Effect of a Multicomponent Food Pantry Intervention in Client Subgroups

Nutrition promotion programs may have varying effects and influence health disparities. SuperShelf promotes healthy choices in food pantries through inventory changes and nudge implementation (e.g., choice architecture). This secondary analysis of the SuperShelf cluster-randomized trial assessed whether the effect of SuperShelf on client diet quality differed by equity characteristics. English-, Spanish-, or Somali-speaking adult clients from 11 food pantries in Minnesota were included (N = 193). We measured change in diet quality by the Healthy Eating Index 2015 (HEI-2015; maximum score 100) using up to two 24 h dietary recalls from pre-intervention and post-intervention periods. We used linear mixed-effects models to determine whether the effect of SuperShelf on diet quality varied by self-reported gender, race/ethnicity, education, and employment status. In separate adjusted models, the interactions of SuperShelf and gender, education, or employment status were not significant. The interaction of SuperShelf and race/ethnicity was significant (p-interaction = 0.008), but pairwise comparisons in diet quality were non-significant in all racial/ethnic subgroups. SuperShelf did not have differential effects on diet quality by gender, race/ethnicity, education, or employment status, suggesting it does not worsen dietary disparities among food pantry clients, though more subgroup analyses are needed to explore potential racial/ethnic disparities in this context.

Integrating HPV self-collect into primary care to address cervical cancer screening disparities

Human papillomavirus (HPV) self-collect shows promise to increase cervical cancer screening rates in underscreened populations, such as Somali patients, but little is known about how to integrate such an approach in primary care. In this study, primary care providers and staff who provide primary care services to Somali women were asked for their views on integrating HPV self-collect into routine care to address cervical cancer screening disparities. Thirty primary care providers and staff participated in semi-structured interviews exploring their views on HPV self-collect and their anticipated needs or barriers to implementing this approach into the clinic generally and with specific patient populations, such as Somali women. A thematic analysis using the constructivist version of grounded theory was undertaken. Providers and staff anticipate positive patient reaction to the option of HPV self-collect, and were interested in using this approach both for Somali patients and for all patients in general. HPV self-collect was viewed as straightforward to integrate into existing clinic workflows. Providers largely lacked awareness of the evidence supporting primary HPV testing and HPV self-collect specifically, sharing concerns about effectiveness of self-collect and the lack of a physical exam. Providers felt clinic-wide staff education and patient education, along with strategies to address disparities, such as cultural and linguistic tailoring would be needed for successful implementation. Integrating HPV self-collect as an option in the cervical cancer screening process in a primary care clinical encounter offers considerable opportunity to address health disparities and may benefit all patients.

A Cluster-Randomized Evaluation of the SuperShelf Intervention in Choice-Based Food Pantries

BACKGROUND

Interventions in food pantry settings have the potential to improve health among clients at risk of diet-related disease.

PURPOSE

This study evaluates whether a cluster-randomized, behavioral intervention in food pantries resulted in improved client outcomes.

METHODS

Sixteen Minnesota food pantries were randomized to an intervention (n = 8) or control condition (n = 8). The intervention offered pantries technical assistance to improve healthy food supply and implement behavioral economics strategies to promote healthy food selection. A convenience sample of adult clients were enrolled (paired sample, 158 intervention, 159 control) and followed for 1 year. Additional clients were enrolled at follow-up to assess food selection (follow-up sample, 85 intervention, 102 control). Analysis was limited to data from 11 pantries (5 intervention, 6 control) due to COVID-19. Outcome measures included Healthy Eating Index-2015 (HEI-2015) total and subcomponent scores for 24-hr dietary recalls and client cart selections, and Life's Simple 7 (LS7) total and subcomponent scores. Multilevel mixed-effects models tested whether client outcomes differed by intervention condition.

RESULTS

In adjusted models, there were no statistically significant differences by intervention condition in HEI-2015 or LS7 scores. Clients in intervention food pantries had improved Refined Grain subcomponent scores (p = .004); clients in control pantries had worsened Saturated Fat subcomponents scores (p = .019) and improved physical activity scores (p = .007).

CONCLUSIONS

The intervention did not result in improved diet quality or cardiovascular health as measured by HEI-2015 or LS7. Coordinated efforts across settings are needed to address health risks facing this population.

