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Yamoah O, Schulte J, Osborn L, Ogland-Hand C, Zubieta AC, Freedman DA. Pantry clients and Supplemental Nutrition Assistance Program-Education practitioners' perspectives on factors influencing healthy eating policy, system and environmental interventions in food pantries. J Nutr Sci 2023; 12:e81. [PMID: 37528826 PMCID: PMC10388411 DOI: 10.1017/jns.2023.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/06/2023] [Accepted: 06/19/2023] [Indexed: 08/03/2023] Open
Abstract
The Supplemental Nutrition Assistance Program-Education identified food pantries as a targeted setting for policy, system, and environmental (PSE) interventions to promote healthy eating among households who rely on pantries to supplement their food needs. The present study sought to identify factors influencing capacity and readiness to implement healthy eating PSE interventions in food pantries. Qualitative interviews were conducted via zoom with twenty-six community residents with experience receiving SNAP benefits and twelve SNAP-Ed staff in rural and urban counties in Ohio to identify themes and indicators related to community/organisational capacity and readiness to implement healthy eating PSE interventions in food pantries. Themes and related indicators generated based on inductive and deductive coding of interview transcripts were prioritised and weighted by eleven community nutrition experts during a virtual consensus conference. Five themes emerged; expert-derived weights (scaled low, 0 to high, 1) reflect the perceived importance of each to implementation of healthy eating PSE interventions in food pantries: food pantry capacity and logistics [0⋅252], networks and relationships [0⋅228], community nutrition practitioner capacity [0⋅212], food pantry user characteristics [0⋅156], and stigma and stereotypes [0⋅1⋅52]. Overall, seventeen indicators were identified reflecting these themes. Successful and sustained PSE interventions at food pantries will require a tailored approach that considers food pantries' capacity, needs and opportunities within the community, and capacity of community nutrition practitioners. The themes and indicators identified provide guidance for responsive PSE approaches in food pantries that meet communities where they are.
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Key Words
- Assessment
- COREQ, the consolidated criteria for reporting qualitative research
- Food pantry
- Healthy eating
- IRB, Institutional Review Board
- NPP, Nutrition Pantry Program
- OSU, Ohio State University
- PSE, policy, system and environmental
- Policy, systems, and environmental (PSE) interventions
- READI, Readiness Assessment and Decision Instrument
- RUCA, Rural–Urban Commuting Area
- Readiness
- SNAP, Supplemental Nutrition Assistance Program
- SNAP-Ed, Supplemental Nutrition Assistance Program Education program
- WIC, Special Supplemental Nutrition Program for Women, Infants and Children
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Affiliation(s)
- Owusua Yamoah
- Mary Ann Swetland Center for Environmental Health, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Jillian Schulte
- Mary Ann Swetland Center for Environmental Health, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
- Department of Anthropology, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Lindsay Osborn
- Mary Ann Swetland Center for Environmental Health, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Callie Ogland-Hand
- Mary Ann Swetland Center for Environmental Health, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Ana Claudia Zubieta
- College of Food, Agricultural, and Environmental Sciences (CFAES), OSU Extension, 381B Campbell Hall, 1787 Neil Avenue, Columbus, OH 43210, USA
| | - Darcy A. Freedman
- Mary Ann Swetland Center for Environmental Health, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
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Gerber S, O'Hearn M, Cruz SM, Reedy J, Mozaffarian D. Changes in Food Security, Healthfulness, and Access During the Coronavirus Disease 2019 Pandemic: Results From a National United States Survey. Curr Dev Nutr 2023; 7:100060. [PMID: 36937244 PMCID: PMC9968449 DOI: 10.1016/j.cdnut.2023.100060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/15/2023] [Accepted: 02/18/2023] [Indexed: 02/27/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) disrupted access to food and adequate nutrition and the types of foods consumed. However, little empiric data exists on the changes in American's food and nutrition habits 2 y into the pandemic. Objectives To assess current and altered food choices ∼2 y into the COVID-19 pandemic in the months after historic public pandemic relief. Methods A national sample of 1878 United States adults balanced by age, sex, race/ethnicity, and income completed a one-time, online, semi-quantitative, 44-item questionnaire in Fall 2021 asking about the demographics, COVID-19 food choice changes (including free-text), and consumer priorities. This analysis investigates COVID-19 impacts on food security, healthfulness, and access. Results More than 35% of respondents reported improved food security and >45% reported improved food healthfulness compared with prepandemic status. Improvement was reported in more than 30% of Black/African-American and Hispanic/Latinx adults, adults with lower annual income, and female sex, despite over 75% reporting reduced choice of where to eat or buy food. The pandemic offered occasion for many to improve diet, but a similar number expressed that the pandemic destabilized healthy habits. Conclusions Our novel findings suggest that by late 2021, most Americans had improved food security and food choice healthfulness, despite reduced access to food service and retail, although with worsening among a meaningful proportion of Americans as well as heterogeneity in these changes. Vigorous federal, state, city, and community responses to the pandemic may have played a role in improving the food security and food choice healthfulness during the COVID-19 pandemic. Health crises differently impact health behaviors, but when accompanied by vigorous civic and community response, food security, and food healthfulness can be fortified.
