Supporting each other: Older adults' experiences empowering food security and social inclusion in rural and food desert communities.

Older adults vulnerable to food insecurity are at risk of poor psychological and physical health. Poor public infrastructure or proximity to food sources can exacerbate risk of food insecurity. Reduced statutory services for social care has heightened the responsibility on third sector organisations and community-led volunteering, essential to supporting healthy ageing in place and reducing the inequalities of ageing. The aim of this qualitative study was to explore how older adults' volunteering with a third sector organisation focused on food access supports food security and builds social capital for socially or economically marginalised older adults within rural and food desert communities. The study aims to bridge the knowledge gap of how volunteering in vulnerable geographies affects food insecurity and community. Semi-structured interviews were conducted with seven older (55+) volunteer 'meal makers' working with the third sector organisation Food Train and its 'Meal Makers' project. Interview recordings were transcribed and thematically analysed. Ecomap methodology was used to illustrate the lived experiences of older adult volunteers as told through the interviews. Two themes were identified by Thematic Analysis: (1) Networks, connectedness, and exposure to social capital, and (2) Supplementary support. This study finds that older adult volunteers are well placed within community interventions supporting food insecure older adults in rural or food desert communities. Ecomaps demonstrated that high social capital volunteers can mediate food access barriers and highlighted points of local knowledge and social connection. Volunteer engagement provides opportunities for food secure older adults to share local knowledge and build networks of food support and social inclusion for food insecure older adults. Older age volunteering should be advocated as a multi-faceted intervention promoting mutual health and wellbeing in volunteer and beneficiary.

Designing a Contextualized Food-Based Strategy to Improve the Dietary Diversity of Children in Rural Farming Households in Central Uganda.

BACKGROUND: Food-based strategies have a high potential of improving the diet quality and reducing the prevalence of nutrient deficiencies in agriculture-dependent communities. Their design is however complex with trade-offs that are rarely systematically presented to allow replication and efficient contextualization. OBJECTIVE: The systematic design of a food-based strategy to improve the dietary diversity of children in rural farming communities in Uganda. METHODS: The intervention mapping protocol was used to provide a systematic approach to developing theory-based and evidence-based intervention methods and strategy. RESULTS: The priority behavioral and environmental determinants identified were related to food production, consumption, and efficacy while the personal determinants focused on knowledge, skills, self-efficacy, attitude, and outcome expectations. The aim of the resulting strategy was set to improve the availability, accessibility, and consumption of diverse foods, with a particular focus on production diversity, production practices, market access, and market diversity. Behaviour change methods were selected to enhance ability and self-efficacy, strategic goal setting, and provision of feedback. The strategy focused on household groups for learning, demonstration, practice, and social support. The validation showed that the determinants and actors incorporated in the strategy were important and relevant for improving the productivity, food availability, dietary diversity, livelihoods, and health of rural farming households and communities. CONCLUSION: Application of the protocol yielded a contextualized food-based strategy that can be adjusted for use in other smallholder contexts in developing countries by piloting implementation plans based on the strategy; reassessing the key determinants and implementing the revised strategy; or replicating the whole design process.

Plain language titleDesigning a Food-Based Strategy to Improve the Dietary Diversity of Children in Farming Households in Central UgandaPlain language summaryFood-based strategies have a high potential of improving the diet quality of communities that depend on agriculture for their food and livelihoods. However, the design of food-based strategies is complex and rarely systematically presented to allow replication and efficient contextualization. The intervention mapping protocol was used to systematically design a food-based strategy to improve the dietary diversity of children in rural farming communities in Uganda. Through this process, the main factors influencing dietary diversity were identified. The factors were related to food production and consumption, knowledge, skills, self-assuredness, attitude, and the expected outcomes. The developed strategy was designed to improve the availability, accessibility, and consumption of diverse foods. The strategy mainly focused on the diversity of foods produced by households, the production practices used, household access to markets, and the diversity of foods available in these markets. Household groups were central to the selected behavior change methods as they would provide an environment for learning, demonstration, practice, and provide social support. The strategy and its development process can be used as per the implementation plan or further adjusted for use in other smallholder settings in developing countries.

