Abstract
Objective:
We documented nutritional quality of a weekend food backpack program with 5 bag types tailored for ethnic food preferences and reported participants’ satisfaction and usage of the program.
Methods:
The Healthy Eating Index (HEI)-2020 scores were calculated to assess the quality of the food items by bag type. We also recruited 49 caregivers of elementary school-aged children in Minnesota using multilingual flyers from December 2022 to May 2023. Caregivers’ program satisfaction and usage were assessed through online surveys.
Results:
The HEI-2020 total scores ranged from 67 to 83 across the bag type. Participants liked 90% of the food items and used all or some of the items in 79% of the bags.
Conclusion and Implications:
A tailored weekend food backpack program can provide high quality food with high satisfaction and usage. Further research is needed to determine whether such tailored programs can improve food security and diet quality.
Keywords: weekend backpack, ethnic food preference, nutrition, usage, satisfaction
INTRODUCTION
Food insecurity, the lack of access to enough food for an active, healthy life for all household members,1 is a public health concern in the United States. Its negative impact on children’s physical, mental, and behavioral health has been well documented.2–4 Despite continued efforts to address food insecurity, trends in the prevalence of food insecurity have remained unchanged in the past 20 years.1 In 2021, 10.2% of all households in the United States were food insecure.1 Compared to the national average, the prevalence of food insecurity among households with children was higher at 12.5%. Of those food insecure households with children, 0.7% (274,000 households) experienced very low food security resulting in reduced food intake and disrupted eating patterns at times.1 Additionally, prevalence of food insecurity was higher in households with low income (26.5%), households headed by single mothers (24.3%), and households with non-Hispanic Black or Hispanic origin (36.0%).1 These disparities of food insecurity suggest a possible role for innovative interventions that address the differing needs of varying subsets of people experiencing food insecurity.
Weekend backpack programs, a type of nutrition assistance programs implemented by non-profit organizations, provide students with a bag of non-perishable food items on the last day of the school week to consume over the weekends or during extended school breaks. The first backpack program was launched in 1995 in response to a school nurse’s request for help with students who presented hunger-related symptoms after the weekend.5 Since then, backpack programs have rapidly diffused nationwide as a way to alleviate food insecurity. One of the largest food backpack programs estimated that over 54 million meals were provided in 2022.6 Although rigorous evaluations of the effects of backpack programs on food insecurity are limited, several studies documented a perceived benefit of the program from the participants: parents and children participating in the program are less likely to worry about food.7–9 Concerns have been expressed, however, that backpack programs do not address the root causes of food insecurity and the nutritional quality of food provided through them is not ideal.10,11 Additionally, foods provided may not align with the diverse eating traditions and preferences of the families served. Tailoring of backpack programs may be needed as many racial/ethnic minorities have a higher prevalence of food insecurity than White/Caucasian Americans.1
Every Meal, one of the largest nonprofit organizations that operate a weekend backpack program in Minnesota, provides 5 different types of food bags that caregivers can choose from: a) East African dietary preferences, b) Southeast Asian dietary preferences, c) Latino dietary preferences, d) a wide variety of food items (with no particular dietary preferences targeted), and e) ready-to-eat items that require little or no preparation. This program has evolved into providing these 5 different bag types with 4 different menus for each bag type to reflect the diverse preferences of the families receiving the program. This innovative programming is aligned with the characteristics of a person-centered, culturally sensitive, health service model in that it respects clients’ culturally diverse eating traditions and preferences. This model has shown to lead to better use of program benefits, achievement of intended outcomes, and promotion of well-being among those using the health services.12,13 It is unclear, however, whether, providing culturally relevant foods to accommodate the food preferences of participating families meets nutritional guidelines, is being used by the targeted families with racial/ethnic minorities, and contributes to satisfaction with and usage of the foods provided. Therefore, we aimed to evaluate Every Meal’s weekend backpack program by a) assessing nutritional quality of the foods by bag type, b) describing the type and number of bags participants received by child race/ethnicity, and c) examining participants’ use of, and satisfaction with, the food provided in the bag(s) they received.
