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

Benchmarking the university campus food environment and exploring student perspectives about food insecurity and healthy eating: a case study from Australia

OBJECTIVE

To benchmark the university food environment and explore students' experiences with food insecurity and healthy eating in order to inform interventions to improve access and affordability of healthy foods for university students.

DESIGN

A food environment audit was conducted on the university campus using the Uni-Food tool from April to May 2022 and was comprised of three main components, university systems and governance, campus facilities and environment, and food retail outlets. A qualitative study design was also used to conduct focus groups and semi-structured interviews with students to explore key themes regarding their experiences with food insecurity and healthy eating.

SETTING

Macquarie University, Australia.

PARTICIPANTS

For the food environment audit 24 retail outlets on campus and for the qualitative component 29 domestic and international students enrolled at Macquarie University.

RESULTS

The university only scored 27% in total for all components in the food environment audit. The results showed the need for better governance and leadership of the food environment. The qualitative component suggested that the main barriers to accessing healthy foods were related to availability, pricing, and knowledge of healthy foods. Future intervention ideas included free fruits and vegetables, food relief, discounts, improved self-catering facilities, education, and increased healthy food outlets.

CONCLUSIONS

Improving governance measures related to healthy eating on campus are a core priority to strengthen the food environment and students identified pricing and availability as key issues. These findings will inform effective and feasible interventions to improve food security and healthy eating on campus.

Food insecurity in adults with severe mental illness: A systematic review with meta-analysis

INTRODUCTION

Food insecurity in adults living with Severe Mental Illness (SMI) is an underresearched area worldwide.

AIM

This systematic review and meta-analysis aimed to identify and collate evidence on food insecurity in adults with SMI, in high- and upper-middle income countries.

METHOD

A comprehensive electronic search was completed up to August 2022. Random effects meta-analysis was undertaken to determine the prevalence and the odds ratio for food insecurity in adults with SMI. Narrative synthesis explored the data further.

RESULTS

Sixteen publications were included (13 in the meta-analysis). The prevalence estimate of food insecurity in adults with SMI was 41% (95% CI: 29% to 53%, I2  = 99.9%, n = 13). Adults with SMI were 3.31 (95% CI: 2.03 to 5.41) times more likely to experience food insecurity than comparators without SMI (z = 6.29, p < .001, I2  = 98.9%, n = 6). Food insecurity appears to be a risk factor for developing SMI.

DISCUSSION

This review suggests adults with SMI living in high- or upper-middle income countries are more likely to experience food insecurity than the general population and that this relationship may be inverse.

IMPLICATIONS FOR PRACTICE

Mental health practitioners should be aware of food insecurity and support individuals with SMI to access sufficient food.

The lived experience of food insecurity among adults with obesity: a quantitative and qualitative systematic review

BACKGROUND

Food insecurity and obesity are increasing both globally and in the UK. In thisreview we systematically assess the lived experiences of people with obesity who are food insecure and often turn to foodbanks.

METHODS

We systematically searched electronic databases from January 2007 until October 2022. Data from eligible studies were extracted and the studies assessed for quality. Thematicanalysis and narrative synthesis approach was used to analyse the extracted data.

RESULTS

Six themes were identified among 25 included studies, including: the financial cost of food; psychological aspects related to food insecurity; geographical access and the foodenvironment; food practices in the home; experience of food assistance; and parental-childrelationships. The cost of healthy food and psychological factors were identified as keydriving factors of the relationship between food insecurity and obesity. Psychological factorssuch as depression, low self-esteem and stress played an important part in the livedexperience of people with obesity and food insecurity.

CONCLUSION

The food environment provides context in which food decisions are made,therefore, systems change is necessary to ensure families can afford the food that enables ahealthy diet. For clinicians, identification, and attention to the impact of food insecurity onpeople with obesity are important.

