Foods Distributed During Federal Disaster Relief Response in Puerto Rico After Hurricane María Did Not Fully Meet Federal Nutrition Recommendations

Revision of "Nutritional Reference Values for Feeding at Evacuation Shelters" and Model Menus: A Qualitative Study

OBJECTIVE

In 2011, the Japanese government issued nutritional reference values for energy; protein; vitamins B1, B2, and C; and salt to deal with poor meal quality in evacuation shelters. Because they were not widely used owing to their impracticality, the authors had examined the values according to the experience-based opinions of public health dietitians. Furthermore, we developed a usage tool containing a model menu that meets these values. This study aimed to confirm the usability of these revised values and model menus and collect ideas for improvement.

METHODS

We conducted 8 semi-structured group interviews with 12 dietitians, 9 disaster management officers, and 2 public health nurses in local governments supposed to have been affected by a large-scale disaster.

RESULTS

New reference values were highly evaluated by most participants. Interviewees said that model menus were helpful for evacuees or disaster officers who are unfamiliar with nutrition because they show combinations of food items that meet the reference values instead of the amounts of energy and nutrients. To improve their understanding, it was suggested that food items be categorized by staples, main dishes, and side dishes, encouraging them to complete these three components of a balanced diet. Because it was difficult to meet all the reference values in the immediate aftermath of the disaster, it was suggested that the time-dependent priority of each nutrient and model menus that supply the nutrient should be shown by disaster phases along with the assumed availability of utility for cooking in each phase.

CONCLUSION

The new reference values were feasible to meet during emergencies. Although model menus were also appreciated, further improvements were necessary for better understanding.

Impact of the COVID-19 pandemic on the adaptability and resiliency of school food programs across Canada

Introduction

Following the sudden closure of schools due to the pandemic in 2020, many school food program (SFP) operators lost their operating venues and had to innovate to continue distributing meals to children. Our objective was to assess the impact of the COVID-19 pandemic on the delivery, adaptability, and resiliency of school food programs across Canada by conducting a systematic rapid review.

Materials and methods

Systematic literature searches identified newspaper articles and social media sources related to the adaptations and challenges faced by school food programs across Canada in response to the COVID-19 pandemic. Included sources were assessed and thematically categorized according to the dimensions of the Analysis Grid for Environments Linked to Obesity (ANGELO) and Getting To Equity (GTE) frameworks to identify factors impacting the delivery, adaptability, and resiliency of school food programs in Canada.

Results

School food programs in Canada made various efforts to meet existing and new challenges associated with the delivery of these programs to keep feeding school children, particularly those most vulnerable, during the pandemic. Distribution of food kits, prepared meals and gift cards/coupons were successful pathways in ensuring support for food accessibility to students and their families. Increased collaborations between community members and organizations/stakeholders to help maintain food delivery or collectively offer new modes to deliver foods were most frequently cited as key to facilitating school food programming. However, maintenance and sustainability related to operating costs and funding were identified as key challenges to successful school food programming.

Conclusion

Our study highlights the swift and substantial transformation school food programs,, underwent in response to the pandemic, driven by the urgent need to ensure that students still had access to nutritious meals and the importance of policy and resource support to bolster the adaptability and resiliency of these programs. Findings on facilitators and challenges to school food programs during the early months of the COVID-19 pandemic can inform development of guidelines to design a robust national Canadian school food program and help make existing programs more sustainable, adaptable, and resilient.

Impact of Hurricanes Irma and Maria on Asthma, Hypertension, and Depression in a Sample of the Puerto Rico Population

OBJECTIVE

To evaluate the impact of Hurricanes Irma and Maria on 3 major chronic diseases in Puerto Rico.

METHODS

San Juan Overweight Adults Longitudinal study participants were re-evaluated after Hurricanes Irma and Maria (May 2019-July 2020) for the Preparedness to Reduce Exposures and Diseases Post-hurricanes and Augment Resilience study. This study compared the prevalence and incidence of asthma, depression, and hypertension within the same 364 individuals over time.

RESULTS

Asthma and depression prevalence and incidence did not change significantly after the hurricanes. The prevalence of hypertension increased significantly after the hurricanes (OR = 2.2, 95% CI: 1.2, 3.9). The incidence of hypertension after the hurricanes (IR = 9.0, 95% CI: 6.5, 12.4) increased significantly compared to before the hurricanes (IR = 6.1, 95% CI: 4.5, 8.0) (age-adjusted incidence rate ratio [aIRR] = 1.4, 95% CI: 4.5, 8.0) for similar time periods.

