Food Insecurity,Neighborhood Food Access,and Food Assistance in Philadelphia

An estimated 17.6 million American households were food insecure in 2012, meaning they were unable to obtain enough food for an active and healthy life. Programs to augment local access to healthy foods are increasingly widespread, with unclear effects on food security. At the same time, the US government has recently enacted major cuts to federal food assistance programs. In this study, we examined the association between food insecurity (skipping or reducing meal size because of budget), neighborhood food access (self-reported access to fruits and vegetables and quality of grocery stores), and receipt of food assistance using the 2008, 2010, and 2012 waves of the Southeastern Pennsylvania Household Health Survey. Of 11,599 respondents, 16.7 % reported food insecurity; 79.4 % of the food insecure found it easy or very easy to find fruits and vegetables, and 60.6 % reported excellent or good quality neighborhood grocery stores. In our regression models adjusting for individual- and neighborhood-level covariates, compared to those who reported very difficult access to fruits and vegetables, those who reported difficult, easy or very easy access were less likely to report food insecurity (OR 0.62: 95 % CI 0.43–0.90, 0.33: 95 % CI 0.23–0.47, and 0.28: 95 % CI 0.20–0.40). Compared to those who reported poor stores, those who reported fair, good, and excellent quality stores were also less likely to report food insecurity (OR 0.81: 95 % CI 0.60–1.08, 0.58: 95 % CI 0.43–0.78, and 0.43: 95 % CI 0.31–0.59). Compared to individuals not receiving food assistance, those receiving Supplemental Nutrition Assistance Program (SNAP) benefits were significantly more likely to be food insecure (OR 1.36: 95 % CI 1.11–1.67), while those receiving benefits from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (OR 1.17: 95 % CI 0.77–1.78) and those receiving both SNAP and WIC (OR 0.84: 95 % CI 0.61–1.17) did not have significantly different odds of food insecurity. In conclusion, better neighborhood food access is associated with lower risk of food insecurity. However, most food insecure individuals reported good access. Improving diet in communities with high rates of food insecurity likely requires not only improved access but also greater affordability.     

Linking Neighborhood Characteristics to Food Insecurity in Older Adults: The Role of Perceived Safety, Social Cohesion, and Walkability

Among the 14.6% of American households experiencing food insecurity, approximately 2 million are occupied by older adults. Food insecurity among older adults has been linked to poor health, lower cognitive function, and poor mental health outcomes. While evidence of the association between individual or household-level factors and food insecurity has been documented, the role of neighborhood-level factors is largely understudied. This study uses data from a representative sample of 1,870 New York City senior center participants in 2008 to investigate the relationship between three neighborhood-level factors (walkability, safety, and social cohesion) and food insecurity among the elderly. Issues relating to food security were measured by three separate outcome measures: whether the participant had a concern about having enough to eat this past month (concern about food security), whether the participant was unable to afford food during the past year (insufficient food intake related to financial resources), and whether the participant experienced hunger in the past year related to not being able to leave home (mobility-related food insufficiency). Unadjusted and adjusted logistic regression was performed for each measure of food insecurity. Results indicate that neighborhood walkability is an important correlate of mobility-related food insufficiency and concern about food insecurity, even after controlling the effects of other relevant factors.     

Food Insecurity Among Hispanic/Latino Youth: Who Is at Risk and What Are the Health Correlates?

Purpose

We examined the correlates and health implications of household food insecurity among Hispanic/Latino youth (aged 8–16 years), a high food insecurity–risk population.

