Associations between Household- and Child-Referenced Food Security Status and Dietary Intake among Low-Income Urban Black Children.

We examined whether dietary intake differs across household and child food security (FS) status, and Supplemental Nutrition Assistance Program (SNAP) participation among Black children (ages 9-15) in a low-income urban setting. This cross-sectional survey used the USDA 18-item Household Food Security Survey, that includes the 8-item Child Module, and a validated FFQ to assess children's diet (n=451). Nutrient intake differed across child FS status, but not household FS. SNAP participation was associated with better micronutrient intake (vitamin D and calcium) among food secure children. Assessing child-specific FS and nutrient adequacy clarifies children's actual experience and informs child-targeted policies.

Equity-Promoting Strategies in Online Grocery Shopping: Recommendations Provided by Households of Low Income.

OBJECTIVE: To explore barriers and facilitators of online grocery shopping and identify community-driven strategies to promote equity in online food access. DESIGN: This qualitative study used a purposive recruitment strategy to conduct 11 focus groups and 5 in-depth interviews between November 2020 and March 2021. SETTING: Data collection was conducted virtually with participants residing in diverse (majority urban) regions of Maryland. PARICIPANTS: 44 primary household food purchasers with young children (aged < 8 years) eligible for the Supplemental Nutrition Assistance Program (SNAP). PHENOMENON OF INTEREST: Barriers and facilitators of online grocery shopping and strategies elicited by the community to leverage SNAP and online food retailer services to reduce inequities in healthy food access. ANALYSIS: We coded and analyzed transcripts on the basis of the Socioecological Model, Theory of Planned Behavior, and an Equity-Oriented Framework. RESULTS: Overall, we identified 10 themes across all socioecological levels, all of which reflected both barriers and facilitators to online shopping: (1) individual: trust of shoppers, technology, (2) interpersonal: spousal/children needs, (3) community: safety and security, (4) organizational: retail experience and food quality, and (5) policy: SNAP and structural inequities. Participant recommendations included improving food access and communication with hired shoppers, implementing more payment/cost-saving options, and offering educational programming for SNAP participants on using benefits online. CONCLUSIONS AND IMPLICATIONS: Households of low-income identified barriers and facilitators of online grocery shopping across the socioecological levels, emphasizing the need for a multilevel approach to equity promotion. We recommend future work to explore the suggested actionable pathways, which involve delivery providers, grocery stores, nutrition educators, and policymakers leveraging online grocery features (ie, meal planning support) and policies (ie, expansion of the SNAP Online Purchasing Pilot to more retailers) to reducing deterrents (ie, delivery fees waived) for an equity-promoting online grocery environment.

Giving Families a Voice for Equitable Healthy Food Access in the Wake of Online Grocery Shopping.

Understanding the views of families from low-income backgrounds about inequities in healthy food access and grocery purchase is critical to food access policies. This study explored perspectives of families eligible for the Supplemental Nutrition Assistance Program (SNAP) on healthy food access in physical and online grocery environments. The qualitative design used purposive sampling of 44 primary household food purchasers with children (aged ≤ 8), between November 2020-March 2021, through 11 online focus groups and 5 in-depth interviews. Grounded theory was used to identify community-level perceived inequities, including influences of COVID-19 pandemic, SNAP and online grocery services. The most salient perceived causes of inequitable food access were neighborhood resource deficiencies and public transportation limitations. Rural communities, people with disabilities, older adults, racially and ethnically diverse groups were perceived to be disproportionately impacted by food inequities, which were exacerbated by the pandemic. The ability to use SNAP benefits to buy foods online facilitated healthy food access. Delivery fees and lack of control over food selection were barriers. Barriers to healthy food access aggravated by SNAP included social stigma, inability to acquire cooked meals, and inadequate amount of monthly funds. Findings provide a foundation for policy redesign to promote equitable healthy food systems.

A click too far from fresh foods: A mixed methods comparison of online and in-store grocery behaviors among low-income households.

