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Summary:

The article from the NIH National Health Institute presents findings from a review and analysis investigating the effects of physical activity on mental health in children and adolescents. It uses data from multiple studies and concludes that physical activity has a significant positive impact on various aspects of mental health, including reducing symptoms of depression and anxiety, improving self-esteem, and enhancing overall psychological well-being among young people.

Relevance to Teaching Health to Elementary Students: Understanding the relationship between physical activity and mental health is important for educators teaching health to elementary students. This article highlights the importance of promoting regular physical activity in schools to support students' mental well-being. Teachers can create lessons on the benefits of exercise for mental health, physical activity breaks into the school day, and encourage active play during recess to create room for positive mental health in elementary students.

Biddle, S. J. H., Ciaccioni, S., Thomas, G., & Vergeer, I. (2021). Effects of Physical Activity on Mental Health in Children and Adolescents: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine, 10(15), 3366. https://doi.org/10.3390/jcm10153366

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Rosa Casas, Academic Editor

Abstract

Food insecurity is a broad and serious public health issue in the United States, where many people are reporting lack of access to healthy foods. The reduced availability of healthy, affordable foods has led to increased consumption of energy-dense and nutrient-poor foods, resulting in increasing the risk for many chronic diseases such as obesity, cardiovascular diseases, and type 2 diabetes mellitus. Thus, identifying promising approaches to increase access to healthy foods through improving the food environment is of importance. The purpose of this review article is to highlight how the food environment affects directly a person's food choices, and how to increase access to healthy foods through improving environmental approaches. The literature search was focused on finding different approaches to improve food security, primarily those with an impact on food environment. Overall, potential solutions were gathered through multilevel environmental approaches, including nutrition education and peer education, community-based participatory research, and policy changes in supplemental nutrition programs. A recommendation to reduce food insecurity is learning to create meals with a variety of seasonal fruits and vegetables purchased from affordable farmers' markets.

Keywords: food insecurity, chronic disease, multilevel approaches, low-income, food environment

1. Introduction

Food insecurity comprises limited or uncertain access to nutritious and adequate food intake and is widespread in the United States [ 1]. The United States Department of Agriculture (USDA) reported that 10.5% of Americans were food insecure at least some of the time during 2019 [ 2]. Many individuals who are food insecure utilize food banks and food pantries to procure food, but studies have shown that pantry users consume limited amounts of fruits, vegetables, and fiber [ 3]. The majority of the calories for this population are taken from energy-dense, nutrient-poor foods, including refined grains and foods high in added sugars and saturated fats, in contrast with the food-secure population, who have access to more nutrient-dense and healthier options [ 4]. This can result in the consumption of empty calories, rather than insufficient calories [ 4]. In general, food-secure individuals are more likely to meet the recommended dietary allowance for nutrients than food-insecure individuals [ 5]. This is displayed in a study by Champagne et al. [ 5], in which researchers determined the food security status through self-reported food intake, and found that food insecurity is associated with lower-quality diets assessed by the healthy eating index (HEI) scores.

A few factors that affect poor diet quality are related to lack of access to healthy foods in the surrounding neighborhood and limited household income [ 3, 6]. The macro-environmental sector refers to broad infrastructure (including food advertising and health systems), whereas micro-environments indicate local settings (such as workplaces and homes) [ 7]. Through improving these food environments, access to healthy food options can be increased, resulting in better diet quality and reduced chronic disease risk in these populations. Therefore, developing effective strategies to improve the diet quality and nutritional status of high-risk populations is important for the prevention of diet-related chronic disease. This review paper will evaluate specific risks for chronic disease associated with food insecurity and strategies to improve the food environment and individuals' choices towards a healthier diet and lifestyle. The objectives will be reached through assessing the literature on mixed-method intervention studies with residents of low-income communities.

2. Materials and Methods

To learn more about food insecurity and the risk of chronic disease, as well as approaches to improve food access, a literature search was conducted in June 2021 using the databases PubMed, Scopus, and Google Scholar, with a combination of keywords "food insecurity", "chronic disease", "food access", "multilevel approaches", "low-income", "healthy eating", "community", and "policy changes". Reading through each study, the titles and abstracts were observed to identify which articles provided informative data that helped towards reducing food insecurity. As summarized in Table 1 , full-length articles and book chapters in English with the US population in focus for all age ranges were selected. There were no limits to the state or region in the US in which the studies were conducted. The study designs conducted were randomized controlled trials, clinical trials, comparative studies, multicenter studies, and cohort studies. Notes, comments, editorials, and review articles were excluded from the articles with an exception of two review articles that were complementary to the data from other major studies. Studies that had other populations in focus, including low-income communities outside of the US, were excluded. Additionally, there were studies selected from the reference lists of relevant articles. Studies that compared the lifestyle and diet of food-secure populations vs. food-insecure populations were included, with a specific focus on the impact of the food environment. As different approaches to improve food security were searched for this narrative review, there was a focus on nutrition and peer education, community-based research, policy changes, and multilevel approaches.

Table 1

Parameter

Criteria

Exclusion

Search terms included

Food insecurity, chronic disease, multilevel approaches, low-income, food environment.

N/A

Criteria for study design

RCT, clinical trials, comparative studies, multicenter studies, cohort studies, qualitative studies, books.

Review articles, notes, comments, editorials.

Criteria for subject population

Low-income populations, all age ranges.

Other populations, low-income population not living in US.

Criteria for outcomes

Improved dietary behavior, weight status, improved lifestyle, educating the community on healthier choices when on a budget.

N/A

3. Food Insecurity and Risk for Diet-Related Chronic Disease

3.1. Obesity

At the individual level, rates of obesity are higher among groups with low education and low incomes [ 8, 9]. Current meta-analysis studies show that food insecurity increases the risk for obesity for adults (odds ratio 1.15) in food-insecure households, especially women odds ratio of 1.26) [ 10]. Paeratakul et al. [ 9] assessed data from the USDA Agricultural Research Service Continuing Survey of Food Intakes by Individuals, and reported that, among other factors, socioeconomic condition is one of the main factors leading to greater obesity severity. The study further linked obesity rates with an increased incidence of diabetes, hypertension, and high serum cholesterol, which further supports the role of socioeconomic factors in increasing these disease risks through an increase in obesity [ 9]. Individuals with food insecurity commonly use resources, such as food pantries, for access to a variety of products. An important issue that has been shown to lead to obesity among low-income populations is the poor nutritional quality of food and lack of knowledge of how to prepare certain fresh produce provided by the food pantries and other food assistance programs [ 5, 11]. A great focus has been towards children in low-income populations and their greater risk of obesity due to their diet patterns and food choices [ 12]. Kaur et al. [ 12] analyzed the National Health and Nutrition Examination Survey (NHANES) data assessing personal food insecurity through USDA's Food Security Survey Module to determine its relationship with obesity risk. The researchers determined that obesity was significantly associated with levels of food insecurity among children of ages 6 to 11 years, with an odds ratio of 1.81; 95% confidence interval (CI) 1.33 to 2.48 [ 12].

Food pantries are good resources from which to analyze the needs of food-insecure populations and determine obesity rates. Studies of food pantry participants concluded that the mean body mass index (BMI) of the pantry users was 29.5 kg/m ², and 78.0% of the population of obese pantry users were women [ 3, 5, 11, 13]. Many people from the population have shown an interest in regularly consuming nutritious food and fresh produce, but they reported that these products were unaffordable [ 14, 15].

3.2. Cardiovascular Diseases

According to the American Heart Association, the seven cardiovascular health metrics are based on smoking, diet, physical activity, BMI, blood pressure, total cholesterol, and fasting glucose [ 16]. Individuals with food insecurity face barriers meeting the ideal cardiovascular health metrics, including lower odds of meeting at least three metrics ( p < 0.01) [ 17]. Data further show a greater presence of hypertension and heart disease in individuals with lower education and income compared to others [ 9]. Furthermore, hypertension is associated with greater intake of added sugar and sugar-sweetened beverages ( p < 0.05) [ 18]. Adults from food-insecure households had a 21% higher risk of clinical hypertension than adults from food-secure households [ 19]. A systemic review and meta-analysis of 36 studies indicated an association between food-insecure adults and self-reported hypertension with an odds ratio of 1.13 [ 20]. Additionally, very low food security was associated with increased risk for cardiovascular disease, and a 58% higher risk for cardiovascular disease mortality [ 21, 22, 23]. Sun et al. focused on associations of adult food insecurity with all-cause and cardiovascular disease mortality in US adults [ 23]. This study concluded that participants with very low food security had a higher risk of cardiovascular disease compared with those with high food security, with an odds ratio of 1.54 (95% CI 1.04-2.26) [ 23].

