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Datta BK, Phillips S. Long COVID and the Higher Risk of Food Insecurity Among Participants and Nonparticipants of Food Assistance Programs in the United States. J Acad Nutr Diet 2024:S2212-2672(24)00731-7. [PMID: 39111695 DOI: 10.1016/j.jand.2024.07.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 07/28/2024] [Accepted: 07/31/2024] [Indexed: 08/30/2024]
Abstract
BACKGROUND In the aftermath of the COVID-19 public health emergency, it is important to understand the extent of socioeconomic burdens of long COVID, defined as continuation of symptoms after initial infection, including food insecurity. OBJECTIVE This study aimed to assess the association between long COVID and family food insecurity among low-income individuals (or any of their family members living with them) who were participants and nonparticipants in public food assistance programs (Supplemental Nutrition Assistance Program [SNAP], Special Supplemental Nutrition Program for Women, Infants, and Children [WIC], and National School Lunch Program [NSLP]) in the United States. DESIGN The study used an observational cross-sectional design. PARTICIPANTS/SETTING Data on 7151 adults (aged 18+ years), with family income of < 200% of the Federal Poverty line, from the 2022 National Health Interview Survey, were analyzed. MAIN OUTCOME MEASURES Level of family food security, based on responses to a set of 10 questions measuring family's food security during the past 30 days. STATISTICAL ANALYSES PERFORMED Multinomial logistic regression models were estimated to obtain relative risk ratios of marginal and low/very low food security, relative to the base outcome of high food security, for long COVID status. Multivariable models were estimated separately for the full sample and for subgroups of food assistance participants and nonparticipants. A seemingly unrelated regression (SUR) specification was estimated to assess whether the estimates were different across the participant and nonparticipant subgroups. RESULTS Compared with individuals who never had COVID-19, the adjusted relative risks of experiencing marginal and low/very low food security were 1.42 (95% CI, 1.00-2.02) and 1.43 (95% CI, 1.08-1.91) times higher, respectively, for individuals who had long COVID. Although the adjusted risks were not observed to be statistically significant in the participant subgroup, among nonparticipants, adjusted relative risk ratios were 2.34 (95% CI, 1.43-3.82) and 1.56 (95% CI, 1.02-2.39), respectively. SUR results showed that relationships between long COVID and food insecurity were only different for marginal and not low/very low levels of food security between food assistance participant and nonparticipant groups. CONCLUSIONS Study findings highlight a significantly higher risk of marginal and low/very low- food security among low-income adults who had long COVID, especially those who were nonparticipants in public food assistance programs. Further research is warranted to explore the causal pathways of this relationship for informing policies to mitigate the burden of long COVID.
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Affiliation(s)
- Biplab Kumar Datta
- Institute of Public and Preventive Health, Augusta University, Augusta, Georgia; Department of Health Management, Economics and Policy, School of Public Health, Augusta University, Augusta, Georgia.
| | - Serena Phillips
- Department of Economics, College of Arts and Sciences, University of Missouri, Columbia, Missouri
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Kibe LW, Bosah A, Schrode KM, Kuo Y, Shaheen M, Adinkra E, Sanchez H, Bazargan M. Assessing Food Access, Exercise, and Dietary History among Older African American Parishioners During the COVID-19 Pandemic (C-FED Study): Design, Opportunities, Challenges, and Lessons Learned. J Racial Ethn Health Disparities 2024; 11:1857-1868. [PMID: 37336866 PMCID: PMC11110797 DOI: 10.1007/s40615-023-01657-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/20/2023] [Accepted: 05/24/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES Unhealthy diets and inadequate exercise are associated with chronic health conditions and excess mortality. Older African Americans do not meet dietary and exercise guidelines, and this may have worsened during the COVID-19 pandemic due to individual and environmental factors, including food insecurity. Studies evaluating these dynamics are essential for developing interventions. This narrative details a study protocol and data collection experiences during the pandemic. METHODS Participants > 55 years African American old completed detailed food frequency, exercise, and food access questionnaires between October 2020 and July 2021. Observations of the study administrators (authors of this manuscript) for the duration of the study are presented. Details on the study design and reflections on the opportunities, challenges, and lessons learned are summarized. Future manuscripts will report data analysis of study findings. RESULTS A total of 123 older African American adults participated in the study, and 118 (70% female) completed all three questionnaires. More than 50% of the participants had at least two primary chronic conditions. About 85% were fully vaccinated against COVID-19. Applying community-based participatory approaches, leveraging partnerships, and exercising flexibility approaches were pivotal to successfully implementing the study protocol. CONCLUSIONS Despite challenges related to the COVID-19 pandemic, detailed data on older African American adults' diet and exercise habits were obtained. Our study design and experiences will benefit future researchers. More importantly, results from our study will inform interventions and policies aimed at minimizing consequences associated with poor diet and exercise habits during the pandemic among this vulnerable population.
