Structural Racism as a Contributor to Lung Cancer Incidence and Mortality Rates Among Black Populations in the United States.

BACKGROUND: Although racial disparities in lung cancer incidence and mortality have diminished in recent years, lung cancer remains the second most diagnosed cancer among US Black populations. Many factors contributing to disparities in lung cancer are rooted in structural racism. To quantify this relationship, we examined associations between a multidimensional measure of county-level structural racism and county lung cancer incidence and mortality rates among Black populations, while accounting for county levels of environmental quality. METHODS: We merged 2016-2020 data from the United States Cancer Statistics Data Visualization Tool, a pre-existing county-level structural racism index, the Environmental Protection Agency's 2006-2010 Environmental Quality Index (EQI), 2023 County Health Rankings, and the 2021 United States Census American Community Survey. We conducted multivariable linear regressions to examine associations between county-level structural racism and county-level lung cancer incidence and mortality rates. RESULTS: Among Black males and females, each standard deviation increase in county-level structural racism score was associated with an increase in county-level lung cancer incidence of 6.4 (95% CI: 4.4, 8.5) cases per 100,000 and an increase of 3.3 (95% CI: 2.0, 4.6) lung cancer deaths per 100,000. When examining these associations stratified by sex, larger associations between structural racism and lung cancer rates were observed among Black male populations than among Black females. CONCLUSION: Structural racism contributes to both the number of new lung cancer cases and the number of deaths caused by lung cancer among Black populations. Those aiming to reduce lung cancer cases and deaths should consider addressing racism as a root-cause.

Ours to eat and own: assessing the feasibility of a cooperative meal-kit service to improve food access.

OBJECTIVE: Although typically serving higher income and younger demographic groups, meal-kit subscription services have the potential to improve food availability and dietary quality in communities experiencing low food access due to systemic discrimination. This study describes the development and characteristics of a pilot community-led meal-kit service (SouthEats) and evaluates key implementation outcomes of adoption, acceptability, and feasibility among households experiencing less income. DESIGN: We utilised a mixed methods study design, including data from administrative records, customer surveys and worker interviews. Thematic qualitative analyses and descriptive quantitative analyses were conducted to illuminate the characteristics and extent the pilot meal-kit service was adopted, acceptable, and financially feasible among the target populations. SETTING: The study took place in Washington DC, USA. PARTICIPANTS: Study participants included SouthEats consumers (n 35) and workers (n 3). RESULTS: During the pilot period, sixty-seven community members signed up for the meal-kit service, with 52 % making recurring purchases. Our results suggest that the meal-kit service is acceptable among people living in low food access areas. Our feasibility analysis indicates that, although not without challenges, the SouthEats model could be financially feasible. CONCLUSION: These preliminary insights can inform the scalability and potential replication of this service and provide foundational evidence for an approach that may be used to improve food access.

Evaluating a Washington DC Community-based meal-kit service aimed at mitigating dietary disparities: Results from the SouthEats pilot study.

Background: Vegetable consumption is known to reduce the risk of various chronic health conditions. Yet a small percentage of US adults consume enough vegetables to meet national dietary guidelines. The SouthEats community-led meal-kit service was developed in Washington DC to address known barriers to healthy eating and vegetable consumption among middle- and low-income households. Methods: Using a series of online surveys, we conducted a pilot study to provide preliminary information on the influence of SouthEats on vegetable consumption and factors known to influence vegetable consumption. Wilcoxon matched-pair sign ranked tests were used to examine changes in key outcomes between baseline, midpoint and endpoint surveys. Results: Among SouthEats customers who completed all pilot study surveys (n = 23) there was a significant decrease in the median amount of time spent on meal prep between baseline and midpoint. Between baseline and endpoint, participants also indicated increased feelings that they had enough time to meet their needs including cooking healthfully. Overall vegetable and fruit and vegetable consumption increased between the baseline and midpoint but then decreased between the midpoint and endpoint survey periods. However, there were no statistically significant changes in the outcomes of home eating behaviors, perceptions of neighborhood healthy food access, vegetable self-efficacy, or vegetable consumption. Conclusion: Our results provide some preliminary evidence suggesting that the SouthEats meal-kit service could help reduce the amount of time spent on cooking, reduce feelings of time scarcity, and increase vegetable consumption in the short-term. Further research exploring this topic will require a larger study sample.

Dietary Behaviors among New Users of Meal-Kit Services during the Early Months of the COVID-19 Pandemic.

The COVID-19 pandemic changed the way people acquired food, including increased use of meal-kit delivery services. Investigators analyzed data from a national survey of US adults collected between July 2020 and September 2020, to describe new users of meal-kit services during the pandemic and explore associations between new use of meal-kits and dietary behaviors. Bivariate and multivariate regression analyses were conducted to identify differences in demographic characteristics and reported dietary behaviors between new and never meal-kit users. Nearly all new meal-kit users were under the age of 55 years (92.5%), lived in urban areas (90.1%), and reported having children in their households (82%). A higher proportion of new users were current SNAP participants (32.8%) compared to never users (17.1%). Compared to never users, new users of meal-kit services reported eating more fruits and vegetables (PR: 1.95, 95% CI: 1.42, 2.68), and more red and processed meats (PR: 2.39, 95% CI: 1.49-3.85) since the pandemic began. Results suggest that meal-kit services may have been a useful resource for certain populations during the early months of COVID-19 and are potentially associated with increased consumption of certain foods. Further research examining the continued use and the influence of meal-kit services on diet is needed.

Garden Access, Race and Vegetable Acquisition among U.S. Adults: Findings from a National Survey.

With the majority of U.S. adults not meeting recommended vegetable intakes and well-documented racial and ethnic disparities in fruit and vegetable consumption, various approaches to increase vegetable consumption have been implemented. Gardening is one approach that has been associated with increased vegetable consumption in various subpopulations; however, limited national data exist examining this relationship. Since vegetable acquisition is a necessary antecedent to increased vegetable consumption, this study examines if garden access is associated with vegetable acquisition among adults in a nationally representative sample of U.S. households. Data come from the National Food Acquisition and Purchasing Survey (FAPS), a survey of 4826 US households. Descriptive analysis and modified Poisson regressions were performed to examine associations between household garden access and vegetable acquisition amongst the total population and by race. Results indicate that for foods for at-home consumption, respondents with their own garden had a 30% greater prevalence (PR: 1.30, 95% CI: 1.01, 1.64) of acquiring enough vegetables to meet USDA recommendations compared to respondents in households without access to any gardens. Among Black respondents, those with access to their own garden had over two times increased prevalence (PR: 2.35, 95% CI: 1.10, 5.01) of acquiring enough vegetables to meet recommended consumption amounts, compared to Black respondents without any access to a garden. No relationships between garden access and vegetable acquisition were observed for White or Asian respondents. This information may contribute to the body of evidence on strategies for increasing vegetable consumption among U.S. adults.