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Finkel MA, Barrios D, Partida I, Kelman E, Hulse E, Rosenthal A, Reiss J, Schwartz R, Meyer D, Woo Baidal JA. Participant and Stakeholder Perceptions of the Food FARMacy Emergency Food Assistance Program for the Coronavirus Disease 2019 Pandemic: A Qualitative Study. J Acad Nutr Diet 2024; 124:1118-1133. [PMID: 37926236 PMCID: PMC11068857 DOI: 10.1016/j.jand.2023.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Food FARMacy is a clinical-community emergency food assistance program developed in response to food insecurity during the COVID-19 pandemic. Few qualitative studies have examined participant, and clinical and community stakeholder experiences with these food assistance programs. OBJECTIVE To examine the motivations, experiences, and perceptions of Food FARMacy participants and program stakeholders. DESIGN A qualitative study using in-depth interviews between March 2021 and July 2021. PARTICIPANTS AND SETTING Twenty-four Food FARMacy participants and 10 program stakeholders in New York, NY (Manhattan, Brooklyn, and Queens) older than age 18 years were interviewed. STATISTICAL ANALYSES PERFORMED Interviews were recorded, transcribed, translated, and analyzed using thematic analysis. Participant and program stakeholder interviews were analyzed separately. Themes that were salient in both groups were combined for reporting. RESULTS Both program participants and stakeholders perceived: pandemic-related demands combined with reduced resources motivated participation; convenience, safety, and ease of access facilitated program retention; participants valued fresh produce and diversity of foods; the program improved diet and health; minimizing food waste was a priority; and social cohesion was an unexpected program benefit. Two additional themes among only program stakeholders also were identified: aligned values, flexibility, and communication were key to successful partnerships; and trust between community partners and community members drove programmatic success. CONCLUSIONS Results suggest that a multisite clinical-community partnership to provide emergency food assistance in New York City can be leveraged to reduce barriers to healthy food access and address food insecurity during crises.
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Affiliation(s)
- Morgan A Finkel
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Daniela Barrios
- Clinical Patient Coordinator, Union Square Practice, New York, New York
| | - Ivette Partida
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | | | - Emma Hulse
- CHALK Program, New York Presbyterian Hospital, New York, New York
| | | | | | | | - Dodi Meyer
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York; NewYork-Presbyterian Division of Community and Population Health/Columbia Campus, New York, New York
| | - Jennifer A Woo Baidal
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York.
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Sánchez KD, Díaz Rios LK, Payán DD. Nutrition Environment Gaps and Distribution Challenges in Rural Food Pantries During the COVID-19 Pandemic: A Mixed-Methods Study. J Acad Nutr Diet 2024; 124:713-724.e4. [PMID: 38103595 DOI: 10.1016/j.jand.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Food insecurity disproportionately affects low-income, racially marginalized, and rural communities. The COVID-19 pandemic led to higher demand for emergency food distribution, potentially impacting food pantry operations and services. Limited research exists assessing consumer nutrition environments of pantries in rural regions. OBJECTIVES To assess the consumer nutrition environment of rural food pantries and report challenges and adaptations encountered during the pandemic. DESIGN A mixed-methods, cross-sectional survey. PARTICIPANTS/SETTING Nineteen food pantry representatives from California's San Joaquin Valley were surveyed between August 2020 and June 2021. Representatives were eligible if their pantry served the general population and was open at least once a week. Nine were church-based pantries, and 10 were from other settings. MAIN OUTCOME MEASURES The Nutrition Environment Food Pantry Assessment Tool (NEFPAT) measured the nutrition food environment and scored pantries as bronze (0-15), silver (16-31), or gold (32-47) categories. Eleven items were developed to explore pandemic-related challenges. STATISTICAL ANALYSES PERFORMED Independent χ2 tests assessed the relationship between the organization type and NEFPAT scores and food supply sources. Fisher's exact test explored associations between food pantry type, NEFPAT category, and challenges. Nonparametric tests were run on non-normally distributed data. Inductive content analysis was used to examine open-ended pandemic-related questions. RESULTS The nutrition environment of most pantries was suboptimal, because no pantry scored in the "gold" category based on total NEFPAT scores (median, 18 of 47). No statistically significant differences were found in the NEFPAT scores by organization type. Most pantries did not provide healthy food nudges or culturally diverse foods. Key COVID-19 challenges encountered consisted of supply- and demand-side issues, including reduced personnel, capacity, and resources, and increased client quantity and demand for food. CONCLUSIONS Assessing the nutrition environment of rural food pantries revealed gaps and strategies for improvement, including the use of healthy nudges and increasing the availability of culturally diverse foods.
