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.

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.

Associations between Barriers to Food Pantry Use, Visit Frequency, Pantry Experiences, and Amount of Food Received.

Background/Objectives: Barriers to food pantry use have been identified but little information is available regarding how these barriers are related to food pantry use. The purpose of this study was to assess relationships between barriers and (1) user demographic characteristics, (2) visit frequency and amount of food received, and (3) satisfaction with pantry visit experiences. Methods: Data were used from the 2022 Minnesota Food Shelf Survey, which included responses from 288 food pantries across the state with 6267 individuals reporting on barriers to pantry use. Survey barrier statements included limits on frequency of visits allowed, lack of reliable transportation, scheduling difficulties, and other. Survey satisfaction statements included being able to choose food types, being made welcome, having an easy selection process, having different varieties of food available, and foods having a favorable appearance. Chi-square and mixed model logistic regression analyses were used to assess relationships between reporting barriers and demographic characteristics, visit satisfaction, visit frequency, and amount of food received in the past 6 months. Results: Respondents were primarily non-Hispanic White (65%) and female (68%). Regression models showed that reporting barriers to pantry use was not associated with user demographic characteristics, but was associated with greater odds of visiting the pantry more often, and lower odds of getting more food from the pantry or reporting a satisfactory food pantry visit experience. Conclusions: Findings may be useful for food pantry staff to improve pantry access and visit experiences and for public health professionals who advise those who use food pantries to supplement household food supplies.

Food Insecurity, MyPlate Recognition, and Meal Preparation Confidence Among College Food Pantry Users.

OBJECTIVE: This study examined college students' food security status, Choose MyPlate familiarity, and confidence in preparing healthy meals using food pantry ingredients. METHODS: A sample of 354 student users of a college food pantry in the US southeastern region were surveyed before using the food pantry for the first time. RESULTS: Of the respondents, 81.3% were food insecure, and 47% of the overall sample experienced very low food security. About one-third (37.3%) recognized MyPlate; of those, 89.4% stated intention to use MyPlate knowledge making pantry selections. Students familiar with MyPlate (P = 0.003) and intending to use MyPlate when making food selections (P = 0.02) exhibited greater confidence. Differences were not observed on the basis of food security status. CONCLUSIONS AND IMPLICATIONS: These findings suggest that familiarity with simple nutritional guidelines such as MyPlate may improve students' intended food pantry selections and healthy meal selection confidence.

Protocol for the Support Application for Food PAntrieS trial: design, implementation, and evaluation plan for a digital application to promote healthy food access and support food pantry operations.

Introduction: Food-insecure households commonly rely on food pantries to supplement their nutritional needs, a challenge that was underscored during the COVID-19 pandemic. Food pantries, and the food banks that supply them, face common challenges in meeting variable client volume and dietary needs under normal and emergency (e.g., pandemic, natural disaster) conditions. A scalable digital strategy that has the capacity to streamline the emergency food distribution system, while promoting healthy food options, managing volunteer recruitment and training, and connecting to emergency management systems in times of need, is urgently required. To address this gap, we are developing a working mobile application (app) called the Support Application for Food PAntrieS (SAFPAS) and will evaluate its feasibility and impact on food pantry staff preparedness, stocking, and client uptake of healthful foods and beverages in two urban United States settings. Methods: This paper describes the protocol for a randomized controlled trial of the SAFPAS mobile application. We will conduct formative research in Baltimore, Maryland and Detroit, Michigan to develop and refine the SAFPAS app and increase scalability potential to other urban settings. Then we will test the app in 20 food pantries in Baltimore randomized to intervention or comparison. The impact of the app will be evaluated at several levels of the emergency food system, including food pantry clients (n = 360), food pantry staff and volunteers (n = 100), food pantry stock, and city agencies such as the local food bank and Office of Emergency Management. The primary outcome of the SAFPAS trial is to improve the healthfulness of the foods received by food pantry clients, measured using the Food Assessment Scoring Tool (FAST). Post-trial, we will conduct additional formative research in Detroit to prepare the app for scale-up. Discussion: We anticipate that SAFPAS will improve alignment in the supply and demand for healthy foods among food pantry clients, food pantries, and city agencies which supply food in Baltimore. Real-time, bidirectional communication between entities across the system allows for increased situational awareness at all levels during normal and emergency operations. By conducting formative research in Detroit, we hope to increase the scalability of the SAFPAS app to additional settings nationwide. Clinical trial registration: NCT87654321. https://classic.clinicaltrials.gov/ct2/show/NCT05880004.

