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Availability, Accessibility, Utilization: In-Depth Interviews with Food Insecure Residents and Emergency Food Providers in New Haven, CT
Abstract
Approximately 34% of residents from New Haven’s six lowest-income neighborhoods are food insecure, significantly higher than the rest of Connecticut and country (both approximately 12%). To understand the availability, accessibility, and utility of emergency food programs, we conducted 34 semi-structured qualitative interviews with 20 food insecure residents and 14 emergency food providers. Many depend on food programs as a long-term strategy of supplementing groceries rather than a temporary solution in emergency situations; providers are struggling to meet this demand. Transportation and time are barriers to accessing food from programs. Policies and food programs should focus on disseminating accurate information, streamlining policies and practices, and supporting and expanding food programs to meet population need.
... Food insecurity is a widespread challenge in the United States, with a national prevalence of approximately 10% [1]. This rate triples in New Haven, CT, where food insecurity impacts over 30% of adults residing in neighborhoods with the fewest economic resources and which are predominantly Black and Latinx communities [2,3]. Research shows a strong association between food insecurity and adverse health outcomes, including a significantly higher prevalence of chronic diseases, such as diabetes, hypertension, hyperlipidemia, and heart disease, as well as adverse mental health outcomes [4][5][6]. ...
Food insecurity is widespread in the United States. The COVID-19 pandemic intensified the need for food assistance and created opportunities for collaboration among historically-siloed organizations. Research has demonstrated the importance of coalition building and community organizing in Policy, Systems, and Environmental (PSE) change and its potential to address equitable access to food, ultimately improving population health outcomes. In New Haven, community partners formed a coalition to address systems-level issues in the local food assistance system through the Greater New Haven Coordinated Food Assistance Network (CFAN). Organizing the development of CFAN within the framework of Collaborating for Equity and Justice (CEJ) reveals a new way of collaborating with communities for social change with an explicit focus on equity and justice. A document review exploring the initiation and growth of the network found that 165 individuals, representing 63 organizations, participated in CFAN since its inception and collaborated on 50 actions that promote food access and overall health. Eighty-one percent of these actions advanced equitable resource distribution across the food system, with forty-five percent focused on coordinating food programs to meet the needs of underserved communities. With the goal of improving access to food while addressing overall equity within the system, the authors describe CFAN as a potential community organizing model in food assistance systems.
... 10 Previous research has affirmed the relationship between socioeconomic problems such as poverty, ill health, dietary quality, education level, and food insecurity. [11][12][13][14][15][16][17] Qualitative studies have also identified feelings of stigma and shame, [18][19][20] dealing with persistent and long-term need, [21][22][23][24] and the challenges of dealing with poor health or chronic conditions while food is insecure. [25][26][27] Some studies have explored the broader social factors impacting food pantry clients, and these include employment challenges, 22,25 financial challenges, 11,22,25,28,29 a history of food insecurity, 29 and the need for basic foods. ...
Objectives:
In 2017 a community-University of Minnesota collaborative conducted a statewide survey of food pantry clients.
Methods:
Of the 188 food pantries surveyed, 4321 individual client surveys were returned, from which 2,251 open-ended responses were analyzed.
Results:
Respondents shared gratitude for the food pantry in meeting their needs for food and support. Many described accessing healthy food that was needed to address health needs. Respondents described life circumstances and hardships that led to food pantry use.
Conclusion:
The supportive environment provided by food pantries position them to address the needs of clients, including those with complex health needs.
