1
|
Sanchez S, Zuelch M, Funderburk K. Reimagining the Role of the Registered Dietitian Nutritionist in Food Pantry Sites and Settings. J Acad Nutr Diet 2024:S2212-2672(24)00247-8. [PMID: 38763463 DOI: 10.1016/j.jand.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 05/21/2024]
Affiliation(s)
- Sofia Sanchez
- Alabama Cooperative Extension System, Supplemental Nutrition Assistance Program-Education, Auburn University, Auburn, Alabama.
| | - Michelle Zuelch
- Department of Nutrition, University of California, Davis, California
| | - Katie Funderburk
- Alabama Cooperative Extension System, Supplemental Nutrition Assistance Program-Education, Auburn University, Auburn, Alabama
| |
Collapse
|
2
|
Mobley C, Luo Y, Fernandez M, Hossfeld L. Social Determinants of Health and College Food Insecurity. Nutrients 2024; 16:1391. [PMID: 38732637 PMCID: PMC11085391 DOI: 10.3390/nu16091391] [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: 03/18/2024] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
In recent years, many students have faced economic hardship and experienced food insecurity, even as universities strive to create more equitable pathways to college. There is a need for a more holistic perspective that addresses the complexity of food insecurity amongst college students. To this end, we examined the relationship between the social determinants of health, including college food insecurity (CoFI) and childhood food insecurity (ChFI), and their relationship with well-being measures. The study sample was a convenience sample that included 372 students at a public university who responded to an online survey in fall 2021. Students were asked to report their food security status in the previous 30 days. We used the following analytical strategies: chi-square tests to determine differences between food secure (FS) and food insecure (FI) students; binary logistic regression of CoFI on student demographics and ChFI; and ordinal or binary logistic regression for well-being measures. Black students, off-campus students, first-generation students, in-state students, and humanities/behavioral/social/health sciences majors were more likely to report CoFI. FI students were more likely to have experienced ChFI and to have lower scores on all well-being measures. ChFI was associated with four well-being measures and its effects were mediated by CoFI. College student health initiatives would benefit from accounting for SDOH, including ChFI experiences and its subsequent cumulative disadvantages experienced during college.
Collapse
Affiliation(s)
- Catherine Mobley
- Department of Sociology, Anthropology and Criminal Justice, Clemson University, Clemson, SC 29634, USA;
| | - Ye Luo
- Department of Sociology, Anthropology and Criminal Justice, Clemson University, Clemson, SC 29634, USA;
| | - Mariela Fernandez
- Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, SC 29634, USA;
| | - Leslie Hossfeld
- College of Behavioral, Social and Health Science, Clemson University, Clemson, SC 29634, USA;
| |
Collapse
|
3
|
Brostow DP, Smith AA, Bahraini NH, Besterman-Dahan K, Forster JE, Brenner LA. Nutrition and Food Security Among Veterans: Operationalizing Nutritional Functioning. Arch Phys Med Rehabil 2024:S0003-9993(24)00948-1. [PMID: 38649010 DOI: 10.1016/j.apmr.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 04/03/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To assess injured military veterans' experiences, beliefs, and daily physical and psychosocial functioning in relation to food and nutrition. DESIGN We used a convergent mixed-methods study design and the International Classification of Functioning, Disability, and Health to operationalize the core constructs and influencing factors related to physical and psychosocial functioning, food, and nutrition. SETTING Three Veterans Affairs polytrauma rehabilitation centers. PARTICIPANTS Veterans who served in the United States military on or after September 11, 2001, and whose medical diagnoses met the criteria for polytrauma; at least 1 mild traumatic brain injury and at least 1 associated comorbidity (eg, posttraumatic stress disorder, chronic musculoskeletal pain, vestibular disturbances), for a total N of 43. INTERVENTIONS None. MAIN OUTCOME MEASURES Themes from survey responses and semistructured interview data were pooled into core constructs and influencing factors. RESULTS Thirty-seven veterans completed all surveys and participated in recorded interviews. Based on qualitative and quantitative data, veterans' relation to food and nutrition (ie, nutritional functioning) was found to be characterized by 5 core constructs, including food background, nutrition knowledge, meal aptitude, resource navigation, and navigation to/of food spaces. Nutritional functioning was found to be shaped by 5 influencing factors, including injuries and health conditions, ideological and cultural exposures, relations, current beliefs, and current behaviors. CONCLUSIONS Nutritional functioning (food background, nutrition knowledge, meal aptitude, resource navigation, navigation to/of food spaces) among injured veterans is complex and shaped by multiple physical, psychosocial, economic, and cultural factors.
