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.

Impact of the COVID-19 Pandemic on Food Accessibility Procurement for Baltimore City Corner Store Owners

Objectives Corner stores are small independently run retail outlets that serve their immediate neighborhoods. Since nutritious foods have high supply-side purchasing and transportation costs, these stores more readily stock energy-dense processed foods and sugar-sweetened beverages. To improve the cost-effective distribution of healthy foods in an under-resourced urban food system, we are developing the Baltimore Urban food Distribution (BUD) mobile application (app), which aims to improve the ability for corner stores to stock healthier items via collective purchasing and shared delivery from local suppliers. No studies have been conducted on how COVID-19 has impacted food procurement by corner stores. This study aims to (1) list corner store sourcing and procurement strategies pre- and post-COVID-19;(2) quantify corner store sales and traffic pre- and post-COVID-19;and (3) identify perceived barriers to the supply chain because of COVID-19. Methods In-depth interviews (n = 13) and unstructured interviews (n = 28) with Baltimore, MD corner store owners have been ongoing since December 2021, where 38 stores are anticipated to be recruited by spring of 2022. Interviews took place at the corner store lasting 60 minutes, and included one survey, the Store Impact Questionnaire (SIQ) and Adult Impact Questionnaire (AIQ) and additional open-ended questions. Results Corner store owner food procurement strategies have changed, and they have experienced decreased traffic and sales since the onset of COVID-19. This includes having to minimize what is offered in the store, having less availability of healthy items, and using fewer vendors. We anticipate this study will further demonstrate that food procurement practices were destabilized because of COVID-19. Conclusions Understanding the impact of COVID-19 is crucial in improving the distribution tactics implemented by the BUD to ensure continuous availability of affordable, healthy foods and beverages. The success of the BUD app is dependent on meeting the needs of corner store owners and adapting to the changing food environment. Funding Sources NHLBI, NIH, award number R34HL145368.

The Baltimore Urban Food Distribution (BUD) App: Study Protocol to Assess the Feasibility of a Food Systems Intervention.

Low-income urban communities in the United States commonly lack ready access to healthy foods. This is due in part to a food distribution system that favors the provision of high-fat, high-sugar, high-sodium processed foods to small retail food stores, and impedes their healthier alternatives, such as fresh produce. The Baltimore Urban food Distribution (BUD) study is a multilevel, multicomponent systems intervention that aims to improve healthy food access in low-income neighborhoods of Baltimore, Maryland. The primary intervention is the BUD application (app), which uses the power of collective purchasing and delivery to affordably move foods from local producers and wholesalers to the city's many corner stores. We will implement the BUD app in a sample of 38 corner stores, randomized to intervention and comparison. Extensive evaluation will be conducted at each level of the intervention to assess overall feasibility and effectiveness via mixed methods, including app usage data, and process and impact measures on suppliers, corner stores, and consumers. BUD represents one of the first attempts to implement an intervention that engages multiple levels of a local food system. We anticipate that the app will provide a financially viable alternative for Baltimore corner stores to increase their stocking and sales of healthier foods, subsequently increasing healthy food access and improving diet-related health outcomes for under-resourced consumers. The design of the intervention and the evaluation plan of the BUD project are documented here, including future steps for scale-up. Trial registration #: NCT05010018.

A Commentary on the Healthy Community Stores Case Study Project: Implications for Retailers, Policy, and Future Research.

In the United States, low-income, underserved rural and urban settings experience poor access to healthy, affordable food. Introducing new food outlets in these locations has shown mixed results for improving healthy food consumption. The Healthy Community Stores Case Study Project (HCSCSP) explored an alternative strategy: supporting mission-driven, locally owned, healthy community food stores to improve healthy food access. The HCSCSP used a multiple case study approach, and conducted a cross-case analysis of seven urban healthy food stores across the United States. The main purpose of this commentary paper is to summarize the main practice strategies for stores as well as future directions for researchers and policy-makers based on results from the prior cross-case analyses. We organize these strategies using key concepts from the Retail Food Environment and Customer Interaction Model. Several key strategies for store success are presented including the use of non-traditional business models, focus on specific retail actors such as store champions and multiple vendor relationships, and a stores' role in the broader community context, as well as the striking challenges faced across store locations. Further exploration of these store strategies and how they are implemented is needed, and may inform policies that can support these types of healthy retail sites and sustain their efforts in improving healthy food access in their communities.

Enhancing Artificial Intelligence for Twitter-based Public Discourse on Food Security During the COVID-19 Pandemic.

