As tap water distrust has grown in the USA with greater levels among Black and Hispanic households, we aimed to examine recent trends in not drinking tap water including the period covering the US Flint Water Crisis and racial/ethnic disparities in these trends.

Cross-sectional analysis. We used log-binomial regressions and marginal predicted probabilities to examine US nationally representative trends in tap and bottled water consumption overall and by race/ethnicity.

The National Health and Nutrition Examination Survey data, 2011–2018.

Nationally representative sample of 9439 children aged 2–19 years and 17 268 adults.

Among US children and adults, respectively, in 2017–2018 there was a 63 % (adjusted prevalence ratio (PR): 1·63, 95 % CI (1·25, 2·12), P < 0·001)) and 40 % (PR: 1·40, 95 % CI (1·16, 1·69), P = 0·001)) higher prevalence of not drinking tap water compared to 2013–2014 (pre-Flint Water Crisis). For Black children and adults, the probability of not drinking tap water increased significantly from 18·1 % (95 % CI (13·4, 22·8)) and 24·6 % (95 % CI (20·7, 28·4)) in 2013–2014 to 29·3 % (95 % CI (23·5, 35·1)) and 34·5 % (95 % CI (29·4, 39·6)) in 2017–2018. Among Hispanic children and adults, not drinking tap water increased significantly from 24·5 % (95 % CI (19·4, 29·6)) and 27·1 % (95 % CI (23·0, 31·2)) in 2013–2014 to 39·7 % (95 % CI (32·7, 46·8)) and 38·1 % (95 % CI (33·0, 43·1)) in 2017–2018. No significant increases were observed among Asian or White persons between 2013–2014 and 2017–2018. Similar trends were found in bottled water consumption.

This study found persistent disparities in the tap water consumption gap from 2011 to 2018. Black and Hispanics’ probability of not drinking tap water increased following the Flint Water Crisis.

To analyse the trend of social inequality in food consumption among Brazilians from 2008 to 2019.

Time series analyses using cross-sectional annual data from the Telephone Surveillance System (VIGITEL 2008–2019). Food consumption was evaluated through: (1) consumption of five or more portions of fruits and vegetables in ≥5 d/week; (2) consumption of beans in ≥5 d/week and (3) consumption of soft drinks or artificial juices in ≥5 d/week. Absolute inequality was assessed by the slope index of inequality (SII) and relative inequality by the concentration index (CIX). SII and CIX positive values indicate higher prevalence among more educated citizens and negative among less educated ones. Time trend was assessed by linear regression using weighted least squares.

26 Brazilian state capitals and the Federal District.

621 689 individuals ≥18 years.

Fruits and vegetable consumption was more prevalent among the more educated citizens, while beans were mostly consumed by the less educated, and soft drinks or artificial juices was more prevalent among individuals with intermediate education. The highest absolute inequality was found for beans (SII2019 -25·9). In 12 years, the absolute inequality increased for fruit and vegetable consumption (from SII2008 12·8 to SII2019 16·2), remained for beans (SII2008 -23·1 to SII2019 -25·9) and reduced for soft drinks or artificial juices (SII2008 8·7 to SII2019 0·4). Relative inequality was low and constant.

Despite the advances reducing inequalities in soft drinks or artificial juice consumption, the increase in the social gap for adequate consumption of fruits and vegetables is troublesome.

FFQ assess habitual dietary intake and are relatively inexpensive to process, but may take up to 60 min to complete. This article describes the validation of the Flower-FFQ, which consists of four short FFQ measuring the intake of energy and macronutrients or specific (micro)nutrients/foods that can be merged into one complete daily assessment using predefined algorithms.

Participants completed the Flower-FFQ and validated regular-FFQ (n 401). Urinary N (n 242) and K excretions (n 361) were measured. We evaluated: (1) group-level bias, (2) correlations and (3) cross-classification.

Observational study.

Dutch adults, 54 ± 11 (mean ± SD) years.