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Affiliation(s)
- Lucy W Kibe
- Physician Assistant Program, Charles R. Drew University of Medicine and Science, 1731 E. 120Th St., Los Angeles, CA, 90059, USA.
| | - Adaobi Bosah
- Physician Assistant Program, Charles R. Drew University of Medicine and Science, 1731 E. 120Th St., Los Angeles, CA, 90059, USA
| | - Katrina M Schrode
- Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, CA, 90059, USA
| | - Yufu Kuo
- Physician Assistant Program, Charles R. Drew University of Medicine and Science, 1731 E. 120Th St., Los Angeles, CA, 90059, USA
| | - Magda Shaheen
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, 90059, USA
| | - Edward Adinkra
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, 90059, USA
| | - Humberto Sanchez
- Office of Research, Charles R. Drew University of Medicine and Science, Los Angeles, CA, 90059, USA
| | - Mohsen Bazargan
- Physician Assistant Program, Charles R. Drew University of Medicine and Science, 1731 E. 120Th St., Los Angeles, CA, 90059, USA
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, 90059, USA
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, 90059, USA
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Park S, Ortega AN, Chen J, Mortensen K, Bustamante AV. Association of food insecurity with health, access to care, affordability of care, financial burden of care, and financial hardships among US adults during the COVID-19 pandemic. Public Health 2024; 230:183-189. [PMID: 38565064 DOI: 10.1016/j.puhe.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/15/2024] [Accepted: 02/27/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES To examine the associations between food insecurity and health, access to care, affordability of care, financial burden of care, and financial hardships among US adults during the COVID-19 pandemic and examine whether the associations were less pronounced among adults with safety nets. STUDY DESIGN We conducted a retrospective longitudinal cohort study using the 2020-2021 Medical Expenditure Panel Survey. METHODS Linear probability models were used to assess the associations between food insecurity in one year and the outcomes of interest in the following year while adjusting for baseline characteristics. We performed the analyses for the entire population and then conducted stratified analyses for adults with and without Supplemental Nutrition Assistance Program (SNAP) benefits or Medicaid coverage. RESULTS Compared with food-secure adults, food-insecure adults were 9.1 percentage points less likely to report life satisfaction and 9.9, 10.2, and 13.2 percentage points more likely to experience delays in getting medical care, postpone or forgo medical care because of cost, and struggle with paying medical bills. Food-insecure adults were 30.4, 27.2, and 23.5 percentage points more likely to face challenges in affording necessities, paying utility bills, and meeting rent or mortgage payments on time than food-secure adults. Notably, the strengths of these associations were attenuated among adults with SNAP benefits or Medicaid coverage. CONCLUSIONS Food insecurity was associated with poor health, limited access to and affordability of care, and a greater financial burden of care among US adults during the pandemic. Nevertheless, safety net programs can play a critical role in alleviating adverse consequences.
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Affiliation(s)
- S Park
- Department of Health Policy and Management, College of Health Science, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea; Department of Healthcare Sciences, Graduate School, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea; L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
| | - A N Ortega
- Thompson School of Social Work and Public Health, University of Hawai'i at Manoa, 2430 Campus Rd, Honolulu, HI, 96822, USA.
| | - J Chen
- Department of Health Policy and Management, School of Public Health, University of Maryland, 4200 Valley Dr, College Park, MD, 20742, USA.
| | - K Mortensen
- Department of Health Management and Policy, Hebert Business School, University of Miami, 5250 University Dr, Coral Gables, FL 33146, USA.
| | - A V Bustamante
- Department of Health Policy and Management, Fielding School of Public Health, UCLA, UCLA Latino Policy and Politics Institute, 650 Charles Young Dr. S., Los Angeles, CA, 90095, USA.
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Harville II C, James DCS, Patterson A, Harper S, Petchulat-McMillan L. A Cross-Sectional Study of Grocery Shopping Factors of Importance among Food-Insecure African Americans. Nutrients 2024; 16:1188. [PMID: 38674878 PMCID: PMC11054405 DOI: 10.3390/nu16081188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/04/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
The objective of this study was to (1) assess via cross-sectional survey the prevalence of food insecurity among African Americans [AAs] after their most recent grocery shopping trip, and (2) examine the grocery shopping factors of importance and characteristics of food-insecure AA grocery shoppers. Most (70.4%) were food-insecure. Food-insecure grocery shoppers were significantly more likely to be younger, less educated, who often skipped meals and/or practiced fasting, accessed a food pantry, were SNAP recipients, were considered to not be in "good" health, and who had higher BMI compared to food-secure shoppers (p ≤ 0.03 * for all). Our data showed that AAs shopped for groceries a mean 2.20 ± 1.29 times per week, for low prices (72.1%), without a weekly budget (58.9%), with a grocery list (44.6%) or using an app (27.6%), for high-quality vegetables (27.5%), for good customer service (22.9%), for store brands (20.8%) and name brands (17.9%).Food-insecure shoppers were significantly more likely to grocery shop more times per week, have a weekly budget, and use an app, but were significantly less likely to report store brands, name brands, good customer service, and high-quality vegetables as grocery factors of importance (p ≤ 0.03 * for all). Grocery strategies such as shopping with a grocery app and/or grocery list could help food-insecure AAs reduce grocery trips, promote meal planning to save money, and avoid skipping meals/fasting, while eating healthier.
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Affiliation(s)
- Cedric Harville II
- Department of Applied Health, Southern Illinois University-Edwardsville, Campus Box 1147, Edwardsville, IL 62026, USA; (A.P.); (S.H.); (L.P.-M.)
| | - Delores C. S. James
- Health Education & Behavior, University of Florida, 1864 Stadium Road, Gainesville, FL 32603, USA;
| | - Amaria Patterson
- Department of Applied Health, Southern Illinois University-Edwardsville, Campus Box 1147, Edwardsville, IL 62026, USA; (A.P.); (S.H.); (L.P.-M.)
| | - Sheila Harper
- Department of Applied Health, Southern Illinois University-Edwardsville, Campus Box 1147, Edwardsville, IL 62026, USA; (A.P.); (S.H.); (L.P.-M.)
| | - Lindy Petchulat-McMillan
- Department of Applied Health, Southern Illinois University-Edwardsville, Campus Box 1147, Edwardsville, IL 62026, USA; (A.P.); (S.H.); (L.P.-M.)