Background. Food insecurity, affecting approximately 10% of the U.S. population, with up to 40% or higher in some communities, is associated with higher rates of chronic conditions and inversely associated with diet quality. Nutrition interventions implemented at food pantries are an effective strategy to increase healthy food choices and improve health outcomes for people experiencing food and nutrition insecurity. Supporting Wellness at Pantries (SWAP), a stoplight nutrition ranking system, can facilitate healthy food procurement and distribution at pantries. Purpose. Guided by the RE-AIM Framework, this study assesses the implementation and outcomes of SWAP as nutritional guidance and institutional policy intervention, to increase procurement and distribution of healthy foods in pantries. Method. Mixed-methods evaluation included observations, process forms, and in-depth interviews. Food inventory assessments were conducted at baseline and 2-year follow-up. Results. Two large pantries in New Haven, Connecticut, collectively reaching more than 12,200 individuals yearly, implemented SWAP in 2019. Implementation was consistent prepandemic at both pantries. Due to COVID-mandated distribution changes, pantries adapted SWAP implementation during the pandemic while still maintaining the “spirit of SWAP.” One pantry increased the percentage of Green foods offered. Challenges to healthy food distribution are considered. Discussion. This study has implications for policy, systems, and environmental changes. It shows the potential for SWAP adoption at pantries, which can serve as a guide for continued healthy food procurement and advocacy. Maintaining the “spirit of SWAP” shows promising results for food pantries looking to implement nutrition interventions when standard practice may not be possible.
Introduction
This study analyzes the effects of food accessibility on fresh food intake and body mass index (BMI) in the lowest level of local government areas (LLGAs) of South Korea.
Methods
We used four sub-variables of physical food accessibility: access to food retailers, availability of public transportation, car ownership, and apartment residence. We used data from the Korea National Health and Nutrition Survey, which were matched with the number of food retail stores and the number of bus stops and subway exits in each respondent's LLGA. We divided the respondents into urban dwellers and rural dwellers in the path analysis.
Results
The access to food retailers and convenience in public transport were inferior in rural areas relative to urban areas. In urban areas, access to food retailers and public transportation did not affect fresh food intake and BMI, and there was no indirect effect of fresh food intake on BMI. In rural areas, fresh food intake decreased as access to food retailers decreased, which indirectly deteriorated BMI.
Conclusions
The issue of physical accessibility to food supplies in rural areas must be prioritized, and relevant policy interventions from local governments are necessary. Owning private automobiles increased the opportunity to eat fresh foods, and the effect was higher in rural areas, where car ownership lowered BMI indirectly. This suggests that the relative disadvantage of access to food retailers and inconvenient public transport in rural areas can be overcome through transport policies. By doing so, residents can be provided with better access to competitively priced, good-quality food.
This research brings together concerns of food environments, food insecurity, and food access to demonstrate four measures of access for an emergency food provider network. Based on the interacting concerns of accessibility and accommodation, the measures are proximity, segment coverage, transit access, and transit time. Proximity measures geographic access, whereas segment coverage focuses on access at different times of the day, on different days of the week, during different weeks of the month. The two transit measures use the region’s actual transit network scheduling to address space–time access via transit. The measures are applied to the food pantry network of Cuyahoga County, Ohio. Each demonstrates a unique nuance of access in the emergency food provider context, providing useful inputs into the process of meeting a community’s emergency food needs.
An estimated 85.7 percent of American households were food secure throughout the entire year in 2013, meaning that they had access at all times to enough food for an active, healthy life for all household members. The remaining households (14.3 percent) were food insecure at least some time during the year, including 5.6 percent with very low food security, meaning that the food intake of one or more household members was reduced and their eating patterns were disrupted at times during the year because the household lacked money and other resources for food. The change in food insecurity overall from the prior year (from 14.5 percent in 2012) was not statistically significant. The cumulative decline in food insecurity from 2011 (14.9 percent) to 2013 (14.3 percent) was statistically significant. The prevalence rate of very low food security was essentially unchanged from 5.7 percent in 2011 and 2012. Children and adults were food-insecure in 9.9 percent of households with children in 2013, essentially unchanged from 10.0 percent in 2011 and 2012. In 2013, the typical food-secure household spent 30 percent more on food than the typical food-insecure household of the same size and household composition. Sixty-two percent of all food-insecure households participated in one or more of the three largest Federal food and nutrition assistance programs during the month prior to the 2013 survey.
