Feeding the Future

In an era where millions of Americans don’t have enough—or enough high-quality—food, School of Public Health and Health Professions researchers are at the forefront of studying, developing and implementing practical interventions that are already showing promise. Led by Lucia Leone, PhD, associate professor in the Department of Community Health and Health Behavior, the team is tackling food (in)security through novel approaches that combine research, community engagement and policy advocacy.

Leone's journey to food security— or, the term she prefers, “nutrition security”—research began with personal experience. Growing up on Buffalo's West Side before the prevalence of farmers markets, Leone witnessed firsthand the challenges of accessing fresh, healthy food without reliable transportation.

"I was always interested in nutrition as a kid, but my mom's experience trying to get healthy food on a limited income helped me to have empathy for people who are food insecure," she explains. "My mom was good at stretching her food benefits by planning meals, but she still had to rely on family and food pantries for help occasionally. She didn't have a car, so we only were able to get fresh fruits and vegetables occasionally and had to fill in with frozen and whatever was available at the nearest convenience store.”

Moving from the personal to the national, the scale of the problem becomes evident. According to United States Department of Agriculture measures, about 12 percent of the U.S. population experiences food insecurity, with higher rates among families with young children and Black and Hispanic families.

The research team's work has yielded several meaningful findings, reshaping their understanding of food security interventions.

"The notion of availability is huge. We see such a correlation between access to a car and people's food access," Leone explains. "If the food is not available nearby, transport is paramount. Quality is also up there as a factor."

Another discovery is that improving food environments alone—for instance plopping a supermarket into a neighborhood—isn't enough. Success requires community engagement and communication.

"We've shown that you can change people's diet/food security by changing the food environment," Leone explains. "But we also see that having community engagement and buy-in will help stores be successful. Mobile produce markets do this really well: they engage the community in food choices—it's not for them, it's with them."

The team's flagship work, the Veggie Van program, is, indeed, a mobile produce market initiative and has been operating for nearly 15 years. In fact, they just finished a seven-year study about mobile markets that showed, albeit on a small scale, they could improve food security.

“Now our work is going toward implementation, because these are hard programs to run,” Leone explains. “We’re trying to understand how community organizations and retailers can implement these evidence-based practices so that they’re sustainable.”

Interestingly, at the tail end of the team’s seven-year study, they realized they hadn’t looked at their own campus. Data from UB’s Office of Student Life and analysis by one of Leone’s graduate students revealed a definite need, as does a recent survey by the National Center for Education Statistics at the U.S. Department of Education. It confirms that more than 4 million students in U.S. higher education institutions experience food insecurity, and 2.3 million more students have marginal food security. A survey conducted by Leone’s team on the University at Buffalo campus found the rate to be a striking 58 percent.

Leone notes, "Having a meal plan doesn't help, and we're still analyzing the data on why that is. For a college student working multiple jobs, they might get the cheapest meal plan, which doesn't cover all their meals, and they're still trying to figure out how to get food for their other meals."

Enter the UB Veggie Van, which has been operating on North and South campuses for more than a year now.

Leah Vermont, director of the Veggie Van Training Center, emphasizes the program's impact, which is focused on increasing access as well as affordability through student discounts: “Our current research is showing a significant reduction in food insecurity so far, and interest is strong among a campus community. Students can now build this into their daily lives at UB. We’re basically filling the gap between Blue Table [UB’s emergency food pantry] and Campus Dining."

In another direct outreach program, the UB Free Farm Stand Markets also began this past year to operate across all three campuses, offering—at no cost—not just fruits and vegetables but also protein, dairy and pantry items.

The initiative has been particularly valuable for international students, who face additional barriers. "They face the same issues that other students do, but it's exacerbated," Vermont notes.

"They can't access state/federal programs, often don't have cars, and the food environment here can be very different, with difficulty accessing culturally appropriate food."

While efforts to improve food security exist within different areas UB, the current imperative is to emphasize collaboration. “We’re all starting to make partnerships and understand what’s happening within departments and schools. The players that can help have been really helpful, and there are still great opportunities to get students access to fresh food and veggies," Vermont says.

One way UB Veggie Van is building ties is in connecting more students to SNAP (the federal Supplemental Nutrition Assistance Program) by accepting SNAP at the market and helping to increase awareness of SNAP eligibility for college students through its ambassador program.

“A low percentage of students utilize these benefits even through they’re eligible,” Vermont explains. UB’s Division of Student Life also helps to address this policy barrier and provides outreach and assistance to encourage students to sign up for SNAP.

The impact of student food insecurity extends far beyond immediate hunger.

