"Nothing is going to change three months from now": A mixed methods characterization of food bank use in Greater Vancouver

The role of dignity in food assistance: Participant experiences with a free meal kit program

Federal and private food assistance programs play a crucial role in addressing hunger and nutrition insecurity in the United States. However, using food assistance poses inherent challenges to the construction of food dignity given the longstanding neoliberal stigma surrounding the use of charitable food programs. A human rights approach to food shifts the emphasis from receiving enough food to promoting a food system that values and promotes dignity. Drawing on 116 in-depth interviews with 67 participants during and after their use of a free 4-week meal kit program called Pass the Love, this analysis reveals six components of a high-dignity food experience. These include: (1) unconditional access (2) providing a complete meal (3) fresh and healthy food (4) minimizing access and preparation burden (5) conveying care and generating positive emotional experiences, and (6) honoring diverse foodways and practices. This study contributes to a growing literature on food dignity and suggests that food assistance programs can better achieve their goals by fostering food dignity.

Association between food security status and dietary patterns in a cohort of first-time food-aid users

OBJECTIVE

To examine the associations between food security status and dietary patterns among first-time food-aid users.

METHODS

From September 2018 to January 2020, a sample of 1001 newly registered food-aid users from 106 community-based food donation organizations were recruited across urban, rural, and peri-urban areas in four administrative regions of the province of Quebec, Canada. The Household Food Security Survey Module (HFSSM) and the Short Diet Questionnaire (SDQ) were used to assess food security status and food intake, respectively. A posteriori dietary patterns were identified through principal component analysis. Regression analyses were performed on 987 participants with complete data to quantify the association between food security status and dietary patterns.

RESULTS

Three main dietary patterns were identified: prudent (intake of fruits and fruit juice, plant-based beverages and legumes, green salad, carrots, other vegetables, whole grains, and fish), western (intake of poultry, red meat, potatoes and fried potatoes, rice, and pasta and refined grains), and snack foods (intake of salty snacks, cheese, butter and margarine, sweets, condiments, sweet beverages, and processed meat). Food insecurity was negatively associated with the prudent dietary pattern and positively associated with the snack food dietary pattern.

CONCLUSION

This study highlights the complexity of dietary patterns in a vulnerable population of first-time food-aid users, especially among those who are severely food insecure.

Characterizing Trends in the Use of Food Donations and Other Food-Related Community-Based Social Assistance Programs in a Cohort of New Food Bank Users in Quebec, Canada

Objective: To characterize 12-month trends in the use of food donations and other food-related community-based social assistance programs (CB-SAPs) during the first year following the enrollment of new food bank (FB) users in Quebec, Canada. Methods: A cohort of 1,001 newly registered FB-users in Quebec from the Pathways Study were followed-up during 12-month following baseline assessment. Outcomes were monthly use of food donations and other food-related CB-SAPs. Main predictors were alternative food source utilization (AFSU) profiles: 1) exclusive-FB-users; 2) FB+fruit/vegetable-market-users; and 3) Multiple/diverse-AFS-users. Covariates included sociodemographic characteristics, health status, and major life events. We fit Bayesian hierarchical mixed-effect models, accounting for spatial clustering, temporal correlation, and censoring. Results: We observed an overall downward trend of food donation use among study completers (n = 745). Each AFSU profile had a distinctive monthly trend of food donation use, but probabilities of use across the three profiles overlapped, between 44% and 55%. The use of other food-related CB-SAPs was low and not correlated with AFSU profiles. Conclusion: De novo FB-users use food donations in different ways over time according to specific contextual AFSU profiles.

Experiences and perceived outcomes of a grocery gift card programme for households at risk of food insecurity

OBJECTIVE

This study explored programme recipients' and deliverers' experiences and perceived outcomes of accessing or facilitating a grocery gift card (GGC) programme from I Can for Kids (iCAN), a community-based programme that provides GGC to low-income families with children.

DESIGN

This qualitative descriptive study used Freedman et al's framework of nutritious food access to guide data generation and analysis. Semi-structured interviews were conducted between August and November 2020. Data were analysed using directed content analysis with a deductive-inductive approach.

