We conducted interviews with parents earning low wages to understand their experiences related to financial responsibilities and use of government and informal resources in Raleigh, North Carolina....

<p>The charitable food system is rapidly evolving. Interventions that target the food pantry environment and use behavioral economics are in high demand, but can be difficult to implement in a low-resource setting. This is an analysis of secondary, environment-level outcomes in a food pantry intervention (SuperShelf); the study evaluates whether the intervention resulted in measurable changes to the food pantry environment and improved diet quality of the food available to clients, compared with a control group of food pantries. Eleven food pantries were randomized to an intervention (n = 5) or control (n = 6) condition and completed baseline and one-year follow-up measures between 2018 and 2020. The intervention addressed healthy food supply and the appeal of healthy foods using behavioral economics. Assessments included manager surveys, intervention fidelity, food inventory, and food supply tracked over 5 days. Measures included change in intervention fidelity (range 0–100) with four subcomponents; Healthy Eating Index scores (HEI-2015, range 0–100) with 13 subcomponents; and Food Assortment Scoring Tool scores (FAST, range 0–100). Descriptive analyses and t-tests examined pre–post changes within and between intervention arms. Average fidelity scores increased from baseline to follow-up in the intervention group compared with the control group (p &amp;lt; .001), as did FAST scores (p = .02). Average HEI-2015 Total scores increased in the intervention group by 6.3 points and by 1.6 points in the control group, but the difference in change between groups was not statistically significant (p = .56). The intervention was implemented with high fidelity at five sites, with some evidence of change in the nutritional quality of the food available on the shelf to clients.</p>

<p>Natural experiments are often used for answering research questions in which randomization is implausible. Effective recruitment strategies are well documented for observational cohort studies and clinical trials, unlike recruitment methods for time-sensitive natural experiments. In this time-sensitive study of the impact of a minimum wage policy, we aimed to recruit 900 low-wage workers in Minneapolis, Minnesota, and Raleigh, North Carolina. We present our recruitment strategies, challenges, and successes for participant screening and enrollment of a difficult-to-reach population.</p>

Objective: In 2018, Minneapolis began phased implementation of an ordinance to increase the local minimum wage to $15/hour. We sought to determine whether the first phase of implementation was associated with changes in frequency of consumption of fruits and vegetables, whole grain-rich foods, and foods high in added sugars among low-wage workers. Design: Natural experiment. Setting: The Wages Study is a prospective cohort study of 974 low-wage workers followed throughout the phased implementation of the ordinance (2018-2022). We used difference-in-difference analysis to compare outcomes among workers in Minneapolis, Minnesota, to those in a comparison city (Raleigh, North Carolina). We assessed wages using participants’ pay stubs and dietary intake using the National Cancer Institute Dietary Screener Questionnaire. Participants: Analyses use the first two waves of Wages data (2018 [baseline], 2019) and includes 267 and 336 low-wage workers in Minneapolis and Raleigh (respectively). Results: After the first phase of implementation, wages increased in both cities, but the increase was $0.82 greater in Minneapolis (p=0.02). However, the first phase of the policy’s implementation was not associated with changes in daily frequency of consumption of fruits and vegetables (IRR=1.03, 95% CI: 0.86-1.24, p=0.73), whole grain-rich foods (IRR=1.23, 95% CI: 0.89-1.70, p=0.20), or foods high in added sugars (IRR=1.13, 95% CI: 0.86-1.47, p=0.38) among workers in Minneapolis compared to Raleigh. Conclusions: The first phase of implementation of the Minneapolis minimum wage policy was associated with increased wages, but not with changes in dietary intake. Future research should examine whether full implementation is associated dietary changes.

INTRODUCTION: Food pantries serve households in need, including many with a family member with a diet-related chronic disease, yet data on client priorities to inform hunger relief practices are lacking. We used a statewide client survey in Minnesota to determine needs and priorities of food pantry clients in 2017 and 2019 and to identify how well Minnesota pantries met those needs in 2019. METHODS: Our survey was administered in 2017 and 2019. Food pantries in Minnesota were mailed 25 surveys each, with instructions for administering the surveys anonymously to clients. Descriptive analyses compared 2017 and 2019 data and compared client priorities for foods and services with how often they were available at the pantry in 2019. RESULTS: The 2017 survey represented 4,321 clients from 188 pantries; the 2019 survey represented 5,529 clients from 220 pantries. Most measures of food pantry use were consistently high across the years; about three-quarters of clients had been visiting the pantry for a year or more. In 2019, 85% of clients said it was important to have fresh fruits and vegetables, but only 52% said these were always available. About two-thirds had a household member with a diet-related chronic disease. The ability to choose their own foods was clients' top priority. CONCLUSION: The types of food most requested by clients tended to be healthy but were inconsistently available. Most important to clients was being able to choose their own food. Results underscore the need for continued monitoring of client priorities.

Work-related policies, including minimum wage and food assistance work requirements, can affect food security for people with lower incomes. This study conducted 112 qualitative interviews to under...

