Patients with diabetes struggling to afford food and control their HbA1c in food-insecure areas in Bronx, NY.

OBJECTIVE: To characterise the association between risk of poor glycaemic control and self-reported and area-level food insecurity among adult patients with type 2 diabetes. DESIGN: We performed a retrospective, observational analysis of cross-sectional data routinely collected within a health system. Logistic regressions estimated the association between glycaemic control and the dual effect of self-reported and area-level measures of food insecurity. SETTING: The health system included a network of ambulatory primary and speciality care sites and hospitals in Bronx County, NY. PARTICIPANTS: Patients diagnosed with type 2 diabetes who completed a health-related social need (HRSN) assessment between April 2018 and December 2019. RESULTS: 5500 patients with type 2 diabetes were assessed for HRSN with 7·1 % reporting an unmet food need. Patients with self-reported food needs demonstrated higher odds of having poor glycaemic control compared with those without food needs (adjusted OR (aOR): 1·59, 95 % CI: 1·26, 2·00). However, there was no conclusive evidence that area-level food insecurity alone was a significant predictor of glycaemic control (aOR: 1·15, 95 % CI: 0·96, 1·39). Patients with self-reported food needs residing in food-secure (aOR: 1·83, 95 % CI: 1·22, 2·74) and food-insecure (aOR: 1·72, 95 % CI: 1·25, 2·37) areas showed higher odds of poor glycaemic control than those without self-reported food needs residing in food-secure areas. CONCLUSIONS: These findings highlight the importance of utilising patient- and area-level social needs data to identify individuals for targeted interventions with increased risk of adverse health outcomes.

Perceived self- and social stigma among campus-based food pantry users.

Participants: A critical public health issue facing many universities is food insecurity. Food insecurity has been associated with many academic, physical, and mental health issues. Although the number of campus-based food pantries has grown exponentially, self-, and social stigma have been associated with low rates of utilization. Methods: The current quantitative study examined perceptions of food pantry stigma among food insecure college students (n = 93) who have accessed food pantry services. Results: Results reveal moderate levels of food pantry stigma with no statistically significant differences in food pantry stigma scores by level of food security (p = .322) and frequency of food pantry use (p = .263). Few participants indicated perceptions of social stigma, yet mixed results were observed regarding self-stigma. Conclusion: More research is warranted aimed at gaining a better understanding of food pantry stigma among college students that can inform campus-based interventions, practices, and policies aimed at increasing the utilization of campus-based food pantry resources.

Rethinking Our Roots: The Ground-Up Approach to Heart Health & Planetary Sustainability.

Cardiovascular disease is the leading cause of death in the United States. Poor dietary habits are not only a major modifiable risk factor for cardiovascular disease and other chronic illnesses, but they also harm planetary health. Our food system is complex, shaped by agricultural practices and human behaviors. To change it, we need to understand why current agricultural practices exist and address nutrition education, food insecurity, and nutritional security. There are effective ways to make our food system healthier, more equitable, and more sustainable. The best available evidence points to plant-forward diets as the keystone to this complex issue. This manuscript reviews how human and planetary health are connected through our food system and suggests solutions for diets that prevent and treat cardiovascular disease while promoting planetary health.

Perceived impact of a state-level universal free school meal policy on households with varying income levels: An analysis of parental perspectives.

BACKGROUND: In the U.S., a means-tested approach is often used to provide free or reduced-price meals (FRPM) to students from lower-income households. However, federal income thresholds do not account for regional cost of living variations. Thus, many ineligible households may be at risk for food insecurity. Universal free school meal (UFSM) policies may help address this issue, especially in states with a higher cost of living. OBJECTIVE: To evaluate parent perceptions of the impact of Massachusetts' statewide UFSM policy on households eligible and ineligible for FRPM. DESIGN: Cross-sectional survey of parents across income categories conducted during the 2022-23 school year. PARTICIPANTS/SETTING: Massachusetts parents (n=403) with children in grades kindergarten-12 with incomes ranging from <185% of the Federal Poverty Line (FPL) to >300% of the FPL. MAIN OUTCOME MEASURES: Parents' perceived impact of Massachusetts' UFSM policy on their child and household. STATISTICAL ANALYSES PERFORMED: Analysis of variance examined differences in the perceived impact of UFSM by FRPM eligibility, adjusting for demographic characteristics. RESULTS: Households that were FRPM eligible or near eligible were significantly more likely to report that their ability to have enough food for their family would be harder without UFSM (p<0.0001) compared to those in the highest income category. Across all income categories, approximately 75% of parents reported that school meals should be free for all children, and UFSM saved their family money and time and reduced stress, with no significant differences by FRPM eligibility. Roughly half (52%) reported their household finances would be hurt and 42% of parents from households eligible for FRPM reported their child would be less likely to eat school meals if the UFSM policy ended. CONCLUSIONS: This study found strong parent support of UFSM policies regardless of income level. Additionally, parents perceived that discontinuing UFSM may adversely impact school meal participation, including among students from lower income households, as well as food security among households ineligible for FRPM, particularly in areas with higher costs of living. Policies to expand UFSM should be considered among additional states and at the national level.

