Impact of Food Insecurity on Clinical Outcomes in Newly Diagnosed Pediatric Ibd Patients

Purpose: Inflammatory bowel disease (IBD) is an autoimmune disease that consists of Crohn's Disease (CD) and ulcerative colitis (UC). IBD is thought to result from an environmental trigger, one of which could be diet, in a genetically susceptible host. Food insecurity is defined as limited or uncertain access to enough food. It is estimated that 1 in 7 children in the United States experience food insecurity which is estimated to be about 13 million children. This number has increased since the COVID pandemic to 1 in 4. Louisiana has one of the higher rates of food insecurity in the country with an estimate of over 249,000 children affected. Food insecurity is higher in African American and Hispanic households. Despite nutrition playing a significant role in IBD, there is limited data on food insecurity and IBD. Only one adult study identified that adult IBD patients had 69% higher odds of being food insecure compared to peers without IBD. The purpose of this study is to evaluate if pediatric patients with IBD are food insecure. Our hypothesis is that newly diagnosed pediatric IBD patients who are food insecure have worse clinical outcomes than those who are food secure 6 months after diagnosis. The primary aim will be to assess if food insecurity is associated with escalations in therapy within the first 6 months of diagnosis. Secondary aim of the study is to determine if food insecurity is associated with other clinical outcomes. Food access will also be evaluated to see if patients who are food insecure live in areas defined as a food desert, decrease access to nearby grocery stores, or food swamps, defined as adequate access to food but mostly higher calorie food options over healthy food options. Method(s): This is a prospective study of newly diagnosed pediatric IBD patients seen in the Louisiana State University Health Science Center Pediatric Gastroenterology Division at Children's Hospital New Orleans. Patients were screened for food insecurity using the United States Department of Agriculture's food insecurity screening and the American Academy of Pediatrics' Food Insecurity 2-Question Screen. Data was collected including escalations in medication, hospitalizations, surgeries, emergency room visits and nutritional data over the first 6 months of diagnosis. To determine diet quality, food journals were completed, or comprehensive diet recalls were performed then analyzed by a licensed dietitian. Result(s): There are currently 13 patients enrolled in this ongoing study. All patients have Crohn's Disease and receive maintenance therapy with TNF alpha antagonist (infliximab or biosimilar). Most patients are female (69%), Medicaid insurer (54%), with approximately half identifying as white race (46%) and half identifying as African American (46%). The average age at diagnosis was 14.4 years (+/- 2.7 years). Nine of the patients (69%) have no grocery stores within 1 mile of their home. Three patients lived in a food swamp (23%), 1 of which also had low food security. There was one patient who did not live in a food desert or food swamp but identified as having low food security. The average BMI was 19.4 and 3 had a BMI z-score less than -1 at diagnosis. Two parents were identified as having low food security and 2 patients screened positive for low food security. Only one survey matched low food security for both parent and child. For transportation, many traveled to appointments by automobile but were not owners of the automobile. At one month after diagnosis, there was 1 medication change due to the development of antibodies, 2 courses of oral steroids, 2 patients had an additional medication added (methotrexate for both), 3 hospitalizations, 1 surgery;however, none of the patients fit criteria for low food security. There were 2 emergency room visits, 1 of 2 were food insecure. Weight gain in one month ranged from 0.3 to 10.4 kilograms. One food insecure patient lost 0.8 kilograms at 1 month. Conclusion(s): While there were few patients identified as food insecure, each patient had relatively poor access to healthy food options. Every patient in the study either fell into the category of having no grocery stores within a mile of their home, living in a food swamp or having low food security. Establishment of additional surrogates for food insecurity may be warranted to better assess the association of food insecurity with IBD. The significance of food insecurity in pediatric IBD remains unclear. However, longer follow-up is planned to further assess the relationship between food insecurity and clinical and nutritional outcomes. Additional studies are forthcoming to evaluate the impact food quality within the diet of pediatric IBD patients has on short-term and long-term health outcomes.

Preference and Utilization of Food Resources by Refugee and Immigrant Populations