Collapse
Affiliation(s)
- Diana P Brostow
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Alexandra A Smith
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO
| | - Nazanin H Bahraini
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Karen Besterman-Dahan
- VA VISN (Veteran Integrated Services Network) 5 Mental Illness Research Education and Clinical Center (MIRECC), Washington, DC; Department of Nutrition and Dietetics, College of Public Health, University of South Florida, Tampa, FL
| | - Jeri E Forster
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Lisa A Brenner
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO; Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| |
Collapse
|
4
|
Azimi MN, Rahman MM. Food insecurity, environment, institutional quality, and health outcomes: evidence from South Asia. Global Health 2024; 20:21. [PMID: 38459556 PMCID: PMC10924333 DOI: 10.1186/s12992-024-01022-2] [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: 09/06/2023] [Accepted: 02/12/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Food insecurity and environmental degradation pose significant threats to health outcomes in South Asia, necessitating effective policy interventions. Therefore, this study aims to examine the impact of food insecurity and environmental degradation on health outcome indicators amidst global inflationary shocks and institutional quality arrangements. Additionally, it aims to explore the intricate moderating role of institutional quality on the relationship between food insecurity, endogenous variables, and external shocks. METHOD In alignment with the study's objectives, a set of panel data spanning from 2000 to 2021 is compiled for South Asia. The study introduces a novel variable representing inflationary shock, crafted through the integration of inflation datapoints and the application of the generalized autoregressive conditional heteroskedasticity model. Additionally, a distinctive aggregate institutional quality index is formulated, drawing from six key measures of the Worldwide Governance indicators. To scrutinize the effects of food insecurity, environmental degradation, and other explanatory variables, the study employs the two-step system generalized method of moment technique, offering a robust analytical approach to uncover complex relationships and dynamics in the region. RESULTS The results indicate that the prevalence of undernourishment, inequality in per capita calorie intake, and CO2 emissions significantly reduce life expectancy and increase mortality rates. Additionally, it shows that per capita kilocalorie supply, per capita GDP, per capita health expenditures, and urbanization are statistically significant for increasing life expectancy and decreasing mortality rates. The findings reveal that inflationary shocks severely affect food insecurity and environmental factors, exerting further pressure on contemporary life expectancy and mortality rates. In rebuttal, the institutional quality index is found to have significant effects on increasing and decreasing life expectancy and mortality rates, respectively. Furthermore, the institutional quality index is effective in moderating the nexus between food insecurity, environmental degradation, and health outcomes while also neutralizing the negative impact of inflationary shocks on the subject. CONCLUSION The results verify triple health constraints such as food insecurity, environmental factors, and economic vulnerability to global shocks, which impose severe effects on life expectancy and mortality rates. Furthermore, poor institutional quality is identified as a hindrance to health outcomes in South Asia. The findings suggest specific policy implications that are explicitly discussed.
Collapse
Affiliation(s)
- Mohammad Naim Azimi
- School of Business, University of Southern Queensland, Toowoomba, Australia.
| | | |
Collapse
|
5
|
Wang MX, Durant RW. Populationwide Longevity and Food Insecurity. JAMA Intern Med 2024; 184:321. [PMID: 38285560 DOI: 10.1001/jamainternmed.2023.7958] [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: 01/31/2024]
Affiliation(s)
- Melinda X Wang
- Department of Medicine, University of California, San Francisco, San Francisco
- Editorial Fellow, JAMA Internal Medicine
| | - Raegan W Durant
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham
- Diversity, Equity, and Inclusion Associate Editor, JAMA Internal Medicine
| |
Collapse
|
6
|
Amegbletor DY, Goldberg D, Pope DA, Heckman BW. Food and Nutrition Security as Social Determinants of Health: Fostering Collective Impact to Build Equity. Prim Care 2023; 50:633-644. [PMID: 37866836 DOI: 10.1016/j.pop.2023.05.006] [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] [Indexed: 10/24/2023]
Abstract
An overview of the state of the American diet, how it relates to public health outcomes and the obesity epidemic, and how it arises from the policy and infrastructure that have been developed over the course of the 20th and 21st centuries. The article concludes by laying out concrete solutions for urban revitalization, providing people in underserved communities sovereignty over their food supply, and work with multi-stakeholder cooperatives to overcome the effects of food insecurity and poor diet quality.
