Inside out: Food and Nutrition Security for Justice Involved Adults in Philadelphia

Objective. Among those who face food insecurity, adults incarcerated in prison suffer from food insecurity and diet-related health problems at higher rates than the general population and face unique challenges to maintaining health promoting behaviors. The aim of this formative pilot and feasibility study was to describe the development and testing of an adapted, evidence-based nutritional health program developed by a partnership between The Food Trust, a food and nutrition security non-profit in Philadelphia, the Philadelphia Department of Prisons, and a member of the formerly incarcerated community to deliver evidence-based nutritional health information tailored to the prison food environment. The intervention entailed a weekly, 6-week health promotion program designed specifically for the prison setting based on evidence-based practices for improving nutrition, food security, and overall health and wellbeing outcomes. The aim of this study is to describe the formative and summative evaluation of this novel program and assess implementation feasibility, and participant acceptability, utilization, and pre-post changes in nutrition and physical activity behaviors.

Design. This mixed-methods study took place in Philadelphia, PA in 2023. N = 66 inmates were recruited from two correctional facilities to participate in a 6-week pilot program examining overall program feasibility, utilization, engagement, and acceptability. Acceptability, pre-post surveys, and food journals were administered within weekly programming. Main outcome measures included participant acceptability and feasibility, self-reported diet, food purchasing, and exercise behaviors. Univariate (means, standard deviations, frequencies, and ranges), bivariate (paired samples t-tests, independent samples t-tests, Parsons’s correlations) and ordinary least squares multiple regression analyses were conducted in SPSS v.29 to assess changes from pre-post, adjusting for attendance, gender, age, and mental health.

Results. Participants: Adults aged 18+ years, n = 66 (n = 26 men, n = 40 women) participated at baseline and 31 (n = 8 men, n = 23 women) participated at follow-up. The majority of participants were between the ages of 18–35 (61%) and were Black (75%). The retention rate was 47%. The high rate of attrition is due to inmates being released during the course of the program. On average, the participation rates were high (74%), with most people who completed pre-post tests (n = 23) attending more than two-thirds of classes offered. Feasibility and acceptability surveys show high levels of program acceptance and utilization of resources offered. Food journal data show limited food variety, high levels of snacking, and inconsistent reporting for meals served.

Participants. reported significant improvements (p<.05) from pre- to post-test on purchases of reduced-sodium/added-fat foods, improving the overall healthfulness of foods purchased at the prison commissary, and increasing time spent engaging in physical activities. Those reporting making small changes to eat healthier or be more active also increased from pre to post, but this was not significant (p>.05).

Conclusions. This partnered, community-driven health promotion intervention was a feasible and acceptable way to help support improvements in health promotion behaviors including overall healthfulness of foods purchased and improvements in time spent exercising among prisoners who typically face major institutional barriers to health.