The effects of Hurricane Katrina on food access disparities in New Orleans

"It's Gonna Be Okay"-A Qualitative Exploration of the COVID-19 Pandemic's Effects on African American Participants During a Dietary Intervention Study

BACKGROUND

African American adults are at increased risk for chronic diseases. Limited research exists regarding how the COVID-19 pandemic affected African American adults in behavioral interventions.

OBJECTIVE

This study assessed how the early months of the COVID-19 pandemic, before vaccine availability and widespread testing, affected stress, nutrition, and exercise behaviors of African American adults participating in a dietary intervention study.

DESIGN

This was a qualitative interview study conducted with participants from both diet groups as part of the ongoing Nutritious Eating with Soul (NEW Soul) study. NEW Soul is a 2-year, randomized dietary intervention study with participants randomized to follow a vegan (intervention) or low-fat omnivorous diet (control), with both diets focused on soul food.

PARTICIPANTS/SETTING

Participants (n = 20) came from 2 cohorts of the larger intervention study in South Carolina and were purposefully recruited based on high and low attendance at intervention sessions. Participants in the first cohort were near the end of the intervention, and participants in the second cohort were near the mid-point. The interviews were conducted from June to July 2020.

MAIN OUTCOME MEASURES

Outcomes included participants' experiences related to stress, nutrition, and exercise behaviors during the early months of the COVID-19 pandemic.

ANALYSIS

Interviews were recorded and transcribed verbatim. Interview transcripts were coded by two coders using NVivo software. Interviews were coded through content analysis using a constant comparative method.

RESULTS

Participants discussed the following 3 themes in relation to health behaviors: increased stress, change in routines, and advice to follow health goals.

CONCLUSIONS

Findings provide perspectives for designing interventions for African American adults establishing new routines to overcome setbacks and changes in routines created by the COVID-19 pandemic.

COVID-19 Pandemic Associations on Mental and Physical Health in African Americans Participating in a Behavioral Intervention

The COVID-19 pandemic has had disproportionate effects on communities of color, with higher death rates among African Americans (AA). The purpose of this study was to assess associations in African Americans' mental and physical health with the COVID-19 pandemic. Data for this study came from a larger nutrition intervention of AAs in the Southeastern United States, the Nutritious Eating with Soul study. Data collected before and after March 15, 2020 (the day when local South Carolina schools and businesses closed), were analyzed to assess the association of the pandemic on participants' stress, control of healthy eating, physical activity, and body mass index. Repeated measures analysis of covariance using full maximum likelihood estimation to handle missing data was used. At the onset of the COVID-19 pandemic, 150 participants were enrolled in the study (48.2 ± 10.6 years old, 79% female, 75% with college degree or higher). Participants' reporting of stress did not show statistically significant change over time. Cognitive control increased 1.43 points (F = 20.60, p < 0.0001) and body mass index increased 0.72 kg/m2 (F = 10.68, p = 0.001). Future longitudinal studies should investigate how the COVID-19 pandemic continues to present challenges to understanding and improving health among African Americans. The study is registered at www.clinicaltrials.gov NCT03354377.

Structural racism and geographic access to food retailers in the United States: A scoping review

This scoping review summarized findings and key measures from U.S.-based studies that 1) examined associations between geographic indicators of structural racism (e.g., redlining, racial segregation) and access to food retailers (e.g., supermarkets, convenience stores) or 2) documented disparities in access by neighborhood racial/ethnic composition. In 2022, relevant scientific literature was reviewed using Covidence software. Independent reviewers examined 13,069 citations; 163 citations advanced to the full-text review stage and 70 were selected for inclusion. Twenty-one studies (30%) linked one or more indicator of structural racism to food retailer access while 49 (70%) solely examined differences in access by neighborhood racial/ethnic composition. All studies featuring indicators of structural racism reported significant findings; however, indicators varied across studies making it difficult to make direct comparisons. Key indicators of structural racism in the food access literature included redlining (n = 3), gentrification (n = 3), and racial segregation (n = 4). Many U.S.-based studies have evaluated food retailer access by neighborhood racial/ethnic composition. Moving forward, studies should model indicators of structural racism and determine their influence on geographic access to large and small food retailers.

