Food waste economically and environmentally impacts every industry in the U.S., including healthcare systems.Discussions of waste reduction in healthcare generally focuses on failure of care delivery, lack of care coordination, overtreatment, pricing failures (e.g., overpricing of procedures such as computed tomography scans), and fraud and abuse (Cafarella, 2012). Food, however, is a major waste stream component produced every day by patients, healthcare workers, and visitors. Globally, approximately 1.3 million tons of food is lost or wasted each year. Food losses can occur anywhere in the food chain between producer and consumer; food waste results when safe and nutritious food is discarded (Food and Agriculture Association of the United Nations [FAO], 2021). At the same time, nearly 1 billion people around the world go hungry (FAO, 2021). This juxtaposition between waste/loss and need represents a major social and environmental problem which must be addressed. In the United States alone, approximately 31% of the food supply (133 billion pounds) is wasted annually (United States Environmental Protection Agency [EPA], 2021a), producing significant methane emissions. As a potent greenhouse gas, methane has 25 times the global warming potential of carbon dioxide (EPA, 2021a). This paper examines the food waste management and disposal methods, findings and implications from a study conducted in rural northeastern United States hospitals.

Food Waste in Hospital Settings

Hospital solid waste, which includes organic (i.e., food) and inorganic matter is of significant concern (Chandrappa & Das, 2012). According to the United Nations Environmental Program [UNEP], (2012), hospitals produce 71% of all healthcare-related solid waste; 10-15% of this is food waste (Practice Greenhealth, 2021). Hospitals include acute care—those that provide short-term medical care for brief, urgent episodes of illness (Hirshon et al., 2013), specialty care such as psychiatric hospitals to provide care for persons with mental illness, and rural critical access hospitals that meet specific criteria: (a) greater than 35 miles from any other hospital; (b) limited to 25 staffed beds; and (c) annual average stay of 96 hours or less for acute care patients (Centers for Medicare and Medicaid [CMS], 2021).

Food waste (solid and liquid) potentially produced in the 6,210 U.S. hospitals can be staggering (American Hospital Association [AHA], 2019). Alshqaqeeq, Twomey, Overcash, and Sadkhi (2017) found the amount of food waste produced in one hospital that serves 6,640 patient meals per week can equal more than 48,000 lbs. (24 tons) of food/year including losses during preparation and food that is prepared and uneaten or refused by patients. Complex food planning systems utilized by hospitals reflect a trend toward over production of food, and poor appetites of hospitalized patients (Goonan, Mirosa, & Spence, 2014). A related study reported that just 28% of meals ordered were eaten completely and 29% were less than half eaten. Thirty-nine percent of the food served to patients was returned to the kitchen as food waste (van-Bokhorst-de van der Schueren, Roosenmalen, Weijs, & Langius, 2012).

Although food waste is generally thought of as solid, other sources include liquid from prepared infant and enteral formulas. Studies report that 61% of prepared infant formula and 18% - 62% of enteral formulas can be wasted (Ryan-Fogarty, Becker, Moles, & O’Regan, 2017; Silkroski, Allen, & Storm, 1998). Unconsumed, wasted food—liquid or solid—is costly to hospitals and harmful to the environment (Goonan et al., 2014; Ryan-Fogarty et al., 2017).

Food Waste Measurement
Comprehensive food waste data is lacking over industrial, commercial and institutional sectors where this metric is not routinely monitored (Commission for Environmental Cooperation [CEC], 2017; Ofei, Holst, Rasmussen, & Mikkelsen, 2015). Moreover, waste measurements, where recorded, may be highly inaccurate based on measurement parameters. Data may not include waste from food preparation or food preparation surplus, and is largely dependent on subjective methods of monitoring patient food intake such as plate diagram food estimation (¼, ½, ¾, all food), or failure to routinely collect information (Ofei, Holst et al., 2015; Winzer, Luger, & Schindler, 2018). Accuracy is further challenged with multiple disposal processes that include dispatching regular waste to landfills (municipal solid waste [MSW]), incineration with ash transported to landfills, and insink garbage disposal that routes liquid to wastewater treatment plants (WWTP). Insink food disposal contributes to biosolids from WWTP that can be deposited in landfills, incinerated, or used as fertilizer (EPA, 2021c).