PARTICIPANTS

Fifty-four participants were purposively recruited, including thirty-seven programme recipients who accessed iCAN's GGC programme and seventeen programme deliverers who facilitated it.

SETTING

Calgary, Alberta, Canada.

RESULTS

Three themes were generated from the data. First, iCAN's GGC programme promoted a sense of autonomy and dignity among programme recipients as they appreciated receiving financial support, the flexibility and convenience of using GGC, and the freedom to select foods they desired. Recipients perceived these benefits improved their social and emotional well-being. Second, recipients reported that the use of GGC improved their households' dietary patterns and food skills. Third, both participant groups identified programmatic strengths and limitations.

CONCLUSION

Programme recipients reported that iCAN's GGC programme provided them with dignified access to nutritious food and improved their households' finances, dietary patterns, and social and emotional well-being. Increasing the number of GGC provided to households on each occasion, establishing clear and consistent criteria for distributing GGC to recipients, and increasing potential donors' awareness of iCAN's GGC programme may augment the amount of support iCAN could provide to households.

Food-related worry and food bank use during the COVID-19 pandemic in Canada: results from a nationally representative multi-round study

BACKGROUND

Early in the COVID-19 pandemic, nearly one in five adults in Canada worried about having enough food to meet their household's needs. Relatedly, throughout the pandemic, public messaging repeatedly urged Canadians to support food charities, including food banks. Yet few studies have examined food bank usage during the pandemic or whether food charities were widely used by Canadians worried about food access.

METHODS

This study draws on four rounds of nationally representative surveying conducted during the COVID-19 pandemic between May 2020 and December 2021 among adults 18 years and older living in Canada. Descriptive statistics were used to examine rates of food-related worry during all four survey rounds. Data from the fourth survey round, collected in December 2021, were used to explore use of food-based community programs since the onset of the pandemic, including food banks. Logistic regression analyses were used to examine differences in socio-demographic and health-related characteristics between adults who did and did not report accessing food banks before and after adjusting for household income.

RESULTS

Across survey rounds (n = 12,091), more than one in seven participants reported stress or worry related to having enough food to meet their household's basic needs in the previous two weeks. Yet, by December 2021, fewer than 4% of participants reported ever accessing a food bank during the pandemic. Younger age, living with a child, financial concerns due to the pandemic, two different measures of food worry, pre-existing mental health conditions, disability, LGBT2Q + identity, and racialized or Indigenous identity, were each statistically significantly associated with higher odds of using food banks even when controlling for household income.

CONCLUSIONS

Despite persistently high rates of food-related worry in 2020 and 2021 in Canada, relatively few adults reported accessing food banks or other charity-based community food programs. While respondents facing social, financial, and health-related inequities and reporting food worry were more likely to use food banks, most respondents did not report food bank use, regardless of financial or demographic circumstances or experiences of food worry. Findings align with previous research indicating that more adequate and comprehensive supports are needed to alleviate food-related-worry in Canada.

Food donation as a strategy to reduce food waste in an emerging Latin American country: a case study in Uruguay

Abstract

Food donation has expanded globally and has become a common form of food assistance in emerging countries. However, research on food donation experiences in these settings is still scarce.

Purpose

In this context, the objectives of the present work were as follows: (i) to explore the views of Uruguayan stakeholders on food donation as a strategy to reduce food waste, (ii) to identify barriers and enablers for food donation in Uruguay, and (iii) to explore the organizational characteristics of Uruguayan food banks.

Methods

A qualitative approach based on two data collection strategies was used: documentary content analysis of official governmental documents and in-depth semi-structured interviews with key stakeholders related to food waste and food donations in Uruguay.

Results

Food donation emerged as a central strategy for food waste reduction in the view of Uruguayan stakeholders, mainly because it was perceived as an efficient strategy to reduce food insecurity. The complexity of food donation was acknowledged by Uruguayan stakeholders and who identified several barriers for its implementation related to economic considerations, the characteristics of the donated products, legal and commercial considerations, and organizational characteristics of food banks.