Flower-FFQ1, Flower-FFQ2, Flower-FFQ3 and Flower-FFQ4 were completed in ±24, 9, 8 and 9 min (±50 min total), respectively. The regular-FFQ was completed in ±43 min. Mean energy (flower v. regular: 7953 v. 8718 kJ/d) and macronutrient intakes (carbohydrates: 204 v. 222 g/d; protein: 75 v. 76 g/d; fat: 74 v. 83 g/d; ethanol: 8 v. 12 g/d) were comparatively similar. Spearman correlations between Flower-FFQ and regular-FFQ ranged from 0·60 to 0·80 for macronutrients and from 0·40 to 0·80 for micronutrients and foods. For all micronutrients and foods, ≥ 78 % of the participants classified in the same/adjacent quartile. The Flower-FFQ underestimated urinary N and K excretions by 24 and 18 %; 75 and 73 % of the participants ranked in the same/adjacent quartile.

Completing the Flower-FFQ required 50 min with a maximum of 25 min per short FFQ. The Flower-FFQ has a moderate to good ranking ability for most nutrients and foods and performs sufficiently to study diet–disease associations.

To explore the accuracy of estimated 24-h urinary iodine excretion (24-h UIEest) in assessing iodine nutritional status.

Fasting venous blood, 24-h and spot urine samples were collected during the day. The urinary iodine concentration (UIC) and urinary creatinine concentration (UCrC) were measured, and the urinary iodine-to-creatinine ratio (UI/Cr), 24-h UIEest, and 24-h urinary iodine excretion (24-h UIE) were calculated. At the population level, correlation and consistency between UIC, UI/Cr, 24-h UIEest and 24-h UIE were assessed using correlation analysis and Bland–Altman plots. At the individual level, receiver operating characteristic (ROC) curves were used to analyse the accuracy of the above indicators for evaluating insufficient and excessive iodine intake. The reference interval of 24-h UIEest was established based on percentile values.

Indicator can accurately evaluate individual iodine nutrition during pregnancy remains controversial.

Pregnant women (n 788).

Using 24-h UIE as standard, the correlation coefficients of 24-h UIEest from different periods of the day ranged from 0·409 to 0·531, and the relative average differences ranged from 4·4 % to 10·9 %. For diagnosis of insufficient iodine intake, the area under the ROC curve of 24-h UIEest was 0·754, sensitivity and specificity were 79·6 % and 65·4 %, respectively. For diagnosis of excessive iodine intake, the area of 24-h UIEest was 0·771, sensitivity and specificity were 66·7 % and 82·0 %, respectively. The reference interval of 24-h UIEest was 58·43–597·65 μg.

Twenty-four-hour UIEest can better indicate iodine nutritional status at a relatively large sample size in a given population of pregnant women. It can be used for early screening at the individual level to obtain more lead time for pregnant women.

Approximately 50 % of Dutch community-dwelling older adults does not meet protein recommendations. This study assesses the effect of replacing low protein foods with protein-rich alternatives on the protein intake of Dutch community-dwelling older adults.

The Dutch National Food Consumption Survey—Older Adults 2010–2012 (DNFCS-OA) was used for scenario modelling. Dietary intake was estimated based on two 24-h recalls. Commonly consumed products were replaced by comparable products rich in protein (scenario 1), foods enriched in protein (scenario 2) and a combination of both (scenario 3). Replacement scenarios were confined to participants whose dietary protein intake was < 1·0 g/kg BW/d (n 391). Habitual protein intake of all older adults was estimated, adjusting for effects of within-person variation in the 2-d intake data.

A simulation study based on the DNFCS-OA.

727 Dutch community-dwelling older adults aged 70+.

Mean protein intake of the total population increased from 1·0 to 1·2 g/kg BW/d (scenarios 1 and 2) and to 1·3 g/kg BW/d (scenario 3). The percentage of participants with intakes of ≥ 1·0 g/kg BW/d increased from 47·1 % to 91·4 %, 90·2 % and 94·6 %, respectively, in scenarios 1, 2 and 3. The largest increases in protein intake were due to replacements in food groups: yoghurt, cream desserts and pudding, potatoes, vegetables and legumes and non-alcoholic beverages and milk in scenario 1 and bread; yoghurt, cream desserts and pudding and soups in scenario 2.

