Creating Integrated Strategies for Increasing Access to Healthy Affordable Food in Urban Communities: A Case Study of Intersecting Food Initiatives

Emotional Distress in a Marginalized Population as a Function of Household-Level Social Determinants of Health

Low-income, underrepresented communities of color are disproportionally affected by emotional distress. Little is known about malleable, household-level determinants of emotional distress, addressable by feasible, stigma-neutral interventions. The present study addressed this knowledge gap by analyzing secondary data from a cross-sectional community needs assessment survey in a marginalized urban community (N = 677). Relying on dominance analyses, authors found that, on average, the largest household-level contributions to respondents' emotional distress included exposures to fellow household members' alcohol use and anger-driven behaviors. Both determinants are arguably feasible to address via household-level interventions and community-level preventive efforts. Household members' physical and serious mental illness and drug use were moderately associated with respondents' emotional distress; household cohesion and communications, residential overcrowding, and child behavior played a minimal role. Article concludes with a discussion of public health implications of the results.

Nutrition interventions addressing structural racism: a scoping review

African Americans experience high rates of obesity and food insecurity in part due to structural racism, or overlapping discriminatory systems and practices in housing, education, employment, health care and other settings. Nutrition education and nutrition-focused policy, systems and environmental changes may be able to address structural racism in the food environment. This scoping review aimed to summarise the available literature regarding nutrition interventions for African Americans that address structural racism in the food environment and compare them with the 'Getting to Equity in Obesity Prevention' framework of suggested interventions. An electronic literature search was conducted with the assistance of a research librarian encompassing six databases: MEDLINE, PyscINFO, Agricola, ERIC, SocINDEX and ProQuest Dissertations & Theses. A total of thirty sources were identified detailing interventions addressing structural barriers to healthy eating. The majority of nutrition interventions addressing structural racism consisted of policy, systems and/or environmental changes in combination with nutrition education, strategies focused on proximal causes of racial health disparities. Only two articles each targeted the 'reduce deterrents' and 'improve social and economic resources' aspects of the framework, interventions which may be better suited to addressing structural racism in the food environment. Because African Americans experience high rates of obesity and food insecurity and encounter structural barriers to healthy eating in the food environment, researchers and public health professionals should address this gap in the literature.

Socioeconomic Stability Buffers Racial Discrimination Effect on Depression in a Marginalized Community

Depression disproportionately burdens poverty-affected minority communities. Racism and racial discrimination are well-known determinants of depression among members of marginalized minority communities. Less is known about potential buffers of the discrimination effects on depression, particularly those that could serve as targets for efficient community-based policies and interventions. Our secondary analysis of data from a community needs assessment survey (N = 677) in an urban minority neighborhood of low socio-economic status revealed that high school completion and current employment significantly weakened the association between discrimination and depression. Our findings frame community-level efforts to foster high school completion and employment as potential strategies to reduce the footprint of racism on the mental health of marginalized community members. Implications for future research and policy are discussed.

Revisiting revitalization: exploring how structural determinants moderate pathways between neighborhood change and health

Vacant housing can produce many issues that affect residents’ quality of life, especially in historically segregated communities of color. To address these challenges, local governments invest in strategic, place-based revitalization initiatives focused on the regeneration of vacant housing. Yet, the outcomes of these efforts remain contested. To maximize health benefits of revitalization investments, a more nuanced understanding of pathways between neighborhood changes and residents’ responses, adaptations, and ability to thrive is necessary, though, remains largely absent in the literature. Using the Vacants to Value initiative in Baltimore, MD as a case study, we explore (1) how health manifests among certain groups in the context of vacant housing revitalization; (2) how vacant housing and its regeneration engender social and cultural environmental change i.e., gentrification; and (3) what structural determinants (cultural norms, policies, institutions, and practices) contribute to the distribution of material resources and benefits of revitalization. Results suggest that vacant housing revitalization requires more than just physical remedies to maximize health. Our findings demonstrate how vacant housing revitalization influences the physical environment, social environment, and structural determinants of material resources and community engagement that can ultimately impact residents’ physical, mental, and social health. This study recommends that because housing disparities are rooted in structural inequalities, how policies, practices, and processes moderate pathways for residents to adapt and benefit from neighborhood changes is consequential for health and health equity. Establishing shared governance structures is a promising approach to foster equitable decision-making and outcomes. Going forward in urban regeneration, pathways to retain and strengthen the social environment while revitalizing the physical environment may be promising to achieve healthy communities.

