Food insecurity and hunger safety net use among single-room occupancy tenants in San Francisco, CA

ABSTRACT Objective: Using an adaption of the Photovoice method, this study explored how food insecurity affected parents’ ability to provide food for their family, their strategies for managing household food insecurity, and the impact of food insecurity on their well-being. Design: Parents submitted photos around their families’ experiences with food insecurity. Afterwards, they completed in-depth, semi-structured interviews about their photos. The interviews were transcribed and analyzed for thematic content using the constant comparative method. Setting: San Francisco Bay Area, California, USA. Subjects: 17 parents (14 mothers and 3 fathers) were recruited from a broader qualitative study on understanding the experiences of food insecurity in low-income families. Results: Four themes were identified from the parents’ photos and interviews. First, parents described multiple aspects of their food environment that promoted unhealthy eating behaviors. Second, parents shared strategies they employed to acquire food with limited resources. Third, parents expressed feelings of shame, guilt, and distress resulting from their experience of food insecurity. And finally, parents described treating their children to special foods to cultivate a sense of normalcy. Conclusions: Parents highlighted the external contributors and internal struggles of their experiences of food insecurity. Additional research to understand the experiences of the food-insecure families may help to improve nutrition interventions targeting this structurally vulnerable population.

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High food insecurity in Latinx families and associated COVID-19 infection in the Greater Bay Area, California

BMC Nutrition ◽

10.1186/s40795-021-00419-1 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Milagro Escobar ◽

Andrea DeCastro Mendez ◽

Maria Romero Encinas ◽

Sofia Villagomez ◽

Janet M. Wojcicki

Keyword(s):

Food Security ◽

Food Insecurity ◽

San Francisco ◽

Employment Status ◽

The United States ◽

Household Food Security ◽

Bay Area ◽

Household Food ◽

History Of ◽

The Impact

Abstract Background Food insecurity impacts nearly one-in-four Latinx households in the United States and has been exacerbated by the novel coronavirus or COVID-19 pandemic. Methods We examined the impact of COVID-19 on household and child food security in three preexisting, longitudinal, Latinx urban cohorts in the San Francisco Bay Area (N = 375 households, 1875 individuals). Households were initially recruited during pregnancy and postpartum at Zuckerberg San Francisco General Hospital (ZSFG) and UCSF Benioff prior to the COVID-19 pandemic. For this COVID-19 sub-study, participants responded to a 15-min telephonic interview. Participants answered 18 questions from the US Food Security Food Module (US HFSSM) and questions on types of food consumption, housing and employment status, and history of COVID-19 infection as per community or hospital-based testing. Food security and insecurity levels were compared with prior year metrics. Results We found low levels of household food security in Latinx families (by cohort: 29.2%; 34.2%; 60.0%) and child food security (56.9%, 54.1%, 78.0%) with differences between cohorts explained by self-reported levels of education and employment status. Food security levels were much lower than those reported previously in two cohorts where data had been recorded from prior years. Reported history of COVID-19 infection in households was 4.8% (95% Confidence Interval (CI); 1.5–14.3%); 7.2% (95%CI, 3.6–13.9%) and 3.5% (95%CI, 1.7–7.2%) by cohort and was associated with food insecurity in the two larger cohorts (p = 0.03; p = 0.01 respectively). Conclusions Latinx families in the Bay Area with children are experiencing a sharp rise in food insecurity levels during the COVID-19 epidemic. Food insecurity, similar to other indices of poverty, is associated with increased risk for COVID-19 infection. Comprehensive interventions are needed to address food insecurity in Latinx populations and further studies are needed to better assess independent associations between household food insecurity, poor nutritional health and risk of COVID-19 infection.

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Abstract 16520: Predictors of Thirty Day Readmission in a Vulnerable and Underserved Urban Heart Failure Population

Circulation ◽

10.1161/circ.142.suppl_3.16520 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Alexandra B Steverson ◽

Paul Marano ◽

Caren Chen ◽

Yifei Ma ◽

Rachel Stern ◽

...

