Implementation of Food is Medicine Programs in Healthcare Settings: A Narrative Review.

Food is Medicine (FIM) programs to improve the accessibility of fruits and vegetables (FVs) or other healthy foods among patients with low income and diet-related chronic diseases are promising to improve food and nutrition security in the United States (US). However, FIM programs are relatively new and implementation guidance for healthcare settings using an implementation science lens is lacking. We used a narrative review to describe the evidence base on barriers and facilitators to FIM program integration in US healthcare settings following the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework. Evidence surrounding the EPIS Inner Context was a focus, including constructs Leadership, Organizational Characteristics, Quality and Fidelity Monitoring and Support, Organizational Staffing Processes, and Individual Characteristics. Peer-reviewed and grey literature about barriers and facilitators to FIM programs were of interest, defined as programs that screen and refer eligible patients with diet-related chronic disease experiencing food insecurity to healthy, unprepared foods. Thirty-one sources were included in the narrative review, including 22 peer-reviewed articles, four reports, four toolkits, and one thesis. Twenty-eight sources (90%) described EPIS Inner Context facilitators and 26 sources (84%) described FIM program barriers. The most common barriers and facilitators to FIM programs were regarding Quality and Fidelity Monitoring and Support (e.g., use of electronic medical records for tracking and evaluation, strategies to support implementation) and Organizational Staffing Processes (e.g., clear delineation of staff roles and capacity); although, barriers and facilitators to FIM programs were identified among all EPIS Inner Context constructs. We synthesized barriers and facilitators to create an EPIS-informed implementation checklist for healthcare settings for use among healthcare organizations/providers, partner organizations, and technical assistance personnel. We discuss future directions to align FIM efforts with implementation science terminology and theories, models, and frameworks to improve the implementation evidence base and support FIM researchers and practitioners.

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.

Perspective: Leveraging Electronic Health Record Data Within Food Is Medicine Program Evaluation: Considerations and Potential Paths Forward.

Government, health care systems and payers, philanthropic entities, advocacy groups, nonprofit organizations, community groups, and for-profit companies are presently making the case for Food is Medicine (FIM) nutrition programs to become reimbursable within health care services. FIM researchers are working urgently to build evidence for FIM programs' cost-effectiveness by showing improvements in health outcomes and health care utilization. However, primary collection of this data is costly, difficult to implement, and burdensome to participants. Electronic health records (EHRs) offer a promising alternative to primary data collection because they provide already-collected information from existing clinical care. A few FIM studies have leveraged EHRs to demonstrate positive impacts on biomarkers or health care utilization, but many FIM studies run into insurmountable difficulties in their attempts to use EHRs. The authors of this commentary serve as evaluators and/or technical assistance providers with the United States Department of Agriculture's Gus Schumacher Nutrition Incentive Program National Training, Technical Assistance, Evaluation, and Information Center. They work closely with over 100 Gus Schumacher Nutrition Incentive Program Produce Prescription FIM projects, which, as of 2023, span 34 US states and territories. In this commentary, we describe recurring challenges related to using EHRs in FIM evaluation, particularly in relation to biomarkers and health care utilization. We also outline potential opportunities and reasonable expectations for what can be learned from EHR data and describe other (non-EHR) data sources to consider for evaluation of long-term health outcomes and health care utilization. Large integrated health systems may be best positioned to use their own data to examine outcomes of interest to the broader field.

Creating Healthy Environments for Schools: A Comprehensive Approach to Improving Nutrition in Arkansas Public Schools.

BACKGROUND: Nutrition plays a vital role in children's physical and emotional health. More than half of school age children's calories are provided in the school food environment, making school interventions an opportunity to address child nutrition. METHODS: The Creating Health Environments for Schools (CHEFS) program is designed to leverage local resources to create customized solutions that improve the nutritional content of school food and encourage children to choose healthier food. There are 8 components: (1) customizing nutrition plans, (2) modifying/replacing menu items, (3) helping procure healthier food, (4) providing equipment grants, (5) training cafeteria staff, (6) implementing environmental changes and nudges, (7) engaging students and parents, and (8) supporting sustainability. Supporting child nutrition directors is key to facilitating cooperation with schools. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Menu modifications and procurement are interrelated and depend on successfully collaborating with corporate, independent, and local food services organizations. Limited school budgets require low or no-cost solutions and staff training. Student and parent engagement are critical to facilitate culturally-appropriate solutions that increase awareness of healthy food. CONCLUSIONS: Every school district has particular resources and constraints. CHEFs engaged stakeholders to design customized solutions and encourage healthier nutrition for school children.