Purpose/Objectives: Cultural values are often cited as important influences on an individual, family or communities' health decisions. However, culture as a positive predictor of healthy food behavior may be less significant than structural and economic barriers such as documentation status and access to healthy food. This is particularly true for refugee and immigrant children living in districts that are considered food deserts. The 2018 Roanoke City Community Health Assessment reports that 5% of survey respondents indicated their unhealthy behavior is due to lack of cultural value of health. Food preference, however, is seldom reported. Additionally, resources such as food banks/pantries (FBP) can be highly variable in access and requirements of proof of residency, legal documentation, or age. Preliminary attestations from local food banks also indicate additional barriers due to lack of language interpreters and limited hours, particularly during the COVID-19 pandemic. This may suggest these factors play a larger role for refugee and immigrant populations on healthy food behaviors. This study seeks to explore challenges to achieving food health for refugees and immigrants by assessing food preferences and utilization of community resources. Demographic and geographic information are analyzed in order to better understand contributing factors. Design/Methods: A 10-question survey was administered to 132 refugee and immigrant households with assistance of an interpreter as needed. The survey asked about food resources used within the last year, food and household item preferences, and deidentified demographics. The Hunger Vital Sign questionnaire, a validated tool, was used to screen for Food Insecurity. Results: 86.2% of survey respondents reported having at least one child at home. 46.8% of households with children reported to be food-insecure. Figure 1 shows resources used by households with children. Figure 2 shows food preferences among respondents. Only 20.5% of respondents from a food desert area, despite a high density of FBP, reported utilizing FBP in the last year. Respondents are represented by 25 countries. Conclusion/Discussion: Households with children, especially those screening positive for food insecurity, primarily utilized community organizations over food pantries and schools for their food help during COVID-19 pandemic. The primary utilization of community organizations includes those living in identified food desert areas. These food desert areas have a higher density of FBP, but rates of utilization are the same compared to all respondents regardless of geographic location. Additionally, milk/eggs and vegetables were the highest requested foods. This provides evidence of preference for healthier foods suggesting culture plays little role in achieving food health. More influential factors to consider are access, availability and awareness of these resources, which may be addressed by interventions that bolster community relationships in order to bridge these gaps.

UNEQUAL DISTRIBUTION: ACCESS TO SARS-COV2 TESTING SITES IN COMPARISON TO SARS-COV2 POSITIVITY RATES IN MONROE COUNTY MARCH -OCTOBER 2020

BACKGROUND: Over the course of the 20th century, Monroe County NY, has developed into a community facing significant defacto segregation: a central crescent of the city has lower economic indicators and a predominantly minority community. We set out to analyze rates of SARS-COV2 as well as the distribution of SARS-COV2 testing sites across Monroe County during the first wave of the pandemic (March 2020-Sept 2020). Our hypothesis was that while disease rates would be higher in historical disadvantaged areas, the distribution of testing resources would be less accessible. This is a potentially novel methodology to demonstrate layers of unequal access to resources. METHODS: We extracted data on the total number of SARS-COV2 cases by zip code in Monroe County, NY from March 23 - October 21, 2020 and SARS-COV2 testing sites from the Monroe County Department of Health website. Sociodemographic factors were taken from the 2015 American Community Survey. We used geospatial analysis to assess the local spatial autocorrelation of SARS-COV2 rates. We adapted a definition based on the USDA's 4th definition for food deserts to create a measure of “SARS-COV2 testing site desert.” To overcome coordination of census tract level definitions with zip code level data, we assumed an equivalency factor where we divided the total zip code population by 4000 (average census tract size). We then tested whether SARS-COV2 testing sites were accessible using this definition. RESULTS: There were statistically significant differences in local spatial autocorrelation which allowed us to separate the county into “SARS-COV2 hot zones” and “SARS-COV2 cold zones.” The hot zones had a statistically significant lower median income and a higher percentage of Black and Hispanic residents. The cold zones along the perimeter had a higher median income and higher percentage of white residents (Mann Whitney p values < 0.05). Using the definition for SARS-COV2 testing site deserts, the hot zones had less access to testing sites than the cold zones. CONCLUSIONS: SARS-COV2 case rates were differentially distributed in the first wave of the pandemic in Monroe County. There were significantly higher positivity rates in areas with predominately black residents, lower median incomes, and limited car access. These areas with higher SARSCOV2 positivity rates also had lower initial access to SARS-COV2 testing sites, creating an example of compounded inequity. Creating specific definitions surrounding healthcare access that consider transportation and can be rapidly analyzed may allow for more effective future resource allocation. An early version of this analysis allowed healthcare systems and community organizations to create pilot SARS-COV2 testing sites in areas with higher rates of disease in real time. Using geospatial data analyses provides an exciting potential way to model and impact change in equitable healthcare delivery.