Bazzano et al. [ 24] conducted the first NHANES Follow-up Study to observe fruit and vegetable intake through a food-frequency questionnaire, and the incidence of mortality from cardiovascular disease from medical records and death certificates. A significant association was identified between frequency of fruit and vegetable intake and incidence of and mortality from stroke, ischemic heart disease, and cardiovascular disease [ 24]. Bazzano et al. [ 24] further concluded that consuming three or more fruits and vegetables per day, compared to less than one per day, was associated with a 27% lower stroke incidence, a 42% lower stroke mortality, a 24% lower ischemic heart disease mortality, a 27% lower cardiovascular disease mortality, and a 15% lower all-cause mortality. Due to the high cost of fruits and vegetables, lack of transportation, low quality products in low-income areas, and other factors, individuals in these neighborhoods consume fewer servings of fruits and vegetables than the Dietary Guidelines recommendations, leading to an increased risk for cardiovascular disease [ 25]. Among nonelderly adults with household income <200% of the federal poverty level, analysis of NHANES data by Seligman et al. [ 19] (a nationally representative survey of the US population) found an association between food insecurity and clinical evidence of hypertension and diabetes.

3.3. Diabetes Mellitus

As previously mentioned, poor diet quality includes low nutrient consumption and high intake of energy dense foods. This lifestyle factor is one of the main factors leading to diabetes mellitus. Walker et al. [ 13] conducted a cross-sectional analysis with data from the NHANES survey 2005-2014 to evaluate levels of food security and its association to diabetes. The results indicated higher risk for food insecurity, with an odds ratio for prediabetes of 1.39 (95% CI 1.21-1.59), for undiagnosed diabetes of 1.81 (95% CI 1.37-2.38), and for diagnosed diabetes of 1.58 (95% CI 1.29-1.93) [ 13]. The results are supported by a cross-sectional study; when compared to individuals with food security, participants with low food security were 1.35 times more likely to have prediabetes (95% CI: 1.17-1.55) [ 26]. Very-low-food-secure participants, compared with both low-food-secure and food-secure participants, have been reported to have greater diabetes distress and more frequent and severe hypoglycemic episodes [ 27]. Individuals with food insecurity live paycheck by paycheck or wait for monthly assistance, which can lead to a cycle of restraining dietary intake during hard times and overeating during food restock [ 28]. This process can lead to insulin resistance and diabetes [ 13, 28, 29]. In individuals with food security the self-management to improve diabetes is easier, but a lack of quality food makes diabetes self-management more difficult, worsening the food-insecure individual's health condition [ 27]. A meta-analysis study by Abdurahman et al. further strengthens the hypothesis for an association between household food insecurity and increased risk of type 2 diabetes, with an odds ratio value of 1.27 (95% CI 1.11-1.42) [ 30]. Based on the studies mentioned previously, it appears that food insecurity is associated with different stages of diabetes mellitus; however, there are some recent studies that contrast the findings and do not suggest an association between food insecurity and clinically determined type 2 diabetes or significant differences in fasting blood glucose and HbA1c [ 31]. Beltran et al. additionally stated that food insecurity is a complex issue and it might look different depending on factors such as social, economic, and geographic consideration [ 31]. The study explained that the differences in the findings might be a result of the difference in food insecurity concepts, where in some cases hunger and chronic starvation are the primary drives of food insecurity [ 31]. In another study, starvation due to food insecurity was related to worsening signs of insulin sensitivity in type 2 diabetes [ 29]. Meanwhile, food-insecure areas in the United States are usually not associated with hunger, but mainly with intake of lower-quality, high-calorie foods, which increase a person's risk for type 2 diabetes [ 31].

4. The Impact of Food Environment on Access to Healthy Food Choices

The nutritional environment is affected not only by the number of stores in an area but also the availability and cost of healthy food items. Reduced access to fresh produce greatly impacts food choices for low-income populations [ 32]. Typically, individuals with reliable transportation make frequent trips to supermarkets [ 32, 33]. However, many people in low-income neighborhoods rely greatly on food pantries due to the lack of transportation and availability of fresh produce in their areas [ 33]. A research study, conducted in a low-income neighborhood in Pomona, CA, determined that 41% of the food pantry clients did not live within walking distance of a store with a variety of fresh produce and 13% did not have access to any type of food store with fresh produce [ 33]. This problem is widespread in many areas in the US and highlights rural adults not being able to meet recommended nutrition guidelines due to environmental barriers and lack of community resources [ 33]. In areas with food insecurity, convenience stores are more common than supermarkets or grocery stores [ 32]. These stores have a very limited range of food items and are more likely to stock less healthy versions of products (for example: low-fiber bread vs. high-fiber bread, whole milk vs. reduced-fat milk vs. low-fat or nonfat milk) [ 32]. A multicenter study in Hartford, CT, combined customer shopping behavior with store food inventory data, and concluded that when there is a greater variety of fresh products, such as fruits and vegetables, there is an increased likelihood of these products being purchased [ 34]. This research study conducted face-to-face interviews on different days and at different times of the day to measure typical food shopping behaviors and determine whether shoppers had access to and used the Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefits in the store [ 34]. They also maintained inventories, using a modified version of the Nutrition Environment Measures Survey in Stores (which included the availability of fresh/canned fruits and vegetables, and whole grain and reduced-fat dairy products) to measure availability and quality of healthy food in stores [ 34]. Due to an increased variety of fruits and vegetables offered, those receiving SNAP were significantly more likely to purchase fruit ( p < 0.05) and vegetables ( p < 0.01), compared with those who were not receiving SNAP [ 34].

When it comes to the cost of fresh products, more healthful versions of food items are typically more expensive than the corresponding less-healthful versions, with the exception of milk [ 35]. At the same time, foods with high energy density provide the most calories at a lower cost, which contributes to people in low-income populations consuming them over fresh, nutrient-dense products [ 35]. Alteration of this environment, as with the study discussed above by Martin et al. [ 34], may significantly change these consumption habits.

5. Environmental Approaches to Improve Food Security and Nutritional Status: Multilevel Intervention Studies with Residents of Low-Income Communities

Figure 1 uses the framework of the socioecological model (SEM) concept, as outlined by the Centers for Disease Control and Prevention [ 36], to summarize the key multilevel approaches discussed in this review for improving food security and nutritional status. Environmental approaches and nutrition programs can improve food security more efficiently if they work in a multilevel interaction approach [ 36]. This interaction starts from working personally with the individual, to creating a support system of family, friends, and social networks [ 36]. Other more significant factors that can assist this population are resources provided through schools or workplaces, communities (considering cultural values and norms), and policy changes from local laws to national changes [ 36]. Multilevel approaches have been used to increase the fruit and vegetable intake in low-income housing communities. Table 2 summarizes the key approaches that have led to improvements in food security. A 12-month cluster, randomized controlled trial (RCT) was conducted to demonstrate the benefit of year-round fruit and vegetable markets at improving fruit and vegetable (F&V) intake for low-income adults [ 37]. This research study featured discount fresh fruit and vegetable markets called 'Fresh to You' (FTY), as well as a multicomponent, educational intervention, which was a combination of individual, community, and policy change approaches [ 37]. The prices of the fruits and vegetables were kept at or below the retail prices at local supermarkets [ 37]. This study also included chef-run cooking demonstrations, taste-testing events, shared recipes, and educational boxes (including newsletters, DVDs, reusable shopping bags, and kitchenware) and two six-week educational/motivational campaigns, which focused on increasing intake and variety of fruits and vegetables [ 37]. The results indicated that more than half of the participants attended a few of the FTY markets [ 37]. From baseline to 12 months, there was an increase in total fruit and vegetable intake by 0.44 cup/day (as assessed by the National Cancer Institute's 'Eating at America's Table All Day Screener') in the intervention group with the control group decreasing intake by 0.08 cup/day [ 37]. There was also an increase in the frequency of fruits and vegetables by 0.24 servings per day, which was assessed through the Fruit and Vegetable Habits Questionnaire Score [ 37]. Reading newsletters or attending campaign events was not associated with any change in fruit and vegetable consumption, but watching DVDs was associated with an increase in fruit and vegetable intake by 0.69 cup/day [ 37].

