Global Food Insecurity and African, Caribbean, and Black (ACB) Populations During the COVID-19 Pandemic: a Rapid Review

Food insecurity and other barriers to adherence to a gluten-free diet in individuals with coeliac disease and non-coeliac gluten sensitivity in the Netherlands: a mixed-methods study

OBJECTIVES

To determine the prevalence of food insecurity among individuals with coeliac disease (CeD) and non-coeliac gluten sensitivity (NCGS) in the Netherlands and explore its association with diet quality and other barriers to adherence to a gluten-free diet.

DESIGN

Mixed-method design comprising a survey and semistructured interviews.

SETTING

An online survey was distributed through social media accounts and the newsletter of the Dutch Association for Celiac Disease. Community-dwelling patients were surveyed and interviewed between June and November 2023.

PARTICIPANTS AND OUTCOME MEASURES

In total 548 adults with CeD and NCGS in the Netherlands who adhered to a gluten-free diet completed the survey including questions related to demographics, household food insecurity, financial stress and diet quality. Regression analyses were conducted to assess associations between food insecurity and diet quality, and between food insecurity and perceived difficulty of gluten-free eating and cooking. Additionally, semistructured interviews with eight food insecure adults with CeD were conducted.

RESULTS

The prevalence of food insecurity was 23.2%, with 10.4% reporting very low food security. Very low food insecurity was associated with poorer diet quality (β=-5.5; 95% CI=-9.2 to -1.9; p=0.003). Food insecurity was associated with heightened perceived barriers across multiple themes. In age, income and education adjusted models, compared with food secure participants, low food secure participants were more likely to experience difficulty regarding skills (OR=2.5; 95% CI=1.5 to 4.3; p≤0.001), social circumstances (OR=2.6; 95% CI=1.1 to 6.4; p=0.038), resources (OR=2.5; 95% CI=1.5 to 4.4; p=0.001) and naturally gluten-free products (OR=1.8; 95% CI=1.0 to 3.1; p=0.045) in gluten-free eating and cooking. Participants with very low food security were more likely to experience difficulty regarding skills (OR=4.4; 95% CI=2.4 to 8.1; p≤0.001) and resources (OR=4.2; 95% CI=2.3 to 7.8; p<0.001) in gluten-free eating and cooking. The qualitative analysis provided a deeper understanding of these challenges, including employed strategies to manage costs and insights into the mental burden associated with adhering to a gluten-free diet.

CONCLUSION

These findings indicate that food insecurity is prevalent among Dutch people with CeD and NCGS, with potential impact on diet quality and adherence to a gluten-free diet. It further provided insight into perceived barriers to adhering to a gluten-free diet among this target population. These challenges should be taken into account by clinicians and policy makers.

Uncovering the drivers of food insecurity in Cameroon: insights from a nationwide cross-sectional analysis

BACKGROUND

Despite global efforts to achieve zero hunger, food insecurity remains a critical challenge in several African countries, including Cameroon. This study aims to identify sociodemographic predictors of food insecurity across Cameroon through a comprehensive, nationwide cross-sectional analysis.

METHODS

Data for this study were drawn from the 2018 Cameroon Demographic and Health Survey (CDHS). Food insecurity levels were evaluated using the Food Insecurity Experience Scale (FIES). To estimate the probabilities of moderate and severe food insecurity among different sociodemographic groups, logistic regression models were applied, with results expressed as average marginal effects (AME).

RESULTS

The findings reveal that approximately 24.86% of participants experienced moderate food insecurity, while 28.96% faced severe food insecurity. Among men, the proportion experiencing severe food insecurity was 38.8%, compared to 24.3% for women. Multivariable regression analysis showed that severe food insecurity was less likely among women [AME = 0.84, 95% CI = 0.83,0.86], Muslims [AME = 0.91, 95%CI = 0.90,0.93], individuals with higher education levels (secondary education: AME = 0.93, 95%CI = 0.90,0.95; higher education: AME = 0.87, 95%CI = 0.85,0.90), those owning land (either alone or jointly) [AME = 0.92, 95%CI = 0.89,0.96], wealthiest households (moderate food insecurity: AME = 0.91, 95%CI = 0.88,0.93; severe food insecurity: AME = 0.73, 95%CI = 0.70,0.75), female-headed households [AME = 0.97, 95%CI = 0.96,0.99], and rural residents [AME = 0.97, 95%CI = 0.95,0.98].