Conclusion

Although most barriers were aligned with results from previous studies conducted in developed countries, some specificities to the Uruguayan context were also identified. Clear and detailed legal frameworks to ensure that the donated products reach the target population along with nutritional requirements for the foods to be donated were deemed necessary.

The nutritional quality of food parcels provided by food banks and the effectiveness of food banks at reducing food insecurity in developed countries: a mixed-method systematic review

BACKGROUND

Research indicates that food parcels provided by food banks are nutritionally poor. Food insecurity and the use of food banks are both rising, with detrimental effects on the dietary intake and health of users. This mixed-method systematic review aims to investigate the current nutritional adequacy of pre-packaged food parcels and whether using food banks reduces the food insecurity and improves the dietary intake of their users.

METHODS

A mixed-method systematic literature review, restricted to articles published from 2015, was conducted using eight electronic databases, four grey literature databases and eight relevant websites. Quantitative findings, investigating the nutritional quality of food parcels and/or their impact on dietary intake or food insecurity, were presented narratively. Qualitative findings reporting the views of food bank users regarding food from food banks underwent thematic synthesis. These independent syntheses were integrated using configurative analysis and presented narratively.

RESULTS

Of 2189 articles, 11 quantitative and 10 qualitative were included. Food parcels were inconsistent at meeting nutritional requirements and often failed to meet individual needs, including cultural and health preferences. Using food banks improved food security and dietary quality of users, allowing otherwise unachievable access to food. However, food insecurity remained, and is explained by limited food variety, quality and choice. The mixed-method findings support interventions to ensure consistent, adequate nutrition at food banks, including catering for individual needs.

CONCLUSIONS

Food banks are a lifeline for those severely food insecure. However when used alone, food banks struggle to eliminate the heightened food insecurity of their users. Efforts to improve the nutritional quality of food parcels could improve the experiences and diet-related outcomes of those requiring food banks.

Food Hubs as a Means to Promote Food Security in Post-Secondary Institutions: A Scoping Review

An estimated 20 to 50% of post-secondary students experience food insecurity. Students who are food insecure are more likely to have poor health and lower academic performance relative to food secure peers. Food hubs are physical or digital spaces that provide access to food initiatives and wraparound programs such as employment placement or income support are increasingly of interest as a means to respond to food insecurity. We conducted a scoping review to identify best practices and effective approaches to food hubs that promote food security in post-secondary institutions in North America. The Medline, Embase, CAB Direct and Web of Science databases were searched. A total of 4637 articles were identified and screened by two reviewers. Four articles were included. They encompassed a mix of interventions: a campus pantry and garden, a food rescue program, food literacy-based curriculum and a toolkit to support implementation of interventions on campus. The heterogeneity of studies precluded identification of best practices, but positive impacts of all interventions were noted on metrics such as self-efficacy and greater awareness of food insecurity. The gap in evidence on effective approaches that promote campus food security is a critical barrier to development and implementation of interventions, and should be addressed in future studies.

More food for thought: a follow-up qualitative study on experiences of food bank access and food insecurity in Ottawa, Canada

BACKGROUND

Despite the widespread proliferation of food banks in high-income countries over the past several decades, there is a paucity of data regarding the long-term experiences of the people who rely on food banks. We were unable to find any other studies with follow-up interviews later than 6 months after baseline.

OBJECTIVE

This study examined the changes in the lived experiences of people who accessed food banks over a period of 18 months.

METHODS

Semi-structured interviews were conducted with 11 people who accessed food banks in Ottawa, Canada and who had participated in a 6-month study that ended one full year before this follow-up study was done. Transcripts of the interviews were analyzed through a general inductive approach involving repeated readings and coding of relevant segments of text with NVivo software according to themes that emerged iteratively. Code reports were then used to discuss and reach consensus on a final set of themes.

RESULTS

Three main themes emerged: (1) chronic physical and mental health issues intersecting with food bank access; (2) psychosocial impact of relying on food banks; and (3) living on a low income and dealing with poverty. Chronic physical and mental health conditions were prevalent among the participants. As well, 10 of the 11 participants in this 18-month follow-up continued to rely on food banks as a regular resource - not as an emergency relief measure - to supplement their nutritional needs. While most of the participants reported that food banks helped them in some way, many shortcomings were also noted regarding food amounts, quality and choice. Overall, there was little change reported since the 6-month follow-up.

