Equity-oriented food supports: Learnings from the Nova Scotia COVID-19 pandemic response.

SETTING: Public health measures enacted during the COVID-19 pandemic significantly impacted Nova Scotians experiencing food insecurity. Public Health (PH), Nova Scotia Health, created a provincial Housing Isolation Program (HIP) which addressed barriers to isolation, including food access, for COVID-19 cases and contacts being followed by PH. INTERVENTION: HIP worked with partners to coordinate and respond to urgent food needs of isolating clients by providing grocery and meal delivery options. HIP also made referrals to government and community partners for income and food supports. This program was intended to minimize the spread of COVID-19 by facilitating isolation while meeting basic needs for people with no other means of support. OUTCOMES: From December 2020 to March 2022, HIP completed grocery and meal deliveries for 579 clients, 1351 referrals to a provincial Income Support Program, and 231 referrals to external food supports. HIP staff worked with clients to manage potential perceptions of stigma. Challenges reported included the urgency of food needs, lack of social supports, and availability and accessibility constraints in rural communities, as well as difficulty accessing culturally appropriate foods and special diets. IMPLICATIONS: This intervention demonstrates the importance of addressing food insecurity during emergency preparedness, planning, and response. During emergencies, planning and mobilizing food access requires an equity-oriented approach to overcome stigma. Broadly, continued reliance on charitable responses creates significant vulnerability during emergencies and addressing root causes of food insecurity through social policy will provide longer-term protection.

RéSUMé: CONTEXTE: Les mesures de santé publique adoptées pendant la pandémie de COVID-19 ont eu un important impact sur la population néo-écossaise en situation d'insécurité alimentaire. Les Services de santé publique de Santé Nouvelle-Écosse ont créé un programme provincial d'hébergement en isolement (Housing Isolation Program - HIP) qui s'est attaqué aux obstacles à l'isolement, y compris l'accès à la nourriture, pour les cas de COVID-19 et les contacts suivis par la Santé publique. INTERVENTION: Le programme d'hébergement en isolement (HIP) a travaillé avec des partenaires pour assurer la coordination et répondre aux besoins alimentaires urgents de la clientèle isolée en proposant des solutions de livraison d'épicerie et de repas. Le HIP a également orienté la clientèle vers des partenaires gouvernementaux et communautaires pour qu'elle bénéficie d'un soutien au revenu et d'une aide alimentaire. Ce programme visait à minimiser la propagation de la COVID-19 en rendant l'isolement plus facile tout en répondant aux besoins fondamentaux des personnes qui n'ont pas d'autre source de soutien. RéSULTATS: De décembre 2020 à mars 2022, le HIP a effectué des livraisons d'épicerie et de repas pour 579 personnes; 1 351 aiguillages vers un programme provincial de soutien au revenu; et 231 aiguillages vers des soutiens alimentaires externes. Le personnel du HIP a travaillé avec la clientèle pour gérer les perceptions potentielles de stigmatisation. Parmi les difficultés signalées, citons l'urgence des besoins alimentaires, le manque de soutien social, les contraintes de disponibilité et d'accessibilité dans les communautés rurales, ainsi que la difficulté d'accès à des aliments culturellement adaptés et à des régimes alimentaires particuliers. IMPLICATIONS: Cette intervention démontre l'importance de la prise en compte de l'insécurité alimentaire lors de la préparation, de la planification et de l'intervention en cas d'urgence. Dans les situations d'urgence, la planification et la mobilisation de l'accès à la nourriture nécessitent une approche axée sur l'équité afin de surmonter la stigmatisation. D'une manière générale, le fait de continuer à s'appuyer sur des réponses d'ordre caritatif crée une vulnérabilité importante dans les situations d'urgence. S'attaquer aux causes profondes de l'insécurité alimentaire au moyen d'une politique sociale permettra d'assurer une protection à plus long terme.

Exploring the associations of food and financial insecurity and food assistance with breastfeeding practices among first-time mothers.

