Food Deserts Research Articles

Community-level social determinants of health and pregestational and gestational diabetes

Individual adverse social determinants of health are associated with increased risk of diabetes in pregnancy, but the relative influence of neighborhood or community-level social determinants of health is unknown. This study aimed to determine whether living in neighborhoods with greater socioeconomic disadvantage, food deserts, or less walkability was associated with having pregestational diabetes and developing gestational diabetes. We conducted a secondary analysis of the prospective Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be. Home addresses in the first trimester were geocoded at the census tract level. The exposures (modeled separately) were the following 3 neighborhood-level measures of adverse social determinants of health: (1) socioeconomic disadvantage, defined by the Area Deprivation Index and measured in tertiles from the lowest tertile (ie, least disadvantage [T1]) to the highest (ie, most disadvantage [T3]); (2) food desert, defined by the United States Department of Agriculture Food Access Research Atlas (yes/no by low income and low access criteria); and (3) less walkability, defined by the Environmental Protection Agency National Walkability Index (most walkable score [15.26-20.0] vs less walkable score [<15.26]). Multinomial logistic regression was used to model the odds of gestational diabetes or pregestational diabetes relative to no diabetes as the reference, adjusted for age at delivery, chronic hypertension, Medicaid insurance status, and low household income (<130% of the US poverty level). Among the 9155 assessed individuals, the mean Area Deprivation Index score was 39.0 (interquartile range, 19.0-71.0), 37.0% lived in a food desert, and 41.0% lived in a less walkable neighborhood. The frequency of pregestational and gestational diabetes diagnosis was 1.5% and 4.2%, respectively. Individuals living in a community in the highest tertile of socioeconomic disadvantage had increased odds of entering pregnancy with pregestational diabetes compared with those in the lowest tertile (T3 vs T1: 2.6% vs 0.8%; adjusted odds ratio, 2.52; 95% confidence interval, 1.41-4.48). Individuals living in a food desert (4.8% vs 4.0%; adjusted odds ratio, 1.37; 95% confidence interval, 1.06-1.77) and in a less walkable neighborhood (4.4% vs 3.8%; adjusted odds ratio, 1.33; 95% confidence interval, 1.04-1.71) had increased odds of gestational diabetes. There was no significant association between living in a food desert or a less walkable neighborhood and pregestational diabetes, or between socioeconomic disadvantage and gestational diabetes. Nulliparous individuals living in a neighborhood with higher socioeconomic disadvantage were at increased odds of entering pregnancy with pregestational diabetes, and those living in a food desert or a less walkable neighborhood were at increased odds of developing gestational diabetes, after controlling for known covariates.

Abstract A102: Evaluating relationship between food environment and pancreatic cancer demographics and outcomes

Abstract Introduction: Various socioeconomic factors have been investigated in the context of pancreatic cancer outcomes. However, the impact of factors relating to one’s ability to access healthy food such as food desert residence have not been studied. This study aimed to utilize a state-wide cancer database to explore the intersectionality of food desert residence with other patient socioeconomic factors as well their respective relationships with pancreatic cancer survival. Methods: The Virginia Department of Health Cancer Registry was queried for patients between 18 and 89 years of age who were diagnosed with a primary pancreatic malignancy during the 2009-2018 time frame. Patient addresses at presentation were mapped onto the United States Department of Agriculture (USDA) Food Access Research Atlas to determine food desert residence. Demographics, tumor characteristics, treatment characteristics, and survival data were collected. R version 4.3.0 (Vienna, Austria) was utilized to assess data via descriptive statistics, bivariate and multivariate analysis. Results: Patients’ age at diagnosis, insurance types, and race were significantly associated with their food desert residential status at baseline. Kaplan-Meier analysis demonstrated that while receipt of surgery and chemotherapy (p &amp;lt; 0.0001) were associated with decreased mortality, food desert status was not substantially associated with mortality risk within this cohort. In the fully adjusted Cox regression model, patients in the Other race category (mostly Asian Americans) had a statistically lower hazard ratio compared to Caucasian patients (adjusted HR 0.62; 95% CI 0.39-0.97). Patients with private insurance (adjusted HR 0.45; 95% CI 0.24-0.87), Medicare/Medicaid (adjusted HR 0.46; 95% CI 0.24-0.88), or other type insurance (adjusted HR 0.36; 95% CI 0.17-0.78) had lower hazard ratios compared to those who were uninsured. Conclusions: Patient food desert residence status and other socioeconomic factors are interconnected. While living in a food desert alone was not associated with pancreatic cancer survival, race and insurance status were found to be predictors of decreased mortality risk. Future studies are warranted to investigate the disease characteristics and survival profile of patients with both low access to healthy foods and low income. Citation Format: Vignesh Vudatha, Christopher Liu, Jian He, Devon Freudenberger, Nolan Wages, Jose Trevino. Evaluating relationship between food environment and pancreatic cancer demographics and outcomes [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A102.

