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.

Promoting healthful food purchases through in-store interventions: Empirical evidence from rural food deserts.

Effective ways to promote healthful food intake in rural areas are understudied. The paper evaluated whether a two-component, in-store intervention designed to encourage healthy food purchases was associated with improved healthfulness scores of food items purchased by shoppers in rural food deserts. One component introduced a point-of-sales label that assigned a single numerical score to each food item facilitating direct comparisons of the product's nutrition with those of other products shelved around it. The other component was a one-day nutrition education workshop promoted within the store. Interventions took place in 2015 at two stores in rural counties in the U.S. Midwest. Four stores in similar communities were selected as the control group. We applied a difference-in-difference model to estimate changes in the healthfulness of food items purchased attributable to the intervention among shoppers at the treatment stores (n = 486) and control stores (n = 10,759) using store transaction data. Healthfulness of food items was measured in terms of food scores published by the Environmental Working Group on a 1-10 scale. Both components had minimal impacts on the scores, although 0.2 and 0.1 points increases in the score per item and score per dollar were statistically significant at the 1% level respectively. A year after the intervention, these small effects of the intervention further diminished compared to the immediately after implementation. Results suggest the average effects of intervention across the study communities had limited practical significance but benefited some rural residents who were exposed to the intervention.

The impact of financial incentives and restrictions on cyclical food expenditures among low-income households receiving nutrition assistance: a randomized controlled trial.

BACKGROUND: The Supplemental Nutrition Assistance Program (SNAP) is the largest anti-hunger program in the United States. Two proposed interventions to encourage healthier food expenditures among SNAP participants have generated significant debate: financial incentives for fruits and vegetables, and restrictions on foods high in added sugar. To date, however, no study has assessed the impact of these interventions on the benefit cycle, a pattern of rapid depletion of SNAP benefits that has been linked to worsening nutrition and health outcomes over the benefit month. METHODS: Low-income households not currently enrolled in SNAP (n = 249) received benefits every 4 weeks for 12 weeks on a study-specific benefit card. Households were randomized to one of four study arms: 1) incentive (30% incentive for fruits and vegetables purchased with study benefits), 2) restriction (not allowed to buy sugar-sweetened beverages, sweet baked goods, or candy using study benefits), 3) incentive plus restriction, or 4) control (no incentive or restriction). Weekly household food expenditures were evaluated using generalized estimating equations. RESULTS: Compared to the control group, financial incentives increased fruit and vegetable purchases, but only in the first 2 weeks after benefit disbursement. Restrictions decreased expenditures on foods high in added sugar throughout the benefit month, but the magnitude of the impact decreased as the month progressed. Notably, restrictions mitigated cyclical expenditures. CONCLUSIONS: Policies to improve nutrition outcomes among SNAP participants should consider including targeted interventions in the second half of the month to address the benefit cycle and attendant nutrition outcomes. TRIAL REGISTRATION: ClinicalTrial.gov, NCT02643576 . Retrospectively registered December 22, 2014.

Trends in cyclical food expenditures among low-income households receiving monthly nutrition assistance: results from a prospective study.

OBJECTIVE: Supplemental Nutrition Assistance Program (SNAP) benefits are rapidly depleted after distribution. This phenomenon, known as the benefit cycle, is associated with poor nutrition and health outcomes. However, to date, no study has evaluated trends in food expenditures before and after households receive benefits using prospective data, and whether these trends vary by household characteristics. DESIGN: Generalised estimating equations were used to model weekly household food expenditures during baseline (pre-benefit) and intervention months by vendor (restaurants and food retailers). Food retailer expenditures were further evaluated by food category (fruits and vegetables and foods high in added sugar). All expenditures were evaluated by household composition, demographics and economic means. SETTING: Minneapolis-St. Paul, Minnesota, metropolitan area. PARTICIPANTS: Low-income households (n 249) enrolled May 2013-August 2015. RESULTS: Weekly food retailer expenditures did not vary during baseline (pre-benefit), but demonstrated a cyclical pattern after households received benefits across all household characteristics and for both food categories, particularly for fruits and vegetables. Households with greater economic resources spent more throughout the month compared with those with fewer resources. Households with lower food security status experienced more severe fluctuations in spending compared with more food secure households. CONCLUSIONS: Cyclical food purchasing was observed broadly across different household characteristics and food categories, with notable differences by household economic means and food security status. Proposed SNAP policy changes designed to smooth food expenditures across the benefit month, such as increased frequency of benefit distribution, should include a focus on households with fewest resources.

