Effect of a Multicomponent Food Pantry Intervention in Client Subgroups.

Nutrition promotion programs may have varying effects and influence health disparities. SuperShelf promotes healthy choices in food pantries through inventory changes and nudge implementation (e.g., choice architecture). This secondary analysis of the SuperShelf cluster-randomized trial assessed whether the effect of SuperShelf on client diet quality differed by equity characteristics. English-, Spanish-, or Somali-speaking adult clients from 11 food pantries in Minnesota were included (N = 193). We measured change in diet quality by the Healthy Eating Index 2015 (HEI-2015; maximum score 100) using up to two 24 h dietary recalls from pre-intervention and post-intervention periods. We used linear mixed-effects models to determine whether the effect of SuperShelf on diet quality varied by self-reported gender, race/ethnicity, education, and employment status. In separate adjusted models, the interactions of SuperShelf and gender, education, or employment status were not significant. The interaction of SuperShelf and race/ethnicity was significant (p-interaction = 0.008), but pairwise comparisons in diet quality were non-significant in all racial/ethnic subgroups. SuperShelf did not have differential effects on diet quality by gender, race/ethnicity, education, or employment status, suggesting it does not worsen dietary disparities among food pantry clients, though more subgroup analyses are needed to explore potential racial/ethnic disparities in this context.

A Cluster-Randomized Evaluation of the SuperShelf Intervention in Choice-Based Food Pantries.

BACKGROUND: Interventions in food pantry settings have the potential to improve health among clients at risk of diet-related disease. PURPOSE: This study evaluates whether a cluster-randomized, behavioral intervention in food pantries resulted in improved client outcomes. METHODS: Sixteen Minnesota food pantries were randomized to an intervention (n = 8) or control condition (n = 8). The intervention offered pantries technical assistance to improve healthy food supply and implement behavioral economics strategies to promote healthy food selection. A convenience sample of adult clients were enrolled (paired sample, 158 intervention, 159 control) and followed for 1 year. Additional clients were enrolled at follow-up to assess food selection (follow-up sample, 85 intervention, 102 control). Analysis was limited to data from 11 pantries (5 intervention, 6 control) due to COVID-19. Outcome measures included Healthy Eating Index-2015 (HEI-2015) total and subcomponent scores for 24-hr dietary recalls and client cart selections, and Life's Simple 7 (LS7) total and subcomponent scores. Multilevel mixed-effects models tested whether client outcomes differed by intervention condition. RESULTS: In adjusted models, there were no statistically significant differences by intervention condition in HEI-2015 or LS7 scores. Clients in intervention food pantries had improved Refined Grain subcomponent scores (p = .004); clients in control pantries had worsened Saturated Fat subcomponents scores (p = .019) and improved physical activity scores (p = .007). CONCLUSIONS: The intervention did not result in improved diet quality or cardiovascular health as measured by HEI-2015 or LS7. Coordinated efforts across settings are needed to address health risks facing this population.

Food pantries are an optimal setting to address health and diet quality among clients experiencing food insecurity. This study tests whether a food pantry intervention resulted in improved dietary and cardiovascular outcomes among clients. Sixteen Minnesota food pantries were randomized to either receive an intervention or a delayed intervention. The intervention offered food pantries technical assistance to improve healthy food supply and "nudge" clients toward healthy choices. Due to the COVID-19 pandemic, measures were completed 11 pantries (5 intervention, 6 control). Outcome measures included diet quality of food selected by clients, diet quality of food consumed by clients, and Life's Simple 7 measure of cardiovascular health. The intervention did not result in improved diet quality or cardiovascular health. Coordinated efforts across community settings are needed to address health risks facing this population.

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.

Early results of a natural experiment evaluating the effects of a local minimum wage policy on the diet-related health of low-wage workers, 2018-2020.

