1
|
Landry MJ, Heying E, Qamar Z, Hagedorn-Hatfield RL, Savoie-Roskos MR, Cuite CL, Zigmont VA, OoNorasak K, Chen S. Advancing college food security: priority research gaps. Nutr Res Rev 2024; 37:108-120. [PMID: 37158045 DOI: 10.1017/s0954422423000094] [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] [Indexed: 05/10/2023]
Abstract
Despite over a decade of both quantitative and qualitative studies, food insecurity among US college/university students remains a pervasive problem within higher education. The purpose of this perspective piece was to highlight research gaps in the area of college food insecurity and provide rationale for the research community to focus on these gaps going forward. A group of food insecurity researchers from a variety of higher education institutions across the United States identified five thematic areas of research gaps: screening and estimates of food insecurity; longitudinal changes in food insecurity; impact of food insecurity on broader health and academic outcomes; evaluation of impact, sustainability and cost effectiveness of existing programmes and initiatives; and state and federal policies and programmes. Within these thematic areas, nineteen specific research gaps were identified that have limited or no peer-reviewed, published research. These research gaps result in a limited understanding of the magnitude, severity and persistence of college food insecurity, the negative short- and long-term impacts of food insecurity on health, academic performance and overall college experience, and effective solutions and policies to prevent or meaningfully address food insecurity among college students. Research in these identified priority areas may help accelerate action and interdisciplinary collaboration to alleviate food insecurity among college students and play a critical role in informing the development or refinement of programmes and services that better support college student food security needs.
Collapse
Affiliation(s)
- Matthew J Landry
- Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Emily Heying
- Department of Nutrition, College of Saint Benedict & Saint John's University, Saint Joseph, MN, USA
| | - Zubaida Qamar
- Department of Family, Interiors, Nutrition and Apparel, San Francisco State University, San Francisco, CA, USA
| | | | - Mateja R Savoie-Roskos
- Department of Nutrition, Dietetics and Food Sciences, Utah State University, Logan, UT, USA
| | - Cara L Cuite
- Department of Human Ecology, School of Environmental and Biological Sciences, Rutgers University, New Brunswick, NJ, USA
| | - Victoria A Zigmont
- Department of Health, Exercise Science, and Recreation Management, School of Applied Sciences, University of Mississippi, Oxford, MS, USA
| | - Kendra OoNorasak
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY, USA
| | - Susan Chen
- Department of Nutrition, Food Science, and Packaging, San José State University, San José, CA, USA
| |
Collapse
|
2
|
Alba C, Wang X, An R. Are Supplemental Nutrition Assistance Program Restrictions on Sugar-Sweetened Beverages Effective in Reducing Purchase or Consumption? A Systematic Review. Nutrients 2024; 16:1459. [PMID: 38794697 PMCID: PMC11123964 DOI: 10.3390/nu16101459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
The participants in the Supplemental Nutrition Assistance Program (SNAP) consume greater amounts of sugar and sweetened beverages (SSBs) compared to non-eligible individuals, which could result in potential negative health outcomes. This can be attributed to the lack of restrictions on SSB purchases with SNAP benefits. In view of the increasing calls from advocates and policymakers to restrict the purchase of SSBs with SNAP benefits, we performed a systematic review to assess its impact towards SSB purchases and consumption. We searched articles from five databases-Cochrane, EBSCO, SCOPUS, Web of Science, and PubMed-and selected seven studies, four of which were randomized controlled trials (RCTs) and three were simulation modeling studies. All three simulation studies and one RCT reported outcomes in terms of consumption, while the other three RCTs reported outcomes in terms of purchases. All seven studies found that an SSB restriction led to a decrease in SSB consumption or purchases, with six studies reporting significant results. Nonetheless, limitations exist. These include limited studies on this subject, potential workarounds circumventing SSB restrictions, like making purchases using personal cash, potentially differed estimated effects when combined with incentives or other initiatives, and the limited geographical scope among the selected RCTs.
Collapse
Affiliation(s)
- Charles Alba
- Division of Computational & Data Sciences, Washington University in St Louis, St. Louis, MO 63130, USA;
| | - Xi Wang
- Brown School, Washington University in St Louis, St. Louis, MO 63130, USA;
| | - Ruopeng An
- Division of Computational & Data Sciences, Washington University in St Louis, St. Louis, MO 63130, USA;
- Brown School, Washington University in St Louis, St. Louis, MO 63130, USA;
| |
Collapse
|
3
|
Berkowitz SA, Drake C, Byhoff E. Food Insecurity and Social Policy: A Comparative Analysis of Welfare State Regimes in 19 Countries. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2024; 54:76-86. [PMID: 38087472 PMCID: PMC10954393 DOI: 10.1177/27551938231219200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/04/2023] [Accepted: 09/22/2023] [Indexed: 01/18/2024]
Abstract
We sought to determine whether a country's social policy configuration-its welfare state regime-is associated with food insecurity risk. We conducted a cross-sectional study of 2017 U.N. Food and Agriculture Organization individual-level food insecurity survey data from 19 countries (the most recent data available prior to COVID-19). Countries were categorized into three welfare state regimes: liberal (e.g., the United States), corporatist (e.g., Germany), or social democratic (e.g., Norway). Food insecurity probability, calibrated to an international reference standard, was calculated using a Rasch model. We used linear regression to compare food insecurity probability across regime types, adjusting for per-capita gross domestic product, age, gender, education, and household composition. There were 19,008 participants. The mean food insecurity probability was 0.067 (SD: 0.217). In adjusted analyses and compared with liberal regimes, food insecurity probability was lower in corporatist (risk difference: -0.039, 95% CI -0.066 to -0.011, p = .006) and social democratic regimes (risk difference: -0.037, 95% CI -0.062 to -0.012, p = .004). Social policy configuration is strongly associated with food insecurity risk. Social policy changes may help lower food insecurity risk in countries with high risk.
