Innovative Methods for Integrating Social Determinants of Health Data with Administrative Claims to Facilitate Health Equity Research

Objectives: The Covid-19 pandemic highlighted the importance of considering Social Determinants of Health (SDoH) in healthcare research. Administrative claims databases are widely used for research, but often lack SDoH data or sufficient transparency in how these data were obtained. This study describes innovative methods for integrating SDoH data with administrative claims to facilitate health equity research. Method(s): The HealthCore Integrated Research Database (HIRD) contains medical and pharmacy claims from a large, national US payer starting in 2006 and includes commercial (Comm), Medicare Advantage (MCare), and Medicaid (MCaid) populations. The HIRD includes individually identifiable information, which was used for linking with SDoH data from the following sources: national neighborhood-level data from the American Community Survey, the Food Access Research Atlas, and the National Center for Health Statistics' urbanicity classification;and member-level data on race/ethnicity from enrollment files, medical records, self-attestation, and imputation algorithms. We examined SDoH metrics for members enrolled as of 05-July-2022 and compared them to the respective US national data using descriptive statistics. We also examined telehealth utilization in 2022. Result(s): SDoH data were available for ~95% of currently active members in the HIRD (Comm/MCare/MCaid 12.5m/1m/7.6m). Socioeconomic characteristics at the neighborhood-level differed by membership type and vs. national data: % of members with at least a high-school education (90/88/84 vs. 87);median family income ($98k/$76k/$70k vs. $82k);% of members living in low-income low-food-access tracts (9/14/18 vs. 13);urban (57/52/47 vs. 61). At the member-level, the % of White Non-Hispanics, Black Non-Hispanics, Asian Non-Hispanics, and Hispanics were 61/6/5/6 (Comm), 76/12/2/2 (MCare), and 45/26/5/19 (MCaid). Imputation contributed 15-60% of race/ethnicity values across membership types. Telehealth utilization increased with socioeconomic status. Conclusion(s): We successfully integrated SDoH data from a variety of sources with administrative claims. SDoH characteristics differed by type of insurance coverage and were associated with differences in telehealth utilization.Copyright © 2023

Changes in Food Acquisition Source, Behaviors, and Perceptions During Early Months of COVID-19 Pandemic: Differences Between Those Living in and Not Living in Low Income Low Food Access Urban Areas

We examine the impact of the COVID-19 pandemic on food access in US households located in low-income low-food access (LILA) zip codes and those in other areas. We explored changes in utilization of key food sources and in reported challenges, worries, and strategies related to obtaining food. Living in a LILA zip code was associated with a higher prevalence of using food programs, experiencing challenges finding help for food, worrying that food was unsafe, and worrying about losing access to food programs. Examining food acquisition during the pandemic may inform ways to reduce barriers to food access.Copyright © 2023 Taylor & Francis Group, LLC.

Did A Fruit and Vegetable Incentive Program Support low-income Households in North Carolina during the COVID-19 Pandemic? A Mixed Methods Assessment of the Healthy Helping Program and Other Pandemic-Related Food Assistance

In 2020, the Healthy Helping Fruit and Vegetable Program provided SNAP-eligible beneficiaries with $40/month, for up to 3 months, to purchase fruits and vegetablesata chainsupermarket inNorthCarolina.A survey to describeparticipants' experiences with the program and interviews to explore whether these experiences were shaped byparticipating inotherpandemic-related food access programs were conducted.In conjunction with other food access programs,programs that allow participants freedom to choose what they purchase mayalleviate household hardships and provide greater access tonutrient-dense foods during the COVID-19 pandemic and beyond..Copyright © 2022 Taylor & Francis Group, LLC.

School Food Programming across Canada during the COVID 19 Pandemic: Program Reach and Modalities

In 2020, after the COVID-19 pandemic resulted in widespread school closures and a consequent pause in school food programs (SFP), stakeholder groups soon found alternate methods for delivering meals and snacks to students. This paper examines the breadth of school food programming in Canada during the pandemic. SFPs collectively offered meals (breakfast was most frequent), food boxes, and gift cards and average weekly distributions were over 10,000 meals. In most cases, the programs provided enough food/coupons to feed multiple or all household members. Almost half the programs received funding from provincial/territorial governments and around two-thirds received charitable contributions.Copyright © 2022 Taylor & Francis Group, LLC.

