{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:27:59Z","timestamp":1792787279644,"version":"4.5.0"},"reference-count":43,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T00:00:00Z","timestamp":1764720000000},"content-version":"unspecified","delay-in-days":155,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Texas Health Resources"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2025,11,17]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>While 86% of US households are food secure, nutritional quality remains poor. Minimal research has been conducted to identify and address the complex, multilevel barriers and solutions for nutrition security in local communities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We employed a mixed-methods community-based participatory research approach to better understand nutrition security by identifying multilevel barriers and potential solutions from the perspectives of 35 low-income community residents, 27 food system workers and 7 local policy-makers in the Dallas-Fort Worth metroplex.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four themes emerged: (1) access to healthy food is complex; (2) community member gaps in nutrition knowledge and food preparation; (3) overcoming daily logistical challenges and (4) awareness, use and evaluation of nutrition security resources. Community members discussed 28 barriers and 17 solutions to eating fresh fruits and vegetables (FFV) and rated them on their impact. Knowledge and education barriers made it more difficult to eat FFV than access or logistics. The most impactful community member solutions were mitigating transportation challenges and increasing awareness of food programmes. Food system workers discussed and rated 21 barriers to eating FFV and 26 solutions\u2014the most impactful barrier was a lack of cohesive food system planning, and the most impactful potential solutions were improving the location of quality grocery stores, increasing food programme locations and integrating community members\u2019 feedback in food system planning. Policymakers reported 15 barriers to eating FFV and 19 solutions; the most impactful barriers were a lack of locally grown food and methods of food storage. The most impactful policy-maker solutions were improvement of food system planning and integrating community members\u2019 feedback in food system planning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Nutrition security is not universally defined nor understood. Incorporating perspectives across the food system is necessary to address root causes and meaningful solutions to nutrition security.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-003642","type":"journal-article","created":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T19:10:17Z","timestamp":1764875417000},"page":"e003642","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Complex, multilevel barriers and solutions for nutrition security in the USA: a community-based participatory research approach"],"prefix":"10.1136","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-0075-6381","authenticated-orcid":false,"given":"Brittany D","family":"Linde","sequence":"first","affiliation":[{"name":"Healthy People, Healthy Communities, Texas Health Resources, Arlington, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel J","family":"Meadows","sequence":"additional","affiliation":[{"name":"Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, Fort Worth, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellyn","family":"Maese","sequence":"additional","affiliation":[{"name":"Gallup Inc, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Miljanich","sequence":"additional","affiliation":[{"name":"Gallup Inc, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Frome","sequence":"additional","affiliation":[{"name":"Gallup Inc, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Dufrene","sequence":"additional","affiliation":[{"name":"Healthy People, Healthy Communities, Texas Health Resources, Arlington, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,12,4]]},"reference":[{"key":"2026010703080724000_3.2.e003642.1","unstructured":"FAO, IFAD, UNICEF, WFP, WHO . 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