Food Insecure Patients Research Articles

Food insecurity in a pre-bariatric surgery sample: prevalence, demographics and food shopping behaviour.

To identify the prevalence and demographic characteristics of food insecurity in a presurgical bariatric population. To date there has been no research on food insecurity in a presurgical bariatric population. Participants completed the ten-item adult food security survey module created by the US Department of Agriculture (USDA), with additional questions related to food shopping behaviours and perceived affordability of post-bariatric supplements. USDA scoring guidelines were used to classify participants as food secure, marginally food secure and food insecure. Academic medical centre bariatric surgery clinic in Central Pennsylvania, USA. Adult bariatric surgery candidates (n 174). There was a prevalence of 17·8 % for food insecurity and 27·6 % for marginal food security. Food insecurity was associated with younger age, higher BMI, non-White race/ethnicity, having less than a college education, living in an urban area, receiving Medicaid/Medicare and participating in nutrition assistance programmes. Food-insecure participants endorsed food shopping behaviours that could interfere with postsurgical dietary adherence and perceived post-bariatric supplies as unaffordable or inaccessible. These results highlight the importance of screening bariatric surgical patients for food insecurity. Further study of this important problem within the bariatric population should address effects of food insecurity and related shopping behaviours on postsurgical outcomes and inform the development of programmes to better assist these high-risk patients.

Adiposity, Cardiovascular Health, and Food Insecurity in an Underserved Population (OR02-01-19)

ObjectivesInvestigate differences in the associations between adiposity, cardiovascular health (CVH), and food insecurity by key social determinants (sex, race, and health literacy) in a sample of underserved patients. MethodsThe sample included 800 patients (21–74 years old; 67% African American; 84% female) with obesity (body mass index [BMI] ≥ 30). Adiposity was assessed using BMI and waist circumference (WC). CVH was assessed using the American Heart Association Life’s Simple 7. Food insecurity was determined by the 6-Item Food Security Survey. Health literacy was measured using the REALM-SF. Mixed models with interaction terms between food insecurity and sex, race, and health literacy were analyzed for BMI, WC, and CVH. Stratified models were then analyzed as indicated by significant interaction terms. ResultsMean BMI, WC, and CVH were 37.3 kg/m2 (±4.6), 113.5 cm (±12.4), 6.7 (±1.9), respectively. Thirty-one % of patients were food insecure and 31% had low health literacy. Significant food insecurity by sex interactions were seen for adiposity. Sex-stratified models showed women who were food insecure had greater BMI (38.2 vs. 37.2 kg/m2; P = 0.02) and WC (114.0 vs 111.2 cm; P = 0.007) than food secure counterparts, but associations were not significant in men. Significant food insecurity by health literacy interactions were also seen for adiposity. Health literacy-stratified models showed food insecure participants with better health literacy had greater BMI (39.1 vs. 37.7 kg/m2; P = 0.004) and WC (121.7 vs. 118.2 cm; P = 0.007) than food secure counterparts, but associations were not significant in those with low health literacy. No significant interactions were observed for race. ConclusionsSignificant differences in adiposity were seen in food insecure vs. food secure women, as well as in food insecure vs. food secure patients with better health literacy. These data suggest that adiposity is a greater burden in food insecure patients and may pose challenges for obesity treatment in underserved populations. Funding SourcesThis research was supported by the PCORI (#OB-1402–10,977), the NIGMS of the NIH that funds the Louisiana Clinical and Translational Science Center (1 U54 GM104940), and NORC Center Grant “Nutrition and Metabolic Health Through the Lifespan” sponsored by NIDDK (#P30DK072476).

CE: Addressing Food Insecurity in Vulnerable Populations.

