exploratory factor analysis and item response theory were used to develop the SCAT.

Results: The SCAT was highly correlated with the adapted NEMS-CS ( r = .79). Short-form corner store audit tool scores placed stores in the same healthfulness categories as did the adapted NEMS-CS in 88% of the cases. Phone response matches indicated that store owners did not distinguish between 2% and low-fat milk and tended to round up the fruit and vegetable count to 5 if they had fewer varieties.

Conclusion: The SCAT discriminates between higher versus lower healthfulness scores of corner stores and is feasible for use as a phone audit tool.

Background: Understanding determinants of high consumption of sugar-sweetened beverages (SSBs), a highly prevalent obesogenic behavior, will help build effective customized public health interventions.

Objective: Our aim was to identify child and parent lifestyle and household demographic factors predictive of high SSB consumption frequency in children from low-income, ethnically diverse communities that may help inform public health interventions.

Design: We used a cross-sectional telephone household survey.

Participants/setting: Participants were 717 boys and 686 girls aged 3 to 18 years old from the New Jersey Childhood Obesity Study living in five low-income cities (Camden, New Brunswick, Newark, Trenton, and Vineland). The adult most knowledgeable about household food shopping completed a questionnaire over the telephone inquiring about their and their child's dietary and physical activity habits, and household-, parent-, and child-level demographics.

Main outcome measures: Child's SSB consumption frequency was measured.

Statistical analysis performed: Multivariate ordered logit models were designed to investigate a variety of variables hypothesized to affect the frequency of SSB consumption. Exploratory stratified analyses by race, sex, and age were also conducted.

Results: Eight percent of our study participants never consumed SSBs, 45% consumed SSBs at least once per day, and 23% consumed twice or more per day. SSB consumption was higher among children 12 to 18 years vs 3 to 5 years (P<0.0001), of non-Hispanic black vs non-Hispanic white race/ethnicity (P=0.010), who were moderate fast food consumers vs never consumers (P=0.003), and those whose parents were high vs low SSB consumers (P<0.0001). Living in a non-English-speaking household (P=0.030), having a parent with a college or higher education vs less than high school (P=0.003), and having breakfast 6 to 7 days/wk vs never to 2 days/wk or less were associated with lower SSB consumption (P=0.001).

Conclusions: We identified a number of household-, parent-, and child-level predictors of SSB consumption, which varied by race, sex, and age, useful for building customized interventions targeting certain behaviors in ethnically diverse, low-income children.

Objective: This study compared the prices of unhealthy (chips) and healthy (ready-to-eat fruit) snacks that students are likely to purchase from corner stores.

Methods: Snacks were purchased from 325 New Jersey corner stores; chip prices were compared with fruit prices overall and by store sales volume and block group characteristics.

Results: Prices did not differ significantly between chips and fruit in the overall sample in which both items were available (n = 104) (chips: $0.46 ± $0.15; fruit: $0.49 ± $0.19; P = .48) or by store or block group characteristics. Neither mean fruit prices nor mean chip prices differed by store sales volume or by neighborhood characteristics.

Conclusions and implications: Promoting ready-to-eat fruits in corner stores to children as a price-neutral alternative to calorically dense snacks can be a viable strategy to improve the nutritional quality of snacks commonly purchased at corner stores.

The U.S. Preventive Task Force recommends that all patients be screened for obesity and given appropriate weight loss advice, if needed, as nutrition counseling by primary care physicians is a key objective for Healthy People 2020. This study assesses the association between health care provider's (HCP) advice to lose weight and eating behaviors among obese individuals. Data were collected using a household survey of adults in five New Jersey cities in 2009–10. Analyses presented are limited to 548 obese participants. Negative-binomial regression analysis determined the association of participants' eating behaviors and HCP's advice to lose weight, after adjusting for the participant's attempt to lose weight and demographic variables. Despite being obese, only 48% of the participants received weight loss advice from their HCP while 68% stated they were attempting to lose weight. HCP's advice to lose weight was associated with increased salad and fruit consumption (PR 1.3, 95% CI 1.06-1.61; PR 1.23, 95% CI 1.02-1.48). Attempting to lose weight was positively associated with a higher consumption of fruit (PR 1.39, 95% CI 1.13-1.72), vegetables (PR 1.22, 95% CI 1.07-1.39), and with eating fruits and vegetables as snacks (PR 1.62, 95% CI 1.28-2.05). Attempting to lose weight was negatively associated with consumption of sweet snacks (PR 0.68, 95% CI 0.49-0.94), sugar sweetened beverages (PR 0.71, 95% CI 0.58-0.87) and fast food (PR 0.77, 95% CI 0.62-0.97). There were no significant interactions between HCP's advice and attempts to lose weight. Obese adult's attempt to lose weight, and not HCP's advice to lose weight, was a predictor for healthy eating behaviors. Interventions in medical practices should train HCPs on effective strategies for motivating obese patients to adopt healthier lifestyles.

This study explores the association between parental perception of the nutritional quality of school meals and whether students eat lunch served at school. We use data from five low-income cities in New Jersey that have high minority populations. Students whose parents perceive the quality of school meals to be healthy have greater odds of eating meals served at school. Recent changes in guidelines for the United States Department of Agriculture's National School Lunch Program met with resistance from several fronts. Advocates for and implementers of improved school meals may benefit from partnering with parents to increase the acceptance and utilization of improved school offerings.

Background

Few children accumulate the recommended ≥60 minutes of physical activity each day. Active travel to and from school (ATS) is a potential source of increased activity for children, accounting for 22% of total trips and time spent traveling by school-aged children.

Purpose

This study identifies the association of parents’ perceptions of the neighborhood, geospatial variables, and demographic characteristics with ATS among students in four low-income, densely populated urban communities with predominantly minority populations.

Methods

Data were collected in 2009–2010 from households with school-attending children in four low-income New Jersey cities. Multivariate logistic regression analyses (n=765) identified predictors of ATS. Analyses were conducted in 2012.

Results

In all, 54% of students actively commuted to school. Students whose parents perceived the neighborhood as very unpleasant for activity were less likely (OR=0.39) to actively commute, as were students living farther from school, with a 6% reduction in ATS for every 0.10 mile increase in distance to school. Perceptions of crime, traffic, and sidewalk conditions were not predictors of ATS.

Conclusions

Parents’ perceptions of the pleasantness of the neighborhood, independent of the effects of distance from school, may outweigh concerns about crime, traffic, or conditions of sidewalks in predicting active commuting to school in the low-income urban communities studied. Efforts such as cleaning up graffiti, taking care of abandoned buildings, and providing shade trees to improve neighborhood environments are likely to increase ATS, as are efforts that encourage locating schools closer to the populations they serve.