Caregiver Preferences for Primary Care Clinic-Based Food Assistance: A Discrete Choice Experiment

OBJECTIVE

The American Academy of Pediatrics recommends that pediatric providers screen families for food insecurity and connect them to appropriate resources. However, it is unclear how clinics can best provide families with resources consistent with their needs and preferences. In this study, we elicited caregiver preferences for clinic-based food assistance.

METHODS

We conducted a cross-sectional discrete choice experiment in which caregivers at 2 pediatric primary care clinics were asked to choose between hypothetical food programs. Programs varied across 4 categories: 1) resources provided (eg, food delivery, food in clinic, assistance enrolling in benefits); 2) support staff providing resources (eg, social worker, community health worker, physician, or nurse); 3) outreach modality (eg, phone, email, text); and 4) outreach frequency. Multinomial logistic regression was used to assess caregiver preferences within each category and the relative importance of each category to caregiver decisions.

RESULTS

We surveyed 142 caregivers who were predominantly Black (87%) and Medicaid-insured (90%). Caregiver preferences for food programs were most strongly influenced by the food resources provided. Caregivers preferred food delivery over other forms of food supports, such as food provided in clinic. They preferred assistance from a benefits enrollment specialist, community health worker, or social worker to assistance from a physician or nurse.

CONCLUSIONS

Pediatric clinics serving families at risk of food insecurity should use caregiver preferences to inform the design of family-centered interventions. Clinics should consider connecting caregivers with food delivery programs, and pediatric payors should adopt reimbursement models that support multidisciplinary team-based care to address food insecurity.

Factors Associated with Uptake of an Open Access Health Center-Based Mobile Produce Market: A Case for Expanded Eligibility

BACKGROUND

Healthcare-based food assistance programs show promise, but are underutilized. Strict eligibility requirements and program scheduling may dampen reach and outcomes.

OBJECTIVE

To explore factors associated with uptake of a health center-based mobile produce market with no eligibility requirements and few barriers to entry.

DESIGN

A cross-sectional analysis of medical record, socio-demographic, environmental, and market attendance data was used.

PARTICIPANTS/SETTING

The study sample consisted of 3,071 adults (18+ years) who were patients of an urban health center in eastern Massachusetts and registered for the mobile market during the study period of August 2016 to February 2020.

MAIN OUTCOME MEASURES

The main outcome measure was monthly market attendance over the study period.

STATISTICAL ANALYSES

T-tests and chi-squared tests were used to compare market users and never-users. Multiple logistic regression was used to analyze variables associated with market attendance each month.

RESULTS

In multiple variable analyses, SNAP enrollment was associated with slightly less frequent monthly market use (OR = 0.989 95% CI =0.984, 0.994). Day-of, on-site market registration was associated with more frequent monthly use than self-registration on non-market days (OR 1.08, 95% CI 1.07 to 1.08). Having a psychiatric or substance use disorder diagnosis was associated with slightly less frequent market attendance (OR 0.99, 95% CI 0.98 to 0.99, and OR 0.96, 95% CI 0.95-0.97, respectively) compared to registrants without these diagnoses.

CONCLUSIONS

Individual, community-level, and organizational factors are associated with uptake of a free mobile produce market, and should be considered when designing programs.

Federal food assistance accessibility and acceptability among Indigenous Peoples in the United States: A scoping review

The purpose of this scoping review was to determine the extent to which accessibility and acceptability of federal food assistance programs in the United States (U.S.) have been evaluated among Indigenous Peoples, and to summarize what is currently known. Twelve publications were found that examine aspects of accessibility or acceptability by indigenous peoples of one or more federal food assistance programs, including the Supplemental Nutrition Assistance Program (SNAP) and/or the Food Distribution Program on Indian Reservations (FDPIR) (n=8), the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (n=3), and the National School Lunch Program (NSLP) (n=1). No publications were found to include the Commodity Supplemental Food Program (CSFP) or the Child and Adult Care Food Program (CACFP). Publications ranged in time from 1990 - 2023, and all reported on findings from rural populations, while three also included urban settings. Program accessibility varied by program type and geographic location. Road conditions, transportation access, telephone and internet connectivity, and overall number of food stores were identified as key access barriers to SNAP and WIC benefit redemption in rural areas. Program acceptability was attributed to factors such as being tribally administered, providing culturally sensitive services, and offering foods of cultural significance. For these reasons, FDPIR and WIC were more frequently described as acceptable compared to SNAP and NSLP. However, SNAP was occasionally described as more acceptable than other assistance programs because it allows participants autonomy to decide which foods to purchase and when. Overall, little attention has been paid to the accessibility and acceptability of federal food assistance programs among Indigenous Peoples in the U.S. More research is needed to understand and improve the participation experiences and health trajectories of these priority populations.

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.

The association between the supplemental nutrition assistance programme participation and dental caries among U.S. adults

INTRODUCTION

The Supplemental Nutrition Assistance Programme (SNAP) is a federal programme aimed to alleviate hunger and improve food insecurity. The impact of SNAP participation on overall health has been studied. However, little is known about the effects of SNAP participation on oral health. We aimed to investigate the association between participating in SNAP and dental caries and to explore the role of food insecurity as a moderator in this relationship.

METHODS

We obtained data from the National Health and Nutrition Examination Survey (NHANES) cycles 2011-2012 and 2013-2014.The primary outcome was untreated dental caries (none vs. one or more). Self-reported SNAP participation status in the past 12 months was the predictor, and food security was the moderator. Food security was measured as overall food security status (full food secure/ food insecure) and household-level food security (full, marginal, low and very low). Bivariate and multiple logistic regression analyses were conducted to evaluate the relationship between SNAP and dental caries, and whether food insecurity moderates this relationship. Statistical analysis was carried out in September 2020.

RESULTS

Our results suggested that after adjusting for potential confounders, SNAP participants were more likely to have untreated dental caries than non-SNAP participants (odds ratio: 1.6; 95% CI: 1.2-2.0). Food security status did not alter the relationship between SNAP participation and untreated dental caries.

CONCLUSIONS

Food security status did not alter the relationship between SNAP participation and untreated dental caries. SNAP participation was associated with untreated dental caries among U.S. adults, and this was not affected by their food security status.

From the Field to the Patient: A Rural Food Recovery-Based Produce Rx Program

Poor nutrition is a major risk factor for chronic diseases, and emerging produce prescription (PRx) programs are a growing approach to addressing gaps in diet quality to promote health. This article describes a food recovery-based PRx framework called Farm to Clinic (F2C). The F2C program includes a partnership between the North Carolina Association of Free and Charitable Clinics (NCAFCC), Society of Saint Andrews (SoSA), and a local food bank. Patients (n = 4,691) were rural, uninsured, and received care at one of three NCAFCC clinics in Eastern North Carolina. Student volunteers gathered gleaned and/or salvaged produce and delivered it to clinics and/or patients directly. Successes of the current model include complementing chronic disease management and health promotion in a cost-effective way that also assists with reducing food waste. In addition, the patients who participate in the program are connected with produce at their primary care clinic and do not have to drive to an additional community site for produce. Some challenges have included consistency with gleaning; therefore, the program has switched to primarily salvaged produce. Areas for expansion and improvement on the F2C model are also outlined and include incorporating a more prioritized eligibility criteria, provision of additional complimentary resources such as nutrition education and culinary support, as well as improved formal evaluation (e.g., use of food and clinical impact). Finally, the F2C model utilizes community partners that have been established nationwide which allows for replication of a framework in other geographic areas.

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.