Lessons on food security from the COVID-19 pandemic in Bermuda

Compared with other OECD countries, Bermuda ranks third globally in terms of income inequality globally. During the COVID-19 pandemic, anecdotal evidence suggested, significant fluctuations in the food demand and supply. We aimed to examine the impact of the COVID-19 pandemic on food insecurity, with a focus on the availability and affordability of various foods in Bermuda. We utilized a cross-sectional study design to investigate potential drivers of food insecurity within the local population. To gauge the level of household food insecurity we relied on the Bermuda Omnibus survey (N = 400) undertaken by Total Research Associates Ltd via telephone. To assess changes in food availability and affordability we conducted semi-structured interviews with key stakeholders who played pivotal roles in shaping food accessibility availability and affordability of food in Bermuda. These interviews were systematically analysed using the framework method. We performed analyses of food retail and import data to evaluate fluctuations in food prices and their impact on food availability and affordability. We found statistically significant associations between changes in food consumption, household income, and government aid. Food aid beneficiaries ate fewer fruits and vegetables by 50% [95% CI:17%-83%] and less fresh meat and fish by 39% [95 CI:3%-75%] compared with residents who did not receive any aid during the COVID-19 period from March 2020 to March 2021. Although we did not identify statistically significant food price increases feeding programmes played a pivotal role in preventing food insecurity during the pandemic in Bermuda. However, a lack of monitoring regarding the nutritional quality within the programmes, allowed a wide availability of foods high in sugar, salts, and fats, disproportionately affected low-income populations. In conclusion, food availability in Bermuda remained largely unaffected during the pandemic. Nevertheless, the surge in demand for feeding programs underscores underlying food security challenges in Bermuda and warrants further attention.

The Nutritional Quality of Food Donated to a Western Australian Food Bank

Food banks provide an indispensable service to people experiencing severe food insecurity. Food banks source donations from across the food system; however, the food redistributed to clients across the developed world is nutritionally poor. This, together with the increasing prevalence of diet-related diseases and food insecurity, has prompted a focus on nutritional quality. Despite more food being distributed via food banks in Australia, the nutritional quality of donated food remains unreported. This study analyzed all food (84,996 kg (1216 products)) donated to Foodbank WA over a 5-day period using diet-, food-, and nutrient-based nutrition classification schemes (NCSs). A total of 42% (27% of total weight) of donated food products were deemed 'unsuitable' and 19% (23% by weight) were 'suitable' according to all NCSs. There was no agreement on 39% of products (50% by weight). Overall, NOVA and the Healthy Eating Research Nutrition Guidelines (HERNG) (κ = 0.521) had the highest level of agreement and the ADGs and HERNGs the lowest (κ = 0.329). The findings confirm the poor nutritional quality of food donated to food banks and the need to work with donors to improve the food they donate. Fit-for-purpose nutrition guidelines are urgently needed for Australian food banks to support them in providing nutritious food to their vulnerable clients.

Food insecurity in children and young people in Scotland

The aim of this review is to highlight the key issues in relation to food insecurity among children and young people living in Scotland. It provides an overview of the current context of food insecurity more generally within the UK and specifically in Scotland. Food insecurity has risen in Scotland evidenced through responses to national surveys and the dramatic increase in households relying on emergency food provision. Food insecurity is highest among young people, single parent families and single men. The key drivers of food insecurity include insufficient income, welfare reform, food inflation and geo-political events. Evidence suggests that food insecurity is negatively related to sufficient nutritional intake, and the implications for physical and mental health are profound. Policy actions implemented to mitigate the impact of food insecurity on children and young people include the introduction of the Scottish Child Payment, food voucher schemes, free school meals, and holiday food provision. Further evidence is required to evaluate the success of these policies in reducing or mitigating food insecurity. The review concludes by considering the ways in which a rights-based approach to food might benefit children and young people living in Scotland, and argues that wider systemic change is required.

Co-design of a personalised digital intervention to improve vegetable intake in adults living in Australian rural communities

BACKGROUND

Diets low in vegetables are a main contributor to the health burden experienced by Australians living in rural communities. Given the ubiquity of smartphones and access to the Internet, digital interventions may offer an accessible delivery model for a dietary intervention in rural communities. However, no digital interventions to address low vegetable intake have been co-designed with adults living in rural areas. This paper describes the co-design of a digital intervention to improve vegetable intake with rural community members and research partners.

METHODS

Active participants in the co-design process were adults ≥ 18 years living in three rural Australian communities (total n = 57) and research partners (n = 4) representing three local rural governments and one peak non-government health organisation. An iterative co-design process was undertaken to understand the needs (pre-design phase) and ideas (generative phase) of the target population. Eight online workshops and a community survey were conducted between July and December 2021. The MoSCoW prioritisation method was used to help participants identify the 'Must-have, Should-have, Could-have, and Won't-have or will not have right now' features and functions of the digital intervention. Workshops were transcribed and inductively analysed using NVivo. Convergent and divergent themes were identified between the workshops and community survey to identify how to implement the digital intervention in the community.