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Malik FS, Liese AD, Ellyson A, Reid LA, Reboussin BA, Sauder KA, Frongillo EA, Pihoker C, Dabelea D, Reynolds K, Jensen ET, Marcovina S, Bowlby DA, Mendoza JA. Household food insecurity and associations with hemoglobin A 1c and acute diabetes-related complications in youth and young adults with type 1 diabetes: The SEARCH for Diabetes in Youth study. Diabetes Res Clin Pract 2024; 212:111608. [PMID: 38574894 PMCID: PMC11290462 DOI: 10.1016/j.diabres.2024.111608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/20/2024] [Accepted: 03/06/2024] [Indexed: 04/06/2024]
Abstract
AIMS To examine, among youth and young adults (YYA) with type 1 diabetes (T1D), the association of household food insecurity (HFI) with: 1) HbA1c and 2) episodes of diabetic ketoacidosis (DKA) and severe hypoglycemia. METHODS HFI was assessed using the U.S. Household Food Security Survey Module in SEARCH for Diabetes in Youth participants with T1D between 2016 and 2019. Linear and logistic regression models adjusted for age, diabetes duration, sex, race, ethnicity, clinic site, parent/participant education, household income, health insurance, and diabetes technology use. RESULTS Of 1830 participants (mean age 20.8 ± 5.0 years, 70.0 % non-Hispanic White), HbA1c was collected for 1060 individuals (mean HbA1c 9.2 % ± 2.0 %). The prevalence of HFI was 16.4 %. In the past 12 months, 18.2 % and 9.9 % reported an episode of DKA or severe hypoglycemia, respectively. Compared to participants who were food secure, HFI was associated with a 0.33 % (95 % CI 0.003, 0.657) higher HbA1c level. Those with HFI had 1.58 (95 % CI 1.13, 2.21) times the adjusted odds of an episode of DKA and 1.53 (95 % CI 0.99, 2.37) times the adjusted odds of an episode of severe hypoglycemia as those without HFI. CONCLUSIONS HFI is associated with higher HbA1c levels and increased odds of DKA in YYA with T1D.
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Affiliation(s)
- Faisal S Malik
- Department of Pediatrics, University of Washington School of Medicine, Seattle, United States; Seattle Children's Research Institute, Seattle, United States.
| | | | - Alice Ellyson
- Department of Pediatrics, University of Washington School of Medicine, Seattle, United States; Seattle Children's Research Institute, Seattle, United States
| | | | - Beth A Reboussin
- Wake Forest University School of Medicine, Winston-Salem, United States
| | | | | | - Catherine Pihoker
- Department of Pediatrics, University of Washington School of Medicine, Seattle, United States; Seattle Children's Research Institute, Seattle, United States
| | - Dana Dabelea
- University of Colorado Anschutz Medical Campus, Aurora, United States
| | - Kristi Reynolds
- Kaiser Permanente Southern California, Pasadena, United States
| | | | | | | | - Jason A Mendoza
- Department of Pediatrics, University of Washington School of Medicine, Seattle, United States; Seattle Children's Research Institute, Seattle, United States; Fred Hutchinson Cancer Center, Seattle, United States
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Meyer D, Lowensen K, Perrin N, Moore A, Mehta SH, Himmelfarb CR, Inglesby TV, Jennings JM, Mueller AK, LaRicci JN, Gallo W, Bocek AP, Farley JE. An evaluation of the impact of social and structural determinants of health on forgone care during the COVID-19 pandemic in Baltimore, Maryland. PLoS One 2024; 19:e0302064. [PMID: 38739666 PMCID: PMC11090349 DOI: 10.1371/journal.pone.0302064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/27/2024] [Indexed: 05/16/2024] Open
Abstract
Evidence suggests that reductions in healthcare utilization, including forgone care, during the COVID-19 pandemic may be contributing towards excess morbidity and mortality. The objective of this study was to describe individual and community-level correlates of forgone care during the COVID-19 pandemic. We conducted a cross-sectional, secondary data analysis of participants (n = 2,003) who reported needing healthcare in two population-representative surveys conducted in Baltimore, MD in 2021 and 2021-2022. Abstracted data included the experience of forgone care, socio-demographic data, comorbidities, financial strain, and community of residence. Participant's community of residence were linked with data acquired from the Baltimore Neighborhood Indicators Alliance relevant to healthcare access and utilization, including walkability and internet access, among others. The data were analyzed using weighted random effects logistic regression. Individual-level factors found to be associated with increased odds for forgone care included individuals age 35-49 (compared to 18-34), female sex, experiencing housing insecurity during the pandemic, and the presence of functional limitations and mental illness. Black/African American individuals were found to have reduced odds of forgone care, compared to any other race. No community-level factors were significant in the multilevel analyses. Moving forward, it will be critical that health systems identify ways to address any barriers to care that populations might be experiencing, such as the use of mobile health services or telemedicine platforms. Additionally, public health emergency preparedness planning efforts must account for the unique needs of communities during future crises, to ensure that their health needs can continue to be met. Finally, additional research is needed to better understand how healthcare access and utilization practices have changed during versus before the pandemic.
