Leah M. Connor

Food insecurity and dietary quality in US adults and children: a systematic review

BACKGROUND Food insecurity is adversely associated with the physical and mental health of adults and children, and the mechanism that underlies this association has been assumed to be dietary intake of lower quality in food insecure than food secure individuals. A thorough understanding of observed associations between food insecurity and dietary quality is needed to test this assumption and may highlight pathways through which to improve the health of food-insecure adults and children. OBJECTIVE We systematically reviewed all evidence of associations between food insecurity and dietary quality and contrasted associations observed in adults and those for children. DESIGN Evidence came from studies that appeared in indexed, peer-reviewed journals and 1) sampled US residents, 2) separately sampled children and adults, 3) contained a measure of food insecurity or food insufficiency, and 4) included at least one measure of dietary quality. RESULTS In adults, 170 associations between food insecurity and dietary quality were tested, and 50 associations (29%) suggested an adverse association. Food-insecure adults consumed fewer vegetables, fruit, and dairy products than did food secure adults and had lower intake of vitamins A and B-6, calcium, magnesium, and zinc. In children, 130 associations were tested, and 21 associations (16%) showed an adverse association. There was substantial evidence of only lower fruit consumption in food-insecure compared with food-secure children. Reporting and publication biases may have contributed to an overestimation of the association between food insecurity and dietary quality. CONCLUSIONS Food insecurity is adversely associated with dietary quality in adults, particularly intakes of nutrient-rich vegetables, fruit, and dairy that promote good health. However, food insecurity was less-consistently associated with lower dietary quality in children. The idea that parents effectively shield their children from compromised dietary quality because of food shortages is supported by the evidence.

Rural food and physical activity assessment using an electronic tablet- based application, New York, 2013-2014

Introduction A community’s built environment can influence health behaviors. Rural populations experience significant health disparities, yet built environment studies in these settings are limited. We used an electronic tablet-based community assessment tool to conduct built environment audits in rural settings. The primary objective of this qualitative study was to evaluate the usefulness of the tool in identifying barriers and facilitators to healthy eating and active living. The second objective was to understand resident perspectives on community features and opportunities for improvement. Methods Participants were recruited from 4 rural communities in New York State. Using the tool, participants completed 2 audits, which consisted of taking pictures and recording audio narratives about community features perceived as assets or barriers to healthy eating and active living. Follow-up focus groups explored the audit experience, data captured, and opportunities for change. Results Twenty-four adults (mean age, 69.4 y [standard deviation, 13.2 y]), 6 per community, participated in the study. The most frequently captured features related to active living were related to roads, sidewalks, and walkable destinations. Restaurants, nontraditional food stores, and supermarkets were identified in the food environment in relation to the cost, quality, and selection of healthy foods available. In general, participants found the assessment tool to be simple and enjoyable to use. Conclusion An electronic tablet–based tool can be used to assess rural food and physical activity environments and may be useful in identifying and prioritizing resident-led change initiatives. This resident-led assessment approach may also be helpful for informing and evaluating rural community-based interventions.

Development and testing of a community audit tool to assess rural built environments: Inventories for Community Health Assessment in Rural Towns

Rural populations face unique challenges to physical activity that are largely driven by environmental conditions. However, research on rural built environments and physical activity is limited by a paucity of rural-specific environmental assessment tools. The aim of this paper is to describe the development and testing of a rural assessment tool: Inventories for Community Health Assessment in Rural Towns (iCHART). The iCHART tool was developed in 2013 through a multistep process consisting of an extensive literature search to identify existing tools, an expert panel review, and pilot testing in five rural US communities. Tool items represent rural built environment features that influence active living and physical activity: community design, transportation infrastructure, safety, aesthetics, and recreational facilities. To assess reliability, field testing was performed in 26 rural communities across five states between July and November of 2014. Reliability between the research team and community testers was high among all testing communities (average percent agreement = 77%). Agreement was also high for intra-rater reliability (average kappa = 0.72) and inter-rater reliability (average percent agreement = 84%) among community testers. Findings suggest that the iCHART tool provides a reliable assessment of rural built environment features and can be used to inform the development of contextually-appropriate physical activity opportunities in rural communities.

