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Background Despite the many benefits of school meals, not all students participate. One reason students may not participate in school meals is because they instead purchase breakfast or lunch from food outlets located around schools that mostly carry unhealthy items. This study examined whether school participation in the Community Eligibility Provision (CEP), which allows qualifying schools to serve free meals to all students, moderated the association between the community food environment around schools and student meal participation. Methods This study employed a longitudinal repeated-measures design using school-level data collected between 2014 and 2020 within four low-income school districts ( n  = 126 schools) in the US. We obtained meal participation data from state records and created a measure characterizing the community food environment within 0.25 miles of schools (characterized as low-density of unhealthy food outlets vs. high-density of unhealthy food outlets) through a latent class analysis. Regression analysis estimated associations between community food environments, CEP participation, and participation rates in school breakfast and school lunch, assessed in separate models. Results While no moderating effect of school CEP status was observed for breakfast or lunch participation, school breakfast participation was predicted to be 4% lower in high-density food environments than in low-density environments ( P -value = .049) among non-CEP schools, and there was no difference in participation by the community food environment among CEP-participating schools. Differences in breakfast participation by the community food environment among non-CEP schools were mostly attributable to middle/high schools, with participation predicted to be 10% lower in high-density environments than in low-density environments among non-CEP middle/high schools ( P -value < .001), whereas such a difference in participation was not observed among non-CEP elementary schools. Conclusions Negative associations between food environment around schools and school breakfast participation were observed only among middle and high schools not participating in CEP, suggesting that policy actions to increase access to free school meals may benefit students, particularly older children and adolescents.

Findings from a pilot randomized trial of 916 households indicated that outreach text messages were not an effective strategy to increase enrollment in the United States Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) among eligible households in Arizona.

Background Policy, systems, and environmental (PSE) approaches, including those enacted in early childhood education (ECE) settings, can improve child health outcomes. The use of implementation strategies, or the ways in which these approaches are enacted across settings, may modify intervention impact. Therefore, the purpose of this review was to examine the implementation strategies used among interventions utilizing PSE approaches in the ECE setting. Methods Seven databases including MEDLINE, PubMed, Web of Science, and EMBASE, were searched for interventions in ECE settings including children (0–6 years) that utilized ≥ 1 PSE approach. Eligible studies included either a child-level outcome (i.e., weight, physical activity, or diet) or an environmental outcome (i.e., nutrition and physical activity environment). Data extracted included study characteristics, description of the intervention, and description of the implementation of the intervention. Implementation strategies were coded using the School Implementation Strategies Translating ERIC Resources (SISTER) taxonomy. The Downs and Black checklist was completed to assess study quality. Results One hundred and four studies representing 97 interventions were identified. Fourteen (14%) did not report any implementation strategies. Of the remaining 83 interventions reporting implementation strategies, the mean number of implementation strategies employed per intervention was 3.8 (± 2.3) (range 1–11). However, few interventions (5/83, 6%) clearly named and defined implementation strategies. Most implementation strategies came from the “train and educate stakeholders” SISTER domain (177/318, 56%), and the most frequently used implementation strategy was “conduct educational meetings (50/83, 60%). Most studies were classified as good (59/104, 57%) or fair (40/104, 38%) quality. Conclusions In this review, many interventions appeared to use multiple implementation strategies to support ECE PSE interventions, though few explicitly documented or described those strategies. These findings suggest that more precise documentation of implementation strategies is needed to enhance replication and scalability of ECE interventions. Registration PROSPERO# CRD42022306670.

