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Item Accuracy of Electronic Health Record Food Insecurity, Housing Instability, and Financial Strain Screening in Adult Primary Care(American Medical Association, 2023) Harle, Christopher A.; Wu, Wei; Vest, Joshua R.; Psychology, School of ScienceItem Addressing Food Insecurity: Lessons Learned from Co-Locating a Food Pantry with a Federally Qualified Health Center(Ubiquity Press, 2022-09-30) Reinoso, Deanna; Haut, Dawn; Claffey, Stephen; Hahn Keiner, Kathy; Chavez, Alejandra; Nace, Nicole; Carter, Amy; Pediatrics, School of MedicineIntroduction: Social determinants of health, such as food insecurity, contribute to chronic health conditions, decreased quality of life, and health disparities. Increasingly, healthcare systems seek to address social determinants of health by integrating medical and social care. Description: Eskenazi Health Center Pecar is a Federally Qualified Health Center providing comprehensive primary care to vulnerable patients in Indianapolis, IN, USA. This health center, in coalition with community partners, established and continually developed an integrated food pantry model to address food insecurity, improve nutrition education, and support patient access to healthy food. Discussion: Food insecurity and poor nutrition are common in primary care and contribute to the incidence and outcomes of chronic conditions such as obesity, hypertension, and diabetes. Long-term management of food assistance and nutrition programs requires substantial resources, partnerships, and leadership. We describe lessons learned in food pantry partnership, funding, logistics, and sustainability in a collaborative food access model integrated into healthcare. These lessons learned can be utilized by other health systems to scale up and accelerate strategies to better address food security and nutrition education. This paper articulates best practices for integrating a food pantry model within primary care with the goal of long-term sustainability and direct impact on patient health outcomes.Item Children’s Dietary Quality and Micronutrient Adequacy by Food Security in the Household and among Household Children(2019-04-27) Jun, Shinyoung; Zeh, Mary J.; Eicher-Miller, Heather A.; Bailey, Regan L.Children’s food-security status has been described largely based on either the classification of food security in the household or among household children, but few studies have investigated the relationship between food security among household children and overall dietary quality. Our goal was to examine children’s dietary quality and micronutrient adequacy by food-security classification for the household and among household children. Data from 5540 children (2–17 years) from the National Health and Nutrition Examination Survey (NHANES) 2011–2014 were analyzed. Food-security status was assessed using the U.S. Household Food Security Survey Module and categorized into high, marginal, low, and very low food security for the households and among household children. Dietary quality and micronutrient adequacy were characterized by the Healthy Eating Index (HEI) 2015 and Mean Adequacy Ratio (MAR; based on total nutrient intakes from diet and dietary supplements), respectively. The HEI 2015 scores did not substantially vary by either food-security classification, but the MAR was greater in high compared to very low food security in households and among household children; a linear relationship was found only among household children. In general, very good agreement was observed between the classifications, but the strength of agreement differed by children’s age, race/Hispanic origin, and family income. In conclusion, micronutrient adequacy, but not dietary quality, significantly differed by food-security status. While the agreement between food security in the household and among household children is very good, classification of food security among household children may be more sensitive to detecting differences in exposure to nutrients.Item Delivering Food Resources and Kitchen Skills (FoRKS) to Adults with Food Insecurity and Hypertension: A Pilot Study(MDPI, 2023-03-17) Rivera, Rebecca L.; Adams, Mariah; Dawkins, Emily; Carter, Amy; Zhang, Xuan; Tu, Wanzhu; Peña, Armando; Holden, Richard J.; Clark, Daniel O.; Medicine, School of MedicineFood insecurity affects nearly 50 million Americans and is linked to cardiovascular disease risk factors and health disparities. The purpose of this single-arm pilot study was to determine the feasibility of a 16-week dietitian-led lifestyle intervention to concurrently address food access, nutrition literacy, cooking skills, and hypertension among safety-net primary care adult patients. The Food Resources and Kitchen Skills (FoRKS) intervention provided nutrition education and support for hypertension self-management, group kitchen skills and cooking classes from a health center teaching kitchen, medically tailored home-delivered meals and meal kits, and a kitchen toolkit. Feasibility and process measures included class attendance rates and satisfaction and social support and self-efficacy toward healthy food behaviors. Outcome measures included food security, blood pressure, diet quality, and weight. Participants (n = 13) were on average {mean (SD)} aged 58.9 ± 4.5 years, 10 were female, and 12 were Black or African American. Attendance averaged 