Collapse
Affiliation(s)
- Duncan Y Amegbletor
- Department of Psychiatry & Behavioral Sciences, Meharry Medical College, 1005 Dr. D.B. Todd, Jr. Boulevard, Nashville, TN 37208, USA
| | - Danny Goldberg
- Grow2Learn Cooperative, 445 Kemper Drive, North, Madison, TN 37115, USA
| | - Derek A Pope
- Department of Psychiatry & Behavioral Sciences, Meharry Medical College, 1005 Dr. D.B. Todd, Jr. Boulevard, Nashville, TN 37208, USA
| | - Bryan W Heckman
- Department of Psychiatry & Behavioral Sciences, Meharry Medical College, 1005 Dr. D.B. Todd, Jr. Boulevard, Nashville, TN 37208, USA; Division of Public Health, School of Graduate Studies and Research, Meharry Medical College, 1005 Dr. D.B. Todd, Jr. Boulevard, Nashville, TN 37208, USA.
| |
Collapse
|
7
|
Allen S, Onsando WM, Patel I, Canavan C, Goodman D, Dev A. Food Insecurity and Food Access Among Women in Northern New England During the Perinatal Period. J Obstet Gynecol Neonatal Nurs 2023; 52:374-383. [PMID: 37524310 DOI: 10.1016/j.jogn.2023.06.004] [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: 04/11/2023] [Revised: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE To describe the experience of food insecurity and food access among women in northern New England during the perinatal period. DESIGN Qualitative descriptive. SETTING Hospital system in northern New England. PARTICIPANTS Twelve pregnant women and two women who gave birth. METHODS We interviewed participants during pregnancy and the postpartum period about their experiences of food insecurity, including screening, their willingness and ability to access food programs, and the extent to which their food needs were met through referrals. We analyzed interview transcripts to identify themes related to participants' experiences of food insecurity; food support, including screening and referral; and opportunities for improvement in current food support interventions. RESULTS Most participants accepted being screened for food insecurity and were satisfied with the food distributed in their perinatal care settings. Food insecurity consistently occurred alongside general financial strain, housing insecurity, and transportation needs, which affirmed the interconnectedness of social determinants of health. Other co-occurring risks included intimate partner violence, substance use, and mental health challenges. Food receipt was facilitated by care team members who were knowledgeable about food distribution programs. Barriers to food receipt included challenges with enrolling in public assistance programs, poor awareness among participants of available resources, the persistence and unpredictability of food insecurity, and stigma. We identified three distinct themes that described participants' experiences with food insecurity during pregnancy and the postpartum period: Experience of Being Screened for Food Insecurity, Intersecting Social Needs, and Experience of Accessing Resources. CONCLUSION These findings can be used to inform comprehensive food support programs that reflect the needs and values of women during the perinatal period. Interventions to screen and intervene for food insecurity during and after pregnancy align with the quality standards of The Joint Commission and should be integrated into nursing practice.
