Unlocking gender dynamics in food and nutrition security in Ghana: assessing dietary diversity, food security, and crop diversification among cocoa household heads in the Juaboso-Bia cocoa landscape.

BACKGROUND: Malnutrition is a worldwide problem that impacts every country, affecting one in three individuals, including Ghana. According to estimates from the Food and Agriculture Organization (FAO), 690 million people were undernourished globally in 2019. Malnutrition is no exception in rural cocoa communities in Ghana. The expansion of cocoa is causing food insecurity and low dietary diversity in most cocoa-growing areas. There is little information on the food security status and dietary diversity among male-headed and female-headed cocoa households in the Juaboso-Bia cocoa landscape. Thus, this study sought to explore the dietary diversity distribution, food security status, sources of staple food, food unavailability periods, food production status, themes contributing to low dietary diversity and food insecurity, and perception of the impact of cocoa expansion on crop diversification among male-headed and female-headed cocoa households in the study area. METHODS: Both quantitative and qualitative research methods were employed to address the research questions. The study collected 200 semi-structured questionnaire data and 14 in-depth interview data from cocoa household heads in the Juaboso-Bia landscape. The survey data was cleaned and analysis, such as household dietary diversity status, food security status, and binary logistic regression were performed in the Statistical Package for Social Scientists (SPSS). The in-depth interviews were analyzed using thematic analysis. RESULTS: Through this study, it was revealed that 62.8% of the male-headed cocoa households had medium to high dietary diversity compared to their female counterparts 39.3%. About 47.9% of the male-headed households were food secure than the female-headed households (29.1%). Moreover, the months that both male and female-headed households recalled facing severe food unavailability were July and June. In addition, climate change/variability, unavailable lands, poverty, large household size, and gender stereotypes were themes promoting low dietary diversity and food insecurity among male and female-headed households. Furthermore, sex, total household income, and cropland conversion to cocoa were the variables influencing household heads' perception of the impact of cocoa expansion on crop diversification. CONCLUSIONS: The study showed that the male-headed cocoa households had high dietary diversity and were food secure than the female-headed cocoa households, lending credence to the conceptual framework applied in this study. There is a significant relationship between household head gender and food security status. Therefore, this study recommends the following interventions to improve dietary diversity and food security among male and female-headed cocoa households: raise awareness about the need for diverse diets and provide practical information on how to incorporate a greater variety of food groups into their daily meals; and promote gender equity and inclusivity in food security interventions. Future research could investigate how gender mainstreaming policies in agriculture have helped empower and improve the food security of female-headed households in Ghana.

Fruit and Vegetable Intake, Food Security, Barriers to Healthy Eating, and Empowerment among Dietetic Interns and Physician Assistant Interns: A Cross-Sectional Pilot Study.

Students are required to complete supervised practice hours prior to becoming Registered Dietitians and Physician Assistants. Research suggests that environmental and social factors affect dietetic interns' diets during their internship, although these factors have not been studied among physician assistant interns. This cross-sectional study utilized an online survey to compare dietetic interns' (n = 81) and physician assistant interns' (n = 79) fruit and vegetable intake, food security, barriers to healthy eating, and empowerment for making healthy dietary choices during an internship. Differences were assessed via independent t-tests and chi-square distributions. The significance was set at p < 0.05. Dietetic interns had a higher vegetable intake (p = 0.002) while physician assistant interns had higher rates of food insecurity (p = 0.040). Dietetic interns reported a greater impact on their dietary choices due to mental fatigue (p = 0.006), while physician assistant interns' dietary choices were more heavily impacted by peer influence, interactions with patients, and interactions with preceptors (p < 0.05). There was not a group difference in overall empowerment (p = 0.157), although both groups rated empowerment for asking for help with food and nutrition challenges the lowest of the empowerment sub-items. Addressing interns' unique needs may support students' educational success and wellbeing once they are professionals, promote a diverse workforce, and ensure optimal care for patients.

Has food security in the EU countries worsened during the COVID-19 pandemic? Analysis of physical and economic access to food.