The Design and Impact of a Clinic-Based Community Program on Food Insecurity, Healthy Eating Behaviors, and Mood

Food insecurity is a national issue that disproportionately impacts Louisiana citizens, contributing to the state's poor health outcomes. We know that the Supplemental Nutrition Assistance Program (SNAP) and food pantries improve access to food, but we have limited data on what interventions improve food insecurity. The Geaux Get Healthy Clinical Program at Our Lady of the Lake (GGHOLOL) is a clinic-based community program that leverages community partnerships and a clinical setting to provide education and access to resources for individuals with food insecurity. This prospective study examines the impact of GGHOLOL on food insecurity as a pre-post survey evaluation over a two-year period. A total of 57 research participants with food insecurity completed the program. Mean food security scores improved at completion of GGHOLOL, and these scores further improved 6 months after enrollment. Furthermore, participants demonstrated sustainable improvements in healthy eating, cooking, and shopping behaviors. Lastly, participants improved their overall depression scores at the completion of the program with sustainable improvement at 6 months. With the improvement in GGHOLOL on food insecurity and nutrition behaviors, GGHOLOL may serve as a model for other programs addressing food insecurity in the future.

A pilot randomized controlled trial comparing nutritious meal kits and no-prep meals to improve food security and diet quality among food pantry clients

Background

Food pantry clients have high rates of food insecurity and greater risk for and prevalence of diet-related diseases. Many clients face time, resource, and physical constraints that limit their ability to prepare healthy meals using foods typically provided by pantries. We compared two novel approaches to alleviate those barriers and encourage healthier eating: meal kits, which bundle ingredients with a recipe on how to prepare a healthy meal, and nutritious no-prep meals, which can be eaten after thawing or microwaving.

Methods

Participants were adult pantry clients from a large food pantry in the Southern sector of Dallas, Texas. We conducted a repeated measures between-subjects study with 70 clients randomized to receive 14-days of meal kits (n=35) or no-prep meals (n=35). Participants completed questionnaires at baseline and twoweek follow-up on demographics, hedonic liking of study meals, perceived dietary quality, and food security. Two-way repeated measures analysis of variance was used to examine group and time effects, and group by time interactions. We also describe feasibility and satisfaction outcomes to inform future implementation.

Results

Sixty-six participants completed the study (94%). Participants were predominantly Hispanic or Latino(a) (63%) and African American or Black (31%) women (90%). There was a significant interaction on hedonic liking of study meals (ηp2=0.16, F(1,64)=11.78, p<.001), such that participants that received meal kits had greater improvements in hedonic liking over time than participants in the no-prep group. We observed significant improvements in perceived dietary quality (ηp2=0.36, F(1,64)=36.38, p<.001) and food security (ηp2=0.36, F(1,64)=36.38, p<.001) across both groups over time, but no between group differences or significant interactions indicating one intervention was more effective than the other. Program satisfaction was high across both groups, but higher among the meal kit group (ηp2=0.09, F(1,64)=6.28, p=.015).

Conclusions

Results suggest nutritious meal kits and no-prep meals may be desirable nutrition intervention strategies for pantry clients and have potential to increase food security and perceived dietary quality in the short-term. Our findings are limited by a small sample and short follow-up. Future studies should continue to test both interventions, and include longer follow-up, objective measures of dietary quality, and relevant clinical outcomes.

Trial Registration

This trial was registered on 25/10/2022 on Clinicaltrials.gov, identifier: NCT05593510.

Early introduction of complementary foods/drinks and milk feeding type in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC)

Infants younger than 4 months are not ready for complementary foods/drinks (any solid or liquid other than breast milk or infant formula). Almost half of US infants participate in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), which provides nutrition education and support to low-income families. We describe the prevalence of early introduction (<4 months) of complementary foods/drinks and examine the association of milk feeding type (fully breastfed, partially breastfed or fully formula fed) with early introduction of complementary foods/drinks. We used data from 3310 families in the longitudinal WIC Infant and Toddler Feeding Practices Study-2. We described the prevalence of early introduction of complementary foods/drinks and modeled the association of milk feeding type at Month 1 with early introduction of complementary foods/drinks using multi-variable logistic regression. Thirty-eight percent of infants were introduced early to complementary foods/drinks (<4 months). In adjusted models, infants who were fully formula fed or partially breastfed at Month 1 were 75% and 57%, respectively, more likely to be introduced early to complementary foods/drinks compared with fully breastfed infants. Almost two in five infants were given complementary foods/drinks early. Formula feeding at Month 1 was associated with higher odds of early introduction of complementary foods/drinks. There are opportunities to support families participating in WIC to prevent early introduction of complementary foods/drinks and promote child health.

Policy approaches to nutrition-focused food banking in industrialized countries: a scoping review

OBJECTIVE

This review aims to synthesize the literature describing policy approaches to nutrition-focused food banking in industrialized countries, spanning the period 2000 to October 2021.

BACKGROUND

The charitable food system provides food assistance to increasing numbers of people experiencing food insecurity in industrialized countries. Calls to improve the nutrition quality of foods provided by foods banks, pantries, and shelves have increased, yet little is known about the challenges faced when initiating policy in this setting.

METHODS

A protocol based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews Guidelines was developed and registered with Open Science Framework. Four electronic databases (MEDLINE [Ovid], Global Health, ProQuest, and Scopus) were searched for peer-reviewed articles published in English. A gray literature search was conducted using Google Advanced Search.

RESULTS

Of 642 peer-reviewed articles screened, 15 were eligible for inclusion. In addition, 24 gray literature documents were included. These 39 papers were assessed against the Iron Triangle of Hunger Relief and the Campbell et al framework of organizational factors. Six themes were identified: (1) there is a moral imperative to take action to ensure the provision of appropriate and nutritious food for vulnerable clients; (2) nutrition policies are unlikely to be formalized; (3) the unpredictability of donated food is a barrier to providing healthy foods; (4) reliance on donations affects the sector's willingness to reduce the unhealthy inventory for fear of losing donors, and the challenges of managing donor relationships were emphasized; (5) organizational capacity (volunteer workforce, executive leadership support) must be considered; (6) the existing measure of success is a weight-based metric that does not support food banks' prioritizing of healthy foods. These, and other characteristics, were incorporated into an adapted framework.

CONCLUSION

There is a need and opportunity for nutrition-focused food banking. A priority action area is the adoption of an outcome metric that is based on nutritional quality, to reorient the charitable food system.

Impact of Produce Prescriptions on Diet, Food Security, and Cardiometabolic Health Outcomes: A Multisite Evaluation of 9 Produce Prescription Programs in the United States

BACKGROUND

Produce prescriptions may improve cardiometabolic health by increasing fruit and vegetable (F&V) consumption and food insecurity yet impacts on clinical outcomes and health status have not been evaluated in large, multisite evaluations.

METHODS

This multisite, pre- and post-evaluation used individual-level data from 22 produce prescription locations in 12 US states from 2014 to 2020. No programs were previously evaluated. The study included 3881 individuals (2064 adults aged 18+ years and 1817 children aged 2-17 years) with, or at risk for, poor cardiometabolic health recruited from clinics serving low-income neighborhoods. Programs provided financial incentives to purchase F&V at grocery stores or farmers markets (median, $63/months; duration, 4-10 months). Surveys assessed F&V intake, food security, and self-reported health; glycated hemoglobin, blood pressure, body mass index (BMI), and BMI z-score were measured at clinics. Adjusted, multilevel mixed models accounted for clustering by program.