Collapse
Affiliation(s)
- Seth A. Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Connor Drake
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Population Health Science, Duke University School of Medicine, Durham, NC, USA
| | - Elena Byhoff
- Division of Health Systems Science, Department of Medicine, UMass Chan Medical School, Worcester, MA, USA
| |
Collapse
|
4
|
Wolfson JA, Leung CW. Food Insecurity in the COVID-19 Era: A National Wake-up Call to Strengthen SNAP Policy. Ann Intern Med 2024; 177:255-256. [PMID: 38163362 DOI: 10.7326/m23-3363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Affiliation(s)
- Julia A Wolfson
- Department of Health, Policy and Management and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Cindy W Leung
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| |
Collapse
|
5
|
Xie L, O'Connor J, Albert S, Gary-Webb T, Sharbaugh M, Donohue JM, Ennis M, Hutcheson D, Cole ES. Churn in Supplemental Nutrition Assistance Program: Changes in Medicaid Expenditure and Acute Care Utilization. Med Care 2024; 62:3-10. [PMID: 37449863 DOI: 10.1097/mlr.0000000000001887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND The Supplemental Nutrition Assistance Program (SNAP) provides financial assistance to low-income individuals and families to help them purchase food. However, when participants experience short-term disenrollment from the program, known as churn, it can disrupt their health care usage patterns or result in acute health care needs due to the loss of financial benefits and time burden required to reapply for SNAP. OBJECTIVE The objective of this study was to examine the changes in health care expenditures and acute care utilization during periods of SNAP churn compared with nonchurn periods among those who churn during the study period. RESEARCH DESIGN Longitudinal analysis of Pennsylvania Medicaid claims data for enrollees participating in SNAP between 2016 and 2018 using individual fixed-effects models. We add to the literature by estimating whether these changes varied based on the amount of SNAP benefit lost, or differed between adults and children. RESULTS We found that SNAP churn was associated with reductions in pharmacy and primary care spending across all SNAP benefit levels and age groups. Specifically, our findings indicate a reduction of 4%-6% in pharmacy expenditures for adults and 2%-4% for children. Moreover, there was a 3%-4% decrease in primary care expenditures for adults and a 4%-6% decrease for children. Acute care utilization did not significantly change during a SNAP churn period. CONCLUSION Our findings of decreases in pharmacy and primary care spending suggest that preventing SNAP churn may help reduce instances where adult and child participants forgo necessary care.
Collapse
Affiliation(s)
- Liyang Xie
- NORC at the University of Chicago, Bethesda, MD
| | - Jason O'Connor
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA
| | - Steven Albert
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Tiffany Gary-Webb
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Michael Sharbaugh
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA
| | - Julie M Donohue
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA
| | - Molly Ennis
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA
| | - Deborah Hutcheson
- Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA
| | - Evan S Cole
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
6
|
Tamargo JA, Strath LJ, Karanth SD, Spector AL, Sibille KT, Anton S, Cruz-Almeida Y. Food insecurity is associated with chronic pain and high-impact chronic pain in the USA. Public Health Nutr 2023; 27:e7. [PMID: 38087858 PMCID: PMC10830368 DOI: 10.1017/s1368980023002732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/08/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE This study evaluated whether food insecurity (US Adult Food Security Survey) was associated with chronic pain (≥ 3 months) and high-impact chronic pain (i.e. pain that limits work and life) among US adults. DESIGN Cross-sectional analysis. SETTING Nationally representative sample of non-institutionalised adults in the USA. PARTICIPANTS 79 686 adults from the National Health Interview Survey (2019-2021). RESULTS Marginal, low and very low food security were associated with increased prevalence odds of chronic pain (OR: 1·58 (95 % CI 1·44, 1·72), 2·28 (95 % CI 2·06, 2·52) and 3·37 (95 % CI 3·01, 3·78), respectively) and high-impact chronic pain (OR: 1·28 (95 % CI 1·14, 1·42), 1·55 (95 % CI 1·37, 1·75) and 1·90 (95 % CI 1·65, 2·18), respectively) in a dose-response fashion (P-trend < 0·0001 for both), adjusted for sociodemographic, socio-economic and clinically relevant factors. Participation in Supplemental Nutrition Assistance Program (SNAP) and age modified the association between food insecurity and chronic pain. CONCLUSIONS These findings illustrate the impact of socio-economic factors on chronic pain and suggest that food insecurity may be a social determinant of chronic pain. Further research is needed to better understand the complex relationship between food insecurity and chronic pain and to identify targets for interventions. Moreover, the consideration of food insecurity in the clinical assessment of pain and pain-related conditions among socio-economically disadvantaged adults may be warranted.
Collapse
Affiliation(s)
- Javier A Tamargo
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Institute on Aging, University of Florida, Gainesville, FL, USA
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
| | - Larissa J Strath
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
| | - Shama D Karanth
- University of Florida Health Cancer Center, University of Florida, Gainesville, FL, USA
| | - Antoinette L Spector
- College of Health Professions and Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Kimberly T Sibille
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Department of Physical Medicine & Rehabilitation, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Stephen Anton
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Institute on Aging, University of Florida, Gainesville, FL, USA
| | - Yenisel Cruz-Almeida
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Institute on Aging, University of Florida, Gainesville, FL, USA
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
| |
Collapse
|
7
|
Kenney EL, Poole MK, Frost N, Kinderknecht K, Mozaffarian RS, Andreyeva T. How policy implementation shapes the impact of U.S. food assistance policies: the case study of the Child and Adult Care Food Program. FRONTIERS IN HEALTH SERVICES 2023; 3:1286050. [PMID: 38028947 PMCID: PMC10653325 DOI: 10.3389/frhs.2023.1286050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023]
Abstract
Much of the chronic disease burden in the U.S. population can be traced to poor diet. There has been a sustained focus on influencing children's diets and encouraging healthier eating habits by changing policies for what foods and beverages can be served to children through large federally-funded nutrition assistance programs. Yet without attention to how nutrition policies are implemented, and the surrounding context for these policies, these policy changes may not have the intended results. In this perspective, we used Bullock et al.'s (2021) Process Model of Implementation from a Policy Perspective to analyze how the complexities of the implementation process of large-scale nutrition policies can dilute potential health outcomes. We examine the Child and Adult Care Food Program (CACFP), a federal program focused on supporting the provision of nutritious meals to over 4 million children attending childcare, as a case study. We examine how the larger societal contexts of food insecurity, attitudes towards the social safety net, and a fragmented childcare system interact with CACFP. We review the "policy package" of CACFP itself, in terms of its regulatory requirements, and the various federal, state, and local implementation agencies that shape CACFP's on-the-ground implementation. We then review the evidence for how each component of the CACFP policy implementation process impacts uptake, costs, feasibility, equity, and effectiveness at improving children's nutrition. Our case study demonstrates how public health researchers and practitioners must consider the complexities of policy implementation processes to ensure effective implementation of nutrition policies intended to improve population health.
