Food Insecure Individuals Research Articles

An Exploration of the Influences Contributing to Food Insecurity in Chester County, Pennsylvania.

Food security refers to the ideal state or condition of households that have access at all times to enough food for their members to live an active, healthy life. To better understand local food insecurity, a needs assessment was implemented to explore contributing factors and discuss solutions. A qualitative study including nine focus groups with low-income adults who receive food assistance (N = 82) and four focus groups with emergency food providers (N = 21) was conducted. Focus group data were analyzed using phenomenological methods. Five themes emerged from the residents: (1) food accessibility both contributes to and reduces food insecurity; (2) residents understand the need for and practice the act of preserving foods; (3) food shopping behaviors were similar for the residents and stores were well received; (4) benefits and barriers with food insecurity are similar; and (5) variety and quality of food and food safety of emergency foods are concerns. The food provider focus groups indicated that they recognized similar problems faced by the residents, and they stressed the need for education. Food insecure individuals should continue in the conversations around solutions, and a comprehensive look at food insecurity through local food and health care systems might determine additional needs.

Validity of the Food Insecurity Experience Scale for Use in Sub-Saharan Africa and Characteristics of Food-Insecure Individuals

BackgroundThe Food Insecurity Experience Scale (FIES) is a UN FAO—Voices of the Hungry project (FAO-VoH) metric of food insecurity (FI). The FAO-VoH tested the psychometric properties of FIES with the use of global 2014 Gallup World Poll (GWP) data. However, similarities in its psychometric structure in sub-Saharan Africa (SSA) to allow aggregation of SSA results were untested. ObjectivesWe aimed to 1) assess the validity of FIES for use in SSA, 2) determine the prevalence of FI by country, age group, and gender, and 3) examine the sociodemographic and economic characteristics of individuals with FI. MethodsThe Rasch modeling procedure was applied to data collected by GWP in 2014 and 2015 on 57,792 respondents aged ≥19 y in SSA. ResultsFIES largely met the Rasch model assumptions of equal discrimination and conditional independence. However, 34.3% of countries had high outfits (≥2.0) for the item “went without eating for a whole day.” Four countries had significant correlations for the items “were hungry but did not eat” and “ran out of food.” The overall prevalence of severe FI (SFI) was 36.4%, ranging from 6.0% in Mauritius to 87.3% in South Sudan. Older adults were at significantly higher risk of SFI than younger adults (38.6% and 35.8%, respectively, P < 0.0001), and women more than men (37.3% and 35.4%, respectively, P < 0.0001). Higher proportions of individuals with SFI were rural residents, less educated, lower income, unemployed, and lived in households with many children under the age of 15 y. ConclusionsFIES has acceptable levels of internal validity for use in SSA. However, the item “went without eating for a whole day” may need cognitive testing in a few SSA countries. For countries with correlated items, 1 of the items may be excluded.

Food insecurity status and mortality among adults in Ontario, Canada.

BackgroundFood insecurity is associated with a wide array of negative health outcomes and higher health care costs but there has been no population-based study of the association of food insecurity and mortality in high-income countries.MethodsWe use cross-sectional population surveys linked to encoded health administrative data. The sample is 90,368 adults, living in Ontario and respondents in the Canadian Community Health Survey (CCHS). The outcome of interest is all-cause mortality at any time after the interview and within four years of the interview. The primary variable of interest is food insecurity status, with individuals classed as “food secure”, “marginally food insecure”, “moderately food insecure”, or “severely food insecure”. We use logistic regression models to determine the association of mortality with food insecurity status, adjusting for other social determinants of health.ResultsUsing a full set of covariates, in comparison to food secure individuals, the odds of death at any point after the interview are 1.28 (CI = 1.08, 1.52) for marginally food insecure individuals, 1.49 (CI = 1.29, 1.73) for moderately food insecure individuals, and 2.60 (CI = 2.17, 3.12) for severely food insecure individuals. When mortality within four years of the interview is considered, the odds are, respectively, 1.19 (CI = 0.95, 1.50), 1.65 (CI = 1.37, 1.98), and 2.31 (CI = 1.81, 2.93).InterpretationThese findings demonstrate that food insecurity is associated with higher mortality rates and these higher rates are especially large for the most severe food insecurity category. Efforts to reduce food insecurity should be incorporated into broader public health initiatives to reduce mortality.