CONCLUSIONS

These findings underscore that food insecurity affects a substantial portion of the Cameroonian population, with certain sociodemographic groups more vulnerable than others. This study proposes targeted policy recommendations to address food insecurity in Cameroon, including social assistance programs for at-risk groups, investments in socioeconomic empowerment, improvements in agricultural productivity, and ongoing research to guide evidence-based interventions.

Sowing Seeds of Sovereignty: A Qualitative Exploration of Chapter Leader Experiences Who Belong to an African, Caribbean, and Black Women's Agriculture Advocacy Collective

African, Caribbean, and Black (ACB) populations are disproportionately impacted by food insecurity since the COVID-19 pandemic, with reports including limited access to healthy, affordable, and available food resulting in the exacerbation of existing health disparities and poorer living conditions and environments. Many interventions addressing food insecurity among ACB populations incorporate downstream models that emphasize consumer-level solutions (e.g., food donation or assistance programs). While useful for developing short-term solutions, these approaches do not meaningfully engage broader structures and root-causes-and, in many ways, reify existing inequities among these populations. Missing from mainstream dialogue is how food insecurity inequities at the individual level are often generated at higher structural levels and the unique assets of a targeted community or population to grow/distribute their own food and restore frayed transnational cultural foodways. This paper documents a case study of an international, Black women-led agriculture education collective headquartered in the South-Central region of the United States. Drawing on in-depth interviews with affiliate chapter leaders in the United States, US Virgin Islands, and Africa (n = 22), the research investigates how chapter leaders describe unique opportunities and barriers to farming and developing food insecurity solutions. Emergent themes from the data analysis were: (1) diasporically linked barriers, (a) infrastructural/political barriers and (b) patriarchal barriers; (2) mobilizing strategies; and (3) cultural and context-specific solutions. Findings from this study contribute important insights for food security development research centering community-based and grassroots organizing models addressing inequities in food production and health.

Exploring the experiences of Haitians/Haitian Americans in Miami-Dade County, Florida during the COVID-19 pandemic: how this community coped with the public health emergency

Objective

To explore and describe the experiences of Haitians/Haitian Americans in Miami-Dade County, Florida during the COVID-19 pandemic, including their attitudes and practices towards vaccination.

Design

We interviewed 15 community members and 15 stakeholders in the Haitian/Haitian American community in Miami-Dade County, Florida using a semi-structured interview guide. The qualitative interviews were conducted between February 4, 2021, and October 1, 2021. They were conducted in both English and Haitian Creole, audio recorded transcribed/translated, and coded using thematic content analysis.

Results

The analyses revealed 9 major themes: (1) thoughts about the pandemic, (2) concerns about the COVID-19 vaccines, (3) healthcare access, February-October 2021, (4) intrapersonal relationship dynamics, (5) thoughts about individuals diagnosed with COVID-19, (6) thoughts about prevention measures (e.g., wearing masks, hand hygiene, social distancing, vaccination), (7) mental health struggles and coping, (8) food insecurity, and (9) overall experiences of the pandemic. The findings reveal that the COVID-19 public health emergency negatively affected Haitians/Haitian Americans across several domains, including employment, healthcare access, personal relationships, and food security.

Conclusion

This research echoes the compounding negative experiences reported by multiple disadvantaged groups during the COVID-19 pandemic. From loss of employment to healthcare barriers, the pandemic forced many Haitians/Haitian Americans into greater economic and social instability. Interventions addressing these issues should recognize how these factors may interact and compound the experiences of this group. Health and public health agencies should work alongside community partners to build trust so that preventive efforts will be more readily accepted during public health emergencies.

