The American Public Health Association Annual Meeting - Swetland Research Presentations


The American Public Health Association (APHA) will be hosting their Annual Meeting and Expo virtually October 24th - 28th. This event is the largest gathering of public health professionals and will include innovative and informative discussions, as well as provide networking opportunities, poster sessions, and more! Register early and gain access to connect with other attendees beginning the week of October 19th through the Virtual Meeting Platform. Here you will be able to network with other public health professionals, preview pre-recorded poster sessions, and participate in the Joint Policy Commission Hearings. Students and prospective students are able to connect with participating universities through APHA 2020 for free. Below are three opportunities to learn about work related to the Swetland Center: 


“Fixes that fail” system archetype as a model for conceptualizing food system inequities


Authors:  Elizabeth Benninger, Gwen. Donley, Megan Schmidt-Sane, Jill Clark, David Lounsbury, Dominique Rose & Darcy Freedman on Behalf of the Modeling the Future of Food in your Neighborhood Collaborative 

Presenter: Elizabeth Benninger

Presentation Date: October 27, 2020, 3:00pm(mt), 5pm(et), session 4293.0 - Finding Solutions: Employing Systems Thinking and Novel Strategies to Improve Nutrition

Access to fresh and healthy food within a neighborhood has been identified as a social mechanism contributing to community health outcomes. Within the United States, limited access to fresh and healthy food is more common in low-income, racial and ethnic minority neighborhoods considered to be “food deserts”, which contributes to inequities related to food security, dietary patterns, and health outcomes. This has resulted in a focus on food systems as a social determinant of health. Grounded in the understanding that challenges related to equity within a food system are complex and rooted in both structural and systems problems, this presentation will demonstrate the use of systems thinking to further our understanding of the food system. Within Systems thinking, we map qualitative interview data from various community stakeholders (N=22) to the systems archetype of “Fixes that fail” in order to describe structural challenges, such as incarceration and poverty, that shape the problem of food system inequity in our communities. The findings highlight complex food system insights related to racial disparities in incarceration, economic opportunity, and wealth. The presentation further discusses the ways in which existing food system interventions, in the absence of addressing the root causes of poverty and structural racism, pose the risk of reinforcing existing racial and socioeconomic inequities.


Identifying targets for health promotion efforts designed to reduce food insecurity


Session: Food and Nutrition, Poster 

Authors: Embaye, M., Freedman, D., Ngendahimana, D., Bell, B., Zaim, H., Banks, A., & Chisolm, D. 

Introduction: Food insecurity influences health outcomes and is increasingly measured at routine healthcare visits. The goal of this research was to identify modifiable characteristics related to endorsement of two food insecurity screener questions often asked in healthcare settings. Methods: Analysis was focused on cross-sectional survey data collected from participants (N=442) living in urban neighborhoods in Ohio, defined as “food deserts” by the USDA. Participants were categorized as high (n=190) or low food secure (n=252) based on responses to two items about worry/stress about food and food adequacy. Data were analyzed using logistic regression. Results: Finding it easy to eat fresh and healthy food was associated with less likelihood of reporting low food security status (OR =0.73; 95% CI = (0.56,0.95)). This was also true for those who shop with their own car (OR = 0.55; 95% CI = (0.35,0.87)). Factors that increased the odds of reporting low food security status included having a chronic disease (OR = 1.59; 95% CI = (1.04, 2.41)), receiving SNAP (OR = 1.81; 95% CI = (1.14,2.86)), experiencing significant life changes in the past year (OR = 1.88; 95 % CI = (1.22, 2.90)), and more frequent shopping at primary store (OR = 1.10; 95 % CI = (1.03, 1.18)). Discussion: Health care institutions seeking to address the link between food insecurity and health may prioritize populations with chronic disease and receipt of SNAP. Additional interventions to reduce food insecurity may focus on provision of transportation supports and other services to buffer stressful life events.


SNAP sales increase after doubling monetary fruit and vegetable incentive value at farmers’ markets in Ohio


Authors: Roberto Martinez, MD, MPH, David Ngendahimana, MS, PhD, Lauren Vargo, MUPD, Gwendolyn Donley, MPH, Tevis Foreman, Ana Bird and Darcy Freedman, MPH, PhD, (1) Case Western Reserve University, Cleveland, OH, (2) Produce Perks Midwest, Cincinnati, OH

Presenter: Roberto Martinez

Presentation Date: Wednesday, October 28, 2020: 8:30 a.m. - 10:00 a.m. Session: Assessing the Effects of Nutrition Incentives on Local Agriculture, Food Insecurity, and Diet (ID=61772)

Introduction: The U.S Department of Agriculture’s (USDA) Food Insecurity Nutrition Incentive (FNI) program has demonstrated improved food security and daily intake of fruit and vegetables among families participating in the Supplemental Nutrition Assistance Program (SNAP). FINI grant funds support monetary incentives for SNAP participants to buy produce at food retailers including farmers’ markets (FMs). Since 2015, two FINI grants and a state-funded SNAP incentive program have been supporting fruit and vegetable incentives at FMs in Ohio. The maximum value of the incentive doubled from $10 to $20 in May 2018. Approach: Interrupted time series design was used to compare SNAP sale trends at FMs during two time points over 24 months: May 2017-April 2018 ($10 incentive maximum) and May 2018-April 2019 ($20 incentive maximum). Fifty-three FMs met the inclusion criteria, including having SNAP sales data during both time points and reporting individual SNAP transaction sales and nutrition incentive distribution data through software developed by the research team. Estimates of the effect of doubling of cap incentives were adjusted for seasonality and number of fruits and vegetable vendors. Results: Doubling the maximum incentive value was associated with a 2.5-fold increase in weekly SNAP sales at FMs. Overall FM sales were 2.8 times greater than sales before the incentive maximum doubled from $10 to $20. Discussion: Increasing the maximum nutrition incentive dollar amount resulted in an increase in SNAP sales at FMs over time. Doubling incentives available at direct-to-consumer sites supports both SNAP users and local food economies.

APHA 2020 — Creating the Healthiest Nation: Preventing Violence