A new approach to a wicked problem: development of a cross-sector community-centered learning network to tackle childhood food inequity.

Food insecurity is a complex societal problem that disproportionately impacts households with children and those led by minoritized populations, with negative impacts on health across the life course. System to Achieve Food Equity adapted the learning systems model, used to address similarly complex problems, to tackle food insecurity at a neighborhood level. SAFE, born out of the COVID-19 pandemic, leverages a family-centered, community-based, cross-sector network fundamentally aimed at changing the food system so that all children in Cincinnati have the food they need to thrive. Through the following principles, Community-Led Network, Co-Production with Community, Equitable Sustainability, Learning to Learn Together, Distributing Leadership and Power, and Shared Data and Governance, SAFE has grown to over 300 individuals and 100 organizations, funded 9 novel interventions, distributed over 270,000 meals, and created a collaborative of motivated like-minded stakeholders. Future work includes improved data collection and sharing, support for increased stakeholder engagement and greater distribution of leadership and power, advocacy for policy change, refining measurement tools of network maturity for community settings, and collaboration with other efforts that contribute to food security indirectly.

Climate and conflict-induced child nutrition crisis in Sub-Saharan Africa.

This commentary explores the intersection between climate, conflict, and child nutrition, highlighting the severe child nutrition crisis in Sub-Saharan Africa exacerbated by climate change and ongoing conflicts. Shifting climate patterns disrupt agricultural productivity and food security, while persistent conflicts displace populations and destroy infrastructure, significantly increasing food insecurity and malnutrition among children. Recent UNICEF data indicates that 1 in 4 children globally live in severe food poverty, with those affected up to 50% more likely to suffer from life-threatening malnutrition. Over half a billion children reside in areas prone to climate-related extreme weather events, challenging food production, distribution, and access. Extreme weather events have led to crop failures, food shortages, and price spikes, disproportionately affecting vulnerable populations. Changes in temperature and precipitation patterns also alter the nutritional content of crops, worsening nutritional challenges. Conflicts in SSA have led to a food crisis of unprecedented scale, with over 80% of the 137 million Africans facing acute food insecurity located in conflict-affected countries. The conflict between Russia and Ukraine has further disrupted global food and fertilizer supply chains, exacerbating food shortages and inflation in many African countries. Addressing this crisis requires a multifaceted approach integrating evidence-based, cost-effective strategies. This commentary advocates for the adoption of the 3 C approach-climate-smart school feeding programs, cultivation of edible insects, and community-based food hubs-as solutions to enhance child nutrition and build climate resilience.

Perceived Food-Related Responsibilities Among Adults Aged 60 Years and Older.

Food citizenship states individuals, organizations, and governments have responsibilities for their actions and policies around food. We conducted twenty semi-structured interviews with older adults as an exploratory study about perceived food-related responsibilities. The government and agribusiness were seen as responsible for food safety and how healthy foods are. The government, agribusiness, and emergency food providers were seen as responsible for availability and accessibility. Individuals were seen as having a personal responsibility to access and choose healthy, safe foods. These results have important implications for understanding how older adults think about the roles themselves and others play in the food system.

Patient and Community Health Worker (CHW) Perspectives on a CHW-delivered Nutrition Intervention for Low-Income Adults with Hypertension: A Qualitative Study.