From proximity concerns to constant snacking: Narratives of food access and consumption patterns before and during the COVID-19 pandemic

Objective: The goal of this research was to uncover narratives around food access and consumption among Black women who attend HBCUs before and during the COVID-19 pandemic. Participants: Black women, ages 18-25. Methods: Focus groups were used to understand how participants defined healthy foods as well as barriers and facilitators of consumption. During the pandemic follow-up focus groups uncovered how COVID-19 impacted their access and consumption patterns. Results: Findings revealed that HCBU women faced similar and distinct concerns around food access prior to and during the pandemic. Students were limited by price, budgets, proximity to healthy foods, kitchen access, and cooking tools. However, proximity or transportation both before and during the COVID-19 pandemic encouraged students to access healthy foods. Conclusion: For students who are already at a societal disadvantage and attend a university located in a food desert, access to nutritious foods can be an exacerbated plight.

Factors That Contribute to the Mental Health of Black Youth during COVID-19 Pandemic

BACKGROUND

The mental health of Black youth during the COVID-19 pandemic is potentially influenced by various systemic factors, including racism, socioeconomic disparities, and access to culturally sensitive mental health support. Understanding these influences is essential for developing effective interventions to mitigate mental health disparities.

METHODS

Our project used a community-based participatory (CBP) research design with an intersectional theoretical perspective. An advisory committee consisting of fourteen Black youth supported all aspects of our project. The research team consisted of experienced Black researchers who also trained six Black youths as research assistants and co-researchers. The co-researchers conducted individual interviews, contributed to data analysis, and mobilized knowledge. Participants were recruited through the advisory committee members and networks of Black youth co-researchers and sent an email invitation to Black community organizations. Forty-eight Black identified were interviewed between the ages of 16 and 30 in Canada. The data was analyzed thematically. We kept a reflexive note throughout all aspects of the project.

RESULTS

Participants reported significant challenges with online schooling, including a lack of support and access to resources. Lockdowns exacerbated stress, particularly for those living in toxic living/home environments. Financial burdens, such as food insecurity and precarious employment, were prevalent and exacerbated mental health challenges. Additionally, experiences of anti-Black racism and police brutality during the pandemic heightened stress and anxiety among participants.

CONCLUSIONS

The findings underscore the complex interplay of systemic factors in shaping the mental health of Black youth during the COVID-19 pandemic. Addressing these disparities requires targeted interventions that address structural inequities and provide culturally competent support to mitigate the impact on mental well-being.

Advancing Nutrition and Dietetics Research in Global Food and Nutrition Security: A Roundtable Meeting Report

Food and nutrition security remains a relevant issue globally, impacting nutritional status and other health outcomes. This is further complicated by various environmental factors that impact stable access to, availability of, and utilization of nutritious foods. Nutrition and dietetics practitioners play an important role in the identification and treatment of food and nutrition security and are also well positioned to advance research that can support food and nutrition security solutions. To address this important issue, the Academy of Nutrition and Dietetics' Council on Research convened a Global Food and Nutrition Security Research Task Force (Task Force). To leverage existing information and expertise in this area and identify the need for future evidence, the Task Force hosted a virtual roundtable with key internal and external stakeholders. This 2-day event included discussions on research gaps, potential entry points for nutrition and dietetics practitioners, and important equity considerations in the area of food and nutrition security research. The identified research gaps included the need for standardized terminology for consistent data collection, the need for validated screening and assessment tools that can be used across settings and also assess diet quality, additional translational and implementation science research, multi-sectoral and multi-pronged approaches, interdisciplinary collaboration with community partners, incorporation of research into policy development, and additional evidence on food systems approaches to target food and nutrition security. To more clearly identify the entry points for practitioners, five examples from various countries were included to identify food and nutrition security issues and how nutrition and dietetics practitioners can be involved in research to address food and nutrition security. The Task Force would like this information to inform a research agenda and be leveraged by the larger scientific community to drive future funding and research opportunities for food and nutrition professionals on this topic.