"There's a strong relationship between food insecurity and academic outcomes, which has been shown in college campuses on an observational level," Leone notes. "Once we can demonstrate that programs like Veggie Van can improve not just food security but also educational outcomes, we hope we can get policymakers to listen and possibly get campuses to pay for these programs. Think about the long-term effects— maybe you can change someone's academic trajectory."

While the boots-on-the-ground approach is exceedingly important, shaping public policy is another key team effort. Christina Kasprzak, PhD, is postdoctoral associate and research assistant professor in the Department of Community Health and Health Behavior working on policy related to nutrition security. She notes that policy changes tend to address access and affordability.

“At the federal level, nutrition assistance programs [like SNAP and WIC] hold a lot of potential for combatting food insecurity and are recognized for having positive impacts on food insecurity and health outcomes,” she says, “but there is still room for improvement and expansion of these programs.” Changes could be things like increased benefits for participants, and expansion of program eligibility to include students, immigrants and Asset-Limited-Income-Constrained (ALICE) households, among others.

“Increased funding to healthy food incentive programs,” Kasprzak adds, “either at the federal or state levels, can maximize nutrition assistance benefits by incentivizing the purchase of healthy, often locally grown, food. Regarding access, we also need increased recognition and state or federal funding toward food access solutions to either open or expand their operations in food insecure communities.” Recognition at the federal and state levels of mobile produce markets, for instance, could remove the regulatory barriers they face in starting and staying successful.

“We also know that small food retailers, including corner stores, dollar stores and grocery stores, have an interest in expanding their options to include healthier food to better serve food insecure communities. Receiving subsidies would incentivize small retailers to do so, which would increase access,” she says.

One significant policy development the team is involved with is New York’s Medicaid Section 1115 Medicaid Redesign Team Waiver, which now allows Medicaid to cover food needs based on social determinants of health.

"You get screened by a doctor, and you can get a prescription to get free food, in theory," Leone explains. "We're trying to work out the details with the Western New York Integrative Care Collaborative, which takes in referrals and identifies organizations who can provide the food."

One approach the team is testing involves combining food prescription deliveries with choice-based options.

"We're trying to combine food prescription deliveries with the ability to choose what you want to eat," Leone explains. Their research with seniors who receive care at Erie County Medical Center has shown promising results with this hybrid model. They've found that while choice is important, many people prefer pre-selected bundles when they perceive them as a good value and when the bundles reduce the effort needed to get healthy food.

"We're already seeing much larger redemption rates with the food delivery method," Leone notes. "People who actually get the food seem to be using it. We hope we can directly apply our results in New York State to affect what the waiver looks like." 

A sidebar to Leone’s research is its influence on dispelling common myths about food insecurity. For instance, she explains that the federal Special Supplemental Nutrition Program for Women, Infants, and Children—WIC—has bi-partisan support because it's focused on moms and kids, and only allows purchase of certain healthy foods. SNAP gets more regulatory attention because recipients can buy what they want.

“The scrutiny is based on the misconception that people don't know how to eat or spend their money,” Leone says. “In reality, the problem is that healthy foods are often just not accessible or affordable."

Looking ahead, the team has more major initiatives in progress in addition to the Medicaid Waiver work.

"We're transitioning to disseminating best practices for food security interventions and implementing with organizations across country," Leone explains. "The Veggie Van model needs training and technical assistance, which we're trying to get to more organizations."

Through Leone's food business, FreshFix, they're also investigating sustainable models that combine charitable efforts with grant-supported projects. The recently launched Eat Local WNY initiative aims to strengthen the local food economy while improving access to fresh, local produce.

The research team's work represents a comprehensive approach to addressing food insecurity, combining direct intervention with policy advocacy and community engagement.

Kasprzak emphasizes, "Receiving subsidies would incentivize small retailers to [offer healthy food], which would increase access. Thinking bigger picture, policies that address the root causes of poverty such as guaranteed income, affordable housing, livable wages, and access to health care and education will increase the likelihood food insecurity strategies will be effective."

The team’s success in demonstrating the effectiveness of mobile markets and other interventions is helping to shape the future of food security programs both locally and nationally. As the work expands, it offers a vision—and plan—for what effective, sustainable efforts to growing food security across diverse populations can be.

The work of Leone and her team closely tracks with what the public health field identifies as the five critical components of health care accessibility. Their research shows that addressing all these factors is crucial for successful interventions, especially since they’re central to addressing inequities.

1. Availability: Can I find the food we need and want?
2. Accessibility: Is my market convenient to get to? Do the hours work?
3. Affordability: Can I afford to buy healthy foods? Are discounts available if I need them?
4. Acceptability: Can I find food for my cultural and dietary preferences? Is the food I can buy high quality?
5. Accommodation: Does the market staff speak my language? Can I pay for food using SNAP, WIC or another program? What if I’m a senior?