The aim of the paper is to provide an ex-post assessment of the impact of the COVID-19 pandemic on food insecurity in the EU-27 countries expressed by physical and economic food access. We analysed trade and price effects, together with food insecurity and malnutrition indicators. Actual levels of the indicators were compared with their pre-pandemic magnitudes and/or with counterfactual levels derived from predictive models. We also aimed to compare the objective statistics with the subjective consumers' perception of their households' food security. Our research indicates that the EU food trade was more resilient to COVID-19 impacts than the trade in non-food products, while food trade decreases were of a temporary nature. This did not affect the trade balance significantly; however, the import reduction threatened the physical food access in most EU countries. Regarding economic food access, the results indicate that the increase in food prices was offset by the increase in disposable income. It may suggest that the COVID-19 pandemic did not significantly affect the deterioration of economic access to food in the EU countries. However, the prevalence of severe food insecurity in the total population or the proportion of households reporting inability to afford a meal with meat, chicken, fish, or a vegetarian equivalent increased in 2020-2021 compared to 2019. This means that the comparative analysis of the real data on prices and households' income, as well as consumer financial situation and food consumption affordability, does not offer a clear answer concerning the impact of the COVID-19 pandemic on the food security of EU households.

Designing a community-supported agriculture model for increasing food security.

The institutionalization of participation is a topic that has been discussed in different ways over the last few decades. There are many diverse aspects of the agricultural sector and rural communities that can be identified and used to bring about a major change in agriculture. Community supported agriculture (CSA) is one of the participatory and sustainable approaches that can be used in this regard. CSA is a relatively new socioeconomic model for producing food materials, increasing food security, improving the quality of food materials and conserving agricultural land, plants and animals. This research aimed to design a CSA model that was operationalized in Markazi province, Iran, with the aim of increasing food security. It was a survey study applied through a questionnaire. The statistical population (N=110) consisted of all active farmers in Ghazel Dareh village who were selected through the census method. The necessary information was collected through a questionnaire (84 of which were completed and returned) and analyzed using SPSS v. 25 and LISREL. The results showed that economic, socio-institutional, policy-making, educational and infrastructural factors significantly influenced the development of CSA. Infrastructural and socio-institutional factors with impact factors of 0.88 and 0.54 had the largest and smallest effect on CSA, respectively. Finally, since all impact factors were positive, we can say that improving each of these factors could improve the development of CSA in the study area.

Using photovoice to generate solutions to improve food security among families living in remote Aboriginal and/or Torres Strait Islander communities in Australia.

The right to food security has been recognised internationally, and nationally in Australia by Aboriginal Community Controlled Health Organisations. This study aims to explore food (in)security and solutions for improvement of food security in remote Aboriginal and/or Torres Strait Islander communities in Australia, from the perspective of caregivers of children within the context of the family using photovoice. Participants took part in workshops discussing participant photographs of food (in)security, including solutions. Themes and sub-themes with associated solutions included traditional food use, sharing as a part of culture, the cost of healthy food, energy and transport, and housing and income. Community leaders used these data in setting priorities for advocacy to improve food security in their communities.

Food Security and Diet Quality Improvements among At-Risk, Low-Income, Older Adults following a Free Meal Pilot Program.

Older adults are at a greater risk for food insecurity compared to the general population. This study aimed to describe changes in diet quality and food insecurity following a free meal program at low-income, older adult housing complexes. Study participants were recruited from two low-income older adult public housing complexes in Kentucky. Fifty participants were enrolled and received 1-4 free weekly meals across 3 months as part of the Meals on Wings pilot program. Surveys and a 24 h dietary recall were completed at baseline and 3 months. Participants were predominately female, 69 years of age, and Black or African American race. Food security status (FSS) and dietary quality through the Healthy Eating Index (HEI) were assessed as primary measures. Participants were placed in "at-risk" categories of the (1a) lower quartile of the HEI and (1b) lower than 51% HEI, or (2) "low" or "very low" food security status based on the USDA Household Food Security Screener (FSS). Multiple linear regression (MLR) models were conducted for HEI and FSS scores to include time, group, time*group interaction, and control of meal utilization percentage (i.e., dose). The MLR for the HEI quartile had a significant time by quartile interaction that was present for an increase in the HEI in Q1 (n = 12; 32.42 ± 5.95% to n = 6; 46.10 ± 10.62%; p < 0.0001) and a decrease in the HEI for Q4 (n = 12; 70.68 ± 7.13% to n = 9; 52.36 ± 11.57%; p < 0.0001). For those low food security participants (n = 24; 48.0%), the average food insecurity score from the 6-item USDA screener improved from 4.09 ± 1.62 at baseline to 2.63 ± 2.41 at 3 months (p = 0.0064). The MLR for the FSS had a significant group*time interaction (p = 0.0071). In our population, particularly those vulnerable with lowest dietary quality and food insecurity status, we did see improvements across the free meal pilot program. However, a small sample, limited generalizability, and limited data collection measures urge caution when using these results to extrapolate for the general population. However, the current results are promising and should encourage further investigation of the effects of meal assistance programs on the health and well-being of older adults.