Food banks play a major role in the food aid sector by distributing donated and purchased groceries directly to food insecure families. The public health implications of food insecurity are significant, particularly as food insecurity has a higher prevalence among certain population groups. This review consolidates current knowledge about the function and efficacy of food banks to address food insecurity. A systematic review was conducted. Thirty-five publications were reviewed, of which 14 examined food security status, 13 analysed nutritional quality of food provided, and 24 considered clients' needs in relation to food bank use. This review found that while food banks have an important role to play in providing immediate solutions to severe food deprivation, they are limited in their capacity to improve overall food security outcomes due to the limited provision of nutrient-dense foods in insufficient amounts, especially from dairy, vegetables and fruits. Food banks have the potential to improve food security outcomes when operational resources are adequate, provisions of perishable food groups are available, and client needs are identified and addressed.
In gerontology the most recognized and elaborate discourse about sampling is generally thought to be in quantitative research associated with survey research and medical research. But sampling has long been a central concern in the social and humanistic inquiry, albeit in a different guise suited to the different goals. There is a need for more explicit discussion of qualitative sampling issues. This article will outline the guiding principles and rationales, features, and practices of sampling in qualitative research. It then describes common questions about sampling in qualitative research. In conclusion it proposes the concept of qualitative clarity as a set of principles (analogous to statistical power) to guide assessments of qualitative sampling in a particular study or proposal.
The purpose of this article is to define qualitative research, explain its design, explore its congruence with quantitative research, and provide examples of its applications in dietetics. Also, methods to ensure validity, reliability, and relevance are addressed. Readers will gain increased knowledge about qualitative research and greater competency in evaluating this type of research. The hope is that food and nutrition professionals will be inspired to conduct and publish qualitative research, adding to the body of peer-reviewed dietetics-related qualitative publications. This type of research must be methodically planned and implemented with attention to validity, reliability, and relevance. This rigorous approach boosts the probability that the research will add to the scientific literature and qualify for publication.
The purposes of this study were to estimate the prevalence of household food insufficiency in Canada, to identify sociodemographic characteristics of households most likely to report food insufficiency and to examine the relationship between food insufficiency and physical, mental and social health. These objectives were achieved through an analysis of data from the 1996/1997 National Population Health Survey. An estimated 4% of Canadians, 1.1 million people, were found to be living in food-insufficient households. Single-parent families, households reporting their major source of income as welfare, unemployment insurance or workers' compensation, those who did not own their own homes and households in Western Canada were more likely to report food insufficiency. The likelihood of reporting food insufficiency increased dramatically as income adequacy deteriorated. Individuals from food-insufficient households had significantly higher odds of reporting poor/fair health, of having poor functional health, restricted activity and multiple chronic conditions, of suffering from major depression and distress, and of having poor social support. Individuals in food-insufficient households were also more likely to report heart disease, diabetes, high blood pressure and food allergies. Men in food-insufficient households were less likely to be overweight; after adjusting for potentially confounding variables, no other associations were found between food insufficiency and body mass index. These findings suggest that food insufficiency is one dimension of a more pervasive vulnerability to a range of physical, mental and social health problems among households struggling with economic constraints.
This article explores whether social capital-a measure of trust, reciprocity and social networks-is positively associated with household food security, independent of household-level socioeconomic factors. Interviews were conducted in 330 low-income households from Hartford, Connecticut. Social capital was measured using a 7-item Likert scale and was analyzed using household- and community-level scores. Household food security and hunger were measured using the US Household Food Security Module. chi2 tests were used to examine associations between social capital, food security and household demographic characteristics. Logistic regression was used to examine whether household- and community-level social capital decreases the odds of household hunger, and to estimate which household characteristics increase the likelihood of having social capital. Consistent with our hypotheses, social capital, at both the household and community levels, is significantly associated with household food security in these data. Community-level social capital is significantly associated with decreased odds of experiencing hunger (adjusted odds ratio (AOR)=0.47 [95% CI 0.28, 0.81], P<0.01), while controlling for household socioeconomic status. Results show that households with an elderly member are over two and a half times as likely to have high social capital (AOR=2.68 [1.22, 5.87], P<0.01) than are non-elderly households, after controlling for socioeconomic status. Having a household member who participates in a social or civic organization is also significantly associated with having higher levels of social capital. Social capital, particularly in terms of reciprocity among neighbors, contributes to household food security. Households may have similarly limited financial or food resources, but households with higher levels of social capital are less likely to experience hunger.
