. 2023 Dec 30;119(3):850–861. doi: 10.1016/j.ajcnut.2023.12.019

TABLE 1.

Food insecurity and neighborhood food environments research gaps and opportunities

	Research gaps and opportunities
Food insecurity	Measurement and research design • Examine determinants and drivers of food insecurity. More research needs to be conducted to understand the determinants and drivers of food insecurity in these and other understudied populations, including American Indians, Black persons in the Upper Midwest, young adults not in college, 50- to 59-y-olds, and people with disabilities. • Examine the pathways and mechanisms linking race/ethnicity and socioeconomic status to food insecurity risk. Although the higher prevalence of food insecurity experienced by racial/ethnic minorities and low-income populations is well documented, these disparities could be driven by various risk factors such as disability and structural oppression, explaining the source of the unequal burden. • Understand the intergenerational implications of food insecurity and longitudinal studies on the long-term impacts of food insecurity across the life course. • Prioritize research that understands and promotes action and policy change. There is a need to understand the interaction of broader economic policies and income supports such as increases in minimum wage and expansion of Earned Income Tax Credit on food insecurity rates. • Develop measures to assess nutrition security. Nutrition security includes not only getting enough food but also the equitable availability and affordability of healthy foods to aid in disease prevention and management. Given the increased focus on improving nutrition security in the nation, novel measures are needed to assess nutrition security. Intervention studies • Consider the impact of the broader neighborhood context such as lack of affordable housing on food insecurity and build on the lived experiences of underserved populations within the context of their environment. • Address the stigma attached to food insecurity and participation in food assistance programs. Consider innovative approaches to expand access to Food and Nutrition Assistance Programs. • Integrate models of food sovereignty and social justice in interventions, particularly in American Indian and other historically marginalized communities. • Address food insecurity as a poverty issue and support nontraditional intervention studies (e.g., Building Wealth and Health Network) • Increase support for nutrition education programs. Recent studies suggest that providing supplemental funding for food and nutrition education increases the odds of making healthy food choices. • Explore interventions targeting key cardiometabolic health that have the potential to improve food insecurity and simultaneously address multiple health challenges.
Neighborhood food environments	Measurement and research design • Develop research to better characterize the current food retail environment and consumer behavior through additional measures and using new technologies. Direct observation studies using Global Positioning System (GPS) and GIS data can predict food environment interactions and inform intervention development. Eye tracking data can also help to identify mechanisms of behavioral choice within food store environments. • Investigate online food shopping environments and consumer shopping patterns to better understand their role in influencing diet and diet quality. Online food environments are often characterized by personalized messaging and frequent change using digital algorithms, which introduces challenges for measurement and interpretation. Because many shoppers who use online shopping combine that method with in-store shopping, research to understand “hybrid” food environments will be critical. • Integrate rigorous food choice and diet outcome measures in research study designs. Additional neighborhood characteristics may influence the effects of interventions, and these relationships and pathways are part of understanding the link between neighborhood food environments and health. Furthermore, using store sales data at both the aggregate (store) and individual (shopper) levels to estimate food choices may be useful. Intervention studies • Develop multilevel, multicomponent interventions to improve the healthy food environments and choices. A better understanding of the supply chain for small stores can inform effective strategies in these challenging retail food environments. Multilevel interventions that address unhealthy food marketing, individual- and family-level nutrition knowledge, point-of-purchase consumer guidance, and economic incentives to reduce costs of healthy foods are needed to effectively impact dietary behaviors. • Investigate the impact of interventions and policies to achieve healthier retail food environments and whether/how they impact dietary intake. For example, an important research focus would be to examine the national impact of the Healthy Food Financing Initiative (HFFI) and the GusNIP Incentive Program on food purchases and dietary intake health indicators and to explore the association of the effects across diverse communities. From a broad perspective, understanding the health, economic, and quality of life effects of opening new supermarkets in underserved communities or “food deserts” would significantly contribute to understanding retail food environments. • Community-engaged research methods in health disparities populations including rural, socioeconomically disadvantaged, and racial/ethnic minority communities. This includes expanding the use of equity-oriented strategies, measures, and outcomes in intervention research and exploring solutions to the root causes of inequities in healthy food access, including historical disinvestment in communities, structural racism, and racial/ethnic neighborhood segregation. • Develop interventions targeting the food environment that explicitly consider health equity and integrate other social determinants of health. • Use study designs that are methodically strongest for addressing biases and unmeasured confounders including novel trial designs. Earlier studies have yielded different or limited results on whether diet changes after a neighborhood intervention such as a new full-service grocery store.
Cross-cutting themes	Data and technology • Collect new data to better understand the intergenerational impacts of food insecurity. Furthermore, studies are needed to collect data investigating the effects of food insecurity in relation to other life events and leverage existing efforts. • Consider the use of GPS and GIS data in research focused on the assessment of the neighborhood food environment. Innovated data sources can provide real-time changes in food environments and better capture consumer purchasing patterns in the neighborhood context. • Disaggregate data, although protecting individual and community privacy, to better identify populations most impacted by food insecurity, hunger, and nutrition insecurity. Subpopulations within communities may experience unique risks, and disaggregated data can assist with developing more tailored approaches to prevent and alleviate the burden of food and nutrition security among these demographics. • Implement culturally and community-responsive technologies and methodologies for promoting nutrition and health. For example, data scientists have designed participatory technologies, mobile mapping, and SMS platform to link equitable food systems and community-powered health interventions. Partnerships • Promote efforts to increase community data capacity beyond federal grants, and increase training in data science, including using participatory technology and community-driven data to transform the food environment and increase access to healthier foods using an equitable, community-centered approach. Existing datasets are often limited, given disparities in research participation and this approach brings equity and accuracy to community-level data. • Foster new partnerships, which are key to achieving health equity. Partnerships with various sectors, such as food retailers, foundations, community-based organizations, and advocacy groups, are critical to addressing food insecurity and increasing healthy food access. • Leverage existing local, regional, and federal efforts, such as Project Bread, CDC’s Racial and Ethnic Approaches to Community Health (REACH) program, federal assistance programs (e.g., SNAP, GusNIP Incentive Program, Centers for Medicaid, and Medicare Services), to reduce food insecurity and address neighborhood food environments. Community-engaged research and perspectives of those with lived experience • Promote community-engaged research methods in health disparities populations to broaden knowledge about solutions to address food access and food insecurity in these high-risk populations. For example, rural areas provide an optimal context for examining how geography, income, and race contribute to food security and neighborhood food environments. Community-engaged approaches, including qualitative and mixed-methods research, are also critical for the empowerment of historically disadvantaged groups to take agency over the developing • Increase support for underrepresented researchers with lived experience, which can contribute to innovative questions and effective solutions. Prioritizing support for researchers from and funding for minority and underrepresented groups could bring an expanded lens to food insecurity and neighborhood food environment research, which can contribute to innovative questions and effective solutions. Researchers with lived experience and those immersed in community-engaged research have the potential to identify intervention strategies that lead to innovative solutions to reduce health disparities.

