Elizabeth L. Adams

Background: The 2025 United States government shutdown (October 1–November 12) resulted in historic disruptions to benefit distribution for the Supplemental Nutrition Assistance Program (SNAP). The purpose of this study was to examine South Carolina SNAP recipients’ perceptions of the 2025 government shutdown and how it impacted their food access. Methods: South Carolina issued SNAP benefits on November 14, 2025, after a maximum 14-day lapse, for households who typically get their benefits between the 1 ^st and 14 ^th of the month. Caregivers ( n = 74) in SNAP participating in an ongoing clinical trial were invited to complete a brief online survey between November 19 and 27, 2025 to assess if/how November SNAP benefits were impacted and what strategies were used to access food during this time. Descriptive statistics were applied to survey items. Responses for open ended questions were coded into themes. Results: Fifty-five caregivers completed the survey (76% response rate). Most (85.5%) reported their November SNAP benefits were impacted. Of those impacted, the most common response was a delay in distribution (80.9%). Some caregivers (43.6%) used new or different strategies to access food during the shutdown, the most common being community food resources (e.g., food banks; 62.5%) and support from friends and family (29.2%). When asked to describe these impacts in detail, caregivers described four main themes: constrained food choices, shift toward different foods, financial coping strategies, and emotional strain. Conclusion: These findings underscore the importance of continuous SNAP benefit distribution and enacting contingency plans during federal disruptions to prevent future undue hardship.

The Structured Days Hypothesis suggests that the school day helps to regulate obesogenic behaviors, whereas out-of-school periods (e.g., summer) contribute to worsening obesogenic behaviors (e.g., low levels of physical activity, increased screen time, later sleep patterns, and unhealthy diet). However, little is known about how out-of-school periods impact children with intellectual and developmental disabilities who experience diagnosis-related challenges and unique family circumstances. This paper outlines a conceptual framework that proposes how out-of-school periods may be associated with obesogenic behaviors in children with intellectual and developmental disabilities, and how child- and family-level factors moderate this relationship. The hypotheses generated from the extension of the Structured Days Hypothesis to children will guide future research in this area, providing insight into who and when the risk for worsening obesogenic behavior is the greatest. This future research will provide information to help inform policies and interventions aimed at improving health outcomes and increasing access to supportive environments for this population.

Background: To examine the efficacy of providing free summer day camp (SDC) to children from low-income families on changes in physical activity, time spent sedentary, and screentime. Methods: Across three summers (2021–2023), we randomized 422 children (8.2 ± 1.5yrs, 48% female, 51% Black, 69% at or below 200% Federal Poverty Level, 30% food insecure) from seven elementary schools to one of two conditions: summer as usual (control, n = 199) or free SDC for 8-10wks (intervention, n = 223). Accelerometry measured activity (moderate-to-vigorous PA [MVPA] and time spent sedentary) and parent daily report of screentime were measured using a 14-day in April/May (school) and July (summer). Intent-to-treat analysis examined changes in behaviors between school and summer. Exposure models examined differences in behaviors during summer on days when children attended vs. did not attend a SDC in both intervention and control children. Results: Intent-to-treat models indicated in the summer children in the intervention group accumulated + 15.0 min/day (95CI 12.0 to 18.0) more MVPA and spent − 29.7 min/day (-37.7 to -21.8) less time sedentary and − 14.1 min/day (-23.9 to -4.3) on screens, compared to children in the control group. Exposure models indicated, on days children attended SDCs, they accumulated more MVPA (+ 26.1 min/day, 22.5 to 29.7), and spent less time sedentary (-63.5 min/day, -72.9 to -54.1) and on screens (-9.5 min/day, -20.1 to 1.2), compared to days when children did not attend SDC. Conclusions: Policies targeting upstream structural factors, such as universal access to existing community SDCs during summer, could lead to improvements in health behaviors among children from low-income households. Clinical trials.Gov: NCT04072549

The Supplemental Nutrition Assistance Program (SNAP) has financial incentive programs where recipients can purchase fruits and vegetables (F&V) at

The Society for Behavioral Medicine supports permanent federal funding for Food is Medicine services to address nutrition-related chronic conditions. The Section 1115 Demonstration Waivers are currently serving as a temporary funding mechanism to pilot interventions aimed at improving health-related social needs, including food-related programs that support the prevention, management, and treatment of nutrition-related chronic conditions; however providing permanent funding for Food is Medicine services covered under Section 1115 Demonstration Waivers will allow states to utilize their federally set budgets to provide nutrition supports as a healthcare service. The sense of impermanency of the nutrition programs being implemented during the pilot period makes it challenging to establish effective workflow and implementation at scale.

The Society of Behavioral Medicine (SBM) supports passing the Expanding Access To Local Foods Act—a bill to promote economic opportunities for farmers and ranchers to strengthen local food supply chains, and to increase access to nutritious foods among households experiencing food insecurity and chronic disease risk.

