Objective: Food insecure populations suffer a greater burden of chronic diseases than the general population, are more likely to consume ultra-processed food, and less likely to meet dietary recommendations. Ultra-processed food has increased in availability and consumption across the globe, especially among low-income populations and can lead to deleterious health effects (e.g., chronic diseases). Food pantries serve low-income and food insecure populations and offer food that ranges from ultra-processed to unprocessed. For many pantries, the nutrient quality of the food supply is not consistent. The UnProcessed Pantry Project (UP3) was designed to promote a food supply at pantries that limits ultra-processed food, increase the availability of nutritious perishable and non-perishable food through acquisition and policy, and support food justice. 

Methods: A single group design was used with 45 food pantry clients at two pantry sites recruited to participate in a pilot study for UP3. Participants were supplied with 50% of their household food needs each week. A curriculum provided education focusing on knowledge, attitudes, and skills to decrease ultra-processed food consumption. Environmental supports included weekly check-ins with participants, recipes, increased un-processed food in the food supply, and staff to assist with food procurement. Dietary quality measured by the Healthy Eating Index (HEI), psychosocial and psychosocial factors, HbA1c, blood pressure, cholesterol, BMI, waist circumference assessed changes from pre-to-post.

Results: In total, 37 participants completed UP3. Dietary quality significantly improved with a HEI of 47.18 ± 12.20 at pre and 54.53 ± 13.18 at post (p = 0.10). BMI (p = 0.004), waist circumference (p = 0.000), and cholesterol (p = 0.024) significantly improved from pre to post. Participants significantly (p< 0.05)  improved their knowledge, attitude, and behavior around ultra-processed food consumption. No significant changes in blood pressure or HbA1c occurred from pre to post although a positive trend was observed.

Conclusions: This pilot study indicates that UP3 is a tool that can be applied in food pantries to guide access to promote consumption of nutritious food and ultimately reduce risk of chronic diseases among health disparate populations.

Objective: The Community Food Bank of Southern Arizona (CFB) provides emergency food assistance to 33,500+ households across 5 counties monthly; 41.7% of CFB households have reported >1 member with Type 2 diabetes (T2D). The objective of this study was to identify CFB clients’ perspectives regarding whether and how modifications to food assistance boxes (5-7 items including canned/dried legumes, vegetables, and grains) should occur, and if additional resources were needed to support diet quality in food-insecure households with T2D.

Methods: Twenty food bank clients with T2D or living with a person with T2D were recruited to participate in one in-depth interview. Eligible participants spoke and understood English or Spanish and received food assistance currently. A semi-structured script was used to guide participants as they examined food items typically offered by CFB and discussed how they utilized them. Participants were asked to select two foods to hypothetically remove from current offerings and, suggest two new foods to include. Interviewers probed for additional information regarding what constituted appropriate foods (e.g., utility, cultural relevance, preferences, health concerns). Interviews were conducted in English (n=10) and Spanish (n=10), audio-recorded, and transcribed. Transcripts were independently coded by two researchers. A code book was developed based on the interview script and verified by a senior researcher. Themes were identified using data-driven analysis in NVivo.

Results: Participants were majority female, Hispanic, 64.9-years-old, and at risk of food insecurity. Participants reported utilizing most foods provided by CFB. There was high agreement regarding which foods to remove (e.g., split peas and black beans) and the rationale (e.g., lack of knowledge, cultural incongruence). Participants also agreed on substitutions (e.g., whole oats, cooking oil) citing health and/or flexibility and cost. Additional resources suggested by participants to manage T2D included monthly classes, recipes, help obtaining medical supplies, and access to health providers.

Conclusions: Client-suggested modifications of food assistance and related resources included increased cultural responsiveness of foods, greater instrumental support with regard to meal preparation, medical management of T2D, and improved access to care.