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Approximately 1 in 6 children in the United States, and 1 in 5 children in our local county (Hamilton County, Ohio), are food insecure. Here, we describe a novel community–academic partnership to address food inequity through distributed leadership and shared power with local neighborhood leaders. Using neighborhood-level data and community voice, 3 Cincinnati neighborhoods with high rates of poverty and food insecurity were selected as the primary intervention targets. Neighborhood leadership councils with community members representing each neighborhood were created. These councils requested intervention proposals and then decided which community designed interventions would receive grant funding. The academic partner provided grant funding distribution, quality improvement support, and data guidance and support for all partners, as well as community engagement support if desired by the community-led intervention leaders. In its first year (2021–2022), 9 interventions were funded, moving more than $250 000 into community-designed and community-led interventions to promote food security in 3 disadvantaged neighborhoods. Through leveraging community partnerships, these initiatives supplied 89 039 equivalent meals, including 56 244 pounds of produce, serving at least 3106 families in 3 neighborhoods in Cincinnati. Critical to the success of the initiatives were distributed leadership, shared power, word of mouth, and community engagement. The success of this type of community–academic partnership shows promise to address a wide variety of social and health challenges.

The System to Achieve Food Equity Learning Network (SAFE) began as a response to the COVID-19 pandemic surge in food insecurity. Nationally, rates of food insecurity rose dramatically during the pandemic, with an estimated increase of an additional 7 million children from 2018, to a total of 18 million children.1  This increase was experienced locally in Cincinnati, Ohio. The experience of food insecurity during childhood is associated with a myriad of negative health, socioemotional, and developmental effects.2,3  Pediatricians are called on to address childhood food insecurity.4  The primary goal of SAFE’s collective effort in response was to increase food security and improve nutrition quality for all 66 000 children living in Cincinnati, with a focus on children who live in households and neighborhoods experiencing a disproportionate burden of food insecurity. The network brought together key partners to address food insecurity, including the local hospital system, local government, the regional food policy council, nonprofit organizations including food pantries, the school system, and the library system. By initiating open lines of communication between these critical stakeholders, SAFE was beginning to build a learning network.5 

As a first step, SAFE mapped childhood poverty and emergency free-food distribution sites across Cincinnati as a means of identifying geographic areas likely experiencing a gap between anticipated need and current supply. To focus our learning, guided by neighborhood-level data and community voice, SAFE chose 3 neighborhoods to target its initial collective response: Avondale, East Price Hill, and Lower Price Hill. These 3 neighborhoods have faced decades of underinvestment, in no small part because of the redlining practices of the 1930s through which the Home Owners Loan Corporation likely labeled them as “hazardous,”6  thus making it nearly impossible to obtain a mortgage and driving away investment. In 2020, residents in Avondale, East Price Hill, and Lower Price Hill self-identified their race as 81%, 36%, and 48% Black, respectively, and households self-reported incomes of 33%, 27%, and 66% below the federal poverty level, respectively.7  These rates of poverty are significantly higher than the United States average of approximately 12%.8  East Price Hill also has a significant Latino population, with 20% of residents self-identifying as Hispanic/Latino.7  By selecting these neighborhoods, SAFE also aimed to address inequities driven and sustained by systemic racism.9 

In November 2021, with a desire to grow and address food insecurity beyond emergency food distribution, SAFE launched its community-led intervention initiative. The goal of this initiative was to facilitate innovative, family-centered, and community-led interventions to catalyze transformational change to improve food security. The SAFE learning network invited individuals and organizations to submit project proposals to improve food security in any of the selected neighborhoods. Embedded in the mission of the initiative was coproduction.5  Neighborhood leadership councils informed, assessed, and selected the community-created interventions that would receive funding to support their neighborhood. The stewardship team reviewed the input from the neighborhood leadership councils, considered the social impact of the interventions, and determined the financial award that would be distributed to the recipients (aiming to prevent inequitable disbursement of funds). In addition, the stewardship team strived to support new or emerging community leaders who would receive funding, looking for ways to support their development, success, and ensure sustained future growth. In the pursuit of equity, shared power and a collaborative culture were essential.

The SAFE Learning Network was awarded $475 000 of grant funding from a foundation, with more than $250 000 to be stewarded through the academic partner to fund community-designed, community-chosen, and community-led initiatives to promote food equity. The remaining budget was used for a community connector position at a nonprofit, a community engagement specialist, and funding for additional research and infrastructure. The idea to finance community-led food equity interventions was first presented and discussed at regularly scheduled SAFE meetings. SAFE sought community-led interventions that were based in improvement science and would include measurable tests of change.