RESULTS

Consensus was reached on a concept for a digital intervention that addressed individual and food environment barriers to vegetable intake, specific to rural communities. Implementation recommendations centred on (i) food literacy approaches to improve skills via access to vegetable-rich recipes and healthy eating resources, (ii) access to personalisation options and behaviour change support, and (iii) improving the community food environment by providing information on and access to local food initiatives.

CONCLUSIONS

Rural-dwelling adults expressed preferences for personalised intervention features that can enhance food literacy and engagement with community food environments. This research will inform the development of the prototyping (evaluation phase) and feasibility testing (post-design phase) of this intervention.

Lifestyle interventions in nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is a dynamic chronic liver disease that develops in close association with metabolic irregularities. Between 2016 and 2019, the global prevalence among adults was reported as 38% and among children and adolescents it was about 10%. NAFLD can be progressive and is associated with increased mortality from cardiovascular disease, extrahepatic cancers and liver complications. Despite these numerous adverse outcomes, no pharmacological treatments currently exist to treat nonalcoholic steatohepatitis, the progressive form of NAFLD. Therefore, the main treatment is the pursuit of a healthy lifestyle for both children and adults, which includes a diet rich in fruits, nuts, seeds, whole grains, fish and chicken and avoiding overconsumption of ultra-processed food, red meat, sugar-sweetened beverages and foods cooked at high heat. Physical activity at a level where one can talk but not sing is also recommended, including leisure-time activities and structured exercise. Avoidance of smoking and alcohol is also recommended. Policy-makers, community and school leaders need to work together to make their environments healthy by developing walkable and safe spaces with food stores stocked with culturally appropriate and healthy food items at affordable prices as well as providing age-appropriate and safe play areas in both schools and neighbourhoods.

What qualitative research can tell us about food and nutrition security in the UK and why we should pay attention to what it is telling us

Poor dietary patterns leading to poorer health and increased health care use have affected people living in disadvantaged economic circumstances in the UK for decades, which many fear will be exacerbated due to the UK's current so-called 'cost of living crisis'. The voices of experts by experience of those health and social inequalities are not routinely included in health improvement intervention development in relation to obesity prevention policy and programmes. Obesity is highly correlated with food insecurity experience in high-income country contexts (where food insecurity data are routinely collected) and is similarly socially patterned. Using a health equity lens, this review paper highlights qualitative research findings that have revealed the perspectives and direct experiences of people living with food insecurity, or those others supporting food-insecure households, that shed light on the role and influence of the socio-economic contextual factors food-insecure people live with day-to-day. Insights from qualitative research that have focused on the granular detail of day-to-day household resource management can help us understand not only how food insecurity differentially impacts individual household members, but also how behavioural responses/food coping strategies are playing into pathways that lead to avoidable ill health such as obesity, diabetes and other chronic health conditions, including mental health problems. This review paper concludes by discussing research and policy implications in relation to food-insecure households containing people with chronic health conditions, and for pregnant women and families with infants and very young children living in the UK today.

Social supermarkets, nutritional implications and healthy eating: exploration of members and their views

BACKGROUND

The Covid-19 pandemic has increased the need for food support but simultaneously enabled substantial innovation in food support provision, including the evolution of social supermarkets (SSM). These allow consumers to choose from a range of low-cost products, minimise stigma and reduce food waste. Data from members of two Sussex SSM were gathered for their perspectives and experiences, as well as potential nutritional implications of the SSM.

METHODS

Questionnaires administered face-to-face during site visits and optional telephone interviews were used. Data were collected during three site visits; 111 participants completed questionnaires, and an additional 25 detailed interviews with members of the SSM were completed. All data were gathered between December 2021 and May 2022.

RESULTS

Overall, the SSMs were valued by their members. Social, economic and nutritional benefits were identified. SSM increased consumer choice and reduced stigma. Most members visited regularly, using SSM to supplement other food purchases. They valued the opportunity to choose their own foods and opportunities to socialise, in addition to the range of food and household items offered. The majority agreed that healthy eating was important but time and cost were barriers especially for younger members. SSM introduced members to novel foods and dishes, potentially diversifying dietary intakes. Challenges included restrictions on the amounts of food available, depending on the timing of visits. This was a greater challenge for those more reliant on SSM for household needs.

CONCLUSIONS

SSM represent an innovative and less stigmatising model of food support. Greater variety of food offered suggests their potential to diversify and improve dietary intakes. Challenges include ensuring stability of food supply and reducing stigma further.