Table 2

Author

Type of Study

Target
Population

Sample Size

Type of Approach

Outcome Measure

Results

Gans. et al. [ 37]

RCT

Western adults

1587

Individual, community, policy Changes

Fruit and vegetable consumption measured by National Cancer Institute's "Eating at America's Table All Day Screener"

-↑ total intake F & V by 0.44 c/day with the control group ↓ by 0.08 c/day ( p < 0.02).
-↑ F&V frequency ( p = 0.01)

Trude. et al. [ 40]

RCT

Obese children (9-15 years old) in 30 areas of Baltimore.

401

Individual, interpersonal, organizational, community, policy

-Purchase and consumption of low-sugar foods and beverages.

-↑ healthier purchases by 1.4 more items per week compared to the control group.
-There was a 3.5% ↓ in kcal from sweets for older intervention youths.

Weber. et al. [ 44]

Review and analysis of features

WIC
participants

17 app features

Organizational and community

-Reviewing app stores and their benefits to users.

App features were classified into categories for shopping management, WIC required nutrition education modules and others. The app was rated with 4-5/5 stars

White et al. [ 52]

Multicenter randomized intervention trial

Children

53

Community and policy

-Increasing food access based on availability, accessibility, affordability, acceptability, and accommodation.

Availability was enhanced for those who could select their own produce items.
Flexible pick-up times and locations.
↑ access to F&V.

McGuirt et al.
[ 54]

Qualitative Study

Women of child-bearing age

37

Individual, organizational, and policy

-Examine willingness to shop at farmers' markets.

More likely to shop at farmers' market when price saving ↑ at least 20%.

Adding culturally competent aspects to a community approach, with resources focused on multiethnic communities, materials provided in the population's native language, and incorporation of recipes and food demonstrations from their country of origin, may result in improvements in diet quality [ 38]. Hammons et al. [ 38] added these cultural aspects and reported greater interest for the individuals to try recipes provided with fruits and vegetables and an overall increase in daily servings of fruits and vegetables consumed [ 38]. The results are supported by another study that reported an increase in variety of fruits and vegetables ( p < 0.01 for both), after a six-week cooking program at the Community Food Bank that teaches food pantry clients plant-based recipes [ 39]. These data further indicated a decrease in purchases of carbonated beverages and desserts with a value of p < 0.01 [ 39].

B'more Healthy Communities for Kids was a multilevel obesity prevention study that sought to improve healthier food purchasing and help reduce sweet-snack consumption among low-income African-American youths [ 40]. This group worked to achieve the objectives for two-year time period, through youth-led nutrition education in recreation centers, in-store promotion, and social media programs [ 40]. In this multilevel approach, many areas for education were considered, including promoting healthier alternatives to beverages and snacks, and sharing information for healthier cooking methods through promoting healthier cooking ingredients, such as low-fat milk, 100% whole wheat bread, and fresh/canned/frozen vegetables [ 40]. The multiple components involved wholesales, which were encouraged to stock B'more Healthy Communities for Kids-promoted healthier food alternatives [ 40]. They also worked on improving supply for healthier options of foods and beverages in corner stores and carryout restaurants, as well as improving demand through taste tests for healthier alternatives [ 40]. Posters, handouts, and educational sessions were provided. Through these sessions there were peer-led, hands-on activities where participants learned different sugar and fat contents in drinks and snacks and were introduced to the traffic light labeling method for beverages and snacks [ 40]. For additional resources, recipes, news, and educational activities related to healthier eating behaviors were sent through social media and texting [ 40]. The text message platform was focused towards caregivers with goal setting strategies and educational activities, where they received messages three to five times a week related to healthier eating behavior [ 40].

B'more Healthy Communities for Kids also worked with key city stakeholders to support policies for a healthier food environment and provided evidence-based information to support the development of policies at the city level using a Geographic Information System/System Science simulation model to help stakeholder decision-making in regard to sugar-sweetened beverage warning labels, urban farm tax credits, mobile meals, etc. [ 40]. The results showed that the overall intervention group purchased 1.4 more healthier foods and beverages per week in relation to the comparison youth. Additionally, there was a decrease in calorie intake from sweet snacks and desserts among older intervention youths [ 40]. This finding was supported by other results in improving the availability of healthier foods and beverages in small food stores in intervention zones, indicating that food availability affects an individual's choice [ 40]. Overweight and obesity are major issues, especially in low-income communities, but community-enhanced school programs can be effective in reducing childhood obesity in these populations [ 41]. Schools with health program training and community partnerships decreased the percentage of students classified as overweight/obese by 8.3%, compared to a 1.3% decrease in schools that were provided only with health program training, without the community aspect [ 41].

In the case of emergency food aid, there are also food banks open and available around the US. Wetherill et al. [ 42] conducted a study to look a strategies and innovative programs that are focused on advancing nutrition-focused food banking in the United States. This study included in-person or phone interviews to obtain further information regarding personal experiences, perceptions, and practices related to nutrition-focused food banking [ 42]. Overall, the study findings indicated that food banks are implementing a variety of multi-level approaches to improve healthy food access among users [ 42]. This is done through four major themes: building a healthier food inventory at the food bank; enhancing partner agency healthy food access, storage, and distribution capacity; nutrition education outreach; and expanding community partnerships and intervention settings for healthy food distribution, including healthcare and schools [ 42].

5.1. Individual Nutrition Education and Peer Education

The main factors that have been shown to increase fruit and vegetable consumption in multilevel approaches are taste tests and nutrition education, including providing healthy recipes for participants [ 37]. Along with healthy recipes, some studies have focused on helping improve participants' cooking skills to make low-cost meals, which further decreased food insecurity, by increasing cooking at home and reducing the amount of time people ate out at restaurants, leading to increased total variety of vegetables and fruits in the diet [ 34, 37, 39, 40]. Even short-term nutrition education has made people more aware concerning sodium in processed foods and nutrient and calorie-dense foods, the importance of physical activity, and interpreting nutrition levels [ 43].

WIC focuses on improving the health and nutritional status of pregnant and postpartum low-income women and children up to the age of 5 years. The participants of these programs are faced with many barriers when shopping for the correct foods on their WIC food list, therefore nutrition education is a great tool to better assist this population [ 44]. Through mobile phone apps, there are educational tools to help the participants with shopping management features, clinic appointments, and informational resources [ 44]. Shopping management features assisted the WIC participants with real-time shopping for WIC foods in the grocery store, including food benefit balance checking, barcode scanning, and checking if the item was WIC eligible [ 44]. The participants shared that this app was very easy to use and convenient in helping pick the right products, while saving time [ 44]. Some applications also allowed participants to manage their WIC clinic visits, and view their future appointments and the documents needed to be provided in the appointments [ 44]. Required nutrition education modules were also features, which could be completed from home instead of going to the clinic [ 44]. Throughout a 7 month period, Weber et al. [ 44] reviewed the main features of a publicly available mobile phone app for WIC participants and concluded that, even though all the features were beneficial and useful, the most frequently used were the shopping management features. Some users shared their feedback, giving the app 4-5 stars out of 5 stars for being time saving, convenient, and an overall great app [ 44]. Other users would have liked in addition a nutrition/healthy section with recipes and ideas to help people learn to consume healthier choices, not just the WIC-approved foods [ 44].

Another approach to increase diet quality for low-income populations is individual tailoring of nutrition education [ 18]. A recent pilot 8 week study assessed the effectiveness and acceptability of personalized nutrition intervention for mobile food pantry users [ 45]. When comparing the treatment group with the control group, a personalized nutrition education intervention was effective in improving the diet for food-insecure participants (4.54% vs. 0.18% improvement in healthy eating index scores) [ 45]. Culturally tailored nutrition education involving family time and physical activity has also been a way to incorporate healthier food choices [ 46, 47]. These approaches also include educational information in the participant's native language, including all the handouts, recipes, and visual guides [ 47]. Focusing on diet based on culture, studies have also worked with tiendas, small Latino stores, to promote greater intake of fresh produce among consumers [ 46].

Education programs culturally tailored to a specific group have also been shown to be effective. Flores-Luevano et al. [ 48] conducted a bilingual culturally tailored, hands-on diabetes education program among Mexican American adults with diabetes. The sessions were interactive with demonstrations, activities to promote problem-solving, and facilitated group dynamics through sharing personal experiences [ 48]. This, intertwined with peer-education, resulted in improvements in glycated hemoglobin by −1.1% and total cholesterol with −17.2 mg/dL at 6 months post-intervention [ 48]. There were also behavioral changes, such as glucose self-monitoring improvement by 1.3 times increase a week, increased exercise levels, and increased positive nutritional behavior by 2.23, and the benefits were observed with attendance rates as low as 50% [ 48].