Associations between shopper impulsivity and cyclical food purchasing: Results from a prospective trial of low-income households receiving monthly benefits.

Supplemental Nutrition Assistance Program (SNAP) benefits are rapidly depleted after distribution. This phenomenon, known as the benefit cycle, is associated with poor nutrition and health outcomes. Proposed interventions targeting the benefit cycle often focus on impulsive decision-making. However, it remains unclear whether shopper impulsivity is associated with food purchasing behavior. Using data from a prospective trial, we evaluate whether shopper impulsivity is associated with food purchasing behavior before and after households receive nutrition assistance. In this study, 249 low-income households in the Minneapolis-St. Paul, Minnesota, metropolitan area received monthly benefits for three months. Overall impulsivity and impulsivity subtraits of the primary shopper was assessed using the Barratt Impulsiveness Scale-11. Both total food expenditures and expenditures for two specific categories (fruits and vegetables, and foods high in added sugar) were evaluated. Generalized estimating equations were used to model household expenditures as a function of week since benefit distribution, impulsivity, and their interaction. Results showed that during the benefit period, food expenditures were cyclical and patterned by impulsivity. Shoppers with greater overall impulsivity spent $40.62 more in week 1 (p < 0.001). While more impulsive shoppers spent more on foods high in added sugar throughout the month (p < 0.05 for all weeks), no patterns were observed for fruits and vegetables. These findings suggest that greater impulsivity exacerbates cyclical food purchasing behavior. The impact of shopper impulsivity is especially notable for expenditures on foods high in added sugar. SNAP educational interventions to mitigate the benefit cycle may be strengthened by focusing on more impulsive shoppers and on strategies to reduce impulsive purchases of foods high in added sugar.

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 behavioural economics approach to improving healthy food selection among food pantry clients.

OBJECTIVE: To test the effect of a behavioural economics intervention in two food pantries on the nutritional quality of foods available at the pantries and the foods selected by adults visiting food pantries. DESIGN: An intervention (SuperShelf) was implemented in two food pantries (Sites A and B), with two other pantries (Sites C and D) serving as a control for pantry outcomes. The intervention aimed to increase the amount and variety of healthy foods (supply), as well as the appeal of healthy foods (demand) using behavioural economics strategies. Assessments included baseline and 4-month follow-up client surveys, client cart inventories, pantry inventories and environmental assessments. A fidelity score (range 0-100) was assigned to each intervention pantry to measure the degree of implementation. A Healthy Eating Index-2010 (HEI-2010) score (range 0-100) was generated for each client cart and pantry. SETTING: Four Minnesota food pantries, USA.ParticipantsClients visiting intervention pantries before (n 71) and after (n 70) the intervention. RESULTS: Fidelity scores differed by intervention site (Site A=82, Site B=51). At Site A, in adjusted models, client cart HEI-2010 scores increased on average by 11·8 points (P<0·0001), whereas there was no change at Site B. HEI-2010 pantry environment scores increased in intervention pantries (Site A=8 points, Site B=19 points) and decreased slightly in control pantries (Site C=-4 points, Site D=-3 points). CONCLUSIONS: When implemented as intended, SuperShelf has the potential to improve the nutritional quality of foods available to and selected by pantry clients.

Don't Say "Beans" When Promoting Plant Protein to Family Meal Planners.

