Objective This study pilot-tested combining financial incentives to purchase fruits and vegetables with nutrition education focused on cooking to increase the consumption of fruits and vegetables and improve attitudes around healthy eating on a budget among low-income adults. The goal of the pilot study was to examine implementation feasibility and fidelity, acceptability of the intervention components by participants, and effectiveness. Design The study design was a pre-post individual-level comparison without a control group. The pilot intervention included two components, a scan card providing free produce up to a weekly maximum dollar amount for use over a two-month period, and two sessions of tailored nutrition and cooking education. Outcomes included self-reported attitudes about health eating and daily fruit and vegetable consumption from one 24-hour dietary recall collected before and after the intervention. Setting Greater Minneapolis/St. Paul area in Minnesota. Participants Adults (n=120) were recruited from five community food pantries. Results Findings indicated that the financial incentive component of the intervention was highly feasible and acceptable to participants, but attendance at the nutrition education sessions was moderate. Participants had a statistically significant increase in the consumption of fruit, from an average of 1.00 cup per day to 1.78 cups per day (p<0.001) but no significant change in vegetable consumption or attitudes with respect to their ability to put together a healthy meal. Conclusion While combining financial incentives with nutrition education appears to be acceptable to low-income adult participants, barriers to attendance of nutrition education sessions need to be addressed in future research.

BACKGROUND Interest in initiatives that promote home cooking has been increasing, but no studies have examined whether home cooking is associated with dietary quality using longitudinal data on meals served in a diverse sample of families. OBJECTIVE The present study examined data on multiple meals per family in diverse households to determine whether home-cooked meals are more likely to contain nutritious ingredients than pre-prepared meals. DESIGN Data for the study came from the National Institutes of Health–funded Family Matters Study. As part of this study, between 2015 and 2016, 150 families provided ecological momentary assessment data on 3,935 meals over an 8-day observation window. PARTICIPANTS/SETTING In this study, investigators followed 150 families with children aged 5 to 7 years old from six racial/ethnic groups (n=25 each non-Hispanic white, non-Hispanic black, Hispanic, Native American, Hmong, and Somali families). Recruitment occurred through primary care clinics serving low-income populations in Minnesota. MAIN OUTCOME MEASURES The main outcomes were participants’ self-reports of whether they served fruits, vegetables, and whole grains at a meal, and reports were made within hours of the meal. STATISTICAL ANALYSES PERFORMED Within-group estimator methods were used to estimate the associations between meal preparation and types of food served. These models held constant time-invariant characteristics of families and adjusted for whether the meal was breakfast, lunch, dinner, or a snack and whether it was a weekend meal. RESULTS For all racial/ethnic and poverty status groups, meals that were fully or partly home-cooked were more likely to contain fruits and vegetables than pre-prepared meals (P<0.001). Meals that were partly home-cooked were the most likely to contain whole grains (P<0.001). Restaurant meals were more likely to contain vegetables than pre-prepared meals (P<0.001) but were equally likely to contain fruits and/or whole grains as pre-prepared meals. CONCLUSIONS Interventions or initiatives that encourage fully or partly home-cooked meals may help families incorporate nutritious foods into their diets. In addition, evaluations of potential strategies to increase the likelihood of supplementing pre-prepared and restaurant meals with nutritious meal ingredients warrants further investigation.

This study randomized a sample of households covered by one large health plan to two different surveys on health insurance coverage and matched person-level survey reports to enrollment records. The goal was to compare accuracy of coverage type and uninsured estimates produced by the health insurance modules from two major federal surveys - the redesigned Current Population Survey Annual Social and Economic Supplement (CPS) and the American Community Survey (ACS) - after implementation of the Affordable Care Act. The sample was stratified by coverage type, including two types of public coverage (Medicaid and a state-sponsored program) and three types of private coverage (employer-sponsored, non-group, and marketplace plans). Consistent with previous studies, accurate reporting of private coverage is higher than public coverage. Generally, misreporting the wrong type of coverage is more likely than incorrectly reporting no coverage; the CPS module overestimated the uninsured by 1.9 and the ACS module by 3.5 percentage points. Other differences in accuracy metrics between the CPS and ACS are relatively small, suggesting that reporting accuracy should not be a factor in decisions about which source of survey data to use. Results consistently indicate that the Medicaid undercount has been substantially reduced with the redesigned CPS.