CONCLUSION

Hurricanes Irma and Maria were associated with a significant increase in the prevalence and incidence of hypertension in this study population. Contrary to expectations, no significant increases were observed in depression and asthma prevalence after the hurricanes. Results from this study can inform better strategies to prevent and manage hypertension in the population affected by a hurricane.

Meal plans for meeting the reference values using food items available in shelters

BACKGROUND

We have suggested "Revised Nutritional Reference Values for Feeding at Evacuation Shelters" (Revised RV) as a daily nutritional recommendation for meals served at evacuation shelters where poor diets had been reported. Since there are no meal examples to satisfy the Revised RV, our objectives were, for the future meal provision, to develop nutritionally adequate meal plans using the foods served at shelters in the past and to examine if the Revised RV could be met by changing combination of foods available.

METHODS

In this case study using secondary data, we analyzed food weights of 86 meals served and recorded at 12 shelters after the heavy rains in July 2020. We obtained these data from Kumamoto Prefecture that was damaged and asked us dietary assessment for nutrition assistance. Foods were classified into 3 types according to the check mark in the record sheets: food aid (commercial packaged food), boxed meal, and hot meal service. We counted serving frequency of each food and analyzed nutritional differences by their combinations. Menus were devised by choosing foods that were served more frequently or were more nutritious among those served at shelters. The target values for one meal were set at 1/3 of the Revised RV for energy, protein, vitamins B₁, B₂, and C, and salt.

RESULTS

None of the meals served in the shelters satisfied the target. We created 2 menus using food aid only: (#1 curry doughnut, milk with long shelf-life, and orange jelly) and (#2 salmon rice ball, ham and cheese sandwich, and vegetable juice); 1 menu by combination of boxed meal and food aid: (#3 boxed meal and vegetable juice); and 2 menus by combination of hot meal service and food aid: (#4 chicken meatball soup, packaged tofu, soy sauce, preprocessed white rice, and bottled green tea) and (#5 bamboo shoots rice, chicken and vegetable miso soup, and bottled green tea). Planned menus generally contained more energy, protein, and vitamins and less salt than the meals served. Their vitamin C contents were especially higher.

CONCLUSION

Nutritionally adequate meals could be planned by changing the combination of foods available in shelters.

Hurricanes Irma and Maria and Diabetes incidence in Puerto Rico

OBJECTIVE

To evaluate the impact of Hurricanes Irma/Maria on diabetes incidence in Puerto Rico. Mortality increased substantially after the hurricanes, but morbidity was not assessed.

METHODS

We recruited 364 participants from the San Juan Overweight Adults Longitudinal Study (SOALS) aged 40-65 years who completed a three-year follow-up and were free of diabetes. We conducted additional questionnaires 1.7-2.5 years after hurricanes. Glycosylated hemoglobin (HbA1c), fasting glucose and insulin were assessed at all three visits. We compared diabetes incidence between pre-hurricane visits and between visits spanning the hurricanes using Generalized Estimating Equation (GEE) adjusting for within person repeated measures, age, and body mass index (BMI).

RESULTS

Diabetes incidence was significantly higher spanning the hurricanes than pre-hurricane (multivariate GEE model: IRR = 2.1; 95% CI: 1.4-3.1). There was a significantly higher increase spanning the hurricanes compared to pre-hurricanes for Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) (median: 0.3 uIU/mL vs. 0.2 uIU/mL). HbA1c levels increased by 0.4% spanning the hurricanes.

CONCLUSION

Increases in diabetes incidence, HOMA-IR and HbA1c were higher spanning the hurricanes compared to the pre-hurricanes period. The increase in diabetes incidence remains significant after adjusting for age and BMI.

Emergency food distribution efforts in New Orleans, LA after Hurricane Ida

Background

The provision of food aid after a natural disaster is necessary to prevent hunger, particularly in low-resourced and low-income communities. Little is known about the operational challenges associated with ensuring equitable distribution of emergency food resources to communities in need following a disaster. To address this gap, this study assessed emergency food distribution efforts in New Orleans, LA during the 2 weeks following Hurricane Ida's landfall on August 29, 2021.

Methods

Information on free food distribution events was gathered from online sources. A list of distribution sites was generated that included data on operational logistics (e.g., address, days of operation, hours of operation, etc.), food offerings (e.g., prepared meals, groceries, etc.), and socio-demographic characteristics of the surrounding community. Geospatial mapping and bivariate analyses were used to analyze the site data.