OBJECTIVE: Social determinants of health (SDoH), such as food and financial insecurity and food assistance, are potentially modifiable factors that may influence breastfeeding initiation and duration. Knowledge gaps exist regarding the relationship between these SDoH and infant feeding practices. We explored the relationships of food and financial insecurity and food assistance with the continuation of breastfeeding at four months postpartum among mothers and whether race and ethnicity modified these associations. DESIGN: Mothers retrospectively reported food and financial insecurity and receipt of food assistance (e.g. Women, Infants and Children and Supplemental Nutrition Assistance Program) during pregnancy with their first child and infant feeding practices (exclusive/mostly breastfeeding v. exclusive/mostly formula feeding) following the birth of their first child. Sociodemographic-adjusted modified Poisson regressions estimated prevalence ratios and 95 % CI. SETTING: Minneapolis-St. Paul, Minnesota. PARTICIPANTS: Mothers who participated in the Life-course Experiences And Pregnancy study (LEAP) (n 486). RESULTS: Ten percent of mothers reported food insecurity, 43 % financial insecurity and 22 % food assistance during their pregnancies. At four months postpartum, 63 % exclusively/mostly breastfed and 37 % exclusively/mostly formula-fed. We found a lower adjusted prevalence of breastfeeding at four months postpartum for mothers who reported experiencing food insecurity (0·65; 0·43-0·98) and receiving food assistance (0·66; 0·94-0·88) relative to those who did not. For financial insecurity (aPR 0·92; 0·78, 1·08), adjusted estimates showed little evidence of an association. CONCLUSIONS: We found a lower level of breastfeeding among mothers experiencing food insecurity and using food assistance. Resources to support longer breastfeeding duration for mothers are needed. Moreover, facilitators, barriers and mechanisms of breastfeeding initiation and duration must be identified.

Diet Quality of Community Café Meals Among Guests With Food Insecurity.

OBJECTIVE: Compare the diet quality of a meal consumed at a community café (café meals), a pay-what-you-can restaurant, to a meal consumed for an equivalent eating occasion on the day before (comparison meal) by guests with food insecurity. METHODS: Dietary recalls were collected from café guests with food insecurity to determine the Healthy Eating Index-2020 (HEI-2020) total and component scores. Healthy Eating Index-2020 scores were compared between meals using paired-sample t tests and Wilcoxon signed-rank tests. RESULTS: Most participants (n = 40; 80% male; 42.5% Black) had very low food security (70.0%). Café meal had a higher HEI-2020 total score (46.7 ± 10.5 vs 34.4 ± 11.6; P < 0.001) and total vegetables (2.6 ± 2.0 vs 1.2 ± 1.7; P = 0.004), total fruits (2.1 ± 2.2 vs 0.6 ± 1.5; P < 0.001), whole fruits (1.6 ± 2.0 vs 0.3 ± 0.9; P < 0.001), and refined grains (7.8 ± 3.5 vs 3.9 ± 3.9; P < 0.001) scores than comparison meals. CONCLUSIONS AND IMPLICATIONS: The café meal had better diet quality than the comparison meal, suggesting its potential for improving diet quality among guests with food insecurity.

SNAP Online Food Shopping: Nutrition Education Needs Perceived by Practitioners.

The change in policy that allowed Supplemental Nutrition Assistance Program recipients to redeem their benefits online during the coronavirus disease 2019 pandemic highlighted the potential role of nutrition education programs in facilitating the purchase of healthy, economical food online. The objective of this exploratory qualitative study was to understand the education provided by nutrition educators on online grocery shopping and educators' perspectives on education needs and ways that healthy purchases can be encouraged online. Interviews revealed topics that can be included in in-person education on online shopping, insights for online nutrition education, and promotion strategies for encouraging healthy purchases by low-income shoppers online.

A produce prescription program for patients with low incomes in North Carolina resulted in increased produce purchases.

