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Objective: To describe national disparities in retail food environments by neighbourhood composition (race/ethnicity and socio-economic status) across time and space., Design: We examined built food environments (retail outlets) between 1990 and 2014 for census tracts in the contiguous USA ( n 71 547). We measured retail food environment as counts of all food stores, all unhealthy food sources (including fast food, convenience stores, bakeries and ice cream) and healthy food stores (including supermarkets, fruit and vegetable markets) from National Establishment Time Series business data. Changes in food environment were mapped to display spatial patterns. Multi-level Poisson models, clustered by tract, estimated time trends in counts of food stores with a land area offset and independent variables population density, racial composition (categorised as predominantly one race/ethnicity (>60 %) or mixed), and inflation-adjusted income tertile., Setting: The contiguous USA between 1990 and 2014., Participants: All census tracts ( n 71 547)., Results: All food stores and unhealthy food sources increased, while the subcategory healthy food remained relatively stable. In models adjusting for population density, predominantly non-Hispanic Black, Hispanic, Asian and mixed tracts had significantly more destinations of all food categories than predominantly non-Hispanic White tracts. This disparity increased over time, predominantly driven by larger increases in unhealthy food sources for tracts which were not predominantly non-Hispanic White. Income and food store access were inversely related, although disparities narrowed over time., Conclusions: Our findings illustrate a national food landscape with both persistent and shifting spatial patterns in the availability of establishments across neighbourhoods with different racial/ethnic and socio-economic compositions.

Background: The economic burden of traumatic injuries forces families into difficult tradeoffs between healthcare and nutrition, particularly among those with a low income. However, the epidemiology of food insecurity among individuals reporting having experienced fractures is not well understood., Questions/purposes: (1) Do individuals in the National Health Interview Survey reporting having experienced fractures also report food insecurity more frequently than individuals in the general population? (2) Are specific factors associated with a higher risk of food insecurity in patients with fractures?, Methods: This retrospective, cross-sectional analysis of the National Health Interview Survey was conducted to identify patients who reported a fracture within 3 months before survey completion. The National Health Interview Survey is an annual serial, cross-sectional survey administered by the United States Centers for Disease Control, involving approximately 90,000 individuals across 35,000 American households. The survey is designed to be generalizable to the civilian, noninstitutionalized United States population and is therefore well suited to evaluate longitudinal trends in physical, economic, and psychosocial health factors nationwide. We analyzed data from 2011 to 2017 and identified 1399 individuals who reported sustaining a fracture during the 3 months preceding their survey response. Among these patients, 27% (384 of 1399) were older than 65 years, 77% (1074) were White, 57% (796) were women, and 14% (191) were uninsured. A raw score compiled from 10 food security questions developed by the United States Department of Agriculture was used to determine the odds of 30-day food insecurity for each patient. A multivariate logistic regression analysis was performed to determine factors associated with food insecurity among patients reporting fractures . In the overall sample of National Health Interview Survey respondents, approximately 0.6% (1399 of 239,168) reported a fracture., Results: Overall, 17% (241 of 1399) of individuals reporting broken bones or fractures in the National Health Interview Survey also reported food insecurity. Individuals reporting fractures were more likely to report food insecurity if they also were aged between 45 and 64 years (adjusted odds ratio 4.0 [95% confidence interval 2.1 to 7.6]; p < 0.001), had a household income below USD 49,716 (200% of the federal poverty level) per year (adjusted OR 3.1 [95% CI 1.9 to 5.1]; p < 0.001), were current tobacco smokers (adjusted OR 2.8 [95% CI 1.6 to 5.1]; p < 0.001), and were of Black race (adjusted OR 1.9 [95% CI 1.1 to 3.4]; p = 0.02)., Conclusion: Among patients with fractures, food insecurity screening and routine nutritional assessments may help to direct financially vulnerable patients toward available community resources. Such screening programs may improve adherence to nutritional recommendations in the trauma recovery period and improve the physiologic environment for adequate soft tissue and bone healing. Future research may benefit from the inclusion of clinical nutritional data, a broader representation of high-energy injuries, and a prospective study design to evaluate cost-efficient avenues for food insecurity interventions in the context of locally available social services networks., Level of Evidence: Level III, prognostic study., Competing Interests: Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request., (Copyright © 2022 by the Association of Bone and Joint Surgeons.)

