Shelter Environment and Placement in Community Affects Lifestyle Factors among Homeless Families in Minnesota

Transportation needs and mobility patterns of persons experiencing homelessness following shelter decentralization

The provision and siting of homeless emergency shelters have community-wide implications for addressing the needs of people experiencing homelessness (PEH). In Utah, Salt Lake County's transition from a large, centralized emergency shelter sited in a free transit zone to a decentralized scattered-site model outside of a no-cost transit zone provided the context to evaluate how transportation access and mobility patterns of PEH were affected as they were displaced from a centralized service network in a downtown core. We conducted 19 in-depth, semi-structured interviews with PEH aged 18 + who were staying in one of three distributed resource centers who had also previously stayed at the former centralized shelter. Thematic analysis of the interviews resulted in three categories, each with distinct sub-categories: 1) Pre-decentralization transportation and mobility, 2) Post-decentralization transportation and mobility, and 3) Recommendations to improve transportation access for PEH, including lowering or eliminating financial barriers to transportation and expanding transit and shuttle van frequency and route radius. Study findings demonstrate that there is a significant need for community planners to collaborate on the siting of homeless shelters to provide more affordable, flexible, and equitable access to transportation networks.

Diet Quality, Health, and Wellbeing within the Irish Homeless Sector: A Qualitative Exploration

Financial barriers and limited cooking facilities are major obstacles to healthy dietary practices among the homeless population. Homelessness is currently at crisis point and up-to-date evidence from multiple stakeholders is needed to address dietary inequalities. The aim of this study was to understand dietary practices, barriers to healthy eating within homeless services from multiple perspectives. Twelve service users and five healthcare and social service providers participated in semi-structured interviews. Data were analysed thematically. Four themes were identified which included: lack of control over diet and food supply; sources of food for the homeless population; practical barriers to good nutrition; and the impact of diet on emotional and physical wellbeing. Frequent consumption of energy-dense, nutrient-poor foods was reported. Food insecurity resulted in perceived depressive symptoms and stress. Barriers to healthy diet included financial constraints and a lack of access to cooking and storage facilities. Our study highlights low levels of food skills and healthy eating knowledge among service users and service providers. In order to address diet-related health disparities, health promotion initiatives should be targeted at building healthy public policy in relation to diet and nutrition and developing food skills with members of this population and service providers.

Assessing the Cost of Healthy and Unhealthy Diets: A Systematic Review of Methods

PURPOSE OF REVIEW

Poor diets are a leading risk factor for chronic disease globally. Research suggests healthy foods are often harder to access, more expensive, and of a lower quality in rural/remote or low-income/high minority areas. Food pricing studies are frequently undertaken to explore food affordability. We aimed to capture and summarise food environment costing methodologies used in both urban and rural settings.

RECENT FINDINGS

Our systematic review of high-income countries between 2006 and 2021 found 100 relevant food pricing studies. Most were conducted in the USA (n = 47) and Australia (n = 24), predominantly in urban areas (n = 74) and cross-sectional in design (n = 76). All described a data collection methodology, with just over half (n = 57) using a named instrument. The main purpose for studies was to monitor food pricing, predominantly using the 'food basket', followed by the Nutrition Environment Measures Survey for Stores (NEMS-S). Comparatively, the Healthy Diets Australian Standardised Affordability and Price (ASAP) instrument supplied data on relative affordability to household incomes. Future research would benefit from a universal instrument reflecting geographic and socio-cultural context and collecting longitudinal data to inform and evaluate initiatives targeting food affordability, availability, and accessibility.

Evaluation of Farm Fresh Food Boxes: A Hybrid Alternative Food Network Market Innovation

Using a mixed-methods design, we evaluated Farm Fresh Food Box (F3B) a market innovation designed to expand producer markets, stabilize rural retail businesses, and improve rural food access. In the F3B model, pre-ordered Community Supported Agriculture (CSA)-style produce boxes are sold through rural retail outlets. F3B was implemented from 2016 to 2018 as part of a United States Department of Agriculture (USDA)-funded multi-state extension and research collaboration project in 3 geographically diverse and rural areas: Vermont, Washington, and California. The F3B evaluation aimed to (1) assess market potential; (2) determine logistics for successful implementation; (3) describe the benefits and drawbacks for farmers and retailers; and (4) measure consumers’ attitudes and purchase behavior. A national market survey indicated consumers would be likely to purchase F3B if it was perceived to offer good value on fresh local produce, without need for a subscription. The model put a few additional labor burdens on farmers and retailers, but required time for relationship-building and more record-keeping time for farmers. Those who purchased a F3B were generally satisfied with the quality, quantity and variety of produce each week and a high proportion considered F3B to be a good value for the money. As a new business innovation, F3B showed only modest profit, but retailers and farmers felt it was worthwhile to expand their customer base, promote their brand and develop their partnership. F3B began a means to address flattened growth in direct to consumer produce sales, food deserts and dwindling retail options for fresh foods in rural areas. We discuss F3B as a potential solution to food system weaknesses exposed by the COIVD-19 pandemic because it offers touch-free, high-quality local produce ready for curbside pickup at a convenient location.

