What Clients Are Saying About Your Pantry

Tips for improving the flow of healthy foods and beverages from your pantry to your clients.

Transcript

1. #CAUSINGCHANGEMFB
2. How can food pantries successfully improve their stocking and distribution of healthier foods and beverages? Bengucan Gunen – Candidate, Master of Science in Public Health Bloomberg School of Public Health Johns Hopkins University bgunen1@jhmi.edu Sally Yan – Candidate, Master of Science in Public Health Bloomberg School of Public Health Johns Hopkins University syan9@jhu.edu
3. How can food pantries successfully improve their stocking and distribution of healthier foods and beverages? Bengucan Gunen, Sally Yan, Tim Regan, Joel Gittelsohn September 21, 2018
4. © 2014, Johns Hopkins University. All rights reserved. ©2018, Johns Hopkins University. All rights reserved. Gap 1: Limited Healthy Food/Beverage Access • Baltimore residents in low-income neighborhoods have high access to energy- dense foods, but limited access to healthier foods and beverages (D’Angelo 2011) • Large percentages of food pantry users did not meet the recommendations for A, C, D, and B vitamins, or iron, magnesium, and zinc (Simmet 2017) • Inadequate intakes of fruits, vegetables, and dairy • Pantries have limited ability to offer fresh foods
5. © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved. ©2015, Johns Hopkins University. All rights reserved. ©2016, Johns Hopkins University. All rights reserved. ©2018, Johns Hopkins University. All rights reserved. Freshplace • Founded by Foodshare (FS), Chrysalis Center (CC), Inc., and Junior League of Hartford (JLH), Inc. • Designed and evaluated by the University of Connecticut • Intervention: 1 pantry in Hartford, CT • switched to client choice model • monthly motivational interviewing with project manager • referrals to community services • Comparison: 1 “traditional” food pantry distributing pre-packed bags of food in Hartford, CT • Improved food security, self-sufficiency • Increased fruit and vegetable consumption by one serving per day
6. © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved. ©2015, Johns Hopkins University. All rights reserved. ©2016, Johns Hopkins University. All rights reserved. ©2018, Johns Hopkins University. All rights reserved. Pilot Food Bank Intervention Featuring Diabetes- Appropriate Food • 1/3 of households that use food bank services have at least one household member that had diabetes • Provided diabetic food pantry users with diabetes- appropriate food at 32 pantries in TX, CA, and OH • Box consisting of whole grains, lean meats, beans, low-sodium vegetables, no sugar added fruit, and shelf-stable dairy products • Additional fresh produce, milk, yogurt, cheese, bread, and frozen lean meat • Improvements in pre-post analyses of: • Hemoglobin A1c (decreased from 8.11 percent to 7.96 percent) • Fruit and vegetable intake (which increased from 2.8 to 3.1 servings/day) • Self-efficacy • Medication adherence
7. © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved. ©2015, Johns Hopkins University. All rights reserved. ©2016, Johns Hopkins University. All rights reserved. ©2018, Johns Hopkins University. All rights reserved. SuperShelf • Multi-component approach to increase the availability and uptake of healthy options at food pantries in MN • Transform participating food pantries (n=8 transformation; n=8 control): • Creating an appealing, dignified experience for clients • Highlighting healthy options • Collect pantry- and client-level data • FAST to assess healthfulness of foods/beverages at food pantry • Client surveys on diet, health outcomes • For more details, visit supershelfmn.org
8. © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved. ©2015, Johns Hopkins University. All rights reserved. ©2016, Johns Hopkins University. All rights reserved. ©2018, Johns Hopkins University. All rights reserved. Gap 2: Need for Reliable Assessment Tool for Food Bank/Pantry Food Quality • Foods to Encourage (F2E) • Binary • F2E percentage: [ Foods to encourage / total food ] * 100 • Detailed Foods to Encourage • Based on F2E, but excludes processed products high in sodium, total sugar, saturated fat, trans fat • Choosing Healthy Options Program (CHOP) • Created by Greater Pittsburgh Community Food Bank • A ranking tool to assess nutrition of specific food products • Stoplight system • Takes into account calories, saturated fat, fiber, protein, vitamins A and C, calcium, and iron
9. © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved. ©2015, Johns Hopkins University. All rights reserved. ©2016, Johns Hopkins University. All rights reserved. ©2018, Johns Hopkins University. All rights reserved. Baltimore City Food Pantries From a previous trial (B’more Healthy Communities for Kids): • 40% of residents in low-income neighborhoods are food insecure • 15% of a sample of low-income households used food pantry in last month Maryland Food Bank supplies food to 225 partners in Baltimore City Food pantries are commonly located in schools, churches, community organizations Some food pantries offer additional services (job training; referrals to other programs)
10. © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved. ©2015, Johns Hopkins University. All rights reserved. ©2016, Johns Hopkins University. All rights reserved. ©2018, Johns Hopkins University. All rights reserved. Progress/Funding for Studying Baltimore City’s Food Pantries 1. BAHI Seed Grant on Obesity and the Food System: Formative research in 15 medium and large food pantries 2. UHI Student-Community Small Grant Awards: Formative research in 7 small food pantries 3. Lerner Center Community Scholars Grant: Pilot Trial to Test the Feasibility of Interventions to Improve Healthy Food Access in Baltimore City Food Pantries
11. Formative Research
12. © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved. ©2015, Johns Hopkins University. All rights reserved. ©2016, Johns Hopkins University. All rights reserved. ©2018, Johns Hopkins University. All rights reserved. Specific Aims of Formative Research in Food Pantries 1. To conduct formative research on the role of food pantries in Baltimore City's food environment and on pantry operations 2. To develop and pilot a food pantry data collection instrument (Food Pantry Environmental Checklist, FPEC) 3. To assess the variability of healthy foods and beverages offered at food pantries
13. © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved. ©2015, Johns Hopkins University. All rights reserved. ©2016, Johns Hopkins University. All rights reserved. ©2018, Johns Hopkins University. All rights reserved. Formative Research Methods • 22 food pantries (annual distribution) • 7 small (<10,000) • 10 medium (>=10,000 to <25,000) • 5 large (>=25,000) • In-depth interviews with food pantry managers (n=23) • Direct observations of food pantry settings (n=23) • 3 repeated FPEC visits, approx. 1 month apart (n=22)
14. ©2015, Johns Hopkins University. All rights reserved. ©2015, Johns Hopkins University. All rights reserved. ©2016, Johns Hopkins University. All rights reserved. ©2018, Johns Hopkins University. All rights reserved. FPEC Data Collection Table 1. Food Pantry Distribution Methods Small (n=7) Medium (n=10) Large (n=5) Distributes pre-packed bags, % 71 80 60 Follows the client choice model, % 71 40 40 Fills bags per client requests, % 14 50 60
15. ©2015, Johns Hopkins University. All rights reserved. ©2015, Johns Hopkins University. All rights reserved. ©2016, Johns Hopkins University. All rights reserved. ©2018, Johns Hopkins University. All rights reserved. Table 2. Food Pantry Guidelines for Food Procurement, Distribution and Policy Changes Small (n=7) Mediu m (n=10) Large (n=5) Gives suggestions on cooking, % 100 60 60 Escorts clients into the food pantry, % 71 50 40 Makes changes to orders based on client feedback, % 57 50 60 Encourages clients to pick up items, % 43 70 80 Has a limit on how often a client can pick up food, % 43 40 100 Requires permission from board/supervisor to implement changes, % 43 40 60 Allows clients to swap out items from bags, % 29 70 40
16. Header/Full Bleed Image Name/Subject Subhead Title/caption Title/caption ©2015, Johns Hopkins University. All rights reserved. ©2015, Johns Hopkins University. All rights reserved. ©2018, Johns Hopkins University. All rights reserved. 0.0 0.5 1.0 1.5 2.0 2.5 3.0 FPEC1 FPEC2 FPEC3 Average Nutrition Education Materials Score* Small (n=7) Medium (n=10) Large (n=5) * Maximum score is 3; food pantries receive 1 point each for the availability of shelf labels, posters, and flyers. Availability of Nutrition Education Materials in Baltimore City Food Pantries