Food and nutrition insecurity occurs when healthy and safe food cannot be obtained by socially acceptable means and arises as a result of complex interactions between socioeconomic and demographic determinants. These factors contribute to discrepancies in health and well-being between men and women and may also explain differential rates of food insecurity. The objectives of this cross-sectional study were to investigate the intersection between gender, education, nutrition knowledge and food security status within a high-income country context. Australian adults over 16 years of age who identified as having primary responsibility for food in their household were recruited via social media and a panel. Respondents completed a self-administered survey that included sociodemographic data, nutrition-related knowledge and food security status. Food security was measured using the Australian Household Food and Nutrition Security Scale an adapted version of the United States Department of Agriculture Household Food Security Survey. Among the 1010 survey respondents, household food insecurity (HFI) was highly prevalent (43% were food insecure, with 26% of these severely food insecure). Gender may affect associations between education, nutrition knowledge and HFI. Education was significantly associated with HFI among women but not among men. Conversely, nutrition knowledge was significantly inversely associated with food security among men but not among women. Differences in determinants of HFI exist between men and women, and programs aimed at addressing food insecurity may be more effective if tailored accordingly to account for the social and demographic factors associated with HFI., (© 2022 John Wiley & Sons Ltd.)

Objective: Despite the growing food insecurity crisis in the United States, limited evidence exists about the effects of food insecurity on the unmet health care needs of peripartum (pregnant and postpartum) women. The aim of this study was to examine the association between food insecurity and delayed or forgone health care among peripartum women in the United States from 2019 to 2021., Methods: We conducted a pooled cross-sectional analysis using data from the 2019, 2020, and 2021 National Health Interview Surveys. Food security status was defined by type (high/marginal, low, and very low). Descriptive analysis and multivariable logistic regression, adjusted for sociodemographic and health-related characteristics, were conducted to estimate the overall and specific delayed or forgone health care (yes or no) between the different categories of food security., Results: Of the 1525 peripartum women (weighted, N = 5,580,186), 11% of peripartum women in the United States experienced suboptimal food security in the 12 mo between 2019 and 2021, with 5% experiencing low and 5% experiencing very low food security. This included 6% (95% confidence interval [CI], 5-8%) who reported delaying filling a medical prescription, 6% (95% CI, 5-8%) who required counseling or therapy from a mental health professional but did not receive it, 6% (5-8%) who delayed counseling or therapy from a mental health professional, 8% (95% CI, 6-10%) who needed medical care but did not receive it, and 9% (95% CI, 7-10%) who delayed medical care. Peripartum women with low and very food security were more likely to delay or forego health care due to cost concerns than food-secure peripartum women. In the multivariable analyses adjusted for predisposing, enabling, and need-based factors, women with low and very low food security had higher risk for delayed or forgone health care than those with marginal or high food security., Conclusion: This study demonstrated a positive association between food insecurity and cost-related unmet health care needs among peripartum women. Future empirical studies are needed to assess the effects of peripartum health care interventions targeting food insecurity on reducing health care access disparities associated with costs and improving peripartum health outcomes., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Routines and rituals are ubiquitous across scholarship in family communication yet are overlapping and idiosyncratic concepts, making a clear distinction between them difficult. This paper builds clarification around the concepts by arguing for attending to what we call the routinized and ritualized aspects of family activities. We demonstrate this approach's utility through a qualitative thematic discourse analysis of 697 Twitter posts discussing the COVID-19 pandemic's impact on family food practices in the United States. We identify three themes that convey the broad impacts of lockdown conditions on family food practices: bolstering, disruption, and reimagining. We then analyze each theme's salience within daily meals and holiday meals – two food provisioning sites frequently considered routines and rituals, respectively. Theoretically, this paper forwards a conceptualization of routines and rituals that delineates the symbolic and instrumental elements embedded within each; empirically, it demonstrates the multifaced effects of the pandemic on family food life. [ABSTRACT FROM AUTHOR]

This paper uses distinctions between differing senses of "private," "public" and "political" in the United States to argue for the value of framing food issues as a collective problem that calls for broadscale demands for justice. We argue that food choices do not simply belong to the realm of private preferences and market transactions. Rather, they are a set of decisions that have systemic causes and public consequences. They are shaped and constrained by public policies that underwrite the transportation of food over long distances as well as particular crops and foodstuffs, and by the vendors and advertisers who try to convince us to eat more of the foods they produce. Because the consequences of eating an abundance of empty calories are not easily remedied at the personal level, citizens need to demand public, systemic solutions, including better food information, youth food education, and a healthier food supply. [ABSTRACT FROM AUTHOR]

Aim: US federal, state, and local governments implemented numerous COVID-19 shelter-in-place orders (lockdowns) starting in March 2020 to ensure social distancing regulations and help stop the spread of COVID-19. It is important to know how these lockdowns affected businesses, such as restaurants, in regions that vary in terms of poverty status and geography. In this paper, we analyze the differential changes in rural and urban restaurant visits by the restaurants' NAICS codes following the COVID-19 lockdowns. Our analysis contributes to the public policy literature and helps operational planning for food distribution during a pandemic. Methods: Since urban and rural consumer behavior and food resources are significantly different, it is crucial to conduct a comparative analysis. Our study applies a difference-in-differences model to capture the differential effects lockdowns have on urban and rural restaurants. Results: We find that restaurant visits declined significantly in both rural and urban counties after shelter-at-home orders. The decrease in total restaurant visits was almost twice as high in urban counties as in rural counties. We also find that visits to fast-food restaurants increased in rural counties during shelter-at-home orders. Conclusions: These results contribute to previous studies on the dearth of healthy food in rural and poorer regions, and inform important public policy response in the wake of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

