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Hilal S, Kolozsvári LR, Indrayathi PA, Saeed SN, Rurik I. Psychological Distress and Food Insecurity among International Students at a Hungarian University: A Post-Pandemic Survey. Nutrients 2024; 16:241. [PMID: 38257134 PMCID: PMC10820830 DOI: 10.3390/nu16020241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/28/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
The aim of the present study was two-fold: Firstly, to estimate the prevalence of psychological distress among international students at a Hungarian university two years after the COVID-19 outbreak; and secondly, to identify its demographic and socioeconomic factors, with special regard to the students' food-security status. A cross-sectional study using a self-administered questionnaire was carried out from 27 March to 3 July 2022 among international students at the University of Debrecen. The questionnaire included information on demographic and socioeconomic characteristics, food-security status (six-item United States Department of Agriculture Food Security Survey Module (USDA-FSSM)), and psychological distress (Depression, Anxiety and Stress Scale (DASS-21)). Bivariate analysis was conducted to examine the potential associations between demographic/socioeconomic factors and psychological distress. Additionally, multiple logistic regression was employed to further analyze these associations. Of 398 participants, 42.2%, 48.7%, and 29.4% reported mild to extremely severe depression, anxiety, and stress, respectively. The ages 18-24 (AOR = 2.619; 95% CI: 1.206-5.689) and 25-29 (AOR = 2.663; 95% CI: 1.159-6.119), reporting a low perception of health status (AOR = 1.726; 95% CI: 1.081-2.755), and being food insecure (AOR = 1.984; 95% CI: 1.274-3.090) were significantly associated with depressive symptoms. Being female (AOR = 1.674; 95% CI: 1.090-2.571), reporting a low perception of health status (AOR = 1.736; 95% CI: 1.098-2.744), and being food insecure (AOR = 2.047; 95% CI: 1.327-3.157) were significantly associated with anxiety symptoms. Furthermore, being female (AOR = 1.702; 95% CI: 1.026-2.824)), living with roommates (AOR = 1.977; 95% CI: 1.075-3.635), reporting a low perception of health status (AOR = 2.840; 95% CI: 1.678-4.807), and being food insecure (AOR = 2.295; 95% CI:1.398-3.767) were significantly associated with symptoms of stress. Psychosocial programs combined with strategies to alleviate food insecurity are required to enhance international students' mental health and well-being.
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Affiliation(s)
- Soukaina Hilal
- Department of Family and Occupational Medicine, University of Debrecen, 4032 Debrecen, Hungary; (L.R.K.); (P.A.I.)
- Doctoral School of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary; (S.N.S.); (I.R.)
| | - László Róbert Kolozsvári
- Department of Family and Occupational Medicine, University of Debrecen, 4032 Debrecen, Hungary; (L.R.K.); (P.A.I.)
- Doctoral School of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary; (S.N.S.); (I.R.)
| | - Putu Ayu Indrayathi
- Department of Family and Occupational Medicine, University of Debrecen, 4032 Debrecen, Hungary; (L.R.K.); (P.A.I.)
- Doctoral School of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary; (S.N.S.); (I.R.)
| | - Sami Najmaddin Saeed
- Doctoral School of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary; (S.N.S.); (I.R.)
- Department of Public Health and Epidemiology, University of Debrecen, 4028 Debrecen, Hungary
| | - Imre Rurik
- Doctoral School of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary; (S.N.S.); (I.R.)
- Department of Family Medicine, Semmelweis University, 1085 Budapest, Hungary
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102
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Beck J, Koebach A, Abreu L, Regassa MD, Hoeffler A, Stojetz W, Brück T. COVID-19 Pandemic and Food Insecurity Fuel the Mental Health Crisis in Africa. Int J Public Health 2024; 68:1606369. [PMID: 38283859 PMCID: PMC10811217 DOI: 10.3389/ijph.2023.1606369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/18/2023] [Indexed: 01/30/2024] Open
Abstract
Objective: Providing country-level estimates for prevalence rates of Generalized Anxiety Disorder (GAD), COVID-19 exposure and food insecurity (FI) and assessing the role of persistent threats to survival-exemplified by exposure to COVID-19 and FI-for the mental health crisis in Africa. Methods: Original phone-based survey data from Mozambique, Sierra Leone, Tanzania and Uganda (12 consecutive cross-sections in 2021; n = 23,943) were analyzed to estimate prevalence rates of GAD. Logistic regression models and mediation analysis using structural equation models identify risk and protective factors. Results: The overall prevalence of GAD in 2021 was 23.3%; 40.2% in Mozambique, 17.0% in Sierra Leone, 18.0% in Tanzania, and 19.1% in Uganda. Both COVID-19 exposure (ORadj. 1.4; CI 1.3-1.6) and FI (ORadj 3.2; CI 2.7-3.8) are independent and significant predictors of GAD. Thus, the impact of FI on GAD was considerably stronger than that of COVID-19 exposure. Conclusion: Persistent threats to survival play a substantial role for mental health, specifically GAD. High anxiety prevalence in the population requires programs to reduce violence and enhance social support. Even during a pandemic, addressing FI as a key driver of GAD should be prioritized by policymakers.
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Affiliation(s)
- Jule Beck
- Development Research Group, Department of Politics and Public Administration, University of Konstanz, Konstanz, Germany
| | - Anke Koebach
- Development Research Group, Department of Politics and Public Administration, University of Konstanz, Konstanz, Germany
| | - Liliana Abreu
- Development Research Group, Department of Politics and Public Administration, University of Konstanz, Konstanz, Germany
| | | | - Anke Hoeffler
- Development Research Group, Department of Politics and Public Administration, University of Konstanz, Konstanz, Germany
| | - Wolfgang Stojetz
- ISDC—International Security and Development Center, Berlin, Germany
| | - Tilman Brück
- Leibniz Institute of Vegetable and Ornamental Crops, Großbeeren, Germany
- ISDC—International Security and Development Center, Berlin, Germany
- Albrecht Daniel Thaer Institute for Agricultural and Horticultural Sciences, Faculty of Life Sciences, Humboldt University of Berlin, Berlin, Germany
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103
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Himmelgreen D, Romero-Daza N, Webb WA, Heuer JN, Gray D, Lehigh GR. Implementing a Food Prescription Program during COVID-19: Benefits and Barriers. Healthcare (Basel) 2024; 12:182. [PMID: 38255070 PMCID: PMC10815315 DOI: 10.3390/healthcare12020182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/06/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Food prescription programs (Food Rx) have the potential to improve management of diet-related chronic diseases or underlying conditions such as type 2 diabetes (T2D), hypertension, and high body mass index (BMI) among food-insecure patients. The purpose of this study was to examine the effectiveness of a Food Rx program implemented in two community-based clinics in Florida. Data were collected through researcher-administered surveys (food insecurity, demographics, and socio-economic variables) and biometric data (HbA1c, blood pressure, and BMI). Key results include the following: (1) Hispanic patients are more likely to utilize the program than their Black and White counterparts (p < 0.001); (2) older patients (≥50 years) have a higher food redemption rate when compared to younger patients (36-49.9 years); (3) food redemption rate is negatively associated with food security scores indicating improvements in food security status over time (r2 = -0.184, p = 0.036); (4) diabetic patients with higher baseline HbA1c (>9%) have significant reductions in glycated hemoglobin (p = 0.011) over time as compared to patients with lower baseline values (<7%); and (5) patients enrolled in the program for at least 6 months have a significant reduction in systolic blood pressure (p = 0.051). Changes in BMI were not significantly associated with redemption rates. This study is significant as it offers insights into the potential benefits and challenges of implementing Food Rx programs to address diet-related chronic diseases among underserved populations.
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Affiliation(s)
- David Himmelgreen
- Department of Anthropology, University of South Florida, Tampa, FL 33620, USA; (N.R.-D.); (W.A.W.); (J.N.H.); (D.G.); (G.R.L.)
- Center for the Advancement of Food Security and Healthy Communities, University of South Florida, Tampa, FL 33620, USA
| | - Nancy Romero-Daza
- Department of Anthropology, University of South Florida, Tampa, FL 33620, USA; (N.R.-D.); (W.A.W.); (J.N.H.); (D.G.); (G.R.L.)
- Center for the Advancement of Food Security and Healthy Communities, University of South Florida, Tampa, FL 33620, USA
| | - William Alex Webb
- Department of Anthropology, University of South Florida, Tampa, FL 33620, USA; (N.R.-D.); (W.A.W.); (J.N.H.); (D.G.); (G.R.L.)
- Center for the Advancement of Food Security and Healthy Communities, University of South Florida, Tampa, FL 33620, USA
| | - Jacquelyn N. Heuer
- Department of Anthropology, University of South Florida, Tampa, FL 33620, USA; (N.R.-D.); (W.A.W.); (J.N.H.); (D.G.); (G.R.L.)
- Center for the Advancement of Food Security and Healthy Communities, University of South Florida, Tampa, FL 33620, USA
| | - Deven Gray
- Department of Anthropology, University of South Florida, Tampa, FL 33620, USA; (N.R.-D.); (W.A.W.); (J.N.H.); (D.G.); (G.R.L.)
- Center for the Advancement of Food Security and Healthy Communities, University of South Florida, Tampa, FL 33620, USA
| | - Gabrielle R. Lehigh
- Department of Anthropology, University of South Florida, Tampa, FL 33620, USA; (N.R.-D.); (W.A.W.); (J.N.H.); (D.G.); (G.R.L.)
- Center for the Advancement of Food Security and Healthy Communities, University of South Florida, Tampa, FL 33620, USA
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104
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Hoteit M, Khadra R, Fadlallah Z, Mourad Y, Chahine M, Skaiki F, Al Manasfi E, Chahine A, Poh OBJ, Tzenios N. Prevalence and Time Trends of Low Serum B12 Levels and Inadequate B12 Dietary Intake in Lebanese Adults amidst the Food Insecurity Situation: Findings from a Nationally Representative Cross-Sectional Study. Nutrients 2024; 16:226. [PMID: 38257119 PMCID: PMC10818865 DOI: 10.3390/nu16020226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Rising food insecurity (FI) and the increased prices of animal-based foods could compromise vitamin B12 (B12) intake and serum levels in food-insecure people. Our study aims to determine the prevalence of low levels of serum B12 and its inadequate dietary intake among a nationally representative sample of Lebanese adults aged 18 to 64 years, while exploring the impact of FI and identifying other potential predictors. The B12 intake was assessed using a food frequency questionnaire and the mean of two non-consecutive 24 h recalls. The B12 serum levels were also examined. To examine the time trends in the B12 serum levels and dietary intake, the data from a large representative digitized database of 6290 participants were collected, along with the examination of FAOSTAT food consumption data both before and during the economic crisis period. Our findings revealed that 47.3% of households in Lebanon experienced FI. The inadequate intake of B12 food sources was prevalent in 52.5% of participants, and 61.1% presented with low (23%) or intermediate (38.1%) levels of serum B12. The food-secure households had a higher proportion of B12 intake from meats (p = 0.004), while traditional foods contributed more to food-insecure households (p = 0.000). The participants who were female, unemployed, food-insecure, and had low dietary diversity were about two to three times more likely to have inadequate B12 intake. The predictors of low levels of serum B12 included residing in Beqaa (OR = 2.856 and 95% CI = 1.018-8.01) and having inadequate B12 intake (OR = 1.788 and 95% CI = 1.2-2.65). The findings from observing the time trends in the consumption and the serum levels of B12 indicate a considerable decline in the consumption of most animal-based foods compared to the pre-crisis period, associated with a decline in the serum levels of B12. In conclusion, an alarming prevalence of low dietary intake and low serum levels of B12 was revealed among Lebanese adults, and the indirect effect of FI on B12 serum levels mediated through B12 intake was inferred.
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Affiliation(s)
- Maha Hoteit
- Food Sciences Unit, National Council for Scientific Research-Lebanon (CNRS-L), Beirut P.O. Box 11-8281, Lebanon (Z.F.)
- Faculty of Public Health, Section 1, Lebanese University, Beirut P.O. Box 6573, Lebanon
| | - Razan Khadra
- Food Sciences Unit, National Council for Scientific Research-Lebanon (CNRS-L), Beirut P.O. Box 11-8281, Lebanon (Z.F.)
| | - Zahraa Fadlallah
- Food Sciences Unit, National Council for Scientific Research-Lebanon (CNRS-L), Beirut P.O. Box 11-8281, Lebanon (Z.F.)
| | - Youmna Mourad
- Al Hadi Laboratory and IVF Center, Beirut 1103, Lebanon;
| | - Mohamad Chahine
- Biological and Chemical Technology, Kursk State Medical University, 305000 Kursk, Russia;
| | - Farouk Skaiki
- Department of Molecular Biology, General Management, Al Karim Medical Laboratories, Saida 1600, Lebanon;
| | | | | | | | - Nikolaos Tzenios
- Faculty of Public Health, Charisma University, London EC1V 7QE, UK
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105
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Dave JM, Chen TA, Castro AN, White M, Onugha EA, Zimmerman S, Thompson D. Regional Variability in the Prevalence of Food Insecurity and Diet Quality among United States Children. Nutrients 2024; 16:224. [PMID: 38257117 PMCID: PMC10819603 DOI: 10.3390/nu16020224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/29/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
Understanding the association between food security status (FSS) and diet quality in children is crucial. This study investigated regional variability in FSS, participation in the federal nutrition assistance program (FNAP), and diet quality among US children. National Health and Nutrition Examination Survey (NHANES) data from 2013 to 2016 were analyzed. The association between FSS, FNAP participation, and diet quality (Healthy Eating Index-HEI-2015) was assessed using multiple linear/logistic regression models. The sample included 6403 children (mean age: 7.5 years; 51% male; 33% Hispanic). Within the sample, 13% reported child food insecurity, and 30% reported household food insecurity. Additionally, 90% participated in the FNAP, and 88% were enrolled in school lunch programs. Children in urban areas were significantly more likely to report household food insecurity than those in rural areas (29.15% vs. 19.10%). The overall HEI-2015 score was 48.2. The associations between child/household FSS and FNAP participation as well as between child/household FSS and diet quality did not differ by urban/rural residence status, irrespective of the children's age groups. There is a need for improvement in children's diet quality, regardless of age or urban/rural residence. The findings suggest that improving children's diets requires broader action as well as the prioritizing of children in urban areas experiencing food insecurity in future dietary interventions.
