Food Insecurity Screening in Safety-Net Clinics in Los Angeles County: Lessons for Post-Pandemic Planning.

INTRODUCTION: Food insecurity is a major public health problem in the United States which was exacerbated by the COVID-19 pandemic. We used a multi-method approach to understand barriers and facilitators to implementing food insecurity screening and referrals at safety net health care clinics in Los Angeles County before the pandemic. METHODS: In 2018, we surveyed 1013 adult patients across eleven safety-net clinic waiting rooms in Los Angeles County. Descriptive statistics were generated to characterize food insecurity status, attitudes toward receiving food assistance, and use of public assistance programs. Twelve interviews with clinic staff explored effective and sustainable approaches to food insecurity screening and referral. RESULTS: Patients welcomed the opportunity to access food assistance in the clinic setting; 45% preferred discussing food issues directly with the doctor. Missed opportunities to screen for food insecurity and refer patients to food assistance were identified at the clinic level. Barriers to these opportunities included: competing demands on staff and clinic resources, difficulty establishing referral pathways, and doubts surrounding data. DISCUSSION: Integrating food insecurity assessment in clinical settings requires infrastructure support, staff training, clinic buy-in, and more coordination and oversight from local government, health center entities, and public health agencies.

Food Security, Fruit and Vegetable Intake, and Chronic Conditions among Supplemental Nutrition Assistance Program Education Participants Attending Free Food and Produce Events

Non-traditional settings, such as schools, early childhood education programs, and healthcare clinics, can play a critical role in preventing obesity by providing free and nutritious food outside of food pantries to households that are experiencing low or very low food security, particularly during emergency situations. This evaluation study describes a low-income population that attended free food and produce distribution events during the COVID-19 pandemic. In 2021, a cross-sectional survey was administered to this group (n = 1498) to assess their food security status, fruit and vegetable (F+V) consumption, and prevalence of chronic disease condition(s). Program and event assessments were carried out using descriptive, bivariate, and multivariable logistic regression analyses. More than a quarter (26%) of the participants attended the free food events for the first time. Approximately 70% reported some level of low food security, 57% to 64% did not meet F+V intake recommendations, and 37% had a diet-related chronic disease condition. In the adjusted models, households with very low food security had lower odds of meeting F+V recommendations (aOR, 0.41, 95% CI, 0.28, 0.58 and aOR, 0.27, 95% CI, 0.19, 0.39, respectively) and higher odds of having a chronic condition (aOR, 3.49, 95% CI, 2.34, 5.20) than those with high or marginal food security. Given these experiences, future research should examine how safety net food assistance programs can incorporate alternative service/distribution models to improve the nutritional value of the foods they offer.