Marshall et al. [ 49] conducted a two-year follow-up study using a one-group pre-post evaluation design that focused on school-based nutrition education and food co-op intervention and how it can increase children's intake of fruits and vegetables. In this study, 407 families completed baseline data, of which 262 parent-dyads agreed to participate in the two-year follow-up study, where the parents were provided with education along with their children [ 49]. This nutrition education included changes in home setting, such as increased frequency of cooking behaviors, increased usage of nutrition facts labels in making grocery purchasing decisions, and increased food availability of fruits and vegetables [ 49]. The results of the study showed an increase in child intake of fruits by 0.18 cup/day, vegetables by 0.14 cup/day, and fiber by 1.06 g/1000 kcal, and a significant decrease in total fat intake by 1.55 g/1000 kcal and percent daily calories from sugary beverages by 0.52% [ 49]. Parents also reported an increase in daily intake of vegetables by 0.6 cups/d and combined fruits and vegetables ( p < 0.05) [ 49].

5.2. Community-Based Participatory Research

Community-based participatory research is a kind of study where community members, organizational representatives, and academic researchers are all equally involved in the process [ 50]. This research method is important to collect the data on what kind of lessons and resources will be beneficial for the population, but also to make the participants more comfortable and more open when conducting interviews with educators of the community. This approach was used in the selected studies to modify elements in the environment, which would result in an increase in nutrient-dense food consumption. A number of studies have focused on improving diet quality and reducing metabolic risk through gardening and cooking [ 47, 48, 51]. These studies organized classes tailored towards low-income youths and consisted of lessons about gardening, where they used "hands-on" approaches to facilitate participation in planting, growing, and harvesting organic fruits and vegetables [ 47, 48, 51]. Additional interactive cooking and nutrition lessons were included with the fruits and vegetables raised from the garden [ 47, 51].

These elements worked to increase fruit and vegetable consumption and preparation of healthy snacks and meals [ 47, 51]. Creative food preparation with blending of new vegetables into juices or other dishes has also been a way to introduce unfamiliar foods to children and other family members [ 47, 51, 52]. Participants shared that their children would be curious of the new items introduced each week and they were excited to include them in their smoothies [ 47, 51, 52].

As previously mentioned, accessibility and affordability are two of the main factors that lead to food security. Since supermarkets and convenience stores are known to have expensive products, a way to provide access to food in low-income families is community-supported agriculture products. Community-supported agriculture products are more affordable and flexible in their accessibility [ 52]. Farm Fresh Foods for Healthy Kids examined the perception of food access among low-income families in nine communities participating in community-supported agriculture [ 52]. Participants reported improved access to food products and benefited from flexible pick-up times and locations; however, despite the cost being relatively low, payment remained a barrier for some [ 52]. A multistate randomized intervention trial targeted obesity prevention in low-income families through improving access to affordable, local, seasonal produce through community-supported agriculture and support of obesity-related behavior changes through tailored education to increase knowledge and skills, and provide increased revenue and business to support community-supported agriculture farmers [ 53]. Even though the community took steps to help low-income populations, there are still barriers that need to be faced for more effective results of current and future studies [ 53]. When shopping through community-supported agriculture, participants believed that they were saving money for produce of high quality, compared to the grocery stores [ 53].

McGuirt et al. [ 54] examined the influence of farmers' market pricing and accessibility on willingness to shop at farmers' markets, among low-income women. Percentage price savings were presented visually as discounts at the standard amount, or there were pictures of the amount of produce a consumer could buy at the farmers' market compared to the supermarket, reflecting the savings [ 54]. The different quantity bought with the same price was determined by a member of the research group who went to local supermarkets to establish the price per pound and calculate the amount to compare with the products from the farmers' market [ 54]. The results of this study showed that there was an increased interest to shop at farmers' markets when there was at least a 20% price saving [ 54, 55]. Additionally, participants were more influenced by the visual representation of a greater quantity of produce with the price savings, rather than the money saved by the reduced price [ 54].

5.3. Policy Changes in Supplemental Nutrition Programs

To reduce energy-dense, low-nutrient food consumption, there need to be environmental and policy changes that promote healthy eating. The main categories that need to be in focus, based on research, are pricing, nutrition labeling, and access to healthier ready-to-go foods [ 55, 56, 57]. Additionally, to increase food security and diet quality, policy changes are needed in school programs that work on strengthening links to the traditional, nutrient-dense food system in schools [ 58]. A significant increase in fruit and vegetable intake has been shown with greater access to healthier ready-to-go foods [ 58]. Additionally, reducing the cost of healthier snacks increases the consumption of these products [ 57, 59]. When prices of fruits and vegetables were reduced by 50% for high school students, their consumption increased by twofold to fourfold [ 55]. Low-fat snack sales increased by 93% with a 50% reduction in their prices [ 59]. Studies also worked with key city stakeholders to support policies for a healthier food environment and provided evidence-based information to support the development of these policies [ 40].

6. Discussion and Conclusions

Food insecurity is a widespread problem in the US that greatly affects quality of life, leading to greater risk for obesity, diabetes, and cardiovascular diseases. There are a number of barriers causing food insecurity in certain areas, such as lack of transportation, food deserts or food swamps, and lack of nutrition education. This review paper discussed certain approaches to reduce food insecurity in low-income communities and increase access to healthful foods, especially consumption of fruits and vegetables. Multilevel approaches are shown to have the most distinguishable results and also take into consideration a wide spectrum of reasons and factors. Multilevel approaches have included nutrition educational material, taste-testing events, price reduction of healthy products, increased access to healthy options, and overall policy changes. The major limitation to multilevel approaches is that when a change is observed, there is not a way to specifically identify which components of the intervention led to changes in food behaviors [ 35]. Other potential limitations of studies thus far have included small sample sizes and sample populations that were predominantly women, self-reporting of data, potentially leading to bias, and the possibility that participants may not have fully represented the low-income population of interest [ 38, 39, 53, 55]. Beneficial approaches comprise community-based research, which obtains an input from the community, where the main focus is on factors that lead to food insecurity and how to reduce these barriers. Farmers' markets that provide local, seasonal, affordable produce are shown to be a way to support behavior changes and increase access to fresh produce [ 12]. Nutrition education helps decrease food insecurity from a different approach, through hands-on activities and peer-education to increase cooking skills and help incorporate a variety of fruits and vegetables in the diet [ 17, 37, 49].

Additionally, current studies have shown a need for more research, but it is important to point out that perception of an individual's food environment may impact the foods they purchase and consume [ 60]. For example, if they perceive the environment to be poor, they may be less likely to buy fruits and vegetables and other healthy options [ 60]. Furthermore, future research can further focus on how to effectively improve diet quality and reduce diet-related chronic disease risk by developing and validating multi-dimensional intervention studies tailored for target populations with special needs and barriers, and studying the impact of the perceived food environment and social support on improving the diet quality of a population with poor access to healthy foods.

Funding Statement

This research received no external funding.

Author Contributions

Conceptualization, D.Z., O.K.C. and M.J.P.; writing-original draft preparation, D.Z.; writing-review and editing, D.Z., O.K.C. and M.J.P. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Not applicable.

Conflicts of Interest

The authors declare no conflict of interest.

Footnotes

Publisher's Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

39. Flynn M.M., Reinert S., Schiff A.R. A Six-Week Cooking Program of Plant-Based Recipes Improves Food Security, Body Weight, and Food Purchases for Food Pantry Clients. J. Hunger Environ. Nutr. 2013;8:73-84. doi: 10.1080/19320248.2012.758066. [[ CrossRef] Google Scholar]

Articles from Nutrients are provided here courtesy of Multidisciplinary Digital Publishing Institute (MDPI)

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Increasing Access to Healthy Foods through Improving Food Environment: A Review of Mixed Methods Intervention Studies with Residents of Low-Income Communities

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Food insecurity is a broad and serious public health issue in the United States, where many people are reporting lack of access to healthy foods. The reduced availability of healthy, affordable foods has led to increased consumption of energy-dense and ...

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Summary:

The resource from StopBullying.gov examines the relationship between social-emotional learning and bullying prevention. It emphasizes how SEL skills, such as empathy, communication, and problem-solving, can help create a positive school climate and cut out any instances of bullying. The article provides insights into different SEL programs and strategies that educators can use to promote respect, inclusion, and empathy among students, contributing to the prevention of bullying.