17. Header/Full Bleed Image Name/Subject Subhead Title/caption Title/caption ©2015, Johns Hopkins University. All rights reserved. ©2015, Johns Hopkins University. All rights reserved. ©2018, Johns Hopkins University. All rights reserved. 0 50 100 150 200 250 300 350 Average Number of Clients Served in Last 2 Weeks Small (n=7) Medium (n=10) Large (n=5) FPEC 2 FPEC 3 FPEC 1 Client Volume in Baltimore City Food Pantries
18. Header/Full Bleed Image Name/Subject Subhead Title/caption Title/caption ©2015, Johns Hopkins University. All rights reserved. ©2015, Johns Hopkins University. All rights reserved. ©2018, Johns Hopkins University. All rights reserved. 0 100 200 300 400 500 600 700 FPEC1 FPEC2 FPEC3 Average Number of Estimated Volunteer Hours in Last 2 Weeks Small (n=7) Medium (n=10) Large (n=5) Volunteer Hours at Baltimore City Food Pantries
19. Header/Full Bleed Image Name/Subject Subhead Title/caption Title/caption ©2015, Johns Hopkins University. All rights reserved. ©2015, Johns Hopkins University. All rights reserved. ©2018, Johns Hopkins University. All rights reserved. 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 FPEC1 FPEC2 FPEC3 Average Lean Meat Availability Score* Small (n=7) Medium (n=10) Large (n=5) *Maximum score is 5; food pantries receive 1 point each for the availability of unseasoned fresh/frozen chicken breast, unseasoned fresh/frozen turkey, >85% lean fresh/frozen ground beef, canned chicken in water, and canned fish in water. Availability of Canned and Fresh Lean Meats in Baltimore City Food Pantries
20. Header/Full Bleed Image Name/Subject Subhead Title/caption Title/caption ©2015, Johns Hopkins University. All rights reserved. ©2015, Johns Hopkins University. All rights reserved. ©2018, Johns Hopkins University. All rights reserved. 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 FPEC1 FPEC2 FPEC3 Average Produce Availability Score* Small (n=7) Medium (n=10) Large (n=5) *Maximum score is 4; food pantries receive 1 point each for the availability of unseasoned frozen vegetables, unsweetened frozen fruits, fresh vegetables, and fresh fruits. Availability of Fresh and Frozen Fruit/Veg in Baltimore City Food Pantries
21. Header/Full Bleed Image Name/Subject Subhead Title/caption Title/caption ©2015, Johns Hopkins University. All rights reserved. ©2015, Johns Hopkins University. All rights reserved. ©2018, Johns Hopkins University. All rights reserved. 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 FPEC1 FPEC2 FPEC3 Average Whole Grain Availability Score* Small (n=7) Medium (n=10) Large (n=5) *Maximum score is 4; food pantries receive 1 point each for the availability of brown rice, 100% whole wheat pasta, 100% whole wheat bread, and plain oatmeal Availability of Whole Grains in Baltimore City Food Pantries
22. Header/Full Bleed Image Name/Subject Subhead Title/caption Title/caption ©2015, Johns Hopkins University. All rights reserved. ©2015, Johns Hopkins University. All rights reserved. ©2018, Johns Hopkins University. All rights reserved. 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 FPEC1 FPEC2 FPEC3 Average Low-Sugar Drink Availability Score* Small (n=7) Medium (n=10) Large (n=5) *Maximum score is 5; food pantries receive 1 point each for the availability of diet soda, diet sports drinks, unsweetened tea/iced tea, water or sparkling water, and 100% fruit juice. Availability of Low-Sugar Drinks in Baltimore City Food Pantries
23. ©2015, Johns Hopkins University. All rights reserved. ©2015, Johns Hopkins University. All rights reserved. ©2016, Johns Hopkins University. All rights reserved. ©2018, Johns Hopkins University. All rights reserved. Summary: Opportunities for Intervention • Food availability: No pantry had much variety of healthy options • Small pantries were less likely than medium or large to have low- sodium canned items, lean meats, and fresh/frozen fruits and vegetables • Infrastructure: Small pantries were less likely than medium or large pantries to have refrigerators • Client support: Small pantries were more likely than medium or large to have staff/volunteers escort clients through the pantry and give suggestions on how to prepare foods
