Barbara Gordon

Background: This study explored the observations and experiences of athletic trainers (ATs) regarding food security constraints and drivers among collegiate student-athletes through the framework of the social determinants of health (SDOH). Methods: Seventeen ATs from nine public Mountain West Division I schools participated in one of six 90 min, virtual focus groups conducted in July–December 2023. A phenomenological design and constructivist theoretical framework were employed to analyze transcripts, compile themes, infer food security constraints and drivers, and map them to SDOH domains. Results: Emerging constraints and drivers mapped to seven of the eight SDOH domains (education, employment, health systems and services, housing, income and wealth, physical environment, and social environment); no themes related to the public safety domain. Conclusions: ATs identified a considerable number of food security constraints and drivers; however, based on the findings of other studies, their observations were not comprehensive. Incorporating the findings of those other studies, food security constraints and drivers exist across all eight SDOH domains. Four concepts spanned multiple domains: student-athlete normative expectations, nutrition/food security prioritization, financial disparities, and residing off campus. To ensure food security among collegiate student-athletes, AT perceptions suggest that structural changes facilitating the implementation of necessary food drivers may be warranted.

Though it has been well established that a subset of collegiate student-athletes in the United States (U.S.) are not food secure, efficacious solutions for mitigating this issue appear to be elusive. This study identified system-level barriers and enablers to food security among student-athletes through the lens of collegiate athletic professionals (athletic directors, athletic trainers, sports dietitians, and strength and conditioning coaches). Using a phenomenological-informed design and constructivist theoretical framework, researchers explored the experiences and insights of participants (n = 27, Division I, northwestern U.S.) via six online focus groups July–December 2023. Categorical themes for barriers to food security were finances, culture, and competing priorities; enablers were on-campus supplemental food assistance, referrals to community services, and educational programming. A gap analysis was performed; existing solutions enabling food security and aspirational solutions for addressing food insecurity were compared, and gaps identified. Based on the insights of athletic professionals, a lack of student-athlete-centric solutions to ensure food security emerged. The introduction of shared revenue programs in American college sports may address some of food security barriers; however, additional funds may not mitigate the contribution of competing priorities and scheduling issues experienced by student-athletes. System-level changes are required to enable food security among this population.

This study examined the efficacy of pediatric Produce Prescription Programs (PPP) on food security status, dietary intake, and health outcomes among children, and aimed to determine the optimal prescription dosage and exposure duration required to promote beneficial outcomes. A systematic review of studies published within the past 10 years, reporting on discrete food security status, dietary quality, and health outcomes among children was conducted. Studies not reporting child-specific data or not published in the English language were excluded. Three databases were searched (PubMed, CINAHL Complete, and EBSCO), data was narratively compiled, and the Newcastle-Ottawa Quality Assessment was employed to assess risk of bias. Prescription monetary amounts (dosages) were standardized, facilitating comparison between programs and outcomes. Nine studies (n = 3808 at-risk children) conducted at 52 sites were retrieved. Program protocols varied. Participation improved food security and fruit/vegetable intake; some beneficial changes were similar regardless of produce dosage and exposure. Data suggest conjecturally that a minimum dosage of $70/month adjusted for locality, cost-of-living and implementation year and exposure of ≥6 months might promote achievement of FV recommended guidelines. The value of educational components emerged in the studies. The findings of this study are limited by the high risk of bias embedded in the included interventions, as well as high heterogeneity amongst the programs. More research on program designs, the impact of PPPs on health outcomes, and cost-benefit analyses are warranted. Rigorous study designs are needed to assess the health impacts and long-term efficacy of pediatric PPPs.

Collegiate student-athletes are particularly vulnerable to food insecurity (FI). Prevalence rates range from 9.9% to 65%, although research is limited among this population. Background/Objectives: The challenge of balancing academic and degree progression requirements with training and competition demands can increase the risk for FI among student-athletes. Furthermore, insufficient funds for food has been reported for student-athletes living both on campus and off campus. Methods: This qualitative study employed a phenomenological design and constructivist theoretical framework to explore the experiences of athletic trainers, sports dietitians/nutritionists, and other professionals working with student-athletes in identifying and addressing FI among student-athletes via a series of online focus groups. Results: Participants (n = 27, 12 public colleges) had ≥7 years of collegiate athletics work experience, and most had been in their current position for <3 years. Five approaches to FI screening emerged; specifically, no screening, screening varies by team/sport, informal screening, dietitian screening, and formal screening. Emerging social determinants of FI included financial challenges, competing priorities, cultural/societal impacts, limited life skills, and the food environment. All these factors precipitated on a systems level, including individual, team/athletic department, and university/societal tiers. Conclusions: Athletic department and university policies and budgetary decisions emerged as potential antagonists of food security among student-athletes. FI mitigation strategies for student-athletes must go beyond simply addressing individual factors. Obtainment of food security among collegiate student-athletes requires system changes at the team/athletic department and university tiers.