METHODS
Descriptions of Every Meal’s Weekend Backpack Program
Every Meal’s mission is to provide nutritious, delicious, and culturally relevant food while upholding the dignity of the families and children it serves to address food gaps, i.e., the times when children do not have access to school meals.14 This person-centered program is advertised via flyers, letters, and social media through partnering schools and community organizations. The promotional materials include each bag’s name, a description with a list and a picture of sample food items (e.g. Blue Bag, Tailored for East African dietary preferences, this bag is pork-free and may contain items such as tuna, spaghetti, etc). Interested caregivers complete a paper or electronic version of the enrollment form available in English, Spanish, Hmong, and Somali. They indicate the type of bag they want to receive and submit the enrollment application to their child’s school. The number of students enrolled for each bag type in a school is shared with Every Meal to facilitate the food bag delivery. Enrollment is open throughout the school year, and families with multiple children may receive one food bag per child per week.
Every Meal has standards for the quantity and quality of the food bags. The parameter for the amount of food in a food bag is 4 to 5 pounds, a weight that a child can carry in a backpack and can make about 3 to 4 meals, considering an industry standard of 1.2 pounds per meal.15 Every Meal’s 2 registered dietitians developed nutritional guidelines for menu planning and created menus that include the following per bag: energy (1400 to 2200 kcal), saturated fat (less than 20 g), sodium (less than 2300 mg), added sugar (less than 24 g), dietary fiber (greater than 25 g), and protein (greater than 20 g). When developing menus, Every Meal actively seeks feedback from school district cultural liaisons, culturally affiliated community organizations, and program participants through taste tests and online surveys with the goal of providing food items that are delicious and culturally relevant. Every Meal has 4 rotating menus for each of the 5 bag types (a total of 20 menus) (Supplemental Table 1). For example, the bag tailored for Latino dietary preferences contains items such as rice, black beans, and corn flour. The bag tailored for Southeast Asian dietary preferences contains items such as rice, coconut milk, bamboos shoots and curry paste.
Participants
For the current study, 49 Every Meal participating primary caregivers of elementary school-aged children were recruited from 20 public schools and 2 charter schools in Ramsey County, Minnesota from December 2022 to May 2023. This county was selected due to higher racial/ethnic diversity and poverty compared to the state’s average according to the 2021 U.S. Census Data (33% vs. 16% of people of color; 13% vs 8% of people in poverty).16 A study flyer written in English, Spanish, Hmong and Somali was added in each food bag prior to bag distribution during the study period to recruit participants. Interested caregivers were invited to complete a brief survey for eligibility screening. Caregivers were eligible to participate in the study if a) they are biological or adoptive parent or primary caregiver with legal guardianship, b) their child attends one of the partnering elementary schools, c) their child is enrolled in Every Meal’s weekend backpack program, d) they have not previously participated in the study with other children in the household, and e) they are comfortable speaking and reading English, Spanish, Hmong or Somali. Study staff contacted interested caregivers who were eligible to further explain the study and obtain written informed consent. English-speaking caregivers who preferred electronic consent could review and sign the written consent form online. For caregivers who spoke a language other than English, the written consent process was completed over the phone with a study staff member and a certified interpreter. Enrolled caregivers (n=49) were then asked to complete an online demographic survey with questions about their child, themselves and their household (Table 1). Race or ethnicity was self-reported by the caregivers from a list including Hispanic, Latino/a or Spanish Origin, not Hispanic, Latino/a or Spanish Origin, American Indian/Alaskan Native, Asian, Black/African American, Native Hawaiian or Pacific Islander, White/Caucasian, and Other (specify). Caregivers identified the child participant if they had multiple elementary school-aged children participating in Every Meal’s weekend backpack program. The University of Minnesota Institutional Review Board approved the study protocol with a full board review (No. STUDY00017449).
Table 1.