Factors Associated with the Usefulness of Public Health Communication in the Context of COVID-19: Lessons Learned from the African, Caribbean, and Black Communities in Ottawa, Ontario

Public health communication is critical for promoting behaviours that can prevent the transmission of COVID-19. However, there are concerns about the effectiveness of public health communication within Canada's African, Caribbean, and Black (ACB) communities. In the community sample of ACB people in Ottawa, Ontario, we asked community members if they perceive public health message related to COVID-19 to be effective. Using this question, the current study aimed to explore factors associated with the perceived usefulness of public health messages related to COVID-19. Results from the multivariate analysis have shown that ACB people with lower levels of risk perception for COVID-19 were less likely to perceive that public health messages were useful (OR = 0.405, p < 0.01). In addition, mistrust in government COVID-19 information was also negatively associated with their perception that health messages are useful (OR = 0.169, p < 0.01). For socioeconomic status, ACB people with no high school diploma (OR = 0.362, p < 0.05) and income dissatisfaction (OR = 0.431, p < 0.05) were less likely to report the perceived usefulness compared to those with a bachelor's degree and income satisfaction. Based on these findings, we discussed implications for policymakers and directions for future research.

Racial Health Disparities and Black Heterogeneity in COVID-19: A Case Study of Miami Gardens

The COVID-19 pandemic is a critical public health concern that has disproportionately affected the Black community in the United States. The purpose of this study was to examine the risk and protective factors faced by residents in the City of Miami Gardens during the COVID-19 pandemic, with emphases placed on racial health disparities and Black heterogeneity. Using convenience and snowball sampling, quantitative and qualitative data for this study were collected via an anonymous online questionnaire using QuestionPro. Survey links were distributed by e-mail invitations with assistance from city officials to the residents of this predominantly Black city in Florida (n = 83). Descriptive statistics and relevant qualitative responses are presented. Furthermore, a machine learning (ML) approach was used to select the most critical variables that characterized the two racial groups (Black versus non-Black participants) based on four ML feature selectors. Study findings offered important and interesting insights. Specifically, despite the greater prevalence of adopting measures to protect themselves and others from COVID-19, Black participants were more susceptible to activities that increased their COVID-19 risk levels. In addition, their rate of infection, particularly among the Afro-Caribbean ethnic group, was reported to be higher, indicating the need to further investigate the underlying conditions and root causes (including vaccine hesitancy and refusal) that contribute to their greater health disparities.

SNAP participation moderates the association between household food insecurity and HbA1c among Cambodian Americans with depression

OBJECTIVES

We tested whether participation in the Supplemental Nutrition Assistance Program (SNAP) moderated the relation between household food insecurity and HbA1c among Cambodian Americans with depression enrolled in a diabetes prevention trial.

METHODS

Community health workers assessed household food insecurity and SNAP participation. HbA1c was ascertained using direct enzymatic assay.

RESULTS

Among the n = 189 respondents, 19% were food insecure, 41% received SNAP benefits, and mean HbA1c = 5.5%. There was a significant interaction between SNAP and food insecurity. HbA1c was highest among participants without SNAP who were food insecure. Simple effects analysis revealed a significant difference within the no SNAP group [Mean (SD): Secure = 5.38 (0.38), Insecure = 5.78 (0.36)] and no difference within the SNAP group [Secure = 5.61(0.44), Insecure = 5.61(0.55)]. Differences remained significant after controlling for demographic, socioeconomic, and clinical indicators.

CONCLUSIONS

SNAP may protect against the deleterious association between household food insecurity and HbA1c.

Food Security as Ethics and Social Responsibility: An Application of the Food Abundance Index in an Urban Setting

High levels of food insecurity signal the presence of disparities and inequities in local food access that have been shown to negatively impact the health and well-being of individuals and communities. Some argue that the lack of healthy, affordable and culturally relevant food within a community represents a troubling social and ethical concern for any society. The current research conducts an assessment of a specific community utilizing the framework outlined by the Food Abundance Index (FAI) scorecard. Combined with contemporary regional data on the demographics of the area, data revealed extremely low scores for both access and density dimensions. Our findings can help business, community and policymakers better understand and target evidence-based solutions to address the issue of food insecurity within this region.