CONCLUSIONS

The shortcomings reported by participants can mostly be attributed to the dependence of food banks on charitable donations; thus, despite the commendable work of food bank staff and volunteers, participants described the food assistance as inadequate. Additionally, long-term food bank usage was a common denominator in the lived experiences of all our participants; therefore, our findings reinforce the need for assistance programs that target long-term food insecurity and its underlying causes, to replace or supplement charity-based food bank programs.

Use of Formal and Informal Food Resources by Food Insecure Families in Lima, Peru: A Mixed-Methods Analysis

The goal of this study was to measure food insecurity among families with children in a low-income district of Lima, Peru and to identify the formal and informal food resources available to them that may affect their food security status. In June-July 2019, we collected data from 329 randomly selected households in Villa El Salvador (Lima, Peru). Following a mixed methods approach, we found that the percentage of households using food assistance programs (FAPs) increased with increasing levels of food insecurity, but two FAPs were heavily used by households regardless of food (in)security. The main reasons for using FAPs included financial need, already being signed up in the program, and believing that the food was of nutritional value; the main reasons for non-use were finding the program unnecessary, dislike or poor perceived quality of the food, and not being able to sign up for the program. Similarly, informal food resources, such as buying food on credit or receiving food from someone outside the household, were incrementally used with increased levels of food insecurity. Our study clarifies the relationship between level of household food insecurity and FAP use - FAPs more commonly used by food insecure households were used because of financial need, whereas the FAPs most commonly used by food secure households were those with automatic enrollment. At a programmatic level, our research highlights the need for making nutritious and preferred foods available in FAPs and standardizing the application of enrollment criteria.

Changes in accessibility to emergency and community food services during COVID-19 and implications for low income populations in Hamilton, Ontario

In this paper we analyze the changes in accessibility to emergency and community food services before and during the COVID-19 pandemic in the City of Hamilton, Ontario. Many of these food services are the last line of support for households facing food insecurity; as such, their relevance cannot be ignored in the midst of the economic upheaval caused by the pandemic. Our analysis is based on the application of balanced floating catchment areas and concentrates on households with lower incomes (<CAD40,000, approximately the Low Income Cutoff Value for a city of Hamilton's size). We find that accessibility was low to begin with in suburban and exurban parts of the city; furthermore, about 14% of locations originally available in Hamilton closed during the pandemic, further reducing accessibility. The impact of closures on the level of service of the remaining facilities, and on accessibility, was disproportionate, with system-wide losses exceeding 39%. Those losses were geographically and demographically uneven. While every part of the city faced a reduction in accessibility, inner suburbs fared worse in terms of loss of accessibility. As well, children (age ≤18) appear to have been impacted the most.

Chronic pain and depressive symptoms are related to food insecurity among urban food bank users

BACKGROUND

Food bank users suffer high food insecurity. Food insecurity increases risk for chronic health conditions. However, chronic pain and its relation to food insecurity among food bank users is unknown. Knowledge about populations with chronic pain is important to direct appropriate public health nutritional strategies.

METHODS

Participants completed a survey including sleep, pain, depressive symptoms and food insecurity measures. Descriptive statistics characterized the burden of chronic pain among the sample, and a series of chi-square and t-tests assessed for demographic differences between food bank users who reported pain compared to those who did not. Logistic regression tested for variables predicting food insecurity.

RESULTS

Within the sample (N = 207), 53% reported a chronic pain diagnosis. Adults with pain were more likely to receive food stamps and to have a mental health condition than those without pain. Regression analyses revealed that depressive symptoms and chronic pain significantly predicted food insecurity when controlling for age and gender.

CONCLUSIONS

Exploring the link between depression, pain and nutritional resources may enhance understanding of causal relationships driving food insecurity. Public health officials should address nutritional needs of adults including those with chronic pain who use food bank services.

Technical Assistance is Related to Improvements in the Food Pantry Consumer Nutrition Environment

OBJECTIVE

To assess changes in food pantries' consumer nutrition environment (CNE) after the provision of technical assistance.

