1
|
Wei J, Zhang Y, Lohman MC, Merchant AT. Supplemental Nutrition Assistance Program and depressive symptoms among adults with low family income in the U.S.: The National Health and Nutrition Examination Survey 2011-2018. J Affect Disord 2024; 362:828-834. [PMID: 39029691 DOI: 10.1016/j.jad.2024.07.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/28/2024] [Accepted: 07/14/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND The Supplemental Nutrition Assistance Program (SNAP) has been established to reduce food insecurity. Limited evidence is available on SNAP participation status over time and depressive symptoms. We aimed to examine the associations of SNAP status over time among low-income individuals, with depressive symptoms in the U.S. METHODS NHANES participants aged ≥20 years of low family income from 2011 to 2018 with information available on depressive symptoms and SNAP use were included in analysis. Depressive symptoms were assessed using 9-item Patient Health Questionnaire (PHQ-9), and PHQ-9 score ≥ 10 is indicative of significant depressive symptoms. Multivariable linear and logistic regressions models were conducted to examine the associations of SNAP participation status over time (never receiving SNAP, receiving SNAP prior to >12 months ago, current receiving SNAP, receiving SNAP in the last 12 months but not currently) with depressive symptoms and significant depressive symptoms. RESULTS Currently receiving SNAP (beta (β) = 0.17, 95 % CI: 0.10, 0.25; odds ratio (OR) = 1.52, 95 % confidence interval (CI): 1.16, 2.00) and receiving SNAP in the last 12 months but not currently (β = 0.24, 95 % CI: 0.04, 0.43; OR = 1.83, 95 % CI: 1.16, 2.89) were associated with higher depressive symptoms and higher prevalence of significant depressive symptoms. LIMITATIONS The cross-sectional design precludes causal interpretation, and key variables were measured with self-report. CONCLUSION Receiving SNAP in the last 12 months was associated with higher levels of depressive symptoms among individuals with low family income. Improvement on diet quality may be important for reducing depressive symptoms among SNAP users.
Collapse
Affiliation(s)
- Jingkai Wei
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America.
| | - Yanan Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - Matthew C Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| |
Collapse
|
2
|
Mmari K, Harper K, Kawatachi J, Jenkins M, Gross S, Lu S, Skinner R, Marshall B. The Association between Federal Nutrition Assistance Programs and Adolescent Food Security during the COVID-19 Pandemic: Evidence from Baltimore, Maryland. Nutrients 2024; 16:2876. [PMID: 39275192 PMCID: PMC11397004 DOI: 10.3390/nu16172876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 08/20/2024] [Accepted: 08/23/2024] [Indexed: 09/16/2024] Open
Abstract
Given the lack of attention on adolescent food insecurity, the primary objective of this study was to assess the association of household participation in federal food assistance programs with food security status among adolescents in Baltimore during the COVID-19 pandemic. Adolescents, ages 14-19 years, were invited to participate in two online surveys. The baseline was implemented between October 2020 and January 2021, while the follow-up took place one year later from November 2021 to January 2022 after schools had re-opened. We then matched survey participants with household participation in food nutrition assistance programs using data obtained from the Maryland Department of Social Services. We used logistic regression to examine the association between food assistance program participation status and food insecurity. Additionally, to examine whether the impact of program participation on food insecurity changed between the baseline survey and one year later at follow-up when schools re-opened, a difference-in-differences analysis was conducted. The results showed no significant associations between adolescent food security and participation in any of the federal nutrition assistance programs. Increased attention on how best to improve adolescent food security in low-income households that can respond to the unique needs of adolescents is clearly warranted.
Collapse
Affiliation(s)
- Kristin Mmari
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Kaitlyn Harper
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Jon Kawatachi
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Marina Jenkins
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Susan Gross
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Stacy Lu
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Rebecca Skinner
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Beth Marshall
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| |
Collapse
|
3
|
Takeuchi S. Homeless Youth, Public Benefits, and Health: A Call for Policy Reform. J Adolesc Health 2024; 75:372. [PMID: 39025588 DOI: 10.1016/j.jadohealth.2024.03.015] [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] [Received: 12/01/2023] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 07/20/2024]
Affiliation(s)
- Sachi Takeuchi
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
4
|
Austin AE, Sokol RL. Emergency Allotments in SNAP and Food Hardship Among Households With Children. JAMA Netw Open 2024; 7:e2428680. [PMID: 39150708 PMCID: PMC11329880 DOI: 10.1001/jamanetworkopen.2024.28680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 06/24/2024] [Indexed: 08/17/2024] Open
Abstract
Importance Households with children and minoritized racial and ethnic groups experience a disproportionate burden of food hardship. During the COVID-19 pandemic, the US federal government implemented emergency allotments in the Supplemental Nutrition Assistance Program (SNAP), increasing the amount of food purchasing assistance received by many participating households. Objective To examine the association of implementing emergency allotments in SNAP with food hardship among households with children overall and for households with Black, Hispanic, and White children by comparing income-eligible households that did and did not participate in SNAP. Design, Setting, and Participants This ecologic cross-sectional study used 2016-2022 National Survey of Children's Health data and a difference-in-differences approach to compare changes in the risk of food hardship from before implementation of emergency allotments in SNAP (2016-2019) to during implementation (2020-2022). Households with children younger than 18 years and incomes 130% or less of the federal poverty level (FPL) in all 50 states and Washington, DC, were included. Exposure Implementation of emergency allotments in SNAP. Main Outcome and Measures The primary outcome was caregiver report of household food hardship during the past 12 months. Results Of 44 753 households with incomes 130% or less of the FPL, a weighted 23.4% had Black children, 56.7% had White children, and 19.9% had children of other races. More than one-third of households (37.8%) had Hispanic children, and 31.8% had young children aged 0 to 5 years. The percentage of households that experienced food hardship decreased from 2016 to 2021 (from 62.9% to 48.2% among SNAP-participating households and from 44.3% to 38.9% among income-eligible nonparticipating households) but increased in 2022 (to 58.0% among SNAP-participating households and to 47.5% among nonparticipating households). Adjusting for confounders, implementing emergency allotments in SNAP was associated with a decreased risk of food hardship among SNAP-participating compared with nonparticipating households (risk ratio [RR], 0.88; 95% CI, 0.81-0.96). Implementing emergency allotments in SNAP was associated with a decreased risk of food hardship among SNAP-participating households with Hispanic (RR, 0.86; 95% CI, 0.72-1.02) and White (RR, 0.85; 95% CI, 0.76-0.94) children compared with nonparticipating households but not among households with Black children (RR, 1.04; 95% CI, 0.87-1.23). Conclusions and Relevance In this ecologic cross-sectional study, implementing emergency allotments in SNAP was associated with a decreased risk of food hardship among households with children. Efforts are needed to ensure that all populations benefit from economic policies.
Collapse
Affiliation(s)
- Anna E. Austin
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Rebeccah L. Sokol
- School of Social Work, University of Michigan, Ann Arbor
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor
| |
Collapse
|
5
|
Parikh RV, Nau CL, Tan TC, Tucher E, Vallejo JD, Jimenez JJ, Horiuchi KM, Allen AR, Stehr P, Alexeeff SE, Han B, Lo JC, Mozaffarian D, Go AS, Grant RW. Rationale and design of the KP ENRICH trial: A food is medicine intervention in low-income high-risk adults with diabetes within Kaiser Permanente. Contemp Clin Trials 2024; 143:107601. [PMID: 38851480 DOI: 10.1016/j.cct.2024.107601] [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: 03/04/2024] [Revised: 05/11/2024] [Accepted: 06/05/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Food insecurity is associated with poor glycemic control and increased risk for diabetes-related complications. The clinical benefit of addressing these challenges through a medically supportive grocery prescription (GRx) program in patients with type 2 diabetes mellitus (T2D) remains unclear. We report the aims and design of a randomized clinical trial to evaluate the effectiveness of a 6-month GRx intervention on hemoglobin A1c (HbA1c) levels among low-income adults with T2D. METHODS The Kaiser Permanente Evaluating Nutritional Interventions in Food-Insecure High-Risk Adults (KP ENRICH) Study is a pragmatic randomized trial enrolling 1100 participants within Kaiser Permanente Northern California and Southern California, two integrated health care delivery systems serving >9 million members. Medicaid-insured adults with T2D and baseline HbA1c ≥7.5% will be randomized at a 1:1 ratio to either GRx, delivered as $100 per month for select items from among a curated list of healthful food groups in an online grocery ordering and home-delivery platform along with biweekly digital nutrition educational materials, or control, consisting of free membership and deliveries from the online grocery platform but without curated food groups or purchasing dollars. The primary outcome is 6-month change in HbA1c. Secondary outcomes include 12-month change in HbA1c, and 6- and 12-month change in medical resource utilization, food security, nutrition security, dietary habits, diabetes-related quality of life, and dietary self-efficacy. CONCLUSIONS The results of this large randomized clinical trial of GRx will help inform future policy and health system-based initiatives to improve food and nutrition security, disease management, and health equity among patients with T2D.
Collapse
Affiliation(s)
- Rishi V Parikh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA; Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Claudia L Nau
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Thida C Tan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Emma Tucher
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Jessica D Vallejo
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Jennifer J Jimenez
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Kate M Horiuchi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Amanda R Allen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Peter Stehr
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Stacey E Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Bing Han
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Joan C Lo
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Dariush Mozaffarian
- Food is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Richard W Grant
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA, USA
| |
Collapse
|
6
|
Goldman BJ, Freiria CN, Landry MJ, Arikawa AY, Wright L. Research trends and gaps concerning food insecurity in college students in the United States: a scoping review. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-40. [PMID: 38870038 DOI: 10.1080/07448481.2024.2351420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/19/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE This scoping review explores the broad body of peer-reviewed research measuring food insecurity in post-secondary students in the U.S. to identify trends and gaps to inform future research. METHODS Three search engines (PubMed, Web of Science, and CINHAL Full Text) were systematically searched for articles reporting on food security status in U.S. college students. RESULTS One-hundred and sixty studies met inclusion criteria. Emerging high-risk student characteristics include gender non-conforming (GNC) and non-binary, financial independence in college, and pregnant and parenting students. Emerging correlates include lack of transportation, anxiety, and eating disorders. CONCLUSIONS Prevalence data can be used by colleges to advocate for services and programs. Additional multi-institutional cohort, longitudinal and qualitative studies are needed to identify timely interventions and effective solutions. A new "rights-based" approach to food security solutions that includes nutrition and food literacy for all students is needed.
Collapse
Affiliation(s)
- Barbara J Goldman
- Department of Health Science, Palm Beach State College, Palm Beach Gardens, FL, USA
| | | | - Matthew J Landry
- Department of Population Health and Disease Prevention, University of California, Irvine, CA, USA
| | - Andrea Y Arikawa
- Department of Nutrition and Dietetics, University of North Florida, Jacksonville, FL, USA
| | - Lauri Wright
- Nutrition Programs, College of Public Health, University of South Florida, Tampa, FL, USA
| |
Collapse
|
7
|
Poole H, Lona A, Barroga TRM, Ghrist M, Mulcahy ER. Understanding the Role of Extension Professionals in Public Health and One Health in Kansas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:747. [PMID: 38928993 PMCID: PMC11203570 DOI: 10.3390/ijerph21060747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/20/2024] [Accepted: 05/25/2024] [Indexed: 06/28/2024]
Abstract
This study aims to understand the roles of selected extension professionals (EPs) in the field of public health and One Health and the challenges involved in performing these duties to their communities in the state of Kansas. To evaluate the role of EPs in public health and One Health, researchers interviewed nine (9) EPs following a set of structured questions. Emerging themes were extrapolated from the responses of the EPs. Researchers assigned codes for qualitative analysis and assigned themes related to public health, One Health, and effective delivery of services. Researchers identified the following themes related to the role of EPs in public health (youth development, physical activity, personal health care, proper nutrition, access to transportation), One Health (food safety and food security, environmental health, disease control and prevention) and effective delivery of services (community engagement, collaboration, challenges in implementation). The study provided an overview of the diverse roles that EPs play in public health and One Health, keys on how to engage the community effectively, and challenges in extending services to the community.