Collapse
|
8
|
Chinaemelum A, Munir MM, Azap L, Woldesenbet S, Dillhoff M, Cloyd J, Ejaz A, Pawlik TM. Impact of Food Insecurity on Outcomes Following Resection of Hepatopancreaticobiliary Cancer. Ann Surg Oncol 2023; 30:5365-5373. [PMID: 37314542 DOI: 10.1245/s10434-023-13723-w] [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: 03/17/2023] [Accepted: 05/23/2023] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Food insecurity (FI) may predispose individuals to suboptimal nutrition, leading to chronic disease and poor health outcomes. We sought to assess the impact of county-level FI on postoperative outcomes among patients undergoing resection of hepatopancreaticobiliary (HPB) cancer. METHODS Patients who were diagnosed with HPB cancer between 2010 and 2015 were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Data on annual county-level FI were obtained from the Feeding America: Mapping the Meal Gap report and were categorized into tertiles. Textbook outcome was defined as no extended length of stay, perioperative complications, 90-day readmission, and 90-day mortality. Multiple logistic regression and Cox regression models were used to assess outcomes and survival relative to FI. RESULTS Among 49,882 patients (hepatocellular: n = 11,937, 23.9%; intrahepatic cholangiocarcinoma: n = 2111, 4.2%; extrahepatic cholangiocarcinoma: n = 4047, 8.1%; gallbladder: n = 2853, 5.7%; pancreatic: n = 28,934, 58.0%), 6702 (13.4%) patients underwent a surgical resection. Median age was 75 years (interquartile range 69-82), and most patients were male (n = 25,767, 51.7%) and self-identified as White (n = 36,381, 72.9%). Overall, 5291 (10.6%) and 39,664 (79.5%) individuals resided in low or moderate FI counties, respectively, while 4927 (9.8%) patients resided in high FI counties. Achievement of textbook outcome (TO) was 56.3% (n = 6702). After adjusting for competing risk factors, patients residing in high FI counties had lower odds to achieve a TO versus individuals living in low FI counties (odds ratio 0.69, 95% confidence interval [CI] 0.54-0.88, p = 0.003). In addition, patients residing in moderate and high FI counties had a greater risk of mortality at 1- (referent, low, moderate: hazard ratio [HR] 1.09, 95% CI 1.05-1.14; high: HR 1.14, 95% CI 1.08-1.21), 3- (referent, low, moderate: HR 1.09, 95% CI 1.05-1.14; high: HR 1.14, 95% CI 1.08-1.21), and 5- (referent, low, moderate: HR 1.05, 95% CI 1.01-1.09; high: HR 1.07, 95% CI 1.02-1.13) years versus individuals from low FI counties. CONCLUSIONS FI was associated with adverse perioperative outcomes and long-term survival following resection of an HPB malignancy. Interventions directed towards mitigating nutritional inequities are needed to improve outcomes among vulnerable HPB populations.
Collapse
Affiliation(s)
- Akpunonu Chinaemelum
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Lovette Azap
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Mary Dillhoff
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Jordan Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Surgery, Oncology, Health Services Management and Policy, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
| |
Collapse
|
9
|
John JC, Gonzalez J, Chan SG, McPherson H, Aiyer JN, Galvan E, Browning N, Sharma SV. A coalition-driven examination of organization capacity to address food insecurity in Greater Houston: a qualitative research study. Front Public Health 2023; 11:1167100. [PMID: 37649787 PMCID: PMC10464906 DOI: 10.3389/fpubh.2023.1167100] [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: 02/15/2023] [Accepted: 07/17/2023] [Indexed: 09/01/2023] Open
Abstract
Background Economic and social hardships have worsened food insecurity, particularly among low income and racial-ethnic minority groups. Given the core goal of the 150+ member Houston Health Equity Collective (HEC) to reduce food insecurity by 5% in 2025, we explored member organizations' capacity and challenges faced in screening and responding to food insecurity through care coordination efforts. Methods A twice-administered Qualtrics XM survey (Provo, Utah) with 76 organizations, followed by five focus groups with 22 of these organizations, explored reach and response efforts to food insecurity. Qualitative assessments lasted between 0.5 to 1.5 h, were audio-recorded, cleaned, coded, and thematically analyzed using NVivo, version 11 (Burlington, Massachusetts). The qualitative study was guided by a general inductive approach. In total, over 6 h of audiovisual recording were extracted, and over 100 pages of text exported to NVivo for data analysis. The research team read and coded transcripts independently using the codebook, and met routinely to discuss and resolve codes -resulting in numerous revisions to the codebook. Coding structure was discussed at multiple meetings and differences were addressed through consensus. Predominant qualitative themes impacting food insecurity screening were "stigma and cultural-related barriers", "clinic capacity and attitudes", "need to focus on upstream influences of food insecurity and SDOH needs", "impact of COVID-19", and "need for HEC system responses". Main recommendations to enhance screening and reach included improving staff culture, enhancing cultural sensitivity across organizational practices, and using shared technology to coordinate care. Respondents stated that the HEC can drive these recommendations through networking opportunities, use of shared resource directory, and placing focus on upstream factors. Conclusions Recommendations to target food insecurity must focus on organizational staff responsiveness and sensitivity to patients' needs. Of equal importance is the need for increased attention to the upstream influencers and integration of systems-level interventions to holistically target the barriers impacting food insecurity.