RESULTS

After a median participation of 6.0 months, F&V intake increased by 0.85 (95% CI, 0.68-1.02) and 0.26 (95% CI, 0.06-0.45) cups per day among adults and children, respectively. The odds of being food insecure dropped by one-third (odds ratio, 0.63 [0.52-0.76]) and odds of improving 1 level in self-reported health status increased for adults (odds ratio, 1.62 [1.30-2.02]) and children (odds ratio, 2.37 [1.70-3.31]). Among adults with glycated hemoglobin ≥6.5%, glycated hemoglobin declined by -0.29% age points (-0.42 to -0.16); among adults with hypertension, systolic and diastolic blood pressures declined by -8.38 mm Hg (-10.13 to -6.62) and -4.94 mm Hg (-5.96 to -3.92); and among adults with overweight or obesity, BMI decreased by -0.36 kg/m2 (-0.64 to -0.09). Child BMI z-score did not change -0.01 (-0.06 to 0.04).

CONCLUSIONS

In this large, multisite evaluation, produce prescriptions were associated with significant improvements in F&V intake, food security, and health status for adults and children, and clinically relevant improvements in glycated hemoglobin, blood pressure, and BMI for adults with poor cardiometabolic health.

Print News About Food Assistance

Objective

To understand how equity appeared in news about food assistance from 2021.

Methods

We assessed a national sample of news articles (N=298) for equity arguments and language about racial and health equity.

Results

Only 28% of coverage argued that food assistance programs promote equity. Just 6% mentioned people of color or named racial disparities in food access.

Discussion

Narratives that explain how food assistance programs reduce inequities could deepen their policy appeal and broaden public perceptions around recipients.

Health Equity Implications

There are opportunities for news coverage to expand the discussion of how food assistance programs improve racial and health equity outcomes.

Human milk expression in the first year postpartum among persons with low incomes

BACKGROUND

Expressing milk (i.e., human milk) is common in the USA, but practices are unknown among families in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). This study of a WIC population explores the practice of and reasons for expressing milk in the first year postpartum.

METHODS

We analysed data from a longitudinal study to examine milk expression at 1, 3, 5, 7, 9, 11, and 13 months postpartum among breastfeeding persons enrolled in WIC with term singletons. We cross-sectionally analysed the weighted prevalence of milk expression at each survey month and report reasons for milk expression in the first 7 months.

RESULTS

Among the study participants who reported feeding human milk at Month 1, 70.4% expressed milk in the first 13 months postpartum. The prevalence of milk expression was 56.8% at Month 1 and decreased to 13.9% at Month 13 among those feeding any human milk that month. Reasons for expressing milk changed over time; in the first month, increasing milk supply, relieving engorgement, and having an emergency supply of milk were common. In later months, having a supply of milk available so that someone else could feed their infant was common.

CONCLUSIONS

Clinicians, health educators, WIC staff, and others working with WIC families can promote optimal expressed milk feeding and storage practices. Extra attention and support may be especially important in the first months postpartum when milk expression is common. Support for persons who are expressing milk can be tailored for reasons of milk expression.

A Qualitative Examination of the Detroit Community Food Response to COVID-19

The COVID-19 pandemic increased the need for food assistance due to surging unemployment, the closure of in-person schooling, and other factors. This posed a historic challenge to organizations that address food insecurity: meeting the surging need for food while minimizing COVID-19 transmission. This study aimed to identify how food insecurity program operations changed during the pandemic and to examine the facilitators/successes and barriers/challenges to operations. Semi-structured interviews were conducted with staff at 13 organizations involved in addressing food insecurity in Detroit during the pandemic. Interviews were coded by two coders, summarized, and then used to create matrices and concept map displays for each organization. We found that nearly all programs changed to a contactless food distribution format, and most programs experienced an increase in demand for food. Common successes/facilitators included keeping clients and staff safe from COVID-19 and waivers that eased program rules. Common challenges/barriers included the increased need for labor and food. Lack of funding was a barrier for some organizations, and others that experienced an increase in funding reported that it facilitated their work. This research identified the needs of programs addressing food insecurity during the COVID-19 pandemic, which can inform future disaster planning.

Food and nutrition security in the Philippines during the COVID-19 pandemic

Objective: The COVID-19 pandemic placed the Philippines' food and nutrition issues front and center. In this paper, we discuss the response of its government in addressing food and nutrition security at the beginning of the COVID-19 pandemic and describe its implications on nutritional status. We also cite initiatives that address food accessibility and availability in the communities. Lastly, we explore the importance of nutrition security dimension in food security. Methods: We analyze food and nutrition security issues in the Philippines during the COVID-19 pandemic through online reports and news articles. Results: The distribution of food and financial assistance in the country was extensive, albeit insufficient, considering the prolonged lockdown restrictions. Constantly changing community quarantine guidelines have affected the movement of food supply, delivery of health services, and household economic security. Nutrition programs, such as vitamin A supplementation, feeding for children, and micronutrient supplementation for pregnant women, had lower coverage rates, and by the latter half of 2020, the country had reached its highest recorded hunger rate. Cases of both undernutrition and overnutrition are predicted to rise because of dietary imbalances and a variety of factors. Conversely, community members and some local government units took it upon themselves to improve the food situation in their areas. The provision of food packs containing fresh fruits and vegetables was lauded, as it exemplified a conscious effort to deal with nutrition security. Conclusion: Efforts to address food security have always focused on increasing accessibility, availability, and affordability, often neglecting the nutritional components of foods. Strategies that incorporate nutrition security into food security are much needed in the country, especially during emergencies like the COVID-19 pandemic.

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.

Post-Resettlement Food Insecurity: Afghan Refugees and Challenges of the New Environment

BACKGROUND

Lack of access to adequate, safe, and nutritious food is a major concern for the Afghan population due to ongoing war and humanitarian crises. Recently resettled Afghan refugees in the US continue to face challenges securing adequate, nutritious food resources in new environments. This study examined Afghan refugees' food access and insecurity in the San Joaquin Valley, California.

METHODS

Semi-structured, in-depth interviews were conducted to collect the perspectives and experiences of key informants and newly arrived Afghan refugees.

RESULTS

This study highlights environmental and structural factors (availability and accessibility of grocery stores; availability of religious-appropriate items in the stores; the public benefit received by a family; and public transportation) and individual factors (religious and cultural practices; financial and language barriers) as major determinants of post-resettlement food insecurity.

CONCLUSION

Increasing the accessibility and affordability of culturally and religiously appropriate food items within the US food system, enhancing the collaboration of community volunteers and resettlement organizations in the direct assistance of new families, and providing continuous access to public benefits are possible steps to mitigate the risk of food insecurity among Afghan refugees. This study suggests a continuous examination of the degree of food insecurity in this population and its attendant health impacts.

Sexual Orientation and Food Hardship: National Survey of Family Growth, 2011-2019

OBJECTIVE

Given the high rates of poverty observed among sexual minority groups and their social vulnerability, we examined the prevalence and correlation of food hardship, measured as food insecurity, receipt of free or reduced-cost food, and Supplemental Nutrition Assistance Program (SNAP) participation among low-income sexual minority and heterosexual adults using population-level health surveillance data.

METHODS

We used 4 waves of pooled data (2011-2019) from the National Survey of Family Growth for adults aged 18-44 years. We compared the sexual orientation subgroups and used logistic regression to predict the likelihood of food hardship.

RESULTS

Among men, gay and bisexual men had higher odds of experiencing food insecurity than their heterosexual counterparts (adjusted odds ratio [aOR] = 1.97 and 1.83, respectively). Compared with heterosexual men, bisexual men had significantly higher odds of receiving free or reduced-cost food, but gay men did not. The odds of participating in SNAP did not differ significantly among gay, bisexual, and heterosexual men. Among women, only bisexual women were more prone to experiencing food insecurity than their heterosexual counterparts (aOR = 1.81). The odds of receiving free or reduced-cost food did not differ significantly among heterosexual, bisexual, and lesbian women. However, compared with heterosexual women, lesbian women had significantly lower odds (aOR = 0.62) and bisexual women had significantly higher odds (aOR = 1.24) of participating in SNAP.