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Affiliation(s)
- Jayna M. Dave
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Avenue, Houston, TX 77030, USA; (A.N.C.); (M.W.); (D.T.)
| | - Tzuan A. Chen
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Boulevard, Houston, TX 77204, USA;
- HEALTH Research Institute, University of Houston, 4349 Martin Luther King Boulevard, Houston, TX 77204, USA
| | - Alexandra N. Castro
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Avenue, Houston, TX 77030, USA; (A.N.C.); (M.W.); (D.T.)
| | - Mamie White
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Avenue, Houston, TX 77030, USA; (A.N.C.); (M.W.); (D.T.)
| | - Elizabeth A. Onugha
- Renal Services, Texas Children’s Hospital, 1102 Bates Avenue, Houston, TX 77030, USA;
- Department of Pediatrics—Nephrology, Baylor College of Medicine, 1102 Bates Avenue, Houston, TX 77030, USA
| | - Sloane Zimmerman
- Department of Pediatrics—Gastroenterology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA;
| | - Debbe Thompson
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Avenue, Houston, TX 77030, USA; (A.N.C.); (M.W.); (D.T.)
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106
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Rosen F, Settel L, Irvine F, Koselka EPD, Miller JD, Young SL. Associations between food insecurity and child and parental physical, nutritional, psychosocial and economic well-being globally during the first 1000 days: A scoping review. Matern Child Nutr 2024; 20:e13574. [PMID: 37828823 PMCID: PMC10750018 DOI: 10.1111/mcn.13574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023]
Abstract
Food insecurity affects billions of individuals annually and contributes to myriad poor health outcomes. Experiences of food insecurity may be particularly harmful during the first 1000 days, but literature on the topic has not been synthesized. We therefore aimed to characterize all available studies examining associations between food insecurity and nutritional, psychosocial, physical and economic well-being among parents and children during this period. We implemented a standardized search strategy across 11 databases. Four researchers screened 10,257 articles, 120 of which met the inclusion criteria. Most studies were conducted in Sub-Saharan Africa (43.3%), followed by North America (20.8%). Studies were primarily quantitative (95.8%), cross-sectional (70.0%) and focused on women (pregnant or post-partum, 48.3%) or women and children (15.8%). Physical health outcomes were the most investigated (n = 87 studies), followed by nutritional (n = 69), psychosocial (n = 35) and economic well-being (n = 2). The most studied associations were between food insecurity and stunting (n = 15), maternal depression (n = 12), child dietary diversity (n = 7) and maternal body mass index (n = 6). The strength of evidence for the observed associations varied across populations as well as within and between examined outcomes. We recommend that future studies recruit more diverse study populations, consider temporality of relationships, use instruments that facilitate cross-site comparisons, measure individual-level food insecurity and outcomes most likely to be impacted by food insecurity, evaluate contextual factors that may modify the effects of food insecurity and employ analytic techniques that permit assessment of causal pathways.
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Affiliation(s)
- Francesca Rosen
- Department of Global Health StudiesNorthwestern UniversityEvanstonIllinoisUSA
| | - Lily Settel
- Department of Global Health StudiesNorthwestern UniversityEvanstonIllinoisUSA
- Department of AnthropologyNorthwestern UniversityEvanstonIllinoisUSA
| | - Faith Irvine
- Department of Global Health StudiesNorthwestern UniversityEvanstonIllinoisUSA
| | | | - Joshua D. Miller
- Department of AnthropologyNorthwestern UniversityEvanstonIllinoisUSA
- Department of NutritionUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Sera L. Young
- Department of AnthropologyNorthwestern UniversityEvanstonIllinoisUSA
- Institute for Policy ResearchNorthwestern UniversityEvanstonIllinoisUSA
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107
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Wolfson JA, Insolera N, Laska MN, Leung CW. High Prevalence of Food Insecurity and Related Disparities Among US College and University Students From 2015-2019. J Nutr Educ Behav 2024; 56:27-34. [PMID: 37999695 PMCID: PMC10841716 DOI: 10.1016/j.jneb.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE We examined food insecurity prevalence among college students included as part of a large, ongoing, nationally representative survey and examined trends and associations with sociodemographic measures. METHODS Data come from the Panel Study of Income Dynamics, a nationally representative longitudinal household panel survey, and include 2,538 college students from 2015-2019. Food security status was assessed using the US Department of Agriculture's 18-item Household Food Security Survey Module. RESULTS From 2015 to 2019, 11% of college students experienced marginal food security, and 15% experienced food insecurity. Food insecurity was 12% in 2015 and 14% in 2017 and 2019. More Black and Hispanic students experienced food insecurity than White students (21% and 26%, vs 9%, respectively; P <0.001), as did first-generation than non-first-generation students (18% vs 10%; P = 0.01). CONCLUSIONS AND IMPLICATIONS College food insecurity is an urgent public health issue demanding greater response from colleges and universities and state and federal governments.
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Affiliation(s)
- Julia A Wolfson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Noura Insolera
- Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Melissa N Laska
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Cindy W Leung
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI
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108
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Kim-Mozeleski JE, Castele MC, Nambiar P, Chagin KM, Pike Moore S, Hardy P, Cook K, Sehgal AR. A Randomized Trial to Address Food Insecurity and Promote Smoking Cessation Among Low-Income Adults. J Prim Care Community Health 2024; 15:21501319241245275. [PMID: 38584453 PMCID: PMC11003330 DOI: 10.1177/21501319241245275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/09/2024] Open
Abstract
Many low-income adults who smoke also have unmet social needs, such as food insecurity, which can serve as a barrier to smoking cessation. We developed a novel intervention to jointly address smoking cessation and food insecurity and assessed its feasibility, acceptability, and preliminary outcomes. We enrolled participants who screened for food insecurity, reported smoking daily, and were ready to quit. All participants received 3 months of resources navigation from a community health worker through monthly telephone calls for referrals and check-ins for smoking cessation and food access resources. Participants randomized to the intervention group received an economic intervention equivalent to the cost of 1 week of groceries/month for 3 months. We randomized 55 participants who were smoking on average 13 cigarettes/day. The trial was feasible and acceptable based on 3-month retention rates (80%) and end-of-study qualitative feedback (91% would recommend the study to others). At 3 months, participants in the intervention versus control group reported a longer length of abstinence from smoking and had a higher proportion of serious quit attempts. Results from this pilot study suggest the importance of attending to social needs, particularly food insecurity, as a strategy to promote smoking cessation among low-income adults who smoke.
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Affiliation(s)
| | | | | | - Kevin M. Chagin
- The Institute for H.O.P.E.™, The MetroHealth System, Cleveland, OH, USA
| | | | - Patricia Hardy
- The Institute for H.O.P.E.™, The MetroHealth System, Cleveland, OH, USA
| | - Karen Cook
- The Institute for H.O.P.E.™, The MetroHealth System, Cleveland, OH, USA
| | - Ashwini R. Sehgal
- The Institute for H.O.P.E.™, The MetroHealth System, Cleveland, OH, USA
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109
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Duck AA, Karimi M, Watkins LL, Tacy JW, Savell CL, Hall KC. Metabolic syndrome risk among adolescents in the Deep South and the relationships with behavioral health, food insecurity, and physical activity. J SPEC PEDIATR NURS 2024; 29:e12420. [PMID: 38095121 DOI: 10.1111/jspn.12420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/11/2023] [Accepted: 12/04/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE A combination of physical and psychosocial risk factors put adolescents at risk for poor cardiometabolic health and chronic disease burden, often recognized as metabolic syndrome. The purposes of this study were to (1) identify the prevalence of metabolic syndrome risk among adolescents, utilizing the metabolic syndrome severity index, and (2) determine the relationship between metabolic syndrome risk and behavioral health, food insecurity, and physical inactivity among adolescents. METHODS AND DESIGN A cross-sectional, descriptive, correlational design was deployed in an inner-city high school in the Deep South. An 8-month recruitment and enrollment period yielded a sample of 55 adolescents. A battery of measures included assessment of demographic data, anthropometric, cardiovascular, and psychosocial data. Utilizing these data elements, a progressive methodological approach was used to identify metabolic severity risk as a continuous variable for use in the adolescent population. RESULTS All participants identified as African American/Black. Among them, 71% (N = 39) were female and an average age of 16 (SD = 1.3) years old, with 67.3% (N = 37) of the sample at risk for metabolic syndrome. There was not a statistically significant relationship between metabolic syndrome severity score and behavioral health risk, food insecurity, and physical inactivity in this sample. PRACTICE IMPLICATIONS Future use of the continuous metabolic syndrome severity score may guide practice by utilizing longitudinal data to assess the trends of metabolic syndrome severity scores in relation to disease outcomes in adolescents. This may promote the identification of psychosocial and physical interrelationships with metabolic syndrome, thus improving overall health through the development of age-appropriate interventions.
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Affiliation(s)
- Angela A Duck
- University of Mississippi Medical Center School of Nursing, Jackson, Mississippi, USA
| | - Masoumeh Karimi
- University of Mississippi Medical Center School of Nursing, Jackson, Mississippi, USA
| | - LaDaryl L Watkins
- University of Mississippi Medical Center School of Nursing, Jackson, Mississippi, USA
| | - Joseph W Tacy
- University of Mississippi Medical Center School of Nursing, Jackson, Mississippi, USA
| | - Christy L Savell
- University of Mississippi Medical Center School of Nursing, Jackson, Mississippi, USA
| | - Katherine C Hall
- University of Mississippi Medical Center School of Nursing, Jackson, Mississippi, USA
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110
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Tuthill EL, Maltby AE, Odhiambo BC, Akama E, Dawson-Rose C, Weiser SD. Resilient Mothering: An Application of Transitions Theory From Pregnancy to Motherhood Among Women Living With HIV in Western Kenya. ANS Adv Nurs Sci 2024; 47:E20-E39. [PMID: 36656116 PMCID: PMC10354209 DOI: 10.1097/ans.0000000000000478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Efficacious strategies can now prevent the transmission of HIV from mother to child. However, transmission rates remain unacceptably high, especially in sub-Saharan Africa. Understanding women's perinatal transitions can inform interventions to support adherence to preventive strategies. Therefore, we applied Transitions Theory in a longitudinal qualitative study to explore perinatal transitions among women living with HIV in western Kenya. We conducted in-depth interviews with 30 women living with HIV at 3 key time points and, using our findings, described the theory's concepts in terms of participants' experiences. We then proposed theory-based interventions that could support smooth transition processes and positive outcomes.
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Affiliation(s)
- Emily L. Tuthill
- Department of Community Health Systems, School of Nursing University of California, San Francisco, CA, USA
| | - Ann E. Maltby
- Department of Community Health Systems, School of Nursing University of California, San Francisco, CA, USA
| | | | - Eliud Akama
- Kenya Medical Research Institute- Center for Microbiology Research, Nairobi Kenya
| | - Carol Dawson-Rose
- Department of Community Health Systems, School of Nursing University of California, San Francisco, CA, USA
| | - Sheri D. Weiser
- Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California San Francisco
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111
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Radtke MD, Steinberg FM, Scherr RE. Methods for Assessing Health Outcomes Associated with Food Insecurity in the United States College Student Population: A Narrative Review. Adv Nutr 2024; 15:100131. [PMID: 37865221 PMCID: PMC10831897 DOI: 10.1016/j.advnut.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 10/03/2023] [Accepted: 10/12/2023] [Indexed: 10/23/2023] Open
Abstract
In the United States, college students experience disproportionate food insecurity (FI) rates compared to the national prevalence. The experience of acute and chronic FI has been associated with negative physical and mental health outcomes in this population. This narrative review aims to summarize the current methodologies for assessing health outcomes associated with the experience of FI in college students in the United States. To date, assessing the health outcomes of FI has predominately consisted of subjective assessments, such as self-reported measures of dietary intake, perceived health status, stress, depression, anxiety, and sleep behaviors. This review, along with the emergence of FI as an international public health concern, establishes the need for novel, innovative, and objective biomarkers to evaluate the short- and long-term impacts of FI on physical and mental health outcomes in college students. The inclusion of objective biomarkers will further elucidate the relationship between FI and a multitude of health outcomes to better inform strategies for reducing the pervasiveness of FI in the United States college student population.
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Affiliation(s)
- Marcela D Radtke
- Propel Postdoctoral Fellow, Department of Epidemiology and Population Health, Stanford School of Medicine, Stanford University, Palo Alto, CA, USA 94305
| | | | - Rachel E Scherr
- Family, Interiors, Nutrition & Apparel Department, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA, USA, 94132; Scherr Nutrition Science Consulting, San Francisco, CA, 94115.
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112
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Aytekin Sahin G, Mengi Celik O. Evaluation of food insecurity and associated factors in women of childbearing age: A community-based study from Turkey. Food Sci Nutr 2024; 12:154-161. [PMID: 38323300 PMCID: PMC10846561 DOI: 10.1002/fsn3.3743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/25/2023] [Accepted: 09/23/2023] [Indexed: 02/08/2024] Open
Abstract
Food security is an important factor in ensuring a healthy diet. However, it has been reported that women are more vulnerable to food insecurity than men in many countries. In addition, there is little evidence that Mediterranean diet (MD) adherence is associated with a lower risk of food insecurity. Therefore, this study aimed to evaluate food insecurity and associated factors in women of childbearing age. In addition, women's adherence to MD and its relationship with food insecurity were evaluated. This descriptive and cross-sectional study was conducted with 2675 adult women aged 18-49. The demographic characteristics, anthropometric measurements, nutritional habits, compliance with the MD, and the level of food insecurity were evaluated using the structured, self-administered, web-based questionnaire form. The mean age of the individuals was 29.5 ± 10.35 years. 21.6% of individuals had food insecurity, and 5.2% had severe food insecurity. 36.4% of the individuals adhere to the MD. There was a statistically significant difference between the individuals with and without food security regarding age, marital status, and income status (p < .05). However, there was no statistically significant difference in terms of the Mediterranean diet adherence score (MEDAS) and MEDAS classification between individuals with and without food security (p > .05). It was determined that age, marital status, and income status affected food insecurity (R 2 = 0.374; p < .001). Also, it was determined that age, number of main meals and snacks, and income status affected adherence to MD (R 2 = 0.286; p < .001). In conclusion, considering the fragility of women in food insecurity, more comprehensive studies should be conducted in this area to better define the factors associated with food insecurity in women and inform policymakers. In addition, the results of this study can shed light on comprehensive intervention studies in this area.