DESIGN

Pre-post study with 2 phases.

SETTING

Staff completed observational assessments using the Nutrition Environment Food Pantry Assessment Tool (NEFPAT) at food pantries in an initial pilot phase. Then, staff conducted NEFPAT observations at pantries in Illinois statewide.

PARTICIPANTS

In the pilot phase, 6 staff assessed 28 pantries. In the statewide phase, 35 staff assessed 119 pantries.

INTERVENTION

After completing an initial NEFPAT at each pantry, technical assistance was provided by staff to support changes in the pantries' CNE before another NEFPAT observation was completed.

MAIN OUTCOME MEASURE

Changes in the CNE, as assessed with the NEFPAT, when comparing preassessment and postassessment.

ANALYSIS

Score differences were evaluated with paired t tests.

RESULTS

In the pilot phase, among 23 pantries with preassessment and postassessment data, 2 objectives on the NEFPAT observation increased significantly. In the statewide phase, among 66 pantries with preassessment and postassessment data, most NEFPAT objectives and the overall NEFPAT score (22.12 ± 8.16 vs 28.20 ± 7.14, P < 0.001) significantly increased.

CONCLUSIONS AND IMPLICATIONS

Technical assistance provided by Supplemental Nutrition Assistance Program Education implementing staff were related to improvements in the CNE of food pantries in Illinois. Future work should evaluate the association of these CNE changes with changes in behavior among pantry patrons.

The lived experience of food pantry users in Minnesota: Qualitative findings from a statewide survey

Objectives

In 2017 a community-University of Minnesota collaborative conducted a statewide survey of food pantry clients.

Methods

Of the 188 food pantries surveyed, 4321 individual client surveys were returned, from which 2,251 open-ended responses were analyzed.

Results

Respondents shared gratitude for the food pantry in meeting their needs for food and support. Many described accessing healthy food that was needed to address health needs. Respondents described life circumstances and hardships that led to food pantry use.

Conclusion

The supportive environment provided by food pantries position them to address the needs of clients, including those with complex health needs.

The impact of novel and traditional food bank approaches on food insecurity: a longitudinal study in Ottawa, Canada

Background

Food insecurity is strongly associated with poor mental and physical health, especially with chronic diseases. Food banks have become the primary long-term solution to addressing food insecurity. Traditionally, food banks provide assistance in the form of pre-packed hampers based on the food supplies on hand, such that the food items often do not meet the recipients’ cultural, religious or medical requirements. Recently, new approaches have been implemented by food banks, including choice models of food selection, additional onsite programming, and integrating food banks within Community Resource Centres.

Methods

This study examined changes in food security and physical and mental health, at four time points over 18 months at eleven food banks in Ottawa, Ontario, Canada. The participants – people who accessed these food banks – were surveyed using the Household Food Security Survey Module (HFSSM) and the Short-Form Health Survey Version 2 (SF-12). Statistical analyses included: pairwise paired t-tests between the mean perceived physical and mental health scores across the four waves of data collection, and longitudinal mixed effects regression models to understand how food security changed over time.

Results

The majority of people who were food insecure at baseline remained food insecure at the 18-month follow-up, although there was a small downward trend in the proportion of people in the severely food insecure category. Conversely, there was a small but significant increase in the mean perceived mental health score at the 18-month follow-up compared to baseline. We found significant reductions in food insecurity for people who accessed food banks that offered a Choice model of food distribution and food banks that were integrated within Community Resource Centres.

Conclusions

Food banks offer some relief of food insecurity but they don’t eliminate the problem. In this study, reductions in food insecurity were associated with food banks that offered a Choice model and those that were integrated within a Community Resource Centre. There was a slight improvement in perceived mental health at the 18-month time point; however, moderately and severely food insecure participants still had much lower perceived mental health than the general population.

