Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): School-Based Family Intervention, Food Programs

Intervention Description: The Virginia 365 Project, provided two sets of benefits to the treatment schools. The first set of benefits expanded free school-based nutrition assistance programs to all children in treatment schools, offering free breakfast, lunch, and supper each school day, as well as a food backpack on weekends and school breaks. The second set of benefits involved loosening restrictions in the Child and Adult Care Food Program (CACFP) and strengthening school backpack programs

Intervention Results: At follow-up, 1,393 treatment households and 1,243 control households completed a survey sufficiently to be included in the analysis. The rate of FI-C in treatment households was higher at 25.9% compared with 23.9% in control households, a difference of 2 percentage points (95% CI 0.1 to 3.9). The rate of very low food security among children in treatment households was lower at 3.2% compared with 3.9% in control households, a difference of -0.7 percentage points (95% CI -1.3 to -0.10).

Conclusion: Although the distinction in nutrition assistance benefits between treatment and control schools was less than planned, providing a suite of school-based nutrition assistance programs targeted broadly to low-income households with children has both positive and negative impacts on child and household food insecurity.

Study Design: cluster-randomized trial

Setting: School -based

Population of Focus: Children attending low-income schools

Sample Size: 2596

Age Range: 5/18/2024

Intervention Components (click on component to see a list of all articles that use that intervention): Family-Based Interventions, Food Programs

Intervention Description: The intervention in the study involved the opening of a new full-service supermarket in a food desert neighborhood in Pittsburgh, Pennsylvania.

Intervention Results: After the supermarket's opening, SNAP participants' food security improved and intake of added sugars declined in the intervention neighborhood, but both were unchanged in a comparison neighborhood without a new supermarket. Intervention neighborhood participants also experienced relative declines in the percentage of daily calories from solid fats, alcoholic beverages, and added sugars.

Conclusion: Findings suggest that HFFI amplifies the effects of SNAP participation on improving food security and dietary quality in food deserts.

Study Design: Quasi-experimental pre-post design

Setting: Community-based

Population of Focus: Households in food desserts

Sample Size: 280

Age Range: n/a

Intervention Components (click on component to see a list of all articles that use that intervention): Policy (Community), Food Programs

Intervention Description: Over 2011-2013, the SEBTC demonstrations were evaluated by using a random assignment design. Households were randomly assigned a monthly $60-per-child benefit, a monthly $30-per-child benefit, or no benefit, depending on the study year.

Intervention Results: SEBTC reduced the prevalence of very low food security among children by one-third. It also had positive impacts on 6 of the 8 child nutrition outcomes measured (amounts of fruits and vegetables; whole grains; dairy foods; and added sugars).

Conclusion: SEBTC is a promising model to improve food security and the dietary quality of low-income school-aged children in the summer months.

Study Design: Random assignment design

Setting: Community-based

Population of Focus: Households with school-aged children

Sample Size: 52000

Age Range: n/a

Intervention Components (click on component to see a list of all articles that use that intervention): Family-Based Interventions, Food Programs

Intervention Description: Grow Your Groceries program involved providing home gardening kits, specifically fabric grow bags, to families at risk of food insecurity in Chicago. The program aimed to address food insecurity during the COVID-19 pandemic by empowering participants to grow their own healthy food. Participants received support and resources to cultivate fruits, vegetables, and herbs at home using the provided grow kits.

Intervention Results: Qualitative data were analyzed using an iterative coding process. Quantitative data were analyzed using descriptive statistics. Most participants reported confidence in using a grow kit to grow food, increased healthy food consumption, easier access to healthy food, and high likelihood of growing food again. Additionally, participants described increased connections within their communities, increased interaction with their family, and personal growth as benefits of the program.

Conclusion: Results demonstrate the benefits of a novel home gardening program that uses fabric grow bags to address food insecurity. A larger scale program evaluation is necessary to better understand the impacts of participating in this home gardening program.

Study Design: Participatory approach

Setting: Community-based

Population of Focus: Families

Sample Size: 78

Age Range: 18-66

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment (Provider), Referrals, Food Programs

Intervention Description: This study evaluated the efficacy of screening and referral through process evaluation, key informant interviews, and focus groups with 19 caregivers and 11 clinic staff. Three pediatric clinics implemented a two-question food insecurity screening of 7,284 families with children younger than five years.

Intervention Results: Using grounded theory, transcript themes were coded into facilitators and barriers of screening and referral. Facilitators included trust between caregivers and staff, choice of screening methods, and assistance navigating benefits application. Barriers included complex administration of referral, privacy and stigma concerns, and caregivers' current benefit enrollment or ineligibility.

Conclusion: Results demonstrate importance of integrated screening and referral consent processes, strong communication, and convenient outreach for families.

