The Supplemental Nutrition Assistance Program (SNAP) Online Purchasing Pilot (OPP) authorised the use of SNAP benefits online in Maryland in May 2020. We assessed shopping behaviour and intentions associated with uptake and intended future use of online grocery shopping during and after COVID-19 among SNAP-eligible households.

In this mixed-methods study, participants completed a survey on online grocery shopping, and a purposefully sampled subset participated in focus groups or in-depth interviews between November 2020 and March 2021.

Predominantly urban households in Maryland

Primary shoppers of SNAP-eligible households with young children (n 310)

Most participants reported first shopping for groceries online after the OPP was implemented (57 %). Families who purchased groceries in-store less frequently were less likely to report ever buying groceries online (rate ratio (RR): 0·66, 95 % CI 0·46, 0·93) compared with weekly grocery shoppers. Shoppers who intended to purchase more groceries online in the next 6 months were more likely to have online shopping experience, although this differed by timing of online grocery service adoption. Participants reported more negative attitudes towards in-store grocery shopping during the pandemic than prior to its onset and cited COVID-19 as a motivator for ordering groceries online in focus groups. Most participants who had shopped online planned to continue after the pandemic (79 %).

Most participants who shopped online started during the COVID-19 pandemic and considered the pandemic a key motivator. Findings suggest that low-income households will continue to shop online, affirming the need for policies that promote equitable access to healthy food online.

The public health nutrition workforce is well placed to contribute to bold climate action; however, tertiary educators are seeking practical examples of how to adequately prepare our future workforce. This study examines the responses of university students engaged in a co-designed planetary health education workshop as part of their public health nutrition training.

A mixed-methods approach was used to collect and interpret student responses to four interactive tasks facilitated during an in-person workshop. Data were analysed using statistical tests, frequency counting and content analysis.

The intervention was co-designed by students (n 5) and an educator over a 4-week period as part of a larger multi-disciplinary study at an Australian university.

The workshop engaged nutrition and dietetics students (n 44) enrolled in public health nutrition coursework.

Students reported an increase in self-perceived knowledge about planetary health as a concept and how they can promote it within their future professional roles. Students’ descriptions of what planetary health means to them were focused on humans’ role in protecting and preserving the ecosystem, the responsible and sustainable use of natural resources and a need to sustain a healthy life for future generations. Students prioritised the values of ‘collaboration’ and ‘respect’ as being critical to guide personal and professional practice to promote planetary health.

This study demonstrated that incorporating planetary health curricula designed by, and for, university students could be a feasible and effective way to prepare the future public health nutrition workforce to address planetary health challenges.

This study assessed the association between baseline sociodemographic variables, body composition and 4-year changes in the intake of food groups, including sugar-sweetened beverages (SSB) among children, after the implementation of the health promotion levy.

Prospective cohort study.

Ten schools in North West Province, South Africa.

950 children aged 5–9 years at baseline and data of 672 children at follow-up. The frequency of intake from healthy and unhealthy food groups was assessed by questionnaire. Anthropometric and sociodemographic information were collected; BMI-for-age z-scores were calculated. The health promotion levy was implemented after baseline and follow-up measurements were done after 4 years. A random intercept generalised linear mixed model analysis was applied to investigate the time effect of the weekly intake of the foods adjusting for BMI-for-age z-scores and sociodemographic characteristics of the children.

The weekly frequency of intake from most food groups remained unchanged at follow-up. The frequency of SSB intake decreased significantly over 4 years. Decreased intake of SSB was not linked to increased intake of healthy foods. Changes in intakes from SSB were not associated with household income, parental education or BMI-for-age z-score categories. A decreased frequency of intake from SSB was observed following the implementation of the health promotion levy after baseline, in line with reports of national decreases in SSB sales in South Africa since 2017.

The decreased frequency of SSB intakes following the implementation of the health promotion levy in South Africa may indicate that health policies can promote healthier dietary habits.

Early education and care (ECEC) is part of the everyday life of most children in developed economies, presenting exceptional opportunity to support nutrition and ongoing food preferences. Yet, the degree to which such opportunity is captured in policy-driven assessment and quality ratings of ECEC services is unknown.

Abductive thematic analysis was conducted, guided by key domains of knowledge in nutrition literature and examining identified themes within these domains.

ECEC services (n 38) in Queensland, Australia.

Data were a random sample of field notes pertaining to mealtimes and food provision (n 182) collected as evidence to inform quality ratings during assessment visits to ECEC services.

