THE IMPLEMENTATION AND EFFECTIVENESS OF FOOD AND NUTRITION SECURITY INTERVENTIONS IN THE US CHARITABLE FOOD SYSTEM
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Food insecurity is associated with suboptimal diet quality and higher risks for diet-related chronic diseases. Individuals seeking food assistance from the charitable food system (CFS) are disproportionally affected by food insecurity. Therefore, the overall objectives of this dissertation were to evaluate the effectiveness and understand the implementation of food and nutrition security interventions in the CFS in the United States (U.S). Chapter 1 provides a literature review on the role of CFS and “Food is Medicine” interventions in addressing food and nutrition security. Chapter 2 is a scoping review aiming to identify the facilitators, barriers, and contexts for implementing nutrition interventions in food banks, food pantries, and soup kitchens in the U.S. Common barriers were related to limited resources at CFS organizations and lack of tailoring to the intervention target populations. Common facilitators included partnerships and connections, adequately addressing participants' needs, and aligning the intervention's mission with that of the CFS organizations. Chapter 3 is an observational quasi-experimental pilot study aiming to examine the preliminary effectiveness of a subsidized community-based agriculture program (“Farm Share”) based at an urban food pantry on food security and dietary behaviors. Compared to the control group, the skin carotenoids significantly increased in the Farm Share group (p = 0.002), even after adjusting for smoking status, age, sex, and birthplace (p = 0.005). Improvements in food security (p = 0.187) and fruit and vegetable intake (p = 0.184) were observed but not significantly different from the control group. Chapter 4 is a qualitative case study aiming to describe the implementation considerations of a produce prescription program based at the same food pantry in Chapter 3. I conducted semi-structured interviews with program implementers (n = 12). A Spanish-speaking researcher and I conducted two focus groups (n = 5 per group) with program participants. Constructed themes focused on the program structure, target population, clinical partnerships, and program sustainability. The findings highlighted the trade-offs between program impact and accessibility. Chapter 5 provides a summary of key findings, implications, and future directions for research, practice, and policy. The overall findings from this dissertation highlight the opportunities and challenges associated with implementing and evaluating food pantry-based nutrition interventions.