Mechanisms underlying food insecurity in the aftermath of climate-related shocks: a systematic review

Food insecurity is prevalent, affecting 1·2 billion people globally in 2021. However, the effects of food insecurity are unequally distributed across populations and climate-related shocks threaten to exacerbate food insecurity and associated health consequences. The mechanisms underlying this exacerbation at the household level are largely unknown. We aimed to synthesise the available evidence on the mechanisms connecting extreme climate events to household-level food insecurity and highlight the research gaps that must be addressed to inform better food security and health policy. For this systematic review, a comprehensive literature search was done by a medical librarian in February, 2021 for articles about food security and climate-related shocks. Relevant publications were identified by searching the following databases with a combination of standardised index terms and keywords: MEDLINE, Embase, CINAHL, GreenFILE, Environment Complete, Web of Science Core Collection, and Global Health. Searches were limited to human studies published in English. Included studies measured food security outcomes using indicators developed by the UN Food and Agricultural Organization (ie, consumption patterns, livelihood change, malnutrition, and mortality) and explained the mechanism behind the household-level or population-level food insecurity. Purely theoretical, modelling, and review studies were excluded. Quality assessment was conducted using the appropriate Joanna Briggs Institute Critical Appraisal Tool. Data were analysed using thematic analysis of the categories of mechanism (interpreted using internationally accepted frameworks), risk and resilience factors, and author policy recommendations. We found a paucity of data with only 18 studies meeting criteria for inclusion out of 337 studies identified for full-text review. All the studies that were included in our analysis showed worse food security outcomes after climate-related shocks. Food availability was the most common mechanism cited (17 studies), although most studies addressed at least one additional mechanism (15 studies). Studies were of mixed methodologies with nuanced discussions of risk and resilience factors, and of policy recommendations. This systematic review shows that there is an incomplete assessment of food security at the household and community level after climate-related shocks in the literature and finds that food availability is the primary mechanism studied. The low number of studies on this topic limits subgroup analysis and generalisability; however, the good quality of the studies allows for important policy recommendations around improving resilience to climate shocks and suggestions for future research including the need for a more granular understanding of mechanisms and feasible adaptation solutions.

Our Voice NOLA: Leveraging a Community Engaged Citizen Science Method to Contextualize the New Orleans Food Environment

OBJECTIVE

We employed the Our Voice citizen scientist method using a mobile application (app) to identify and contextualize neighborhood-level features influencing food access and wellbeing in New Orleans, Louisiana.

DESIGN

A three-phase, multi-method study comprised of: (1) a researcher-assisted tag-a-long neighborhood walk (referred to as a 'journey') with the Discovery Tool (DT) app to document neighborhood-level features via geo-coded photos and audio-recorded narratives; (2) a post-journey interview to enable citizen scientists to share their lived experiences; and (3) a community meeting with citizen scientists and local stakeholders.

SETTING

Various neighborhoods in New Orleans, Louisiana, USA.

PARTICIPANTS

Citizen Scientists (i.e., residents) aged 18 years and older.

MAIN OUTCOME MEASURE(S)

Features that influence food access and health behaviors.

ANALYSIS

Descriptive statistics and a thematic content analysis were conducted to assess survey and app data.

RESULTS

Citizen scientists (N = 14) captured 178 photos and 184 audio narratives. Eight major themes were identified: safety; walkability; aesthetics; amenities; food; health services; neighborhood changes; and infrastructure/city planning. The post-journey interview provided insights around the abovementioned themes. The community meeting demonstrated the willingness of citizen scientists and stakeholders to convene and discuss issues and relevant solutions.

CONCLUSIONS AND IMPLICATIONS

Findings demonstrate the ability of technology and citizen science to help better understand the complexities of New Orleans' past, present and distinct culture-and implications for food access and wellbeing in the context of trauma in an urban ecosystem.

Emergency food distribution efforts in New Orleans, LA after Hurricane Ida

Background

The provision of food aid after a natural disaster is necessary to prevent hunger, particularly in low-resourced and low-income communities. Little is known about the operational challenges associated with ensuring equitable distribution of emergency food resources to communities in need following a disaster. To address this gap, this study assessed emergency food distribution efforts in New Orleans, LA during the 2 weeks following Hurricane Ida's landfall on August 29, 2021.