Relevance to Teaching Health to Elementary Students: Understanding the link between social-emotional learning and bullying prevention is essential for educators teaching health to elementary students. This resource highlights the importance of incorporating SEL skills into the curriculum to create a supportive and inclusive learning environment. Teachers can integrate SEL activities, discussions, and role-playing exercises into their lessons to teach students valuable social skills and empower them to stand up against bullying. By promoting empathy, communication, and problem-solving, educators can create positive relationships and set up students with the tools they need to prevent bullying and promote mental well-being.

U.S. Department of Health and Human Services. (n.d.). Social Emotional Learning and Bullying Prevention. StopBullying.gov. Retrieved from https://www.stopbullying.gov/resources/research-resources/social-emotional-learning-bullying-prevention

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Social emotional learning (SEL) is an educational approach that helps people develop social skills and awareness of themselves and others. School-based SEL can help students improve their academic and interpersonal success. It focuses on the positive behaviors of students instead of the negative behaviors to promote youth development. 1
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Benefits for students and schools

Developing social and emotional skills can have many benefits. It can significantly enrich students' mental health, behavior, and education. An evaluation of 213 school-based SEL programs showed these students had improved relationships with peers, teachers and school. When children learn social and emotional skills in school, it can also help them improve academically. 2 The evaluation also found a decrease in student conduct problems, substance use, and emotional distress. 2

Developing students' social and emotional skills is a promising approach to prevent bullying. Studies have shown that these skills help protect students from becoming targets of bullying. They can also lower the risk of someone bullying others. 3 Through SEL students can develop empathy and resolve conflicts better. They can also build particular skills that can prevent students from getting involved in bullying. 3 These skills include self-awareness, self-management, and responsible decision making. 2

Social Emotional Learning (SEL) in the Classroom

Here are some ways to include SEL within the classroom:

School-wide SEL framework: The program works to create a positive school environment. Teachers, staff, students, and sometimes parents participate.

Formal integration of SEL into curricula: This might include scripted, step-by-step trainings. It often has clear, structured, strategies.

Teacher-led integration of SEL: Teachers can bring this learning into their classes and teaching practices.

There are many resources and programs available to train educators how to teach SEL. These programs also help educators build their own emotional and social skills. Teachers with good social and emotional skills tend to have greater job satisfaction, express more positivity towards students, and have less problems managing classrooms. 3 SEL works best when the whole school is aware of and commits to positive behaviors.

Source and Research Limitations

This research summary is based on the most up to date research on bullying and prevention, but it is important to note that this research has several important limitations. Most of the research is cross-sectional, which means it took place at one point in time. This type of research shows what may be related at that time, but cannot tell us which came first or if one caused the other to occur.

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Social Emotional Learning and Bullying Prevention

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Social emotional learning (SEL) programs in schools is a promising approach to prevent bullying.

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Summary:

The Substance Abuse and Mental Health Services Administration (SAMHSA) provides information on understanding child trauma. It explains the definition of trauma, the types of traumatic events children may experience, and the potential impacts on their physical, emotional, and psychological well-being. It also highlights the importance of trauma care and supportive interventions to help children and families heal and thrive after experiencing trauma.

Relevance to Teaching Health to Elementary Students: Educators teaching health to elementary students must understand child trauma to create a safe and supportive learning environment. This resource from SAMHSA emphasizes the impact of trauma on children's lives and highlights the need for trauma approaches in schools. Teachers can add in trauma-sensitive practices into their classroom management and instruction, such as creating routines, creating a sense of safety and trust, and providing opportunities for emotional expression and support. By recognizing and addressing the effects of trauma, educators can empower students to overcome these problems.

Substance Abuse and Mental Health Services Administration. (n.d.). Understanding Child Trauma. SAMHSA. Retrieved from https://www.samhsa.gov/child-trauma/understanding-child-traum

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Fast Facts

At least 1 in 7 children have experienced child abuse and/or neglect in the past year, and this is likely an underestimate. In 2019, 1,840 children died of abuse and neglect in the United States.

Each day, more than 1,000 youth are treated in emergency departments for physical assault-related injuries.

In 2019, about 1 in 5 high school students reported being bullied on school property in the last year.

8% of high school students had been in a physical fight on school property one or more times during the 12 months before the survey.

Each day, about 14 youth die from homicide, and more than 1,300 are treated in emergency departments for violence-related injuries.
It's important to recognize the signs of traumatic stress and its short- and long-term impact.
The signs of traumatic stress may be different in each child. Young children may react differently than older children.

Preschool Children

Fear being separated from their parent/caregiver

Cry or scream a lot

Eat poorly or lose weight

Have nightmares

Elementary School Children

Become anxious or fearful

Feel guilt or shame

Have a hard time concentrating

Have difficulty sleeping

Middle and High School Children

Feel depressed or alone

Develop eating disorders or self-harming behaviors

Begin abusing alcohol or drugs

Become involved in risky sexual behavior

The Body's Alarm System

Everyone has an alarm system in their body that is designed to keep them safe from harm. When activated, this tool prepares the body to fight or run away. The alarm can be activated at any perceived sign of trouble and leave kids feeling scared, angry, irritable, or even withdrawn.

Healthy Steps Kids Can Take to Respond to the Alarm

Recognize what activates the alarm and how their body reacts

Decide whether there is real trouble and seek help from a trusted adult

Practice deep breathing and other relaxation methods

Impact of Trauma

The impact of child traumatic stress can last well beyond childhood. In fact, research has shown that child trauma survivors may experience:

Learning problems, including lower grades and more suspensions and expulsions

Increased use of health and mental health services

Increase involvement with the child welfare and juvenile justice systems

Long-term health problems (e.g., diabetes and heart disease)

Trauma is a risk factor for nearly all behavioral health and substance use disorders.
There is hope. Children can and do recover from traumatic events, and you can play an important role in their recovery.
A critical part of children's recovery is having a supportive caregiving system, access to effective treatments, and service systems that are trauma informed.

Get Help Now
SAMHSA Behavioral Health Treatment Services Locator The National Child Traumatic Stress Network: Get Help Now Healthcare Toolbox: Basics of Trauma-Informed Care
Not all children experience child traumatic stress after experiencing a traumatic event. With support, many children are able to recover and thrive.

As a caring adult and/or family member, you play an important role.

Remember To:

Assure the child that he or she is safe.

Explain that he or she is not responsible. Children often blame themselves for events that are completely out of their control.

Be patient. Some children will recover quickly while others recover more slowly. Reassure them that they do not need to feel guilty or bad about any feelings or thoughts.

Seek the help of a trained professional. When needed, a mental health professional trained in evidence-based trauma treatment can help children and families cope and move toward recovery. Ask your pediatrician, family physician, school counselor, or clergy member for a referral.

Visit the following websites for more information:

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Recognize the signs of child traumatic stress and the impact that trauma may have on children. The infographic developed by SAMHSA's National Child Traumatic Stress Initiative (NCSTI) provides information on the prevalence and impact of traumatic events on children, and what actions can be taken to support children who experience traumatic events.

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Summary:

The Cleveland Clinic Health Essentials article provides an overview of the five stages of grief: denial, anger, bargaining, depression, and acceptance. It explains each stage in detail, describing the emotions and experiences associated with grief. The article goes over the fact that grief is a natural response to loss and that individuals may progress through the stages at their own pace. It also offers suggestions for coping with grief and seeking support during the grieving process.

Relevance to Teaching Health to Elementary Students: Understanding the stages of grief is important for educators teaching health to elementary students, as children may experience loss and grief in different ways. This resource from Cleveland Clinic Health Essentials can inform teachers about the emotional responses children may show when coping with loss, such as the death of a loved one, a pet, or a life change. Teachers can use age-appropriate discussions and activities about grief into the curriculum to help students understand and navigate their emotions. By providing a supportive and empathetic environment, educators can help children process grief and develop healthy coping strategies.

Cleveland Clinic. (n.d.). Understanding the 5 Stages of Grief. Health Essentials. Retrieved from https://health.clevelandclinic.org/5-stages-of-grief

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There's no way around it: Grief is never easy. And though we tend to associate grief with death, other life events can trigger grief, too - from the end of a relationship to the loss of a job to financial hardships.