Results

Seventy-four distribution sites operated in the 2 weeks after Hurricane Ida. Approximately 47.3% were located in census tracts with >80% Black residents, and 39.2% were in tracts with >30% poverty. A large proportion of sites offered prepared meals (86.2%) and only operated 1 day (36.5%). Tracts with >80% Black residents had more sites that operated only 1 day (p = 0.04). Tracts with >30% poverty had more sites that started distributing food resources 7-15 days after the hurricane (p = 0.02).

Conclusions

Most low-income and low-resourced communities in New Orleans had access to emergency food resources; however, several limitations in operations were identified that may have influenced access. Future initiatives to prevent hunger after a natural disaster in New Orleans, and elsewhere, should improve operational logistics for food aid.

Emergency food supplies and food security in Wuhan and Nanjing, China, during the COVID-19 pandemic: Evidence from a field survey

MOTIVATION

Detailed empirical work on the impact of the COVID-19 pandemic on food security is scant. Local management of food security has received little attention.

PURPOSE

This article describes emergency food policies in Wuhan and Nanjing, China during lockdown in 2020 and their implications for household food security in the two cities.

METHODS AND APPROACH

Policy documents and background data describe the emergency measures. Online surveys of residents of two Chinese cities were used to gauge household food security.

FINDINGS

Despite the determined efforts of provincial and city governments to ensure that food reached people who were locked down in Wuhan, or subject to restrictions on movement in Nanjing, households experienced some decline in food security. Most households found they could not access their preferred foods. But a minority of households did not get enough to eat.Government had contingency plans for the pandemic that ensured that most people had sufficient, if not preferred, food. But not all households were fully covered.

POLICY IMPLICATIONS

A more resilient system of food distribution is needed, including a relatively closed and independent home delivery system. Grassroots organizations such as residential community committees, property management organizations, and spontaneous volunteer groups need to be brought into the management of emergency food provision.

Association between adverse experiences during Hurricane María and mental and emotional distress among adults in Puerto Rico

OBJECTIVES

To evaluate the association between adverse experiences during Hurricane María and mental and emotional distress in Puerto Rico.

METHODS

This cross-sectional study used baseline data from adult (30-75 years) participants of the Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT). Enrolled individuals prior to COVID-19 who completed a 33-item questionnaire on Hurricane María-related experiences (sub-categorized as personal, service, or property losses), depression symptomatology, post-traumatic stress disorder (PTSD), and anxiety were included for analysis (n = 456).

RESULTS

Most participants experienced fear for their family's safety, damage to their home and personal items, communication outages, and water shortages. Each additional stressor was significantly associated with higher odds of depression symptoms, PTSD, and anxiety. Personal losses were significantly associated with higher likelihood of all outcomes, while services losses were associated with depression symptoms and anxiety; property loss was not significantly associated with any outcome.

CONCLUSIONS

Adverse experiences during a major natural disaster are associated with mental and emotional distress. Strategies to minimize hardships during natural disasters, especially personal and service losses, are essential to preserve mental health. Post-disaster psychological support to individuals is crucial.

Lessons Learned for Emergency Feeding During Modifications to 11 School Feeding Programs in Latin America and the Caribbean During the COVID-19 Pandemic

BACKGROUND

School feeding programs (SFPs) can play a crucial role in the emergency food and nutrition response, but there is a dearth of information on how SFPs operate during emergencies.

DESIGN AND METHODS

A rapid comparative assessment of 11 SFPs throughout Latin America and the Caribbean during the COVID-19 pandemic. Data from (1) systematic document search and (2) surveys with key informants (n = 23) about barriers/facilitators to modifications were systematically analyzed using a multiple case study approach.

RESULTS

During the pandemic, all SFPs continued (although continuation plans varied from a few days in Chile to >1 month in Puerto Rico) via food kits, food vouchers, and/or grab n' go meals. The SFP implementation was highly dependent on the programs' autonomy and financial support, which impacted their logistics to acquire and distribute foods during the pandemic. The types of foods offered in some SFPs suggest that established nutritional guidelines were not always followed. Key informants expressed concerns about the deterioration of the nutritional quality of foods offered during the pandemic and lack of community engagement that impeded distribution to the neediest.

CONCLUSIONS

Results underscore the urgency for clear implementation guidance on how to modify SFP during emergencies. Public health implications include (1) allocation of autonomous resources to an intersectoral working group to safeguard nutritional benefits during emergencies, (2) strengthening efforts of SFP community engagement before and during emergencies, and (3) establishing guidelines of the types of foods that can be distributed to meet the nutritional needs of beneficiaries during emergencies.

