ABSTRACT
Objective: Food insecurity impacts 1 out of 6 patients with celiac disease (CD) in the United States, and rates have increased during the COVID-19 pandemic. This is particularly concerning for vulnerable populations who require specialized medical diets. State and federal resource programs do not account for the increased cost of gluten-free (GF) foods, and food pantries do not address overall health issues that often come with food insecurity. Our project aimed to provide GF food to food insecure families through a hospital-based food pantry and offer dietitian-led cooking classes to improve dietary quality and nutrition knowledge. Method(s): To address barriers to food access, Boston Children's Hospital (BCH) opened a food pantry, the Family Food Connections (FFC), in the Jamaica Plain neighborhood of Boston. FFC offers weekly food supplies to BCH patient families and community members. GF food bags are available for those who request them. Monthly virtual cooking classes led by a registered dietitian are offered free of charge to families with and without CD. All classes are held via Zoom with simultaneous translation services available in Spanish. Classes feature naturally GF recipes, and provide instructions on scratch cooking, nutrition education, and use of ingredients found in the food packages. The recipes are designed to include seasonal ingredients and are used as a platform to teach about nutrition related topics. Classes also serve as an open forum for families to ask nutrition and meal preparation related questions to the dietitian instructor. Metrics on pantry usage and class attendance were collected using Zoom analytics tools and REDCap. Result(s): Utilization of both the food pantry and cooking classes increased monthly. During the first six months of operation, an average of 500 families per week visited the FFC for food packages, totaling over 5,000 unique family visits. Of these families, 122 indicated needing all gluten-free food (64) or some gluten-free food (58). As of May 2022, 34 families attended the live virtual cooking classes, and 628 families viewed the recorded sessions. Survey questionnaire responses were limited to date (N=11) but did indicate that families previously had never attended a cooking class due to a lack of time, or they were not aware that classes were available. Conclusion(s): Initial utilization of the FFC, GF food packages, and accompanying cooking classes revealed a significant demand for the provision of GF food as well as a GF focused cooking and nutrition education program. The classes allow for processing nutrition education through non-intentional learning, and provide an opportunity to improve health and quality of life for all who attend, regardless of dietary restrictions. Future studies will evaluate changes in health outcomes, quality of life, cooking habits, and GF diet knowledge.
ABSTRACT
Background: Refugees are at risk for low health literacy and high rates of illness and hospitalization. A partnership between medical professionals at Yale and two New-Haven, CT-based refugee resettlement organizations aimed to create and implement a family-based, interactive pediatric healthcare curriculum with a goal of increasing childhood health knowledge among refugee families. Methods: Seven 1-hour, in-person classes and 1 virtual class were taught by pediatric residents with real-time translation in Pashto, Dari, Arabic, Swahili, and Kinyarwanda on the topics of child nutrition, safety, parenting, and oral health. Each class incorporated play-based activities for toddlers-a My Healthy Plate puzzle, street-crossing simulation, teeth-brushing demonstration, and block play-which were integrated into parental discussion with visual aids. Knowledge acquisition and satisfaction was assessed using pre- and posttests. Results: 67 adult participants had an 85% response rate. Average knowledge test scores increased in 5 of 7 classes, reaching significance in a class on parenting (mean 52% vs 90%, paired t-test p = 0.03) and child safety (mean 80% vs 97%, p = 0.04). 100% of respondents (67% response rate) reported increased understanding of the topic and would recommend the class to a friend. There were 5 participants for the virtual class. Conclusion: Child health education classes conducted for refugee families can improve knowledge of pediatric healthcare topics and provide positive experiences. A close relationship between healthcare providers and community refugee organizations has the potential to improve health education in refugee families. Future studies will assess efficacy and satisfaction of virtual classes during the COVID-19 pandemic.