Collapse
Affiliation(s)
- Heather Poole
- Master of Public Health Program, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66502, USA
| | - Antoinette Lona
- Department of Diagnostic Medicine and Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66502, USA
| | - Toni Rose M. Barroga
- Master of Public Health Program, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66502, USA
- Department of Agriculture, Bureau of Animal Industry, Quezon City 1100, Philippines
| | - McKenzie Ghrist
- Master of Public Health Program, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66502, USA
| | - Ellyn R. Mulcahy
- Master of Public Health Program, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66502, USA
- Department of Diagnostic Medicine and Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66502, USA
| |
Collapse
|
8
|
Fielding-Singh P, Fan JX. Dietary Patterns Among US Children: A Cluster Analysis. J Acad Nutr Diet 2024; 124:700-712. [PMID: 38081384 DOI: 10.1016/j.jand.2023.12.001] [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: 09/23/2022] [Revised: 11/13/2023] [Accepted: 12/05/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Most children in the United States consume low-quality diets. Identifying children's dietary patterns and their association with sociodemographic characteristics is important for designing tailored youth dietary interventions. OBJECTIVE This study's objective was to use cluster analysis to investigate children's dietary patterns and these patterns' associations with sociodemographic characteristics. DESIGN Data from two cycles (2015-2016 and 2017-2018) of the National Health and Nutrition Examination Survey were evaluated to examine dietary patterns. PARTICIPANTS AND SETTING Participants included 3,044 US youth aged 2 to 11 years who completed at least 1 valid 24-hour diet recall. MAIN OUTCOME MEASURES The main outcome measures were Healthy Eating Index (HEI) 2015 component and composite scores. STATISTICAL ANALYSES PERFORMED A cluster analysis was performed on standardized scores of 11 components of the HEI-2015 to identify dietary patterns. One logistic analysis combined the two higher-HEI score clusters and the 2 lower-HEI score clusters to form a 3-category variable of higher-, medium-, and lower-HEI score clusters. Another logistic analysis contrasted 2 higher- and then the 2 lower-HEI clusters with each other to examine sociodemographic factors contributing to cluster membership. RESULTS Five clusters were identified, each displaying a distinct dietary pattern. Older, non-Hispanic Black, and overweight children had higher odds of being in the higher-HEI clusters than the medium-HEI cluster. Being older and non-Hispanic Black were linked to higher odds of being in the lower-HEI clusters than the medium-HEI cluster. Conversely, being Mexican American and living with a college-educated reference person were associated with lower odds of being in the lower-HEI clusters compared with the medium-HEI cluster. Among the higher-HEI clusters, Mexican American and Asian American children had higher odds of being in the Pescatarian cluster. Among the lower-HEI clusters, children who were racially or ethnically minoritized had lower odds of being in the Excess Sugar cluster. CONCLUSIONS Children in this study displayed different dietary patterns, with key sociodemographic variation.
Collapse
Affiliation(s)
| | - Jessie X Fan
- Department of Family and Consumer Studies, University of Utah, Salt Lake City, Utah
| |
Collapse
|
9
|
Siddiqi SM, Cantor J, Ghosh Dastidar M, Beckman R, Richardson AS, Baird M, Burns RM, Dubowitz T. Food Insecurity Among Aging SNAP Participants and Eligible Nonparticipants in Two Predominantly Low-Income Black Neighborhoods: Implications for SNAP Enrollment and Outreach for Older Adults. J Acad Nutr Diet 2024; 124:747-756.e3. [PMID: 38184230 DOI: 10.1016/j.jand.2023.12.011] [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: 10/18/2022] [Revised: 11/22/2023] [Accepted: 12/22/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND The Supplemental Nutrition Assistance Program (SNAP) plays a critical role in alleviating poverty and food insecurity. Despite these benefits, many older Americans who are eligible for SNAP do not participate in the program. Few studies have explored household factors and food insecurity outcomes associated with nonparticipation among older Black Americans. OBJECTIVES The study aim was to explore changes in food insecurity and related financial hardship outcomes between 2020 and 2021 among SNAP participants, eligible nonparticipants, and ineligible nonparticipants; compare reasons for not participating in SNAP; and to compare household factors associated with SNAP nonparticipation. METHODS Longitudinal design examining data from 2020 and 2021 to assess changes in food insecurity over the course of the coronavirus disease 2019 pandemic. PARTICIPANTS/SETTING Participants were 528 adults (aged 30 to 97 years) in households randomly selected from a listing of all residential addresses in two predominantly Black neighborhoods with lower incomes in Pittsburgh, PA, and surveyed between March to May 2020 and May to December 2021. MAIN OUTCOME MEASURES Food security was measured using the validated 6-item US Department of Agriculture Adult Food Security Survey Module. STATISTICAL ANALYSES PERFORMED Findings are based on a descriptive analysis of food security and related indicators. Statistical testing was performed to assess differences between SNAP participation status and individual characteristics, food security, and financial hardship using Wald F test for continuous measures and Pearson χ2 test for categorical measures. A multivariable linear model was used to assess the association of SNAP participation and eligibility status with change in food insecurity. RESULTS In cross-sectional analyses of 2021 data, no differences were observed between SNAP participants and eligible nonparticipants for food insecurity, food bank use, mean weekly food spending per person, and difficulty paying for basics. However, with respect to changes in food insecurity over the course of the pandemic, SNAP participants experienced a greater improvement in mean food security scores between 2020 and 2021 (-0.52 reduction in mean food insecurity score or a 16% improvement in food security; P ≤ 0.05) relative to SNAP-eligible nonparticipants. Perceived ineligibility (71.3%) and perceived lack of need (23%) were the most common reasons for not participating in SNAP. CONCLUSIONS More than one-third of SNAP participants and eligible nonparticipants experienced food insecurity and financial hardship. However, there were differences in the changes in food insecurity between these groups.
Collapse
Affiliation(s)
- Sameer M Siddiqi
- Department of Behavioral and Policy Sciences, RAND Corporation, Arlington, Virginia
| | | | | | - Robin Beckman
- Department of Economics, Sociology, and Statistics, RAND Corporation, Santa Monica, California
| | - Andrea S Richardson
- Department of Behavioral and Policy Sciences, RAND Corporation, Pittsburgh, Pennsylvania
| | - Matthew Baird
- Department of Economics, Sociology, and Statistics, Pittsburgh, Pennsylvania
| | - Rachel M Burns
- Department of Economics, Sociology, and Statistics, Pittsburgh, Pennsylvania
| | - Tamara Dubowitz
- Department of Behavioral and Policy Sciences, RAND Corporation, Pittsburgh, Pennsylvania.
| |
Collapse
|
10
|
Acciai F, Uehara S, Ojinnaka C, Yedidia MJ, Ohri-Vachaspati P. The association between unhealthy dietary behaviors and participation in the Supplemental Nutrition Assistance Program (SNAP): No evidence in support of the self-selection hypothesis. Appetite 2024; 197:107302. [PMID: 38462052 PMCID: PMC11045168 DOI: 10.1016/j.appet.2024.107302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 02/21/2024] [Accepted: 03/07/2024] [Indexed: 03/12/2024]
Abstract
Supplemental Nutrition Assistance Program (SNAP) participants tend to have unhealthier dietary consumption compared to eligible non-participants. It has been suggested, though never empirically tested, that individuals who enroll in SNAP may have unhealthy diets prior to program participation. Using a longitudinal cohort study design, we examined the association between low-income adults' SNAP participation status and prior dietary behaviors to test the argument that individuals with unhealthier dietary consumption self-select into SNAP. A sample of households from predominantly lower-income cities were surveyed at baseline (T1) and 2-4 years later (T2). The main analyses were restricted to adults who did not participate in SNAP at T1 and with household income <200% of the federal poverty line (n = 170) at both T1 and T2. Participants were grouped into two categories, based on their SNAP participation at T2; (a) Non-participants (n = 132): no SNAP participation at T1 or T2, and (b) T2 SNAP participants (n = 38): SNAP participation at T2 but not T1. Daily consumption frequency of whole fruits, fruit juice, vegetables, sugar-sweetened beverages (SSBs), and energy dense snacks were measured through self-reports. To observe dietary differences between the two groups prior to SNAP participation, T1 behaviors were compared. There were no significant differences in dietary behaviors at T1 (prior to SNAP participation) between non-participants and T2 participants, providing no evidence of self-selection of individuals with unhealthier dietary consumption into SNAP among our study sample. Improvements in SNAP participants' diets may benefit from focusing on policy changes that encourage healthy dietary habits during participation in the program.
Collapse
Affiliation(s)
- Francesco Acciai
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA.
| | - Sarah Uehara
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Chinedum Ojinnaka
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Michael J Yedidia
- Center for State Health Policy, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | | |
Collapse
|
11
|
Park S, Ortega AN, Chen J, Mortensen K, Bustamante AV. Association of food insecurity with health, access to care, affordability of care, financial burden of care, and financial hardships among US adults during the COVID-19 pandemic. Public Health 2024; 230:183-189. [PMID: 38565064 DOI: 10.1016/j.puhe.2024.02.028] [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: 01/21/2024] [Revised: 02/15/2024] [Accepted: 02/27/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES To examine the associations between food insecurity and health, access to care, affordability of care, financial burden of care, and financial hardships among US adults during the COVID-19 pandemic and examine whether the associations were less pronounced among adults with safety nets. STUDY DESIGN We conducted a retrospective longitudinal cohort study using the 2020-2021 Medical Expenditure Panel Survey. METHODS Linear probability models were used to assess the associations between food insecurity in one year and the outcomes of interest in the following year while adjusting for baseline characteristics. We performed the analyses for the entire population and then conducted stratified analyses for adults with and without Supplemental Nutrition Assistance Program (SNAP) benefits or Medicaid coverage. RESULTS Compared with food-secure adults, food-insecure adults were 9.1 percentage points less likely to report life satisfaction and 9.9, 10.2, and 13.2 percentage points more likely to experience delays in getting medical care, postpone or forgo medical care because of cost, and struggle with paying medical bills. Food-insecure adults were 30.4, 27.2, and 23.5 percentage points more likely to face challenges in affording necessities, paying utility bills, and meeting rent or mortgage payments on time than food-secure adults. Notably, the strengths of these associations were attenuated among adults with SNAP benefits or Medicaid coverage. CONCLUSIONS Food insecurity was associated with poor health, limited access to and affordability of care, and a greater financial burden of care among US adults during the pandemic. Nevertheless, safety net programs can play a critical role in alleviating adverse consequences.
Collapse
Affiliation(s)
- S Park
- Department of Health Policy and Management, College of Health Science, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea; Department of Healthcare Sciences, Graduate School, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea; L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
| | - A N Ortega
- Thompson School of Social Work and Public Health, University of Hawai'i at Manoa, 2430 Campus Rd, Honolulu, HI, 96822, USA.
| | - J Chen
- Department of Health Policy and Management, School of Public Health, University of Maryland, 4200 Valley Dr, College Park, MD, 20742, USA.
| | - K Mortensen
- Department of Health Management and Policy, Hebert Business School, University of Miami, 5250 University Dr, Coral Gables, FL 33146, USA.
| | - A V Bustamante
- Department of Health Policy and Management, Fielding School of Public Health, UCLA, UCLA Latino Policy and Politics Institute, 650 Charles Young Dr. S., Los Angeles, CA, 90095, USA.
| |
Collapse
|
12
|
Almohamad M, Dave JM, Calloway EE, Li R, Sharma S. Relationship between Food Security, Nutrition Security, and Diabetes: The Role of Supplemental Nutrition Assistance Program Participation. Curr Dev Nutr 2024; 8:102153. [PMID: 38693968 PMCID: PMC11061707 DOI: 10.1016/j.cdnut.2024.102153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/24/2024] [Accepted: 03/28/2024] [Indexed: 05/03/2024] Open
Abstract
Background Inadequate nutrition and poor diet quality are associated with a heightened risk of diabetes. The connection between food insecurity measures and diabetes has been established, with evidence indicating that Supplemental Nutrition Assistance Program (SNAP) participation contributes to reductions in food insecurity. Recently developed nutrition security measures, defined as the ability to acquire healthful foods to prevent diseases, and their association with diabetes and SNAP participation are not yet understood. Objectives This study aimed to assess the relationship between food security and nutrition security in relation to diabetes overall and by SNAP participation and nutrition security as potential modifiers. Methods Secondary data analysis of cross-sectional pilot study data collected from adults in 5 US states (N = 517). Logistic regression mixed models included moderation analysis and clustering effects by state to address site-level confounding. Results Higher nutrition security scores among adults, after adjusting for confounders, were significantly associated with lower odds of diabetes risk (adjusted odds ratio = 0.59; 95% confidence interval: 0.40, 0.87; P value = 0.008). Statistically significant interaction effect of differences according to SNAP participation was observed for nutrition security (Phomogeneity/interaction = 0.021), adjusting for age, gender, race/ethnicity, education, employment, National School Lunch Program, Special Supplemental Nutrition Program for Women, Infants, and Children, food pantry use, household with children, survey mode, and food security. The association between food security and diabetes was not statistically significant overall. However, statistically significant interaction effect of differences according to SNAP participation was observed for food security (Phomogeneity/interaction = 0.047). Further, no interaction effect of differences in nutrition security was found between food security and self-reported diabetes/prediabetes (Phomogeneity/interaction = 0.250). Conclusions This study sheds light on the early exploration of the intricate relationship between nutrition security and diabetes. The findings suggest that a higher nutrition security score, after adjusting for confounders, was significantly associated with lower odds of diabetes risk. Notably, there were statistically significant interaction effects in these associations based on SNAP participation.
