The COVID-19 pandemic led to greater food insecurity across the world, and government and charitable organisations did not always respond quickly enough or adequately to meet food needs. Mutual aid (MA) – neighbours helping neighbours to meet survival needs – mobilised residents to share food, often through outdoor food cabinets and refrigerators. This study aims to understand how MA food sharing was implemented, including food availability, acceptability, accessibility and impact on food access.

This case study describes one MA food sharing system by triangulating data from flyers, notes from nineteen volunteer meetings, six cabinet host interviews, data extracted from 1387 social media posts and 356 photographs, and 111 resident surveys.

Tompkins County, NY, USA (total population about 100 000).

We estimated high availability of food: approximately 250 000 food servings were shared monthly, mostly carbohydrates. Most residents obtaining food found it acceptable, including satisfaction with food safety and cleanliness, food quantity, and ease of travel to the cabinets but were less satisfied with food variety. MA food sharing was accessible to food-insecure, unemployed and disabled residents, but not other priority populations. About two-thirds of residents reported improved food access. Volunteers exhibited tenacity and ingenuity in meeting operational challenges which included trash and vandalism, winter weather and unusable food contributions while foregrounding residents’ safety and privacy as shared values and navigating conflicting views about fairness.

In times of crisis, MA can improve food access through free food sharing cabinets, but barriers include unacceptable food contributions and outdoor conditions.

Subsidised or cost-offset community-supported agriculture (CO-CSA) connects farms directly to low-income households and can improve fruit and vegetable intake. This analysis identifies factors associated with participation in CO-CSA.

Farm Fresh Foods for Healthy Kids (F3HK) provided a half-price, summer CO-CSA plus healthy eating classes to low-income households with children. Community characteristics (population, socio-demographics and health statistics) and CO-CSA operational practices (share sizes, pick up sites, payment options and produce selection) are described and associations with participation levels are examined.

Ten communities in New York (NY), North Carolina (NC), Vermont and Washington states in USA.

Caregiver–child dyads enrolled in spring 2016 or 2017.

Residents of micropolitan communities had more education and less poverty than in small towns. The one rural location (NC2) had the fewest college graduates (10 %) and most poverty (23 %) and poor health statistics. Most F3HK participants were white, except in NC where 45·2 % were African American. CO-CSA participation varied significantly across communities from 33 % (NC2) to 89 % (NY1) of weeks picked up. Most CO-CSA farms offered multiple share sizes (69·2 %) and participation was higher than when not offered (76·8 % v. 57·7 % of weeks); whereas 53·8 % offered a community pick up location, and participation in these communities was lower than elsewhere (64·7 % v. 78·2 % of weeks).

CO-CSA programmes should consider offering a choice of share sizes and innovate to address potential barriers such as rural location and limited education and income among residents. Future research is needed to better understand barriers to participation, particularly among participants utilising community pick up locations.

To examine cross-sectional associations between farmers’ market shopping behaviours and objectively measured and self-reported fruit and vegetable (FV) intake among rural North Carolina (NC) and New York City (NYC) shoppers.

Cross-sectional intercept surveys were used to assess self-reported FV intake and three measures of farmers’ market shopping behaviour: (1) frequency of purchasing FV; (2) variety of FV purchased and (3) dollars spent on FV. Skin carotenoids, a non-invasive biomarker for FV intake, were objectively measured using pressure-mediated reflection spectroscopy. Associations between farmers’ market shopping behaviours and FV intake were examined using regression models that controlled for demographic variables (e.g. age, sex, race, smoking status, education, income and state).

Farmers’ markets (n 17 markets) in rural NC and NYC.

A convenience sample of 645 farmers’ market shoppers.

Farmers’ market shoppers in NYC purchased a greater variety of FV and had higher skin carotenoid scores compared with shoppers in rural NC. Among all shoppers, there was a positive, statistically significant association between self-reported frequency of shopping at farmers’ markets and self-reported as well as objectively assessed FV intake. The variety of FV purchased and farmers’ market spending on FV also were positively associated with self-reported FV intake, but not skin carotenoids.

Those who shop for FV more frequently at a farmers’ markets, purchase a greater variety of FV and spend more money on FV have higher self-reported, and in some cases higher objectively measured FV intake. Further research is needed to understand these associations and test causality.

To examine participants’ experiences with nutrition education classes that were implemented with and designed to complement a cost-offset community-supported agriculture (CSA) programme.

Qualitative analysis of data from twenty-eight focus groups with ninety-six participants enrolled in Farm Fresh Foods for Healthy Kids (F3HK). Transcribed data were coded and analysed by a priori and emergent themes.

Rural and micropolitan communities in New York, North Carolina, Vermont and Washington (USA).

Ninety-six F3HK participants.

Participants found recipes and class activities helpful and reported improvements in nutrition knowledge, food preservation skills and home cooking behaviours for themselves and their children; they also reported that classes promoted a sense of community. Some educators better incorporated CSA produce into lessons, which participants reported as beneficial. Other obligations and class logistics were barriers to attendance; participants recommended that lessons be offered multiple times weekly at different times of day. Other suggestions included lengthening class duration to encourage social engagement; emphasising recipes to incorporate that week’s CSA produce and pantry staples and offering additional strategies to incorporate children in classes.

Complementing a cost-offset CSA with nutrition education may enhance programme benefits to low-income families by improving nutrition knowledge and cooking behaviours. However, future interventions will benefit from ongoing coordination between educators and local growing trajectories to maximise timely coverage of unfamiliar produce in lessons; synchronous scheduling of CSA pick-up and classes for participant convenience and creative strategies to engage children and/or provide childcare.

To examine perspectives on food access among low-income families participating in a cost-offset community-supported agriculture (CO-CSA) programme.

Farm Fresh Foods for Healthy Kids (F3HK) is a multicentre randomized intervention trial assessing the effect of CO-CSA on dietary intake and quality among children from low-income families. Focus groups were conducted at the end of the first CO-CSA season. Participants were interviewed about programme experiences, framed by five dimensions of food access: availability, accessibility, affordability, acceptability and accommodation. Transcribed data were coded on these dimensions plus emergent themes.

Nine communities in the US states of New York, North Carolina, Washington and Vermont.

Fifty-three F3HK adults with children.

CSA models were structured by partner farms. Produce quantity was abundant; however, availability was enhanced for participants who were able to select their own produce items. Flexible CSA pick-up times and locations made produce pick-up more accessible. Despite being affordable to most, payment timing was a barrier for some. Unfamiliar foods and quick spoilage hindered acceptability through challenging meal planning, despite accommodations that included preparation advice.

Although CO-CSA may facilitate increased access to fruits and vegetables for low-income families, perceptions of positive diet change may be limited by the ability to incorporate share pick-up into regular travel patterns and meal planning. Food waste concerns may be particularly acute for families with constrained resources. Future research should examine whether CO-CSA with flexible logistics and produce self-selection are sustainable for low-income families and CSA farms.