INTRODUCTION/OBJECTIVES: Adults with food insecurity (FI) face barriers to hypertension management, including difficulty adhering to diet recommendations. Few community health worker (CHW) interventions focus on diet to improve blood pressure. This qualitative study elicited patient and CHW perspectives on healthy eating and a future CHW nutrition intervention for patients with hypertension. METHODS: Twenty-five patients with hypertension and FI and 5 CHWs participating in a hypertension health coaching program from 5 Boston-area health centers participated in semi-structured interviews from July to September 2023. Interviews were audio recorded, transcribed, and analyzed using the Framework Method. RESULTS: Themes included: 1) Variable patient knowledge about dietary patterns for hypertension management and low confidence in interpreting nutrition labels; 2) Culture influenced healthy food perception; and 3) Barriers to healthy eating included cost, limited cooking abilities/supplies, and competing demands. Patients and CHWs favored simple nutrition education materials (e.g., traffic light nutrition ranking, healthy meals on a budget). Patients had mixed opinions about CHW-accompanied supermarket visits. CONCLUSIONS: This study identified culture, knowledge gaps, and budget constraints as factors influencing diet among patients with hypertension and FI. A CHW-delivered intervention could include simplified nutrition education, strategies for healthy eating on a budget, and linkage to community-based food programs.

COVID-19 and its effects on food producers: panel data evidence from Burkina Faso.

INTRODUCTION: Burkina Faso implemented stringent measures in response to the COVID-19 pandemic that profoundly affected its economy and might have exacerbated food insecurity. While prior studies have assessed the impact of these measures on consumers, there is a dearth of evidence of its effects on food producers in Sub-Saharan Africa. This study aims (i) to evaluate the repercussions of COVID-19 on the possession of food production assets and on the number of livestock owned; and (ii) to determine the correlation between the food insecurity experience scale (FIES) score, ownership of these assets, and the number of livestock owned. METHODS: This study employs a pre-post comparison design in two panels of randomly selected households in Burkina Faso. While Panel A was constituted of 384 households predominantly (76%) living in rural areas, Panel B comprised 504 households, only half of which (51%) lived in rural areas. All households were visited twice: in July 2019 and February 2021, for Panel A, and in February 2020 and February 2021, for Panel B. Panel B was added to the study before the pandemic thanks to additional funding; the timing of the survey was harmonized in both panels for the second round. Regression models were used with fixed effects at the household level, controlling for potential time-invariant confounding variables, and correlation coefficients between possession of production assets or number of livestock and FIES score were measured. RESULTS: Our findings indicate that the possession of some assets in Panel A (cart, livestock, bicycle, watch) was significantly reduced during the pandemic, as was the herd sizes among livestock-owning households in both panels. Households with fewer production assets and number of livestock were more likely to experience food insecurity. CONCLUSION: This study underscores the vulnerability of rural households in Burkina Faso to the economic disruptions caused by the COVID-19 pandemic. Addressing the challenges faced by farming and livestock-owning households is crucial for mitigating food insecurity and improving resilience in the face of ongoing crises.

Health, economic and social impacts of the Brazilian cash transfer program on the lives of its beneficiaries: a scoping review.

BACKGROUND: The Bolsa Família cash transfer Program (BFP) aims to break the poverty cycle by providing a minimum income to poor families conditioned on their investment in human capital (such as, education and health) and currently is the largest Program in the world in terms of the number of beneficiaries. Because there is a scarcity of reviews grouping studies on the impacts of the BFP, the objective of this scoping review was to identify and describe studies which evaluate the impact of the BFP on poverty, health, education, and other related outcomes. METHODS: We searched for quantitative, qualitative, and mixed-method articles that assessed the impact of the BFP on any aspect of the beneficiaries' lives between 2003 and March 2021. We included quantitative articles that used experimental, quasi-experimental or pre and post comparison designs. We excluded articles that analyzed impacts on political outcomes. There was no age restriction for the participants. The search was done in seven electronic databases. RESULTS: One thousand five hundred forty-six papers were identified and 94 fulfilled the inclusion criteria. Poverty and health outcomes were the most common outcomes studied. We found consistent evidence of the positive impact of the BFP on poverty reduction, as well as employment outcomes. We also found positive impacts in relation to mortality rates for children and adults, school dropout and school attendance among children and adolescents, and violence related outcomes such as homicide, suicide, crime, and hospitalization. However, we also found some evidence that BFP increased intimate partner violence and gender stereotypes among women and no evidence of impact on teenage pregnancy. CONCLUSIONS: Overall, the studies included found that BFP showed positive impacts on most poverty, health and education outcomes. More studies are needed to confirm some results, especially about violence and stereotype against women as there were few evaluations on these outcomes.