Interprofessional Students' Perspectives on Culinary Medicine Training: Intentions from Plate to Practice.

Purpose: The purpose of this pilot study was to determine the impact a culinary medicine teaching activity had on interprofessional healthcare students' knowledge, confidence, and intent to apply practical dietary principles in practice. Methods: Thirteen interprofessional students (n = 13) completed a 3-h, hands-on culinary medicine session focused on recipe conversion and nutritional coaching skills to modify a favorite comfort food into a significantly more nutritious, Mediterranean diet-based meal. Participants produced variations of a recipe to gain a deeper understanding of how diet modifications that consider both taste and nutritional value can treat health conditions. Pre- and post-session surveys were administered to evaluate participants' knowledge and intent to apply culinary medicine principles into their respective healthcare practices. Findings: Students reported an increase in the belief that nutritional counseling should be included in routine appointments, as well as increased confidence in their ability to implement culinary medicine into practice. All students reported the intent to integrate culinary medicine into practice, and a likelihood that they would recommend culinary medicine training to other healthcare professionals. Conclusion: Interprofessional students reported learning satisfaction throughout the hands-on, chef-led and faculty-facilitated culinary medicine teaching activity and found the nutritional content to be especially transferable to working with patients.

An integrated approach to address diabetes in the context of food insecurity: Delivering health study protocol.

Background: Diabetes self-management education and support (DSMES) interventions among food insecure individuals with type 2 diabetes (T2D) have found modest improvements in nutrition and health outcomes but are limited by barriers to attendance and retention. This study applies a community-based participatory research approach, engaging community members at all levels of intervention planning, development, implementation, and dissemination, to deliver a plain-language DSMES curriculum to food insecure community members with T2D. Methods: This is a single-arm, pre-post design assessing the efficacy of a 12-week home-delivered DSMES curriculum and T2D-appropriate food box intervention to improve the nutrition and health outcomes of food insecure individuals with T2D. The intervention consists of a weekly food box delivery and handout with video links on key DSMES topics, developed and refined using community advisor feedback. Up to 100 English-, Spanish-, or Marshallese-speaking adult participants with T2D (HbA1c ≥ 7%) and food insecurity are being recruited from food pantries in northwest Arkansas. Data is collected at pre-intervention and immediately post-intervention. The primary study outcome is change in HbA1c. Secondary measures include diet quality (Healthy Eating Index-2015, calculated from 3 24-h dietary recall interviews via phone), body mass index, blood pressure, skin carotenoids, food security, T2D self-management behaviors, T2D self-efficacy, and T2D-related distress. Results: Recruitment began in August 2021 and enrollment is anticipated to be complete in March 2023. Conclusion: Findings from this study will provide a rich understanding of diabetes-related health outcomes and dietary patterns of individuals with food insecurity and T2D and inform future food-focused DSMES interventions in this setting.

Food Pantry Clients' Needs, Preferences, and Recommendations for Food Pantries: A Qualitative Study.

A qualitative formative approach was used to explore food pantry clients' needs, preferences, and recommendations regarding food received from food pantries. Fifty adult clients of six Arkansas food pantries were interviewed in English, Spanish, or Marshallese. Data analysis used the constant comparative qualitative methodology. In choice and minimal choice pantries, three themes emerged: clients need increased quantities of food, particularly more proteins and dairy; clients desire higher quality food, including healthy food and food not close to expiration; and clients desire familiar foods and food appropriate for their health needs. System level policy changes are needed to address clients' recommendations.

Prevalence and associations between food insecurity and overweight/obesity among native Hawaiian and Pacific Islander adolescents.