OBJECTIVE: The current study presents results of a midpoint analysis of an ongoing natural experiment evaluating the diet-related effects of the Minneapolis Minimum Wage Ordinance, which incrementally increases the minimum wage to $15/h. DESIGN: A difference-in-difference (DiD) analysis of measures collected among low-wage workers in two U.S. cities (one city with a wage increase policy and one comparison city). Measures included employment-related variables (hourly wage, hours worked and non-employment assessed by survey questions with wages verified by paystubs), BMI measured by study scales and stadiometers and diet-related mediators (food insecurity, Supplemental Nutrition Assistance Program (SNAP) participation and daily servings of fruits and vegetables, whole-grain rich foods and foods high in added sugars measured by survey questions). SETTING: Minneapolis, Minnesota and Raleigh, North Carolina. PARTICIPANTS: A cohort of 580 low-wage workers (268 in Minneapolis and 312 in Raleigh) who completed three annual study visits between 2018 and 2020. RESULTS: In DiD models adjusted for time-varying and non-time-varying confounders, there were no statistically significant differences in variables of interest in Minneapolis compared with Raleigh. Trends across both cities were evident, showing a steady increase in hourly wage, stable BMI, an overall decrease in food insecurity and non-linear trends in employment, hours worked, SNAP participation and dietary outcomes. CONCLUSION: There was no evidence of a beneficial or adverse effect of the Minimum Wage Ordinance on health-related variables during a period of economic and social change. The COVID-19 pandemic and other contextual factors likely contributed to the observed trends in both cities.

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.

The lived experience of food pantry users in Minnesota: Qualitative findings from a statewide survey.

Objectives: In 2017 a community-University of Minnesota collaborative conducted a statewide survey of food pantry clients. Methods: Of the 188 food pantries surveyed, 4321 individual client surveys were returned, from which 2,251 open-ended responses were analyzed. Results: Respondents shared gratitude for the food pantry in meeting their needs for food and support. Many described accessing healthy food that was needed to address health needs. Respondents described life circumstances and hardships that led to food pantry use. Conclusion: The supportive environment provided by food pantries position them to address the needs of clients, including those with complex health needs.

Selective Daily Mobility Bias in the Community Food Environment: Case Study of Greater Hartford, Connecticut.

The community food environment has potential influences on community members' dietary health outcomes, such as obesity and Type II diabetes. However, most existing studies evaluating such health effects neglect human mobility. In food patrons' daily travels, certain locations may be preferred and patronized more frequently than others. This behavioral uncertainty, known as the selective daily mobility bias (SDMB), is less explored in community-food-environment research. In this paper, we aim to confirm the existence of the SDMB by systematically exploring the large-scale GPS-based restaurant-visit patterns in the Greater Harford region, Connecticut. Next, we explore the restaurant and neighborhood characteristics that are associated with the restaurant-visit patterns. Our primary results demonstrate that (1) most restaurant customers originate from areas outside of the census tract where the restaurant is located, and (2) restaurants located in socially vulnerable areas attract more customers in total, more customers from local areas, and more customers from other socially vulnerable areas. These results confirm the relevance of the SDMB to the community food environment, and suggest ways that the SDMB can be moderated by an uneven socio-economic landscape. The findings demonstrate the necessity of incorporating human-mobility data into the study of the community food environment.

Examining Changes in Food Security, Perceived Stress, and Dietary Intake in a Cohort of Low-Wage Workers Experiencing an Increase in Hourly Wage.

OBJECTIVE: To determine whether an increase in hourly wages was associated with changes in food security and perceived stress among low-wage workers. We also determined whether changes in food security and stress were associated with changes in diet. SETTING: Wages is a prospective cohort study following 974 low-wage workers in Minneapolis, MN, where an ordinance is incrementally increasing minimum wage to US$15/hr from 2018 to 2022, and a comparison community with no minimum wage ordinance (Raleigh, NC). Interaction models were estimated using generalized estimating equations. PARTICIPANTS: Analyses used two waves of data (2018 [baseline], 2019) and included 219 and 321 low-wage workers in Minneapolis and Raleigh (respectively). RESULTS: Average hourly wages increased from US$9.77 (SD US$1.69) to US$11.67 (SD US$4.02). Changes in wages were not associated with changes in food security (odds ratio = 1.05, 95% confidence interval [CI] [0.89, 1.23], p = .57) or stress (ß = -0.01, 95% CI [-0.04, 0.03], p = .70) after 1 year of policy implementation. Changes in food security were not associated with changes in diet. However, we found significant changes in the frequency of fruit and vegetable intake across time by levels of stress, with decreased intake from Wave 1 to 2 at low levels of stress, and increased intake at high levels of stress (incidence rate ratio = 1.17, 95% CI [1.05, 1.31], p = .01). CONCLUSIONS: Changes in wages were not associated with changes in food security or stress in a sample of low-wage workers. Future research should examine whether full implementation of a minimum wage increase is associated with changes in these outcomes.

Validating a Nutrition Ranking System for Food Pantries Using the Healthy Eating Index-2015.

