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Atoloye AT, Akinsola O, Murillo M. Examining Factors Associated with the Use of Community Food Resources: An Application of the Andersen Model to Inform Future Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:76. [PMID: 38248540 PMCID: PMC10815130 DOI: 10.3390/ijerph21010076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/31/2023] [Accepted: 01/05/2024] [Indexed: 01/23/2024]
Abstract
The role of the food environment in shaping nutrition and health has gained substantial attention from policymakers, public health researchers, and advocacy groups. To promote equities in food access and nutrition outcomes, understanding factors linked with the utilization of local community food resources is crucial. Using Andersen's service utilization model, we explained how adults use their neighborhood food resources. In a cross-sectional study design, an online survey was conducted in REDCap Version 13.4.0 via the Amazon Mechanical Turk (MTurk) involving 1830 adults with a mean age of 37.9 ± 12.1 years. Participants answered questions on predisposing, enabling, and need factors that influence their use of different community food resources. The predisposing factors that were statistically significant included age, family size, marital status, race, and ethnicity. The enabling factors included travel time, travel mode, income, and shopping decision motivators (such as being able to use Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) vouchers, delivery services, great sales, and coupons). Food security and community food resources need for lower food price were the significant need factors. However, these factors vary by the types of food resources. In conclusion, enhancing the utilization of community-based food access initiatives and programs among underserved families requires consideration of family composition, racial and ethnic diversity, and transportation access.
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Affiliation(s)
- Abiodun T. Atoloye
- Department of Nutrition, Dietetics, and Food Sciences, Utah State University, Logan, UT 84322, USA
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Sharareh N, Adesoba TP, Wallace AS, Bybee S, Potter LN, Seligman H, Wilson FA. Associations between food insecurity and other social risk factors among U.S. adults. J Gen Intern Med 2024; 39:52-60. [PMID: 37558857 PMCID: PMC10817876 DOI: 10.1007/s11606-023-08360-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Food insecurity (FI) often co-exists with other social risk factors, which makes addressing it particularly challenging. The degree of association between FI and other social risk factors across different levels of income and before and during the COVID-19 pandemic is currently unknown, impeding the ability to design effective interventions for addressing these co-existing social risk factors. OBJECTIVE To determine the association between FI and other social risk factors overall and across different levels of income-poverty ratios and before (2019) and during (2020-2021) the pandemic. DESIGN We used nationally representative data from the 2019-2021 National Health Interview Survey for our cross-sectional analysis. Social risk factors available in NHIS included difficulties paying for medical bills, difficulties paying for medications, receiving income assistance, receiving rental assistance, and "not working last week". SUBJECTS 93,047 adults (≥18 years old). KEY RESULTS Individuals with other social risk factors (except receiving income assistance) were more likely to report FI, even after adjusting for income and education inequalities. While poverty leads to a higher prevalence of FI, associations between FI and other social risk factors were stronger among people with higher incomes, which may be related to their ineligibility for social safety net programs. Associations were similar before and during the pandemic, perhaps due to the extensive provision of social safety net programs during the pandemic. CONCLUSIONS Future research should explore how access to a variety of social safety net programs may impact the association between social risk factors. With the expiration of most pandemic-related social supports, further research and monitoring are also needed to examine FI in the context of increasing food and housing costs. Our findings may also have implications for the expansion of income-based program eligibility criteria and screening for social risk factors across all patients and not only low-income people.
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Affiliation(s)
- Nasser Sharareh
- Department of Population Health Sciences, Spence Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA.
| | - Taiwo P Adesoba
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Andrea S Wallace
- Department of Population Health Sciences, Spence Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Sara Bybee
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Lindsey N Potter
- Department of Population Health Sciences, Spence Fox Eccles School of Medicine at the University of Utah, Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Hilary Seligman
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Fernando A Wilson
- Department of Population Health Sciences, Spence Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
- Matheson Center for Health Care Studies, Department of Economics, College of Social and Behavioral Science, University of Utah, Salt Lake City, UT, USA
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Sharareh N, Bybee S, Goldstein E, Jones S, Hess R, Wallace A, Seligman H, Wilson FA. Disparities in food insecurity between sexual minority and heterosexual adults - a higher burden on bisexual individuals. Front Public Health 2023; 11:1237091. [PMID: 37608986 PMCID: PMC10441544 DOI: 10.3389/fpubh.2023.1237091] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023] Open
Abstract
Background Sexual minorities-individuals who identify as gay/lesbian, bisexual, or other non-heterosexual individuals-experience higher rates of food insecurity (FI) compared to heterosexual individuals. During the COVID-19 pandemic, discrimination and structural racism, which are known risk factors for food insecurity, were perpetuated against sexual and racial/ethnic minorities. However, to our knowledge, a nationally representative analysis of the impact of the pandemic on food insecurity by sexual minority status and based on race/ethnicity is missing. We aimed to determine the degree of association between FI and sexual minority adults overall, before (2019) and during (2020-2021) the pandemic, and stratified by race/ethnicity. Methods We used nationally representative data from the 2019-2021 National Health Interview Survey (NHIS). We specified multivariable logistic regression models to determine the association between FI and identifying as a sexual minority adult (≥18 years old), including gay/lesbian, bisexual, and other non-heterosexual individuals. Results Overall, we only observed FI disparities between bisexuals and heterosexuals (aOR 1.61 [95% CI 1.31-1.99]). Stratified by year, this association was significant only during the pandemic. Stratified by race/ethnicity, non-Hispanic white and non-Hispanic black individuals identifying as bisexual also experienced a significantly higher FI rate than their heterosexual counterparts. Conclusion Our results may be a manifestation of the disproportionate impact of discrimination on bisexual individuals' FI experiences. With the growing number of legislative bills targeting the rights of sexual minorities, we expect to see a higher burden of FI among bisexuals, particularly, bisexual people of color. Future intersectional research regarding FI among bisexual and racial/ethnic minority individuals would further elucidate how membership in multiple minority groups may contribute to a higher risk of FI.
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Affiliation(s)
- Nasser Sharareh
- Department of Population Health Sciences, Spence Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Sara Bybee
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Evan Goldstein
- Department of Population Health Sciences, Spence Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Shannon Jones
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, United States
| | - Rachel Hess
- Department of Population Health Sciences, Spence Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Andrea Wallace
- Department of Population Health Sciences, Spence Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Hilary Seligman
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Fernando A. Wilson
- Department of Population Health Sciences, Spence Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
- Matheson Center for Health Care Studies, University of Utah, Salt Lake City, UT, United States
- Department of Economics, College of Social and Behavioral Science, University of Utah, Salt Lake City, UT, United States
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