Abstract A101: Assessing contemporary cancer prevention infrastructure in neighborhoods of historical residential segregation to better understand patterns of breast cancer disparities

Abstract Background: Breast cancer disparities among minoritized women in the United States (U.S.) not only persist but continue to widen. Neighborhood attributes are established drivers of cancer disparities in the U.S. An emerging area of research centers on the associative relationship of historical processes of segregation, particularly redlining practices, on breast cancer disparities. However, these studies have not considered the differences in contemporary neighborhood attributes in historically segregated and non-segregated neighborhoods. This study focuses on 2019 neighborhood attributes that work together to better understand differences in physical environment access to breast cancer prevention lifestyle habits such as access to fresh produce, green spaces, and clinical sites for prevention screenings. Methods: Using ArcGIS Pro we created GIS maps of Tucson, Arizona capturing food environments, green spaces, public transportation, and Medicaid cancer screenings site. The current neighborhood attributes were then layered over historic neighborhoods identified from historical documents to determine differences in access to these resources for breast cancer prevention. We used U.S. Census data to map sociodemographic data to the Census tract neighborhood level. Findings: The GIS maps demonstrate the neighborhoods established by historical segregation have more food deserts, fewer green spaces, limited public transportation, and no Medicaid Well WomanCheck mammography screening sites were located in close proximity to the historically segregated neighborhoods. The historically non-segregated communities did not have similar levels of disinvestment and had a higher presence of resources for non-genetic cancer prevention lifestyle habits. Discussion: To our knowledge, this is the first study to compare contemporary neighborhood attributes based on the historical status of segregated and non-segregated to understand how this impacts access to cancer prevention resources that may contribute to breast cancer disparities experienced among historically marginalized communities. The historical legacy of segregation shapes contemporary geographies, structural social determinants of health, and the gaps in non-genetic cancer prevention resources influencing breast cancer disparities. To build health equity, local policymakers must implement policies to address remnants of historical segregation in these communities that still navigate the reverberations of these historical processes. Zoning laws should be considered as a key target for structural interventions to build equitable access to breast cancer prevention infrastructure in neighborhoods established by historical segregation. Citation Format: Celina I. Valencia, Francisco Mendoza. Assessing contemporary cancer prevention infrastructure in neighborhoods of historical residential segregation to better understand patterns of breast cancer disparities [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A101.

Food deserts and food swamps, new concepts for urban planning

Food deserts and food swamps, new concepts for urban planning

Association of County-Level Food Deserts and Food Swamps with Hepatopancreatobiliary Cancer Outcomes