Collapse
Affiliation(s)
- Maha Almohamad
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, United States
| | - Jayna M Dave
- US Department of Agriculture/ Agricultural Research Service Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Eric E Calloway
- Gretchen Swanson Center for Nutrition, Omaha, NE, United States
| | - Ruosha Li
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, United States
| | - Shreela Sharma
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, United States
| |
Collapse
|
13
|
Kawano B, Grisel B, Wischmeyer P, Holsman M, Agarwal S, Fernandez-Moure J, Haines KL. Racial and ethnic demographics in malnutrition related deaths. Clin Nutr ESPEN 2024; 60:135-138. [PMID: 38479901 DOI: 10.1016/j.clnesp.2024.01.018] [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: 05/05/2023] [Revised: 01/11/2024] [Accepted: 01/18/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND AND AIMS Currently, 40 million Americans are food insecure. They are forced to skip meals and buy non-nutritious food, leading to health disparities for those of low socioeconomic status. This study aims to investigate relationships between malnutrition deaths and sociodemographic groups. METHODS This cross-sectional study from 2009 to 2018 used aggregate data from the CDC Wide-ranging Online Data for Epidemiologic Research (CDC Wonder). Patients with known race, gender, and Hispanic origin age ≥18 who died from malnutrition (E40-E46) were included. Place of death was grouped into home, inpatient medical facility, hospice facility, nursing facility/long-term care, other (including outpatient, ED, and DOA), and unknown. Crude rates of malnutrition deaths per 100,000 persons for race, gender, and Hispanic origin were calculated using US census estimates. Gross proportions of total deaths were calculated for each place of death. RESULTS Between 2009 and 2018, there were 46,517 malnutrition deaths in the US. Death rates for Black (1.8) and White Americans (2) were twice as high compared to Native Americans (1.1) and Asians or Pacific Islanders (0.7). Death rates among females (2.3) were higher than males (1.5). Death rates among non-Hispanics (2.1) were twice as high compared to Hispanics (0.7). Most people who died of malnutrition died in hospitals (37 %). CONCLUSION Malnutrition deaths occur at greater rates among White, Black, non-Hispanic Americans, and females. Despite reported disparities in food access, Black and White Americans have similar malnutrition mortality rates, raising concerns that malnutrition is under-diagnosed among Black patients. Given the existing nutrition literature, this finding requires further investigation.
Collapse
Affiliation(s)
- Bradley Kawano
- Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Braylee Grisel
- Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Paul Wischmeyer
- Division of Critical Care Surgery, Department of Anesthesia, Duke University Medical Center, Durham, NC, USA.
| | - Maximilian Holsman
- Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Suresh Agarwal
- Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Joseph Fernandez-Moure
- Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Krista L Haines
- Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
| |
Collapse
|
14
|
Castro LF, Adu Y, Castro M, Palacios C, Sheikh M, Barrios Y, Bennett K, Prabhu F. Investigating level of food security among patients with hypertension and diabetes at a student-run free clinic. Proc AMIA Symp 2024; 37:598-601. [PMID: 38910821 PMCID: PMC11188835 DOI: 10.1080/08998280.2024.2333231] [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: 10/19/2023] [Accepted: 03/05/2024] [Indexed: 06/25/2024] Open
Abstract
Background Nutritional recommendations for patients with type 2 diabetes mellitus (T2DM) and hypertension assume high food security. However, food insecurity is estimated to affect 10% of the US population and more so patients at our student-run free clinic (SRFC). The aims of the study were to (1) assess food security in patients with a diagnosis of T2DM, hypertension, or both and (2) examine the relationship between food security and glycated hemoglobin (HbA1C) or blood pressure at an SRFC. Methods Eligible participants completed a 10-item food security questionnaire and an item addressing perceived barriers. Most recent HbA1C and blood pressure measurements were gathered. Comparisons were made using univariate or multivariate linear regression analysis. Results Results from 79 participants showed that 25.3% experienced high food security, 29.1% had marginal food security, 13.9% had low food security, and 30.4% had very low food security. No statistically significant association was found between food security category and HbA1C or blood pressure. However, we did find that approximately 73% of patients experienced some degree of food insecurity. Conclusions Patients at our SRFC are ethnically and racially diverse, most have a high school education or less, and most have food insecurity. No association between food security category and HbA1C or blood pressure control was found. Providers should consider the degree of food insecurity and incorporate a culturally sensitive approach when making nutritional recommendations.
Collapse
Affiliation(s)
- Luis F. Castro
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Yaw Adu
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Maribel Castro
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Clarissa Palacios
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Muneeza Sheikh
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Yesenia Barrios
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Kelly Bennett
- Department of Family and Community Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Fiona Prabhu
- Department of Family and Community Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| |
Collapse
|
15
|
Odoms-Young A, Brown AGM, Agurs-Collins T, Glanz K. Food Insecurity, Neighborhood Food Environment, and Health Disparities: State of the Science, Research Gaps and Opportunities. Am J Clin Nutr 2024; 119:850-861. [PMID: 38160801 PMCID: PMC10972712 DOI: 10.1016/j.ajcnut.2023.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024] Open
Abstract
Food insecurity and the lack of access to affordable, nutritious food are associated with poor dietary quality and an increased risk of diet-related diseases, including cardiovascular disease, diabetes, and certain types of cancer. Those of lower socioeconomic status and racial and ethnic minority groups experience higher rates of food insecurity, are more likely to live in under-resourced food environments, and continue to bear the greatest burden of diet-related chronic diseases in the United States. Despite the growing body of literature in this area, there are still significant gaps in our understanding of the various pathways that link food insecurity and neighborhood food environments to racial/ethnic and socioeconomic disparities in health and the most effective intervention strategies to address these disparities. To better understand the science in this area, the National Institutes of Health, in collaboration with the Centers for Disease Control (CDC) and Prevention and the United States Department of Agriculture (USDA), convened a virtual 3-d workshop 21-23 September 2021: Food Insecurity, Neighborhood Food Environment, and Nutrition Health Disparities: State of the Science. The workshop brought together a diverse group of researchers, practitioners, policymakers, and federal partners with expertise in nutrition, the food environment, health and social policy, and behavioral and social sciences. The workshop had the following 3 research objectives: 1) summarize the state of the science and knowledge gaps related to food insecurity, neighborhood food environments, and nutrition health disparities, 2) identify research opportunities and strategies to address research gaps, and 3) examine evidence-based interventions and implementation approaches to address food insecurity and neighborhood food environments to promote health equity. This article summarizes workshop proceedings and describes research gaps and future opportunities that emerged from discussions.
Collapse
Affiliation(s)
- Angela Odoms-Young
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY, United States
| | - Alison G M Brown
- National Heart Lung and Blood Institute, Division of Cardiovascular Sciences, Bethesda, MD, United States.
| | - Tanya Agurs-Collins
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States
| | - Karen Glanz
- Perelman School of Medicine and School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| |
Collapse
|
16
|
Sokol RL, Austin AE. State expansion of Supplemental Nutrition Assistance Program eligibility and rates of firearm-involved deaths in the United States. Inj Prev 2024:ip-2023-045035. [PMID: 38365447 DOI: 10.1136/ip-2023-045035] [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: 07/06/2023] [Accepted: 02/02/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Poverty is a consistent correlate of firearm-involved mortality, yet little work has considered the effects of social and economic policies on these deaths. This study examined associations of state elimination of the asset test and increases in the income limit for Supplemental Nutrition Assistance Program (SNAP) eligibility with rates of firearm-involved suicide and homicide deaths in the United States. METHODS This ecological repeated cross-sectional study used 2015-2019 data from the SNAP Policy Database and death certificate data from the National Vital Statistics System. The exposures were (1) state elimination of the asset test for SNAP eligibility and (2) state elimination of the asset test and increases in the income limit for SNAP eligibility, compared with (3) state adoption of neither policy. The outcomes were firearm-involved suicide deaths and firearm-involved homicide deaths. The research team conducted mixed-effects regressions to estimate associations. RESULTS State elimination of the asset test for SNAP eligibility (incidence rate ratio (IRR), 0.67; 95% CI, 0.48 to 0.91) and state adoption of both eliminating the asset test and increasing the income limit for SNAP eligibility (IRR, 0.68; 95% CI, 0.49 to 0.92) were associated with decreased rates of firearm-involved suicide deaths compared with state adoption of neither policy. There were no associations with state firearm-involved homicide rates. CONCLUSIONS SNAP is an important social safety net programme that addresses food insecurity, and the present results suggest it may also contribute to reducing firearm-involved suicide.
Collapse
Affiliation(s)
- Rebeccah Lyn Sokol
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, Michigan, USA
| | - Anna E Austin
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
17
|
Bahanan L, Singhal A, Zhao Y, Scott T, Kaye E. The association between the supplemental nutrition assistance programme participation and dental caries among U.S. adults. Int J Dent Hyg 2024; 22:251-257. [PMID: 34758187 DOI: 10.1111/idh.12562] [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: 06/29/2021] [Revised: 10/04/2021] [Accepted: 11/07/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The Supplemental Nutrition Assistance Programme (SNAP) is a federal programme aimed to alleviate hunger and improve food insecurity. The impact of SNAP participation on overall health has been studied. However, little is known about the effects of SNAP participation on oral health. We aimed to investigate the association between participating in SNAP and dental caries and to explore the role of food insecurity as a moderator in this relationship. METHODS We obtained data from the National Health and Nutrition Examination Survey (NHANES) cycles 2011-2012 and 2013-2014.The primary outcome was untreated dental caries (none vs. one or more). Self-reported SNAP participation status in the past 12 months was the predictor, and food security was the moderator. Food security was measured as overall food security status (full food secure/ food insecure) and household-level food security (full, marginal, low and very low). Bivariate and multiple logistic regression analyses were conducted to evaluate the relationship between SNAP and dental caries, and whether food insecurity moderates this relationship. Statistical analysis was carried out in September 2020. RESULTS Our results suggested that after adjusting for potential confounders, SNAP participants were more likely to have untreated dental caries than non-SNAP participants (odds ratio: 1.6; 95% CI: 1.2-2.0). Food security status did not alter the relationship between SNAP participation and untreated dental caries. CONCLUSIONS Food security status did not alter the relationship between SNAP participation and untreated dental caries. SNAP participation was associated with untreated dental caries among U.S. adults, and this was not affected by their food security status.
Collapse
Affiliation(s)
- Lina Bahanan
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Astha Singhal
- Department of Health Policy & Health Services Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts, USA
| | - Yihong Zhao
- Center of Alcohol and Substance Use Studies, Department of Applied Psychology, Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Thayer Scott
- Department of Health Policy & Health Services Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts, USA
| | - Elizabeth Kaye
- Department of Health Policy & Health Services Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts, USA
| |
Collapse
|
18
|
Curd J, Hong M. Exploring the Lived Experiences of Rural Hospice Social Workers in Navigating "Cracked" Systems. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2024; 20:26-47. [PMID: 37750970 DOI: 10.1080/15524256.2023.2262154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Social workers often encounter health and resource disparities and caregiver challenges in support of hospice patients and families. Social workers also play a critical role in navigating systems and confronting systemic barriers. Their input regarding macro practice is invaluable, though there is not much literature pertaining to end-of-life disparities as experienced from the social worker point of view. There is also limited research from the hospice social worker perspective, with little pertaining to those providing care in rural areas. To address these gaps, this phenomenological study explored the lived experiences of rural hospice social workers to better understand their role in these matters. Data collection occurred through in-depth unstructured qualitative interviews. A total of 19 rural hospice workers participated in the study. There were four main themes identified: systemic issues in hospice settings, resource and geographic barriers, tensions and benefits of interprofessional collaboration, and hospice work environment. Based on these findings, recommendations for hospice social work practice, research, and policy include support of and elevation of the voice of hospice social workers on the interprofessional team, assessment of resource barriers to improve hospice social work interventions and improve quality of life for dying persons, education of hospice administrators to understand best ways to support hospice social, and implementation of policy change to expedite access to caregiver resources at end of life.