Special Issue: The relationship between nutrition and COVID-19. (Special Issue: The relationship between nutrition and COVID-19.)

This special issue contains 8 articles that discuss and highlights the importance of nutrition in mitigating the mental and health-related issues associated with the pandemic, as well as its effects on diet quality and physical activity levels. Topics include: (1) a systematic literature review that emphasizes the role of nutrition in minimizing mental and health-related issues during COVID-19. The review concludes that a healthy diet rich in essential nutrients can play a crucial role in supporting mental health, immune function and overall well-being during the pandemic. In addition, it highlights the need for public health interventions that promote healthy eating habits and provide access to nutritious foods, (2) adherence to the Mediterranean diet in Greek adolescents during COVID-19, (3) a randomized, double-blind, placebo-controlled clinical trial investigated the effect of synbiotics on inflammatory markers and white blood cell count in COVID-19 patients, (4) COVID-19 pandemic anxiety was reflected in nutritional habits in adults, (5) investigation of the link between metabolic risks, dietary patterns and COVID-19 prognosis, (6) exploration of the factors related to sedentary lifestyle in a Brazilian sample during the COVID-19 initial quarantine.

The COVID-19 Pandemic and College Student Food Access: Perspectives from Students at Four North Carolina Universities

Food insecurity prevalence among college students has increased. The COVID-19 pandemic exacerbated food insecurity generally but the particular impact on college students was unclear. In-depth interviews were conducted at four North Carolina universities to determine how the pandemic impacted food access. Students were asked about the food resources they turned to and what universities could do to help. Evidence suggests food access was disrupted during the pandemic for most students, and disruption varied throughout the pandemic. Students provided recommendations for how universities can improve food access. Universities need to better prepare to support food security among students, pandemic or not.

Food Insecurity and Stress Among Rural Residents in South Carolina: The Moderating Influences of Household Characteristics, Neighborhood Social Environment and Food Environment.

Food insecurity is linked with poor physical and mental health outcomes, including anxiety, depression and stress. Rural residents in particular face unique challenges obtaining healthy food; the COVID-19 pandemic exacerbated the relationship between food insecurity and mental health outcomes. This study examines the relationship between food insecurity and stress, and the moderating influence of household characteristics, neighborhood social environment and food environment on this relationship, using a sample of 630 rural South Carolina (SC) residents during COVID-19. Two measures of stress were used in this study: current levels of stress and changes in stress since COVID-19. Results showed a gradient pattern between food insecurity and stress: rural residents with high food insecurity were 6.1 times more likely and those with moderate food insecurity were 3.4 times more likely to report higher level of general stress than those with low food insecurity; rural residents with high food insecurity were 3.3 times more likely and those with moderate food insecurity were 2.0 times more likely to report greater increase in stress after COVID-19 than those with low food insecurity. Neighborhood social environment and food environment provided a buffering effect on the relationship between food insecurity and stress. A stronger social environment after COVID-19 and higher levels of easiness in food access mitigated the negative impacts of food insecurity on stress. Efforts to ameliorate food insecurity should address these broader contextual variables, involving community-level factors.

Food insecurity and eating behavior prior to the COVID-19 pandemic. An exploratory study in Venezuela.

Background: The aim of this research was to explore how food insecurity affected food behavior prior to the COVID-19 pandemic (year 2018-2019) in a sample of people residing in nine administrative regions of Venezuela. Method(s): 1099 people aged between 17 and 75 years participated, with a majority residing in the Andes, Capital and Central regions of the country. A reduced version of a modified national survey on living conditions (Encovi-2017) composed of 11 questions was administered. Estimates with chi square (chi2) were made to verify associations between the characteristics of the sample (age, region of origin and sex) with the approaches of the administered survey. Result(s): A high degree of food insecurity was observed as people reported concerns about food access (88.95%), or lack of them (55.79%), periods of food deprivation and alteration of eating patterns. Those participants under 21 years were more likely to alter their daily intake pattern (p = 0.01), with women being the most affected in terms of the family running out of food in the last three months (p = 0.020) and if in the last trimester a whole day had gone without eating (p = 0.05). Conclusion(s): The study shows that women and young people under 21 years of age or middle-aged adults and inhabitants of the Capital region turn out to be the people most affected by food insecurity as they consumed less food or ate fewer servings per day. The data reveal a worsening of the food situation.Copyright © 2022 Sociedad Espanola de Nutricion Comunitaria. All rights reserved.