BackgroundMalnutrition has been linked to the development of hepatopancreatobiliary (HPB) cancer. We sought to examine the association between food swamps and food deserts on surgical outcomes of patients with HPB cancer. MethodsPatients who underwent surgery for HPB cancer between 2014 and 2020 were identified from the Medicare Standard Analytic Files. Patient-level data were linked to the United States Department of Agriculture data on food swamps and deserts. Multivariable regression was performed to examine the association between the food environment and outcomes. ResultsAmong 53,426 patients, patients from the worse food environment were more likely to be Black, have a higher Charlson Comorbidity Index, and reside in areas with high social vulnerability. Following surgery, the overall incidence of textbook outcome (TO) was 41.6% (n = 22,220). Patients residing in the worse food environments less often achieved a TO versus individuals residing in the healthiest food environments (food swamp: 39.4% vs. 43.9%; food desert: 38.5% vs 42.2%; p < 0.05). On multivariable analysis, individuals residing in the poorest food environments were associated with lower odds of achieving TO compared with individuals living in healthiest food environments (food swamp: OR 0.83, 95%CI 0.75–0.92, food desert: OR 0.86, 95%CI 0.76–0.97; both p < 0.05). ConclusionThe surrounding food environment of patients may serve as a modifiable socio-demographic risk factor that contributes to disparities in surgical outcomes of HPB cancer.

Food Desert Residence Is Not Associated With Dietary Adherence or Complication Rates in Patients With Isolated Mandibular Fractures

BackgroundMandible fracture management requires postoperative dietary modifications to promote healing. Over 20 million Americans live in food deserts, low-income neighborhoods over one mile from a grocery store. The relationship between food desert residence (FDR) and adherence to postoperative dietary instructions remains unexplored. PurposeThis study’s purpose is to evaluate the relationships between FDR, known risk factors, dietary adherence, and complications among patients with isolated mandible fractures.Study design, setting, sample: This retrospective cohort study was conducted at a level 1 trauma center and analyzed patients with mandible fractures between January 2015 and December 2020. Inclusion criteria included operative treatment of adult patients for mandible fractures; pregnant, incarcerated, and patients with incomplete data were excluded. PredictorFDR was the predictor variable of interest. FDR (coded yes or no) was generated by converting patient addresses to census tract GeoIDs and comparing them to the USDA Food Access Research Atlas. OutcomeThe study examined two outcome variables: dietary adherence and postoperative complications. Dietary adherence was coded as adherent or nonadherent, indicating documented compliance with postoperative dietary modifications. Postoperative complications were coded as present or absent, reflecting infection, hardware failure, and mandible malunion or nonunion. CovariatesThe covariates analyzed included age, sex, ethnicity, mechanism of injury, medical and psychiatric comorbidities (including diagnoses such as diabetes, hypertension, and schizophrenia), and tobacco use. AnalysisRelative risks and multivariate logistic regression models were generated for both outcome variables. Two-tailed p-values < 0.05 were considered statistically significant. ResultsDuring the study period, 143 patients had complete data allowing for FDR and dietary adherence determination; 124 of whom (86.7%) had complication data recorded. Of the cohort, 51/143 (35.7%) resided within a food desert, 30/143 (21.0%) exhibited dietary nonadherence, and 46/124 (37.1%) experienced complications. FDR was not associated with increased risk of dietary nonadherence (RR 0.92, 95% CI 0.52-1.61, p=0.76) or complications (RR 1.19, 95% CI 0.75 – 1.89; p=0.46). On multivariate regression, dietary nonadherence was associated with increased complications (OR 2.85, 95% CI 1.01-8.09, p=0.049). ConclusionThere was no association between FDR and dietary nonadherence or complications in mandible fracture patients. However, dietary nonadherence was associated with complications, highlighting the need for further research and intervention.

Retail Inequality: Reframing the Food Desert Debate

Retail Inequality: Reframing the Food Desert Debate

The FINDING-Food Intervention: A Mixed-Methods Feasibility Study Addressing Food Insecurity