OBJECTIVES: To assess if participation in a North Carolina produce prescription program for Supplemental Nutrition Assistance Program (SNAP) participants with diet-sensitive health conditions (SuperSNAP) is associated with changes in purchase composition and spending source. METHODS: This study used loyalty-card transaction data (October 2019-April 2022). We applied a linear mixed-effects model with overlap weights to perform a difference-indifferences analysis of purchases by SuperSNAP program enrollees compared to the control group. RESULTS: The sample included 1440 SuperSNAP shoppers and 45,851 control shoppers. Compared to shoppers only on SNAP, SuperSNAP shoppers spent $82.98 (95% CI (75.6, 90.3), p-value <0.001) more per month, $76.09 (95% CI (69.4, 82.8), pvalue <0.001) of which were spent strictly on food and beverage products. Among SuperSNAP shoppers, out of the $40 SuperSNAP benefit each month, an estimated $34.86 (95% CI (33.9, 35.8), p-value <0.001) of it was spent on fruits and vegetables. CONCLUSIONS: This study shows the promise of targeted produce prescription programs for SNAP participants in encouraging shifts in purchase composition.

Impact of a school-based food assistance program on household food insecurity in Greece, 2012-2019: a multi-year evaluation of the DIATROFI program.

Background: Childhood food insecurity can persist among low socioeconomic areas in high-income countries. Universal Free School Meal (UFSM) programs are designed to respond to this pressing issue. This study aimed to conduct a multi-year evaluation of the DIATROFI Program's impact on household food insecurity in Greece. Methods: This study utilized data from 18,716 students (618 kindergarten to high schools), from low socioeconomic areas participating in the school-level UFSM Program DIATROFI between 2012 and 2019. Parents of students completed annual baseline and follow-up paper-based self-completed questionnaires. The primary outcome was household food insecurity, measured using the Food Security Survey Module (FSSM) at both questionnaires, and evaluated through mixed linear and logistic regression models with repeated measurements. Findings: Students' median age was 9 years old (Interquartile range (IQR): 6.5, 12.0), 51.6% (n = 9658) were girls, and 82.2% (n = 15,382) lived in low/medium socioeconomic affluence households. Households with food insecurity reduced from 51.5% (n = 9630) to 47.6% (n = 8901) after one school year. Food insecurity score declined steadily for four years of consecutive participation, compared to baseline score (one-year b:-0.26; 95% Confidence Interval (CI):-0.30, -0.22, and four-year -1.28; -1.53, -1.03). The likelihood of retaining food insecure status reduced from 17% after one-year participation (Odds Ratio (OR): 0.83; 95% CI: 0.79, 0.87) to 36% after four-year participation (0.64; 0.49, 0.82). The Program's impact on household food insecurity alleviation was greater among households with low parental education and low socioeconomic affluence. Interpretation: The DIATROFI Program effectively improved household food security during and after the Greek socioeconomic crisis. School-level UFSM programs targeting underprivileged students can improve household food insecurity, with a more pronounced effect with increased years of participation, and among economically disadvantaged households. Funding: The DIATROFI Program was funded through various national and private organizations, including national prefecture authorities, Greek payment authorities, philanthropic/charitable organizations, and private companies.

Child meal support program, food and nutrition insecurity, and health among Korean children.

BACKGROUND: Korea's child meal support program (CMSP) aims to reduce food and nutrition insecurity (FNI) and improve health among children from low-income households. AIM: We examined the impact of different types of CMSP on children's FNI and health in Korea, analyzing meal frequency and healthful food consumption (FNI), and general health and depression (health) among child meal card (CMC) and facility meal service (FMS) participants compared with nonparticipants. METHODS: The 2018 Comprehensive Survey on Korean Children data were analyzed. Precisely, 847 children from low-income households aged 9-17 were categorized into CMC (n = 331), FMS (n = 209), and income-eligible nonparticipants (n = 307). Propensity score-weighted generalized linear models assessed CMSP's impact on FNI and health. Stratified generalized linear models examined heterogeneity in FNI-health associations by CMSP status. RESULTS: CMC participants reported more frequent breakfast consumption (odds ratio [OR] = 0.662, p < 0.05) but poorer self-rated general health (OR = 1.890, p < 0.05); FMS participants were less likely to have three meals (OR = 1.814, p < 0.05), fruits and vegetables (OR = 2.194, p < 0.001), and protein-rich foods daily (OR = 1.695, p < 0.05) than nonparticipants. Health risks associated with healthful food consumption and meal frequency were more pronounced among CMC and FMS/nonparticipants, respectively. CONCLUSION: CMSP had a limited impact on reducing FNI and improving health among children from low-income households. CMC appeared more effective than FMS in alleviating FNI, notwithstanding potential health concerns. Food assistance programs should seek comprehensive enhancements in children's food and nutrition security and health.