In the United States, low-income, underserved rural and urban settings experience poor access to healthy, affordable food. Introducing new food outlets in these locations has shown mixed results for improving healthy food consumption. The Healthy Community Stores Case Study Project (HCSCSP) explored an alternative strategy: supporting mission-driven, locally owned, healthy community food stores to improve healthy food access. The HCSCSP used a multiple case study approach, and conducted a cross-case analysis of seven urban healthy food stores across the United States. The main purpose of this commentary paper is to summarize the main practice strategies for stores as well as future directions for researchers and policy-makers based on results from the prior cross-case analyses. We organize these strategies using key concepts from the Retail Food Environment and Customer Interaction Model. Several key strategies for store success are presented including the use of non-traditional business models, focus on specific retail actors such as store champions and multiple vendor relationships, and a stores' role in the broader community context, as well as the striking challenges faced across store locations. Further exploration of these store strategies and how they are implemented is needed, and may inform policies that can support these types of healthy retail sites and sustain their efforts in improving healthy food access in their communities.

Parental feeding practices and styles influence child diet quality and growth. The extent to which these factors have been assessed in the context of disadvantage, particularly household food insecurity (HFI), is unknown. This is important, as interventions designed to increase responsive practices and styles may not consider the unique needs of families with HFI. To address this gap, a scoping review of studies published from 1990 to July 2021 in three electronic databases was conducted. A priori inclusion criteria were, population: families with children aged 0-5 years experiencing food insecurity and/or disadvantage; concept: parental feeding practices/behaviours/style; and context: high income countries. The search identified 12,950 unique papers, 504 full-text articles were screened and 131 met the inclusion criteria. Almost all the studies (91%) were conducted in the United States with recruitment via existing programs for families on low incomes. Only 27 papers assessed feeding practices or styles in the context of HFI. Of the eleven interventions identified, two assessed the proportion of participants who were food insecure. More research is required in families outside of the United States, with an emphasis on comprehensive and valid measures of HFI and feeding practices. Intervention design should be sensitive to factors associated with poverty, including food insecurity.

Objective: Students are at risk of food insecurity. We aimed to determine: the prevalence of food insecurity among students; the variables associated with student food insecurity; and appropriate solutions. Participants: We collected data from 339 students at a large state university in the western United States between December 2016 and February 2017. Methods: We used an anonymous online survey that incorporated the USDA US Six-Item Short Food Security Survey. Results: First, 54% of respondents had been food insecure within the last year. Second, students in receipt of financial aid were significantly more likely to be food insecure. Third, respondents proposed solutions to student food insecurity that included on-campus food assistance programs, education initiatives, and off-campus food assistance programs. Conclusions: Our paper contributes to a growing body of knowledge about the extent and causes of, and solutions to, food insecurity among college students.

The protection of critical infrastructure (water, energy, food supply, healthcare etc.) from cyberattack has moved from a hypothetical concern to a very real one for the United States. Unfortunately, the cybersecurity for such infrastructure is provided by a multiplicity of organisations, inside and outside the US federal government. In this paper, the authors address how the US Department of Homeland Security and US Department of Defense have evolved to address the cyber critical infrastructure protection (CIP) mission and the issues that have emerged in doing so. Presented here is a description of critical infrastructure's vulnerability to cyberattack, an assessment of relevant cybersecurity efforts by the US government, and consideration of the civilian–military issues involved in finding remedies to the problem of cybersecurity in critical infrastructure. [ABSTRACT FROM AUTHOR]

In the United States, food banks play an important role in helping to reduce the rate of food insecurity by distributing donated food among the population in need. One of the challenges that food banks face is to equitably distribute food donations among their clients such that, ideally, each recipient receives the same amount of food. They aim to do so while minimizing waste that occurs due to spoilage and capacity limitations. Perishable food items present specific challenges since they are susceptible to spoilage and need to be distributed before their expiry dates. Based on our longstanding partnership with a large food bank located in the southeastern United States, we present a capacitated, multiperiod, multiproduct network flow model to help them equitably and effectively distribute perishable food donations among the food‐insecure population in their service region. The model is applied within the context of a case study and reveals managerial insights that would be useful to practitioners. Our findings show that although equity is one of the food bank's highest priorities, inequities cannot be eliminated completely. Given the inevitability of inequitable food allocations in practice, this paper provides food banks guidance on how to strategically control inequities using two approaches: (i) by increasing the number of periods for which equity should be satisfied or (ii$ii$) by allowing deviations from a perfectly equitable distribution. The results show that modest deviations from perfect equity using either approach can lead to significant improvements in both the quality and quantity of food distributed and can also reduce food waste. While approach (ii$ii$) is preferable, the most desirable outcomes occur when both are applied simultaneously. We also find that county capacities inhibit a food bank's ability to achieve balance between equity and effectiveness when distributing perishables. Our framework provides food banks the flexibility to balance the trade‐off between effectiveness and equity based on their preferences. [ABSTRACT FROM AUTHOR]