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Affiliation(s)
- Diane Meyer
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing, Baltimore, MD, United States of America
- Center for Health Security, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Kelly Lowensen
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing, Baltimore, MD, United States of America
| | - Nancy Perrin
- Johns Hopkins University, School of Nursing, Baltimore, MD, United States of America
| | - Ayana Moore
- FHI 360, Durham, NC, United States of America
| | - Shruti H. Mehta
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Cheryl R. Himmelfarb
- Johns Hopkins University, School of Nursing, Baltimore, MD, United States of America
| | - Thomas V. Inglesby
- Center for Health Security, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Jacky M. Jennings
- Department of Pediatrics, Johns Hopkins University, School of Medicine, Baltimore, MD, United States of America
| | - Alexandra K. Mueller
- Department of Pediatrics, Johns Hopkins University, School of Medicine, Baltimore, MD, United States of America
| | - Jessica N. LaRicci
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing, Baltimore, MD, United States of America
| | - Woudase Gallo
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing, Baltimore, MD, United States of America
| | - Adam P. Bocek
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing, Baltimore, MD, United States of America
| | - Jason E. Farley
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing, Baltimore, MD, United States of America
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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.
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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.
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Mui Y, Adam A, Santo R, Bassarab K, Wolfson JA, Palmer A. Characterizing Food Policy Councils' Network Partnerships and COVID-19 Responses. Nutrients 2024; 16:915. [PMID: 38612949 PMCID: PMC11013245 DOI: 10.3390/nu16070915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/11/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
The COVID-19 pandemic pushed millions of Americans into food insecurity. Food policy councils (FPCs) across the country played a vital role in organizing coordinated food responses across multiple sectors. We used a social network analysis (SNA) approach to investigate: (1) the network of partnering organizations and agencies within FPCs; (2) how the characteristics of FPCs' network partnerships (i.e., degree, coreness, and density) related to programmatic, policy, and advocacy actions in response to the pandemic; and (3) how FPCs' use of a racial or social equity framework shifted their network partnerships and responses. Local government agencies and food supply chain actors were core in FPCs' network partnerships, while public utilities, correctional facilities, social justice groups, and others were non-core partners. Network density was more likely to be associated with any action by FPCs, and it was especially pronounced for advocacy actions taken by FPCs; trends were similar among FPCs that reported using a racial or social equity framework. The findings begin to uncover core actors in FPCs' partnerships and opportunities to establish new partnerships, particularly with social justice groups. The results also suggest that network density (interconnectedness) may be more important than other network characteristics when responding to food-related needs.
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Affiliation(s)
- Yeeli Mui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (A.A.); (J.A.W.)
| | - Atif Adam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (A.A.); (J.A.W.)
| | - Raychel Santo
- Johns Hopkins Center for a Livable Future, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (R.S.); (K.B.); (A.P.)
| | - Karen Bassarab
- Johns Hopkins Center for a Livable Future, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (R.S.); (K.B.); (A.P.)
| | - Julia A. Wolfson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (A.A.); (J.A.W.)
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Anne Palmer
- Johns Hopkins Center for a Livable Future, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (R.S.); (K.B.); (A.P.)
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Zacher M, Raker EJ, Meadows MC, Ramírez S, Woods T, Lowe SR. Mental health during the COVID-19 pandemic in a longitudinal study of Hurricane Katrina survivors. SSM - MENTAL HEALTH 2023; 3:100198. [PMID: 36844796 PMCID: PMC9940480 DOI: 10.1016/j.ssmmh.2023.100198] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
While the COVID-19 pandemic is known to have caused widespread mental health challenges, it remains unknown how the prevalence, presentation, and predictors of mental health adversity during the pandemic compare to other mass crises. We shed light on this question using longitudinal survey data (2003-2021) from 424 low-income mothers who were affected by both the pandemic and Hurricane Katrina, which struck the U.S. Gulf Coast in 2005. The prevalence of elevated posttraumatic stress symptoms was similar 1-year into the pandemic (41.6%) as 1-year post-Katrina (41.9%), while elevated psychological distress was more prevalent 1-year into the pandemic (48.3%) than 1-year post-Katrina (37.2%). Adjusted logistic regression models showed that pandemic-related bereavement, fear or worry, lapsed medical care, and economic stressors predicted mental health adversity during the pandemic. Similar exposures were associated with mental health adversity post-Katrina. Findings underscore the continued need for pandemic-related mental health services and suggest that preventing traumatic or stressful exposures may reduce the mental health impacts of future mass crises.