Food insecurity is an economic and social condition involving limited or uncertain access to food. The problem of food insecurity in communities is influenced by economic conditions, food deserts, and barriers to accessing healthy food. Individuals experiencing food insecurity often endure concurrent problems of financial instability, hunger, and poor mental and physical health. Public and non-profit services in the U.S., such as the federally supported Supplemental Nutrition Assistance Program (SNAP) and community food banks, provide food-related assistance to individuals who are at a high risk of experiencing food insecurity. Unfortunately, many individuals who qualify for these services still experience food insecurity due to barriers preventing them from accessing food. Effective approaches for removing barriers that prevent individuals from accessing food are needed to mitigate the increased risk of chronic disease among vulnerable populations. This study tested a novel food insecurity intervention called FINDING-Food, which stands for Frequent Informational Nudges Directing Individuals to Needed Goods. Informational nudges were used to promote food security through the removal of information barriers to accessing food. The intervention used in this mixed-methods feasibility study consisted of informational nudges in the form of weekly text messages that were sent to food pantry clients experiencing food insecurity (n = 24). The study aims were to test the efficacy and acceptability of the intervention by examining whether the informational nudges could enhance food pantry utilization, increase SNAP registration, and promote food security. Quantitative study results showed a lower prevalence of food insecurity in the intervention group than the control group at the end of the study. Qualitative findings revealed how intervention group participants who completed the study (n = 9) found the text messages to be helpful and informative. These study findings can enhance future food insecurity interventions aiming to eliminate barriers that prevent individuals who are food insecure from accessing healthy food.

Food desert residence has limited impact on veteran fecal microbiome composition: a U.S. Veteran Microbiome Project study.

Social and economic inequities can have a profound impact on human health. The inequities could result in alterations to the gut microbiome, an important factor that may have profound abilities to alter health outcomes. Moreover, the strong correlations between social and economic inequities have been long understood. However, to date, limited research regarding the microbiome and mental health within the context of socioeconomic inequities exists. One particular inequity that may influence both mental health and the gut microbiome is living in a food desert. Persons living in food deserts may lack access to sufficient and/or nutritious food and often experience other inequities, such as increased exposure to air pollution and poor access to healthcare. Together, these factors may confer a unique risk for microbial perturbation. Indeed, external factors beyond a food desert might compound over time to have a lasting effect on an individual's gut microbiome. Therefore, adoption of a life-course approach is expected to increase the ecological validity of research related to social inequities, the gut microbiome, and physical and mental health.

Associations Between Food Security and Social Determinants of Health with Dietary Intakes – A Pilot Study

ABSTRACT Food insecurity is a major social determinant of health (SDH). However, further research is needed on the associations between SDH and diet among individuals living in urban food deserts. We designed a pilot study to examine the associations between diet and seven measures of SDH. Forty-five participants were enrolled in the study and were scheduled for an in-person or telephone interview. Food insecurity was significantly associated with greater intakes of fast food and refined grains. Employment was significantly associated with higher intake of alcohol. Findings from this pilot study confirm the importance of examining SDH in relation to diet.

Urban Food Deserts: Improving the USDA Identification Methodology Through Inclusion of Neighborhood Racial Attributes

Urban Food Deserts: Improving the USDA Identification Methodology Through Inclusion of Neighborhood Racial Attributes

SynthEco - A multi-layered digital ecosystem for analysing complex human behaviour in context