P33 - Barriers to Accessing Adequate, Healthy Foods in Two Rural Communities in North Carolina

Background (Background, Rationale, Prior Research, and/or Theory): Rural households face unique challenges related to high rates of food insecurity, the lack of access to adequate, healthy food, which is associated with poor health outcomes. However, research shows that church-based interventions are effective in rural communities. Objective: This study sought to identify and describe challenges of food access in a rural community and promote church-based interventions. Study Design, Setting, Participants, Intervention: In partnership with two United Methodist Churches in rural North Carolina, three focus group interviews (n = 23) were conducted focusing on health and nutrition issues with six to ten local residents who administered or received church aid. Outcome Measures and Analysis: Outcome measures included a qualitative description of barriers to food access. Using the constant comparative method to analyze themes, four researchers independently developed a list of barriers and came to a consensus. Results: The focus groups elucidated several barriers, including lack of local and homegrown food, high costs of healthy foods, inadequate food and nutrition resources, an absence of economic opportunities, and trouble navigating the food environment. Some of these issues, such as lack of access to homegrown food, are unique to rural populations due to culture and location. Viable solutions include providing fruits and vegetables through local church gardens, partnerships with local farmers, and promoting community resources such as transportation and education. Conclusions and Implications: This study described rural Appalachia's food environment and identified multiple barriers to accessing enough quality food from the perspectives of food insecure individuals and food assistance volunteers. By obtaining these viewpoints, community solutions that promote rural food security became evident. Funding: None.

Associations between Food Security Status and Dietary Inflammatory Potential within Lower-Income Adults from the United States National Health and Nutrition Examination Survey, Cycles 2007 to 2014

BackgroundEvidence suggests both that chronic inflammation mediates the association of food insecurity with adverse health outcomes and that diet may be a significant source of inflammation among food insecure individuals. ObjectiveTo examine whether food security status is associated with dietary inflammatory potential. Design and participantsCross-sectional data came from the National Health and Nutrition Examination Survey (NHANES), cycles 2007 to 2014 (n=10,630). The analysis sample is representative of noninstitutionalized US adults with an income-to-poverty ratio ≤3.00. Main outcomeDietary Inflammatory Index (DII) score, calculated using the average of two 24-hour dietary recalls, was the main outcome measure. Statistical analysisType III F tests or χ2 tests compared population characteristics by food security status, defined using the US Food Security Survey Module. Multivariable linear regression was used to estimate the association between food security status and the DII score and moderation by demographic factors. Survey weighting procedures accounted for the effects of stratification and clustering used in the NHANES study design. ResultsWhen accounting for socioeconomic status, demographic factors, and health status, DII score was higher at greater levels of food insecurity (P=0.0033). Those with very low food security had a 0.31 (95% CI=0.12 to 0.49) higher DII score than those with high food security. Age moderated the association between food security status and DII score (interaction P=0.0103), where the magnitude of the association between DII score and severity of food insecurity was higher for those >65 years than for younger age groups. ConclusionFood security status may be associated with dietary inflammatory potential, which is hypothesized to play a role in multiple chronic health conditions. Further research is needed to determine the causal nature of this relationship and evaluate how best to implement programs designed to address health disparities within food insecure populations.

The Relation between Food Insecurity and Mental Health Care Service Utilization in Ontario.

