Addressing Food Insecurity through a Health Equity Lens: a Case Study of Large Urban School Districts during the COVID-19 Pandemic.
Addressing Food Insecurity through a Health Equity Lens: a Case Study of Large Urban School Districts during the COVID-19 Pandemic.
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DOI：
10.1007/s11524-020-00476-0
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发表时间：
2020-12
期刊：
影响因子：
--
通讯作者：
Gadhoke P
中科院分区：
文献类型：
--
作者：
McLoughlin GM;McCarthy JA;McGuirt JT;Singleton CR;Dunn CG;Gadhoke P
在公共卫生紧急情况期间，学校供餐机会减少，可能会加剧粮食不安全和营养状况，特别是对城市地区的低收入儿童而言。为了防止健康差距的加剧，有必要了解紧急情况下大城市学区之间的膳食分配的实施情况，以及这些战略在多大程度上提供了公平的膳食机会。我们对COVID-19大流行期间四个大型城市学区的案例研究旨在解决这些知识差距。在实现公平（GTE）框架的指导下，我们进行了一项混合方法研究，评估了四个大型城市学区（芝加哥公立学校、休斯顿独立学区、洛杉矶联合学区和纽约市教育局）的紧急膳食分配和战略实施情况。我们从学区网站收集了（1）餐饮服务和交付网站和（2）地区文件，政策，沟通和资源的数据。我们采用定性编码方法，根据GTE框架的四个组成部分（增加健康选择、减少阻碍因素、增强社区能力以及增加社会和经济资源），确定了独特和共享的地区策略，以解决疫情期间的膳食分配和沟通问题。我们将地区人口普查区边界与2018年美国社区调查和美国农业部食物沙漠数据的人口数据相匹配，并使用地理信息系统（GIS）软件来确定相对于学生人口的用餐地点，高贫困地区和高少数民族人口，以及食物沙漠。我们发现，所有地区都制定了优化膳食供应的策略，这些策略在不同的案例中有所不同。增加健康选择的战略包括为成年人和其他公众提供服务，及时提供用餐地点的信息，并促进均衡饮食。提供膳食的数量和频率各不相同，各区促进高质量营养的程度有限。减少与使用包容性语言和图像有关的威慑，并以多种语言提供有关社交距离做法的安全信息。地区通过与第一反应者、救济和其他社区组织合作建立社区能力。社会和经济资源的增加体现在向家庭提供技术援助、为基本工作者提供儿童保育推荐以及其他保健资源。地理空间分析表明，各城市的服务地点在一定程度上因人口和食品环境而异，在覆盖范围方面存在潜在差距。这项研究确定了有可能增加公平获得营养援助计划的战略。我们的研究结果可以支持（1）在大流行期间解决儿童食品不安全问题的持续努力，以及（2）通过夏季食品服务计划和无缝夏季选项等计划提供未来的膳食。未来的研究应进一步研究用餐地点放置背后的基本原理以及地点可用性如何随时间变化。
Reduced access to school meals during public health emergencies can accelerate food insecurity and nutritional status, particularly for low-income children in urban areas. To prevent the exacerbation of health disparities, there is a need to understand the implementation of meal distribution among large urban school districts during emergencies and to what degree these strategies provide equitable meal access. Our case study of four large urban school districts during the COVID-19 pandemic aims to address these knowledge gaps. Guided by the Getting to Equity (GTE) framework, we conducted a mixed-methods study evaluating emergency meal distribution and strategy implementation in four large urban school districts (Chicago Public Schools, Houston Independent School District, Los Angeles Unified School District, and New York City Department of Education). We gathered data from school district websites on (1) meal service and delivery sites and (2) district documents, policies, communication, and resources. Using qualitative coding approaches, we identified unique and shared district strategies to address meal distribution and communications during the pandemic according to the four components of the GTE framework: increase healthy options, reduce deterrents, build on community capacity, and increase social and economic resources. We matched district census tract boundaries to demographic data from the 2018 American Community Survey and United States Department of Agriculture food desert data, and used geographic information systems (GIS) software to identify meal site locations relative to student population, areas of high poverty and high minority populations, and food deserts. We found that all districts developed strategies to optimize meal provision, which varied across case site. Strategies to increase healthy options included serving adults and other members of the general public, providing timely information on meal site locations, and promoting consumption of a balanced diet. The quantity and frequency of meals served varied, and the degree to which districts promoted high-quality nutrition was limited. Reducing deterrents related to using inclusive language and images and providing safety information on social distancing practices in multiple languages. Districts built community capacity through partnering with first responder, relief, and other community organizations. Increased social and economic resources were illustrated by providing technology assistance to families, childcare referrals for essential workers, and other wellness resources. Geospatial analysis suggests that service locations across cities varied to some degree by demographics and food environment, with potential gaps in reach. This study identifies strategies that have the potential to increase equitable access to nutrition assistance programs. Our findings can support (1) ongoing efforts to address child food insecurity during the pandemic and (2) future meal provision through programs like the Summer Food Service Program and Seamless Summer Option. Future research should further examine the rationale behind meal site placement and how site availability changed over time.
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