Speaking of Hunger: Food Shortages, Poverty and Community Assistance in Urban South Africa.

How people speak of hunger extends beyond statements about food adequacy; people's remarks may reflect experiences of poverty and feelings of vulnerability, and may be used to request help. In this article, we build on the idea of idioms of distress to conceptualize hunger talk as expressing more than an empty belly. We draw on ethnographic data gathered in two settings in South Africa: one a peri-urban area under traditional jurisdiction in the Eastern Cape Province; the other an inner-city suburb of the largest city, Johannesburg, in Gauteng. Hunger-related idioms of distress help illustrate the complex interplay of social, economic, and cultural factors, and allow people to speak of various affective and material aspects of their lives.

Food (in)security in relation to nutrition (in)security in a national cross-sectional sample of Supplemental Nutrition Assistance Program participants: considerations of an emerging construct.

BACKGROUND: Food insecurity, lack of access to sufficient food for an active, healthy life, is a persistent problem in the United States. Recently, nutrition security has emerged as a new concept. However, limited research exists examining how nutrition security relates to the established concept of food security. OBJECTIVES: This study assessed a recent metric of nutrition security and explored how well it describes the underlying construct among a sample of Supplemental Nutrition Assistance Program (SNAP) participants. We examined the correlation between food and nutrition security and demographic predictors of joint food and nutrition security status. METHODS: We conducted a national, web-based survey (Qualtrics; 30 September-19 October, 2022) in English and Spanish of adults aged ≥18 y (n = 1454) who reported receiving SNAP benefits in the past 12 mo. We measured food security using the US Department of Agriculture 6-item Food Security Survey and assessed nutrition security using the Gretchen Swanson Center for Nutrition Household Nutrition Security measure. We used multinominal logistic regression to examine demographic predictors of food and nutrition security. RESULTS: The majority (80.4%) of SNAP participants experienced food insecurity, and 59.1% reported experiencing nutrition insecurity. Food and nutrition security were moderately correlated (0.41); 55.6% of SNAP participants were both food and nutrition insecure, 3.5% were food secure but nutrition insecure, 24.8% were food insecure but nutrition secure, and 16.1% were both food and nutrition secure. Of SNAP participants, 24.8% reported experiencing food insecurity but not nutrition insecurity. Hispanic ethnicity and Southern residence were associated with joint food and nutrition insecurity. CONCLUSIONS: These findings raise questions about how nutrition security is conceptualized and measured and its added value beyond existing food security measurement scales. Further research is needed to understand differences in food and nutrition security experiences and risk factors and determine a validated definition and measure of nutrition security for future policy solutions.

Food security status and cardiometabolic health by sex/gender and race/ethnicity among adults in the United States.

BACKGROUND: Minoritized racial/ethnic groups and women in the United States (US) are disproportionately burdened by food insecurity, which likely contributes to disparities in cardiovascular health (CVH). Disparities are projected to widen due to the worsening climate crisis that is straining the agricultural system including food supplies. Nonetheless, studies have not investigated the relationship between food security status and 'ideal' CVH in a large, nationally-representative and racially/ethnically diverse US sample. METHODS AND RESULTS: We investigated household food security status in relation to 'ideal' CVH among US adults (N = 157,001) using 2014-2018/2020 National Health Interview Survey data. Food security status was defined as very low, low, marginal, or high. A summed score of 4 health behaviors and 3 clinical factors totaling 7 different measures was dichotomized (yes/no) to assess modified 'ideal' CVH (mICVH). Using Poisson regression with robust variance, we estimated prevalence ratios (PRs) and 95% CIs of mICVH by household food security status. We stratified models by sex/gender and race/ethnicity. Very low food security prevalence was higher among non-Hispanic (NH)-Black (8.0%) compared to Hispanic/Latinx (5.1%), NH-White (3.1%) and NH-Asian (1.7%) adults. The association between very low versus high food security and mICVH was stronger among women (PR = 0.23 [95% CI: 0.17-0.31]) than men (PR = 0.48 [95% CI: 0.35-0.66]). Compared to NH-White adults with high food security, racially/ethnically minoritized groups with very low to high food security were generally less likely (range: [PRvery low = 0.25[95% CI: 0.14-0.44] - [PRhigh = 0.88 [95% CI: 0.79-0.97]) to meet mICVH criteria. CONCLUSIONS: Food insecurity was associated with lower mICVH prevalence and racially/ethnically minoritized groups were disproportionately burdened.