To determine the relationship between household food insecurity status over a 12-month period and adults' use of publicly funded health care services in Ontario for mental health reasons during this period. Data for 80,942 Ontario residents, 18 to 64 years old, who participated in the Canadian Community Health Survey in 2005, 2007-2008, 2009-2010, or 2011-2012 were linked to administrative health care data to determine individuals' hospitalizations, emergency department visits, and visits to psychiatrists and primary care physicians for mental health reasons. Household food insecurity over the past 12 months was assessed using the Household Food Security Survey Module. Logistic regression models were used to estimate the odds of mental health service utilization in the past 12 months by household food insecurity status, adjusting for sociodemographic factors and prior use of mental health services. In our fully adjusted models, in comparison to food-secure individuals, the odds of any mental health care service utilization over the past 12 months were 1.15 (95% confidence interval [CI], 1.04 to 1.29) for marginally food-insecure individuals, 1.39 (95% CI, 1.19 to 1.42) for moderately food-insecure individuals, and 1.50 (95% CI, 1.35 to 1.68) for severely food-insecure individuals. A similar pattern persisted across individual types of services, with odds of utilization highest with severe food insecurity. Household food insecurity status is a robust predictor of mental health service utilization among working-age adults in Ontario. Policy interventions are required to address the underlying causes of food insecurity and the particular vulnerability of individuals with mental illness.

Dynamic Volunteer Staffing in Multicrop Gleaning Operations

Gleaning programs organize volunteer gleaners to harvest a variety of leftover crops that are donated by farmers for the purpose of feeding food-insecure individuals. Thus, the gleaning process simultaneously reduces food waste and food insecurity. However, the operationalization of this process is challenging because gleaning relies on two uncertain sources of input: the food and labor supplies. The purpose of this paper is to help gleaning organizations increase the (value-weighted) volume of fresh food gleaned by better managing the uncertainties in the gleaning operation. We develop a model to capture the uncertainties in food and labor supplies and seek a dynamic volunteer staffing policy that maximizes the payoff associated with the amount of food gleaned. The exact analysis of the staffing problem seems intractable. Therefore, we resort to an approximation in the heavy traffic regime. In that regime, we characterize the system dynamics of the multicrop gleaning operation and derive the optimal staffing policy in closed form. The optimal policy is a nested threshold policy that specifies the staffing level for each class of donation (i.e., a donation of a particular crop type and donation size). The policy depends on the number of available gleaners and the backlog of gleaning donations. A numerical study using data calibrated from a gleaning organization in the Boston area shows that the dynamic staffing policy we propose can recover approximately 10% of the volume lost when the gleaning organization uses a static policy. To achieve this improvement, no capital or major process changes would be required -- only some small changes to the staffing level requests.

Association of food insecurity with frailty among older adults in India

Past investigations in different nations have demonstrated that food insecurity may lead to frailty among older adults; however, there is no evidence concerning these associations in India. Our investigation tries to fill this gap utilizing WAVE I of WHO SAGE 2007 information. To examine the independent effect of food insecurity on frailty. To assess differences in frailty and other correlates between food secure and insecure older individuals. The Fried phenotype approach was used to create a frailty index using the presence of five indicators among older adults: exhaustion, weight loss, physical activity, weakness, and walking speed. Respondents were called robust, pre-frail, or frail based on the presence of zero, one, or two or more indicators from the five indicators, respectively. Individuals were classified as food insecure based on their responses to two five-point Likert scale-type questions: if they had less food than required because there was not enough food and if they had been hungry but did not eat because they could not afford food in more than 1 or 2 months in the last 12 months. Bivariate analysis was performed to determine the differences in all the correlates and frailty among older adults with food security and insecurity. Step-by-step logistic regression analysis was performed to estimate the effect of food insecurity on frailty. Bivariate results show that from a total of 6650 adults aged 50 years or older, 16.05% are food insecure, and of them, 19% are frail. In addition, frailty is significantly associated with food insecurity (p < 0.001). These findings are further corroborated by multivariate analysis results showing that food insecure older adults have higher odds of being frail compared to their counterparts (OR = 1.31, 95% CI 1.10; 1.65, P < 0.001) in the adjusted model for all the correlates. Education and wealth are also among major factors aggravating frailty among older adults. Based on our results, we conclude that, after controlling for correlates, food insecurity is associated with frailty, which further prevents older adults from accessing nutritious food and causes them to lose their independence. Thus, the government needs to introduce focused sustenance programs for the elderly population who do not have regular access to food and are frail to prevent early disability and mortality.

