Insecurity Resources Research Articles

Emergency Department Food Insecurity Screening, Food Voucher Distribution and Utilization: A Prospective Cohort Study

Objective: Food insecurity is a prevalent social risk among emergency department (ED) patients. Patients who may benefit from food insecurity resources may be identified via ED-based screening; however, many patients experience difficulty accessing resources after discharge. Co-locating resources in or near the ED may improve utilization by patients, but this approach remains largely unstudied. This study characterized the acceptance and use of a food voucher redeemable at a hospital food market for patients who screened positive for food insecurity during their ED visit. Methods: This prospective cohort study, conducted at a single county-funded ED, included consecutive adult patients who presented on weekdays between 8 AM–8 PM from July–October 2022 and consented to research participation. We excluded patients who required resuscitation on arrival or could not provide written informed consent in English. Study participants completed a paper version of the two-question Hunger Vital Sign screening tool, administered by research staff. Participants who screened positive received a uniquely numbered $30 food voucher redeemable at the hospital’s co-located food market. Voucher redemption was quantified through regular evaluation of market receipt records at 30-day intervals. The primary outcome was the proportion of redeemed vouchers. Secondary outcomes included the proportion of participants screening positive for food insecurity, proportion of participants accepting vouchers, and associated descriptive statistics. Results: Of the 396 eligible individuals approached, 377 (95.2%) consented and completed food insecurity screening. Most were middle-aged (median 53 years, interquartile range 30–58 years), 191 were female (50.4%), 242 were Black (63.9%), and 343 were non-Hispanic (91.0%). Of the participants, 228 (60.2%) screened positive for food insecurity and 224 received vouchers (98.2%), of which 86 were redeemed (38.4%) a median of nine days after the ED visit. Conclusion: A high proportion of participants screened positive for food insecurity and accepted food vouchers; however, less than half of all vouchers were redeemed at the co-located food market. These results imply ED food voucher distribution for food insecurity is feasible, but co-location of resources alone may be insufficient in addressing the social risk and alludes to a limited understanding of facilitators and barriers to resource utilization following ED-based social needs screening.

O22 Food Insecurity and Opportunities for Interventions: Perspectives of American Indian Elders from an Urban Health Care Clinic

<h3>Background</h3> Food insecurity can negatively impact chronic disease management. Older adults often have more nutrition-related chronic disease and barriers to healthful eating such as unreliable transportation and living on a fixed-income. Urban American Indian (AI) serving clinics provide a trusted source of care for American Indian elders and services to mitigate food insecurity among American Indian elders are warranted. <h3>Objective</h3> The objective of this study was to explore the perspectives of AI elders living in 1 large city regarding locally available food insecurity resources and opportunities for the urban clinic to expand food insecurity support. <h3>Study Design, Setting, Participants</h3> Qualitative individual interviews with AI elderly (≥60 years old) patients from an urban AI clinic. Participants (n = 24) engaged in 1 30–90-minute telephone interview. Participants were recruited by clinic staff. <h3>Measurable Outcome/Analysis</h3> One researcher conducted all interviews using a semi-structured moderator guide with probes. "Scenario-based" questions were included to obtain interviewee responses to each scenario. This approach was intended to de-stigmatize food insecurity for participants who may have felt shame in sharing their own experiences with food insecurity. Interviews were audio recorded, transcribed verbatim, and analyzed using the constant comparison method and Atlas.ti. <h3>Results</h3> Four key themes emerged: 1) hunger-mitigating resources exist but don't necessarily lessen food insecurity; 2) multiple layers of challenges present barriers to healthy nutrition for AI elders; 3) unique facilitators rooted in AI culture can help decrease food insecurity; and 4) there are many clinic-based opportunities for programs to improve food insecurity. <h3>Conclusion</h3> These findings provide a foundation for urban-serving AI clinics to develop and implement food insecurity resources for their elders. Resources should build on cultural strengths and be specific to the challenges faced by elders. Some challenges are not unique to AIs and similar resources could be developed for other urban organizations serving elders.

Insecure Resources, Bilateral Trade, and Endogenous Predation: A Game‐Theoretic Analysis of Conflict and Trade

This article analyzes how interstate conflict over resources affects the incentives to trade and how greater trade openness affects the endogenous decisions of arming by enemy countries. We identify conditions under which there is trade between two adversary countries and show that each adversary's arming affects domestic welfare in three different ways. The first is an export‐revenue effect, which increases welfare because arming causes export revenue to go up (i.e., there is an arming‐induced terms‐of‐trade improvement). The second is a resource‐predation effect, which increases welfare because arming increases the appropriation of a rival country's resource input to produce a consumption good. The third is an output‐distortion effect, which reduces welfare because arming lowers the domestic production of civilian goods. Based on these effects, we show circumstances in which greater trade openness reduces the intensity of arming. We also discuss the implications of resource security asymmetry for conflict and trade.

Caregivers' Experiences With Food Insecurity Screening and Impact of Food Insecurity Resources.

We explored caregivers' experiences with food insecurity screening in a primary care setting and the impact of resources provided. English- and Spanish-speaking food insecure caregivers of children aged 1 to 5 years were recruited. In-depth individual semistructured interviews were conducted (n = 17) eliciting caregivers' experiences with food insecurity, clinic screening, and resources provided. Interviews were audio-recorded and transcribed verbatim. Interviews were double-coded and thematic analysis was used to identify themes and subthemes. All caregivers described multiple and repeat experiences with food insecurity. Food insecurity screening was acceptable, but families were not always connected with resources. Caregivers described WIC (Women, Infants, and Children) as the most commonly used program to address food insecurity and infrequently utilized other food insecurity resources. Screening for food insecurity in primary care was generally well accepted by this sample of food insecure caregivers. Future studies are needed to determine how to improve connecting resources with families most in need.

Insecure resources, rent seeking, and wage inequality

This paper explores how insecure resources affect skilled-unskilled wage inequality in the background of rent seeking. Through building the general equilibrium models embedded with contest success functions, we find that wage inequality is determined by the output elasticities of rent-seeking efforts and the capital intensities of different sectors, and that sometimes the threshold of insecure resources also plays an important role.

Trade and insecure resources

We construct a model of conflict and trade to study the consequences of interstate disputes over contested resources (land, oil, water or other resources) for arming, welfare and trade flows. Different trade regimes imply different costs of such disputes in terms of arming. Depending on world prices, free trade can intensify arming to such an extent that the additional security costs it brings swamp the traditional gains from trade and thus render autarky more desirable for one or all rival states. Free trade, though, is always an equilibrium, and sometimes is a dominant one with features of a prisoner's dilemma outcome. Furthermore, contestation of resources can reverse a country's apparent comparative advantage relative to its comparative advantage in the absence of conflict. And, where such conflict is present, comparisons of autarkic prices to world prices could be inaccurate predictors of trade patterns.