PURPOSE: To identify "headlines" that would engage recipients to consider plant protein over red meat. DESIGN: Mail and web survey. SETTING: Urban Minnesota community. SUBJECTS: 144 survey respondents from our health plan and community program distribution lists who live with at least 1 other person and eat meat. INTERVENTION: We asked respondents how likely they would be to click on each of 24 headlines with a motivator (eating plant protein for health vs for environmental reasons) and a barrier (family preferences, knowledge about plant proteins, or cooking skills). 16 headlines contained the word "beans". MEASURES: We created categorical variables for each headline construct: (1) motivator, (2) barrier, and (3) reference to beans. Using a mixed model with random effects, we compared, for each construct, respondents' self-reported likelihood to click on a headline. RESULTS: Health-related headlines performed significantly better than environmental headlines (P = .0019, 95% CI .01, .11). Family-oriented headlines performed slightly better than skills-oriented (P = .0927, 95% CI -.01, .11) and knowledge-oriented (P = .0960, 95% CI -.01, .11) headlines. Headlines containing the word "beans" performed significantly worse than those not containing "beans" (P < .0001, 95% CI -.22, -.12). CONCLUSIONS: The population represented by our survey respondents report being most likely to click on headlines that emphasize health and family. They report they are significantly less likely to click on headlines that promote beans.

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.

Cover crop management practices to promote soil health and climate adaptation: Grappling with varied success from farmer and researcher observations.

Soil health is a pathway through which farm and environmental outcomes can be improved together on agricultural landscapes, and management to improve soil health is increasingly recognized as a strategy for agricultural producers to adapt to climate change-related impacts such as erosion and flooding. Many incentive programs exist or are in development to support the adoption of practices that promote soil health for these reasons, but few on-farm trials have compared the intersections of farmer versus researcher observations of soil health or of soil health compared with climate adaptation. The purpose of our study was to assess soil health outcomes and adaptation to simulated climate change in response to cover cropping on working farms enrolled in a Minnesota Natural Resources Conservation Service (NRCS)-funded Environmental Quality Incentives Program. This incentive program required the inclusion of diverse cover crop mixtures into existing farm crop rotations. We conducted farmer surveys, NRCS protocol field soil assessments, and NRCS-recommended laboratory assays on farms from across the state of Minnesota in a paired design comparing fields on the same or adjacent farms of the same soil mapping unit. Although 85% of farmers reported improvements in soil attributes or productivity, most field and laboratory assessments produced a high amount of variability in responsiveness to cover cropping. Despite this variability, we saw a significant decrease in bare ground and significant increases in earthworm counts, cellobiohydrolase microbial activity, and the Visual Evaluation of Soil Structure (VESS). Although researcher measurements did not show improvement in physical characteristics or infiltration other than the VESS field assessment, 67% of farmers reported improvements to the physical structure of the soil, associated with improved outcomes such as earlier planting dates and consistent crop growth across fields. When more than five species of cover crops were present, the percentage of reported improvements increased to >80%. We also found no significant improvement to climate change adaptation measured by nutrient or sediment loss after a simulated storm event. Together, our results suggest that adding a diverse annual cover crop mix to increase continuous cover can improve characteristics associated with soil health and that there needs to be a stronger focus in understanding variation in realized soil health outcomes on farms, including more co-creation of research with farmer partners.

Impacts of COVID-19 on US agri-food supply chain businesses: Regional survey results.

Visible disruptions of appropriate food distribution for end consumers during the onset of the COVID-19 pandemic prompted calls for an urgent, renewed look at how the U.S. agri-food system is impacted by and responds to pandemics, natural disasters, and human-made crises. Previous studies suggest the COVID-19 pandemic yielded uneven impacts across agri-food supply chain segments and regions. For a rigorously comparable assessment of the impact of COVID-19 on agri-food businesses, a survey was administered from February to April 2021 to five segments of the agri-food supply chain in three study regions (California, Florida, and the two-state region of Minnesota-Wisconsin). Results (N = 870) measuring the self-reported changes in quarterly business revenue in 2020 compared to businesses' typical experience pre-COVID-19 suggest significant differences across supply chain segments and regions. In the Minnesota-Wisconsin region, restaurants took the largest hit and the upstream supply chains were relatively unaffected. In California, however, the negative impacts were felt throughout the supply chain. Two factors likely contributed to regional differences: (1) regional disparities in pandemic evolution and governance and (2) structural differences in regional agri-food systems. Regionalized and localized planning and the development of best-practices will be necessary for the U.S. agri-food system to enhance preparedness for and resilience to future pandemics, natural disasters, and human-made crises.

The value of values-based supply chains: farmer perspective.

