No abstract

This study demonstrated a positive impact of including FRM skills and confidence building in a nutrition education program, the effects of which could be seen for 6 months after participation in the program. Equipping low-income families with FRM skills allowed them to access healthier foods even during times of hardship.

The objectives of this study were to determine the prevalence and correlates of postpartum depressive symptoms (PDS) among women with a recent live birth and specifically among women participating in and eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Pregnancy Risk Assessment and Monitoring System data from 22 states in 2006-2008 (n = 75,234) were used to estimate the prevalence of PDS using a two-question screener. Associations between PDS and respondent demographics, risk factors and behaviors, and WIC program eligibility and participation were assessed using logistic regression. Overall prevalence of PDS was 13.8 %:19.8 % among WIC participants, 16.3 % among non-participants eligible for WIC, and 6.8 % of women not eligible for the program. PDS prevalence was higher among younger, less educated, and poorer women, as well as those engaging in risky behaviors during pregnancy (smoking and binge drinking), and those with an unintended pregnancy and who experienced intimate partner violence during pregnancy. Controlling for these factors, the odds of PDS were no different between WIC participants and women eligible but not participating in the program (aOR 1.08, 95 % CI 0.97-1.22), but WIC enrollees were significantly more likely than ineligible women to report PDS (aOR 1.65, 95 % CI 1.39-1.95). WIC serves more than 1 million pregnant women each year, one-fifth of whom may experience PDS. WIC has a unique opportunity to screen and provide referrals to new mothers receiving postpartum WIC benefits.

Food insecurity has been associated with poor health and health outcomes among older adults, yet food assistance resources are available and underutilized. Routine screening and referral for food insecurity in primary care is one avenue to connect food-insecure older adults with available resources. This qualitative study aims to better understand the beliefs of primary care providers (PCPs) about food security screening and referrals in a primary care setting and perceived barriers to implementation. PCPs (n = 16) who have older adult patients but do not routinely screen for food insecurity were interviewed by phone. PCPs recognize the importance of food security for older patients and discuss nutrition and food access with patients under certain circumstances. Concerns emerged with regard to implementing a systematic screening and referral process: limited time to meet with patients, a lack of resources for addressing food insecurity, and prioritizing food insecurity at both the health system and the patient levels. Despite perceived challenges, PCPs are receptive to the idea of systematically screening and referring patients to external resources for food assistance and support. Barriers could be addressed by health systems prioritizing food insecurity as a health concern and public and private payers providing reimbursement for screening.

Women in the United States make approximately 80% of the health care decisions for their families, yet often go without health care coverage themselves. The implementation of the Affordable Care Act provides an historical opportunity for women to gain health care coverage for themselves and their families. The focus of this commentary is on women's leadership roles in the context of health care decision- making and Affordable Care Act education and outreach, and implications for reaching broader health and social goals.

The objective of this study is to describe the prevalence of postpartum contraceptive use among women experiencing a live birth in Florida in 2004-2005. To examine the association between family planning counseling during prenatal care visits and the use of effective contraceptive methods among postpartum women. Matched data from Florida PRAMS and Vital Statistics were used (n = 3,962). Weighted logistic regression was used to determine the association between prenatal family planning counseling and effective postpartum contraceptive use. Odds ratios were adjusted for use of contraception prior to pregnancy, well-baby checkup, race, ethnicity, nativity, education, marital status, poverty level, stress before or during pregnancy, and parity. Women who reported discussing family planning with their prenatal care provider were more likely to use effective contraception postpartum (AOR: 1.5, 1.1-2.0) compared to women who did not report a discussion. Women who used contraception prior to pregnancy (AOR: 2.3, 1.7-3.2) and women who experienced no stress before or during pregnancy (AOR: 2.0, 1.2-3.4) were also more likely to use contraception in the postpartum period. A significant interaction was identified between family planning counseling during prenatal visits and maternal education. Stratum specific odds ratios for women who received prenatal family planning counseling were significant for women with less than high school education (AOR: 2.5, 1.3-5.1) and for women with high school education (AOR: 2.0, 1.2-3.4). Women reporting family planning counseling during prenatal care were more likely to use effective contraception postpartum. While women with high school or less than high school education levels benefited from prenatal family planning counseling, the greatest benefit was observed for women with less than high school education. Integrating family planning counseling into prenatal care may increase the use of effective contraceptive methods among postpartum women.

Findings point to a spillover "income effect" as SNAP may help older adults better afford their medications, conceivably by reducing out-of-pocket food expenditures. When prescribing treatment plans, health systems and payers have a vested interest in connecting older patients to SNAP and other resources that may help address barriers to care.

IMPORTANCE Understanding if the association of social programs with health care access and utilization, especially among older adults with costly chronic medical conditions, can help in improving strategies for self-management of disease.OBJECTIVE To examine whether participation in the Supplemental Nutrition Assistance Program (SNAP) is associated with a reduced likelihood of low-income older adults with diabetes (aged Ն65 years) needing to forgo medications because of cost. DESIGN, SETTING, AND PARTICIPANTSThis repeated cross-sectional, population-based study included 1302 seniors who participated in the National Health Interview Survey from 2013 through 2016. Individuals in the study were diagnosed with diabetes or borderline diabetes, were eligible to receive SNAP benefits, were prescribed medications, and incurred more than zero US dollars in out-of-pocket medical expenses in the past year. The data analysis was performed from October 2017 to April 2018.EXPOSURES Self-reported participation in SNAP. MAIN OUTCOMES AND MEASURESCost-related medication nonadherence derived from responses to whether in the past year, older adults with diabetes delayed refilling a prescription, took less medication, and skipped medication doses because of cost. To estimate the association between participation in SNAP and cost-related medication nonadherence, we used 2-stage, regression-adjusted propensity score matching, conditional on sociodemographic and health and health care-related characteristics of individuals. Estimated propensity scores were used to create matched groups of participants in SNAP and eligible nonparticipants. After matching, a fully adjusted weighted model that included all covariates plus food security status was used to estimate the association between SNAP and cost-related medication nonadherence in the matched sample. RESULTSThe final analytic sample before matching included 1385 older adults (448 [32.3%] men, 769 [55.5%] non-Hispanic white, and 628 [45.3%] aged Ն75 years), with 503 of them participating in SNAP (36.3%) and 178 reporting cost-related medication nonadherence (12.9%) in the past year. After matching, 1302 older adults were retained (434 [33.3%] men, 716 [55.0%] non-Hispanic white, and 581 [44.6%] aged Ն75 years); treatment and comparison groups were similar for all characteristics. Participants in SNAP had a moderate decrease in cost-related medication nonadherence compared with eligible nonparticipants (5.3 percentage point reduction; 95% CI, 0.5-10.0 percentage point reduction; P = .03). Similar reductions were observed for subgroups that had prescription drug coverage (5.8 percentage point reduction; 95% CI, 0.6-11.0) and less than $500 in out-of-pocket medical costs in the previous year (6.4 percentage point reduction; 95% CI, 0.8-11.9), but not for older adults lacking prescription coverage or those with higher medical costs. Results remained robust to several sensitivity analyses. CONCLUSIONS AND RELEVANCEThe findings suggest that participation in SNAP may help improve adherence to...