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Lee JJ, Sultana N, Nishita C. Participant Assessment of an Alternative Flexible Congregate Nutrition Meal Program for Older Adults. J Nutr Gerontol Geriatr 2024; 43:134-150. [PMID: 38915295 DOI: 10.1080/21551197.2024.2367972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
Congregate Nutrition Services have long been a pillar of public health assistance, championing the independence and community engagement of older Americans. The advent of COVID-19, however, restricted access to these services due to the closure of physical locations. In response, Lanakila Meals on Wheels initiated a virtual congregate meal program, Kūpuna U, in collaboration with community partners in Honolulu County. The program combined grab-and-go or home-delivered meals with virtual and in-person classes to improve both nutrition and socialization for older adults. This study aimed to capture participant feedback to assess and enhance the Kūpuna U program, developing it as a flexible and scalable congregate meal solution applicable nationwide. Five focus group discussions were conducted with program participants (n = 34). The majority of participants were female (74%), Asian (73%), and living alone (56%). Participants found the program beneficial, enhancing their nutrition, social engagement, and learning experiences on various topics tailored for older adults. Supportive staff played a crucial role in motivating participants to stay engaged. Participants also identified potential enhancements to the program, including more activities and courses, expanded hours, additional in-person options at various locations, and culturally tailored meals.
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Affiliation(s)
- Jenny Jinyoung Lee
- Thompson School of Social Work and Public Health, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
| | - Nargis Sultana
- Thompson School of Social Work and Public Health, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
| | - Christy Nishita
- Thompson School of Social Work and Public Health, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
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Nelson K, Jackson AM, Nguyen CJ, Noonan C, Muller C, MacLehose RF, Manson SM, Dillard DA, Buchwald D. Food insecurity in urban American Indian and Alaska Native populations during the COVID-19 pandemic. BMC Public Health 2024; 24:903. [PMID: 38539099 PMCID: PMC10967146 DOI: 10.1186/s12889-024-18390-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Food insecurity is an important social determinant of health that was exacerbated by the COVID-19 pandemic. Both food insecurity and COVID-19 infection disproportionately affect racial and ethnic minority groups, particularly American Indian and Alaska Native communities; however, there is little evidence as to whether food insecurity is associated with COVID-19 infection or COVID-19 preventive behaviors such as vaccination uptake. The purpose of this study was to evaluate associations between food insecurity, COVID-19 infection, and vaccination status among urban American Indian and Alaska Native adults seen at 5 clinics serving urban Native people. METHODS In partnership with health organizations in Alaska, Colorado, Kansas, Minnesota, and New Mexico, the study team conducted a cross-sectional survey in 2021 to assess food security status and attitudes, barriers, and facilitators for COVID-19 testing and vaccination. Logistic regression was used to examine the association of food security status with sociodemographic factors and COVID-19 infection and vaccination status. Marginal standardization was applied to present results as prevalence differences. RESULTS Among 730 American Indian and Alaska Native adults, the prevalence of food insecurity measured during the pandemic was 38%. For participants who reported persistent food security status before and during the pandemic (n = 588), the prevalence of food insecurity was 25%. Prevalence of COVID-19 infection and vaccination did not vary by food security status after adjustment for confounders. CONCLUSIONS High rates of food insecurity among American Indian and Alaska Native communities likely increased during the COVID-19 pandemic. However, despite the high prevalence of food insecurity, community-led efforts to reduce COVID-19 infection and increase vaccination uptake across Indian Health Service and Tribal healthcare facilities may have mitigated the negative impacts of the pandemic for families experiencing food insecurity. These successful approaches serve as an important reference for future public health efforts that require innovative strategies to improve overall health in American Indian and Alaska Native communities.
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Affiliation(s)
- Katie Nelson
- Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA, 98101, USA.
| | | | - Cassandra J Nguyen
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Carolyn Noonan
- Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA, 98101, USA
| | - Clemma Muller
- Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA, 98101, USA
| | - Richard F MacLehose
- Division of Epidemiology and Community Health, Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Spero M Manson
- Colorado School of Public Health, Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Denise A Dillard
- Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA, 98101, USA
| | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA, 98101, USA
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Nelson K, Jackson AM, Nguyen CJ, Noonan C, Muller C, MacLehose RF, Manson SM, Dillard D, Buchwald D. Food Insecurity in Urban American Indian and Alaska Native Populations During the COVID-19 Pandemic. RESEARCH SQUARE 2023:rs.3.rs-3711655. [PMID: 38168406 PMCID: PMC10760224 DOI: 10.21203/rs.3.rs-3711655/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Background Food insecurity is an important social determinant of health that was exacerbated by the COVID-19 pandemic. Both food insecurity and COVID-19 infection disproportionately affect racial and ethnic minority groups, particularly American Indian and Alaska Native communities; however, there is little evidence as to whether food insecurity is associated with COVID-19 infection or COVID-19 preventive behaviors such as vaccination uptake. The purpose of this study was to evaluate associations between food insecurity, COVID-19 infection, and vaccination status among urban American Indian and Alaska Native adults seen at 5 clinics serving urban Native people. Methods In partnership with health organizations in Alaska, Colorado, Kansas, Minnesota, and New Mexico, the study team conducted a cross-sectional survey in 2021 to assess food security status and attitudes, barriers, and facilitators for COVID-19 testing and vaccination. Logistic regression was used to examine the association of food security status with sociodemographic factors and COVID-19 infection and vaccination status. Marginal standardization was applied to present results as prevalence differences. Results Among 730 American Indian and Alaska Native adults, the prevalence of food insecurity measured during the pandemic was 38%. For participants who reported persistent food security status before and during the pandemic (n=588), the prevalence of food insecurity was 25%. Prevalence of COVID-19 infection and vaccination did not vary by food security status after adjustment for confounders. Conclusions High rates of food insecurity among American Indian and Alaska Native communities likely increased during the COVID-19 pandemic. However, despite the high prevalence of food insecurity, community-led efforts to reduce COVID-19 infection and increase vaccination uptake across Indian Health Service and Tribal healthcare facilities may have mitigated the negative impacts of the pandemic for families experiencing food insecurity. These successful approaches serve as an important reference for future public health efforts that require innovative strategies to improve overall health in AIAN communities.