The contribution of urban garden cultivation to food self-sufficiency in areas at risk of food desertification during the Covid-19 pandemic

This paper assesses the contribution made by the cultivation of urban gardens to the food self-sufficiency of mountain municipalities at risk of food desertification during 2020 in South Tyrol (Italy). The pandemic-induced economic downturn and mobility restrictions have left more territories severely exposed to the adverse risk of food desertification. A food desert is a territory where people are food-insecure because of job/income loss or through the absence of food retail facilities. During lockdown, many non-essential firms were forced to close. This meant that many workers, especially those in more precarious positions, lost their jobs, while entrepreneurs had consistent financial shortcomings. Local population mobility was restricted to the municipality of residence, with reduced access to grocery stores outside that area. Disrupted food supply chains and panic buying stimulated short-term food shortages, emptied municipal food stores and meant that supplies often failed to meet local needs. This insecurity left mountain municipalities increasingly vulnerable to desertification. The most food-insecure areas are those that depend heavily on the tourism sector and those with limited access to food retail facilities or other organized forms of food supply in proximity. Their challenges through the period of Covid-19 have heightened questions about their access to food and possible initiatives to increase their food self-sufficiency. Among the initiatives most frequently debated in that period, gardening has been highly valued. This paper contributes to the debate by presenting a Decision Support System (DSS) that calculates the land required for food self-sufficiency in South Tyrolean municipalities and the percentage covered by the production of local urban gardens. The results demonstrate that urban gardens’ contribution to local food self-sufficiency is almost insignificant in these municipalities, representing less than 1 % of the municipal needs. Restricting the analysis to self-sufficiency in fruit and vegetable production only, findings derived from the DSS application confirm the insignificance of urban gardens’ production levels, which remains below 1 % of the municipal needs.

Food insecurity, food deserts, reproduction and pregnancy: we should alert from now.

Food insecurity and food deserts are prominent global health problems, now exacerbated by current COVID-19 pandemic. Some evidence points to the importance of food security, particularly for women in their reproductive age. Women's health and their nutrition status, across the continuum of preconception to pregnancy and postpartum are critical aspects for ensuring positive gestation course and short-/long-term outcomes by affecting essential developmental pathways. Several adverse outcomes (both maternal and neonatal) were reported in scientific literature. Screening programs, new economic policies, implementation of assistance since preconception could be a good strategy to mitigate the negative consequences of food insecurity. Potential strategies could include addressing misconceptions about healthy maternal diet and breast milk adequacy, stress management, promote social support networks, and connecting to supplemental nutrition assistance programs.KEY POINTSFood insecurity (limited food access owing to cost) and desert foods (living in areas with low physical/personal access to nutritious food) are major public health concerns.Large geographical and within-country disparities, multiple socio-economic determinants.Childbearing age and pregnancy are groups at higher vulnerability to develop complications.Food insecurity negatively affects offspring health and development.Peri-conceptional window: an early clinical opportunity to screen and to apply preventive strategies.Help vulnerable groups to have access to more affordable nutritious food, educate and change unhealthy behaviors, adequate stress management, social support networks.

A Review of Food Insecurity and Chronic Cardiovascular Disease: Implications during the COVID-19 Pandemic.

Cardiovascular disease is the leading cause of death and disability globally. Self-management of cardiovascular disease includes the consumption of nutrient-dense foods and prudent dietary patterns, such as the DASH (Dietary Approaches to Stop Hypertension) and Mediterranean Diet to decrease inflammation and stress. Over the last few decades, there has been a growing interest in food insecurity and health outcomes in the United States. While it is well established that diet plays a role in the development of cardiovascular disease, there is little known regarding the role of food insecurity and cardiovascular disease. As a result of unprecedented unemployment rates during and following the global COVID-19 pandemic, all dimensions of food insecurity have been impacted, including declines in food availability, accessibility, utilization, and stability. This paper summarizes the existing quantitative and qualitative literature exploring the social determinants of health (economics/poverty, employment, limited access to health care, and food) that affect the self-management of cardiovascular disease, including healthy nutrition, highlighting special considerations during the COVID-19 global pandemic.

COVID-19 exacerbates unequal food access.

Inequality to food access has always been a serious problem, yet it became even more critical during the COVID-19 pandemic, which exacerbated social inequality and reshaped essential travel. This study provides a holistic view of spatio-temporal changes in food access based on observed travel data for all grocery shopping trips in Columbus, Ohio, during and after the state-wide stay-at-home period. We estimated the decline and recovery patterns of store visits during the pandemic to identify the key socio-economic and built environment determinants of food shopping patterns. The results show a disparity: during the lockdown, store visits to dollar stores declined the least, while visits to big-box stores declined the most and recovered the fastest. Visits to stores in low-income areas experienced smaller changes even during the lockdown period. A higher percentage of low-income customers was associated with lower store visits during the lockdown period. Furthermore, stores with a higher percentage of white customers declined the least and recovered faster during the reopening phase. Our study improves the understanding of the impact of the COVID-19 crisis on food access disparities and business performance. It highlights the role of COVID-19 and similar disruptions on exposing underlying social problems in the US.