The Food Recovery Hierarchy

The EPA Food Recovery Hierarchy provides a prioritization framework to reduce waste and promote a circular food economyThe EPA Food Recovery Hierarchy provides a prioritization framework to reduce waste and promote a circular food economy (EPA, 2021b) aimed at optimal use and reuse of natural resources to protect and preserve the environment (Rood, Muilwijk, & Westhoek, 2017). The Recovery Hierarchy has 6 levels, or steps (Figure 1) beginning with source reduction. This approach saves resources associated with food production (such as water, energy, fertilizers, and pesticides), while reducing greenhouse gas (GHG) emissions produced in manufacturing, transporting, and disposing of food (Kurian, 2017). Step 2 is to feed hungry people, followed by feed animals (Step 3). Step 4 encourages industrial uses to generate energy; Step 5 is composting, which is followed by the least preferred disposal methods, landfill or incineration.

Figure 1: Food Recovery Hierarchy

[View full size]

(EPA, 2021b)

Aligning the existing literature on food waste in hospitals with the Food Recovery Hierarchy highlights strengths and gaps within the literature and with broader current practice.

Step 1. Source reduction. To meet source reduction challenges, several strategies have been discussed in the literature. First, educational campaign “quick wins” can be effective with minimal cost (Cristóbal, Castellani, Manfredi, & Sala, 2018). These campaigns increase awareness and inform behavior and institutional change. Second, the careful assessment of food preparation processes can provide details that reduce excess food preparation. For example, a study of the U.S. Army Public Health Command [USAPHC] (USAPHC, 2013) showed “having a choice of meals [for patients] results in less waste, cold food is more likely to be wasted” (p.4). Third, Ofei, Holst, Rasmussen, & Mikkelsen (2014) examined trolley meal service, which decentralizes food service to patients and provides food/meal choice and portion size control from a portable food trolley. While this service results in less waste due to portion control, challenges included advance meal ordering with fluctuating patient census, inability to control portion sizes based on standard recommendations geared toward reducing food excess and consequent waste, and a lack of waste data collection procedures (Ofei et al., 2014; Ofei, Werther et al., 2015). Additionally, room service (RS) allows patients to place meal orders from a menu at flexible times; with plate waste significantly reduced from 30% to 17% (P < .001) when compared to the traditional food service model (McCray, Maunder, Barsha, & Mackenzie-Shalders, 2018). Moreover, RS is found to increase satisfaction. Finally, spoken meal ordering systems (i.e., nutritional assistants visiting patients to discuss menu options) creates a customized approach to meal planning, that compared to traditional paper ordering, reduced mean plate waste from 30% to 26% (P < .001; McCray, Maunder, Norris, Moir, & MacKenzie-Shalders, 2018).

Step 2. Feed hungry people. Donations to food banks are suggested to reduce food waste in hospitals (EPA, 2016); hospital food waste can be successfully recovered through donation to food insecure individuals (Galvan, Hanson, & George, 2018; Grenier & Wynn, 2018). However, food hygiene regulatory restraints may place limits on reusing unserved food; there is paucity in the literature about these practices (Ofei, Werther et al., 2015).