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Affiliation(s)
| | | | | | | | | | | | - Spero M Manson
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus
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Samuel LJ, Zhu J, Dwivedi P, Stuart EA, Szanton SL, Li Q, Thorpe RJ, Reed NS, Swenor BK. Food insecurity gaps in the Supplemental Nutrition Assistance Program based on disability status. Disabil Health J 2023; 16:101486. [PMID: 37353370 PMCID: PMC10527001 DOI: 10.1016/j.dhjo.2023.101486] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/23/2023] [Accepted: 05/28/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Households including someone with disabilities experience disproportionately high food insecurity rates and likely face disproportionate barriers accessing Supplemental Nutrition Assistance Program (SNAP) benefits. OBJECTIVE This article aims to examine the role of SNAP with regard to food insecurity disparities based on disability status. METHODS Modified Poisson regression models examined food insecurity risk based on disability status (household includes no one with disabilities vs. those with work-limiting disabilities or non-work-limiting disabilities) among 2018 Survey of Income and Program Participation households eligible for SNAP (income ≤130% of the poverty threshold). Weighted estimates were used to account for the study design and non-response. RESULTS Households including someone with work-limiting disabilities were more than twice as likely to be food insecure than households including no one with disabilities (PR = 2.16, 95% CI: 1.90, 2.45); households including someone with non-work-limiting disabilities were 65% more likely (PR = 1.65, 95% CI: 1.39, 1.95). However, disparities were more pronounced among households not participating in SNAP (PR = 2.67, 95% CI: 2.22, 3.23 for work-limiting disabilities and PR = 1.86, 95% CI: 1.44, 2.40 for non-work-limiting disabilities) than SNAP-participating households (PR = 1.71, 95% CI: 1.45, 2.03 and PR = 1.46, 95% CI: 1.17, 1.82, respectively). Approximately 4.2 million low-income U.S. households including someone with disabilities are food insecure. Of these, 1.4 million were not participating in SNAP and another 2.8 million households were food insecure despite participating in SNAP. CONCLUSIONS Access to SNAP benefits is not proportionate to the scale of food insecurity among households that include people with disabilities. Action is needed to strengthen food assistance for those with disabilities.
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Affiliation(s)
| | - Jiafeng Zhu
- Johns Hopkins Bloomberg School of Public Health, USA.
| | | | | | - Sarah L Szanton
- Johns Hopkins School of Nursing, Public Health, and Medicine, USA.
| | - Qiwei Li
- Johns Hopkins School of Nursing, USA.
| | | | | | - Bonnielin K Swenor
- The Johns Hopkins Disability Health Research Center, Johns Hopkins School of Nursing, USA.
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Samuel LJ, Crews DC, Swenor BK, Zhu J, Stuart EA, Szanton SL, Kim B, Dwivedi P, Li Q, Reed NS, Thorpe RJ. Supplemental Nutrition Assistance Program Access and Racial Disparities in Food Insecurity. JAMA Netw Open 2023; 6:e2320196. [PMID: 37358853 PMCID: PMC10293911 DOI: 10.1001/jamanetworkopen.2023.20196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/10/2023] [Indexed: 06/27/2023] Open
Abstract
Importance Racially minoritized people experience disproportionately high rates of food insecurity. The Supplemental Nutrition Assistance Program (SNAP) reduces food insecurity. Objective To evaluate SNAP access with regard to racial disparities in food insecurity. Design, Setting, and Participants This cross-sectional study used data from the 2018 Survey of Income and Program Participation (SIPP). On the basis of random sampling strategies, 44 870 households were eligible for the SIPP, and 26 215 (58.4%) participated. Sampling weights accounted for survey design and nonresponse. Data were analyzed from February 25 to December 12, 2022. Exposures This study examined disparities based on household racial composition (entirely Asian, entirely Black, entirely White, and multiple races or multirace based on SIPP categories). Main Outcomes and Measures Food insecurity during the prior year was measured using the validated 6-item US Department of Agriculture Food Security Survey Module. SNAP participation during the prior year was classified based on whether anyone in the household received SNAP benefits. Modified Poisson regression tested hypothesized disparities in food insecurity. Results A total of 4974 households that were eligible for SNAP (income ≤130% of the poverty threshold) were included in this study. A total of 218 households (5%) were entirely Asian, 1014 (22%) were entirely Black, 3313 (65%) were entirely White, and 429 (8%) were multiracial or of other racial groups. Adjusting for household characteristics, households that were entirely Black (prevalence rate [PR], 1.18; 95% CI, 1.04-1.33) or multiracial (PR, 1.25; 95% CI, 1.06-1.46) were more likely to be food insecure than entirely White households, but associations differed depending on SNAP participation. Among households that did not participate in SNAP, those that were entirely Black (PR, 1.52; 97.5% CI, 1.20-1.93) or multiracial (PR, 1.42; 97.5% CI, 1.04-1.94) were more likely to be food insecure than White households; however, among SNAP participants, Black households were less likely than White households to be food insecure (PR, 0.84; 97.5% CI, 0.71-0.99). Conclusions and Relevance In this cross-sectional study, racial disparities in food insecurity were found among low-income households that do not participate in SNAP but not among those that do, suggesting that access to SNAP should be improved. These results also highlight the need to examine the structural and systemic racism in food systems and in access to food assistance that may contribute to disparities.