In pursuit of codesign and distributed leadership, SAFE created neighborhood leadership councils of 5 to 7 community members from the 3 neighborhoods of focus (Avondale, East Price Hill, and Lower Price Hill; Fig 1). Existing relationships between the academic partner and many families and community members allowed SAFE to quickly create the neighborhood leadership councils. Our hospital system has previously created neighborhood leadership councils for disease-specific conditions such as asthma. Additionally, our Center for Clinical & Translational Science & Training has strong community connections with a long history of community-engaged work. Proposals to address food equity in the 3 neighborhoods of focus were solicited from community members via flyers and social media. Proposals were then presented to the neighborhood leadership councils for codesign and evaluation. Neighborhood leadership evaluated the proposal using a rubric (Supplemental Table 2). The stewardship team had 10 members, including 5 representatives of the academic partner, and 5 members of nonprofit organizations. Based on assessments made by the neighborhood leadership team, the stewardship team evaluated the impact of the proposed initiatives and determined the financial award. One way coproduction was woven into the fabric of this initiative was through a model of shared governance to ensure equitable evaluation and selection of the interventions (Fig 2). The model consisted of a neighborhood leadership council in each of the neighborhoods and a stewardship team.

FIGURE 1

Timeline of community-led intervention process.

FIGURE 1

Timeline of community-led intervention process.

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FIGURE 2

Model of approach used to ensure distributed leadership and shared power through checks and balances during this work.

FIGURE 2

Model of approach used to ensure distributed leadership and shared power through checks and balances during this work.

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Data to be collected/tracked were determined by the intervention leader with support from the academic partner. Once funding was distributed, the academic partner provided data management, quality improvement, and community engagement support as wanted or as needed by the community-led intervention leaders. For example, during biweekly meetings with quality improvement specialists, intervention leaders’ learnings and data were captured using the A3 method template.10  Built into the design of this advocacy work was a series of checks and balances to ensure distributed leadership and shared power (Fig 2).

The community-led intervention process brought together key stakeholders and allocated decision-making to the community by having the neighborhood leadership councils codesign and determine which community designed and led interventions to fund. More than $250 000 funded 9 different interventions (Table 1). Funded interventions ranged from supporting the expansion of existing programs, to investing in new programming of existing organizations, to supporting the startup of first-time interventions. Given the rolling nature of application acceptance, most intervention learnings and results were captured within the first 6 months of intervention initiation. The chosen interventions included a community garden, a mobile food pantry, shelf-stable food delivery, produce delivery, and a resident-designed, launched, and operated nonprofit grocery and deli enterprise offering a range of needs-based free-food programming. Collectively, the community-led initiatives were able to supply more than 89 039 meals, including 56 244 pounds of produce, serving at least 3106 families, and they provided nutrition and cooking education to 3 neighborhoods in Cincinnati. The amount of meals and produce distributed by partners per dollar invested varied in part because some interventions, such as the grocery store, sold produce in addition to free giveaways. Other community-led interventions have additional sources of funding that allowed them to have larger reach than would be expected based on the SAFE funding alone. A summary of the first year of the SAFE Learning Network’s work is available online.11 