: Food insecurity affects people of all ages, in every area in which nurses work or volunteer. The U.S. Department of Agriculture describes food insecurity as the lack of "consistent, dependable access to adequate food for active, healthy living." The health effects of food insecurity include, but are not limited to, obesity, diabetes, hypertension, low birth weight, depression, and anxiety. Food insecurity is associated with single parenthood, low socioeconomic status, having three or more children, having low educational attainment, being a member of a racial or ethnic minority, renting a home, living in a city, and having a disabled household member. Veterans and military families; college students; members of the lesbian, gay, bisexual, and transgender community; and immigrants have also been identified as at elevated risk. The American Academy of Pediatrics, Academy of Nutrition and Dietetics, and AARP have called for innovative programs and universal screening tools to identify those who are experiencing or are at risk for food insecurity and connect them to available resources. In addition to screening patients for food insecurity and intervening on their behalf, nurses play a vital role in advocating for food-insecure families and supporting community involvement.

Dietary Impact of Produce Prescriptions for Patients With Hypertension.

IntroductionLittle is known regarding the impact of produce prescriptions within the context of hypertension visits at safety net clinics. We evaluated intervention effectiveness on patient usage of farmers markets and dietary change related to fruit and vegetable consumption.MethodsHealth Improvement Partnership — Cuyahoga worked with 3 clinics to integrate, implement, and evaluated a produce prescription for hypertension (PRxHTN) program. PRxHTN involves 3 monthly, nonphysician provider visits, comprising blood pressure measurement, nutrition counseling, and four $10 farmers market produce vouchers, for hypertensive adult patients screening positive for food insecurity. Dietary measures were collected at visits 1 and 3. Voucher use was tracked via farmers market redemption logs.ResultsOf the 224 participants from 3 clinics, most were middle-aged (mean age, 62 y), female (72%), and African American (97%) and had a high school education or less (62%). Eighty-six percent visited a farmers market to use their produce vouchers, with one-third reporting it was their first farmers market visit ever. Median number of farmers market visits was 2 (range: 0–6), and median number of vouchers redeemed was 8 (range: 0–12). Among the subsample with follow-up survey data (n = 137), significant improvement in fruit and vegetable consumption was observed as well as a decline in fast food consumption.ConclusionPRxHTN participants visited at least 1 farmers market, reported increases in provider communication related to diet, and exhibited significant changes in dietary behavior. PRxHTN can serve as a strong model for linking safety net clinics with farmers markets to promote community resource use and improve fruit and vegetable consumption among food-insecure patients with hypertension.

Complexities of Addressing Food Insecurity in an Urban Population.

There is an association between food insecurity, poor health outcomes, and increased health care spending. The Temple Food Insecurity Program was initiated to screen patients for food insecurity as part of the post Temple University Hospital discharge process. The community is economically challenged and food insecurity is a significant problem. Food insecure patients were identified and referred to community-based resources, with a 30-day follow-up call. Screening was successful in 3655 patients, 27% (n = 987) of whom reported food insecurity. Of these patients, 66% (n = 647) were already receiving benefits through the Supplemental Nutrition Assistance Program (SNAP), but were still food insecure. All patients with food insecurity were referred to one of 2 resources for help. Despite significant need, less than a quarter of patients connected with these resources. Qualitative data revealed that some patients did not remember the information provided to them, were overwhelmed with poor health or other social determinants of health, had competing priorities, did not perceive the need for food assistance; and experienced system barriers. Health literacy also was an issue. Health care systems addressing food insecurity should consider the high prevalence of food insecurity in impoverished regions, the reality that SNAP benefits may not alleviate food insecurity for many patients, and the need for individualized, custom care plans that address barriers and reflect patient priorities and capabilities. Engaging patients differently may be aided by additional communication from community food resources directly to patients who provide permission for this added service.

Increased Consumption of Fresh, Local Vegetables to Food Insecure Patients in Innovative Farm-to-Patient Collaboration

Describe the role of a provider-referred farm-to-patient program in increasing access and consumption of fresh, local vegetables to food insecure patients

Relationship of self-reported food insecurity and symptom burden in patients with cancer.

e18771Background: One in eight residents in Maine are food insecure, higher than the national average of one in six. NECS is partnered with a local food bank to help identify food insecure patients...