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Affiliation(s)
| | - Deidra C. Crews
- Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Bonnielin K. Swenor
- Johns Hopkins School of Nursing, Baltimore, Maryland
- The Johns Hopkins Disability Health Research Center, Baltimore, Maryland
| | - Jiafeng Zhu
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Elizabeth A. Stuart
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Sarah L. Szanton
- Johns Hopkins School of Nursing, Baltimore, Maryland
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Boeun Kim
- Johns Hopkins School of Nursing, Baltimore, Maryland
| | | | - Qiwei Li
- Johns Hopkins School of Nursing, Baltimore, Maryland
- College of Health and Human Services, University of California, Fresno
| | - Nicholas S. Reed
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Roland J. Thorpe
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Cai J. Food Insecurity and COVID-19 Infection: Findings From the 2020-2021 National Health Interview Survey. AJPM FOCUS 2023; 2:100069. [PMID: 36687320 PMCID: PMC9847318 DOI: 10.1016/j.focus.2023.100069] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Introduction The purpose of this study was to examine the sociodemographic and health-related factors associated with food insecurity and the association between food insecurity and COVID-19 infection using a nationally representative sample in the U.S. Methods Cross-sectional data of 61,050 adults (aged ≥18 years) from the 2020 and 2021 National Health Interview Survey were analyzed. Food insecurity was measured by the 10-item U.S. Department of Agriculture Food Security Survey Module. Weighted multivariable logistic regression models were used to estimate associations with food insecurity. Results A total of 6.8% of the National Health Interview Survey participants lived in food-insecure households, and 18.9% tested positive for COVID-19 infection. Young (aged 18-34 years) or middle (aged 35-64 years) age, female sex, minor race/ethnicity (Hispanic/non-Hispanic Black/non-Hispanic Asian/others), education level less than high school, unmarried status, unemployment, poverty (below the federal poverty level), having no health insurance, a larger number of adults and children in the household, poorer self-reported health status, and the presence of chronic conditions were significantly associated with food insecurity (AOR ranged from 1.20 to 3.15, all p<0.0001). Food insecurity was independently associated with positive COVID-19 infection (AOR=1.25, 95% CI=1.11, 1.40), controlling for sociodemographic and health-related factors. The greatest magnitude of the association was observed for the non-Hispanic Black participants (AOR=1.47, 95% CI=1.15, 1.88), female participants (AOR=1.44, 95% CI=1.20, 1.71), and those below the federal poverty level (AOR=1.39, 95% CI=1.12, 1.73) across all the subgroups. Conclusions Food insecurity disproportionately affected vulnerable subgroups such as young adults, female individuals, minority race/ethnicity groups, and those with lower socioeconomic status, and was associated with positive COVID-19 infection. Policies addressing food insecurity may help to reduce the likelihood of COVID-19 infection, especially for those vulnerable subgroups.
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Affiliation(s)
- Jiahui Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, Bloomington, Indiana
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Kibe LW, Bazargan M, Bosah A, Schrode KM, Kuo Y, Andikrah E, Shaheen M. Diet Quality of Older African Americans: Impact of Knowledge and Perceived Threat of COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5274. [PMID: 37047890 PMCID: PMC10094625 DOI: 10.3390/ijerph20075274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/25/2023] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
Confusing health messages and environmental changes intended to prevent the spread of the COVID-19 virus have affected the dietary behavior of older African Americans. We investigated the impact of COVID-19-related factors on diet quality and the relationship between food access and diet quality. We surveyed 150 African Americans aged 55 years and above during the COVID-19 pandemic. The data obtained included socio-demographic and health information, and COVID-19-related knowledge and perceptions. Dietary intake data was obtained using the Diet History Questionnaire III. Analyses included bivariate and multivariable statistics. Overall, based on United States Department of Agriculture guidelines, the diet quality of older African Americans was poor. Lower knowledge and a lower perceived threat of COVID-19 were significantly associated with poor diet quality. Additionally, older African Americans with chronic diseases and food insecurity had poor diet quality. The COVID-19 pandemic has highlighted the fragility of diet quality. The combined impact of poor knowledge and perceived threat of COVID-19, chronic disease, and food insecurity contribute to poor diet quality in this population. This study adds to the well-known need for strategies to support the right to a healthy diet, particularly during COVID-19 and future pandemics. Proactive interventions to counteract the potential consequences of poor diets are needed.