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.

Opportunities to improve population health: possibilities for healthier food environments

The recent Covid-19 pandemic highlighted stark social inequalities, notably around access to food, nutrition and to green or blue space (i.e. outdoor spaces with vegetation and water). Consequently, obesity is socio-economically patterned by this inequality; and while the environmental drivers of obesity are widely acknowledged, there is currently little upstream intervention. We know that living with obesity contributes to increasing health inequalities, and places healthcare systems under huge strain. Our environment could broadly be described obesogenic, in the sense of supporting unhealthful eating patterns and sedentary behaviour. Evidence points to the existence of nearly 700 UK obesity policies, all of which have had little success. Obesity prevention and treatment has focused on educational and behavioural interventions targeted at individual consumers. A more sustainable approach would be to try and change the environments that promote less healthy eating and high energy intake as well as sedentary behaviour. Approaches which modify the environment have the potential to assist in the prevention of this complex condition. This review paper focuses on the role of wider food environments or foodscapes. While there is an imperfect evidence base relating to the role of the foodscape in terms of the obesity crisis, policy, practice, civic society and industry must work together and take action now, in areas where current evidence suggests change is required. Despite the current cost-of-living crisis, shaping the foodscape to better support healthful eating decisions has the potential to be a key aspect of a successful obesity prevention intervention.

Food banks: Understanding their role in the food insecure population in the UK

The present paper reviews the growing body of literature on food insecurity and food bank use in the UK. It provides an overview of food insecurity in this context, followed by a description of the emergence of food banks, highlighting how any role that food banks play in the food insecure population is limited. Data on food insecurity and food bank use suggest many people experiencing food insecurity do not receive help from food banks. To better understand the factors influencing the relationship between food insecurity and food bank use, a conceptual framework is outlined, suggesting the relationship is far from straightforward and contingent on many factors. The nature and availability of food banks and other local support services and individual-level factors influence the likelihood of food banks being used in the context of food insecurity. Then, the extent to which food banks can impact food insecurity is also dependent on the quantity and quality of food distributed, as well as other support services offered from food banks. Closing reflections highlight rising living costs and food banks reporting that they do not have capacity to cope with increasing demand, underscoring the need for policy interventions. Reliance on food banks to respond to food insecurity may ultimately impede formulation of effective policy interventions to reduce food insecurity, giving the illusion of widespread available support, whilst food insecurity persists among those receiving help from food banks and those who experience food insecurity but do not use food banks.

Teaching medical students about nutrition: from basic principles to practical strategies

Poor nutrition is widely recognised as one of the key modifiable risks to health and life, with doctors in an ideal position to recognise when suboptimal nutrition is impacting on their patients' health and provide them with advice and support to create sustainable and achievable diet and lifestyle modifications. However, it has been acknowledged that nutrition training within medical schools is extremely varied, and in many cases inadequate. The Association for Nutrition UK Undergraduate Curriculum in Nutrition for Medical Doctors provides medical schools with guidance on what should be included in the training of all medical students. This paper discusses three key ways in which medical schools can support the implementation of nutrition into their teaching; incorporating nutrition within the core medical curriculum teaching, the use of subject specific experts to support and deliver nutrition training, and the inclusion of nutrition within formal assessment so as to reinforce and cement learnings into practical, applicable actions and advice.

Dietary risk of donated food at an Australian food bank: an audit protocol

BACKGROUND

Sufficient, safe and nutritious food is unattainable for many people experiencing severe food insecurity, putting them at dietary risk. Food banks, a growing part of the charitable food system (CFS), are the main source of food relief in developed countries. Donations of surplus, unsalable food from supermarkets, producers and manufacturers is the main source of the food supply, and this can be unpredictable, insufficient and inappropriate. The universal performance indicator of food-banking success is a weight-based measure, complemented by various initiatives to track the nutritional quality of food provided. There is currently no method that assesses the dietary risk of donated food related to nutrition and food safety. This protocol describes a method developed to identify and assess the dietary risk of donated food at an Australian food bank including the type, amount, nutrition quality, and food safety.

METHODS

An audit of all food donated to a food bank servicing one Australian state was conducted over five consecutive days in May 2022. The audit process used a mobile device to take photographs of all incoming deliveries to the food bank. The images were manually annotated to document the type of food, product information (brand and product name, variety), the donor's name, weight (kilograms), and date-marking details. Data was extracted from the photographs and assessed against pre-determined dietary risk criterion for food safety (date marking, damaged packaging, visible food spoilage) and nutrition quality according to the principles of the Australian Guide to Healthy Eating, and the NOVA classification of level of processing.