Household Instability and Unpredictable Earnings Hinder Coping in Households with Food Insecure Children

ABSTRACT This mixed-methods study explored the circumstances and coping strategies of households at risk of food insecurity among children. Quantitative analyses guided the selection of two samples of households: (1) at risk for food insecure children, yet children were food secure (n = 19) and (2) with food insecure children (n = 54). Qualitative interviews with parents revealed that households with food insecure children were complex and fluctuating in composition and had unpredictable earnings. Coping strategies were similar in both samples, except that households with at risk yet food secure children described home cooking, a household coping strategy that may be attributed to their stable household composition and resources.

Fruit and Vegetable Preferences and Practices May Hinder Participation in Community-Supported Agriculture Among Low-Income Rural Families

Objective Describe fruit and vegetable (FV) preferences and other factors that may influence participation in community‐supported agriculture (CSA). Design In‐depth, semi‐structured interviews. Setting Eight rural/micropolitan communities in 4 US states. Participants There were 41 caregivers and 20 children (8–12 years of age) from low‐income, English‐speaking households. Phenomena of Interest Knowledge, attitudes, and behaviors regarding FVs; perceived barriers to CSA participation. Analysis Transcribed verbatim and iteratively coded. Results Caregivers and children believed FVs were important to health, yet FVs were not featured in dinners or snacks and consumption was challenged by limited preferences and neophobia. Few caregivers and children knew about the seasonality of FV. Most caregivers were unfamiliar with CSA and had concerns about CSA cost, accessibility, produce quality, and selection. Conclusions and Implications These qualitative data support improvements in: 1) CSA distribution practices to offer flexible payment and pick‐up options, more fruits, and self‐selection of FV; 2) public awareness of produce seasonality and the CSA distribution model as necessary precursors to participation, and lower cost for low‐income families who highlighted this barrier; and 3) capacity to prepare FV by enhancing skills and providing time‐saving kitchen tools. Approaches to aligning CSA practices with the needs and preferences of low‐income families warrant further research.

Eating on schooldays and non-schooldays among children at risk for food insecurity: Implications for weekend food backpack programs

ABSTRACT Anecdotal reports suggest that food insecure children may go hungry when school meals are unavailable. Weekend food backpack (WFB) programs provide children with food for weekends and holidays. We conducted 22 interviews with parents of children at risk of food insecurity, 9 of whom got WFBs. Participants and nonparticipants had similar household resources and food security. Overall, parents found the WBP helpful. WFB snacks were popular with children and eaten quickly, which sometimes conflicted with parenting practices. Other WFB foods were shared within and outside the household. Research is needed to examine the efficiency and effectiveness of the WFB model relative to other interventions to ameliorate food insecurity among children.

A Civic Engagement Approach to Encourage Healthy Eating and Active Living in Rural Towns: The HEART Club Pilot Project:

Purpose: To assess the feasibility and effectiveness of a civic engagement curriculum (encouraging Healthy Eating and Activity in Rural Towns [HEART] Club) designed to engage rural residents in improving their local food or physical activity environment. Design: Pre–post surveys and focus groups. Setting: Three rural Northeastern towns in the United States. Participants: Twenty-six rural residents (7-12 per town) recruited by local extension educators. Measures: Online surveys were used to assess outcomes related to feasibility (satisfaction) and effectiveness (knowledge, awareness, motivation, self-efficacy, and group efficacy for community change). Feasibility was also assessed through attendance logs, benchmark achievement records, and post-implementation focus groups. Analysis: Participant characteristics and feasibility measures were summarized using descriptive statistics. Pre–post changes in effectiveness outcomes were assessed using Wilcoxon signed rank tests. Focus group data were thematically examined to identify barriers to and facilitators of HEART Club progress. Results: Meeting attendance and program satisfaction were high (88% and 91%). Participants reported improvements in awareness; however, no other significant changes were observed. All HEART Clubs accomplished 3 or more project benchmarks after 6 months of implementation. Despite competing priorities and limited finances, groups effectively leveraged existing resources to achieve their goals. Important facilitators of success included stakeholder support, effective leadership, and positive group dynamics. Conclusion: These findings suggest that resident-driven initiatives that build upon local resources and establish feasible goals can successfully foster environmental change in rural communities.