The overarching goal of this application is to 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, through policy and practice changes and capacity-building. At the client level, the intervention targets healthy food demand, using behavioral economic and educational approaches. 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, measured by a Hunger Relief Nutrition Index. The study also aims to improve implementation of policies and 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. After a 1-year needs assessment, an intervention will be conducted in 2 waves in Years 2-3. Years 4-5 will be focused on analysis and local and regional dissemination through channels supported by our partnering agencies. This work capitalizes on a palpable local momentum towards improving the hunger relief system.
Research aims address the need for a system- wide approach to improving the hunger relief network and evaluation of its impact on client outcomes.

Public Health Relevance

The hunger safety net fills a critical need among low-income adults with diet-related chronic disease. The challenges faced within the hunger relief network require a multimodal approach for improvement. This study will evaluate the impact of a multicomponent intervention, targeting the supply of healthy food in food pantries and encouraging the selection of healthier items, on client diet and cardiovascular disease risk.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Community-Level Health Promotion Study Section (CLHP)
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Nicastro, Holly L
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University of Minnesota Twin Cities
Family Medicine
Schools of Medicine
United States
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