Social Analysis Model- A Tool for Examining Community-Based Food Justice/Food Security Issues

Upon the introduction of this social analysis model, dietetic students and community nutrition practitioners will have a valuable tool that can be used for the assessment and diagnosis of food insecurity within community groups. Use of this social analysis model will enhance the development of evidence-based interventions, as well as monitoring and evaluation approaches for programs serving food insecure individuals in the community.

Effectiveness of the Fresh Rx Program in Food Bank Clients with Chronic Disease

To determine the impact of the Fresh Rx program of the Regional Food Bank of Oklahoma on clients with obesity, hypertension, and/or diabetes. 120 food bank clients diagnosed with obesity, hypertension, and/or diabetes were recruited by two low income clinics to participate in the Fresh Rx Program for nine months. The program combined access to healthy food through a free mobile market, food tastings, brief nutrition and lifestyle education, and medical care. A short survey and clinical measures of BMI, blood pressure, and hemoglobin A1c were used to assess the effectiveness of the program using chi square and ANOVA. Fresh Rx program participants reported becoming food secure, and having increased access to fresh fruits and vegetables and improved perceptions of their health and control over their health. Satisfaction with the program was overwhelmingly positive. However, reported intake of fruits and vegetables, clinical measures of body weight, blood pressure, and diabetes control were not improved. The program combined food distribution, nutrition education, and health screenings as an effective way to positively influence the food insecurity of low-income, food-insecure individuals with chronic diseases. Improvements on program focus, intensity of nutrition education, and adjustments to content could improve the impact of the program.

Cigarette Smoking among Women Who Are Homeless or Unstably Housed: Examining the Role of Food Insecurity

Smoking prevalence remains high among individuals who are homeless, partly due to stressors related to homelessness. Beyond housing insecurity, homelessness involves financial stresses and unmet subsistence needs. In particular, food insecurity contributes to negative health outcomes and other health risks. This study examined associations between food insecurity severity and smoking among homeless and marginally housed women in San Francisco, California. We used data from 247 women from a longitudinal cohort study. Generalized estimating equations were used to estimate longitudinal associations between study factors and smoking based on data from five biannual assessment points between 2009 and 2012. The longitudinal adjusted odds of smoking were higher among severely food insecure individuals compared to those who were not food insecure (AOR=1.68, 95% CI [1.02, 2.78]), while associations with other study factors, including demographics, time, HIV status, mental health, and substance use (except marijuana use), did not reach levels of significance. Similar adjusted longitudinal results were observed when food insecurity was the dependent variable and smoking an independent variable, suggesting the possibility of a bidirectional association. Considering unmet needs, such as food and hunger, may improve comprehensive smoking cessation strategies targeting individuals for whom mainstream tobacco control efforts have not been effective. Similarly, offering improved access to smoking cessation resources should be considered in efforts to address food insecurity among individuals experiencing homelessness.