Racial/Ethnic Disparities in Food Pantry Use and Barriers in Massachusetts during the First Year of the COVID-19 Pandemic

This study sought to describe racial disparities in food insecurity, food pantry use, and barriers to and experiences with food pantries during the first year of the COVID-19 pandemic. We surveyed 2928 adults in Massachusetts regarding food access in the year before and during the first year of the pandemic. Weighted multivariable logistic regression models assessed racial differences in barriers to and experiences with pantry use during the pandemic. Black and Latino adults experienced the highest prevalence of food insecurity and pantry use. Additionally, Black and Latino adults reported more barriers to, but less stigma around, pantry use compared to White adults. Latino adults were less likely to know about pantry hours/locations and encounter staff who spoke their language. Black and Latino adults were also more likely to find pantry hours/locations inconvenient and have difficulty with transportation. The COVID-19 pandemic resulted in increased food insecurity, and food access inequities persisted. Programmatic policies to improve pantry access in communities of color could include increasing the hours/days that pantries are open, increasing bilingual staff, providing transportation or delivery, and creating multilingual public awareness campaigns on how to locate pantries.     

Racial Disparities in COVID-19 Vaccine Acceptance: Building Trust to Protect Nursing Home Staff and Residents

Vaccines are critical to protect both nursing home residents and staff from COVID-19, but some staff have expressed reservations about being vaccinated. In this brief report, we describe interventions that Genesis HealthCare—one of the largest US long-term care providers—implemented after recognizing midway through vaccinations that racial and ethnic disparities existed in vaccine uptake among employees, with black and Hispanic employees having significantly lower rates of vaccination than their peers. Specifically, Genesis engaged its Diversity, Equity, and Inclusion (DEI) Committee to identify ways to augment its already comprehensive vaccine education campaign in order to build confidence among employees from minority communities. Interventions implemented beginning in late January 2021 included adding DEI representatives to information sessions to facilitate culturally sensitive discussions; holding information sessions at all times of day and night, and inviting employees’ family members to join; increasing availability of multilingual educational materials; and featuring DEI representatives in social media campaigns. Between the end of January and beginning of March 2021, we observed statistically significant improvements in the likelihood of black and Hispanic employees being vaccinated relative to white employees, calculated as the relative risk of vaccination, suggesting a reduction in vaccination disparity. Whether these trends are directly related to the organization’s efforts, or rather reflect individuals needing longer to become comfortable with the vaccines, is difficult to discern in the absence of a formal pragmatic trial. Still, these findings support the continuation of targeted educational and engagement efforts to improve vaccine uptake among staff, and the critical need to ensure that nursing homes have ongoing access to vaccine supply to continue their vaccination programs.     

Food Insecurity,Dietary Diversity,and Coping Strategies in Jordan during the COVID-19 Pandemic: A Cross-Sectional Study

The 2019 coronavirus disease (COVID-19) is an emerging respiratory infection with severe impacts on the nutritional status of the worldwide population. This cross-sectional study was conducted to assess the food insecurity, dietary diversity, and food-related coping strategies in Jordan during the pandemic using an online, self-administered questionnaire. Among the 740 adults who completed the survey, the prevalence of food security was 84.1%, whereas 2% and 13.9% were moderately and severely food-insecure, respectively. The determinants of food insecurity were educational level, monthly income, marital status, availability of health insurance, and type of residence. In addition, food insecurity was significantly higher among the participants who consumed two or fewer meals per day (p = 0.015). Moreover, an acceptable food consumption score was shown among 76.2% of the participants, and the remaining participants were at borderline (14.1%) or had poor scores (9.7%), with a significant association between food insecurity and food consumption scores (p < 0.001). The food-related coping strategies studied were significantly associated with food insecurity at both levels (p < 0.001) and were more evident in the severely food-insecure group. These findings highlight the adverse effects of COVID-19 restrictions on nutritional status, especially among food-insecure households, which might reduce food accessibility due to economic difficulties.     

Food Insecurity Pre- and Post the COVID-19 Pandemic and Economic Crisis in Lebanon: Prevalence and Projections

The coronavirus (COVID-19) pandemic has had serious repercussions on the global economy, work force, and food systems. In Lebanon, the pandemic overlapped with an economic crisis, which threatened to exacerbate food insecurity (FI). The present study aims to evaluate the trends and projections of FI in Lebanon due to overlapping health and economic crises. Data from Gallup World Poll (GWP) 2015–2017 surveys conducted in Lebanon on nationally representative adults (n = 3000) were used to assess FI trends and explore its sociodemographic correlates. Predictive models were performed to forecast trends in FI (2018–2022), using GWP data along with income reduction scenarios to estimate the impact of the pandemic and economic crises. Pre crises, trend analyses showed that FI could reach 27% considering wave year and income. Post crises, FI was estimated to reach on average 36% to 39%, considering 50–70% income reduction scenarios among Lebanese population. FI projections are expected to be higher among females compared to males and among older adults compared to younger ones (p < 0.05). These alarming findings call for emergency food security policies and evidence-based programs to mitigate the burden of multiple crises on the FI of Lebanese households and promote resilience for future shocks.     