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Affiliation(s)
- Gizem Aytekin Sahin
- Department of Nutrition and Dietetics, Faculty of Health SciencesNuh Naci Yazgan UniversityKayseriTurkey
| | - Ozge Mengi Celik
- Department of Nutrition and Dietetics, Gulhane Faculty of Health SciencesUniversity of Health SciencesAnkaraTurkey
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113
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Wetherill MS, Bridges KM, Talavera GE, Harvey SP, Skidmore B, Burger ES. Planting Seeds for Food Is Medicine: Pre-Implementation Planning Methods and Formative Evaluation Findings From a Multi-Clinic Initiative in the Midwest. J Prim Care Community Health 2024; 15:21501319241241465. [PMID: 38523426 PMCID: PMC10962037 DOI: 10.1177/21501319241241465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024] Open
Abstract
Food is medicine (FIM) initiatives are an emerging strategy for addressing nutrition-related health disparities increasingly endorsed by providers, payers, and policymakers. However, food insecurity screening protocols and oversight of medically-tailored food assistance programs are novel for many healthcare settings. Here, we describe the pre-implementation planning processes used to successfully engage federally-qualified health centers (FQHCs) across Kansas to develop new FIM initiatives. A Kansas-based philanthropic foundation facilitated pre-implementation planning for FQHCs over 17 months across 3 stages: 1) Community inquiry, 2) FIM learning event with invitation for FQHC attendees to request pre-implementation funding, and 3) Pre-implementation planning workshops and application assignments for FQHC grantees to develop a FIM implementation grant proposal. We evaluated satisfaction and perceived utility of these pre-implementation planning activities via post-workshop surveys and qualitative comparisons of FIM design components from pre-implementation and implementation grant applications. All 7 FQHCs attending the learning event applied for and were awarded pre-implementation planning grants; 6 submitted an implementation grant application following workshop completion. FQHCs rated pre-implementation support activities favorably; however, most clinics cited limited staff as a barrier to effective planning. As compared to pre-implementation planning grant proposals, all FQHCs elected to narrow their priority population to people with pre-diabetes or diabetes with better articulation of evidence-based nutrition prescriptions and intervention models in their final program designs. In the midst of a nationwide FIM groundswell, we recommend that funders, clinic stakeholders, and evaluators work together to devise and financially support appropriate pre-implementation planning activities prior to launching new FIM initiatives.
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114
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Masa R, Shangani S, Baruah D, Operario D. The Association of Food Insecurity, Mental Health, and Healthcare Access and Use Among Lesbian, Gay, and Bisexual Adults in the United States: Results From the 2021 National Health Interview Survey. Am J Health Promot 2024; 38:68-79. [PMID: 37899588 PMCID: PMC10748451 DOI: 10.1177/08901171231211134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
PURPOSE We sought to describe the prevalence of food insecurity and its relationship with mental health, health care access, and use among lesbian, gay, and bisexual (LGB) adults in the U.S. DESIGN AND SETTING We analyzed data from the National Health Interview Survey (NHIS), a cross-sectional study of noninstitutionalized adults from all 50 states and the District of Columbia. SAMPLE The study sample was restricted to LGB adults ≥18 years (N = 1178) from the 2021 NHIS survey. MEASURES Food security was assessed using the 10-item U.S Adult Food Security Survey Module. Study outcomes were mental health (depression, anxiety, life satisfaction, and serious psychological distress), health care utilization, and medication adherence. ANALYSIS Descriptive statistics and linear and generalized linear regressions. RESULTS The study sample consisted of 69% White, 14% Hispanic/Latinx, 9% Black, and 8% people of other races. Approximately half (53%) identified as bisexual and 47% identified as gay or lesbian. Eleven percent were food insecure. Sexual orientation, income-to-poverty ratio, and health insurance were significant correlates of food insecurity. In multivariable analyses, food insecurity was significantly associated with mental illness (including depression, anxiety, and serious psychological distress), limited health care access and use (including inability to pay medical bills, delay in getting medical and mental health care, and going without needed medical and mental health care), and medication nonadherence (including skipping medication, taking less medication, delay filling prescription, and going without needed prescription). CONCLUSION Food insecurity is a constant predictor of adverse mental health and low medical and mental health care use rates among LGB adults in the United States. Achieving food security in LGB people requires improving their financial and nonfinancial resources to obtain food.
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Affiliation(s)
- Rainier Masa
- School of Social Work, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Dicky Baruah
- School of Social Work, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Don Operario
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
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115
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Crowther VB, Davis Weaver J, Green-Weir RR, Moton BA, Simmons MV, Alexander AK, Weatherspoon MA, Nash B, Jones JG, Robinson C. Factors Associated With Food Insecurity Among a Community-Based Sample of Older Adults in a North Florida County. Gerontol Geriatr Med 2024; 10:23337214231221328. [PMID: 38204920 PMCID: PMC10777757 DOI: 10.1177/23337214231221328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 01/12/2024] Open
Abstract
Food insecurity impacts the lives of 7.6 million U.S. adults aged 60 and older and is linked to numerous life challenges. This study examined the nature of food insecurity among community-based participants ≥65 years in a north Florida county and conceptualized food insecurity as encompassing the lack of food and individual adaptability. Thus, food insecurity was measured using three dependent variables: (1) worrying that food would run out, (2) cutting meal size or skipping meals, and (3) food not lasting. Logistic regression revealed that older participants, those with better-perceived health status, and those who were confident that they could find solutions to their problems had lower odds of reporting food insecurity. However, respondents who lived in low-income, low-access zip codes and those who received food assistance were more likely to report food insecurity. To improve outcomes and reduce healthcare disparities, solutions to food insecurity must vary in focus and approach.
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Affiliation(s)
| | | | | | - Brandon A. Moton
- Florida Agricultural and Mechanical University, Tallahassee, USA
| | - Mary V. Simmons
- Florida Agricultural and Mechanical University, Tallahassee, USA
| | | | | | - Brittany Nash
- Florida Agricultural and Mechanical University, Tallahassee, USA
| | - Jian G. Jones
- Florida Agricultural and Mechanical University, Tallahassee, USA
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116
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Langer B, Gupta RK, Kumari R, Mahajan R. Food Insecurity and its Association with Dietary Diversity: A Cross-Sectional Study in Rural Households in Jammu. Indian J Community Med 2024; 49:70-75. [PMID: 38425949 PMCID: PMC10900475 DOI: 10.4103/ijcm.ijcm_811_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/06/2023] [Indexed: 03/02/2024] Open
Abstract
Background Food insecurity is a matter of public health concern as it is associated with adverse health outcomes particularly among vulnerable population. Accessibility and availability of nutritious and culturally appropriate food is paramount to achieve zero hunger. To assess the prevalence of household food insecurity, to estimate the household dietary diversity and its association with household food insecurity. Material and Methods Using multistage sampling 381 rural households were surveyed. Household Food Insecurity Access Scale and House hold Dietary Diversity Scale were used as study instruments. Chi square test was used to compare the two groups and P < 0.05 was considered to be statistically significant. Results Prevalence of household insecurity was 33.3% (127) among the surveyed households and 8.1% (31) had severe food insecurity. The mean HFIS score was 6.85 ± 4.82. The household Dietary diversity score was 8.14 ± 1.54 for food secure and 6.51 ± 1.38 for severely food insecure households. There was a statistically significant difference in intake of milk and milk products, fruits, eggs and meat/poultry among food secure and insecure households (P < 0.001 respectively). Conclusion Food insecurity was high in rural households and was associated with lower dietary intake of foods from protein group, necessitating a need to reinforce the food security programmes in rural India with focus to enhance protein rich diet.
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Affiliation(s)
- Bhavna Langer
- Department of Community Medicine, GMC Jammu, Jammu and Kashmir, India
| | - Rajiv Kumar Gupta
- Department of Community Medicine, GMC Jammu, Jammu and Kashmir, India
| | - Rashmi Kumari
- Department of Community Medicine, GMC Jammu, Jammu and Kashmir, India
| | - Richa Mahajan
- Department of Community Medicine, GMC Jammu, Jammu and Kashmir, India
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117
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Wang H, El-Abbadi N. Food Insecurity, Race and Ethnicity, and Cognitive Function Among United States Older Adults. J Nutr 2024; 154:233-242. [PMID: 37984739 PMCID: PMC10925888 DOI: 10.1016/j.tjnut.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/07/2023] [Accepted: 11/17/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Cognitive impairment and dementia are severe public health issues in aging populations, which can be exacerbated by insufficient or unhealthy dietary intake. Food (in)security status is linked to cognitive function among older adults, but the relationship is complex and can vary by sociodemographic characteristics. OBJECTIVE This article aimed to investigate the association between food insecurity and cognitive function among United States older adults and explore potential variations by race and ethnicity groups. METHODS We prospectively examined changes in cognitive function and incidence of cognitive impairment alongside the presence of self-reported food insecurity among older adults of different racial and ethnic groups. Data were from the 2012-2018 Health and Retirement Study (HRS) and the 2013 Health Care and Nutrition Study (HCNS), including N = 6,638 United States adults aged 50 years and older. Food insecurity was measured by a self-reported United States Household Food Security Survey Module, and cognitive function was assessed by the modified version of the Telephone Interview for Cognitive Status. RESULTS Results showed that 17% of United States older adults reported food insecurity in the 2013 HCNS. Compared with food secure older adults, those reporting food insecurity experienced worsened cognitive functioning over time (B = -0.63, p < .001), and they were more likely to have onset of cognitive impairment (OR= 1.46, p < .001) in the 6-y observation. Compared with non-Hispanic White older adults, being non-Hispanic Black, non-Hispanic Other, or Hispanic was associated with 2.96, 2.09, or 1.26 odds (p < .001) of cognitive impairment (2012-2018), respectively. Older adults of racial and ethnic minority groups also had higher risks of experiencing the double burden of cognitive impairment alongside food insecurity compared with non-Hispanic White older adults. CONCLUSION Findings underscore racial and ethnic structural disparities in food security and cognitive health in the United States aging population.
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Affiliation(s)
- Haowei Wang
- Department of Sociology and Aging Studies Institute, Maxwell School of Citizenship and Public Affairs, Syracuse University, NY, United States.
| | - Naglaa El-Abbadi
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, United States
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118
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Kim N, Fischer L, Gross SH, Weissman M, Essel K. Feasibility and Impact Assessment of a Food Insecurity Protocol in a Large Urban Pediatric Primary Care Network. J Prim Care Community Health 2024; 15:21501319241236009. [PMID: 38554002 PMCID: PMC10981847 DOI: 10.1177/21501319241236009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION/OBJECTIVES In 2022, 1 in 6 households with children experienced food insecurity (FI) in the United States. The negative impact of FI on child health is well documented and pediatric clinicians are encouraged to actively screen and intervene in clinical settings. This study aims to evaluate the feasibility and impact of a FI management protocol implemented in 2017 at a pediatric primary care health network serving patients who are Medicaid-eligible in Washington, DC. METHODS In 2019, an 18-item electronic survey was sent to a convenience sample of 42 pediatric clinicians within the health network to understand their knowledge, attitudes, and behaviors surrounding implementation. Both quantitative and qualitative responses were collected and analyzed. We report frequencies of the Likert-type responses, including perceived compliance with protocol components and intervention efficacy. We evaluated the relationship between FI knowledge level and rates of clinician documentation compliance by chi square and Cramer's V statistic for effect size. Open-ended responses were reviewed, and common themes were identified and used to provide context for quantitative results. RESULTS AND CONCLUSIONS Out of 42 clinicians invited to complete the survey, 35 completed responses. All respondents reported universal screening for FI (100%) at routine examinations, 80% reported frequently electronically documenting FI in medical records, and 91% of clinicians reported frequently referring families who screened positive for FI to at least one FI resource, with 24% reporting that resources met families' needs. Open-ended responses revealed increased awareness of FI prevalence and of patient experiences in households experiencing FI, increased satisfaction with clinical management of FI, but also concerns around having limited clinical time to do the protocol and the usefulness and accessibility of referred resources. In conclusion, implementing this pilot FI protocol was feasible, but clinicians perceived limited impact of the protocol on alleviating FI and desired more robust intervention options. Further improvements include shifting the burden of performing the protocol away from the clinician, such as by streamlining the protocol or identifying a resource staff member, and establishing more accessible and effective FI interventions such as "Food as Medicine" offerings in partnership with community organizations.
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Affiliation(s)
- Noah Kim
- Children’s National Hospital, Washington, DC, USA
| | - Laura Fischer
- Children’s National Hospital, Washington, DC, USA
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | | | - Mark Weissman
- Children’s National Hospital, Washington, DC, USA
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Kofi Essel
- Children’s National Hospital, Washington, DC, USA
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
- Elevance Health, Indianapolis, IN, USA
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119
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Frank M, Daniel L, Hays CN, Shanahan ME, Naumann RB, McNaughton Reyes HL, Austin AE. Association of Food Insecurity With Multiple Forms of Interpersonal and Self-Directed Violence: A Systematic Review. Trauma Violence Abuse 2024; 25:828-845. [PMID: 37009984 PMCID: PMC10666476 DOI: 10.1177/15248380231165689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Economic stress, broadly defined, is associated with an increased likelihood of multiple forms of violence. Food insecurity is a distinct economic stressor and material hardship that is amenable to programmatic and policy intervention. To inform intervention and identify gaps in the current evidence base, we conducted a systematic review to synthesize and critically evaluate the existing literature regarding the association between food insecurity and five forms of interpersonal and self-directed violence: intimate partner violence (IPV), suicidality, peer violence and bullying, youth dating violence, and child maltreatment, in high-income countries. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and searched six electronic databases from their start date through February of 2022. We included studies that examined food insecurity as the exposure and an outcome measure of IPV, suicide, suicidality, peer violence, bullying, youth dating violence, or child maltreatment; were peer-reviewed and published in English; reported quantitative data; and took place in a high-income country. We identified 20 relevant studies. Nineteen studies found that food insecurity was associated with an increased likelihood of these forms of violence. Results highlight the potential for programs and policies that address food insecurity to function as primary prevention strategies for multiple forms of violence and underscore the importance of trauma-informed approaches in organizations providing food assistance. Additional theory-driven research with validated measures of food insecurity and clearly established temporality between measures of food insecurity and violence is needed to strengthen the existing evidence base.