Collapse
Affiliation(s)
- Jessica Curd
- Social Work, Indiana University Indianapolis, Indiana, USA
| | - Michin Hong
- Social Work, Indiana University Indianapolis, Indiana, USA
| |
Collapse
|
19
|
Sanjeevi N, Monsivais P. Association of emergency allotment discontinuation with household food insufficiency in Supplemental Nutrition Assistance Program participants: A quasi-experimental study. Prev Med 2023; 177:107784. [PMID: 38007199 DOI: 10.1016/j.ypmed.2023.107784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/27/2023] [Accepted: 11/14/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVE The Supplemental Nutrition Assistance Program (SNAP) was modified to mitigate food insecurity faced by low-income families during the pandemic. These changes included enhancement of SNAP benefits via 2020 emergency allotments (EA). Despite the high food price inflation in 2022, 17 states ceased providing EA benefits by end of 2022. The objective of this research is to examine the impact of EA discontinuation on food insufficiency. METHODS Using Household Pulse Survey data from December 2021-January 2023, SNAP participants (n = 57,556) from states that discontinued EA at some point during the study period and those from states that did not discontinue EA were included. The main analyses examined the impact of EA discontinuation on food insufficiency via staggered difference-in-difference models using two-way fixed effects (TWFE) regression. Additional analyses examined this association using Callaway-Sant'Anna approach for difference-in-difference analyses. RESULTS Using TWFE, EA discontinuation was significantly associated with increased food insufficiency in the overall sample, as well as in individuals who were non-Hispanic White and Hispanic, and who had annual family incomes of less than $25,000. Investigation of time-varying association of EA termination with food insufficiency suggested that EA discontinuation was significantly associated with greater food insufficiency in the second week following rollback. DiD analyses using Callaway-Sant'Anna approach suggested that states' rollback of EA was significantly associated with higher food insufficiency in non-Hispanic White individuals. CONCLUSION Findings imply that EA discontinuation, amidst the corresponding surge in inflation, could have contributed to increased rates of household food insufficiency.
Collapse
Affiliation(s)
- Namrata Sanjeevi
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington.
| | - Pablo Monsivais
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| |
Collapse
|
20
|
DiFiore G, Wood S, Jenssen BP, Fiks AG, Mayne SL. Cumulative Health Vulnerabilities Among Adolescents by Age and Neighborhood Opportunity. Pediatrics 2023; 152:e2023062657. [PMID: 37974515 PMCID: PMC10774653 DOI: 10.1542/peds.2023-062657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Early detection of health vulnerabilities in adolescents is integral to promoting healthy behaviors into adulthood. Our objective was to quantify the prevalence of health vulnerabilities among adolescents and examine differences by age and neighborhood opportunity. METHODS In a cross-sectional analysis of electronic health record data for adolescents aged 13 to 18 years with preventive visits in a large pediatric primary care network between September 2021 and September 2022, we examined 5 health vulnerabilities: Tobacco use, substance use, firearm access, condomless intercourse, and depressive symptoms. Health vulnerabilities were assessed via self-reported adolescent health questionnaire and the validated Patient Health Questionnaire-Modified. Prevalence of health vulnerabilities were calculated alone and in combination, and compared by age and by quintile of neighborhood Child Opportunity Index (COI) score. Multivariable logistic regression estimated associations of neighborhood COI with reporting ≥2 health vulnerabilities. RESULTS Among 40 197 adolescents (57.7% aged 13-15 years, 66.3% living in "high"/"very high" COI neighborhoods), 29.7% reported at least 1 health vulnerability and 7.9% reported ≥2 vulnerabilities. Cumulative health vulnerabilities were more prevalent among older adolescents and adolescents from lower opportunity neighborhoods. In adjusted models, lower COI was associated with 65% higher odds of having ≥2 vulnerabilities (odds ratio 1.65, 95% confidence interval 1.43-1.91) compared with adolescents from the highest COI quintile. CONCLUSIONS Understanding the relationship between health vulnerabilities and neighborhood opportunities among adolescents may allow pediatric primary care providers and health systems to offer more tailored community support services and transdiagnostic specialized care navigation to address the health needs of teens with multiple vulnerabilities.
Collapse
Affiliation(s)
| | - Sarah Wood
- Clinical Futures and PolicyLab
- The Craig Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Department of Pediatrics, Perelman School of Medicine
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian P. Jenssen
- Clinical Futures and PolicyLab
- The Department of Pediatrics, Perelman School of Medicine
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander G. Fiks
- Clinical Futures and PolicyLab
- The Craig Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Department of Pediatrics, Perelman School of Medicine
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephanie L. Mayne
- Clinical Futures and PolicyLab
- The Department of Pediatrics, Perelman School of Medicine
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
21
|
Patterson EJ, Johnson LT. Structural Inequality and COVID-19 Mortality in Chicago: An Ecological Analysis. J Racial Ethn Health Disparities 2023; 10:2620-2629. [PMID: 36348182 PMCID: PMC9643901 DOI: 10.1007/s40615-022-01440-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Prior studies establish that Black neighborhoods and older persons experience higher rates of COVID-19 death than white neighborhoods and younger persons. However, such works point to the effect of age on COVID-19 mortality and the racial and ethnic inequalities present in COVID-19 deaths as independent vectors of inequality, neglecting to consider the multiplicative impact of structural conditions. METHODS Using weekly ZIP code counts of deaths from March 2020 through July 2021 from the Chicago Department of Public Health (n = 4168) and measures of structural characteristics derived from the 5-year estimates of the 2019 American Community Survey, the current study examined how place, racial composition, and the age structure of communities act in tandem to shape the number of deaths due to COVID-19. We used STATA to estimate negative binomial models predictive of COVID-19 mortality. RESULTS Findings from our statistical analysis revealed that in predominately Black neighborhoods, racial composition amplified the association of age structure (65 +) on COVID-19 mortality by 40%. Neighborhoods that were not predominately black did not show this multiplicative risk of death. Our findings underscore that the elevated risk of death in in older Black communities is attributed to historic and contemporary structural inequality. CONCLUSIONS Although society typically frames pandemics as natural disasters, doing such undermines dimensions of marginalization that amplify vulnerability among select populations. To begin eliminating such inequalities, the USA must deal with the entrenched limitations of institutions that render unequal attention and care to sectors of its population.
Collapse
|
22
|
Babb AM, Suttles SA, Daellenbach I, DuPilka JH, Knudsen DC. Adequacy of SNAP Benefits for Indiana Households, 2022. Am J Public Health 2023; 113:S224-S226. [PMID: 38118080 PMCID: PMC10733888 DOI: 10.2105/ajph.2023.307408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2023] [Indexed: 12/22/2023]
Abstract
We investigated the adequacy of Supplemental Nutrition Assistance Program (SNAP) benefits for Indiana households. Methods included focus groups, interviews, and a statewide survey of 652 households. SNAP benefit-level increases over the course of the COVID-19 pandemic increased their adequacy overall yet were still inadequate for some households. As of June 2022, Indiana households reported their SNAP benefits lasting 13 days a month. The inadequacy of SNAP benefits reveals that some participating households still experience food insecurity, which has adverse public health implications. (Am J Public Health. 2023;113(S3):S224-S226. https://doi.org/10.2105/AJPH.2023.307408).
Collapse
Affiliation(s)
- Angela M Babb
- Angela M. Babb is with the Ostrom Workshop, Indiana University, Bloomington. Shellye A. Suttles and Jenna H. DuPilka are with the O'Neill School of Public and Environmental Affairs, Indiana University. Isabelle Daellenbach is with the Maurer School of Law, Indiana University. Daniel C. Knudsen is professor emeritus, Department of Geography, Indiana University
| | - Shellye A Suttles
- Angela M. Babb is with the Ostrom Workshop, Indiana University, Bloomington. Shellye A. Suttles and Jenna H. DuPilka are with the O'Neill School of Public and Environmental Affairs, Indiana University. Isabelle Daellenbach is with the Maurer School of Law, Indiana University. Daniel C. Knudsen is professor emeritus, Department of Geography, Indiana University
| | - Isabelle Daellenbach
- Angela M. Babb is with the Ostrom Workshop, Indiana University, Bloomington. Shellye A. Suttles and Jenna H. DuPilka are with the O'Neill School of Public and Environmental Affairs, Indiana University. Isabelle Daellenbach is with the Maurer School of Law, Indiana University. Daniel C. Knudsen is professor emeritus, Department of Geography, Indiana University
| | - Jenna H DuPilka
- Angela M. Babb is with the Ostrom Workshop, Indiana University, Bloomington. Shellye A. Suttles and Jenna H. DuPilka are with the O'Neill School of Public and Environmental Affairs, Indiana University. Isabelle Daellenbach is with the Maurer School of Law, Indiana University. Daniel C. Knudsen is professor emeritus, Department of Geography, Indiana University
| | - Daniel C Knudsen
- Angela M. Babb is with the Ostrom Workshop, Indiana University, Bloomington. Shellye A. Suttles and Jenna H. DuPilka are with the O'Neill School of Public and Environmental Affairs, Indiana University. Isabelle Daellenbach is with the Maurer School of Law, Indiana University. Daniel C. Knudsen is professor emeritus, Department of Geography, Indiana University
| |
Collapse
|
23
|
Bangham C, Zack RM, Nelson E, Liu X, Codner A, Hicks JM, Greece JA. Assessing the effect of adverse economic events on severity of hunger among food pantry clients. Front Public Health 2023; 11:1286094. [PMID: 38026276 PMCID: PMC10644360 DOI: 10.3389/fpubh.2023.1286094] [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: 08/30/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
This study assessed relationship between adverse economic events (AEE) and hunger level (i.e., little to no, moderate, severe). A cross-sectional survey was conducted from June to August 2018 in 10 food pantries with 616 food pantry users. Hunger level was assessed by the Household Hunger Scale. AEE were evaluated over the past 3 months. Participants (60.55%) experienced unexpected or increased medical expenses (17.69%), job loss (13.64%), pay reduction (11.85%), and death of a family member (9.09%). Pay reduction (OR = 1.87, 95% CI: 1.12, 3.14) and increased debt (OR = 2.71, 95% CI: 1.92, 3.84) were associated with moderate hunger; death of a family member (OR = 2.43, 95% CI: 1.21, 4.90), pay reduction (OR = 2.95, 95% CI: 1.24, 7.04), and increased debt (OR = 3.46, 95% CI: 1.98, 6.04) were associated with severe hunger. Awareness of AEE can inform public health programs and policies for people in need of additional resources, which is essential in times of increased economic instability.
Collapse
Affiliation(s)
- Candice Bangham
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Rachel M. Zack
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Eva Nelson
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Xinyang Liu
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Alyson Codner
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Jacqueline Milton Hicks
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States
| | - Jacey A. Greece
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| |
Collapse
|
24
|
Vu M, Trinh D, Kandula NR, Pham NHT, Makelarski J, Seligman HK. Low-Income Asian Americans: High Levels Of Food Insecurity And Low Participation In The CalFresh Nutrition Program. Health Aff (Millwood) 2023; 42:1420-1430. [PMID: 37729587 PMCID: PMC11184507 DOI: 10.1377/hlthaff.2023.00116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Little is known about food insecurity and the extent of Supplemental Nutrition Assistance Program (SNAP) participation in the heterogeneous Asian American population. Using California Health Interview Survey data from the period 2011-20, we examined both issues among low-income Asian American adults from six origin groups: Chinese, Filipino, Japanese, Korean, South Asian, and Vietnamese. We found high and varied levels of overall food insecurity, with the highest burden among Filipino adults (40 percent). Food insecurity by severity was also heterogenous; very low food security affected 2 percent of Chinese adults but 9 percent and 10 percent of Filipino and Japanese adults, respectively. Participation in CalFresh (California-implemented SNAP) ranged from 11 percent and 12 percent among Korean and Chinese adults, respectively, to 20 percent among Vietnamese adults. Compared with English-proficient low-income Asian American adults, those with limited English proficiency were no less likely to participate in CalFresh, possibly reflecting language assistance required by California law and provided by community-based organizations. These results underscore the importance of collecting and reporting disaggregated data by Asian origin group that could inform targeted outreach and interventions.