19 of 22 (87.1%) classes and satisfaction was rated as high. Food self-efficacy and food security improved, and blood pressure and weight declined. FoRKS is a promising intervention that warrants further evaluation for its potential to reduce cardiovascular disease risk factors among adults with food insecurity and hypertension.Item Dietary Quality and Usual Intake of Underconsumed Nutrients and Related Food Groups Differ by Food Security Status for Rural, Midwestern Food Pantry Clients(Elsevier, 2020) Wright, Breanne N.; Tooze, Janet A.; Bailey, Regan L.; Liu, Yibin; Rivera, Rebecca L.; McCormack, Lacey; Stluka, Suzanne; Franzen-Castle, Lisa; Henne, Becky; Mehrle, Donna; Remley, Dan; Eicher-Miller, Heather A.; Medicine, School of MedicineBackground: Food pantry users represent a predominantly food insecure population, yet dietary intake may differ among food secure (FS), low FS, and very low FS clients. Usual intake of food groups and nutrients by food security status has not previously been compared among food pantry clients. Objective: This study aimed to estimate the usual intakes of underconsumed nutrients (ie, potassium; dietary fiber; choline; magnesium; calcium; vitamins A, D, E, and C; and iron) and related food groups (ie, vegetables, fruits, whole grains, and dairy) and dietary quality, and to evaluate their relationship with food security status. Design: This cross-sectional, secondary analysis used baseline data from a prior intervention study (Clinical Trial Registry: NCT03566095). A demographic questionnaire, the US Household Food Security Survey Module, and up to three 24-hour dietary recalls on nonconsecutive days, including weekdays and weekends, were collected. Participants/setting: This community-based study included a convenience sample of adult, midwestern food pantry clients (N=579) recruited from August to November 2014. Main outcome measures: Main outcomes evaluated were Healthy Eating Index-2010 scores and usual intakes of underconsumed nutrients and related food groups. Statistical analyses performed: Linear regression models and the National Cancer Institute method, adjusting for confounders, were used to estimate associations of food security with diet quality and usual intake, respectively. Results: Being FS was associated with a higher whole grains HEI-2010 score and higher mean usual intake of whole grains compared with being low FS. Being FS was associated with higher usual intakes of iron and dairy compared with being very low FS. Being FS was associated with a higher mean usual intake of dark green vegetables compared with being low FS and very low FS. Usual intakes were below federal guidance for all subgroups of food security. Conclusions: Although food security status may differentiate dietary intake among food pantry clients, improvements are needed among all clients.Item Food Donation Mobile Apps –What Has Been Done and How It Can Be Improved(Office of the Vice Chancellor for Research, 2016-04-08) Capulong, JivaFood insecurity, a lack of access to healthy and affordable food, is a major issue within the US and many nonprofit organizations, like food banks and food pantries are unable to keep up with increased demand for food support . With smartphones progressively increasing their capability in their application to everyday life, how can they play a role in the supporting of people living with food insecurity? In this study, we reviewed multiple mobile applications available free on the iOS app store, including Food Bank, AmpleHarvest, St.Mary’s Food Bank, RoadrunnerFood Bank, and Wood Buffalo Food Bank, taking note of what features they possess, and how well they functioned. Our findings have shown that the most common features consisted of a map for locating food banks, and a contribution function for donating money and giving suggestions and information for donating food and volunteering. Further notable features found that were not as common include are sources page referring to other food support programs, a page for upcoming events, and social media integration. Notable issues included some apps being comparatively lacking in features, leading to gaps in opportunity. Furthermore, issues of long-term application and project sustainability were noticeable, where a lack of regular updates in some apps are suspected to be the cause of dated appearances , functions not loading, and crashes . It was important to note that the apps with more features and better functionality are more state specific, run by local organizations . This analysis suggests that the cost, production, and maintenance of free apps may b e a productive are a to explore. Over all, our initial research helps us understand the current landscape of donation technology among mobile applications. In further research, studies with core stakeholders, including donors and donation recipients, would help gain understanding and assessment in new donation methods and platformsItem Food Insecurity and Sugar-Sweetened Beverage Consumption Among WIC-Enrolled Families in the First 1,000 Days(Elsevier, 2020-08) Fernández, Cristina R.; Chen, Ling; Cheng, Erika R.; Charles, Nalini; Meyer, Dodi; Monk, Catherine; Woo Baidal, Jennifer; Pediatrics, School of MedicineObjective: Determine the association between household food insecurity and habitual sugar-sweetened beverage (SSB) consumption among Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)-enrolled