Improving Local Food Systems through the Coordination of Agriculture Supply Chain Actors

A local food system is an alternative food network that shortens and more effectively structures the supply chain system. An intermediary actor functioning as an aggregator is needed in the local food system. The food hub is one such intermediary actor with an essential role in strengthening the local food system and increasing the competence of small farmers to compete with large-scale food distribution. Many studies have been conducted on the effectiveness and efficiency of food hubs; however, changing the supply chain system to one that is based on a local food system is challenging. This study aims to build a conceptual model that describes the activities and coordination of the actors involved in a food hub to achieve a local food system. In this study, a soft system methodology and case study approach are used to answer the research question. The results show that two transformations are needed to achieve a local food system: changing the supply chain system to one that is shorter and more structured and increasing quality consistency. Recommendations are presented in the form of a series of human activity systems to achieve transformations. Human activities to achieve a shorter and structured supply chain involve building cooperation, operating operational activities to add value, product identification, promotion, and developing fair-trade contracts. Human activities required to achieve transformation of increasing quality consistency include identifying high-demand customer requirements, forecasting, scheduling planting, and harvesting, improving training, cooperating with research institutions, farmer assistance, and quality inspection.

Scenarios for handling the impact of COVID-19 based on food supply network through regional food hubs under uncertainty

This paper discusses an optimization model for handling the impact of the COVID-19 pandemic based on food supply network through regional food hubs (RFHs) under uncertainty. To this end, uncertainty is assumed in the demand and production data. During the Pandemic COVID-19 period, uncertainty has increased and the food supply chain system has changed. Thus, a new configuration of the food supply network requires analysis. In this paper, the concept of RFH is introduced to connect producers in rural areas and customers in urban areas. This paper determines the location and capacity of RFHs, the food supply network, the sum of maximum food supplies, and minimum logistics cost. This is done via a Multi-Objective Many-to-Many Location-Routing Problem model. Furthermore, since the conditions of the COVID-19 pandemic is uncertain, robust optimization is employed to handle uncertainties. During the current pandemic, red zones are defined to indicate the severity of the pandemic in a region. In this paper, the numerical experiment is considered for three scenarios: when a region is in large-scale social distancing, partial social distancing, or normal conditions. This social distancing situation is based on the defined red zones. The optimal food supply network is obtained for the three scenarios and the best scenario among the three is identified.

Bringing Healthy Retail to Urban "Food Swamps": a Case Study of CBPR-Informed Policy and Neighborhood Change in San Francisco

In urban "food swamps" like San Francisco's Tenderloin, the absence of full-service grocery stores and plethora of corner stores saturated with tobacco, alcohol, and processed food contribute to high rates of chronic disease. We explore the genesis of the Tenderloin Healthy Corner Store Coalition, its relationship with health department and academic partners, and its contributions to the passage and implementation of a healthy retail ordinance through community-based participatory research (CBPR), capacity building, and advocacy. The healthy retail ordinance incentivizes small stores to increase space for healthy foods and decrease tobacco and alcohol availability. Through Yin's multi-method case study analysis, we examined the partnership's processes and contributions to the ordinance within the framework of Kingdon's three-stage policymaking model. We also assessed preliminary outcomes of the ordinance, including a 35% increase in produce sales and moderate declines in tobacco sales in the first four stores participating in the Tenderloin, as well as a "ripple effect," through which non-participating stores also improved their retail environments. Despite challenges, CBPR partnerships led by a strong community coalition concerned with bedrock issues like food justice and neighborhood inequities in tobacco exposure may represent an important avenue for health equity-focused research and its translation into practice.