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Bradley SE, Heuer JN, Hahm B, Pettey K, Besterman-Dahan K. "Just Food doesn't Do It": Understanding Food Insecurity Among Rural Veterans in the United States. Ecol Food Nutr 2024:1-21. [PMID: 39097942 DOI: 10.1080/03670244.2024.2387339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
Food security among rural veteran populations is an understudied subject. This study uses qualitative data from 106 semi-structured interviews conducted with staff from programs at the United States Department of Veterans Affairs (VA) and other federal agencies, staff from non-governmental organizations (NGOs), food security researchers, and food insecure veterans to identify the barriers to and facilitators for rural veteran food security. Barriers identified included external, structural barriers that exist in rural areas; internal barriers to using food assistance, such as feeling stigmatized; and barriers related to other social determinants of health, including a lack of education, employment, or housing stability.
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Affiliation(s)
- Sarah E Bradley
- Center for Healthcare Outcomes & Policy (CHOP) Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Research Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Jacquelyn N Heuer
- Research Service, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Bridget Hahm
- Research Service, Edward Hines, Jr. VA Hospital, Hines, Illinois, USA
| | - Kristin Pettey
- Office of Rural Health, Veterans Rural Health Resource Center, Salt Lake City, Utah, USA
| | - Karen Besterman-Dahan
- Mental Health, VISN 5 Mental Illness Research, Education and Clinical Center, Baltimore, Maryland, USA
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Griesemer I, Palmer JA, MacLaren RZ, Harvey KLL, Li M, Garikipati A, Linsky AM, Mohr DC, Gurewich D. Rural Veterans' Experiences with Social Risk Factors: Impacts, Challenges, and Care System Recommendations. J Gen Intern Med 2024; 39:782-789. [PMID: 38010459 PMCID: PMC11043235 DOI: 10.1007/s11606-023-08530-8] [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: 04/20/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Social risk factors, such as food insecurity and financial needs, are associated with increased risk of cardiovascular diseases, health conditions that are highly prevalent in rural populations. A better understanding of rural Veterans' experiences with social risk factors can inform expansion of Veterans Health Administration (VHA) efforts to address social needs. OBJECTIVE To examine social risk and need from rural Veterans' lived experiences and develop recommendations for VHA to address social needs. DESIGN We conducted semi-structured interviews with participants purposively sampled for racial diversity. The interview guide was informed by Andersen's Behavioral Model of Health Services Use and the Outcomes from Addressing Social Determinants of Health in Systems framework. PARTICIPANTS Rural Veterans with or at risk of cardiovascular disease who participated in a parent survey and agreed to be recontacted. APPROACH Interviews were recorded and transcribed. We analyzed transcripts using directed qualitative content analysis to identify themes. KEY RESULTS Interviews (n = 29) took place from March to June 2022. We identified four themes: (1) Social needs can impact access to healthcare, (2) Structural factors can make it difficult to get help for social needs, (3) Some Veterans are reluctant to seek help, and (4) Veterans recommended enhancing resource dissemination and navigation support. CONCLUSIONS VHA interventions should include active dissemination of information on social needs resources and navigation support to help Veterans access resources. Community-based organizations (e.g., Veteran Service Organizations) could be key partners in the design and implementation of future social need interventions.
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Affiliation(s)
- Ida Griesemer
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA.
| | - Jennifer A Palmer
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Risette Z MacLaren
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
| | - Kimberly L L Harvey
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
| | - Mingfei Li
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
- Department of Mathematical Sciences, Bentley University, Waltham, MA, USA
| | | | - Amy M Linsky
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - David C Mohr
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
- Department of Health Law, Policy & Management, School of Public Health, Boston University, Boston, MA, USA
| | - Deborah Gurewich
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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Qin Y, Sneddon DA, MacDermid Wadsworth S, Topp D, Sterrett RA, Newton JR, Eicher-Miller HA. Grit but Not Help-Seeking Was Associated with Food Insecurity among Low Income, At-Risk Rural Veterans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2500. [PMID: 36767870 PMCID: PMC9916015 DOI: 10.3390/ijerph20032500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/14/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
Rural veterans have poorer health, use healthcare services less often than their urban counterparts, and have more prevalent food insecurity than average U.S. households. Food insecurity and resource use may be influenced by modifiable psychological attributes such as grit and help-seeking behaviors, which may be improved through interventions. Grit and help-seeking have not been previously evaluated among rural veterans. Thus, this cross-sectional study evaluated the hypothesis that grit and help-seeking were associated with food insecurity and the use of resources. Food security, resource use, grit, and help-seeking behavior were assessed among rural veterans (≥18 years) from five food pantries in southern Illinois counties (n = 177) from March 2021 to November 2021. Adjusted multiple regression was used to estimate the relationship between the odds of food insecurity and the use of resources with grit and help-seeking scores. Higher grit scores were significantly associated with lower odds of food insecurity (OR = 0.5, p = 0.009). No other associations were detected. The results provided evidence to inform the content of future educational interventions to improve food insecurity and address health disparities among rural veterans by addressing grit. The enhancement of psychological traits such as grit is related to food security and has the potential to benefit other aspects of well-being.
