Molly De Marco

“In a Country as Affluent as America, People Should be Eating”: Experiences With and Perceptions of Food Insecurity Among Rural and Urban Oregonians

Many factors are associated with food insecurity in the United States. We conducted interviews with 25 low-income and/or food-insecure Oregonians to explore their experiences with food insecurity, the role of social support, and whether these experiences differed based on rural/urban residence. Ill health and unemployment emerged as food-insecurity contributors. Coping strategies cited included use of nutrition assistance programs, alternate food sources, and drawing on social support. The findings suggest that policy and practice efforts should be directed at increasing the human capital of low-income Oregonians and the benefit levels of essential nutrition assistance programs.

Perceived discrimination during prenatal care, labor, and delivery: an examination of data from the Oregon Pregnancy Risk Assessment Monitoring System, 1998-1999, 2000, and 2001.

Although recent research has examined discrimination in health care, no studies have investigated womens experiences during prenatal or obstetrical care. Analyses of data from the Oregon Pregnancy Risk Assessment Monitoring System showed that 18.53% of mothers reported discrimination by providers during prenatal care, labor, or delivery, most commonly because of age or insurance status. Perceived discrimination was associated with maternal characteristics such as age, marital status, and type of insurance, but not with number of subsequent well-baby visits.

The relationship between income and food insecurity among Oregon residents: does social support matter?

OBJECTIVE Millions of US households experienced food insecurity in 2005. Research indicates that low wages and little social support contribute to food insecurity. The present study aimed to examine whether social support moderates the relationship between income and food insecurity. DESIGN Using a mail survey, we collected data on social support sources (social network, intimate partner and community) and social support functions from a social network (instrumental, informational and emotional). We used hierarchical logistic regression to examine the potential moderation of various measures of social support on the relationship between income and food insecurity, adjusting for potential confounding variables. SETTING Oregon, USA. SUBJECTS A stratified random sample of Oregonians aged 18-64 years (n 343). RESULTS We found no evidence of an association between social support and food insecurity, nor any evidence that social support acts as a moderator between income and food insecurity, regardless of the measure of social support used. CONCLUSIONS Although previous research suggested that social support could offset the negative impact of low income on food security, our study did not find support for such an effect.

Assessing the Readiness of Black Churches to Engage in Health Disparities Research

We assessed church readiness to engage in health disparities research using a newly developed instrument, examined the correlates of readiness, and described strategies that churches used to promote health. We pilot tested the instrument with churches in a church-academic partnership (n = 12). We determined level of readiness to engage in research and assessed correlates of readiness. We also conducted interviews with participating pastors to explore strategies they had in place to support research engagement. Churches scored fairly high in readiness (average of 4.04 out of 5). Churches with a pastor who promoted the importance of good nutrition in a sermon or had a budget for health-related activities had significantly higher readiness scores than churches without such practices. Having a tool to evaluate church readiness to engage in research will inform targeted technical assistance and research projects that will strengthen church-academic partnerships and improve capacity to address health disparities.

The Association Between Sociodemographic Factors, Participation in Assistance Programs, and Food Insecurity Among Oregon Residents

ABSTRACT We measured food insecurity and investigated whether sociodemographics and assistance program use were associated with food insecurity in a random sample of working-age Oregonians (N = 343) using hierarchical logistic regression. About 14% of Oregonians were food insecure. Food insecurity was significantly associated with less education, unemployment, household income 30% of income for housing. Having a household member who had used Social Security Insurance or frequented a food bank increased the odds of food insecurity, whereas Food Stamp Program participation decreased the odds of food insecurity. This study supports previous research linking food insecurity to human capital and economic factors and can inform public health programs and policies designed to lower food insecurity.We measured food insecurity and investigated whether sociodemographics and assistance program use were associated with food insecurity in a random sample of working-age Oregonians (N = 343) using hierarchical logistic regression. About 14% of Oregonians were food insecure. Food insecurity was significantly associated with less education, unemployment, household income 30% of income for housing. Having a household member who had used Social Security Insurance or frequented a food bank increased the odds of food insecurity, whereas Food Stamp Program participation decreased the odds of food insecurity. This study supports previous research linking food insecurity to human capital and economic factors and can inform public health programs and policies designed to lower food insecurity.ABSTRACT We measured food insecurity and investigated whether sociodemographics and assistance program use were associated with food insecurity in a random sample of working-age Oregonians (N = 343) using hierarchical logistic regression. About 14% of Oregonians were food insecure. Food insecurity was significantly associated with less education, unemployment, household income <

Insurance-Based Discrimination During Prenatal Care, Labor, and Delivery: Perceptions of Oregon Mothers

20,000, lack of homeownership, and paying >30% of income for housing. Having a household member who had used Social Security Insurance or frequented a food bank increased the odds of food insecurity, whereas Food Stamp Program participation decreased the odds of food insecurity. This study supports previous research linking food insecurity to human capital and economic factors and can inform public health programs and policies designed to lower food insecurity.