Collapse
Affiliation(s)
- Erica L. Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Mary Kathryn Poole
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | | | - Kelsey Kinderknecht
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Rebecca S. Mozaffarian
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Tatiana Andreyeva
- Department of Agricultural and Resource Economics, Rudd Center for Food Policy and Health, University of Connecticut, Storrs, CT, United States
| |
Collapse
|
8
|
Chaparro MP, Auchincloss AH, Argibay S, Ruggiero DA, Purtle J, Langellier BA. County- and state-level immigration policies are associated with Supplemental Nutrition Assistance Program (SNAP) participation among Latino households. Soc Sci Med 2023; 333:116141. [PMID: 37572629 PMCID: PMC10530172 DOI: 10.1016/j.socscimed.2023.116141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023]
Abstract
The purpose of this study was to investigate the association between county- and state-level immigrant criminalizing and integrating policies and Latino household participation in the largest safety net program against food insecurity in the U.S., the Supplemental Nutrition Assistance Program (SNAP). Our outcome, county-level proportion of SNAP-participating Latino households, and county-level covariates were obtained from the American Community Survey 1-year county files (N = 675 counties) for 13 years (2007-2019). Our exposures were county-level presence of sanctuary policies and a state-level immigrant friendliness score, created based on 19 immigrant criminalizing and integrating state-level policies obtained from the Urban Institute's State Immigration Policies Resource. We classified every county in the sample as 1) sanctuary policy + immigrant friendly state, 2) sanctuary policy + immigrant unfriendly state, 3) no sanctuary policy + immigrant friendly state, and 4) no sanctuary policy + immigrant unfriendly state. Using multivariable generalized linear models that adjusted for poverty levels and other social composition characteristics of counties, we found that county-level SNAP participation among Latino households was 1.1 percentage-point higher in counties with sanctuary policies (B = 1.12, 95%CI = 0.26-1.98), compared to counties with no sanctuary policies, and 1.6 percentage-point higher in counties with sanctuary policies in immigrant friendly states (B = 1.59, 95%CI = 0.33-2.84), compared to counties with no sanctuary policy in immigrant unfriendly states. Local and state immigration policy, even when unrelated to SNAP eligibility, may influence SNAP participation among Latino households. Jurisdictions which lack sanctuary policies or have more criminalizing and less integrating policies should consider adopting targeted outreach strategies to increase SNAP enrollment among Latino households.
Collapse
Affiliation(s)
- M Pia Chaparro
- Nutritional Sciences Program, Department of Health Systems and Population Health, School of Public Health, University of Washington, Raitt Hall 305, Box 353410, Seattle, WA, 98195, USA.
| | - Amy H Auchincloss
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Nesbitt Hall, 3215 Market St., Philadelphia, PA, 19104, USA.
| | - Sofia Argibay
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Nesbitt Hall, 3215 Market St., Philadelphia, PA, 19104, USA.
| | - Dominic A Ruggiero
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Nesbitt Hall, 3215 Market St., Philadelphia, PA, 19104, USA.
| | - Jonathan Purtle
- Department of Public Health Policy and Management, School of Global Public Health, New York University, 708 Broadway, New York, NY, 10003, USA.
| | - Brent A Langellier
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Nesbitt Hall, 3215 Market St., Philadelphia, PA, 19104, USA.
| |
Collapse
|
9
|
Cheng J, Malone A, Thorndike AN. Importance of Nutrition Security to CVD Prevention Efforts in the USA. Curr Atheroscler Rep 2023; 25:219-230. [PMID: 36995553 PMCID: PMC10060138 DOI: 10.1007/s11883-023-01097-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE OF REVIEW The importance of addressing nutrition security for the primary and secondary prevention of cardiovascular disease (CVD) in the USA is reviewed by describing the relationships between food security, diet quality, and CVD risk along with the ability of governmental, community, and healthcare policies and interventions to address nutrition security. RECENT FINDINGS Existing safety net programs have shown to be effective at improving food security and diet quality and reducing risk for CVD, but continued efforts to increase reach and improve standards are needed. Adoption of policies, healthcare initiatives, and community- and individual-level interventions addressing the nutritional intake of socioeconomically disadvantaged populations may also lessen CVD burden, but scaling interventions remains a key challenge. Research suggests simultaneously addressing food security and diet quality is feasible and could help reduce socioeconomic disparities in CVD morbidity and mortality. Intervening at multiple levels among high-risk groups should be a priority.
Collapse
Affiliation(s)
- Jessica Cheng
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA USA
| | - Ashlie Malone
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Anne N. Thorndike
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA 02114 USA
| |
Collapse
|
10
|
Figueroa R, Verma R. Constituent-driven health policy informed by policy advocacy literature. Transl Behav Med 2023; 13:338-342. [PMID: 36694934 DOI: 10.1093/tbm/ibac116] [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: 01/26/2023] Open
Abstract
In this position paper, a theoretical framework is proposed to formulate engaged, evidence-based health policy based on the priorities of constituents. An initial literature review was conducted to gain insight on the gaps in knowledge. Three emergent domains were identified: advocacy, research, and policymaking. The inputs and intermediates to the final output (equitable, evidence-based health policy outcomes) were identified and further elaborated upon in each corresponding section of the paper. Additionally, the main objective of each domain based on the literature review and the implications of each step were noted. Researchers have been identified as crucial to the education of policymakers to ultimately produce informed, evidence-based policy. Community advocates and researchers must attempt to advocate for policy issues as the ultimate role of policymakers in this process necessitates effective engagement to promote political will in the policymaking process. To do so, community advocates must scale-up from the individual to coalitions with strong leadership. In conjunction with a policy champion, these efforts by constituents (community advocates and researchers) would result in the most effective modes of policy development and implementation. The Constituent-driven Policy Advocacy Model (CPAM) introduced in this paper creates the potential for a new precedent in policymaking, in which advocacy, community engagement, evidence synthesis and evaluation, as well as science communication are common practices, leading to more sensitive, targeted, and equitable policy outcomes.