Collapse
Affiliation(s)
- Jemima C. John
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | | | - Sara-Grace Chan
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Heidi McPherson
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jennifer N. Aiyer
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | | | | | - Shreela V. Sharma
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| |
Collapse
|
10
|
Lee WC, Lin S, Yang TC, Serag H. Cross-sectional study of food insecurity and medical expenditures by race and ethnicity. ETHNICITY & HEALTH 2023; 28:794-808. [PMID: 36576145 DOI: 10.1080/13557858.2022.2161090] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/14/2022] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Food insecurity is a risk factor for morbidity and mortality leading to high medical expenditures, but race/ethnicity was used as adjustments in the literature. The study sought to use race/ethnicity as a key predictor to compare racial differences in associations between food insecurity and expenditures of seven health services among non-institutionalized adults. DESIGN This cross-sectional study used Medical Expenditure Panel Survey that collects information on food insecurity in 2016 (n=24,179) and 2017 (n=22,539). We examined the association between race/ethnicity and food insecurity status and documented the extent to which impacts of food insecurity on medical expenditures varied by race/ethnicity. We fit multivariable models for each racial group, adjusting for states, age, gender, insurance, and education. Adults older than 18 years were included. RESULTS The results show that blacks experienced an inter-racial disparity in food insecurity whereas Hispanics experienced intra-racial disparity. A higher percentage of blacks (28.7%) reported at least one type of food insecurity (11.2% of whites). Around 20% of blacks reported being worried about running out of food and the corresponding number is 8.4% among whites. Hispanics reported more food insecurity issues than whites. Moreover, food insecurity is positively associated with expenditures on emergency room utilization (99% increase for other races vs. 51% increase for whites) but is negatively associated with dental care utilization (43% decrease for blacks and 44% for whites). Except for Hispanics, prescription expenditure has the most positive association with food insecurity, and food insecure blacks are the only group that did not significantly use home health. CONCLUSION The study expanded our understanding of food insecurity by investigating how it affected seven types of medical expenditures for each of four racial populations. An interdisciplinary effort is needed to enhance the food supply for minorities. Policy interventions to address intra-racial disparities among Hispanics and inter-racial disparities among African Americans are imperative to close the gap.
Collapse
Affiliation(s)
- Wei-Chen Lee
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Sherry Lin
- Department of Health Policy and Management, Texas A&M University, College Station, TX, USA
| | - Tse-Chuan Yang
- Department of Sociology, State University of New York at Albany, Albany, NY, USA
| | - Hani Serag
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| |
Collapse
|
11
|
Will KK, Mutyala J, Essary AC. Health systems science: A call to action. JAAPA 2023; 36:45-46. [PMID: 37229585 DOI: 10.1097/01.jaa.0000931464.13332.f1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Kristen K Will
- Kristen K. Will is assistant dean and clinical associate professor in the College of Health Solutions at Arizona State University in Phoenix. Jiya Mutyala is a student intern with Arizona State University. Alison C. Essary is chair and professor in the Department of PA Studies at Northern Arizona University in Phoenix. The authors have disclosed no potential conflicts of interest, financial or otherwise
| | | | | |
Collapse
|
12
|
Goitia JJ, Onwuzurike J, Chen A, Wu YL, Shen AYJ, Lee MS. Association between vehicle ownership and disparities in mortality after myocardial infarction. Am J Prev Cardiol 2023; 14:100500. [PMID: 37181802 PMCID: PMC10173400 DOI: 10.1016/j.ajpc.2023.100500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/12/2023] [Accepted: 04/23/2023] [Indexed: 05/16/2023] Open
Abstract