CONCLUSION

Our findings contribute to the limited literature examining trends in food hardship among sexual minority groups and suggest potentially different patterns of food insecurity, food assistance, and SNAP participation among sexual orientation subgroups, which may call for group-specific, nuanced approaches for lessening food hardship.

The Nutritional Quality of Food Provision at UK Government-Funded Holiday Clubs: A Cross-Sectional Analysis of Energy and Nutrient Content

A large proportion of children are at risk of food insecurity during school holidays in the UK. The government-funded Holiday Activities and Food (HAF) programme provides free holiday clubs offering at least one healthy meal/day to eligible children and adolescents. This study aims at evaluating the nutritional quality of food provision at HAF holiday clubs, particularly hot/cold and vegetarian/non-vegetarian meals. Menu variants (n = 2759) from 49 HAF holiday clubs were assessed for adherence to School Food Standards (SFS) and their notional compositional quality, which was scored utilising a novel nutrient-based meal quality index. The median adherence to SFS across all available menus was 70% (IQR 59-79%). Overall, hot variants scored statistically higher menu quality scores than cold variants for both 5-11y (92.3 (80.7-102.7) vs. 80.4 (69.3-90.6)) and 11-18y (73.5 (62.5-85.8) vs. 58.9 (50.0-70.7)) criteria. Cold and hot menu variants tended to score differentially for quality sub-components. These findings highlight areas for potential future improvement in HAF holiday club provision with a tendency for food provision to appear less ideal for attendees for those aged 11-18. Ensuring that children from low-income households have access to a healthy diet is crucial to reduce UK health inequalities.

An Analysis of SNAP Online Purchasing Behavior in California: A Review of the First 7 Months of Program Implementation and Lessons Learned

PURPOSE

The Supplemental Nutrition Assistance Program (SNAP) Online Purchasing Pilot (OPP) allows for the online purchase of groceries using SNAP benefits. First implemented in California in late April 2020, little is known about program usage. This study assessed initial implementation of SNAP Online in California using SNAP OPP transaction data from April - October 2020. Insights can identify usage differences by demographics, store availability, and rurality to help inform future pilot programs and nutrition initiatives.

DESIGN

Using generalized estimating equations, we modeled county-level associations between transactions and county-level demographics, rurality, and retailer availability.

SETTING

Transaction data from California's Department of Social Services (CDSS) was linked with publicly-available, county-level demographics.

SUBJECTS

Anonymized county-level data on SNAP Online transactions and CalFresh households.

MEASURES

The primary outcome was successful SNAP Online food transactions per county.

ANALYSIS

Generalized estimating equation models with clustering by county was used.

RESULTS

During the first 7 months, median SNAP Online transactions per county per month was 665; 2.7% of total SNAP redemptions were from SNAP Online. Counties with more female-led, disabled, Latino, or Asian CalFresh households had fewer Amazon transactions. Each additional Walmart per county corresponded to 260.7 more Walmart transactions (P < .001). Each percent increase in county zip codes covered by Amazon Fresh corresponded to 45.4 fewer Walmart transactions (P < .05) and 37.3 more Amazon transactions (P < .001).

CONCLUSION

Number of stores per county was associated with greater online grocery transactions, whereas rurality was not. County-level SNAP demographics correlated with transactions at particular retailers.

Food Security is Associated with Higher Diet Quality Among Children of the US-Affiliated Pacific Region

BACKGROUND

The prevalence of food insecurity and its relationship to diet quality are factors impacting the health of persons living across the United States-affiliated Pacific region (USAP).

OBJECTIVES

The aim of this study was to describe characterize the relationship between household food security status and diet quality of 2- to 8-y-old children across jurisdictions in the USAP.

METHODS

Baseline data from 2- to 8-y-olds (n = 3099) enrolled in the Children's Healthy Living Program for Remote Underserved Minority Populations in the Pacific region, an obesity prevention study conducted in communities across Alaska, American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), Guam, and Hawaii, and a concomitant prevalence study in communities across the Freely Associated States (FAS) (the Federated States of Micronesia: Kosrae, Pohnpei, Chuuk, Yap; Republic of Marshall Islands; Republic of Palau) were collected in 2012. Caregivers self-reported sociodemographic data and food insecurity. Assisted by their caregiver, children completed two dietary records on nonconsecutive, randomly assigned days. The Healthy Eating Index 2005 (HEI-2005) was used to assess the diet quality. Data were summarized overall and by jurisdiction. Differences in HEI-2005 and HEI component scores among jurisdictions and by household food security status were tested using 1-factor ANOVA.

RESULTS

Half or more of participants from American Samoa, Guam, CNMI, and FAS reported household food insecurity (n = 295, 59.7%; n = 292, 49.9%; n = 267, 54.6%; n = 572, 69.0%, respectively). HEI-2005 scores varied by jurisdiction (P < 0.001) and were significantly lower among FAS participants (54.7 ± 1.2) than among all other jurisdictions (P < 0.05). Total diet quality scores did not differ by food security status (59.9 ± 0.8 food secure compared with 58.3 ± 1.1 food insecure, P = 0.07); however, most diet quality adequacy component scores were significantly higher and moderation component scores significantly lower among participants in food secure households than those in food insecure households.

CONCLUSIONS

Significant differences in children's diet quality and household food security existed across USAP jurisdictions.

Knowledge and perceptions of nutrition assistance programmes among young adult students

The purpose of this qualitative study was to investigate the perceptions of nutrition assistance programmes among young adult students in the United States, and to identify how the current social and political climate, including the COVID-19 pandemic, has impacted these perceptions and the overall willingness of young adult students to participate in these programmes. Participants were recruited via email and social media to participate in 20-min virtual, semi-structured interviews. Twenty-three participants, between the ages of 18 and 25 years from three states in the United States were interviewed. Ten participants reported having experienced food insecurity (FI) in their lifetime, with 21 participants currently having enough food to eat, while two sometimes did not currently have enough to eat. Seven participants had utilised nutrition programmes in their lifetime. Interviews were video and audio recorded, transcribed, and coded using a six-step thematic analysis. Young adult students were largely unaware of nutrition assistance programmes and eligibility requirements but still perceived these programmes to be successful, with a higher proportion of the participants who had utilised a nutrition assistance programme in their lifetime expressing the view that they were generally successful compared to those who had never utilised one. Most were cognizant of the social stigma surrounding these programmes yet expressed a willingness to utilise them and reported an increased willingness to utilise nutrition assistance programmes as a result of the COVID-19 pandemic. COVID-19 made young adult students aware of FI and the important role nutrition assistance programmes play in our society. Young adult students expressed the belief that the Biden administration will have a positive impact on nutrition assistance programmes but had a general hesitation to discuss politics. The COVID-19 pandemic has increased young adult students' willingness to utilise nutrition assistance programmes, although, access to these programmes remains low due to a lack of knowledge and general unawareness of programme availability and accessibility. Education is needed to improve overall knowledge of, and facilitate access to, nutrition assistance programmes while combating perceptions around stigma.

Can Ordering Groceries Online Support Diet Quality in Adults Who Live in Low Food Access and Low-Income Environments?

During the COVID-19 pandemic, U.S. food assistance programs allowed the use of program benefits to order groceries online. We examined relationships between the food environment, food assistance, online grocery ordering, and diet quality among adults from one low-income, low food access community in Northeastern Connecticut during the pandemic. Via online survey, adults (n = 276) reported their perceived home and store food environments, food assistance participation, whether they ordered groceries online, and consumption frequency and liking of foods/beverages to calculate diet quality indices. Those who ordered groceries online (44.6%) were more likely to participate in food assistance programs and report greater diet quality. Perceived healthiness of store and home food environments was variable, with the ease of obtaining and selecting unhealthy foods in the neighborhood significantly greater than healthy foods. Healthier perceived home food environments were associated with significantly higher diet qualities, especially among individuals who participated in multiple food assistance programs. Ordering groceries online interacted with multiple measures of the food environment to influence diet quality. Generally, the poorest diet quality was observed among individuals who perceived their store and home food environments as least healthy and who did not order groceries online. Thus, ordering groceries online may support higher diet quality among adults who can use their food assistance for purchasing groceries online and who live in low-income, low-access food environments.