Food insecurity and substance use among young adults in the United States.

PURPOSE: The purpose of this study was to examine the association between food insecurity and substance use among young adults aged 18-25 in the U.S. METHODS: A cross-sectional online survey was completed by a diverse sample of 1024 young adults (50.2 % female; 62 % non-white; m age = 21.7[SD = 2.26]) between January-April 2022. Logistic regression analyses were used to examine the association between food insecurity and current cigarette use, Electronic Nicotine Delivery System (ENDS) use, cannabis use, alcohol use, and binge drinking controlling for socio-demographic and economic factors, mental health, and experiences of discrimination. RESULTS: Nearly 70 % of participants reported being food insecure over the past year. Substance use was also common: 45.9 % of participants reported current cigarette use, 50.9 % ENDS use, 57 % cannabis use, 65.9 % alcohol use, and 50.4 % engaged in binge drinking in the past two weeks. Being food insecure was associated with greater odds of cigarette use (OR = 2.49, 95 % CI = [1.77, 3.50]), ENDS use (OR = 2.18, 95 % CI = [1.58, 3.01]), cannabis use (OR = 1.73, 95 % CI = [1.26, 2.37]), alcohol use (OR = 1.60, 95 % CI = [1.16, 2.19]) and binge drinking (OR = 1.98, 95 % CI = [1.44, 2.72]), controlling for all other factors. CONCLUSION: Food insecurity may serve as an important indicator of substance use among young adults. Practitioners should consider screening for food insecurity, providing information about food access, and developing interventions to address food insecurity among the young adults with whom they work. Future research should examine these associations prospectively to better understand how food insecurity may contribute to the initiation and/or escalation of substance use.

Shorter Telomere Length is Associated with Food Insecurity in Older People: A Cross-Sectional Study.

BACKGROUND: Telomere length has been investigated as a biomarker of biological aging and is associated with several diseases, lifestyle, and socioeconomic factors. OBJECTIVE: This study aimed to verify whether food insecurity is associated with shorter telomere length in older people. METHODS: This is a cross-sectional study carried out in a municipality in the interior of Brazil, with a sample of 440 older people from the community. For telomere length analysis, a blood sample was obtained from each participant, followed by real-time qPCR, and sociodemographic and health information was collected through interviews. Food security/insecurity was measured using the reduced version of the Brazilian Food Insecurity Scale. Descriptive analysis and multiple logistic regression were performed to analyze the factors associated with shorter telomere length, adopting a significance level of 5%. RESULTS: We found that food insecurity was significantly associated with shorter telomere length, regardless of age group, skin color, tabagism, physical activity, milk and dairy consumption, living arrangement, and basic activities of daily life. CONCLUSION: The findings show the importance of ensuring full access to adequate nutrition for the older population, who are physiologically and socially vulnerable.

Conceptualising food banking in the UK from drivers of use to impacts on health and wellbeing: A systematic review and directed content analysis.

Food banks have become commonplace in the UK as an emergency response to food insecurity. However, food banks are not a long-term solution to food insecurity and are often not accessed by those in need. In the context of the cost-of-living crisis, and increased food insecurity, this systematic review applied market/government failure theory, voluntary failure theory, and Radimer et al.'s (1990) domains of food insecurity to explore three important aspects relevant to the food banking experience: the drivers of food bank use; the limitations of the current food bank model; and the impacts of the food banking model for food bank clients. Empirical, peer-reviewed articles written in English with a UK food bank context and reporting relevant data to these aspects were eligible for inclusion. In total, 221 titles were identified using four databases (Web of Science, SCOPUS, PubMed, CINHAL Plus) in July 2022. The final sample of 41 articles (comprising qualitative, quantitative and mixed methods studies), were quality assessed using the Mixed Methods Appraisal Tool. Data were extracted and analysed through directed content analysis. Market and government failures were widely reported to drive food bank use. Insufficiency, paternalism and particularism represented key limitations of the food bank model. Negative health and psychological impacts of food bank use were prominent, yet social impacts were largely positive. Consequently, new solutions are needed to promote positive health and psychological impacts for food bank clients in the UK. The application of these findings to other high-income countries experiencing food insecurity should be determined.