DISCUSSION

Fifteen hundred images were required to assess the dietary risk of 86,050 kg of donated food. There were 72 separate donations, largely from supermarkets and food manufacturers. Data analysis will enable identification of dietary risk, particularly for nutrition quality and food safety. This is important given the absence of food regulation for CFS donations, and the vulnerability of the client group. This protocol highlights the need for more transparency and accountability from food donors, about the food they donate.

Assessing the nutritional content and adequacy of food parcels among vulnerable Lebanese during a double crisis: COVID-19 pandemic and an economic meltdown

OBJECTIVES

This study aimed to explore the nutritional content and quality of food parcels distributed in Lebanon and assess their adherence to dietary guidelines during the COVID-19 pandemic and an unprecedented economic crisis.

DESIGN

Cross-sectional study (June-July 2020); phone survey (thirty items).

SETTING

Lebanon.

PARTICIPANTS

Food parcel providers (FPP; n 72) involved in food parcel distribution (FPD), mainly to Lebanese households.

RESULTS

FPP included international non-governmental organizations (INGO) (n 3), local non-governmental organizations (n 45) and personal initiatives (n 24). Overall, low adherence to the World Food Programme (WFP) food parcel guidelines were observed among FPP for specific food items, including vegetables, fish, legumes and cereals, whereas salt content significantly surpassed the guidelines (all P-values <0·001). On average, a food parcel provided 608·4 ± 55 kcal/d/person. The greatest contributors to total energy intake (TE) in the food parcel were carbohydrates (46·4 %) and fats (46·8 %), while protein contributed to 7 %TE. In addition, %TE from fats and sugars significantly surpassed the dietary reference intakes (DRI) for a single person per d (134-234 % and 185 % of DRI, respectively, P-values <0·001). Only 10-15 % of daily needs for key micronutrients, including Fe, Zn, thiamin, riboflavin and dietary folate, were met through the food parcels. Adequate food safety and hygiene practices were reported among FPP, yet dramatic changes in food costs due to overlapping crises affected the quality and quantity of food in parcels.

CONCLUSIONS

Findings highlight the need to improve the nutritional content of food parcels and adherence to dietary guidelines to alleviate food and nutrition insecurity while preventing diet-related diseases among vulnerable beneficiaries in Lebanon.

Food Insecurity, Food Assistance, and Psychological Distress among University Students: Cross-Sectional Survey Western Australia, 2020

University students have been identified as a population sub-group vulnerable to food insecurity. This vulnerability increased in 2020 due to the COVID-19 pandemic. This study aimed to assess factors associated with food insecurity among university students and the differences between students with and without children. A cross-sectional survey of (n = 213) students attending one university in Western Australia measured food insecurity, psychological distress, and socio-demographic characteristics. Logistic regression analyses were conducted to identify factors associated with food insecurity. Forty-eight percent of students who responded to the survey had experienced food insecurity in 2020. International students who were studying in Australia were nine times more likely to experience food insecurity than domestic students (AOR = 9.13; 95% CI = 2.32-35.97). International students with children were more likely to experience food insecurity than international students without children (p < 0.001) and domestic students with (p < 0.001) or without children (p < 0.001). For each unit increase in depression level, the likelihood of experiencing food insecurity increased (AOR = 1.62; 95% CI = 1.12-2.33). Findings show a higher prevalence of food insecurity among international university students and students with children during the COVID-19 pandemic and that food insecurity was associated with higher levels of psychological distress. These findings highlight the need for targeted interventions to mitigate the risk of food insecurity among Australian university students, particularly among international students, students with children, and those experiencing psychological distress.

Importance of Nutrition Security to CVD Prevention Efforts in the USA

PURPOSE OF REVIEW

The importance of addressing nutrition security for the primary and secondary prevention of cardiovascular disease (CVD) in the USA is reviewed by describing the relationships between food security, diet quality, and CVD risk along with the ability of governmental, community, and healthcare policies and interventions to address nutrition security.

