The impact of social enterprise on food insecurity – An Australian case study

Like many high‐income countries, in Australia there are a range of programmes in place, from social security to food banks, to help address food insecurity. So far, they have been unable to adequately alleviate and prevent this growing nutrition challenge. This paper presents an evaluation of a new type of intervention in the food security landscape, the social enterprise. The Community Grocer is a social enterprise that operates weekly fresh fruit and vegetable markets in Melbourne, Australia. The aim of the study was to examine the market's ability to increase access, use and availability of nutritious food in a socially acceptable way, for low socioeconomic status urban‐dwelling individuals. The mixed‐method evaluation included: comparative price audits (n = 27) at local (<1 km) stores; analysis of operational data from sample markets (n = 3); customer surveys (n = 91) and customer interviews (n = 12), collected in two phases (Autumn 2017, Summer 2018). The results found common (n = 10) fruit and vegetables cost, on average, approximately 40% less at the social enterprise, than local stores. Over twenty per cent of customers were food insecure and 80% of households were low income. Thirty‐four different nationalities shopped at the market, and just over half (54%) shopped there weekly. More than 50 types of vegetables and fruit were available to purchase, varying for cultural preferences and seasonality, which supported variety and choice. Overall, this enterprise promotes food security in a localised area through low‐cost, convenient, dignified and nutritious offerings.     

The impact of holiday clubs on household food insecurity—A pilot study

This research investigates whether holiday clubs have the potential to reduce food insecurity among households in the United Kingdom. We survey parents (n = 38) of children attending seven different holiday clubs to estimate the percentage of children in those programmes who come from food insecure households. Results suggest that 42% (16 out of 38 respondents) of children come from households defined as “food insecure” and 24% (9 out of 38 respondents) come from households that are “food insecure with hunger.” When secure and insecure households are compared, we discover that food insecure households benefit the most from holiday clubs, which suggests that they may play an important role in mitigating household food insecurity.     

Health professionals’ experiences and perspectives on food insecurity and long‐term conditions: A qualitative investigation

Estimates suggest that over 10% of the UK population are affected by food insecurity. International evidence indicates that food insecurity is a risk factor for many long‐term health conditions, and can adversely affect people's ability to manage existing conditions. Food insecurity is thus not only a serious social concern but also a healthcare issue requiring the attention of UK health professionals. An exploratory qualitative study was undertaken to investigate the experiences and views of health professionals in north east Scotland, with a particular focus on support for people with long‐term conditions whom they believed were affected by food insecurity. Two focus groups and nine semi‐structured interviews were undertaken with a total of 20 health professionals between March and July 2016. Thematic analysis generated three main themes. The health professionals had (a) diverse levels of understanding and experience of food insecurity, but between them identified a range of (b) negative impacts of food insecurity on condition‐management, especially for diet dependent conditions or medication regimes, and for mental health. Even for those health professionals more familiar with food insecurity, there were various (c) practical and ethical uncertainties about identifying and working with food insecure patients (it could be difficult to judge, for example, whether and how to raise the issue with people, to tailor dietary advice to reflect food insecurity, and to engage with other agencies working to address food insecurity). This study indicates that health professionals working with food insecure patients have learning and support needs that warrant further investigation. Debates about health professionals’ responsibilities, and interventions to guide and support health professionals, including tools that might be used to screen for food insecurity, must also reflect the diverse lived needs and values of people who experience food insecurity.     

Determinants of a dietary pattern linked with greater metabolic risk and its tracking during adolescence

Background

Although growing evidence suggests that dietary patterns associated with noncommunicable diseases in adulthood may develop early in life, when these are established, as well as their determinants, remains unclear.