Most dynamic CGE models work with periods of 1 year. This limits their applicability for analysing the effects of shocks that operate over a short period or with different intensities through a year. It is relatively easy to convert an annual CGE model to shorter periodicity, for example a quarter, if we ignore seasonal differences in the pattern of economic activity, but this is not acceptable for agriculture. This paper introduces seasonal factors to the agricultural specification in a detailed quarterly CGE model of the United States. The model is then applied to analyse the effects of the COVID pandemic on U.S. farm industries. Taking account of the general features of the pandemic such as the reduction in household spending, we find that these effects are mild relative to the effects on most other industries. However, agriculture is subject to potential supply‐chain disruptions. We apply our quarterly model to analyse two such possibilities: loss of labour at harvest time in Fruit & nut farms, and temporary closure of meat‐processing plants. We find that these disruptions are unlikely to cause noticeable reductions in the supply of food products to U.S. households. [ABSTRACT FROM AUTHOR]

Background: Snacking is nearly universal and contributes significant energy to U.S. children's diets. Little is known, however, about where and when snacking intake occurs and if such patterns change with age. This research evaluated age-related differences in eating location, food source location, and timing of snacking among U.S. children aged 1–19 years (y). Methods: A cross-sectional analysis of snacking among 14,666 children in the 2007–2018 U.S. National Health and Nutrition Examination Survey was conducted using a single 24-hour dietary recall. Snacking was participant-defined and included all eating occasions outside of meals. Linear regression and analysis of covariance were used to examine the effects of age (toddler 1–2 y, preschooler 3–5 y, school-age 6–11 y, adolescent 12–19 y) on the percentage of daily snack energy consumed by eating location (at home vs. away from home), food source location (grocery store, convenience store, school/childcare, restaurant, from someone else (i.e. "socially"), and other), and time of day (morning, 6am-12pm; early afternoon, 12pm-3pm; late afternoon/afterschool 3pm-6pm; evening 6pm-9pm, late-night 9pm-12am, and overnight 12am-6am). Results: On average, U.S. children consumed most of their daily snacking energy at home (71%), from foods and beverages obtained from grocery stores (75%), and in the late afternoon/afterschool (31%). Toddlers and preschoolers consumed a greater percentage of their daily snack energy during the morning hours compared to school-age children and adolescents (both p < 0.001); school-age children consumed the most in the evening (27%, p < 0.001), and adolescents consumed the most in the late-night period (22%, p < 0.001). Age-related increases were seen in the percentage of daily snacking energy eaten outside the home (p < 0.001), and obtained socially (p < 0.001), from restaurants (p < 0.001), and convenience stores (p < 0.001). Conclusion: Findings reveal age-related differences in eating location, food source location, and timing of snack intake among U.S. children aged 1–19 y. Younger children consume a greater percentage of snacking calories in the morning and at home relative to older children. School-age children and adolescents show greater snacking in the evening and at night and from foods obtained and eaten outside the home. Efforts to promote healthy snacking behaviors among children should consider developmental differences in snacking patterns. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID‐19) pandemic increased food insecurity among US households, however, little is known about how infants, who rely primarily on human milk and/or infant formula, were impacted. We conducted an online survey with US caregivers of infants under 2 years of age (N = 319) to assess how the COVID‐19 pandemic impacted breastfeeding, formula‐feeding and household ability to obtain infant‐feeding supplies and lactation support (68% mothers; 66% White; 8% living in poverty). We found that 31% of families who used infant formula indicated that they experienced various challenges in obtaining infant formula, citing the following top three reasons: the formula was sold out (20%), they had to travel to multiple stores (21%) or formula was too expensive (8%). In response, 33% of families who used formula reported resorting to deleterious formula‐feeding practices such as diluting formula with extra water (11%) or cereal (10%), preparing smaller bottles (8%) or saving leftover mixed bottles for later (11%). Of the families who fed infants human milk, 53% reported feeding changes directly as a result of the pandemic, for example, 46% increased their provisioning of human milk due to perceived benefits for the infant's immune system (37%), ability to work remotely/stay home (31%), concerns about money (9%) or formula shortages (8%). Fifteen percent of families who fed human milk reported that they did not receive the lactation support they needed and 4.8% stopped breastfeeding. To protect infant food and nutrition security, our results underscore the need for policies to support breastfeeding and ensure equitable and reliable access to infant formula. Key messages: One in three families who fed infants formula reported using one or more deleterious formula‐feeding practices during the coronavirus disease 2019 pandemic, likely due to formula shortages and financial strain.Of the families who fed infants human milk, 15% reported difficulties accessing lactation support directly as a result of the pandemic, although 46% of families reported increased provision of human milk.Flexible government programmes and policies are needed to ensure equitable access to lactation support and infant formula during crises. [ABSTRACT FROM AUTHOR]