Thinking globally, acting locally: Supporting systems change within communities to enhance food security action

Food systems are complex, with a multitude of drivers including climate change, income markets, policy, social norms, and demography Within food systems, food supply chain activities influence food resources, and in turn, diets. More broadly, economic, social and environmental impacts dictate a person's dietary quantity, quality, diversity, safety, and adequacy.(1) Food security is a term describing a situation where everyone has physical, social, and economic access to nutritious food which meets their dietary needs and food preferences. Not only does food need to be available, accessible, utilised, stable, but also sustainable.(1) However, in a global context, food systems are fraught with issues threatening food security, including shocks such as the COVID-19 pandemic,(2) and war Globally, 2020 food prices were higher than in the previous six years. Within Australia, we lack food system resiliency due to a casualised workforce, reliance on international workers, a concentration of supermarket power, and widening inequities, among others Evidence suggests that Australia will not meet global targets to achieve the 'Zero Hunger' 2030 Sustainable Development Agenda We face an incredible challenge;to feed an increasing population sustainably. Local food systems, also known as 'alternative food networks', are often sold for local or regional markets.(3) Australian research reported barriers to purchasing and consuming more locally grown food such as affordability, limited availability, and a lack of interest. While enablers included altruistic reasons such as financially supporting farmers, personal health perceptions or an environmental contribution.(4) Evidence suggests local food systems encourage seasonal eating and dietary diversity, connect consumers and producers, and increase food system resiliency.(5,6) This presentation asserts that communities must participate in shaping the food systems which impact their food security. Food Policy Groups (FPG) are a potential mechanism to involve community and food system stakeholders in driving such actions forward These inter-agency alliances focus on impact areas such as food access, equity, and food system resiliency. A scoping review was undertaken in August-November 2022, to synthesise the literature describing the impact of FPG on local food systems within highincome countries. A total of 355 peer-reviewed and grey literature sources were imported into Covidence for screening;31 duplicates were removed, 324 sources were screened, 146 full-text sources assessed for eligibility. Thirty-one sources with evaluation evidence demonstrating their impact were extracted. FPG focused on increasing food system equity, such as distributing culturally appropriate food;increased access to healthy food, such as successfully advocating for food objectives to be written into local food system plans;supporting food system resiliency, such as achieving local food procurement in schools. The international evidence suggests FPG are impactful across several food system aspects. Future research will examine whether FPG could be an effective mechanism for local food system change in Australia.

Harnessing the connectivity of climate change, food systems and diets: Taking action to improve human and planetary health

With climate change, the COVID-19 pandemic, and ongoing conflicts, food systems and the diets they produce are facing increasing fragility. In a turbulent, hot world, threatened resiliency and sustainability of food systems could make it all the more complicated to nourish a population of 9.7 billion by 2050. Climate change is having adverse impacts across food systems with more frequent and intense extreme events that will challenge food production, storage, and transport, potentially imperiling the global population's ability to access and afford healthy diets. Inadequate diets will contribute further to detrimental human and planetary health impacts. At the same time, the way food is grown, processed, packaged, and transported is having adverse impacts on the environment and finite natural resources further accelerating climate change, tropical deforestation, and biodiversity loss. This state-of-the-science iterative review covers three areas. The paper's first section presents how climate change is connected to food systems and how dietary trends and foods consumed worldwide impact human health, climate change, and environmental degradation. The second area articulates how food systems affect global dietary trends and the macro forces shaping food systems and diets. The last section highlights how specific food policies and actions related to dietary transitions can contribute to climate adaptation and mitigation responses and, at the same time, improve human and planetary health. While there is significant urgency in acting, it is also critical to move beyond the political inertia and bridge the separatism of food systems and climate change agendas that currently exists among governments and private sector actors. The window is closing and closing fast. © 2023 The Authors

COVID-19, Climate Change, and Conflict in Honduras: A food system disruption analysis.

In Honduras, as in many settings between 2020 and 2022, food security was affected by the COVID-19 pandemic, climate change, and conflicts-what some refer to as "The Three Cs." These challenges have had overlapping impacts on food supply chains, food assistance programs, food prices, household purchasing power, physical access to food, and food acceptability. This article applies a food system disruption analysis-adapted from a fault tree analysis originally developed for a municipal context in the United States-to the context of Honduras to systematically examine how the Three Cs affected food availability, accessibility, and acceptability. This article demonstrates the value of approaching food security through a disruption analysis, especially for settings impacted by multiple, interconnected, ongoing crises.

