Reaching rural veterans: a new mechanism to connect rural, low-income US Veterans with resources and improve food security

Abstract

Background Rural, low-income US veterans face additional barriers to accessing food and resources compared to urban veterans. Based on both social-ecological and cultural competence approaches, the Reaching Rural Veterans (RRV) pilot intervention built on the existing infrastructure of food pantries to improve food security and connect rural, low-income veterans with resources. This article describes the process of implementing and evaluating RRV. Methods Five rural food pantries within each of two states, Indiana and Kentucky, received training in cultural competence and held monthly outreach events where food and services were offered to veterans. Veteran adult participants completed an assessment at baseline and 3-month follow-up that measured food security using the US Household Food Security Survey Module and self-reported resource enrollment. Repeated measures logistic regression models evaluated the odds of improving food security and resource enrollment from baseline to follow-up (significance P < 0.05). Results RRV recruited 234 participants; 53% completed the follow-up assessment. At follow-up, the odds of household (P = 0.009) and adult (P = 0.01) food security increased, as did enrollment in one or more of the following resources: Temporary Assistance for Needy Families, Supplemental Security Income, General Assistance or Assistance from the Township Trustee (P = 0.005). Conclusions RRV yielded promising preliminary results of improved food security and resource use.

Food Insecurity in US Military Veterans

“…68 In contrast, 7 publications reported on surveys specifically designed for veterans such as the Veterans Aging Cohort Study (VACS), 69,70 the Women Veterans Health Utilization and Experience Survey (WV-HUES), 71,72 the Northstar Survey, 73,74 and the Weight and Veterans’ Environments Study 75 —all involved users of Department of Veterans Affairs (VA) health care. Two studies piloted approaches to examining FI in veterans, 76,77 while another qualitatively examined FI and related issues using focus group methods. 78 Longitudinal survey data were cited as data sources in some reports—either a single wave of data was evaluated or pooled or multiple years of data were used.…”

“…Eight central themes were dominant (Figure 1): (1) FI prevalence in veterans (n = 4), 64,67,70,73 (2) health status (n = 7), 60,66,69,70,74,75,79 (3) dietary practices/service-related dietary experiences (n = 2), 68,78 (4) health care utilization (n = 2), 71,72 (5) economic instability (n = 2), 61,63 (6) homelessness/housing instability (n = 1), 76 (7) federal food program participation (n = 1), 62 and (8) community and emergency preparedness factors (n = 5). 65,75,77,79,80 Health status was the most dominant domain, while food program participation and homelessness/housing instability were the least dominant (Figure 2).…”

“…Five studies examined community characteristics or emergency preparedness in relation to FI. 65,75,77,79,80 Wright et al 77 examined the effect of a pilot program to improve awareness of food resources (eg, food pantries, food programs such as SNAP and Temporary Assistance to Needy Families) for veterans. Household FI was defined based on the 18-item USDA measure.…”

“…For example, the USDA HFSSM that has been deemed valid and reliable based on its use in civilian populations 4,86,87 was used in various versions (full, abbreviated) for the majority of studies. 60,64,67,71 -74,77,79 Of the 21 studies, 2 reported the use of the entire 18-item module, 64,77 while at least 7 relied on various shortened versions of the HFSSM. 60,63,67,71,72,74,79 Two studies 69,70 used the USAID-developed, 9-item assessment, the HFIAS.…”

The Need for Investment in Rigorous Interventions to Improve Child Food Security

“…Such interventions may be particularly impactful and practical for rural populations, where reach may be difficult, and in situations where social distancing is appropriate in order to limit fact-to-face interactions, as with the current coronavirus pandemic. 17 The strong evaluation protocol implemented for the food security outcome used a randomized and controlled design at the school district level paired with a widely used and vali-dated measure (US Household Food Security Survey Module). 18 The potential for selection bias is lessened due to this rigorous study design and, further, the adjustment for participant nonresponse in the analysis through the creation of sample weights based on the original consenting sample helps to maintain representation of the target population, that is, children living in the Chickasaw Nation tribal area.…”