Step 3. Feed animals. When food is produced and no longer fit for human consumption, it may be suitable for feeding farm animals. This food diversion strategy is commonly used in university settings. For example, Rutgers University dining facility has diverted food scraps to a farm to feed pigs and cattle since the 1960s, reporting 1.125 tons of diverted food scraps/day (EPA, 2009). There are, however, state and federal regulations delineating which animals can be fed hospital food waste, and the types of scraps that are allowed (Leib et al., 2016). For example, the Food and Drug Administration (FDA) prohibits animal tissue in feeds for ruminant animals (e.g., cattle) and the federal Swine Health Protection Act (SHPA) requires that meat and animal byproduct scraps are heat treated to kill disease causing microorganisms. State laws may impose further regulations that include a license to feed waste to swine (Leib et al., 2016). As with the reuse of unserved food, there is little information in the literature regarding food scrap diversion in hospitals.

Steps 4 and 5, composting and anaerobic digesting, use food waste to promote a circular food economy. Composting is the process of using organic material, including food scraps, to produce a product used to improve soil health. In anaerobic digestion, microorganisms break down organics and food to produce digestate used for soil enhancement and biogases, which may be a source of renewable energy (EPA, 2017b). Lastly, step 6, landfill or incineration are not recommended. These processes add to the large volume of solid waste produced in the healthcare industry that is disposed of as MSW and are considered the method of last resort if steps one through five are not practiced.

...tracking the number of hospitals that have adopted and maintained composting/anaerobic digestion efforts to mitigate food waste is limited...Given the regulatory restraints described above, it is more likely that uneaten food in a hospital setting will go to a landfill or be composted, as compared being donated to hungry people or fed to animals (Ofei, Werther et al., 2015). The percentage of food waste composted versus sent to a landfill are site and context-specific as differences in staff cooperation, municipal composting availability, and waste reduction commitments vary by facility, state, and country (Goonan et al., 2014). Food diversion sites are found throughout the U.S, with operations that are small, large, and privately owned (EPA, 2021b). However, tracking the number of hospitals that have adopted and maintained composting/anaerobic digestion efforts to mitigate food waste is limited due to the diversity of initiatives and lack of a centralized tracking systems (Platt, Goldstein, Coker, & Brown, 2014).

Quantifying in-sink food waste is also difficult to track because processed waste is treated as wastewater where it may be converted to biogas (energy) or biosolids which are also used to enrich soil. Both promote a circular food economy and environmental sustainability, but this technology is relatively new, and processing is currently being refined to protect the environment and produce maximum benefit (Edwards, Othman, Crossin, & Burns, 2017; Kuo & Dow, 2017; Zahan, Othman, & Rajendram, 2016).

While focusing on source reduction and food production processes is important in a sustainable food system, paying attention to food waste is necessary as it affects all levels of the food recovery hierarchy and could foster efficient food production (Sonnino & McWilliam, 2011). In this study, we sought to gather preliminary data about food waste and disposal processes in seven hospitals in one rural northeastern U. S. state through semi-structured interviews with hospital employees.

Materials and Methods

Semi-structured interviews were used to elicit information about food waste procedures at seven selected hospitals. The proposed study was reviewed by the University of Maine Internal Review Board (# 2018-06-07) and granted exempt status.

Participant Recruitment and Sampling

Telephone numbers were obtained from hospital websites. Through telephone contact, an email database of hospital nutritional directors and environmental service directors within the state of Maine was developed. Potential participants’ email addresses were confirmed, facilitating targeting of subject facilities. Recruitment letters with consent forms were emailed until seven interviews were scheduled at different hospitals across Maine to collect preliminary information.

Survey Construction and Study Procedure

A survey constructed for the purpose of defining food waste management procedures within hospitals served as the basis for development of interview questions. To ensure robust data collection, a content expert at the Maine Department of Environmental Protection provided survey input prior to participant interviews. Nutrition managers at targeted hospitals were subsequently interviewed face-to-face. Once the survey question replies were recorded, interviewees were given the opportunity to enhance the survey by suggesting removal of specific questions or addition of new questions. Subsequent interviews incorporated participant feedback. All interviews were 30-60 minutes in length; detailed interview notes were taken in lieu of audio or video recording.