The sDOR.2-6y™ Is a Valid Measure of Nutrition Risk Independent of BMI-for-Age z-Score and Household Food Security Status in Preschool Aged-Children.

Parents' feeding practices are a function of child eating behaviors, health, and other factors. Adherence to the Satter Division of Responsibility in Feeding (sDOR) model has not been examined relating to child BMI, household food security, or child eating behavior. This study evaluates the adherence to sDOR in relation to child eating behavior, nutrition risk, BMI-for-age, dietary intake, and food security. Ninety-one parent-child (3 to <6 years) dyads completed a cross-sectional asymmetric survey in August-November 2019; n = 69 parents from the original sample completed additional and retrospective questions in June 2021. Main outcomes included sDOR adherence (sDOR.2-6y™), a Child Eating Behavior Questionnaire (CEBQ), nutrition risk (NutriSTEP®), the USDA 6-item screener, the Block Kids Food Screener, and eating competence (ecSI 2.0™). The children's weight and height were investigator-measured. Associations were tested with Pearson's r and Chi Square for continuous and categorical variables, independent sample t-test, one-way ANOVA, or Mann-Whitney U compared means. The dietary comparisons used Spearman's rho correlation coefficient. sDOR adherence was associated with a lower nutrition risk (r = 0.26, p = 0.03) and showed convergent validation with child eating behavior for three child eating behavior (CEBQ) constructs. sDOR.2-6y™ was not related to the child BMI-for-age z-score (r = 0.11, p = 0.39, n = 69). NutriSTEP® was associated with dietary quality and higher ecSI 2.0TM (r = 0.32, p = 0.008, n = 69). No associations between sDOR.2-6y™ and food security or dietary intake were noted.

A Neoteric Paradigm to Improve Food Security: The Predictors of Women's Influence on Egocentric Networks' Food Waste Behaviors.

COVID-19, the most recent multi-dimensional global food crisis, challenged leadership and impacted individuals' personal networks. Two cross-sectional surveys were disseminated to women involved in their state's women's leadership committee to understand food waste behaviors. An egocentric network analysis was chosen as the methodology to better understand personal advice network characteristics and examine the impacts of Farm Bureau women's leadership committee members' advice networks on their food waste behavior. A multilevel model was conducted to identify factors related to respondents leading their network members toward positive food waste decisions. Independent variables included in the variables at the individual (e.g., each respondent's race, generation), dyadic (e.g., length respondent has known each member of her network), and network levels (e.g., proportion of the respondent's network that was female) were included in the model. Women were more likely to report connections with people they led to positive food waste behaviors and food security when: they had higher food waste sum scores, they were part of Generation X, the network member they led to more positive food waste behaviors was a friend, and if there were fewer women in their advice networks.

Construction of China's food security evaluation index system and spatiotemporal evolution.

Food security is a vital material foundation for a nation's development and has been a topic of significant concern on the international stage in recent years. With a population exceeding 1.4 billion, China is not only a major producer but also a substantial consumer of food. Ensuring food security in China is not only a top priority for its socio-economic development but also a driving force in maintaining the stability of the global food supply chain and reducing the number of hungry people worldwide. However, a lack of comprehensive research into the Chinese food security system remains. This study addresses this gap by constructing a comprehensive evaluation framework encompassing four dimensions: food supply, accessibility, production stability, and sustainability. Utilizing the Moran's Index and generating LISA (Local Indicators of Spatial Association) maps, we analyze the spatial correlations of food security. The Dagum Gini coefficient and kernel density estimation are applied to assess heterogeneity and spatial disparities. Furthermore, this research employs the Exponential Smoothing (ETS) model to forecast food security trends. The findings reveal that the overall composite food security score exhibited fluctuations, initially increasing and reaching its peak of 0.407 in 2003, followed by a subsequent sharp decline after 2019. Spatially, food security exhibits correlations, with the Huang-Huai-Hai Plain and Northeast regions consistently showing high-high clustering. In contrast, the Western and Southern regions exhibit low-low clustering at specific periods. The Dagum Gini coefficient indicates that overall food security disparities are relatively small. However, these disparities have gradually expanded in recent years, with inter-group differences becoming predominant after 2005. As indicated by the kernel density estimation, the dynamic distribution of food security initially widens and then narrows, suggesting a shift from dispersed to concentrated data distribution. This phenomenon is accompanied by polarization and convergence trends, particularly evident after 2015. According to the ETS model, the study forecasts a substantial risk of declining food security in China over the next decade, largely influenced by the ongoing pandemic. In conclusion, this research provides a comprehensive assessment of the changing status of food security in China. It offers early warnings through predictive analysis, addressing the existing research gaps in the field of food security.