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Affiliation(s)
- Meghan Zacher
- Population Studies and Training Center, Brown University, Providence, RI, 02912, USA
| | - Ethan J Raker
- Department of Sociology, University of British Columbia, Vancouver, Canada
| | - Marie-Claire Meadows
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Saúl Ramírez
- Department of Sociology, Harvard University, Cambridge, MA, 02138, USA
| | - Tyler Woods
- Department of Sociology, Harvard University, Cambridge, MA, 02138, USA
| | - Sarah R Lowe
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, 06510, USA
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Ujah OI, LeCounte ES, Ogbu CE, Kirby RS. Food insecurity and delayed or forgone health care among pregnant and postpartum women in the United States, 2019-2021. Nutrition 2023; 116:112165. [PMID: 37573618 DOI: 10.1016/j.nut.2023.112165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/29/2023] [Accepted: 07/15/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE Despite the growing food insecurity crisis in the United States, limited evidence exists about the effects of food insecurity on the unmet health care needs of peripartum (pregnant and postpartum) women. The aim of this study was to examine the association between food insecurity and delayed or forgone health care among peripartum women in the United States from 2019 to 2021. METHODS We conducted a pooled cross-sectional analysis using data from the 2019, 2020, and 2021 National Health Interview Surveys. Food security status was defined by type (high/marginal, low, and very low). Descriptive analysis and multivariable logistic regression, adjusted for sociodemographic and health-related characteristics, were conducted to estimate the overall and specific delayed or forgone health care (yes or no) between the different categories of food security. RESULTS Of the 1525 peripartum women (weighted, N = 5,580,186), 11% of peripartum women in the United States experienced suboptimal food security in the 12 mo between 2019 and 2021, with 5% experiencing low and 5% experiencing very low food security. This included 6% (95% confidence interval [CI], 5-8%) who reported delaying filling a medical prescription, 6% (95% CI, 5-8%) who required counseling or therapy from a mental health professional but did not receive it, 6% (5-8%) who delayed counseling or therapy from a mental health professional, 8% (95% CI, 6-10%) who needed medical care but did not receive it, and 9% (95% CI, 7-10%) who delayed medical care. Peripartum women with low and very food security were more likely to delay or forego health care due to cost concerns than food-secure peripartum women. In the multivariable analyses adjusted for predisposing, enabling, and need-based factors, women with low and very low food security had higher risk for delayed or forgone health care than those with marginal or high food security. CONCLUSION This study demonstrated a positive association between food insecurity and cost-related unmet health care needs among peripartum women. Future empirical studies are needed to assess the effects of peripartum health care interventions targeting food insecurity on reducing health care access disparities associated with costs and improving peripartum health outcomes.
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Affiliation(s)
- Otobo I Ujah
- College of Public Health, University of South Florida, Tampa, Florida, United States.
| | - Erica S LeCounte
- College of Public Health, University of South Florida, Tampa, Florida, United States
| | - Chukwuemeka E Ogbu
- College of Public Health, University of South Florida, Tampa, Florida, United States
| | - Russell S Kirby
- College of Public Health, University of South Florida, Tampa, Florida, United States
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Cai J, Bidulescu A. Trends in unmet health care needs among adults in the U.S., 2019-2021. Prev Med 2023; 175:107699. [PMID: 37690672 DOI: 10.1016/j.ypmed.2023.107699] [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: 04/17/2023] [Revised: 09/03/2023] [Accepted: 09/06/2023] [Indexed: 09/12/2023]
Abstract
To examine recent trends in unmet health care needs among US adults, cross-sectional data of 93,047 adults from 2019 to 2021 National Health Interview Survey were analyzed. The weighted prevalence and changes in prevalence of cost-related or COVID-19-related unmet health care needs were estimated, first overall and then stratified by socio-demographic characteristics. The prevalence of cost-related unmet health care needs was 8.3% (95% CI: 7.8%, 8.8%) in 2019, which significantly decreased to 6.6% (95% CI: 6.2%, 7.0%) in 2020 and 6.1% (95% CI: 5.7%, 6.4%) in 2021. Across most socio-demographic groups, the prevalence of cost-related unmet health care needs significantly decreased between 2019 and 2020 (absolute changes ranged from -7.4% to -1%) and between 2019 and 2021 (absolute changes ranged from -10.5% to -1.2%), with significant reductions among uninsured adults, adults below the federal poverty level, and Hispanics. The prevalence of COVID-19-related unmet health care needs was 15.7% (95% CI: 14.9%, 16.4%) in 2020, which decreased to 11.9% (95% CI: 11.5%, 12.4%) in 2021. The prevalence of COVID-19-related unmet health care needs significantly decreased across most socio-demographic groups between 2020 and 2021 (absolute changes ranged from -4.9% to -2.4%), with significant reductions among the older, the unemployed, non-Hispanic Black adults, and adults with education level ≥ college. Overall, a modest decrease in the prevalence of both cost-related and COVID-19-related unmet health care needs was observed between 2019 and 2021. However, the fact that over 10% of US adults had unmet health care needs because of the COVID-19 pandemic is still concerning, warranting continued surveillance.
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Affiliation(s)
- Jiahui Cai
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, IN, United States.