Barriers to COVID-19 Health Products in Low-and Middle-Income Countries During the COVID-19 Pandemic: A Rapid Systematic Review and Evidence Synthesis

Introduction

The coronavirus disease 2019 (COVID-19) pandemic has intensified the urgency in addressing pressing global health access challenges and has also laid bare the pervasive structural and systemic inequities that make certain segments of society more vulnerable to the tragic consequences of the disease. This rapid systematic review analyses the barriers to COVID-19 health products in low-and middle-income countries (LMICs). It does so from the canon of global health equity and access to medicines by proposing an access to health products in low-and middle-income countries framework and typology adapted to underscore the complex interactive and multiplicative nature and effects of barriers to health products and their root cause as they coexist across different levels of society in LMICs.

Methods

Modified versions of the Joanna Briggs Institute (JBI) reviewers' manual for evidence synthesis of systematic reviews and the PRISMA-ScR framework were used to guide the search strategy, identification, and screening of biomedical, social science, and gray literature published in English between 1 January 2020 and 30 April 2021.

Results

The initial search resulted in 5,956 articles, with 72 articles included in this review after screening protocol and inclusion criteria were applied. Thirty one percent of the articles focused on Africa. The review revealed that barriers to COVID-19 health products were commonly caused by market forces (64%), the unavailability (53%), inaccessibility (42%), and unaffordability (35%), of the products, incongruent donors' agenda and funding (33%) and unreliable health and supply systems (28%). They commonly existed at the international and regional (79%), health sectoral (46%), and national cross-sectoral [public policy] (19%) levels. The historical heritage of colonialism in LMICs was a commonly attributed root cause of the barriers to COVID-19 health products in developing countries.

Conclusion

This review has outlined and elaborated on the various barriers to health products that must be comprehensively addressed to mount a successful global, regional, national and subnational response to present and future epidemics and pandemics in LMICs.

Emerging technologies and their roles during the COVID-19 pandemic and safety challenges of frontline medical staff: a rapid review

Purpose

The coronavirus 2019 (COVID-19) pandemic has rapidly spread worldwide, with an ever-increasing number of confirmed positive cases and mortality rate. Moreover, frontline medical staff fighting with the COVID-19 infection have been infected and show psychological effects of the pandemic. This study presents an overview of the emerging literature on the safety challenges of frontline medical staff and how technology is being used to control the COVID-19 pandemic.

Methods

This study conducts a rapid review of available studies by following the “preferred reporting items for systematic reviews and meta-analyses” (PRISMA) guidelines. Sixty-three articles were selected for this rapid review paper from three popular digital data repositories.

Results

The majority of the studies chosen focused on the discussion of COVID-19 with regard to China, Singapore, Italy, and the USA. A previously proposed framework is used to synthesize the findings of this study. The results throw light on the several challenges faced by medical staff during the COVID-19 pandemic. Eleven major technologies have been identified in this paper.

Conclusion

This work concludes that technology helps in the prevention and detection of the COVID-19 infection, where it specifically helps in reducing the safety challenges of frontline medical staff and monitoring the COVID-19 patients.

Ghana's rice value chain resilience in the context of COVID-19

The 2020 State of the Food Security and Nutrition World report suggests that the COVID-19 pandemic may render 83 to 132 million people food insecure. The global south has been projected to be adversely affected by COVID-19 in terms of food and nutritional security. This potentially renders Africa off track in achieving SDG -2 of zero hunger by 2030. Ghana is a net importer of rice and how the sector responded to the global pandemic has received less traction in the agri-food system literature. There is skewed literature that concentrates on the global north. The paper employed a qualitative approach involving key informant interviews across 6 regions in Ghana. The study covered 48 Agricultural Extension Agents (AEAs) and Monitoring and Evaluation (M&E) officers, 80 farmers, and 48 market leaders. We use one of the country's main food staple - rice to show the food (in)-security situation during the pandemic. We articulate that using the right food security conceptual and theoretical framing remains imperative in understanding food (in)-security. The findings showed price hikes during the imposition of lockdown affected access (physical and effective demand). Rice however remained available during and after the lockdown imposition. Ghana's rice production output was affected during the COVID-19 pandemic in 2020. The ramification of COVID-19 on Ghana's rice sector was not dire but points to the vulnerability of the rice value chain to future pandemics. Important policy actions are needed to consolidate particular gains made in Ghana's planting for food and jobs to minimize rice imports.