<p>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 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).
</p><p>Food
pantries may be an important venue for interventions to improve food security
and dietary outcomes. Since dietary intake and use of food pantries may differ
by food security status, the efficacy of such interventions 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 diet-related
outcomes among food pantry clients. Therefore, the aims of this dissertation
were to 1) characterize differences in diet quality and intake between FS, LFS
and VLFS pantry clients; 2) explore associations between the nutritional
quality of the pantry food environment (foods in stock and foods distributed to
clients) and client diet quality by food security status; and 3) evaluate the
intermediate effects of a SEM, community-based intervention to improve diet-related
outcomes among pantry clients with comparison by food security status.</p><p>Aim
1 was addressed by examining associations between food security and both diet
quality and usual intake (in separate mixed multiple linear regression models)
in a cross-sectional analysis of adult food pantry clients at baseline. FS
status was associated with a higher Healthy Eating Index-2010 (HEI-2010) whole
grains score, as well as a higher mean usual intakes 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.</p><p>Aim
2 was addressed by evaluating the relationship between the quality of the mix
of foods in stock (pantry inventories) and distributed (client food bags) at
food pantries with client diet quality, and investigating how these
relationships varied by food security status, in a cross-sectional analysis of
adult food pantry clients at baseline. 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 components. VLFS clients
consumed more whole grains from client food bags compared to FS clients, and
consumed more greens and beans from pantry inventories compared to LFS clients.</p><p>Aim
3 was addressed by evaluating longitudinal changes in adult food security, diet
quality and usual intake over the first two years (baseline to midpoint) of a
three-year SEM, community-based food pantry intervention‒ Voices for Food
(Clinical Trial Registry: NCT0356609). Adult food security score improved in
the intervention group, while HEI-2010 total score and several component scores
improved in the comparison group. When comparing the change in main outcomes
over time between the intervention and comparison groups, no favorable
differences were observed at this intermediate time point.</p><p>
</p><p>Food
pantries do not comprise a homogeneous population of clients. Pantry clients
have different quality diets and rely on pantries to acquire different types of
foods depending on their food security status. Food pantries may be an
important venue to target interventions that improve diet-related outcomes,
with consideration for the complex interplay between food security status, the
pantry food environment and availability of resources to prepare healthy foods.
Evaluation
of the final study time point, as well as further investigation of the
dose-dependent effect of each intervention component and other individual
community characteristics, may elucidate the relationship between the intervention and client outcomes.</p><p></p>
| Identifer | oai:union.ndltd.org:purdue.edu/oai:figshare.com:article/8038727 |
| Date | 14 May 2019 |
| Creators | Breanne N. Wright (5930408) |
| Source Sets | Purdue University |
| Detected Language | English |
| Type | Text, Thesis |
| Rights | CC BY-NC-SA 4.0 |
| Relation | https://figshare.com/articles/Intermediate_Effects_of_a_Social_Ecological_Modeled_Community-Based_Intervention_on_the_Food_Security_and_Dietary_Intake_of_Rural_Midwestern_Adult_Food_Pantry_Clients/8038727 |
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