Recipient Organization
COLORADO STATE UNIVERSITY
(N/A)
FORT COLLINS,CO 80523
Performing Department
(N/A)
Non Technical Summary
This project aims to understand whetherresidents living above and below the federal poverty level (FPT) for food assistancehave different levels of access to healthy, safe, and affordable foods that promotehealth and well-being. We areespecially interested in understandingaccess to healthy, safe, and affordable foods that promotehealth and well-being in high cost-of-living areas, especially among residents who struggle to get enough food.Currently, more than 18 million Americans live in areas with a cost-of-living 40% higher than the national average. Within Colorado, higher cost-of-living cities like Denver, Boulder, and ski-tourism towns in the mountains boast median housing prices from $600,000 to $6.5 million.Our project is with community partners based in one high cost-of-living region known as the Parachute to Aspen Corridorin Colorado. Thisregion is referred to as "resort-rural" with world-class ski resorts surrounded by rural mountain communities. High housing costs, seasonal work, lengthy commutes and limited access to affordable, healthy foods are especially salient for the 130,000 residents living there.Today, a family of four must report income at or below 130% FPT($34,068) to be eligible for the Supplemental Nutrition Assistance Program (SNAP),leaving many to rely on food pantries or other coping strategies (like forgoing medical care) to obtain nutritionally adequate food. A family of four in theParachute to Aspen Corridorregionmust earn $96,674 (377% FPT) to be self-sufficient, or to not rely on federal or social assistance.How households caught in this $60,000 income gap between SNAP eligibility and self-sufficiency use their resources is central to understanding the economic, social and environmental factors that contribute to healthy food access within this population.This project will surveyresidents who struggle to get enough food (regardless of income) about what the foods theyeat and have access to in their homes and communities. We will explore how easy it is for people in the community to eat and access healthyfoodsacross different householdincome levels (both above and below the federal poverty level). We willask people to reportwhere theyget their food to get an idea of what food stores, pantries, soup kitchens, etc. as wellto get a better understanding of whichfood sources best contribute to healthy, safe, and affordable foods that promotehealth and well-being. Finally, we will ask residents to take photos of images from their daily lives that best demonstrate their challenges to meeting their basic needs. Residents will annotate what the photos mean to them and will discuss these photos in a group setting. The information gleaned from thesesurveys, photos, and conversations will be used to inform a 5 year regional strategic plan to addressaccess to healthy, safe, and affordable foods that promotehealth and well-being in the area. At a national level, currently more than 18 million Americans live in major urban areas with a cost of living 40% higher than the national average. Urban populations (87% in 2020) are projected to continue to grow, reaching 89% of the total US population by 2050. As out-of-state and foreign investment in houses increases and affordable housing locations experience increased gentrification; technology continues to replace, rather than augment lower wage jobs; and women forgo returning to the workplace for childcare in these uncertain times, we expect this population of those struggling to get enough food and enough healthy food, above poverty to grow. Research informing policy for this growing problem is lacking. Information collected via this proposal will help to inform policy for the short-term and longer-term for this overlooked population.
Animal Health Component
(N/A)
Research Effort Categories
Basic
60%
Applied
(N/A)
Developmental
40%
Goals / Objectives
The overall goal of this project is to directly inform future community-led efforts including a 5-year regional strategic plan for addressing food and nutrition insecurity in the Parachute to Aspen Corridor (PAC), a high-cost-of-livingregion in a mountain resort rural area of Colorado. Specifically, we aimto understand nutrition insecurity at the individual, household, and community levels for individuals that experience food insecurity and are above 185% federal poverty threshold (FPT),those between 130 and 185% FPT who could also qualify for WIC if they met other eligibility criteria, and those below 130% FPT (referred to herein as households above and below FPT for food assistance).The findings from this proposed research will be integral to ensuring that dietary quality measures and chronic disease prevention are also included in future efforts in the region. Our research team and community partners plan to use the findings from this work to submit a standard grant to conduct a community-based participatory research evaluation of future food and nutrition security interventions with additional Extension and education project objectives.We propose to address this call through the following three main research objectives: Objective 1. Identify and compare diet quality at the individual, household, and community levels for individuals from households above and below the FPTfor food assistance, respectively. Surveys and one 24-hour dietary recall will be conducted with members of the community to characterize nutrition security (defined herein as the Healthy Eating Index-2020, HEI, as a metric for diet quality)at the individual level. The Home-IDEA3 checklistwill be used to assess the HEI in the home environment. The diet recall will include additional questions about where participants procure meals, snacks and beverages for Objective 2 below and to identify community-level HEI (the HEI of food available in the community, rather than based on dietary intake).Differences in HEI for each group at each level will be explored.Objective 2. Identify food acquisition patterns in individuals from households above and below the FPT for food assistance, respectively. Using the above information from the 24-hour recalls and two follow-up surveys, we will empirically derive food acquisition patterns using latent class analysis, a method to uncover subgroups of individuals that are similar in where they go to obtain food. We will quantify differences in food acquisition patterns for each income group.Objective 3. Understand people's lived experiences of food insecurity and the challenges of meeting basic needs, including what factors influence where PAC community members acquire food, dietary intake, and their perceptions around the availability of healthy foods at food outlets. We will use photovoice,a participatory research method, and group discussions of photographs to provide a platform for residents to share their lived experience of accessing food in the PAC region. Inductive thematic analysis will be used to code emerging themes among photos and narratives.