Association of food insecurity with changes in diet quality, weight, and glycemia over two years in adults with prediabetes and type 2 diabetes on medicaid.

Little is known about longitudinal associations between food insecurity (FI) and diet, weight, and glycemia in people with prediabetes and type 2 diabetes (T2D). In a secondary analysis of Medicaid-enrolled health center patients with prediabetes or T2D in Boston, Massachusetts (N = 188), we examined associations between food security (FS) and measures of diet quality, weight, and hyperglycemia. FS (10-item USDA FS module) was ascertained at baseline, 1-year, and 2-year follow-up and categorized as persistently secure, intermittently insecure, or persistently insecure. Associations between FS category and changes in Healthy Eating Index-2020 (HEI-20), body mass index (BMI), and hemoglobin A1c (A1c) from baseline to year 2 were assessed using multivariate generalized linear models. Participants had median (p25, p75) age of 52 (42, 57); 71.8% were female and 62.8% Hispanic. Over follow-up, 32.4% were persistently food secure, 33.0% intermittently insecure, and 34.5% persistently insecure. Baseline mean (SD) HEI-20, BMI, and A1c were 55.8 (14.5), 35.9 (8.7) kg/m2, 7.1% (1.6) and did not differ by FS category. FS category was not associated with changes in HEI-20, BMI, and A1c at 2 years (all p > 0.05). Results suggest that Medicaid-enrolled adults with prediabetes or T2D, regardless of FS status, would benefit from dietary and weight management interventions.

Key predictors of food security and nutrition in Africa: a spatio-temporal model-based study.

There is voluminous literature on Food Security in Africa. This study explicitly considers the spatio-temporal factors in addition to the usual FAO-based metrics in modeling and understanding the dynamics of food security and nutrition across the African continent. To better understand the complex trajectory and burden of food insecurity and nutrition in Africa, it is crucial to consider space-time factors when modeling and interpreting food security. The spatio-temporal anova model was found to be superior(employing statistical criteria) to the other three models from the spatio-temporal interaction domain models. The results of the study suggest that dietary supply adequacy, food stability, and consumption status are positively associated with severe food security, while average food supply and environmental factors have negative effects on Food Security and Nutrition. The findings also indicate that severe food insecurity and malnutrition are spatially and temporally correlated across the African continent. Spatio-temporal modeling and spatial mapping are essential components of a comprehensive practice to reduce the burden of severe food insecurity. likewise, any planning and intervention to improve the average food supply and environment to promote sustainable development should be regional instead of one size fit all.

Food is Medicine Initiative for Mitigating Food Insecurity in the United States.

OBJECTIVES: While several food assistance programs in the United States tackle food insecurity, a relatively new program, "Food is Medicine," (FIM) initiated in some cities not only addresses food insecurity but also targets chronic diseases by customizing the food delivered to its recipients. This review describes federal programs providing food assistance and evaluates the various sub-programs categorized under the FIM initiative. METHODS: A literature search was conducted from July 7, 2023 to November 9, 2023 using the search term, "Food is Medicine", to identify articles indexed within three major electronic databases, PubMed, Medline, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Eligibility criteria for inclusion were: focus on any aspect of the FIM initiative within the United States, and publication as a peer-reviewed journal article in the English language. A total of 180 articles were retrieved; publications outside the eligibility criteria and duplicates were excluded for a final list of 72 publications. Supporting publications related to food insecurity, governmental and organizational websites related to FIM and other programs discussed in this review were also included. RESULTS: The FIM program includes medically tailored meals, medically tailored groceries, and produce prescriptions. Data suggest that it has lowered food insecurity, promoted better management of health, improved health outcomes, and has, therefore, lowered healthcare costs. CONCLUSIONS: Overall, this umbrella program is having a positive impact on communities that have been offered and participate in this program. Limitations and challenges that need to be overcome to ensure its success are discussed.

"If the food is finished after my brother eats then we (girls) sleep hungry." Food insecurity and dietary diversity among slum-dwelling adolescent girls and boys in Pakistan: A mixed methods study.