A cooking intervention increased food literacy of students who frequently used the campus food pantry: A Pilot Program.

OBJECTIVES: Students who obtain food from a campus food pantry may benefit from participating in a nutrition/cooking intervention. PARTICIPANTS AND METHODS: Twenty-seven students 18-30 years of age attending a university in the southeastern US participated in the IRB approved study. One 2-hour class was offered each week for four weeks in the on-campus cooking laboratory. Subjects indicated how often they cooked a dinner meal at home and completed the Eating and Food Literacy Behaviors Questionnaire (EFLBQ) before and after participating in the program. RESULTS: The total EFLBQ, Factor 1 (Health and Nutrition) and Factor 3 (Food Preparation) scores, and the frequency of cooking a dinner meal at home were all higher post-program (all p < 0.05). CONCLUSIONS: This pilot study suggests that an on-campus cooking program can increase the food literacy and frequency of cooking meals by university students who obtained items from the campus food pantry.

Measuring access to food banks and food pantries: A scoping review of spatial analysis approaches.

Food banks and food pantries are crucial in supporting access to food and addressing food insecurity for millions of people. This scoping review identified eighteen articles that applied spatial analysis approaches to measure access to food banks and food pantries. The review summarizes the methods and primary findings of these studies, and examines how these address different dimensions of food access. Findings suggest that the majority of studies measured the accessibility and availability dimensions of food access, and two addressed accommodation. Through a discussion of these studies' methods and broader literature on food environments, we highlight opportunities to integrate advanced geospatial and mixed methods to support an empirically grounded and broader understanding of food bank and pantry access in future research. This will yield a more holistic picture of food environments and provide practical implications for site selection, resource allocation, and food assistance operations.

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.

Campus Food Pantry Use May Improve Daily Frequency of Fruit and Vegetable Intake Among California University Students Experiencing Food Insecurity.

BACKGROUND: University students are at increased risk for both food insecurity and suboptimal fruit and vegetable (F/V) intake. Campus food pantries (CFP) have been a common intervention in response to student food insecurity, but there have been few evaluations of the effectiveness of this strategy on improving students' dietary intake. OBJECTIVE: To examine differences in the frequency of F/V intake by food security status, and whether the number of monthly CFP visits was associated with frequency of F/V intake among university students who were CFP clients. DESIGN: Cross-sectional PARTICIPANTS: The study population included 1,188 university students across the 10-campus University of California system who had accessed their CFP or Basic Needs Center. MAIN MEASURES: United States Department of Agriculture (USDA) 6-item short food security module, monthly CFP visits, and self-reported frequency of F/V intake (daily). STATISTICAL ANALYSES PERFORMED: T-tests were performed to compare differences in mean daily frequency of F/V intake by food security status. Generalized linear models were used to examine associations between monthly CFP visits and mean daily frequency of F/V intake. Using a post hoc Wald test, an interaction term (monthly CFP visits × food security status) was included to the models to determine whether food security status modified associations. RESULTS: Students experiencing food insecurity consumed total F/V 0.48 fewer times per day compared with students who were food secure (2.64 ± 2.11 vs 3.12 ± 2.01; P < .001). Among students experiencing food insecurity, each monthly CFP visit was associated with higher daily frequencies of intake for total F/V (ß = 0.06), whole fruit (ß = 0.03), 100% fruit juice (ß = 0.01), and leafy greens (ß = 0.01); however, no associations were found among the food-secure group. CONCLUSIONS: Findings suggest that CFPs may be supporting students in need of nutritional assistance increase their daily frequency of F/V intake. Future studies are needed to validate these findings to inform investment in campus food pantries and support university students in need of nutritional assistance.

