Intermediate Effects of a Social Ecological Modeled, Community-Based Intervention on the Food Security and Dietary Intake of Rural, Midwestern, Adult Food Pantry Clients

Breanne Natasha Wright, Purdue University

Abstract

Food insecurity, or limited access to enough foods for an active, healthy life, characterizes the situation of 65% of US food pantry clients. Food insecurity is associated with poor dietary intake of key food groups and nutrients, diet-related chronic disease, poor physical and mental health, and reduced quality of life. Although food pantry clients are prevalently food insecure, there is a sizeable proportion of food pantry clients who are classified as food secure (FS), or report having adequate access to healthy foods. Previous studies suggest that food secure pantry clients may use pantry resources differently, and have diets that differ in quality and intake, compared to food insecure clients (including low food secure [LFS] and very low food secure [VLFS] clients). The high prevalence of food insecurity among food pantry clients suggests that food pantries may be an important venue to reach food insecure individuals and intervene to improve dietary outcomes. Since dietary intake and use of food pantries may differ by food security status, the efficacy of interventions to improve dietary outcomes in the food pantry setting may also differ by food security status. A social ecological modeled (SEM), community-based intervention in the food pantry setting is promising in sustaining local change efforts and may facilitate long-term implementation of strategies to improve food security and dietary intake among food pantry clients. Therefore, the aims of this dissertation were to 1) characterize differences in dietary intake between FS, LFS and VLFS pantry clients in a cross-sectional analysis; 2) explore associations between the nutritional quality of the food pantry environment (foods stocked and distributed by foods pantries) and pantry client diet quality by food security status in a cross-sectional analysis; and 3) evaluate the intermediate effects of a SEM, community-based intervention to improve dietary outcomes among pantry clients with comparison by food security status in a longitudinal analysis. This dissertation begins with an introductory chapter that will provide an overview of the problem of food insecurity and the venue food pantries represent as a food assistance resource, the evidence base for conducting nutrition interventions in the food pantry setting, the rationale and design of the Voices for Food (VFF) intervention, and a detailed review of contemporary food security and dietary assessment tools that were utilized in analyses. The first chapter ends with a description of the research aims, hypotheses, and objectives, as well as a guide to the structure of the dissertation. The research studies presented in chapters 2-4 fill a gap in the literature by addressing how food security status may be related to dietary intake, the foods clients consume and are exposed to at food pantries, and the capability for improvements in the nutritional quality of the pantry food environment to influence their dietary patterns. The second chapter describes a cross-sectional analysis at baseline that compared dietary quality and usual intake of energy, nutrients that are currently under-consumed in the US, and related food groups by FS, LFS, and VLFS status. Adult food pantry clients (n = 617) completed a demographic survey, the US Household Food Security Survey Module, and up to three 24-hour dietary recalls (24-HRs) on non-consecutive days including weekdays and weekend days. Healthy Eating Index-2010 (HEI-2010) total and component scores and usual intake using the National Cancer Institute method were estimated using ≥3 client 24-HRs. Mixed multiple linear regression models adjusting for confounders determined associations between food security status and both diet quality and usual intake (in separate models). Cross-sectional analyses at baseline determined that FS status was associated with a higher HEI-2010 whole grains score, as well as a higher mean usual intake of whole grains and iron, compared to LFS status. FS status was also associated with higher mean usual intakes of dark green vegetables and total dairy compared to LFS and VLFS status. The third chapter describes a cross-sectional analysis at baseline that evaluated the relationship between the quality of the mix of foods in stock (pantry inventories) and distributed (client food bags) by food pantries with client diet quality, and investigated how these relationships varied by food security status. Pantry inventories, client food bags, and client diets were scored using the HEI-2010. Multiple linear regression models adjusting for confounders determined associations between HEI-2010 total and component scores for pantry inventories and client food bags (in separate models) and the corresponding scores for client dietary intake. Client food bag HEI-2010 scores were positively associated with client diet scores for the total vegetables, total fruit, total protein foods, and sodium components, while pantry inventory HEI-2010 scores were negatively associated with client diet scores for the total score and for the total fruit and fatty acids component scores. VLFS clients consumed more whole grains from client food bags compared to FS clients, and consumed more greens and beans compared to LFS clients from pantry inventories.

Degree

Ph.D.

Advisors

Eicher-Miller, Purdue University.

Subject Area

Public health|Mental health|Agronomy|Food Science|Medicine|Pharmaceutical sciences|Social structure

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