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Affiliation(s)
- Lucy W. Kibe
- Physician Assistant Program, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Mohsen Bazargan
- Physician Assistant Program, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
- Department of Family Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA
| | - Adaobi Bosah
- Physician Assistant Program, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Katrina M. Schrode
- Department of Psychiatry, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Yufu Kuo
- Physician Assistant Program, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Edward Andikrah
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
| | - Magda Shaheen
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA
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Cai J, Bidulescu A. The association between chronic conditions, COVID-19 infection, and food insecurity among the older US adults: findings from the 2020-2021 National Health Interview Survey. BMC Public Health 2023; 23:179. [PMID: 36703149 PMCID: PMC9880360 DOI: 10.1186/s12889-023-15061-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND This study aims to examine how the presence of chronic conditions or positive COVID-19 infection (as exposures) is related to food insecurity (as an outcome) in the older population and whether there is a dose-response relationship between the number of chronic conditions and the severity of food insecurity. METHODS Cross-sectional data of 17,977 older adults (≥ 65 years) from the 2020-2021 National Health Interview Survey were analyzed. Chronic conditions included physical health conditions (i.e., arthritis, coronary heart diseases, hypertension, stroke, prediabetes, diabetes, asthma, chronic obstructive pulmonary disease, and disability) and mental health conditions (i.e., anxiety and depression disorder). COVID-19 infection status was determined by a self-reported diagnosis of COVID-19. Household food insecurity was measured using the 10-item US Department of Agriculture (USDA) Food Security Survey Module with a 30-day look-back window. Multinomial logistic regression models were used to examine the association between health conditions and food insecurity controlling for socio-demographic factors. RESULTS Our results indicated that 4.0% of the older adults lived in food-insecure households. The presence of chronic conditions was significantly associated with higher odds of being food insecure independent of socio-demographic factors (AOR ranged from 1.17 to 3.58, all p < 0.0001). Compared with participants with 0-1 chronic condition, the odds of being (low or very low) food insecure was 1.09 to 4.07 times higher for those with 2, or ≥ 3 chronic conditions (all p < 0.0001). The severity of food insecurity significantly increased as the number of chronic conditions increased (p for trend < 0.0001). Besides, COVID-infected participants were 82% more likely to be very low food secure than the non-infected participants (AOR = 1.82, 95% CI: 1.80, 1.84). CONCLUSIONS The presence of chronic conditions or positive COVID-infection is independently associated with household food insecurity. Clinical health professionals may help identify and assist individuals at risk of food insecurity. Management and improvement of health conditions may help reduce the prevalence and severity of food insecurity in the older population.
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Affiliation(s)
- Jiahui Cai
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, IN, USA.
| | - Aurelian Bidulescu
- grid.411377.70000 0001 0790 959XDepartment of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, IN USA
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13
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Choi SL, Lee YG. Financial hardship and change in emotional well-being before to during COVID-19 pandemic among middle-aged and older Americans: Moderating effects of internal coping resources. Soc Sci Med 2023; 317:115572. [PMID: 36473337 PMCID: PMC9683862 DOI: 10.1016/j.socscimed.2022.115572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 11/10/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate associations between financial hardship and change in emotional well-being-positive and negative affect-before to during the COVID-19 pandemic among middle-aged and older Americans and to examine the extent to which associations were moderated by internal coping resources-dispositional mastery and optimism. METHOD Data derived from the Leave-Behind Questionnaire in the 2016 and 2020 waves of the Health and Retirement Study, a nationally representative longitudinal survey of U.S. adults aged 51 and older (N = 1312). We estimated multivariate ordinary least squares regression models with interaction terms to evaluate prospectively the benefits of mastery and optimism as internal coping resources for middle-aged and older adults. RESULTS Dispositional mastery moderated the effects of financial hardship on changes in negative and positive affect, respectively, before to during the COVID-19 pandemic; however, optimism did not significantly moderate the effects of financial hardship on change in negative and positive affect before to during the COVID-19 pandemic. CONCLUSIONS Our findings have implications for interventions aimed at improving middle-aged and older adults' emotional well-being by promoting internal coping resources. Specifically, interventions should focus on financial hardship and mastery for vulnerable middle-aged and older adults in the context of public health crises.
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Affiliation(s)
- Shinae L. Choi
- The University of Alabama, 304 Adams Hall, Box 870158, Tuscaloosa, AL, 35487, USA,Center for Innovation in Social Science, Boston University, 704 Commonwealth Ave, Boston, MA, 02215, USA,Corresponding author. Department of Consumer Sciences, College of Human Environmental Sciences, The University of Alabama, 304 Adams Hall, Box 870158, Tuscaloosa, AL, 35487
| | - Yoon G. Lee
- Utah State University, 2905 Old Main Hill, Logan, UT, 84322, USA
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Paparella A, Purgatorio C, Chaves-López C, Rossi C, Serio A. The Multifaceted Relationship between the COVID-19 Pandemic and the Food System. Foods 2022; 11:2816. [PMID: 36140944 PMCID: PMC9497833 DOI: 10.3390/foods11182816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/03/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
The SARS-CoV-2 pandemic is being questioned for its possible food transmission, due to several reports of the virus on food, outbreaks developed in food companies, as well as its origins linked to the wet market of Wuhan, China. The purpose of this review is to analyze the scientific evidence gathered so far on the relationship between food and the pandemic, considering all aspects of the food system that can be involved. The collected data indicate that there is no evidence that foods represent a risk for the transmission of SARS-CoV-2. In fact, even if the virus can persist on food surfaces, there are currently no proven cases of infection from food. Moreover, the pandemic showed to have deeply influenced the eating habits of consumers and their purchasing methods, but also to have enhanced food waste and poverty. Another important finding is the role of meat processing plants as suitable environments for the onset of outbreaks. Lessons learned from the pandemic include the correct management of spaces, food hygiene education for both food workers and common people, the enhancement of alternative commercial channels, the reorganization of food activities, in particular wet markets, and intensive farming, following correct hygiene practices. All these outcomes lead to another crucial lesson, which is the importance of the resilience of the food system. These lessons should be assimilated to deal with the present pandemic and possible future emergencies. Future research directions include further investigation of the factors linked to the food system that can favor the emergence of viruses, and of innovative technologies that can reduce viral transmission.