OBJECTIVE: This study estimates the prevalence of, and associations between, family food insecurity and overweight/obesity among Native Hawaiian and Pacific Islander (NHPI) adolescents and explores socio-demographic factors which might have a moderation effect on the association. DESIGN: Cross-sectional study using 2014 NHPI-National Health Interview Survey data reported by a parent or guardian. Family-level food security was assessed by the US Department of Agriculture 10-item questionnaire. BMI for age and sex ≥ 85th and 95th percentiles defined overweight and obesity, respectively, according to US Centers for Disease Control and Prevention criteria. SETTING: The USA, including all 50 states and the District of Columbia. PARTICIPANTS: 383 NHPI adolescents aged 12-17 in the USA. RESULTS: A third (33·5 %) of NHPI adolescents aged 12-17 were overweight (19·1 %) or obese (14·4 %); 8·1 % had low food security; and 8·5 % had very low food security. Mean family food security score was 1·06, which corresponds to marginal food security. We found no association between family food insecurity and adolescent overweight/obesity or between any other covariates and overweight/obesity, except for family Supplemental Nutrition Assistance Program (SNAP) participation. Odds of being overweight/obese were 77 % lower for adolescents in families participating in SNAP (OR: 0·23, 95 % CI: 0·08, 0·64, P = 0·007). The association between SNAP participation and lower odds of overweight/obesity was particularly pronounced for adolescent girls in food-insecure families. CONCLUSIONS: The association between SNAP participation and lower odds of overweight/obesity suggests potential benefit of research to determine whether interventions to increase SNAP enrollment would improve NHPI adolescents' health outcomes.

Experiences of Farmers Market Vendors in a Healthy Food Incentive Program.

Healthy food incentive programs for Supplemental Nutrition Assistance Program participants, often implemented in farmers markets, have shown promise in improving the purchase and consumption of fruits and vegetables. However, variation in program context, program strategies, and participant populations has produced gaps in knowledge about which healthy food incentive program implementation strategies are most effective, and few studies have focused on farmers market vendors' experiences. This study evaluated experiences of farmers market vendors who participated in the Northwest Arkansas Double Your Dollars (NWA DYD) healthy food incentive program intended to increase access to healthy foods for local Hispanic/Latino and Marshallese community members with low incomes. Data were collected from a convenience sample of vendors participating in NWA DYD at the three largest participating markets on the last Saturday in October 2021. Program staff collected quantitative, categorical, and open-ended data through face-to-face surveys. Forty-one vendors completed the survey. Vendors believed NWA DYD was beneficial and easy to use, expanded their customer base, and increased participation of Hispanic/Latino and Marshallese shoppers. Vendors also identified challenges in participation related to administrative burdens and delayed reimbursements. Vendors did not identify NWA DYD as a driver for expanded production for the upcoming growing season. Vendors' experiences at NWA DYD provide implications for others interested in implementing effective healthy food incentive programs. Improving access to farmers markets through effective healthy food incentive programs is an important step toward increasing consumption of fresh, healthy foods among communities with low incomes facing elevated prevalence of chronic disease.

A Cluster Randomized Controlled Trial Comparing Diabetes Prevention Program Interventions for Overweight/Obese Marshallese Adults.

This study compared the effectiveness of two Diabetes Prevention Program (DPP) interventions on weight loss among overweight and obese Marshallese adults. The study was a two-arm cluster randomized controlled trial conducted in 30 churches in Arkansas and Oklahoma. Marshallese adults with a body mass index ≥25 kg/m2 were eligible for the study. The study sample included 380 participants. Participants received either a faith-based adaptation of the DPP or a family-focused adaptation of the DPP, each delivered over 24 weeks. The primary outcome was weight change from baseline. Secondary outcomes included changes in Hemoglobin A1c, blood pressure, dietary intake, family support for healthy behaviors, and physical activity. Outcomes were examined longitudinally using general linear mixed effects regression models, adjusting for baseline outcomes, sociodemographic covariates, and clustering of participants within churches. Reductions in weight were small for both groups. Overall, only 7.1% of all participants lost 5% or more of their baseline body weight. There were no significant differences in weight loss between the 2 arms at 6 months (P = .3599) or at 12 months (P = .3207). Significant differences in systolic and diastolic blood pressure were found between the 2 arms at 6 months (P = .0293; P = .0068, respectively). Significant within-arm changes were found for sugar-sweetened beverage consumption and family support for both arms at both follow-ups. Both interventions achieved a modest weight loss. While even modest weight loss can be clinically significant, future research is needed to identify chronic disease prevention interventions that can successfully reduce weight for this at-risk population.

Implementation and Preliminary Effectiveness of a Multidisciplinary Telemedicine Pilot Initiative for Patients with Chronic Non-Cancer Pain in Rural and Underserved Areas at a Major Academic Medical Center.