| | - Aurelian Bidulescu
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, IN, United States
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Hernandez M, Wong R, Yu X, Mehta N. In the wake of a crisis: Caught between housing and healthcare. SSM Popul Health 2023; 23:101453. [PMID: 37456616 PMCID: PMC10338349 DOI: 10.1016/j.ssmph.2023.101453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 06/08/2023] [Accepted: 06/11/2023] [Indexed: 07/18/2023] Open
Abstract
Objective To measure the association between housing insecurity and foregone medication due to cost among Medicare beneficiaries aged 65+ during the Recession. Methods Data came from Medicare beneficiaries aged 65+ years from the 2006-2012 waves of the Health and Retirement Study (HRS). Two-wave housing insecurity changes are evaluated as follows: (i) No insecurity, (ii) Persistent insecurity, (iii) Onset insecurity, and (iv) Onset security. We implemented a series of four weighted longitudinal General Estimating Equation (GEE) models, two minimally adjusted and two fully adjusted models, to estimate the probability of foregone medications due to cost between 2008 and 2012. Results Our study sample was restricted to non-proxy interviews of non-institutionalized Medicare beneficiaries aged 65+ in the 2006 wave (n = 9936) and their follow up visits (n = 8753; in 2008; n = 7464 in 2010; and n = 6594 in 2012). Results from our fully adjusted model indicated that the odds of foregone medication was 64% higher among individuals experiencing Onset insecurity versus No insecurity in 2008, and also generally larger for individuals experiencing Onset Insecurity versus Persistent Insecurity. Odds of foregone medication was also larger among females, minority versus non-Hispanic white adults, those reporting a chronic condition, those with higher medical expenditures, and those living in the South versus Northeast. Conclusion This study drew from nationally representative data to elucidate the disparate health and financial impacts of a crisis on Medicare beneficiaries who, despite health insurance coverage, displayed variability in foregone medication patterns. Our findings suggest that the onset of housing insecurity is most closely linked with unexpected acute economic shocks leading households with little time to adapt and forcing trade-offs in their prescription and other needs purchases. Both housing and healthcare policy implications exist from these findings including expansion of low-income housing units and rent relief post-recession as well as wider prescription drug coverage for Medicare adults.
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Affiliation(s)
- Monica Hernandez
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch Galveston, 301 University Blvd, Galveston, TX 77555, USA
| | - Rebeca Wong
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch Galveston, 301 University Blvd, Galveston, TX 77555, USA
- Sealy Center on Aging, University of Texas Medical Branch Galveston, 301 University Blvd, Galveston, TX 77555, USA
| | - Xiaoying Yu
- Department of Biostatistics & Data Science, School of Public and Population Health, University of Texas Medical Branch Galveston, 301 University Blvd, Galveston, TX 77555, USA
| | - Neil Mehta
- Department of Epidemiology, School of Public and Population Health, University of Texas Medical Branch Galveston, 301 University Blvd, Galveston, TX 77555, USA
- Sealy Center on Aging, University of Texas Medical Branch Galveston, 301 University Blvd, Galveston, TX 77555, USA
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11
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Jones HN, Leiman DA, Porter Starr KN, North R, Pieper CF, Robison RD, Cohen SM. Dysphagia in Older Adults is Associated With Food Insecurity and Being Homebound. J Appl Gerontol 2023; 42:1993-2002. [PMID: 37249305 PMCID: PMC10811649 DOI: 10.1177/07334648231177568] [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: 05/31/2023] Open
Abstract
Objective: Our aim was to evaluate relationships between swallowing difficulty (dysphagia) and social determinants of health (SDOH) in older adults ≥65 years. Method: Cross-sectional analyses were performed in community-dwelling Medicare beneficiaries from the National Health & Aging Trends Study (NHATS). The primary exposure was self-reported difficulty chewing/swallowing in the prior month. Dependent measures included a variety of SDOH outcomes (e.g., food insecurity [FI]). Weighted logistic regression models were estimated to determine associations between dysphagia and SDOH outcomes. Results: Of 4041 participants, 428 (10.6%) self-reported dysphagia. In the adjusted model, dysphagia was associated with significantly increased odds for FI (odds ratio [OR] = 1.48, 95% confidence interval [CI] = 1.06, 2.07, p = .023) and being homebound (OR = 1.32, 95% CI = 1.13, 1.55, p= < .001). Discussion: Older adults with dysphagia had increased odds of FI and being homebound. These associations have implications for health-promoting interventions at the individual and policy levels in older adults.
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Affiliation(s)
- Harrison N. Jones
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
| | - David A. Leiman
- Department of Medicine, Division of Gastroenterology, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | - Kathryn N. Porter Starr
- Department of Medicine, Division of Geriatrics, Duke University School of Medicine, Durham, NC
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC
- Durham VA Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, NC
| | - Rebecca North
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC
| | - Carl F. Pieper
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | - Raele D. Robison
- Department of Medicine, University of Wisconsin-Madison, Madison, WI
| | - Seth M. Cohen
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
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12
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Choe H, Pak TY. Food insecurity and unmet healthcare needs in South Korea. Int J Equity Health 2023; 22:148. [PMID: 37542235 PMCID: PMC10403829 DOI: 10.1186/s12939-023-01937-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/18/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Food insecurity is a significant risk factor for chronic and infectious diseases. It is also a barrier to accessing healthcare because food insecurity tends to co-occur with other socioeconomic disadvantages. The objective of this study is to examine whether food insecure individuals in South Korea can access desired level of healthcare when needed. METHODS This repeated cross-sectional study used data from the 2013-2015 and 2019-2021 waves of the Korean National Health and Nutrition Examination Survey. Multivariable logistic regression models were used to examine the association between household food insecurity and two indicators of unmet healthcare needs - any experience of forgoing medical service and the reasons for unmet needs (problems with availability, acceptability, and accessibility). Covariates indicating predisposing, enabling, and need factors were included in the regression analyses. RESULTS Of the 19,394 participants aged 19-64 years, 4.5% were moderately food insecure, 0.9% were severely food insecure, and 9.3% reported unmet healthcare needs. In the adjusted model, moderate food insecurity (OR, 1.47; 95% CI, 1.19-1.82) and severe food insecurity (OR, 3.32; 95% CI, 2.27-4.85) were associated with higher odds of unmet healthcare needs in a dose-graded manner. These associations were largely due to the increased odds of accessibility-related unmet needs among participants with moderate (OR, 2.31; 95% CI, 1.68-3.19) and severe food insecurity (OR, 6.15; 95% CI, 3.91-9.68). CONCLUSIONS Food insecurity was associated with higher odds of unmet healthcare needs among Korean adults. Competing life demands may have a cumulative impact on health over the short and long term. Efforts to address trade-offs between healthcare needs and food insecurity may improve the health and well-being of marginalized populations.
