Produce prescription projects: Challenges, solutions, and emerging best practices - Perspectives from health care providers.

Produce prescription projects are becoming increasingly common. This study explores perspectives and experiences of a sample of health care providers throughout the United States participating in implementing produce prescription projects with funding from the United States Department of Agriculture. Surveys (N = 34) were administered to collect demographic and descriptive data. Subsequently, individual key-informant interviews with participating health care providers (N = 16) were conducted via videoconference. Participants in this study included physicians and clinical staff (e.g., nursing, nutrition, social work) who work at health care organizations that facilitate a produce prescription project. Interview transcripts were coded using thematic qualitative analysis methods. Four cross-cutting key themes emerged. First, interviewees shared operational challenges, including lack of time/staff, difficulty with provider/patient engagement (some related to COVID-19), steep "trial and error" learning curve, and formidable barriers related to data sharing and research-related requirements (e.g., Institutional Review Board approvals). Second, interviewees elucidated their solutions, lessons learned, and emerging best practices as a response to challenges (e.g., importance of having a full-time paid staff member to manage PPR within clinic). Third, interviewees expressed satisfaction with produce prescription projects, particularly related to positive patient experiences (e.g., improved clinical outcomes and improved food security). Fourth, interviewees also shared appreciation for rigorous program evaluation to establish sustained funding and advance policies. However, they contextualized this appreciation within challenges outlined regarding collecting and sharing patient-related data outcomes. Findings provide emergent best practices and inform additional resources that are needed to sustainably implement and rigorously evaluate produce prescription projects.

Disparities in dietary practices during the COVID-19 pandemic by food security status.

Little is known about the differences in dietary practices among food secure and food insecure populations during the early COVID-19 pandemic restrictions. The purpose of this study was to examine differences in dietary practices the early COVID-19 pandemic restrictions between adults reporting food security versus food insecurity. An online cross-sectional survey using validated measures was administered between April and September 2020 to explore both dietary patterns and practices and food security status among persons residing in five U.S. states from different regions of the country during the COVID-19 pandemic. Between-group differences (food secure versus food insecure) were examined for dietary practice outcomes using Pearson's Chi-Square test statistic, with Fisher's Exact test for cell counts less than five. There were 3,213 adult respondents. Food insecurity increased among the survey sample from 15.9% before the COVID-19 pandemic to 23.1% during the onset of the COVID-19 pandemic (p < 0.01). Compared to food secure respondents, those experiencing food insecurity reported more group gatherings for meals during the pandemic, decreased fruit and vegetable intake, and a need for more nutrition support resources than food secure respondents (p < 0.05). Food secure individuals reported increasing alcohol consumption, more frequent take-out or delivery ordering from fast food or restaurants, and more interest in supporting the local food system (p < 0.05). Results indicate a clear risk of disparities in dietary practices based on food security status during the early COVID-19 pandemic restrictions. Public health research, practice, and policy efforts should tailor specific efforts towards both food secure and food insecure groups.

Successful Community Nutrition Incentive Program Data Collection during the COVID-19 Pandemic: A Case Study.

Background: The coronavirus 2019 (COVID-19) pandemic has complicated rigorous evaluation of public health nutrition programs. The USDA Gus Schumacher Nutrition Incentive Program (USDA GusNIP) funds nutrition incentive programs to improve fruit and vegetable purchasing and intake by incentivizing Supplemental Nutrition Assistance Program (SNAP) participants at the point of sale. GusNIP grantees are required to collect survey data (e.g., fruit and vegetable intake and food insecurity status) on a subset of participants. However, due to COVID-19, most GusNIP grantees faced formidable barriers to data collection. The Hunger Task Force Mobile Market (HTFMM), a Wisconsin-based 2019 GusNIP grantee, used particularly innovative methods to successfully collect these data (n > 500 surveys). Objectives: The aim was to explore HTFMM's successful participant-level data-collection evaluation during COVID-19. Methods: A single case study methodological approach framed this study. The case is the HTFMM in Milwaukee, WI, USA. Participants included HTFMM leadership (n = 3), evaluators (n = 2), staff (n = 3), volunteers (n = 3), and customers (n = 10). These teleconference interviews were recorded and transcribed verbatim. Transcripts were coded using thematic qualitative analysis methods with 2 independent coders. Results: Four salient themes emerged: 1) there were multiple key players with unique roles and responsibilities who contributed to personalized, proactive, and time-intensive, telephone-based proctored survey collection methods; 2) the importance of resources dedicated to comprehensive evaluation; 3) longstanding relationships rooted in trust and community-based service are key to successful program delivery, engagement, and evaluation; and 4) the COVID-19 data-collection protocol also serves to mitigate nonpandemic challenges to in-person survey collection. Conclusions: These findings provide guidance on how alternative methods for data collection during COVID-19 can be used and applied to other situations that may affect the ability to collect participant-level data. These findings contribute to a growing body of literature as to best practices and approaches to collecting participant-level data to evaluate public health nutrition programs.