Examining measurement invariance of appetitive trait and ARFID symptom measures by food security status.

OBJECTIVE: Measures assessing appetitive traits (i.e., individual differences in the desire to consume food) and disordered eating have generally been developed in predominantly food-secure populations. The current study aims to test measurement invariance (MI) for a measure of appetitive traits and a measure of Avoidant Restrictive Food Intake Disorder (ARFID) symptomology across food security status. METHOD: Data from a sample of mothers (n = 634) and two undergraduate samples (n = 945 and n = 442) were used to assess MI for the Adult Eating Behavior Questionnaire (AEBQ), which measures appetitive traits, and the Nine Item ARFID Screen (NIAS), which measures ARFID symptomology. Current food security was assessed using the 18-item USDA Household Food Security Survey Module, which was dichotomized into two groups: 1) the 'food insecure' group included marginal, low, and very low food security and 2) the 'food secure' group included high food security. Overall and multi-group confirmatory factor analyses were conducted separately for each measure in each sample. RESULTS: Results demonstrated scalar (i.e., strong) MI for both measures across samples, indicating that these measures performed equivalently across food-secure and food-insecure individuals. CONCLUSION: Findings suggest that differences in appetitive traits by food security status observed in prior research are not artifacts of measurement differences, but instead reflect true differences. Additionally, past mixed results regarding the relationship between food insecurity (FI) and ARFID symptomology are not likely driven by measurement error when using the NIAS.

Associations of Increased WIC Benefits for Fruits and Vegetables With Food Security and Satisfaction by Race and Ethnicity.

Introduction: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutrition support for racially and ethnically diverse populations. In 2021, the monthly cash value benefit (CVB) for the purchase of fruits and vegetables increased from $9 to $35 and was later adjusted to $24. This study investigated, by racial and ethnic groups, whether CVB increases were associated with increases in CVB redemption, household food security, child fruit and vegetable intake, satisfaction with CVB amount, and likelihood of continued participation in WIC if the CVB returned to $9 per month. Methods: We conducted a longitudinal study of WIC participants (N = 1,770) in southern California at 3 time points, from April 2021 through May 2022; the CVB amount was $9 at baseline, $35 at Survey 2, and $24 at Survey 3. Racial and ethnic groups were Hispanic English-speakers, Hispanic Spanish-speakers, non-Hispanic Asian, non-Hispanic Black, non-Hispanic Other, and non-Hispanic White. We used mixed-effect and modified Poisson regressions to evaluate outcomes by group. Results: At baseline, groups differed significantly in dollars of CVB redeemed, percentage of CVB redeemed, household food security, and satisfaction with CVB amount. After the increase in CVB, we found increases in all groups in CVB redemption, household food security, and satisfaction. Non-Hispanic Black and Hispanic English-speaking groups, who had low levels of satisfaction at baseline, had larger increases in satisfaction than other groups. Reported likelihood of continued WIC participation if the monthly CVB returned to $9 also differed significantly by group, ranging from 62.5% to 90.0%. Conclusion: The increase in CVB for children receiving WIC benefited all racial and ethnic groups. Continued investment in an augmented CVB could improve health outcomes for a racially and ethnically diverse WIC population.

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 Security and Health Outcomes following Gray Divorce.

The study evaluates the immediate and long-term consequences of gray divorce (i.e., marital dissolution after age 50) for the food security, depression, and disability of older Americans. Staggered Difference-in-Difference models were fitted to a nationally representative longitudinal sample of adults aged ≥ 50 years from the Health and Retirement Study, 1998-2018. Food insecurity and disability increase in the year of gray divorce and remain significantly elevated for up to six years or more following the event, consistent with the chronic strain model of gray divorce. Gray divorce has particularly adverse consequences for the food security of older women, while no gender differences were observed for disability. Increasing trends in gray divorce have important negative implications for food security and health of older Americans, particularly women, who appear to be less prepared to financially withstand a marital collapse in older age. Targeted policies to provide nutrition assistance and support in reemployment might be necessary to reduce the burden of food insecurity in the wake of gray divorce among women.