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Affiliation(s)
- Suzannah Gerber
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
- Betty and Guy Beatty Liver and Obesity Research Center, Inova Medical System, Fairfax, VA, United States
| | - Meghan O'Hearn
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Sylara Marie Cruz
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Julia Reedy
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Dariush Mozaffarian
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
- Tufts Medical Center, Tufts University School of Medicine, Boston, MA, United States
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Schuler BR, Vazquez CE, O'Reilly N. From childhood obesity risk to healthy growth in the U.S.: A 10-year social work research & policy update. Prev Med Rep 2023; 31:102071. [PMID: 36471767 PMCID: PMC9719025 DOI: 10.1016/j.pmedr.2022.102071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 12/03/2022] Open
Abstract
Childhood obesity is a major health issue and a prominent chronic health condition for children in the United States (U.S.), caused by a multitude of factors. Most existing models of childhood obesity prevention have not worked, yielding little to no effect on improving weight status or the proximal health behaviors most attributed to obesity risk: nutritional intake, physical activity, sedentary behaviors, and sleep. There is an urgent need for new approaches to prevent health disparities that are responsive to impacts of economic inequality on healthy child growth in marginalized populations. In this Short Commentary, a social justice update is provided to motivate a new generation of research that promotes equitable and healthy child growth under present-day social, economic, and political circumstances. Social work-specific research and policy recommendations are provided to guide future research that targets underlying social and economic determinants of weight-related health disparities in childhood. Recommendations include research on cross-disciplinary metrics to better capture reductions in health disparities and the development and testing of policy and system interventions that address structural issues and strengthen health resources in marginalized communities. Progress in reducing disparities in childhood obesity will likely remain inhibited until recommendations from social work research are incorporated to strengthen existing medical and public health models and redirect the childhood obesity epidemic toward equitable, healthy child growth.
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Affiliation(s)
- Brittany R. Schuler
- School of Social Work, College of Public Health, Temple University, 1301 Cecil B Moore Ave., Ritter Annex 5 Floor, Philadelphia, PA 19122, United States
| | - Christian E. Vazquez
- School of Social Work, The University of Texas at Arlington, Arlington, TX 76019, United States
| | - Nicole O'Reilly
- School of Social Work, Boise State University, 1910 University Dr., Boise, ID 83725, United States
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Nelson E, Bangham C, Modi S, Liu X, Codner A, Milton Hicks J, Greece J. Understanding the impacts of COVID-19 on the determinants of food insecurity: A state-specific examination. Prev Med Rep 2022; 28:101871. [PMID: 35785406 PMCID: PMC9235214 DOI: 10.1016/j.pmedr.2022.101871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 11/18/2022] Open
Abstract
This paper examines risk factors influencing food insecurity during the first year of the COVID-19 pandemic in a state in the U.S. heavily impacted by it and offers recommendations for multi-sector intervention. The U.S. Census Bureau Household Pulse Survey was analyzed to evaluate the impacts of COVID-19 on food security in Massachusetts from April 2020 through March 2021 using a study sample of 57,678 participants. Food security was defined as a categorical variable (food security, marginal food security, low food security, very low food security) and binary variable (food security and food insecurity). Known or suspected factors that contribute to it, such as childcare, education, employment, housing, and transportation were examined in multivariate logistic regression models. Data imputation methods accounted for missing data. Sociodemographic characteristics, including lower education level and living in a household with children, were determinants of food insecurity. Another factor that influenced food insecurity was economic hardships, such as unemployment, being laid off due to COVID-19, not working due to concerns about contracting or spreading COVID-19, or not having enough money to buy food. A third factor influencing food insecurity was food environment, such as lack of geographic access to healthy foods. Some of these factors have been exacerbated by the pandemic and will continue to impact food security. These should be addressed through a comprehensive approach with public health efforts considering all levels of the social ecological model and the context created by the pandemic.