Local and regional food supply chains are gaining increasing support from public and private sectors for their contributions to economic development and promoting sustainability. However, the impacts of regionalization are not well understood. We employ a spatial-temporal model of production and transportation to evaluate the supply chain outcomes of a decade-long process of food regionalization for fresh broccoli in the eastern United States (US). Our results indicate that eastern broccoli supply chains displaced products sourced from the western US and met over 15% of the annual demand in eastern markets in 2017. We find that total broccoli supply chain costs and food miles increased in the period 2007–2017. Nevertheless, eastern-grown broccoli has contributed to reducing regional food miles in the eastern region (from 365 miles in 2007 to 255 miles in 2017) and experienced only modest increases in supply chains costs (a 3.4% increase, compared to a 16.5% increase for broccoli shipped from western US) during the same period. Our results provide valuable information for policymakers and the fresh produce industry interested in promoting regional food supply chains. [ABSTRACT FROM AUTHOR]

Objectives: To examine the association between chronic obstructive pulmonary disease status and indicators of economic instability and stress to better understand the magnitude of these issues in persons with chronic obstructive pulmonary disease. Methods: Analyzed 2017 Behavioral Risk Factor Surveillance System data from 16 states that administered the 'Social Determinants of Health' module, which included economic instability and stress measures (N = 101,461). Associations between self-reported doctor-diagnosed chronic obstructive pulmonary disease status and each measure were examined using multinomial logistic models. Results: Adults with chronic obstructive pulmonary disease were more likely (p < 0.001) than adults without to report not having enough money at month end (21.0% vs. 7.9%) or just enough money (44.9% vs. 37.2%); being unable to pay mortgage, rent, or utility bills (19.2% vs. 8.8%); and that often or sometimes food did not last or could not afford to eat balanced meals (37.9% vs. 20.6%), as well as stress all or most of the time (27.3% vs. 11.6%). Associations were attenuated although remained significant after adjustments for sociodemographic and health characteristics. Discussion: Financial, housing, and food insecurity and frequent stress were more prevalent in adults with chronic obstructive pulmonary disease than without. Findings highlight the importance of including strategies to address challenges related to economic instability and stress in chronic obstructive pulmonary disease management programs. [ABSTRACT FROM AUTHOR]

Background: In recent reviews of available measures, no existing measures assessed all four pillars of food security and most only assessed one or two pillars–predominantly the access pillar. The purpose of this study was to preliminarily develop novel measures of availability, utilization, and stability that are complementary to the USDA's household food security survey measure (HFSSM). Methods: A formative phase included an expert advisory group, literature scans, and interviews with individuals experiencing food insecurity. From April-June 2021, the new measures were piloted in five states (California, Florida, Maryland, North Carolina, and Washington). The cross-sectional pilot survey included the new measures (perceived limited availability, utilization barriers, and food insecurity stability), scales and items for validation (e.g., food security, and self-reported dietary and health outcomes), and demographic questions. Exploratory factor analysis was used to assess dimensionality, internal consistency was assessed using Kuder-Richardson formula 21 (KR21), and convergent and discriminant validity were assessed using Spearman's correlation coefficients. Also, a brief screener version was created for the utilization barriers measure that may be necessary for certain applications (e.g., clinical intake screening to inform referrals to assistance programs). Results: The analytic samples (perceived limited availability (n = 334); utilization barriers (n = 428); food insecurity stability (n = 445)) were around 45 years old on average, most households had children, over two-thirds were food insecure, over three-fourths were women, and the samples were racially/ethnically diverse. All items loaded highly and unambiguously to a factor (factor loadings range 0.525–0.903). Food insecurity stability showed a four-factor structure, utilization barriers showed a two-factor structure, and perceived limited availability showed a two-factor structure. KR21 metrics ranged from 0.72 to 0.84. Higher scores for the new measures were generally associated with increased food insecurity (rhos = 0.248–0.497), except for one of the food insecurity stability scores. Also, several of the measures were associated with statistically significantly worse health and dietary outcomes. Conclusions: The findings support the reliability and construct validity of these new measures within a largely low-income and food insecure sample of households in the United States. Following further testing, such as Confirmatory Factor Analysis in future samples, these measures may be used in various applications to promote a more comprehensive understanding of the food insecurity experience. Such work can help inform novel intervention approaches to address food insecurity more fully. [ABSTRACT FROM AUTHOR]