"Grief is a natural response to any kind of loss," says clinical psychologist Regina Josell, PsyD. "People experience it in different ways, but typically, it includes a variety of intense emotions, like sadness, anger, irritability and guilt."

Dr. Josell explains the five stages of grief, including what they are, how they manifest and when to seek support from a therapist who can help you cope.

What are the five stages of grief?

Swiss-American psychiatrist and researcher Elisabeth Kübler-Ross first outlined five stages of grief - sometimes called the Kübler-Ross model - in her 1969 book On Death and Dying.

"Dr. Kübler-Ross spent her career studying the dying process and the impact of death on survivors," Dr. Josell says. "She outlined a five-stage protocol of dying to help us understand the process." This protocol was later applied to those impacted by someone else's death.

Keep in mind that these stages are meant to be descriptive and don't necessarily apply to everyone or happen in the order presented.The five stages of grief can be summarized as:

1. Denial

You're let go from your job, but the next day, you still get up early and start to get ready to head into the office, just in case your boss changes their mind. Your grandmother recently passed away, but you still feel like she might pick up the phone if you call to say hello.

"Denial refers to the difficulty comprehending the reality of a loss," Dr. Josell explains. "It can take a while to wrap your head around the fact that you've experienced a significant loss - that things are different, and they're not going back to the way they were."

Symptoms of denial during the grieving process might include:

Believing that there's been a mistake and your loved one isn't actually gone.

Refusing to discuss your loss or acting like everything is OK when you do.

Busying yourself with work or other things so you don't have to confront your feelings of loss.

Pretending like your loved one has gone on a vacation or will be back soon.

Continuing to speak about your lost loved one in the present tense.

2. Anger

"Anger is a perfectly natural response, and in the case of loss, it can be directed at a variety of sources," Dr. Josell says. It can also manifest as blame - the feeling that someone else is at fault for your loss.

You might feel angry with yourself for some perceived role in the loss, or even at your loved one for dying. Maybe you're mad at doctors or first responders for "letting" your loved one die, or at God for letting something so unfair and tragic happen.

As with every other stage of grief, these emotions can be experienced in reaction to non-death losses, too. Say you lost your job and feel angry at the co-worker who took on your workload. Or you couldn't afford your mortgage and had to sell your family home, leaving you feeling angry with politicians about the state of the economy.

Your anger could also be less targeted, less sensible. "Sometimes, you're just angry at innocent bystanders, like the guy in the checkout line at the grocery store who looked at you funny," Dr. Josell says. "It's not always rational."

3. Bargaining

The bargaining process sometimes happens before your loss has fully occurred, like when you think, "If I recover from cancer, I promise I'll start going to go to church every week," or "If my husband pulls through after his heart attack, I'll never argue with him again."

But it can take place afterward, too, in the form of "if only" thinking:

"If only we'd gone to a different doctor, maybe she could've been treated in time."

"If only we hadn't gone on vacation, he wouldn't have contracted this disease."

"If only I'd gotten my dog an electric collar, she wouldn't have run out into the street."

This may not look like bargaining, but Dr. Josell says the thinking is similar. "We engage in a type of mental gymnastics to try to undo something that we can't undo," she explains.

4. Depression

It's natural to be sad when someone you love dies or when you've experienced another major loss. Symptoms of the depression stage of grief can include:

Loss of hope about the future.

Feeling directionless, lost or confused about your life.

Difficulty concentrating.

Difficulty making decisions.

Grief-related depression can cause physical symptoms, too, like aches and pains and changes in sleep patterns. Studies show that it can even cause increased inflammation in your body, which can worsen existing health issues and lead to new ones.

The depression stage of grieving isn't the same as major depressive disorder (also known as major depression or clinical depression), a mental health condition that combines a number of emotional, cognitive and physical symptoms.

"However, grief can turn into clinical depression, so it's really important that you address your grief while you're experiencing it," Dr. Josell advises.

5. Acceptance

The sadness and sense of loss of grief may never fully fade. But the acceptance stage represents learning to live with the loss - a newfound ability to acknowledge the reality of your loss and to allow sorrow and joy to live alongside one another.

In this stage of grief, you're no longer immobilized by your sadness. For example, you can hear a song on the radio that reminds you of your loved one without bursting into tears.

"Acceptance is a sense of understanding that there is a finality to what has happened," Dr. Josell says. "You can hold onto your sadness while still experiencing good memories of the past and maintaining hope for the future."

How long does grief last?

There's no set timeline for grief, and anyone who tells you to "move on" or "get over it" is underestimating and misunderstanding the weight of loss.

That said, the length of your grieving process depends on what kind of grief you're experiencing.

Uncomplicated grief: Sometimes referred to as "normal grief," most of the symptoms - including the five stages - happen within the first two years of loss.

Complicated grief: This type of profound, intense grief extends for a prolonged period of time and can be debilitating.

In some sense, of course, all grief is complicated, stirring a tide of emotions that feel anything but straightforward. And many of the signs and symptoms of complicated grief are the same as those of uncomplicated grief. In uncomplicated grief, though, the intensity of those reactions softens with time. Complicated grief, on the other hand, is more intense, persistent and prolonged, significantly interfering with a return to "normal" life.

When to ask for help

If you're experiencing intense emotional distress or struggling to return to your regular routine after your loss, consider seeking the help of a therapist. Talking about loss, sharing your distress and having your grief witnessed can significantly facilitate the healing process.

The bottom line, Dr. Josell says, is simple: "If you feel you're suffering, go talk to somebody."

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What To Know About the 5 Stages of Grief After a Loss

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Grief is never easy, be it the loss of a loved one or a relationship or even a job or opportunity. But understanding grief and its stages might help you and those who support you find a way through.

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Summary:

This review from (NCBI) explores the effects of alcohol on social behavior. It goes over different aspects of social behavior influenced by alcohol consumption, including aggression, social bonding, and interpersonal interactions. The review discusses how alcohol can change social views and affect decision-making, leading to both positive and negative social outcomes. It goes over the importance of understanding the relationship between alcohol and social behavior for developing effective strategies and promoting responsible drinking habits.

Relevance to Teaching Health to Elementary Students: Educators teaching health to elementary students can benefit from understanding the impact of alcohol on social behavior to effectively educate students about the risks of alcohol use. This review provides insights into how alcohol consumption can affect social interactions and decision-making processes. Teachers can use age-appropriate discussions about the effects of alcohol on behavior in their curriculum, highlighting the importance of making healthy choices and going against peer pressure. By promoting alcohol awareness and responsible decision-making skills, educators can help students make good choices and avoid risky behaviors.

Sayette, M. A. (2020). The Impact of Alcohol on Social Behavior: A Review. Alcohol Research: Current Reviews, 40(1), 01. https://doi.org/10.35946/arcr.v40.1.01

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Alcoholism can be considered an issue in a few regards. One of the main issues with it are the social consequences. For all the social benefits of alcohol, such as helping people to relax, there are problems too. Alcoholism generally leads to an increase in joblessness, assaults and mental health issues. But what are alcoholism's worst effects and can the problem be combated?

Alcoholism Statistics - Social Effects

According to The National Institute On Alcohol Abuse And Alcoholism, around 27% of people in the US admitted to binge drinking in the past month, with a further 7% admitting they drank heavily. This staggering statistic often leads to unfortunate social consequences. One of which is family, with more than 10% of children in the United States, living in a household where at least one parent abuses alcohol. In addition to that, there are other social effects. For example 1 in 4 college students admits to feeling that alcohol leads to lowering their exam performance, missing class or leaving college altogether. Almost 700,000 students a year also experience assault, with nearly 100,000 of those students being victims of sexual assault. Social consequences don't end there, however, with an estimated 88,000 people dying from consuming too much of the substance annually. These statistics highlight the dangers and social effects of alcohol abuse.

Effects of Alcoholism on Society at Large

Alcoholism effects on an individual are generally there for all to see. Although alcohol's social effects are often less visible, the effects on society, in general, aren't. From an increased chance of being involved in crime, to drink driving or to be sexually irresponsible, alcoholism creates dangers.

Drink Driving as the Biggest Social Concern

According to the National Institute on Alcohol Abuse And Alcoholism, drink drivers accounted for over 31% of all driving fatalities in the US. The consequences of drink driving incidents are that on many occasions several families are affected by one person's actions. It creates a spiral of anguish well beyond the person affected by alcoholism and effects society in general.