Urban Stress Indirectly Influences Psychological Symptoms through Its Association with Distress Tolerance and Perceived Social Support among Adults Experiencing Homelessness

Traditionally, intrapersonal characteristics (distress tolerance) and interpersonal characteristics (social support) have been studied separately rather than simultaneously. In the current study, we address this gap by simultaneously examining these characteristics as potential indirect associations linking established urban stress-depression and urban stress-Post-Traumatic Stress Disorder (PTSD) relationships. Adults experiencing homelessness were recruited from six homeless shelters in Oklahoma City (n = 567). Participants self-reported urban life stress (Urban Life Stress Scale), distress tolerance (Distress Tolerance Scale), social support (Interpersonal Support Evaluation List 12), major depressive disorder (Patient Health Questionnaire-8), and PTSD symptoms (Primary Care Post-Traumatic Stress Disorder screener). Covariate-adjusted structural equation models indicated a significant indirect effect of distress tolerance on the urban stress-depression (b = 0.101, 95% CI = 0.061, 0.147) and urban stress-PTSD (b = 0.065, 95% CI = 0.023, 0.112) relationships. Additionally, a significant indirect effect of social support on the urban stress-depression (b = 0.091, 95% CI = 0.053, 0.133) and urban stress-PTSD relationships (b = 0.043, 95% CI = 0.006, 0.082) was evident. Further, both the urban stress-depression (b = 0.022, 95% CI = 0.011, 0.037) and urban stress-PTSD relationships (b = 0.014, 95% CI = 0.005, 0.026) were associated indirectly through social support to distress tolerance. Interventions that aim to increase social support may also increase distress tolerance skills and indirectly reduce depressive and PTSD symptoms in the context of urban stress among adults experiencing homelessness.

Cooking, healthy eating, fitness and fun (CHEFFs): qualitative evaluation of a nutrition education program for children living at urban family homeless shelters

OBJECTIVES

We assessed the feasibility of a 15-week nutrition education, physical activity, and media literacy program for children living in urban family homeless shelters.

METHODS

We developed a qualitative monitoring tool to evaluate program process and impact at 2 shelter sites in the Bronx, New York, from 2009 to 2012. Facilitators recorded indications of participants' understanding of intended messages and demonstrations of changes in attitudes and behaviors. Comments, insights, and actions were recorded as they occurred. Facilitators also documented barriers to delivery of content and activities as intended. We used content analysis to examine data for patterns and identify themes.

RESULTS

A total of 162 children participated at the 2 shelter sites. Analysis of qualitative data yielded 3 themes: (1) children's knowledge and understanding of content, (2) children's shift in attitudes or intentions, and (3) interpretations through children's life experience. Food insecurity as well as shelter food service and policies were important influences on children's choices, hunger, and sense of well-being.

CONCLUSIONS

Children's experiences highlighted the need to advocate for shelter policies that adequately provide for children's nutritional and physical activity requirements and foster academic development.

Health and Eating Behavior Differs between Lean/Normal and Overweight/Obese Low-Income Women Living in Food-Insecure Environments

Purpose.

To explore differences and similarities in environmental, personal, and behavioral factors influencing eating behavior among low-income women of varying weight status.

Design.

Focus groups (n = 16) were used to collect qualitative data. Quantitative data collected included demographic, lifestyle, and anthropometric (heights and weights).

Setting.

Community centers, libraries, and homeless shelters in low-income neighborhoods.

Participants.

Of the 83 participants, 58% were African-American, 28% were white, and the remainder were American Indian, Hispanic, or mixed race. A total of 35% of participants were lean/normal (body mass index < 25 kg/m2) and 65% were overweight/obese (body mass index > 25 kg/m2).

Method.

Focus group methodology was used to collect data on 83 participants. Social Cognitive Theory (SCT) provided the theoretical basis. Transcripts were analyzed using the open-coding method and comments between lean/normal and overweight/obese women were systematically compared.

Results.

Focus group themes were food environment, aberrant eating behavior, health values, and beliefs. Differences in personal and behavioral factors were apparent between overweight/obese and lean/normal women, with the former group frequently discussing emotional eating, overeating, and stashing food, and the latter group communicating greater nutrition knowledge and describing regular physical activity. Both groups similarly expressed experiences with food insecurity and lived in low-income environments.

Conclusion.

For low-income women, personal and behavioral factors may modify the influence of their obesogenic food environment. Further research within the context of SCT should examine differences between lean/normal and overweight/obese women living in the same environment.

Food-related environmental, behavioral, and personal factors associated with body mass index among urban, low-income African-American, American Indian, and Caucasian women

PURPOSE

To examine racial/ethnic differences in relationships between food-related environmental, behavioral and personal factors and low-income women's weight status using Social Cognitive Theory (SCT) as a framework.

DESIGN

Cross-sectional survey.

SETTING

Community sites and low-income housing developments in the Twin Cities metropolitan area.

SUBJECTS

Low-income African-American, American Indian, and Caucasian women ≥18 years old (n  =  367).

MEASURES

Participants completed a survey including demographic, food security, and theoretically based questions. Heights and weights were measured to determine body mass index (BMI).