Background: Arkansas lacks adequate access to high-quality pain care, as evidenced, in part, by it having the second highest opioid prescribing rate in the United States. To improve access to high-quality treatment of chronic pain, we developed the Arkansas Improving Multidisciplinary Pain Care and Treatment (AR-IMPACT) Telemedicine Clinic, a multidisciplinary and interprofessional team of specialists who provide evidence-based pain management for patients with chronic pain. Methods: We conducted a single-arm pilot trial of the AR-IMPACT Telemedicine Clinic with rural, university-affiliated primary care clinics. We assessed the AR-IMPACT Telemedicine Clinic using an implementation framework and preliminary effectiveness measures. Specifically, we assessed 5 of the 8 implementation outcomes of the framework (ie, penetration, adoption, acceptability, appropriateness, and feasibility) using a mixed methods approach. To evaluate implementation outcomes, we used surveys, interviews, and administrative data. We used electronic health record data to measure preliminary effectiveness (ie, changes in average morphine milligram equivalents per day and pain and depression scores). Results: The AR-IMPACT team saw 23 patients that were referred by 13 primary care physicians from three rural, university-affiliated primary care clinics over one year. Of the 19 patients willing to participate in the pilot study, 12 identified as women, 31.6% identified as Black, and over 50% had less than a bachelor's level education. Patients rated the clinic positively with high overall satisfaction. Referring physicians indicated high levels of appropriateness, acceptability, and feasibility of the program. AR-IMPACT team members identified several barriers and facilitators to the feasibility of implementing the program. No changes in preliminary effectiveness measures were statistically significant. Conclusion: Overall, the AR-IMPACT Telemedicine Clinic obtained moderate penetration and adoption, was highly acceptable to patients, was highly acceptable and appropriate to providers, and was moderately feasible to providers and AR-IMPACT team members.

Study protocol for family model diabetes self-management education with Marshallese participants in faith-based organizations.

Background: Culturally-appropriate family models of diabetes self-management education and support (DSMES) using community health workers (CHWs) have been shown to help address barriers to improving type 2 diabetes mellitus (T2DM) self-management for racial/ethnic minority communities; however, there is limited DSMES research among Marshallese and other Pacific Islanders. Using a community-based participatory research approach, we engaged community stakeholders to co-design a study to implement a culturally adapted family model DSMES (F-DSMES) intervention in faith-based organizations (FBOs) (i.e., churches). Methods: Using a cluster-randomized controlled trial design, we will assess the effectiveness of the F-DSMES intervention for Marshallese patients with T2DM in Arkansas and Oklahoma. Twenty-four FBOs (with 12 primary participants per FBO) will be randomized to one of two study arms: the intervention arm or the wait-list control arm. Primary participants must have at least one family member willing to attend education sessions and data collection events. The F-DSMES intervention consists of ten h of diabetes education delivered by CHWs over eight to ten weeks. Data will be collected from the intervention arm at pre-intervention (baseline), immediate post-intervention (12 weeks), and three months post-intervention. The wait-list control arm will complete a second pre-intervention data collection before receiving the intervention. The primary study outcome will be glycemic control, as measured by HbA1c. Secondary measures include glucose, weight, body mass index, blood pressure, diabetes self-management behaviors, and diabetes management self-efficacy. Conclusion: The knowledge gained from this research will inform future DSMES and other health promotion interventions conducted with Marshallese and other Pacific Islander communities.

Reducing Sodium Content of Foods Served in Arkansas's Largest School District: Evaluation of the Sodium Reduction in Communities Program.

PURPOSE AND OBJECTIVES: The Centers for Disease Control and Prevention's Sodium Reduction in Communities Program aims to reduce dietary sodium intake through policy, systems, and environmental approaches. The objective of our study was to evaluate changes in sodium levels over 5 years (2016-2021) in food served in school lunches as an outcome of a Sodium Reduction in Communities program in Arkansas's largest school district. INTERVENTION APPROACH: We collaborated with Springdale Public Schools (SPS) to reduce dietary sodium intake in school lunches through increased implementation of 1) food service guidelines, 2) procurement practices, 3) food preparation practices, and 4) environmental strategies. These activities were maintained from year 1 through year 5. Implementation priorities were informed each year by evaluation findings from the preceding year. EVALUATION METHODS: We collected lunch service records and information on nutritional content of menu items for the 30 schools under the direction of SPS's Child Nutrition Department. We used a pretest-posttest quantitative evaluation design to analyze annual changes in the sodium content of meals, from baseline through year 5. RESULTS: From baseline through year 1, SPS reduced sodium served per diner, per entrée offered, and per entrée served. These reductions were maintained from baseline through 5 years of follow-up. Mean sodium per 1,000 kcal per diner served was 1,740 mg at baseline and was lower in each of the 5 follow-up years: 1,488 mg (14% decrease) in year 1; 1,495 mg (14% decrease) in year 2; 1,612 mg (7% decrease) in year 3; 1,560 mg (10% decrease) in year 4; and 1,532 mg (12% decrease) in year 5. Energy served per diner remained stable. IMPLICATIONS FOR PUBLIC HEALTH: Our study provides evidence for sustained sodium reduction strategies in a large ethnically and socioeconomically diverse school district, pointing to the potential benefit of implementing similar strategies in other school districts. The study also shows how program evaluation can be used to support sustainability.