OBJECTIVE To examine level of participation and satisfaction with the Healthy Savings Program (HSP), a programme that provides price discounts on healthier foods. DESIGN For Study 1, a survey was distributed to a random sample of adults who were invited to participate in a version of the HSP that provided a discount for the purchase of fresh produce and discounts on other healthier foods. In Study 2, interviews were conducted with a convenience sample of adults invited to participate in a version of the HSP that provided price discounts on specific products only (no fresh produce discount). SETTING The HSP is provided to all employer-based insurance plan members of a large health plan. Employers can choose to enhance the version of the HSP that their employees receive by paying for a weekly discount on fresh produce. SUBJECTS Employees in employer groups that received the enhanced HSP (Study 1) and employees in an employer group (Study 2) that received the standard HSP. RESULTS Among survey respondents in Study 1, 69·3 % reported using the HSP card. Most were satisfied with the fresh produce discount and ease of use of the HSP card. Satisfaction was lower for selection of participating stores, amounts of discounts and selection of discounted products. In Study 2, barriers to the use of the HSP card cited included the limited number of participating stores and the limited selection of discounted products. CONCLUSIONS Satisfaction with some elements of the HSP was high while other elements may need improvement to increase programme use.

Introduction: To determine the prevalence of reaching multiple Healthy People 2020 (HP 2020) objectives including nutrition and weight status, sleep health, physical activity, health-related quality of life, social determinants of health, and education among low-income, diverse children and adults. Methods: Children ages 5- to7-yearsold (n = 150; 47% female) and their parents (mean age = 35; 91% mothers) from 6 racial/ethnic and immigrant/refugee groups (n = 25 from each; African American, Native American, Hispanic, Hmong, Somali, White) participated in this cross-sectional mixed-methods study. Results: Overall, the majority of HP 2020 objectives were not being met across this low-income, racially/ethnically diverse, and immigrant/refugee sample of children and adults. In particular, African American children and parents consistently fell below the majority of the HP 2020 targets, with only 5 of the 24 HP 2020 objectives being met. Additionally, immigrant children and parents met less than 2/3 of the HP 2020 objectives. Discussion: Concerted public health efforts are needed to address the disparities in reaching the HP 2020 objectives and informing the development of the future HP 2030 objectives among low-income, racially/ethnically diverse, and immigrant children and parents. In order to achieve and assess the current and future HP objectives in these diverse populations, changes may be needed in both interventions and assessment tools.

Background: Although prior research suggests that stress may play a role in parent's use of food-related parenting practices, it is unclear whether certain types of stress (e.g., transient, chronic) result in different food-related parenting practices. Identifying whether and how transient (i.e., momentary; parent/child conflict) and chronic (i.e., long-term; unemployment >6months) sources of stress are related to parent food-related parenting practices is important with regard to childhood obesity. This is particularly important within racially/ethnically diverse parents who may be more likely to experience both types of stress and whohave higher levels of obesity and related health problems. The current study examined the association between transient and chronic stressors and food-related parenting practices in a racially/ethnically diverse and immigrant sample. Methods: The current study is a cross-sectional, mixed-methods study using ecological momentary assessment (EMA). Parents (mean age=35; 95% mothers) of children ages 5-7years old (n=61) from six racial/ethnic groups (African American, American Indian, Hispanic, Hmong, Somali, White) participated in this ten-day in-home observation with families. Results: Transient stressors, specifically interpersonal conflicts, had significant within-day effects on engaging in more unhealthful food-related parenting practices the same evening with across-day effects weakening by day three. In contrast, financial transient stressors had stronger across-day effects. Chronic stressors, including stressful life events were not consistently associated with more unhealthful food-related parenting practices. Conclusions: Transient sources of stress were significantly associated with food-related parenting practices in racially/ethnically diverse and immigrant households. Chronic stressors were not consistently associated with food-related parenting practices. Future research and interventions may want to assess for transient sources of stress in parents and target these momentary factors in order to promote healthful food-related parenting practices.