Cyclic Formula Feeding Among Infants Participating in the Special Supplemental Nutrition Program for Women, Infants, and Children.

BACKGROUND: Low-income households often experience a cyclic pattern in food availability, with acute food shortages at month end. Variations in the monthly feeding of infant formula are understudied. OBJECTIVES: This study aimed to compare the amount and frequency of formula consumed at the beginning and end of the monthly Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) assistance cycle and test associations with total energy intake and other feeding practices among infants aged 7-11 mo. METHODS: This study was conducted between May 2020 and April 2021 in the southeastern United States and involved mothers of infants participating in WIC's fully formula package. Mothers were interviewed and 24-h feeding recalls were conducted at the beginning and end of the month. We defined month beginning as 5 d following the first WIC formula purchase and month end as 5 d before the next monthly cycle. Fifty mother-infant dyads participated in single or multiple monthly cycles, totaling 98 monthly cycles. Generalized linear mixed-effects modeling was used to test differences in formula feeding at month beginning and end. RESULTS: Most participants (84%) were African American or Latino and >90% purchased all formula within 2-3 d of the WIC issuance. The energy intake from formula at month beginning was significantly higher than at month end (67.63% and 57.85%, respectively; P = 0.002), with no differences in total energy intake. The odds of infants being fed cow milk and fruit juices/drinks increased from month beginning to end (P < 0.05). CONCLUSIONS: Infants in low-income households are at risk of experiencing a cyclic feeding pattern characterized by higher formula feeding at month beginning and an increase in feeding of nonrecommended drinks at month end. The WIC program policy could review educational and distribution options to reduce cyclic formula feeding and clarify caregivers' understanding of infants' formula needs. Household-level investigations into formula management and determinants of cyclic feeding are warranted.

Experiences accessing nutritious foods and perceptions of nutritional support needs among pregnant and post-partum mothers with low income in the United States.

Access to nutritious foods, a social determinant of health, contributes to disparities in maternal and infant health outcomes such as mental health, breastfeeding intensity and cardiometabolic risk. This study explored perceived nutrition access and intake among pregnant or post-partum women eligible for Medicaid. Qualitative, semistructured interviews were conducted with 18 women who were either currently pregnant (n = 4) or up to 12 months post-partum (n = 14) in 2021-2022. Mothers spoke English (n = 11) or Spanish (n = 7) and lived in the Texas Panhandle. Interviews were audio-recorded, transcribed, translated (Spanish to English) and verified. Two or more researchers coded each interview until consensus was reached using thematic analysis with ATLAS.ti software. The study revealed five drivers for nutrition access. (1) Social factors influenced nutrition; those with less support expressed limited ability to eat healthfully. (2) The Women, Infants and Children program was perceived as a helpful resource for some, while others faced challenges obtaining it. (3) Stress was bidirectionally related to unhealthy food choices, with food sometimes used as a coping mechanism. (4) Mothers prioritized their babies and others and had limited ability and time to prepare healthy meals. (5) Most participants felt they received inadequate nutrition guidance from their healthcare providers. Participants provided positive responses to a proposed nutritious home-delivered meal intervention. Low-income women may experience nutritional challenges specific to this life stage. Interventions that reduce stress and burden of household tasks (e.g. cooking) and improve education and access to nutritious foods may improve mothers' ability to consume nutritious foods.