Background: Research is needed that identifies environmental resource disparities and applies multiple rural definitions. Therefore, this study aims to examine urban‐rural differences in food and physical activity (PA) environment resource availability by applying several commonly used rural definitions. We also examine differences in resource availability within urban‐rural categories that are typically aggregated. Methods: Six food environment variables (access to grocery/superstores, farmers' markets, fast food, full‐service restaurants, convenience stores, and breastfeeding‐friendly facilities) and 4 PA environment variables (access to exercise opportunities and schools, walkability, and violent crimes) were included in the childhood obesogenic environment index (COEI). Total COEI, PA environment, and food environment index scores were generated by calculating the average percentile for related variables. US Department of Agriculture Urban Influence Codes, Office of Management and Budget codes, Rural‐Urban Continuum Codes, Census Bureau Population Estimates for percent rural, and Rural Urban Commuting Area Codes were used. One‐way ANOVA was used to detect urban‐rural differences. Results: The greatest urban‐rural disparities in COEI (F=310.2, P<.0001) and PA environment (F=562.5, P<.0001) were seen using RUCC codes. For food environments, the greatest urban‐rural disparities were seen using Census Bureau percent rural categories (food: F=24.9, P<.0001). Comparing remote rural categories, differences were seen for food environments (F=3.1, P=.0270) and PA environments (F=10.2, P<.0001). Comparing metro‐adjacent rural categories, differences were seen for PA environment (F=4.7, P=.0090). Conclusion: Findings inform future research on urban and rural environments by outlining major differences between urban‐rural classifications in identifying disparities in access to health‐promoting resources. [ABSTRACT FROM AUTHOR]

Black and low-income neighborhoods tend to have higher concentrations of fast-food restaurants and low produce supply stores. Limited access to and consumption of nutrient-rich foods is associated with poor health outcomes. Given the realities of food access, many members within the Black communities grow food as a strategy of resistance to food apartheid, and for the healing and self-determination that agriculture offers. In this paper, we unpack the history of Black people, agriculture, and land in the United States. In addition to our brief historical review, we conduct a descriptive epidemiologic study of community food-growing spaces, food access, and neighborhood racial composition in present day Philadelphia. We leverage one of the few existing datasets that systematically documents community food-growing locations throughout a major US city. By applying spatial regression techniques, we use conditional autoregressive models to determine if there are spatial associations between Black neighborhoods, poverty, food access, and urban agriculture in Philadelphia. Fully adjusted spatial models showed significant associations between Black neighborhoods and urban agriculture (RR: 1.28, 95% CI = 1.03, 1.59) and poverty and urban agriculture (RR: 1.27, 95% CI = 1.1, 1.46). The association between low food access and the presence of urban agriculture was generally increased across neighborhoods with a higher proportion of Black residents. These results show that Philadelphia neighborhoods with higher populations of Black people and neighborhoods with lower incomes, on average, tend to have more community gardens and urban farms. While the garden data is non-temporal and non-causal, one possible explanation for these findings, in alignment with what Philadelphia growers have claimed, is that urban agriculture may be a manifestation of collective agency and community resistance in Black and low-income communities, particularly in neighborhoods with low food access. • Black neighborhoods, on average, have more community gardens and urban farms. • High poverty neighborhoods have more community gardens and urban farms. • Philadelphia City Council should support and implement the Urban Agriculture Plan. [ABSTRACT FROM AUTHOR]

Objective: The 2018-2019 federal government partial shutdown resulted in a one-time disruption to the usual disbursement schedule of Supplemental Nutrition Assistance Program (SNAP) benefits nationwide. We assessed the relationship between this disruption and hyperglycemia and hypoglycemia medical encounters among beneficiaries with diabetes.Research Design and Methods: To estimate whether the one-time change in benefit disbursement affected the monthly cycle of hyperglycemia or hypoglycemia encounter rates, we used linked administrative Medicaid claims and SNAP disbursement data from West Virginia in a fixed-effects model with interactions between week of the month and the two months of interest-January and February 2019. We controlled for week, month, year, and county effects as well as individual characteristics, and we clustered SEs by individual.Results: We found that the early disbursement of SNAP benefits in January 2019 resulted in a spike in hyperglycemia four times the rate in a typical month. Further, we found a decrease in both hyperglycemia and hypoglycemia in late February.Conclusions: Our findings suggest that the early distribution of benefits led to a temporary increase in food consumption among West Virginia Medicaid beneficiaries with diabetes. Findings from late February also imply that individuals may have a way to prepare for reduced food resources. These results shed new light on the effects of unexpected changes to the timing of safety net payments as well as an understanding of unintended consequences of government shutdowns. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has caused disproportionate suffering among vulnerable and socioeconomically disadvantaged portions of the population. Low-income and minority populations are likely to experience disparate disease and mental health burdens. Currently, there is little evidence regarding how the experience of the early months of the US COVID-19 outbreak differed by income level, and how that related to mental health symptoms. The present study used data from a national sample of US adults (n = 5023) who completed measures related to the COVID experience, the COVID-19 Fear Scale, the Generalized Anxiety Disorder-7 (GAD-7), and the Patient Health Questionnaire-8 (PHQ-8). Multivariable regression was performed to determine whether income level (low: <$45,000 vs high: ≥$75,000) was significantly associated with COVID experience measures, PHQ-8, GAD-7, and COVID fear scores. Among the low-income group, COVID-19 had a significantly greater negative impact on: family income/employment, access to food, access to mental health treatment, and stress and discord in the family. Participants in the low-income group also had greater odds of a PHQ-8 score ≥10 (odds ratio [OR] = 1.38, 95% confidence interval [CI] 1.08, 1.77) and a GAD-7 score ≥10 (OR = 1.65, 95% CI 1.27, 2.14) compared to those in the high-income group. Study findings suggest substantial differences in how COVID-19 impacted daily life and mental health between adults living in low-income households compared to high-earning households during the early months of the pandemic. [ABSTRACT FROM AUTHOR]