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Houghtaling B, Cater M, Bryant D, Brooks A, Holston D. What is the availability, affordability, and quality of foods and beverages aligned with dietary guidance in Louisiana Supplemental Nutrition Assistance Program (SNAP) authorized stores? Prev Med Rep 2021; 24:101578. [PMID: 34976640 PMCID: PMC8683981 DOI: 10.1016/j.pmedr.2021.101578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 11/23/2022] Open
Abstract
SNAP stores in Louisiana score low on measures of healthy food access. No differences in healthy food access were found between rural/urban SNAP stores. Independent SNAP stores scored lower on healthy food access than corporate stores. SNAP grocery and dollar stores scored higher than SNAP convenience stores. Healthy retail partnerships with independent SNAP retailers are needed in Louisiana.
Healthy food retail strategies are delivered by Cooperative Extension Services in Louisiana to improve public health among communities with lower income. To guide Cooperative Extension Services Programming, the aim of this study was to assess healthy food access among SNAP-authorized stores. This included comparing the availability, affordability, and quality of healthy foods sold in these stores by geography, ownership, and store type. Seventy-five Louisiana SNAP-authorized stores were selected for measurement. Between October 2019 and March 2020 (prior to the COVID-19 national emergency declaration), trained researchers used the Nutrition Environment Measures Survey in Stores (NEMS-S) to assess the availability, affordability, and quality of healthy versus less healthy foods and beverages in 42 SNAP-authorized stores, including: grocery (n = 12, 29%), convenience (n = 17, 41%), drug (n = 1, 2%), dollar (n = 11, 26%), and butcher/meat (n = 1, 2%). Multivariate analysis of variance (a priori, p < 0.05) determined if differences in total NEMS-S scores or subscores existed by geography (urban versus rural), ownership (corporate/chain versus independent), or store type. No urban/rural differences were identified. Corporate/chain SNAP-authorized stores scored higher on average than independent SNAP-authorized stores for the total NEMS-S score (17.2 versus 8.1; p = 0.009) and availability subscore (13.1 versus 6.1; p = 0.02). SNAP-authorized grocery stores scored higher than all other store types (total NEMS-S score 27.6), followed by SNAP-authorized dollar stores (total NEMS-S score 10.7), and SNAP-authorized convenience stores (total NEMS-S score 5) (p < 0.001). Louisiana Cooperative Extension Services should explore ways to scale healthy food retail strategies statewide with a specific emphasis on independent and smaller SNAP-authorized retailers.
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Key Words
- Beverages
- CDC, Centers for Disease Control and Prevention
- DGA, 2020–2025 Dietary Guidelines for Americans
- EFNEP, Expanded Food and Nutrition Education Program
- Food
- Food access
- Food assistance
- Food security
- NEMS-S, Nutrition Environment Measures Survey in Stores
- PSE, policy, systems, and environmental
- Public health
- RUCC, Rural-Urban Continuum Code
- SNAP, Supplemental Nutrition Assistance Program
- SNAP-Ed, Supplemental Nutrition Assistance Program Education
- WIC, Special Supplemental Nutrition Assistance Program for Women, Infants, and Children
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Affiliation(s)
- Bailey Houghtaling
- School of Nutrition and Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA 70803, USA
- Corresponding author.