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Affiliation(s)
- Antonello Paparella
- Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, 64100 Teramo, Italy
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Wilson T, Bendich A. Nutrition Guidelines for Improved Clinical Care. Med Clin North Am 2022; 106:819-836. [PMID: 36154702 PMCID: PMC9046061 DOI: 10.1016/j.mcna.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Given the importance of poor nutrition as a cause for human chronic disease, it is surprising that nutrition receives so little attention during medical school training and in clinical practice. Specific vitamins, minerals, fatty acids, amino acids and water in the diet are essential for health, and deficiencies lead or contribute to many diseases. Proper use of the dietary guidelines and nutrition facts labeling can improve nutritional status and lead to the consumption of a healthy diet. COVID-19 has altered access to nutritious foods for millions and increased awareness of the importance of diet and immune function. An improved appreciation for nutrition will improve the outcomes of clinical care.
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Affiliation(s)
- Ted Wilson
- Department of Biology, Winona State University, Rm 232, Pasteur Hall, Winona, MN 55987, USA.
| | - Adrianne Bendich
- Springer/Nature Nutrition and Health Book Series Editor, retired, 8765 Via Brilliante Wellington, FL 33411, USA
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Gonzalvo JD, Meredith A, Adeoye–Olatunde O, Kimiecik C, Pastakia S, Rodriguez N, Ruiz Y, Ott C, Schellhase E, Crawford E, Crowe S, Samuel J, Conklin M, Adams J, Karwa R. A Call to Action from The Purdue University Center for Health Equity and Innovation (
CHEqI
). JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jasmine D. Gonzalvo
- Purdue University College of Pharmacy, Center for Health Equity and Innovation Eskenazi Health, West Lafayette Indiana
| | - Ashley Meredith
- Purdue University College of Pharmacy, Center for Health Equity and Innovation Eskenazi Health, West Lafayette Indiana
| | - Omolola Adeoye–Olatunde
- Purdue University College of Pharmacy, Center for Health Equity and Innovation, West Lafayette Indiana
| | - Carlyn Kimiecik
- Purdue University Department of Public Health, Purdue University College of Pharmacy, Center for Health Equity and Innovation, West Lafayette Indiana
| | - Sonak Pastakia
- Purdue University College of Pharmacy, Center for Health Equity and Innovation, West Lafayette Indiana
- AMPATH Kenya Moi University School of Medicine Eldoret Kenya
| | - Natalia Rodriguez
- Purdue University, Department of Public Health, College of Health and Human Sciences, West Lafayette Indiana
| | - Yumary Ruiz
- Purdue University, Department of Public Health, College of Health and Human Sciences, West Lafayette Indiana
| | - Carol Ott
- Purdue University College of Pharmacy, Center for Health Equity and Innovation Eskenazi Health, West Lafayette Indiana
| | - Ellen Schellhase
- Purdue University College of Pharmacy, Center for Health Equity and Innovation, West Lafayette Indiana
| | - Elizabeth Crawford
- Purdue University College of Pharmacy, Center for Health Equity and Innovation, West Lafayette Indiana
| | - Susie Crowe
- Purdue University College of Pharmacy, Center for Health Equity and Innovation, West Lafayette Indiana
| | - Jeffrey Samuel
- Purdue University College of Pharmacy, Center for Health Equity and Innovation, West Lafayette Indiana
- USAID Global Health Bureau ‐ Office of HIV/AIDS
| | - Megan Conklin
- Purdue University College of Pharmacy, Center for Health Equity and Innovation, West Lafayette Indiana
| | - Jerome Adams
- Purdue University, Executive Director of Health Equity Initiatives, West Lafayette Indiana
| | - Rakhi Karwa
- Purdue University College of Pharmacy, Center for Health Equity and Innovation, West Lafayette Indiana
- AMPATH Kenya Moi University School of Medicine Eldoret Kenya
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Dombrowski RD, Hill AB, Bode B, Knoff KAG, Dastgerdizad H, Kulik N, Mallare J, Blount-Dorn K, Bynum W. Assessing the Influence of Food Insecurity and Retail Environments as a Proxy for Structural Racism on the COVID-19 Pandemic in an Urban Setting. Nutrients 2022; 14:2130. [PMID: 35631271 PMCID: PMC9145022 DOI: 10.3390/nu14102130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/21/2022] [Accepted: 05/13/2022] [Indexed: 11/16/2022] Open
Abstract
A collaborative partnership launched the Great Grocer Project (GGP) in March 2021 in Detroit, Michigan where health inequities, including deaths due to COVID-19, have historically been politically determined and informed by socially entrenched norms. Institutional and structural racism has contributed to a lack of diversity in store ownership among Detroit grocers and limited access to high-quality, affordable healthy foods as well as disparate food insecurity among Detroit residents. The GGP seeks to promote Detroit's healthy grocers to improve community health and economic vitality through research, programs, and policies that have the potential to advance health equity. A cross-sectional design was used to explore relationships between scores from the Nutrition Environment Measures Surveys-Stores (NEMS-S) in 62 stores and city-level data of COVID-19 cases and deaths as well as calls to 211 for food assistance. Regression and predictive analyses were conducted at the ZIP code level throughout the city to determine a relationship between the community food environment and food insecurity on COVID-19 cases and deaths. COVID-19 cases and deaths contributed to greater food insecurity. The use of ZIP code data and the small sample size were limitations within this study. Causation could not be determined in this study; therefore, further analyses should explore the potential effects of individual grocery stores on COVID-related outcomes since a cluster of high-scoring NEMS-S stores and calls to 211 for food security resources inferred a potential protective factor. Poor nutrition has been shown to be associated with increased hospitalizations and deaths due to COVID-19. It is important to understand if a limited food environment can also have a negative effect on COVID-19 rates and deaths. Lessons learned from Detroit could have implications for other communities in using food environment improvements to prevent an uptick in food insecurity and deaths due to COVID-19 and other coronaviruses.
