• Corpus ID: 53625852

Promoting Client Nutrition in Urban Utah Food Pantries

@inproceedings{Coombs2018PromotingCN,
  title={Promoting Client Nutrition in Urban Utah Food Pantries},
  author={Casey Coombs},
  year={2018}
}

• C. Coombs
• Published 2018
• Medicine

Food insecure Americans are at risk for poor dietary intake which can lead to obesity, type II diabetes, heart disease and certain cancers. Many food insecure Americans receive food assistance from emergency food sites such as food pantries. Nutrition interventions that address the most common barriers that prevent pantry clients from making healthy choices have the potential to improve the dietary quality of this susceptible population. Nutrition intervention developers should consider healthy food availability, visibility and appeal when designing effective programs. Nudge strategies, such as shelf labels that help pantry clients quickly identify healthy options, may provide a sustainable, low-cost intervention that can be easily implemented in a variety of settings. Introduction Background According to the United States Department of Agriculture (USDA) 41.2 million Americans, including 6.5 million children lived in households considered food insecure in 2016 (United States Department of Agriculture [USDA], 2016). Food insecurity is defined by the USDA as an insufficient amount of food to support an active and healthy lifestyle (USDA, 2016). Food insecurity exists in every county of the United States (Weinfeld et al., 2014). Members of food insecure households often utilize several strategies throughout the month to maintain an adequate supply of food (Weinfeld et al., 2 2014). These strategies often include one of the three major federal food programs including the Supplemental Nutrition Assistance Program (SNAP), the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and the National School Lunch Program (NSLP) (Weinfeld et al., 2014). Despite resources made available through these federal programs, many households continue to struggle to obtain a consistent, adequate supply of food. In these instances, many individuals turn to emergency food sites such as food pantries, food banks and soup kitchens to keep food in their homes (Weinfeld et al., 2014). Traditionally, emergency sites supplied food for short periods during especially dire times (Weinfeld et al., 2014). However, there has been a shift in the role of food pantries from short-term emergency food suppliers to becoming part of a longer-term food security strategy (Weinfeld et al., 2014). Feeding America, a network of food banks across the nation, collected data on the 46.5 million Americans they serve annually with their charitable food programs. Findings from their 2014 survey indicated that 63% of respondents reported planning to visit the food pantry monthly as part of their food security strategy, rather than visiting the pantry spontaneously when their food supplies and budgets ran out (Weinfeld et al., 2014). This long-term reliance on food pantries increases the importance of ensuring that pantries not only have enough food for their clients, but also have a variety of nutritious foods. Food insecure Americans often consume diets that contain inadequate amounts of fruits, vegetables and micronutrients, which is associated with increased risk of obesity and chronic diseases such as type II diabetes mellitus, heart disease and certain types of cancer (Champagne et al., 2007; Drewnowki & Specter, 2004; Seligman et al., 2010). Increasing access to healthy choices in food pantries is one important strategy to improve 3 the nutritional quality of food pantry users’ diets, which may help reduce their risk of obesity and related diseases (Akobundo, Cohen, Laus, Schulte, & Soussloff, 2004; Martin, Wu, Wolff, Colantonio, & Grady, 2013; Robaina & Martin, 2013; Simmet, Depa, Tinnemann, Stroebele-Benschop, 2017a). Improving access to healthy foods in food pantries is one important step in reducing the health disparities experienced by many low-income Americans (Akobundo et al., 2004; Byker Shanks, 2017; Kaiser, Hermsen, 2015; Knoblock-Hahn, Murphy, Brown, Medrow, 2017; Martin et al., 2013; Robaina & Martin, 2013, Simmet et al., 2017a). However, simply increasing the availability of healthy foods does not ensure that food pantry clients will select and ultimately consume them (Wilson, Just, Swigert, & Wansink, 2016). Recently, the use of behavioral economic strategies known as nudges have been examined as a means to encourage individuals to select more nutritious foods (Wilson et al., 2016). Although using nudges to specifically encourage healthy food selection is a relatively new concept, food retailers have successfully used nudges for product promotion, placement and price to promote targeted items for a long time (Glanz, Bader & Iyer, 2012). A growing area of interest is the use of these nudge strategies in client-choice food pantries. Client-choice food pantries are those in which clients select their own foods from a variety of available items (Remley, Zubieta, Lambea, Quinonez, & Taylor, 2010; Wilson