Background: Food pantry clients are at a high risk for diet-related chronic disease and suboptimal diet. Relatively little research has examined diet quality measures in choice-based food pantries where clients can choose their own food. Objective: This study tested whether the diet quality scores for food at the pantry were associated with client food selection scores, and whether client food selection scores at the pantry were associated with client diet intake scores. Design: This cross-sectional regression analysis, part of a larger evaluation study (SuperShelf), used baseline data from client and food pantry surveys, food pantry inventories, assessments of client food selections (“client carts”), and single 24-hour client dietary recalls. Participants/setting: The analysis includes 316 clients who completed a survey (282 of whom completed a dietary recall measure) from one of 16 choice-based Minnesota food pantries during 2018-2019. Adult English, Spanish, or Somali-speaking clients were eligible in the case that they had selected food on the day of recruitment at their food pantry visit. Main outcome measures: A Healthy Eating Index-2015 (HEI-2015) Total score and 13 subcomponent scores were calculated for: pantry food inventories of food available on the shelf, client carts, and a 24-hour client dietary recall. Statistical analysis: Descriptive statistics were generated for client and food pantry characteristics, and for HEI-2015 Total score and subcomponent scores. Linear regression models tested the association between HEI-2015 Total score and subcomponent scores for food pantry inventory and client carts, and for client carts and dietary recalls, adjusted for covariates. Results: Food pantry inventory HEI-2015 Total score averaged 65.1, client cart Total score averaged 60.8, and dietary recall Total score averaged 50.9. The diet quality scores for inventory were not associated with client cart scores, except for Added Sugars (P =.005). Client cart HEI-2015 Total score was positively associated with client diet HEI-2015 Total score (P =.002) and associations for Total Fruits, Whole Fruits, Total Vegetables, Greens and Beans, Whole Grains, Seafood and Plant Proteins, and Added Sugars subcomponents were statistically significant. Conclusions: In choice-based Minnesota food pantries, the diet quality of food selected by clients was positively associated with client diet quality.

In 2017, a community-University of Minnesota collaborative conducted a statewide survey of food pantry clients. Of the 188 food pantries surveyed, 4321 individual client surveys were returned, from...

Policies to improve healthy food retail have been recognized as a potential means of reducing diet-related health disparities. The revised 2014 Minneapolis Staple Foods Ordinance instituted minimum stocking standards for healthy, staple foods. The objective of this study was to examine retailer compliance with the policy, and whether compliance varied by neighborhood and store characteristics. In this natural experiment, audits were conducted annually pre- and post-ordinance (2014–2017) in 155 small/nontraditional stores in Minneapolis, MN and a comparison city (St. Paul, MN). Compliance measures for 10 product categories included: (1) met requirements for ≥8 categories; (2) 10-point scale (one point for each requirement met); and (3) carried any item in each category. Store characteristics included store size and ownership status. Neighborhood characteristics included census-tract socioeconomic status and low-income/low-access status. Analyses were conducted in 2018. All compliance measures increased in both Minneapolis and St. Paul from pre- to post-policy; Minneapolis increases were greater only for carrying any item in each category (p < 0.01). In Minneapolis, corporate (vs. independent) stores were generally more compliant. No differences were found by neighborhood characteristics. Overall trends suggest broad movement among Minneapolis stores towards providing a minimum level of staple foods. Increases were greater in corporate stores. Trends do not suggest neighborhood-level disparities in compliance. ClinicalTrials.gov NCT02774330, retrospectively registered May 17, 2016.

BACKGROUND Breakfast consumption is associated with better diet quality and healthier weights, yet many adolescents miss breakfast. Nationally, 17.1% of students participate in the School Breakfast Program (SBP). Only 10% of high school students participate. OBJECTIVE Our aim was to evaluate an environmental intervention to increase SBP participation in high schools. DESIGN A group randomized trial was carried out from 2012 to 2015. PARTICIPANTS/SETTING Ninth- and 10th-grade students enrolled in 16 rural schools in Minnesota (median 387 students) were randomized to intervention or control condition. INTERVENTION A school-based intervention that included two key components was implemented over a 12-month period. One component focused on increasing SBP participation by increasing student access to school breakfast through changes in school breakfast service practices (eg, serving breakfast from a grab-n-go cart in the atrium; expanding breakfast service times). The other component focused on promoting school breakfast through student-directed marketing campaigns. MAIN OUTCOME MEASURE Change in school-level participation in the SBP was assessed between baseline (among ninth and tenth graders) and follow-up (among tenth and eleventh graders). School meal and attendance records were used to assess change in school-level participation rates in the SBP. STATISTICAL ANALYSES The Wilcoxon test was used for analysis of difference in change in mean SBP participation rate by experimental group. RESULTS The median change in SBP participation rate between baseline and follow-up was 3% (interquartile range=13.5%) among the eight schools in the intervention group and 0.5% (interquartile range=0.7%) among the eight schools in the control group. This difference in change between groups was statistically significant (Wilcoxon test, P=0.03). The intervention effect increased throughout the intervention period, with change in mean SBP participation rate by the end of the school year reaching 10.3% (95% CI 3.0 to 17.6). However, among the intervention schools, the change in mean SBP participation rates was highly variable (range=–0.8% to 24.8%). CONCLUSIONS Interventions designed to improve access to the SBP by reducing environmental and social barriers have potential to increase participation among high school students.

