A Multi-Site Analysis of the Prevalence of Food Insecurity in the United States, before and during the COVID-19 Pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic profoundly affected food systems including food security. Understanding how the COVID-19 pandemic impacted food security is important to provide support and identify long-term impacts and needs. OBJECTIVE: The National Food Access and COVID research Team (NFACT) was formed to assess food security over different US study sites throughout the pandemic, using common instruments and measurements. This study presents results from 18 study sites across 15 states and nationally over the first year of the COVID-19 pandemic. METHODS: A validated survey instrument was developed and implemented in whole or part through an online survey of adults across the sites throughout the first year of the pandemic, representing 22 separate surveys. Sampling methods for each study site were convenience, representative, or high-risk targeted. Food security was measured using the USDA 6-item module. Food security prevalence was analyzed using ANOVA by sampling method to assess statistically significant differences. RESULTS: Respondents (n = 27,168) indicate higher prevalence of food insecurity (low or very low food security) since the COVID-19 pandemic, compared with before the pandemic. In nearly all study sites, there is a higher prevalence of food insecurity among Black, Indigenous, and People of Color (BIPOC), households with children, and those with job disruptions. The findings demonstrate lingering food insecurity, with high prevalence over time in sites with repeat cross-sectional surveys. There are no statistically significant differences between convenience and representative surveys, but a statistically higher prevalence of food insecurity among high-risk compared with convenience surveys. CONCLUSIONS: This comprehensive study demonstrates a higher prevalence of food insecurity in the first year of the COVID-19 pandemic. These impacts were prevalent for certain demographic groups, and most pronounced for surveys targeting high-risk populations. Results especially document the continued high levels of food insecurity, as well as the variability in estimates due to the survey implementation method.

The US Supplemental Nutrition Assistance Program - Education improves nutrition-related behaviors.

The aim of this study was to measure whether participating in Supplemental Nutrition Assistance Program - Education (SNAP-Ed) interventions is associated with changes in meeting recommendations for healthy eating and food resource management behaviours, such as shopping, among low-income children, adolescents, and adults in eight states in the US Southeast. The study used a one-group pre-test post-test design, analysing aggregate data on nutrition and shopping behaviours collected during Federal Fiscal Year 17 from SNAP-Ed direct education in community settings. Twenty-five implementing agencies in Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee provided aggregated data on program participants. Because survey questions differed, agencies followed standard recoding guidelines. The number of participants varied depending on the indicator; the maximum number was n 43 303 pre-tests, n 43 256 post-test. Participants were significantly more likely to consume more than one kind of fruit (pooled relative risk (RR), 1⋅10; 95% confidence interval (CI), 1⋅09-1⋅11) and more than one kind of vegetable (pooled RR, 1⋅14; 95% CI, 1⋅12-1⋅15) after the intervention than before. On average, participants consumed 0⋅34 cups more of fruit per day (95% CI, 0⋅31-0⋅37), and 0⋅22 cups more of vegetables per day (95% CI, 0⋅19-0⋅25) after the intervention, compared to before. About 701 policy, systems, and environmental changes for nutrition supports were reported. This study suggests that SNAP-Ed direct education is associated with positive behaviour changes in the US Southeast. It provides a methodology that can inform data aggregation efforts across unique SNAP-Ed programs or other similar nutrition education programs to report on the collective impact.

My Quest, a Community-Based mHealth Intervention to Increase Physical Activity and Promote Weight Loss in Predominantly Rural-Dwelling, Low-Income, Alabama Women.

Rural-dwelling, overweight/obese, limited-resource individuals and women have the lowest leisure-time physical activity rates among Americans. This community-based, single-group pre- posttest study sought to increase physical activity, step counts, and promote weight loss in 104 low-income women (84% rural). Analyses included nonparametric and repeated-measures analyses of variance to determine physical activity behaviors, step counts, and weight loss. Results show, from pre- to postintervention, participants improved self-reported step counts, physical activity goal setting and behaviors, and body weight. This study adds support that text message programs can reach a high-risk, limited-resource, predominantly rural population to promote physical activity and weight loss.

Multilevel Faith-Based Public Health Initiative in Rural Alabama, 2017.

Recent shifts in public health approaches to reduce and prevent chronic disease encourage interventions to include multiple levels of the social ecological model. The objective of this 1-group pretest-posttest study was to determine differences in faith community policies and environments; interpersonal support; and individual behavior before and after Live Well Faith Communities, a 9-week, faith-based health promotion initiative. The study included a convenience sample of faith communities and participants. Validated instruments assessed faith communities' policies and environments and participants' interpersonal and individual practices and behaviors. Seventy-two small-group sessions with 737 adults were implemented in 14 faith communities. Faith communities adopted policies requiring healthy options for meals and snacks and implemented environmental changes to promote healthy eating and physical activity. Participants reported significant improvements in healthy eating encouragement, shopping practices, and vegetable consumption. Multilevel interventions prompt community organizations to become healthier places and individuals to adopt healthy lifestyles.

My Quest, an Intervention Using Text Messaging to Improve Dietary and Physical Activity Behaviors and Promote Weight Loss in Low-Income Women.

OBJECTIVE: To evaluate changes in dietary and physical activity behaviors and weight after implementation of a 12-week text messaging initiative (My Quest). DESIGN: The researchers conducted a 1-group, pre- to posttest study design to determine changes after implementation of a text messaging initiative developed using the tenets of the Social Cognitive Theory. SETTING: A total of 55 Alabama counties (84% rural) with high rates of poverty, overweight/obesity, and chronic diseases. PARTICIPANTS: Convenience sample of low-income, primarily overweight/obese women (n = 104). INTERVENTION: Short texts (n = 2-3/d) provided health tips, reminders, and goal-setting prompts. Weekly electronic newsletters provided tips and recipes. Participant self-monitored body weight weekly. MAIN OUTCOME MEASURE: Outcomes included goal setting, self-efficacy, behavioral and environmental factors, self-monitoring, and body weight; data collection occurred through text message response and online surveys. ANALYSIS: Analyses were conducted using McNemar test (dichotomous data), Wilcoxon signed rank test (ordinal data), or paired t test (continuous data). RESULTS: Participants significantly (P < .05) improved dietary and physical activity behaviors and food environment; increased dietary and physical activity goal setting; and reduced body weight. CONCLUSIONS AND IMPLICATIONS: A low-cost, text messaging initiative particularly targeting women residing in rural communities with high rates of poverty and obesity can promote weight loss and improve dietary and physical activity behaviors. Future studies may include a control group and social support component such as group text messaging.