Food Selection
Conditions
Keywords
Food insecurity, Food pantries
Brief summary
The investigator proposes an evaluation of a randomized, sustainable intervention in 8 intervention and 8 control pantries. We will enroll a sample clients at the food pantry at baseline and follow them for 1 year to assess changes in overall diet quality (the primary outcome) and cardiovascular health. We will also enroll a sample of clients at follow-up to assess to assess the nutritional quality of food selected at the pantry.
Detailed description
Evaluate the health impact of an intervention targeting the hunger relief network and the clients with food insecurity it serves. The long-term goal of this work is to reduce nutrition-related health disparities by intervening on a system that serves individuals at high risk for chronic disease. In 2014, an estimated 14% of U.S. households experienced food insecurity (i.e., they lacked access to enough food for an active, healthy life for all household members). Large numbers of low-income, racial/ethnic minority, and immigrant families who experience food insecurity rely on a hunger relief network that includes food banks and food pantries. Pantry clients have demonstrated poor nutritional outcomes, high chronic disease rates, and dissatisfaction with the quality and cultural-appropriateness of food offered. Unlike other food assistance programs, there are currently no standards on the nutritional quality of pantry offerings, but recent work by our study team demonstrated the need to improve the healthfulness of hunger relief network inventory. We proposed an evaluation of a randomized, sustainable intervention in 8 intervention and 8 control pantries. We will enroll clients at baseline and follow them for 1 year to assess changes in overall diet quality (the primary outcome). Working with our food bank partners, the intervention at the pantry level targets the supply of nutritious foods. At the client level, the intervention targets healthy food demand. Measured outcomes include overall diet quality (the primary outcome), as assessed by the Healthy Eating Index-2015 (HEI), the nutritional quality of foods selected at the food shelf visit, and cardiovascular disease health (assessed by the American Heart Association's Life's Simple 7 scores). The study will also evaluate the impact of a multilevel intervention on the nutritional quality of pantry offerings. The study also aims to improve implementation of practices that promote a nutrition-focused hunger relief network.
Interventions
BEHAVIORALIntervention Food Pantries
Food pantries will receive consulting services to transform their food offerings and environment in order to influence client health behaviors.
OTHERControl Food Pantries
Normal food pantry use
Sponsors
University of Connecticut
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 99 Years
Healthy volunteers
No
Inclusion criteria
-≥18 years old * Mentally capable of consent and participation * Speak English, Spanish, or Somali * Have access to a phone
Exclusion criteria
* Not capable of consent or participation * Speak only languages other than English, Spanish or Somali * Not a food pantry user
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Diet Quality of Clients | Baseline, 1 year | Assessed by Healthy Eating Index-2015 scores (scale 0-100), with 100 representing the best possible score (i.e., nutritional quality best aligned with Dietary Guidelines for Americans) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Nutritional Quality of Food Selected by Clients at the Food Pantry | 1 year post-sample comparison | Assessed by Healthy Eating Index-2015 scores (scale 0-100), with 100 representing the best possible score (i.e., nutritional quality best aligned with Dietary Guidelines for Americans) |
| Cardiovascular Health | Baseline, 1 year | American Heart Association's Life's Simple 7 (LS7) scores (scale 0 -7), with 7 representing the best possible score for cardiovascular health |
Countries
United States
Participant flow
Recruitment details
Two samples of participants were enrolled. The first (Sample A, n=317), had measures collected at two time points. They were enrolled at baseline and followed for one year to assess change in diet quality (primary outcome) and cardiovascular measures (secondary outcome). The second (Sample B, n=187) had measures collected at one time point only. They were enrolled at the pantry during the follow-up period to assess post-intervention client cart diet quality (secondary outcome).