Project Methods
Objective 1Study Design. We will evaluate healthy eating index (HEI) at the individual, household, and community levels for individuals experiencing food insecurity using a cross-sectional study design with surveys and one 24-hour dietary recall, as well as home and food environment assessments. Differences between individuals living in households below 130% of the federal poverty threshold (FPT), between 130 and 185% FPT, and greater than 185% FPT will also be evaluated.Recruitment.Community partnersfrom government, local public health, and non-profits will be integral to helping recruit participants for all proposed activities. Inclusion criteria includes participants 1) live and/or work in Pitkin, Eagle, or Garfield counties (PAC region), 2) are 18 years or older and 3) experienced food insecurity within the past 12 months based on the validated Hunger Vital Signs.For evaluations involving individual-, household-, and community-level diet quality: We will aim to recruit a total of 174 participants (n=58 in each group): below 130% FPT, between 130 and 185% FPT, and greater than 185% FPT for the initial surveys and 24-diet recalls. These same participants will be asked to complete the home food environment questionnaire and will be used in the assessment of community-level diet quality, as described below.Outcome measures: Diet quality at the individual, household, and community levels. All assessments of diet quality will use the most current version of the HEIscore to determine how well the food eaten and available align with the Dietary Guidelines for Americans.Individual-level HEI. One 24-hour dietary recall for each participant will be collected over the phone using Nutrition Data System for Research (NDSR), a computer-based software application developed at the University of Minnesota Nutrition Coordinating Center (NCC) that facilitates the collection of recalls in a standardized fashion.Recalls will be conducted by NCC staff in both English and Spanish. Dietary intake data gathered by interview is governed by a multiple-pass interview approach.HEI total and component scores will be calculated and provided for the intake day.Household-level HEI. The Home Inventory Describing Eating and Activity (Home IDEA-3) is a self-report survey and was modified, based on the work by this research team, to assess the home environment of low-income families. The Home IDEA-3, evaluates food (131 items), PA devices (16 items), and electronic devices (e.g., television; 9 items). Previously, members of the study team demonstrated strong validity in using the Home-IDEA survey to measure HEI.Community-level HEI assessments will be conducted by aggregating foods purchased/consumed at various food outlets across all participants using the additional questions about where they acquired food and beverages in the 24-hour diet recall. A list of all food retailers, food pantries, soup kitchens, and/or other community food assistance resources will be compiled using input from our community partners, assessed and modified based on cognitive testing, and provided to participants in advance of the recall. Food outlets will be further characterized using categories outlined in Vineyard M et al. (2020) including stores, restaurants, and community food programs (soup kitchens, food pantries, etc.). Individual participants will be assigned a weighted community level HEI score based on the relative contribution of their diet from each of the food outlet types.Other Individual, household, and community measuresinclude food insecurity using thevalidated USDA 10 or 18-item food security survey questions will be used to identify food insecurity status among households;use of food assistance;sociodemographics;economic tradeoffs, such as allocating funds for food with other necessities (e.g., How often during the past month did you have to choose between paying for food or paying for utilities/rent/medications?); and household resiliency.Study outcome of the data analysis. Descriptive statistics (%, means, sd, ranges, and distributions) will be calculated for the above constructs. One-way multivariate analysis of variance (MANOVA) will be used to evaluate differences in the individual-, household-, and community-level HEI by income group adjusted for relevant covariates. Missing data will be dealt with using multiple imputation procedures. The a priori type I error rate will be set at 5% with Bonferroni corrections for multiple comparisons.Objective 2Study design, recruitment, and evaluation measures. Participants will include a subset of 45 PAC residents recruited for Objective 1 (15 in each income group). In addition to completing the 24-hour recall, these participants will be followed up via their preferred method of communication (phone call, email, text) on two additional randomly selected days to complete a brief survey of where they acquired their food and beverages, thereby allowing us to get a better picture of usual food acquisition behaviors over multiple days. Similar to the dietary recalls, these assessments will ask participants to report on the previous 24 hours. The same list of food sources from the community-level HEI assessment will be evaluated for these surveys. Additional evaluation measures will include those described in Objective 1 under the subsection "other Individual, household, and community measures".Analyses. Food acquisition patterns will be empirically derived using latent class analysis (LCA), a method to uncover subgroups of individuals that are similar in where they obtain food. The best fit LCA model (and number of subgroups) will be identified based on fit statistics (AIC, BIC, and G2). Participants will be assigned into subgroups using posterior probabilities indicating the likelihood that each individual falls into a given subgroup. We will explore then differences in food acquisition patterns for each income group, and for those using federal food assistance vs those not using federal food assistance using multinomial logistic regressions and logistic regressions adjusted for relevant sociodemographics.Objective 3Recruitment and protocol. The same recruitment strategies for objective 1 and 2 will be used to recruit n=30 photovoice participants. Prior to photovoice, community members will be trained in how to facilitate the photovoice training for participants. Following recruitment, participants will be randomly divided into three parallel cohorts (n=10). Each cohort will attend an introductory workshop where they will be briefed on the project and train for the photovoice method by a peer trainer. Photovoice training will include instructions on photography, ethics, and topics to photograph.Participants will be asked to photograph their daily lived experiences navigating food insecurity and meeting their basic needs of where they get food, what they eat, and their perceptions around the availability of healthy foods within the region. To provide voice to the photos, participants will be asked to write a brief description of the meaning of the photo.Analysis. Cohorts will have a two-hour follow-up meeting to review, discuss, and codify photos with facilitators, allowing participants to engage in the data analysis of photovoice results. Facilitators will follow the SHOWeD technique to guide discussion: 1) What do you See here? 2) What's really Happening here? 3) How does this relate to Our lives? 4) Why does this problem or strength exist? 5) What can we Do about this?Participants will identify emerging themes found throughout the images, as well as community assets and opportunities for growth that may be discussed with community decision makers. Final analyses and synthesis of data will be completed by the research team to categorize themes found for the three cohorts.Results from all objectives will be presented at a community stakeholder event, in infographics,and used to submit a standard grant proposal.