Results

Sample
Participants were employed as nutritional and environmental service directors at seven hospitals with years worked at the facility ranging from 3.5 to 26 (mean = 11 years). Job titles included Nutritional or Dietary Directors (5), and two environmental service (EVS)/Nutrition Directors. Two participants had applied degrees in culinary arts and experience as chefs to guide budgetary decisions, food ordering, and menu preparation.

Nutritional directors were the most knowledgeable about hospital food waste. The number of staffed beds in the hospitals ranged from 25 to 411. Interview sites included four acute care hospitals, two psychiatric hospitals (one not-for-profit and one state institution), and one critical access hospital (Table 1). Questions were refined, added, and deleted throughout the interview process, as described previously.

Table 1. Hospitals and Disposal Methods

# Staffed Beds	Hospitals	Acute Care	Critical Access	Specialty	In-sink Disposal	Compost /AD CURRENT	Compost /AD PAST	Compost /AD POTENTIAL
0-50	4	2	1	1	2	1	2	4
50-200	2	1	N/A	1	1	0	1	1
200+	1	1	N/A	0	1	0	1	1
Total	7	4	1	2	4	1	4	6

Meal Preparation
Participants from four hospitals reported preparing meals “from scratch,” including peeling, cutting, dicing and blanching fresh vegetables. Food menu items included soups, meatloaf, and baked goods. These hospitals reported buying some frozen items such as pre-cut broccoli florets or diced potatoes. Of the three remaining hospitals, one prepared meals, including casseroles, “from scratch” and used pre-packaged dinner items. The last two hospitals largely used prepared meal items (items were pre-cut, frozen, and already prepared). In these hospitals, vegetable preparation was minimal (e.g., broccoli is bought in florettes). Compared to the hospitals that prepared food from fresh fruits and vegetables, food preparation waste was minimized when prepared meal items were commonly used. However, it is misleading to indicate that preparing fresh food leads to more food waste, as the pre-prepared meal items used in these hospitals were also processed fresh at an external facility and subsequently shipped to the hospital.

Ugly Vegetable Use
At all sites, food was delivered weekly. Imperfect fruit and vegetables (i.e., ugly) and unacceptable food was returned to contracted food service providers. Accepted food that was close to spoiling was reportedly used immediately. For example, overly ripe strawberries were used to make strawberry shortcake and excess asparagus were blanched and frozen. Participants routinely indicated that budgetary considerations motivated food waste mitigation practices. One participant attributed the focus on budgetary concerns, creatively repurposing food, and limiting waste to previous culinary curriculum and training.

Food Waste Disposal
In the hospitals, food for patients is prepared and disposed of separately from visitor meals and beverages (i.e., cafeteria food). There were four primary ways of disposing all food waste described during interviews: (a) in-sink garbage disposal; (b) MSW/Incineration; (c) farm animal feed, and (d) composting. Waste volume could not be quantified by any study participants.

Food Waste from Patients
After patients’ meals, all hospitals followed the same procedure: gathering food trays in a central cart for waste disposal in the nutrition kitchen. Five of the seven hospitals reported that patients’ food waste was disposed of using in-sink garbage disposals with most food scraped into sinks for disposal. However, a few items (e.g., rice) can cause disposal obstruction and are therefore routinely discarded in solid waste containers disposed of with other MSW. Bones are not a concern with patient food waste because patient dishes are deboned. One hospital placed all food waste in bins collected by a composting company, and one hospital placed all food waste in clear waste bags to be incinerated off-site by a third-party contractor.

In five hospitals, food waste from patients’ subject to isolation precautions—because of infectious disease such as methicillin resistant Staphylococcus Aureus—were not disposed of in a manner congruent with isolation protocols. Food waste from patients in isolation were discarded using the same food waste process as for other non-infectious patients. Food was discarded via an in-sink garbage disposal in the hospital kitchen or composted. Two hospitals used disposable eating utensils with all food/paper waste discarded as MSW.