The field notes mapped to three theory-driven domains: provisions, practices and education. Reflecting policy specification, health, hygiene and safety were a key focus, but food quality and quantity were not. Assessors noted the promotion of child autonomy at mealtimes, yet little evidence pertaining to characteristics of educator-child interactions.

Despite evidence that childhood nutrition is crucial for optimal development and learning, the quality and quantity of food are not directly assessed. Relationships and interactions at mealtimes provide an environment ideal for promoting learning and development, yet the policy guiding inspection and assessment of ECEC services directs focus to a more limited lens of safety, hygiene and promotion of ‘healthy foods’. Our findings identify a narrow conceptualisation of mealtimes focused on ‘health’ as limiting the potential to leverage mealtimes as places to support children’s nutrition and attendant development and learning.

To examine the proportion of products offered by leading food brands in Canada that are ‘unhealthy’ according to Health Canada’s (HC) nutrient profile model for proposed restrictions on food marketing to children (M2K-NPM).

Nutritional information for products offered by top brands was sourced from the University of Toronto FLIP and Menu-FLIP 2020 databases, respectively. HC’s M2K-NPM, which includes thresholds for Na, total sugars and saturated fat, was applied to products.

Canada.

Overall, 1385 products from top breakfast cereal (n 15 brands, n 222 products), beverage (n 21 brands, n 769 products) and yogurt (n 10 brands, n 394 products) brands, and 3153 menu items from seventeen chain restaurants in Canada were assessed (n 60 unique brands overall).

For 42 % of brands (n 21), 100 % of their products exceeded ≥1 nutrient threshold(s), with ≥50 % of the products offered by twenty-three brands (46 %) exceeding two thresholds. Specifically, one or more nutrient thresholds were exceeded by ≥50 % of the products offered by 14/15 breakfast cereal brands, 18/21 beverage brands, all ten yogurt brands and all seventeen restaurant brands. Notably, 100·0 % of the products offered by ten breakfast cereal, six beverage, two yogurt and three restaurant brands exceeded ≥1 threshold(s).

Most products offered by top food brands in Canada exceeded HC’s M2K-NPM thresholds. Nonetheless, these brands could still be marketed under the proposed regulations, which exclude brand marketing (i.e. promotions without an identifiable product) despite its contribution to marketing power. These findings reinforce the need for Canada and other countries to include brand marketing in M2K policies.

To explore mothers’ and early childhood (EC) educators’ experiences of breast-feeding/breast milk provision and breast-feeding support in child care centres (CCC) in the USA.

We conducted one-time, semi-structured phone interviews with mothers and EC educators to examine perceptions of support, accommodations and barriers to breast-feeding in CCC. We administered a background survey to assess participant characteristics and quantify perceived degree of breast-feeding support in the workplace (mothers) and CCC (mothers and EC educators).

US-based CCC

Fifty working mothers using CCC for their infants and twenty-two EC educators

Interview themes and background surveys reflected neutral feelings towards breast-feeding support received (mothers) and provided (EC educators) in CCC. Maternal expectations for breast-feeding support in CCC were generally low; workplace and social support for breast-feeding were perceived as the most important factors impacting breast-feeding. EC educators’ capacity to offer breast-feeding support was constrained by CCC infant feeding regulations, inadequate breast-feeding training and time limitations. Tensions arose when mothers attempted to manage low milk supply at the CCC level by requesting EC educators to individualise feeding or milk storage practices for their infant.

Breast-feeding efforts of working mothers are undermined in multiple settings, including the workplace and CCC. Improving breast-feeding outcomes for this population requires structural/policy changes that: (1) maximise opportunities for continued, direct breast-feeding and maternal/infant proximity and (2) enforce evidence-based CCC feeding protocols and standards and EC educator lactation training.

The Baby-Friendly Hospital Initiative (BFHI) designation is known to increase breast-feeding rates in the USA. However, less is known about barriers and facilitators to breast-feeding support practices in BFHI hospitals and how they differ from non-BFHI hospitals. We examined what barriers and facilitators are perceived to affect breast-feeding practices among BFHI and non-BFHI hospital administrators and further explored factors that presented challenges to the adoption and continuation of breast-feeding support practices.

Cross-sectional study was conducted. We measured whether hospitals were implementing 12 breast-feeding support practices and identified barriers and facilitators to the practices. The survey questionnaire included both structured and open-ended questions.