Methods

We examined determinants and tracking of a dietary pattern (DP ) associated with metabolic risk and its key food groups among 860 adolescents in the Western Australian Pregnancy (Raine) Cohort study. Food intake was reported using a food frequency questionnaire (FFQ ) at 14 and 17 years. Z ‐scores for an ‘energy‐dense, high‐fat, low‐fibre’ DP were estimated by applying reduced rank regression at both ages. Tracking was based on the predictive value (PV ) of remaining in the DP Z ‐score or food intake quartile at 14 and 17 years. Early‐life exposures included: maternal age; maternal pre‐pregnancy body mass index ; parent smoking status during pregnancy; and parent socio‐economic position (SEP ) at 14 and 17 years. Associations between the DP Z ‐scores, early‐life factors and SEP were analysed using regression analysis.

Results

Dietary tracking was strongest among boys with high DP Z ‐scores, high intakes of processed meat, low‐fibre bread, crisps and savoury snacks (PV > 1) and the lowest intakes of vegetables, fruit and legumes. Lower maternal education (β = 0.09, P  = 0.002 at 14 years; β = 0.14, P  < 0.001 at 17 years) and lower maternal age at birth (β = 0.09, P  = 0.003 at 14 years; β = 0.11, P  = 0.004 at 17 years) were positively associated with higher DP Z ‐scores.

Conclusions

An energy‐dense, high‐fat, low‐fibre dietary pattern tracks more strongly among adolescent boys who have high scores for this pattern at 14 years of age. These findings highlight target foods and population subgroups for early interventions aiming to improve dietary behaviours.

     

Is something better than nothing? Food insecurity and eating patterns of young people experiencing homelessness

Objective: Food insecurity is an increasing problem in marginalised groups that affects diet quality. We aimed to examine the extent of food insecurity and the eating patterns of young people accessing support from specialist homelessness services. Methods: A cross‐sectional survey with a researcher‐administered food frequency and food insecurity questionnaire was undertaken with 50 young people experiencing homelessness, aged 14–26 years. Participants were recruited from 11 specialist homelessness services providing support and accommodation for young people in central and south‐western Sydney. Results: Food insecurity was a recent experience for 70% of participants. Eighty‐five per cent of participants living independently experienced food insecurity, compared to 66% of young people in supported accommodation. Consumption of core food groups was low, as almost all participants did not meet recommended daily servings of vegetables and breads and cereals. Consumption of sugar‐sweetened soft drinks was high. Conclusions: Food insecurity and poor diet quality are salient issues for this group of young people accessing support from specialist homelessness services. Implications: These findings highlight the need for a greater focus on advocacy and policy action to increase social supports and improve food security and nutrition for young people experiencing homelessness.     

Housing Circumstances are Associated with Household Food Access among Low-Income Urban Families

Household food insecurity is a pervasive problem in North America with serious health consequences. While affordable housing has been cited as a potential policy approach to improve food insecurity, the relationship between conventional notions of housing affordability and household food security is not well understood. Furthermore, the influence of housing subsidies, a key policy intervention aimed at improving housing affordability in Western countries, on food insecurity is unclear. We undertook a cross-sectional survey of 473 families in market rental (n = 222) and subsidized (n = 251) housing in high-poverty urban neighborhoods to examine the influence of housing circumstances on household food security. Food insecurity, evident among two thirds of families, was inversely associated with income and after-shelter income. Food insecurity prevalence did not differ between families in market and subsidized housing, but families in subsidized housing had lower odds of food insecurity than those on a waiting list for such housing. Market families with housing costs that consumed more than 30% of their income had increased odds of food insecurity. Rent arrears were also positively associated with food insecurity. Compromises in housing quality were evident, perhaps reflecting the impact of financial constraints on multiple basic needs as well as conscious efforts to contain housing costs to free up resources for food and other needs. Our findings raise questions about current housing affordability norms and highlight the need for a review of housing interventions to ensure that they enable families to maintain adequate housing and obtain their other basic needs.     