Food Waste from the Cafeteria
Six hospitals operated cafeterias that offer food and beverages for purchase by visitors and staff. Three hospitals disposed of cafeteria food waste via insink methods, one disposed of food waste with a combination of insink disposal and MSW, one contracted with a composting company, and one varied disposal processes depending on the season. In the summer, food waste is scrapped into large plastic buckets delivered by staff to feed pigs. In the winter, all food waste is scrapped into waste bags for disposal as MSW.

Limiting Food Waste
All participants reported using similar strategies to limit waste. Repurposing is practiced through turning stale bread into croutons, making soups with excess vegetables, preparing food as a salad bar topping (e.g., diced chicken), or packaging “to go” meals from the surplus café food after regular mealtimes. Interview participants closely monitored food stock and food shipments to reduce surplus. Lastly, food such as soda/chips (not opened or expired) were offered to staff or to staff to feed farm animals such as pigs.

Donations to feed the hungry or others in need varied at interview sites. One hospital donated unused visitor cafeteria food, but regulatory and liability concerns limited or prohibited three sites from utilizing food donation practices. Two hospitals reported that an in-house food waste reduction system (e.g., offering excess food to staff) eliminated the need to donate to outside organizations.

Six hospitals that did not use composting discussed interest in composting or anaerobic digestion systems. However, participants reported barriers to composting including cost, procedural considerations (e.g., movement of heavy bins filled with food waste) and hiring and training personnel to manage the food waste process.

Discussion

Improvements in the food preparation process must be made to minimize food waste in hospitals. The first step is a careful assessment of factors that contribute to excess food preparation. These factors vary among hospitals, and therefore, planning may not be consistent across all facilities. Current literature highlights some similarities in relationships between patients’ situations and their food choices. For example, one study of hospital food services (USAPHC, 2013) found giving patients’ meal choice can reduce food waste, that cold food is wasted more frequently than hot food, and that women, in general, eat smaller portions, so often have more leftovers. Patients experiencing long-term hospitalizations may waste food more often than those confined for shorter stays.

Improvements in the food preparation process must be made to minimize food waste in hospitals. Our data show that all seven hospitals refuse “ugly” vegetables, which likely contributes to food waste. To reduce this waste, hospitals could accept all fruits and vegetables, including imperfect produce (at a lower price), reserving them for preparation of items such as soups and sauces. This approach could offer dual benefits: waste prevention and creating cost savings for hospitals.

In addition, different food preparation methods (‘from scratch’ vs. using pre-cut vegetables, or frozen items) produce varying amounts of food waste. However, the perceived waste reduction from using pre-cut or frozen items is misleading as waste is produced by the processor/packer rather than in the hospital kitchen. Our findings indicate that food waste management is a complex process that requires careful planning and execution. The specificity of each hospital should dictate internal waste minimization policies and initiatives (Romani, Grappi, Bagozzi, & Barone, 2018; Schmidt & Matthies, 2018).

Our study further suggests that educational preparation of the nutritional director with a focus on food management efficiency and budgetary concerns may facilitate development of hospital kitchens where employees focus on food waste prevention. Culinary schools require completion of culinary operations and management courses (York County Community College, 2021), which include meal planning and budgetary strategies and constraints. Research shows that certain behaviors, such as food meal planning, deliberate purchasing (i.e., not over purchasing), and leftover consumption practices significantly limit food waste (Romani et al., 2018; Schmidt & Matthies, 2018). Because knowledge, attitudes, and behaviors influence waste habits, the importance of education concerning food preparation efficiency and waste prevention strategies should not be overlooked. These prevention practices impact hospital food management and culinary school graduates may be ideally suited to careers as hospital nutritional directors.