Communicating accessible messages for food insecure communities in Northern Mozambique: Supporting Sustainable Development Goal 2

PURPOSE

This paper describes a collaborative project between Trinity College Dublin in Ireland and the United Nations' World Food Programme (WFP) Mozambique country office. The Sphere standards require that information on humanitarian assistance should be in languages and formats accessible to people who cannot read or who have communication difficulties. Nevertheless, there remains a gap in both implementing this guidance consistently and in understanding the impact of doing so when engaging with affected populations.

METHOD

This commentary describes the process of developing key messages regarding targeting of humanitarian food assistance in communication-accessible formats, and field testing of these materials with community committees and partners.

RESULT

The communication-accessible materials were well received by communities, and humanitarian staff and partners found them to be useful in community engagement.

CONCLUSION

Materials designed to be maximally accessible to people with communication differences and disabilities may also address inclusion for affected populations with different education, literacy, and language backgrounds. This commentary focuses on Sustainable Development Goal (SDG) 2 as an exemplar of the use of communication accessible messaging in humanitarian response.

Food security and food access during the COVID-19 pandemic: Impacts, adaptations, and looking ahead

The coronavirus disease 2019 (COVID-19) pandemic continues to alter US household food consumption and food spending. Although terminology used to describe food insecurity has varied during the COVID-19 pandemic, many reliable estimates illustrate a dramatic increase in food insecurity from approximately 10% of US households before the pandemic to 25%-30% of households during the pandemic, with an even higher prevalence reported by more vulnerable and socially disadvantaged populations. To address the increase in food and economic insecurity, food and nutrition assistance policies and programs made innovative and temporary changes, and enrollment in these programs generally increased. However, some changes to food, nutrition, and income assistance programs are now expiring or contracting even as food insecurity prevalence is again on the rise and elevated food and nutrition assistance needs are expected to persist based on historical patterns. American Society for Parenteral and Enteral Nutrition (ASPEN) practitioners can play an important role in identifying clients at elevated risk of food insecurity-related acute and chronic conditions and connecting high-risk clients to resources. ASPEN practitioners can contribute to the evidence base linking food insecurity and nutrition outcomes. ASPEN practitioners can also advocate for addressing the root social and structural determinants of food insecurity and for the continuation of effective food and nutrition policy changes and innovations.

Health of the Food Environment Is Associated With Heart Failure Mortality in the United States

BACKGROUND

Food environment factors contribute to cardiovascular disease, but their effect on population-level heart failure (HF) mortality is unclear.

METHODS

We utilized the National Vital Statistics System and USDA Food Environment Atlas to collect HF mortality rates (MR) and 2 county food environment indices: (1) food insecurity percentage (FI%) and (2) food environment index (FEI), a scaled index (0-10, 10 best) incorporating FI% and access to healthy food. We used linear regression to estimate the association between food environment and HF MR Results: Mean county FI% and FEI were 13% and 7.8 in 2956 included counties. Counties with FI% above the national median had significantly higher HF MR (30.7 versus 26.7 per 100 000; P<0.001) compared with FI% below the national median. Counties with HF MR above the national median had higher FI%, lower FEI, lower density of grocery stores, poorer access to stores among older adults, and lower Supplemental Nutrition Assistance Program participation rate (P<0.001 for all). Lower county FI% (β=-1.3% per 1% decrease) and higher county FEI (β=-3.6% per 1-unit increase in FEI) were significantly associated with lower HF MR after adjustment for county demographic, socioeconomic, and health factors. This association was stronger for HF MR compared with non-HF cardiovascular disease MR and all-cause MR The relationship between food environment and HF MR was stronger in counties with the highest income inequity and poverty rate.

CONCLUSIONS

Healthier food environment is significantly associated with lower HF mortality at the county level. This reinforces the role of food security on cardiovascular outcomes.

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.

Caregivers' Perceived Impact of WIC's Temporary Cash-Value Benefit (CVB) Increases on Fruit and Vegetable Purchasing, Consumption, and Access in Massachusetts

Responding to the COVID-19 pandemic, the American Rescue Plan (2021) allowed state agencies of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) the option of temporarily increasing the Cash-Value Benefit (CVB) for fruit and vegetable (FV) purchases. To examine the impact of this enhancement on WIC caregiver experience, the MA WIC State Office invited 4600 randomly selected MA WIC caregivers to complete an online survey (February-March 2022). Eligible adults had at least one child, had been enrolled at least a year, and were aware of the increase. Of those who opened the screener (n = 545), 58.9% completed it (n = 321). We calculated the frequencies of reporting increased FV outcomes and tested whether responses differed by race/ethnicity, market access, and food security. Most caregivers perceived the CVB increase to benefit FV purchasing (amount and quality, 71.0% and 55.5%), FV consumption (offered to children and personally consumed, 70.1% and 63.2%), and satisfaction with the WIC food package (37.1% reported improved satisfaction, pre- vs. post-increase). Probability of reporting improved outcomes was not found to differ by race/ethnicity, market access, or food security. CVB increases may pose important implications for dietary behaviors and satisfaction with WIC. Policymakers should consider making this increase permanent.

Grocery Purchase Changes Were Associated With A North Carolina COVID-19 Food Assistance Incentive Program

Many low-income Americans experience food insecurity, which may have been exacerbated by economic instability during the early stages of the COVID-19 pandemic in 2020. In this study we assessed the impact of Healthy Helping, a short-term fruit and vegetable incentive program aimed at alleviating food insecurity and improving diet quality for Supplemental Nutrition Assistance Program participants, on grocery purchases, using transaction data from a large supermarket chain in North Carolina. We compared Healthy Helping participants' purchases of key food groups before and during the program with purchases by control shoppers participating in federal food assistance programs during the same period. Healthy Helping enrollment was associated with a $26.95 increase in monthly spending on fruit, vegetables, nuts, and legumes-an increase of 2.5 grams of fiber per 1,000 kilocalories purchased-and other shifts in the composition of food purchases, relative to control shoppers. These findings suggest that the program increased healthy food purchases while also increasing dollar sales at participating retailers. On average, participants did not use the full benefit; future research should explore factors associated with non- or underuse of benefits, to inform program design and outreach.

SNAP participation moderates the association between household food insecurity and HbA1c among Cambodian Americans with depression

OBJECTIVES

We tested whether participation in the Supplemental Nutrition Assistance Program (SNAP) moderated the relation between household food insecurity and HbA1c among Cambodian Americans with depression enrolled in a diabetes prevention trial.

METHODS

Community health workers assessed household food insecurity and SNAP participation. HbA1c was ascertained using direct enzymatic assay.

RESULTS

Among the n = 189 respondents, 19% were food insecure, 41% received SNAP benefits, and mean HbA1c = 5.5%. There was a significant interaction between SNAP and food insecurity. HbA1c was highest among participants without SNAP who were food insecure. Simple effects analysis revealed a significant difference within the no SNAP group [Mean (SD): Secure = 5.38 (0.38), Insecure = 5.78 (0.36)] and no difference within the SNAP group [Secure = 5.61(0.44), Insecure = 5.61(0.55)]. Differences remained significant after controlling for demographic, socioeconomic, and clinical indicators.

CONCLUSIONS

SNAP may protect against the deleterious association between household food insecurity and HbA1c.