Nutrition Environment Gaps and Distribution Challenges in Rural Food Pantries During the COVID-19 Pandemic: A Mixed-Methods Study.

BACKGROUND: Food insecurity disproportionately affects low-income, racially marginalized, and rural communities. The COVID-19 pandemic led to higher demand for emergency food distribution, potentially impacting food pantry operations and services. Limited research exists assessing consumer nutrition environments of pantries in rural regions. OBJECTIVES: To assess the consumer nutrition environment of rural food pantries and report challenges and adaptations encountered during the pandemic. DESIGN: A mixed-methods, cross-sectional survey. PARTICIPANTS/SETTING: Nineteen food pantry representatives from California's San Joaquin Valley were surveyed between August 2020 and June 2021. Representatives were eligible if their pantry served the general population and was open at least once a week. Nine were church-based pantries, and 10 were from other settings. MAIN OUTCOME MEASURES: The Nutrition Environment Food Pantry Assessment Tool (NEFPAT) measured the nutrition food environment and scored pantries as bronze (0-15), silver (16-31), or gold (32-47) categories. Eleven items were developed to explore pandemic-related challenges. STATISTICAL ANALYSES PERFORMED: Independent χ2 tests assessed the relationship between the organization type and NEFPAT scores and food supply sources. Fisher's exact test explored associations between food pantry type, NEFPAT category, and challenges. Nonparametric tests were run on non-normally distributed data. Inductive content analysis was used to examine open-ended pandemic-related questions. RESULTS: The nutrition environment of most pantries was suboptimal, because no pantry scored in the "gold" category based on total NEFPAT scores (median, 18 of 47). No statistically significant differences were found in the NEFPAT scores by organization type. Most pantries did not provide healthy food nudges or culturally diverse foods. Key COVID-19 challenges encountered consisted of supply- and demand-side issues, including reduced personnel, capacity, and resources, and increased client quantity and demand for food. CONCLUSIONS: Assessing the nutrition environment of rural food pantries revealed gaps and strategies for improvement, including the use of healthy nudges and increasing the availability of culturally diverse foods.

Construct validity of the Charitable Food Nutrition Index.

Background: Food pantries are an important source of food for those facing food insecurity. The Charitable Food Nutrition Index (CFNI) was developed for research and practice to measure the nutritional quality of assortments of foods in this setting. Objective: The study assessed the construct validity of the CFNI using secondary data from a group-randomized food pantry intervention in Minnesota. Methods: The CFNI was calculated for each client cart post-intervention (n = 187; 85 intervention, 102 control). CFNI scores were based on the proportion of items in each client cart ranked "green," "yellow," or "red" using the Healthy Eating Research Nutrition Guidelines for the Charitable Food System. An implementation score assessing intervention fidelity was measured for each pantry (n = 11; 5 intervention, 6 control) based on the four intervention subcomponents: aesthetics/use of space; healthy food prominence and appeal; unhealthy food de-emphasis; and stocking standards. Mixed linear models were used to test whether: (a) client carts from pantries in the intervention condition had higher CFNI scores than those in the control condition, and (b) higher implementation scores were associated with higher CFNI scores. Results: In adjusted models, clients from intervention group pantries had higher CFNI scores, reflecting a healthier assortment of foods compared with clients from control group pantries (p = 0.022). CFNI scores were positively associated with greater fidelity to the intervention (p = 0.020). Conclusions: The CFNI was sensitive enough to detect the effects of the intervention in the expected directions. These findings support its construct validity and utility as a measure in the charitable food system.