Food Insecurity amid the COVID-19 Pandemic: Food Charity, Government Assistance, and Employment

To mitigate the effects of the coronavirus disease 2019 (COVID-19) pandemic, the federal government has implemented several financial assistance programs, including unprecedented funding to food charities. Using the Canadian Perspectives Survey Series 2, we examine the demographic, employment, and behavioural characteristics associated with food insecurity in April-May 2020. We find that one-quarter of job-insecure individuals experienced food insecurity that was strongly associated with pandemic-related disruptions to employment income, major financial hardship, and use of food charity, yet the vast majority of food-insecure households did not report receiving any charitable food assistance. Increased financial support for low-income households would reduce food insecurity and mitigate negative repercussions of the pandemic.

The prevalence, severity and experience of food insecurity in Australia: An investigation of food aid use

High costs of living and low wage growth in Australia have resulted in an increase in the number of people experiencing food insecurity, and a corresponding increase in the number of people accessing food aid. This research employs qualitative methods alongside standard methods to explore food security to investigate these issues in food aid settings in Victoria, Australia. The two aims of this study were, 1) to explore the profile of people who access food aid and 2) to explore the experiences of people accessing food aid. A convenience sample of people was recruited from organisations that distribute food aid from across the state. People in need of food aid typically self-refer to charities, who then apply varied and localised criteria to manage access to the charitable service. Interviews were conducted with 78 participants between June 2018 and January 2019. Participants had been accessing food aid for 4 years on average (SD 5.7, range 1 month-40 years), most participants were female (n = 57, 73.1%), with an average age of 52.6 years (SD 15.9), and over half were born in Australia (n = 44, 56.4%). Most participants were in receipt of a government welfare payment (n = 75, 96.2%), and over 40% were living in private rental accommodation. Around two thirds of participants reported low or very low food security (n = 54, 67.5%). Participants reported a range of both positive and negative experiences accessing food aid. This study adds to the body of literature exploring food insecurity in high-income settings and its persistence despite significant national economic prosperity. Current economic and political conditions in Australia mean that the reliance on food aid by welfare recipients is unlikely to decrease.

A qualitative investigation of lived experiences of long-term health condition management with people who are food insecure

Background

As more people are living with one or more chronic health conditions, supporting patients to become activated, self-managers of their conditions has become a key health policy focus both in the UK and internationally. There is also growing evidence in the UK that those with long term health conditions have an increased risk of being food insecure. While international evidence indicates that food insecurity adversely affects individual’s health condition management capability, little is known about how those so affected manage their condition(s) in this context. An investigation of lived experience of health condition management was undertaken with food insecure people living in north east Scotland. The study aimed to explore the challenges facing food insecure people in terms of, i. their self-care condition management practices, and ii. disclosing and discussing the experience of managing their condition with a health care professional, and iii. Notions of the support they might wish to receive from them.

Methods

Twenty in-depth interviews were conducted with individuals attending a food bank and food pantry in north east Scotland. Interview audio recordings were fully transcribed and thematically analysed.

Results

Individuals reporting multiple physical and mental health conditions, took part in the study. Four main themes were identified i.e.: 1. food practices, trade-offs and compromises, that relate to economic constraints and lack of choice; 2. illness experiences and food as they relate to physical and mental ill-health; 3. (in) visibility of participants’ economic vulnerability within health care consultations; and 4. perceptions and expectations of the health care system.

Conclusions

This study, the first of its kind in the UK, indicated that participants’ health condition management aspirations were undermined by the experience of food insecurity, and that their health care consultations in were, on the whole, devoid of discussions of those challenges. As such, the study indicated practical and ethical implications for health care policy, practice and research associated with the risk of intervention-generated health inequalities that were suggested by this study. Better understanding is needed about the impact of household food insecurity on existing ill health, wellbeing and health care use across the UK.

Food Charity, Shame/ing and the Enactment of Worth

Food insecurity is a significant problem in many countries, including Australia. Consequently, food hubs, through which food is distributed using a supermarket style layout, have become an important new source of charity food provision. However, little is known about users' experiences. We draw on ethnographic research to understand the everyday experiences of people using South Australian food hubs. We suggest that attempts to produce a more dignified experience by creating a normalizing experience of shopping is not being achieved, because of the shame and stigma surrounding poverty, confusing operational processes, poor food quality, staff attitudes, and the disciplinary capacity of food hubs.