Collapse
Affiliation(s)
- Milkie Vu
- Milkie Vu , Northwestern University, Chicago, Illinois
| | - Duy Trinh
- Duy Trinh, Princeton University, Princeton, New Jersey
| | | | - Nhat-Ha Tran Pham
- Nhat-Ha Tran Pham, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Hilary K Seligman
- Hilary K. Seligman, University of California San Francisco, San Francisco, California
| |
Collapse
|
25
|
Johnson S, Fischer L, Gupta S, Lazerov J, Singletary J, Essel K. "I Felt Like I Had Something I Could Do About It": Pediatric Clinician Experiences With a Food Insecurity-Focused Produce Prescription Program. Clin Pediatr (Phila) 2023; 62:1018-1026. [PMID: 36691293 DOI: 10.1177/00099228221150604] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Efforts to address food insecurity (FI) in pediatric clinics have increased over the last decade, particularly after a groundbreaking 2015 American Academy of Pediatrics policy statement supporting universal routine screening and intervening. Produce prescription programs are a novel strategy addressing FI. Limited data exist on effectiveness and feasibility in pediatric clinical settings. This study explored clinician experiences after enrolling patients who completed a produce prescription program in an urban primary-care clinic in Washington, DC. One year after program completion, the experiences of 11 clinicians were explored through qualitative interviews and coded using thematic content analysis. Identified themes explored changes in clinician knowledge, attitudes, and behaviors. Clinicians expressed that the program offered a tangible resource to address FI, building trust and strengthening their sense of self-efficacy in addressing families' concerns. Incorporation of a produce prescription intervention to address FI was feasible and well accepted by pediatric primary-care clinicians.
Collapse
Affiliation(s)
- Sheryl Johnson
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Laura Fischer
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Children's National Hospital, Washington, DC, USA
| | - Simran Gupta
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Jessica Lazerov
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Children's National Hospital, Washington, DC, USA
| | | | - Kofi Essel
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Children's National Hospital, Washington, DC, USA
| |
Collapse
|
26
|
Levi R, Bleich SN, Seligman HK. Food Insecurity and Diabetes: Overview of Intersections and Potential Dual Solutions. Diabetes Care 2023; 46:1599-1608. [PMID: 37354336 PMCID: PMC10465985 DOI: 10.2337/dci23-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/24/2023] [Indexed: 06/26/2023]
Abstract
Food insecurity increases the risk of developing diabetes and its complications. In this article, we describe the complex relationship that exists between food insecurity and diabetes and describe potential mechanisms that may underlie this association. We then describe how two different types of interventions, food-is-medicine and federal nutrition assistance programs, may help address both food insecurity and health. Finally, we outline the research, policy, and practice opportunities that exist to address food insecurity and reduce diabetes-related health disparities.
Collapse
Affiliation(s)
- Ronli Levi
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA
| | - Sara N. Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Hilary K. Seligman
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA
| |
Collapse
|
27
|
Pomeranz JL. Policy Opportunities and Legal Considerations to Reform SNAP-Authorized Food Retail Environments. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:614-621. [PMID: 36943396 DOI: 10.1097/phh.0000000000001730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
CONTEXT There is an invigorated national interest in nutrition security, with emphasis on the Supplemental Nutrition Assistance Program (SNAP) playing a key role. OBJECTIVE To support healthy food purchasing, several strategies have emerged to modify the food retail environment. However, the legal feasibility of several such policy options has not been established. DESIGN Research was conducted using Lexis+ to evaluate statutes, regulations, and case law to determine the legal feasibility of requiring retail-based SNAP signage and nutrition disclosures, healthy endcaps and checkout aisles, and tying advertising restrictions to the licensing of SNAP retailers. SETTING US in-store and online food retail retailers. MAIN OUTCOME MEASURE Legal feasibility. RESULTS Requiring retailers that designate certain foods or locations as SNAP-eligible to consistently do so in all SNAP-eligible pages/locations is likely feasible. If properly drafted to focus on the nutritional quality of food, healthy checkout and endcap restrictions are legally feasible. It is of unclear legal feasibility to require retailers (especially in-store) to disclose nutrition-related labeling, shelf tags, or nonfactual symbols indicating the relative healthfulness of products. Restricting or banning advertising is not legally feasible even if the government ties the restrictions to retail licensing requirements. CONCLUSIONS Entities seeking to support healthy food retail should not seek to restrict advertising or compel retailers to convey messages against their interests. The government can license retailers and require them to abide by laws and other requirements that do not violate their constitutional rights. The government can also use its own speech through public service announcements, billboards, and transit advertising to encourage healthy food consumption for all shoppers including those who use SNAP. Additional research is warranted into online retail practices to evaluate variations in online checkout pages and to determine whether online retailers treat SNAP participants differently from non-SNAP participants.
Collapse
Affiliation(s)
- Jennifer L Pomeranz
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
| |
Collapse
|
28
|
Li J, Zuo D, Heflin CM. Adoption Of Standard Medical Deduction Increased SNAP Enrollment And Benefits In 21 Participating States. Health Aff (Millwood) 2023; 42:1173-1181. [PMID: 37549333 PMCID: PMC10500947 DOI: 10.1377/hlthaff.2022.01575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
The Supplemental Nutrition Assistance Program (SNAP) reduces food insecurity but is underused among many households. To increase SNAP participation, twenty-one states have adopted the standard medical deduction (SMD), which simplifies administrative requirements for eligible households (those with older adults or people with disabilities). However, to offset the costs of the SMD, states have reduced SNAP benefits elsewhere, raising concerns of negative spillover effects. Using national data from the period 2004-19 and a fixed-effects estimator, we found that the SMD was associated with increased SNAP participation among SMD-eligible households, in terms of aggregate household counts (20 percent) and as a share of households receiving SNAP (5 percentage points). Moreover, estimated annual SNAP benefits per state increased for SMD-eligible households but decreased (although not statistically significantly) for ineligible households. Offsetting SNAP costs may have benefited households with older adults and households with people with disabilities at the expense of others.
Collapse
Affiliation(s)
- Jun Li
- Jun Li , Syracuse University, Syracuse, New York
| | | | | |
Collapse
|
29
|
Yamanis T, Gomez CM, Landis M, Donnelly C, Morrissey T, Gan J, Rosen JG, Smith OW, Page K, Zea MC. Pandemic-Era Policies That Can Help End the HIV Epidemic for Latinas/os/xs. AIDS Patient Care STDS 2023; 37:374-378. [PMID: 37498198 PMCID: PMC10457647 DOI: 10.1089/apc.2023.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Affiliation(s)
- Thespina Yamanis
- American University, School of International Service, Washington, District of Columbia, USA
| | - Cristian Mendoza Gomez
- American University, College of Arts and Sciences, Washington, District of Columbia, USA
| | - Miriam Landis
- American University, College of Arts and Sciences, Washington, District of Columbia, USA
| | - Corey Donnelly
- American University, School of International Service, Washington, District of Columbia, USA
| | - Taryn Morrissey
- American University, School of Public Affairs, Washington, District of Columbia, USA
| | - Jody Gan
- American University, College of Arts and Sciences, Washington, District of Columbia, USA
| | - Joseph Gregory Rosen
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, USA
| | | | - Kathleen Page
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maria Cecilia Zea
- The George Washington University, Department of Psychology, Washington, District of Columbia, USA
| |
Collapse
|
30
|
Mann M, Harary D, Louis S, Wang T, Bonuck K, Isasi CR, Charron MJ, Fuloria M. Association of parent-child interactions with parental psychological distress and resilience during the COVID-19 pandemic. Front Pediatr 2023; 11:1150216. [PMID: 37425276 PMCID: PMC10326543 DOI: 10.3389/fped.2023.1150216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/09/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction The effects of psychological distress/resilience on parent-child engagement (e.g., family dinners, reading) during the COVID-19 pandemic have not been well studied. Among very young children from underrepresented backgrounds enrolled in the ongoing longitudinal Bronx Mother Baby Health Study of healthy term infants, we (1) examined associations between exposures to COVID-19-related events, demographic factors and parental psychological distress and resilience; and (2) correlated these factors with parent-child engagement activities. Methods Between June 2020-August 2021, parents of 105 Bronx Mother Baby Health Study participants aged birth-25 months completed questionnaires related to exposures to COVID-19-related events, frequency of positive parent-child engagement activities, food and housing insecurity, and parental psychological distress and resilience. Families were also asked open ended questions about the pandemic's impact. Results 29.8% and 47.6% of parents reported food and housing insecurity, respectively. Greater exposures to COVID-19-related events were associated with increased parental psychological distress. Positive parent-child interactions were associated with demographic factors and higher levels of maternal education, but not with exposures to COVID-19-related events. Discussion This study adds to a growing body of literature on the negative impacts of COVID-19 exposures and psychosocial stressors on families during the pandemic, supporting the need for enhanced mental health resources and social supports for families.
Collapse
Affiliation(s)
- Mana Mann
- Department of Pediatrics, Flushing Hospital Medical Center, Queens, NY, United States
| | - David Harary
- Department of Pediatrics, Division of Neonatology, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Shirley Louis
- Department of Pediatrics, Division of Neonatology, Children’s Hospital of Michigan, Detroit, MI, United States
| | - Tao Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Karen Bonuck
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Carmen R. Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Pediatrics, Division of Adolescent Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Maureen J. Charron
- Department of Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Biochemistry, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Medicine, Division of Endocrinology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Mamta Fuloria
- Department of Pediatrics, Division of Neonatology, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, United States
| |
Collapse
|
31
|
Goode RW, Godoy SM, Olson K, Berg S, Agbozo B, Gwira R, Xu Y, Wolfe H, Bhutani J, Alexander R. "If I start panicking over having enough, then I start eating too much": Understanding the eating behaviors of SNAP recipients in larger bodies during COVID-19. Eat Behav 2023; 49:101741. [PMID: 37229948 DOI: 10.1016/j.eatbeh.2023.101741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND/OBJECTIVE Living in a food-insecure household may increase the risk for disordered eating. Though the Supplemental Nutrition Assistance Program (SNAP) was designed to reduce food insecurity, it may increase risk for disordered eating with the frequency in which benefits are distributed. Limited research has explored the lived experiences of managing eating behaviors while on SNAP, particularly among SNAP participants in larger bodies, and during COVID-19. Thus, the purpose of this study is to examine the experiences with eating behaviors among adults with a BMI ≥ 25 kg/m2, and who received SNAP benefits during the COVID-19 pandemic. METHODS Eligible adults were recruited to participate in a semi-structured interview. Interviews were transcribed verbatim and analyzed using thematic analysis and content analysis. RESULTS Participants (N = 16), had a mean (±SD) age of 43.4 ± 10.9 years, and overwhelmingly identified as female (86 %). One-third of the participants were Black. We identified 4 main themes: (1) not having enough money/benefits to cover needs; (2) navigating loss of control and emotional eating; (3) making sure the kids are alright; and (4) still feeling the pressure to manage weight. CONCLUSION Managing eating behaviors while also navigating SNAP benefits is complex and may exacerbate risk of disordered eating.