Nourishing the Mind: How Food Security Influences Mental Wellbeing.

Food insecurity is a significant public health problem worldwide and critical to mental health. There is a complex relationship between food security and mental health. We carried out a narrative review study aiming to address how food insecurity impacts mental wellbeing by focusing on the mental health repercussions of food insecurity, recognizing its pivotal role in attaining Sustainable Development Goals 2 (on hunger) and 3 (on enhancing global wellbeing). A comprehensive search was conducted on PubMed and Google Scholar, incorporating Google searches for pertinent reports and policy documents. To address these questions, we emphasized and elucidated the interconnectedness between food security and mental health. The review shows that food security and mental health share a profound relationship influenced by multifaceted factors like socioeconomic conditions, access to nutritious food, and societal inequalities. We then provide recommendations for integrating food security into mental health strategies based on the insights and conclusions drawn. Strategies ranging from sustainable farming practices to urban agriculture initiatives and digital mental health services demonstrate avenues for enhancing food safety and mental wellbeing. This highlights the need for collaborative interdisciplinary efforts and systemic reforms to address these interconnected challenges.

Combining social protection interventions for better food security: Evidence from female-headed households in Amhara region, Ethiopia.

Ethiopia introduced its flagship poverty-targeted social protection program, the Productive safety net program (PSNP), in 2005 and Community-Based Health Insurance (CBHI) in 2011. Although both programs operate in several districts with some overlaps, evidence is scarce on how these large-scale programs jointly affect the food security of vulnerable groups. This study examines the impacts of a combination of these programs on food security outcomes among female-headed households in a chronically food-insecure and drought-prone district. Cross-sectional data were collected from 365 female-headed households selected through multi-stage sampling technique and analyzed using Inverse-probability-weighted regression adjustment (IPWRA) strategy to assess the effect of the programs on food security. The results show that while 63.6% of sample households are enrolled in CBHI and 48.8% are beneficiaries of PSNP's conditional cash transfer (CCT) component, membership in both social protection programs was 38.9%. The IPWRA analysis finds that inclusion in the CCT combined with CBHI, on average, increased dietary diversity score by 0.918 (95% CI 0.779-1.057) and food consumption score by 0.576 (95% CI 0.464-0.688). It also reduced household food insecurity access scale by 8.658 (95% CI -9.775 - -7.541). In all assessments, a combination of CBHI and CCT always produced results of a larger magnitude than each of CBHI and CCT alone. The findings provide evidence of the potentials of integrating social protection programs to increase food security outcomes among the most vulnerable and marginalized groups in a developing country. In addition, the results have also useful implications to achieve sustainable development goals related to ending hunger and achieving food security among vulnerable groups.

Queering food security research: A critical analysis of 2SLGBTQ+ People's experiences of food insecurity in Toronto during the COVID-19 pandemic.

INTRODUCTION: Household food insecurity (HFI), stress, isolation, and discrimination are major determinants of health that disproportionately affect 2SLGBTQ + people. The COVID-19 pandemic potentially exacerbated these inequities. This study investigates HFI rates among 2SLGBTQ + adults living in diverse household conditions during the pandemic and explores the idea that heteronormative conceptions of the "household" may affect measurement of HFI. METHODS: Cross-sectional survey responses were collected from 437 self-identified 2SLGBTQ + people from Toronto, Canada between March and July 2021. The survey measured HFI, sexual/gender identities, socio-demographic factors, household composition, and psycho-social stress/distress. Multinomial logistic regression was used to assess variation in odds of marginal, moderate, and severe HFI in relation to sexual/gender identities, household composition, psycho-social distress, and socio-demographic covariates. RESULTS: Forty-two percent of respondents reported some level of HFI, with severe HFI higher among respondents who were bisexual, transgender/gender diverse, and/or assigned-female-at-birth. Living alone was associated with decreased odds of reporting marginal HFI but increased odds of moderate or severe HFI compared to living with a partner, family, or roommates; living with children was associated with decreased odds of both marginal and severe HFI. One indicator of psycho-social distress (perceived discrimination) was associated with higher odds of all levels of HFI, while the other (isolation) was associated with decreased odds of marginal HFI. CONCLUSION: These findings highlight the high prevalence of HFI linked with discrimination among 2SLGBTQ + individuals during the pandemic. The complicated results regarding household composition and social isolation may suggest a need to revise definitions of the household when measuring, monitoring, and seeking to mitigate HFI in 2SLGBTQ + communities.