Study Objectives: Evaluate the performance of actigraphy-based open-source and proprietary sleep algorithms compared to polysomnography in children with suspected sleep disorders. Methods: In a sleep clinic, 110 children (5–12 years, 54% female, 50% black, 82% with sleep disorders) wore wrist-placed ActiGraph GT9X during overnight polysomnography. Actigraphy data were scored as sleep or wake using open-source GGIR and proprietary ActiLife software. Discrepancy and epoch-by-epoch analyses were conducted to assess agreement between algorithms and polysomnography, along with equivalence testing. Results: The open-source vanHees2015 algorithm showed good accuracy (79.5% ± 12.0%), sensitivity (81.1% ± 13.5%), and specificity (66.0% ± 23.8%) for sleep detection but was outperformed by the proprietary ActiLife algorithms. The magnitude and trend of bias for total sleep time (TST), sleep efficiency (SE), sleep onset latency, and wake after sleep onset were similar between algorithms. TST and SE were statistically equivalent for the Cole-Kripke (Actilife) and vanHees2015 algorithms compared to the Sadeh (Actilife) algorithm. The Cole-Kripke (ActiLife) demonstrated higher sensitivity (90.5%) to detect sleep but lower specificity (61.2%) than Cole-Kripke (GGIR) (sensitivity: 62.7%, specificity: 79.9%). Sadeh and Cole-Kripke estimated sleep outcomes were not statistically equivalent between implementations in ActiLife and GGIR. Conclusions: The open-source vanHees2015 algorithm performed well but slightly worse than the proprietary ActiLife algorithms in children. The open-source nature vanHees2015 makes it ideal for clinical pediatric use. Implementation of the Sadeh and Cole-Kripke algorithms in the proprietary ActiLife and open-source GGIR software yield different sleep estimates, so comparisons between studies using these different implementations should be avoided.

This study identified specific feeding and growth topics discussed during 2-, 4-, and 6-month well-child visits. Conversations between mothers (N = 20) and pediatricians (N = 5) during visits were audio-recorded. Conversation segments were classified as pediatrician-initiated guidance, mother-initiated questions/concerns, or updates using directed content analysis. Pediatricians and mothers completed surveys on perceptions of guidance delivered. Feeding clusters included introducing solids/drinks, breast milk/formula amount and timing, feeding in specific situations; and breast milk/formula preparation. Growth clusters included appropriate growth and growth tracking. There was considerable variability in specific topics discussed between and within families across visits. Mothers desired additional guidance around introducing solids (42.1%) and allergen foods (31.6%). Pediatricians (80%) felt the amount of guidance to deliver in a standard visit was too much, and additional guidance outside of visits would benefit caregivers. Future research should investigate strategies to further support families by offering additional guidance during or outside of well-child visits.

The 2021 Expanded Child Tax Credit (ECTC) lifted millions of children out of poverty and drastically improved well-being. These impacts were particularly salient for families with lower income among those who received the full ECTC benefit. This study gathered lived experiences on the ECTC cessation and explored differential impacts across income levels to inform discussions around policy restoration. Semi-structured interviews were conducted with parents who had a child (2-12 years) who received the full ECTC. Interviews occurred in May 2022 after the ECTC ended. Changes in financial security and health were assessed. Families were classified as having lower vs. higher income (LI; n=19 vs. HI; n=19) corresponding to household income below vs. above 200% of the Federal Poverty Line. Inductive analysis and constant-comparison methods generated themes on similarities/differences between groups. Results indicated families with LI experienced severe financial constraints and greater negative emotions, after the ECTC ended. Many reduced spending, budgeted, accepted financial support from family/friends, and delayed credit card payments. More families with HI reported the ECTC provided a financial buffer placingthem in a more secure position to meet current needs. Both groups reported negative impacts from inflation coinciding with the ECTC ending and minimal changes in their income tax return. Families overwhelmingly reported a desire for the ECTC to continue, despite experiencing different degrees of impact due to these financial changes. Families with LI faced greater hardships after the ECTC ended. Differences across income highlight the need for ECTC restoration, particularly for families in severely under-resourced circumstances.

Background: Twenty-four hour movement behaviors (ie, physical activity [PA], screen time [ST], and sleep) are associated with children’s health outcomes. Identifying day-level contextual factors, such as child care, that positively influence children’s movement behaviors may help identify potential intervention targets, like improving access to child care programs. This study aimed to examine the between- and within-person effects of child care on preschoolers’ 24-hour movement behaviors. Methods: Children (N = 74, 4.7 [0.9] y, 48.9% girls, 63.3% White) wore an Axivity AX3 accelerometer on their nondominant wrist 24 hours per day for 14 days to measure PA and sleep. Parents completed surveys each night about their child’s ST and child care attendance that day. Linear mixed effects models predicted day-level 24-hour movement behaviors from hours spent in child care. Results: Children spent an average of 5.0 (2.9) hours per day in child care. For every additional hour of child care above their average, children had 0.3 hours (95% CI, −0.3 to −0.2) less ST that day. Between-person effects showed that compared with children who attended fewer overall hours of child care, children who attended more hours had less overall ST (B = −0.2 h; 95% CI, −0.4 to 0.0). Child care was not significantly associated with PA or sleep. Conclusions: Child care attendance was not associated with 24-hour PA or sleep; however, it was associated with less ST. More research utilizing objective measures of ST and more robust measures of daily schedules or structure is necessary to better understand how existing infrastructure may influence preschool-aged children’s 24-hour movement behaviors. In addition, future research should consider how access to child care may influence child care attendance.