Abstract Research in the field of representative bureaucracy provides evidence that the presence of minority teachers can improve educational outcomes for minority students. We test two possible mechanisms by examining if the presence of minority teachers increases how ‘connected’ minority students feel to their school and the student's educational aspirations. Previous research has established a strong link between both of these factors and educational and non-educational outcomes. We find that increasing representation of African American and Latino/a teachers increases educational expectations for African American students, while increasing representation of Latino/a teachers increases school connectedness and educational expectations for Latino/a students.

Approximately 2 million Americans experience homelessness each year. 1 Families with children are estimated to make up 34% of the homeless population (i.e., 23% children and 11% adults) on any given night. 2 A substantial portion of homeless children have physical, developmental , behavioral, and emotional problems. Homeless children commonly experience acute and chronic health problems such as asthma, 3-6 ear infections, 6 lead toxicity, 7,8 immunization delays, 9 nutritional deficits including overweight and obesity, 4, 10, 11 developmental or growth delays , 12, 13 and problems in cognitive functioning. 14 Children in homeless families also have a high current prevalence of mental health problems, ranging from 12% to 47% depending on the age of the children, assessment measures, and geographic area. 4, 15-19 The literature has provided solid evidence that the extent of health and mental health problems among homeless children is greater than that among the general population of children. However, the evidence is mixed as to whether homeless children differ from housed low-income children on health, developmental, and mental health outcomes. Some studies have found that homeless children are more likely than low-income stably housed children to have fair or poor health status, 6 severe health problems, 3 delayed developmental status, 12 disruptive behavior disorders, 18 and, among boys, internalizing and externalizing behavior problems. 17 A review of the studies on the cognitive functioning of homeless children and adolescents concluded that homeless children tend to have lower intellectual functioning than those who are domiciled. 20 Other studies have reported that both groups of children have high rates of developmental, behavioral, and emotional problems, and they do not differ significantly from each other. 15,21-23 A review of published studies between 1987 and 2004 stated that the detrimental impact of homelessness measured as a stay in a family shelter on children's health tends to be in the mild to moderate range. 24 Although previous studies of the health status of homeless children and families have added greatly to knowledge of this population's needs, they have had several limitations. With a few exceptions, 25,26 most studies in this area have relied on cross-sectional designs, which makes determining the causal relationships between homelessness and health outcomes difficult. Little is known about whether homeless families differ from housed low-income families before homeless episodes. Studies have typically been based on a sample from a single geographic area and have often used a small convenience sample. In addition, variations in the age of the sample, settings from which the study participants were recruited (e.g., shelters, clinics, schools), and assessment measures make it difficult to compare and generalize the findings. Last, many studies currently available relied on decade-old or even older data, which do not reflect the recent trends in homeless-ness and health. 25,27 We built on previous studies using public-release data from the Fragile Families and Child Wellbeing Study (FFS). First, the sample was recruited in 20 large US cities and included children in families who have experienced homelessness and others who were at risk. Second, unlike in studies based on families staying in shelter settings, we counted as homeless a family living in temporary housing , in a shelter, or in a place not meant for human habitation (e.g., the streets, abandoned buildings, and automobiles). In addition to measures of homelessness, the data include information on doubling-up episodes, an additional important measure of precarious housing status. Third, the data include a wide range of health-related measures and control variables, including individual and household characteristics. Finally, the use of longitudinal data enabled us to compare children's health status over time by homeless and doubled-up Objectives. We assessed the independent effect of homeless and doubled-up episodes on physical and mental health, cognitive development, and health care use among children. Methods. We used data from 4 waves of the Fragile Families and Child Wellbeing Study, involving a sample of 2631 low-income children in 20 large US cities who have been followed since birth. Multivariate analyses involved logistic regression using the hybrid method to include both fixed and random effects. Results. Of the sample, 9.8% experienced homelessness and an additional 23.6% had a doubled-up episode. Housing status had little significant adverse effect on child physical or mental health, cognitive development, or health care use. Conclusions. Family and environmental stressors common to many children in poverty, rather than just homeless and doubled-up episodes, were associated with young children's poor health and cognitive development and high health care use. Practitioners need to identify and respond to parental and family needs for support services in addition to housing assistance to effectively improve the health and development of young children who experience residential instability , particularly those in homeless families. (Am J