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Affiliation(s)
- Madeline Frank
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leah Daniel
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Caroline N. Hays
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | - Anna E. Austin
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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120
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Sharareh N, Adesoba TP, Wallace AS, Bybee S, Potter LN, Seligman H, Wilson FA. Associations between food insecurity and other social risk factors among U.S. adults. J Gen Intern Med 2024; 39:52-60. [PMID: 37558857 PMCID: PMC10817876 DOI: 10.1007/s11606-023-08360-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Food insecurity (FI) often co-exists with other social risk factors, which makes addressing it particularly challenging. The degree of association between FI and other social risk factors across different levels of income and before and during the COVID-19 pandemic is currently unknown, impeding the ability to design effective interventions for addressing these co-existing social risk factors. OBJECTIVE To determine the association between FI and other social risk factors overall and across different levels of income-poverty ratios and before (2019) and during (2020-2021) the pandemic. DESIGN We used nationally representative data from the 2019-2021 National Health Interview Survey for our cross-sectional analysis. Social risk factors available in NHIS included difficulties paying for medical bills, difficulties paying for medications, receiving income assistance, receiving rental assistance, and "not working last week". SUBJECTS 93,047 adults (≥18 years old). KEY RESULTS Individuals with other social risk factors (except receiving income assistance) were more likely to report FI, even after adjusting for income and education inequalities. While poverty leads to a higher prevalence of FI, associations between FI and other social risk factors were stronger among people with higher incomes, which may be related to their ineligibility for social safety net programs. Associations were similar before and during the pandemic, perhaps due to the extensive provision of social safety net programs during the pandemic. CONCLUSIONS Future research should explore how access to a variety of social safety net programs may impact the association between social risk factors. With the expiration of most pandemic-related social supports, further research and monitoring are also needed to examine FI in the context of increasing food and housing costs. Our findings may also have implications for the expansion of income-based program eligibility criteria and screening for social risk factors across all patients and not only low-income people.
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Affiliation(s)
- Nasser Sharareh
- Department of Population Health Sciences, Spence Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA.
| | - Taiwo P Adesoba
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Andrea S Wallace
- Department of Population Health Sciences, Spence Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Sara Bybee
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Lindsey N Potter
- Department of Population Health Sciences, Spence Fox Eccles School of Medicine at the University of Utah, Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Hilary Seligman
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Fernando A Wilson
- Department of Population Health Sciences, Spence Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
- Matheson Center for Health Care Studies, Department of Economics, College of Social and Behavioral Science, University of Utah, Salt Lake City, UT, USA
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121
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Perez L, Gendelman S, Kendrick J. Home-Delivered Medically Tailored Meal Engagement Among Hemodialysis Patients and Providers. J Ren Nutr 2024; 34:40-46. [PMID: 37640277 DOI: 10.1053/j.jrn.2023.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/03/2023] [Accepted: 08/20/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE Hemodialysis patients face one of the most difficult diets among clinical patient populations. Furthermore, dialysis dietary adherence is generally reported as low with providers generally lacking the time and resources to implement effective behavior change. The purpose of this study was to elucidate measures of patient and provider engagement with home-delivered medically tailored meals (MTMs). METHODS We surveyed patients and staff at dialysis centers within the Denver metropolitan area. Surveys focused on 1) patient dietary intake, 2) awareness, support, and utilization of meal programs, and 3) nutritional challenges and barriers (including food security). RESULTS We surveyed 118 patients (mean age 61.0 ± 14.2 year, 58.5% male, and dialysis vintage of 4.6 ± 4.9 years) and 26 staff across the included dialysis facilities. Patients were 20.3% White/Non-Hispanic, 35.6% Hispanic/Latin, and 31.4% Black/African American. Most patients reported eating 2 meals per day (N = 53, 44.9%) and 52.2% reported difficulty with following a kidney diet. The most cited reasons for not following the diet were behavioral or knowledge (38.5%), taste (26.3%), time/convenience (26.9%) and food autonomy (16.9%). Sixty participants (52.2%) reported living in a food desert and 26.3% reported food insecurity. Seventy-one patients (61.2%) were aware of MTMs but only 40.5% had been referred. Most (76.9%) dialysis providers were aware of MTMs but only 15 (57.7%) had actually referred patients to such a service. Black individuals were less likely to be referred for MTMs than White or Hispanics/Latin (29.7% vs 48.1% White and 45.0% Hispanic/Latin) individuals. CONCLUSION Medically tailored meals (MTMs) represent a potential method to alleviate or bypass some of the many barriers expressed by patients. Our findings reveal a critical need for education around MTMs for both patients and providers. Medically tailored meals (MTMs) could potentially demonstrate health kidney dietary patterns that might translate to altered dietary preferences or toward future behavior change.
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Affiliation(s)
- Luis Perez
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Sam Gendelman
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jessica Kendrick
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO.
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122
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Armendáriz-Arnez C, Tamayo-Ortiz M, Mora-Ardila F, Rodríguez-Barrena ME, Barros-Sierra D, Castillo F, Sánchez-Vargas A, Lopez-Carr D, Deardorff J, Eskenazi B, Mora AM. Prevalence of SARS-CoV-2 infection and impact of the COVID-19 pandemic in avocado farmworkers from Mexico. Front Public Health 2023; 11:1252530. [PMID: 38174080 PMCID: PMC10761533 DOI: 10.3389/fpubh.2023.1252530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction The COVID-19 pandemic disproportionately affected farmworkers in the United States and Europe, leading to increased morbidity and mortality. However, little is known about the specific impact of the pandemic on agriculture and food production workers in low- and middle-income countries. This study aimed to investigate the prevalence of SARS-CoV-2 infection and assess the mental health and economic consequences of the COVID-19 pandemic among avocado farmworkers in Michoacan, Mexico. Methods We conducted a cross-sectional study of adult farmworkers (n = 395) in May 2021. We collected survey data, nasal swabs and saliva samples for SARS-CoV-2 RNA detection, and blood samples for immunoglobulin G (IgG) reactivity measurements. Results None of the farmworkers tested positive for SARS-CoV-2 RNA. However, among unvaccinated farmworkers (n = 336, 85%), approximately one-third (33%) showed evidence of past infection (positive for IgG against SARS-CoV-2). Unvaccinated farmworkers who lived with other farmworkers (aRR = 1.55; 95% CI: 1.05, 2.05), had ever lived with someone with COVID-19 (aRR = 1.82; 95% CI: 1.22, 2.43), and who had diabetes (aRR = 2.19; 95% CI: 1.53, 2.85) had a higher risk of testing IgG-positive for SARS-CoV-2 infection. In contrast, unvaccinated farmworkers living in more rural areas (outside of Tingambato or Uruapan) (aRR = 0.71; 95% CI: 0.46, 0.96) or cooking with wood-burning stove (aRR = 0.75; 95% CI: 0.55, 0.96) had a lower risk of IgG-positivity. Moreover, 66% of farmworkers reported a negative impact of the pandemic on their lives, 29% reported experiencing food insecurity and difficulty paying bills, and 10% reported depression or anxiety symptoms. Conclusion The COVID-19 pandemic has significantly affected the mental health and financial well-being of avocado farmworkers. Consequently, the implementation of interventions and prevention efforts, such as providing mental health support and food assistance services, is imperative.
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Affiliation(s)
- Cynthia Armendáriz-Arnez
- Escuela Nacional de Estudios Superiores Unidad Morelia, Universidad Nacional Autónoma de México, Morelia, Mexico
| | - Marcela Tamayo-Ortiz
- Department of Environmental Health Sciences, Columbia Mailman School of Public Health, New York, NY, United States
| | - Francisco Mora-Ardila
- Instituto de Investigaciones en Ecosistemas y Sustentabilidad, Universidad Nacional Autónoma de México, Morelia, Mexico
| | | | | | - Federico Castillo
- Department of Environmental Science, Policy and Management, University of California, Berkeley, Berkeley, CA, United States
| | - Armando Sánchez-Vargas
- Institute of Economic Research, Universidad Nacional Autónoma de Mexico, Mexico City, Mexico
| | - David Lopez-Carr
- Department of Geography, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Julianna Deardorff
- Center for Environmental Research and Community Health, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Brenda Eskenazi
- Center for Environmental Research and Community Health, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Ana M. Mora
- Center for Environmental Research and Community Health, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
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Verma H, Verma A, Bettag J, Kolli S, Kurashima K, Manithody C, Jain A. Role of Effective Policy and Screening in Managing Pediatric Nutritional Insecurity as the Most Important Social Determinant of Health Influencing Health Outcomes. Nutrients 2023; 16:5. [PMID: 38201835 PMCID: PMC10780641 DOI: 10.3390/nu16010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024] Open
Abstract
Social Determinants of Health (SDOH) impact nearly half of health outcomes, surpassing the influence of human behavior, clinical care, and the physical environment. SDOH has five domains: Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, and Social and Community Context. Any adversity arising out of these interlinked domains predominantly affects children due to their greater susceptibility, and the adverse outcomes may span generations. Unfavorable SDOH may cause food insecurity, malnutrition, unbalanced gut microbiome, acute and chronic illnesses, inadequate education, unemployment, and lower life expectancy. Systematic screening by health care workers and physicians utilizing currently available tools and questionnaires can identify children susceptible to adverse childhood experiences, but there is a deficiency with respect to streamlined approach and institutional support. Additionally, current ameliorating supplemental food programs fall short of pediatric nutritional requirements. We propose a nutrition-based Surveillance, Screening, Referral, and Reevaluation (SSRR) plan encompassing a holistic approach to SDOH with a core emphasis on food insecurity, coupled with standardizing outcome-based interventions. We also propose more inclusive use of Food Prescription Programs, tailored to individual children's needs, with emphasis on education and access to healthy food.
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Affiliation(s)
- Hema Verma
- SLU College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO 63104, USA
| | - Arun Verma
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, MO 63103, USA; (A.V.); (J.B.); (S.K.)
| | - Jeffery Bettag
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, MO 63103, USA; (A.V.); (J.B.); (S.K.)
| | - Sree Kolli
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, MO 63103, USA; (A.V.); (J.B.); (S.K.)
| | - Kento Kurashima
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, MO 63103, USA; (A.V.); (J.B.); (S.K.)
| | - Chandrashekhara Manithody
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, MO 63103, USA; (A.V.); (J.B.); (S.K.)
| | - Ajay Jain
- Department of Pediatrics, Saint Louis University School of Medicine, Saint Louis, MO 63103, USA; (A.V.); (J.B.); (S.K.)
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Zelko A, Salerno PRVO, Al-Kindi S, Ho F, Rocha FP, Nasir K, Rajagopalan S, Deo S, Sattar N. Geographically Weighted Modeling to Explore Social and Environmental Factors Affecting County-Level Cardiovascular Mortality in People With Diabetes in the United States: A Cross-Sectional Analysis. Am J Cardiol 2023; 209:193-198. [PMID: 37865123 PMCID: PMC10873078 DOI: 10.1016/j.amjcard.2023.09.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/15/2023] [Accepted: 09/24/2023] [Indexed: 10/23/2023]
Abstract
Disparities exist in the cardiovascular mortality rates among people with type 2 diabetes (T2D). Research has established that these disparities are often related to the environmental and social determinations of health. This study explores the spatial variation between air pollution, social determinants of health and T2D related age-adjusted cardiovascular mortality (aa-CVM) in the United States. We obtained county-level T2D related to aa-CVM (per 100,000 residents) from Centers for Disease Control and Prevention WONDER (Wide-ranging Online Data for Epidemiologic Research) (2010 to 2019). We fit a geographically weighted linear regression with aa-CVM as the outcome and the following covariates (ambient air pollution [particulate matter of 2.5 µm size], median annual household income, racial/ethnic minorities, higher education, rurality, food insecurity, and primary health care access) were included. Overall, the median aa-CVM rate was 92.9 and highest in the South (102.2). In the West, aa-CVM was significantly associated with particulate matter of 2.5 µm size, annual median household income, racial minority status and primary health care access. Food insecurity was the most significant exposure in the Midwest and Northeast, while in the South, annual median household income and food insecurity were significant. In conclusion, this study demonstrated a substantial regional variation of exposure to determinants of T2D related aa-CVM in the United States. These findings should be considered in policy frameworks and interventions as part of community-level approaches to addressing T2D related aa-CVM, and within broader state and national discussions of the importance of population health.
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Affiliation(s)
- Andrea Zelko
- College of Public Health, Kent State University, Kent, Ohio
| | - Pedro R V O Salerno
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | - Sadeer Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio; Case School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Fredrick Ho
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Fanny Petermann Rocha
- Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile; School of Metabolic and Cardiovascular Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Khurram Nasir
- Department of Cardiology, Houston Methodist Center, Houston, Texas
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio; Case School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Salil Deo
- Case School of Medicine, Case Western Reserve University, Cleveland, Ohio; School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom; Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio.
| | - Naveed Sattar
- School of Metabolic and Cardiovascular Sciences, University of Glasgow, Glasgow, United Kingdom
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Nelson K, Jackson AM, Nguyen CJ, Noonan C, Muller C, MacLehose RF, Manson SM, Dillard D, Buchwald D. Food Insecurity in Urban American Indian and Alaska Native Populations During the COVID-19 Pandemic. Res Sq 2023:rs.3.rs-3711655. [PMID: 38168406 PMCID: PMC10760224 DOI: 10.21203/rs.3.rs-3711655/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Background Food insecurity is an important social determinant of health that was exacerbated by the COVID-19 pandemic. Both food insecurity and COVID-19 infection disproportionately affect racial and ethnic minority groups, particularly American Indian and Alaska Native communities; however, there is little evidence as to whether food insecurity is associated with COVID-19 infection or COVID-19 preventive behaviors such as vaccination uptake. The purpose of this study was to evaluate associations between food insecurity, COVID-19 infection, and vaccination status among urban American Indian and Alaska Native adults seen at 5 clinics serving urban Native people. Methods In partnership with health organizations in Alaska, Colorado, Kansas, Minnesota, and New Mexico, the study team conducted a cross-sectional survey in 2021 to assess food security status and attitudes, barriers, and facilitators for COVID-19 testing and vaccination. Logistic regression was used to examine the association of food security status with sociodemographic factors and COVID-19 infection and vaccination status. Marginal standardization was applied to present results as prevalence differences. Results Among 730 American Indian and Alaska Native adults, the prevalence of food insecurity measured during the pandemic was 38%. For participants who reported persistent food security status before and during the pandemic (n=588), the prevalence of food insecurity was 25%. Prevalence of COVID-19 infection and vaccination did not vary by food security status after adjustment for confounders. Conclusions High rates of food insecurity among American Indian and Alaska Native communities likely increased during the COVID-19 pandemic. However, despite the high prevalence of food insecurity, community-led efforts to reduce COVID-19 infection and increase vaccination uptake across Indian Health Service and Tribal healthcare facilities may have mitigated the negative impacts of the pandemic for families experiencing food insecurity. These successful approaches serve as an important reference for future public health efforts that require innovative strategies to improve overall health in AIAN communities.