The 2022 White House National Strategy on Hunger, Nutrition, and Health outlined goals for ending hunger in the US. Actions fell into five areas, called pillars; the goal of Pillar 5 was to enhance nutrition and food security research. This study leveraged participatory research theory and the National Strategy for developing a statewide, evidence-informed food security research agenda. A mixed-methods study employing the Community Engagement in Research Continuum (CEnR) was implemented. Engagement strategies included collecting baseline data via a statewide survey and encouraging participants of a statewide Summit to participate in a collective prioritization process. Surveys were emailed to a purposive sample of 1575 contacts; 31 registered for the in-person session. A total of 197 records were included in the survey analysis; all 31 registrants attended the in-person session. The research agenda was to include two objectives for implementation over the next two years. Academic and nonacademic stakeholders interacted as peers during the prioritization exercise. The first research objective was to conduct food assistance usage gap analyses; the second was to investigate barriers to collaboration among Idaho’s food security programs. The CEnR proved efficacious for producing a stakeholder-generated research agenda. Leveraging a national framework helped facilitate asset-based, actionable strategies within a proposed timeline.

Whole health models of care aim to coordinate care across sectors, address the needs of older adults with multiple chronic conditions, and promote health equity. The FlourishCare team will present data on the effectiveness of a whole health model, the FlourishCare Model (FCM), serving 159 older adults with multiple chronic conditions, using a two-level longitudinal design and hierarchical linear modeling to test a multilevel growth model. The results showed significant growth in total FlourishCare Index (FCI) scores over time for individual health behaviors, healthcare access, and social determinants. Biological determinants showed significant growth only for rural patients. The FCM was able to support patients with lower education attainment to improve at a higher rate than those with higher education attainment, both for the total score on the FCI and for healthcare access. The FCM was also able to support rural patients at a higher rate than urban patients to gain access to healthcare, and it supported Hispanic patients the most in improving their social determinants of health. The study demonstrates the importance of a whole health approach to care, which focuses on what matters most to patients, particularly older adults who place importance on quality-of-life outcomes. The study also shows how a whole health approach can address health equity by accelerating the flourishing of rural, Hispanic patients with lower educational attainment, promoting social and racial justice.

Background: Clinical guidelines developed by urologic, urogynecologic, and gynecologic associations around the globe include recommendations on nutrition-related lifestyle and behavioral change for bladder storage conditions. This study identified and compared clinical guidelines on three urological conditions (interstitial cystitis/bladder pain syndrome (IC/BPS), overactive bladder, and stress urinary incontinence) affecting adult women. Methods: A three-step process was employed to identify the guidelines. Next, a quality assessment of the guidelines was conducted employing the Appraisal of Guidelines Research and Evaluation (AGREE II) International tool. (3) Results: Twenty-two clinical guidelines, prepared by seventeen groups spanning four continents, met the inclusion criteria. The AGREE II analyses revealed that most of the guideline development processes complied with best practices. The most extensive nutrition recommendations were for women with IC/BPS. Dietary manipulation for the other two storage LUTS primarily focused on the restriction or limitation of specific beverages and/or optimal fluid intake. (4) Conclusion: Clinical guidelines for IC/BPS, overactive bladder, and stress urinary incontinence include nutrition recommendations; however, the extent of dietary manipulation varied by condition. The need to ensure that clinicians are informing patients of the limitations of the evidence supporting those recommendations emerged. Furthermore, given the need to treat nutrition-related comorbid conditions as a strategy to help mitigate these three urological disorders, the value of referral to a dietitian for medical nutrition therapy is apparent.

Though the interest in community engagement in research (CEnR) protocols has increased, studies reporting on the findings of tested CEnR engagement measurement scales for health studies are sparse. A systematic review was conducted from January 1 to March 1, 2023, to identify validated, quantitative CEnR engagement measurement tools for health studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was employed. The rigor of scale development, testing, and implementation was explored, and a `best practices evaluation conducted. Themes on the readiness of scales for implementation in health research studies were narratively compiled. Nineteen studies met the search inclusion criteria—reporting on the development, testing, and implementation of seven CEnR engagement measurement scales for health studies. Scale implementation studies precipitated only two of the studies. None of the scales followed the rigorous process dictated in best practices; however, at this time, three scales have gone through the most robust testing processes. Advancement of the science of engagement measurement requires consensus on terminology, application of best practices for scale development and testing protocols, and consistency of reporting findings.

This study confirms the findings of similar research, specifically that individuals with interstitial cystitis/bladder pain syndrome (IC/BPS) report that certain foods and beverages exacerbate symptomatology. Of note are the significant findings of the disparate experiences of racial groups. The authors report that, compared with their White counterparts, Black patients were more apt to report that alcoholic beverages and noncaffeinated beverages were bothersome.