To explore gender differences in food insecurity (FI) and minimum dietary diversity (MDD) among adolescent girls and boys in a slum community in Karachi, we employed an explanatory sequential mixed methods study that included a survey of 391 girls and boys of 10-19 years of age and followed by semi-structured interviews of eight purposely selected food insecure adolescents. Survey data was analyzed by Cox proportional algorithm and adjusted prevalence ratios (APR) with 95% confidence intervals (CI) were estimated for associated factors of FI and thematic analysis was undertaken for qualitative work. Meta inferences for mixed methods study were drawn by joint display analysis of survey results juxtaposed to qualitative findings. Overall, FI among adolescents was prevalent (46.5%) which was not different between boys (52.7%) and girls (47.3%) (APR 0.8, (95% CI 0.6, 1.2); p-value-0.4). MDD (5/10 food groups consumed) was achieved by only 23.0% and it was also not different between boys (25.1%) and girls (20.9%) (p-value-0.3). The survey found no significant difference in FI and MDD between boys and girls however, qualitative findings provided insight into the cultural practices at mealtimes that prefer boys. Qualitative results contrasted the survey results and revealed the increased vulnerability of girls towards FI and low MDD compared to boys due to gender norms.

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.

The big business of sustainable food production and consumption: Exploring the transition to alternative proteins.

A widespread sense of the unsustainability of the food system has taken hold in recent years, leading to calls for fundamental change. The role of animal agriculture is central to many of these debates, leading to interest in the possibility of a "protein transition," whereby the production and consumption of animal-derived foods is replaced with plant-based substitutes or "alternative proteins." Despite the potential sustainability implications of this transition, the developmental trajectories and transformative potential of the associated technologies remain underexplored. This article sheds light on these dynamics by addressing two questions: 1) how have alternative protein innovations developed over the past three decades, and 2) what explains their more recent acceleration? To answer these questions, the article makes an empirical analysis of four alternative protein innovations, and the partial destabilization of the animal agriculture system between 1990 and 2021, guided by the multi-level perspective. The analysis highlights an intensification in corporate engagement with alternative protein development and diffusion. This intensification is judged to be consistent with the beginnings of a wider corporate reorientation, occurring alongside a rise in pressures on the animal agriculture system, notably an increasing scientific consensus and societal awareness of the links between climate change and meat-intensive diets. The paper demonstrates how differences in technological maturity across the niche innovations have resulted in potentially transformative pressures, which are consistent with an emerging sustainability transition, manifesting differently in terms of the extent of diffusion of the alternative protein niches.

Does alleviating poverty increase cognitive performance? Short- and long-term evidence from a randomized controlled trial.

In this Registered Report, we investigated the impact of a cash transfer based poverty alleviation program on cognitive performance. We analyzed data from a randomized controlled trial conducted on low-income, high-risk individuals in Liberia where a random half of the participants (n = 251) received a $200 lump-sum unconditional cash transfer - equivalent approximately to 300% of their monthly income - while the other half (n = 222) did not. We tested both the short-term (2-5 weeks) and the long-term (12-13 months) impact of the treatment via several executive function measures. The observed effect sizes of cash transfers on cognitive performance (b = .13 for the short- and b = .08 for the long-term) were roughly three and four times smaller than suggested by prior non-randomized research. Bayesian analyses revealed that the overall evidence supporting the existence of these effects is inconclusive. A multiverse analysis showed that neither alternative analytical specifications nor alternative processing of the dataset changed the results consistently. However cognitive performance varied between the executive function measures, suggesting that cash transfers may affect the subcomponents of executive function differently.

Assessing rural household's food groups-and-sources and dietary diversity pattern in Malaita Province.