Revising "Nutritional Reference Values for Feeding at Evacuation Shelters" According to Nutrition Assistance by Public Health Dietitians Based on Past Major Natural Disasters in Japan: A Qualitative Study

It is important to provide nutritionally adequate food in shelters to maintain the health of evacuees. Since the Great East Japan Earthquake in 2011, Japan’s Ministry of Health, Labour and Welfare has released the “Nutritional Reference Values for Evacuation Shelters” (Reference Values) after every major natural disaster. There is clear evidence, however, that the Reference Values have only been used infrequently. This study aims to revise these guidelines to include the actual situation in the affected areas and the feasibility of the endeavor. This qualitative study uses group interviews with local government dietitians to propose revisions to Japan’s Reference Values. These revisions include the following: issuing Reference Values within 1 week of a disaster, showing one type of values for meal planning for each age group, showing the minimum values of vitamins, upgrading salt to basic components, creating three phases of nutrition (Day 1, Days 1–3, and After Day 4), stipulating food amounts rather than nutrient values, and creating a manual. Local government officials could use the Reference Values as guidelines for choosing food reserves, and dietitians could use them while formulating supplementary nutrition strategies for a model menu in preparation for disasters.

Capturing Disruptions to Food Availability After Disasters: Assessing the Food Environment Following Hurricanes Florence and María

OBJECTIVE

The aim of this study was to describe the results of food environment assessments completed after Hurricane Florence in North Carolina (2018) and Hurricane María in Puerto Rico (2017), and provide recommendations for assessing disaster food environments.

METHODS

Adapted structured observation protocols were used to conduct rapid assessments of the availability, price, and quality of specific foods in retail markets.

RESULTS

In both settings, unhealthful food items (soda, chips, fruit-flavored drinks) and milk were widely available and at lower prices than domestic averages. The adapted instrument in Puerto Rico allowed for documentation of greater availability of canned items compared with fresh or frozen foods. In both settings, researchers noted the inability of the instrument to document items that are important to assess postdisaster: ready-to-heat and ready-to-eat foods; food preparation facilities and supplies; hygiene supplies; and empty shelf-space.

CONCLUSIONS

The instruments, despite their limitations, were able to capture food availability issues in postdisaster environments. Future instrument adaptation is necessary to capture availability of all major food groups, healthful and unhealthful options, shelf-stable, ready-to-eat, and ready-to-heat foods versus other formats (fresh, frozen), and cooking and hygiene supplies.

Traditional foodstuffs and household food security in a time of crisis

Traditional foodstuffs play an important role in household food security. No research has, however, attempted to examine traditional foodstuffs in light of disasters and crises. Such research can provide a useful outlook on how traditional foodstuffs can aid households in a situation of disrupted food supply. This outlook becomes relevant in view of future disastrous events that can undermine household food security, especially in poor disadvantaged communities. This study examined the role of traditional foodstuffs during a major crisis. The study adopted an ethnographic perspective and the method of semi-structured household interviews to explore how traditional foodstuffs were used by communities in the city of Mosul, Iraq, under the ISIS administration and during the liberation war (2016-2017). The study showcased the critical role of traditional foodstuffs in survival of local households. It highlighted the importance of cross-generational knowledge of traditional foodstuffs in community preparedness for disasters and crises. The study proposed to integrate traditional foodstuffs into governmental strategies on household food security in Iraq, and beyond. It suggested including traditional foodstuffs in the humanitarian food supply chains in the regions prone to disasters and crises. Future research should examine the prerequisites for such inclusion, especially from the viewpoint of societal and political acceptance of traditional foodstuffs and methods of their production.

Management Of Chronic Noncommunicable Diseases After Natural Disasters In The Caribbean: A Scoping Review

Extreme weather events in the Caribbean region are becoming increasingly severe because of climate change. The region also has high rates of poorly controlled chronic noncommunicable diseases (NCDs), which were responsible for at least 30 percent of deaths after two recent hurricanes. We conducted a scoping review of literature published between 1974 and 2020 to understand the burden and management of chronic NCDs in the Caribbean after natural disasters. Of the twenty-nine articles included in this review, most described experiences related to Hurricanes Dorian (2019) and Irma and Maria (2017) and the Haiti earthquake (2010). Challenges included access to medication, acute care services, and appropriate food, as well as communication difficulties and reliance on ad hoc volunteers and outside aid. Mitigating these challenges requires different approaches, including makeshift points of medication dispensing, disease surveillance systems, and chronic disease self-management education programs. Evidence is needed to inform policies to build resilient health systems and integrate NCD management into regional and national disaster preparedness and response plans.