Introduction &amp; BackgroundHuman behaviour is multi-faceted and complex, with different dimensions interacting and impacting each other and individuals operating in an environmental context. In order to understand this behaviour better, the combination of data from different sources is useful to uncover some of those interactions and complexities. We present a multi-layered digital ecosystem based on a data platform providing statistically representative synthetic population derived from census data at different geo-spatial granularity, which we call SynthEco. This platform is enriched with individual data stemming from cohorts and cross-sectional surveys and geo-scanning of different layers of socio-environmental actors and conditions to create a complex digital ecosystem.&#x0D; Objectives &amp; ApproachThe objective of SynthEco is to allow for the analysis of behaviour, as well as health and wellbeing outcomes, through the integration of cohort and cross-sectional data into a geospatially anchored synthetic population embedded into environmental data which is forming the backdrop. We demonstrate the use of this platform on the example of Montreal, Canada. The synthetic population is first generated from census data using iterative proportional fitting, which allows for the creation of a population data set that is artificial yet statistically representative for a given geospatial granularity, such as a city. Each individual household is assigned a geospatial location, which allows for the consideration of their surrounding environment including enterprises or institutions such as schools, hospitals and the local food environment. Through fuzzy matching and statistical extrapolation, different cohort and cross-sectional survey data are then merged to individual records, in order to describe them in more detail. This includes health, as well as financial wellbeing or social environment descriptors.&#x0D; Relevance to Digital FootprintsThere are two important points made through the presented work in relation to Digital Footprints data: the first is the technical approach to merging multiple datasets describing different dimensions of interacting human characteristics and behaviour by anchoring them into a synthetic population through fuzzy record matching. The second is the consideration of a spatial dimension when describing human behaviour. This is especially important when describing behaviour within local environments, such as the interaction with local food outlets.&#x0D; ResultsRecent work in this context includes an analysis of the food environment in Montreal, Canada. It introduces a way of utilising the synthetic population to predict the healthfulness of their local environment in terms of healthy food outlets, as well as providing a platform for the analysis of food environment surveillance and intervention simulations. For this purpose, the healthfulness of different census tract regions in Montreal is calculated to identify food deserts, food swamps, as well as healthy areas as defined through the Modified Retail Food Environment Index. We test different machine learning approaches to then predict these healthfulness scores using census variables from the synthetic population in their respective census tract, achieving accuracy scores of around 0.53 to 0.60. This demonstrates that census data has some limited predictive power in explaining the healthiness of the local food environment, which could be especially relevant for situations in which no information on the retailers is available to local policy makers. Future work can extend this approach to also include further data describing the population, stemming from the integrated cohorts and survey data, which could improve the prediction accuracy or help in identifying areas of concern.&#x0D; Conclusions &amp; ImplicationsThe presented SynthEco platform views individuals as agents nested within modular systems of systems, trying to capture both internal systems and processes as well as environmental ones within which individuals are operating. The platform thus enables the application of computational systems modelling for the analysis of individual human behaviour in contexts. As demonstrated through the example of using SynthEco in the context of healthier food environments, the approach is especially relevant to practitioners and policy makers interested in local intervention strategies and identifying areas for targeted policy related to different dimensions of health and wellbeing.

Association between food environments and fetal growth in pregnant Brazilian women

IntroductionBirth weight is described as one of the main determinants of newborns’ chances of survival. Among the associated causes, or risk factors, the mother’s nutritional status strongly influences fetal growth and birth weight outcomes of the concept. This study evaluates the association between food deserts, small for gestational age (SGA), large for gestational age (LGA) and low birth weight (LBW) newborns.DesignThis is a cross-sectional population study, resulting from individual data from the Live Birth Information System (SINASC), and commune data from mapping food deserts (CAISAN) in Brazil. The newborn’s size was defined as follows: appropriate for gestational age (between 10 and 90th percentile), SGA (< 10th percentile), LGA (> 90th percentile), and low birth weight < 2,500 g. To characterize food environments, we used tertiles of the density of establishments which sell in natura and ultra-processed foods. Logistic regression modeling was conducted to investigate the associations of interest.ResultsWe analyzed 2,632,314 live births in Brazil in 2016, after appropriate adjustments, women living in municipalities with limited availability of fresh foods had a higher chance of having newborns with SGA [OR2nd tertile: 1.06 (1.05–1.07)] and LBW [OR2nd tertile: 1.11 (1.09–1.12)]. Conversely, municipalities with greater availability of ultra-processed foods had a higher chance of having newborns with SGA [OR3rd tertile: 1.04 (1.02–1.06)] and LBW [OR2nd tertile: 1.13 (1.11–1.16)]. Stratification by race showed that Black and Mixed/Brown women had a higher chance of having newborns with SGA [OR3rd tertile: 1.09 (1.01–1.18)] and [OR3rd tertile: 1.06 (1.04–1.09)], respectively, while Mixed-race women also had a higher chance of having newborns with LBW [OR3rd tertile: 1.17 (1.14–1.20)]. Indigenous women were associated with LGA [OR3rd tertile: 1.20 (1.01–1.45)].ConclusionThe study found that living in areas with limited access to healthy foods was associated with an increased risk of SGA and low birth weight among newborns, particularly among Black and Mixed/Brown women. Therefore, urgent initiatives aimed at reducing social inequalities and mitigating the impact of poor food environments are needed in Brazil.