RECENT FINDINGS

Existing safety net programs have shown to be effective at improving food security and diet quality and reducing risk for CVD, but continued efforts to increase reach and improve standards are needed. Adoption of policies, healthcare initiatives, and community- and individual-level interventions addressing the nutritional intake of socioeconomically disadvantaged populations may also lessen CVD burden, but scaling interventions remains a key challenge. Research suggests simultaneously addressing food security and diet quality is feasible and could help reduce socioeconomic disparities in CVD morbidity and mortality. Intervening at multiple levels among high-risk groups should be a priority.

A mixed-method systematic review and meta-analysis of the influences of food environments and food insecurity on obesity in high-income countries

Obesity remains a serious public health concern in rich countries and the current obesogenic food environments and food insecurity are predictors of this disease. The impact of these variables on rising obesity trends is, however, mixed and inconsistent, due to measurement issues and cross-sectional study designs. To further the work in this area, this review aimed to summarize quantitative and qualitative data on the relationship between these variables, among adults and children across high-income countries. A mixed-method systematic review was conducted using 13 electronic databases, up to August 2021. Two authors independently extracted data and evaluated quality of publications. Random-effects meta-analysis was used to estimate the odds ratio (OR) for the association between food insecurity and obesity. Where statistical pooling for extracted statistics related to food environments was not possible due to heterogeneity, a narrative synthesis was performed. Meta-analysis of 36,113 adults and children showed statistically significant associations between food insecurity and obesity (OR: 1.503, 95% confidence interval: 1.432-1.577, p < .05). Narrative synthesis showed association between different types of food environments and obesity. Findings from qualitative studies regarding a reliance on energy-dense, nutrient-poor foods owing to their affordability and accessibility aligned with findings from quantitative studies. Results from both qualitative and quantitative studies regarding the potential links between increased body weight and participation in food assistance programs such as food banks were supportive of weight gain. To address obesity among individuals experiencing food insecurity, wide-reaching approaches are required, especially among those surrounded by unhealthy food environments which could potentially influence food choice.

Higher Prevalence of Food Insecurity and Psychological Distress among International University Students during the COVID-19 Pandemic: An Australian Perspective

The COVID-19 pandemic and related disruptions have not only affected university students' learning and academic outcomes, but also other issues, such as food security status, mental health and employment. In Australia, international students faced additional pressures due to sudden border closures and lack of eligibility for government-provided financial support. This study explored the experiences of domestic and international university students residing in Australia during the early stages of the COVID-19 pandemic across a range of outcomes. A cross-sectional online survey was conducted between July and September 2020 at Macquarie University in Sydney, Australia. The online survey included food insecurity status, mental health (psychological distress), disruptions to study, employment and sleep. A total of 105 students (n = 66 domestic and n = 39 international) completed the survey. Respondents reported having food insecurity (41.9%) and psychological distress (52.2%, with high and very high levels), with international students reporting significantly higher food insecurity (OR = 9.86 (95% CI 3.9-24.8), p < 0.001) and psychological distress scores (t(90) = 2.68, 95% CI: 1.30 to 8.81, p = 0.009) than domestic students. About one quarter of all respondents reported disruptions to study and employment status around the time of the survey. When asked what government support should be provided for international students, 'financial aid' was the most frequently suggested form of support. This research may help governments and educational institutions design appropriate support, particularly financial and psychological, for both international and domestic university students.

Rural Household Food Insecurity among Latino Immigrants during the COVID-19 Pandemic

U.S. food insecurity rates rapidly increased during the COVID-19 pandemic, with disproportionate impacts on Latino immigrant households. We conducted a qualitative study to investigate how household food environments of rural Latino immigrants were affected during the COVID-19 pandemic. Thirty-one respondents (42% from low food security households) completed interviews (July 2020-April 2021) across four rural counties in California. A rural household food security conceptual framework was used to analyze the data. Early in the pandemic, food availability was impacted by school closures and the increased consumption of meals/snacks at home; food access was impacted by reduced incomes. Barriers to access included limited transportation, excess distance, and lack of convenience. Key resources for mitigating food insecurity were the Supplemental Nutrition Assistance Program (SNAP), the Pandemic Electronic Benefits Transfer (P-EBT), school meals, charitable food programs, and social capital, although the adequacy and acceptability of charitable food distributions were noted issues. Respondents expressed concern about legal status, stigma, and the public charge rule when discussing barriers to government nutrition assistance programs. They reported that food pantries and P-EBT had fewer access barriers. Positive coping strategies included health-promoting food substitutions and the reduced consumption of meals outside the home. Results can inform the development of policy and systems interventions to decrease food insecurity and nutrition-related health disparities among rural Latino immigrants.