Federal Food Assistance Accessibility and Acceptability Among Indigenous Peoples in the United States: A Scoping Review.

The purpose of this scoping review was to determine the extent to which accessibility and acceptability of federal food assistance programs in the United States have been evaluated among indigenous peoples and to summarize what is currently known. Twelve publications were found that examine aspects of accessibility or acceptability by indigenous peoples of 1 or more federal food assistance programs, including the supplemental nutrition assistance program (SNAP) and/or the Food Distribution Program on Indian Reservations (n = 8), the Special Supplemental Nutrition Program for Women, infants, and children (WIC) (n = 3), and the national school lunch program (n = 1). No publications were found to include the commodity supplemental food program or the child and adult care food program. Publications ranged in time from 1990-2023, and all reported on findings from rural populations, whereas 3 also included urban settings. Program accessibility varied by program type and geographic location. Road conditions, transportation access, telephone and internet connectivity, and an overall number of food stores were identified as key access barriers to SNAP and WIC benefit redemption in rural areas. Program acceptability was attributed to factors such as being tribally administered, providing culturally sensitive services, and offering foods of cultural significance. For these reasons, Food Distribution Program on Indian Reservations and WIC were more frequently described as acceptable compared to SNAP and national school lunch programs. However, SNAP was occasionally described as more acceptable than other assistance programs because it allows participants autonomy to decide which foods to purchase and when. Overall, little attention has been paid to the accessibility and acceptability of federal food assistance programs among indigenous peoples in the United States. More research is needed to understand and improve the participation experiences and health trajectories of these priority populations.

Factors Associated With Uptake of an Open Access Health Center-Based Mobile Produce Market: A Case for Expanded Eligibility.

BACKGROUND: Health care-based food assistance programs show promise but are underutilized. Strict eligibility requirements and program scheduling may dampen reach and outcomes. OBJECTIVE: To explore factors associated with uptake of a health center-based mobile produce market with no eligibility requirements and few barriers to entry. DESIGN: A cross-sectional analysis of medical record, sociodemographic, environmental, and market attendance data was used. PARTICIPANTS/SETTING: The study sample consisted of 3071 adults (18+ years) who were patients of an urban health center in eastern Massachusetts and registered for the mobile market during the study period of August 2016 to February 2020. MAIN OUTCOME MEASURES: The main outcome measure was monthly market attendance over the study period. STATISTICAL ANALYSES: T-tests and χ2 tests were used to compare market users and never-users. Multiple logistic regression was used to analyze variables associated with market attendance each month. RESULTS: In multiple variable analyses, Supplemental Nutrition Assistance Program enrollment was associated with slightly less frequent monthly market use (odds ratio [OR], 0.989; 95% CI, 0.984-0.994). Day-of, on-site market registration was associated with more frequent monthly use than self-registration on nonmarket days (OR, 1.08; 95% CI, 1.07-1.08). Having a psychiatric or substance use disorder diagnosis was associated with slightly less frequent market attendance (OR, 0.99; 95% CI, 0.98-0.99; and OR, 0.96; 95% CI, 0.95-0.97, respectively) compared with registrants without these diagnoses. CONCLUSIONS: Individual, community-level, and organizational factors are associated with uptake of a free mobile produce market and should be considered when designing programs.

Healthy food delivery for type 2 diabetes management in rural clinics' patients: A comparative effectiveness randomized controlled trial protocol.