Food insecurity screening and local food access: Contributions to nutritional outcomes among children and adults with cystic fibrosis in the United States

BackgroundAs the nutritional status of people with CF (PwCF) is associated with their socioeconomic status, it is important to understand factors related to food security and food access that play a role in the nutritional outcomes of this population. We assessed the contributions of CF program-level food insecurity screening practices and area-level food access for nutritional outcomes among PwCF. MethodsWe conducted a cross-sectional analysis of 2019 data from the U.S. CF Patient Registry (CFFPR), linked to survey data on CF program-level food insecurity screening and 2019 patient zip code-level food access. Pediatric and adult populations were analyzed separately. Nutritional outcomes were assessed with annualized BMI percentiles (CDC charts) for children and BMI (kg/m2) for adults, with underweight status defined as BMIp <10% for children and BMI <18.5 kg/m2 for adults, and overweight or obese status defined as BMIp >85% for children and BMI >25 kg/m2 for adults. Analyses were adjusted for patient sociodemographic and clinical characteristics. ResultsThe study population included 11,971 pediatric and 14,817 adult PwCF. A total of 137 CF programs responded to the survey, representing 71% of the pediatric sample and 45% of the CFFPR adult sample. The joint models of nutritional status as a function of both program-level food insecurity screening and area-level food access produced the following findings. Among children with CF, screening at every visit vs less frequently was associated with 39% lower odds of being underweight (OR 0.61, p = 0.019), and the effect remained the same and statistically significant after adjusting for all covariates (aOR 0.61, p = 0.047). Residence in a food desert was associated both with higher odds of being underweight (OR 1.66, p = 0.036; aOR 1.58, p = 0.008) and with lower BMIp (-4.81%, p = 0.004; adjusted -3.73%, p = 0.014). Among adults with CF, screening in writing vs verbally was associated with higher odds of being overweight (OR 1.22, p = 0.028; aOR 1.36, p = 0.002) and higher BMI (adjusted 0.43 kg/m2, p = 0.032). Residence in a food desert was associated with higher odds of being underweight (OR 1.48, p = 0.025). ConclusionsFood insecurity screening and local food access are independent predictors of nutritional status among PwCF. More frequent screening is associated with less underweight among children with CF, whereas screening in writing (vs verbally) is associated with higher BMI among adults. Limited food access is associated with higher odds of being underweight in both children and adults with CF, and additionally with lower BMI among children with CF.Study results highlight the need for standardized, evidence-based food insecurity screening across CF care programs and for equitable food access to optimize the nutritional outcomes of PwCF.

Food deserts and dental care utilization in the United States.

Although food deserts are known to impact health and healthcare utilization, no research has investigated the relationship between food deserts and dental care utilization. This study aimed to fill this gap by assessing the relationship between living in a food desert and self-reported dental care utilization in the past year. Data are from the National Longitudinal Study of Adolescent to Adult Health (N = 10,495). The association between food deserts and dental care utilization was assessed using covariate-adjusted multiple logistic regression. Living in a food desert was associated with higher odds of not utilizing dental care in the past year. This association was concentrated among high-poverty areas (≥20% poverty rate). The current study is the first to assess the relationship between living in a food desert and dental care utilization. The findings demonstrate that individuals living in low-income urban food deserts may be at increased risk for not utilizing dental care.

Before the Streetlights Come On: Black America's Urgent Call for Climate Solutions (An Excerpt)

Abstract: This excerpt is the chapter titled "The Cultural Appropriation of Collard Greens: Food Insecurity and the ClimateCrisis" from Before The Streetlights Come On: Black America's Call for Climate Solutions (BroadLeaf Publishing, 2023). The chapterlinks together climate crisis, policy, and food deserts. Produce inflation—like the absurd pricing of three collard green stalks in a health foods store, just miles from boundless fields of homegrown greens—is a phenomenon of global warming's effect on farming and its broad implications on the global food system. Such implications contribute to the growing number of food deserts across the US and their direct correlation to climate crisis and our current governmental food assistance program's shortcomings. Toney reveals Black Americans' response to this injustice, and how the nation at large can learn from the solutions being surfaced by the Black community, like vegan lifestyles, cruelty-free animal care, and home gardening. The very community disproportionately affected by climate crisis can lead the way in changing it.

