Despite recommendations for systematic food insecurity screening in pediatric primary care, feasible interventions in clinical settings are lacking. The goal of this study was to examine reach, feasibility, and retention in Food FARMacia, a pilot clinically based food insecurity intervention among children aged <6 years. We examined electronic health record data to assess reach and performed a prospective, longitudinal study of families in Food FARMacia (May 2019 to January 2020) to examine attendance and retention. We used descriptive statistics and bivariate analyses to assess outcomes. Among 650 pediatric patients, 172 reported household food insecurity and 50 registered for Food FARMacia (child mean age 22 ± 18 months; 88% Hispanic/Latino). Demographic characteristics of Food FARMacia participants were similar to those of the target group. Median attendance rate was 75% (10 sessions) and retention in both the study and program was 68%. Older child age (retention: age 26.7 ± 18.7 months vs. attrition: age 12.1 ± 13.8 months, p = 0.01), Hispanic/Latino ethnicity (retention: 97% vs. attrition: 69%, p < 0.01), and larger household size (retention: 4.5 ± 1.1 vs. attrition: 3.7 ± 1.4, p = 0.04) correlated with retention. A clinically based mobile food pantry pilot program and study reached the target population and were feasible.

Interactive Nutrition Comics for Urban Minority Youth (Intervention INC) is an innovative, web-based interactive comic tool for dietary self-management, which aims to decrease obesity risk among urban minority preadolescents. The feasibility and acceptability of Intervention INC was assessed by implementing a two-group randomized pilot study. To date, intervention studies have typically faced various barriers in recruiting and retaining study participants. The purpose of this paper is to describe recruitment and retention activities from this study and in particular, discuss challenges faced, strategies implemented, and lessons learned. Black/AA and Latino children (ages 9–12 years) and their parent/guardian were recruited from East Harlem/Harlem, New York. Recruitment strategies included flyering in the community, having a convenient study location, providing participation incentives, and partnering with community/school-based organizations. Potential participants were screened for eligibility; enrollees completed online surveys and interviews at baseline (T1), intervention midpoint (T2), intervention end (T3), and 3-months post-intervention (T4). Retention strategies included flexible scheduling, reminder calls/texts, incremental compensation, and consistent study staff. Eighty-nine enrolled dyads completed a T1 visit (August to November 2017) and were randomized to the experimental (E, n = 45) or comparison (C, n = 44) group. Enrolled dyads learned about the study through community events (39%), community flyering (34%), friend/referral (15%), or a community clinic partner (12%). T1 child demographics were mean age = 10.4 ± 1.0 years, 61% female, 62% Black and 42% Latino, and 51% overweight/obese; parent demographics were mean age = 30.8 ± 8.9 years, 94% female, and 55% Black and 45% Latino. Survey completion rates by dyad were high throughout the study: T2, 87%; T3, 89%; and T4, 84%. Average data collection per session was 65 min. Parents at T4 (n = 76) felt they received enough study information (97%) and that their questions were answered properly (80%). Eighty-one percent of children at T4 (n = 75) were very satisfied/extremely satisfied with how study staff communicated and interacted with them. Effective recruitment strategies consisted of community events and flyering, while a variety of retention strategies were also used to successfully engage urban Black/AA and Latino families in this study. Though our findings are limited to only Latino and Black families in low-income neighborhoods, we have identified successful strategies for this specific high-risk population and potentially similar others. ClinicalTrials.gov, NCT03165474 , registered 15 May 2017

In cross-sectional studies, food insecurity is associated with adverse health and dietary outcomes. Whether self-reported health and dietary outcomes change in response to improvements in food security has not been examined. We sought to examine how increases in food security are related to changes in health and dietary factors. In this longitudinal, observational study, we included adult participants in a clinical-community emergency food assistance program in New York City from July 2020 to November 2021. Program staff measured food security with a validated six-item measure at program enrollment and six-month re-enrollment. Participants self-reported health and dietary factors (vegetable, fruit, juice, and sugar-sweetened beverage (SSB) consumption frequency). We used multivariable regression to examine associations between change in food security with change in health and dietary factors over six months. Among 310 participants, the mean food security score improved by 1.7 ± 2.3 points over six months. In unadjusted models, each point improvement in food security was associated with increased vegetable (β = 0.10 times; 95% CI: 0.05–0.15); fruit (β = 0.08 times; 95% CI: 0.03–0.14); and juice (β = 0.10 times; 95% CI: 0.05–0.15) consumption. In adjusted models, results remained significant for vegetable and fruit consumption, but not juice. Change in food security was not associated with change in health or SSB outcomes. In this cohort during COVID-19, improved food security was associated with improved vegetable and fruit consumption. Randomized trials that examine the effectiveness of clinical-community partnerships focused on improving food security and nutrition are warranted.