Successful Community Nutrition Incentive Program Data Collection During the COVID-19 Pandemic: A Case Study

Background The COVID-19 pandemic has complicated rigorous evaluation of public health nutrition programs. The United States Department of Agriculture Gus Schumacher Nutrition Incentive Program (GusNIP) funds nutrition incentive programs to improve fruit and vegetable purchasing and intake by incentivizing Supplemental Nutrition Assistance Program (SNAP) participants at the point of sale. GusNIP grantees are required to collect survey data (e.g., fruit and vegetable intake and food insecurity status) on a subset of participants. However, due to COVID-19, most GusNIP grantees faced formidable barriers to data collection. The Hunger Task Force Mobile Market (HTFMM), a Wisconsin-based 2019 GusNIP grantee, employed particularly innovative methods to successfully collect these data (n > 500 surveys). Objective To explore HTFMM's successful participant-level data collection evaluation during COVID-19. Methods A single case study methodological approach framed this study. The case is HTFMM in Milwaukee, WI, USA. Participants included HTFMM: leadership (n = 3), evaluators (n = 2), staff (n = 3), volunteers (n = 3), and customers (n = 10). These teleconference interviews were recorded and transcribed verbatim. Transcripts were coded using thematic qualitative analysis methods with two independent coders. Results Four salient themes emerged. 1) There were multiple key players with unique roles and responsibilities who contributed to personalized, proactive, and time-intensive telephone-based proctored survey collection methods;2) the importance of resources dedicated to comprehensive evaluation;3) longstanding relationships rooted in trust and community-based service are key to successful program delivery, engagement, and evaluation;4) the COVID-19 data collection protocol also serves to mitigate non-pandemic challenges to in-person survey collection. Conclusions These findings provide guidance on how alternative methods for data collection during COVID-19 can be employed and applied to other situations which may affect the ability to collect participant-level data. These findings contribute to a growing body of literature as to best practices and approaches to collecting participant-level data to evaluate public health nutrition programs. This paper details a case study of a mobile fruit and vegetable market and features key facilitators that led to successful public health nutrition program evaluation during the COVID-19 pandemic.

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.

The Influence of the COVID-19 Pandemic on the Food Supply in the Emergency Food System: A Case Study at 2 Food Pantries.

BACKGROUND: The onset of the coronavirus disease 2019 (COVID-19) pandemic increased demand for emergency food assistance and has caused operational shifts in the emergency food system. OBJECTIVE: This research explored how the initial phase of the COVID-19 pandemic influenced the food supply of 2 food pantries. METHODS: A case study approach was applied to collect data during the initial phase of the COVID-19 pandemic. Food supply data were collected weekly at 2 food pantries in southwest Montana for 17 wk in 2020. Surveys and interviews were conducted with food pantry clients and staff, respectively. Descriptive statistics and inferential statistics were applied to analyze quantitative data. Food supply data were analyzed using the Healthy Eating Index (HEI)-2015, NOVA system, and Unprocessed Pantry Project (UP3) Framework. Thematic analysis was applied to qualitative data. RESULTS: The food boxes collected between the 2 food pantries (n = 43) had a mean (± SD) total HEI-2015 score of 76.41 ± 7.37 out of a possible score of 100. According to both the NOVA and the UP3 Framework, 23.4% of the total food distributed was ultra-processed food. Of the food distributed, 50.0% and 48.3% was fresh, unprocessed food according to NOVA and UP3 Frameworks, respectively. From staff interviews, 3 themes arose that describe the food pantry operations that experienced change during the COVID-19 pandemic, including food procurement, distribution preparation, and food distribution. Nine supporting subthemes describing the causes and consequences of the operational themes were identified. Staff perceived that the nutrient quality of the food boxes increased from food distributed previously to the COVID-19 pandemic, whereas over one-third (39.4%) of food pantry clients who responded to surveys preferred the food box model. CONCLUSIONS: The COVID-19 pandemic has caused enormous operational challenges within food pantries. Food pantries overcame these challenges by swiftly and effectively altering operations so as to continue to distribute nutritious food boxes to pantry clients.

Examining the relationship between physical activity and mental health during the COVID-19 pandemic across five U.S. States.

The objectives of this paper are to investigate: 1) how the COVID-19 pandemic influenced both physical activity practices and mental health status, and 2) to assess the relationship between the two. Our mixed-methods study draws on 4,026 online survey responses collected between April - September 2020 across five states (Louisiana, Montana, North Carolina, Oregon and West Virginia). Logistic regression models were run for two outcome variables (physical activity and mental health status (measured using the Kessler Psychological Distress scale)). Researchers controlled for race/ethnicity, household income/size, gender, urbanicity, education, employment, use of government assistance and presence of chronic health conditions. Qualitative analysis was applied to open-ended survey responses to contextualize quantitative findings. Household income was significant in predicting difficulty maintaining pre-pandemic physical activity levels; pre-pandemic physical activity levels were associated with increased psychological distress levels during COVID-19; and race/ethnicity, income status and urbanicity were significantly associated with deteriorating mental health status and physical activity levels during COVID-19. Data suggests that a bi-directional, cyclical relationship between physical activity and mental health exists. Policy implications should include physical activity promotion as a protective factor against declining mental health.

Examining Rural Food-Insecure Families' Perceptions of the Supplemental Nutrition Assistance Program: A Qualitative Study.

The Supplemental Nutrition Assistance Program (SNAP) is a critical program that helps reduce the risk of food insecurity, yet little is known about how SNAP addresses the needs of rural, food-insecure residents in the United States (U.S.). This study examines how rural, food-insecure residents perceive SNAP. Semi-structured interviews were conducted with 153 individuals living in six diverse rural regions of Arkansas, Montana, North Carolina, Oregon, Texas, and West Virginia. SNAP was described as a crucial stop-gap program, keeping families from experiencing persistent food insecurity, making food dollars stretch when the family budget is tight, and helping them purchase healthier foods. For many rural residents interviewed, SNAP was viewed in a largely positive light. In efforts to continue improving SNAP, particularly in light of its relevance during and post-coronavirus (COVID-19) pandemic, policymakers must be aware of rural families' perceptions of SNAP. Specific improvements may include increased transparency regarding funding formulas, budgeting and nutrition education for recipients, effective training to improve customer service, connections among social service agencies within a community, and increased availability of automation to streamline application processes.