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Affiliation(s)
| | | | | | | | | | | | - Spero M Manson
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus
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Zinga J, van der Pligt P, Lindberg R, Vasilevski V, Lee A, McKay F. Food insecurity screening procedures used in reproductive healthcare settings. Nutr Rev 2023; 82:76-89. [PMID: 37120152 DOI: 10.1093/nutrit/nuad039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
CONTEXT Food insecurity is an important determinant of health and should be identified by clinicians during routine reproductive healthcare. The procedures used in reproductive healthcare settings to identify people experiencing food insecurity have not been fully researched. OBJECTIVE The objective of this study was to synthesize evidence from published studies that describe the procedures implemented by clinicians in healthcare settings to identify food insecurity in pregnant women, or women of reproductive age (15 years-49 years). DATA SOURCES Four databases were searched in April 2022 to identify studies that met the eligibility criteria. DATA EXTRACTION Studies that used tools that were both validated or newly developed were considered, as were studies that incorporated food insecurity screening as part of a multidomain screening tool. Two authors completed the screening, data extraction, and quality assessment independently. DATA ANALYSIS There were 1075 studies identified; after screening, 7 studies were included in the narrative synthesis, including studies relating to women who were pregnant or in the postpartum period; none of the included studies related to women in the preconception stage. Four screening tools were identified: 2- and 6-item tools specifically focused on food insecurity, a 58-item multidomain tool incorporating 4 food insecurity items, and a modified version of the 2-item tool. Methods of implementing screening varied across studies. Three described subsequent processes that supported food-insecure patients once identified. CONCLUSION Few published studies have investigated optimal screening tools and their implementation within reproductive healthcare settings to address food insecurity for this priority population group. Further research is required to determine: the optimal tool, preferable screening methods from the perspectives of both patients and clinicians, and potential strategies for implementation in countries outside of the United States. An additional evidence gap remains about referral pathways and appropriate supports for this population once food insecurity is identified. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42022319687.
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Affiliation(s)
- Julia Zinga
- are with the School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
- are with the Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
- are with the Nutrition and Dietetics Department, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Paige van der Pligt
- are with the School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
- are with the Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
- is with the Department of Nutrition, Western Health, Footscray, Victoria, Australia
| | - Rebecca Lindberg
- are with the School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
- are with the Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
| | - Vidanka Vasilevski
- are with the Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
- is with the School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Amelia Lee
- are with the Nutrition and Dietetics Department, Royal Women's Hospital, Parkville, Victoria, Australia
- are with the School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Fiona McKay
- are with the School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
- are with the Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
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Giles EL, Eskandari F, McGeechan G, Scott S, Lake AA, Teasdale S, Ekers D, Augustine A, Le Savauge N, Lynch C, Moore H, Smith J. Food insecurity in adults with severe mental illness living in Northern England: Peer research interview findings. Int J Ment Health Nurs 2023. [PMID: 38059552 DOI: 10.1111/inm.13270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/02/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023]
Abstract
Food insecurity means that a person does not have access to sufficient nutritious food for normal growth and health. Food insecurity can lead to many health problems such as obesity, heart disease, diabetes, and other long term health conditions. People living with a severe mental illness are more likely to experience food insecurity than people without mental illness. Peer-led in-depth interviews were conducted with adults with severe mental illness from Northern England, during which their experiences of food insecurity and strategies to tackle food insecurity were discussed. Interviews took place between March and December 2022, with interviews being transcribed and analysed using deductive and inductive thematic analysis. Thirteen interviews were conducted, finding that food insecurity in adults with severe mental illness was often a long-standing issue. Unemployment, the cost-of-living crisis and fuel poverty impacted on experiences of food insecurity. Difficulties accessing food banks such as transport, stigma, and the limited selection of available food was also discussed. Strategies to tackle food insecurity centred on making food banks more accessible and improving the quality of available food. Future research should aim to eradicate food insecurity for adults with severe mental illness, as limited research and action focuses on this population group over and above 'mental illness' or 'poor mental health'. Removing barriers to accessing food such as lack of transport, and providing food which is of adequate nutritional quality, should be prioritised, as well as tackling the stigma and accessibility issues surrounding food banks use.
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Affiliation(s)
- Emma L Giles
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
- Fuse, The Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Fatemeh Eskandari
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
- Fuse, The Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Grant McGeechan
- Fuse, The Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Centre for Applied Psychological Science, School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Steph Scott
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Amelia A Lake
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
- Fuse, The Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Scott Teasdale
- Discipline of Psychiatry & Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - David Ekers
- Department of Health Sciences, University of York (Mental Health and Addictions Research Group), York, UK
- Flatts Lane Centre, Tees, Esk and Wear Valleys NHS Foundation Trust Flatts Lane, Normanby, Tees Valley, Middlesbrough, UK
| | | | | | | | | | - Jo Smith
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
- Fuse, The Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- Flatts Lane Centre, Tees, Esk and Wear Valleys NHS Foundation Trust Flatts Lane, Normanby, Tees Valley, Middlesbrough, UK
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Cuauro SE, Santos N, Andrade E, Dani AW, Sanchious SN, Hooper SC, Becker CB. Internalized Weight Stigma and Weight Discrimination: Associations with Quality of Life and Psychosocial Impairment in a Sample Living with Food Insecurity. Int J Environ Res Public Health 2023; 20:7147. [PMID: 38131699 PMCID: PMC10742389 DOI: 10.3390/ijerph20247147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/26/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023]
Abstract
Research suggests that experiencing weight discrimination is associated with a lower quality of life and poor psychological and physical health. However, much of the existing weight discrimination literature has neglected under-represented groups. Little is known about how the experience of weight discrimination affects quality of life and eating/weight-related psychosocial impairment in those living with food insecurity. The present study investigated the associations of weight discrimination and eating/weight-related psychosocial impairment and quality of life. We examined internalized weight stigma and several psychological indicators as potential mediators. Participants (N = 1085) who were recruited from a local food bank completed a questionnaire assessing food insecurity, weight discrimination, internalized weight stigma, eating disorder pathology, anxiety, depression, eating/weight-related psychosocial impairment, and quality of life. Overall, almost one in four participants reported experiencing weight discrimination. Our serial mediation models indicated that increased experiences of weight discrimination were associated with greater internalized weight stigma and psychopathology, which were in turn associated with lower quality of life and greater eating/weight-related psychosocial impairment. Thus, experiencing weight discrimination may negatively impact quality of life and eating/weight-related psychosocial impairment through its effect on mental health. It is imperative to address the negative effects of the widespread discrimination of people based on their weight.
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Affiliation(s)
- Sabrina E. Cuauro
- Department of Psychology, Trinity University, San Antonio, TX 78212, USA; (N.S.); (E.A.); (A.W.D.); (S.N.S.); (C.B.B.)
- Department of Psychological Sciences, Rice University, Houston, TX 77005, USA
| | - Natalia Santos
- Department of Psychology, Trinity University, San Antonio, TX 78212, USA; (N.S.); (E.A.); (A.W.D.); (S.N.S.); (C.B.B.)
| | - Estefania Andrade
- Department of Psychology, Trinity University, San Antonio, TX 78212, USA; (N.S.); (E.A.); (A.W.D.); (S.N.S.); (C.B.B.)
| | - Anoushka W. Dani
- Department of Psychology, Trinity University, San Antonio, TX 78212, USA; (N.S.); (E.A.); (A.W.D.); (S.N.S.); (C.B.B.)
| | - Saivone N. Sanchious
- Department of Psychology, Trinity University, San Antonio, TX 78212, USA; (N.S.); (E.A.); (A.W.D.); (S.N.S.); (C.B.B.)
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI 02912, USA
| | - Savannah C. Hooper
- Department of Psychological and Brain Science, University of Louisville, Louisville, KY 40292, USA;
| | - Carolyn Black Becker
- Department of Psychology, Trinity University, San Antonio, TX 78212, USA; (N.S.); (E.A.); (A.W.D.); (S.N.S.); (C.B.B.)
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Ukonu IC, Wallace CA, Lowe NM. Household food security and dietary diversity in south-eastern Nigeria. Matern Child Nutr 2023:e13599. [PMID: 38047327 DOI: 10.1111/mcn.13599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 12/05/2023]
Abstract
The aim of this study was to investigate household food security (access) level and the dietary diversity of households in the Nsukka Local Government Area in South-eastern Nigeria. From 20 local communities of Nsukka, 390 women were randomly sampled from the women's group and asked to complete a survey that determined the Household Food Insecurity Access Scale scores and the Household Dietary Diversity Scores (HDDS). The descriptive results indicated a high level of food insecurity with 82.6% households reporting various degrees of food insecurity. Over half of the sampled population experienced insufficient food quality. They either ate unwanted food (65.9%), limited variety (63.1%), or unpreferred food (64.6%). Some households experienced insufficient food intake by going a whole day without food (38.2%), go to sleep hungry (45.1%), or have no food of any kind (49%). The analysis of variance showed no significant difference (p = 0.428) in the food security level of households headed by males as compared with those headed by females. Approximately 53.6% of households fell at or below the average HDDS; males headed 48% of these households, while females headed 64%. The chi-square test indicated factors associated with household food security including age, education, work status and income, whereas the gender of the household head, household size and marital status were not significantly associated. Public-private partnerships, nutrition orientation and food intervention programs could improve food security in this area.
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Affiliation(s)
- Ijeoma C Ukonu
- School of Sport and Health Sciences, The University of Central Lancashire, Preston, UK
| | - Carol A Wallace
- School of Sport and Health Sciences, The University of Central Lancashire, Preston, UK
| | - Nicola M Lowe
- School of Sport and Health Sciences, The University of Central Lancashire, Preston, UK
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Onono MA, Frongillo EA, Sheira LA, Odhiambo G, Wekesa P, Conroy AA, Cohen CR, Bukusi EA, Weiser SD. Links between Household-Level Income-Generating Agricultural Intervention and the Psychological Well-Being of Adolescent Girls in Human Immunodeficiency Virus-Affected Households in Southwestern Kenya: A Qualitative Inquiry. J Nutr 2023; 153:3595-3603. [PMID: 37863268 PMCID: PMC10739770 DOI: 10.1016/j.tjnut.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/26/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Adolescent girls may experience poor psychological well-being, such as social isolation, shame, anxiety, hopelessness, and despair linked to food insecurity. OBJECTIVES This study aimed to investigate the experiences with and perceived effects of a household-level income-generating agricultural intervention on the psychological well-being of adolescent girls in human immunodeficiency virus (HIV)-affected households in southwestern Kenya. METHODS We conducted 62 in-depth interviews with HIV-affected adolescent girls and caregiver dyads in Adolescent Shamba Maisha (NCT03741634), a sub-study of adolescent girls and caregivers with a household member participating in Shamba Maisha (NCT01548599), a multisectoral agricultural and finance intervention trial aimed to improve food security and HIV health indicators. Participants were purposively sampled to ensure diversity in terms of age and location. Data were audiotaped, transcribed, translated, and uploaded into Dedoose (Sociocultural Research Consultants, LLC) software for management. Data were analyzed thematically based on reports from Dedoose. RESULTS We found evidence that a household-level structural intervention aimed at increasing food and financial security among persons living with HIV can contribute to better psychological well-being among adolescent girls residing in these households. The intervention also affected: 1) reduction of social isolation, 2) reduction of shame and stigma, 3) increased attendance and concentration in school, 4) improved caregiver mental health, and 5) reduced parental aggression and improved household communication. These associations were reported more commonly among those in the intervention arm than the control arm. CONCLUSIONS This study extends existing research by demonstrating how multisectoral structural interventions delivered at a household level can improve the psychological well-being of adolescents. We recommend that future research test livelihood interventions designed specifically for adolescent girls that integrate food-security interventions with other elements to address the social and psychological consequences of food insecurity holistically. This trial was registered at clinicaltrials.gov as NCT03741634.
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Affiliation(s)
- Maricianah A Onono
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States.
| | - Lila A Sheira
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California San Francisco, CA, United States
| | - Gladys Odhiambo
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Pauline Wekesa
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Amy A Conroy
- Division of Prevention Science, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, United States
| | - Craig R Cohen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sheri D Weiser
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California San Francisco, CA, United States
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Gray GM, Zirikly A, Ahumada LM, Rouhizadeh M, Richards T, Kitchen C, Foroughmand I, Hatef E. Application of natural language processing to identify social needs from patient medical notes: development and assessment of a scalable, performant, and rule-based model in an integrated healthcare delivery system. JAMIA Open 2023; 6:ooad085. [PMID: 37799347 PMCID: PMC10550267 DOI: 10.1093/jamiaopen/ooad085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 10/07/2023] Open
Abstract
Objectives To develop and test a scalable, performant, and rule-based model for identifying 3 major domains of social needs (residential instability, food insecurity, and transportation issues) from the unstructured data in electronic health records (EHRs). Materials and Methods We included patients aged 18 years or older who received care at the Johns Hopkins Health System (JHHS) between July 2016 and June 2021 and had at least 1 unstructured (free-text) note in their EHR during the study period. We used a combination of manual lexicon curation and semiautomated lexicon creation for feature development. We developed an initial rules-based pipeline (Match Pipeline) using 2 keyword sets for each social needs domain. We performed rule-based keyword matching for distinct lexicons and tested the algorithm using an annotated dataset comprising 192 patients. Starting with a set of expert-identified keywords, we tested the adjustments by evaluating false positives and negatives identified in the labeled dataset. We assessed the performance of the algorithm using measures of precision, recall, and F1 score. Results The algorithm for identifying residential instability had the best overall performance, with a weighted average for precision, recall, and F1 score of 0.92, 0.84, and 0.92 for identifying patients with homelessness and 0.84, 0.82, and 0.79 for identifying patients with housing insecurity. Metrics for the food insecurity algorithm were high but the transportation issues algorithm was the lowest overall performing metric. Discussion The NLP algorithm in identifying social needs at JHHS performed relatively well and would provide the opportunity for implementation in a healthcare system. Conclusion The NLP approach developed in this project could be adapted and potentially operationalized in the routine data processes of a healthcare system.