Keyword(s):

Heart Failure ◽

Substance Use ◽

San Francisco ◽

Chart Review ◽

Safety Net ◽

Housing Status ◽

Medical Comorbidities ◽

Increased Risk ◽

Safety Net Hospital ◽

Icd 10

Introduction: Heart failure (HF) readmission quality metrics disproportionately impact reimbursement in safety net hospitals. Prior research has demonstrated the effect of medical comorbidities on readmission, however, there is a paucity of data on predictors of readmission in vulnerable and underserved HF patients. We sought to evaluate the effect of demographics, medical and social comorbidities on risk of 30 day readmission in an academic safety net hospital in San Francisco. Methods: We performed a retrospective chart review from 2018 to 2020. Patients were included if treated for HF while on inpatient cardiology or medicine services and were assigned an ICD-10 discharge code for HF. Patients less than 21 years old were excluded. Demographics and comorbidities were obtained through evaluation of ICD-10 discharge codes and chart review. Multivariate modeling was used to determine predictors of 30 day readmission. Results: The study population included 383 patients in which the mean age was 60±13 years and 73% (n=282) were male. 44% (170) were Black, 23% (88) were Latinx, 33% (127) were not housed, 97% (371) had public insurance, and 21% (81) had a diagnosis of mental illness. 46% (177) had CAD, 76% (291) hypertension, and 36% (177) DM. Substance use was common with 30% (114) using methamphetamines, 36% (138) cocaine, 18% (69) opioids, and 35% (135) alcohol. On multi-variate analysis, EF less than 40% (75%, 285) was the only medical comorbidity associated with an increased risk of readmission (OR 1.86, 1.1-3.1, p= 0.018). Social variables associated with increased risk of readmission included identifying as Black (OR 2.26, 1.03-5.0, p= 0.043) or Latinx (OR 3.43, 1.41-7.59, p= 0.006), homelessness (OR 3.02, 1.76-5.18, p=<0.001), and specific substance use: methamphetamine (OR 2.23, 1.39-3.57, p=0.001), cocaine (OR 1.63, 1.03-2.57, p= 0.037), opioids (OR 1.81, 1.05-3.13, p= 0.033), and alcohol (OR 2.26, 1.43-3.58, p= 0.001). Conclusion: Race, housing status and substance use were more strongly associated with readmission risk than medical comorbidities in a population of urban, vulnerable and underserved HF patients. Interventions to improve HF readmission metrics should consider addressing racial and social disparities in similar populations.

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Abstract 16247: Methamphetamine Use Predicts Worse Prognosis in a Safety Net Heart Failure Population

Circulation ◽

10.1161/circ.142.suppl_3.16247 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Anjali B Thakkar ◽

Yifei Ma ◽

Teresa Wang ◽

Alexandra Teng ◽

Rebecca Scherzer ◽

...

Keyword(s):

Heart Failure ◽

Coronary Artery ◽

San Francisco ◽

Cox Regression ◽

Bypass Graft ◽

Safety Net ◽

High Risk Population ◽

Age And Gender ◽

Safety Net Hospital ◽

And Gender

Background: Methamphetamine (MA) use is rising, and overdose deaths have increased by 500% in San Francisco since 2008. MA use is associated with heart failure (HF); yet, cardiovascular (CV) outcomes in this population have not been described. Methods: We performed a retrospective case-control study of HF patients at a safety net hospital in San Francisco. Between January 2001-June 2019, 1771 HF patients with MA use were matched by age and gender to 3542 HF patients without MA use. We examined age and gender-adjusted associations of MA use with likelihood of index HF admission and 30-day readmission (HF and all-cause), and used demographic-adjusted Cox regression model with competing risks to compare hazard rates associated with MA use over the 18-year study period. Results: At time of HF diagnosis, mean age was 52 years and 77% were male. Patients with MA use were significantly more likely than non-MA users to be black (49.1% vs 33.0%), and to have comorbid conditions including HIV (14.5% vs 4.7%), pulmonary hypertension (11.1% vs 7.7%), hypertension (82.0% vs 77.6%), and cocaine use (58.0% vs 14.7%). Despite similar rates of coronary artery disease, myocardial infarction, and diabetes, HF patients with MA use were less likely to have percutaneous coronary intervention (6.1% vs 8.2%) or coronary artery bypass graft (0.8% vs 1.4%), p<0.05 for all. Compared to HF patients without MA use, HF patients with MA use had higher rates of index HF hospitalizations (36.0% vs 21.7%, adjusted odds ratio 2.04, 95% CI 1.80-2.32, p<0.01), 30-day HF readmission (12.2% vs 6.4%, adjusted hazard ratio (aHR) 1.87, 95% CI 1.31-2.67, p<0.01) and 30-day all cause readmission (20.9% vs 14.3%, aHR 1.46, 95% CI 1.14-1.88, p<0.01). Exposure to MA was associated with higher likelihood of death during the study period, regardless of hospitalizations (22.4% vs 15.1%, aHR=1.17, 95% CI 1.03-1.33, p<0.01). Conclusions: In our study, HF patients with MA use were more likely to be admitted for an index HF admission; subsequently, they were also more likely to be readmitted within 30 days. Regardless of hospitalization risk, individuals with MA use had higher likelihood of death. Further study to understand the clinical and socioeconomic factors driving worse outcomes in this high-risk population is needed.