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Affiliation(s)
- Rachael D. Dombrowski
- Center for Health and Community Impact, Division of Kinesiology, Health & Sport Studies, College of Education, Wayne State University, Detroit, MI 48202, USA; (B.B.); (K.A.G.K.); (H.D.); (N.K.); (J.M.)
| | - Alex B. Hill
- Center for Urban Studies, College of Liberal Arts and Science, Urban Health, Wayne State University, Detroit, MI 48202, USA;
| | - Bree Bode
- Center for Health and Community Impact, Division of Kinesiology, Health & Sport Studies, College of Education, Wayne State University, Detroit, MI 48202, USA; (B.B.); (K.A.G.K.); (H.D.); (N.K.); (J.M.)
| | - Kathryn A. G. Knoff
- Center for Health and Community Impact, Division of Kinesiology, Health & Sport Studies, College of Education, Wayne State University, Detroit, MI 48202, USA; (B.B.); (K.A.G.K.); (H.D.); (N.K.); (J.M.)
| | - Hadis Dastgerdizad
- Center for Health and Community Impact, Division of Kinesiology, Health & Sport Studies, College of Education, Wayne State University, Detroit, MI 48202, USA; (B.B.); (K.A.G.K.); (H.D.); (N.K.); (J.M.)
| | - Noel Kulik
- Center for Health and Community Impact, Division of Kinesiology, Health & Sport Studies, College of Education, Wayne State University, Detroit, MI 48202, USA; (B.B.); (K.A.G.K.); (H.D.); (N.K.); (J.M.)
| | - James Mallare
- Center for Health and Community Impact, Division of Kinesiology, Health & Sport Studies, College of Education, Wayne State University, Detroit, MI 48202, USA; (B.B.); (K.A.G.K.); (H.D.); (N.K.); (J.M.)
| | | | - Winona Bynum
- Detroit Food Policy Council, Detroit, MI 48226, USA; (K.B.-D.); (W.B.)
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Abstract
IMPORTANCE Allostatic overload, a biomarker of wear and tear, could be the potential pathway through which food insecurity leads to increased morbidity risk. OBJECTIVE To assess the association of food insecurity with allostatic load (AL) among US adults aged 50 years or older. DESIGN, SETTING, AND PARTICIPANTS A multiwave longitudinal cohort study was conducted using data from the 2006 to 2014 waves of the Health and Retirement Study in a national cohort study setting. The data comprise 26 509 person-years observations from 14 394 noninstitutionalized individuals aged 50 years or older during the study period. Data were analyzed from September 1 to December 14, 2020. EXPOSURES Moderate food insecurity (not enough money to buy the food needed) and severe food insecurity (reduced food intake due to financial constraints) measured at the household level. MAIN OUTCOMES AND MEASURES The AL score (0-9, with higher scores indicating a greater risk of physiologic dysregulation) and binary indicators of dysregulated inflammatory (C-reactive protein), cardiovascular (systolic and diastolic blood pressure, pulse rate, and cystatin C), and metabolic (hemoglobin A1c, body mass index, waist-to-height ratio, total cholesterol to high-density lipoprotein cholesterol ratio) systems. RESULTS Of 14 394 participants included in the analysis, the median age was 60 (IQR, 56-69) years, 8143 (56.6%) were women, 517 (3.6%) were moderately food insecure, and 804 (5.6%) were severely food insecure. In adjusted models, the incidence rate of AL was 1.05 (95% CI, 1.00-1.09) times higher for the participants with moderate food insecurity and 1.11 (95% CI, 1.07-1.15) times higher for the participants with severe food insecurity, compared with those who were food secure. The increased incidence rate of AL among participants with severe food insecurity was associated with C-reactive protein level (odds ratio [OR], 1.22; 95% CI, 1.04-1.44), cystatin C level (OR, 1.23; 95% CI, 1.01-1.51), hemoglobin A1c level (OR, 1.27; 95% CI, 1.01-1.59), body mass index (OR, 1.84; 95% CI, 1.41-2.40), waist-to-height ratio (OR, 1.54; 95% CI, 1.26-1.88), and total to high-density lipoprotein cholesterol ratio (OR, 1.32; 95% CI, 1.10-1.59) inflated to the high-risk range. The interaction between moderate food insecurity and Supplemental Nutrition Assistance Program (SNAP) enrollment (β = -0.18; P = .001) and the interaction between severe food insecurity and SNAP enrollment (β = -0.09; P = .02) were associated with a reduction in AL. CONCLUSIONS AND RELEVANCE In this national cohort study of US adults aged 50 years or older, food insecurity was associated with higher AL, mainly through dysregulation of the inflammatory and metabolic systems. SNAP enrollment may modify this association between food insecurity and AL.
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Affiliation(s)
- Tae-Young Pak
- Department of Consumer Science and Convergence Program for Social Innovation, Sungkyunkwan University, Seoul, South Korea
| | - GwanSeon Kim
- College of Agriculture, Arkansas State University, Jonesboro
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