Multidisciplinary study of the health and nutritional status of persons living in households at risk of poverty with children in Germany (MEGA_kids): Study design and methods.

Background: In Germany, the nutritional situation of adults and children living in households at risk of poverty has been insufficiently studied so far. Aim: The aim of the mixed-methods study MEGA_kids is to gain a deeper understanding of the nutritional situation including socioeconomic, behavioral, and attitudinal factors and health characteristics among persons living in families at risk of poverty. Method: MEGA_kids is a mixed-methods cross-sectional study consisting of four modules combining quantitative and qualitative methods. The first module (A) applies self-administered questionnaires to assess the individual's diet, household food insecurity, and several other factors among adults and children of 500 households. Cash receipts are used to assess household's food expenses. For the second module (B), a semistructured interview guide is used to identify factors influencing food security and nutritional quality from the perspective of a subsample of module A (n = 20). The third module (C) applies the participatory World Café technique to explore experiences and generate ideas for tailored support measures for a healthy diet from the perspective of 40 parents participating in module A. Finally, the fourth module (D) investigates the knowledge and usage of existing nutrition-related preventive measures among 200 parents at risk of poverty by using an online questionnaire. Conclusion: By providing a comprehensive picture of nutritional aspects of families living at risk of poverty, MEGA_kids will guide officials to target and prioritize public health nutrition measures, inform policy makers to implement and improve healthy policies and, finally, identify research gaps to be prioritized.

Impact of a smoking cessation program on smoking prevalence and food security among food pantry users - a study protocol for a pragmatic cluster randomised controlled trial.

BACKGROUND: Among food pantry users there is a high prevalence of both smoking and food insecurity, which may be related to one another. This study aims to evaluate the impact of a smoking cessation program carried out in food pantries on the smoking status and the food security status of food pantry users. METHODS / DESIGN: Before starting the cluster randomised controlled trial, stakeholders will be engaged to adapt a behavioural group counselling program for smoking cessation to the needs of the food pantry users in a pre study. Food pantry users and workers as well as other experts, such as smoking cessation trainers, social workers, and psychologists, will be involved, using the world café technique and telephone interviews and a qualitative thematic analysis for data analysis to design the concept of the intervention program will be applied. In the second phase, the impact of the intervention on the smoking status and on food insecurity will be investigated by a cluster randomised controlled trial. A total of 416 food pantry users across 32 clusters (food pantries) in Berlin, Germany, should be recruited and randomly assigned to either the intervention group or the waiting list control group. The intervention will consist of a behavioural group counselling program for smoking cessation, specially tailored for food pantry users, as well as optional nicotine replacement therapy and the implementation of environmental smoking reduction measures in the food pantries. The primary outcomes 6 months after the treatment will be self-reported continuous smoking abstinence, validated by exhaled carbon monoxide (< 10 ppm of carbon monoxide), and increased food security level (the percentage of participants with an improved food security level). DISCUSSION: This study will be the first long-term investigation into the effect of a smoking cessation program on smoking status and food insecurity. The results of this study will inform the implementation of smoking cessation programs in food pantries throughout Germany. TRIAL REGISTRATION: Prospectively registered DRKS00020037 . Registered 29 April 2020.

The German Food Bank System and Its Users-A Cross-Sectional Study.

Although food banks are a well-known resource for low-income people struggling to meet their food needs, they have rarely been investigated on a large scale. This study aims to contribute to the actual debate about the potential and limitations of food banks to decrease the prevalence of food insecurity by providing a representative picture of the German food bank system and its users. Publicly accessible data were used to map residents, public welfare recipients, and food banks. In addition, a comprehensive survey was distributed to all 934 "Tafel" food banks. The results show that nearly all residents and welfare recipients have access to at least one food bank located in the districts in which they reside. Differences in the density of food banks exist between eastern and western Germany. Food banks provide mainly healthy fresh food, but they heavily rely on food donations from local retailers and on volunteer labor. Although changes in the number of user households by income seem to mirror trends in the number of welfare recipients, food bank users appear to represent only a fraction of the food-insecure population in Germany. Food banks might have the potential to improve users' diet and food security, but they are not able to reach all food-insecure residents in Germany.