Research gaps and opportunities

Food insecurity

Measurement and research design

•
Examine determinants and drivers of food insecurity. More research needs to be conducted to understand the determinants and drivers of food insecurity in these and other understudied populations, including American Indians, Black persons in the Upper Midwest, young adults not in college, 50- to 59-y-olds, and people with disabilities.
•
Examine the pathways and mechanisms linking race/ethnicity and socioeconomic status to food insecurity risk. Although the higher prevalence of food insecurity experienced by racial/ethnic minorities and low-income populations is well documented, these disparities could be driven by various risk factors such as disability and structural oppression, explaining the source of the unequal burden.
•
Understand the intergenerational implications of food insecurity and longitudinal studies on the long-term impacts of food insecurity across the life course.
•
Prioritize research that understands and promotes action and policy change. There is a need to understand the interaction of broader economic policies and income supports such as increases in minimum wage and expansion of Earned Income Tax Credit on food insecurity rates.
•
Develop measures to assess nutrition security. Nutrition security includes not only getting enough food but also the equitable availability and affordability of healthy foods to aid in disease prevention and management. Given the increased focus on improving nutrition security in the nation, novel measures are needed to assess nutrition security.

Intervention studies

•
Consider the impact of the broader neighborhood context such as lack of affordable housing on food insecurity and build on the lived experiences of underserved populations within the context of their environment.
•
Address the stigma attached to food insecurity and participation in food assistance programs. Consider innovative approaches to expand access to Food and Nutrition Assistance Programs.
•
Integrate models of food sovereignty and social justice in interventions, particularly in American Indian and other historically marginalized communities.
•
Address food insecurity as a poverty issue and support nontraditional intervention studies (e.g., Building Wealth and Health Network)
•
Increase support for nutrition education programs. Recent studies suggest that providing supplemental funding for food and nutrition education increases the odds of making healthy food choices.
•
Explore interventions targeting key cardiometabolic health that have the potential to improve food insecurity and simultaneously address multiple health challenges.