Abstract P084: Food for Thought: Patient Perspectives on Medically Tailored Meal Delivery for Patients With Diabetes Who Experience Food Insecurity

Introduction: Food insecurity, limited or uncertain access to nutritious food owing to cost, is a major impediment to dietary adherence in diabetes management. Medically tailored meal (MTM) programs, which deliver ready-to-eat meals prepared under the supervision of a dietitian tailored to specific nutritional needs, are potentially transformative interventions for food insecure diabetes patients. However, mechanisms whereby MTM might improve diabetes management are understudied. Hypothesis: We hypothesized that MTM may improve diabetes management by overcoming financial barriers to following a healthy diet and modeling healthy meals. Methods: This qualitative study included 20 participants in a randomized crossover trial of MTM for patients with suboptimally controlled type 2 diabetes (Hemoglobin A1c > 8.0%) and food insecurity (assessed using USDA Food Security Household Survey Module). The goal was to investigate mechanisms whereby MTM affects diabetes management using semi-structured interviews, until saturation was achieved. Participants were asked to give their perceptions regarding how the meals influenced diabetes management and awareness. Interviews were recorded, transcribed verbatim, and coded independently by two investigators. Using qualitative analysis following the immersion-crystallization approach, we evaluated how receiving medically tailored meals influenced diabetes management for patients who are food insecure. Results: Many participants reported that the meals helped with managing their diabetes and increased their understanding about diabetes (example quotation: “When I started my A1c level was so high. And when I started this program they had to teach me how much food I have to eat and all the protein I have to get. And then through the program my A1c went down.”). Participants also noted that the program taught them about healthier food options and portion control, with many suggesting that the meals served as a model for their diet and meal preparation after the study (example quotations: “It gave me a couple of ideas as far as using let's say barley or bulgur wheat. It also gave me an idea of the kinds of things, the range of things that were acceptable, and the portion size was helpful too.” “I used to eat a lot of Italian macaroni and sauce, and eat bread, and dunk my bread in sauce. I don't do that anymore.”). Finally, participants noted that meal delivery relieved financial barriers to eating more healthily (example quotations: “Financially, it saved me a real lot of money. I would not have been able to afford those kinds of meals myself.” “It’s actually helped me out a lot because they cut me down on food stamps, so I was actually unable at the time to be able to eat the foods I was supposed to.“). Conclusions: Medically tailored meal delivery is a promising intervention that may help vulnerable patients with diabetes overcome several barriers to improving health.

Clinical-Community Partnerships to Identify Patients With Food Insecurity and Address Food Needs.

IntroductionMore than 42 million people in the United States are food insecure. Although some health care entities are addressing food insecurity among patients because of associations with disease risk and management, little is known about the components of these initiatives.MethodsThe Systematic Screening and Assessment Method was used to conduct a landscape assessment of US health care entity–based programs that screen patients for food insecurity and connect them with food resources. A network of food insecurity researchers, experts, and practitioners identified 57 programs, 22 of which met the inclusion criteria of being health care entities that 1) screen patients for food insecurity, 2) link patients to food resources, and 3) target patients including adults aged 50 years or older (a focus of this assessment). Data on key features of each program were abstracted from documentation and telephone interviews.ResultsMost programs (n = 13) focus on patients with chronic disease, and most (n = 12) partner with food banks. Common interventions include referrals to or a list of food resources (n = 19), case managers who navigate patients to resources (n = 15), assistance with federal benefit applications (n = 14), patient education and skill building (n = 13), and distribution of fruit and vegetable vouchers redeemable at farmers markets (n = 8). Most programs (n = 14) routinely screen all patients.ConclusionThe programs reviewed use various strategies to screen patients, including older adults, for food insecurity and to connect them to food resources. Research is needed on program effectiveness in improving patient outcomes. Such evidence can be used to inform the investments of potential stakeholders, including health care entities, community organizations, and insurers.