Characteristics of Study Participants Enrolled in Every Meal’s Weekend Backpack Program (n=49)
| Characteristics | Mean (SD) or n (%) |
|---|---|
| Child age, years (n=47)a | 8 (1.8) |
| Child sex (n=47)a | |
| Female | 23 (49) |
| Child ethnicity (n=45)a | |
| Hispanic, Latino/a or Spanish Origin | 14 (31) |
| Child race (n=44)a | |
| American Indian/Alaskan Native | 1 (2) |
| Asian | 13 (30) |
| Black/African American | 1 (2) |
| White/Caucasian | 16 (36) |
| Multiracial | 9 (20) |
| Other | 4 (9) |
| Caregiver work status (n=44)a | |
| Working full-time | 20 (45) |
| Working part-time | 7 (16) |
| Unemployed | 11 (25) |
| Multiple responses | 5 (11) |
| Other | 1 (2) |
| Highest degree of caregivers in the household (n=45)a | |
| Less than high school | 4 (9) |
| High school or some college | 21(47) |
| Bachelor’s or higher degree | 20 (44) |
| Number of people living in the household (n=46)a | 6 (3.0) |
| Receipt of public assistance (Check all that apply) (n=49) | |
| Supplemental Nutrition Assistance Program | 15 (31) |
| Special Supplemental Nutrition Program for Women, Infants & Children | 12 (24) |
| Blinded (State) Family Investment Program | 8 (16) |
| Free/reduced price school lunch | 29 (59) |
| Food pantry/Soup kitchen | 2 (4) |
| Other | 8 (16) |
| Household food security (n=43)a | |
| High food security | 14 (33) |
| Marginal food security | 5 (12) |
| Low food security | 18 (42) |
| Very low food security | 6 (14) |
n is not equal to 49 due to missing or participant choosing not to answer.
Data Collection
Nutritional quality.
For the nutritional quality analysis (Table 2), study staff collected all of the available 20 menus in addition to the product details, including brand names, nutrition labels, and package size in collaboration with a dietitian from Every Meal. The collected data (n=104 food items) were then entered into the Nutrition Data System for Research (NDSR) version 2021 (Nutrition Coordinating Center, University of Minnesota, Minneapolis, MN, USA, 2021), which is a Windows-based analysis program that calculates nutrients and provides files for analysis. The amount of dried beans and grains before cooking were entered and converted into the cooked yield amounts (1 serving size of cooked dry beans = ½ cup) in NDSR. For food items that did not have a close match in the NDSR database regarding energy, total fat, total carbohydrate, total protein, and sodium content, a user recipe was created to match the ingredients in consultation with the Nutrition Coordinating Center staff (n=14 foods) or the Center staff was asked to create a new food item and add it to the database (n=6 foods).
Table 2.
Healthy Eating Index-2020 Total and Component Scores of Every Meal’s Weekend Backpack Menus by Bag Type
| Maximum Score | East African | Wide Variety | Latino | Southeast Asian | All-readyto-eat | |
|---|---|---|---|---|---|---|
| Total calories | - | 11447.1 | 10327.1 | 11668.5 | 12057.2 | 5668.6 |
| HEI-2020 total score | 100 | 70.9 | 77.6 | 69.8 | 66.7 | 82.6 |
| Adequacy Components | ||||||
| Total vegetables | 5 | 5.0 | 5.0 | 5.0 | 5.0 | 5.0 |
| Greens and beans | 5 | 5.0 | 5.0 | 5.0 | 5.0 | 1.4 |
| Total fruit | 5 | 3.8 | 4.5 | 4.0 | 3.5 | 5.0 |
| Whole fruit | 5 | 5.0 | 5.0 | 5.0 | 5.0 | 5.0 |
| Whole grains | 10 | 10.0 | 7.9 | 8.6 | 8.3 | 4.9 |
| Dairy | 10 | 1.1 | 0.2 | 2.2 | 2.2 | 7.1 |
| Total protein foods | 5 | 5.0 | 5.0 | 5.0 | 5.0 | 5.0 |
| Seafood and plant proteins | 5 | 5.0 | 5.0 | 5.0 | 5.0 | 5.0 |
| Fatty acidsa | 10 | 0 | 10.0 | 0 | 0 | 10.0 |
| Moderation Components | ||||||
| Sodium | 10 | 10.0 | 10.0 | 10.0 | 10.0 | 6.5 |
| Refined grains | 10 | 1.0 | 0 | 0 | 0 | 9.5 |
| Added sugars | 10 | 10.0 | 10.0 | 10.0 | 10.0 | 8.2 |
| Saturated fatty acids | 10 | 10.0 | 10.0 | 10.0 | 7.7 | 10.0 |
East African: tailored for East African dietary preferences. Wide Variety: tailored for a wide variety of food items. Latino: tailored for Latino dietary preferences. Southeast Asian: tailored for Southeast Asian dietary preferences. All-ready-to-eat: tailored for ready-to-eat items with little or no preparation required for those with limited kitchen access.