Background Access to reliable transportation is fundamental in the management of chronic disease. The purpose of this study was to investigate the association between vehicle ownership at the neighborhood-level and long-term mortality after myocardial infarction (MI). Methods This is a retrospective observational study evaluating adult patients admitted for MI between January 1st, 2006, and December 31st, 2016. Neighborhoods were defined by census tract and household vehicle ownership data was obtained from the American Community Survey courtesy of the University of California, Los Angeles Center for Neighborhood Knowledge. Patients were divided into 2 groups: those living in neighborhoods with higher vehicle ownership, and those living in neighborhoods with lower vehicle ownership. The cutoff of 4.34% of households reporting not owning a vehicle was used to define a neighborhood as one with "higher" vs "lower" vehicle ownership as this was the median value for the cohort. The association between vehicle ownership and all-cause mortality after MI was assessed using Cox proportional hazards regression models. Results A total of 30,126 patients were included (age 68.1 +/- 13.5 years, 63.2% male). After adjusting for age, sex, race/ethnicity, and medical comorbidities, lower vehicle ownership was associated with increased all-cause mortality after MI (hazard ratio [HR] 1.10; 95% confidence interval [CI] 1.06-1.14; p<0.001). This finding remained significant after adjusting for median household income (HR 1.06; 95% CI 1.02-1.10; p = 0.007). Upon comparison of White and Black patients living in neighborhoods with lower vehicle ownership; Black patients were found to have an increased all-cause mortality after MI (HR 1.21, 95% CI 1.13-1.30, p<0.001), a difference which remained significant after adjusting for income (HR 1.20; 95% CI 1.12-1.29; p<0.001). There was no significant difference in mortality between White and Black patients living in neighborhoods with higher vehicle ownership. Conclusion Lower vehicle ownership was associated with increased mortality after MI. Black patients living in neighborhoods with lower vehicle ownership had a higher mortality after MI than White patients living in similar neighborhoods but Black patients living in neighborhoods with higher vehicle ownership had no worse mortality than their White counterparts. This study highlights the importance of transportation in determining health status after MI.
Collapse
Affiliation(s)
- Jesse J Goitia
- Division of Cardiology, University of California, Irvine
- Corresponding author at: Division of Cardiology, University of California, Irvine, 333 City Blvd W, Ste 400, Orange, CA 92868, USA.
| | - James Onwuzurike
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Aiyu Chen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Yi-Lin Wu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Albert Yuh-Jer Shen
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Ming-Sum Lee
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| |
Collapse
|
13
|
Johnson LW, Diaz I. Exploring the Social Determinants of Health and Health Disparities in Traumatic Brain Injury: A Scoping Review. Brain Sci 2023; 13:brainsci13050707. [PMID: 37239178 DOI: 10.3390/brainsci13050707] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/09/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
Traumatic brain injury (TBI) is a global health concern, that can leave lasting physical, cognitive, and/or behavioral changes for many who sustain this type of injury. Because of the heterogeneity of this population, development of appropriate intervention tools can be difficult. Social determinants of health (SDoH) are factors that may impact TBI incidence, recovery, and outcome. The purpose of this study is to describe and analyze the existing literature regarding the prevailing SDoH and health disparities (HDs) associated with TBI in adults. A scoping review, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework was used to explore three electronic databases-PubMed, Medline, and CINAHL. Searches identified peer-reviewed empirical literature addressing aspects of SDoH and HDs related to TBI. A total of 123 records were identified and reduced to 27 studies based on inclusion criteria. Results revealed race/ethnicity was the most commonly reported SDoH impacting TBI, followed by an individual's insurance status. Health disparities were noted to occur across the continuum of TBI, including TBI risk, acute hospitalization, rehabilitation, and recovery. The most frequently reported HD was that Whites are more likely to be discharged to inpatient rehabilitation compared to racial/ethnic minorities. Health disparities associated with TBI are most commonly associated with the race/ethnicity SDoH, though insurance status and socioeconomic status commonly influence health inequities as well. The additional need for evidence related to the impact of other, lesser researched, SDoH is discussed, as well as clinical implications that can be used to target intervention for at-risk groups using an individual's known SDoH.
