A multi-component intervention in the hunger relief network to improve diet among adults experiencing food insecurity

摘要 该应用程序的首要目标是评估针对以下人群的干预措施的健康影响： 饥饿救济网络及其所服务的粮食无保障客户。这项工作的长期目标是减少 营养相关的健康差异，通过干预为慢性病高风险个人提供服务的系统， 疾病2014年，估计有14%的美国家庭经历了粮食不安全（即，他们无法进入 为所有家庭成员过上积极、健康的生活提供足够的食物）。大量低收入、 面临粮食不安全的少数民族/族裔和移民家庭依靠饥饿救济网络 包括食品银行和食品储藏室。食品储藏室的客户表现出营养不良的结果，高 慢性病发病率，以及对所提供食物的质量和文化适宜性的不满。不像 其他食品援助计划，目前没有标准的食品储藏室提供的营养质量， 但我们的研究小组最近的工作表明，需要改善饥饿救济的健康状况， 网络库存。我们提出了一个评估的随机，可持续的干预，在8个干预和 8控制柜我们将在基线时招募272名客户，并随访1年，以评估总体变化 饮食质量（主要结果）。与我们的食品银行合作伙伴合作， 通过改变政策和做法以及能力建设，以营养食品的供应为目标。在客户端 在这一层面，干预措施利用行为经济学和教育方法，针对健康食品需求。 测量的结果包括整体饮食质量（主要结果），由健康饮食评估 指数-2010（HEI），在食品货架访问中选择的食品的营养质量和心血管疾病 健康（由美国心脏协会的生活简单7分评估）。该研究还将评估 多层次干预对食品储藏室提供的营养质量的影响，通过饥饿救济衡量 营养指数。该研究还旨在改善促进发展的政策和做法的执行情况， 通过调查和关键知情人访谈评估的以营养为重点的饥饿救济网络。作为探索性 目的是，这项研究将评估食品和服务的文化适当性，考虑到穷人的负担， 少数民族、移民和难民家庭的粮食供应。经过一年的需求评估，干预措施将 在第2-3年分2波进行。第4-5年将侧重于分析， 通过我们的伙伴机构支持的渠道进行传播。这项工作利用了一个明显的 当地改善饥饿救济系统的势头。研究目标是解决系统的需求- 采取广泛的方法改进饥饿救济网络，并评价其对客户成果的影响。

ABSTRACT The overarching goal of this application is to 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 272 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, through policy and practice changes and capacity-building. At the client level, the intervention targets healthy food demand, using behavioral economic and educational approaches. Measured outcomes include overall diet quality (the primary outcome), as assessed by the Healthy Eating Index-2010 (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, measured by a Hunger Relief Nutrition Index. The study also aims to improve implementation of policies and practices that promote a nutrition-focused hunger relief network, as assessed by survey and key informant interviews. As an exploratory aim, the study will evaluate the cultural appropriateness of pantry foods and services, given the burden of poor food access on minority, immigrant, and refugee families. After a 1-year needs assessment, an intervention will be conducted in 2 waves in Years 2-3. Years 4-5 will be focused on analysis and local and regional dissemination through channels supported by our partnering agencies. This work capitalizes on a palpable local momentum towards improving the hunger relief system. Research aims address the need for a system- wide approach to improving the hunger relief network and evaluation of its impact on client outcomes.