Food Insecurity and Health Outcomes

Abstract Food insecurity is increasingly recognized as a major health crisis in the U.S. More than 42 million persons were food insecure in 2015, far higher than the levels preceding the 2007 Great Recession. Decades of research demonstrate that food insecurity diminishes individuals’ overall well-being. The recognition of food insecurity as a health crisis, however, stems from a more recent appreciation of the multiple negative health outcomes and, thus, higher health care costs, attributable to food insecurity. An extensive literature from multiple fields, including agricultural economics, economics, medicine, and nutrition, has emerged in recognition of food insecurity as a health crisis. Among other findings, food insecurity among children is associated with increased risks of some birth defects, anemia, lower nutrient intakes, cognitive problems, and aggression and anxiety. Food insecurity is also associated with higher risks of being hospitalized, poorer general health, worse oral health and with having asthma, behavioral problems, depression, and suicidal ideation. For adults, studies have shown that food insecurity is associated with decreased nutrient intakes; increased rates of mental health problems (including depression), diabetes, hypertension, and hyperlipidemia; being in poor or fair health; and poor sleep outcomes. Food insecurity and poor health are likely linked bi-directionally; that is, it is true both that living in a food insecure household predisposes an individual to poor health, and that poor health predisposes one to living in a food insecure household. After describing how food insecurity is measured, we turn to the multiple causes of food insecurity and potential pathways through which food insecurity leads to these negative health outcomes. Finally, we describe two recently articulated interventions designed to address both food insecurity and its health impact. The first is a targeted increase in benefit levels for supplemental nutrition assistance program (SNAP, formerly known as the Food Stamp Program) enrollees and near eligible households, and the second provides tailored support for food insecure individuals with diabetes.

Revealing the Prevalence and Consequences of Food Insecurity in Children with Epilepsy.

Food insecurity (FI) affects more than one in five American children and is increasingly addressed during pediatric primary care. Its relevance during subspecialty care, including in the treatment of chronic conditions like epilepsy, is largely unknown. This study sought to determine the FI prevalence among children with epilepsy and examine the relationship between FI and healthcare utilization, health-related quality-of-life (HR-QOL), and medication side effect control. This was a retrospective cohort study using electronic health record data from children, aged 2-17 years, seen for epilepsy management at an academic pediatric hospital. The primary predictor was household FI status, determined using a validated screening tool employed in the hospital's pediatric neurology clinics. The primary outcome was unplanned healthcare utilization in the 6months following initial FI screen. Secondary outcomes were standardized, validated assessments of HR-QOL and epilepsy medication side effects. Nearly 14% of the 691 children seen in the clinics for epilepsy lived in food insecure households. The impact of FI on healthcare utilization varied by race. For Caucasians, healthcare utilization rates were significantly higher among food insecure individuals than food secure individuals (37 vs. 17%, p = 0.003). Among African Americans, healthcare utilization rates did not vary with food security status (p = 0.6). Children in food insecure households had lower HR-QOL (p < 0.0001) and higher medication side effects (p = 0.0005). FI is common among children with epilepsy and may influence adverse health outcomes. Further exploration into how FI and other social determinants influence management of and determine outcomes for chronic diseases is warranted.

Time Trends and Patterns of Reported Egg Consumption in the U.S. by Sociodemographic Characteristics.

Eggs have the potential to contribute essential nutrients to nutritionally vulnerable populations on limited food budgets. Further research is needed to better understand patterns of egg consumption across diverse sociodemographic groups in order to inform clinical practice to improve nutrient adequacy. Data on demographics and egg intake of 29,694 U.S. adults were obtained from the National Health and Nutrition Examination Survey, 2001–2012. The National Cancer Institute’s usual intake methodology was used to estimate the distribution of egg intake. Linear and logistic regression models were used to test for time trends in egg consumption and for differences between sociodemographic groups. The proportion of the U.S. population, overall (21%–22%; p = 0.311) and by sociodemographic group (p > 0.05 for all groups), that reported consuming eggs remained unchanged from 2001 to 2012. Mean egg consumption increased overall from 23.0 (95% CI, 20.8–25.2) g/day in 2001–2002 to 25.5 (22.7–28.4) g/day in 2011–2012 (p = 0.012), but not among food insecure individuals (p = 0.816) and Supplemental Nutrition Assistance Program (SNAP) participants (p = 0.399). No differences in the odds of egg consumption were observed by income level, food security status, or SNAP participation status (p > 0.05 for all groups). Given the nutritional benefits of eggs, as well as their low cost and culinary versatility, the results presented here have important implications for reducing disparities in health outcomes and diet quality, in particular among food insecure individuals and SNAP participants. Further research is needed to examine factors that influence egg consumption and associated nutrient intake, and to identify potential barriers to increasing egg consumption, such as egg price changes, across diverse sociodemographic groups.