This simulation model shows that replacing low protein foods with comparable alternatives rich in protein can increase the protein intake of Dutch community-dwelling older adults considerably. Results can be used as a basis for nutritional counselling.

The Democratic Republic of the Congo (DRC) has one of the highest levels of child undernutrition globally; however, little information exists on the underlying socio-economic inequalities resulting in undernutrition. This study aims to examine the differences in the nutritional statuses of children across different wealth quintiles and explores the association between malnutrition in children and related factors.

We utilised the 2018 Multiple Indicator Cluster Survey data. We estimated the prevalence of malnutrition across all twenty-six provinces. The study used the WHO 2006 child growth standards to measure stunting, underweight and wasting. We employed a mixed-effect linear model to analyse the association between nutritional status and healthcare accessibility, domestic sanitation, and socio-demographic factors.

Twenty-six provinces in the DRC.

21 477 children under 5 years of age and 21 828 women of childbearing age in the DRC.

The national prevalence of underweight, stunting and wasting was found to be 23·33 %, 42·05 % and 5·66 %, respectively. Household wealth and mother’s education level were significantly positively associated with the nutritional statuses of children. Among households in the lowest wealth quintile, residence in urban areas was a protective factor against undernutrition.

The findings of this study indicate considerable socio-economic inequalities in the nutritional statuses of children under 5 years of age in the DRC, highlighting the need for nutrition promotion as part of maternal and child healthcare. Interventions and policies should include improving nutrition education for less-educated mothers, in particular, in the central provinces of the DRC.

Child undernutrition is a global public health problem with serious implications. In this study, we estimate predictive algorithms for the determinants of childhood stunting by using various machine learning (ML) algorithms.

This study draws on data from the Ethiopian Demographic and Health Survey of 2016. Five ML algorithms including eXtreme gradient boosting, k-nearest neighbours (k-NN), random forest, neural network and the generalised linear models were considered to predict the socio-demographic risk factors for undernutrition in Ethiopia.

Households in Ethiopia.

A total of 9471 children below 5 years of age participated in this study.

The descriptive results show substantial regional variations in child stunting, wasting and underweight in Ethiopia. Also, among the five ML algorithms, xgbTree algorithm shows a better prediction ability than the generalised linear mixed algorithm. The best predicting algorithm (xgbTree) shows diverse important predictors of undernutrition across the three outcomes which include time to water source, anaemia history, child age greater than 30 months, small birth size and maternal underweight, among others.

The xgbTree algorithm was a reasonably superior ML algorithm for predicting childhood undernutrition in Ethiopia compared to other ML algorithms considered in this study. The findings support improvement in access to water supply, food security and fertility regulation, among others, in the quest to considerably improve childhood nutrition in Ethiopia.

We sought to produce the first meta-analysis (of medical trainee competency improvement in nutrition counseling) informing the first cohort study of patient diet improvement through medical trainees and providers counseling patients on nutrition.

(Part A) A systematic review and meta-analysis informing (Part B) the intervention analysed in the world’s largest prospective multi-centre cohort study on hands-on cooking and nutrition education for medical trainees, providers and patients.

(A) Medical educational institutions. (B) Teaching kitchens.

(A) Medical trainees. (B) Trainees, providers and patients.

(A) Of the 212 citations identified (n 1698 trainees), eleven studies met inclusion criteria. The overall effect size was 9·80 (95 % CI (7·15, 12·45) and 95 % CI (6·87, 13·85); P < 0·001), comparable with the machine learning (ML)-augmented results. The number needed to treat for the top performing high-quality study was 12. (B) The hands-on cooking and nutrition education curriculum from the top performing study were applied for medical trainees and providers who subsequently taught patients in the same curriculum (n 5847). The intervention compared with standard medical care and education alone significantly increased the odds of superior diets (high/medium v. low Mediterranean diet adherence) for residents/fellows most (OR 10·79, 95 % CI (4·94, 23·58); P < 0·001) followed by students (OR 9·62, 95 % CI (5·92, 15·63); P < 0·001), providers (OR 5·19, 95 % CI (3·23, 8·32), P < 0·001) and patients (OR 2·48, 95 % CI (1·38, 4·45); P = 0·002), results consistent with those from ML.