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Affiliation(s)
- Hwi Choe
- Department of Consumer Science and Convergence Program for Social Innovation, Sungkyunkwan University, Seoul, South Korea
| | - Tae-Young Pak
- Department of Consumer Science and Convergence Program for Social Innovation, Sungkyunkwan University, Seoul, South Korea.
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13
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Conboy NE, Nickow A, Awoonor-Williams JK, Hirschhorn LR. Self-reported delays in care-seeking in West Africa during the first wave of the COVID-19 pandemic. BMC Health Serv Res 2023; 23:785. [PMID: 37481561 PMCID: PMC10363320 DOI: 10.1186/s12913-023-09812-x] [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: 12/19/2022] [Accepted: 07/13/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic caused delays in care-seeking due to fears of infection and decreased healthcare access globally. These delays have been linked in some countries to COVID-19 perceptions, decreased income, and food insecurity, but little is known about patient-level factors for decreased care-seeking specifically at the beginning of COVID-19 in West Africa. Understanding these factors is important to identify those at highest risk and address healthcare-related barriers. METHODS This study used self-reported data from telephone surveys in a population-based sample in Burkina Faso (n = 1352), Ghana (n = 1621), and Sierra Leone (n = 1301) in May-June 2020. Questions assessed delays in care-seeking, sociodemographic variables, COVID-19 beliefs, and food insecurity. Bivariate analyses using chi-square and multivariate analyses using logistic regression were used to explore associations between factors and delays in care-seeking by country. Independent variables were chosen based on prior research suggesting that financial insecurity, older age, female sex, rural location, and COVID-related concerns are associated with delays. RESULTS Between March-June 2020, 9.9%, 10.6%, and 5.7% of participants in Burkina Faso, Ghana, and Sierra Leone, respectively, delayed care-seeking. Food insecurity was prevalent (21.8-46.1%) and in bivariate analyses was associated with delays in care-seeking in Burkina Faso and Ghana. Concern about risk of household contraction of COVID-19 was common (18.1-36.0%) and in Ghana and Sierra Leone was associated with delays in care-seeking in both bivariate and multivariate analyses. In bivariate analyses, females showed more delays in Burkina Faso, while age above 30 and urban location were associated with delays in Ghana. In multivariate analyses, food insecurity was associated with increased delayed care-seeking in Burkina Faso. CONCLUSIONS Multiple factors were associated with delays in care-seeking early in the COVID-19 pandemic, with food insecurity and concerns about infection showing significant associations in multiple countries. These findings highlight the need to invest in clinic accessibility, community education, and financial assistance to address barriers in healthcare. While many delays have subsided since the initial phase of the COVID-19 pandemic, understanding factors associated with early disruptions of care-seeking at the patient and household level will inform strategies for maintaining healthcare access during future pandemics in West Africa.
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Affiliation(s)
- Natalie E Conboy
- Northwestern University Feinberg School of Medicine, IL, Chicago, USA.
| | - Andre Nickow
- Northwestern University Global Poverty Research Lab, Evanston, IL, USA
| | - John Koku Awoonor-Williams
- Formerly of the Department of Policy, Planning, Monitoring and Evaluation, Ghana Health Service, Accra, Ghana
| | - Lisa R Hirschhorn
- Northwestern University Feinberg School of Medicine, IL, Chicago, USA
- Robert J. Havey Institute of Global Health, Chicago, IL, USA
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14
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Mulia N, Ye Y, Greenfield TK, Martinez P, Patterson D, Kerr WC, Karriker-Jaffe KJ. Inequitable access to general and behavioral healthcare in the US during the COVID-19 pandemic: A role for telehealth? Prev Med 2023; 169:107426. [PMID: 36709864 PMCID: PMC9877144 DOI: 10.1016/j.ypmed.2023.107426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/27/2023]
Abstract
Wide-ranging effects of the COVID-19 pandemic have led to increased psychological distress and alcohol consumption, and disproportionate hardship for disadvantaged groups. Early in the pandemic, telehealth services were expanded to maintain healthcare access amidst lockdowns, medical office closures, and fear of infection. This study examines general and behavioral healthcare access and disparities during the first year of the pandemic. Data are from the 2019-2020 US National Alcohol Survey (collected February 2019 to April 2020) and its COVID follow-up survey conducted January 30 to March 28, 2021 (N = 1819). General and behavioral healthcare-related outcomes were assessed at follow-up, and included perceived need for and receipt of care, delayed care, and use of telehealth since April 1, 2020. Results indicate that the majority of respondents with perceived need for healthcare received some behavioral healthcare (reported by 63%) and particularly general healthcare (88%), but nearly half (48%) delayed needed care. Delays were mostly due to COVID-related reasons, but cost barriers also were common and significantly impeded care-seeking by uninsured persons, young adults, rural residents, and persons whose employment was reduced by the pandemic. Disparities in the receipt of healthcare were pronounced for Hispanic/Latinx (vs. White) and lower-income (vs. higher-income) groups (AORs <0.37, p's < 0.05). Notably, telehealth was commonly used by Hispanic/Latinx and lower-income groups for general and particularly behavioral healthcare. Results suggest that telehealth has provided an important bridge to healthcare for certain medically underserved groups during the pandemic, and may be vital to future efforts to increase equity in healthcare access.