This study aims to describe reasons for discontinuing participation and experiences participating in the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) during the COVID-19 pandemic. We analyzed data from a cross-sectional online survey distributed to a national sample, restricted to (1) households that discontinued participating in SNAP (n = 146) or WIC (n = 149) during the pandemic and (2) households that participated in SNAP (n = 501) or WIC (n = 141) during spring 2021—approximately one year into the pandemic. We conducted thematic analyses of open-ended survey questions and descriptive statistics for Likert-scale items. Themes raised by respondents who discontinued participating in SNAP or WIC included difficulty recertifying and virus exposure concerns. Former WIC participants reported the program was not worth the effort and former SNAP participants reported failing to requalify. Respondents participating in WIC or SNAP during the pandemic mentioned transportation barriers and insufficient benefit value. WIC participants had trouble redeeming benefits in stores and SNAP participants desired improved online grocery purchasing experiences. These results suggest that enhancements to WIC and SNAP, such as expanded online purchasing options, program flexibilities, and benefit increases, can improve program participation to ensure access to critical nutrition supports, especially during emergencies.

Background/Objectives: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) improves the health of nutritionally at-risk populations. However, engagement challenges, such as missed appointments and unredeemed food benefits, may limit program efficacy. Barriers to engagement are heightened among American Indian populations, who often experience disproportionately high levels of participation-related challenges. This study assessed whether newly developed health communication theory-based text messages incorporating persuasive language and different message framing (i.e., gain-framed and loss-framed) improved WIC appointment attendance and food benefit redemption rates, above and beyond standard information-based reminders. Methods: The sample included participants served by the Inter Tribal Council of Arizona WIC between the months of September 2022 and February 2023 who (a) had an appointment during the intervention period (n = 7584) or (b) were eligible to receive a reminder text about unused food benefits during the intervention period (n = 2177). A three-phase intervention design was used, with each phase lasting six weeks. During the baseline phase, participants received standard information-based text messages, while during the two intervention phases, participants received newly developed messages using (1) gain-framed and (2) loss-framed persuasive language. Difference-in-difference regression analyses compared whether differences in outcomes (i.e., appointment attendance and monthly food benefit redemption rates) between participants who received reminder messages and those who did not differed over intervention phases. Results: Receipt of both gain-framed and loss-framed theory-based messages was associated with higher appointment attendance, when compared to receipt of standard information-based messages during baseline (p = 0.003 and p = 0.01, respectively). Neither the gain-framed nor loss-framed messages were associated with higher food benefit redemption rates than standard messages. Conclusions: Results indicated that persuasive communication theory-based text reminders may be an effective, low-cost strategy to boost WIC appointment attendance among American Indians.

To support families during the COVID-19 pandemic, the USDA allowed all US schools to offer meals at no cost regardless of family income, a policy referred to as Universal Free Meals or Healthy School Meals for All (HSM4A). Despite the recognized benefits and popularity of HSM4A during the pandemic, the policy expired in June 2022. The goal of this study was to gather perceptions of parents in Arizona about school meals, the HSM4A program, and the discontinuation of HSM4A. In collaboration with a local anti-hunger group, using an online survey distributed in September and October 2022, we collected data from a diverse sample of over 2000 parents living in Arizona. Parents unequivocally supported HSM4A during the pandemic (97%) and expressed support for continuing to offer HSM4A (95%). High levels of support were seen across all groups in the study, including from individuals who identified as politically conservative. We also analyzed 750 responses to an open-ended question asking respondents to share their thoughts about offering meals to all Arizona students regardless of family income. The majority of emergent themes related to perceived benefits of HSM4A, including reducing financial burden and stress for families. Our findings will be useful for advocates and policy makers considering HSM4A legislation.