Collapse
Affiliation(s)
- Roger Figueroa
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, New York, USA
| | - Rahul Verma
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, New York, USA
| |
Collapse
|
11
|
Varela EG, McVay MA, Shelnutt KP, Mobley AR. The Determinants of Food Insecurity Among Hispanic/Latinx Households With Young Children: A Narrative Review. Adv Nutr 2023; 14:190-210. [PMID: 36811589 PMCID: PMC10103006 DOI: 10.1016/j.advnut.2022.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 12/01/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022] Open
Abstract
Food insecurity has disproportionately impacted Hispanic/Latinx households in the United States, specifically those with young children. Although the literature provides evidence of an association between food insecurity and adverse health outcomes in young children, minimal research has addressed the social determinants and related risk factors associated with food insecurity among Hispanic/Latinx households with children under three, a highly vulnerable population. Using the Socio-Ecological Model (SEM) as a framework, this narrative review identified factors associated with food insecurity among Hispanic/Latinx households with children under three. A literature search was conducted using PubMed and four additional search engines. Inclusion criteria consisted of articles published in English from November 1996 to May 2022 that examined food insecurity among Hispanic/Latinx households with children under three. Articles were excluded if conducted in settings other than the US and/or focused on refugees and temporary migrant workers. Data were extracted (i.e., objective, setting, population, study design, measures of food insecurity, results) from the final articles (n = 27). The strength of each article's evidence was also evaluated. Results identified individual factors (i.e., intergenerational poverty, education, acculturation, language, etc.), interpersonal factors (i.e., household composition, social support, cultural customs), organizational factors (i.e., interagency collaboration, organizational rules), community factors (i.e., food environment, stigma, etc.), and public policy/societal factors (i.e., nutrition assistance programs, benefit cliffs, etc.) associated with a food security status of this population. Overall, most articles were classified as "medium" or higher quality for the strength of evidence, and more frequently focused on individual or policy factors. Findings indicate the need for more research to include a focus on public policy/society factors, as well as on multiple levels of the SEM with considerations of how individual and policy levels intersect and to create or adapt nutrition-related and culturally appropriate interventions to improve food security of Hispanic/Latinx households with young children.
Collapse
Affiliation(s)
- Elder Garcia Varela
- Graduate Research and Teaching Assistant, Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
| | - Megan A McVay
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
| | - Karla P Shelnutt
- Department of Family, Youth & Community Sciences, University of Florida, Gainesville, FL, USA
| | - Amy R Mobley
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA.
| |
Collapse
|
12
|
Snowden LR, Michaels E. Racial Bias Correlates with States Having Fewer Health Professional Shortage Areas and Fewer Federally Qualified Community Health Center Sites. J Racial Ethn Health Disparities 2023; 10:325-333. [PMID: 35006584 PMCID: PMC8744578 DOI: 10.1007/s40615-021-01223-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/09/2021] [Accepted: 12/21/2021] [Indexed: 02/03/2023]
Abstract
Federally Qualified Community Health Centers (FQHCs), serving Health Professional Shortage Areas (HPSAs), are fixtures of the healthcare safety net and are central to healthcare delivery for African Americans and other marginalized Americans. Anti-African American bias, tied to anti- "welfare" sentiment and to a belief in African Americans' supposed safety net dependency, can suppress states' willingness to identify HPSAs and to apply for and operate FQHCs. Drawing on data from n = 1,084,553 non-Hispanic White Project Implicit respondents from 2013-2018, we investigated associations between state-level implicit and explicit racial bias and availability of FQHCs and with HPSA designations. After controlling for states' sociopolitical conservatism, wealth, health status, and acceptance of the Affordable Care Act's Medicaid expansion, greater racial bias was correlated with fewer FQHC delivery sites and fewer HPSA designations. White's bias against African Americans is associated with fewer FQHC opportunities for care and fewer identifications of treatment need for African Americans and other low-income people lacking healthcare options, reflecting bias-influenced neglect.
Collapse
Affiliation(s)
- Lonnie R. Snowden
- grid.47840.3f0000 0001 2181 7878Health Policy and Management Division, School of Public Health, University of California, Berkeley, CA USA
| | - Eli Michaels
- grid.47840.3f0000 0001 2181 7878Epidemiology Division, School of Public Health, University of California, Berkeley, CA USA
| |
Collapse
|
13
|
Walch AK, Ohle KA, Koller KR, Alexie L, Lee F, Palmer L, Nu J, Thomas TK, Bersamin A. Impact of Assistance Programs on Indigenous Ways of Life in 12 Rural Remote Western Alaska Native Communities: Elder Perspectives Shared in Formative Work for the "Got Neqpiaq?" Project. Int J Circumpolar Health 2022; 81:2024679. [PMID: 35037587 PMCID: PMC8765241 DOI: 10.1080/22423982.2021.2024679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022] Open
Abstract
For more than 50 years, government programmes in the USA have been in place to help those in need have consistent access to food and education. However, questions have surfaced regarding whether or not these support impact traditional ways, such as cultural activities, food preferences, and overall health, particularly for Indigenous populations. In this paper, we share insights voiced by Alaska Native Elders in the Yukon-Kuskokwim region of Alaska and their perceptions of regulations, assistance, and the impact government assistance programmes have had on their culture. Elders raised concerns so that those administering these programmes will consider how best to meet food security and education needs without interfering with Indigenous cultural practices and traditional lifestyle.
Collapse
Affiliation(s)
- Amanda K. Walch
- Dietetics & Nutrition, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Kathryn A. Ohle
- Early Childhood Education, Grand Valley State University, Grand Rapids, Michigan, USA
| | - Kathryn R. Koller
- Research Nurse Supervisor, Alaska Native Tribal Health Consortium, Research Services, Anchorage, Alaska, USA
| | - Lucinda Alexie
- Yukon-Kuskokwim Health Corporation Research Department, Associate Research Coordinator, Bethel, Alaska, USA
| | - Flora Lee
- Epidemiology Research Nurse, Alaska Native Tribal Health Consortium Research Services, Anchorage, Alaska, USA
| | - Lea Palmer
- Registered Dietitian Nutritionist, RurAL Cap Head Start, Anchorage, Alaska, USA
| | - Jennifer Nu
- Research Associate, Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska, USA
| | - Timothy K. Thomas
- Alaska Native Tribal Health Consortium Research Services, Anchorage, Alaska, USA
| | - Andrea Bersamin
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska, USA
| |
Collapse
|
14
|
Headrick G, Ellison C, Bresnahan C, Green C, Lyons M, Moran A. State Implementation of SNAP Waivers and Flexibilities During the COVID-19 Pandemic: Perspectives From State Agency Leaders. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:982-997. [PMID: 36184356 PMCID: PMC9552006 DOI: 10.1016/j.jneb.2022.07.009] [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: 12/29/2021] [Revised: 07/17/2022] [Accepted: 07/28/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To describe state agencies' implementation of the Supplemental Nutrition Assistance Program (SNAP) during the first year of the coronavirus disease of 2019 (COVID-19) pandemic, barriers and facilitators to SNAP implementation, and recommendations to improve SNAP implementation. DESIGN Qualitative methodology guided by Bullock's determinants of policy implementation framework using 7 semistructured, virtual focus groups in April 2021. SETTING Twenty-six states representing all 7 US Department of Agriculture Food and Nutrition Service regions. PARTICIPANTS Four focus groups with state-level SNAP administrators and 3 focus groups with state-level SNAP supportive services (Supplemental Nutrition Assistance Program-Education, Employment & Training, and Outreach) supervisors (n = 62). PHENOMENON OF INTEREST Supplemental Nutrition Assistance Program implementation during the COVID-19 pandemic. ANALYSIS Thematic analysis using a phronetic iterative approach. RESULTS Six primary themes emerged: the policy response, technology needs, collaboration, participant communication, funding realities, and equity. Implementation challenges included the design of waivers in the early pandemic response, inadequate federal guidance and funding, outdated technology, and prepandemic regulations limiting state authority. Modernized technology systems, availability of virtual programming, partnerships, and enhanced benefits facilitated SNAP implementation. CONCLUSIONS AND IMPLICATIONS Supplemental Nutrition Assistance Program administrators adapted their programs to deliver services virtually during the COVID-19 pandemic. These experiences highlighted the importance of certain policy determinants, such as modernized technology and streamlined application processes, to improve outcomes for SNAP participants and staff.