The current study suggests that medical trainees and providers can improve patients’ diets with nutrition counseling in a manner that is clinically and cost effective and may simultaneously advance societal equity.

To assess the relationship between exposure to social media food messages and self-reported adolescent eating outcomes (including food intake, perceived norms and food literacy).

A cross-sectional survey was used to assess reported exposure to core and non-core food messages (including marketing messages) on social media, as well as reported food intake, perceived norms, food literacy, attitudes, self-regulation, among others.

18 secondary schools across Flanders, Belgium.

1002 adolescents 11–19 years of age.

Self-reported exposure to food marketing and overall food messages on social media was positively associated with eating attitudes, behaviours, perceived norms and food literacy among adolescents. Interestingly, the relationship between food exposure and intake was shaped differently depending on food type; descriptive norms mediated the positive relationship between non-core food social media exposure and non-core food intake (e.g. indirect effect estimate on self-reported sweets consumption is 0·005, se 0·002, P < 0·01), while food literacy mediated the positive relationship between core food social media exposure and core food intake (e.g. indirect effect estimate on self-reported vegetable consumption is 0·01, se 0·003, P < 0·000).

This study highlights the significance of social media in relation to adolescent eating. There is an opportunity for health professionals to use social media in the promotion of core food among adolescents. We call for relevant policy actions to regulate the marketing of non-core food to adolescents on social media.

Feeding practices used by educators in Early Childhood Education and Care (ECEC) settings can influence the diet quality of young children. However, Australian data is scarce and limited to describing barriers to responsive feeding. This study describes the use of feeding practices amongst a group of Australian educators.

Direct observation of feeding practices and assessment of centre policy were conducted using the ‘Environment and Policy Assessment and Observation’ tool. Self-reported feeding practices and demographic data were collected via online survey using the Childcare Food and Activity Practices Questionnaire.

Ten centre-based ECEC services in South East Queensland, Australia.

Educators working in ECEC.

A total of 120 meals were observed and 88 educators provided self-report data (n 84 female). Centre policy supported the use of responsive feeding practices, and this was reflected in the high frequency with which children could decide what and how much to eat, across both observed and self-report data as well as low levels of pressure to eat and use of food as a reward (observed at 19·9 % and 0 % of meals). The only apparent discrepancy was regarding modelling. Median score for self-reported role-modelling was 5·0 (4·3–5·0) and educators were observed to sit with children at 75 % of meals, however observed occasions of enthusiastic role modelling was only 22 % (0–33·3) of meals.

Research addressing how educators conceptualise feeding practices, as well under what circumstances they are used, particularly in centres with different models of food provision, may shed light on why modelling is rarely implemented in practice.

The WHO recommends that low birth weight infants receive donor human milk (DHM) when mother’s milk is not available. Systematic reviews have been published regarding clinical outcomes of infants receiving DHM, as well as the impact of pasteurisation on the composition of DHM; however, information about milk bank donors has not been systematically assessed.

We conducted a systematic scoping review of original research articles about milk bank donors published before August 2020.

Globally.

Donors to milk banks.

A total of twenty-eight studies were included across a variety of geographies: the USA (n 8), Brazil (n 7), Spain (n 4), India (n 2), and single studies in France, Norway, Poland, Italy, Taiwan, Korea and China. Study variables were grouped into six main categories: Donor Demographics (n 19), Clinical Characteristics (n 20), Donor Experiences (n 16), Donation Patterns (n 16), Lifestyle Characteristics (n 4) and Lactation/Breast-feeding History (n 8). Some demographic characteristics were commonly reported across regions, while other, including gender and race, were infrequently explored. Factors that might influence the composition of DHM, including birth timing (term or pre-term), milk type (colostrum, transition or mature) and maternal diet were not regularly studied. Other gaps in the literature included (1) donors’ motivations and barriers to donation, (2) lactation and breast-feeding history, including factors that influence donors to pump and amass surplus milk, and (3) donation patterns, including whether donors are also selling milk to corporations or sharing milk with peers.