| | - Melissa Cater
- Agricultural and Extension Education and Evaluation, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA 70803, USA
| | - De'Jerra Bryant
- School of Nutrition and Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA 70803, USA
| | - Allie Brooks
- School of Nutrition and Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA 70803, USA
| | - Denise Holston
- School of Nutrition and Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA 70803, USA
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Parks CA, Han P, Fricke HE, Parker HA, Hesterman OB, Yaroch AL. Reducing food insecurity and improving fruit and vegetable intake through a nutrition incentive program in Michigan, USA. SSM Popul Health 2021; 15:100898. [PMID: 34458551 PMCID: PMC8379520 DOI: 10.1016/j.ssmph.2021.100898] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/12/2021] [Accepted: 08/15/2021] [Indexed: 12/04/2022] Open
Abstract
Background Nutrition incentive (NI) programs increase the purchase of fruits and vegetables (FVs) among low-income participants. Double Up Food Bucks (DUFB) is a robust statewide NI program in the United States. The purpose of this paper is to report findings from DUFB in Michigan describing the factors related to FV intake (FVI) and food insecurity among participants in a NI program. Methods We administered a repeated cross-sectional survey with a convenience sample of DUFB participants at farmers markets and grocery stores (over the 2016, 2017, 2018 seasons). The survey was conducted online via paper-pencil. Descriptive statistics were calculated for all variables. A logistic regression model estimated household food insecurity and a linear regression estimated FVI with DUFB use/perceptions, sociodemographics, and health status as independent variables (significance level = p < 0.05). Results Descriptive results revealed that participants that completed surveys at grocery stores tended to be more racially-ethnically diverse and younger than participants that completed surveys at farmers markets. Participants with lower length of time participating in DUFB (i.e., lower dose) (p < 0.001), greater FV purchases (p < 0.05), and lower perceived health status (p < 0.001) tended to report being food insecure more frequently. Participants with increased length of time participating in DUFB (p < 0.05), greater FV purchases (p < 0.001), being male (p < 0.01), and greater perceived health status (p < 0.001) tended to report higher levels of FVI more frequently. Conclusions Longer participation in DUFB leads to improved outcomes with FVI and food security, suggesting that NI programs do have the intended positive impact they were designed to achieve. Low income populations carry a larger burden of obesity, food insecurity, and chronic disease. Nutrition incentive programs were developed to address affordability barriers to healthy eating among SNAP participants. Participants at grocery stores tended to be more racially-ethnically diverse and younger than participants at farmers markets. Participants with longer time in the program reported greater FVI and higher levels of food security.
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Key Words
- DSQ, Dietary Screener Questionnaire
- DUFB, Double Up Food Bucks
- FINI, Food Insecurity Nutrition Incentive
- FVI, Fruit and vegetable intake
- FVs, Fruit and vegetables
- Farmers markets
- Food insecurity
- Fruit and vegetable consumption
- Grocery stores
- GusNIP, Gus Schumacher Nutrition Incentive Program
- NI, Nutrition incentive
- NIFA, National Institute of Food and Agriculture
- Nutrition incentives
- SNAP, Supplemental Nutrition Assistance Program
- U.S., United States
- USDA, United States Department of Agriculture
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Affiliation(s)
- C A Parks
- Gretchen Swanson Center for Nutrition, 8401 West Dodge Road, Suite 100, Omaha, NE, 68114, USA
| | - P Han
- University of Michigan, Department of Biostatistics, M4531, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - H E Fricke
- Gretchen Swanson Center for Nutrition, 8401 West Dodge Road, Suite 100, Omaha, NE, 68114, USA
| | - H A Parker
- Fair Food Network, 1250 North Main Street, North Suite, Ann Arbor, MI, 48104, USA
| | - O B Hesterman
- Fair Food Network, 1250 North Main Street, North Suite, Ann Arbor, MI, 48104, USA
| | - A L Yaroch
- Gretchen Swanson Center for Nutrition, 8401 West Dodge Road, Suite 100, Omaha, NE, 68114, USA
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Belarmino EH, Malinowski A, Flynn K. Diaper need is associated with risk for food insecurity in a statewide sample of participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Prev Med Rep 2021; 22:101332. [PMID: 33680720 DOI: 10.1016/j.pmedr.2021.101332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 01/28/2021] [Accepted: 02/09/2021] [Indexed: 11/23/2022] Open
Abstract
One-third of low-income families with a child in diapers report diaper need. Families with diaper need are more likely to be at risk for food insecurity. Disposable diapers represent a considerable financial burden for young families. Addressing diaper need may provide a tangible way to reduce food insecurity.