Exploring Journey Maps as Products From Qualitative Research: Application Through Food Insecure Veterans' Experiences.

Journey maps are graphic representations of participant, user, customer, or patient experiences or "journeys" with a particular phenomenon, product, business, or organization. Journey maps help visualize complex pathways and phases in accessible, digestible ways. They also capture emotions, reactions, and values associated with the processes participants undergo, complemented by images or quotes from participants. Here, we outline the foundations of journey maps in research and in practice settings. Our goal is to describe journey maps to researchers new to the product and emphasize the novelty and utility of journey maps as visual products from qualitative research particularly in a health setting. To explore journey maps-including their benefits, drawbacks, and relevance-we discuss examples including our own process for designing a journey map of food insecure Veterans' experiences using qualitative, in-depth interviews and supported by member checking. Our journey map depicts food insecurity as a repetitive process, a unique contribution given that many journey maps are designed with discrete starting and stopping points. We conclude by discussing the novelty of journey maps as innovative products that researchers can use to identify opportunities for process improvements and innovation using multiple data sources or methods.

"It's Really About Those Social Determinants of Health that Drive It": Addressing Food Insecurity in Rural Veterans.

BACKGROUND: The Department of Veterans Affairs (VA) employs numerous strategies to address food insecurity among rural veterans. This manuscript discusses findings from a quality improvement project examining factors impacting food insecurity among rural veterans. METHODS: Qualitative interviews were conducted with VA expert informants (n = 30) who worked in national program offices addressing veteran food insecurity, site visit participants (n = 57) at three VA Medical Centers (VAMCs), and rural veterans who screened positive for food insecurity at the VAMC sites (n = 10). Interviews were analyzed with analysis matrices. RESULTS: Current VA programming includes a national food insecurity screening initiative and connecting veterans with local community resources. Veteran participants provided suggestions for addressing veteran food insecurity, including outreach and education. In addition, these interviews demonstrate that rural veteran food insecurity is intrinsically interwoven with other social determinants of health. CONCLUSIONS: Addressing rural veteran food insecurity must include strategies for understanding and supporting interconnected veteran needs.

Food Insecurity and Diabetes Insulin Adherence Among Older Adults.

Older adults in the United States continue to be impacted by food insecurity. Diabetes is on the rise in older adults and insulin therapy is often recommended as treatment. However, less is known about the relationship between food insecurity and insulin adherence among older adults. The current study utilized secondary data analysis methods to examine the 2021 National Health Interview Survey to explore the relationship between food insecurity and insulin adherence among adults aged 55 and older who are living with diabetes. Results of multivariable logistic regression suggest that participants experiencing food insecurity were more likely to take less insulin than needed and delay buying insulin in the past 12 months compared to participants who were food secure. Homeownership was inversely associated with taking less insulin than needed. Higher income-to-poverty ratio was also inversely associated with skipping insulin doses, taking less insulin than needed, and delaying the purchase of insulin. Our results showed that other racialized/ethnic groups (i.e., American Indian, Alaskan Native, Asian, biracial, and multiracial persons) compared to White were less likely to skip an insulin dose and take less insulin than needed. Suggesting food insecurity should be considered when insulin therapy is recommended for older adults with diabetes.

Overall and race-specific associations between state-level minimum wage policy and food insecurity in the United States.