TABLE 1

Overview of Community-Led Initiatives to Address Food Inequity

Community-Led Initiative and Target NeighborhoodDescriptionNeighborhood Leadership CommentsAward AmountUse of FundingOutcome Measure
HyperFarm
Avondale 
Use hydroponic indoor farming to provide fresh, local produce delivered weekly to local families. “The neighborhood is in need of accessing fresh local food.” “Great and innovative way to provide fresh food to the community.” $90 100 Purchased an indoor hydroponic farming system ($80 000). Because of delays with zoning and electricity, pivoted. Partnered with food delivery company to deliver produce from community gardens (some vegetables not available from gardens were purchased in bulk). 62 families were registered and received biweekly deliveries of
15-20 lb of fresh produce. This totaled 3152 lb of fresh produce over 3 mo. 
Queen Mother’s Market:
Avondale Community Garden 
Establish a community garden, provide hands-on experience in gardening; offer education related to nutrition, healthy meal planning and food choices “Includes education of fruits and vegetables to relatable health issues in the community of Avondale. Shifting the mind set of why fruits and vegetables are important will be key.” $20 000 Garden beds, gardening equipment 30 families received boxes of produce from the garden weekly for 3 mo. 
Last Mile Mobile Market
Avondale 
Use a refrigerated van to use as a mobile food pantry to take rescued food from grocers and food establishments to provides local access to boxes of free, fresh food including meat, dairy, produce, and bread. “Yes, without a grocery store being in Avondale residents are limited to what they have available. I like that this mobile van offers a variety of food options. Many times families do not feel that they have options, so this will like more of a choice.” “Spreading the word is important.” $50 000 Staffing and volunteer recruitment. Also funded refrigerated van maintenance, insurance, and fueling. Shelving units to outfit the refrigerated van and materials needed for food distribution events (folding tables, tent, whiteboard, gloves, bags) Total of 34 972 lb of food distributed. Average of 45 shoppers per distribution day. 
Childhood Food Solutions
Avondale 
Deliver shelf-stable basic groceries to local families. Provide extra boxes as requested with aim of getting families through days when they have no other option for food. “Assisting in filling the meal gap, but the food may not be sustainable. They are giving people food, but the food is very unhealthy.” “Not a long-term solution.” $20 000 Groceries, boxes, and delivery. 163 families received a total of 448 food boxes on a monthly or biweekly basis.
Conducted survey of recipients to see how boxes helped families: With 97 responses in the past 4 mo, families reported:
Less stress - 59%
More money for groceries - 58%
Not going to bed hungry - 51%
More energy - 40% 
Meiser’s Fresh Grocery & Deli
Lower Price Hill 
Support opening and pilot of new community-designed, driven, and operated grocery store.
Supply and manage inventory of free food and affordable food (WIC, SNAP, and Produce Perks). Establish system to track inventories, customer activity and sales. Advertise Meiser’s Green Giveaways. 
N/A (test applicant, did not present to neighborhood leadership group. Leaders remarked that the relationship with the SAFE Learning Network led to their first use of improvement science methodology, and allowed for cross-neighborhood and interorganizational collaborations). $12 000 Additional 10 h/wk for 3 mo for an associate ($15/h). Associate training and community outreach. Transaction processing costs and service subscription. Purchasing inventory to become a WIC-qualified location ($10 000). 10 307 meals worth of food sold. 515 households registered for Green Giveaways over first year from opening. Store hours were expanded from 30 to 60 h/wk. Median sales increased from about $1300 per week to >$4000 in transactions each week. Cooking tools and household items were distributed so that families had the necessary items to prepare desired meals and recipes. 
Isaiah 55 Inc
The Kanggy Garden Project
Lower Price Hill 
Provide a mobile delivery service to provide healthy, prepared meals and meal kits. “Yes, we need healthy foods and also have the food delivered to people with instructions and a meal they can cook themselves.” $10 000 Coolers, insulated delivery bags, food 122 families received hot meal/meal kits weekly for up to 6 wk. 
Feeding the Future- Lord Gym’s Ministries
East Price Hill 
Sponsor 65–80 children to learn how to make 5 easy meals in a crockpot, after which the children keep the crockpot. “This intervention could generate excellent output/good impact at the community.”
“This neighborhood is very much depending on the SAFE program. I would like to thank you all for contributing your time and concerns to my community. One team one mission.” 
$25 000 Crockpots, food, and commercial kitchen equipment 2804 meals served, 67 households where children learned how to cook meals in a crockpot/kept crockpot after. 
MyWhy
East and Lower Price Hill 
Provide a pay-as-you-go farmer’s market. “I think they have a well-developed plan. I also like that they partner with other organizations. There is strength in collaboration.” $15 050 (SNAP, WIC, Produce Perks cover 2/3 of market, this is remaining 1/3) Marketing materials, fruit distribution, farmer’s markets. 37 567 lb of fresh produce distributed. 
Eat 2 Live Food Equity
Lower Price Hill 
Sponsor 10 local families to learn how to make healthy and nutritious meals “The community needs to learn about cooking, budgeting and having a Black man teach these classes is a bonus.” $10 000 Cookware, recipe ingredients, space rental. Participants who regularly attended also received grocery gift cards. 234 meals served over 6 wk (September and October 2022) 