OBJECTIVE: Food security during public health emergencies relies on situational awareness of needs and resources. Artificial intelligence (AI) has revolutionized situational awareness during crises, allowing the allocation of resources to needs through machine learning algorithms. Limited research exists monitoring Twitter for changes in the food security-related public discourse during the COVID-19 pandemic. We aim to address that gap with AI by classifying food security topics on Twitter and showing topic frequency per day. METHODS: Tweets were scraped from Twitter from January 2020 through December 2021 using food security keywords. Latent Dirichlet Allocation (LDA) topic modeling was performed, followed by time-series analyses on topic frequency per day. RESULTS: 237,107 tweets were scraped and classified into topics, including food needs and resources, emergency preparedness and response, and mental/physical health. After the WHO's pandemic declaration, there were relative increases in topic density per day regarding food pantries, food banks, economic and food security crises, essential services, and emergency preparedness advice. Threats to food security in Tigray emerged in 2021. CONCLUSIONS: AI is a powerful yet underused tool to monitor food insecurity on social media. Machine learning tools to improve emergency response should be prioritized, along with measurement of impact. Further food insecurity word patterns testing, as generated by this research, with supervised machine learning models can accelerate the uptake of these tools by policymakers and aid organizations.

Impacts of COVID-19 on a Food Security Study with the Baltimore Native Community.

Urban American Indian/Alaska Native peoples experience disproportionate levels of food insecurity when compared to the general US population. Through a collaborative research partnership between Native American Lifelines of Baltimore, an Urban Indian Health Program, and a Johns Hopkins Bloomberg School of Public Health student-led research team, food security was identified as a priority issue. A sequential explanatory mixed methods study was planned to explore food security and food sovereignty in the Baltimore Native community prior to the COVID-19 pandemic. Due to the local impact of COVID-19, a community-based participatory research approach guided the community-academic team to revise the original study and increase understanding of how the pandemic impacted food security in the community. This article highlights the lessons learned and strengths of using a community-based participatory approach to guide adaptations made due to COVID-19 to this research study. By utilizing a co-learning approach and emphasizing flexibility, we were able to collaboratively collect meaningful data to drive future community solutions to food insecurity while building an evidence base for policy changes to better support urban Native food security.

Current Use and Demand for Digital Tools to Enhance Food Pantry Management: Findings from a Nationwide Survey

Background Food insecurity has skyrocketed during the COVID-19 pandemic, compounded by critical limitations and unparalleled needs at food pantries. Interconnectivity between food pantry staff and clients is vital to food security. Digital tools are widely used in public health;however, little is known about current use or desire for digital tools in food pantry settings. Objective To define types of digital tools currently used for pantry management and identify gaps and interest in specific digital tool features to enhance pantry management. Study Design, Setting, Participants A cross-sectional online survey of U.S. food pantries was disseminated from January-May 2022. Using the foodpantries.org database, every tenth food pantry in each state was recruited via email and asked to complete the survey via Google Forms. The response rate was 27.4% (n=283/1,032). Most respondents (64.5%) identified as food pantry directors. Measurable Outcome/Analysis Descriptive statistics were used to characterize pantry location, size (pounds of food distributed), number of staff and volunteers (SV), use of a client choice model, and to describe the current tools used by pantries for multiple aspects of management. Results A majority (54.8%) of respondents represented large food pantries. Pantry-specific digital applications were rarely used. Instead, respondents reported using word-of-mouth and email to recruit SV, phone calls and emails for SV scheduling, and in-person classes for SV trainings. Clients were most often contacted via phone or email. There was high demand for an app for SV scheduling (50.2%), providing a safe, remote version of client choice (42.4%), client registration (35.7%), client and SV communications (35.0%), and connecting with nearby emergency services (22.3%). Conclusions Food pantry directors desired an app to support SV management, SV and client communication, safe client choice, and connection to emergency services. Future app development to enhance food pantry management and optimize food distribution is greatly needed. Funding None.

Identifying Strategies to Improve Enrollment and Participation in Three Rural Native American WIC Programs

Objectives The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has a strong track record of improving birth and health outcomes in high-risk populations. For the past decade and a half, WIC enrollment among Native American women and children has declined by approximately 40% for reasons that have not yet been elucidated. The objectives of this work are to 1) Understand the individual-, household-, and community-level factors that facilitate and impede participation in three rural tribal WIC programs, and 2) Identify strategies for addressing significant unexplained declines in WIC participation. Methods We partnered with three tribal WIC agencies – two in the Southwest and one in the Midwest – to plan and conduct this formative research. In-depth qualitative interviews (n = 35) were conducted with current and former WIC participants, eligible non-participants, WIC staff, tribal health administrators, and managers of food store that accept WIC in each study community. Interview transcripts were inductively coded and crosscutting emergent themes across communities were identified by four researchers. Results Tribal WIC agencies are highly valued for their culturally-competent staff and the integration of traditional knowledge and values into their services. However, participation barriers related to internet and telephone connectivity have become amplified during the COVID-19 pandemic, and a complicated and often embarrassing food shopping experience is a major obstacle to WIC benefit redemption in small rural food stores. Dominant themes differed greatly by community, indicating that intervention strategies to address declines in WIC participation should be tailored to community-level infrastructure, policy, and cultural values, which are unique to each community. Conclusions This work represents an important step toward improving understanding of the strengths and weaknesses of the WIC program in rural Native communities and identifying key focus areas for future interventions. Funding Sources Robert Wood Johnson Foundation Healthy Eating Research Grant #77,235.

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.

Increasing Healthy Food Access for Low-Income Communities: Protocol of the Healthy Community Stores Case Study Project.