Assessing the effect of adverse economic events on severity of hunger among food pantry clients.

This study assessed relationship between adverse economic events (AEE) and hunger level (i.e., little to no, moderate, severe). A cross-sectional survey was conducted from June to August 2018 in 10 food pantries with 616 food pantry users. Hunger level was assessed by the Household Hunger Scale. AEE were evaluated over the past 3 months. Participants (60.55%) experienced unexpected or increased medical expenses (17.69%), job loss (13.64%), pay reduction (11.85%), and death of a family member (9.09%). Pay reduction (OR = 1.87, 95% CI: 1.12, 3.14) and increased debt (OR = 2.71, 95% CI: 1.92, 3.84) were associated with moderate hunger; death of a family member (OR = 2.43, 95% CI: 1.21, 4.90), pay reduction (OR = 2.95, 95% CI: 1.24, 7.04), and increased debt (OR = 3.46, 95% CI: 1.98, 6.04) were associated with severe hunger. Awareness of AEE can inform public health programs and policies for people in need of additional resources, which is essential in times of increased economic instability.

Experiences of New Visitors With Low Food Security Seeking Food Assistance During the COVID-19 Pandemic.

OBJECTIVE: To describe the experiences of first-time visitors with low food security seeking food assistance during the coronavirus disease 2019 pandemic. DESIGN: A qualitative study. SETTING: Emergency food distribution sites in West Central Florida. PARTICIPANTS: Adults (aged 18-64 years) seeking food assistance between November, 2020 and July, 2021. PHENOMENON OF INTEREST: Using food security as a multidimensional concept, in-depth interviews explored the impact of emergency food assistance on food availability, access, utilization, and stability. ANALYSIS: Applied thematic analysis was conducted to identify emergent themes. RESULTS: Participants (n = 18) were White (55.6%), female (72.2%), and aged 40-59 years (55.6%). Seven salient themes described participants' experience seeking food assistance (eg, the crisis resulting in seeking food assistance, mixed quality of pantry foods, and gaining firsthand insight on hunger). Although food assistance increased food availability and access, there were barriers to using the pantry foods (eg, foods not preferred, health/allergies). CONCLUSIONS AND IMPLICATIONS: Study findings suggest that first-time visitors seeking emergency food assistance during the coronavirus disease 2019 pandemic may be experiencing temporary cycles of financial instability, which could impact dietary quality. Because pantry foods are often the primary source of household food supply, client-focused emergency food distribution tailored to client needs can increase food availability, access, and utilization.

Participant and Stakeholder Perceptions of the Food FARMacy Emergency Food Assistance Program for the Coronavirus Disease 2019 Pandemic: A Qualitative Study.

BACKGROUND: Food FARMacy is a clinical-community emergency food assistance program developed in response to food insecurity during the COVID-19 pandemic. Few qualitative studies have examined participant, and clinical and community stakeholder experiences with these food assistance programs. OBJECTIVE: To examine the motivations, experiences, and perceptions of Food FARMacy participants and program stakeholders. DESIGN: A qualitative study using in-depth interviews between March 2021 and July 2021. PARTICIPANTS AND SETTING: Twenty-four Food FARMacy participants and 10 program stakeholders in New York, NY (Manhattan, Brooklyn, and Queens) older than age 18 years were interviewed. STATISTICAL ANALYSES PERFORMED: Interviews were recorded, transcribed, translated, and analyzed using thematic analysis. Participant and program stakeholder interviews were analyzed separately. Themes that were salient in both groups were combined for reporting. RESULTS: Both program participants and stakeholders perceived: pandemic-related demands combined with reduced resources motivated participation; convenience, safety, and ease of access facilitated program retention; participants valued fresh produce and diversity of foods; the program improved diet and health; minimizing food waste was a priority; and social cohesion was an unexpected program benefit. Two additional themes among only program stakeholders also were identified: aligned values, flexibility, and communication were key to successful partnerships; and trust between community partners and community members drove programmatic success. CONCLUSIONS: Results suggest that a multisite clinical-community partnership to provide emergency food assistance in New York City can be leveraged to reduce barriers to healthy food access and address food insecurity during crises.