Primary Care Providers’ Perspectives on Screening Older Adult Patients for Food Insecurity

ABSTRACTFood insecurity has been associated with poor health and health outcomes among older adults, yet food assistance resources are available and underutilized. Routine screening and referral for food insecurity in primary care is one avenue to connect food-insecure older adults with available resources. This qualitative study aims to better understand the beliefs of primary care providers (PCPs) about food security screening and referrals in a primary care setting and perceived barriers to implementation. PCPs (n = 16) who have older adult patients but do not routinely screen for food insecurity were interviewed by phone. PCPs recognize the importance of food security for older patients and discuss nutrition and food access with patients under certain circumstances. Concerns emerged with regard to implementing a systematic screening and referral process: limited time to meet with patients, a lack of resources for addressing food insecurity, and prioritizing food insecurity at both the health system and the patient levels. Despite perceived challenges, PCPs are receptive to the idea of systematically screening and referring patients to external resources for food assistance and support. Barriers could be addressed by health systems prioritizing food insecurity as a health concern and public and private payers providing reimbursement for screening.

Developing and Implementing a Food Insecurity Screening Initiative for Adult Patients Living With Type 2 Diabetes.

Routine food insecurity screening is recommended in diabetes care to inform more tailored interventions that better support diabetes self-management among food-insecure patients. This pilot study explored the acceptability and feasibility of a food insecurity screening initiative within a diabetes care setting in Toronto. A systematic literature review informed the development of a food insecurity screening initiative to help health-care providers tailor diabetes management plans and better support food-insecure patients with type 2 diabetes. Interviews with 10 patients and a focus group with 15 care providers elicited feedback on the relevance and acceptance of the food insecurity screening questions and a care algorithm. Subsequently, 5 care providers at 4 sites implemented the screening initiative over 2 weeks, screening 33 patients. After implementation, 7 patients and 5 care providers were interviewed to assess the acceptability and feasibility of the screening initiative. Our findings demonstrate that patients are willing to share their experiences of food insecurity, despite the sensitivity of this topic. Screening elicited information about how patients cope with food insecurity and how this affects their ability to self-manage diabetes. Care providers found this information helpful in directing their care and support for patients. Using a standardized, respectful method of assessing food insecurity can better equip health-care providers to support food-insecure patients with diabetes self-management. Further evaluation of this initiative is needed to determine how food insecurity screening can affect patients' self-management and related health outcomes.

Medication Adherence and Health Outcomes of People Living with HIV Who Are Food Insecure and Prescribed Antiretrovirals That Should Be Taken with Food.

IntroductionFood insecurity is a well-established predictor of poor health outcomes. Antiretroviral therapies (ARTs) that should be taken with food to increase bioavailability may further challenge food insecure patients. This study examined factors associated with antiretroviral adherence and HIV viral suppression among people living with HIV who are food insecure and prescribed medications that require food.MethodsA community sample of 313 men and 105 women who experienced food insecurity in the previous month and were currently taking ART completed computerized interviews, urine screening for drug use, prospective biweekly unannounced pill count adherence assessments, and obtained their HIV viral load and CD4 cell counts from medical records.ResultsIndividuals taking ART regimens that should be taken with food were significantly more likely to be unemployed, were living longer with an HIV diagnosis, had lower CD4 cell counts, poorer HIV suppression, and endorsed more beliefs that taking medications was necessary for their health. Multivariable regression models controlling for potential confounding factors showed that receiving ART that requires food was significantly related to poorer ART adherence and unsuppressed HIV in this food insecure sample.ConclusionPeople living with HIV who are food insecure likely experience multiple facets of poverty that challenge their medication adherence, but food insecurity is the only such factor that is directly related to the pharmacokinetics of some antiretroviral medications. Achieving optimal treatment outcomes for HIV infection will require routine assessment of access to food when determining patient-tailored ART regimens.Electronic supplementary materialThe online version of this article (doi:10.1007/s40121-015-0057-y) contains supplementary material, which is available to authorized users.

Identifying knowledge deficits of food insecure patients with diabetes.