Collapse
Affiliation(s)
- Rachel W Goode
- School of Social Work, University of North Carolina at Chapel Hill, Tate Turner Kuralt Building, 325 Pittsboro St CB #3550, Chapel Hill, NC 27599-3550, United States of America; University of North Carolina at Chapel Hill Nutrition Research Institute, 500 Laureate Wy., Kannapolis, NC 28081, United States of America; Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sarah M Godoy
- School of Social Work, University of North Carolina at Chapel Hill, Tate Turner Kuralt Building, 325 Pittsboro St CB #3550, Chapel Hill, NC 27599-3550, United States of America
| | - Katie Olson
- School of Social Work, University of North Carolina at Chapel Hill, Tate Turner Kuralt Building, 325 Pittsboro St CB #3550, Chapel Hill, NC 27599-3550, United States of America
| | - Sophia Berg
- Department of Psychology and Neuroscience, University of North Carolina Chapel Hill, Campus Box #3270 235 E. Cameron Avenue, Chapel Hill, NC 27599-3270, United States of America
| | - Bridgette Agbozo
- School of Social Work, University of North Carolina at Chapel Hill, Tate Turner Kuralt Building, 325 Pittsboro St CB #3550, Chapel Hill, NC 27599-3550, United States of America
| | - Rebecca Gwira
- Georgia State University Department of Counseling and Psychological Services, College of Education & Human Development, Suite 950 30 Pryor St. SW, Atlanta, GA 30303, United States of America
| | - Yiwen Xu
- Statistics & Operations Research University of North Carolina at Chapel Hill, 318 Hanes Hall, CB #3260, Chapel Hill, NC 27599-3260, United States of America
| | - Hannah Wolfe
- School of Social Work, University of North Carolina at Chapel Hill, Tate Turner Kuralt Building, 325 Pittsboro St CB #3550, Chapel Hill, NC 27599-3550, United States of America
| | - Jaspreet Bhutani
- School of Social Work, University of North Carolina at Chapel Hill, Tate Turner Kuralt Building, 325 Pittsboro St CB #3550, Chapel Hill, NC 27599-3550, United States of America
| | - Ramine Alexander
- University of North Carolina at Chapel Hill Nutrition Research Institute, 500 Laureate Wy., Kannapolis, NC 28081, United States of America.
| |
Collapse
|
32
|
Kim H, Mahmood A, Chang CF, Hammarlund NE, Dobalian A. Impact of the Affordable Care Act on participation in the Supplemental Nutrition Assistance Program among low-income older Medicare beneficiaries. BMC Health Serv Res 2023; 23:509. [PMID: 37208673 DOI: 10.1186/s12913-023-09557-7] [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: 01/12/2023] [Accepted: 05/16/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND The Affordable Care Act (ACA) provisions, especially Medicaid expansion, are believed to have "spillover effects," such as boosting participation in the Supplemental Nutrition Assistance Program (SNAP) among eligible individuals in the United States (US). However, little empirical evidence exists about the impact of the ACA, with its focus on the dual eligible population, on SNAP participation. The current study investigates whether the ACA, under an explicit policy aim of enhancing the interface between Medicare and Medicaid, has improved participation in the SNAP among low-income older Medicare beneficiaries. METHODS We extracted 2009 through 2018 data from the US Medical Expenditure Panel Survey (MEPS) for low-income (≤ %138 Federal Poverty Level [FPL]) older Medicare beneficiaries (n = 50,466; aged ≥ 65), and low-income (≤ %138 FPL) younger adults (aged 20 to < 65 years, n = 190,443). MEPS respondents of > %138 FPL incomes, younger Medicare and Medicaid beneficiaries, and older adults without Medicare were excluded from this study. Using a quasi-experimental comparative interrupted time-series design, we examined (1) whether ACA's support for the Medicare-Medicaid dual-eligible program, through facilitating the online Medicaid application process, was associated with an increase in SNAP uptake among low-income older Medicare beneficiaries, and (2) in the instance of an association, to assess the magnitude of SNAP uptake that can be explicitly attributed to the policy's implementation. The outcome, SNAP participation, was measured annually from 2009 through 2018. The year 2014 was set as the intervention point when the Medicare-Medicaid Coordination Office started facilitating Medicaid applications online for eligible Medicare beneficiaries. RESULTS Overall, the change in the probability of SNAP enrollment from the pre- to post-intervention period was 17.4 percentage points higher among low-income older Medicare enrollees, compared to similarly low-income, SNAP-eligible, younger adults (β = 0.174, P < .001). This boost in SNAP uptake was significant and more apparent among older White (β = 0.137, P = .049), Asians (β = 0.408, P = .047), and all non-Hispanic adults (β = 0.030, P < .001). CONCLUSIONS The ACA had a positive, measurable effect on SNAP participation among older Medicare beneficiaries. Policymakers should consider additional approaches that link enrollment to multiple programs to increase SNAP participation. Further, there may be a need for additional, targeted efforts to address structural barriers to uptake among African Americans and Hispanics.
Collapse
Affiliation(s)
- Hyunmin Kim
- School of Health Professions, The University of Southern Mississippi, 118 College Drive #5122, Hattiesburg, MS, 39406, USA.
| | - Asos Mahmood
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Medicine-General Internal Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Cyril F Chang
- Department of Economics, Fogelman College of Business and Economics, The University of Memphis, Memphis, TN, USA
| | - Noah E Hammarlund
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - Aram Dobalian
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
33
|
Goliaei Z, Gonzalez M, Diaz Rios K, Pokhrel M, Burke NJ. Post-Resettlement Food Insecurity: Afghan Refugees and Challenges of the New Environment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105846. [PMID: 37239572 DOI: 10.3390/ijerph20105846] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Lack of access to adequate, safe, and nutritious food is a major concern for the Afghan population due to ongoing war and humanitarian crises. Recently resettled Afghan refugees in the US continue to face challenges securing adequate, nutritious food resources in new environments. This study examined Afghan refugees' food access and insecurity in the San Joaquin Valley, California. METHODS Semi-structured, in-depth interviews were conducted to collect the perspectives and experiences of key informants and newly arrived Afghan refugees. RESULTS This study highlights environmental and structural factors (availability and accessibility of grocery stores; availability of religious-appropriate items in the stores; the public benefit received by a family; and public transportation) and individual factors (religious and cultural practices; financial and language barriers) as major determinants of post-resettlement food insecurity. CONCLUSION Increasing the accessibility and affordability of culturally and religiously appropriate food items within the US food system, enhancing the collaboration of community volunteers and resettlement organizations in the direct assistance of new families, and providing continuous access to public benefits are possible steps to mitigate the risk of food insecurity among Afghan refugees. This study suggests a continuous examination of the degree of food insecurity in this population and its attendant health impacts.
Collapse
Affiliation(s)
- Zahra Goliaei
- Public Health Program, College of Education and Health Science, Touro University of California, Vallejo, CA 94592, USA
| | - Mariaelena Gonzalez
- Department of Public Health, School of Social Science, Humanities, & Arts, The University of California Merced, Merced, CA 95343, USA
| | - Karina Diaz Rios
- Department of Public Health, School of Social Science, Humanities, & Arts, The University of California Merced, Merced, CA 95343, USA
| | - Mamata Pokhrel
- Department of Public Health, School of Social Science, Humanities, & Arts, The University of California Merced, Merced, CA 95343, USA
| | - Nancy J Burke
- Department of Public Health, School of Social Science, Humanities, & Arts, The University of California Merced, Merced, CA 95343, USA
| |
Collapse
|
34
|
Munger AL, Speirs KE, Grutzmacher SK, Edwards M. Social Service Providers' Perceptions of Older Adults' Food Access During COVID-19. J Aging Soc Policy 2023:1-18. [PMID: 37125821 DOI: 10.1080/08959420.2023.2205770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The COVID-19 pandemic exacerbated risk factors for food insecurity among older adults, while also altering how government agencies and social service organizations could serve this population given their disproportionate vulnerability to the virus. The current study sought to understand social service providers' perspectives about how low-income community-dwelling older adults' access to food and related resources changed during the COVID pandemic. Data were collected via in-depth interviews with 22 social service providers from Oregon-based public and private social service agencies. Responses indicated that changes to older adults' food access during the pandemic stemmed from increases in public benefit amounts and social distancing guidelines. Participants indicated that temporary increases in SNAP allotments supported older adults' food security. Additionally, social distancing guidelines disrupted usual ways of procuring food, such as going to grocery stores, obtaining food with the assistance of family or neighbors, receiving deliveries from social programs, and visiting congregate meal sites. Food assistance programs changed their operations to reduce in-person interaction and increase the use of technology. When investigating older adults' food access, future research should consider adults' experiences of and barriers to SNAP receipt, social support from social networks and safety net programs, and technology access and knowledge.
Collapse
Affiliation(s)
- Ashley L Munger
- Department of Child and Family Studies, California State University, Los Angeles, USA
| | - Katherine E Speirs
- Human Development and Family Studies, The John and Doris Norton School of Human Ecology, University of Arizona, Tucson, AZ, USA
| | - Stephanie K Grutzmacher
- School of Biological and Population Health Sciences, Oregon State University, Corvallis, USA
| | - Mark Edwards
- School of Social Policy, Oregon State University, Corvallis, USA
| |
Collapse
|
35
|
Lu I, Welle E, Sadeghzadeh CJ, Harnack LJ, Perez-Velazco X, De Marco M, Pratt R, Caspi C. Experiences of Parents Earning Low Wages in Raleigh, North Carolina: Compounding Effects of Caretaker Responsibility, Piecemeal Resources, and Lack of Economic Opportunities. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2023; 19:600-618. [PMID: 39081553 PMCID: PMC11286216 DOI: 10.1080/19320248.2023.2195578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
We conducted interviews with parents earning low wages to understand their experiences related to financial responsibilities and use of government and informal resources in Raleigh, North Carolina. Inadequate economic opportunities and assistance programs, and high costs of living, compounded into cycles of playing catch up on expenses. Assistance programs aimed at alleviating hardships related to poverty were described as piecemeal. We found that social and economic systems failed to support parents earning low wages. Our findings suggest that ordinances that assure a livable minimum wage paired with expansions of safety net programs could better meet the needs these parents.
Collapse
Affiliation(s)
- Isabel Lu
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill
| | - Emily Welle
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, United States
| | - Claire Jon Sadeghzadeh
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill
| | - Lisa J Harnack
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, United States
| | - Ximena Perez-Velazco
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill
| | - Molly De Marco
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill
| | - Rebekah Pratt
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, United States
| | - Caitlin Caspi
- Rudd Center for Food Policy and Obesity, University of Connecticut, United States; Department of Allied Health Sciences, University of Connecticut, United States
| |
Collapse
|
36
|
Mahmood A, Kedia S, Dillon PJ, Kim H, Arshad H, Ray M. Food security status and breast cancer screening among women in the United States: Evidence from the Health and Retirement Study and Health Care and Nutrition Study. Cancer Causes Control 2023; 34:321-335. [PMID: 36695824 DOI: 10.1007/s10552-023-01667-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 01/03/2023] [Indexed: 01/26/2023]
Abstract
PURPOSE To assess the impact of food insecurity on biennial breast cancer screenings (i.e., mammography or breast X-ray) among older women in the United States (US). METHODS Data from the 2014 and 2016 waves of the Health and Retirement Study and the 2013 Health Care and Nutrition Study were used. The analyses were limited to a nationally representative sample of 2,861 women between 50 and 74 years of age, residing in the US. We employed a propensity score weighting method to balance observed confounders between food-secure and food-insecure women and fit a binary logistic regression to investigate population-level estimates for the association between food security and breast cancer screening. RESULTS Food insecurity was significantly associated with failure to obtain a mammogram or breast X-ray within the past two years. Food-insecure women had 54% lower odds of reporting breast cancer screening in the past 2 years (adjusted OR = 0.46; 95% CI 0.30-0.70, p-value < 0.001) as compared to food-secure women. Additional factors associated with a higher likelihood of receiving breast cancer screenings included greater educational attainment, higher household income, regular access to health care/advice, not smoking, and not being physically disabled or experiencing depressive symptoms. CONCLUSION Results demonstrate a socioeconomic gradient existing in regard to the utilization of regular breast cancer screenings among women. Those who tend to have lower education, lower income, and lack of reliable healthcare access are more likely to be food insecure. Thus, more likely to face the financial, logistical, or environmental barriers in obtaining screening services that accompany food insecurity.