Healthy Options in Food Pantries—A Qualitative Analysis of Factors Affecting the Provision of Healthy Food Items in St. Louis, Missouri

ABSTRACTIn 2015, 15.8 million households experienced food insecurity at some point during the year. One out of every 8 American households utilizes a food bank or food pantry to meet their food needs during the year. Understanding the factors that influence whether food pantries provide healthy options to clients can lead to opportunities to improve the health of food insecure individuals. Telephone interviews were conducted with food pantry staff (n = 12) in the greater St. Louis area. Using focused coding, interviews were analyzed for factors that facilitate or hinder increasing access to healthy options in food pantries. Pantry staff described barriers (e.g., perishable food storage) and facilitators (e.g., donor relationships) that affected their ability to provide clients with healthy food options. The results of this study will inform interventions aimed at improving the delivery of healthy food options to food pantry clients.

Food Insecurity, CKD, and Subsequent ESRD in US Adults

Poor access to food among low-income adults has been recognized as a risk factor for chronic kidney disease (CKD), but there are no data for the impact of food insecurity on progression to end-stage renal disease (ESRD). We hypothesized that food insecurity would be independently associated with risk for ESRD among persons with and without earlier stages of CKD. Longitudinal cohort study. 2,320 adults (aged≥ 20 years) with CKD and 10,448 adults with no CKD enrolled in NHANES III (1988-1994) with household income≤ 400% of the federal poverty level linked to the Medicare ESRD Registry for a median follow-up of 12 years. Food insecurity, defined as an affirmative response to the food-insecurity screening question. Development of ESRD. Demographics, income, diabetes, hypertension, estimated glomerular filtration rate, and albuminuria. Dietary acid load was estimated from 24-hour dietary recall. We used a Fine-Gray competing-risk model to estimate the relative hazard (RH) for ESRD associated with food insecurity after adjusting for covariates. 4.5% of adults with CKD were food insecure. Food-insecure individuals were more likely to be younger and have diabetes (29.9%), hypertension (73.9%), or albuminuria (90.4%) as compared with their counterparts (P<0.05). Median dietary acid load in the food-secure versus food-insecure group was 51.2 mEq/d versus 55.6 mEq/d, respectively (P=0.05). Food-insecure adults were more likely to develop ESRD (RH, 1.38; 95% CI, 1.08-3.10) compared with food-secure adults after adjustment for demographics, income, diabetes, hypertension, estimated glomerular filtration rate, and albuminuria. In the non-CKD group, 5.7% were food insecure. We did not find a significant association between food insecurity and ESRD (RH, 0.77; 95% CI, 0.40-1.49). Use of single 24-hour diet recall; lack of laboratory follow-up data and measure of changes in food insecurity over time; follow-up of cohort ended 10 years ago. Among adults with CKD, food insecurity was independently associated with a higher likelihood of developing ESRD. Innovative approaches to address food insecurity should be tested for their impact on CKD outcomes.

Comprehensive and Medically Appropriate Food Support Is Associated with Improved HIV and Diabetes Health.