<div class="abstract" data-abstract-type="normal"><div class='sec'><span class="bold">Objective</span><p>To test the effect of a behavioural economics intervention in two food pantries on the nutritional quality of foods available at the pantries and the foods selected by adults visiting food pantries.</p></div><div class='sec'><span class="bold">Design</span><p>An intervention (SuperShelf) was implemented in two food pantries (Sites A and B), with two other pantries (Sites C and D) serving as a control for pantry outcomes. The intervention aimed to increase the amount and variety of healthy foods (supply), as well as the appeal of healthy foods (demand) using behavioural economics strategies. Assessments included baseline and 4-month follow-up client surveys, client cart inventories, pantry inventories and environmental assessments. A fidelity score (range 0–100) was assigned to each intervention pantry to measure the degree of implementation. A Healthy Eating Index-2010 (HEI-2010) score (range 0–100) was generated for each client cart and pantry.</p></div><div class='sec'><span class="bold">Setting</span><p>Four Minnesota food pantries, USA.</p></div><div class='sec'><span class="bold">Participants</span><p>Clients visiting intervention pantries before (<span class='italic'>n</span> 71) and after (<span class='italic'>n</span> 70) the intervention.</p></div><div class='sec'><span class="bold">Results</span><p>Fidelity scores differed by intervention site (Site A=82, Site B=51). At Site A, in adjusted models, client cart HEI-2010 scores increased on average by 11·8 points (<span class='italic'>P</span>&lt;0·0001), whereas there was no change at Site B. HEI-2010 pantry environment scores increased in intervention pantries (Site A=8 points, Site B=19 points) and decreased slightly in control pantries (Site C=−4 points, Site D=−3 points).</p></div><div class='sec'><span class="bold">Conclusions</span><p>When implemented as intended, SuperShelf has the potential to improve the nutritional quality of foods available to and selected by pantry clients.</p></div></div>

<div class="abstract" data-abstract-type="normal"><div class='sec'><span class="bold">Objective</span><p>We examined differences in consumer-level characteristics and structural resources and capabilities of small and non-traditional food retailers (i.e. corner stores, gas-marts, pharmacies, dollar stores) by racial segregation of store neighbourhood and corporate status (corporate/franchise- <span class='italic'>v</span>. independently owned).</p></div><div class='sec'><span class="bold">Design</span><p>Observational store assessments and manager surveys were used to examine availability-, affordability- and marketing-related characteristics experienced by consumers as well as store resources (e.g. access to distributors) and perceived capabilities for healthful changes (e.g. reduce pricing on healthy foods). Cross-sectional regression analyses of store and manager data based on neighbourhood segregation and store corporate status were conducted.</p></div><div class='sec'><span class="bold">Setting</span><p>Small and non-traditional food stores in Minneapolis and St. Paul, MN, USA.</p></div><div class='sec'><span class="bold">Participants</span><p>One hundred and thirty-nine stores; seventy-eight managers.</p></div><div class='sec'><span class="bold">Results</span><p>Several consumer- and structural-level differences occurred by corporate status, independent of residential segregation. Compared with independently owned stores, corporate/franchise-owned stores were more likely to: not offer fresh produce; when offered, receive produce via direct delivery and charge higher prices; promote unhealthier consumer purchases; and have managers that perceived greater difficulty in making healthful changes (<span class='italic'>P</span>≤0·05). Only two significant differences were identified by residential racial segregation. Stores in predominantly people of colour communities (&lt;30 % non-Hispanic White) had less availability of fresh fruit and less promotion of unhealthy impulse buys relative to stores in predominantly White communities (<span class='italic'>P</span>≤0·05).</p></div><div class='sec'><span class="bold">Conclusions</span><p>Corporate status appears to be a relevant determinant of the consumer-level food environment of small and non-traditional stores. Policies and interventions aimed at making these settings healthier may need to consider multiple social determinants to enable successful implementation.</p></div></div>

The aim of this study was to examine associations between perceived neighborhood food environments and food purchasing at small and non-traditional food stores. Intercept interviews of 661 customers were conducted in 105 small and non-traditional food stores. We captured (1) customer perceptions of the neighborhood food environment, (2) associations between customer perceptions and store-level characteristics, and (3) customers’ perceptions and shopping behaviors. Findings suggest that customers with more favorable perceptions of the neighborhood food environment were more likely to purchase fruits and vegetables, despite no significant association between perceptions of the neighborhood and objectively measured store characteristics.