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.

Giving Families a Voice for Equitable Healthy Food Access in the Wake of Online Grocery Shopping.

Understanding the views of families from low-income backgrounds about inequities in healthy food access and grocery purchase is critical to food access policies. This study explored perspectives of families eligible for the Supplemental Nutrition Assistance Program (SNAP) on healthy food access in physical and online grocery environments. The qualitative design used purposive sampling of 44 primary household food purchasers with children (aged ≤ 8), between November 2020-March 2021, through 11 online focus groups and 5 in-depth interviews. Grounded theory was used to identify community-level perceived inequities, including influences of COVID-19 pandemic, SNAP and online grocery services. The most salient perceived causes of inequitable food access were neighborhood resource deficiencies and public transportation limitations. Rural communities, people with disabilities, older adults, racially and ethnically diverse groups were perceived to be disproportionately impacted by food inequities, which were exacerbated by the pandemic. The ability to use SNAP benefits to buy foods online facilitated healthy food access. Delivery fees and lack of control over food selection were barriers. Barriers to healthy food access aggravated by SNAP included social stigma, inability to acquire cooked meals, and inadequate amount of monthly funds. Findings provide a foundation for policy redesign to promote equitable healthy food systems.

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.

“More Worthwhile than the Paycheck”: An Innovative Summer Internship in Northern Manhattan to Engage Youth in Food Justice Promotion

Purpose: Youth engagement in food justice movements to address healthy food access and nutrition-related disparities is a powerful tool for community health promotion and youth empowerment. Such opportunities are often unpaid and inaccessible to low-income youth. Launched in 2019, NewYork-Presbyterian Hospital (NYP) Youth Market is a paid 8-week summer internship in Northern Manhattan that engages youth in a community health intervention and supports their personal professional development. Methods: Youth ages 16-22 were recruited from NYP partner schools and youth programs in Washington Heights, Inwood, and the South Bronx, communities with suboptimal access to healthy food and disparately high rates of obesity and food insecurity. Interns managed their own weekly farm stand and provided nutrition education and cooking demonstrations at GrowNYC Fort Washington Greenmarket. They participated in didactics led by NYP staff and community partners on nutrition and disease, food systems, and small business management. Due to COVID-19, the 2020/2021 programs were adapted to become partially-virtual with interactive didactics on Zoom, and responded to community needs by distributing emergency food packages to food insecure families. Matched, de-identified pre-post online surveys for 2021 assessed attitudes, self-efficacy, and lessons learned via Likert scale (analyzed using Wilcoxon signed-rank test) and open-ended questions (assessed for common themes). Results: 2021 interns (n=20, median age=17, 100% self-identified as persons of color) largely aspired to careers in healthcare/public health/nutrition (65%). Youth led 21 nutrition workshops for community members;a total of 17,645 pounds of healthy food was distributed to the community via farm stand sales, emergency food distributions, donations, and redemptions of NYP fruit and vegetable prescriptions. Pre-post analysis findings (missing=1) demonstrated several statistically significant findings of improvement. Interns self-reported a median increase of one more fruit (p<0.01) and one more vegetable (p<0.01) eaten per day, but did not significantly change their sugar-sweetened beverage consumption (p=0.48). Youth expressed increased confidence (5-point scale: 1=not confident at all to 5=very confident) in their ability to share information with friends/family about healthy eating (mean pre=3.20, post=4.21, p<0.01) and information on resources for someone experiencing food insecurity (mean pre=2.40, post=4.00, p<0.001). In response to open-ended questions, interns emphasized improvement in their public-speaking/communication skills and felt enriched by mentorship from both their peers and a diverse group of professionals. They gained positive feelings of community connectedness through customer nutrition education and emergency food distributions. One intern stated, “There are so many people that don't have the key information about nutrition and how to overall live healthy lives and it's so important to acquire and spread this knowledge because it allows you to become self-reliant and more responsible with your lifestyle.” Another intern commented, “The experience is so much more worthwhile than the paycheck”. Conclusions: NYP Youth Market demonstrates a valuable model of youth engagement in paid work to promote community access to healthy food, improve their own nutrition behaviors, and develop their burgeoning health careers. Next steps include developing program enhancements, such as hands-on farming experience and strengthening the program’s mentorship component. Sources of Support: NewYork-Presbyterian Hospital Choosing Healthy & Active Lifestyles for Kids Program, partnered with GrowNYC Greenmarkets.

Social determinants of health and health inequalities in context of COVID-19 pandemic

Introduction: The COVID-19 pandemic has disproportionally affected disadvantaged populations, exposing existing inequalities in the society and widening health inequalities. Health inequalities are those preventable differences in health status between groups that arise from the unequal opportunities and unequal distribution of resources related to health, which determine the risk of people getting ill, ability to prevent illness or opportunities to access medical care. Material and Methods: Literature search was done through relevant science databases. Available studies regarding health inequalities in context of COVID-19 pandemic were examined and presented in this review. Results and Conclusions: The higher risks of COVID-19 infection and mortality has been noticed for specific groups that are disproportionally affected by pandemic due to inequalities in the social determinants of health, such as living and working conditions, access to healthy food, opportunities for maintaining hygiene and access to healthcare. To understand why lower socioeconomic groups and minorities are more susceptible to infection, broader context of the pandemic has to be observed. Although the existence of virus is a key factor, differences in infection, prevalence, severity and mortality rates seem to be a result of a synergistic effect of the virus itself, social determinants of health and inequalities in pre-existing chronic diseases. The important task for the future is to create more equal and healthier living and working conditions, improving the health of the most vulnerable groups and reducing inequalities in the population.

A Multi-Pronged Evaluation of a Healthy Food Access Initiative in Central Texas: Study Design, Methods, and Baseline Findings of the FRESH-Austin Evaluation Study.

Food insecurity and limited healthy food access are complex public health issues and warrant multi-level evaluations. The purpose of this paper was to present the overall study design and baseline results of the multi-pronged evaluation of a healthy food access (i.e., Fresh for Less (FFL)) initiative in Central Texas. The 2018-2021 FRESH-Austin study was a natural experiment that utilized a cluster random sampling strategy to recruit three groups of participants (total n = 400): (1) customers at FFL assets, (2) residents that lived within 1.5 miles of an FFL asset, and (3) residents from a comparison community. Evaluation measures included annual cohort surveys, accelerometers and GPS devices, store-level audits, and built environment assessments. Data are being used to inform and validate an agent-based model (ABM) to predict food shopping and consumption behaviors. Sociodemographic factors and food shopping and consumption behaviors were similar across the three groups; however, customers recruited at FFL assets were lower income and had a higher prevalence of food insecurity. The baseline findings demonstrate the need for multi-level food access interventions, such as FFL, in low-income communities. In the future, ABM can be used as a cost-effective way to determine potential impacts of future large-scale food environment programs and policies.