The Need for Investment in Rigorous Interventions to Improve Child Food Security.

M ORE THAN 1 OUT OF EVERY 7 US CHILDREN (15.2%) in 2018 lived in a household where at least 1 member experienced restricted access to enough food for an active, healthy life, known as food insecurity. Such high prevalence of food insecurity in a country with one of the world’s largest economies and most plentiful food supplies is an ongoing national tragedy. Food insecurity is associated with inadequate dietary intake and unmet requirements for food groups and nutrients essential to child growth demanded at critical points in child development to reach potential. Thus, sub-optimal dietary intake in situations of childhood food insecurity (not including fetal and prenatal time periods) may have implications for lifelong disease risk. A childhood experience of living in a food insecure household, where strained resources are known to impact relationships among household members, is related to poor psychological, social, and learning outcomes that can further impact child trajectories to achievement and future adult contributions to society. US households and children receive food resources to support food security through federal food assistance programs like the Supplemental Nutrition Assistance Program (SNAP); Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); National School Lunch and Breakfast Programs; Summer Food Service Program; and Child and Adult Care Food Programs, representing the main US child nutrition and hunger safety net. Yet, food insecurity persists and investment in creating and evaluating new interventions is rare. Thus, national investment and attention to food insecurity prevention, especially among children, holds the promise of solving pressing current child health problems and those of future American adults. Dedicated resources to improve food security among US children were provided through reauthorization of the Child Nutrition Act as the 2010 Healthy, Hunger-Free Kids Act (HHFKA). Goals of the HHFKA were to expand nutritious food access and reduce childhood obesity and other health risks in US children. Forty million dollars were specifically reserved for demonstration projects that tested innovative strategies to improve food security and $10 million was designated for research to “enhance our understanding of the causes and consequences of hunger and food insecurity among children” that “will help inform future policy decisions on effective means of program delivery.” The Chickasaw Nation Packed Promise Project was one of the Childhood Hunger Demonstration projects supported by these grant funds through the Food and Nutrition Service of the US Department of Agriculture. A description of this project and results of the independent evaluation of food security and dietary intake are published in this supplement to the Journal of the Academy of Nutrition and Dietetics. This editorial comments on the Chickasaw Nation Packed Promise Project, first by summarizing the project and then by highlighting the following strengths: maintaining participation, public-private collaboration of intervention delivery, and randomized controlled study design. The lessons learned from the project thatmay be improved in future food security interventions are also reviewed and include the following: inclusion of 1-year food security assessment, use of food security score or 4range classification, accounting for intervention “dose,” and improved dietary assessment and analytical design.