Collapse
Affiliation(s)
- Gabby Headrick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Carolyn Ellison
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Carolyn Bresnahan
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Chloe Green
- American Public Human Services Association, Arlington, VA
| | - Matt Lyons
- American Public Human Services Association, Arlington, VA
| | - Alyssa Moran
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| |
Collapse
|
15
|
Asaria P, Bennett JE, Elliott P, Rashid T, Iyathooray Daby H, Douglass M, Francis DP, Fecht D, Ezzati M. Contributions of event rates, pre-hospital deaths, and deaths following hospitalisation to variations in myocardial infarction mortality in 326 districts in England: a spatial analysis of linked hospitalisation and mortality data. Lancet Public Health 2022; 7:e813-e824. [PMID: 35850144 PMCID: PMC10506182 DOI: 10.1016/s2468-2667(22)00108-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/11/2022] [Accepted: 04/19/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Myocardial infarction mortality varies substantially within high-income countries. There is limited guidance on what interventions-including primary and secondary prevention, or improvement of care pathways and quality-can reduce myocardial infarction mortality. Our aim was to understand the contributions of incidence (event rate), pre-hospital deaths, and hospital case fatality to the variations in myocardial infarction mortality within England. METHODS We used linked data from national databases on hospitalisations and deaths with acute myocardial infarction (ICD-10 codes I21 and I22) as a primary hospital diagnosis or underlying cause of death, from Jan 1, 2015, to Dec 31, 2018. We used geographical identifiers to estimate myocardial infarction event rate (number of events per 100 000 population), death rate (number of deaths per 100 000 population), total case fatality (proportion of events that resulted in death), pre-hospital fatality (proportion of events that resulted in pre-hospital death), and hospital case fatality (proportion of admissions due to myocardial infarction that resulted in death within 28 days of admission) for men and women aged 45 years and older across 326 districts in England. Data were analysed in a Bayesian spatial model that accounted for similarities and differences in spatial patterns of fatal and non-fatal myocardial infarction. Age-standardised rates were calculated by weighting age-specific rates by the corresponding national share of the appropriate denominator for each measure. FINDINGS From 2015 to 2018, national age-standardised death rates were 63 per 100 000 population in women and 126 per 100 000 in men, and event rates were 233 per 100 000 in women and 512 per 100 000 in men. After age-standardisation, 15·0% of events in women and 16·9% in men resulted in death before hospitalisation, and hospital case fatality was 10·8% in women and 10·6% in men. Across districts, the 99th-to-1st percentile ratio of age-standardised myocardial infarction death rates was 2·63 (95% credible interval 2·45-2·83) in women and 2·56 (2·37-2·76) in men, with death rates highest in parts of northern England. The main contributor to this variation was myocardial infarction event rate, with a 99th-to-1st percentile ratio of 2·55 (2·39-2·72) in women and 2·17 (2·08-2·27) in men across districts. Pre-hospital fatality was greater than hospital case fatality in every district. Pre-hospital fatality had a 99th-to-1st percentile ratio of 1·60 (1·50-1·70) in women and 1·75 (1·66-1·86) in men across districts, and made a greater contribution to variation in total case fatality than did hospital case fatality (99th-to-1st percentile ratio 1·39 [1·29-1·49] and 1·49 [1·39-1·60]). The contribution of case fatality to variation in deaths across districts was largest in women aged 55-64 and 65-74 years and in men aged 55-64, 65-74, and 75-84 years. Pre-hospital fatality was slightly higher in men than in women in most districts and age groups, whereas hospital case fatality was higher in women in virtually all districts at ages up to and including 65-74 years. INTERPRETATION Most of the variation in myocardial infarction mortality in England is due to variation in myocardial infarction event rate, with a smaller role for case fatality. Most variation in case fatality occurs before rather than after hospital admission. Reducing subnational variations in myocardial infarction mortality requires interventions that reduce event rate and pre-hospital deaths. FUNDING Wellcome Trust, British Heart Foundation, Medical Research Council (UK Research and Innovation), and National Institute for Health Research (UK).
Collapse
Affiliation(s)
- Perviz Asaria
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; Department of Cardiology, Imperial College NHS Trust, London, UK
| | - James E Bennett
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; UK Small Area Health Statistics Unit, School of Public Health, Imperial College London, London, UK
| | - Theo Rashid
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Hima Iyathooray Daby
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; UK Small Area Health Statistics Unit, School of Public Health, Imperial College London, London, UK
| | - Margaret Douglass
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; UK Small Area Health Statistics Unit, School of Public Health, Imperial College London, London, UK
| | - Darrel P Francis
- Department of Cardiology, Imperial College NHS Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Daniela Fecht
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; UK Small Area Health Statistics Unit, School of Public Health, Imperial College London, London, UK
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; Regional Institute for Population Studies, University of Ghana, Accra, Ghana.
| |
Collapse
|
16
|
Varela EG, Zeldman J, Mobley AR. Community Stakeholders' Perceptions on Barriers and Facilitators to Food Security of Families with Children under Three Years before and during COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10642. [PMID: 36078356 PMCID: PMC9518144 DOI: 10.3390/ijerph191710642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
Children living in food-insecure households have poorer overall health than children in food-secure households. While U.S. nutrition assistance programs provide resources, these cannot consistently offer age-appropriate nutritional foods for young children. This study aimed to determine community stakeholders' perceptions of the barriers and facilitators to obtaining adequate, high-quality, and age-appropriate foods for children ages 0-3 in Florida before and during COVID-19. Community stakeholders (n = 32) participated in a 60 min interview via Zoom using a semi-structured script based on the PRECEDE component of the PRECEDE-PROCEED model. Interviews were transcribed verbatim and coded by two researchers using a thematic analysis approach. Stakeholders' perceptions revealed a lack of awareness surrounding eligibility for assistance programs, a lack of knowledge regarding how to obtain resources and services, and stigma associated with receiving benefits. These remained significant barriers to obtaining healthful foods for households with young children before and during COVID-19. Nonetheless, barriers were exacerbated during the pandemic. Unemployment rates rose, intensifying these households' financial hardships and food insecurity levels. Likewise, stakeholders suggested the need for families to become more aware of federal assistance eligibility requirements and available opportunities via social media and referrals. Identifying risk factors associated with food insecurity can inform future interventions to safeguard young children's health and well-being.