Fatty acids were calculated by summing polyunsaturated fatty acids (PUFAs) and monosaturated fatty acids (MUFAs)and dividing it by saturated fatty acids (SFAs); (PUFAs + MUFAs)/SFAs.
Survey data on bag receipt, use of and satisfaction with the food.
An online survey was sent to participating caregivers every Monday for 4 consecutive weeks after study enrollment. Each survey included the same set of questions about the number and type of bags they received the previous Friday (“How many food bags did your family receive last Friday?”, and “What color food bag(s) did your family receive last Friday? Check all that apply.”), their use of (“How much food in the bag you received last Friday have you used?”, and “Were there any food items in the bag that you or your family could not eat because of your cultural or religious reasons?”) and plan for any unused food items (“What will you do with foods you have not used yet?”), as well as satisfaction with the food items (“How much did you like the items in the bag?”, “How satisfied were you with the variety of food in the bag?”, and “Were the food items in the bag mostly what you like to use for cooking?”). Detailed response options are provided in Tables 3, 4 and 5. Upon completion of each survey, participants were compensated with a $10 gift card.
Table 3.
Every Meal’s Weekend Backpack Bag Types Most Frequently Selected by Families During the 4-Week Study Period, by Child Race/Ethnicitya
| Child race/ethnicity | |||||
|---|---|---|---|---|---|
| Hispanic (n=13) n (%)b |
Non-Hispanic Asian (n=13) n (%) |
Non-Hispanic Otherc (n=8) n (%) |
Non-Hispanic White (n=10) n (%) |
Prefer not to answer/missing (n=4) n (%) |
|
| Bag type | |||||
| Do not recall | 2 (15) | 0 (0) | 1 (13) | 3 (30) | 0 (0) |
| East Africand | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
| Wide Varietye | 2 (15) | 1 (8) | 4 (50) | 1 (10) | 0 (0) |
| Latinof | 7 (54) | 0 (0) | 0 (0) | 1 (10) | 0 (0) |
| Southeast Asiang | 0 (0) | 10 (77) | 2 (25) | 0 (0) | 1 (25) |
| All-ready-to-eath | 2 (15) | 1 (8) | 1 (13) | 3 (30) | 1 (25) |
| Tie between two or more bag types | 0 (0) | 1 (8) | 0 (0) | 2 (20) | 2 (50) |
During the study period, participants did not always select the same bag type. To summarize the bag type within race/ethnicity groups, we first determined the bag type that each participant selected most often (e.g., a participant bag type was classified as East African if the person selected 3 East African bags and 1 ready-to-eat-item bag during the study period).
n = 13 due to 1 missing response.
Other includes Black/African American, multiple race or any other race reported by caregivers.
East African: tailored for East African dietary preferences.
Wide Variety: tailored for a wide variety of food items.
Latino: tailored for Latino dietary preferences.
Southeast Asian: tailored for Southeast Asian dietary preferences.
All-ready-to-eat: tailored for ready-to-eat items with little or no preparation required for those with limited kitchen access.
Table 4.