ABSTRACT
Background: Food insecurity, defined as lack of consistent access to enough food for an active, healthy life was projected to affect 1 in 6 children in the United States in 2021. Market basket studies have consistently found that gluten-free (GF) foods are more expensive than their gluten-containing counterparts. We conducted an anonymous survey to determine the prevalence of food insecurity in households with children on a gluten-free diet (GFD) and how it can impact a child's adherence to a GFD. Methods: An anonymous electronic survey was distributed through celiac support groups, national celiac organization newsletters, and social media from March to May 2021. Survey items included demographic and medical information. Food insecurity risk before and during the COVID-19 pandemic was evaluated using the validated adapted Hunger Vital Signs Screener modified with “glutenfree food” to each screening question. Results: The 413 households with children on a GFD that completed the survey primarily self-identified as white (86%, 354). All 10 zip-code regions in the United States were represented. Most had a household income > $80000, resided in a mortgaged home, and were relatively well-educated. The most common reason for a GFD was celiac disease (CD) (92%, 378), and 72% (266) had been on a GFD for >2 years. All households noted a decrease in availability of GF foods during the pandemic (p<0.001). Pre-pandemic, 21% (86) of the households with at least one child following a GFD screened positive for food insecurity. When asked specifically about GF foods, 23% (94) of the households screened positive. Both food insecurity (25%, 104) and GF food insecurity (28%, 116) increased during the pandemic. Both before and during the COVID- 19 pandemic, 5% (19) of the households who were food secure screened positive for GF food insecurity. In one of ten households, individuals on a GFD ate gluten because there were no GF options available. Gluten ingestion due to unavailability of GF foods was higher in households who screened positive for food insecurity (aOR=5) or GF food insecurity (aOR=7). Gluten was eaten before and during the COVID-19 pandemic with a significant increase during the pandemic(p<0.001). Conclusions: Using a nationwide survey, we found that both overall and GF food insecurity have increased for households with children on a GFD. Rates of reported intentional gluten consumption because no GF options were available increased from 1 in 20 households to 1 in 10 households. Food insecurity increased the odds of a household member on a GFD eating gluten on purpose/intentionally. Food insecurity is an underrecognized risk to our celiac patients. Gastroenterologists should incorporate food insecurity screening into their practice for patients on a GFD, especially in the setting of celiac symptom exacerbation.(Figure Presented)Food Insecurity, Intentional Gluten Ingestion and Gluten-Free Food Availability (n=413) (a) Food and Gluten-Free Food Insecurity in Households with Children on a Gluten-Free Diet was measured by screening patients via the validated and adapted Hunger Vital Signs Screener. There was no significant difference in food insecurity before and during the pandemic. (b) Intentional Gluten Ingestion due to Unavailability of Gluten-Free Foods before and during pandemic was compared with test of proportions showing a significant difference (p value < 0.05) (c) Gluten-Free Food availability before the pandemic and (d) Gluten-Free Food availability during the pandemic showed decreasing availability of gluten free foods.
ABSTRACT
Background: The U.S. Department of Agriculture defines food insecurity as a lack of consistent access to enough food for an active, healthy life. Feeding America projects 13 million children (1 in 6) may experience food insecurity in 2021. Currently, a gluten-free diet is the only available treatment for celiac disease. Studies conducted around the world have shown consistently that gluten-free foods are more expensive than their gluten-containing counterparts. State and federal food assistance programs often do not account for the increased cost of gluten-free food. The purpose of our study was to determine the prevalence of food insecurity in families with a child diagnosed with celiac disease and whether or not food security has been affected by the coronavirus 2019(COVID-19) pandemic. Methods: An anonymous electronic survey was distributed through online community celiac support groups as well as national celiac organization newsletters. A total of three messages were posted in each online forum at approximately 2-week intervals. Basic demographic information and medical history was obtained. We evaluated food insecurity risk before COVID-19 and during the COVID-19 pandemic using the validated National Center for Health Statistics US Household Six-Item Short Form Food Security Survey Module. Results: A total of 118 responses were received. Responses were collected from all 10 zip-code regions in the United States. The median age of the gluten-free children was 12 years;34% (38) were male, 82% (97) lived in single child households and 70% (78) attended public school. In the households surveyed, 86% identified their race as white, 58% had salary >$100,000, 84% (92) mortgaged/owned their home and 84% (92) of the parents had at least a bachelor's degree. Most (91%) of the children were following a gluten-free diet for celiac disease, with 80% diagnosed via intestinal biopsy. The majority of participants (65%) had been on gluten-free diet for >2 years. Prior to the COVID-19 pandemic, 25% (29) of the participants screened positive for food insecurity and when asked specifically about gluten-free food access, 26% (31) of the participants screened positive. During the COVID-19 pandemic, access to gluten-free foods decreased (31% screened positive for food insecurity) even though the overall rate of food insecurity was stable (26%). 9% (10) of the children had eaten gluten because there were no gluten-free options available. During the COVID-19 pandemic, 35% (41) of the respondents reported that gluten-free foods in the area was limited (often going without things they need) or very poor (purchase most gluten-free foods online). Conclusions: Food insecurity affected nearly 1 in 3 surveyed families of children following a gluten-free diet during the COVID-19 pandemic. This is significantly higher than Feeding America's projections for food insecurity for 2021.There has also been decreased availability of gluten-free foods. During the COVID-19 pandemic, 1 in 10 children with celiac have eaten gluten because there were no gluten-free options available. Given these startling statistics, it is crucial that all gastroenterologists incorporate food insecurity screening into their practice for patients on gluten-free diets and be prepared to provide referrals to appropriate community resources.