BACKGROUND: Rural populations experience a higher prevalence of both food insecurity and type 2 diabetes mellitus (T2DM) than metropolitan populations and face many challenges in accessing resources essential to optimal T2DM self-management. This study aims to address these challenges by delivering a T2DM-appropriate food box and recipes directly to rural participants' homes. METHODS: This is a comparative effectiveness randomized controlled trial including 400 English- or Spanish-speaking rural adult participants with T2DM (HbA1c ≥6.5%) experiencing food insecurity. Participants are randomly assigned to a 3-month Healthy Food Delivery Intervention (HFDI) plus one 60-min virtual consultation with a diabetes educator or consultation only. The HFDI includes a weekly food box delivery with recipes. Data are collected at pre-intervention, 3-months (post-intervention), 9-months, and 15-months. The primary outcome is change in HbA1c, with secondary measures including diet quality (Healthy Eating Index-2015, calculated from one 24-h dietary recall at each data collection time point), cardio-metabolic risk factors (i.e., blood pressure, lipids, body mass index, glucose), and patient-centered outcomes (e.g., T2DM self-efficacy, T2DM-related distress). Process evaluation data (e.g., successful food box deliveries, diabetes educator consultation attendance, intervention satisfaction) are collected during and post-intervention (3-months). A cost-effectiveness analysis based on traditional cost per quality-adjusted life year gain thresholds will be conducted to estimate the incremental cost-effectiveness between HFDI plus consultation and consultation alone. CONCLUSION: Findings from this study will provide evidence regarding the effectiveness of an intervention that promotes participant adherence and improves access to healthy food. CLINICAL TRIAL REGISTRATION: NCT04876053.

Caregiver Preferences for Primary Care Clinic-Based Food Assistance: A Discrete Choice Experiment.

OBJECTIVE: The American Academy of Pediatrics recommends that pediatric providers screen families for food insecurity and connect them to appropriate resources. However, it is unclear how clinics can best provide families with resources consistent with their needs and preferences. In this study, we elicited caregiver preferences for clinic-based food assistance. METHODS: We conducted a cross-sectional discrete choice experiment in which caregivers at 2 pediatric primary care clinics were asked to choose between hypothetical food programs. Programs varied across 4 categories: 1) resources provided (eg, food delivery, food in clinic, assistance enrolling in benefits); 2) support staff providing resources (eg, social worker, community health worker, physician, or nurse); 3) outreach modality (eg, phone, email, text); and 4) outreach frequency. Multinomial logistic regression was used to assess caregiver preferences within each category and the relative importance of each category to caregiver decisions. RESULTS: We surveyed 142 caregivers who were predominantly Black (87%) and Medicaid-insured (90%). Caregiver preferences for food programs were most strongly influenced by the food resources provided. Caregivers preferred food delivery over other forms of food supports, such as food provided in clinic. They preferred assistance from a benefits enrollment specialist, community health worker, or social worker to assistance from a physician or nurse. CONCLUSIONS: Pediatric clinics serving families at risk of food insecurity should use caregiver preferences to inform the design of family-centered interventions. Clinics should consider connecting caregivers with food delivery programs, and pediatric payors should adopt reimbursement models that support multidisciplinary team-based care to address food insecurity.

Characterizing Trends in the Use of Food Donations and Other Food-Related Community-Based Social Assistance Programs in a Cohort of New Food Bank Users in Quebec, Canada.

Objective: To characterize 12-month trends in the use of food donations and other food-related community-based social assistance programs (CB-SAPs) during the first year following the enrollment of new food bank (FB) users in Quebec, Canada. Methods: A cohort of 1,001 newly registered FB-users in Quebec from the Pathways Study were followed-up during 12-month following baseline assessment. Outcomes were monthly use of food donations and other food-related CB-SAPs. Main predictors were alternative food source utilization (AFSU) profiles: 1) exclusive-FB-users; 2) FB+fruit/vegetable-market-users; and 3) Multiple/diverse-AFS-users. Covariates included sociodemographic characteristics, health status, and major life events. We fit Bayesian hierarchical mixed-effect models, accounting for spatial clustering, temporal correlation, and censoring. Results: We observed an overall downward trend of food donation use among study completers (n = 745). Each AFSU profile had a distinctive monthly trend of food donation use, but probabilities of use across the three profiles overlapped, between 44% and 55%. The use of other food-related CB-SAPs was low and not correlated with AFSU profiles. Conclusion: De novo FB-users use food donations in different ways over time according to specific contextual AFSU profiles.

The role of the community café in addressing food security: Perceptions of managers and directors.

