Susan M Gross

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Verified

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• PhD MPH RD
• Researcher at Johns Hopkins Bloomberg School of Public Health

This viewpoint explores the evidence behind recommendations for low-fat dairy consumption in children.

Given the lack of attention on adolescent food insecurity, the primary objective of this study was to assess the association of household participation in federal food assistance programs with food security status among adolescents in Baltimore during the COVID-19 pandemic. Adolescents, ages 14–19 years, were invited to participate in two online su...

During the COVID-19 pandemic, the federal government authorized several temporary changes to the Supplemental Nutrition Assistance Program (SNAP) to alleviate the increased economic hardships, including creating a new program called the Pandemic-Electronic Benefit Transfer (P-EBT) and expanding the eligibility and benefits of SNAP. While evidence s...

Background Breastfeeding imparts numerous health and social benefits for families. Barriers deter some individuals from breastfeeding. Rates are lower among certain populations, including participants of the federally funded Women, Infants, and Children's Program (WIC). Women, Infants, and Children's Program provides low‐income pregnant and postpar...

Background While consuming a Mediterranean-style diet (MSD) among pregnant women is expected to affect offspring neurodevelopment, the current evidence is limited. This prospective birth cohort study aimed to explore the association of maternal MSD with neurodevelopmental disabilities (NDD) in offspring, especially among children born to mothers wi...

During the COVID-19 pandemic, the Summer Food Service Program (SFSP) was allowed to operate in untraditional non-summer months to ensure children did not lose access to free and reduced-priced nutritious meals when schools were mandated to close in the United States. This study assessed the impact of the pandemic on the operations and experiences o...

Native American populations experience highly disproportionate rates of poor maternal-child health outcomes. The WIC program aims to safeguard health by providing greater access to nutritious foods, but for reasons not well understood, participation in many tribally-administered WIC programs has declined to a greater extent compared to the national...

This study explored strategies to improve adolescent food security using semi-structured in-depth interviews with 9 policy advocates, 12 parents and 15 adolescents aged between 17 and 20 years, living in households who were eligible for the Supplemental Nutrition Assistance Program in 2020. This study was part of a larger evaluation of adolescent f...

This study evaluated differences in overall diet quality, diet quality components, and food-related contextual factors between adolescents with food security and those with food insecurity. Mixed methods analysis was conducted on data from three 24-h dietary recalls from 61 adolescents ages 14–19 years old living in Baltimore, Maryland, USA in 2020...

Background The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) promotes and supports breastfeeding for low-income women and children. A prior review reported negative associations of WIC with breastfeeding outcomes. WIC food package changes in 2009 increased breastfeeding support. Objective The objectives of this syst...

Background: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is intended to improve maternal and child health outcomes. In 2009, the WIC food package changed to better align with national nutrition recommendations. Purpose: To determine whether WIC participation was associated with improved maternal, neonatal-bir...

The Summer Food Service Program (SFSP) provides meals to children during out-of-school time, such as emergency school closures. This study assessed the trends in participation and operations of Summer Food Service Program (SFSP) sponsors in Maryland from 2016 to 2020 and evaluated the effects of the COVID-19 pandemic from 2019 to 2020. The total nu...

BACKGROUND The use of digital communication platforms to improve health behaviors has increased dramatically in the last decade. Public health practitioners have adopted digital media and marketing technologies such as text messages, mobile applications, and social media to reach diverse populations. However, the relative effectiveness of different...

Background: The use of digital communication platforms to improve health behaviors has increased dramatically over the last decade. Public health practitioners have adopted digital communication technologies such as text messages, mobile apps, and social media to reach diverse populations. However, the effectiveness of digital communication platfo...

Objectives The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has a strong track record of improving birth and health outcomes in high-risk populations. For the past decade and a half, WIC enrollment among Native American women and children has declined by approximately 40% for reasons that have not yet been elucidate...

Objectives The Baby-Friendly Hospital Initiative is an effective intervention to support maternal practices around breastfeeding. However, little is known about its impact on participants of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). The purpose of this study was to evaluate whether Baby Friendly Hospital (BFH...

Large systematic review to evaluate evidence on whether participation in WIC is associated with improved nutrition & health outcomes for women, infants, & children, and whether the associations vary by duration of participation or across population sub-groups. Because of major revisions to Federal regulations for the WIC food package in 2009, we pr...

