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

摘要 此应用程序的总体目标是评估针对 饥饿救济网络及其所服务的粮食无保障的客户。这项工作的长期目标是减少 通过干预一个服务于慢性病高危人群的系统，实现与营养相关的健康差异 疾病。2014年，估计有14%的美国家庭经历了粮食不安全(即，他们无法获得粮食 为所有家庭成员的积极、健康的生活提供足够的食物)。大量的低收入者， 少数族裔和经历粮食不安全的移民家庭依赖饥饿救济网络 这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状况不佳， 慢性病发病率，以及对提供的食物的质量和文化适宜性的不满。不像 其他食品援助计划，目前还没有关于食品储藏室提供的营养质量的标准， 但我们的研究小组最近的工作表明，有必要提高饥饿救济的健康程度 网络库存。我们提出了一项对随机、可持续干预的评估，包括8项干预和 8个控制储藏室。我们将在基线上注册272个客户，并跟踪他们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，在食品储藏室层面的干预 通过政策和做法的改变以及能力建设，以营养食品的供应为目标。在客户端 在这一层面上，干预以健康食品需求为目标，采用行为经济学和教育学的方法。 测量的结果包括总体饮食质量(主要结果)，由健康饮食评估 2010年指数(HEI)，在食品货架访问中选择的食物的营养质量，以及心血管疾病 健康(由美国心脏协会的生活简单7分评估)。这项研究还将评估 多水平干预对以饥饿救济衡量的食品供应营养质量的影响 营养指数。这项研究还旨在改善政策和做法的执行，以促进 以营养为重点的饥饿救济网络，通过调查和主要线人访谈进行评估。作为一个探索者 目的：考虑到穷人的负担，这项研究将评估食品和服务的文化适宜性 少数族裔、移民和难民家庭获得食物。经过为期一年的需求评估后，将进行干预 在2-3年内分两波进行。第4-5年将重点放在分析以及地方和区域 通过我们的合作机构支持的渠道进行传播。这项工作充分利用了一个明显的 改善饥饿救济系统的当地势头。研究的目的是解决对系统的需求-- 改进饥饿救济网络的广泛方法及其对客户成果的影响评估。

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.