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Affiliation(s)
- Geoffrey M Gray
- Center for Pediatric Data Science and Analytic Methodology, Johns Hopkins All Children’s Hospital, St. Petersburg, FL, United States
| | - Ayah Zirikly
- Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Luis M Ahumada
- Center for Pediatric Data Science and Analytic Methodology, Johns Hopkins All Children’s Hospital, St. Petersburg, FL, United States
| | - Masoud Rouhizadeh
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, United States
| | - Thomas Richards
- Department of Health Policy and Management, Center for Population Health Information Technology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Christopher Kitchen
- Department of Health Policy and Management, Center for Population Health Information Technology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Iman Foroughmand
- Department of Health Policy and Management, Center for Population Health Information Technology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Elham Hatef
- Department of Health Policy and Management, Center for Population Health Information Technology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
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132
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Hanson S, Belderson P, Player E, Minihane AM, Sweeting A. "Taking from Peter to pay Paul": The experience of people in receipt of fuel and food vouchers from a UK foodbank. NUTR BULL 2023; 48:500-512. [PMID: 37723996 DOI: 10.1111/nbu.12639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/09/2023] [Accepted: 09/05/2023] [Indexed: 09/20/2023]
Abstract
For people on very low incomes, household fuel and food environments are increasingly uncertain. Many live in precarious situations with little control over their lives. In addition to food parcels, many foodbanks also supply emergency fuel payments. There has been a surge in demand due to the cost of living crisis in the United Kingdom. This qualitative study, using semi-structured interviews, explored the lived experience of people who received a fuel voucher via a foodbank to gain insights into food preparation, eating practices and heating and appliance use in their homes. All participants (n = 6) described a change in life circumstances leaving them at crisis point with overwhelming uncertainty. Using Thematic Analysis, we identified four themes: (1) Bewilderment in using foodbank services; (2) The need to make trade-offs between food and fuel; (3) Feeling shame at using the services and (4) Missing out on pleasurable eating practices. Three case studies give fuller insights and context. All interviewees had acute and complex needs and described being 'at rock bottom', with fuel vouchers viewed as a 'lifeline' to address essential cooking, heating and electrical appliance needs. We, therefore, suggest the need for extra support and follow-up for first-time users who are in a state of denial and shock when seeking help. Further research is needed on how to best help organisations develop strategies to address and ameliorate a sense of powerlessness and shame felt by their clients which likely limits them from seeking help, despite being in acute, complex and dire need.
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Affiliation(s)
- Sarah Hanson
- Faculty of Medicine and Health, University of East Anglia, Norwich, UK
| | - Pippa Belderson
- Faculty of Medicine and Health, University of East Anglia, Norwich, UK
| | - Emily Player
- Faculty of Medicine and Health, University of East Anglia, Norwich, UK
| | | | - Anna Sweeting
- Faculty of Medicine and Health, University of East Anglia, Norwich, UK
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133
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Uy WF, Lillpopp R, Tyson DM, Himmelgreen D, Wright L, Gray HL. Experiences of New Visitors With Low Food Security Seeking Food Assistance During the COVID-19 Pandemic. J Nutr Educ Behav 2023; 55:884-893. [PMID: 37921795 DOI: 10.1016/j.jneb.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE To describe the experiences of first-time visitors with low food security seeking food assistance during the coronavirus disease 2019 pandemic. DESIGN A qualitative study. SETTING Emergency food distribution sites in West Central Florida. PARTICIPANTS Adults (aged 18-64 years) seeking food assistance between November, 2020 and July, 2021. PHENOMENON OF INTEREST Using food security as a multidimensional concept, in-depth interviews explored the impact of emergency food assistance on food availability, access, utilization, and stability. ANALYSIS Applied thematic analysis was conducted to identify emergent themes. RESULTS Participants (n = 18) were White (55.6%), female (72.2%), and aged 40-59 years (55.6%). Seven salient themes described participants' experience seeking food assistance (eg, the crisis resulting in seeking food assistance, mixed quality of pantry foods, and gaining firsthand insight on hunger). Although food assistance increased food availability and access, there were barriers to using the pantry foods (eg, foods not preferred, health/allergies). CONCLUSIONS AND IMPLICATIONS Study findings suggest that first-time visitors seeking emergency food assistance during the coronavirus disease 2019 pandemic may be experiencing temporary cycles of financial instability, which could impact dietary quality. Because pantry foods are often the primary source of household food supply, client-focused emergency food distribution tailored to client needs can increase food availability, access, and utilization.
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Affiliation(s)
- Whitney Fung Uy
- College of Public Health, University of South Florida, Tampa, FL.
| | | | | | | | - Lauri Wright
- Chair of the Department of Nutrition and Dietetics and Director of the Center for Nutrition and Food Security, University of North Florida, Jacksonville, FL
| | - Heewon L Gray
- College of Public Health, University of South Florida, Tampa, FL
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134
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Bennett BL, Cohen JF, Andreyeva T, Esposito J, Burkholder K, Chafouleas SM, Schwartz MB. Predictors of Participation in the U.S. Department of Agriculture Summer Meal Programs: An Examination of Outreach Strategies and Meal Distribution Methods During COVID-19. AJPM Focus 2023; 2:100124. [PMID: 37790948 PMCID: PMC10546601 DOI: 10.1016/j.focus.2023.100124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Significantly fewer children participate in the U.S. Department of Agriculture-sponsored summer meal programs than in the federal school meal programs during the academic year. During the summer of 2021, several pandemic-related waivers supported more flexible operations for summer meal programs, such as allowing grab-and-go meals and the distribution of meals for multiple days at once. This study assessed how summer meal site characteristics and geographically targeted outreach methods were associated with summer meals served in 2021 in Connecticut. Methods Weekly meal count data were requested from all sponsors of the Summer Food Service Program and the National School Lunch Program Seamless Summer Option. Data were received from 78 sponsors with 763 sites. Geographically targeted outreach (e.g., billboards, bus ads, and flyers) was tracked by location each week. Mixed methods ANOVA was used to examine the predictive value of outreach efforts, program characteristics, and meal distribution methods on meals served each week. The program characteristics examined included the hours open per week, the number of weeks serving meals, the maximum number of meals distributed at one time, and the number of open and closed sites in a school district. Results Between June 21 and August 20, 2021, a total of 1,188,669 breakfasts and 1,389,347 lunches were served. Sites that were open more hours per week (mean=7.60 hours per week; range=0.17-35) and gave multiple meals to parents at each visit (mean=4.68 meals; range=1-15) reported greater rates of meal distribution. The outreach efforts assessed were not significantly associated with changes in meal distribution at nearby sites. Conclusions The U.S. Department of Agriculture's waivers in response to COVID-19 permitted extended operating hours and multiple-meal distribution. These operational flexibilities should be considered for permanent regulation changes owing to their positive association with summer meal participation.
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Affiliation(s)
- Brooke L. Bennett
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, Connecticut
| | - Juliana F.W. Cohen
- Center for Health Inclusion, Research and Practice (CHIRP), Merrimack College, North Andover, Massachusetts
- Department of Public Health and Nutrition, Merrimack College, North Andover, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Tatiana Andreyeva
- Department of Agricultural and Resource Economics, Rudd Center for Food Policy and Health, University of Connecticut, Hartford, Connecticut
| | - Julia Esposito
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, Connecticut
| | - Kara Burkholder
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, Connecticut
| | - Sandra M. Chafouleas
- Department of Educational Psychology, University of Connecticut, Storrs, Connecticut
| | - Marlene B. Schwartz
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, Connecticut
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut
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135
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Ueda H. Measurement of food poverty (shoku no hinkon) as capability deprivation in high-income countries: operationalisation with single mothers in Japan. Asia Pac J Clin Nutr 2023; 32:383-391. [PMID: 38135473 DOI: 10.6133/apjcn.202312_32(4).0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Existing food insecurity instruments are focused largely on the financial constraints associated with acquiring sufficient amounts of food. This narrow focus has resulted in underestimating the true prevalence of food poverty, particularly in high-income countries. Food poverty needs to be defined as capability deprivation, extending from the nutritional to the temporal, spatial, qualitative and affective aspects of eating. In this article, the Alkire-Foster counting approach is evaluated and an alternative method for measuring such multidi-mensional food poverty is proposed. The method is demonstrated by using evidence from interviews with 53 single mothers, the most high-risk social group in Japan. On the basis of an operational definition of food deprivation and poverty cut-offs, 16 mothers (30%) were identified as living in food poverty, followed by a qualitative analysis of their deprivation profiles. The results show that the economically-poor were highly likely to fall into food poverty, but that food poverty also occurred without economic deprivation, notably among the mental or physical illness carriers and long-hour workers. This multidimensional and decomposable measurement tool is effective for identifying food-poor populations not reflected in traditional food insecurity measurement instruments.
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Affiliation(s)
- Haruka Ueda
- Japan Society for the Promotion of Science, Nagoya University
- Institute for Advanced Studies on Asia, University of Tokyo.
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136
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Luc G, Keita M, Houssoube F, Wabyona E, Constant A, Bori A, Sadik K, Marshak A, Osman AM. Community Clustering of Food Insecurity and Malnutrition Associated With Systemic Drivers in Chad. Food Nutr Bull 2023; 44:S69-S82. [PMID: 37850926 DOI: 10.1177/03795721231189970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND Chad suffers from protracted hunger, facing high food insecurity (Integrated Food Security Phase Classification 3 and above), and acute malnutrition levels that surpass the emergency threshold (15% global acute malnutrition) yearly. The Food Security Sector, with European Union support, leads an inclusive effort to increase synergy between humanitarian, development, and peace-building actors to understand and address drivers of hunger. OBJECTIVE To understand the spatial distribution of child wasting and household food insecurity and systemic drivers (conflict, livelihoods, vegetation, cultural norms) as well as better understand the relationship between child wasting and household food insecurity in Kanem and Bahr el Ghazal (BeG) region, Chad, with the goal of improving nexus programming and targeting. METHODS A cross-sectional randomized cluster survey was conducted in August 2021 in Kanem and BeG across 86 villages, reaching 7002 households and 6136 children. Data were collected on child anthropometry, household food security, and livelihoods. Using mixed methods, primary data were triangulated with secondary geospatial data on vegetation index and conflicts as well as qualitative interviews with local actors. Analysis was conducted using comparison tests, linear and logistic crude, and adjusted models, as well as looking at the design effect as a measure of clustering of outcomes at the community level. RESULTS The geospatial distribution of hunger indicators shows child wasting and food insecurity are highly clustered. However, communities with a high prevalence of child wasting were not those with the highest levels of food insecurity, indicating different pathways. Clustering of food insecurity and child wasting is due to basic drivers of conflict, health, and seasonal access to natural resources. CONCLUSIONS The high levels of food insecurity and child wasting are each concentrated in specific survey clusters and are not necessarily connected. They result from different causal pathways at the community level linked to the systemic drivers of the rule of access to natural resources, environmental seasonality, and livelihoods. This suggests a greater need for an integrated humanitarian, development, and peace-building interventions to address the persistent high prevalence of food insecurity and child wasting. It also suggests that these community-level and systemic drivers require greater consideration from the start in research design and data collection.
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Affiliation(s)
- Gwenaelle Luc
- Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Modibo Keita
- Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Fata Houssoube
- Food and Agriculture Organization of the United Nations, Rome, Italy
| | | | - Alain Constant
- Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Assad Bori
- Food and Agriculture Organization of the United Nations, Rome, Italy
| | | | - Anastasia Marshak
- Feinstein International Center, Tufts University, Somerville, MA, USA
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137
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Pepetone A, Qutub M, Andrade L, Wallace MP, Kirkpatrick SI. Food Security Status in Relation to Co-operative Enrolment Among University of Waterloo Undergraduate Students: A Cross-Sectional Analysis. CAN J DIET PRACT RES 2023; 84:211-217. [PMID: 37272876 DOI: 10.3148/cjdpr-2023-003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Purpose: Co-operative (co-op) education facilitates development of workplace competencies but may have unintended consequences for financial stability and food security. This study examined the association between co-op program enrolment and food security status among a sample of undergraduate students. Financial insufficiency and strategies to cope with it were also characterized.Methods: Cross-sectional data were collected from 167 co-op and 89 non-co-op students at the University of Waterloo from January to March 2019. Logistic regression assessed associations between co-op program enrolment and food insecurity.Results: Twenty-four percent of co-op and 39.3% of non-co-op students lived in moderately or severely food insecure households. Adjusting for confounders, the odds of living in moderately or severely food insecure households were lower among co-op students (adjusted odds ratio: 0.51, 95% CI: 0.27-0.97), though no association was observed when marginal food insecurity was included within the food insecure category. One-quarter (26.3%) of co-op students and 38.2% of non-co-op students reported financial insufficiency, which they tried to cope with by asking parents or friends for assistance or initiating paid work.Conclusions: Co-op program enrolment was weakly associated with lower odds of living in moderately or severely food insecure households, and food insecurity prevalence was high overall. Efforts are needed to alleviate food insecurity among postsecondary students.
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Affiliation(s)
| | - Mona Qutub
- School of Public Health Sciences, University of Waterloo, Waterloo, ON
| | - Lesley Andrade
- School of Public Health Sciences, University of Waterloo, Waterloo, ON
| | - Michael P Wallace
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON
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Kerins C, Furey S, Kerrigan P, McCartan A, Kelly C, Vaughan E. News media framing of food poverty and insecurity in high-income countries: a rapid review. Health Promot Int 2023; 38:daad188. [PMID: 38150220 PMCID: PMC10752350 DOI: 10.1093/heapro/daad188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
Food poverty and insecurity have become a public health emergency in many high-income countries. News media coverage can shape public and political views towards such issues. This rapid review synthesizes the evidence on how food poverty and insecurity are represented in the news media. Peer-reviewed publications were accessed through three electronic databases, with reference lists of all included studies screened. Primary research studies conducted in high-income countries and published in English since 1995 were included, with no restrictions on study methods. A combination of deductive coding to Entman's framing theory and inductive analysis was used. Ten studies, mostly rated as low quality, were included in the review. Newspapers were the only type of news media examined. The findings showed a largely absent nuanced understanding of food poverty and insecurity, with the problem often defined by food bank use and the consequences mainly focused on physical health. The causes were mostly attributed to structural factors, with the solutions largely focused on charitable food aid. The discourse of recipient (un)deservingness of food aid was evident. Articles often contained views from government officials and charities, with individuals' experiences of food poverty and insecurity largely absent. The findings of this review highlight that a major shift in print media discourse on food poverty and insecurity is required. More balanced and critical news reporting is required to present a more realistic picture of food poverty and insecurity, including its multi-dimensional nature, limitations of food charity and the need for structural solutions to this important issue.