Access to and availability of various food sources is not an issue in rural communities. However, there is no guarantee that households are not affected by nutritional inadequacy, which is still a problem in most underdeveloped nations. A mixed-methods study was conducted to determine the HDDS through the snowballing method for the last 12 months' food groups-and-sources and the 48-h diet recall. Ninety-eight households in two rural communities surrounding Sikwafta (zone one) and Malu'u (zone two) participated in the interview between April and May 2019. The results were then analyzed through SPSS and QDA MINER. The aim is to analyze the household dietary patterns of the communities between the two zones. The study also hypothesizes that the dietary pattern of households has not changed. Results showed that a total of nine food groups were consumed: grain, white roots, tubers, plantains, oils/fats (95.90%), condiments (83.70%), and meat/poultry/sea foods (77.60%). The majority of the food consumed comes from the gardens, followed by other food sources, which make up the average HDDS of five. A correlation analysis found a statistically significant relationship between HDDS and total meal (0.504*), with no relationships between demographics. When comparing 48-h food sources-and-groups to the previous year, there was little to no difference in accessibility and availability. This implies that the majority of households are likely to achieve their nutritional needs within the parameters of their dietary trend. Even though households have adequate access to food, there is a significant need to improve their nutritional needs, even if they consume the average amount of the required food groups.

Increasing Household Diet Diversity and Food Security in Rural Rwanda Using Small-Scale Nutrition-Sensitive Agriculture: A Community-Engaged Proof-of-Concept Study.

Malnutrition and food insecurity remain high in rural Rwanda, where residents consume a low-diversity diet provided through subsistence farming. Agricultural interventions using kitchen gardens may improve diet diversity in some populations. However, little is known about their efficacy when developed using community-based participatory research in combination with nutrition education focused on the empowerment of women. The objective of this study was to develop and implement a kitchen garden and nutrition education intervention using a community-engaged model and examine its impact on household diet diversity and food security. Using a mixed methods community-level design, we assessed a 16-week intervention implemented in Cyanika, Rwanda. Stratified purposeful sampling was used to select women participants representing 42 households. Household diet diversity scores (HHDS) and hunger scores were calculated at the baseline, post-intervention and one-year follow-up. HDDS increased after intervention from a pre-intervention intake of 2.59 [1.3] food groups/day, to 4.85 [1.6] at four months post-intervention and at one year post-intervention, reaching 5.55 [1.3]. There were no significant changes in household hunger scores. Our results indicate that collaborative community-engaged nutrition-sensitive agricultural interventions can increase household diet diversity; however, future work should explore whether this type of intervention strategy can lead to sustained changes and impact nutritional adequacy in this population.

Perceptions of the double value coupon program in southern Illinois.

Introduction: Purchasing produce at farmers markets represents one method by which individuals can purchase and have access to healthful and seasonal fruits. Despite the extension of nutrition assistance programs to local farmers markets, fruit and vegetables consumption has remained below the recommended guidelines, specifically in rural geographical locations. Statement of purpose: The purpose of the study was to explore the aspects of the Link Up Illinois Double Value SNAP Nutrition Incentives Program (DVCP) and its effects on food selection at rural farmers markets for individuals enrolled in nutrition assistance programs. Methods/approach: The current study uses a qualitative methodology in order to uncover barriers local health departments and farmers markets face to implementing the DVCP in their communities and to discover the perspectives of low-income individuals who utilize the DVCP. This paper explores the organizational and community member perceptions of the DVCP and its administration. Semi-structured interviews and one focus group were conducted with health educators from county health departments, DVCP stakeholders, farmers market managers, local farmers, and residents who used the DVCP. A purposeful sampling method was used, intentionally selecting individuals with lived experiences of the research objective. Data were analyzed using a three-cycle coding process, then categorized into overarching themes until thematic saturation was reached. Results: There were a total of 19 individuals who participated in the study. Five themes and four subthemes emerged from data analysis, including organizational capacity, exposure to the DVCP, purchasing power, DVCP advancements, and values. Conclusion/implications: These findings contextualize the facilitators and barriers of multiple stakeholders when implementing nutrition assistance programs at farmers markets. Other similar "double value" programs can utilize these lessons when seeking to increase participation of underrepresented populations at local farmers markets.

The impact of the Mamata conditional cash transfer program on child nutrition in Odisha, India.