Background: The Summer Food Service Program (SFSP) provides free and nutritious meals to children under age 18 during out-of-school times. During the COVID-19 pandemic, Maryland sponsors served over 9.5 million meals to children through an expanded version of the SFSP. This study aimed to explore and compare the factors that enabled 2 SFSP sponsor...

BACKGROUND The Summer Food Service Program (SFSP) is a federally funded program that serves free, nutritious meals during the summer months. In 2019, 6 federal waivers that previously helped sponsors serve meals were rescinded. The purpose of this mixed methods study was to assess the impact of the waiver rescission on the experiences of SFSP spons...

Background The Baby-Friendly Hospital Initiative is an effective intervention to support maternal practices around breastfeeding. However, adherence of hospitals to the Baby-Friendly 10 Steps, as determined from the perspective of women participating in the United States Special Supplemental Nutrition Program for Women, Infants, and Children, has n...

While emerging evidence is highlighting a growing problem of food insecurity among adolescents in disadvantaged neighborhoods, very little is known about the factors that may either protect or place adolescents at higher risk for food insecurity. The primary objective for this analysis, therefore, was to examine the associations between individual-...

This study examined the association of household food security and school participation in the community eligibility provision (CEP). Surveys were collected from 427 households within 5 schools participating in CEP, and therefore providing access to universal free school meals, and three matched comparison district schools, which were CEP-eligible...

Objective To increase our understanding about food insecurity among urban adolescents, we conducted a qualitative study in Baltimore City with adolescents to: (i) explore how adolescents experience and cope with food insecurity; and (ii) identify community-based approaches or interventions for addressing food insecurity. Design A total of eight fo...

Introduction Reproductive age women, particularly low‐income and minority women, are at risk for obesity. As an integral service provider for these women, the US Department of Agriculture Special Supplemental Nutrition Program for Women, Infants, and Children is uniquely positioned to refine its focus and efforts. Methods Strategies for accomplish...

Objective: Examine how the physical cafeteria environment contributes to 6- to 8-year-olds' school food consumption. Design: Cross-sectional observational study. Before-and-after lunch tray photos taken with iPads to capture food selection and consumption. Setting: 10 New York City public elementary school cafeterias. Participants: A total o...

Objective: This pilot study evaluated a cost neutral, integrated Special Supplemental Nutrition Program for Women Infants and Children (WIC) and obstetrical service model designed to prevent postpartum weight retention in obese women. Methods: A sample of women who received benefits from the Johns Hopkins (JH) WIC program and prenatal care from...

Objectives Participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has been associated with lower breastfeeding initiation and duration. This study examines breastfeeding-related factors among WIC participants and nonparticipants that might explain these previous findings. Methods Respondents to the 2007 I...

ABSTRACT Introduction: This analysis examines administrator perceptions of school wellness policies and their implementation as observed in cafeterias. Methods: In a 2013 evaluation of New York City’s CookShop Program, we surveyed a principal or vice principal from 26 elementary schools about 25 nutrition policies concerning competitive foods, heal...

Most US women intend and initiate breastfeeding, yet many do not breastfeed as long as desired. Not meeting one's own prenatal expectations is a plausible mechanism for the previously observed association between lack of breastfeeding and postpartum depression (PPD). This study explored whether meeting prenatal expectations for exclusive breastfeed...

Breastfeeding expectations predict breastfeeding duration. The extent to which expectations for duration are met remains unknown. To evaluate prospective measures of expected breastfeeding duration, changes in expectations over time, and factors associated with meeting expectations. The Infant Feeding Practices Study II followed women from late pre...

Introduction: The purpose of this analysis is to examine the concordance between selection and consumption of school cafeteria foods by 6-8 year old students. Methods: In 2013, 386 students participated in the cafeteria observation portion of an evaluation study to measure the impact of Food Bank of New York City’s CookShop Program on changing nu...

Introduction Obese women are prone to high postpartum weight retention increasing their risk of pregnancy-related complications, accelerated weight gain, and long-term negative outcomes. Evidence supports that an integrated system of targeted and pre/postnatal nutrition counseling, health care, and support services results in return to pre-pregnanc...