The purpose of this project was to identify the self-care needs of adults with diabetes who experience food insecurity. A cross-sectional study design and methodology were used to attain the study data. We invited 153 adults with diabetes who utilized the St Vincent de Paul Food Pantry to complete the diabetes knowledge test. The reliability of the sample was calculated using Cronbach's coefficient α. To determine validity, differences in test scores were examined by diabetes type and treatment, educational attainment, and receipt of diabetes education. The coefficient α for the general test and the insulin-use subscale indicated that both were moderately reliable, α> 0.60. General test scores were significantly associated with educational attainment (p<0.01) and prior diabetes education (p<0.05). We found that participants who attained education beyond high school or previously received diabetes education scored significantly higher on the test compared to those with less than high school education or not receiving diabetes education (p<0.05). Adults with type 1 diabetes had higher general and insulin use scores compared to adults with type 2 diabetes, however the difference was not statistically significant. While general knowledge about diabetes is not a predictor of self-care behavior, it is needed to perform daily self-care activities. Health care providers should assess diabetes knowledge in low income patients who experience food insecurity regularly to identify any gaps in knowledge that can compromise self-care behaviors.

Are our severely ill patients hungry?

e19626 Background: Food insecurity, a disruption in a household’s eating habits due to insufficient resources for food, is a growing problem in the U.S., where 17.4 million households are food insecure. It is especially detrimental to oncology patients. No studies have yet assessed levels of food insecurity among oncology patients in major population centers. This study aims to estimate the prevalence and predictors of food insecurity among a cohort of medically underserved oncology patients. Methods: Demographic background, diagnosis and treatment information, and responses to the USDA Household Food Security Survey Module were collected and analyzed for a sample of 411 patients with a clinical cancer diagnosis who were in care at 10 hospitals in New York, NY. Food insecurity status was defined according to USDA guidelines, by the number of reported food insecure conditions and behaviors in the USDA Household Food Security Survey Module. Results: The prevalence of food insecurity was 55%, with low and very low food security rates of 45% and 10%, respectively. Food insecure patients were more likely to be younger than food secure patients, and have worse access to health care. Conclusions: This cohort of predominantly immigrant and minority cancer patients had rates of food insecurity nearly 5 times higher than the state average. More research is needed to better understand the causes and impact of food insecurity among cancer and other patients with severe and chronic illnesses. Food insecurity screening should be considered as a component of the standard of care for all cancer and chronic disease patients.

Food Security, Health, and Medication Expenditures of Emergency Department Patients

In the United States, 35 million people live in food-insecure households. Although food insecurity and hunger are undesirable in their own right, they also are potential precursors to nutritional, health, and developmental problems. To examine the prevalence of household food insecurity and its association with health problems and medication expenditures among Emergency Department (ED) patients. We conducted a cross-sectional study in four Boston-area EDs and enrolled consecutive adult patients during two 24-h periods at each site. Food security status was measured using the validated 18-item US Household Food Security Survey Module. Overall, 66 (13%; 95% confidence interval [CI] 10-17%) of 520 ED patients screened positive for food insecurity. Among these 66 patients, 32 (48%; 95% CI 36-61%) reported food insecurity with hunger. Patients from food-insecure households differed from food-secure patients with respect to sociodemographic factors. Food-insecure patients were more likely than food-secure patients to report a variety of chronic and mental health problems (all p < 0.05), including obesity. Food-insecure patients, compared to food-secure patients, also were more likely (all p < 0.001) to put off paying for medication to have money for food (27% vs. 4%, respectively), to take medication less often because they couldn't afford more (32% vs. 4%, respectively), to report needing to make a choice between buying medication and food (27% vs. 2%, respectively), and to report getting sick because they couldn't afford to take medication (27% vs. 1%, respectively). ED patients from food-insecure households report more chronic and mental health problems, and difficulty purchasing medication.

Integrating Nutrition Support for Food-Insecure Patients and Their Dependents Into an HIV Care and Treatment Program in Western Kenya

The Academic Model Providing Access to Healthcare (AMPATH) is a partnership between Moi Teaching and Referral Hospital, Moi University School of Medicine, and a consortium of universities led by Indiana University. AMPATH has over 50,000 patients in active care in 17 main clinics around western Kenya. Despite antiretroviral therapy, many patients were not recovering their health because of food insecurity. AMPATH therefore established partnerships with the World Food Program and United States Agency for International Development and began high-production farms to complement food support. Today, nutritionists assess all AMPATH patients and dependents for food security and refer those in need to the food program. We describe the implementation, challenges, and successes of this program.