A hospital-based therapeutic food pantry study for people living with cancer in New Orleans.

INTRODUCTION: Food pantries have the potential to improve health outcomes and quality of life for individuals living with cancer. Gender has been linked to certain cancer symptoms and dietary patterns. Nevertheless, the extent of research on the utilization of food pantries among this population, particularly with regard to gender differences, remains limited. The objective of this study is to explore the demographic characteristics and gender differences in quality of life, as well as the impact of cancer on the lives of individuals who utilize food pantry services. METHODS: Between February 26, 2019 and July 24, 2022, 400 people living with cancer were eligible to participate the University Medical Center New Orleans (UMC) food pantry. Participants were asked to provide demographic information and completed two health assessments related to the challenges in daily activities, nutrition, and mental health. RESULTS: The study participants had a mean age of 54.1, and the majority of the participants were female. More than half of the participants did not have access to a vehicle or use public transportation to access grocery stores. People living with cancer reported several quality of life issues, with the most prevalent challenges being interference of cancer with work, lack of energy, difficulty affording food, pain, and sleep problems. Additionally, less than half of the patients reported consuming fruits and vegetables on a daily basis, and males were found to be less likely to consume them compared to females. DISCUSSION: The current study sheds light on the characteristics and quality of life of individuals who utilize UMC food pantry services, as well as the impact of cancer on their lives. The findings reveal a gender disparity in fruit and vegetable consumption, with male individuals living with cancer reporting lower levels of consumption. IMPLICATIONS FOR RESEARCH AND PRACTICE: Identifying and addressing food insecurity among people living with cancer are necessary. Meanwhile, partnerships with community organizations may be valuable in finding ways to assist cancer survivors in returning to work. Future studies could also focus on encouraging fruit and vegetable consumption, particularly among male individuals living with cancer.

The Association between Food Security Status and the Home Food Environment among a Sample of Rural South Carolina Residents.

Prior research suggests that food security status may have an effect on the home food environment. Further, the literature suggests that food access factors may function to influence said relationship. The purpose of this research is to fill a gap in the literature on this relationship, as well as to identify potential food access effect modifiers. This research employs linear mixed effects modeling with a random intercept variable (zip codes). Eleven food access variables are included in regression analyses and are tested as potential effect modifiers in the association between food security status and the home food environment. Food security status is significantly associated with the home food environment (95% CI = 0.1-1.38) in the unadjusted model. In the adjusted model, food pantry usage is found to be a significant effect modifier on the association between food security status and the home food environment. This research concludes that food security status has a significant but disparate effect on the home food environment depending on participant food pantry usage. Practical implications from this research would be for relevant stakeholders to potentially improve rural food pantry access in order to increase the home food environment among rural and food insecure populations.

Evaluating a Campus Food Pantry's Potential Impact on Nutrition Security using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework.