A recent policy in the U.S. authorized monthly benefits from a nutrition assistance program - Supplemental Nutrition Assistance Program (SNAP) - to be used online to increase grocery access and promote healthy eating. This study examined online grocery attitudes and purchasing behaviors among low-income SNAP-eligible households with young children with and without online grocery experience. An explanatory sequential mixed methods design was used, including a survey informed by the theory of planned behavior (TPB) and focus groups conducted between November-March 2021. In the quantitative phase, 310 Maryland residents completed an online survey assessing TPB constructs (attitudes, social norms, perceived control), and food purchase frequency online and in-store. Subsequently, 42 participated in the qualitative phase. Differences in TPB constructs and food purchases were compared between families with and without online grocery experience. Online food selection and fees were a common obstacle to online grocery purchasing. Families who had purchased groceries online (57%) had more positive attitudes and perceived fewer barriers to online shopping than those who had not. Self-reported frequency of buying fresh produce (OR = 0.34, p < 0.001), meat and seafood (OR = 0.29, p < 0.001), and sweets (OR = 0.54, p = 0.005) were lower online than in-store. Families discussed mistrust of online hired shoppers and fewer impulse purchases online as reasons for less frequent purchases of produce and sweets, respectively. Successful scale-up of the U.S. policy must address barriers to healthier purchasing behaviors to effectively promote equitable food access, such as decreasing delivery fees and improving the online food selection.

An equity-oriented systematic review of online grocery shopping among low-income populations: implications for policy and research.

CONTEXT: Online grocery services are an emerging component of the food system with the potential to address disparities in access to healthy food. OBJECTIVE: We assessed the barriers and facilitators of equitable access to healthy foods in the online grocery environment, and the psychosocial, purchasing, and dietary behaviors related to its use among low-income, diverse populations. DATA SOURCES: Four electronic databases were searched to identify relevant literature; 16 studies were identified. RESULTS: Barriers to equitable access to healthy food included cost and limited availability of online grocery services in food deserts and rural areas. The expansion of online grocery services and the ability to use nutrition assistance benefits online were equity-promoting factors. Perceived low control over food selection was a psychosocial factor that discouraged online grocery use, whereas convenience and lower perceived stress were facilitators. Findings were mixed regarding healthfulness of foods purchased online. Although few studies assessed diet, healthy food consumption was associated with online grocery use. CONCLUSION: Researchers should assess the impact of online grocery shopping on low-income families' food purchases and diet. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD: 42021240277.

Food insecurity, overweight and obesity among low-income African-American families in Baltimore City: associations with food-related perceptions.

OBJECTIVE: To examine associations between food insecurity, excess body weight, psychosocial factors and food behaviours among low-income African-American families. DESIGN: Cross-sectional survey of participants in the baseline evaluation of the B'More Healthy Communities for Kids (BHCK) obesity prevention trial. We collected data on socio-economic factors, food source destinations, acquiring food, preparation methods, psychosocial factors, beliefs and attitudes, participation in food assistance programmes, anthropometry and food security. We used principal component analysis to identify patterns of food source destinations and logistic regression to examine associations. SETTING: Fourteen low-income, predominantly African-American neighbourhoods in Baltimore City, MD, USA. SUBJECTS: Two hundred and ninety-eight adult caregiver-child (10-14 years old) dyads. RESULTS: Of households, 41·6 % had some level of food insecurity and 12·4 % experienced some level of hunger. Food-insecure participants with hunger were significantly more likely to be unemployed and to have lower incomes. We found high rates of excess body weight (overweight and obesity) among adults and children (82·8 % and 37·9 % among food insecure without hunger, 89·2 % and 45·9 % among food insecure with hunger, respectively), although there were no significant differences by food security status. Food source usage patterns, food acquisition, preparation, knowledge, self-efficacy and intentions did not differ by food security. Food security was associated with perceptions that healthy foods are affordable and convenient. Greater caregiver body satisfaction was associated with food insecurity and excess body weight. CONCLUSIONS: In this setting, obesity and food insecurity are major problems. For many food-insecure families, perceptions of healthy foods may serve as additional barriers to their purchase and consumption.

Social representations of safety in food services.

This research aimed to evoke and analyze the perceptions of safe food through the perspective of customers at two different food service settings in São Paulo, Brazil. In-depth interviews (N=66) were conducted using a guide with open questions focused on the individual's perceptions of safety, knowledge of food-borne diseases and self-involvement in the food chain. The Collective Subject Discourse (CSD) technique, based on the Theory of Social Representations, was set as the framework for the content analysis of the individual speeches with the aim of writing a collective discourse representing the "voice of the customer". Similarities and differences reflecting different socio-economic backgrounds came up: in general, the interviewees showed concerns about hygiene and good practices and recognized some food hazards, especially those of chemical and biological natures. In situation of social vulnerability, some customers showed greater concern with the guarantee of access to a substantial meal in face of economic constraint. Finally, most customers reported a passive role in the food chain and seemed to transfer to the restaurant staff the entire responsibility for the safety of the meals served therein.