Food Insecurity Among Cancer Patients in Kentucky: A Pilot Study

Food insecurity is defined as being uncertain of having enough food due to insufficient money or other resources. The purpose of this study was to examine the construct and correlates of food insecurity in a sample of cancer patients in Kentucky. Data were collected in the waiting rooms of the chemotherapy, hematology/oncology, and gynecology/oncology clinics of a university cancer center, and included 115 cancer patients actively receiving treatment (mean age, 55.85 years; range, 23 to 88 years) who completed a series of standardized measures to assess food insecurity status and psychological and nutritional well-being. Descriptive statistics and independent samples t tests were used to assess the prevalence of food insecurity in the sample, and to identify differences between the persons who were food insecure and food secure. The prevalence rates of food insecurity and food insecurity with hunger in the sample were 17.4% and 7.8%, respectively, which are higher than in the general population. Food-insecure patients had statistically significant higher levels of nutritional risk, depression, and financial strain, and lower quality of life compared with food secure patients. Fifty-five percent of food insecure patients reported not taking a prescribed medication because they could not afford it, versus 12.8% of food-secure patients (P = .002). Food insecurity may be an important consideration for clinical oncology practice, especially when caring for individuals of lower socioeconomic status. Further study is warranted, including prospective studies of cancer patients to identify causal relationships among food insecurity, cancer incidence, cancer treatments, and patient outcomes and well-being.

Food Insecurity Among Cancer Patients in Kentucky: A Pilot Study

Purpose Food insecurity is defined as being uncertain of having enough food due to insufficient money or other resources. The purpose of this study was to examine the construct and correlates of food insecurity in a sample of cancer patients in Kentucky. Patients and Methods Data were collected in the waiting rooms of the chemotherapy, hematology/oncology, and gynecology/oncology clinics of a university cancer center, and included 115 cancer patients actively receiving treatment (mean age, 55.85 years; range, 23 to 88 years) who completed a series of standardized measures to assess food insecurity status and psychological and nutritional well-being. Descriptive statistics and independent samples t tests were used to assess the prevalence of food insecurity in the sample, and to identify differences between the persons who were food insecure and food secure. Results The prevalence rates of food insecurity and food insecurity with hunger in the sample were 17.4% and 7.8%, respectively, which are higher than in the general population. Food-insecure patients had statistically significant higher levels of nutritional risk, depression, and financial strain, and lower quality of life compared with food secure patients. Fifty-five percent of food insecure patients reported not taking a prescribed medication because they could not afford it, versus 12.8% of food-secure patients (P = .002). Conclusion Food insecurity may be an important consideration for clinical oncology practice, especially when caring for individuals of lower socioeconomic status. Further study is warranted, including prospective studies of cancer patients to identify causal relationships among food insecurity, cancer incidence, cancer treatments, and patient outcomes and well-being.

Nutritional Status and Food Insecurity in Hemodialysis Patients

The purpose of this study was to determine whether a relationship exists between nutrition status and food security of patients on hemodialysis (HD). A descriptive correlation study. This study consisted of HD patients undergoing treatment at three northeast Louisiana dialysis centers. Ninety-eight HD patients participated in the study. The mean age of subjects was 59.1 +/- 14.2 years. The sample was 44% white and 56% black; 49% male and 51% female. Multiple linear regression and chi2 analysis were used to assess relationships between demographics and food insecurity scores and Subjective Global Assessment scores. Race significantly predicted food insecurity (beta = 0.248; P = .019), with black patients being more food insecure than white subjects. A significant positive relationship was found between the level of education and Subjective Global Assessment scores (beta = 0.222; P = .037). In this sample, 16.3% of the subjects were found to be food insecure, and 64.3% of the patients were mildly to moderately malnourished, whereas another 13.3% were severely malnourished. Future research in this area should include food security questions related to the ability to obtain foods for health. Renal health care professionals should assess patients for possible food insecurity so that appropriate interventions can be implemented.