Participants’ Use of the Food Provided by Every Meal’s Weekend Backpack Program During the 4-Week Study Period
| na (%) | |
|---|---|
| How much food in the bag you received last Friday have you used? (na=167) | |
| A little/Not at all | 35 (21) |
| All/Some | 132 (79) |
| Were there any food items in the bag that you or your family could not eat because of your cultural or religious reasons? (na=167) | |
| Yes | 165 (99) |
| No | 2 (1) |
| What will you do with foods you have not used yet? Check all that apply. (na=272) | |
| Use them later | 81 (30) |
| Keep until having other ingredients | 64 (24) |
| Give to another person or family | 34 (13) |
| Save to use if running out of other foods | 28 (10) |
| Save for an emergency | 26 (10) |
| Donate to a food shelf | 26 (10) |
| Save for a special occasion | 8 (3) |
| Throw away | 5 (2) |
n refers to the number of responses that 49 enrolled participants provided through weekly survey sent during the 4 weeks of the study period to report their use of Every Meal’s food.
Table 5.
Participants’ Satisfaction with the Food Provided by Every Meal’s Weekend Backpack Program During the 4-Week Study Period, by Bag Type
| Bag type | Total n=167 n (%) |
East African n=3 n (%) |
Wide Variety n=39 n (%) |
Latino n=36 n (%) |
Southeast Asian n=52 n (%) |
Ready-to-eat n=37 n (%) |
|---|---|---|---|---|---|---|
| How much did you like the items in the bag? | ||||||
| A little/Not at all | 16 (10) | 0 (0) | 5 (13) | 4 (11) | 2 (4) | 5 (14) |
| Very/Somewhat | 151 (90) | 3 (100) | 34 (87) | 32 (89) | 50 (96) | 32 (86) |
| How satisfied were you with the variety of food in the bag? | ||||||
| A little/Not at all | 25 (15) | 0 (0) | 6 (15) | 6 (17) | 3 (6) | 10 (27) |
| Very/Somewhat | 142 (85) | 3 (100) | 33 (85) | 30 (83) | 49 (94) | 27 (73) |
| Were the food items in the bag mostly what you like to use for cooking? | ||||||
| No | 46 (28) | 1 (33) | 13 (33) | 3 (8) | 7 (13) | 22 (59) |
| Yes | 121 (72) | 2 (67) | 26 (67) | 33 (92) | 45 (87) | 15 (41) |
East African: tailored for East African dietary preferences. Wide Variety: tailored for a wide variety of food items. Latino: tailored for Latino dietary preferences. Southeast Asian: tailored for Southeast Asian dietary preferences. Ready-to-eat: tailored for ready-to-eat items with little or no preparation required.
Data Analysis
The Healthy Eating Index (HEI)-2020 scores were calculated to assess the overall nutritional quality of each of the 5 bag type menus using the Nutrition Coordinating Center’s programming developed using the simple scoring method.17 The maximum possible HEI-2020 score is 100 with a higher score indicative of a menu that is more closely aligned with the recommendations for 13 key nutritional components in the Dietary Guidelines for Americans 2020–2025.18–19 The calculation of HEI-2020 scores and its descriptive statistics were completed in SAS software Version 9.4. (SAS Institute Inc, Cary, NC, USA, 2013). Additionally, participants’ demographic characteristics were summarized using mean (SD) for continuous and count (%) for categorical variables, respectively. During the study period, participants did not always select the same bag type. To summarize the bag type within race/ethnicity groups, we first determined the bag type that each participant selected most often (e.g., a participant bag type was classified as East African if the person selected 3 East African bags and 1 ready-to-eat-item bag during the study period). For every food bag received, participants were asked to complete the survey on use (a little/not at all vs. all/some or yes vs. no), plans for unused foods (use them later, keep until having other ingredients, give to another person or family, etc.), and satisfaction (a little/not at all vs. very/somewhat, or yes vs. no). These responses (n=167) were summarized for all bags in total (use, plans for unused foods, and satisfaction) and by the bag type (satisfaction) using count (%). Analyses were conducted in R software Version 4.3.1 (R Foundation for Statistical Computing, Vienna, Austria, 2023).