Food donation is viewed by some as an ideal method of integrating a circular food economy system to meet societal demand. This study supports the findings of Ofei et al. (2014), that regulatory constraints are a barrier to food waste reduction. Although the Bill Emerson Good Samaritan Food Donation Act (H.R. 2428) provides liability protection to non-profit organizations (including hospitals) unless the donor acts with gross negligence and intentional misconduct, a fear of litigation exists (U. S. Congress 104, 1996). The bill defines gross negligence as “voluntary and conscious conduct by a person with knowledge (at the time of the conduct) that the conduct is likely to be harmful to the health or well-being of another person” (1996, p. 4). Limited food donation practices noted in this study reflect a need for more detailed, prescriptive language that will increase donations by reducing donors’ fear of litigation. Alternately, a carefully defined contract between hospitals’ management and a nonprofit food bank organization could potentially overcome these concerns. As a first step, hospitals could implement a donation strategy with limited quantities of food, with the goal of scaling up the program in the future.

Food donation is viewed by some as an ideal method of integrating a circular food economy...Finally, although our findings reflect that all seven target hospitals showed interest in composting/anaerobic digestion efforts, just one hospital actively composts food waste. All other methods of food waste disposal, including insink disposal, incineration, or regular solid waste collection add to a waste stream that sustains landfills and produces methane gas. Labor costs, including those incurred in implementing and maintaining effective waste reduction systems and training employees to manage these systems, are prohibitive and remain a major obstacle. Hospitals may benefit from developing a cooperative model and joining with other hospitals to contract with a composting and/or a biogas company who will utilize food waste. In recent years, many “Green” designated hospitals have encouraged their vendors to adopt practices working towards environmental sustainability by forming alliances represented by a single, more powerful voice (Practice Greenhealth, 2021). Waste reduction and reuse, however, must be recognized as a priority.

Implications for Nurse Leaders

Nurse leaders are ideally positioned to construct and implement policies to improve the health of patients while practicing sustainability efforts. According to Anaker and Elf (2014), sustainability – as a concept—is being widely used by healthcare leaders during discussions that concern the design of future healthcare systems. One focus could include widespread, developed food donation programs for food insecure populations, which would aim to promote an active and healthy life for this highly vulnerable group (Coleman-Jensen, Rabbitt, Gregory, & Singh, 2019). In the U.S., adequate nutrition intake is a serious concern with 11.1% of all households experiencing food insecurity at some time during 2018 and 552, 830 people experiencing homelessness for at least one night in 2018 (Coleman-Jenson et al., 2019; National Alliance to End Homelessness, 2021). Specifically, malnourished geriatric patients entering the healthcare system experience infectious complications, higher prevalence of frailty, decreased quality of live and cognitive impairments compared to their peers (Dijkink et al., 2020).

The WE ACT-PLEASE framework of environmental stewardship in nursing practice names five waste sources...and seven professional elements...The WE ACT-PLEASE framework of environmental stewardship in nursing practice names five waste sources: Waste, Energy/water, Agriculture/food, Chemicals (WE ACT), and seven professional elements: Transportation; Professional Obligations, Leadership, Education, Accountability, Science, and Engagement (PLEASE), which provides structure and guidance to help nurses create a healthier population (Schenk, 2019). As the framework suggests, effective leadership is critical for the success of any program, including those that support environmental stewardship through food donation programs (Schenk, 2019). Within healthcare institutions, nurse leaders can educate and engage food/nutrition, medical, and nursing staff in compost or donation processes, create outcome metrics to measure successful programs (i.e., reduction of food waste, staff satisfaction, number of food insecure people served, nutritional health of those benefiting from donation program), and target “referral” food donation centers that can service patients that are appropriately – and confidentially—identified while hospitalized. Outside of healthcare institutions, nurse leaders can help drive policy change that will encourage donation, mitigate barriers to food donation, and protect hospitals against litigation. Finally, nurse leaders can support green initiatives that are threaded throughout healthcare institutions to limit food waste, promote composting, and implement donations to help those in need while reducing gasses that contribute to climate change.