[Situation of food assistance users and the association with change in socioeconomic status during COVID-19 pandemic in Japan]

Objective　This study aimed to understand the situation of the users of food assistance activities during the COVID-19 pandemic, and to examine the relationship with the changes in socioeconomic conditions.Methods　A total of 33,004 (16,065 men and 16,939 men) people aged 20 or older who cooperated with an online survey in February 2021 were included in the analysis. The analysis was conducted by classifying users of one of the following types of food assistance as food assistance users and other users as non-users: eating on site (e.g., children's cafeteria), receiving food at a specific location (e.g., food pantry), or having food delivered to their home (e.g., emergency home food delivery). A multiple logistic regression analysis was used to calculate the adjusted odds ratios (95% confidence interval (CI)) for the association between food assistance use and changes in socioeconomic status, which was assessed based on the employment status and household monthly income just before and during the COVID-19 pandemic.Results　The number of users of food assistance was 3,071 (9.3%). Of these, 1,549 (4.7%) were users of children's cafeterias, 1,296 (3.9%) were users of food pantries, and 2,236 (6.8%) were users of emergency home food delivery (with duplicate responses). The adjusted odds ratio for food assistance use was 1.47 (95% CI 1.28-1.70) for those with changes in employment status compared to those with no changes. The adjusted odds ratio for food assistance use was 1.89 (1.65-2.15) for those with reduced income and 1.67 (1.37-2.03) for those with increased household income compared to those with no changes. The adjusted odds ratios for food assistance use were higher for those with changes in employment status and/or household income than those with no changes in both.Conclusions　One in ten individuals used food assistance during the COVID-19 pandemic. It was suggested that many of the users of food assistance had changed their employment status or household income during the COVID-19 pandemic. In the future, it will be necessary to establish a public-private system that can provide information on local food assistance to people whose socioeconomic status has changed rapidly.

Healthy Choices Catch On: Data-informed Evolution of a Social Marketing Campaign

OBJECTIVE

Describe how a multiyear, mixed-methods evaluation informed the evolution of a healthy eating and physical activity social marketing campaign.

DESIGN

Focus groups, A/B survey to test messages and images, telephone interviews (2019) with local programmers, and an annual outcome survey.

SETTING

Statewide through multiple channels: billboards, transit signs, social media, website, and program resources like banners and posters.

PARTICIPANTS

Supplemental Nutrition Assistance Program-Education eligible adults, focusing on mothers and caregivers.

INTERVENTION(S)

Healthy Choices Catch On originally launched in 2006 and has since evolved.

MAIN OUTCOME MEASURE(S)

Fruit and vegetable consumption, physical activity, and campaign recall.

ANALYSIS

Univariate descriptive statistics and multivariate, weighted linear regression modeling. Interview transcriptions were analyzed for common themes.

RESULTS

The multiyear evaluation demonstrated a steady increase in campaign exposure from 2013 to 2017, followed by a decline when new messages and images were introduced in 2018 and 2020. People with greater exposure to messages were more likely to eat more fruits and vegetables and be physically active.

CONCLUSIONS AND IMPLICATIONS

Using a combination of evaluation methods can help inform campaign design and evolution while also demonstrating reach and impact.

Ecological Approach to Family-Style, Multilevel Child Care Intervention: Formative Evaluation Using RE-AIM Framework

OBJECTIVE

Conduct formative evaluation of Ecological Approach to Family-Style Dining (EAT) Intervention.

DESIGN

Qualitative semistructured interviews and demographic surveys.

SETTING

Early care and education (ECE) centers in Nebraska.

PARTICIPANTS

Cooperative Extension coaches (n = 9), ECE administrators (n = 8), and teachers (n = 17) caring for children aged 3-5 years.

INTERVENTION

The EAT intervention (a 16-week, 7-lesson, evidence-based online responsive feeding ECE model) uses a multilevel improvement system of 5 implementation strategies. Early care and education administrators and teachers completed 1 lesson/wk followed by a coaching session.

MAIN OUTCOME MEASURES

The Reach, Effectiveness, Adoption, Implementation, and Maintenance framework includes 5 evaluative dimensions.

ANALYSIS

Thematic analysis.

RESULTS

Overall, 77% of children aged 3-5 years (n = 216) participated from targeted Child and Adult Care Food Program ECEs (Reach). All perceived EAT improved children's nutritional and developmental outcomes and encouraged a positive mealtime environment (Effectiveness). Coaches found professional development incentives important, whereas administrators/teachers valued inservice hours (Adoption). Teachers reported successful implementation of responsive feeding, and administrators supported the teachers (Implementation). All reported they intended to continue using EAT, and administrators and teachers discussed incorporating EAT practices into the handbook/school policy (Maintenance).

CONCLUSION AND IMPLICATIONS

The EAT was valued by all stakeholders for its perceived effectiveness to positively impact children's nutritional outcomes. Furthermore, stakeholders valued the provided incentives and multilevel design with coaching, ECE administrators, and teachers. Future research is needed on how to use Extension coaches in ECE interventions.

Feeding hungry students: College students' experiences using food pantries and successful strategies for implementing on-campus food assistance programs

OBJECTIVE

To examine the components of successful food assistance programs for college students.

PARTICIPANTS

Focus groups conducted during the fall 2019 semester included undergraduate students who accessed a food assistance program on campus (n = 26). Key informant interviews were conducted with professionals working with campus-based food assistance programs (n = 5).

METHODS

Student insight regarding experiences on campus-based food assistance programs was gathered. Key informant interviews were conducted to gain an understanding of strategies put in place to alleviate food insecurity among college students.

RESULTS

Emerging focus group themes included financial stressors, eating strategies, struggling to feed dependents, utilization of university-based food assistance programs, and SNAP enrollment. Key informant interviews revealed six strategies of effective food assistance programs: increasing access, securing funding, procurement/distribution of healthy foods, partnerships, outreach, and decreasing stigmatization.

CONCLUSIONS

A "mission driven" approach has the potential to meet the complex needs of food insecure college students.

A Food Relief Charter for South Australia-Towards a Shared Vision for Pathways Out of Food Insecurity

Chronic food insecurity persists in high-income countries, leading to an entrenched need for food relief. In Australia, food relief services primarily focus on providing food to meet immediate need. To date, there has been few examples of a vision in the sector towards client outcomes and pathways out of food insecurity. In 2016, the South Australian Government commissioned research and community sector engagement to identify potential policy actions to address food insecurity. This article describes the process of developing a co-designed South Australian Food Relief Charter, through policy–research–practice collaboration, and reflects on the role of the Charter as both a policy tool and a declaration of a shared vision. Methods used to develop the Charter, and resulting guiding principles, are discussed. This article reflects on the intentions of the Charter and suggests how its guiding principles may be used to guide collective actions for system improvement. Whilst a Charter alone may be insufficient to create an integrated food relief system that goes beyond the provision of food, it is a useful first step in enabling a culture where the sector can have a unified voice to advocate for the prevention of food insecurity.

Strengthening US Food Policies and Programs to Promote Equity in Nutrition Security: A Policy Statement From the American Heart Association

Nutritionally inadequate dietary intake is a leading contributor to chronic cardiometabolic diseases. Differences in dietary quality contribute to socioeconomic and racial and ethnic health disparities. Food insecurity, a household-level social or economic condition of limited access to sufficient food, is a common cause of inadequate dietary intake. Although US food assistance policies and programs are designed to improve food security, there is growing consensus that they should have a broader focus on nutrition security. In this policy statement, we define nutrition security as an individual or household condition of having equitable and stable availability, access, affordability, and utilization of foods and beverages that promote well-being and prevent and treat disease. Despite existing policies and programs, significant gaps remain for achieving equity in nutrition security across the life span. We provide recommendations for expanding and improving current food assistance policies and programs to achieve nutrition security. These recommendations are guided by several overarching principles: emphasizing nutritional quality, improving reach, ensuring optimal utilization, improving coordination across programs, ensuring stability of access to programs across the life course, and ensuring equity and dignity for access and utilization. We suggest a critical next step will be to develop and implement national measures of nutrition security that can be added to the current US food security measures. Achieving equity in nutrition security will require coordinated and sustained efforts at the federal, state, and local levels. Future advocacy, innovation, and research will be needed to expand existing food assistance policies and programs and to develop and implement new policies and programs that will improve cardiovascular health and reduce disparities in chronic disease.