What is known about milk bank donors in different geographies is often limited to a single study, with heterogeneity in the variables reported.

This study explored social and behavioural factors associated with a home fortification of complementary foods program among families of undernourished children in 14 rural communities in Honduras.

We collected and analysed survey data from a convenience sample of 196 households participating in a nutritional program using home fortification of complementary foods in 2017. The program supplied families with a soy-based atole powder fortified with micronutrients. A research team completed a face-to-face survey exploring social and behavioural factors associated with nutritional supplement use. Anthropometric measurements for participating children were abstracted from health clinic records of previous quarterly appointments.

The study took place in San Jose del Negrito, Honduras.

Participants were parents or guardians of children enrolled in the nutrition program.

Nearly half of participant families shared the nutritional supplement with other family members besides the index child, while 10 % reported using the supplement as a meal replacement for the child. Low education level of mothers was associated with improper use of the supplement (P = 0·005). Poorer families were more likely to share the supplement (P = 0·013).

These results highlight the challenges of programs using home fortification of complementary foods in the context of food scarcity. Findings highlight the importance of increasing rural children’s overall caloric intake, perhaps by increasing access to locally available protein sources. Results also suggest transitioning nutritional programs to family-based interventions to increase overall intended compliance to nutrition programming.

The US Dietary Guidelines for Americans recommends increased consumption of the dairy group to three daily servings for ages 9+ years to help achieve adequate intakes of prominent shortfall nutrients. Identifying affordable, consumer-acceptable foods to replace dairy’s shortfall nutrients is important especially for people who avoid dairy.

Linear programming identified food combinations to replace dairy’s protein and shortfall nutrients. We examined cost, energy and dietary implications of replacing dairy with food combinations optimised for lowest cost, fewest kJ or the smallest amount of food by weight.

National Health and Nutrition Examination Survey (2011–2014).

Nationally representative sample of US population; 2 years and older (n 15 830).

Phase 1 (only dairy foods excluded): when optimised for lowest cost or fewest kJ, all non-dairy food replacements required large amounts (2·5–10 cups) of bottled/tap water. Phase 2 (dairy and unreasonable non-dairy foods excluded (e.g. baby foods; tap/bottled water): when intake of non-dairy foods was constrained to <90th percentile of current intake, the lowest cost food combination replacements for dairy cost 0·5 times more and provide 5·7 times more energy; the lowest energy food combinations cost 5·9 times more, provide 2·5 times more energy and require twice the amount of food by weight; and food combinations providing the smallest amount of food by weight cost 3·5 times more and provide five times more energy than dairy.

Identifying affordable, consumer-acceptable foods that can replace dairy’s shortfall nutrients at both current and recommended dairy intakes remains a challenge.

To simulate the impact – effectiveness and safety – of water fortification with different concentrations of Ca using the Intake Modelling, Assessment and Planning Program.

This is a secondary analysis of national or sub-national dietary intake databases.

Uganda, Lao People’s Democratic Republic (PDR), Bangladesh, Zambia, Argentina, USA and Italy.

We found that for dietary databases assessed from low- and middle-income countries (LMIC), the strategy of fortifying water with 500 mg of Ca/l would decrease the prevalence of low Ca intake in all age groups. We also found that this strategy would be safe as no group would present a percentage of individuals exceeding the upper limit in >2 %, except women aged 19–31 years in Lao PDR, where 6·6 % of women in this group would exceed the upper limit of Ca intake. The same strategy would lead to some groups exceeding the upper limit in USA and Italy.

We found that for most LMIC countries, water fortified with Ca could decrease the prevalence of Ca intake inadequacy without exceeding the upper levels of Ca intake.