Effectiveness-implementation trial comparing a family model of diabetes self-management education and support with a standard model.

BACKGROUND: Diabetes self-management education and support (DSMES) is an effective approach for improving diabetes self-care behaviors to achieve improved glycemic management and other health outcomes. Engaging family members may improve outcomes, both for the person with diabetes (PWD) and for the family members. However, family models of DSMES have been inconsistently defined and delivered. We operationalize Family-DSMES to be generalizable and replicable, detail our protocol for a comparative effectiveness trial comparing Standard-DSMES with Family-DSMES on outcomes for PWDs and family members, and detail our mixed-methods implementation evaluation plan. METHODS: We will examine Family-DSMES relative to Standard-DSMES using a Hybrid Type 1 effectiveness-implementation design. Participants are ≥18 years old with type 2 diabetes mellitus and hemoglobin A1c ≥7.0%, recruited from rural and urban primary care clinics that are part of an academic medical center. Each participant invites a family member. Dyads are randomly assigned to Family- or Standard-DSMES, delivered in a small-group format via telehealth. Data are collected at baseline, immediately post-intervention, and 6-, 12-, and 18-months post-intervention. Outcomes include PWDs' hemoglobin A1c (primary), other biometric, behavioral, and psychosocial outcomes (secondary), and family members' diabetes-related distress, involvement in the PWD's diabetes management, self-efficacy for providing support, and biometric outcomes (exploratory). Our mixed-methods implementation evaluation will include process data collected during the trial and stakeholder interviews guided by the Consolidated Framework for Implementation Research. CONCLUSION: Results will fill knowledge gaps about which type of DSMES may be most effective and guide Family-DSMES implementation efforts. REGISTRATION: The trial is pre-registered at clinicaltrials.gov (#NCT04334109).

Food Pantry Usage Patterns are Associated with Client Sociodemographics and Health.

Characterizing food pantry (FP) clients' FP usage patterns may provide opportunities to tailor health-related interventions. Respondents (n=245) at seven FPs reported their frequency and reliance on FPs and their sociodemographics, health status, and health-related trade-offs. Clients were categorized via latent class analysis. Higher FP usage was associated with being older, having a household member with heart disease, and putting off buying medicine to buy food. Lower FP usage was associated with higher levels of education and having a household member with cancer. Findings highlight the potential importance of measuring FP clients' degree of FP use.

Food insecurity and chronic diseases among Native Hawaiians and Pacific Islanders in the US: results of a population-based survey.

Data from the 2014 Native Hawaiian and Pacific Islander (NHPI) National Health Interview Survey were used to examine associations between food security and individual chronic diseases, total number of chronic diseases, and general health status among 637 NHPI adults with income below 200 percent federal poverty level. Very low food security was associated with hypertension, diabetes, and asthma. Very low food security and marginal food security were associated with having any chronic disease and with having a higher number of chronic diseases. Risk for food insecurity increased as health status decreased. These associations had not previously been documented for NHPI.

Associations among Self-Reported Mental Health, Physical Activity, and Diet during the COVID-19 Pandemic.

Background: Understanding the relationship between physical activity, diet, and mental health during the COVID-19 pandemic may help inform resources encouraging healthy lifestyle choices during the time of an increased threat to health and wellbeing. Aim: Our objective was to examine how self-rated mental health was associated with engagement in physical activity and consumption of fruits and vegetables during the COVID-19 pandemic. Methods: The study utilized cross-sectional survey data from adults (≥18 years of age) living, working, and/or receiving healthcare in Arkansas (n = 754). Multivariable regression models were used to examine the associations between self-rated mental health and the number of days respondents engaged in 30 min of physical activity and the number of days respondents consumed five or more servings of fruits and vegetables. Results: Respondents who reported somewhat poor/poor mental health reported engaging in at least 30 min of physical activity fewer days per week (ß = -.77, p = .018) compared with those reporting excellent mental health, after controlling for sociodemographic factors and self-rated health. The significant association observed in the first two models between mental health and number of days consuming five or more servings of fruits and vegetables became non-significant after inclusion of self-rated health. Conclusion: The relationship between mental health and physical activity and diet reaffirms a need for healthcare providers to promote the importance of maintaining both a healthy physical activity level and a nutrient-rich diet in the face of challenging circumstances, such as a global pandemic.