Increasing Crime Rates Due to Alcohol Abuse

Crime also rises with the intake of alcohol. Assault and sexual assault rise due to the substance. Alcohol and violence have a clear correlation, with many disagreements rapidly spiraling out of control and affecting many. Between 1997 and 2008, alcohol was responsible for up to 37% of crime. It is believed this is because many people do not think about the consequences when intoxicated.

Alcohol-Induced Diseases Spreading

Alcohol's effects on society also come from the lack of inhibition people have when under the influence. A regular abuser may have no memory of who they slept with, where they went or what they did. This can easily lead to the spreading of diseases or the loss of life. According to the Center For Disease Control and Prevention, 19% of young people drink before having sex, with 46% not using a condom. This action could easily lead to the spread of STDs.

Social Effects of Alcohol on the Family

The social effect of alcohol is often felt most harshly in the home. As earlier stated, over 10% of children grow up with at least one parent in their home abusing the substance. So what effects can alcoholism have on a family?

Domestic Abuse

Having an alcoholic in the home often puts a strain on relationships. Alcohol takes away a person's inhibitions and makes them more liable to be unpredictable. Many alcoholics become prone to violence. Alcohol-related domestic abuse may not even be physical, but often abusers look to place blame outside themselves and become psychologically abusive. This can have a negative impact on children as well as a partner.

Negative Impact On Children

Children growing up in a home where one parent is suffering from alcoholism are regularly exposed to negative behavior. It may be violent, psychological or simply a lack of parenting at all. However, there is no question that the social effects of alcoholism can lead to a number of problems, and highlight the danger of an alcohol abuse social problem.

Finance and Family Strain

Heavy drinking can also lead to money problems in the family. Many who abuse the substance struggle to maintain relationships, alcohol at work is no exception. Alcoholics often struggle to continue with their jobs to the full extent, and possibly even stop attending. Many abusers of the substance lose their jobs and create financial issues for their families. This is one of the most challenging social consequences of alcohol, as it is often difficult to regain employment and to lose a job creates a downward spiral for both the alcoholic and the family. For this reason, there are arguments for social security disability for alcohol abuse.

Alcohol's Impact on Youth - the Future of Society Endangered

The social effects of alcohol use are also heavily felt by younger people. As earlier stated, college goers are regular drinkers. However, many people start drinking at a much younger age, despite the illegalities. One of the dangers of underage drinking is that teenagers may have already developed an addiction to the substance before they even reach the freedoms of college. Alcohol and social behavior go hand in hand in college, with many young adults also drinking for the first time. This is arguably just as dangerous, as they may also take the freedom one step too far, and like those who have been drinking longer, can also develop an addiction.

Those who do heavily drink and abuse the substance during youth and college tend to see their grades suffer. Many have admitted to missing classes, dropping out and losing friendships because of their drinking-related issues. They're also more liable to getting into violent and dangerous situations or contracting STD's. In addition to those consequences, heavy drinking can have effects on the world around young people. It often leads to antisocial behavior, such as violence and aggression.

The social effects of alcoholism on youth are some of the most prevalent. Many colleges now focus on highlighting and educating their students about the dangers of heavy drinking. Some even have their rehab programs to help guide students back on to a better path. This is the hope of avoiding social consequences, such as youth being more liable to become alcoholics later in life.

Dealing With The Social Effects Of Alcoholism

The social effect of alcoholism isn't one that is easy for anyone to deal with. The social effects of alcohol abuse make people unpredictable and often unreliable. They are liable to lose their jobs, become violent or simply lose interest in relationships. In addition to that, the mental alcohol effects can leave even former drinkers struggling. With all that considered, can the effects of heavy drinking be a cause for treatment for mental illness? Is alcoholism a disability for social security?

Social security disability for alcoholism isn't currently available for those simply suffering from just alcoholism. However, those who do suffer mental health issues because of the drug can get help. This, in turn, will give families and former abusers a little more support when they so desperately need it and therefore benefit society. Despite this support, there are many other, even more effective ways to deal with the social effects of alcohol abuse and curbing alcohol cravings.

Stopping driving under the influence is a hugely important factor when it comes to dealing with social effects. This can be done by offering a lternate ways home to people with public transport. However, in more remote areas this can be challenging. Therefore, schemes such as introducing sober drinking buddies could be put into place.

Violent crime could also be heavily deterred by simply giving people a better wage to deal with alcoholism and rage. Community guidance programs may help this, as well as deterrents such as regular police patrols or cameras.

Disease can also be significantly lowered, even when under the influence. In countries that provide free medical care, including condoms, disease rates are much lower. If the US provided similar care, then there is the possibility that rates would similarly lower.
The treatment for alcohol addicts is available in all the US states. If you regularly abuse alcohol or know someone who does, seek immediate medical assistance from a doctor. They will guide you towards the best alcohol rehab centers in your area.
Author

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Social Effects of Alcohol Abuse: Cosequences of Alcoholism in Society

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Learn more about social effects of alcohol as a disability for social security. Understand the best ways to deal with alcoholism's social consequences.

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Summary:

The (NIDA) provides insights into preventing tobacco use through evidence-based strategies. The resource discusses approaches to tobacco prevention, including policy interventions, community-based programs, and educational initiatives. It highlights the importance of tobacco control efforts, such as increasing tobacco taxes, involving smoke-free policies, and educating the public about the risks of tobacco use, including the use of e-cigarettes.

Relevance to Teaching Health to Elementary Students: Educators teaching health to elementary students play a huge role in tobacco prevention by educating students about the dangers of tobacco use and promoting healthy behaviors. This resource from NIDA offers valuable information on evidence-based prevention strategies that educators can incorporate into their curriculum. Teachers can engage students in discussions about the harmful effects of tobacco and e-cigarettes, teach skills to say no, and allow ways for students to make good choices about their health. By using tobacco prevention education in the classroom, educators can help students develop lifelong habits of tobacco-free living and contribute to reducing tobacco-related harm in their communities.

National Institute on Drug Abuse. (n.d.). How Can We Prevent Tobacco Use? Research Reports: Tobacco, Nicotine, and E-Cigarettes. Retrieved from https://www.drugabuse.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/how-can-we-prevent-tobacco-use

e (NIDA)

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The medical consequences of tobacco use-including secondhand exposure-make tobacco control and smoking prevention crucial parts of any public health strategy. Since the first Surgeon General's Report on Smoking and Health in 1964, states and communities have made efforts to reduce initiation of smoking, decrease exposure to smoke, and increase cessation. Researchers estimate that these tobacco control efforts are associated with averting an estimated 8 million premature deaths and extending the average life expectancy of men by 2.3 years and of women by 1.6 years. But there is a long way yet to go: roughly 5.6 million adolescents under age 18 are expected to die prematurely as a result of an illness related to smoking.

Prevention can take the form of policy-level measures, such as increased taxation of tobacco products; stricter laws (and enforcement of laws) regulating who can purchase tobacco products; how and where they can be purchased; where and when they can be used (i.e., smoke-free policies in restaurants, bars, and other public places); and restrictions on advertising and mandatory health warnings on packages. Over 100 studies have shown that higher taxes on cigarettes, for example, produce significant reductions in smoking, especially among youth and lower-income individuals. Smoke-free workplace laws and restrictions on advertising have also shown benefits.

Prevention can also take place at the school or community level. Merely educating potential smokers about the health risks has not proven effective. Successful evidence-based interventions aim to reduce or delay initiation of smoking, alcohol use, and illicit drug use, and otherwise improve outcomes for children and teens by reducing or mitigating modifiable risk factors and bolstering protective factors. Risk factors for smoking include having family members or peers who smoke, being in a lower socioeconomic status, living in a neighborhood with high density of tobacco outlets, not participating in team sports, being exposed to smoking in movies, and being sensation-seeking. Although older teens are more likely to smoke than younger teens, the earlier a person starts smoking or using any addictive substance, the more likely they are to develop an addiction. Males are also more likely to take up smoking in adolescence than females.

Some evidence-based interventions show lasting effects on reducing smoking initiation. For instance, communities utilizing the intervention-delivery system, Communities that Care (CTC) for students aged 10 to14 show sustained reduction in male cigarette initiation up to 9 years after the end of the intervention.

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How can we prevent tobacco use? | National Institute on Drug Abuse

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The medical consequences of tobacco use-including secondhand exposure-make tobacco control and smoking prevention crucial parts of any public health strategy. Since the first Surgeon General's Report on Smoking and Health in 1964, states and communities have made efforts to reduce initiation of smoking, decrease exposure to smoke, and increase cessation.