Limitations

This study has several limitations. Participants were unable to provide data on the amount of hospital food waste in their respective hospitals and waste inventories were not conducted due to time and funding constraints. Recommendations for future studies include combining waste inventories with qualitative interviews to better understand waste management philosophies and constraints in hospitals. A random, nationally representative sample of nutritional directors employed at hospitals of varying sizes and designations would offer generalizable data to estimate total amount of food waste generated by hospitals nationwide.

...nurse leaders can support green initiatives that are threaded throughout healthcare institutions to limit food waste...Exploring varied hospital food waste disposal processes and waste stream impacts on MSW, landfills, and WWTP could advance a macro approach that considers every step in the food production, preparation, and disposal cycle. A comprehensive cost analysis of current disposal methods could support food waste diversion and facilitate repurposing within organizations that require customized, viable strategies.

Conclusion

This study contributes to the broader discussion about food waste minimization in hospitals...This study contributes to the broader discussion about food waste minimization in hospitals to provide a baseline for discussion and further investigation. Hospitals should align their food services with the EPA’s Food Recovery Hierarchy by employing best practices. However, without measuring food waste produced at individual hospitals, it is difficult to propose viable waste reduction strategies. Environmental health is inextricably linked to societal and individual health. As stewards of community health, hospitals have a responsibility to mitigate waste production and the effects of waste production and disposal on the public. Reducing food waste must be recognized as a practical method of reducing GHG emissions from hospitals and an important step toward sustainability and environmental responsibility.

Funding: This work was supported by the Diana Davis Spencer Foundation, and through the Interdisciplinary Undergraduate Research Collaborative (IURC) that was funded by the University of Maine Office of the Vice President for Research and Dean of the Graduate School, and the University of Maine System Research Reinvestment Fund.

Acknowledgement: This study was conducted with strong support from the Senator George J. Mitchell Center for Sustainability Solutions at the University of Maine.

Authors

Deborah A. Saber, PhD, RN, CCRN-K
Email: Deborah.saber@maine.edu

Dr. Deborah A. Saber is an Associate Professor of Nursing at the University of Maine and the Director of Nursing Research and Evidence-Based Practice at Northern Light Eastern Maine Medical Center. As a practicing registered nurse, she spent 25 years witnessing food and solid waste increase over time. Her research has focused on sustainability efforts within healthcare organizations. She is a member of the multidisciplinary Materials Management research team within the Senator George J. Mitchell Center for Sustainability Solutions at the University of Maine that focuses on environmental sustainability and a circular economy.

Roya Aziza, PhD
Email: razizi@csudh.edu

Dr. Roya Azizi received her doctoral degree in Policy, Planning, and Development from USC, with a focus on sustainable administration practices and Green Healthcare. She is an adj. Assistant Professor at CSU Dominguez Hills and CSU Fullerton and an advisory council member of the Association for the Advancement of Sustainability in Higher Education (AASHE). She also serves as a CSU Journal of Sustainability & Climate Change editorial board member and a Faculty Representative on the CSUDH Sustainability Committee.

Stacia Dreyer, PhD
Email: Stacia.dreyer@gmail.com

Dr. Stacia Dreyer received her doctoral degree in Environmental Psychology and Behavioral Economics. She has extensive experience applying both quantitative and qualitative social science research methods to a wide range of environmental research projects, from the human dimensions of marine renewable energy to the nexus of food, energy, and water systems.

Deborah Sanford, MBA, MSN, RN
Email: dsanford@northernlight.org

Deborah Sanford is the Vice President of Nursing and Patient Care Service for Northern Light Eastern Maine Medical Center. She has assisted in initiating progressive hospital-wide green programs that include a detailed pharmaceutical waste procedure. 

Hannah Nadeau, BSN, RN
Email: hannah.m.nadeau@maine.edu

Hannah Nadeau graduated with a baccalaureate of nursing degree from the University of Maine School of Nursing in 2021. She is a team member of an Interdisciplinary Undergraduate Research Collaborative that was funded through the University to study food waste. 

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