In 2020, charitable food organizations began adopting Healthy Eating Research (HER) nutrition guidelines, which rank individual foods in tiers (e.g., green, yellow, or red) based on each food's nutrient profile. This study aimed to validate this HER tier-ranked system against the Healthy Eating Index-2015 (HEI) and develop a formula to summarize the percentages of tier-ranked foods in an overall nutritional quality index that correlated with HEI. Using secondary data of foods selected by clients in 16 Minnesota food pantries (n = 503 "client carts"), we generated an HEI score and percentages of green, yellow, and red foods for each cart. As validation, we tested the association between HEI scores and the percentages of tier-ranked foods and compared the means of the tier-ranked variables using quintiles of the HEI scores. HEI scores were positively associated with percentages of green foods and negatively associated with percentages of red foods. Next, we used statistical learning to generate weights to maximize the correlation of the tier-ranked variables and the HEI scores and used these weights to create an index. The index demonstrated a moderate-to-strong correlation with HEI and can be used as a single measure to summarize the overall nutritional quality for sets of tier-ranked foods.

A qualitative analysis of SNAP and minimum wage policies as experienced by workers with lower incomes.

Work-related policies, including minimum wage and food assistance work requirements, can affect food security for people with lower incomes. This study conducted 112 qualitative interviews to understand participant policy experiences in two contexts (Raleigh, North Carolina and Minneapolis, Minnesota). Participants experienced frequent, destabilizing changes to their United States Department of Agriculture Supplemental Nutrition Assistance Program benefits, which they identified as part of a broader safety net. Raleigh workers described an unsupportive policy environment; Minneapolis workers reaped few benefits from an ongoing wage increase. Many workers face complex financial tradeoffs; more sophisticated evaluations should consider broader policy contexts and long-range effects.

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.

Applying the Healthy Eating Index-2015 in a Sample of Choice-Based Minnesota Food Pantries to Test Associations Between Food Pantry Inventory, Client Food Selection, and Client Diet.

BACKGROUND: Food pantry clients are at a high risk for diet-related chronic disease and suboptimal diet. Relatively little research has examined diet quality measures in choice-based food pantries where clients can choose their own food. OBJECTIVE: This study tested whether the diet quality scores for food at the pantry were associated with client food selection scores, and whether client food selection scores at the pantry were associated with client diet intake scores. DESIGN: This cross-sectional regression analysis, part of a larger evaluation study (SuperShelf), used baseline data from client and food pantry surveys, food pantry inventories, assessments of client food selections ("client carts"), and single 24-hour client dietary recalls. PARTICIPANTS/SETTING: The analysis includes 316 clients who completed a survey (282 of whom completed a dietary recall measure) from one of 16 choice-based Minnesota food pantries during 2018-2019. Adult English, Spanish, or Somali-speaking clients were eligible in the case that they had selected food on the day of recruitment at their food pantry visit. MAIN OUTCOME MEASURES: A Healthy Eating Index-2015 (HEI-2015) Total score and 13 subcomponent scores were calculated for: pantry food inventories of food available on the shelf, client carts, and a 24-hour client dietary recall. STATISTICAL ANALYSIS: Descriptive statistics were generated for client and food pantry characteristics, and for HEI-2015 Total score and subcomponent scores. Linear regression models tested the association between HEI-2015 Total score and subcomponent scores for food pantry inventory and client carts, and for client carts and dietary recalls, adjusted for covariates. RESULTS: Food pantry inventory HEI-2015 Total score averaged 65.1, client cart Total score averaged 60.8, and dietary recall Total score averaged 50.9. The diet quality scores for inventory were not associated with client cart scores, except for Added Sugars (P = .005). Client cart HEI-2015 Total score was positively associated with client diet HEI-2015 Total score (P = .002) and associations for Total Fruits, Whole Fruits, Total Vegetables, Greens and Beans, Whole Grains, Seafood and Plant Proteins, and Added Sugars subcomponents were statistically significant. CONCLUSIONS: In choice-based Minnesota food pantries, the diet quality of food selected by clients was positively associated with client diet quality.

Needs and Preferences Among Food Pantry Clients.