Collapse
Affiliation(s)
- Asos Mahmood
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, 956 Court Avenue, Coleman A218A, Memphis, TN, 38163, USA. .,Department of Medicine-General Internal Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Satish Kedia
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, OH, USA
| | - Hyunmin Kim
- School of Health Professions, The University of Southern Mississippi, Hattiesburg, MS, USA
| | - Hassan Arshad
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Meredith Ray
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, TN, USA
| |
Collapse
|
37
|
Bhandari S, Campbell JA, Walker RJ, Thorgerson A, Dawson AZ, Egede LE. Dose response relationship between food insecurity and quality of life in United States adults: 2016-2017. Health Qual Life Outcomes 2023; 21:21. [PMID: 36890499 PMCID: PMC9997014 DOI: 10.1186/s12955-023-02103-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/21/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Food insecurity is associated with worse general health rating, but little research exists investigating whether there is a dose response relationship across levels of food security and mental and physical health domains at the population level. METHODS Data from the Medical Expenditure Panel Survey (2016-2017) with US adults aged 18 years and older was used. The physical component score (PCS) and mental component score (MCS) of Quality of Life, served as the outcome measures. Four categories of food insecurity (high, marginal, low, very low food security) served as the primary independent variable. Linear regression was used to run unadjusted followed by adjusted models. Separate models were run for PCS and MCS. RESULTS In a sample of US adults, 16.1% reported some degree of food insecurity. For PCS, marginal (β = - 2.54 (p < 0.001), low (β = - 3.41, (p < 0.001), and very low (β = - 5.62, (p < 0.001) food security was associated with worse PCS scores, compared to adults with high food security. For MCS, marginal (β = - 3.90 (p < 0.001), low (β = - 4.79, (p < 0.001), and very low (β = - 9.72, (p < 0.001) food security was associated with worse MCS scores, compared to adults with high food security. CONCLUSION Increasing levels of food insecurity were associated with decreased physical and mental health quality of life scores. This relationship was not explained by demographic factors, socioeconomic factors, insurance, or comorbidity burden. This study suggests work is needed to mitigate the impact of social risk, such as food insecurity, on quality of life in adults, and understand pathways and mechanisms for this relationship.
Collapse
Affiliation(s)
- Sanjay Bhandari
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Jennifer A Campbell
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Rebekah J Walker
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Abigail Thorgerson
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Aprill Z Dawson
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Leonard E Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA.
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.
| |
Collapse
|
38
|
Gupta S, Mayers E, Schwierking S, Westrick M, Schier H, Sharn AR, Pannell C, Gunther C. Online Grocery Shopping and the Supplemental Nutrition Assistance Program (SNAP) Electronic Benefit Transfer Card (EBT): Perceptions of Head Start Caregivers. Ecol Food Nutr 2023; 62:75-87. [PMID: 36880800 DOI: 10.1080/03670244.2023.2187383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
The objective of this study was to explore perceptions of online grocery shopping and the online United States Department of Agriculture's (USDA) Supplemental Nutrition Assistance Program (SNAP) Electronic Benefit Transfer card (EBT) program among Head Start caregivers. Three focus groups were conducted between December 2019 and January 2020. Most participants hadn't tried online grocery shopping. Concerns included others choosing perishables, receiving wrong items, and inappropriate substitutes. Perceived benefits included saving time, preventing impulse buys, and eating healthier. Results have broad applicability in the current COVID-19 pandemic where online grocery shopping and the online SNAP EBT program have rapidly expanded across the United States.
Collapse
Affiliation(s)
- Shivani Gupta
- Nationwide Children's Hospital, Department of Gastroenterology, Hepatology, and Nutrition, Columbus, Ohio, USA
| | - Elizabeth Mayers
- College of Food, Agricultural, and Environmental Sciences, Family and Consumer Sciences, The Ohio State University, Columbus, Ohio, USA.,College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Sierra Schwierking
- College of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Miranda Westrick
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Heather Schier
- College of Education and Human Ecology, Department of Human Sciences, Human Nutrition Program, The Ohio State University, Columbus, Ohio, USA
| | - Amy R Sharn
- College of Education and Human Ecology, Department of Human Sciences, Human Nutrition Program, The Ohio State University, Columbus, Ohio, USA
| | - Cara Pannell
- College of Education and Human Ecology, Department of Human Sciences, Human Nutrition Program, The Ohio State University, Columbus, Ohio, USA
| | - Carolyn Gunther
- College of Nursing, Martha S. Pitzer Center for Women, Children, and Youth, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
39
|
Lu P, Kezios K, Yaffe K, Kim S, Zhang A, Milazzo FH, Zeki Al Hazzouri A. Depressive symptoms mediate the relationship between sustained food insecurity and cognition: a causal mediation analysis. Ann Epidemiol 2023; 81:6-13.e1. [PMID: 36822280 DOI: 10.1016/j.annepidem.2023.02.009] [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: 07/19/2022] [Revised: 02/11/2023] [Accepted: 02/17/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE This study aimed to investigate the association of change in food insecurity over time with cognitive function in midlife, and whether depressive symptoms mediated that relationship. METHODS We used longitudinal data from the Coronary Artery Risk Development in Young Adults study. Change in food insecurity in 2000-2005 was coded as "persistently food-secure," "persistently food-insecure," "became food-insecure," and "became food-secure." Depressive symptoms were measured in 2010, and cognitive function was measured in 2015. Multivariable linear regression controlled for sociodemographic and cardiovascular health factors was used. We also conducted causal mediation analysis. RESULTS Our study population included 2448 participants (57.23% female and 43.18% Black, mean age = 40.31 in 2000). Compared with persistent food security, persistently and became food-insecure were associated with worse cognition, particularly with processing speed (βpersistent = -0.20 standard unit, 95% CI = -0.36, -0.04; βbecame = -0.17, 95% CI = -0.31, -0.03), and these associations appeared mediated by depressive symptoms (proportion-mediated = 14% for persistently food-insecure and 18% for became food-insecure). CONCLUSIONS Persistent and transition to food insecurity were associated with worse cognition, both directly and indirectly through increasing depressive symptoms. Targeting food insecurity or depressive symptoms among persistently or became food-insecure individuals may have the potential to slow premature cognitive aging.
Collapse
Affiliation(s)
- Peiyi Lu
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
| | - Katrina Kezios
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Kristine Yaffe
- Department of Neurology, Epidemiology and Biostatistics, University of California San Francisco, San Francisco
| | - Soohyun Kim
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Adina Zhang
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Floriana H Milazzo
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Adina Zeki Al Hazzouri
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| |
Collapse
|
40
|
Lu P, Kezios K, Lee J, Calonico S, Wimer C, Zeki Al Hazzouri A. Association Between Supplemental Nutrition Assistance Program Use and Memory Decline: Findings From the Health and Retirement Study. Neurology 2023; 100:e595-e602. [PMID: 36351816 PMCID: PMC9946186 DOI: 10.1212/wnl.0000000000201499] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/16/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Studies on the effect of the Supplemental Nutrition Assistance Program (SNAP) on the cognitive health of older adults are scarce. We sought to examine the associations between SNAP use and memory decline among SNAP-eligible US older adults. METHODS Participants aged 50+ years and SNAP-eligible in 1996 from the Health and Retirement Study were included. Participants' SNAP eligibility was constructed using federal criteria. Participants also self-reported whether they used SNAP. Memory function was assessed biennially from 1996 through 2016 using a composite score. To account for preexisting differences in characteristics between SNAP users and nonusers, we modeled the probability of SNAP use using demographic and health covariates. Using linear mixed-effects models, we then modeled trajectories of memory function for SNAP users and nonusers using inverse probability (IP) weighting and propensity score (PS) matching techniques. In all models, we accounted for study attrition. RESULTS Of the 3,555 SNAP-eligible participants, a total of 15.7% were SNAP users. At baseline, SNAP users had lower socioeconomic status and a greater number of chronic conditions than nonusers and were more likely to be lost to follow-up. Our multivariable IP-weighted models suggested that SNAP users had worse memory scores at baseline but slower rates of memory decline compared with nonusers (the annual decline rate is -0.038 standardized units [95% CI = -0.044 to -0.032] for users and -0.046 [95% CI = -0.049 to -0.043] for nonusers). Results were slightly stronger from the PS-matched sample (N = 1,014) (the annual decline rate was -0.046 units [95% CI = -0.050 to -0.042] for users and -0.060 units [95% CI = -0.064 to -0.056] for nonusers). Put in other words, our findings suggested that SNAP users had approximately 2 fewer years of cognitive aging over a 10-year period compared with nonusers. DISCUSSION After accounting for preexisting differences between eligible SNAP users and nonusers as well as differential attrition, we find SNAP use to be associated with slower memory function decline.
Collapse
Affiliation(s)
- Peiyi Lu
- From the Departments of Epidemiology (P.L., K.K., A.Z.A.H.) and Health Policy and Management (S.C.), Mailman School of Public Health, School of Social Work (J.L., C.W.), and Center on Poverty and Social Policy (J.L., C.W.), Columbia University, New York, NY.
| | | | | | | | | | | |
Collapse
|
41
|
Allen L, Henry D, Atwood A. SNAP work requirements increase mental health care use. Health Serv Res 2023; 58:60-66. [PMID: 35822399 PMCID: PMC9836954 DOI: 10.1111/1475-6773.14033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE We measured the impact of Supplemental Nutrition Assistance Program (SNAP) work requirements on mental health care use. DATA SOURCES AND STUDY SETTING We used 2015-2018 West Virginia Medicaid and SNAP data. STUDY DESIGN Nine counties were exposed to SNAP work requirements. Using an event study framework, we assessed how this changed the probability and number of visits for depression and anxiety in the treatment versus the control group. DATA COLLECTION/EXTRACTION METHODS The sample included individuals aged 18-49, enrolled in both SNAP and Medicaid at the start of the study. Dually eligible individuals were excluded. PRINCIPAL FINDINGS At baseline, the probability of having a mood disorder visit was 6.1% among women and 5.3% among men, rising by 0.9 percentage points (SE 0.4, relative change +14.1%) among women and 0.7 percentage points (SE 0.3, relative change +13.0%) among men after exposure to work requirements. The probability of having an anxiety visit rose by 1.0 (SE 0.4) percentage points among women, a 17.8% relative increase over the baseline of 5.8%. Among men, the likelihood of having an anxiety visit increased by 1.0 percentage points (SE 0.5), a relative change of 24.3% over a baseline probability of 5.0%, though this effect occurred much more gradually compared to women. CONCLUSIONS Exposure to SNAP work requirements was associated with increases in health care use for mood disorders and anxiety among enrollees. The policy's effect differed between men and women.
Collapse
Affiliation(s)
- Lindsay Allen
- Department of Emergency Medicine, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | | | - Alicia Atwood
- Department of EconomicsVassar CollegePoughkeepsieNew YorkUSA
| |
Collapse
|
42
|
Salinas LMB, Machiorlatti M, Romero Z, Wang L, Alanis E, Treviño-Peña R. The Relationship Between Food Insecurity and Food Assistance Program Participation in Families of Preschool Children in the Rio Grande Valley. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2023. [DOI: 10.1080/19320248.2023.2166802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Lisa Michelle Belzer Salinas
- Department of Health & Biomedical Sciences, College of Health Professions, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Michael Machiorlatti
- Department of Population Health and Biostatistics, School of Medicine, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Zasha Romero
- Department of Health & Human Performance, College of Health Professions, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Lin Wang
- Department of Health & Human Performance, College of Health Professions, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Elizabeth Alanis
- Department of Health & Human Performance, College of Health Professions, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Roberto Treviño-Peña
- Department of Health & Human Performance, College of Health Professions, University of Texas Rio Grande Valley, Edinburg, Texas, USA
- Social & Health Research Center, San Antonio, Texas, USA
| |
Collapse
|
43
|
Nguyen KH, Giron NC, Trivedi AN. Parental Immigration Status, Medicaid Expansion, And Supplemental Nutrition Assistance Program Participation. Health Aff (Millwood) 2023; 42:53-62. [PMID: 36623228 DOI: 10.1377/hlthaff.2022.00288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Anti-immigrant public policies and rhetoric during 2017-19 may have eroded enrollment in safety-net programs, such as the enrollment of children of immigrants in the Supplemental Nutrition Assistance Program (SNAP). At the same time, states' expansion of Medicaid through the Affordable Care Act may have mitigated erosion through coordinated enrollment across safety-net programs, including SNAP and Medicaid. We examined changes in SNAP participation rates by parental immigration status among low-income households in 2015-16 versus 2017-19 for differences by child race and ethnicity or state Medicaid expansion status. Relative to those among citizen children with US-born parents, SNAP participation rates among citizen children from mixed-status families and noncitizen children significantly decreased between 2015-16 and 2017-19, with the magnitude of disparity widening over time. Declines in SNAP participation were sharper for Hispanic and Latino children from mixed-status families, Hispanic and Latino noncitizen children, and noncitizen children residing in nonexpansion states. Findings are consistent with some policy makers' concerns of erosion in SNAP participation. Mechanisms that could be employed to help reverse these trends include policies, outreach strategies, and enrollment processes.
