Food insecurity and health: Development and initial findings of a - - PowerPoint PPT Presentation

Food insecurity and health: Development and initial findings of a community research collaboration

Sandi L. Pruitt June 26, 2017

Reduction of food insecurity, particularly at the severe level, is a public health concern and a modifiable structural determinant of health worthy of macro-level policy intervention

Jessiman-Perreault, G & McIntyre, L. SSM-Population Health, 2017; 3:464-72.

Food insecurity and health

• Food insecurity associated with worse health

& health behaviors & less healthcare access

• Food assistance improves health

– Most evidence about SNAP/WIC – What about food bank assistance?

• 22% of food insecure US adults receive food bank

assistance (58% receive none)

Seligman et al, 2007; Stuff et al, 2004; Pruitt et al, 2016; Pruitt et al, 2015; Gundersen et al, SNAP Matters, 2015

Community-academic partnership

Service providers Researchers, students Health researchers, physicians

Formative, mixed methods Population monitoring Hypothesis testing, statistical inference

• Formative work is

hypothesis-generating and inspires action

• Population monitoring

– Representative, longitudinal, community-

• wned, data collection
• Hypothesis testing

– Evaluate population changes – Evaluate impact of policy changes nationally, regionally, institutionally

2016 engagement metrics

• 183 onsite contact hours
• 300 intern hours
• 200 data collection hours
• 11 training hours
• 136 participants primary data collection
• 15,039 individuals secondary data analysis

Population monitoring

• 12-15K unique individuals; ~5000

households / year

• Monthly, opportunistic data collection at

pickup for 6,000 individuals / year

– Food & economic security – Residential mobility – Health: direct BMI measurement, self- reported health, diabetes, HBP, social support

• Data linkage

– Safety-net EMR – Housing appraisal data

Community Distribution Partners across Dallas County, 880 square miles

Food security by race/ethnicity (n=2,364; 61% Hispanic)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Hispanic African American High Food Security Marginal Food Security Low Food Security Very Low Food Security

14.8% 44.3%

10 20 30 40 50 60 Percent of Clients Month of Survey

Monthly Food Security: Hispanic

High Food Security Marginal Food Security Low Food Security Very Low Food Security 10 20 30 40 50 60 Percent of Clients Month of Survey

Monthly Food Security: African American

High Food Security Marginal Food Security Low Food Security Very Low Food Security

Population monitoring snapshot July 2015- March 2017

Qualitative Research

• 8 Focus groups (4-9 persons each)

– 4 in English, 4 in Spanish – N=47 adult clients, 81% female, 90% Hispanic and African American

• Audio-recorded, transcribed
• Questions and probes focused on health and

economic status, daily living challenges

• Analysis: themes identified by frequency and

qualitative emphasis; excerpts selected from transcripts illustrating themes; Nvivo 9.0

When it affects one, it affects all in the family. I’m in this situation and I have to do the best, but I’m concerned mostly about health issues because all of us [in household] have issues that could take us out, you know… I mean die…

Theme 1:

From one to many and many to one in the household

Mutually reinforcing problems Anxiety about health of other household members Worry about impacts of unstable health and economic circumstances across all members of the household

What I get from here I sometimes send to Mexico to my mom. Because she's alone. Every month that I come here I make her a box and I send it to her, because I know she's all by herself and needs it. They [two neighbors] don't have a job; they've had to do without their husband. Sometimes they don't even have anything to feed their children. A can, pasta, a bag of beans, it helps us to share with someone. Truth is that it helps us and it helps us to help someone else.

Theme 2:

Food-sharing

• Food, health, economic circumstances are

shared across household, family, social networks

• Optimizing food bank assistance to improve

health will require:

– Cross-sector collaboration – Measurement at multiple levels: individual, family, household, social network – Mixed methods – New analytic approaches for opportunistic, messy data – Passion, patience, and resources

Conclusions

Thanks to all our researchers, teachers, staff, students, families, and volunteers

Juan Mijares Project Coordinator UT Southwestern Medical Center David Andrews, PhD Mathematics University of Dallas Carla Pezzia, PhD Medical Anthropology University of Dallas Stephanie Swales, PhD Psychology University of Dallas Robin Higashi, PhD Medical Anthropology UT Southwestern Medical Center Tammy Leonard, PhD Economics University of North Texas Sandi Pruitt, PhD Public Health UT Southwestern Medical Center Oanh Nguyen, MD Internal Medicine UT Southwestern Medical Center Lisa Quirk, MS, MPH Project Coordinator UT Southwestern Medical Center Xia Si PhD Student Economics University of Texas Dallas Amy Hughes, PhD Geographic Information Sciences UT Southwestern Medical Center

Questions?

http://www.udallas.edu/care/