Improving healthy food access in low-income communities continues to be a public health challenge. One strategy for improving healthy food access has been to introduce community food stores, with the mission of increasing healthy food access; however, no study has explored the experiences of different initiatives and models in opening and sustaining healthy food stores. This study used a case study approach to understand the experiences of healthy food stores in low-income communities. The purpose of this paper is to describe the methodology used and protocol followed. A case study approach was used to describe seven healthy food stores across urban settings in the U.S. Each site individually coded their cases, and meetings were held to discuss emerging and cross-cutting themes. A cross-case analysis approach was used to produce a series of papers detailing the results of each theme. Most case studies were on for-profit, full-service grocery stores, with store sizes ranging from 900 to 65,000 square feet. Healthy Food Availability scores across sites ranged from 11.6 (low) to 26.5 (high). The papers resulting from this study will detail the key findings of the case studies and will focus on the challenges, strategies, and experiences of retail food stores attempting to improve healthy food access for disadvantaged communities. The work presented in this special issue will help to advance research in the area of community food stores, and the recommendations can be used by aspiring, new, and current community food store owners.

The role of the school food environment in improving the healthiness of school canteens and the readiness to reopen post COVID-19 pandemic: A study conducted in Indonesia.

BACKGROUND: Indonesian school children spend one-third of their time in school, where they are exposed to a variety of foods at school canteens. However, the healthiness of school canteens is not yet well understood. This study was conducted to characterize the healthiness and quality of management of school canteens, and measure readiness of school canteens to reopen following COVID-19 closures. DESIGN AND METHODS: Mixed-methods were used to conduct a cross-sectional study. Data were collected from schools located in the Bantul District of Indonesia. Primary schools (n=152) were randomly selected, with a final sample size of 147. Data were collected using Google Forms, delivered via WhatsApp or email. School canteens were classified as healthy if they had a Healthy Canteen Score (HCS) >= 10, or unhealthy if they had a HCS < 10. RESULTS: Less than half (43.5%) of school canteens were deemed to be healthy. School canteens were more likely to be healthy if the canteen manager had a formal decision letter (OR=15.2; 95% CI=3.7-62.5); used print material messaging (OR= 3.2 to 4.6 times); or received inspection by external officers periodically (OR=2.8; 95% CI= 1.04-7.5). Readiness to reopen was 4.5 (OR=4.5; 95%CI: 1.1-17.9) times higher among schools that had their own canteen, and 4 (OR=3.9; 95% CI =1.1-13.8) times higher among schools located in rural areas, adjusting for the remaining variables. CONCLUSIONS: School canteen healthiness can be improved by implementing national food policy and healthy school canteen standards accompanied by the existence of good management practices within schools, particularly following the COVID-19 pandemic.

Food-Seeking Behaviors and Food Insecurity Risk During the Coronavirus Disease 2019 Pandemic.

OBJECTIVE: Food insecurity risk increases among disaster-struck individuals. The authors employed the social determinants of health framework to (1) describe the characteristics and food-seeking behaviors of individuals coping with the coronavirus disease 2019 pandemic and (2) evaluate the relationship between these factors and food insecurity risk. DESIGN: A cross-sectional Qualtrics survey was administered May 14-June 8, 2020. PARTICIPANTS: Adults living in New York were recruited online (n = 410). MAIN OUTCOME MEASURE: Food insecurity risk. ANALYSIS: Logistic regression analyses were conducted using a model-building approach. RESULTS: A total of 38.5% of the sample was considered food insecure after the coronavirus disease 2019 outbreak. The final model revealed that not knowing where to find help to acquire food, reporting that more food assistance program benefits would be helpful, being an essential worker, having general anxiety, and being a college student were risk factors for food insecurity regardless of demographic characteristics. CONCLUSIONS AND IMPLICATIONS: With more individuals experiencing food insecurity for the first time, there is a need for enhanced outreach and support. The findings complement emerging research on food insecurity risk during and after the pandemic and can help to inform food assistance programs and policies.

Healthy Food Retail during the COVID-19 Pandemic: Challenges and Future Directions.

Disparities in dietary behaviors have been directly linked to the food environment, including access to retail food outlets. The Coronavirus Disease of 2019 (COVID-19) pandemic has led to major changes in the distribution, sale, purchase, preparation, and consumption of food in the United States (US). This paper reflects on those changes and provides recommendations for research to understand the impact of the pandemic on the retail food environment (RFE) and consumer behavior. Using the Retail Food Environment and Customer Interaction Model, we describe the impact of COVID-19 in four key areas: (1) community, state, tribal, and federal policy; (2) retail actors, business models, and sources; (3) customer experiences; and (4) dietary intake. We discuss how previously existing vulnerabilities and inequalities based on race, ethnicity, class, and geographic location were worsened by the pandemic. We recommend approaches for building a more just and equitable RFE, including understanding the impacts of changing shopping behaviors and adaptations to federal nutrition assistance as well as how small food business can be made more sustainable. By better understanding the RFE adaptations that have characterized the COVID-19 pandemic, we hope to gain greater insight into how our food system can become more resilient in the future.