In the United States, the pay-what-you-can restaurant model (community cafes) is an increasingly popular approach to addressing food insecurity in local communities. We conducted semi-structured interviews (n = 13) with community café executive managers and directors to assess their perceptions of the role that their cafes play in addressing food security (FS). Analysis of interviews revealed two major areas of emphasis by participants. Filling an unoccupied space in the food security landscape. Interviewees regularly cited the goal of making meals available through a dependable schedule, convenient location, and welcoming atmosphere for guests to promote regular visits to the café, and they did so with an awareness of how their practices were shaped by perceived shortcomings in comparable services. In addition, guest agency and social aspects of the café as components of utilization, was another major area. Interviewees often regarded the opportunity of the food insecure guest to choose healthy options (i.e., nutritionally dense) over less healthful ones (i.e., calorically dense) from the menu as a critical component of their service. The social component of the café (e.g., community atmosphere, 'dining-out' experience) was another aspect of the café's function that promoted dignity for the guest which can lead to greater likelihood of return visits. Perceptions shared by participants of the café's role in addressing food security suggest that rather than simply adding to the available options of hunger relief services, the café model attempts to address many areas of concern, such as structural and cultural barriers, found in the traditional forms of charitable food provision.

Longitudinal Associations of Food Security with Health and Dietary Factors among Food FARMacy Participants during COVID-19 in New York City.

In cross-sectional studies, food insecurity is associated with adverse health and dietary outcomes. Whether self-reported health and dietary outcomes change in response to improvements in food security has not been examined. We sought to examine how increases in food security are related to changes in health and dietary factors. In this longitudinal, observational study, we included adult participants in a clinical-community emergency food assistance program in New York City from July 2020 to November 2021. Program staff measured food security with a validated six-item measure at program enrollment and six-month re-enrollment. Participants self-reported health and dietary factors (vegetable, fruit, juice, and sugar-sweetened beverage (SSB) consumption frequency). We used multivariable regression to examine associations between change in food security with change in health and dietary factors over six months. Among 310 participants, the mean food security score improved by 1.7 ± 2.3 points over six months. In unadjusted models, each point improvement in food security was associated with increased vegetable (ß = 0.10 times; 95% CI: 0.05-0.15); fruit (ß = 0.08 times; 95% CI: 0.03-0.14); and juice (ß = 0.10 times; 95% CI: 0.05-0.15) consumption. In adjusted models, results remained significant for vegetable and fruit consumption, but not juice. Change in food security was not associated with change in health or SSB outcomes. In this cohort during COVID-19, improved food security was associated with improved vegetable and fruit consumption. Randomized trials that examine the effectiveness of clinical-community partnerships focused on improving food security and nutrition are warranted.

Increases in New but Not Returning Families to a Midwestern Food Pantry Network During the COVID-19 Pandemic.

BACKGROUND: Food pantries are a resource for those experiencing food insecurity. OBJECTIVE: The purpose of this study was to evaluate changes in food pantry utilization and volunteerism for a food pantry network during the COVID-19 pandemic. DESIGN: This 36-month longitudinal, observational study is a secondary analysis of data collected from an Ohio food pantry network. PARTICIPANTS/SETTING: Participants were clients of a food pantry network. The data represent visits from 12 months prepandemic (March 2019 through February 2020), during the pandemic (March 2020 through February 2021), and after vaccines were readily available (March 2021 through February 2022). MAIN OUTCOME MEASURES: Each data point represents a visit to the pantry network. The main outcome measures were total, returning, and new visits (ie, households that had not previously used this pantry network). The secondary outcome was volunteer hours by month. STATISTICAL ANALYSIS: In order to account for month-to-month variability in pantry utilization, the data were analyzed using a time-series linear regression analysis with the month as the unit of analysis. RESULTS: A total of 174,397 visits were recorded during the course of 36 months. Sixty-nine percent of reporting household members were female, 48% reported at least 1 senior in the home, and 41% reported at least 1 child at home. There was no significant change in total or returning visits during the pandemic or after vaccines were available compared with prepandemic levels. However, there was a significant increase in new households to the food pantry network during the pandemic compared with prepandemic (P = .05). Volunteer hours decreased significantly during the pandemic compared with prepandemic months and remained low even after vaccines were available (P = .004 and P = .003, respectively). CONCLUSIONS: Although there was an increase in households new to the food pantry, overall utilization did not increase.