Purpose: The postponement boundary problem entails that duties and cross-border trade complexity can lead companies to geographically postpone operations to downstream global facilities. The present study aims at investigating the problem to provide insights into the drivers behind the choice of different postponement strategies for global food supply chains. Design/methodology/approach: A single case study was conducted considering an Italian company exporting olive oil toward the United States. Two global postponement strategies, previously formalized in the literature, were tailored for food supply chains. A multi-methodological approach was adopted, combining data obtained through exploratory case research with empirically grounded analytical modeling. A sensitivity analysis was also performed, to investigate outcomes related to the considered problem when changing key parameters. Findings: Bulky and heavy packing materials account for a big percentage of finished products' volume and weight, and this can deeply affect strategies' cost-effectiveness. Postponing packaging operations could allow for taking advantage of lower tariffs levied on bulk goods, contributing to significantly lower duties to be paid. However, important trade-offs could arise related to the required investments, and the fiscal regulatory frameworks must be carefully examined. Originality/value: This study offers an empirical investigation of the postponement boundary problem, which is largely unexplored in the current literature. It also tackles an understudied empirical context as global food supply chains. It summarizes the drivers behind and explores the costs related to the implementation of different strategies, offering an original quantitative approach that could support practitioners' decision-making. Lastly, it formalizes five propositions that could pave the way for further research inquiries. [ABSTRACT FROM AUTHOR]

Background: Our objectives were to describe both the development, and content, of a charitable food dataset that includes geographic information for food pantries in 12 American states.Methods: Food pantries were identified from the foodpantries.org website for 12 states, which were linked to state-, county-, and census-level demographic information. The publicly available 2015 Food Access Research Atlas and the 2010 US Census of Population and Housing were used to obtain demographic information of each study state. We conducted a descriptive analysis and chi-square tests were used to test for differences in patterns of food pantries according to various factors.Results: We identified 3777 food pantries in 12 US states, providing an estimated 4.84 food pantries per 100,000 people, but ranged from 2.60 to 7.76 within individual states. The majority of counties (61.2%) had at least one food pantry. In contrast, only 15.7% of all census tracts in the study states had at least one food pantry. A higher proportion of urban census tracts had food pantries compared to rural tracts. We identified 2388 (63.2%) as being faith-based food pantries. More than a third (34.4%) of food pantries did not have information on their days of operation available. Among the food pantries displaying days of operation, 78.1% were open at least once per week. Only 13.6% of food pantries were open ≤1 day per month.Conclusions: The dataset developed in this study may be linked to food access and food environment data to further examine associations between food pantries and other aspects of the consumer food system (e.g. food deserts) and population health from a systems perspective. Additional linkage with the U.S. Religion Census Data may be useful to examine associations between church communities and the spatial distribution of food pantries. [ABSTRACT FROM AUTHOR]

Purpose: Rural residents are more likely to be obese than urban residents. Research on how people navigate their local food environments through food acquisition behaviors, such as food shopping and restaurant use, in different types of communities may help to create a deeper understanding of the multilevel determinants of obesity. Methods: Data are from a national sample of US adults ages 18‐75. Respondents were recruited from an online survey panel in 2015 and asked about food shopping, restaurant use, diet and weight (N = 3,883). Comparisons were made by level of rurality as assessed by Rural‐Urban Continuum Codes (RUCC) and self‐reported rurality of the area around their home. Findings: Food acquisition behaviors varied minimally by RUCC‐defined level of rurality, with the exceptions of type and distance to primary food store. Rural residents drove further and were more likely to shop at small grocery stores and supercenters than were residents of semiurban or urban counties. In contrast, all of the food acquisition behaviors varied by self‐reported rurality of residential areas. Respondents living in rural areas shopped for groceries less frequently, drove further, more commonly shopped at small grocery stores and supercenters, and used restaurants less frequently. In multivariable analyses, rural, small town, and suburban areas were each significantly associated with BMI and fruit and vegetable intake, but not percent energy from fat. Conclusion: Findings show that self‐reported rurality of residential area is associated with food acquisition behaviors and may partly explain rural‐urban differences in obesity and diet quality. [ABSTRACT FROM AUTHOR]