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Safety & Preventing Unintentional Injury 

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Safety & Preventing Unintentional Injury 

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Summary:

This report from the American Academy of Pediatrics goes over the prevention of unintentional injuries in school-aged children. It provides recommendations for healthcare providers, educators, parents, and policymakers to promote injury prevention strategies. The report covers various injury prevention topics, including playground safety, bicycle safety, sports-related injuries, and drowning prevention. It goes over the importance of collaboration among these people to create safe environments for children and reduce the cause of unintentional injuries.

Relevance to Teaching Health to Elementary Students: Educators teaching health to elementary students play a huge role in promoting injury prevention and safety education. This report offers evidence-based recommendations that educators can use in their curriculum to educate students about injury prevention measures. Teachers can use lessons on playground safety rules, bicycle helmet use, and water safety practices, incorporating interactive activities and role-playing scenarios to promote learning. By teaching students about risk identification and injury prevention strategies, educators can encourage them to make safer choices and contribute to creating a safer school and community environment.

American Academy of Pediatrics. (2022). Preventing Unintentional Injuries in School-Aged Children: A Clinical Report from the American Academy of Pediatrics. Pediatrics, 149(Supplement 6), e2021053852J. https://doi.org/10.1542/peds.2021-053852J

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Preventing Unintentional Injuries in School-Aged Children: A Systematic Review

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BACKGROUND AND OBJECTIVES. Unintentional injuries constitute the leading causes of death and long-term disabilities among children aged 5 to 15 years. We aimed to systematically review published literature on interventions designed to prevent unintentional injuries among school-aged children.METHODS.

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Summary:

This resource from Youth.gov offers guidance for educators on supporting LGBTQ+ youth in educational settings. It provides information on the challenges faced by LGBTQ+ students, including discrimination, bullying, and mental health issues. The guide offers strategies for creating inclusive environments, such as adding in LGBTQ+ content, aiming for supportive policies, and creating a positive relationship with students. It highlights the importance of promoting acceptance, respect, and equality for all students, regardless of sexual orientation or gender identity.

Relevance to Teaching Health to Elementary Students: Educators teaching health to elementary students play a critical role in promoting inclusivity and supporting the well-being of LGBTQ+ youth. This resource leaves teachers with valuable information and strategies to create safe and welcoming spaces for all students, including those who identify as LGBTQ+. Teachers can use lessons on diversity, acceptance, and LGBTQ+ rights in their health education curriculum, creating room for empathy, understanding, and respect among students. By promoting inclusivity and addressing the needs of LGBTQ+ youth, educators can contribute to creating a supportive school environment where all students can thrive.

Youth.gov. (n.d.). Supporting LGBTQ+ Youth: A Guide for Educators. Retrieved from https://youth.gov/youth-topics/lgbt

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Sexual orientation and gender identity/expression are important aspects of a young person's identity. Understanding and expressing sexual orientation and gender and developing related identities are typical development tasks that vary across children and youth. For example, some youth may be unsure of their sexual orientation, whereas others have been clear about it since childhood and have expressed it since a young age. Expressing and exploring gender identity and roles is a part of normal development. The process of understanding and expressing one's sexual orientation and gender identity is unique to each individual. It is not a one-time event and personal, cultural, and social factors may influence how one expresses their sexual orientation and gender identity.

There is currently no universally-accepted acronym inclusive of all youth who are not heterosexual and/or express their gender in diverse ways. The commonly-used acronym - LGBTQ+ (lesbian, gay, bisexual, transgender, queer or questioning, or another diverse gender identity) - refers to the communities included in the "LGBTTTQQIAA" acronym (see Figure 1). This youth topic primarily uses "LGBTQ+" as an inclusive term for simplicity, except when describing research studies explicitly focused on more narrowly-specific communities. See Key Terms and Concepts to learn more about each of these communities.
Figure 1: Communities included in the "strong LGBTTTQQIAA" acronym
Resiliency and Protective Factors

Research on LGBTQ+ youth has focused on the risk factors and disparities these young people experience compared with youth who are not LGBTQ+. However, more recently there has been research on resiliency and protective factors, which offers a strength-based focus on LGBTQ+ youth well-being. For instance, LGBTQ+ youth who have access to spaces that affirm their sexual orientation and gender identity report lower rates of attempting suicide and experiencing supportive environments.

Several factors that can help improve outcomes for LGBTQ+ young people include:

Addressing LGBTQ+-related stigma, discrimination, and violence

Building on the strengths of LGBTQ+ youth

Fostering supports such as family acceptance and safe, affirming environments in schools and other settings

Federal and local policies and practices increasingly acknowledge and focus on the experiences and needs of LGBTQ+ youth. Numerous national advocacy and other organizations are also giving greater attention to LGBTQ+ youth in their work. Fostering safe, affirming communities and youth-serving settings such as schools for all youth requires efforts to address the challenges described here. At the same time, it is also important to acknowledge and build on the strengths, resilience, and factors that protect LGBTQ+ youth from risk, such as connection to caring adults and peers and family acceptance. Parental support of sexual orientation and gender expression provide uniquely strong benefits to positive well-being and mental health in young adulthood and are related to higher levels of self-esteem and lower levels of depression, suicidal ideation, and suicide attempts.

Young people who identify as LGBTQ+ can experience various challenges because of how others respond to their sexual orientation or gender identity/expression. This is also true for youth who are questioning their sexual orientation or gender identity, or may be perceived as LGBTQ+ or gender variant by others. In a 2021 survey of nearly 35,000 LGBTQ+ youth, 75 percent reported having experienced discrimination based on their sexual orientation or gender identity at least once in their lifetime. These negative experiences include high rates of physical and emotional bias and violence; rejection by schools, employment, and communities because of their sexual orientation and/or gender identity/expression.

Research shows that due to these challenges and the associated stress, LGBTQ+ youth are at risk for negative health outcomes and are more likely to attempt suicide, experience homelessness, and use illegal drugs These issues may also contribute to anxiety, depressive symptoms, and feelings of isolation. Youth who express their gender in ways that vary from societal expectations for their perceived sex or gender are at risk for high levels of childhood physical, psychological, and sexual abuse. They are also at risk for school victimization. As a result, they may have poorer well-being than lesbian, gay, and bisexual peers whose gender expression is more closely aligned with societal expectations.

Resources

Health Considerations for LGBTQ Youth
This website provides information on protective factors and data related to health risks and sexual minority youth, as well as related resources.

Practice Brief 1: Providing Services and Supports for Youth Who Are Lesbian, Gay, Bisexual, Transgender, Questioning, Intersex, or Two-Spirit (LGBTQI2-S)(PDF, 8 pages)
This practice brief outlines key information for working with and providing culturally and linguistically competent services to LGBTQI2-S youth.

References
1 Poirier, Fisher, Hunt, & Bearse, 2014
² Poirier, Fisher, Hunt, & Bearse, 2014
³ Poirier, Fisher, Hunt, & Bearse, 2014
⁴ The National Trevor Project, 2021
⁵ Day, Ioverno, & Russell, 2019
⁶ American Association of School Administrators et al., n.d.; National Association of School Nurses, 2003; National Association of School Psychologists, 2006
⁷ Shilo & Savaya, 2011; Sheets & Moor, 2009; Ryann et al., 2010; Snapp et al., 2015; Russell & Fish, 2016
⁸ Gender variant youth are not necessarily LGBT. In fact, any youth who does not fit typical social expectations for his or her mannerisms, behavior, or choice of clothing based on birth-assigned gender, for example, can be considered "gender variant." This does not mean the youth is lesbian, gay, or bisexual - or identifies as a gender different from what he or she was assigned at birth (i.e., transgender).
⁹ The National Trevor Project, 2021 (45 percent of this sample were youth of color, and 38 percent were transgender or nonbinary.
¹⁰ Hunter & Schaecher, 1987; Reis, 1999; Reis & Saewyc, 1999; Ray, 2006; Ryan, Huebner, Diaz, & Sanchez, 2009; SAMHSA, 2014
¹¹ Roberts, Rosario, Corliss, Koenen, & Austin, 2012
¹² Toomey, Ryan, Diaz, & Russell, 2010
¹³ Rieger & Savin-Williams, 2012

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Sexual orientation and gender identity/expression are important aspects of a young person's identity. Understanding and expressing sexual orientation and gender and developing related identities are typical development tasks that vary across children and youth. For example, some youth may be unsure of their sexual orientation, whereas others have been clear about it since childhood and have expressed it since a young age.