Introduction: The high fat/calorie diet of many Americans contributes to high childhood obesity rates. The Cookshop Program was designed by the Foodbank for New York City to provide low income residents with the knowledge and tools to adopt an affordable healthy diet by engaging children in hands-on food preparation and exploration of healthy ingre...

Low-income U.S mothers have high smoking and low breastfeeding rates. Smoking is most prevalent among non-Hispanic white and black mothers. Although breastfeeding's benefits for infants whose mothers smoke outweigh risks of tobacco exposure through breast milk, these mothers may believe that breastfeeding is unsafe. Maryland WIC's 2007 database pro...

African American women continue to have the highest prevalence of obesity in the United States and in the state of Maryland they are disproportionately affected by overweight and obesity. There are many contributing factors including chronic stress and the use of health behaviors such as physical exercise that play a role in increased weight for Af...

This qualitative study analyzes mothers' reports of breastfeeding care experiences from pregnancy through infancy. Most research on medical support for breastfeeding examines a specific practice or intervention during an isolated phase of care. Little is know about how mothers experience breastfeeding education and support from the prenatal period...

Maryland WIC introduced an enhanced food package October 1, 2009. The package for exclusively breastfeeding mothers was designed to facilitate increased duration, and concurrently introduced policy prohibited issuance of formula for the first month of life. Maryland's local WIC Agencies (LWAs, n=23) offer 3 types of breastfeeding support services:...

Introduction: Improving breastfeeding initiation, exclusivity, and duration is a priority for the Maryland WIC program. However, WIC participants' breastfeeding rates consistently fall below those of non-participants. Of the numerous factors that influence breastfeeding decision making, undergoing C-section delivery has been found to be an importan...

Introduction: Healthy People 2020 objectives include reducing low-risk mothers' primary Cesarean rate, minimizing formula use, and increasing breastfeeding exclusivity and duration. Currently, one third of U.S. mothers birth by Cesarean, and these mothers have lower breastfeeding rates. Though WIC supports breastfeeding, women enrolled in the progr...

In the United States, most mothers who initiate breastfeeding will either stop or begin supplementing with formula before their infants are 3 months old. Routine breastfeeding education and support following hospital discharge are critical to breastfeeding success. The purpose of this article is to identify this critical period for supporting and r...

Introduction: Following recommendations by The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics, the USDA Special Supplemental Nutrition Program (WIC) promotes breastfeeding as the optimal infant feeding method and provides its prenatal and breastfeeding participants with breastfeeding education and support...

Introduction: Maryland WIC Breastfeeding Peer Counselors (PC) provide participants with breastfeeding education and support to improve breastfeeding outcomes. However, many Maryland WIC clients don't initiate, or prematurely abandon breastfeeding. Numerous factors predict breastfeeding initiation and duration, including support from the infant's fa...

In October 2009, the USDA's WIC program implemented its revised food packages (RFP) to address chronic disease issues. Increasing whole grain consumption, per National Dietary Guidelines of 2005, was a priority and objective of the RFP,. In this presentation, we describe results from a survey prior to implementation of the RFP, about participants'...

Introduction: Many mothers face pressure to breastfeed from health professionals. Maryland WIC promotes breastfeeding, employing Breastfeeding Peer Counselors (PCs) to provide education and support. However, many Maryland WIC participants don't initiate breastfeeding or breastfeed only briefly. Mothers may feel obligated to offer acceptable reasons...

To assess social and familial environmental influences on fruit and vegetable (FV) consumption of fourth- and fifth-graders living in a culturally diverse, urban setting. In 2006, students from 9 fourth- and fifth-grade classrooms from a public school in the Washington-Baltimore Metropolitan Region were recruited as part of the Food Stamp Nutrition...

This study examined sex differences in calculated and perceived weights and weight-based stigmatization. 371 African Americans (females=258) responded to a health and wellness survey. Body mass index (BMI) was calculated from self-reported height and weight and categorized as underweight (7.0%), normal (48.2%), overweight (29.9%), and obese (14.8%)...

The study sought to explore response modes (via web-based vs paper surveys) and rates to a follow-up health questionnaire and to examine respondent characteristics by response modes. 192 young adult African Americans responded online or by paper. We found observable differences in follow-up responses, with more participants completing the online ve...