There is a debate about the extent to which the effect of prenatal smoking on infant health outcomes is causal. Poor outcomes could be attributable to mother characteristics, which are correlated with smoking. I examine the importance of selection on the effect of prenatal smoking by using three British cohorts where the mothers' knowledge about the harms of prenatal smoking varied substantially. I find that the effect of smoking on the probability of a low birth weight birth conditional on gestation is slightly more than twice as large in 2000 compared with 1958, implying that selection could explain as much as 50% of the current association between smoking and birth outcomes.

Alcohol policies have potentially far-reaching impacts on risky sexual behavior, prenatal health behaviors, and subsequent outcomes for infants. After finding initial evidence in the National Longitudinal Survey of Youth (NLSY) that changes in the minimum legal drinking age (MLDA) are related to prenatal drinking, we examine whether the drinking age influences birth outcomes. Using data from the National Vital Statistics (NVS) for the years 1978–1988, we find that a drinking age of 18 is associated with adverse outcomes among births to young mothers—including higher incidences of low birth weight and premature birth, but not congenital anomalies. The effects are largest among black women. We also report evidence that the MLDA laws alter the composition of births that occur. In states with lenient drinking laws, young black mothers are less likely to report paternal information on the birth certificate, particularly in states with restrictive abortion policies. The evidence suggests that lenient drinking laws generate poor birth outcomes in part because they increase the number of unplanned pregnancies.

This paper explores the relationship between public housing, health outcomes, and health behaviors among low-income housing residents. While public housing can be a dangerous and unhealthy environment in which to live, the subsidized rent may free up resources for nutritious food and health care. In addition, public housing may be of higher quality than the available alternatives, it may provide easier access to health clinics willing to serve the poor, and it may link residents to social support networks, which can improve mental health and the ability to access higher-quality grocery stores. To test whether there is a "back-door" health benefit to the public housing program, we analyze data from the Fragile Families and Child Wellbeing Study. We minimize the effects of selection into public housing with controls and instrumental variables estimation and find that the results are somewhat sensitive to the instrumental variable used, and thus, we conclude that we are unable to detect a robust health benefit from public housing for our measures of health. However, we do find some evidence that public housing residency has mixed effects on domestic violence, increases obesity, and worsens mothers' overall health status.

We quantify the lasting effects of childhood health and economic circumstances on adult health, employment and socioeconomic status, using data from a birth cohort that has been followed from birth into middle age. Controlling for parental income, education and social class, children who experience poor health have significantly lower educational attainment, poorer health, and lower social status as adults. Childhood health and circumstance appear to operate both through their impact on initial adult health and economic status, and through a continuing direct effect of prenatal and childhood health in middle age. Overall, our findings suggest more attention be paid to health as a potential mechanism through which intergenerational transmission of economic status takes place: cohort members born into poorer families experienced poorer childhood health, lower investments in human capital and poorer health in early adulthood, all of which are associated with lower earnings in middle age—the years in which they themselves become parents.