The prevalence of household food security, which reflects adequacy and stability of the food supply, has been measured periodically in the United States and occasionally in high-risk groups or specific regions. Despite a plausible biological mechanism to suggest negative health outcomes of food insecurity, this relation has not been adequately evaluated. This study was conducted in the Lower Mississippi Delta region to examine the association between household food insecurity and self-reported health status in adults. A two-stage stratified cluster sample representative of the population in 36 counties in the Delta region of Arkansas, Louisiana, and Mississippi was selected using list-assisted random digit dialing telephone methodology. After households were selected and screened, a randomly selected adult was interviewed within each sampled household. Data were collected to measure food security status and self-reported mental, physical, and general health status, using the U.S. Food Security Survey Module and the Short Form 12-item Health Survey (SF-12). Data were reported on a sample of 1488 households. Adults in food-insecure households were significantly more likely to rate their health as poor/fair and scored significantly lower on the physical and mental health scales of the SF-12. In regression models controlling for income, gender, and ethnicity, the interaction between food insecurity status and race was a significant predictor of fair/poor health and lower scores on physical and mental health. Household food insecurity is associated with poorer self-reported health status of adults in this rural, high-risk sample in the Lower Mississippi Delta.
Objectives. This study examines whether the mental health consequences associated with food insufficiency vary by food stamp participation status and/or the value of the food stamp benefit received.
Methods. We use longitudinal data from the Panel Study of Income Dynamics along with fixed‐effect methods that control for unobserved heterogeneity to test our hypotheses.
Results. We find that, conditional on the food stamp benefit amount, the emotional distress associated with food insufficiency is higher among food stamp participants. Moreover, we find evidence of a dosage effect such that food‐insufficient individuals who receive higher amounts of food stamp benefits suffer greater emotional distress than food‐insufficient individuals who receive lower levels of food stamp benefits. However, the negative mental health effects of food insufficiency and food stamp participation are driven primarily by periods of transition onto the Food Stamp Program and into food insufficiency.
Conclusions. The negative mental health aspects of participating in the Food Stamp Program seem to outweigh the positive mental health aspects, at least during the period of application and initial receipt, suggesting that programmatic reform is needed to improve overall well‐being among new participants.
We have described self-reported exposure to gun violence in an urban community of color to inform the movement toward a public health approach to gun violence prevention.
The Community Alliance for Research and Engagement at Yale School of Public Health conducted community health needs assessments to document chronic disease prevalence and risk, including exposure to gun violence. We conducted surveys with residents in six low-income neighborhoods in New Haven, Connecticut, using a neighborhood-stratified, population-based sample (n = 1189; weighted sample to represent the neighborhoods, n = 29 675).
Exposure to violence is pervasive in these neighborhoods: 73% heard gunshots; many had family members or close friends hurt (29%) or killed (18%) by violent acts. Although all respondents live in low-income neighborhoods, exposure to violence differs by race/ethnicity and social class. Residents of color experienced significantly more violence than did White residents, with a particularly disparate increase among young Black men aged 18 to 34 years. While not ignoring societal costs of horrific mass shootings, we must be clear that a public health approach to gun violence prevention means focusing on the dual epidemic of mass shootings and urban violence.