Based on a triple difference estimation, this paper shows that the impact of a universal cash transfer on child nutrition differs by household wealth. In 2011, Odisha state in India introduced a conditional maternal cash transfer named "Mamata Scheme". Using data from the National Family Health Survey, I find that the program reduced child wasting by 7 percentage points, a 39% reduction compared to the average prevalence of wasting in the pre-program period. The reduction in child wasting is driven by children from households in the top four of five national wealth quintiles, for whom the program reduced wasting by 13 percentage points or a reduction of about 80%. Children from households in the bottom wealth quintile were 13 percentage points more likely to suffer from wasting than their wealthier counterparts. Reduction in stunting is also limited to children from households in the top four wealth quintiles, with an average program effect of 12 percentage points, that is, a 40% reduction. The results suggest that access to universal cash benefit schemes is important for mothers and children from marginalized households to realize proportionate benefits.

Adult food choices in association with the local retail food environment and food access in resource-poor communities: a scoping review.

BACKGROUND: There is a growing body of research on local retail food environments globally in both urban and rural settings. Despite this, little research has been conducted on adult food choices, local retail environments, and healthy food access in resource-poor communities. The purpose of this study is therefore to provide an overview of the evidence on adult food choices (measured as dietary intake) in association with the local retail food environment and food access in resource-poor communities (defined as low-income communities and/or households). METHODS: We searched nine databases for studies published from July 2005 to March 2022 and identified 2426 records in the primary and updated search. Observational studies, empirical and theoretical studies, focused on adults ≤ 65 years, published in English peer-reviewed journals, examining local retail food environments and food access, were included. Two independent reviewers screened identified articles using the selection criteria and data extraction form. Study characteristics and findings were summarized for all studies and relevant themes summarized for qualitative and mixed methods studies. RESULTS: A total of 47 studies were included in this review. Most studies were cross sectional (93.6%) and conducted in the United States of America (70%). Nineteen (40.4%) studies assessed the association between food choice outcomes and local retail food environment exposures, and evidence on these associations are inconclusive. Associations of certain food choice outcomes with healthy food retail environments were positive for healthy foods (in 11 studies) and unhealthy foods (in 3 studies). Associations of certain food choice outcomes with unhealthy retail food environment exposures were positive for unhealthy foods in 1 study and negative for healthy foods in 3 studies. In 9 studies, some of the food choice outcomes were not associated with retail food environment exposures. A healthy food store type and lower food prices were found to be major facilitators for healthy food access in resource-poor communities, while cost and transportation were the main barriers. CONCLUSIONS: More research is needed on the local retail food environment in communities in low- and middle-income countries to develop better interventions to improve food choices and access to healthy foods in resource-poor communities.

Quantification of food loss and waste and its percentage estimation along the food supply chain in Korea.

Recent changes and food crisis at the international level have raised the awareness of food security in Korea; however, a problem that seems more urgent than the crisis is the lack of a national strategy for food loss and waste (FLW) in Korea. Moreover, where and to what extent food waste is generated in the food supply chain (FSC) is unknown. This study aimed to quantify food waste through material flow analysis and estimate the percentage of loss and waste at each stage of the FSC. The results revealed that 34.1% of the total supply of fruits and vegetables, meat and cereals was lost and wasted in Korea in 2015. Given that the proportion of edible parts in the food supplied for human consumption usually reaches 94.9%, a considerable amount of the food must have been discarded even though they are mostly edible. Furthermore, 47.6% of the total losses and wastes occurred at the upstream stages in the FSC, which include the agricultural production and processing stages, and 52.4% occurred at the downstream stages, which included the consumption stage, that is, distribution and household stages. In particular, more fruit and vegetable FLW were generated in the upstream stages of the FSC, whereas more meat and cereal loss and waste were generated in the downstream stages. The efficiency of policy implementation can be enhanced if food waste reduction strategies involve focusing more on areas with high losses.

Plant-Based Family Food Packages and Weight Change in Children During the COVID-19 Pandemic.

Food insecurity and obesity coexist among children and families. We examined the association between receipt of plant-based family food packages from the Massachusetts General Hospital Revere Food Pantry and change in body mass index (BMI), adjusted for age and sex, among children during the COVID-19 pandemic. Among 35 children aged 2 to 18 years who received the packages between January 2021 and February 2022, we observed a change in BMI of -0.04 kg/m2 (95% CI, -0.08 kg/m2 to -0.01 kg/m2) for each package received. Our results suggest plant-based food packages might mitigate, and potentially reverse, BMI increase in children in households seeking food assistance.