Participants by arm
| Arm | Count |
|---|---|
| Intervention Food Pantries and Clients Food pantries will transform to offer healthier and more appealing food; the effect on clients will be measured;
Intervention Food Pantries: Food pantries will receive consulting services to transform their food offerings and environment in order to influence client health behaviors;
Intervention Clients: Clients who use and were recruited at intervention food pantries. | 243 |
| Control Food Pantries and Clients Food pantries will make no changes during the evaluation period; the effect on clients will be measured;
Control Food Pantries: Normal food pantry operations during the evaluation period;
Control Clients: Clients who use and were recruited at control food pantries. | 261 |
| Total | 504 |
Baseline characteristics
| Characteristic | Intervention Food Pantries and Clients | Control Food Pantries and Clients | Total |
|---|---|---|---|
| Age, Customized 18-64 | 210 Participants | 227 Participants | 437 Participants |
| Age, Customized 65 years and older | 31 Participants | 31 Participants | 62 Participants |
| Age, Customized Less than 18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Customized Unknown | 2 Participants | 3 Participants | 5 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 20 Participants | 15 Participants | 35 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 2 Participants | 2 Participants |
| Race (NIH/OMB) Black or African American | 23 Participants | 56 Participants | 79 Participants |
| Race (NIH/OMB) More than one race | 34 Participants | 19 Participants | 53 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 19 Participants | 16 Participants | 35 Participants |
| Race (NIH/OMB) White | 146 Participants | 153 Participants | 299 Participants |
| Region of Enrollment United States | 243 Participants | 261 Participants | 504 Participants |
| Sex: Female, Male Female | 146 Participants | 169 Participants | 315 Participants |
| Sex: Female, Male Male | 94 Participants | 89 Participants | 183 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 1 / 158 | 1 / 159 |
| other Total, other adverse events | 0 / 158 | 0 / 159 |
| serious Total, serious adverse events | 0 / 158 | 0 / 159 |
Outcome results
Primary
Overall Diet Quality of Clients
Assessed by Healthy Eating Index-2015 scores (scale 0-100), with 100 representing the best possible score (i.e., nutritional quality best aligned with Dietary Guidelines for Americans)
Time frame: Baseline, 1 year
Population: COVID-19 disrupted intervention and post-evaluation activities in 5 sites. The analysis includes participants in Sample A at the 11 completed sites.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Intervention Food Pantries and Clients | Overall Diet Quality of Clients | 1.09 Pre-post change in HEI score on a scale | Standard Error 1.45 |
| Control Food Pantries and Clients | Overall Diet Quality of Clients | -1.42 Pre-post change in HEI score on a scale | Standard Error 1.52 |
p-value: 0.23Mixed Models Analysis
Secondary
Cardiovascular Health
American Heart Association's Life's Simple 7 (LS7) scores (scale 0 -7), with 7 representing the best possible score for cardiovascular health
Time frame: Baseline, 1 year
Population: COVID-19 disrupted intervention and post-evaluation activities in 5 sites. The analysis includes participants in Sample A at the 11 completed sites.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Intervention Food Pantries and Clients | Cardiovascular Health | -0.09 Pre-post change in LS7 score on a scale | Standard Error 0.15 |
| Control Food Pantries and Clients | Cardiovascular Health | 0.41 Pre-post change in LS7 score on a scale | Standard Error 0.16 |
Secondary
Nutritional Quality of Food Selected by Clients at the Food Pantry
Assessed by Healthy Eating Index-2015 scores (scale 0-100), with 100 representing the best possible score (i.e., nutritional quality best aligned with Dietary Guidelines for Americans)
Time frame: 1 year post-sample comparison
Population: COVID-19 disrupted intervention and post-evaluation activities in 5 sites. The analysis includes participants in Sample B at the 11 completed sites.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention Food Pantries and Clients | Nutritional Quality of Food Selected by Clients at the Food Pantry | 60.6 Post-sample HEI score | Standard Deviation 11.8 |
| Control Food Pantries and Clients | Nutritional Quality of Food Selected by Clients at the Food Pantry | 64.0 Post-sample HEI score | Standard Deviation 10 |