Methods

Information on free food distribution events was gathered from online sources. A list of distribution sites was generated that included data on operational logistics (e.g., address, days of operation, hours of operation, etc.), food offerings (e.g., prepared meals, groceries, etc.), and socio-demographic characteristics of the surrounding community. Geospatial mapping and bivariate analyses were used to analyze the site data.

Results

Seventy-four distribution sites operated in the 2 weeks after Hurricane Ida. Approximately 47.3% were located in census tracts with >80% Black residents, and 39.2% were in tracts with >30% poverty. A large proportion of sites offered prepared meals (86.2%) and only operated 1 day (36.5%). Tracts with >80% Black residents had more sites that operated only 1 day (p = 0.04). Tracts with >30% poverty had more sites that started distributing food resources 7-15 days after the hurricane (p = 0.02).

Conclusions

Most low-income and low-resourced communities in New Orleans had access to emergency food resources; however, several limitations in operations were identified that may have influenced access. Future initiatives to prevent hunger after a natural disaster in New Orleans, and elsewhere, should improve operational logistics for food aid.

Perspectives on the Health Effects of Hurricanes: A Review and Challenges

Hurricanes are devastating natural disasters which dramatically modify the physical landscape and alter the socio-physical and biochemical characteristics of the environment, thus exposing the affected communities to new environmental stressors, which persist for weeks to months after the hurricane. This paper has three aims. First, it conceptualizes potential direct and indirect health effects of hurricanes and provides an overview of factors that exacerbate the health effects of hurricanes. Second, it summarizes the literature on the health impact of hurricanes. Finally, it examines the time lag between the hurricane (landfall) and the occurrence of diseases. Two major findings emerge from this paper. Hurricanes are shown to cause and exacerbate multiple diseases, and most adverse health impacts peak within six months following hurricanes. However, chronic diseases, including cardiovascular disease and mental disorders, continue to occur for years following the hurricane impact.

Human-centric infrastructure resilience: Uncovering well-being risk disparity due to infrastructure disruptions in disasters

The objective of this paper is to empirically examine the impacts of infrastructure service disruptions on the well-being of vulnerable populations during disasters. There are limited studies that empirically evaluate the extent to which disruptions in infrastructure system services impact subpopulation groups differently and how these impacts relate to the wellbeing of households. Being able to systematically capture the differential experiences of sub-populations in a community due to infrastructure disruptions is necessary to highlight the differential needs and inequities that households have. In order to address this knowledge gap, this study derives an empirical relationship between sociodemographic factors of households and their subjective well-being impacts due to disruptions in various infrastructure services during and immediately after Hurricane Harvey. Statistical analysis driven by spearman-rank order correlations and fisher-z tests indicated significant disparities in well-being due to service disruptions among vulnerable population groups. The characterization of subjective well-being is used to explain to what extent infrastructure service disruptions influence different subpopulations. The results show that: (1) disruptions in transportation, solid waste, food, and water infrastructure services resulted in more significant well-being impact disparities as compared to electricity and communication services; (2) households identifying as Black and African American experienced well-being impact due to disruptions in food, transportation, and solid waste services; and (3) households were more likely to feel helpless, difficulty doing daily tasks and feeling distance from their community as a result of service disruptions. The findings present novel insights into understanding the role of infrastructure resilience in household well-being and highlights why it is so important to use approaches that consider various factors. Infrastructure resilience models tend to be monolithic. The results provide empirical and quantitative evidence of the inequalities in well-being impacts across various sub-populations. The research approach and findings enable a paradigm shift towards a more human-centric approach to infrastructure resilience.

Dietary Intake and Its Determinants Among Adults Living in the Metropolitan Area of Puerto Rico