BACKGROUND: In the USA, states can set higher minimum wages than the federal government. We investigated the association between state minimum wages and racial/ethnic inequities in food insecurity. METHODS: Household-level food insecurity and sociodemographic data were obtained from the cross-sectional Current Population Survey 2015-2019 (n=189 665 households) and merged by state and year with minimum wage and cost-of-living data obtained from the US Department of Labor and US Bureau of Economic Analysis, respectively. We fitted Poisson regression models with robust standard errors with 12-month or 30-day household food insecurity as the outcome, and minimum wage or inflation-adjusted minimum wage (ie, real wage) as the predictor, adjusting for cost of living, sociodemographic covariates and state fixed-effects. We tested interactions between minimum wage and race/ethnicity and ran race/ethnicity-stratified models. RESULTS: In adjusted models, the real wage was not associated with 12-month or 30-day food insecurity. Minimum wage was associated with 5% lower prevalence rate of 12-month food insecurity (PR 0.95, 95% CI=0.93 to 0.98) and 7% lower prevalence rate of 30-day food insecurity (PR 0.93, 95% CI 0.91 to 0.96) for all households. The interaction p values for race/ethnicity with real wage and minimum wage were p<0.001. In stratified models, results were statistically significant for minimum wage and 12-month food insecurity among non-Hispanic (NH) white households (PR 0.93, 95% CI 0.89 to 0.96) and Hispanic households (PR 0.95, 95% CI 0.92 to 0.98), and minimum wage and 30-day food insecurity among NH white (PR 0.92, 95% CI 0.88 to 0.96), NH black (PR 0.94, 95% CI 0.89 to 0.99) and Hispanic (PR 0.90, 95% CI 0.85 to 0.95) households. CONCLUSIONS: Higher state-level minimum wages, but not real wages, were associated with lower food insecurity prevalence overall and for racial/ethnic subgroups.

The impact of food aid interventions on food insecurity, diet quality and mental health in households with children in high-income countries: a systematic review.

OBJECTIVE: Households with children accessing food aid in high-income countries are often food insecure. We aimed to review the evidence on food aid interventions in households with children and impact on food insecurity, diet quality and mental health. DESIGN: A systematic search was conducted using Web of Science, MEDLINE, CINAHL and PsycINFO. Articles published from January 2008 to July 2022 including cross-sectional, cohort and interventional studies in high-income countries were eligible. SETTING: Food aid is defined as the use of interventions providing free food items by community and/or charitable organisations. PARTICIPANTS: Two-parent, lone parent or households with a primary caregiver with at least one child ≤ 18 years. RESULTS: From a total of 10 394 articles, nine were included. Food banks, mobile pantry combined with a free meal for children, backpack provision during school term and food parcel home delivery interventions were evaluated. Food bank models offering additional support such as community programmes, health and social services, cooking classes and free meals for children, client-choice-based models and programmes providing convenient access were associated with improved food security and diet quality (increased intake of wholegrains, fruit and vegetables). One study reported an improvement in mental health and food bank access at the end of 18 months but not at earlier timepoints and one study reported no change in parents' mental health. CONCLUSIONS: Accessing food aid was linked to improved diet quality and reduced food insecurity in some studies. Allowing clients to choose food items and providing support services were most effective.

Using concept mapping to co-create implementation strategies to address maternal-child food insecurity during the first 1000 days of life.

Food insecurity (FI) has short- and long-term effects on maternal and child health, with persistent inequities within under-resourced communities of colour (e.g., Hispanic and Non-Hispanic Black). Interventions to mitigate maternal-child FI must engage the voices of under-resourced communities of colour to improve implementation and tackle socio-ecological drivers of inequities, leading to positive maternal-child outcomes. This exploratory sequential mixed-methods study aimed to co-create implementation strategies to tailor a culturally sensitive intervention to address FI during the first 1000 days of life in under-resourced communities of colour in Las Vegas. A Community Advisory Board (CAB) engaged in a two-step participatory process. First, through the concept mapping, hierarchical cluster analysis organized 125 strategies into seven thematic areas: policy and advocacy, access to food and resources, built environment, education across systems, social and peer support, cultural congruency and trust, and wellness and mental health. Second, through consensus-building, strategies were combined by similarity (n = 94) and excluded if unrelated to health and nutrition (n = 9). The CAB reached a consensus on 22 strategies classified across three socio-ecological levels. Examples of strategies at the community level (n = 16) included increasing utilization of federal nutrition assistance programmes; at the service level (n = 4), integrating FI screenings and referral coordination systems across services; and at the individual level (n = 2), providing mentorship, education, and support for families and moms. The co-creation of a culturally sensitive intervention to reduce inequities in maternal-child FI during the first 1000 days of life requires multi-level strategies across three socio-ecological levels in under-resourced communities of colour in Las Vegas.