INTRODUCTION: Food pantries serve households in need, including many with a family member with a diet-related chronic disease, yet data on client priorities to inform hunger relief practices are lacking. We used a statewide client survey in Minnesota to determine needs and priorities of food pantry clients in 2017 and 2019 and to identify how well Minnesota pantries met those needs in 2019. METHODS: Our survey was administered in 2017 and 2019. Food pantries in Minnesota were mailed 25 surveys each, with instructions for administering the surveys anonymously to clients. Descriptive analyses compared 2017 and 2019 data and compared client priorities for foods and services with how often they were available at the pantry in 2019. RESULTS: The 2017 survey represented 4,321 clients from 188 pantries; the 2019 survey represented 5,529 clients from 220 pantries. Most measures of food pantry use were consistently high across the years; about three-quarters of clients had been visiting the pantry for a year or more. In 2019, 85% of clients said it was important to have fresh fruits and vegetables, but only 52% said these were always available. About two-thirds had a household member with a diet-related chronic disease. The ability to choose their own foods was clients' top priority. CONCLUSION: The types of food most requested by clients tended to be healthy but were inconsistently available. Most important to clients was being able to choose their own food. Results underscore the need for continued monitoring of client priorities.

A Difference-in-Difference Study Evaluating the Effect of Minimum Wage Policy on Body Mass Index and Related Health Behaviors.

Minimum wage laws are a promising policy lever to promote health equity, but few rigorous evaluations have tested whether and how minimum wage policy affects health outcomes. This paper describes an ongoing difference-in-difference study evaluating the health effects of the 2017 Minneapolis Minimum Wage Ordinance, which incrementally increases the minimum wage to $15/hr. We present: (1) the conceptual model guiding the study including mediating mechanisms, (2) the study design, and (3) baseline findings from the study, and (4) the analytic plan for the remainder of the study. This prospective study follows a cohort of 974 low-wage workers over four years to compare outcomes among low-wage workers in Minneapolis, Minnesota, and those in a comparison city (Raleigh, North Carolina). Measures include height/weight, employment paystubs, two weeks of food purchase receipts, and a survey capturing data on participant demographics, health behaviors, and household finances. Baseline findings offer a profile of individuals likely to be affected by minimum wage laws. While the study is ongoing, the movement to increase local and state minimum wage is currently high on the policy agenda; evidence is needed to determine what role, if any, such policies play in improving the health of those affected.

Association between hourly wages and dietary intake after the first phase of implementation of the Minneapolis minimum wage ordinance.

OBJECTIVE: In 2018, Minneapolis began phased implementation of an ordinance to increase the local minimum wage to $15/h. We sought to determine whether the first phase of implementation was associated with changes in frequency of consumption of fruits and vegetables (F&V), whole-grain-rich foods, and foods high in added sugars among low-wage workers. DESIGN: Natural experiment. SETTING: The Wages Study is a prospective cohort study of 974 low-wage workers followed throughout the phased implementation of the ordinance (2018-2022). We used difference-in-difference analysis to compare outcomes among workers in Minneapolis, Minnesota, to those in a comparison city (Raleigh, North Carolina). We assessed wages using participants' pay stubs and dietary intake using the National Cancer Institute Dietary Screener Questionnaire. PARTICIPANTS: Analyses use the first two waves of Wages data (2018 (baseline), 2019) and includes 267 and 336 low-wage workers in Minneapolis and Raleigh, respectively. RESULTS: After the first phase of implementation, wages increased in both cities, but the increase was $0·84 greater in Minneapolis (P = 0·02). However, the first phase of the policy's implementation was not associated with changes in daily frequency of consumption of F&V (IRR = 1·03, 95 % CI: 0·86, 1·24, P = 0·73), whole-grain-rich foods (IRR = 1·23, 95 % CI: 0·89, 1·70, P = 0·20), or foods high in added sugars (IRR = 1·13, 95 % CI: 0·86, 1·47, P = 0·38) among workers in Minneapolis compared to Raleigh. CONCLUSIONS: The first phase of implementation of the Minneapolis minimum wage policy was associated with increased wages, but not with changes in dietary intake. Future research should examine whether full implementation is associated dietary changes.

Longitudinal Fruit and Vegetable Sales in Small Food Retailers: Response to a Novel Local Food Policy and Variation by Neighborhood Socioeconomic Status.