Community-Led Initiative and Target NeighborhoodDescriptionNeighborhood Leadership CommentsAward AmountUse of FundingOutcome Measure
HyperFarm
Avondale 
Use hydroponic indoor farming to provide fresh, local produce delivered weekly to local families. “The neighborhood is in need of accessing fresh local food.” “Great and innovative way to provide fresh food to the community.” $90 100 Purchased an indoor hydroponic farming system ($80 000). Because of delays with zoning and electricity, pivoted. Partnered with food delivery company to deliver produce from community gardens (some vegetables not available from gardens were purchased in bulk). 62 families were registered and received biweekly deliveries of
15-20 lb of fresh produce. This totaled 3152 lb of fresh produce over 3 mo. 
Queen Mother’s Market:
Avondale Community Garden 
Establish a community garden, provide hands-on experience in gardening; offer education related to nutrition, healthy meal planning and food choices “Includes education of fruits and vegetables to relatable health issues in the community of Avondale. Shifting the mind set of why fruits and vegetables are important will be key.” $20 000 Garden beds, gardening equipment 30 families received boxes of produce from the garden weekly for 3 mo. 
Last Mile Mobile Market
Avondale 
Use a refrigerated van to use as a mobile food pantry to take rescued food from grocers and food establishments to provides local access to boxes of free, fresh food including meat, dairy, produce, and bread. “Yes, without a grocery store being in Avondale residents are limited to what they have available. I like that this mobile van offers a variety of food options. Many times families do not feel that they have options, so this will like more of a choice.” “Spreading the word is important.” $50 000 Staffing and volunteer recruitment. Also funded refrigerated van maintenance, insurance, and fueling. Shelving units to outfit the refrigerated van and materials needed for food distribution events (folding tables, tent, whiteboard, gloves, bags) Total of 34 972 lb of food distributed. Average of 45 shoppers per distribution day. 
Childhood Food Solutions
Avondale 
Deliver shelf-stable basic groceries to local families. Provide extra boxes as requested with aim of getting families through days when they have no other option for food. “Assisting in filling the meal gap, but the food may not be sustainable. They are giving people food, but the food is very unhealthy.” “Not a long-term solution.” $20 000 Groceries, boxes, and delivery. 163 families received a total of 448 food boxes on a monthly or biweekly basis.
Conducted survey of recipients to see how boxes helped families: With 97 responses in the past 4 mo, families reported:
Less stress - 59%
More money for groceries - 58%
Not going to bed hungry - 51%
More energy - 40% 
Meiser’s Fresh Grocery & Deli
Lower Price Hill 
Support opening and pilot of new community-designed, driven, and operated grocery store.
Supply and manage inventory of free food and affordable food (WIC, SNAP, and Produce Perks). Establish system to track inventories, customer activity and sales. Advertise Meiser’s Green Giveaways. 
N/A (test applicant, did not present to neighborhood leadership group. Leaders remarked that the relationship with the SAFE Learning Network led to their first use of improvement science methodology, and allowed for cross-neighborhood and interorganizational collaborations). $12 000 Additional 10 h/wk for 3 mo for an associate ($15/h). Associate training and community outreach. Transaction processing costs and service subscription. Purchasing inventory to become a WIC-qualified location ($10 000). 10 307 meals worth of food sold. 515 households registered for Green Giveaways over first year from opening. Store hours were expanded from 30 to 60 h/wk. Median sales increased from about $1300 per week to >$4000 in transactions each week. Cooking tools and household items were distributed so that families had the necessary items to prepare desired meals and recipes. 
Isaiah 55 Inc
The Kanggy Garden Project
Lower Price Hill 
Provide a mobile delivery service to provide healthy, prepared meals and meal kits. “Yes, we need healthy foods and also have the food delivered to people with instructions and a meal they can cook themselves.” $10 000 Coolers, insulated delivery bags, food 122 families received hot meal/meal kits weekly for up to 6 wk. 
Feeding the Future- Lord Gym’s Ministries
East Price Hill 
Sponsor 65–80 children to learn how to make 5 easy meals in a crockpot, after which the children keep the crockpot. “This intervention could generate excellent output/good impact at the community.”
“This neighborhood is very much depending on the SAFE program. I would like to thank you all for contributing your time and concerns to my community. One team one mission.” 
$25 000 Crockpots, food, and commercial kitchen equipment 2804 meals served, 67 households where children learned how to cook meals in a crockpot/kept crockpot after. 
MyWhy
East and Lower Price Hill 
Provide a pay-as-you-go farmer’s market. “I think they have a well-developed plan. I also like that they partner with other organizations. There is strength in collaboration.” $15 050 (SNAP, WIC, Produce Perks cover 2/3 of market, this is remaining 1/3) Marketing materials, fruit distribution, farmer’s markets. 37 567 lb of fresh produce distributed. 
Eat 2 Live Food Equity
Lower Price Hill 
Sponsor 10 local families to learn how to make healthy and nutritious meals “The community needs to learn about cooking, budgeting and having a Black man teach these classes is a bonus.” $10 000 Cookware, recipe ingredients, space rental. Participants who regularly attended also received grocery gift cards. 234 meals served over 6 wk (September and October 2022) 

