Published online by Cambridge University Press: 05 March 2019
Abstract
Objective
Food pantries play a critical role in combating food insecurity. The objective of the present work was to systematically review and synthesize scientific evidence regarding the effectiveness of food pantry-based interventions in the USA.
Design
Keyword/reference search was conducted in PubMed, Web of Science, Scopus, Cochrane Library and CINAHL for peer-reviewed articles published until May 2018 that met the following criteria. Setting: food pantry and/or food bank in the USA; study design: randomized controlled trial (RCT) or pre–post study; outcomes: diet-related outcomes (e.g. nutrition knowledge, food choice, food security, diet quality); study subjects: food pantry/bank clients.
Results
Fourteen articles evaluating twelve distinct interventions identified from the keyword/reference search met the eligibility criteria and were included in the review. Five were RCT and the remaining seven were pre–post studies. All studies found that food pantry-based interventions were effective in improving participants’ diet-related outcomes. In particular, the nutrition education interventions and the client-choice intervention enhanced participants’ nutrition knowledge, cooking skills, food security status and fresh produce intake. The food display intervention helped pantry clients select healthier food items. The diabetes management intervention reduced participants’ glycaemic level.
Conclusions
Food pantry-based interventions were found to be effective in improving participants’ diet-related outcomes. Interventions were modest in scale and usually short in follow-up duration. Future studies are warranted to address the challenges of conducting interventions in food pantries, such as shortage in personnel and resources, to ensure intervention sustainability and long-term effectiveness.
Keywords
Food pantryFood bankDietInterventionSystematic review
TypeReview ArticleInformation
Public Health Nutrition , Volume 22 , Issue 9 , June 2019 , pp. 1704 – 1716
DOI: https://doi.org/10.1017/S1368980019000144[Opens in a new window]Copyright
© The Authors 2019
Food insecurity, a lack of reliable access to a sufficient quantity of affordable, nutritious food, impacts over one-eighth of American households, with highest rates among households with incomes below the federal poverty level( 1 ). Food insecurity is associated with poor dietary quality and elevated disease risks( Reference Hanson and Connor2 , Reference Laraia3 ). Food banks in the USA typically operate as warehouses that store a large quantity and variety of food items to be distributed by smaller front-line agencies, called food pantries, which directly serve the end users free of charge. Food banks and food pantries in the USA distribute free grocery items to over 46·5 million Americans in need annually( Reference Rochester, Nanney and Story4 , 5 ). Estimations of food insecurity among pantry clients in the USA range from 50 to 84%( 5 – Reference Robaina and Martin7 ). Food pantries are often used to augment the Supplemental Nutrition Assistance Program (SNAP) benefits( Reference Robaina and Martin7 , Reference Bhattarai, Duffy and Raymond8 ). However, some clients use food pantries as their primary or sole food source, partially due to SNAP ineligibility( Reference Dave, Thompson and Svendsen-Sanchez9 ). Food pantries play a critical role in addressing the needs of Americans at high risk of food insecurity( 10 ).
Besides emergency food provision, food pantries may serve as a natural setting and focal point where additional services can be delivered to improve the diet and health status of the highly vulnerable client population. Previous reviews on food pantries largely focused on cross-sectional studies that assessed the nutritional values of foods provided, service types and quality, and client characteristics (e.g. food security status, dietary intake, malnutrition status, health or disease status, and frequencies or reasons for food pantry use)( Reference Bazerghi, McKay and Dunn6 , Reference Simmet, Depa and Tinnemann11 , Reference Simmet, Depa and Tinnemann12 ). One prospective review intends to survey outcomes of disease prevention and management interventions in food pantries, but the review does not assess health behaviour (e.g. food choice) and results have yet to be reported( Reference Long, Rowland and Steelman13 ). The purpose of the present study was to systematically review and synthesize scientific evidence regarding the effectiveness of food pantry-based interventions on diet-related outcomes in the USA. We focused on food pantries in the USA because the types and ways of operation of food banks and pantries differ substantially across countries, and they are also subject to different government regulations and serve diverse populations.
Methods
The systematic review was reported in accordance with the PRIMSA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement( Reference Moher, Liberati and Tetzlaff14 ). Analysis was conducted in May 2018.
Data sources
A keyword search was performed in five electronic bibliographic databases: (i) PubMed; (ii) Web of Science; (iii) Scopus; (iv) Cochrane Library; and (v) Cumulative Index to Nursing and Allied Health Literature (CINAHL). The search algorithm included all the following keywords: ‘food pantry’, ‘food pantries’, ‘food bank’, ‘food banks’, ‘food shelf’, ‘food shelves’, ‘food cupboard’, ‘food cupboards’ and ‘food assistance’. The MeSH (medical subject heading) term ‘food assistance’ was included in the PubMed search. All keywords in the PubMed were searched with the ‘(All fields)’ tag, which are processed using Automatic Term Mapping( 15 ). The Appendix documents the search algorithm in PubMed as an example. The search function ‘TS=Topic’ was used in Web of Science, which launches a search for topic terms in the fields of title, abstract, keywords and Keywords Plus®( 16 ). Titles and abstracts of the articles identified through the keyword search were screened against the study selection criteria. Potentially relevant articles were retrieved for evaluation of the full text. Two reviewers, J.W. and J.S., independently conducted title and abstract screening and identified potentially relevant articles. Inter-rater agreement was assessed using the Cohen’s kappa (κ=0·82). Discrepancies were resolved through face-to-face discussions between R.A., J.W. and J.S.
A reference list search (i.e. backward reference search) and a cited reference search (i.e. forward reference search) were conducted based on the full-text articles meeting the study selection criteria that were identified from the keyword search. Articles identified from the backward and forward reference search were further screened and evaluated using the same study selection criteria. The reference search was repeated on newly identified articles until no additional relevant article was found.
Study selection
Studies that met all of the following criteria were included in the review. (i) Setting: food pantry and/or food bank in the USA; (ii) exposure: any intervention that addresses food pantry clients’ diet-related outcomes (e.g. nutrition knowledge, food choice, food security, diet quality), except for the daily work routine of a food pantry (i.e. food service) or food bank (i.e. food storage and distribution); (iii) study design: randomized controlled trial (RCT) or pre–post study; (iv) study subjects: food pantry/bank clients; (v) article type: peer-reviewed publication; (vi) time window of search: from the inception of an electronic bibliographic database to 28 May 2018; and (vii) language: article written in English.
Studies that met any of the following criteria were excluded from the review: (i) food pantry/bank-related observational studies; (ii) non-peer-reviewed articles; (iii) articles not written in English; or (iv) letters, editorials, study/review protocols or review articles.
Data extraction
A standardized data extraction form was used to collect the following methodological and outcome variables from each included study: authors, publication year, study design, sample size, age range, percentage of women, duration of follow-up, setting, intervention type, intervention components, measures, outcomes, statistical models, covariates adjusted for and estimated intervention effectiveness.