RESULTS
Participant Characteristics
In the study sample, the mean age of the child was 8 years of age (standard deviation (SD) = 1.8) with 49% of them being female, 31% Hispanic, 36% White/Caucasian, 30% Asian, and 20% multiracial (Table 1). More than half of the caregivers were working either full-time or part-time (61%) and had completed less than college education or some college education without a degree (56%). The average number of people living in the household was 6 (SD = 3.0). About 59% of the caregivers reported that their child received free or reduced-price lunch at school and 31% received the Supplemental Nutrition Assistance Program. Most participants (68%) had experienced marginal, low, or very low household food security in the last 30 days.
Nutritional Quality
The Healthy Eating Index (HEI)-2020 total scores of Every Meal’s weekend backpack menus ranged from 67 (bags tailored for Southeast Asian preferences) to 83 (bags with ready-to-eat items) (Table 2) with the bags tailored for Latino and East African dietary preferences having lower HEI total scores of 70 and 71. Overall, component scores for dairy, refined grains and fatty acids tended to be low, with scores less than 30% of the maximum possible component scores for these index components for most bag types. Regardless of bag type, the menus achieved maximum scores in the categories of total vegetables, whole fruit, total protein foods, and seafood/plant proteins. Caregivers in the study sample rated most food bags as “mostly healthy” (n=158 of 167 bags, 95%).
Bag Receipt
Of all the bags selected by study participants during the 4 weeks of data collection (n=167), 31% were the Southeast Asian bag, 23% were the Wide Variety bag, 22% were the Latino bag, 22% were the ready-to-eat-items bag, and 2% were the East African bag. Many participants received bags that aligned with their ethnic background (Table 3). Specifically, 10 of the 13 (77%) non-Hispanic Asian participants received a bag tailored for Southeast Asian dietary preferences, and 7 of the 13 (54%) Hispanic participants received a bag tailored for Latino dietary preferences. Additionally, most participants received the same number of bags (30 of 49 families; 61%) and the same type of bags (34 of 49 families, 69%) each week.
Use of and Satisfaction with the Food
Participants used all or some of the items in 79% of the bags they received the prior Friday (Table 4). Nearly all the food items in each of the bags (99%) were rated as culturally and religiously appropriate for their use. For the items they had not yet used, parents responded to a multiple response option question that they planned to a) use those items later (30%), b) keep the items until having other ingredients (24%), or c) give to another person or family (13%). As shown in Table 5, most caregivers liked the food items (90%) and the variety of the food items (85%). The responses were similar across bag types, with 86% or more liking the food items and 73% or more being satisfied with the variety of the food items. Additionally, the food items in the bags were mostly what the caregivers like to use for cooking (72%).
DISCUSSION
The overall HEI-2020 scores of Every Meal’s food bags were less than 90% of the maximum HEI-score, but similar or better than other weekend backpack programs that lacked tailoring. HEI components that had maximum scores, such as whole fruit and total vegetables, represent key components for healthy eating patterns identified in the Dietary Guidelines for Americans 2020–2025.20 The HEI-2020 total scores of Every Meal’s menus were higher than the previously reported HEI-2005 scores of backpack menus from 9 food banks across the country (range 55 to 78)21 and the HEI-2010 scores of 5 menus of a Montana backpack program (range 42 to 75).22 Furthermore, the HEI-2020 scores of Every Meal’s menus were higher than the average HEI-2020 scores of 54 for US children aged 2 to 18 years old.23 This finding mitigates previous concerns about providing poor quality foods in weekend backpack programs11 and demonstrates that the program may support better nutrition in children. That is, Every Meal provided a nutrition assistance program that emphasizes not only food quantity but also food quality24 while respecting diverse ethnic dietary preferences.