Key learnings emerged from the community-led initiatives that are highly relevant for those planning to conduct similar work. The use of distributed leadership (all interventions were community-designed, -chosen, and -led) neutralized power dynamics and was essential to the production of relevant, meaningful, and effective interventions. The positive outcomes from this approach demonstrate how it is far superior to the “savior” approach in which external organizations intervene in communities autonomously without engaging with communities.12  The shared power model of the community-led initiatives allowed for high levels of community support before the start of any interventions. Because the intervention leaders live and work in the communities they were serving, the leaders also noted better and more timely feedback from the community. Furthermore, the approach saw enhanced success of the individual interventions from increased word of mouth in part because a trusted messenger (the community member leading the intervention) was the one spreading the word about the community-led interventions. Some interventions far surpassed their initial goals. Another key learning was the value of the role of the academic partner as an anchor institution.13  The academic partner was able to convene and support major stakeholders through a combination of its positive reputation in the community and had significant resources available to support interventions. Also, the stewardship team strived to provide additional entrepreneurial development of intervention leaders. They were searching for ways to support the continued growth of intervention leaders as innovators.

A few challenges emerged at the learning network level. One was restrictions regarding the funding timeline. The academic partner had only 1 year from when the funding was initially distributed to report back to the funder. Fortunately, the funder’s reporting requirements were less intensive compared with other funders. An additional challenge was that the academic partner had key staff turnover during the first year of this work. Furthermore, leaders of the community interventions had worries about the funding and experienced some stress surrounding the use of funds (ie, worries they would have to pay back to the academic partner if the interventions were not as successful as proposed). Building trust through clearly described expectations of the academic–community partnership in advance, as well as maintaining open lines of communication, will continue to be crucial for this work. Intervention leaders have noted that open lines of communication helped shift the dynamic from grantee/grantor toward peer to peer.

Additional learnings were gained from qualitative feedback from families about different approaches among the interventions themselves. For example, families praised interventions that gave them choice and at times they expressed disappointment when healthy options were limited, or when there were limited options overall. Families experienced dignity when they felt they had options similar to a grocery store and when there was more intention in giving them options. We would encourage those considering interventions to support food equity in the future to prioritize offering choices to families to increase participation and support dignity. Many interventions addressed common barriers reported by families (Table 1), such as transportation. Families reported food acquisition cost as a significant driver of their food insecurity, and cost was addressed through most interventions by making food free to families. However, some families reported experiencing increased dignity when the intervention used a “pay what you can” or “specials, sales and rewards” model, instead of receiving free food perceived as a “hand out” to prevent feelings of stigma or negative connotations around the word “free.” The enormous degree to which families in our community are experiencing food insecurity underscores the need to advocate for an improved food system and policies that will address underlying drivers of food insecurity.

The community-led intervention leaders faced many barriers, primarily because of current local and federal policies. Many food-insecure families experience cyclical monthly needs, typically with less need during the first few calendar days of the month after public benefits have been distributed.14  This pattern quickly became notable to many leaders of the community-led initiatives, and they adjusted their processes to better meet this cycle. In addition to advocating for changes to public benefits, it is important to consider weekly variation in food needs when planning food equity interventions. Other leaders faced zoning issues, requiring adjustments in plans because of local regulations. Multiple initiative leaders have mentioned frustration with broader food policies preventing them from optimal execution of projects and discussed the need for a more centralized citywide food distribution process to support the development of justice-oriented enterprises. This again underscores the ongoing need to advocate for changes to our food systems and policies to better address hunger and food insecurity in the United States. Through partnership with learning network member, the Greater Cincinnati Regional Food Policy Council, SAFE continues to connect community leaders with systems and policy change advocacy opportunities.