To evaluate the impact of a preschool-based nutrition education programme consisting of twelve 'hands on' nutrition education lessons delivered during the school year on young children's willingness to consume fruits and vegetables. Quasi-experimental, pre-post design including the collection of plate waste evaluation data at the start and end of the 2015-2016 school year within two groups: (1) randomly selected classrooms receiving the intervention and (2) within conveniently sampled preschool classrooms not receiving the intervention serving as a comparison group. Centre-based preschool programmes serving low-income families in the Denver metro area. Three- to five-year-old children in preschool classrooms participating in the intervention during the 2015-2016 school year (n 308) and children enrolled in comparison classrooms (n 215). Repeated-measures logit models assessed whether increases in the odds of consuming small samples of fruits and vegetables between Time 1 (pre-intervention) and Time 2 (post-intervention) were different for children within the intervention group compared with the comparison group. Analyses showed that the change over time in consumption of the three vegetable samples varied by intervention status with greater change occurring among children within the intervention group (edamame: P = 0·001; cauliflower: P ≤ 0·0001 and red pepper: P ≤ 0·0001). Unlike vegetables, the change over time in consumption of the two fruit samples was not different between children within the intervention and comparison groups. An experiential-learning nutrition education programme can positively influence eating behaviours of low-income preschoolers in a centre-based setting by increasing willingness to consume vegetables.

Background Permanent supportive housing (PSH)—subsidized housing paired with support services such as case management—is a key part of national strategic plans to end homelessness. PSH tenants face high overdose risk due to a confluence of individual and environmental risk factors, yet little research has examined overdose prevention in PSH. Methods We describe the protocol for a hybrid type 3 stepped-wedge cluster randomized controlled trial (RCT) of overdose prevention practice implementation in PSH. We adapted evidence-based overdose prevention practices and implementation strategies for PSH using input from stakeholder focus groups. The trial will include 20 PSH buildings (with building size ranging from 20 to over 150 tenants) across New York City and New York’s Capital Region. Buildings will be randomized to one of four 6-month intervention waves during which they will receive a package of implementation support including training in using a PSH Overdose Prevention (POP) Toolkit, time-limited practice facilitation, and learning collaboratives delivered to staff and tenant implementation champions appointed by each building. The primary outcome is building-level fidelity to a defined list of overdose prevention practices. Secondary and exploratory implementation and effectiveness outcomes will be examined using PSH staff and tenant survey questionnaires, and analysis of tenant Medicaid data. We will explore factors related to implementation success, including barriers and facilitators, using qualitative interviews with key stakeholders. The project is being conducted through an academic-community partnership, and an Advisory Board including PSH tenants and other key stakeholders will be engaged in all stages of the project. Discussion We describe the protocol for a hybrid type 3 stepped-wedge cluster RCT of overdose prevention practice implementation in PSH. This study will be the first controlled trial of overdose prevention implementation in PSH settings. The research will make a significant impact by testing and informing future implementation strategies to prevent overdose for a population at particularly high risk for overdose mortality. Findings from this PSH-focused research are expected to be broadly applicable to other housing settings and settings serving people experiencing homelessness. Trial registration ClinicalTrials.gov, NCT05786222 , registered 27 March 2023.

High-order three-dimensional (3D) interactions between more than two genomic loci are common in human chromatin, but their role in gene regulation is unclear. Previous high-order 3D chromatin assays either measure distant interactions across the genome or proximal interactions at selected targets. To address this gap, we developed Pore-C, which combines chromatin conformation capture with nanopore sequencing of concatemers to profile proximal high-order chromatin contacts at the genome scale. We also developed the statistical method Chromunity to identify sets of genomic loci with frequencies of high-order contacts significantly higher than background (‘synergies’). Applying these methods to human cell lines, we found that synergies were enriched in enhancers and promoters in active chromatin and in highly transcribed and lineage-defining genes. In prostate cancer cells, these included binding sites of androgen-driven transcription factors and the promoters of androgen-regulated genes. Concatemers of high-order contacts in highly expressed genes were demethylated relative to pairwise contacts at the same loci. Synergies in breast cancer cells were associated with tyfonas, a class of complex DNA amplicons. These results rigorously link genome-wide high-order 3D interactions to lineage-defining transcriptional programs and establish Pore-C and Chromunity as scalable approaches to assess high-order genome structure. High-order chromatin contacts are identified using a combination of 3C, nanopore sequencing and robust statistical analysis.