The study findings also identified opportunities for strengthening tailored food menus. Component scores for dairy, refined grains and fatty acids were low across the bag types, which suggests a need to revise the nutrition guidelines to specify recommendations for these components. Additionally, the bags tailored for Latino and Southeast Asian dietary preferences, mostly used by Hispanic or Asian participants, had lower HEI total scores. The nutritional differences that were observed in these bags may be influenced by the limited availability of affordable ethnic food options or the provision of culturally preferred items, such as white rice (refined grain), white rice noodles (refined grain) or coconut milk (high in saturated fatty acids). While it is necessary to identify external factors that influence the menu selection process, it is equally important to partner with food bag users to improve the nutritional quality of the menus. The partnership should continue to aim to create healthier food options while honoring ethnic dietary preferences. For example, identifying cost-effective and desirable foods to replace refined grains with whole grains and creating menus with low-fat dairy items and a better balance of unsaturated versus saturated fatty acids may improve nutritional quality while maintaining high program satisfaction and reducing food insecurity.25,26
The provision of a tailored weekend backpack program with high quality food is beneficial only when targeted participants have demand for the program and use it. The study data from the enrolled participants were consistent with Every Meal’s internal records in which 20,050 meals were delivered in 2021 to 44 elementary schools in the same county where 31% were the Southeast Asian bag, 25% were the Wide Variety bag, 18% were the Latino bag, 14% were the ready-to-eat-items bag, and 12% were the East African bag. The gap in receiving bags for East African dietary preferences among the study participants may be due to having fewer East African families enrolled in the study (e.g. 1 Black/African American enrolled in the study; See Table 1). Both the study data and Every Meal’s internal delivery records show demand for the different types of foods provided, which supports the provision of culturally tailored weekend food bags. While it may not be feasible to provide food items through a weekend backpack program that account for the immense diversity of the targeted population and all of their varied food preferences, the current program identified key components of program users’ cultural diet preferences and incorporated it into the program to increase access to familiar food items.
Our findings indicate that Every Meal’s tailored weekend backpack program is well used and liked by participants, suggesting that the provision of the tailored backpack program may have contributed to caregiver’s high satisfaction. These findings, however, need to be interpreted with caution. Self-selection bias may have influenced the results on satisfaction in that those who were highly satisfied may have been more likely to participate in the study. Although unlikely, the $10 incentive provided to parents who completed a weekly study survey theoretically could have influenced food usage. Furthermore, it is unknown whether recipients of a typical backpack program without tailored food bag options report similarly high satisfaction and usage as those who receive tailored food bags.
IMPLICATIONS FOR RESEARCH AND PRACTICE
Results from this study suggest it is feasible to deliver a quality weekend backpack program that is tailored for different eating traditions and dietary preferences with high use of and satisfaction with the foods provided. Further studies are needed to elucidate the casual effects of the program on participants’ program usage, satisfaction, and diet-related outcomes. Identifying the role of the tailored weekend backpack program in diet-related outcomes is important as many children consume more unhealthy foods on the weekends than on week days.27 This is especially true for children who experience food insecurity as they tend to consume more sugar-sweetened beverages and less fruits on weekend days compared to those who experience food security.28 We suggest future research determine whether the high use of and satisfaction with the foods in the tailored backpacks leads to desired outcomes, including increased food security and diet quality of program participants. Using a robust study design, such as group-randomized trials29, may help us clearly understand the impact of the program and to identify which population it benefits the most.
Every Meal’s innovative, tailored weekend backpack program may serve as a model for other organizations who provide similar programs serving children with diverse eating traditions. Every Meal applied strategies to deliver a nutritious tailored weekend backpack program that aligns with participants’ ethnic eating traditions and dietary preferences. The organization’s leadership prioritized participants’ cultural needs, eating traditions, and dietary preferences. They also invited participants’ suggestions and feedback regularly for program planning. Furthermore, Every Meal’s commitment to its program is based primarily on alleviating food insecurity rather than other values that may be the basis for commitment with other non-profit organizations providing food assistance.30 A similar orientation has been suggested to redesign the non-profit food system to value client food needs and preferences.31 This practice shift toward building person-centered, tailored nutrition assistance programs32 may provide a foundation for creating equitable, community-engaged services to improve nutrition security in the short- and long-term.
Supplementary Material
Acknowledgements
The study was supported by the Healthy Foods, Healthy Lives Institute at the University of Minnesota under the Spring 2022 University Faculty Research Grant award, 21SFR-2YR150JU, the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health under award number, K23HD107179, and the National Institutes of Health’s National Center for Advancing Translational Sciences, grant UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official view of the institutes.
We thank Bronwyn Boyce-Erickson and Garrett Peacy for assistance with data collection.
Footnotes
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