The COVID-19 Pandemic as a Threat Multiplier for Childhood Health Disparities: Evidence from St. Louis,MO

The COVID-19 pandemic has highlighted socioeconomic and racial health disparities in the USA. In this study, we examined the COVID-19 pandemic as a threat multiplier for childhood health disparities by evaluating health behavior changes among urban St. Louis, MO, children (ages 6–14) during the COVID-19 pandemic. From 27 October to 10 December 2020, 122 parents/guardians reported on their children’s health behaviors (Eating, Sleeping, Physical activity, Time outside, Time with friends in-person, Time with friends remotely, Time using media for educational proposes, Time using media for non-educational proposes, and Social connectedness) prior to and during the COVID-19 pandemic. We ran K-means cluster analyses to identify distinct health behavior cluster profiles. Relative risks were determined to evaluate behavioral differences between the two clusters. Two distinct cluster profiles were identified: a High Impact profile (n = 49) and a Moderate Impact profile (n = 73). Children in the High Impact cluster had a greater risk of being diagnosed with COVID-19, developed worsened eating habits (RR = 2.10; 95% CI = 1.50–2.93), spent less time sleeping, and spent less time outdoors (RR = 1.55; 95% CI = 1.03–2.43) than the Moderate Impact cluster. The High Impact cluster was more likely to include Black children and children from single-adult households than the Moderate Impact cluster (both p < 0.05). Our findings suggest that the COVID-19 pandemic may be a threat multiplier for childhood health disparities. Further research is needed to better understand the long-term effects of the COVID-19 pandemic on children’s health.     

COVID-19 Vaccine Rollouts and the Reproduction of Urban Spatial Inequality: Disparities Within Large US Cities in March and April 2021 by Racial/Ethnic and Socioeconomic Composition

Rollouts of COVID-19 vaccines in the USA were opportunities to redress disparities that surfaced during the pandemic. Initial eligibility criteria, however, neglected geographic, racial/ethnic, and socioeconomic considerations. Marginalized populations may have faced barriers to then-scarce vaccines, reinforcing disparities. Inequalities may have subsided as eligibility expanded. Using spatial modeling, we investigate how strongly local vaccination levels were associated with socioeconomic and racial/ethnic composition as authorities first extended vaccine eligibility to all adults. We harmonize administrative, demographic, and geospatial data across postal codes in eight large US cities over 3 weeks in Spring 2021. We find that, although vaccines were free regardless of health insurance coverage, local vaccination levels in March and April were negatively associated with poverty, enrollment in means-tested public health insurance (e.g., Medicaid), and the uninsured population. By April, vaccination levels in Black and Hispanic communities were only beginning to reach those of Asian and White communities in March. Increases in vaccination were smaller in socioeconomically disadvantaged Black and Hispanic communities than in more affluent, Asian, and White communities. Our findings suggest vaccine rollouts contributed to cumulative disadvantage. Populations that were left most vulnerable to COVID-19 benefited least from early expansions in vaccine availability in large US cities.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11524-021-00589-0.     