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Affiliation(s)
- Claire Kerins
- Health Promotion Research Centre, School of Health Sciences, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Sinéad Furey
- Department of Hospitality and Tourism Management, Ulster University Business School, Ulster University, Cromore Road, Coleraine, Co. Londonderry BT52 1SA, United Kingdom
| | - Páraic Kerrigan
- School of Information and Communication Studies, University College Dublin, Belfield, Dublin 4 D04 V1W8,Ireland
| | - Aodheen McCartan
- School of Communication and Media, Ulster University, York Street, Belfast, Co. Antrim BT15 1ED, United Kingdom
| | - Colette Kelly
- Health Promotion Research Centre, School of Health Sciences, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Elena Vaughan
- Health Promotion Research Centre, School of Health Sciences, University of Galway, University Road, Galway H91 TK33, Ireland
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139
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Martinez SM, Esaryk E, Chodur G, Singh S, Kalaydjian S, Bullock HE, Britton TA. COVID-19-related stressors exacerbate food insecurity and depressive symptoms among graduate students receiving campus basic needs services: Cross-sectional findings from seven California public universities. Stress Health 2023. [PMID: 38018278 DOI: 10.1002/smi.3345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 10/11/2023] [Accepted: 10/24/2023] [Indexed: 11/30/2023]
Abstract
Prior to the COVID-19 pandemic, food insecurity and depression were growing public health concerns among graduate students. Yet, little is known about how COVID-19-related stressors exacerbated these health outcomes among graduate students. To address this research gap, this study examined two types of COVID-19-related stressors, anticipated concerns about remote learning and challenges interfering with academic and research responsibilities, in relation to food insecurity and depressive symptoms among public university graduate students. Between August and October 2020, 631 graduate students who utilised basic needs services from seven University of California campuses completed an online survey assessing the effects of COVID-19 on their academic experiences, mental health, and basic needs security. Regression analyses examined associations of COVID-19-related concerns and COVID-19-related challenges with food insecurity as well as COVID-19-related concerns and COVID-19-related challenges in relation to depressive symptoms. All four models were adjusted for age, sex, race and ethnicity, campus affiliation, and living with a partner. Models examining food security status as the dependent variable were adjusted for depressive symptoms and vice versa. Graduate students concerned about delayed graduation, post-graduate employment, isolation from faculty and not having access to healthcare reported higher counts of depressive symptoms. Challenges associated with higher counts of depressive symptoms included caring for family more than usual, spending more time on errands and not paying for utilities in full. Students concerned about accessing healthcare had higher odds of experiencing food insecurity. Challenges associated with food insecurity included spending more time on errands, being unable to afford housing and sending money to family members during the pandemic. Our findings illuminate the pandemic's deleterious consequences on graduate students' mental health and food security, underscoring the need for strong academic and basic needs programs and policies.
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Affiliation(s)
- Suzanna M Martinez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Erin Esaryk
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Gwen Chodur
- Department of Nutritional Biology, University of California, Davis, California, USA
| | - Sonali Singh
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Sevan Kalaydjian
- Center for Educational Partnerships, University of California, Irvine, California, USA
| | - Heather E Bullock
- Department of Psychology, University of California, Santa Cruz, California, USA
| | - Tolani A Britton
- School of Education, University of California, Berkeley, California, USA
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140
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Martinez-Brockman JL, Hromi-Fiedler A, Galusha D, Oladele C, Acosta L, Adams OP, Maharaj RG, Nazario CM, Nunez M, Nunez-Smith M, Pérez-Escamilla R. Risk factors for household food insecurity in the Eastern Caribbean Health Outcomes Research Network cohort study. Front Public Health 2023; 11:1269857. [PMID: 38074748 PMCID: PMC10702572 DOI: 10.3389/fpubh.2023.1269857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023] Open
Abstract
Background Globally, 1.3 billion people were considered food insecure as of 2022. In the Caribbean region, the prevalence of moderate or severe food insecurity was 71.3% as of 2020, the highest of all subregions in Latin America. Experienced based measurement scales, like the Latin American and Caribbean Food Security Scale, are efficient measurement tools of food insecurity used globally. The Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study is a population-based longitudinal cohort study in the two Caribbean U.S. territories of Puerto Rico and the U.S. Virgin Islands, as well as in Barbados and Trinidad & Tobago. The purpose of this research was to examine the demographic, psychosocial, behavioral, and environmental risk factors associated with household food insecurity (HFI) among adults ≥40 years of age in the ECHORN cohort. Methods A cross-sectional analysis of baseline ECHORN cohort study data was conducted. The primary outcome was household food insecurity (none, mild, moderate/severe). A total of 16 known and potential risk factors were examined for their association with HFI. The ANOVA and chi-square statistics were used in bivariate analysis. Ordinal logistic regression was used for the multivariable and sex stratified analyses. Results More than one-quarter of the sample (27.3%) experienced HFI. In bivariate analyses, all risk factors examined except for sex, were significantly associated with HFI status. In the multivariable analysis, all variables except sex, education, marital status, smoking status, and residing in Puerto Rico were significant predictors of HFI in the adjusted model. In sex stratified analysis, depression, food availability, self-rated physical health, and island site were significantly associated with increased odds of worsening HFI for women, but not for men. Source of potable water was an important risk factor for both men and women. Discussion The prevalence of HFI in the ECHORN cohort study is comparable to other studies conducted in the region. While women did not have an increased risk of HFI compared to men, a different set of risk factors affected their vulnerability to HFI. More research is needed to understand how water and food security are interrelated in the ECHORN cohort.
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Affiliation(s)
- Josefa L. Martinez-Brockman
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, United States
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Amber Hromi-Fiedler
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States
| | - Deron Galusha
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, United States
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Carol Oladele
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, United States
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Lisbette Acosta
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, United States
| | - O. Peter Adams
- Department of Family Medicine, Faculty of Medical Sciences, University of the West Indies, Cave Hill, Cave Hill, Barbados
| | - Rohan G. Maharaj
- Department of Paraclinical Sciences, University of the West Indies, Saint Augustine, Trinidad and Tobago
| | - Cruz M. Nazario
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico at Medical Sciences Campus, San Juan, Puerto Rico
| | - Maxine Nunez
- School of Nursing, University of the Virgin Islands, St. Thomas, US Virgin Islands
| | - Marcella Nunez-Smith
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, United States
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States
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141
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Kibe LW, Schrode K, Bazargan M, Shaheen M. Impact of food insecurity and food environment on the diet quality of older African Americans during the COVID-19 pandemic. Front Public Health 2023; 11:1268961. [PMID: 38035278 PMCID: PMC10682682 DOI: 10.3389/fpubh.2023.1268961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/12/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction A high quality diet is vital in promoting wellbeing and ensuring good health, particularly for those living with chronic conditions. Older African Americans, already burdened with a higher prevalence of chronic conditions, also face a higher risk for suboptimal diets. The COVID-19 pandemic had lasting effects on access to healthy food for all Americans, but some demographic groups were disproportionately affected. Older African Americans, who already experienced reduced access to healthy food pre-pandemic, were particularly afflicted, but the full extent of the pandemic's impact on their food insecurity and food environment remains unclear. Methods To address this gap, we conducted a study among 102 older African Americans in South Los Angeles between October 2021 and July 2022 during the COVID-19 pandemic. Participants completed surveys on dietary intake, food insecurity, and neighborhood food environment. We measured dietary quality using the healthy eating index (HEI)-2015. The analysis included descriptive, bivariate chi-square, t-tests, analysis of variance, and multiple linear and logistic regression. Results While overall dietary quality was suboptimal, most participants met the guidelines for fruit and vegetable consumption. Food insecurity was associated with lower overall diet quality and lower total fruit and whole fruit intake. However, there was no association between food environment and diet quality. Discussion In light of our findings, further intervention is critical to improving diet quality, especially among older African Americans living with chronic conditions in the post-pandemic era.
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Affiliation(s)
- Lucy W. Kibe
- Physician Assistant Program, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA, United States
| | - Katrina Schrode
- Department of Psychiatry, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA, United States
| | - Mohsen Bazargan
- Physician Assistant Program, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA, United States
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA, United States
- Department of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Magda Shaheen
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA, United States
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142
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Lee H, Moyo GT, Theophilus RJ, Oldewage-Theron W. Association of Dietary Changes with Risk Factors of Type 2 Diabetes among Older Adults in Sharpeville, South Africa, from 2004 to 2014. Nutrients 2023; 15:4751. [PMID: 38004145 PMCID: PMC10675501 DOI: 10.3390/nu15224751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/17/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
This study aimed to evaluate the associations of dietary changes with risk factors of type 2 diabetes among older populations in Sharpeville, South Africa. A 24 h recall assessment, dietary diversity, and anthropometrics were measured. Blood samples were collected to assess fasting glucose and insulin. Regression analysis was performed using SPSS version 20. The mean BMI of the total of 103 participants was 30.63 kg/m2 at baseline and 29.66 kg/m2 at follow-up. Significantly higher BMI levels were reported in women than men both at baseline (p = 0.003) and follow-up (p = 0.009). Waist circumference significantly decreased from 96.20 cm to 93.16 cm (p = 0.046). The mean levels of HOMA-B significantly increased from 88.99 to 111.19 (p = 0.021). BMI was positively associated with intakes of total energy (p = 0.22), polyunsaturated fatty acids (p = 0.050), and cholesterol (p = 0.006). Waist circumference was strongly associated with total energy (p = 0.048), polyunsaturated fatty acids (p = 0.037), trans fatty acids (p = 0.039), and cholesterol (p = 0.000). HOMA-IR and HOMA-B were associated with intakes of fat (HOMA-IR: p = 0.013; HOMA-B: p = 0.040) and monounsaturated fatty acids (HOMA-IR: p = 0.003; HOMA-B: p = 0.040).
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Affiliation(s)
- Hyunjung Lee
- Department of Nutrition, Texas A&M University, College Station, TX 77843, USA
| | - Gugulethu T. Moyo
- Center for Health and Wellbeing, Princeton School of Public and International Affairs, Princeton University, Princeton, NJ 08544, USA;
| | - Rufus J. Theophilus
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL 32611, USA
| | - Wilna Oldewage-Theron
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX 79409, USA
- Department of Sustainable Food Systems and Development, University of the Free State, Bloemfontein 9301, South Africa
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143
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Drumond VZ, de Arruda JAA, Bernabé E, Mesquita RA, Abreu LG. Burden of dental caries in individuals experiencing food insecurity: a systematic review and meta-analysis. Nutr Rev 2023; 81:1525-1555. [PMID: 37040617 DOI: 10.1093/nutrit/nuad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
CONTEXT Food insecurity affects approximately 2.37 billion people worldwide. Individuals experiencing food insecurity are more likely to exhibit poor health-related endpoints. Dental caries, a highly prevalent noncommunicable disease, is modulated by an interplay between biological, behavioral, and environmental factors. OBJECTIVE This systematic review and meta-analysis aimed to assess whether individuals experiencing food insecurity were more likely to exhibit dental caries than individuals facing food security. DATA SOURCES The Web of Science, PubMed, Scopus, Embase, Ovid, CINAHL, LILACS, and APA PsycINFO databases were checked from inception to November 2021. Grey literature and Google Scholar were also examined. An updated search was conducted in August 2022. Observational studies were included if they evaluated the association between dental caries and food insecurity status. DATA EXTRACTION Data extraction was performed by two reviewers. DATA ANALYSIS Random-effects meta-analyses were conducted using R language. In total, 514 references were retrieved from databases, of which 14 articles were included in qualitative synthesis and 7 were merged into meta-analysis. The results of an inverse-variance meta-analysis (OR = 1.62; 95%CI, 1.01-2.60) and a meta-analysis of binary data (OR = 1.66; 95%CI, 1.36-2.02) demonstrated that food-insecure individuals were more likely to exhibit dental caries than food-secure individuals. Inverse-variance meta-analyses appraising multiple strata of food security also showed that individuals experiencing marginal food security (OR = 1.48; 95%CI, 1.28-1.72), individuals experiencing low food security (OR = 1.26; 95%CI, 1.01-1.57), and those experiencing very low food security (OR = 1.33; 95%CI, 1.04-1.71) were more likely to exhibit dental caries than individuals experiencing full food security. CONCLUSION Dental caries is associated with food insecurity. Individuals living with food insecurity are more likely to exhibit dental caries than those who have food security. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42021268582.
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Affiliation(s)
| | - José Alcides A de Arruda
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Eduardo Bernabé
- Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Ricardo A Mesquita
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lucas G Abreu
- Department of Child and Adolescent Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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144
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Abdel-Rahman S, Awwad FA, Ismail EAA, Kibria BMG, Abonazel MR. Predictors of mental health problems during the COVID-19 outbreak in Egypt in 2021. Front Public Health 2023; 11:1234201. [PMID: 38026343 PMCID: PMC10665964 DOI: 10.3389/fpubh.2023.1234201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 10/04/2023] [Indexed: 12/01/2023] Open
Abstract
Background With the widespread outbreak of the coronavirus (COVID-19) pandemic, many countries, including Egypt, have tried to restrict the virus by applying social distancing and precautionary measures. Understanding the impact of COVID-19-induced risks and social distancing measures on individuals' mental health will help mitigate the negative effects of crises by developing appropriate mental health services. This study aimed to investigate the most contributing factors that affected individuals' mental health and how individuals' mental health has changed over the lockdown period in Egypt in 2021. Methods The study draws on a nationally representative sample from the combined COVID-19 MENA Monitor Household Survey conducted by the Economic Research Forum. The data were collected in Egypt by phone over two waves in February 2021 and June 2021. The total number of respondents is 4,007 individuals. The target population is mobile phone owners aged 18-64 years. The 5-item World Health Organization Well-Being Index (WHO-5) is used to assess the individuals' mental health over the past 2 weeks during the pandemic. Penalized models (ridge and LASSO regressions) are used to identify the key drivers of mental health status during the COVID-19 pandemic. Results The mean value of mental health (MH) scores is 10.06 (95% CI: 9.90-10.23). The average MH score for men was significantly higher than for women by 0.87. Rural residents also had significantly higher MH scores than their urban counterparts (10.25 vs. 9.85). Middle-aged adults, the unemployed, and respondents in low-income households experienced the lowest MH scores (9.83, 9.29, and 9.23, respectively). Individuals' mental health has deteriorated due to the negative impacts of the COVID-19 pandemic. Regression analysis demonstrated that experiencing food insecurity and a decrease in household income were independent influencing factors for individuals' mental health (p < 0.001). Furthermore, anxiety about economic status and worrying about contracting the virus had greater negative impacts on mental health scores (p < 0.001). In addition, women, middle-aged adults, urban residents, and those belonging to low-income households were at increased risk of poor mental health (p < 0.05). Conclusion The findings reveal the importance of providing mental health services to support these vulnerable groups during crises and activating social protection policies to protect their food security, incomes, and livelihoods. A gendered policy response to the pandemic is also required to address the mental pressures incurred by women.