Collapse
Affiliation(s)
- Kevin H Nguyen
- Kevin H. Nguyen , Boston University, Boston, Massachusetts
| | - Nicole C Giron
- Nicole C. Giron, Brown University, Providence, Rhode Island
| | - Amal N Trivedi
- Amal N. Trivedi, Brown University and Providence Veterans Affairs Medical Center, Providence, Rhode Island
| |
Collapse
|
44
|
Frank ML, Sato AF. Food Insecurity and Depressive Symptoms Among Adolescents: Does Federal Nutrition Assistance Act as a Buffer? J Dev Behav Pediatr 2023; 44:e41-e48. [PMID: 36563345 PMCID: PMC9793962 DOI: 10.1097/dbp.0000000000001143] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/12/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Food insecurity has been associated with a variety of adverse outcomes in adolescents. However, further research is needed to elucidate whether adolescent self-report food insecurity contributes to depressive symptoms. This study examined the (1) association between food insecurity and depressive symptoms and (2) moderating role of federal nutrition assistance in a nonclinical sample of adolescents. METHOD Adolescents aged 12 to 17 years (N = 141) and one parent/guardian completed self-report questionnaires as part of 2 larger studies examining adolescent stress and eating behaviors. Adolescents (M age = 13.79 years, SD = 1.60, 53.9% female) completed measures of food insecurity and depressive symptoms. RESULTS A bootstrapped linear regression model demonstrated that adolescent food insecurity was significantly, positively associated with depressive symptoms, 95% confidence interval (CI) (0.19-1.64), after controlling for biological sex. Among dyads eligible for federal nutrition assistance (N = 64), the interaction between adolescent food insecurity and National School Lunch Program (NSLP) participation did not reach significance, ΔF(1, 59) = 1.06, 95% CI (-3.80 to 9.29). The interaction between adolescent food insecurity and Supplemental Nutrition Assistance Program (SNAP) participation trended toward significance, ΔF(1, 59) = 2.88, 95% CI (-5.73 to 0.47). CONCLUSION Adolescents with food insecurity may be at a greater risk for experiencing elevated depressive symptoms. Whereas NSLP participation did not act as a buffer, SNAP participation may attenuate the association between food insecurity and depressive symptoms. Larger longitudinal studies are needed to develop a greater understanding of factors that may alter the relationship between adolescent food insecurity and depressive symptoms.
Collapse
Affiliation(s)
- Miranda L. Frank
- Department of Psychological Sciences, Kent State University, Kent, Ohio
| | - Amy. F. Sato
- Department of Psychological Sciences, Kent State University, Kent, Ohio
- Brain Health Research Initiative, Kent State University, Kent, Ohio
| |
Collapse
|
45
|
Bovell-Ammon A, Cuba SED, Cutts DB. Immigrant-Inclusive Policies Promote Child and Family Health. Am J Public Health 2022; 112:1735-1737. [DOI: 10.2105/ajph.2022.307098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Allison Bovell-Ammon
- Allison Bovell-Ammon and Stephanie Ettinger de Cuba are with Children’s HealthWatch, Boston Medical Center, Boston, MA. Stephanie Ettinger de Cuba is also with the Boston University Schools of Public Health and Medicine. Diana B. Cutts is with Hennepin County Medical Center, Minneapolis, MN
| | - Stephanie Ettinger de Cuba
- Allison Bovell-Ammon and Stephanie Ettinger de Cuba are with Children’s HealthWatch, Boston Medical Center, Boston, MA. Stephanie Ettinger de Cuba is also with the Boston University Schools of Public Health and Medicine. Diana B. Cutts is with Hennepin County Medical Center, Minneapolis, MN
| | - Diana B. Cutts
- Allison Bovell-Ammon and Stephanie Ettinger de Cuba are with Children’s HealthWatch, Boston Medical Center, Boston, MA. Stephanie Ettinger de Cuba is also with the Boston University Schools of Public Health and Medicine. Diana B. Cutts is with Hennepin County Medical Center, Minneapolis, MN
| |
Collapse
|
46
|
Walch AK, Ohle KA, Koller KR, Alexie L, Lee F, Palmer L, Nu J, Thomas TK, Bersamin A. Impact of Assistance Programs on Indigenous Ways of Life in 12 Rural Remote Western Alaska Native Communities: Elder Perspectives Shared in Formative Work for the "Got Neqpiaq?" Project. Int J Circumpolar Health 2022; 81:2024679. [PMID: 35037587 PMCID: PMC8765241 DOI: 10.1080/22423982.2021.2024679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022] Open
Abstract
For more than 50 years, government programmes in the USA have been in place to help those in need have consistent access to food and education. However, questions have surfaced regarding whether or not these support impact traditional ways, such as cultural activities, food preferences, and overall health, particularly for Indigenous populations. In this paper, we share insights voiced by Alaska Native Elders in the Yukon-Kuskokwim region of Alaska and their perceptions of regulations, assistance, and the impact government assistance programmes have had on their culture. Elders raised concerns so that those administering these programmes will consider how best to meet food security and education needs without interfering with Indigenous cultural practices and traditional lifestyle.
Collapse
Affiliation(s)
- Amanda K. Walch
- Dietetics & Nutrition, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Kathryn A. Ohle
- Early Childhood Education, Grand Valley State University, Grand Rapids, Michigan, USA
| | - Kathryn R. Koller
- Research Nurse Supervisor, Alaska Native Tribal Health Consortium, Research Services, Anchorage, Alaska, USA
| | - Lucinda Alexie
- Yukon-Kuskokwim Health Corporation Research Department, Associate Research Coordinator, Bethel, Alaska, USA
| | - Flora Lee
- Epidemiology Research Nurse, Alaska Native Tribal Health Consortium Research Services, Anchorage, Alaska, USA
| | - Lea Palmer
- Registered Dietitian Nutritionist, RurAL Cap Head Start, Anchorage, Alaska, USA
| | - Jennifer Nu
- Research Associate, Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska, USA
| | - Timothy K. Thomas
- Alaska Native Tribal Health Consortium Research Services, Anchorage, Alaska, USA
| | - Andrea Bersamin
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska, USA
| |
Collapse
|
47
|
Oldroyd L, Eskandari F, Pratt C, Lake AA. The nutritional quality of food parcels provided by food banks and the effectiveness of food banks at reducing food insecurity in developed countries: a mixed-method systematic review. J Hum Nutr Diet 2022; 35:1202-1229. [PMID: 35112742 PMCID: PMC9790279 DOI: 10.1111/jhn.12994] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/13/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Research indicates that food parcels provided by food banks are nutritionally poor. Food insecurity and the use of food banks are both rising, with detrimental effects on the dietary intake and health of users. This mixed-method systematic review aims to investigate the current nutritional adequacy of pre-packaged food parcels and whether using food banks reduces the food insecurity and improves the dietary intake of their users. METHODS A mixed-method systematic literature review, restricted to articles published from 2015, was conducted using eight electronic databases, four grey literature databases and eight relevant websites. Quantitative findings, investigating the nutritional quality of food parcels and/or their impact on dietary intake or food insecurity, were presented narratively. Qualitative findings reporting the views of food bank users regarding food from food banks underwent thematic synthesis. These independent syntheses were integrated using configurative analysis and presented narratively. RESULTS Of 2189 articles, 11 quantitative and 10 qualitative were included. Food parcels were inconsistent at meeting nutritional requirements and often failed to meet individual needs, including cultural and health preferences. Using food banks improved food security and dietary quality of users, allowing otherwise unachievable access to food. However, food insecurity remained, and is explained by limited food variety, quality and choice. The mixed-method findings support interventions to ensure consistent, adequate nutrition at food banks, including catering for individual needs. CONCLUSIONS Food banks are a lifeline for those severely food insecure. However when used alone, food banks struggle to eliminate the heightened food insecurity of their users. Efforts to improve the nutritional quality of food parcels could improve the experiences and diet-related outcomes of those requiring food banks.
Collapse
Affiliation(s)
- Lucy Oldroyd
- Centre for Public Health Research, School of Health & Life SciencesTeesside UniversityMiddlesbroughUK
| | - Fatemeh Eskandari
- Centre for Public Health Research, School of Health & Life SciencesTeesside UniversityMiddlesbroughUK,Fuse, The Centre for Translational Research in Public HealthNewcastleUK
| | - Charlotte Pratt
- Centre for Public Health Research, School of Health & Life SciencesTeesside UniversityMiddlesbroughUK
| | - Amelia A. Lake
- Centre for Public Health Research, School of Health & Life SciencesTeesside UniversityMiddlesbroughUK,Fuse, The Centre for Translational Research in Public HealthNewcastleUK
| |
Collapse
|
48
|
Alvear-Vega S, Vargas-Garrido H. Social Determinants of the Non-Utilization of the Supplementary Feeding Program (PACAM) Aimed at Older Adults' Nutritional Support. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14580. [PMID: 36361459 PMCID: PMC9656771 DOI: 10.3390/ijerph192114580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/24/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
Chile has implemented the PACAM program to support older people with nutrition and for the prevention of malnutrition and frailty. This work aims to identify the social determinants of older persons not withdrawing PACAM food in order to obtain helpful knowledge for improving the program. First, the CASEN Survey 2017 was used (960,498 observations); the inclusion criterion was PACAM recipients (Yes/No). Next, a probit model was performed with a dichotomous response to determine the marginal effects of each independent variable (e.g., demographic, health, and social). The model shows a good fit (64.4%) with an explained variance between 10.5% to 14.1%. Those variables with more significant marginal effects are people aged 70-75, having tertiary and secondary education, urban living, not participating in social organizations, immigrants, and living in the austral zone. On the other hand, a higher likelihood of consumption was found among people of greater vulnerability (lowest income, lowest education, low health insurance, and aged over 80) and, therefore, in greater fragility. To conclude, the program achieves effective targeting, although improvement actions are required to expand coverage in some groups (indigenous people, immigrants, and people with disabilities). Moreover, authorities should evaluate and reinforce the program with tailored strategies for the older adults who actually withdraw food.
Collapse
|
49
|
Headrick G, Ellison C, Bresnahan C, Green C, Lyons M, Moran A. State Implementation of SNAP Waivers and Flexibilities During the COVID-19 Pandemic: Perspectives From State Agency Leaders. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:982-997. [PMID: 36184356 PMCID: PMC9552006 DOI: 10.1016/j.jneb.2022.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 07/17/2022] [Accepted: 07/28/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To describe state agencies' implementation of the Supplemental Nutrition Assistance Program (SNAP) during the first year of the coronavirus disease of 2019 (COVID-19) pandemic, barriers and facilitators to SNAP implementation, and recommendations to improve SNAP implementation. DESIGN Qualitative methodology guided by Bullock's determinants of policy implementation framework using 7 semistructured, virtual focus groups in April 2021. SETTING Twenty-six states representing all 7 US Department of Agriculture Food and Nutrition Service regions. PARTICIPANTS Four focus groups with state-level SNAP administrators and 3 focus groups with state-level SNAP supportive services (Supplemental Nutrition Assistance Program-Education, Employment & Training, and Outreach) supervisors (n = 62). PHENOMENON OF INTEREST Supplemental Nutrition Assistance Program implementation during the COVID-19 pandemic. ANALYSIS Thematic analysis using a phronetic iterative approach. RESULTS Six primary themes emerged: the policy response, technology needs, collaboration, participant communication, funding realities, and equity. Implementation challenges included the design of waivers in the early pandemic response, inadequate federal guidance and funding, outdated technology, and prepandemic regulations limiting state authority. Modernized technology systems, availability of virtual programming, partnerships, and enhanced benefits facilitated SNAP implementation. CONCLUSIONS AND IMPLICATIONS Supplemental Nutrition Assistance Program administrators adapted their programs to deliver services virtually during the COVID-19 pandemic. These experiences highlighted the importance of certain policy determinants, such as modernized technology and streamlined application processes, to improve outcomes for SNAP participants and staff.
Collapse
Affiliation(s)
- Gabby Headrick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Carolyn Ellison
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Carolyn Bresnahan
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Chloe Green
- American Public Human Services Association, Arlington, VA
| | - Matt Lyons
- American Public Human Services Association, Arlington, VA
| | - Alyssa Moran
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| |
Collapse
|
50
|
Food insecurity among immigrant populations in the United States. Food Secur 2022. [DOI: 10.1007/s12571-022-01322-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|