Diaper need is a form of material hardship that acutely affects families with young children, is not currently addressed by US antipoverty programs, and has received little public or scientific attention. This study examined the association between diaper need and risk for food insecurity in a statewide sample of participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Families enrolled in Vermont WIC in August 2019 were invited to an online survey that included questions related to diaper need and food need. Pearson’s Chi-square tests were used to examine the association between diaper need and risk for food insecurity measured by the Hunger Vital Sign Tool, and the associations between diaper need and other household factors. Follow-up questions asked those with diaper need what they do when they run out of diapers and those without diaper need how they access enough diapers. Responses to these questions were tabulated. Complete data were available for 501 households. Over half (52.3%) were at risk for food insecurity and nearly one-third (32.5%) reported diaper need. Households with diaper need were more likely to be at risk for food insecurity than those without diaper need (p < 0.001). Strategies to avoid running out of diapers included borrowing, stretching supplies, seeking diapers from an agency or support organization, switching to cloth or underwear, and buying on credit. Interventions that address diaper need may alleviate hardship and support health equity among families with young children.
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Abrams SA, Avalos A, Gray M, Hawthorne KM. High Level of Food Insecurity among Families with Children Seeking Routine Care at Federally Qualified Health Centers during the Coronavirus Disease 2019 Pandemic. J Pediatr X 2020; 4:100044. [PMID: 32864604 DOI: 10.1016/j.ympdx.2020.100044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 01/23/2023] Open
Abstract
Objective To assess food insecurity during pediatric visits to federally qualified health centers (FQHCs) during the coronavirus disease-19 pandemic. Study design Interviews using the validated American Academy of Pediatrics 2-question food insecurity screen were performed with 200 consecutive families presenting for pediatric care to 2 FQHC in Central Texas from April 14 to May 20, 2020, during the initial phase of the pandemic in Texas. Brief qualitative interviews were conducted to determine whether families found a worsening of food insecurity during the pandemic. Results Overall, 47% of families had a positive food insecurity screen. More than 90% of these were worrying about food running out and about 60% were positive for the question related to food not lasting. Among families with food insecurity, 94% indicated this had begun or worsened during the pandemic. Of the 115 families volunteering information about employment, 46% reported job loss during this time period. Both ethnicity (P < .001) and Special Supplementation Nutrition Program for Women, Infants and Children (WIC) participation (P = .03) were associated with greater levels of food insecurity. Among primarily Spanish-speaking families participating in the WIC program, 64% reported food insecurity. Conclusions Approximately one-half of families receiving routine pediatric care at a FQHC during the coronavirus disease-19 pandemic reported food insecurity and this was associated with loss of jobs during the pandemic. Participation in the WIC program was not protective against food insecurity. Increased frequency of food insecurity was detected in Hispanic and Spanish-speaking families. Screening of families at an FQHC should be strongly considered as a part of routine pediatric care. Knowledge of community resources is important for providers to share with patients. (J Pediatr: X 2020;4:100044). Trial Registration ClinicalTrials.gov: NCT04378595
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Singleton CR, Young SK, Kessee N, Springfield SE, Sen BP. Examining disparities in diet quality between SNAP participants and non-participants using Oaxaca-Blinder decomposition analysis. Prev Med Rep 2020; 19:101134. [PMID: 32528823 PMCID: PMC7280767 DOI: 10.1016/j.pmedr.2020.101134] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/15/2020] [Accepted: 05/23/2020] [Indexed: 11/26/2022] Open
Abstract
SNAP participants had poorer diet quality compared to non-participants. The HEI-2015 disparity between SNAP participants and income-eligible non-participants was 3.24. Demographics explained 36% of the disparity in diet quality between SNAP participants and income-eligible non-participants. The HEI-2015 disparity between SNAP participants and income-ineligible non-participants was 6.30. Demographics explained 72% of the disparity in diet quality between SNAP participants and income-ineligible non-participants.