Objective: Ensuring access to sufficient foods at all times is critical to veterans' health and well-being. Food insecurity has not been well explored in the veteran population. We examined the prevalence and predictors of food insecurity among low-income veterans, because the highest rates of food insecurity are among low-income households. We also examined rates of Supplemental Nutrition Assistance Program (SNAP) participation among subgroups at the highest risk of food insecurity. Methods: We used univariate analyses and 2011-2017 National Health Interview Survey (NHIS) data on veterans aged ≥21 with family incomes <200% of the federal poverty level to estimate the prevalence of food insecurity. We used bivariate analyses to identify correlates of food insecurity and estimate SNAP participation rates among subgroups of low-income veterans. Percentages were weighted using NHIS survey weights. Results: Of 5146 low-income veterans, 22.5% reported being food insecure in the previous month. Food insecurity was significantly associated with being aged <65 (33.0% aged 45-64 and 29.7% aged 21-44) compared with 15.0% and 6.4% among veterans aged 65-74 and ≥75, respectively (P <.001); unemployed compared with employed or not in the labor force (39.4%, 22.7%, and 20.2%, respectively; P <.001); in fair or poor health compared with good, very good, or excellent heath (31.8% vs 18.2%; P <.001); and having experienced serious psychological distress in the past month (56.3%) compared with not having experienced such distress (19.7%; P <.001). Although overall SNAP participation among low-income veterans was estimated to be 27.0%, participation rates were highest among veterans who had experienced serious psychological distress (44.1%), were unemployed (39.2%), and were renting their home (39.0%). Conclusions: Some low-income veterans are at greater risk of food insecurity than other veterans. Postseparation programs, civilian support services, and veterans' health providers should be aware of the characteristics that place veterans at highest risk of food insecurity. [ABSTRACT FROM AUTHOR]

Background Food bank users suffer high food insecurity. Food insecurity increases risk for chronic health conditions. However, chronic pain and its relation to food insecurity among food bank users is unknown. Knowledge about populations with chronic pain is important to direct appropriate public health nutritional strategies. Methods Participants completed a survey including sleep, pain, depressive symptoms and food insecurity measures. Descriptive statistics characterized the burden of chronic pain among the sample, and a series of chi-square and t-tests assessed for demographic differences between food bank users who reported pain compared to those who did not. Logistic regression tested for variables predicting food insecurity. Results Within the sample (N  = 207), 53% reported a chronic pain diagnosis. Adults with pain were more likely to receive food stamps and to have a mental health condition than those without pain. Regression analyses revealed that depressive symptoms and chronic pain significantly predicted food insecurity when controlling for age and gender. Conclusions Exploring the link between depression, pain and nutritional resources may enhance understanding of causal relationships driving food insecurity. Public health officials should address nutritional needs of adults including those with chronic pain who use food bank services. [ABSTRACT FROM AUTHOR]

In the United States, resettled refugees arrive in designated resettlement cities where they can in theory start a new life with support systems in place. Although refugee resettlement agencies are the main point of contact upon arrival, agencies are mandated to work with refugees for 90 days. Traditionally, local governments have not had purposeful contact with resettled refugee populations, yet the policies they enact and built environments they shape impact the lives and health of resettled refugees in myriad ways. As resettled refugees adjust to new ways of life, local governments can support plans and policies that reinforce healthy lifestyles. Multiple studies show that, among resettled refugee populations, acculturation of diet leads to increased risk of chronic disease. Furthermore, resettled refugee populations may be especially susceptible to experiencing cultural and economic inequities that ultimately contribute to food disparities, possibly leading to detrimental health outcomes. We explore the extent to which local governments in major U.S. resettlement cities consider the needs of resettled refugee populations in planning, particularly in regard to how planning influences food security, nutrition, and food-related and health concerns. Using a mixed-methods approach, we first conduct a review of the comprehensive plans of 10 cities that resettled the most refugees between 2012 and 2016 to determine if and how local governments are planning for resettled refugee populations. With an in-depth case study of the city of Buffalo, we explore the nuances of the findings from the review of comprehensive plans. For this deep-dive case study, interviews and a focus group were conducted with refugees from Burma to gain an understanding of how local governments and civil society groups plan for new American populations, particularly in terms of their food and health. Results carry implications as to how local governments can better serve resettled refugee populations through comprehensive planning. [ABSTRACT FROM AUTHOR]