Examining the Relationship Between Physical Activity and Self-Efficacy for Exercise Among Overweight and Obese Marshallese Adults.

This study examined associations between physical activity frequency and self-efficacy for exercise (SEE) among Marshallese adults in the United States. Data were collected from overweight and obese Marshallese participants (N = 378) enrolled in a Diabetes Prevention Program trial. Logistic and ordinal logistic regressions were employed to examine associations between physical activity and SEE, adjusting for covariates. SEE was significantly associated with engaging in sufficient total physical activity [odds ratio (OR) = 1.70], moderate physical activity (OR = 2.23), and vigorous physical activity (OR = 2.13). Unemployment was associated with less frequent moderate physical activity (OR = 0.59). Younger age (OR = 0.98), being male (OR = 2.67), and reporting excellent health (OR = 3.14) or good health (OR = 2.06) were associated with more frequent vigorous physical activity. Physical activity is a modifiable lifestyle behavior associated with many chronic disease disparities faced by the Marshallese community, and the study results will be useful for practitioners and researchers working to address these disparities.

The Association Between Education and Basic Needs Insecurity for Marshallese During the COVID-19 Pandemic.

BACKGROUND: The purpose of this study was to explore the prevalence of basic needs insecurity and to examine the association between education and basic needs insecurity during the COVID-19 pandemic for Marshallese living in the USA. METHODS: Survey data describing Marshallese experiences during the pandemic were analyzed using descriptive statistics and complementary log-log regression to test the association between education and basic needs insecurity. RESULTS: Marshallese respondents reported no usual source of care (46%), less healthcare (22.3%), and difficulty obtaining medication (34.8%). Nearly 80% reported being food insecure, and 47.5% reported being housing insecure. Marshallese with a high school education or less had higher odds of reporting being food and housing insecure. DISCUSSION: Basic needs insecurities are a serious threat to the health of Marshallese during the pandemic. Results from this study can inform interventions addressing food and housing insecurity, access to healthcare, and medication access for Marshallese communities.

COVID-19 and food insecurity in a vulnerable rural state.

Objective: This study explored variations in food insecurity across sociodemographic groups and changes specific to the COVID-19 pandemic, including income loss, stimulus check receipt, and changes in household size. Design: A cross-sectional online survey was conducted using a 2-item food insecurity screener. COVID-19 related factors and sociodemographic data were collected. Setting: Data were collected in Arkansas, United States, during July and August 2020. Participants: A sample of 1205 adults was recruited using ARresearch, a volunteer research registry. Participants were over the age of 18 and living, working, or receiving health care in Arkansas. Results: The prevalence of food insecurity was 24.9% during the COVID-19 pandemic. Food insecurity was elevated even after the majority of respondents received a stimulus check. Chi-square and t-tests revealed that food insecurity was more prevalent among those who are younger, Black, Hispanic/Latinx, lower-income, less educated, and living in households with children. Multivariate logistic regression revealed that odds of food insecurity were greater for individuals who reported income loss due to the pandemic (OR = 3.29; p < .001), Black respondents (OR = 2.06, p = .014), Hispanic respondents (OR = 3.34, p = .001), those earning less than $25,000 annually (OR = 4.92; p < .001) or between $25,000 to $49,999 (OR = 2.04; p = .023), respondents with a high school degree or less (OR = 4.21; p < .001) or some college (OR = 2.55; p < .001), and those living in households with children (OR = 1.62; p = .021). Odds of food insecurity were lower for those who had received a stimulus check (OR = 0.60; p = .026). Conclusion: Food insecurity prevalence was high in Arkansas in July and August 2020. The risk of food insecurity was uneven across sociodemographic groups. Several factors related to the COVID-19 pandemic were indicators for increased risk of food insecurity. Interventions to address food insecurity that recognize social factors unique to the pandemic are needed to reduce levels of food insecurity.