A Multilevel Intervention in the Hunger Relief Network to Improve Diet Among Adults Experiencing Food Insecurity

Evaluate the health impact of an intervention targeting the hunger relief network and the
clients with food insecurity it serves. The long-term goal of this work is to reduce
nutrition-related health disparities by intervening on a system that serves individuals at
high risk for chronic disease. In 2014, an estimated 14% of U.S. households experienced food
insecurity (i.e., they lacked access to enough food for an active, healthy life for all
household members). Large numbers of low-income, racial/ethnic minority, and immigrant
families who experience food insecurity rely on a hunger relief network that includes food
banks and food pantries. Pantry clients have demonstrated poor nutritional outcomes, high
chronic disease rates, and dissatisfaction with the quality and cultural-appropriateness of
food offered. Unlike other food assistance programs, there are currently no standards on the
nutritional quality of pantry offerings, but recent work by our study team demonstrated the
need to improve the healthfulness of hunger relief network inventory. We proposed an
evaluation of a randomized, sustainable intervention in 8 intervention and 8 control
pantries. We will enroll 272 clients at baseline and follow them for 1 year to assess changes
in overall diet quality (the primary outcome). Working with our food bank partners, the
intervention at the pantry level targets the supply of nutritious foods. At the client level,
the intervention targets healthy food demand. Measured outcomes include overall diet quality
(the primary outcome), as assessed by the Healthy Eating Index-2010 (HEI), the nutritional
quality of foods selected at the food shelf visit, and cardiovascular disease health
(assessed by the American Heart Association's Life's Simple 7 scores). The study will also
evaluate the impact of a multilevel intervention on the nutritional quality of pantry
offerings. The study also aims to improve implementation of practices that promote a
nutrition-focused hunger relief network, as assessed by survey and key informant interviews.
As an exploratory aim, the study will evaluate the cultural appropriateness of pantry foods
and services, given the burden of poor food access on minority, immigrant, and refugee
families.

Inclusion Criteria:

-≥18 years old

- Mentally capable of consent and participation

- Speak English, Spanish, or Somali

Exclusion Criteria:

- Not capable of consent or participation

- Speak only languages other than English, Spanish or Somali

- Not a food pantry user