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Affiliation(s)
- Nina Mulia
- Alcohol Research Group, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA.
| | - Yu Ye
- Alcohol Research Group, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Thomas K Greenfield
- Alcohol Research Group, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Priscilla Martinez
- Alcohol Research Group, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Deidre Patterson
- Alcohol Research Group, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - William C Kerr
- Alcohol Research Group, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
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15
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Abstract
Early in the pandemic, New York City's public hospital system partnered with multiple philanthropic foundations to offer an unconditional cash transfer program for low-income New Yorkers affected by COVID-19. The $1000 cash transfers were designed to help people meet their most immediate health and social needs and were incorporated into healthcare delivery and contact tracing workflows as a response to the public health emergency. To better understand program recipients' experiences, researchers conducted 150 telephone surveys with randomly sampled cash transfer recipients and 20 in-depth qualitative interviews with purposefully sampled survey participants. Survey participants were predominantly Latinx (87%) and women (65%). The most common reported uses of the $1000 were food and rent. Most participants (79%) reported that without the $1000 cash transfer they would have had difficulty paying for basic expenses or making ends meet, with specific positive effects reported related to food, housing, and ability to work. The majority of survey participants reported that receiving the cash assistance somewhat or greatly improved their physical health (83%) and mental health (89%). Qualitative interview results generally supported the survey findings.
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16
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Gibbs L, Thomas AJ, Coelho A, Al-Qassas A, Block K, Meagher N, Eisa L, Fletcher-Lartey S, Ke T, Kerr P, Kwong EJL, MacDougall C, Malith D, Marinkovic Chavez K, Osborne D, Price DJ, Shearer F, Stoove M, Young K, Zhang Y, Gibney KB, Hellard M. Inclusion of Cultural and Linguistic Diversity in COVID-19 Public Health Research: Research Design Adaptations to Seek Different Perspectives in Victoria, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2320. [PMID: 36767686 PMCID: PMC9916203 DOI: 10.3390/ijerph20032320] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/17/2023] [Accepted: 01/21/2023] [Indexed: 06/18/2023]
Abstract
Participation of people from culturally and linguistically diverse (CALD) communities in public health research is often limited by challenges with recruitment, retention and second-language data collection. Consequently, people from CALD communities are at risk of their needs being marginalised in public health interventions. This paper presents intrinsic case analyses of two studies which were adapted to increase the cultural competence of research processes. Both cases were part of the Optimise study, a major mixed methods research study in Australia which provided evidence to inform the Victorian state government's decision-making about COVID-19 public health measures. Case study 1 involved the core Optimise longitudinal cohort study and Case study 2 was the CARE Victorian representative survey, an Optimise sub-study. Both case studies engaged cultural advisors and bilingual staff to adjust the survey measures and research processes to suit target CALD communities. Reflexive processes provided insights into the strengths and weaknesses of the inclusive strategies. Selected survey results are provided, demonstrating variation across CALD communities and in comparison to participants who reported speaking English at home. While in most cases a gradient of disadvantage was evident for CALD communities, some patterns were unexpected. The case studies demonstrate the challenge and value of investing in culturally competent research processes to ensure research guiding policy captures a spectrum of experiences and perspectives.