The impact of a community-based food education programme on dietary pattern in patients with type 2 diabetes: Results of a pilot randomised controlled trial in Portugal

The purpose of this study was to analyse the effects of a food education programme, with easy-to-implement strategies integrated in a community-based exercise programme, on dietary pattern of patients with type 2 diabetes (T2D). Thirty-three patients (65.4 ± 5.9 years old) were engaged in a 9-month randomised controlled trial: a supervised exercise programme (control group [CON]; n = 15; combined exercise; three sessions per week; 75 min per session) or the same exercise programme plus a concomitant 16-week food education programme (experimental group [EXP]; n = 18; 15-min. group classes and dual-task strategies during exercise). Dietary pattern was assessed using a 3-day food record at baseline and at 9 months. The intake of total fat, polyunsaturated fat, and the daily servings of vegetables significantly increased in EXP compared with the CON group. Retention and adherence to the programme were 54% and 49.5 ± 27.2%, respectively. This food education programme improved dietary pattern of patients with T2D. Special attention should be given to strategies that support participants’ attendance.     

Validity and reproducibility of an iodine‐specific food frequency questionnaire to estimate dietary iodine intake in older Australians

Aim: Iodine deficiency, which has adverse effects on health has re‐emerged in Australia. The present study aimed to develop and validate a novel iodine‐specific food frequency questionnaire for use in older Australians. Methods: A 49‐item food frequency questionnaire that included iodine‐rich foods was constructed and administered in 84 men and women aged 60–95 years with normal cognitive function. Dietary iodine intake assessed by the food frequency questionnaire was validated against three repeated 24‐hour dietary recalls. Urinary spot iodine concentrations were selected as iodine intake biomarker. Agreement between the two dietary methods was determined using a Bland–Altman plot and intra‐class coefficients. Correlations between dietary and urinary iodine were assessed. Forty‐three participants repeated the questionnaire after 9 months for reproducibility. Results: Mean iodine intake measured by the food frequency questionnaire and 24‐hour dietary recalls did not differ significantly (P= 0.870). The two methods were moderately correlated (r = 0.377; P < 0.05) and the Bland–Altman plots demonstrated an acceptable level of agreement (P= 0.870). Despite an association (r = 0.230; P < 0.05) between urinary iodine concentrations and 24‐hour dietary recalls, the food frequency questionnaire was not associated with urinary iodine concentration (r = 0.094; P= 0.40). The method of triads showed coefficients of 0.238 (urinary iodine), 0.953(food frequency questionnaire), 0.396 (24‐hour dietary recall) with the unknown true value. Conclusion: A short food frequency questionnaire to assess habitual dietary iodine intake in older Australians has been shown to be valid at the group level with regard to categorising individuals according to their habitual iodine intake. Reproducibility of the food frequency questionnaire remains to be demonstrated.     

Mentoring at Men's Sheds: an international survey about a community approach to health and well‐being

Men's Sheds are named within the Australian and Irish National Male Health Policies as an exemplar of male health and well‐being and offer a range of formal and informal mentoring to counter the known consequences of social exclusion. The study aimed to report on whether Men's Sheds undertake mentoring programmes, and if so, who is being mentored; are mentors being trained, and if so by whom; and the perceived effectiveness of the mentoring programme. Furthermore, the study aimed to explore associations between sheds with a mentoring programme and factors that reflect an inclusive and a health‐focused environment. All known Men's Sheds were invited to participate in the survey; of those, 324 (42.8%) Men's Sheds in Australia and 59 (48.0%) International sheds participated in the study between April and August 2012. Overall, 39.2% (n = 127) of Australian sheds and 23.7% (n = 14) of International sheds undertook formal mentoring. Youth was the most common group being mentored in both Australia (60.6%; n = 77) and Internationally (71.4%; n = 10). Over half of Australian shed co‐ordinators rated their mentoring programme as moderately effective (52.8%; n = 67) and over a third as highly effective (36.2%; n = 46), while half of International shed co‐ordinators rated theirs as highly effective (50.0%; n = 7). The findings from this paper support the notion that a large number of Men's Sheds offer formal mentoring programmes targeting a range of disadvantaged sub‐populations, thus supporting social inclusion. Inter‐generational mentoring is the most frequently occurring type of mentoring programme. While training mentors occurs at some sheds, the efficacy of this training and programme outcomes are unknown. A typology of shed types appears to be emerging based on a divergence of sheds with a more utilitarian focus and sheds that appear to embrace a health and well‐being focus.     

