Improving Food Security to Increase Resiliency to COVID-19 for Latinx Populations (2020-2021)

Background

The coronavirus has had a disproportionate impact on the Latinx community. In Durham County, Latinx people make up 14% of the population but 67% of new confirmed coronavirus cases (as of June 2020). Many factors contribute to this disparity, including preexisting health conditions, occupations and cultural barriers.

For example, the 2017 Durham Community Health Assessment reported that Hispanic/Latino patients were admitted to the emergency department for respiratory complications at twice the rate of non-Hispanic white patients. Latinx people also have higher rates of chronic diseases like diabetes and obesity, rendering them more susceptible to COVID-19 complications. In Durham, those who work in construction and custodial services are more likely to test positive for coronavirus, and Latinx people make up 91% of cases associated with construction work.

Importantly, Latinx households also experience food insecurity at higher rates than white households and are often overlooked when it comes to public health interventions. This exacerbates health disparities and has compounded the ability of the Latinx community to maintain social distancing practices and secure personal protective equipment.

Project Description

This project team will bring together stakeholders from the healthcare, food, environmental and racial justice spaces to develop interventions that address food security in the Latinx community and encompass multifaceted aspects of patient health that expand beyond the current medical, in-clinic perspective.

In particular, team members will investigate:

  1. How the pandemic is affecting the food security of Latinx residents, with additional consideration of how environmental public health factors contribute to this population’s risk for COVID-19 infection
  2. How the incorporation of fresh, local foods may mitigate these effects
  3. How food insecurity manifests differently in other countries experiencing this pandemic and what we can learn from the global response

The team will work with Root Causes, a Duke Medicine student-led initiative focused on healing the food system through education and outreach, community service and advocacy. Root Causes’ Fresh Produce Program provides fresh produce and food education materials to patients experiencing food insecurity in Durham. Previously provided through the Duke Outpatient Clinic, Root Causes has shifted to a no-contact home delivery model since the start of the pandemic. Biweekly deliveries include fresh food, masks, household essentials and educational materials.

Partnering with Lincoln Community Health Center, El Centro Hispano and Duke Healthy Lifestyles, this team will expand Root Causes’ Fresh Produce Program to 100 high-need Latinx families and use regular surveys and deidentified medical records to assess the impact of the service on patient health and literacy related to the coronavirus. Team members will also conduct a literature review and a comparative study of food redistribution organizations (e.g., food security organizations in Nicaragua), and complete interviews to identify local and global best practices in addressing food insecurity as part of the response to the pandemic, with a particular focus on strategies for supporting Latinx and immigrant communities. The team’s findings will inform improvements to the Fresh Produce Program.

Anticipated Outputs

Comparative analysis and report identifying best practices for food system responses to the pandemic; expansion of food delivery and coronavirus educational materials to 100 Latinx households in Durham; survey and data analysis of connection between food security and health outcomes

Student Opportunities

Ideally, this team will be comprised of 5-6 graduate students and 10-12 undergraduate students with interests and backgrounds in primary care medicine, clinical nutrition, health policy and global public health. Students proficient in Spanish are strongly preferred. Students will ideally have a foundational understanding of the social determinants of health including race/racism, food security, environmental justice, access to home health resources and health literacy.

Team members will have the opportunity to hone their skills in data collection and analysis while also developing a deeper understanding of health inequities, food security and challenges facing the Latinx community.

Students will also strengthen their Spanish language skills, particularly in discussing public health topics. Student team members will help recruit participating households; coordinate the food distribution service; design survey and assessment tools; call patients to collect survey data; curate a food-as-medicine curriculum; and host educational Zoom meetings with recipients to discuss health interventions.

Students may also have the opportunity to contribute to abstract and manuscript publication(s) with the potential to present this work at research conferences. Team members will be encouraged, but not required, to volunteer with Root Causes to deliver food (no-contact deliveries).

Team members will be divided into two work streams: 1) produce distribution and nutrition education, and 2) comparative research on local/national/global response. Each work stream team will be led by a faculty leader and project manager and will meet weekly via Zoom. The entire team will meet monthly.

Depending on travel restrictions and the availability of funding, team members will participate in educational retreats several times throughout the year, and a limited number of students may have the opportunity to conduct an immersion trip to Nicaragua in Spring 2021.

Graduate students Catarina Martinez, Elana Horwitz and Hannah Malian will serve as project managers.

Timing

Fall 2020 – Spring 2021

  • Fall 2020: Recruit and enroll patients; create patient survey; distribute baseline survey; contribute to weekly food distribution; host biweekly Zoom “office hours”; host two education retreats; establish relationship with food security organizations in other countries; distribute surveys to Nicaraguan recipients; complete best practices report; adapt food distribution methods
  • Spring 2021: Continue collecting survey data; analyze survey data; host two education retreats; travel to Nicaragua (tentative); develop and present publications and posters

This Team in the News

Durham Nutritious Food Bank Sees Surge in Growth during Coronavirus Pandemic

Crediting

Independent study credit available for fall and spring semesters

 

Image: Healthy, by Ashley Maceli, licensed under CC-BY-NC 2.0

Fruits for sale.

Team Leaders

  • Elana Horwitz, School of Medicine
  • Hannah Malian, UNC Gillings School of Global Public Health
  • Catarina Martinez, Nicholas - Environmental Management - MEM
  • Viviana Martinez-Bianchi, School of Medicine-Family Medicine and Community Health

/graduate Team Members

  • Tamar Chukrun, Medicine-MD
  • Winston Liu, Neurobiology-PHD
  • Sunny Liu, Medicine MD First Year
  • Nidhila Masha, Medicine MD First Year
  • Natalie Wickenheisser, Medicine-MD
  • Willis Wong, Biomedical Sciences
  • Julian Xie, Medicine-MD, Public Policy Studies-MPP

/undergraduate Team Members

  • Elizabeth Berenguer
  • Shreyas Hallur, Public Policy Studies (AB), Statistical Science (BS2)
  • Nathan Heffernan, Public Policy Studies (AB)
  • Emma Herold
  • Elaijah Lapay
  • Nayoon Lee
  • Karina Moreno Bueno, Biology (BS), Global Health (AB2)
  • Faraan Rahim
  • Ana Trejo, Int Comparative Studies (AB)
  • Neha Vyas, Neuroscience (BS)
  • Kathleen Waeldner, Cultural Anthropology (AB)
  • Florence Zhao, Biology (BS)

/yfaculty/staff Team Members

  • Sarah Armstrong, Pediatrics: Healthy Lifestyles Program
  • Kelly Brownell, Sanford School of Public Policy
  • Rushina Cholera, School of Medicine-Pediatrics: Primary Care Pediatrics
  • Saskia Cornes, Franklin Humanities Institute
  • Elizabeth Shapiro-Garcia, Nicholas School of the Environment
  • Corinna Sorenson, School of Medicine-Population Health Sciences|Margolis Center for Health Policy
  • Jennifer Zuckerman, Sanford School of Public Policy

/zcommunity Team Members

  • Root Causes
  • El Centro Hispano, Durham
  • Lincoln Community Health Center
  • LatinX Medical Student Association
  • Farmer Foodshare
  • Durham County Food Security Task Force

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