Introduction: The Maryland WIC program supports breastfeeding through various methods, including peer counselor education and support and distributing breast pumps. WIC recommends against pump use until infants are three weeks; however, many clients begin pumping soon after giving birth. Using qualitative analysis, we identify causes and consequenc...

WIC program prenatal breastfeeding education and support (BFES) is targeted specifically toward women who are least likely to adopt breastfeeding. Modifiable risk factors for these women are identified at enrollment and customized BFES is provided accordingly, to achieve breastfeeding goals. However, pre-pregnancy BMI is not frequently considered a...

Introduction Many WIC clients prematurely discontinue breastfeeding despite program efforts to increase initiation, duration and exclusivity. We report factors associated with early breastfeeding termination for African American (AA) women enrolled in 3 geographically representative Maryland WIC sites. Mixed method analysis of quantitative and qual...

Objective: To explore over a 12 month period similarities and differences in fruit and vegetable (FV) intake and taste preferences among low-income fourth grade children and their parents. Design, Setting and Participants: A school-based cohort study of 32 low-income fourth grade student and their parents. This study is part of a larger investigati...

This cross-sectional study examines Maryland's women, infants, and children (WIC) breastfeeding initiation rates by program participation. The authors report on data regarding demographic and health characteristics and infant feeding practices for infants (n = 18,789) newly WIC-certified from January 1, 2007 to June 30, 2007. The authors compared s...

This study examined the influence of the school environment, particularly staff and cafeteria workers, on fruit and vegetable selection among elementary school children. Attitudes and behaviors of food service personnel and principals at two elementary schools were tested at a pilot nutrition education site. Data were collected using observations,...

Overweight and obesity are epidemic in the United States, particularly among minority populations. This epidemic contributes to the development of chronic conditions that occur later in life such as type 2 diabetes and hypertension. Therefore, it is important to identify factors associated with the development of obesity during young adulthood. We...

This study's purpose was to identify gender differences in body size awareness and perceived impact of weight on social interactions and risk for disease among young African-American adults. A cross-sectional survey of 318 African-American graduating seniors from a historically black college or university (HBCU) was conducted. Data were collected o...

This study examined actual and perceived weight status and body satisfaction of college-age African-American males. We predicted that, in general, males would be accurate about their weight status and satisfied with their body sizes and shapes. The study population was 123 male from a cross-sectional survey of 406 seniors who were scheduled to grad...

The objective of this study was to determine whether there is an association between body image perception and weight status as measured by the body mass index among a group of fourth graders in Maryland. Cross-sectional data on height, weight, and body image were collected in the classroom. At risk for being overweight and being overweight designa...

The objective of this study was to describe breakfast and lunch consumption patterns of fourth-grade students from selected public schools in Maryland and how they differ by geographic location. Data were collected from a sample of 540 fourth-grade public school children (46% male, 62% white; mean age=9 years) from three geographically distinct reg...

Women with disabilities are at risk for poor psychological adjustment and unhealthy weight-control practices. This study was conducted to determine the prevalence of symptoms of eating disorders in a clinic-based sample of women who had two disabling conditions and to identify condition-related risk factors that were linked to these symptoms. A cro...

To compare infant feeding practices among low-income, urban, African-American women enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) with current recommendations for infant feeding. Longitudinal follow-up of women and their infants who participated in a WIC-based breast-feeding promotion project. Women e...

To examine how individuals within a woman's life influence her infant feeding intention, we interviewed 441 African-American women on the breastfeeding attitudes and experiences of their friends, relatives, mother, and the baby's father. Women were interviewed at entry into prenatal care at clinics associated with one of four Baltimore WIC clinics...

To evaluate the relative effects introducing motivational videotapes and/or peer counseling in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics serving African-American women have on breast-feeding duration. Experimental intervention study. Pregnant women were enrolled at or before 24 weeks gestation and were fo...

We evaluated the single and combined effects of introducing a motivational video and peer counseling into four matched WIC clinics on breastfeeding initiation and continuation at 7-10 days among African-American WIC participants. Of the 242 women with complete data, 48% initiated breastfeeding, but only 31% were still breastfeeding at 7-10 days. In...

Thesis (Ph. D.)--Johns Hopkins University, 1996. Vita. Includes bibliographical references (leaves 294-312).