The association of maternal food intake and infants' and toddlers' food intake

Background Young children's first experiences with food may influence development of food preferences and lifelong eating habits. However, little is known about what factors are associated with the development of eating behaviours in infants and toddlers. Studies with older children and adolescents suggest that parental food intake is associated with children's food intake. The purpose of the present paper is to determine whether this association starts even earlier during infancy and toddlerhood. Methods A convenience sample of n= 98 primarily African American mothers of children 6–18 months old completed questionnaires, including questions on their own and their young child's food intake. Mothers completed questions while waiting to be seen by their child's primary care provider. Results Per maternal report, children consumed fruit 2.45 (1.79) times, vegetables 1.63 (1.51) times and snack foods 2.22 (2.49) times each day. Infants' and toddlers' fruit (r= 0.54, P < 0.001), vegetable (r= 0.42, P < 0.001) and snack food (r= 0.37, P < 0.001) intake were significantly associated with maternal intake of each of these foods, respectively. These significant associations remained even after controlling for additional study variables. Conclusion Even at very young ages, maternal food intake is an important correlate of children's food intake. Taken together with findings documenting significant snack food consumption in this age group, findings suggest that development of prevention and intervention programmes to enhance healthy eating behaviours need to start very early, perhaps just prior to children being introduced to complementary foods.     

The role of social enterprise in food insecurity among asylum seekers

People seeking asylum in high‐income countries are vulnerable to food insecurity due to limited opportunities for social and economic participation. Given this vulnerability, nongovernment organisations are attempting to improve food security outcomes through targeted programmes. This study explored the role of a subsidised mobile fresh fruit and vegetable market (the Food Justice Truck—FJT) on the experience of food insecurity for people seeking asylum living in Melbourne, Australia. This research uses a mixed methods approach, employing surveys and semistructured interviews to explore the lived experiences of asylum seekers using the FJT, including their experiences of food insecurity. Half of the asylum seekers interviewed in this study were found to be experiencing food insecurity. Participants in this study sourced food from multiple locations, with the FJT providing a supplemental, but highly valued source of fresh produce. The FJT was identified as positive social setting for some participants included in this research. This research has identified the ability of programmes such as the FJT to act as positive social settings.     

Child Food Insecurity and Iron Deficiency Anemia in Low-Income Infants and Toddlers in the United States

Objective: Examine the association between child-level food insecurity and iron status in young children utilizing community-based data from the Children's Sentinel Nutrition Assessment Program (C-SNAP). Methods: A cross-sectional sample of caregivers of children ≤36 months of age utilizing emergency department (ED) services were interviewed between 6/96–5/01. Caregiver interviews, which included questions on child-level food security, were linked to a primary clinic database containing hemoglobin, red blood cell distribution width, mean corpuscular volume, free erythrocyte protoporphyrin and lead values. Children a priori at-risk for anemia: birthweight ≤2500 g, with HIV/AIDS, sickle cell disease, or lead values ≥10.0 ug/dL, and children ≤6 months of age were excluded from the analysis. Only laboratory tests 365 days prior or 90 days after interview were examined. Iron status was classified in four mutually exclusive categories: 1) Iron Sufficient-No Anemia (ISNA), 2) Anemia (without iron deficiency), 3) Iron Deficient-No Anemia (IDNA), 4) Iron Deficient with Anemia (IDA). Results: 626 ED interviews linked to laboratory data met the inclusion criteria. Food insecure children were significantly more likely to have IDA compared to food secure children [Adjusted Odds Ratio = 2.4, 95% CI (1.1–5.2), p = 0.02]. There was no association between child food insecurity and anemia without iron deficiency or iron deficiency without anemia. Conclusion: These findings suggest an association between child level food insecurity and iron deficiency anemia, a clinically important health indicator with known negative cognitive, behavioral and health consequences. Cuts in spending on food assistance programs that address children's food insecurity may lead to adverse health consequences.Presented at the Pediatric Academic Soceity Meeting, Abstract No. 2668 held April 28, 2001 in Baltimore, MD.     