families during the first 1,000 days. Methods: Cross-sectional analysis of pregnant women and mothers of infants aged under 2 years in the WIC was performed. Families recruited sequentially at consecutive visits completed food insecurity and beverage intake questionnaires; estimated logistic regression models controlled for sociodemographic characteristics. Results: Of 394 Hispanic/Latino mothers and 281 infants, 63% had household food insecurity. Food insecurity significantly increased odds of habitual maternal (unadjusted odds ratio (OR), 2.39; 95% CI, 1.27-4.47; P = .01) and infant SSB consumption (OR, 2.05; 95% CI, 1.15-3.65; P = .02), and the relationship was not attenuated by maternal age, education, or foreign-born status. Conclusions and implications: Food insecurity increased odds of habitual SSB consumption in WIC families. Interventions to curb SSB consumption among WIC-enrolled families in the first 1,000 days in the context of household food insecurity are needed.Item Food Insecurity During COVID-19 in Children with End-Stage Kidney Disease: A Pilot Study(BMC, 2022-07-15) Chan, Melvin; Mokiao, Reya; Wilson, Amy C.; Pottanat, Neha; Hingorani, Sangeeta; Starr, Michelle C.; Pediatrics, School of MedicineBackground: Food insecurity, an important social determinant of health among children, has become more common during the COVID-19 pandemic. Children with chronic diseases including end-stage kidney disease (ESKD) are at higher risk of food insecurity due to their complex care needs, medication burden, and dietary restrictions. No data exists describing food insecurity prevalence in pediatric ESKD patients during the COVID-19 pandemic. Methods: Food insecurity was assessed among families of children (age 0-18 years) with ESKD on chronic dialysis at two pediatric academic medical centers. Families were screened in April 2020 using the Hunger Vital Sign, a validated 2-question screening tool. We assessed impact of COVID-19 on food insecurity. We compared serum phosphorus "pre-COVID" (January/February 2020) to "during COVID" (April/May 2020). Results: A total of 29 families enrolled in this study. 62% (18/29) of children with ESKD lived in food insecure households, and of those, 72% (13/18) reported that COVID-19 had worsened their food insecurity status. During the COVID-19 pandemic, food insecure patients experienced greater rise in their serum phosphorus levels (1.1 mg/dL vs. 0 mg/dL, p = 0.03) and decreased likelihood of having adequate phosphorus control (50% vs. 11%, p = 0.03). Conclusion: Food insecurity was common among children with ESKD on chronic dialysis during the COVID-19 pandemic. Children with food insecurity had a greater increase in their phosphorus levels during the pandemic than did food secure children. Further exploration into how food resources such as an onsite food pantry impacts food insecurity and phosphorus control in children with ESKD is essential.Item Outc-08. Implementing Social Determinant of Health Data Collection for Pediatric, Adolescent and Young Adult Neuro-Oncology Patients in the Clinical Trial Consortia Setting: Progress and Challenges(Oxford University Press, 2023-06-12) Puthenpura, Vidya; Bona, Kira; Cooney, Tab; Coven, Scott; Davidson, Tom; Fouladi, Maryam; Kline, Cassie; Leary, Sarah; Mueller, Sabine; Green, Adam; Marks, Asher; Pediatrics, School of MedicineAdverse social determinants of health (SDoH) are associated with decreased survival and increased long-term complications amongst pediatric and adolescent and young adult (AYA) neuro-oncology patients. These outcome disparities are in part due to inferior access to clinical trials and comprehensive, multidisciplinary care. SDoH including food insecurity, housing instability, inability to pay for utilities, and personal safety issues have been shown to negatively impact therapy adherence and exacerbate survival disparities. As such, efforts to improve health equity must include evaluating and addressing SDoH at diagnosis. Existing literature has been limited by a reliance on proxy measures of adverse SDOH such as neighborhood or census area-level socioeconomic status data, which poorly reflect individual circumstances. There is a complex interplay between neighborhood and personal socioeconomic status that has not been extensively studied and is poorly understood. In addition, socioeconomic status is only one component of SDoH. No validated tool currently exists to assess SDoH amongst pediatric and AYA cancer patients. It is imperative that multicenter clinical trials collect SDoH data to inform both trial design and interpretation of results. These data will be important to understanding and identifying patterns in tumor and toxicity incidence, as well as understanding the burden on families in adhering to trial therapies. Based on our previous work, we will present the importance of incorporating SDoH data collection within the clinical trial consortia setting. In addition, we will review the development of a comprehensive SDoH questionnaire and discuss facilitators and barriers to the incorporation of SDoH questionnaires into multicenter clinical trials and offer solutions based on our experience.Item Strategies to Reduce Food Insecurity for People With Diabetes: A Call to Action(American Diabetes Association, 2023) Wylie-Rosett, Judith; DiMeglio, Linda A.; Pediatrics, School of Medicine