Collapse
Affiliation(s)
- Leslie W Johnson
- Department of Communication Sciences and Disorders, North Carolina Central University, Durham, NC 27707, USA
| | - Isabella Diaz
- Department of Communication Sciences and Disorders, North Carolina Central University, Durham, NC 27707, USA
| |
Collapse
|
14
|
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
|
15
|
Ortiz-Marrón H, Ortiz-Pinto MA, Urtasun Lanza M, Cabañas Pujadas G, Valero Del Pino V, Belmonte Cortés S, Gómez Gascón T, Ordobás Gavín M. Household food insecurity and its association with overweight and obesity in children aged 2 to 14 years. BMC Public Health 2022; 22:1930. [PMID: 36253730 PMCID: PMC9578200 DOI: 10.1186/s12889-022-14308-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective was to estimate the prevalence of household food insecurity (HFI) depending on sociodemographic factors and its association with lifestyle habits and childhood overweight and obesity. METHODS Data was collected from 1,938 children aged 2 to 14 years who participated in the "Study about Malnutrition" of the Community of Madrid. Weight and height were obtained through physical examination. Body mass index was calculated as weight/height2 (kg/m2) and the criteria of the WHO were used for determining conditions of overweight and obesity. The participants' parents answered a structured questionnaire about their diet, lifestyle (physical activity and screen time), and food insecurity. The diet quality was assessed with the Healthy Eating Index in Spain and food insecurity, defined as the lack of consistent access to sufficient food for a healthy life, was measured via three screening questions and the Household Food Insecurity Access Scale (HFIAS). Odds Ratios (ORs) and Relative Risk Ratios (RRRs) were estimated using logistic regression models and adjusted for confounding variables. RESULTS The overall prevalence of HFI was 7.7% (95% CI: 6.6‒9.0), with lower values in children 2 to 4 years old (5.7%, 95% CI: 4.0‒8.1) and significantly higher values in households with low family purchasing power [37.3%; OR: 8.99 (95% CI: 5.5‒14.6)]. A higher prevalence of overweight (33.1%) and obesity (28.4%) was observed in children from families with HFI, who presented a lower quality diet and longer screen time compared to those from food-secure households (21.0% and 11.5%, respectively). The RRR of children in families with HFI relative to those from food-secure households was 2.41 (95% CI: 1.5‒4.0) for overweight and 1.99 (95% CI: 1.2‒3.4) for obesity. CONCLUSION The prevalence of HFI was high in the paediatric population, especially in households with low family purchasing power. HFI was associated with lower diet quality and higher prevalence of childhood overweight and obesity. Our results suggest the need for paediatric services to detect at-risk households at an early stage to avoid this dual burden of child malnutrition.
Collapse
Affiliation(s)
- Honorato Ortiz-Marrón
- Epidemiology Service. General Directorate of Public Health, Department of Health, Community of Madrid, C/ San Martín de Porres nº 6, 28035, Madrid, Spain.
| | - Maira Alejandra Ortiz-Pinto
- Epidemiology Service. General Directorate of Public Health, Department of Health, Community of Madrid, C/ San Martín de Porres nº 6, 28035, Madrid, Spain
| | - María Urtasun Lanza
- Group of Epidemiology and Public Health, Faculty of Medicine, University of Alcalá, Alcalá de Henares, Spain.,APLICA Cooperative, Madrid, Spain
| | - Gloria Cabañas Pujadas
- Epidemiology Service. General Directorate of Public Health, Department of Health, Community of Madrid, C/ San Martín de Porres nº 6, 28035, Madrid, Spain
| | - Virginia Valero Del Pino
- Epidemiology Service. General Directorate of Public Health, Department of Health, Community of Madrid, C/ San Martín de Porres nº 6, 28035, Madrid, Spain
| | - Susana Belmonte Cortés
- Nutrition Service, Department of Health, Community of Madrid, General Directorate of Public Health, Madrid, Spain
| | - Tomás Gómez Gascón
- Foundation for Biosanitary Research and Innovation in Primary Care ES Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain Faculty of Medicine. Universidad Complutense de Madrid, Madrid, Spain
| | - María Ordobás Gavín
- Epidemiology Service. General Directorate of Public Health, Department of Health, Community of Madrid, C/ San Martín de Porres nº 6, 28035, Madrid, Spain
| |
Collapse
|
16
|
Vargo L, Ciesielski TH, Embaye M, Bird A, Freedman DA. Understanding SNAP Recipient Characteristics to Guide Equitable Expansion of Nutrition Incentive Programs in Diverse Food Retail Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19094977. [PMID: 35564371 PMCID: PMC9101614 DOI: 10.3390/ijerph19094977] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/06/2022] [Accepted: 04/15/2022] [Indexed: 12/04/2022]