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Affiliation(s)
- Yue Qin
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA
| | - Douglas A. Sneddon
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN 47907, USA
| | | | - Dave Topp
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN 47907, USA
| | - Rena A. Sterrett
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN 47907, USA
| | - Jake R. Newton
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN 47907, USA
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Abstract
BACKGROUND Food insecurity (FI) is an important public health issue for US veterans. For many veterans, civilian life is fraught with service-incurred health issues and socioeconomic challenges, each risk factors for FI. The FI literature on veterans is limited due to insufficient coverage of the topic's complexity and the methods used to study it in this population. No published analysis has evaluated how FI has been examined in US veterans. OBJECTIVES We assessed how FI has been examined in US military veterans by identifying (1) the major content areas, or domains, studied in association with FI and (2) the existing research gaps. METHODS A scoping literature review was conducted to map the main research domains of the FI literature and identify knowledge gaps. Electronic database and hand searches identified potentially relevant studies (n = 61). Data extraction, utilizing a standardized set of design parameters, was completed. Duplicate removal and application of inclusion/exclusion criteria resulted in the studies (n = 21) selected for critical review. RESULTS Eight research domains were determined: FI prevalence, health status, dietary practices, health care utilization, economic instability, homelessness/housing instability, food program participation, and community/emergency preparedness-the most dominant was health status and the least dominant were social determinants (ie, homelessness/housing instability, food program participation). Research on validity and usability of FI assessment methods in veterans was virtually absent. Military service factors, longitudinal effects, FI among women, intervention effectiveness, and other areas lacked sufficient inquiry. CONCLUSION Research is required on lesser examined content areas and methodology to optimize surveillance and policy for veteran FI.
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Affiliation(s)
- Yasmin S Cypel
- Epidemiology Program, Post-Deployment Health Services (12POP5), Office of Patient Care Services, 8267US Department of Veterans Affairs, Veterans Health Administration, Washington, DC, USA
| | - Jodie G Katon
- 49462US Department of Veterans Affairs (VA) Puget Sound Health Care System, Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.,Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
| | - Mark B Schure
- Department of Health & Human Development, 1705Montana State University, Bozeman, MT, USA
| | - Shanna Smith
- Epidemiology Program, Post-Deployment Health Services (12POP5), Office of Patient Care Services, 8267US Department of Veterans Affairs, Veterans Health Administration, Washington, DC, USA
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Abstract
Purpose of Review This review examines the current epidemiological evidence for the relationship between levels of food insecurity and cardiovascular disease (CVD) outcomes among US adults > 17 years. Recent Findings Review of recent literature revealed that reduced food security was associated with decreased likelihood of good self-reported cardiovascular health and higher odds of reporting CVD-related outcomes such as coronary heart disease, angina, heart attack, peripheral arterial disease, and hypertension. Summary Existing evidence suggests a compelling association between each level of reduced food security and CVD risk with a particularly strong association between very low food security and CVD risk. Policies and public health-based strategies are needed to identify the most vulnerable subgroups, strengthen and enhance access to food assistance programs, and promote awareness and access to healthful foods and beverages to improve food security, nutrition, and cardiovascular health.
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Affiliation(s)
- Yibin Liu
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, 314 Kimball Tower, Buffalo, NY, 14214, USA.
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Eicher-Miller HA. A review of the food security, diet and health outcomes of food pantry clients and the potential for their improvement through food pantry interventions in the United States. Physiol Behav 2020; 220:112871. [PMID: 32179054 DOI: 10.1016/j.physbeh.2020.112871] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 11/19/2022]
Abstract
Food pantries are community-based organizations that provide food to prevalently low and very low food secure households, presenting an opportune point of contact and potential site for interventions. This review evaluates the food security, dietary quality, dietary intake and health outcomes of U.S. adults served by food pantries and the potential for interventions based in food pantries to improve these outcomes. Results from the 15 included studies showed the prevalence of food insecurity and very low food security among food pantry clients was higher than national estimates at up to 89% and 52%, respectively; dietary quality was up to 20 points lower on the Healthy Eating Index compared with U.S. adults; intake for 16 nutrients did not meet the Estimated Average Requirement or exceed the Average Intake for 30% to 100% of clients; and a strikingly high prevalence of obesity, diabetes, heart disease and related conditions, and depressive symptoms were present among U.S. food pantry users. Interventions in food pantries have been successful in improving food security, weight and diabetic control but not dietary quality or intake. However, these few interventions hold promise and present a need for further research investment to address food security, dietary intake and health outcomes among food pantry clients.
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Affiliation(s)
- Heather A Eicher-Miller
- Department of Nutrition Science, Purdue University 700 W. State Street, West Lafayette, IN 47907-2059, United States.
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