Recent studies have reported that SNAP participants have poorer diet quality than non-participants. This study aimed to examine how differences in socio-demographic, household, and health-related measures explain disparities in diet quality between SNAP participants and non-participants using Oaxaca-Blinder decomposition analysis. We analyzed cross-sectional data on 14,331 adult respondents of the National Health and Nutrition Examination Survey (NHANES) 2009 – 2014. To measure diet quality, we applied the Healthy Eating Index (HEI)-2015 to respondents’ 24-hour dietary recall data (scale: 0–100 points). We used Oaxaca-Blinder decomposition analysis to determine how much of the disparity in HEI-2015 total score between SNAP participants and non-participants was explained by socio-demographic (e.g., age, race/ethnicity, educational), household (e.g., household size, food security status), and health-related measures (e.g., BMI, smoking status). Analyses performed revealed significant differences in HEI-2015 total score by SNAP participation status (p < 0.001). We found that the total gap in HEI-2015 total score between SNAP participants and income-ineligible non-participants was 6.30 points. Socio-demographic measures alone explained 72.40% of the disparity. All measures together explained 86.31% of the disparity. The total gap between SNAP participants and income-eligible non-participants was 3.24 points. Socio-demographic measures alone explained 35.51% of this disparity while all measures together explained 56.86%. We observed disparities in diet quality between SNAP participants and non-participants. Socio-demographic, household, and health-related measures explained a significant amount of the disparity that existed between SNAP participants and income-ineligible non-participants; they explained less of the disparity between SNAP participants and income-eligible non-participants.
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Affiliation(s)
- Chelsea R Singleton
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, 1206 S Fourth St., Champaign, IL 61820, USA
| | - Sabrina K Young
- Division of Health Policy and Administration, University of Illinois at Chicago, 1603 W Taylor Street, Chicago, IL 60612, USA
| | - Nicollette Kessee
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 W Taylor St., Chicago, IL 60612, USA
| | - Sparkle E Springfield
- Stanford Prevention Research Center, Stanford University, 3300 Hillview Avenue, Palo Alto, CA 94304, USA
| | - Bisakha P Sen
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL 35294, USA
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Conrad Z, Jahns L, Roemmich JN. Study design for a clinical trial to examine food price elasticity among participants in federal food assistance programs: A laboratory-based grocery store study. Contemp Clin Trials Commun 2018; 10:154-160. [PMID: 30023450 PMCID: PMC6047316 DOI: 10.1016/j.conctc.2018.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/01/2018] [Accepted: 05/04/2018] [Indexed: 12/03/2022] Open
Abstract
We present a protocol for a study investigating the effect of food price changes on purchasing decisions among individuals participating in federal food assistance programs and among those not participating in these programs. We use a laboratory-based grocery store design, which provides greater control over factors influencing food purchasing than in situ experiments in actual grocery stores. We focus primarily, but not exclusively, on eggs because they are highly nutritious, easy to prepare, can be included in many different dishes, and are a part of a wide range of cultural food menus. The primary aim of this study is to compare the own-and cross-price elasticity of eggs between individuals participating in federal food assistance programs and those not participating in these programs. Our secondary aims are to 1) compare the own- and cross-price elasticity of eggs between overweight/obese individuals and non-overweight/obese individuals, 2) examine whether delay discounting moderates the effect of income on own- and cross-price elasticity, 3) examine whether subjective social status moderates the effect of participation in federal food assistance programs on the purchase of high nutrient-dense foods, and 4) examine whether usual psychological stress level moderates the effect of subjective social status on the purchase of high-nutrient dense foods. The results of this study will provide information about the drivers of food demand among low-income adults. A better understanding of these drivers is needed to develop effective nutrition interventions for this large population.