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Abstract 17207: Impact of Racial Differences in Treatment Intensification and Missed Visits on Disparities in BP Control

Circulation ◽

10.1161/circ.142.suppl_3.17207 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Valy Fontil ◽

Lucia Pacca ◽

Brandon Bellows ◽

Elaine Khoong ◽

Charles McCulloch ◽

...

Keyword(s):

Racial Differences ◽

San Francisco ◽

Structural Equation ◽

Safety Net ◽

Clinic Visit ◽

Treatment Intensification ◽

Missed Opportunities ◽

Black Patients ◽

Missed Visits ◽

Equitable Treatment

Introduction: Hypertensive black patients have the lowest rates of blood pressure (BP) control. It is unknown to what extent variation in healthcare processes like treatment intensification (TI) and missed visits explain this disparity. Hypothesis: We hypothesized there would be no racial differences in TI but missed visits would be more frequent among black patients and mediate a sizable percentage of BP control disparities. Methods: We used a structural equation multivariate regression model to estimate the likelihood of BP control (BP<140/90 mm Hg) in black vs. white hypertensive patients, mediated by TI and missed visits. We included 6,556 patients who had diagnosis of hypertension and at least one clinic visit with uncontrolled BP (≥140/90 mm Hg) in 12 safety-net clinics in San Francisco from 2015-2017.We used the standard-based method (SBM), which is predictive of BP control, to calculate TI (dose increase or medication addition). We measured missed visits as the number of “no-shows” in the four weeks after an uncontrolled BP. BP control was defined based on the most recent BP as of Nov 15, 2017. The model adjusted for gender, age, first recorded BP between Jan 2015 and Nov 2017, visit frequency, and diagnosis of diabetes. Results: The mean (SD) age was 57.0 (11.2), 41% were female, and 44% were black. Compared to whites, blacks had more missed opportunities for TI (β=-0.02, p<0.001) and missed more visits (β=0.37, p<0.001). After accounting for these differences, black patients remained less likely than whites to achieve BP control (β=0.16, OR=0.85, 95% CI=0.76-0.95). The indirect effect of decreased TI and missed visits accounted for 22% and 13% of the total effect of black race on BP control, respectively (Figure). Conclusion: Racial inequities in treatment intensification may be responsible for over 20 percent of racial disparities in hypertension. Efforts to ensure more equitable treatment intensification may reduce black-white disparities in BP control.

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Food Insecurity and a Threatened Safety Net

JAMA ◽

10.1001/jama.2019.22150 ◽

2020 ◽

Vol 323 (5) ◽

pp. 406 ◽

Cited By ~ 2

Author(s):

Diana J. Mason

Keyword(s):

Food Insecurity ◽

Safety Net

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Acceptability of Naloxone Dispensing Among Pharmacists

Journal of Pharmacy Practice ◽

10.1177/0897190018798465 ◽

2018 ◽

Vol 33 (3) ◽

pp. 247-254 ◽

Cited By ~ 2

Author(s):

Vivian Do ◽

Emily Behar ◽

Caitlin Turner ◽

Michelle Geier ◽

Phillip Coffin

Keyword(s):

San Francisco ◽

Safety Net ◽

Instructional Materials ◽

Primary Care Clinics ◽

Prescriptive Authority ◽

The Past ◽

Mandatory Training ◽

Safety Net Clinics ◽

The Common

Background: The San Francisco Department of Public Health initiated naloxone prescribing at 6 safety net clinics. We evaluated this intervention, demonstrating that naloxone prescribing from primary care clinics is feasible and acceptable. Objective: To evaluate acceptability of naloxone dispensing to patients prescribed opioids among pharmacists serving clinics participating in a naloxone intervention. Methods: We surveyed 58 pharmacists from November 2013 through January 2015 at pharmacies that serviced San Francisco safety net clinics. Surveys collected information on demographics, experiences in dispensing naloxone, and interest in prescriptive authority. We conducted descriptive analyses and assessed bivariate relationships. Results: Most respondents were staff (56.9%) or supervising pharmacists (34.5%). Most (92.9%) were aware their pharmacy stocked naloxone and 86.8% felt it should be prescribed to some or all patients on long-term opioids. Most (82.1%) dispensed naloxone at least once in the past 12 months. More than half were comfortable providing naloxone education. Nearly half (43.4%) indicated they would want authority to furnish without a prescription. Over half (55.2%) reported no problems dispensing. The common problem was insufficient naloxone knowledge. Only 12% reported more than one problem in dispensing naloxone, which was associated with being uncomfortable with educating patients ( P = .03). Conclusion: Naloxone dispensing was acceptable among pharmacists. Their most cited problem was insufficient naloxone education. This may be resolved with improved instructional materials, incentives for patient education, or mandatory training.