In the last few decades, the emergence of mid-scale, intermediated marketing channels that fall between commodity and direct markets has attracted growing interest from scholars for their potential to preserve small and mid-sized farms while scaling up alternative agrifood sourcing. When such mid-scale supply chains are formed among multiple business partners with shared ethics or values related to the qualities of the food and the business relationships along the supply chain, they may be termed "values-based supply chains (VBSCs)." Most of the research on VBSCs to date has relied primarily on a case study approach that investigates the performance of VBSCs from the perspective of VBSC founders or leaders. In contrast, this research seeks out the perspectives of farmers who participate in VBSCs. A nationwide farmer survey conducted in 2017 offers original insights on farmer motivations for participating in VBSCs and how they are being used by farmers relative to other marketing channels. We find that VBSCs serve farms of all sizes. Overall, smaller farms were more likely to market a higher percentage of overall sales through their VBSC and more likely to rank their VBSC as one of the top three marketing channels in their portfolio. But it was the larger farms that were more likely to perceive VBSC-specific benefits. Our findings confirm that while there is a limited volume of product that such regional supply chains can currently handle, farmers view VBSCs as a valuable marketing option that aligns with their own values and preserves their product's identity. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10460-021-10255-5.

A randomized study of food pantry environment-level change following the SuperShelf intervention.

The charitable food system is rapidly evolving. Interventions that target the food pantry environment and use behavioral economics are in high demand, but can be difficult to implement in a low-resource setting. This is an analysis of secondary, environment-level outcomes in a food pantry intervention (SuperShelf); the study evaluates whether the intervention resulted in measurable changes to the food pantry environment and improved diet quality of the food available to clients, compared with a control group of food pantries. Eleven food pantries were randomized to an intervention (n = 5) or control (n = 6) condition and completed baseline and one-year follow-up measures between 2018 and 2020. The intervention addressed healthy food supply and the appeal of healthy foods using behavioral economics. Assessments included manager surveys, intervention fidelity, food inventory, and food supply tracked over 5 days. Measures included change in intervention fidelity (range 0-100) with four subcomponents; Healthy Eating Index scores (HEI-2015, range 0-100) with 13 subcomponents; and Food Assortment Scoring Tool scores (FAST, range 0-100). Descriptive analyses and t-tests examined pre-post changes within and between intervention arms. Average fidelity scores increased from baseline to follow-up in the intervention group compared with the control group (p < .001), as did FAST scores (p = .02). Average HEI-2015 Total scores increased in the intervention group by 6.3 points and by 1.6 points in the control group, but the difference in change between groups was not statistically significant (p = .56). The intervention was implemented with high fidelity at five sites, with some evidence of change in the nutritional quality of the food available on the shelf to clients.

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.

Food waste tendencies: Behavioral response to cosmetic deterioration of food.

American households discard a significant amount of food that represent a sizable portion of their food expenditures. This study adds to our understanding of product attributes associated with food waste, with a focus on cosmetic deterioration during home storage. Specifically, we profile a sample of U.S. individuals by patterns of common food-related behaviors and determine the effects of product attributes on food waste tendencies at the point of consumption by distinct behavioral profiles. An interactive survey at the Minnesota State Fair (N = 333) was used to obtain measurements on food-related behavior and sociodemographic factors. The survey included a conjoint task to elicit food discard tendencies to construct the food waste proxy. The study considered cosmetic deterioration, date labels, implied shelf life, package size, and prices paid, in fresh, packaged spinach and ground beef products. Factor analysis and latent class modeling categorized the sample into two classes, revealing distinct food-related behavioral patterns. Planners, who constituted a slight majority in our sample, were likely to have established pre-shopping and in-store behavior and food management and cooking skills. Extemporaneous Consumers had inferior food handling routines and were less knowledgeable and skilled in the kitchen. Regression analysis using a random-effects tobit model showed Extemporaneous Consumers were prone to waste a greater portion of the spinach product than Planners. Otherwise, both classes showed similar increases in likelihood to discard the products, as their appearance deteriorated. Their tendency to waste increased with shorter remaining shelf life for spinach but not for ground beef, and was not affected by the date label type. Results suggest an intervention that targets a general audience designed to enhance people's skills to discern edibility of food in home storage by manipulating sensory expectations from cosmetic deterioration could be impactful in efforts to curtail food waste.