Collapse
|
17
|
Houghtaling B, Englund T, Chen S, Pradhananga N, Kraak VI, Serrano E, Harden SM, Davis GC, Misyak S. Supplemental Nutrition Assistance Program (SNAP)-authorized retailers received a low score using the Business Impact Assessment for Obesity and population-level nutrition (BIA-Obesity) tool. BMC Public Health 2022; 22:1225. [PMID: 35725448 PMCID: PMC9208119 DOI: 10.1186/s12889-022-13624-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 06/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Supplemental Nutrition Assistance Program (SNAP) supports Americans with lower income to purchase dietary products at authorized retailers. This research aimed to evaluate SNAP-authorized retailers' public commitments in support of nutrition security and to examine differences between traditional grocers and nontraditional (e.g., convenience, drug, dollar) SNAP-authorized retailers' public commitments. METHODS Prominent United States (U.S.) SNAP-authorized retailers nationally and in two U.S. states (California and Virginia) were identified based on number of store locations (n = 61). Public information available in grey literature were reviewed and scored using the Business Impact Assessment for Obesity and population-level nutrition (BIA-Obesity) tool. SNAP-authorized retailers were classified as traditional (e.g., grocery) or nontraditional (e.g., non-grocery) retailers. Total BIA-Obesity from 0 to 615, representing low to optimal support) and category scores were calculated for corporate strategy, relationships with external organizations, product formulation, nutrition labeling, product and brand promotion, and product accessibility. Descriptive statistics were used to describe BIA-Obesity scores overall and by category. Mann-Whitney U was used to test for potential differences in median BIA-Obesity total scores between traditional and nontraditional SNAP-authorized retailers (a priori, p < 0.05). RESULTS Average total BIA-Obesity scores for SNAP-authorized retailers ranged from 0 to 112 (16.5 ± 23.3). Total BIA-Obesity scores for traditional SNAP-authorized retailers (32.7 ± 33.6; median 25) were higher than nontraditional SNAP-authorized retailer scores (11.2 ± 16; median 5) (p = 0.008). For BIA-Obesity categories, average scores were highest for the category relationships with external organizations (8.3 ± 10.3) and lowest for promotion practices (0.6 ± 2.1). CONCLUSIONS Results of this research underscore a dearth of available evidence and substantial opportunity for improvement regarding SNAP-authorized retailer strategies to support nutrition security among Americans with lower income.
Collapse
Affiliation(s)
- Bailey Houghtaling
- School of Nutrition and Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, 70803, US.
| | - Tessa Englund
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, US
| | - Susan Chen
- Department of Nutrition, Food Science, and Packaging, San José State University, San José, CA, 95192, US
| | - Nila Pradhananga
- School of Nutrition and Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, 70803, US
| | - Vivica I Kraak
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, 24061, US
| | - Elena Serrano
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, 24061, US.,The Virginia Cooperative Extension Family Nutrition Program, Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, 24061, US
| | - Samantha M Harden
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, 24061, US
| | - George C Davis
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, 24061, US.,Department of Agricultural and Applied Economics, Virginia Tech, Blacksburg, VA, 24061, US
| | - Sarah Misyak
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, 24061, US.,The Virginia Cooperative Extension Family Nutrition Program, Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, 24061, US
| |
Collapse
|
18
|
National Investment Framework for Revitalizing the R&D Collaborative Ecosystem of Sustainable Smart Agriculture. SUSTAINABILITY 2022. [DOI: 10.3390/su14116452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Demographic, economic, and environmental issues, including climate change events, aging population, growing urban-rural disparity, and the COVID-19 pandemic, contribute to vulnerabilities in agricultural production and food systems. South Korea has designated smart agriculture as a national strategic investment, expanding investment in research and development (R&D) to develop and commercialize convergence technologies, thus extending sustainable smart agriculture and strengthening global competitiveness. Hence, this study probes the status of smart agricultural R&D investment from the perspectives of public funds, research areas, technologies, regions, organizations, and stakeholders. It examines 5646 public R&D projects worth USD 1408.5 million on smart agriculture in 17 regions and eight technology clusters from 2015 to 2021. Further, it proposes a pool of potential collaborative networks via a case study of strawberry, a representative veritable crop inspiring smart agriculture, to demonstrate the study framework’s usefulness in promoting smart agriculture and establishing a sustainable R&D collaboration ecosystem. The proposed framework, accordingly, allows stakeholders to understand and monitor the status of R&D investment from various perspectives. Moreover, given the insight into the tasks belonging to technical areas and regions that require sustainable cooperation in smart agriculture, central and local governments develop policies to reinforce sustainable smart-farming models.
Collapse
|
19
|
Thorndike AN, Gardner CD, Kendrick KB, Seligman HK, Yaroch AL, Gomes AV, Ivy KN, Scarmo S, Cotwright CJ, Schwartz MB. Strengthening US Food Policies and Programs to Promote Equity in Nutrition Security: A Policy Statement From the American Heart Association. Circulation 2022; 145:e1077-e1093. [PMID: 35535604 DOI: 10.1161/cir.0000000000001072] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nutritionally inadequate dietary intake is a leading contributor to chronic cardiometabolic diseases. Differences in dietary quality contribute to socioeconomic and racial and ethnic health disparities. Food insecurity, a household-level social or economic condition of limited access to sufficient food, is a common cause of inadequate dietary intake. Although US food assistance policies and programs are designed to improve food security, there is growing consensus that they should have a broader focus on nutrition security. In this policy statement, we define nutrition security as an individual or household condition of having equitable and stable availability, access, affordability, and utilization of foods and beverages that promote well-being and prevent and treat disease. Despite existing policies and programs, significant gaps remain for achieving equity in nutrition security across the life span. We provide recommendations for expanding and improving current food assistance policies and programs to achieve nutrition security. These recommendations are guided by several overarching principles: emphasizing nutritional quality, improving reach, ensuring optimal utilization, improving coordination across programs, ensuring stability of access to programs across the life course, and ensuring equity and dignity for access and utilization. We suggest a critical next step will be to develop and implement national measures of nutrition security that can be added to the current US food security measures. Achieving equity in nutrition security will require coordinated and sustained efforts at the federal, state, and local levels. Future advocacy, innovation, and research will be needed to expand existing food assistance policies and programs and to develop and implement new policies and programs that will improve cardiovascular health and reduce disparities in chronic disease.