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Affiliation(s)
- Suzan Abdel-Rahman
- Department of Demography and Biostatistics, Faculty of Graduate Studies for Statistical Research, Cairo University, Giza, Egypt
| | - Fuad A. Awwad
- Department of Quantitative Analysis, College of Business Administration, King Saud University, P.O. Box 71115, Riyadh 11587, Saudi Arabia
| | - Emad A. A. Ismail
- Department of Quantitative Analysis, College of Business Administration, King Saud University, P.O. Box 71115, Riyadh 11587, Saudi Arabia
| | - B. M. Golam Kibria
- Department of Mathematics and Statistics, Florida International University, Miami, FL, United States
| | - Mohamed R. Abonazel
- Department of Applied Statistics and Econometrics, Faculty of Graduate Studies for Statistical Research, Cairo University, Giza, Egypt
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145
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Gannon M, McLaughlin K, Short V, Wu A, Inguito K, Hand DJ, Abatemarco DJ. Food Insecurity and Psychological Distress Amongst Parenting Women in Treatment for Opioid Use: Identifying Barriers to Nutritional Equity and Implications for Future Intervention Research. Am J Health Promot 2023; 37:1141-1146. [PMID: 37489060 DOI: 10.1177/08901171231192840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
PURPOSE To describe the prevalence of food insecurity among pregnant and parenting women with opioid use disorder (OUD), its association with psychosocial health, and their experience with the Special Supplemental Nutrition Program for Women Infant Child (WIC) program. DESIGN This cross-sectional study collected survey data through REDCAP. SETTING The study was conducted at a single, urban, opioid treatment program. SUBJECTS A total of 91 female participants (≥18 years of age and receiving OUD treatment services) were approached about the study and all consented. MEASURES Measures included: US Household Short Form Food Security Survey, Patient Health Questionnaire 4(PHQ4), Perceived Stress Scale (PSS), and a demographics and food behavior survey. ANALYSIS Descriptive analyses (frequency, means) described data and Chi-Square, Fischer's exact, t-tests were used to compare data between food security groups. RESULTS Participants were on average 34 years old, Caucasian (68%), and non-Hispanic (87%). Most reported low (32%) to very low (33%) food security. Pearson correlation analyses indicate a strong positive linear relationship between Food Security Score and PHQ4 Total (P = .0002), PHQ4 Depression (P = .0003), PHQ4 Anxiety (P = .0009), and PSS Total (P < .0001). Only 38% felt the foods available in WIC supported their breastfeeding. Limitations include a single site and recall bias. CONCLUSIONS Significant nutritional inequity in families affected by maternal substance use exists, with potential for adverse maternal and child development related implications.
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Affiliation(s)
- Meghan Gannon
- College of Nursing, Health Policy Systems Track, Scholarly Inquiry, SKMC, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kimberly McLaughlin
- MATER Program Clinical Director, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vanessa Short
- College of Nursing, Population Health Research Track, Scholarly Inquiry, SKMC, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alice Wu
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kai Inguito
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dennis J Hand
- Associate Director of Maternal Addiction Treatment, Education and Research, Jefferson College of Nursing, Thomas Jefferson University, Philadelphia, PA, USA
| | - Diane J Abatemarco
- Director of Maternal Addiction Treatment, Education and Research (MATER), Jefferson College of Nursing, Thomas Jefferson University, Philadelphia, PA, USA
- Population Health Research Track, Scholarly Inquiry, SKMC, Thomas Jefferson University, Philadelphia, PA, USA
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146
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Linde S, Walker RJ, Campbell JA, Egede LE. Historic Residential Redlining and Present-Day Social Determinants of Health, Home Evictions, and Food Insecurity within US Neighborhoods. J Gen Intern Med 2023; 38:3321-3328. [PMID: 37296361 PMCID: PMC10255945 DOI: 10.1007/s11606-023-08258-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Examine the association between historic residential redlining and present-day racial/ethnic composition of neighborhoods, racial/ethnic differences in social determinant of health domains, and risk of home evictions and food insecurity. RESEARCH DESIGN AND METHODS We examined data on 12,334 (for eviction sample), and 8996 (for food insecurity sample), census tracts in 213 counties across 37 states in the USA with data on exposure to historic redlining. First, we examined relationships between Home Owners' Loan Corporation (HOLC) redlining grades (A="Best", B="Still Desirable", C="Definitely Declining", D="Hazardous") and present-day racial/ethnic composition and racial/ethnic differences in social determinant of health domains of neighborhoods. Second, we examined whether historic redlining is associated with present-day home eviction rates (measured across eviction filings rates, and eviction judgment rates for 12,334 census tracts in 2018) and food insecurity (measured across low supermarket access, low supermarket access and income, low supermarket access and low car ownership for 8996 census tracts in 2019). Multivariable regression models were adjusted for census tract population, urban/rural designation, and county level fixed effects. RESULTS Relative to areas with a historic HOLC grading of "A (Best)", areas with a "D (Hazardous)" grading had a 2.59 (95%CI=1.99-3.19; p-value<0.01) higher rate of eviction filings, and a 1.03 (95%CI=0.80-1.27; p-value<0.01) higher rate of eviction judgments. Compared to areas with a historic HOLC grading of "A (Best)", areas rated with a "D (Hazardous)" had a 16.20 (95%CI=15.02-17.79; p-value<0.01) higher rate of food insecurity based on supermarket access and income, and a 6.15 (95%CI =5.53-6.76; p-value<0.01) higher rate of food insecurity based on supermarket access and car ownership. CONCLUSIONS Historic residential redlining is significantly associated with present-day home evictions and food insecurity, highlighting persistent associations between structural racism and present-day social determinants of health.
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Affiliation(s)
- Sebastian Linde
- Medical College of Wisconsin, Department of Medicine, Division of General Internal Medicine, Milwaukee, WI, USA
- Center for Advancing Population Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Rebekah J Walker
- Medical College of Wisconsin, Department of Medicine, Division of General Internal Medicine, Milwaukee, WI, USA
- Center for Advancing Population Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jennifer A Campbell
- Medical College of Wisconsin, Department of Medicine, Division of General Internal Medicine, Milwaukee, WI, USA
- Center for Advancing Population Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Leonard E Egede
- Medical College of Wisconsin, Department of Medicine, Division of General Internal Medicine, Milwaukee, WI, USA.
- Center for Advancing Population Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
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147
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Ferrero EM, Yunker AG, Cuffe S, Gautam S, Mendoza K, Bhupathiraju SN, Mattei J. Nutrition and Health in the Lesbian, Gay, Bisexual, Transgender, Queer/Questioning Community: A Narrative Review. Adv Nutr 2023; 14:1297-1306. [PMID: 37536566 PMCID: PMC10721458 DOI: 10.1016/j.advnut.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 07/16/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023] Open
Abstract
Sexual and gender minorities have a higher risk for health and nutrition-related disparities across the life course compared to the heterosexual or cisgender population. Experiences of stigmatization and discrimination are associated with diminished mental health quality and psychological distress, which are risk factors for developing various eating disorders. Other nutrition disparities include increased risk for food insecurity, body dissatisfaction, and weight complications, such as those experienced by the transgender population in association with gender-affirming hormone therapies. Despite the need for tailored nutrition recommendations that address the unique needs of the lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) community, there are currently no such guidelines in North America. The purpose of this review is to summarize major LGBTQ+ nutrition disparities and highlight the need for tailored recommendations. We examine the evidence on mental health and social disparities in this group, including vulnerabilities to disordered eating, food insecurity, and healthcare provider discrimination. Importantly, we identify a scarcity of literature on dietary concerns and nutrition care guidelines for LGBTQ+ groups, including studies that address intersectionality and differences among specific gender and sexual orientations. These gaps underline the urgency of prioritizing nutrition for LGBTQ+ health needs and for developing tailored public health nutrition recommendations for this underserved population. Our review suggests that future LGBTQ+ health and nutrition research agendas should include personalized and precision nutrition, social determinants of health, diet quality, body image, and healthcare provider cultural competency and responsiveness. Moreover, the current evidence on LGBTQ+ nutrition and health will be strengthened when research studies (including clinical trials) with robust methodologies amplify inclusion and representation of this community to elucidate health and nutrition disparities in sexual and gender minorities.
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Affiliation(s)
- Elisabetta M Ferrero
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Alexandra G Yunker
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Sherri Cuffe
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Saloni Gautam
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Kenny Mendoza
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Shilpa N Bhupathiraju
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
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148
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Matos MS, Suzuki S, White N. Addressing Barriers to Healthy Eating Through Food as Medicine Initiatives. Am J Lifestyle Med 2023; 17:750-753. [PMID: 38511117 PMCID: PMC10948924 DOI: 10.1177/15598276231188645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Poor diet is the number one risk factor for death globally; yet, few adults meet the dietary guidelines for optimal health. Food is medicine initiatives including food pharmacies, produce prescriptions, and medically tailored meals are emerging models to improve diet and reduce diet-related disease. These initiatives target barriers to healthy eating, including access, nutrition knowledge, culinary skill, motivation, and support. The following will discuss significant barriers to healthy eating and describe the strategies employed within these initiatives to overcome such barriers.
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Affiliation(s)
- Marietta Sotomayor Matos
- Department of Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA
| | - Shaye Suzuki
- Department of Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA
| | - Nicole White
- Department of Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA
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149
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Olfert MD, Hagedorn-Hatfield RL, Houghtaling B, Esquivel MK, Hood LB, MacNell L, Soldavini J, Berner M, Savoie Roskos MR, Hingle MD, Mann GR, Waity JF, Knol LL, Walsh J, Kern-Lyons V, Paul C, Pearson K, Goetz JR, Spence M, Anderson-Steeves E, Wall-Bassett ED, Lillis JP, Kelly EB, Hege A, Fontenot MC, Coleman P. Struggling with the basics: food and housing insecurity among college students across twenty-two colleges and universities. J Am Coll Health 2023; 71:2518-2529. [PMID: 34586041 DOI: 10.1080/07448481.2021.1978456] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/13/2021] [Accepted: 09/03/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To quantify the number and type of students failing to secure basic needs. PARTICIPANTS Students attending 22 postsecondary schools in the United States in Fall 2019. METHODS The Adult Food Security Module and part of the #RealCollege Survey were used to measure food and housing insecurity, respectively. Logistic and linear regression models were used to assess the relationship between selected factors and basic needs insecurities. RESULTS Participants (n = 22,153) were classified as 44.1% and 52.3% food insecure and housing insecure, respectively. Homeless students or those who experienced childhood food insecurity were at the greatest odds of college food insecurity. Year in school was the largest contributor to being housing insecure, with PhD or EdD students being 1,157% more likely to experience housing insecurity compared to freshmen. CONCLUSIONS High prevalence of basic needs insecurities remain. Current campus initiatives may be insufficient, calling for a more holistic approach at the campus, state, and national levels.
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Affiliation(s)
- Melissa D Olfert
- Division of Animal and Nutritional Sciences, Davis College of Agriculture, Natural Resources, and Design, West Virginia University, Morgantown, West Virginia, USA
| | - Rebecca L Hagedorn-Hatfield
- Division of Animal and Nutritional Sciences, Davis College of Agriculture, Natural Resources, and Design, West Virginia University, Morgantown, West Virginia, USA
| | - Bailey Houghtaling
- School of Nutrition and Food Sciences, Louisiana State University AgCenter, Baton Rouge, Louisian, USA
| | - Monica K Esquivel
- Department of Human Nutrition, Food, and Animal Sciences, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
| | - Lanae B Hood
- Department of Nutrition, Health, and Human Performance, Meredith College, Raleigh, North Carolina, USA
| | - Lillian MacNell
- Department of Public Health, Campbell University, Buies Creek, North Carolina, USA
| | - Jessica Soldavini
- Center for Health Promotion and Disease Prevention and Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Maureen Berner
- School of Government, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mateja R Savoie Roskos
- Department of Nutrition, Dietetics and Food Sciences, Utah State University, Logan, Utah, USA
| | - Melanie D Hingle
- Department of Nutritional Sciences, University of Arizona, Tucson, Arizona, USA
| | - Georgianna R Mann
- Department of Nutrition and Hospitality Management, The University of Mississippi, University, Mississippi, USA
| | - Julia F Waity
- Department of Sociology and Criminology, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Linda L Knol
- Department of Human Nutrition and Hospitality Management, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Jennifer Walsh
- Department of Health Professions, James Madison University, Harrisonburg, Virginia, USA
| | | | - Christopher Paul
- Department of Public Administration, North Carolina Central University, Durham, North Carolina, USA
| | - Keith Pearson
- Department of Nutrition and Dietetics, School of Public Health, Samford University, Birmingham, Alabama, USA
| | - Jeannine R Goetz
- Department of Dietetics and Nutrition, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Marsha Spence
- Department of Nutrition, University of Tennessee, Knoxville, Tennessee, USA
| | | | - Elizabeth D Wall-Bassett
- School of Health Sciences, Nutrition and Dietetics Program, Western Carolina University, Cullowhee, North Carolina, USA
| | - J Porter Lillis
- Department of Sociology and Criminal Justice, University of North Carolina at Pembroke, Pembroke, North Carolina, USA
| | - E Brooke Kelly
- Department of Sociology and Criminal Justice, University of North Carolina at Pembroke, Pembroke, North Carolina, USA
| | - Adam Hege
- Department of Health & Exercise Science, Appalachian State University, Boone, North Carolina, USA
| | | | - Patricia Coleman
- Cooperative Research, Extension, and Education Services, Northern Marianas College, Saipan, Northern Mariana Islands
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150
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Horlick S, Chatwood S. Exploring community perspectives on the impacts of COVID-19 on food security and food sovereignty in Nunavut communities. Scand J Public Health 2023; 51:1027-1032. [PMID: 37042670 PMCID: PMC10099909 DOI: 10.1177/14034948221139005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 04/13/2023]
Abstract
BACKGROUND In Nunavut, where 70% of children are food insecure, many households rely on school breakfast or community food programmes for nourishment. The COVID-19 pandemic and resulting policies to reduce the spread of the disease have the potential to exacerbate existing issues, including increasing food insecurity in households. Funding programmes were implemented to limit the impact of public-health measures on household and community food security. The overall effects of the actions are not yet understood. METHODS This project used a qualitative approach to examine the determinants of food security and sovereignty and the impact of the COVID-19 pandemic policy responses on these determinants in Arviat and Iqaluit. Narrative analysis applied within a relational epistemology was used to describe the experiences of community members in Iqaluit and Arviat during the COVID-19 pandemic. RESULTS Seven participants were interviewed in Iqaluit (n=3) and Arviat (n=4). Key themes included the importance of decolonisation for food sovereignty, the importance of food sharing to communities and the resilience of communities during COVID-19. Community members wished to see greater support and strengthening of the country (locally harvested) food economy to increase knowledge of food and harvesting skill, and for communities to find ways to reach residents who may fall through the cracks during times of need or crisis. CONCLUSIONS This study is one of the first to document Nunavummiut experiences and perspectives of food security and sovereignty in Arviat and Iqaluit during the COVID-19 pandemic.
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Affiliation(s)
- Sidney Horlick
- University of Alberta, Canada, Qaujigiartiit Health Research Centre
| | - Susan Chatwood
- University of Alberta, Canada, Qaujigiartiit Health Research Centre
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