Food insecurity is associated with negative chronic health outcomes, yet few studies have examined how providing medically appropriate food assistance to food-insecure individuals may improve health outcomes in resource-rich settings. We evaluated a community-based food support intervention in the San Francisco Bay Area for people living with HIV and/or type 2 diabetes mellitus (T2DM) to determine the feasibility, acceptability, and potential impact of the intervention on nutritional, mental health, disease management, healthcare utilization, and physical health outcomes. The 6-month intervention provided meals and snacks designed to comprise 100% of daily energy requirements and meet nutritional guidelines for a healthy diet. We assessed paired outcomes at baseline and 6months using validated measures. Paired t tests and McNemar exact tests were used with continuous and dichotomous outcomes, respectively, to compare pre-post changes. Fifty-two participants (out of 72 initiators) had both baseline and follow-up assessments, including 23 with HIV, 24 with T2DM, and 7 with both HIV and T2DM. Median food pick-up adherence was 93%. Comparing baseline to follow-up, very low food security decreased from 59.6% to 11.5% (p < 0.0001). Frequency of consumption of fats (p = 0.003) decreased, while frequency increased for fruits and vegetables (p = 0.011). Among people with diabetes, frequency of sugar consumption decreased (p = 0.006). We also observed decreased depressive symptoms (p = 0.028) and binge drinking (p = 0.008). At follow-up, fewer participants sacrificed food for healthcare (p = 0.007) or prescriptions (p = 0.046), or sacrificed healthcare for food (p = 0.029). Among people with HIV, 95% adherence to antiretroviral therapy increased from 47 to 70% (p = 0.046). Among people with T2DM, diabetes distress (p < 0.001), and perceived diabetes self-management (p = 0.007) improved. Comprehensive, medically appropriate food support is feasible and may improve multiple health outcomes for food-insecure individuals living with chronic health conditions. Future studies should formally test the impact of medically appropriate food support interventions for food-insecure populations through rigorous, randomized controlled designs.

Dynamic Staffing of Volunteer Gleaning Operations

Gleaning programs organize volunteer gleaners to harvest leftover crops that are donated by farmers for the purpose of feeding food-insecure individuals. Thus, the gleaning process simultaneously reduces food waste and food insecurity. However, the operationalization of this process is challenging because gleaning relies on two uncertain sources of input: the food and labor supplies. The purpose of this paper is to increase the volume of fresh food gleaned by better managing the uncertainties in the gleaning operation. We develop a model to capture the uncertainties in food and labor supplies and seek a dynamic volunteer staffing policy that maximizes the long run average volume of food gleaned. The exact analysis of the staffing problem seems intractable. Therefore, we resort to an approximation in the heavy traffic regime. In that regime, we characterize the system dynamics of the gleaning operation and derive the optimal staffing policy in closed form. The optimal policy is a nested threshold policy that depends on the number of available gleaners and the backlog of gleaning donations. A numerical study using data calibrated from a gleaning organization in the Boston area shows that the dynamic staffing policy we propose can make meaningful improvements to gleaning output over a static policy. To achieve these improvements, no capital or major process changes would be required - only some small changes to the staffing level requests.

A Public-Private Partnership to Mitigate Food Insecurity and Food Waste in Orange County, California.

Food insecurity is a global issue that arises owing to systemic socioeconomic inequities and environmental constraints. To highlight the existence and the extent of food insecurity and food waste, the Orange County Health Department in Orange County, California, created a coalition called "Waste Not Orange County." Orange County is the sixth most populous county in California and has the highest median income, yet 11.4% of those residing in Orange County are food insecure, and 24.0% live in poverty. The overall vision of the coalition is to mitigate hunger in Orange County by educating the community about food donations, identifying food-insecure individuals, and connecting those individuals to sources of food. We examine the coalition's impacts between 2014 and 2016.

Food assistance to tuberculosis patients: lessons from Afghanistan.

Poverty, food insecurity and poor nutrition in the population are important contributors to the burden of tuberculosis (TB). For poor and food-insecure individuals, accessing and successfully completing anti-tuberculosis treatment over an extended period of time is challenging. Food and nutritional support as an incentive and enabler is employed by national TB control programmes (NTPs) worldwide as a means to encourage treatment initiation and adherence and to improve the nutritional status of patients with TB. It also offers a safety net for food-insecure households affected by TB to mitigate the financial consequences of the disease. This paper reports on the primary lessons from the review of the World Food Programme's (WFP's) Food Assistance Programme for TB patients in Afghanistan. It aims to inform the design, implementation and scale-up of TB programmes in settings where food insecurity and malnutrition are prevalent. It also documents qualitative findings that suggest that patients, their families and providers viewed food support as an important asset and an essential element of the national TB control strategy. While the impact on treatment success or case detection could not be quantified, it is likely that the WFP intervention had a positive impact on the patients and their households, therefore contributing to the success of the DOTS-based NTP.