There is scarce information regarding the dietary intake of adults living in Puerto Rico (PR). We aimed to assess intake of nutrients and foods, adherence to recommended intake of nutrients and diet quality, and sociodemographic and lifestyle factors correlated with diet quality among adults in the San Juan metropolitan area of PR. Data were obtained from participants of the cross-sectional convenience-sample Puerto Rico Assessment of Diet, Lifestyle, and Diseases (n = 248; ages 30-75 years). Diet quality was defined using the Alternate Healthy Eating Index 2010 (AHEI; range 0-110 indicating lower-higher quality). Linear regression models were used to relate AHEI to sociodemographic and lifestyle factors. Most participants met the Estimated Average Requirement (EAR) for iron, folate, and vitamins B12 and B6; 61% met the EAR for magnesium and 56% for calcium. Only 4% met the EAR for vitamin D, and 7% met the adequate intake for potassium. The main contributors to total energy intake were sugary beverages (11.8%), sweets/desserts (10.2%), dairy (8.5%), mixed dishes (7.6%), starches (6.3%), fast foods (5.5%), and rice (4.9%). The mean (SD) AHEI score was 59.8 (11.0). The lowest AHEI components for which recommended servings were met were red/processed meats, fruit, sodium, sugary beverages, and polyunsaturated fats, and the highest were nuts/legumes, omega-3 fats, and whole grains. Significantly higher AHEI scores were noted for older adults, other ethnicities (vs. Puerto Rican), being single, having some college or higher education, and never/formerly smoking. Adults living in PR report healthy and unhealthy dietary intakes, providing an opportunity to improve diet at the population level.

Beyond Food Access: The Impact of Parent-, Home-, and Neighborhood-Level Factors on Children's Diets

Despite the growth in empirical research on neighborhood environmental characteristics and their influence on children’s diets, physical activity, and obesity, much remains to be learned, as few have examined the relationship between neighborhood food availability on dietary behavior in children, specifically. This analysis utilized data from a community-based, cross-sectional sample of children (n = 199) that was collected in New Orleans, Louisiana, in 2010. This dataset was linked to food environment data to assess the impact of neighborhood food access as well as household and parent factors on children’s diets. We observed a negligible impact of the neighborhood food environment on children’s diets, except with respect to fast food, with children who had access to fast food within 500 m around their home significantly less likely (OR = 0.35, 95% CI: 0.1, 0.8) to consume vegetables. Key parental and household factors did play a role in diet, including receipt of public assistance and cooking meals at home. Children receiving public assistance were 2.5 times (95% CI: 1.1, 5.4) more likely to consume fruit more than twice per day compared with children not receiving public assistance. Children whose family cooked dinner at home more than 5 times per week had significantly more consumption of fruit (64% vs. 58%) and vegetables (55% vs. 39%), but less soda (27% vs. 43%). Findings highlight the need for future research that focuses on the dynamic and complex relationships between built and social factors in the communities and homes of children that impact their diet in order to develop multilevel prevention approaches that address childhood obesity.

Birth Outcomes in a Disaster Recovery Environment: New Orleans Women After Katrina

OBJECTIVES

To examine how the recovery following Hurricane Katrina affected pregnancy outcomes.

METHODS

308 New Orleans area pregnant women were interviewed 5-7 years after Hurricane Katrina about their exposure to the disaster (danger, damage, and injury); current disruption; and perceptions of recovery. Birthweight, gestational age, birth length, and head circumference were examined in linear models, and low birthweight (<2500 g) and preterm birth (<37 weeks) in logistic models, with adjustment for confounders.

RESULTS

Associations were found between experiencing damage during Katrina and birthweight (adjusted beta for high exposure = -158 g) and between injury and gestational age (adjusted beta = -0.5 days). Of the indicators of recovery experience, most consistently associated with worsened birth outcomes was worry that another hurricane would hit the region (adjusted beta for birthweight: -112 g, p = 0.08; gestational age: -3.2 days, p = 0.02; birth length: -0.65 cm, p = 0.06).

CONCLUSIONS

Natural disaster may have long-term effects on pregnancy outcomes. Alternately, women who are most vulnerable to disaster may be also vulnerable to poor pregnancy outcome.

10 Years Later: Changes in Food Access Disparities in New Orleans since Hurricane Katrina

Inadequate access to healthy food is a problem in many urban neighborhoods, particularly for racial-ethnic minorities and low-income groups who are more likely to reside in food deserts. Although substantial research throughout the country has documented the existence of these disparities, few studies have focused on how this access changes over time or is affected by environmental shocks. This study examined citywide supermarket access in New Orleans as well as racial-ethnic disparities in this access, prior to Hurricane Katrina and at three times afterwards. On-the-ground verification of supermarket locations was conducted in 2004-2005, 2007, 2009, and 2014 and was mapped with secondary demographic data. Census tracts were defined as predominantly African-American neighborhoods if 80 % or more of the population identified as such. HLM Poisson regression analyses were conducted in 2014 to identify the difference in likelihood of finding supermarkets in a neighborhood by race-ethnicity and across all years of interest. Racial-ethnic disparities existed before the storm and worsened after it (IRR = 0.35; 95 % CI = 0.21, 0.60). Improvements in disparities to pre-storm levels were not seen until 2009, 4 years after the storm. By 2014, supermarket access, on average, was not significantly different in African-American neighborhoods than in others (IRR = 0.90; 95 % CI = 0.65, 1.26). The slow recovery of New Orleans' retail food infrastructure after Hurricane Katrina highlights the need for an increased focus on long-term planning to address disparities, especially those that may be exaggerated by shocks.