Small food retailers, including corner/convenience stores, pharmacies, gas-marts, and dollar stores, have historically stocked limited fruits and vegetables, though this may be changing. We examined increases in sales, customer purchasing, and stocking of fresh and/or frozen fruits and vegetables in small food stores over time and in relation to: (a) a local food policy (the Minneapolis Staple Foods Ordinance) and (b) neighborhood socioeconomic status (SES). We used longitudinal data (2014-2017) from 147 randomly-sampled stores in Minneapolis/St. Paul, USA, collected using interviewer-administered manager surveys (measuring sales and stocking) and customer intercepts/observations (measuring purchasing, n = 3039). The local policy required Minneapolis stores to meet minimum stocking standards for fresh/frozen produce and other healthy foods. No ordinance existed in St. Paul. Mixed regression models examined overall change over time and change by city and neighborhood SES. We observed significant increases over time (p < 0.05) in sales and purchasing of fresh fruit and in stocking of fresh fruit, frozen fruit, and frozen vegetables. We did not identify consistent statistical evidence for differential change in sales, purchasing, or stocking by city or neighborhood SES. Key study findings suggest limited differential effects of the local ordinance and/or neighborhood SES. However, findings also indicate significant time trends for some products, including consistent improvements in sales, customer purchasing, and stocking of fresh fruit. Given the ready-to-eat convenience of many fresh fruits and their broad appeal, fresh fruit appears a promising target for advancing the healthfulness of small food retailers.

Store and neighborhood differences in retailer compliance with a local staple foods ordinance.

BACKGROUND: Policies to improve healthy food retail have been recognized as a potential means of reducing diet-related health disparities. The revised 2014 Minneapolis Staple Foods Ordinance instituted minimum stocking standards for healthy, staple foods. The objective of this study was to examine retailer compliance with the policy, and whether compliance varied by neighborhood and store characteristics. METHODS: In this natural experiment, audits were conducted annually pre- and post-ordinance (2014-2017) in 155 small/nontraditional stores in Minneapolis, MN and a comparison city (St. Paul, MN). Compliance measures for 10 product categories included: (1) met requirements for ≥8 categories; (2) 10-point scale (one point for each requirement met); and (3) carried any item in each category. Store characteristics included store size and ownership status. Neighborhood characteristics included census-tract socioeconomic status and low-income/low-access status. Analyses were conducted in 2018. RESULTS: All compliance measures increased in both Minneapolis and St. Paul from pre- to post-policy; Minneapolis increases were greater only for carrying any item in each category (p < 0.01). In Minneapolis, corporate (vs. independent) stores were generally more compliant. No differences were found by neighborhood characteristics. CONCLUSIONS: Overall trends suggest broad movement among Minneapolis stores towards providing a minimum level of staple foods. Increases were greater in corporate stores. Trends do not suggest neighborhood-level disparities in compliance. STUDY REGISTRATION: ClinicalTrials.gov NCT02774330, retrospectively registered May 17, 2016.

Written Nutrition Guidelines, Client Choice Distribution, and Adequate Refrigerator Storage Are Positively Associated with Increased Offerings of Feeding America's Detailed Foods to Encourage (F2E) in a Large Sample of Arkansas Food Pantries.

BACKGROUND: Millions of food-insecure households in the United States obtain food from food pantries each year. These foods are often of insufficient nutritional quality. OBJECTIVE: Our aim was to describe the frequency with which Arkansas food pantries offer foods included in Feeding America's Detailed Foods to Encourage (F2E) framework, and examine food pantry characteristics associated with increased frequency of offering F2E and other foods. DESIGN: This was a 27-item cross-sectional online survey that assessed food pantries' characteristics (eg, storage capacities, number of clients served) and typical food offerings. PARTICIPANTS/SETTING: Partnering with five of Arkansas's six food banks, 764 e-mail invitations were sent to food agency managers across the state. A final sample of 357 food pantries was included in the analyses. MAIN OUTCOME MEASURES: The primary outcomes of interest were the frequencies of offering specific F2E and F2E in general. The F2E framework was developed by Feeding America to more accurately assess food banks' inventories, and its categories (Fruits and Vegetables; Protein; Dairy; and Grains) are generally consistent with MyPlate. STATISTICAL ANALYSES PERFORMED: Descriptive statistics were computed for all food pantry characteristics and frequency of foods offered. Associations between food pantry characteristics and the frequency of offering F2E were examined via multiple linear regression and path analysis. RESULTS: Only 18.5% of food pantries had written nutrition guidelines, and only 19.3% offered client choice distribution. The F2E most commonly offered were meat/poultry/seafood without breading and not fried (59.6%) and peanut butter (58.2%). The least commonly offered F2E were nuts/seeds with nothing added (3.8%) and low-fat/1%/skim cheese (8.2%). Written nutrition guidelines (P<0.001), client choice distribution (P=0.003), and adequate refrigerator storage (P=0.010) were associated with more frequently offering F2E. CONCLUSIONS: This study fills a gap in knowledge by documenting food pantry characteristics that are associated with the frequencies of offering specific types of healthy foods.