The Nutritional Quality of Food Provided from Food Pantries: A Systematic Review of Existing Literature.

BACKGROUND: In many affluent countries, food-insecure households use food pantries to keep their family fed. The long-term dependence of many users on these programs calls for a systematic review of studies on the nutritional quality of food provided by food pantries. OBJECTIVE: The purpose of this systematic review was to summarize the current scientific evidence about the nutritional quality of food bags distributed by food pantries. METHODS: A systematic literature search was conducted in the electronic databases PubMed, PsycINFO, PsycARTICLES, and Psychology Behavioral Sciences Collection to identify cross-sectional, cohort, and intervention studies reporting baseline data conducted in high-income countries and published between 1980 and 2015, which reported the nutritional quality of food bags distributed by food pantries. Identified citations were screened in two stages and data were independently extracted by two authors using a predefined data sheet. The quality of included studies was evaluated using criteria of an adapted Ottawa Scale. The systematic review was reported in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS: Applying the two-stage screening, 9 of 1,546 articles were identified for inclusion. Nutritional quality of food bags varied widely between and within studies. Milk products, vitamins A and C, and calcium were provided in particularly low amounts. None of the studies were nationally representative and only a few studies controlled for the household composition of the recipients of food bags. CONCLUSION: Food pantries likely have a strong influence on users' diets, but the food pantries examined in the selected studies were largely unable to support healthy diets. The distribution of more perishable foods would increase users' diet quality and may have an immense potential to address malnutrition in vulnerable population groups.

The Dietary Quality of Food Pantry Users: A Systematic Review of Existing Literature.

BACKGROUND: Users of food pantries often have a long history of food insecurity and may be vulnerable to nutritional deficiencies. The quality of their diets is not well researched. OBJECTIVE: The purpose of this systematic review was to summarize the published evidence about the dietary quality of food pantry users. METHODS: Systematic database searches of PubMed, PsycINFO, PsycARTICLES, and Psychology Behavioral Sciences Collection, and hand searches of references were conducted to identify cross-sectional, cohort, and intervention studies reporting baseline data, conducted in high-income countries and published between 1980 and 2015, which reported on the nutritional adequacy of individuals who have used a food pantry at least once in the previous 12 months. All identified citations were screened and independently assessed for eligibility. Results for dietary quality were summarized for overall diet quality, energy, food groups, macro- and micronutrients separately. The risk of bias of included studies was evaluated by using criteria of an adapted Ottawa Scale. The systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS: After applying predefined eligibility criteria, 16 articles were identified for inclusion. The diet quality among included food pantry users was low, as reflected by inadequate mean group intake of energy, fruits and vegetables, dairy products, and calcium. Even if the group mean intake was adequate, large percentages of study populations did not meet the recommendations for vitamins A, C, D, and B vitamins, or iron, magnesium, and zinc. The representativeness of the studies varied widely and none of them were nationally representative. CONCLUSION: The current evidence suggests that the dietary intake of most food pantry users does not meet recommendations. Future research should draw more representative samples and investigate the impact of food pantries on users' diet.

Heart failure events, and case fatalities in Switzerland based on hospital statistics and cause of death statistics.

OBJECTIVES: In Switzerland there is a shortage of population-based information on heart failure (HF) incidence and case fatalities (CF). The aim of this study was to estimate HF event rates and both in- and out-of-hospital CF rates. METHODS: Data on HF diagnoses coded according to I 50 (ICD 10) were taken from the Federal Hospital Statistics Database and the Cause of Death Database for the year 2005. RESULTS: Although the total estimated number of HF events was higher for women (n = 4,201) than for men (n = 3,819), men showed higher numbers up to age group 65-74. Looking at age-specific HF cases per 100,000 population, men had higher rates in all age groups. The latter is also true of the age-standardised HF event rate (82.9/100,000 versus 51.4/100,000 population). Overall, CF was 26.3% and higher for women (32.2%) than for men (19.8%). The same is true of out-of-hospital CF but not of in-hospital CF. CONCLUSION: The HF event rate was 20% higher than the HF hospital discharge rate. Out-of-hospital death from HF accounted for the largest proportion of total HF deaths. Sex differences in both the number of HF events and HF event rates can be explained by the larger number of women than men aged 55+ in the Swiss population.