The role of the community café in addressing food security: Perceptions of managers and directors.

In the United States, the pay-what-you-can restaurant model (community cafes) is an increasingly popular approach to addressing food insecurity in local communities. We conducted semi-structured interviews (n = 13) with community café executive managers and directors to assess their perceptions of the role that their cafes play in addressing food security (FS). Analysis of interviews revealed two major areas of emphasis by participants. Filling an unoccupied space in the food security landscape. Interviewees regularly cited the goal of making meals available through a dependable schedule, convenient location, and welcoming atmosphere for guests to promote regular visits to the café, and they did so with an awareness of how their practices were shaped by perceived shortcomings in comparable services. In addition, guest agency and social aspects of the café as components of utilization, was another major area. Interviewees often regarded the opportunity of the food insecure guest to choose healthy options (i.e., nutritionally dense) over less healthful ones (i.e., calorically dense) from the menu as a critical component of their service. The social component of the café (e.g., community atmosphere, 'dining-out' experience) was another aspect of the café's function that promoted dignity for the guest which can lead to greater likelihood of return visits. Perceptions shared by participants of the café's role in addressing food security suggest that rather than simply adding to the available options of hunger relief services, the café model attempts to address many areas of concern, such as structural and cultural barriers, found in the traditional forms of charitable food provision.

Impact of COVID-19 on food security and diet quality in Chilanga District, Zambia.

INTRODUCTION: Food security and nutrition have been severely impacted during the COVID-19 pandemic, particularly in low- and middle-income countries (LMICs). We aimed to quantify the impacts of the pandemic on food security and diet diversity within Chilanga District in Zambia and identify target areas for high-impact social protection and safety net programs. METHODS: We conducted a cross-sectional study in Chilanga district immediately after the Omicron variant surge in February 2022. Diet quality and food security were assessed based on a household diet questionnaire and a Minimum Dietary Diversity-Women (MDD-W) score was calculated. A paired t-test was used to determine whether there was a statistically significant change in the MDD-W score and McNemar test was used to investigate the change in food security between the pre- and peri-COVID-19 period. RESULTS: Compared to the pre-COVID-19 period, there were increases in food prices across the board in the peri-COVID-19 period and decreased consumption of key food categories including legumes, dairy and vitamin A rich foods. Despite high rates of food insecurity, only 6.6% of surveyed households received any cash or in-kind assistance from a government agency, non-profit, or other organization in the post-COVID-19 period. CONCLUSION: The COVID-19 pandemic had significant impacts on food security and dietary diversity in Chilanga district. This is particularly relevant in the low-income communities that we surveyed, which had pre-existing challenges with food security. Additional resources must be invested in Chilanga District and similarly affected areas to address this gap in access to food and promote national equity. Trial Registration N/A.

Longitudinal Associations of Food Security with Health and Dietary Factors among Food FARMacy Participants during COVID-19 in New York City.

In cross-sectional studies, food insecurity is associated with adverse health and dietary outcomes. Whether self-reported health and dietary outcomes change in response to improvements in food security has not been examined. We sought to examine how increases in food security are related to changes in health and dietary factors. In this longitudinal, observational study, we included adult participants in a clinical-community emergency food assistance program in New York City from July 2020 to November 2021. Program staff measured food security with a validated six-item measure at program enrollment and six-month re-enrollment. Participants self-reported health and dietary factors (vegetable, fruit, juice, and sugar-sweetened beverage (SSB) consumption frequency). We used multivariable regression to examine associations between change in food security with change in health and dietary factors over six months. Among 310 participants, the mean food security score improved by 1.7 ± 2.3 points over six months. In unadjusted models, each point improvement in food security was associated with increased vegetable (ß = 0.10 times; 95% CI: 0.05-0.15); fruit (ß = 0.08 times; 95% CI: 0.03-0.14); and juice (ß = 0.10 times; 95% CI: 0.05-0.15) consumption. In adjusted models, results remained significant for vegetable and fruit consumption, but not juice. Change in food security was not associated with change in health or SSB outcomes. In this cohort during COVID-19, improved food security was associated with improved vegetable and fruit consumption. Randomized trials that examine the effectiveness of clinical-community partnerships focused on improving food security and nutrition are warranted.