A national online survey of 137 US food banks was conducted along with in-depth interviews with staff at 6 California food banks to assess the characteristics of their organizational culture, including the extent to which they focused on nutritional quality of emergency food. The majority of US food banks reported a substantial level of commitment to nutrition. Only a minority has written formal nutrition policies, but several California food bankers were in the process of developing policies. US food banks most often reported seeking to increase fresh produce; fewer reported deliberate efforts to increase low-fat dairy, lean meats, or whole grains or to reduce unhealthful foods. California food banks revealed that they have significantly expanded their capacity to respond to increased produce donations, yet there are still substantial limitations to be addressed in procuring, handling, and monitoring the quantity of more nutritious foods. Organizational practices commensurate with a nutrition policy are not widely evident although there is variation. Study results highlight a number of issues for attention in assisting food banks to align their culture, capacity, and practices more closely with their stated commitment to nutrition quality.
Using the Current Population Survey data for 1999, a bivariate probit model was estimated to determine food stamp and food pantries participation for low-income households. Household income, the level of food insecurity, household structure, and metro versus nonmetro residence affected participation decisions in both programs. Shorter application forms for food stamp benefits encouraged food stamp participation. Food Stamp Program participation and food pantry use were found to be positively correlated.
To expand the understanding of potential pathways through which food insecurity is associated with adverse health outcomes, we investigated whether food insecurity is associated with nutritional levels, inflammatory response, and altered immune function.
We performed a cross-sectional analysis of the National Health and Nutrition Examination Survey (1999-2006) with 12,191 participants. We assessed food insecurity using the US Department of Agriculture food security scale module and measured clinical biomarkers from blood samples obtained during participants' visits to mobile examination centers.
Of the study population, 21.5% was food insecure. Food insecurity was associated with higher levels of C-reactive protein (adjusted odds ratio [AOR]=1.21; 95% confidence interval [CI]=1.04, 1.40) and of white blood cell count (AOR=1.36; 95% CI=1.11, 1.67). White blood cell count partly mediated the association between food insecurity and C-reactive protein.
These findings show that food insecurity is associated with increased inflammation, a correlate of chronic diseases. Immune response also appears to be a potential mediator in this pathway.
Food insecurity refers to the inability to afford enough food for an active, healthy life. Numerous studies have shown associations between food insecurity and adverse health outcomes among children. Studies of the health effects of food insecurity among adults are more limited and generally focus on the association between food insecurity and self-reported disease. We therefore examined the association between food insecurity and clinical evidence of diet-sensitive chronic disease, including hypertension, hyperlipidemia, and diabetes. Our population-based sample included 5094 poor adults aged 18-65 y participating in the NHANES (1999-2004 waves). We estimated the association between food insecurity (assessed by the Food Security Survey Module) and self-reported or laboratory/examination evidence of diet-sensitive chronic disease using Poisson regression. We adjusted the models to account for differences in age, gender, race, educational attainment, and income. Food insecurity was associated with self-reported hypertension [adjusted relative risk (ARR) 1.20; 95% CI, 1.04-1.38] and hyperlipidemia (ARR 1.30; 95% CI, 1.09-1.55), but not diabetes (ARR 1.19; 95% CI, 0.89-1.58). Food insecurity was associated with laboratory or examination evidence of hypertension (ARR 1.21; 95% CI, 1.04-1.41) and diabetes (ARR 1.48; 95% CI, 0.94-2.32). The association with laboratory evidence of diabetes did not reach significance in the fully adjusted model unless we used a stricter definition of food insecurity (ARR 2.42; 95% CI, 1.44-4.08). These data show that food insecurity is associated with cardiovascular risk factors. Health policy discussions should focus increased attention on ability to afford high-quality foods for adults with or at risk for chronic disease.
On the basis of an 18-item Household Food Security Scale, a short form was developed to assess financially based food insecurity and hunger in surveys of households with and without children.
To maximize the probability that households would be correctly classified with respect to food insecurity and hunger, 6 items from the full scale were selected on the basis of April 1995 Current Population Survey data.
The short form classified 97.7% of households correctly and underestimated the prevalence of overall food insecurity and of hunger by 0.3 percentage points.
The short form of the Household Food Security Scale is a brief but potentially useful tool for national surveys and some state/local applications.
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