This study included hospital administrators from both BFHI and non-BFHI hospitals from all regions of the USA to help elucidate potential differences.

A stratified random sample of 50 % of BFHI and 50 % of non-BFHI hospitals was obtained. The final sample size included 113 BFHI and 177 non-BFHI hospital administrators.

Low interest among mothers was reported as the most significant barrier to providing breast-feeding support among all administrators. Non-BFHI hospital administrators were more likely to report cost, nursing staff and physician resistance and hospital infrastructure as barriers to initiating practices. In-person training was cited as the most important facilitator among both groups.

Strengthening prenatal education for mothers and trainings for administrative and nursing staff and physicians is warranted in BFHI and non-BFHI hospitals. Staff management and hospital infrastructure need to be improved particularly in non-BFHI hospitals to provide adequate breast-feeding support for mothers.

Humanitarian aid, including food aid, has increasingly shifted towards the provision of cash assistance over in-kind benefits. This paper examines whether food security mediates the relationship between receipt of humanitarian cash transfers and subjective wellbeing among Syrian refugee youth in Jordan.

Secondary analysis of the 2020–21 Survey of Young People in Jordan, which is nationally representative of Syrian youth aged 16–30. We employ stepwise model building and structural equation models.

Jordan.

Syrian refugee youth aged 16–30 (n 1572).

While 92 % of Syrian households with youth received cash transfers from a UN agency, 78 % of households were food insecure using the Food Insecurity Experience Scale. Fifty-one percent of youth suffered from poor wellbeing using the WHO-5 subjective wellbeing scale. Household food insecurity was associated with poorer youth wellbeing. Receiving larger cash transfer amounts was associated with better wellbeing among Syrian youth in unadjusted models. The relationship between receipt of cash transfers and youth wellbeing was not mediated by food security.

We do not find support for the hypothesis that food security is a mediator of the association between cash transfers and subjective wellbeing for this population.

The creation of a healthy food environment is highly dependent on the policies that governments choose to implement. The objective of this study is to compare the level of implementation of current public policies aimed at creating healthy food environments in Burkina Faso with international good practice indicators.

This evaluation was carried out using the Food-EPI tool. The tool has two components (policy and infrastructure support), thirteen domains and fifty-six good practice indicators adapted to the Burkina Faso context.

Burkina Faso.

Expert evaluators divided into two groups: the group of independent experts from universities, NGO and civil society and the group of experts from various government sectors.

Among the fifty-six indicators, it was assessed the level of implementation as ‘high’ for six indicators, ‘medium’ for twenty-four indicators, ‘low’ for twenty-two indicators and ‘very low’ for four indicators. High implementation level indicators include strong and visible political support, targets on exclusive breastfeeding and complementary feeding, strong and visible political support for actions to combat all forms of malnutrition, monitoring of exclusive breastfeeding and complementary feeding indicators, monitoring of promotion and growth surveillance programmes and coordination mechanism (national, state and local government). The indicators on menu labelling, reducing taxes on healthy foods, increasing taxes on unhealthy foods and dietary guidelines are the indicators with a ‘very low’ level of implementation in Burkina Faso.

The general results showed that there is a clear need for further improvements in policy and infrastructure support to promote healthy food environments.

The adoption of policies promoting healthier restaurant food environments is contingent on their acceptability. Limited evidence exists regarding individual characteristics associated with restaurant food environment policy acceptability, especially health-related characteristics. This study examined associations between health characteristics and restaurant food environment policy acceptability among urban Canadians.

Links between health characteristics and complete agreement levels with selected policies were examined using data in the cross-sectional Targeting Healthy Eating and Physical Activity survey study, that is, a large pan-Canadian study on policy acceptability. For each policy, several logistic multilevel regression analyses were conducted.

Canada’s seventeen most populated census metropolitan areas.

Urban Canadian adults responded to the survey (n 27 162).

Body mass index was not associated with acceptability after adjustments for other health and sociodemographic characteristics were made. Across all policies and analyses, those reporting excellent or very good health statuses were more likely to be in complete agreement with targeted policies than those with good health statuses. For selected policies and analyses, those reporting poor health statuses were also more likely to be in complete agreement than those describing their health status as good. For all policies and analyses, both those consuming restaurant-prepared foods daily and those never consuming these foods were more likely to be in complete agreement than those consuming these foods once per week.

More research is needed to explain discrepancies in acceptability according to health characteristics. Bringing this study’s findings to the attention of policymakers may help build momentum for policy enactment.