Many interventions faced barriers from other social determinants of health negatively affecting their local community. For example, the community garden experienced less involvement after there was a nearby gun violence incident. Leaders also commented that families’ stress and experience of trauma affected their ability to engage in some interventions. Home delivery programs were limited in reach because of housing insecurity, leading some families to stop participating in the intervention. Intervention leaders also faced unanticipated expenses. For example, the cost to maintain an inventory of food was greater than expected for some. As with all advocacy work striving to address social determinants of health, it is important to consider the broader social–political context families live in and acknowledge the role of structural racism’s toxic influence at all levels.9 

In its first year (2021–2022), the SAFE Learning Network funded 9 community-designed, chosen, and led interventions to promote food equity. The community-led initiatives supplied more than 89 000 meals, including more than 56 000 pounds of produce, and served more than 3100 families in 3 neighborhoods in Cincinnati over the course of 4 to 6 months. Keys to success of the initiatives included shared power, distributed leadership, word of mouth, and community engagement. Common challenges faced by intervention leaders included policy barriers (both local food regulatory policies and national public benefits policies) and interrelated social determinants of health affecting their neighborhoods. Kroger’s Zero Hunger Zero Waste foundation has granted SAFE an additional year of funding for continued support of the community-led interventions. We are working with the intervention leaders to determine how best to use these funds to continue to support successful interventions and ensure sustainability. The SAFE Learning Network has continued to learn alongside our local community, striving to achieve empowering distributed leadership. Overall, we found the model of a neighborhood leadership council informing a stewardship team to be an excellent way to put decision-making power in the community. We are planning to move toward a networkwide collaborative model of stewardship, to continue to pursue shared power and distributed leadership. The success of this advocacy work demonstrates a potential model of collaboration that could be used to address a wide variety of social and health challenges.

The authors thank Shannon Carr, Anthony J. Fairhead, Matt M. Hawkins, Rebecca M. Hennessey, Mary Beth Knight, and Kai Stoudemire for critically reviewing and revising the manuscript. Thank you to the leaders, team members, and volunteers of the initiatives to address food inequity and the members of the Neighborhood Leadership Councils of Avondale, East Price Hill and Lower Price Hill. Thank you to all members of the System to Achieve Food Equity: All Children Thrive Learning Network, 84.51°, Childhood Food Solutions, Cincinnati and Hamilton County Public Library, Cincinnati Children’s Hospital Medical Center, Cincinnati Public School, City of Cincinnati Office of Environment and Sustainability, Cincinnati City Council, Chef Mike’s Burning with Style Culinary Services, Freestore Foodbank, Greater Cincinnati Regional Food Policy Council, Green Umbrella, Hamilton County Recycling and Solid Waste, Hyperfarm, Isaiah 55, Inc, Kroger’s Zero Hunger Zero Waste Foundation, La Soupe, Last Mile Food Rescue, Lehigh University, Lord’s Gym, MyWhy, Queen Mothers Market, The Health Collaborative, Walnut Hills Redevelopment Foundation, UMC Food Ministry, University of Cincinnati, University of Louisville, and Your Store of the Queen City.

*

A list of network affiliates appears in the Acknowledgments.

Dr Gorecki analyzed the data and drafted the initial manuscript; Ms Sevilla provided quality improvement expertise and support, conceptualized the intervention, designed the data collection instrument, and critically reviewed and revised the manuscript; Ms Gasperetti coordinated the advocacy work, collected the data, and critically reviewed and revised the manuscript; Dr Bartoszek participated in the stewardship team and critically reviewed and revised the manuscript; Dr Chera participated in the stewardship team, contributed to project assessment, and critically reviewed and revised the manuscript; Ms Cutler collected and analyzed the data and critically reviewed and revised the manuscript; Ms Okano provided quality improvement expertise and support, collected the data, and critically reviewed and revised the manuscript; Dr Samuel provided data management and analytics expertise, influenced the stewardship team process design and participated in the stewardship team, and critically reviewed and revised the manuscript; Ms Stewart coordinated the advocacy work, collected the data, and critically reviewed and revised the manuscript; Dr Riley conceptualized and designed the initiative, supervised data collection, analyzed the data, critically reviewed, and revised the manuscript; and all authors approved of the final manuscript and agree to be accountable to all aspects of this work and have participated in this advocacy work.

FUNDING: The community-led initiatives were funded by a grant from The Zero Hunger Zero Waste Foundation. Dr Gorecki’s effort on this project was supported by the National Research Service Award in Primary Medical Care, T32HP10027, through the Health Resources and Services Administration. The other authors received no additional funding.

CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest to disclose. The Health Resources and Services Administration had no role in the design and conduct of the study. Sunny Parr, the executive director of Zero Hunger Zero Waste Foundation, was a member of the System to Achieve Food Equity Learning Network Stewardship Team.

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Supplementary data