The Influence of Food Environments on Food Security Resilience during the COVID-19 Pandemic: An Examination of Urban and Rural Difference in Kenya

Hunger and food insecurity has worsened due to the COVID-19 pandemic. The types of food environments (e.g., natural/built) that people can access may improve household resilience to food-system shocks. This paper examines (1) urban and rural differences in the perceived influence of the COVID-19 pandemic on agricultural, livelihoods, food environment attributes, diets; and (2) whether access to different food environments was associated with food security. A two-part telephonic survey (COVID-19 Surveillance Community Action Network Food Systems Tool and Household Food Insecurity Access Scale) was conducted in Western Kenya (n = 173) and an informal settlement in Nairobi (n = 144) in January/February 2021. Limitations on the acquisition of farm inputs and movement restrictions had an adverse impact on agriculture and food sales. Urban residents reported a more significant impact on livelihoods (97% vs. 87%, p < 0.001), with day laborers being the most impacted. Rural respondents reported access to significantly more food environments and lower food insecurity. Multiple linear regression analysis revealed that younger respondents, ≤1 income source, had more difficulty acquiring food, decreased access to cultivated environments, and increased access to informal markets were predictors for higher food insecurity. These data indicate that access to specific types of food environments may improve household resilience.     

Dietary intake in people consuming a low‐carbohydrate diet in the UK Biobank

Background

Low‐carbohydrate diets are becoming increasingly popular, although their dietary quality outside of clinical studies is unknown. A previous study analysed the dietary intake in people consuming a reduced‐carbohydrate diet (<40% calories). However, it is not clear what foods people consume when carbohydrate is reduced to below 26% of total calories.

Methods

In the present cross‐sectional study, the dietary and nutrient intake collected via up to five consecutive 24‐h dietary recalls and a food frequency questionnaire of 444 individuals (aged 46‐79 years) consuming <26% of calories from carbohydrate (LCHO ) was compared with that of 131 897 individuals consuming ≥45% calories from carbohydrate (NCHO ) using the UK Biobank Dataset. Absolute cut‐offs to define the low‐carbohydrate group (<130 g day^–1; n  = 1953 versus ≥225 g day^–1, n  = 113 036) were also used.

Results

Both NCHO (>45% calories and ≥225 g) groups consumed significantly more high‐sugar, high‐fat snacks [median 6.0, interquartile range (IQR ) = 2.0–11.0 and median 6.0, IQR  = 3.0–11.8, respectively) compared to the LCHO (<26% calories and <130 g) groups (median 0, IQR  = 0–2.8 and median 1, IQR  = 0–3.8, respectively) (P  < 0.0001). Both LCHO groups reported consuming significantly more red meat, oily fish, nuts and seeds but fewer fruits, vegetables and pulses compared to the NCHO groups. In general, the consumption of oily fish, nuts, seeds and pulses was low across the whole cohort and differences in intake between the LCHO and NCHO groups were small. After adjusting for socio‐economic status, most differences remained.

Conclusions

Carbohydrate restriction is associated with both beneficial and potentially deleterious dietary changes compared to a normal carbohydrate intake.

     

Obesity prevention in the family day care setting: impact of the Romp & Chomp intervention on opportunities for children's physical activity and healthy eating