Anxiety Levels of People Living with HIV and Problems in Accessing Healthcare Services and Drugs During the COVID-19 Pandemic.

Introduction: Since its emergence in December 2019, COVID-19 has caused severe morbidity and mortality. Access to healthcare services for individuals with chronic diseases including people living with HIV was disrupted due to many factors such as the density in hospitals and social closure strategies to stop the spread of the pandemic. The aim of this study was to determine whether HIV status and social and medical problems faced by people living with HIV caused anxiety during the COVID-19 pandemic. Material(s) and Method(s): Between October 2021 and February 2022, the Beck anxiety scale and a 16-item questionnaire including questions on demographic information was completed by 100 people living with HIV who visited our Cukurova University Infectious Diseases and Clinical Microbiology outpatient clinic and gave consent to be included in the study. Result(s): Overall, 93 (93%) participants were male and seven (7%) were female, with a mean age of 36 +/- 10 years. Among all participants, 44% reported a decrease in their general quality of life, 42.4% reported an increase in the level of anxiety, 33% reported a decrease in access to resources such as money and food, and 13% reported that they had difficulty in paying the rent of their own house. During the pandemic, 11.3% of the participants lost their jobs and 9.1% lost their health insurance;8.1% reported that they became homeless and moved to live with someone else. Access to antiretroviral treatment decreased in 7.2% of the participants, the number of hospital visits were reduced in 33.3%, and 26% reported a reduction in monitoring tests such as HIV RNA. The mean Beck anxiety score, which was used to evaluate the patients' anxiety level, was 12.32 +/- 12.35 (min-max= 0-54) and suggested mild anxiety symptoms. Conclusion(s): The difficulties and problems in the daily lives of individuals living with HIV have deepened with the COVID-19 pandemic. The data we obtained in our study helps us understand the difficulties and anxiety levels of people living with HIV in receiving healthcare.Copyright © 2022 Bilimsel Tip Yayinevi. All rights reserved.

Emergency food aid and household food security during COVID-19: evidence from a field survey in Senegal

The effectiveness of food aid in reducing household food insecurity in developing countries has been extensively examined in previous studies. This study explores this issue in the context of COVID-19, using the example of emergency food aid provided by the Senegalese government. Field survey data were collected from 4500 recipients and non-recipients, and the matching method was used to examine whether there was a significant difference between the two groups. Several dimensions of food insecurity were explored through five indicators: the food consumption score and the coping strategies index from the World Food Programme and three indicators of simple, moderate and severe food insecurity based on the Food Insecurity Experience Scale of the US Food and Agriculture Organization (FAO). The results show that government aid has a negative and significant impact on the diversity and nutritional value of beneficiary households' diets. Nevertheless, this programme prevented the use of extreme coping strategies. Furthermore, government aid has a positive impact on food security as measured by negative experiences related to food access. Ultimately, despite low nutritional intake, the programme had a positive effect on recipients' food access compared with non-beneficiaries. Therefore, for future interventions, the government should promote local and more nutritious products to sustainably improve food security.

Exploring the impacts of FDA temporary food labeling flexibility among the food allergy community during the COVID-19 pandemic. (Special Issue: The impact of the covid-19 pandemic and the foodservice industries.)

In an attempt to improve access to food distribution systems during the Covid-19 pandemic, the United States Food and Drug Administration (FDA) issued temporary flexibility in food labeling requirements. This requirement affects the Top 8 allergens and could lead to accidental allergen ingestion. The purpose of this study was to utilize a qualitative method to collect and analyze comments to FDA that were available via Allergic Living's website from May 22, 2020, to June 18, 2020, following the release of the food labeling change. In total, 3,033 comments were analyzed using the thematic analysis six-phase framework approach. Various themes were extracted relating to the emotional responses of the new labeling including fear, safety concerns, and trust of certain food product brands among the food allergy community. This research has implications for a broad spectrum of the U.S. food industry including restaurants, grocery stores, specialty food associations, and consumers. Stakeholders and experts in the food allergy community should be consulted when a policy change is occurring, especially during a pandemic affecting access to safe food.