A Mixed-Methods Evaluation of a Novel Food Pantry in a Pediatric Primary Care Center

Evidence suggests that management of food insecurity in primary care may enhance preventive care delivery. This study assessed the impact of a food pantry in a pediatric primary care center over 22 months. Quantitative outcome assessments (number of children affected, number of referrals, and completion of preventative services) compared the child receiving food from the pantry to age-matched controls. Commonalities from interviews with pantry-using families were identified using thematic analysis. A total of 504 index patients received food from the pantry during an office visit. There were 546 in-clinic and community referrals. There was no significant relationship between accessing the pantry and preventative service completion by 27 months of age. Themes that emerged during interviews included the need for an emergency food source, facilitation of referrals, and increased trust in the clinic. An in-clinic food pantry is a feasible and family-welcomed approach to address food insecurity in pediatric primary care.

The Intersection of Food Insecurity and Tobacco Use: A Scoping Review

Cigarette smoking is increasingly concentrated in socioeconomically disadvantaged groups, and food insecurity also disproportionately affects lower-income groups. Recent studies have suggested that smoking and food insecurity operate as risk factors for one another, but there is limited understanding of their intersection. This scoping review aimed to synthesize the published literature on the association between food insecurity and tobacco use across population groups in the United States and Canada. We searched PubMed, Web of Science, and PsycINFO using key words. Studies included were published in English between 2008 and 2018, reported empirical findings, measured both tobacco use and food insecurity, and considered either variable as a study outcome. Nineteen articles were identified; 6 examined tobacco use as an outcome variable and 13 examined food insecurity as an outcome variable. Most articles were of studies using cross-sectional designs. Study samples ranged from general populations, clinical samples, and underserved populations. For each article, we extracted information including specific findings related to the association between food insecurity and tobacco use. We synthesized the current research by formulating a model by which food insecurity and tobacco use are bidirectionally associated. This scoping review concludes that the co-occurrence of food insecurity and tobacco use exists across populations in the United States and Canada. As the evidence is largely from cross-sectional investigations, there is a need for longer term, comprehensive assessments of relationships between tobacco use and food insecurity. Such investigations can inform policies and interventions aimed toward addressing the inequitable burden of tobacco use and of food insecurity among disadvantaged populations.

"A Lot of People Are Struggling Privately. They Don't Know Where to Go or They're Not Sure of What to Do": Frontline Service Provider Perspectives of the Nature of Household Food Insecurity in Scotland

This qualitative study explored frontline service providers' perceptions of the nature of food insecurity in Scotland in 2015 to inform national policy and the provision of locally-based support for 'at risk' groups. A country-wide in-depth interview study was undertaken with informants from 25 health, social care, and third sector organisations. The study investigated informants' perspectives associated with how food insecurity was manifesting itself locally, and what was happening at the local level in response to the existence of food insecurity. Data analysis revealed three key themes. First, the multiple faces and factors of food insecurity involving not only increased concern for previously recognised 'at risk of food insecurity' groups, but also similar concern held about newly food insecure groups including working families, young people and women. Secondly, respondents witnessed stoicism and struggle, but also resistance amongst some food insecure individuals to external offers of help. The final theme identified community participation yet pessimism associated with addressing current and future needs of food insecure groups. These findings have important implications for the design and delivery of health and social policy in Scotland and other countries facing similar challenges.

Examining Patterns of Food Bank Use Over Twenty-Five Years in Vancouver, Canada

Food banks have grown substantially in Canada since the 1980s but little is known about patterns or predictors of engagement including frequency or duration of service use. This study examined food bank program data from a large food bank organization in Vancouver, Canada, finding that between January 1992 and June 2017, at least 116,963 individuals made over 2 million food bank visits. The majority of members were engaged for a short time and came for relatively few visits, but 9% of members engaged in longer-term episodic or ongoing usage over several years, accounting for 65% of all visits. Results from cluster and regression analyses found that documented health and mobility challenges, larger household size, primary income source, and older age were predictors of higher frequency and duration of service usage. Findings add to growing critical examinations of the "emergency food system" highlighting the need for better understanding of the broader social policies influencing food bank use.