Measuring the Food Environment: Shelf Space of Fruits,Vegetables, and Snack Foods in Stores

Dietary patterns may be influenced by the availability and accessibility within stores of different types of foods. However, little is known about the amount of shelf space used for healthy and unhealthy foods in different types of stores. We conducted measurements of the length of shelf space used for fruits, vegetables, and snack foods items in 419 stores in 217 urban census tracts in southern Louisiana and in Los Angeles County. Although supermarkets offered far more shelf space of fruits and vegetables than did other types of stores, they also devoted more shelf space to unhealthy snacks (mean 205 m for all of these items combined) than to fruits and vegetables (mean 117 m, p < 0.001). After supermarkets, drug stores devoted the most shelf space to unhealthy items. The ratio of the total shelf space for fruits and vegetables to the total shelf space for these unhealthy snack items was the lowest (0.10 or below) and very similar in convenience stores, drug stores, and liquor stores, was in a middle range (0.18 to 0.30) in small food stores, and was highest in medium-sized food stores (0.40 to 0.61) and supermarkets (0.55 to 0.72). Simple measurements of shelf space can be used by researchers to characterize the healthfulness of the food environment and by policymakers to establish criteria for favorable policy treatment of stores.

Food Insecurity Prevalence,Severity and Determinants in Australian Households during the COVID-19 Pandemic from the Perspective of Women

This study aimed to describe the prevalence, severity and socio-demographic predictors of food insecurity in Australian households during the COVID-19 pandemic in 2020, from the perspective of women. A cross-sectional online survey of Australian (18–50 years) women was conducted. The survey collected demographic information and utilised the 18-item US Department of Agriculture Household Food Security Survey Module and the Kessler Psychological Distress Scale (K10). A multivariable regression was used to identify predictors of food security status. In this cohort (n = 1005), 19.6% were living in households experiencing food insecurity; with 11.8% experiencing low food-security and 7.8% very low food-security. A further 13.7% of households reported marginal food-security. Poor mental health status (K10 score ≥ 20) predicted household food insecurity at all levels. The presence of more than three children in the household was associated with low food-security (OR 6.24, 95% CI: 2.59–15.03). Those who were renting were 2.10 (95% CI: 1.09–4.05) times likely to experience very low food-security than those owning their own home. The COVID-19 pandemic may have contributed to an increased prevalence of household food insecurity. This study supports the need for a range of responses that address mental health, financial, employment and housing support to food security in Australia.     

Food Insecurity,Dietary Quality,and Health Care Utilization in Lower-Income Adults: A Cross-Sectional Study

BackgroundFood insecurity and poor nutrition are prevalent in the United States and associated with chronic diseases. Understanding relationships among food insecurity, diet, and health care utilization can inform strategies to reduce health disparities.ObjectiveOur aim was to determine associations between food security status and inpatient and outpatient health care utilization and whether they differed by dietary quality in lower-income adults.DesignThis was a cross-sectional study of data from the 2009-2016 National Health and Nutrition Examination Survey.Participants/settingParticipants were 13,956 lower-income (<300% federal poverty level) adults 18 years and older in the United States.Main outcome measuresSelf-reported health care utilization in the past 12 months included no usual source of care, any outpatient visit, any mental health service use, and any hospitalization.Statistical analysesMultiple logistic regression was used to study the association between food insecurity and health care utilization. Analyses were stratified by diet-related comorbidities to account for potential confounding and mediation of health care utilization, and by dietary quality.ResultsIn a sample of lower-income adults <300% federal poverty level, 4,319 participants (27.4%) were food insecure, 2,208 (15.0%) were marginally food secure, and 7,429 (57.6%) were food secure. Food insecurity was associated with having no usual source of care (adjusted odds ratio [aOR] 1.30; 95% CI 1.11 to 1.52), any mental health service use (aOR 2.02; 95% CI 1.61 to 2.52), and any hospitalization (aOR 1.19; 95% CI 1.01 to 1.41). Food-insecure adults were more likely to report no outpatient visits if they had diet-related comorbidities (aOR 1.45; 95% CI 1.10 to 1.92) or the lowest dietary quality (aOR 1.53; 95% CI 1.06 to 2.23). Marginal food security was associated with having no usual source of care (aOR 1.22; 95% CI 1.04 to 1.44).ConclusionsAdults with food insecurity were more likely to be hospitalized, use mental health services, and have no usual source of care. Food-insecure participants with diet-related comorbidities or poor diet were less likely to have outpatient visits. Hospitalizations and mental health visits represent underused opportunities to identify and address food insecurity and dietary intake in lower-income patients.     