Economies of community in local agriculture: farmers in New London, Connecticut, respond to the COVID-19 pandemic

The COVID-19 pandemic highlighted the weaknesses of the U.S. national food system, with grocery store shelves emptied in March and April 2020 and COVID outbreaks reported throughout the summer of 2020 at meat processing plants across the country. Fleetingly, Americans turned to local farms to ensure they could access food safely in a time of uncertainty. This paper examines the economies of community that formed around local farms and how direct engagements between consumers and producers in the face of the pandemic deepened these economic structures that often put community well-being above profits. Within a capitalist system that prioritizes efficient mass production, economies of community illustrate that solidarity can improve local food system resilience. Based on qualitative and quantitative research carried out in the summer of 2020 in New London County in southeastern Connecticut, this research draws on ethnographic interviews with small-scale farmers who developed innovative ways to feed some of their community's most vulnerable members. Community economies show that we should not only depend on standardized large-scale farms and giant retail distribution;the American food system needs to continue to cultivate small-scale local production in order to improve resilience and food access. At present, the sustainability of producing and distributing food occurs at the farmer's expense. The government needs to support local food producers so they can continue to play an integral part in community well-being.

COVID-19 Pandemic Impacted Food Security and Caused Psychosocial Stress in Selected States of Nigeria.

The COVID-19 disease has infected many countries, causing generalized impacts on different income categories. We carried out a survey among households (n = 412) representing different income groups in Nigeria. We used validated food insecurity experience and socio-psychologic tools. Data obtained were analyzed using descriptive and inferential statistics. The earning capacities of the respondents ranged from 145 USD/month for low-income earners to 1945 USD/month for high-income earners. A total of 173 households (42%) ran out of food during the COVID-19 pandemic. All categories of households experienced increasing dependency on the general public and a perception of increasing insecurity, with the high-income earners experiencing the greatest shift. In addition, increasing levels of anger and irritation were experienced among all categories. Of the socio-demographic variables, only gender, educational level of the household head, work hours per day, and family income based on society class were associated (p < 0.05) with food security and hunger due to the COVID-19 pandemic. Although psychological stress was observed to be greater in the low-income earning group, household heads with medium and high family income were more likely to have satisfactory experiences regarding food security and hunger. It is recommended that socio-economic groups should be mapped and support systems should target each group to provide the needed support in terms of health, social, economic, and mental wellness.

Urban Agriculture as a Means to Food Sovereignty? A Case Study of Baltimore City Residents.

A large body of research suggests that neighborhood disparities in food access persist. Emerging evidence suggests that the global COVID-19 pandemic likely exacerbated disparities in food access. Given the potential role that alternative food networks (AFNs) and local food sources may play during times of extreme scarcity, this study examines urban agriculture (e.g., community farms and gardens) as a sustainable strategy to address food insecurity. In-depth qualitative interviews with fifteen community stakeholders revealed several major themes including food insecurity as a feature of systemic racism, food affordability and distance to food as major barriers to food security, and the role of AFNs in creating community empowerment. Our findings indicate that urban agricultural practices help build social capital, inform and educate community members about healthy eating behaviors, and facilitate the distribution of affordable food. Implications for future research and policy targeting sustainable food distribution in marginalized communities of color are discussed.

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.

Collaborative Strategies to Improve Nutrition Security and Education: Lessons Learned During a Pandemic.

BACKGROUND: The COVID-19 pandemic intensified disparities for underserved populations as accessing resources became more difficult. Dairy Council of California launched the Let's Eat Healthy initiative to address nutrition security through collaborative solutions in the school environment. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: To ensure nutrition security for children and families, nutritious food and nutrition education must go hand-in-hand. Improving access to high quality food can help address the health disparities that exist for people who are at increased risk for food insecurity. Nutrition education supports students' holistic learning and social and emotional learning skills. Nutrition education models must be increasingly flexible in the face of ongoing challenges. Collaborative efforts to connect food access hubs, such as schools, with support and resources to provide evidence-based nutrition education and agricultural literacy can equip individuals and communities with the knowledge, skills, and ability to make nutrient-rich food choices. CONCLUSIONS: Investments and strategies in nutrition security that utilize the Individual plus Policy, System, and Environmental (I + PSE) model, such as the Let's Eat Healthy initiative, will effectively influence positive behavior change and improve community health. Navigating challenges in a rapidly changing environment requires people and organizations to work together, across disciplines, to leverage knowledge, experience, resources, expertise, and creative thinking. Improving access to healthy food and nutrition education will be most effective when done through collaboration.