et al., 2016). This is in contrast to food pantry settings where clients receive a prepackaged box of food. Two studies have been conducted to determine the impact of nudge strategies on the movement of healthful food items in client-choice food pantries (Rivera et al., 2016; Wilson et al., 2016). The interventions nudged clients to select targeted items through the use of product placement and/or promotion using 4 shelf labels and posters (Rivera et al., 2016; Wilson et al., 2016). They measured the movement of these items before and after the nudge interventions were in place (Rivera et al., 2016; Wilson et al., 2016). Results showed that more pantry users selected the targeted items after the nudges were introduced (Rivera et al., 2016; Wilson et al., 2016). Researchers concluded that certain nudges do increase the likelihood that individuals will select the targeted item in food pantries (Rivera et al., 2016; Wilson et al., 2016). However, since food pantries primarily serve food insecure Americans, it is important to confirm that these nudge interventions are not exacerbating food insecurity by nudging food pantry users to select items they will not consume at home. To date, no study has surveyed pantry clients to determine if they are not only selecting the nudged items, but also consuming the foods at home. Supplemental Nutrition Assistance Program-Education (SNAP-Ed) Many public health agencies aim to improve the health outcomes of low-income Americans including SNAP-Ed. SNAP-Ed provides nutrition services to adults and youth eligible to receive SNAP benefits. The goal of SNAP-Ed is to increase the likelihood that low-income Americans will make healthy food and lifestyle choices (USDA, 2017). SNAP-Ed implements multi-level strategies to improve both participants’ knowledge and skills necessary to make healthy lifestyle choices, as well as improves access to nutritious foods and physical activity opportunities (USDA, 2017). SNAP-Ed is funded through the federal government and is implemented in every state in the nation (USDA, 2017). In Utah, the SNAP-Ed program, Food $ense, is delivered through the Utah State University Extension system. Individual knowledge and skills are enhanced through direct nutrition education and cooking classes that teach participants how to implement the Dietary 5 Guidelines for Americans and My Plate recommendations. In addition to direct education, Utah’s SNAP-Ed program also implements several policy, systems and environmental (PSE) strategies that aim to make the healthy choice the easy choice in a variety of settings (USDA, 2017). One target setting for Utah’s PSE work is food pantries, where many SNAP-Ed eligible participants receive assistance. One PSE strategy implemented in food pantries is the Thumbs Up for Healthy Choices nudge program, which increases the visibility and appeal of healthy foods within the pantry. Since SNAPEd requires that all program components be evidence based, new programs, such as the Thumbs Up program, must be evaluated to assess its impact and effectiveness (USDA, 2017). Once determined to be an effective program, interventions can then be submitted to the national SNAP-Ed toolkit. The SNAP-Ed toolkit includes approved strategies that can be adopted by SNAP-Ed programs throughout the country. Study objectives and hypotheses The objectives and hypotheses of this study include: 1. To examine if the use of nudge strategies increases the selection of targeted healthy foods by pantry users in six urban Utah food pantries. It is hypothesized that identifying healthy food items with shelf labels will increase the selection of these items by pantry users and that the likelihood of participants reporting they selected these items will increase the longer they have been exposed to the program. These hypotheses were tested by directly surveying clients about their selection of nudged healthy items. 2. To examine if nudge strategies that promote healthy foods improves the dietary quality of food pantry users. It is hypothesized that choosing more healthful foods 6 will improve the diet quality of food pantry users and that the impact of the Thumbs Up program on healthy food consumption will improve with increasing exposure to the program. These hypotheses were assessed by directly surveying pantry clients about their exposure to the program and use of Thumbs Up items at home. 3. To identify the level of interest in a variety of strategies that promote client nutrition among food pantry users not familiar with the Thumbs Up nudge program in place. It is hypothesized that pantry users do value access to healthy foods in food pantries. This hypothesis was tested by surveying food pantry users. Study rationale and significance The significance of this study includes: • This study adds to the small body of literature regarding the impact of nudges in food pantry settings on client selection of healthy food items. • This study is the first to determine the impact of the nudges on reported use and intake of the selected items by food pantry clients. • This study is the first