To prospectively evaluate the association of three dietary patterns: the MIND (Mediterranean-DASH diet intervention for Neurodegenerative Delay) diet; a Mediterranean-type diet and a traditional diet, with all-cause mortality over a 12-year period in an older sample.

A longitudinal birth cohort study. We ascertained dietary patterns using FFQ data at baseline (2004–2007) and mortality using linkage data. Cox regression was used to estimate mortality hazard ratios (HR) with adjustment for confounders.

The Lothian Birth Cohort 1936 (LBC1936) study in Edinburgh, Scotland.

Dietary patterns were ascertained in 882 participants, mean age 69·5 (±0·8) years, at baseline. During the 12-year follow-up (to October 2019), 206 deaths occurred.

In the basic-adjusted model, all three dietary patterns were significantly associated with mortality, the MIND diet and Mediterranean-type diet with a lower risk and the traditional diet with a higher risk. In fully adjusted models, MIND diet score was inversely related to all-cause mortality (HR 0·88; 95 % CI 0·79, 0·97) such that the risk of death was reduced by 12 % per unit increase in MIND diet score. Participants in the top compared with the bottom third of MIND diet score had a 37 % lower risk of death (HR 0·63; 95 % CI 0·41, 0·96). No significant associations with the Mediterranean-type or traditional dietary patterns were observed in the final multivariate model.

Our findings suggest that closer adherence to the MIND diet is associated with a significantly lower risk of all-cause mortality, over 12 years of follow-up, and may constitute a valid public health recommendation for prolonged survival.

Artisanal and small-scale mining (ASM) is a widespread livelihood in low- and middle-income countries; however, many in ASM communities face high levels of poverty and malnutrition. The food environments in ASM communities have non-agricultural rural characteristics that differ from those in urban and agricultural rural areas examined in much existing food environment literature.

We examine these complex external and personal food environments in ASM communities via a study using qualitative and quantitative methods. Market surveys and a cross-sectional household survey, plus qualitative mining site non-participant observations and in-depth structured interviews, were conducted in three waves.

Eighteen study sites in ASM communities in northern Guinea.

Surveys covered mothers in mining households with young children (n 613); in-depth interviews engaged caregivers of young children (n 45), food vendors (n 40) and young single miners (n 15); observations focused on mothers of young children (n 25).

The external food environment in these ASM communities combines widespread availability of commercially processed and staple-heavy foods with lower availability and higher prices for more nutritious, non-staple foods. Within the personal food environment, miners are constrained in their food choices by considerable variability in daily cash income and limited time for acquisition and preparation.

We demonstrate that ASM communities have characteristics of both urban and rural populations and argue for greater nuance and appreciation of complexity in food environment research and resultant policy and programming.

To examine associations between household food insecurity and children’s physical activity and sedentary behaviours.

Secondary analysis was conducted on the Healthy Communities Study, an observational study from 2013 to 2015. Household food insecurity was assessed by two items from the US Department of Agriculture’s 18-item US Household Food Security Survey Module. Physical activity was measured using the 7-d Physical Activity Behaviour Recall instrument. Data were analysed using multilevel statistical modelling.

A total of 130 communities in the USA.

In sum, 5138 US children aged 4–15 years.

No associations were found for the relationship between household food insecurity and child physical activity. A significant interaction between household food insecurity and child sex for sedentary behaviours was observed (P = 0·03).

Additional research capturing a more detailed assessment of children’s experiences of food insecurity in relation to physical activity is warranted. Future studies may consider adopting qualitative study designs or utilising food insecurity measures that specifically target child-level food insecurity. Subsequent research may also seek to further explore sub-group analyses by sex.

To examine the effect of food insecurity during college on graduation and degree attainment.

Secondary analysis of longitudinal panel data. We measured food insecurity concurrent with college enrolment using the 18-question United States Department of Agriculture Household Food Security Survey Module. Educational attainment was measured in 2015–2017 via two questions about college completion and highest degree attained. Logistic and multinomial logit models adjusted for socio-demographic characteristics were estimated.