Associations between Food Preferences,Food Approach,and Food Avoidance in a Polish Adolescents’ COVID-19 Experience (PLACE-19) Study Population

Food preferences are among the strongest predictors of the food choices of adolescents. These are associated with appetitive traits (food approach and avoidance) to some extent. However, no research has been conducted so far analyzing the association between food preferences and appetitive traits of adolescents. The aim of this study was to evaluate the associations between food preferences and appetitive traits in adolescents (aged 15–20 years) within the Polish Adolescents’ COVID-19 Experience (PLACE-19) Study population. The PLACE-19 Study was carried out in a population-based sample of 2448 secondary school students sampled across the country (random quota sampling). Food preferences (including the preference for vegetables, fruit, meat/fish, dairy, snacks, and starches) of the adolescents were assessed using the validated Food Preference Questionnaire (FPQ) while their appetitive traits (hunger, food responsiveness, emotional overeating, enjoyment of food, satiety responsiveness, emotional undereating, food fussiness, slowness in eating) were assessed using the validated Adult Eating Behavior Questionnaire (AEBQ). The k-means clustering was performed to identify the homogenous clusters of respondents based on their preferences, and linear regression was performed to determine the relationship between food preferences and appetitive traits with a model adjusted for sex and age. Based on their preferences, three homogenous clusters of respondents were defined: low-preferring respondents (low preference for all food categories), respondents preferring snacking foods (low preference for all food categories, except for fruit and snacks), and high-preferring respondents (high preference for all food categories). The low-preferring respondents showed the lowest values for all appetitive traits (p = 0.0008), as well as the lowest total score (p = 0.0001), except for food fussiness, for which they showed the highest value (p = 0.0008). All preference scores were positively associated with traits such as hunger, food responsiveness, enjoyment of food, and emotional under-eating, while negatively associated with food fussiness (all p < 0.05). The largest amount of variance was observed for preference for dairy (14.6%; R² = 0.146, p = 0.008) and snacks with respect to enjoyment of food (16.2%; R² = 0.162, p = 0.008), for vegetable with respect to food fussiness (22%; R² = 0.220, p = 0.008), and for meat/fish with respect to enjoyment of food (19.9%; R² = 0.199, p = 0.008) and food fussiness combined (19.1%; R² = 0.191, p = 0.008). These results support the association of food preferences with both food approach traits and food avoidance traits.     

Iron Deficiency Is Associated with Food Insecurity in Pregnant Females in the United States: National Health and Nutrition Examination Survey 1999-2010

Food-insecure pregnant females may be at greater risk of iron deficiency (ID) because nutrition needs increase and more resources are needed to secure food during pregnancy. This may result in a higher risk of infant low birth weight and possibly cognitive impairment in the neonate. The relationships of food insecurity and poverty income ratio (PIR) with iron intake and ID among pregnant females in the United States were investigated using National Health and Nutrition Examination Survey 1999-2010 data (n=1,045). Food security status was classified using the US Food Security Survey Module. One 24-hour dietary recall and a 30-day supplement recall were used to assess iron intake. Ferritin, soluble transferrin receptor, or total body iron classified ID. Difference of supplement intake prevalence, difference in mean iron intake, and association of ID and food security status or PIR were assessed using χ² analysis, Student t test, and logistic regression analysis (adjusted for age, race, survey year, PIR/food security status, education, parity, trimester, smoking, C-reactive protein level, and health insurance coverage), respectively. Mean dietary iron intake was similar among groups. Mean supplemental and total iron intake were lower, whereas odds of ID, classified by ferritin status, were 2.90 times higher for food-insecure pregnant females compared with food-secure pregnant females. Other indicators of ID were not associated with food security status. PIR was not associated with iron intake or ID. Food insecurity status may be a better indicator compared with income status to identify populations at whom to direct interventions aimed at improving access and education regarding iron-rich foods and supplements.