Neighborhood food environments

Measurement and research design

•
Develop research to better characterize the current food retail environment and consumer behavior through additional measures and using new technologies. Direct observation studies using Global Positioning System (GPS) and GIS data can predict food environment interactions and inform intervention development. Eye tracking data can also help to identify mechanisms of behavioral choice within food store environments.
•
Investigate online food shopping environments and consumer shopping patterns to better understand their role in influencing diet and diet quality. Online food environments are often characterized by personalized messaging and frequent change using digital algorithms, which introduces challenges for measurement and interpretation. Because many shoppers who use online shopping combine that method with in-store shopping, research to understand “hybrid” food environments will be critical.
•
Integrate rigorous food choice and diet outcome measures in research study designs. Additional neighborhood characteristics may influence the effects of interventions, and these relationships and pathways are part of understanding the link between neighborhood food environments and health. Furthermore, using store sales data at both the aggregate (store) and individual (shopper) levels to estimate food choices may be useful.

Intervention studies

•
Develop multilevel, multicomponent interventions to improve the healthy food environments and choices. A better understanding of the supply chain for small stores can inform effective strategies in these challenging retail food environments. Multilevel interventions that address unhealthy food marketing, individual- and family-level nutrition knowledge, point-of-purchase consumer guidance, and economic incentives to reduce costs of healthy foods are needed to effectively impact dietary behaviors.
•
Investigate the impact of interventions and policies to achieve healthier retail food environments and whether/how they impact dietary intake. For example, an important research focus would be to examine the national impact of the Healthy Food Financing Initiative (HFFI) and the GusNIP Incentive Program on food purchases and dietary intake health indicators and to explore the association of the effects across diverse communities. From a broad perspective, understanding the health, economic, and quality of life effects of opening new supermarkets in underserved communities or “food deserts” would significantly contribute to understanding retail food environments.
•
Community-engaged research methods in health disparities populations including rural, socioeconomically disadvantaged, and racial/ethnic minority communities. This includes expanding the use of equity-oriented strategies, measures, and outcomes in intervention research and exploring solutions to the root causes of inequities in healthy food access, including historical disinvestment in communities, structural racism, and racial/ethnic neighborhood segregation.
•
Develop interventions targeting the food environment that explicitly consider health equity and integrate other social determinants of health.
•
Use study designs that are methodically strongest for addressing biases and unmeasured confounders including novel trial designs. Earlier studies have yielded different or limited results on whether diet changes after a neighborhood intervention such as a new full-service grocery store.

Cross-cutting themes

Data and technology

•
Collect new data to better understand the intergenerational impacts of food insecurity. Furthermore, studies are needed to collect data investigating the effects of food insecurity in relation to other life events and leverage existing efforts.
•
Consider the use of GPS and GIS data in research focused on the assessment of the neighborhood food environment. Innovated data sources can provide real-time changes in food environments and better capture consumer purchasing patterns in the neighborhood context.
•
Disaggregate data, although protecting individual and community privacy, to better identify populations most impacted by food insecurity, hunger, and nutrition insecurity. Subpopulations within communities may experience unique risks, and disaggregated data can assist with developing more tailored approaches to prevent and alleviate the burden of food and nutrition security among these demographics.
•
Implement culturally and community-responsive technologies and methodologies for promoting nutrition and health. For example, data scientists have designed participatory technologies, mobile mapping, and SMS platform to link equitable food systems and community-powered health interventions.

Partnerships

•
Promote efforts to increase community data capacity beyond federal grants, and increase training in data science, including using participatory technology and community-driven data to transform the food environment and increase access to healthier foods using an equitable, community-centered approach. Existing datasets are often limited, given disparities in research participation and this approach brings equity and accuracy to community-level data.
•
Foster new partnerships, which are key to achieving health equity. Partnerships with various sectors, such as food retailers, foundations, community-based organizations, and advocacy groups, are critical to addressing food insecurity and increasing healthy food access.
•
Leverage existing local, regional, and federal efforts, such as Project Bread, CDC’s Racial and Ethnic Approaches to Community Health (REACH) program, federal assistance programs (e.g., SNAP, GusNIP Incentive Program, Centers for Medicaid, and Medicare Services), to reduce food insecurity and address neighborhood food environments.

Community-engaged research and perspectives of those with lived experience

•
Promote community-engaged research methods in health disparities populations to broaden knowledge about solutions to address food access and food insecurity in these high-risk populations. For example, rural areas provide an optimal context for examining how geography, income, and race contribute to food security and neighborhood food environments. Community-engaged approaches, including qualitative and mixed-methods research, are also critical for the empowerment of historically disadvantaged groups to take agency over the developing
•
Increase support for underrepresented researchers with lived experience, which can contribute to innovative questions and effective solutions. Prioritizing support for researchers from and funding for minority and underrepresented groups could bring an expanded lens to food insecurity and neighborhood food environment research, which can contribute to innovative questions and effective solutions. Researchers with lived experience and those immersed in community-engaged research have the potential to identify intervention strategies that lead to innovative solutions to reduce health disparities.