Abstract
Structural barriers, such as food costs, reduce access to healthy foods for populations with limited income, including those benefitting from the Supplemental Nutrition Assistance Program (SNAP). Nutrition incentive programs seek to address this barrier. Evaluations of SNAP-based incentive programming often focus on one setting (i.e., either farmers’ markets or grocery stores). We examined use patterns, characteristics, and preferences among 253 SNAP consumers with access to incentive programming at both a farmers’ market and a grocery store located within five miles of their home. Cross-sectional survey data were collected in 2019 in two Ohio cities. Despite geographic access, 45% of those surveyed were not using the incentive program; most non-users (80.5%) were unaware of the program. Program users compared to non-users had higher household incomes (p < 0.001) and knew more people using the program (p < 0.001). Grocery stores were the most common setting of use (59%); 29% used at farmers’ markets; 11% used in both settings. User characteristics varied by store setting based on demographics, program experience, fruit and vegetable purchasing and consumption patterns, and social dynamics related to use. Our findings support comprehensive awareness-raising efforts and tailored implementation of incentive programming that attends to diverse segments of SNAP consumers to promote equity in program reach.
Collapse
Affiliation(s)
- Lauren Vargo
- Mary Ann Swetland Center for Environmental Health Research, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Timothy H Ciesielski
- Mary Ann Swetland Center for Environmental Health Research, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Milen Embaye
- Mary Ann Swetland Center for Environmental Health Research, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Ana Bird
- Produce Perks Midwest, Cincinnati, OH 45241, USA
| | - Darcy A Freedman
- Mary Ann Swetland Center for Environmental Health Research, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| |
Collapse
|
17
|
Chagin K, Choate F, Cook K, Fuehrer S, Misak JE, Sehgal AR. A Framework for Evaluating Social Determinants of Health Screening and Referrals for Assistance. J Prim Care Community Health 2021; 12:21501327211052204. [PMID: 34905991 PMCID: PMC8679017 DOI: 10.1177/21501327211052204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction/Objectives: Many health systems screen patients for social determinants of health and
refer patients with social needs to community service organizations for
assistance. We developed a framework based on sequential steps to evaluate
this process. Methods: We reviewed efforts by The MetroHealth System in Cleveland, Ohio and
identified 6 sequential steps: patient screened, has social needs, consents
to referral to a service organization, referral placed, referral accepted,
and referral outcome. Referral outcomes were categorized as resolved
(organization provided requested service or patient self-resolved problem),
or unresolved (patient unable to be contacted or declined assistance). We
then determined the numbers of patients with food insecurity who completed
each step, how completion differed by patient characteristics and service
organization, and reasons for failure to complete specific steps. Results: We used the framework to evaluate screening and assistance steps among 5741
patients who attended a COVID-19 vaccine clinic from February 15-March 31,
2021 and were followed through April 30, 2021. The percentage of patients
who completed each step ranged from 17-98%. Step completion differed by
patient age, patient race, and clinic. Of 360 referrals accepted by
community organizations, 98 (27%) were resolved. The most common reasons for
unresolved referrals were inability of service organization to contact
patients (151), no reason stated (71), and patients declined service
(30). Conclusions: A framework based on sequential steps may be used to evaluate social
determinants of health screening and assistance programs. Further work is
needed to address reasons for failure to complete steps, to include patient
perspectives, and to determine long-term outcomes.
Collapse
Affiliation(s)
| | | | - Karen Cook
- The MetroHealth System, Cleveland, OH, USA
| | | | - James E Misak
- The MetroHealth System, Cleveland, OH, USA.,The MetroHealth System, Cleveland, OH, USA
| | - Ashwini R Sehgal
- The MetroHealth System, Cleveland, OH, USA.,The MetroHealth System, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|