Background: Campus food pantries are uniquely positioned to promote health equity with the foods they make accessible to food-insecure students. Objectives: This study assessed the implementation and effectiveness of a client-choice campus food pantry to understand its potential impact on nutrition security and to inform future implementation. Methods: This observational study was designed using the reach, effectiveness, adoption, implementation, and maintenance framework, leveraging administrative data collected from a client-choice campus food pantry at a large Midwest university from August 2020 to May 2022. Pantry staff tracked student usage and item inventory. Items were analyzed for specific nutrients using the Nutrition Data System for Research. The mean nutrients and servings per food group distributed per visit were calculated and compared with dietary recommendations (effectiveness). Characteristics of pantry operation and setup were detailed (adoption). The percentage of openings with adequate stock to meet distribution guidelines was determined (implementation). Descriptive statistics were calculated, and multiple linear regressions determined whether significant changes in nutrients and food were distributed based on distribution guidelines and stock available. Results: Effectiveness: Vitamin D, fruits, vegetables, and whole grains were below 3 d of the recommended intake for all students, and energy, fiber, potassium, vitamin A, and grains were low for male students. Adoption: The pantry was established through a collaboration with a pre-existing community food pantry and operates as a 501(c) and is managed by campus recreation staff. Implementation: The pantry supplied enough produce for 72% of openings to meet distribution guidelines and enough dairy for 63% of openings. Conclusions: The food and nutrients distributed in limited amounts are consistent with those underconsumed according to the Dietary Guidelines for Americans. More research is needed to understand how pantry implementation can best support nutrition security through the adequate distribution of key nutrients and food groups.

Pantry clients and Supplemental Nutrition Assistance Program-Education practitioners' perspectives on factors influencing healthy eating policy, system and environmental interventions in food pantries.

The Supplemental Nutrition Assistance Program-Education identified food pantries as a targeted setting for policy, system, and environmental (PSE) interventions to promote healthy eating among households who rely on pantries to supplement their food needs. The present study sought to identify factors influencing capacity and readiness to implement healthy eating PSE interventions in food pantries. Qualitative interviews were conducted via zoom with twenty-six community residents with experience receiving SNAP benefits and twelve SNAP-Ed staff in rural and urban counties in Ohio to identify themes and indicators related to community/organisational capacity and readiness to implement healthy eating PSE interventions in food pantries. Themes and related indicators generated based on inductive and deductive coding of interview transcripts were prioritised and weighted by eleven community nutrition experts during a virtual consensus conference. Five themes emerged; expert-derived weights (scaled low, 0 to high, 1) reflect the perceived importance of each to implementation of healthy eating PSE interventions in food pantries: food pantry capacity and logistics [0⋅252], networks and relationships [0⋅228], community nutrition practitioner capacity [0⋅212], food pantry user characteristics [0⋅156], and stigma and stereotypes [0⋅1⋅52]. Overall, seventeen indicators were identified reflecting these themes. Successful and sustained PSE interventions at food pantries will require a tailored approach that considers food pantries' capacity, needs and opportunities within the community, and capacity of community nutrition practitioners. The themes and indicators identified provide guidance for responsive PSE approaches in food pantries that meet communities where they are.

Experiences of Food Pantry Stakeholders and Emergency Food Providers in Rural Minnesota Communities.

OBJECTIVE: This study aimed to describe the experiences influencing food pantry stakeholders' and emergency food providers' ability to meet their shoppers' needs. DESIGN: We conducted 5 focus groups. SETTING: Food pantries in Minnesota in late 2019 and early 2020. PARTICIPANTS: The sample included 37 participants with various roles in the emergency food system. PHENOMENON OF INTEREST: Barriers and challenges facing emergency food providers/stakeholders and practices and resources providers employ. ANALYSIS: We identified major themes using a thematic analysis approach. RESULTS: Participants reported multiple barriers to accessing food pantries, that shopper demographics were changing, and shoppers needed nonfood support, such as personal hygiene items and mental health services. Food pantries required appropriate and sustainable food supplies, additional financial, labor, technical support, and physical infrastructure improvements. Participants described the benefits of their relationship with the University of Minnesota Cooperative Extension, explained how pantries offered healthier foods, highlighted innovative service delivery models, and stressed that their organization connected to many facets of their community. CONCLUSION AND IMPLICATIONS: Food pantries serving rural areas reported meeting community needs by distributing food to their shoppers in an inclusive and health-promoting way but require additional support. These data support nutrition practitioners working to understand the local, place-based context and needs of emergency food providers while building wider and deeper connections between nutrition professionals and the emergency food system.