Study Design: Process evaluation, key informant interviews, and focus groups

Setting: Pediatric clinic

Population of Focus: Familes

Sample Size: 7284

Age Range: n/a

Intervention Components (click on component to see a list of all articles that use that intervention): Policy (Community), Food Programs

Intervention Description: The intervention in this study was the increase in Supplemental Nutrition Assistance Program (SNAP) benefit levels resulting from the re-evaluation of the Thrifty Food Plan (TFP). The TFP serves as the basis for determining SNAP benefit allotments, and in 2021, there was a 21% monthly benefit increase for SNAP participants due to the updated TFP. This increase in SNAP benefits was a critical and permanent change implemented by the USDA amidst the COVID-19 pandemic.

Intervention Results: Prior to the policy change, SNAP participants had significantly worse food insecurity, lower diet quality scores, and higher perceived stress and anxiety/ depression when compared to non-participants (all Ps < 0.05). After adjustment for differences in sociodemographic characteristics, there were no significant effects of the TFP re-evaluation on food insecurity, diet quality, and mental health outcomes among SNAP participants relative to non-participants (all Ps > 0.05). Qualitative responses suggested that rising food prices and growing inflation potentially negated the benefits of the policy change; however, most SNAP participants described the added benefits as helpful in purchasing additional food supplies and offsetting other household costs during this period.

Conclusion: The TFP benefit increase may have helped to prevent inflation-related disparities in food insecurity and health outcomes from widening among SNAP participants and non-participants. Further research is needed to determine the long-term impacts of this policy change.

Study Design: Longitudinal and web-based

Setting: Community-based

Population of Focus: US adults with incomes at or below 65,000

Sample Size: 1776

Age Range: 18-60

Intervention Components (click on component to see a list of all articles that use that intervention): Family-Based Interventions, Food Programs

Intervention Description: The intervention included a multi-component, multi-level Community-Based Participatory Research (CBPR) approach. It utilized a farm-to-school program and parent curricula to enhance community capacity and reduce obesity risk among Native American families. The intervention focused on promoting healthy eating habits, increasing vegetable consumption, and addressing food insecurity within the community

Intervention Results: Vegetable intake significantly increased in intervention children compared to controls for squash (p = 0.0007) and beans (p = 0.0002). Willingness to try scores increased for beans in intervention children (p = 0.049) and tomatoes in both groups (p = 0.01).

Conclusion: FRESH is the first study to implement a farm-to-school intervention in rural, tribally owned ECEs. Future interventions that target healthy dietary intake among children should incorporate a comprehensive parent component in order to support healthy eating for all household members.

Study Design: Randomized wait-list controlled trial

Setting: School and community-based

Population of Focus: Families

Sample Size: 363

Age Range: n/a

Intervention Components (click on component to see a list of all articles that use that intervention): Food Programs

Intervention Description: We conducted a cross-sectional survey among a random sample of child care center directors from four states (Massachusetts, North Carolina, Rhode Island, and South Carolina). We conducted logistic and Poisson regression to calculate the odds and incidence rate ratios of reporting 1) no barriers, 2) specific barriers (e.g., cost), and 3) the total number of barriers, by CACFP status, adjusting for covariates of interest.

Intervention Results: We received 713 surveys (36% response rate). About half (55%) of centers participated in CACFP. The most prevalent reported barriers to serving healthier foods were cost (42%) and children's food preferences (19%). Directors from CACFP centers were twice as likely to report no barriers, compared to directors from non-CACFP centers (OR 2.03; 95% CI [1.36, 3.04]; p < 0.01). Directors from CACFP centers were less likely to report cost as a barrier (OR = 0.46; 95% [CI 0.31, 0.67]; p < 0.001), and reported fewer barriers overall (IRR = 0.77; 95% CI [0.64, 0.92]; p < 0.01), compared to directors from non-CACFP centers.

Conclusion: CACFP directors reported fewer barriers to serving healthier foods in child care centers. Still, cost and children's food preferences are persistent barriers to serving healthier foods in ECE. Future research should evaluate characteristics of CACFP participation that may alleviate these barriers, and whether barriers emerge or persist following 2017 rule changes to CACFP nutrition standards.

Study Design: Early care and education (ECE) is an important setting for influencing young children's dietary intake. There are several factors associated with barriers to healthy eating in ECE, and recent evidence suggests that participation in the Child and Adult Care Food Program (CACFP), the primary national food assistance program in ECE, may be associated with fewer barriers to serving healthier foods. However, no prior studies have examined differences between CACFP participants and non-participants across a large, multi-state sample. This is the first study to examine the association between CACFP participation and barriers to serving healthier foods in ECE using a random sample of directors from two regions across the country.

Setting: Early care and education (ECE)