Background The Romp & Chomp intervention reduced the prevalence of overweight/obesity in pre‐school children in Geelong, Victoria, Australia through an intervention promoting healthy eating and active play in early childhood settings. This study aims to determine if the intervention successfully created more health promoting family day care (FDC) environments. Methods The evaluation had a cross‐sectional, quasi‐experimental design with the intervention FDC service in Geelong and a comparison sample from 17 FDC services across Victoria. A 45‐item questionnaire capturing nutrition‐ and physical activity‐related aspects of the policy, socio‐cultural and physical environments of the FDC service was completed by FDC care providers (in 2008) in the intervention (n= 28) and comparison (n= 223) samples. Results Select results showed intervention children spent less time in screen‐based activities (P= 0.03), organized active play (P < 0.001) and free inside play (P= 0.03) than comparison children. There were more rules related to healthy eating (P < 0.001), more care provider practices that supported children's positive meal experiences (P < 0.001), fewer unhealthy food items allowed (P= 0.05), higher odds of staff being trained in nutrition (P= 0.04) and physical activity (P < 0.001), lower odds of having set minimum times for outside (P < 0.001) and organized (P= 0.01) active play, and of rewarding children with food (P < 0.001). Conclusions Romp & Chomp improved the FDC service to one that discourages sedentary behaviours and promotes opportunities for children to eat nutritious foods. Ongoing investment to increase children's physical activity within the setting and improving the capacity and health literacy of care providers is required to extend and sustain the improvements.     

Personal goals and factors related to QoL in Dutch homeless people: what is the role of goal‐related self‐efficacy?

Very little is known about the personal goals of homeless people and how these relate to their quality of life (QoL). By using survey data on 407 homeless adults upon entry to the social relief system in 2011, we examined the personal goals of homeless adults and the association between their perceived goal‐related self‐efficacy and their QoL. A hierarchical regression analysis was used to analyse the association between QoL and goal‐related self‐efficacy, relative to factors contributing to QoL, such as demographic characteristics, socioeconomic resources, health and service use. Results indicate that the majority of homeless adults had at least one personal goal for the coming 6 months and that most goals concerned housing and daily life (94.3%) and finances (83.6%). The QoL of homeless adults appeared to be lower in comparison with general population samples. General goal‐related self‐efficacy was positively related to QoL (β = 0.09, P = 0.042), independent of socioeconomic resources (i.e. income and housing), health and service use. The strongest predictors of QoL were psychological distress (β = ?0.45, P < 0.001), income (β = 0.14, P = 0.002) and being institutionalised (β = 0.12, P = 0.004). In conclusion, the majority of homeless adults entering the social relief system have personal goals regarding socioeconomic resources and their goal‐related self‐efficacy is positively related to QoL. It is therefore important to take the personal goals of homeless people as the starting point of integrated service programmes and to promote their goal‐related self‐efficacy by strength‐based interventions.     

Knowledge and perceptions of nutrition assistance programmes among young adult students

The purpose of this qualitative study was to investigate the perceptions of nutrition assistance programmes among young adult students in the United States, and to identify how the current social and political climate, including the COVID-19 pandemic, has impacted these perceptions and the overall willingness of young adult students to participate in these programmes. Participants were recruited via email and social media to participate in 20-min virtual, semi-structured interviews. Twenty-three participants, between the ages of 18 and 25 years from three states in the United States were interviewed. Ten participants reported having experienced food insecurity (FI) in their lifetime, with 21 participants currently having enough food to eat, while two sometimes did not currently have enough to eat. Seven participants had utilised nutrition programmes in their lifetime. Interviews were video and audio recorded, transcribed, and coded using a six-step thematic analysis. Young adult students were largely unaware of nutrition assistance programmes and eligibility requirements but still perceived these programmes to be successful, with a higher proportion of the participants who had utilised a nutrition assistance programme in their lifetime expressing the view that they were generally successful compared to those who had never utilised one. Most were cognizant of the social stigma surrounding these programmes yet expressed a willingness to utilise them and reported an increased willingness to utilise nutrition assistance programmes as a result of the COVID-19 pandemic. COVID-19 made young adult students aware of FI and the important role nutrition assistance programmes play in our society. Young adult students expressed the belief that the Biden administration will have a positive impact on nutrition assistance programmes but had a general hesitation to discuss politics. The COVID-19 pandemic has increased young adult students' willingness to utilise nutrition assistance programmes, although, access to these programmes remains low due to a lack of knowledge and general unawareness of programme availability and accessibility. Education is needed to improve overall knowledge of, and facilitate access to, nutrition assistance programmes while combating perceptions around stigma.