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Perceived Neighborhood-level Drivers of Food Insecurity Among Aging Women in the United States (P04-155-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz051.p04-155-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Jacqueline Shieh ◽

Sheri Weiser ◽

Henry Whittle ◽

Ighovwerha Ofotokun ◽

Adaora Adimora ◽

...

Keyword(s):

United States ◽

Chronic Illness ◽

Food Insecurity ◽

San Francisco ◽

The United States ◽

Food Stores ◽

Chapel Hill ◽

Aging Women ◽

The Us ◽

Neighborhood Level

Abstract Objectives Aging populations in the United States (US) exhibit high rates of both food insecurity and chronic illness. Few studies have explored in depth how food insecurity arises among such populations, and how it interacts with experiences of aging. We qualitatively explored how aging, low-income women experience food insecurity at multiple sites across the US, focusing on the neighborhood-level factors that influence these experiences. Methods Study participants were drawn from the San Francisco, CA, Atlanta, GA, and Chapel Hill, NC sites of the Women's Interagency HIV Study (WIHS), a cohort study of women with or at risk for HIV. Using purposive sampling, we recruited 38 women who were food-insecure, 50 years of age or older, either with or at risk for HIV, and from different neighborhoods within each site. Semi-structured interviews explored participants’ perceptions of how their neighborhood influenced their experiences with food security and aging. An inductive-deductive approach was used to thematically analyze the data. Results Participants across the three sites explained that food insecurity was related to limited access to food stores. In San Francisco, this limited access primarily resulted from high food prices, whereas in Atlanta and Chapel Hill long distances to food stores and poor public transport systems were prominent. Most participants also described being dependent on food aid programs, but often found this difficult due to poor quality food and long wait times. Aging-related issues emerged as a cross-cutting theme. Both HIV + and HIV- women explained how fatigue, poor strength, and joint pains all amplified their barriers to accessing food. Women with chronic illness, regardless of HIV status, also found it difficult to afford healthy and nutritious food, which in turn further aggravated their poor health. Conclusions Findings from this study suggest that older women across different settings in the US experience multiple barriers to navigating the food system, with key similarities and differences in barriers and systems of institutional support. While future programs should address common neighborhood-level barriers such as the availability and affordability of healthy foods and transportation, they should also be tailored to aging women, and to the unique local context. Funding Sources NIAID.

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Determinants of Households Vulnerability to Food Insecurity: Evidence from Southern Ethiopia

Journal of Land and Rural Studies ◽

10.1177/2321024920967843 ◽

2020 ◽

Vol 9 (1) ◽

pp. 35-61

Author(s):

Fassil Eshetu ◽

Adem Guye

Keyword(s):

Food Insecurity ◽

Household Head ◽

Safety Net ◽

Least Square ◽

Farm Income ◽

Southern Ethiopia ◽

Small Scale ◽

The Mean ◽

The Government ◽

Semi Arid

This study examines the level and determinants of households’ vulnerability to food insecurity using feasible generalised least square method. Data were collected using structured questionnaires from a random sample of 574 households. Descriptive results indicated that the incidence, depth and severity of food insecurity were 68, 31 and 18 per cent, respectively, while mean vulnerability to food insecurity was 73.34 per cent. The mean level of vulnerability to food insecurity at Chencha (humid), Demba Gofa (semi-arid) and Kamba (arid) districts were 77, 55 and 84 per cent, respectively. In addition, the mean kilocalorie deficiency gap in the study areas was 682 Kcal per adult equivalent per day, while the mean kilocalorie deficiency gaps which would be needed to lift households out of food insecurity were 462, 440 and 506 Kcal per adult equivalent per day at Chencha (humid), Demba Gofa (semi-arid) and Kamba (arid) districts, respectively. Regression results revealed that the age of household head, family size, safety net programmes, distance from healthcare and death of household members significantly increase households’ vulnerability to food insecurity. But farm income, irrigation use and credit use significantly decrease households’ vulnerability to food insecurity. The government needs to provide credit, viable off-farm employment, small-scale irrigation services and road infrastructure to rural poor to reduce vulnerability to food insecurity. Population control and family planning would also increase resource and consumption per capita and will lead to lower vulnerability.

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