24. Header/Full Bleed Image Name/Subject Subhead Title/caption Title/caption ©2015, Johns Hopkins University. All rights reserved. ©2015, Johns Hopkins University. All rights reserved. ©2018, Johns Hopkins University. All rights reserved. Food Bank Food Pantry Household Individual Food Availability Food Pricing Grants for Network Member Capacity Manager Training Resources Food Pantry Policy Manager Skills Point of Selection Promotion Education Annual Income Sociodemographic Food Security Food Selection Foodways Food Preparation Psychosocial Factors Knowledge Self-efficacy Intentions Food Taste Outcome Reduced intake of: SSB and high-fat foods Increased intake of: Fruits, vegetables, lean proteins, whole grains Food Consumption Conceptual Framework for Food Bank and Food Pantry Operations Proposed Intervention Framework
25. Next Steps: Feasibility Trial
26. ©2015, Johns Hopkins University. All rights reserved. ©2015, Johns Hopkins University. All rights reserved. ©2016, Johns Hopkins University. All rights reserved. ©2018, Johns Hopkins University. All rights reserved. Feasibility Trial: Fresh Shelves, Healthy Pantries • Multilevel Intervention Plan • 6 food pantries: 1 intervention and 1 comparison from each size category (i.e. small, medium, large) • 3 phases, each focusing on a different food group • Testing out a combination of manager training, educational/environmental strategies, and pantry-level policy within each phase
27. Header/Full Bleed Image Name/Subject Subhead Title/caption Title/caption ©2015, Johns Hopkins University. All rights reserved. ©2015, Johns Hopkins University. All rights reserved. ©2018, Johns Hopkins University. All rights reserved. Intervention Plan for Fresh Shelves, Healthy Pantries Intervention Phase (Focus) Food Pantry Staff Capacity Building (In-person training) Educational/ Environmental Strategies Policy 1: Lean, Low- Sodium Proteins Video Posters; Healthy options at eye level Minimum requirements 2: Fresh, Frozen and Canned Produce Educational display Recipe cards; Healthy options at entrance Minimum requirements 3: Healthy Carbohydrates Booklet Shelf labels; Posters Limits to stocking less healthy options Funded by the Community Scholars Grant awarded by the Lerner Center for Health Communication and Promotion
28. Header/Full Bleed Image Name/Subject Subhead Title/caption Title/caption ©2015, Johns Hopkins University. All rights reserved. ©2015, Johns Hopkins University. All rights reserved. ©2018, Johns Hopkins University. All rights reserved. Months 1-2 Jul-Aug 2018 Project Start - IRB Approval - Recruitment Months 3-4 Sep-Oct 2018 - Material Development - Baseline Data Collection Months 5-6 Nov-Dec 2018 Phase 1: Lean & Low- Sodium Proteins Months 7-8 Jan-Feb 2019 Phase 2: Fruits & Vegetables Months 9-10 Mar-Apr 2019 Phase 3: Healthy Carbohydrates Month 11 May 2019 Post-Intervention Data Collection Month 12 June 2019 - Analysis - Manuscript and Deliverable Preparation
29. ©2015, Johns Hopkins University. All rights reserved. ©2015, Johns Hopkins University. All rights reserved. ©2016, Johns Hopkins University. All rights reserved. ©2018, Johns Hopkins University. All rights reserved. Fresh Shelves, Healthy Pantries Evaluation Approaches • Client bag audits, at baseline and at project completion – 10 clients from each food pantry – Contents of client bags, sociodemographic characteristics, exposure to intervention at project completion • Food Assortment Scoring Tool (FAST) to see the weight of foods in each food group and calculate a healthfulness score for bags
30. ©2015, Johns Hopkins University. All rights reserved. ©2015, Johns Hopkins University. All rights reserved. ©2016, Johns Hopkins University. All rights reserved. ©2018, Johns Hopkins University. All rights reserved. Evaluation Approaches cont. • Modified FPEC, at baseline and end of each phase – Availability of promoted and de-promoted options; changes in food pantry guidelines • In-depth interviews with food pantry managers at project completion – Feedback on intervention materials and new policies
31. Questions? Thank You! ©2018, Johns Hopkins University. All rights reserved. Tim Regan tregan@mdfoodbank.org Bengucan Gunen bgunen1@jhmi.edu Joel Gittelsohn jgittel1@jhu.edu Sally Yan syan9@jhu.edu www.healthyfoodsystems.net
32. #CAUSINGCHANGEMFB