Food deserts, endometrial cancer survivors, and healthy food access: Is it equitable in rural America? – A geospatial analysis (2127)

Food deserts, endometrial cancer survivors, and healthy food access: Is it equitable in rural America? – A geospatial analysis (2127)

Gynecological cancer survival and association with food deserts (037)

Gynecological cancer survival and association with food deserts (037)

Addressing US Food Deserts: Evaluating Current Solutions and Proposing Other Comprehensive Alternatives

Food deserts, characterized by limited access to affordable and nutritious food options due to the absence of nearby grocery stores, affect the lives of approximately 19 million individuals across the United States. This study critically evaluates the efficacy of current solutions and proposes a comprehensive approach that addresses the spatial challenges inherent in food deserts. Through an extensive literature review and insightful interviews with academic experts and a local food bank, this research examines the limitations of existing initiatives such as SNAP, SNAP-Ed, HFFI, and urban agriculture in effectively tackling food deserts. Notably, most of these programs tackle financial support but do not tackle the widespread and systemic accessibility of supermarkets that is a key characteristic of food deserts. While these programs have shown some positive impact in mitigating food insecurity, they fail to directly address the fundamental issue of distance between individuals and food resources. In response to these limitations, this study proposes a comprehensive solution that centers on enhancing public transit systems and establishing robust online delivery platforms. By improving transportation options, such as implementing shuttle buses, individuals residing in food deserts can more easily access supermarkets and grocery stores, thereby overcoming the distance challenge. Additionally, online delivery services can bridge the gap by providing convenient access to nutritious food, regardless of geographic location. To ensure the effectiveness of these solutions, government subsidies should be considered to alleviate delivery fees and reduce costs.

Home-Delivered Medically Tailored Meal Engagement Among Hemodialysis Patients and Providers

Hemodialysis patients face one of the most difficult diets among clinical patient populations. Furthermore, dialysis dietary adherence is generally reported as low with providers generally lacking the time and resources to implement effective behavior change. The purpose of this study was to elucidate measures of patient and provider engagement with home-delivered medically tailored meals (MTMs). We surveyed patients and staff at dialysis centers within the Denver metropolitan area. Surveys focused on 1) patient dietary intake, 2) awareness, support, and utilization of meal programs, and 3) nutritional challenges and barriers (including food security). We surveyed 118 patients (mean age 61.0 ± 14.2 year, 58.5% male, and dialysis vintage of 4.6 ± 4.9 years) and 26 staff across the included dialysis facilities. Patients were 20.3% White/Non-Hispanic, 35.6% Hispanic/Latin and 31.4% Black/African American. Most patients reported eating two meals per day (N=53, 44.9%) and 52.2% reported difficulty with following a kidney diet. The most cited reasons for not following the diet were behavioral or knowledge (38.5%), taste (26.3%), time/convenience (26.9%) and food autonomy (16.9%). Sixty participants (52.2%) reported living in a food desert and 26.3% reported food insecurity. Seventy-one patients (61.2%) were aware of MTMs but only 40.5% had been referred. Most (76.9%) dialysis providers were aware of MTMs but only 15 (57.7%) had actually referred patients to such a service. Black individuals were less likely to be referred for MTMs than White or Hispanics/Latin (29.7% vs 48.1% White and 45.0% Hispanic/Latin) individuals. MTMs represent a potential method to alleviate or bypass some of the many barriers expressed by patients. Our findings reveal a critical need for education around MTMs for both patients and providers. MTMs could potentially demonstrate health kidney dietary patterns that might translate to altered dietary preferences or towards future behavior change.