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Key Words
- 24HR, 24-h Recall
- BMI, Body Mass Index
- Egg
- Food assistance
- NHANES, National Health and Nutrition Examination Survey
- NRF, Nutrient-rich Foods Index
- Obesity
- Price elasticity
- SNAP, Supplemental Nutrition Assistance Program
- Social status
- Stress
- USDA, United States Department of Agriculture
- WIC, Special Supplemental Nutrition Program for Women, Infants, and Children
- WWEIA, What We Eat In America
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Affiliation(s)
- Zach Conrad
- Grand Forks Human Nutrition Research Center, US Department of Agriculture, Agricultural Research Service, 2420 2nd Ave. N, Grand Forks, ND 58203, USA
| | - Lisa Jahns
- Grand Forks Human Nutrition Research Center, US Department of Agriculture, Agricultural Research Service, 2420 2nd Ave. N, Grand Forks, ND 58203, USA
| | - James N Roemmich
- Grand Forks Human Nutrition Research Center, US Department of Agriculture, Agricultural Research Service, 2420 2nd Ave. N, Grand Forks, ND 58203, USA
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Smith S, Malinak D, Chang J, Perez M, Perez S, Settlecowski E, Rodriggs T, Hsu M, Abrew A, Aedo S. Implementation of a food insecurity screening and referral program in student-run free clinics in San Diego, California. Prev Med Rep 2016; 5:134-139. [PMID: 27990340 PMCID: PMC5157787 DOI: 10.1016/j.pmedr.2016.12.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/24/2016] [Accepted: 12/04/2016] [Indexed: 11/27/2022] Open
Abstract
Food insecurity is associated with many poor health outcomes yet is not routinely addressed in clinical settings. The purpose of this study was to implement a food insecurity screening and referral program in Student-run Free Clinics (SRFC) and to document the prevalence of food insecurity screening in this low-income patient population. All patients seen in three SRFC sites affiliated with one institution in San Diego, California were screened for food insecurity using the 6-item United States Department of Agriculture (USDA) Food Security Survey between January and July 2015 and referred to appropriate resources. The percentage of patients who were food insecure was calculated. The screening rate was 92.5% (430/463 patients), 74.0% (318/430) were food insecure, including 30.7% (132/430) with very low food security. A food insecurity registry and referral tracking system revealed that by January 2016, 201 participants were receiving monthly boxes of food onsite, 66 used an off-site food pantry, and 64 were enrolled in the Supplemental Nutrition Assistance Program (SNAP). It is possible to implement a food insecurity screening and referral program into SRFCs. The prevalence of food insecurity in this population was remarkably high yet remained largely unknown until this program was implemented. Other health care settings, particularly those with underserved patient populations, should consider implementing food insecurity screening and referral programs.
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Affiliation(s)
- Sunny Smith
- Department of Family Medicine and Public Health, University of California San Diego (UCSD), 9500 Gilman Drive #0696, La Jolla, CA 92093-0696, USA; University of California San Diego (UCSD) School of Medicine, 9500 Gilman Drive #0696, La Jolla, CA 92093-0696, USA; University of California San Diego (UCSD) Student-Run Free Clinic Project, 9500 Gilman Drive #0696, La Jolla, CA 92093-0696, USA
| | - David Malinak
- University of California San Diego (UCSD) School of Medicine, 9500 Gilman Drive #0696, La Jolla, CA 92093-0696, USA
| | - Jinnie Chang
- University of California San Diego (UCSD) School of Medicine, 9500 Gilman Drive #0696, La Jolla, CA 92093-0696, USA
| | - Maria Perez
- University of California San Diego (UCSD) Student-Run Free Clinic Project, 9500 Gilman Drive #0696, La Jolla, CA 92093-0696, USA
| | - Sandra Perez
- University of California San Diego (UCSD) Student-Run Free Clinic Project, 9500 Gilman Drive #0696, La Jolla, CA 92093-0696, USA
| | - Erica Settlecowski
- University of California San Diego (UCSD) Student-Run Free Clinic Project, 9500 Gilman Drive #0696, La Jolla, CA 92093-0696, USA
| | - Timothy Rodriggs
- University of California San Diego (UCSD) Student-Run Free Clinic Project, 9500 Gilman Drive #0696, La Jolla, CA 92093-0696, USA
| | - Ming Hsu
- University of California San Diego (UCSD) Student-Run Free Clinic Project, 9500 Gilman Drive #0696, La Jolla, CA 92093-0696, USA
| | - Alexandra Abrew
- University of California San Diego (UCSD) Student-Run Free Clinic Project, 9500 Gilman Drive #0696, La Jolla, CA 92093-0696, USA
| | - Sofia Aedo
- University of California San Diego (UCSD) Student-Run Free Clinic Project, 9500 Gilman Drive #0696, La Jolla, CA 92093-0696, USA
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