Fresh produce consumption and the association between frequency of food shopping, car access, and distance to supermarkets

BACKGROUND

Fresh fruit and vegetables are important components of a healthy diet. Distance to a supermarket has been associated with the ability to access fresh produce.

METHODS

A randomly sampled telephone survey was conducted with the main shopper for 3000 households in New Orleans, Louisiana in 2011. Individuals were asked where and how often they shopped for groceries, frequency of consumption of a variety of foods, and whether they had access to a car. Bivariate models assessed the relationship between four outcomes: car access, distance to the store patronized by the respondent, number of monthly shopping trips, and daily servings of produce. Structural equation modeling (SEM) was used to distinguish direct and indirect effects.

RESULTS

In bivariate models, car access was positively associated with number of shopping trips and produce consumption while distance was inversely associated with shopping trips. In SEM models, produce consumption was not associated with car access or distance, but to the number of monthly shopping trips.

CONCLUSION

The frequency of shopping is associated with car access but a further distance deters it. Access to stores closer to the shopper may promote more frequent shopping and consumption of produce.

Feasibility of increasing access to healthy foods in neighborhood corner stores

The feasibility of working with neighborhood corner stores to increase the availability of fresh fruit and vegetables in low-income neighborhoods in New Orleans was assessed. Household interviews and 24-hour dietary recalls (n = 97), corner store customer intercept interviews (n = 60) and interviews with corner store operators (owners/managers) (n = 12) were conducted in three neighborhoods without supermarkets. Regional produce wholesalers were contacted by phone. Results indicated that the majority of neighborhood residents use supermarkets or super stores as their primary food source. Those who did shop at corner stores typically purchased prepared foods and/or beverages making up nearly one third of their daily energy intake. Most individuals would be likely to purchase fresh fruit and vegetables from the corner stores if these foods were offered. Store operators identified cost, infrastructure and lack of customer demand as major barriers to stocking more fresh produce. Produce wholesalers did not see much business opportunity in supplying fresh produce to neighborhood corner stores on a small scale. Increasing availability of fresh fruit and vegetables in corner stores may be more feasible with the addition of systems changes that provide incentives and make it easier for neighborhood corner stores to stock and sell fresh produce.

Understanding policy enactment: the New Orleans Fresh Food Retailer Initiative

BACKGROUND

Healthy-food financing initiatives have been endorsed as a way to improve food access, but relatively little research exists on understanding the formulation of such policies.

PURPOSE

This paper investigates the development of the New Orleans Fresh Food Retailer Initiative (FFRI) to highlight factors that enabled and impeded its enactment.

METHODS

In 2010 and 2011, semistructured interviews were conducted with 22 key informants with firsthand experience of this case, including representatives from the private sector, nonprofit organizations, and government. A participant-observer approach was used to synthesize these observations with archived written materials and the authors' own observations.

RESULTS

Historical disparities in food access in New Orleans were exacerbated by Hurricane Katrina, which also generated neighborhood activism and a pressing need to rebuild the city. A Food Policy Advisory Committee (FPAC) was formed from diverse groups. This paper describes the evolution of FPAC, its deliberations and report to the City Council, and actions to promote a financing initiative, as well as delays encountered in the process.

CONCLUSIONS

Enactment of the FFRI was facilitated by a window of opportunity that opened in the storm's aftermath, broad-based stakeholder buy-in, the existence of political champions, and policy-relevant information that was simple and convincing. Impediments to success included the constant turnover of city staff, a skeptical state bureaucracy, and the many competing priorities in New Orleans. This study highlights the importance of having a clear policy objective to address a well-defined and illustrated problem, key advocates in diverse organizations, and broad-based support for its implementation.