USA

A nationally representative, balanced panel of 1574 college students in the USA in 1999–2003 with follow-up through 2015–2017 from the Panel Study of Income Dynamics.

In 1999–2003, 14·5 % of college students were food-insecure and were more likely to be older, non-White and first-generation students. In adjusted models, food insecurity was associated with lower odds of college graduation (OR 0·57, 95 % CI: 0·37, 0·88, P = 0·01) and lower likelihood of obtaining a bachelor’s degree (relative risk ratio (RRR) 0·57 95 % CI: 0·35, 0·92, P = 0·02) or graduate/professional degree (RRR 0·39, 95 % CI: 0·17, 0·86, P = 0·022). These associations were more pronounced among first-generation students. And 47·2 % of first-generation students who experienced food insecurity graduated from college; food-insecure first-generation students were less likely to graduate compared to first-generation students who were food-secure (47·2 % v. 59·3 %, P = 0·020) and non-first-generation students who were food-insecure (47·2 % v. 65·2 %, P = 0·037).

Food insecurity during college is a barrier to graduation and higher-degree attainment, particularly for first-generation students. Existing policies and programmes that help mitigate food insecurity should be expanded and more accessible to the college student population.

To identify the relationship between preschool children’s dietary diversity and parents’ care behaviours related to their diet including contents of foods and snacks, mealtime practice and parent–child communication.

Cross-sectional study. Data were extracted from the National Nutrition Survey on Preschool Children in 2015 by Japan’s Ministry of Health, Labour and Welfare.

The distribution of food diversity score (FDS) (maximum of eight points) was confirmed. The participants were divided into higher (≥4 points) and lower (≤3 points) food diversity groups. A comparison between the two groups examined parents’ socio-economic status, children’s health and living conditions, and parental care concerning children’s diets (thirteen items). A multiple regression analysis was performed relating FDS to the factors of parental socio-economic status and child health, and a logistic regression analysis was conducted to identify factors of parental care related to the higher food diversity group.

2143 persons from households with children aged 2–6 years.

Parental care concerning children’s diets was the factor most strongly associated with children’s FDS. Those factors most strongly associated with higher food diversity were nutritional balance of foods (OR: 1·76; 95 % CI 1·44, 2·16; P < 0 0001), snack contents (OR: 1·41; 95 % CI 1·07, 1·86; P = 0·014) and regular mealtimes (OR: 1·30; 95 % CI 1·08, 1·55; P = 0·005).

The findings indicate the importance of parents paying attention to the contents of children’s foods and snacks, ensuring that children eat regularly, and increasing the diversity of their diets.

The British Columbia Farmers’ Market Nutrition Coupon Program (FMNCP) provides low-income households with coupons valued at $21/week for 16 weeks to purchase healthy foods in farmers’ markets. Our objective was to explore FMNCP participants’ experiences of accessing nutritious foods, and perceived programme outcomes.

The current study used qualitative description methodology. Semi-structured interviews were conducted with FMNCP participants during the 2019 farmers' market season. Directed content analysis was used to analyse the data, whereby the five domains of Freedman et al.’s framework of nutritious food access provided the basis for an initial coding scheme. Data that did not fit within the framework’s domains were coded inductively.

One urban and two rural communities in British Columbia, Canada.

Twenty-eight adults who were participating in the FMNCP.

Three themes emerged: autonomy and dignity, social connections and community building, and environmental and programmatic constraints. Firstly, the programme promoted a sense of autonomy and dignity through financial support, increased access to high-quality produce, food-related education and skill development and mitigating stigma and shame. Secondly, shopping in farmers' markets increased social connections and fostered a sense of community. Finally, participants experienced limited food variety in rural farmers' markets, lack of transportation and challenges with redeeming coupons.

Participation in the FMNCP facilitated access to nutritious foods and enhanced participants’ diet quality, well-being and health. Strategies such as increasing the amount and duration of subsidies and expanding programmes may help improve participants’ experiences and outcomes of farmers' market food subsidy programmes.