A randomized study of food pantry environment-level change following the SuperShelf intervention

The charitable food system is rapidly evolving. Interventions that target the food pantry environment and use behavioral economics are in high demand, but can be difficult to implement in a low-resource setting. This is an analysis of secondary, environment-level outcomes in a food pantry intervention (SuperShelf); the study evaluates whether the intervention resulted in measurable changes to the food pantry environment and improved diet quality of the food available to clients, compared with a control group of food pantries. Eleven food pantries were randomized to an intervention (n = 5) or control (n = 6) condition and completed baseline and one-year follow-up measures between 2018 and 2020. The intervention addressed healthy food supply and the appeal of healthy foods using behavioral economics. Assessments included manager surveys, intervention fidelity, food inventory, and food supply tracked over 5 days. Measures included change in intervention fidelity (range 0-100) with four subcomponents; Healthy Eating Index scores (HEI-2015, range 0-100) with 13 subcomponents; and Food Assortment Scoring Tool scores (FAST, range 0-100). Descriptive analyses and t-tests examined pre-post changes within and between intervention arms. Average fidelity scores increased from baseline to follow-up in the intervention group compared with the control group (p < .001), as did FAST scores (p = .02). Average HEI-2015 Total scores increased in the intervention group by 6.3 points and by 1.6 points in the control group, but the difference in change between groups was not statistically significant (p = .56). The intervention was implemented with high fidelity at five sites, with some evidence of change in the nutritional quality of the food available on the shelf to clients.

Applying the Healthy Eating Index-2015 in a Sample of Choice-Based Minnesota Food Pantries to Test Associations Between Food Pantry Inventory, Client Food Selection, and Client Diet

BACKGROUND

Food pantry clients are at a high risk for diet-related chronic disease and suboptimal diet. Relatively little research has examined diet quality measures in choice-based food pantries where clients can choose their own food.

OBJECTIVE

This study tested whether the diet quality scores for food at the pantry were associated with client food selection scores, and whether client food selection scores at the pantry were associated with client diet intake scores.

DESIGN

This cross-sectional regression analysis, part of a larger evaluation study (SuperShelf), used baseline data from client and food pantry surveys, food pantry inventories, assessments of client food selections ("client carts"), and single 24-hour client dietary recalls.

PARTICIPANTS/SETTING

The analysis includes 316 clients who completed a survey (282 of whom completed a dietary recall measure) from one of 16 choice-based Minnesota food pantries during 2018-2019. Adult English, Spanish, or Somali-speaking clients were eligible in the case that they had selected food on the day of recruitment at their food pantry visit.

MAIN OUTCOME MEASURES

A Healthy Eating Index-2015 (HEI-2015) Total score and 13 subcomponent scores were calculated for: pantry food inventories of food available on the shelf, client carts, and a 24-hour client dietary recall.

STATISTICAL ANALYSIS

Descriptive statistics were generated for client and food pantry characteristics, and for HEI-2015 Total score and subcomponent scores. Linear regression models tested the association between HEI-2015 Total score and subcomponent scores for food pantry inventory and client carts, and for client carts and dietary recalls, adjusted for covariates.

RESULTS

Food pantry inventory HEI-2015 Total score averaged 65.1, client cart Total score averaged 60.8, and dietary recall Total score averaged 50.9. The diet quality scores for inventory were not associated with client cart scores, except for Added Sugars (P = .005). Client cart HEI-2015 Total score was positively associated with client diet HEI-2015 Total score (P = .002) and associations for Total Fruits, Whole Fruits, Total Vegetables, Greens and Beans, Whole Grains, Seafood and Plant Proteins, and Added Sugars subcomponents were statistically significant.

CONCLUSIONS

In choice-based Minnesota food pantries, the diet quality of food selected by clients was positively associated with client diet quality.

Needs and Preferences Among Food Pantry Clients

INTRODUCTION

Food pantries serve households in need, including many with a family member with a diet-related chronic disease, yet data on client priorities to inform hunger relief practices are lacking. We used a statewide client survey in Minnesota to determine needs and priorities of food pantry clients in 2017 and 2019 and to identify how well Minnesota pantries met those needs in 2019.

METHODS

Our survey was administered in 2017 and 2019. Food pantries in Minnesota were mailed 25 surveys each, with instructions for administering the surveys anonymously to clients. Descriptive analyses compared 2017 and 2019 data and compared client priorities for foods and services with how often they were available at the pantry in 2019.

RESULTS

The 2017 survey represented 4,321 clients from 188 pantries; the 2019 survey represented 5,529 clients from 220 pantries. Most measures of food pantry use were consistently high across the years; about three-quarters of clients had been visiting the pantry for a year or more. In 2019, 85% of clients said it was important to have fresh fruits and vegetables, but only 52% said these were always available. About two-thirds had a household member with a diet-related chronic disease. The ability to choose their own foods was clients' top priority.

CONCLUSION

The types of food most requested by clients tended to be healthy but were inconsistently available. Most important to clients was being able to choose their own food. Results underscore the need for continued monitoring of client priorities.