Helping College Students Get Supplemental Nutrition Assistance Program: Facilitators of and Barriers to Students Accessing the Federal Nutrition Assistance Program

OBJECTIVE

To identify effective practices for assisting college students with Supplemental Nutrition Assistance Program (SNAP) applications and explore challenges in student SNAP enrollment.

DESIGN

In-depth interviews with key informants on experiences assisting college students with SNAP applications.

SETTING

University of California campuses.

PARTICIPANTS

Twenty-one key informants, including staff from the University of California on-campus Basic Needs Centers, campus financial aid offices, county agencies, and food banks.

PHENOMENON OF INTEREST

Facilitators and barriers of college student SNAP enrollment.

ANALYSIS

Transcripts were coded to identify emerging themes.

RESULTS

Two of the most frequently mentioned facilitators were county staff presence on campus for application assistance and a strong relationship between campus staff and the county SNAP agency. A common barrier was inconsistent student SNAP eligibility information and procedures across county offices.

CONCLUSION AND IMPLICATIONS

Federal coordination with state agencies on student SNAP policy is much needed. This approach could help to eliminate heterogeneous interpretations of student exemptions across counties and between county staff. Future research is warranted to identify policy leverage points at the county, state, and federal levels, such as eliminating the student rule, to ensure equitable access to SNAP among college students.

The Child and Adult Care Food Program: Barriers to Participation and Financial Implications of Underuse

OBJECTIVE

To assess facilitators and barriers to participation in the Child and Adult Care Food Program (CACFP) and estimate foregone federal funds because of CACFP underuse.

METHODS

An online survey of food service practices and experiences with CACFP among Connecticut-based licensed child care centers (n = 231).

RESULTS

Serving meals and the center's nonprofit status predicted CACFP participation. The most common challenge among participants was collecting family income eligibility. Streamlining paperwork (mentioned by 44% of respondents) and funding for nonfood, administrative costs (40%) were recommended facilitators to increase CACFP uptake. Nonparticipating centers had limited knowledge about the program and its eligibility. Foregone federal funding due to CACFP underuse among eligible Connecticut centers was estimated at $30.7 million in 2019, suggesting that 20,300 young children from low-income areas missed out on CACFP-subsidized food.

CONCLUSIONS AND IMPLICATIONS

Improving knowledge about CACFP and reducing participation burdens through additional funding and technical assistance can help expand the program to support child nutrition.

Food Assistance Use Among Food Bank Clients Affected by Type 2 Diabetes

OBJECTIVE

To understand the perspectives of food bank clients affected by type 2 diabetes (T2DM).

DESIGN

Semi-structured in-depth interviews conducted with food bank clients.

SETTING

Arizona regional food bank.

PARTICIPANTS

Twenty English- and Spanish-speaking food bank clients with T2DM or living with a person with T2DM, aged 45-83 years, majority female, Hispanic, and food insecure.

PHENOMENON OF INTEREST

Food bank use and preferences, and how these related to T2DM management.

ANALYSIS

A hybrid thematic analysis combining inductive and deductive reasoning.

RESULTS

Three organizing themes emerged from the analysis. First, food assistance was influenced by food preferences and the ability to pair with existing household foods. Second, desired support included fresh fruits and vegetables, meat, oats, oil, and herbs; recipes; cooking demonstrations; and social support. Third, factors influencing T2DM management were lack of financial resources, low motivation, insufficient nutrition knowledge, low medication adherence, and multiple comorbidities. Participants also expressed resilience and interest in improving T2DM management.

CONCLUSIONS AND IMPLICATIONS

Among a predominantly Hispanic food bank sample, produce and protein-rich foods, nutrition and culinary education, and social support were components of a supportive food bank experience and should be considered when designing food-based interventions for T2DM management for food insecure persons.

Food Security Impacts of the COVID-19 Pandemic: Longitudinal Evidence from a Cohort of Adults in Vermont during the First Year

This study assessed changes in household food insecurity throughout the first year of the COVID-19 pandemic in a cohort of adults in the state of Vermont, USA, and examined the socio-demographic characteristics associated with increased odds of experiencing food insecurity during the pandemic. We conducted three online surveys between March 2020 and March 2021 to collect longitudinal data on food security, use of food assistance programs, and job disruptions during the COVID-19 pandemic. Food security was measured using the USDA six-item module. Among the 441 respondents, food insecurity rates increased significantly during the pandemic and remained above pre-pandemic levels a year after the start of the pandemic. Nearly a third (31.6%) of respondents experienced food insecurity at some point during the first year of the pandemic, with 53.1% of food-insecure households being classified as newly food-insecure. The odds of experiencing food insecurity during the pandemic varied based on socio-demographic factors. Households with children (OR 5.5, 95% CI 1.782−16.936, p < 0.01), women (OR 8.1, 95% CI 1.777−36.647, p < 0.05), BIPOC/Hispanic respondents (OR 11.8, 95% CI 1.615−85.805, p < 0.05), and households experiencing a job disruption (OR 5.0, 95% CI 1.583−16.005, p <0.01) had significantly higher odds of experiencing food insecurity during the first year of the COVID-19 pandemic, while respondents with a college degree (OR 0.08; 95% CI 0.025−0.246; p < 0.001) and household income of ≥USD 50,000 (OR 0.01; 95% CI 0.003−0.038; p < 0.001) had lower odds of experiencing food insecurity. These findings indicate that food insecurity continued to be a significant challenge one year after the start of the pandemic, which is important, given the adverse health impacts associated with food insecurity and health disparities among certain socio-demographic groups.

Moving Food Assistance into the Digital Age: A Scoping Review

One of the most basic needs globally, food assistance refers to the multitude of programs, both governmental and non-governmental, to improve food access and consumption by food-insecure individuals and families. Despite the importance of digital and mobile Health (mHealth) strategies in food insecurity contexts, little is known about their specific use in food assistance programs. Therefore, the purpose of this study was to address that gap by conducting a scoping review of the literature. Keywords were defined within the concepts of food assistance and digital technology. The search included relevant peer-reviewed and grey literature from 2011 to 2021. Excluded articles related to agriculture and non-digital strategies. PRISMA guidelines were followed to perform a partnered, two-round scoping literature review. The final synthesis included 39 studies of which most (84.6%) were from the last five years and United States-based (93.2%). The top three types of articles or studies included text and opinion, qualitative research, and website, application, or model development (17.9%). The top three types of digital tools were websites (56.4%), smartphone applications (20.5%), and chatbots (5.1%). Nineteen digital features were identified as desirable. Most tools included just one or two features. The most popular feature to include was online shopping (n = 14), followed by inventory management, and client tracking. Digital tools for individual food assistance represent an opportunity for equitable and stable access to programs that can enhance or replace in-person services. While this review identified 39 tools, all are in early development and/or implementation stages. Review findings highlight an overall lack of these tools, an absence of user-centered design in their development, and a critical need for research on their effectiveness globally. Further analysis and testing of current digital tool usage and interventions examining the health and food security impacts of such tools should be explored in future studies, including in the context of pandemics, where digital tools allow for help from a distance.