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Affiliation(s)
- Lisa Gibbs
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC 3053, Australia
| | | | | | | | - Karen Block
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC 3053, Australia
| | - Niamh Meagher
- Peter Doherty Institute for Infection & Immunity, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Limya Eisa
- The Burnet Institute, Melbourne, VIC 3004, Australia
| | | | - Tianhui Ke
- The Burnet Institute, Melbourne, VIC 3004, Australia
| | - Phoebe Kerr
- The Burnet Institute, Melbourne, VIC 3004, Australia
| | - Edwin Jit Leung Kwong
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC 3053, Australia
| | - Colin MacDougall
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC 3053, Australia
| | - Deng Malith
- The Burnet Institute, Melbourne, VIC 3004, Australia
| | - Katitza Marinkovic Chavez
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC 3053, Australia
| | | | - David J. Price
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC 3053, Australia
- Peter Doherty Institute for Infection & Immunity, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Freya Shearer
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC 3053, Australia
| | - Mark Stoove
- The Burnet Institute, Melbourne, VIC 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, VIC 3083, Australia
| | - Kathryn Young
- The Burnet Institute, Melbourne, VIC 3004, Australia
| | - Yanqin Zhang
- The Burnet Institute, Melbourne, VIC 3004, Australia
| | - Katherine B. Gibney
- Peter Doherty Institute for Infection & Immunity, The University of Melbourne, Parkville, VIC 3052, Australia
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17
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Park J, Kim C, Son S. Disparities in food insecurity during the COVID-19 pandemic: A two-year analysis. CITIES (LONDON, ENGLAND) 2022; 131:104003. [PMID: 36168406 PMCID: PMC9500096 DOI: 10.1016/j.cities.2022.104003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 09/18/2022] [Accepted: 09/18/2022] [Indexed: 06/01/2023]
Abstract
While the overall level of food insecurity in the United States has remained stable during the COVID-19 pandemic, certain individuals and regions have fared worse than others. This study examines state-level variables affecting individual- and household-level food insecurity during the recent two years of the pandemic beginning in 2020 by utilizing the Household Pulse Survey, a new nationally representative dataset developed by the United States Census Bureau. The results of this study suggest a set of statewide factors, such as pandemic-driven market conditions, COVID-19 prevalence, and the implementation of federal programs, are associated with the level of food insecurity that individuals have experienced during the pandemic over the past two years. The associations varied by household income levels, indicating a strong relationship between higher-income households and market conditions, as well as the importance of federal programs and state policies in alleviating food insecurity among lower-income households. The food insecurity indices also overlapped with different socioeconomic and health hardships caused by the pandemic, such as employment income loss, housing instability, and mental health problems. The findings of this study highlight state-level contexts, particularly the role of state governments, in responding to pandemic-related food insecurity.
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Affiliation(s)
- JungHo Park
- Department of Housing & Interior Design (BK21 Four AgeTech-Service Convergence Major), College of Human Ecology, Kyung Hee University, Seoul, South Korea
| | - Chaeri Kim
- Resource & Environmental Management, Action On Climate, Simon Fraser University, British Columbia, Canada
| | - Seulgi Son
- Department of Urban & Regional Planning, Taubman College of Architecture & Urban Planning, University of Michigan, 2000 Bonisteel Blvd, Ann Arbor, MI 48109, United States
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18
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Payán DD, Perez-Lua F, Goldman-Mellor S, Young MEDT. Rural Household Food Insecurity among Latino Immigrants during the COVID-19 Pandemic. Nutrients 2022; 14:2772. [PMID: 35807952 PMCID: PMC9268956 DOI: 10.3390/nu14132772] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 01/27/2023] Open
Abstract
U.S. food insecurity rates rapidly increased during the COVID-19 pandemic, with disproportionate impacts on Latino immigrant households. We conducted a qualitative study to investigate how household food environments of rural Latino immigrants were affected during the COVID-19 pandemic. Thirty-one respondents (42% from low food security households) completed interviews (July 2020-April 2021) across four rural counties in California. A rural household food security conceptual framework was used to analyze the data. Early in the pandemic, food availability was impacted by school closures and the increased consumption of meals/snacks at home; food access was impacted by reduced incomes. Barriers to access included limited transportation, excess distance, and lack of convenience. Key resources for mitigating food insecurity were the Supplemental Nutrition Assistance Program (SNAP), the Pandemic Electronic Benefits Transfer (P-EBT), school meals, charitable food programs, and social capital, although the adequacy and acceptability of charitable food distributions were noted issues. Respondents expressed concern about legal status, stigma, and the public charge rule when discussing barriers to government nutrition assistance programs. They reported that food pantries and P-EBT had fewer access barriers. Positive coping strategies included health-promoting food substitutions and the reduced consumption of meals outside the home. Results can inform the development of policy and systems interventions to decrease food insecurity and nutrition-related health disparities among rural Latino immigrants.
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Affiliation(s)
- Denise Diaz Payán
- Department of Health, Society and Behavior, Program in Public Health, University of California, Irvine, CA 92697, USA
| | - Fabiola Perez-Lua
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, CA 95343, USA; (F.P.-L.); (S.G.-M.); (M.-E.D.T.Y.)
| | - Sidra Goldman-Mellor
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, CA 95343, USA; (F.P.-L.); (S.G.-M.); (M.-E.D.T.Y.)
| | - Maria-Elena De Trinidad Young
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, CA 95343, USA; (F.P.-L.); (S.G.-M.); (M.-E.D.T.Y.)
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19
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Kapadia F. Confronting and Ending Food Insecurity During and Beyond the Pandemic: A Public Health of Consequence, July 2022. Am J Public Health 2022; 112:962-964. [PMID: 35728028 PMCID: PMC9222449 DOI: 10.2105/ajph.2022.306922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Farzana Kapadia
- Farzana Kapadia is the deputy editor of AJPH and an associate professor of epidemiology at the School of Global Public Health, New York University, New York
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