Collapse
|
20
|
Slagel N, Newman T, Sanville L, Dallas J, Cotto-Rivera E, Moore J, Roberts Mph A, Sun Lee J. Effects of a Fruit and Vegetable Prescription Program With Expanded Education for Low-Income Adults. HEALTH EDUCATION & BEHAVIOR 2022; 49:10901981221091926. [PMID: 35535592 DOI: 10.1177/10901981221091926] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fruit and Vegetable Prescription (FVRx) Programs combine produce prescriptions and nutrition education to reduce fruit and vegetable consumption barriers and promote health among low-income patient populations. This study examined whether a multi-level FVRx intervention model with intensive education improves dietary behaviors, food security, and health outcomes over single-level interventions alone. A 6-month nonrandomized, parallel, controlled trial was conducted with one intervention, FVRx (n = 31) and two comparison groups, Ad hoc Nutrition Education (n = 13) and Control (n = 16). The FVRx group received produce prescriptions (US$1/day/household member) redeemable at a farmer's market, two SNAP-Ed programs, one financial literacy program, and monthly health screenings. The Nutrition Education (NE) group participated in one SNAP-Ed program, and the Control group received safety-net clinic care only. Surveys assessed dietary intake, food security, food purchasing practices, and financial and food resource management. Pre-post clinical biomarkers (blood lipid and hemoglobin A1c) and monthly biometrics (anthropometrics and blood pressure) were measured. Descriptive analysis and one-way analysis of variance (ANOVA) were conducted. Compared with comparison groups, FVRx participants significantly increased the frequency of consuming dark green vegetables, FVRx (0.36 ± 0.72); NE (0.14 ± 0.33); Control (-0.09 ± 0.19) cups/day (p < .05). FVRx participants significantly improved multiple healthful food purchasing practices, and the ability to afford more utilities (FVRx (33%); NE (0%); Control (10%); p < .05). Limited changes were observed in food security and clinical biomarker outcomes between groups. Combining expanded nutrition and financial literacy education with produce prescriptions improves low-income adults' financial and food resources, preference, knowledge, purchase, and consumption of locally grown vegetables over single-level interventions.
Collapse
|
21
|
Krieger J, Bleich SN, Scarmo S, Ng SW. Sugar-Sweetened Beverage Reduction Policies: Progress and Promise. Annu Rev Public Health 2021; 42:439-461. [PMID: 33256536 DOI: 10.1146/annurev-publhealth-090419-103005] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Evidence showing the effectiveness of policies to reduce the consumption of sugar-sweetened beverages (SSBs) is growing. SSBs are one of the largest sources of added sugar in the diet and are linked to multiple adverse health conditions. This review presents a framework illustrating the various types of policies that have been used to reduce SSB exposure and consumption; policies are organized into four categories (financial, information, defaults, and availability) and take into consideration crosscutting policy considerations (feasibility, impact, and equity). Next, for each category, we describe a specific example and provide evidence of impact. Finally, we discuss crosscutting policy considerations, the challenge of choosing among the various policy options, and important areas for future research. Notably, no single policy will reduce SSB consumption to healthy levels, so an integrated policy approach that adapts to changing market and consumption trends; evolving social, political, and public health needs; and emerging science is critical.
Collapse
Affiliation(s)
- James Krieger
- Healthy Food America, Seattle, Washington 98122, USA.,Department of Health Services, School of Public Health, University of Washington, Seattle, Washington 98195, USA;
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115, USA;
| | - Stephanie Scarmo
- American Heart Association, National Center, Dallas, Texas 75231, USA;
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27516, USA;
| |
Collapse
|
22
|
Dunn CG, Bianchi C, Fleischhacker S, Bleich SN. Nationwide Assessment of SNAP Online Purchasing Pilot State Communication Efforts During the COVID-19 Pandemic. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:931-937. [PMID: 34538712 PMCID: PMC8445848 DOI: 10.1016/j.jneb.2021.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 07/01/2021] [Accepted: 07/12/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To conduct a nationwide assessment of communication by participating states and Washington DC about the Supplemental Nutrition Assistance Program (SNAP) Online Purchasing Pilot expansion. DESIGN Systematic coding of official communication from state and DC SNAP administrating agencies. PARTICIPANTS Forty-six states and DC approved to participate in the pilot as of October 2020 (n = 47). Data were collected from official SNAP administrating agency websites, state press releases, and state emergency coronavirus disease 2019 websites. VARIABLES MEASURED Four domains were collected from communication materials: (1) program information, (2) retailer information, (3) health and nutrition information, and (4) communication accessibility. ANALYSIS Qualitative content analysis, descriptive statistics. RESULTS Thirty-four (72%) states issued an official press release about the pilot that was easily accessible through online searches (15 available in multiple languages), 21 (45%) included information on their SNAP agency website, and 15 (32%) included information on their official coronavirus disease 2019 website. Most states identified authorized retailers (n = 37; 79%), provided information about pickup/delivery (n = 31; 66%), and stated the SNAP online start date (n = 29; 62%). About a quarter of states (n = 12; 26%) provided information about nutrition and health. CONCLUSIONS AND IMPLICATIONS State communication about the SNAP online pilot mostly focused on basic program and retailer information and included limited information about nutrition and health.