Beyond Incentives for Involvement to Compensation for Consultants: Increasing Equity in CBPR Approaches

The purpose of this study was to improve understanding of who experiences insurance-based discrimination during prenatal care, labor, and delivery and how their health care may differ from that of other women. We pooled data from the 1998–1999, 2000, and 2001 Oregon Pregnancy Risk Assessment Monitoring System and conducted univariate, bivariate, and multivariate analyses. The women who perceived that they had been treated differently by health care providers during prenatal care, labor, or delivery based on their insurance status were largely a lower income group. Insurance-based discrimination was significantly associated with lower annual household incomes, being unable to pay bills during pregnancy, and being without employer-sponsored insurance for their baby’s delivery, when adjusted for other factors. Insurance-based discrimination was less likely among Hispanic mothers. With respect to the relationship between insurance-based discrimination and receipt of health care, our findings were mixed. Insurance-based discrimination was not significantly associated with the number of topics covered by providers during prenatal care. In contrast, insurance-based discrimination was significantly associated with fewer breastfeeding support actions taken at the hospital and with having had a provider discuss birth control after delivery among women with employer sponsored insurance. These findings draw attention to the need to better understand women’s experiences and perceptions of insurance-based discrimination during prenatal care, labor, and delivery.

Growing Partners: Building a Community–Academic Partnership to Address Health Disparities in Rural North Carolina

Background: Community-based participatory research (CBPR) strives for equitable collaboration among community and academic partners throughout the research process. To build the capacity of academia to function as effective research partners with communities, the North Carolina Translational and Clinical Sciences Institute (NC TraCS), home of the University of North Carolina at Chapel Hill (UNC-CH)’s Clinical and Translational Sciences Award (CTSA), developed a community engagement consulting model. This new model harnesses the expertise of community partners with CBPR experience and compensates them equitably to provide technical assistance to community–academic research partnerships. Objectives: This paper describes approaches to valuing community expertise, the importance of equitable compensation for community partners, the impact on the community partners, opportunities for institutional change, and the constraints faced in model implementation. Methods: Community Experts (CEs) are independent contractor consultants. CEs were interviewed to evaluate their satisfaction with their engagement and compensation for their work. Lessons Learned: (1) CEs have knowledge, power, and credibility to push for systems change. (2) Changes were needed within the university to facilitate successful consultation to community–academic partnerships. (3) Sustaining the CE role requires staff support, continued compensation, increased opportunities for engagement, and careful consideration of position demands. (4) The role provides benefits beyond financial compensation. (5) Opportunities to gather deepened relationships within the partnership and built collective knowledge that strengthened the project. Conclusions: Leveraging CE expertise and compensating them for their role benefits both university and community. Creating a place for community expertise within academia is an important step toward equitably including the community in research.

Engaging Underserved Populations in Affordable Care Act-required Needs Assessments

Background: Community-based participatory research (CBPR) holds tremendous promise for addressing public health disparities. As such, there is a need for academic institutions to build lasting partnerships with community organizations. Herein we have described the process of establishing a relationship between a research university and a Black church in rural North Carolina. We then discuss Harvest of Hope, the church-based pilot garden project that emerged from that partnership. Methods: The partnership began with a third-party effort to connect research universities with Black churches to address health disparities. Building this academic–community partnership included collaborating to determine research questions and programming priorities. Other aspects of the partnership included applying for funding together and building consensus on study budget and aims. The academic partners were responsible for administrative details and the community partners led programming and were largely responsible for participant recruitment. Results: The community and academic partners collaborated to design and implement Harvest of Hope, a church-based pilot garden project involving 44 youth and adults. Community and academic partners shared responsibility for study design, recruitment, programming, and reporting of results. The successful operation of the Harvest of Hope project gave rise to a larger National Institutes of Health (NIH)-funded study, Faith, Farming and the Future (F3) involving 4 churches and 60 youth. Both projects were CBPR efforts to improve healthy food access and reducing chronic disease. This partnership continues to expand as we develop additional CBPR projects targeting physical activity, healthy eating, and environmental justice, among others. Benefits of the partnership include increased community ownership and cultural appropriateness of interventions. Challenges include managing expectations of diverse parties and adequate communication. Lessons learned and strategies for building and maintaining similar partnerships are discussed. Conclusions: The benefits of community-based research for addressing health disparities are many, and there are lessons to be learned that can strengthen community–academic partnerships.

Locally Grown Fruit and Vegetable Purchasing Habits and the Association With Children’s Diet

This article presents information on an Affordable Care Act-mandated community health needs assessment process, which brought four hospitals and a foundation in Pennsylvania together to imbue the assessment with community contributions. Community health needs assessments that engage underserved communities can be powerful symbols of hospitals’ interest in and commitment to finding solutions.