ANALYSIS

Data were split by race/ethnicity and reduced by examining Pearson coefficients for SCT survey questions significantly correlated with BMI (p < .05). Separate environmental, behavioral, and personal multiple linear regression models for each racial/ethnic group were run to explore the proportion of variance in BMI explained by each SCT construct and which questions were significant predictors.

RESULTS

All regression models were statistically significant, although the personal regression models predicted the greatest proportion of the variance in BMI for African-American (15% of the variance), American Indian (22% of the variance), and Caucasian women (37% of the variance).

CONCLUSION

Effective nutrition education and intervention efforts to control the obesity epidemic among urban, low-income women may call for a tailored approach with noted consideration of their racial/ethnic identity. Although broader changes to the food environment are necessary, the importance of addressing personal factors such as nutrition knowledge, self-efficacy, and emotional coping responses to stress, in the context of income constraints, food insecurity, and health beliefs, is also implicated.

Health behaviors and infant health outcomes in homeless pregnant women in the United States

OBJECTIVE

To describe selected demographics; maternal health behaviors before, during, and after pregnancy; and infant health outcomes among homeless women in the United States.

PATIENTS AND METHODS

Analyses are based on Pregnancy Risk Assessment Monitoring System data from 31 participating states from 2000 to 2007 that were linked to birth certificate data, which contain demographic and medical information collected through the state's vital records system. Responses were then weighted to be representative of all women who gave birth in each state during that year. Assessment of these data takes into account the complex sampling designs employed by the states.

RESULTS

Four percent of women reported homelessness within 12 months before pregnancy, with the highest percentage in Illinois, followed by Oregon and Washington. Homeless women were younger, unmarried, uninsured, less educated, less likely to initiate and sustain breastfeeding, and had less prenatal care and well-visits. They were also more likely to be black, Hispanic, smoke cigarettes, be underweight or have class III obesity, and not take preconception multivitamins. Infants had lower birth weights, a longer hospital stay, and were more likely to receive neonatal intensive care.

CONCLUSIONS

In this study we provide additional insight into homelessness in the perinatal period and provide information on ways to direct interventions aimed at improving the health of homeless mothers and infants. Additional research is needed to determine factors that influence pregnancy weight gain and infant feeding practices among homeless women and how this affects infant health.

The art of grocery shopping on a food stamp budget: factors influencing the food choices of low-income women as they try to make ends meet

OBJECTIVE

Amidst a hunger-obesity paradox, the purpose of the present study was to examine the grocery shopping behaviour and food stamp usage of low-income women with children to identify factors influencing their food choices on a limited budget.

DESIGN

Focus groups, which included questions based on Social Cognitive Theory constructs, examined food choice in the context of personal, behavioural and environmental factors. A quantitative grocery shopping activity required participants to prioritize food purchases from a 177-item list on a budget of $US 50 for a one-week period, an amount chosen based on the average household food stamp allotment in 2005.

SUBJECTS

Ninety-two low-income women, with at least one child aged 9-13 years in their household, residing in the Twin Cities, Minnesota, USA.

RESULTS

Participants' mean age was 37 years, and 76% were overweight or obese (BMI> or =25.0 kg/m2). Key findings suggest that their food choices and grocery shopping behaviour were shaped by not only individual and family preferences, but also their economic and environmental situation. Transportation and store accessibility were major determinants of shopping frequency, and they used various strategies to make their food dollars stretch (e.g. shopping based on prices, in-store specials). Generally, meat was the most important food group for purchase and consumption, according to both the qualitative and quantitative data.

CONCLUSIONS

Efforts to improve food budgeting skills, increase nutrition knowledge, and develop meal preparation strategies involving less meat and more fruits and vegetables, could be valuable in helping low-income families nutritionally make the best use of their food dollars.

Dietary intake, overweight status, and perceptions of food insecurity among homeless Minnesotan youth

Youth, 9-18 years (n = 202), living in homeless shelters in Minneapolis, Minnesota, were assessed for height, weight, dietary intake, and perceptions of food insecurity. Perceptions of food security were measured by asking youth to respond to the statements (1) "There are times when we do not have enough food in the house," (2) "I go to bed hungry at night," (3) "I do not get enough to eat at home," and (4) "Have you ever had to miss a meal (or not been able to eat) because there was no food at home?" Additionally, questions evaluated coping mechanisms used by children to ward off hunger. Fifty-five percent of the children reported not enough food in the house and 25% reported going to bed hungry. Youth had inadequate intakes of vitamin D, calcium, and potassium and the majority consumed less than the estimated average requirements (EAR) for vitamins A, C, and E, phosphorus, folate, and zinc. Fruits, vegetables, and dairy were also consumed below recommended levels. Forty-five percent of boys and 50% of girls were at risk-for-overweight or were overweight. Overeating, eating anything, eating disliked foods, and eating at the homes of family and friends were identified as strategies to cope with food insecurity. Overeating when food is available may explain why we see a hunger-obesity paradigm to the magnitude that we do among the poorest Americans. These strategies protect children from the immediate negative associations of poverty and hunger, but they may contribute to long-term weight problems currently found in the US.