Food Assistance Programs and Reduced Hospitalizations for Older Adults with Diabetes

Diabetes is an increasingly common and costly condition for older adults. Each year, as many as 1 in 3 Medicare dollars is spent to treat and manage diabetes and associated comorbidities for people with diabetes. To control health care spending in the US, it is imperative that we identify factors for reducing hospitalizations for these individuals. The purpose of this cross-sectional study was to identify predictors of hospitalization in the past 12 months for community-dwelling older adults with diabetes. Data from round five of the National Health and Aging Trends Study were analyzed to assess the impact of food assistance programs on the risk of hospitalization in the past 12 months for 1094 Medicare recipients ages 65 and older with diabetes. Previous research on the social determinants of health has demonstrated that social stressors like poverty and exposure to racism are associated with poorer health outcomes overall, but we did not find a statistically-significant association between race, gender, age or Medicare/ Medicaid dual-eligibility and hospitalization for our study population. Notably, receipt of Supplemental Nutrition Assistance Program (SNAP) benefits, Meals on Wheels services or other food assistance was associated with a 43% reduction in the risk of hospitalization in the past 12 months. Food assistance programs appear to be a promising strategy for reducing hospitalizations associated with diabetes and its comorbidities. Primary care providers, diabetes educators and other health professionals should be more proactive in their referrals to food assistance programs and other community supports.

Food Preparation Practices for Infants Aged From 7 to 13 Months

OBJECTIVE

To examine infant food preparation practices at age 7, 9, 11, and 13 months overall and by sociodemographic characteristics.

DESIGN

Data from a longitudinal study from the US Department of Agriculture's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Infant and Toddler Feeding Practices Study-2 (ITFPS-2) were used.

PARTICIPANTS

A sample of 1,904 infants (970 males and 934 females) enrolled in WIC who had been introduced to solid foods and were consuming food prepared at home.

MAIN OUTCOME MEASURES

Food preparation practices included pureeing, mashing, chopping/dicing, and prechewing. Estimates were provided overall and by sociodemographics.

ANALYSIS

Prevalence estimates were calculated for each survey month overall and by sociodemographics. Chi-square tests for independence were used to test for differences.

RESULTS

Food preparation practices changed as infants aged. Pureeing and mashing were common in month 7 (57.8% and 59.6%, respectively), but chopping/dicing were the most prevalent by month 13 (85.4%). Food preparation practices did not vary by education status, but statistical differences were consistently observed by race and ethnicity and inconsistently observed by maternal age at birth.

CONCLUSIONS AND IMPLICATIONS

Exposing children to a range of food textures at an appropriate age is important for developmental progress. Continued culturally relevant efforts by WIC educators and health care providers can emphasize the importance of early experiences with food textures.

Accelerating Evaluation of Financial Incentives for Fruits and Vegetables: A Case for Shared Measures

Food insecurity, or lack of consistent access to enough food, is associated with low intakes of fruits and vegetables (FVs) and higher risk of chronic diseases and disproportionately affects populations with low income. Financial incentives for FVs are supported by the 2018 Farm Bill and United States (U.S.) Department of Agriculture’s Gus Schumacher Nutrition Incentive Program (GusNIP) and aim to increase dietary quality and food security among households participating in the Supplemental Nutrition Assistance Program (SNAP) and with low income. Currently, there is no shared evaluation model for the hundreds of financial incentive projects across the U.S. Despite the fact that a majority of these projects are federally funded and united as a cohort of grantees through GusNIP, it is unclear which models and attributes have the greatest public health impact. We explore the evaluation of financial incentives in the U.S. to demonstrate the need for shared measurement in the future. We describe the process of the GusNIP NTAE, a federally supported initiative, to identify and develop shared measurement to be able to determine the potential impact of financial incentives in the U.S. This commentary discusses the rationale, considerations, and next steps for establishing shared evaluation measures for financial incentives for FVs, to accelerate our understanding of impact, and support evidence-based policymaking.

Campus Food Pantry Use Addresses a Gap Among California Public University Students

OBJECTIVE

To identify factors associated with campus food pantry (CFP) visits and evaluate outreach strategies.

DESIGN

Cross-sectional.

SETTING

Ten University of California campuses.

PARTICIPANTS

University of California CFP student users (n = 1,513) completed a survey in 2019.

VARIABLES MEASURED

Students reported reasons for CFP visits, how they heard about the CFP, monthly CFP visits, and food security status. Sociodemographic information was obtained through institutional records.

ANALYSIS

Poisson regression for associations of monthly CFP visits (dependent) with sociodemographic variables (Model 1), reasons for CFP visits (Model 2), and outreach strategies (Model 3). Logistic regression for associations between reasons for CFP visits and food security status (dependent; Model 4).

RESULTS

On average, students made 3.66 (SD, 4.75) CFP visits in the past month. Factors associated with more CFP visits included being first-generation to attend college, Filipino/Pacific Islanders, homeless, older, and male (Model 1). Not wanting to run out of food and hearing about the CFP through basic needs staff were associated with more CFP visits (Models 2 and 3). Students who visited the CFP because of financial insecurity had higher odds of food insecurity (Model 4).

CONCLUSIONS AND IMPLICATIONS

Findings suggest that CFPs provide critical emergency food assistance for students at risk of food insecurity.

The HOME Study: Understanding How College Students at a Hispanic Serving Institution Coped with Food Insecurity in a Pandemic

College students represent a unique population of adults, who may be more likely to experience food insecurity due to their transient circumstances, limited access to resources, and increased educational expenses. But little is known about how college students and their households mitigate food insecurity, particularly during a crisis like the COVID-19 pandemic. The Household Observations of Meals and Environments (HOME) Study described how college students in the US utilized multilevel resources, including an on-campus food pantry, to maintain food security during the pandemic. A convenience sample of college students (n = 18) were recruited from an on-campus food pantry and provided quantitative and qualitative data through online surveys and in-depth Zoom interviews. Survey data were analyzed to describe sociodemographic characteristics. In-depth interviews were recorded, transcribed, coded, and analyzed thematically to identify emergent themes. Social support and the use of an on-campus food pantry were primary factors in maintaining a food security safety net. Students faced barriers when trying to access federal and state food assistance programs and identified multilevel resources, their food security, and the role of social support as facilitators in their perceptions of food insecurity status and experiences. Findings highlight practical implications for research related to on-campus food insecurity interventions and policies to support food security among college students.

Digital Strategies to Improve Food Assistance in Disasters: A Scoping Review

OBJECTIVE

Modern digital strategies, including Internet of Things, machine learning, and mobile applications, have revolutionized situational awareness during disaster management. Despite their importance, no review of digital strategies to support emergency food security efforts has been conducted. This scoping review fills that gap.

METHODS

Keywords were defined within the concepts of food assistance, digital technology, and disasters. After the database searches, PRISMA guidelines were followed to perform a partnered, 2-round scoping literature review.

RESULTS

The search identified 3201 articles, and 26 articles met criteria and were included in the analysis. The data types used to describe the tools were text/opinion (42.3%), qualitative (23.1%), system architecture (19.2%), quantitative and qualitative (11.5 %), and quantitative (3.8%). The tools' main functions were Resource Allocation (41.7%), Data Collection and Management (33%), Interagency Communications (15.4 %), Beneficiary Communications (11.5%), and Fundraising (7.7%). The platforms used to achieve these goals were Mobile Application (36%), Internet of Things (20%), Website (20%), and Mobile Survey (8%); 92% covered the disaster response phase.

CONCLUSIONS

Digital tools for planning, situational awareness, client choice, and recovery are needed to support emergency food assistance, but there is a lack of these tools and research on their effectiveness across all disaster phases.

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.