Collapse
Affiliation(s)
- Caroline G Dunn
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA.
| | | | | | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
| |
Collapse
|
23
|
Landry MJ, Gundersen C, Eicher-Miller HA. Food Insecurity on College and University Campuses: A Context and Rationale for Solutions. J Acad Nutr Diet 2021; 122:519-524. [PMID: 34718223 DOI: 10.1016/j.jand.2021.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Matthew J Landry
- Stanford University, School of Medicine, Stanford Prevention Research Center, Palo Alto, CA.
| | - Craig Gundersen
- Baylor University, Baylor Collaborative on Hunger and Poverty (BCHP), and Department of Economics, Waco, TX
| | - Heather A Eicher-Miller
- Purdue University, College of Health and Human Sciences, Department of Nutrition Science, West Lafayette, IN
| |
Collapse
|
24
|
Houghtaling B, Holston D, Szocs C, Penn J, Qi D, Hedrick V. A rapid review of stocking and marketing practices used to sell sugar-sweetened beverages in U.S. food stores. Obes Rev 2021; 22:e13179. [PMID: 33331094 PMCID: PMC7988563 DOI: 10.1111/obr.13179] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/28/2020] [Accepted: 11/15/2020] [Indexed: 12/29/2022]
Abstract
Sugar-sweetened beverages (SSBs) are a primary source of added sugars in the American diet. Habitual SSB consumption is associated with obesity and noncommunicable disease and is one factor contributing to U.S. health disparities. Public health responses to address marketing-mix and choice-architecture (MMCA) strategies used to sell SSB products may be required. Thus, our goal was to identify original research about stocking and marketing practices used to sell SSB in U.S. food stores. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the World Health Organization (WHO) protocol for rapid reviewing. We searched six databases and Google Scholar using key terms focused on store type and SSB products. We characterized results using an MMCA framework with categories place, profile, portion, pricing, promotion, priming or prompting, and proximity. Our search resulted in the identification of 29 articles. Most results focused on profile (e.g., SSB availability) (n = 13), pricing (e.g., SSB prices or discounts) (n = 13), or promotion (e.g., SSB advertisements) (n = 13) strategies. We found some evidence of targeted MMCA practices toward at-risk consumers and differences by store format, such as increased SSB prominence among supermarkets. The potential for systematic variations in MMCA strategies used to sell SSB requires more research. We discuss implications for public health, health equity, and environmental sustainability.
Collapse
Affiliation(s)
- Bailey Houghtaling
- School of Nutrition and Food Sciences, Louisiana State University (LSU) and LSU Agricultural Center, Baton Rouge, LA, USA
| | - Denise Holston
- School of Nutrition and Food Sciences, Louisiana State University (LSU) and LSU Agricultural Center, Baton Rouge, LA, USA
| | - Courtney Szocs
- E.J. Ourso College of Business, Louisiana State University, Baton Rouge, LA, USA
| | - Jerrod Penn
- Agricultural Economics and Agribusiness, Louisiana State University (LSU) and LSU Agricultural Center, Baton Rouge, LA, USA
| | - Danyi Qi
- Agricultural Economics and Agribusiness, Louisiana State University (LSU) and LSU Agricultural Center, Baton Rouge, LA, USA
| | - Valisa Hedrick
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
| |
Collapse
|
25
|
Valluri S, Mason SM, Peterson HH, Appelhans B, French SA, Harnack LJ. Associations between shopper impulsivity and cyclical food purchasing: Results from a prospective trial of low-income households receiving monthly benefits. Appetite 2021; 163:105238. [PMID: 33811946 DOI: 10.1016/j.appet.2021.105238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/13/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
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.
Collapse
Affiliation(s)
- Sruthi Valluri
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA; University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Susan M Mason
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Hikaru Hanawa Peterson
- Department of Applied Economics, College of Food, Agricultural and Natural Resource Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Brad Appelhans
- Department of Preventive Medicine, Rush Medical College, USA
| | - Simone A French
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Lisa J Harnack
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
26
|
Payán DD, Díaz Rios LK, Ramírez AS, De Trinidad Young ME. Structural Barriers Influencing Food Insecurity, Malnutrition, and Health Among Latinas During and After COVID-19: Considerations and Recommendations. J Acad Nutr Diet 2021; 121:837-843. [PMID: 33568334 PMCID: PMC9391034 DOI: 10.1016/j.jand.2021.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/02/2020] [Accepted: 01/05/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Denise D Payán
- (1)Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced (UC Merced), Merced, CA.
| | - L Karina Díaz Rios
- (2)Division of Agriculture and Natural Resources, Department of Public Health, UC Merced, Merced, CA
| | - A Susana Ramírez
- (1)Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced (UC Merced), Merced, CA
| | - Maria-Elena De Trinidad Young
- (1)Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced (UC Merced), Merced, CA
| |
Collapse
|
27
|
Choi SE, Wright DR, Bleich SN. Impact of Restricting Sugar-Sweetened Beverages From the Supplemental Nutrition Assistance Program on Children's Health. Am J Prev Med 2021; 60:276-284. [PMID: 33349472 DOI: 10.1016/j.amepre.2020.08.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/28/2020] [Accepted: 08/21/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Children enrolled in the Supplemental Nutrition Assistance Program are at higher risk of poor diet, including higher intake of sugar-sweetened beverages than non-Supplemental Nutrition Assistance Program participants. This study aims to identify the impact of restricting sugar-sweetened beverage purchases with Supplemental Nutrition Assistance Program benefits on children's consumption and health. METHODS Using Supplemental Nutrition Assistance Program participation and dietary data of children (aged 2-19 years) in the National Health and Nutrition Examination Survey (2009-2016), a microsimulation model was constructed to assess expected changes in daily sugar-sweetened beverage consumption, total calorie intake, BMI, incidence of dental caries, and obesity prevalence of 2019 U.S. children over a 10-year period, incorporating differences in food consumption and disease risks between the Supplemental Nutrition Assistance Program and the general U.S. POPULATIONS Sensitivity analyses were conducted with various food substitution patterns and Supplemental Nutrition Assistance Program participation characteristics. Analysis was performed in 2019. RESULTS Sugar-sweetened beverage restriction in the Supplemental Nutrition Assistance Program was estimated to reduce daily sugar-sweetened beverage intake by 112.5 g/person (95% CI= -115.9, -109.2), which was estimated to decrease the number of decayed teeth by 0.53/person (95% CI= -0.55, -0.51), an 8.0% decline from the baseline. If sugar-sweetened beverages were substituted with fruit juice and milk, the restriction would be expected to reduce daily total calorie intake by 39.2 kcal/person (95% CI= -39.8, -38.7), resulting 2.6 kg/m2 (95% CI= -2.9, -2.4) decrease in BMI and a 6.2 percentage point (95% CI= -6.5, -5.8) decrease in obesity prevalence among Supplemental Nutrition Assistance Program participants. Estimated changes in total calorie intake and obesity were subject to food substitution patterns. CONCLUSIONS Restricting sugar-sweetened beverage purchases in Supplemental Nutrition Assistance Program could promote a healthier diet and significantly lower the incidence of dental caries and potentially obesity prevalence in children.
Collapse
Affiliation(s)
- Sung Eun Choi
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts.
| | - Davene R Wright
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| |
Collapse
|