Economic determinants and dietary consequences of food insecurity in the United States

Using a gender lens to understand eating behaviours of adolescent females living in low-income households in Bangladesh

Adolescence is a critical period characterized by rapid physical, psychological, and social development and growth. In Bangladesh, high rates of undernutrition persist among adolescent females living in low‐income households. Prevalence of adolescent marriage and pregnancy is extremely high, with almost half of Bangladeshi women giving birth by 18 years of age. Qualitative research was carried out from April to June 2017 to examine individual, social, and environmental factors influencing eating behaviours of female adolescents between 15 and 19 years of age living in low‐income families in urban and rural settings in Bangladesh. Methods included freelisting exercises (33), key informant interviews (11), in‐depth interviews (24), direct observations (16), and focus group discussions (12). Findings show that household food insecurity necessitates adjustments in meal food quality and frequency. Gender norms prescribe that females receive small meal portions and make sacrifices in food consumption so that male family members can eat more. Work and school schedules cause long breaks between meal consumption, restricting food intake of adolescent females for extended periods. Gender discrimination and its manifestations likely amplify susceptibility to psychological stresses in adolescent females. An inferior social position makes adolescent females living in food insecure households vulnerable to undernutrition, with factors affecting food deprivation increasing as they approach childbearing. Policies to increase age of marriage and reduce adolescent pregnancy must continue. Programmes must ensure that school‐going adolescents eat adequately during the school day. Prolonging school education and strengthening the economic viability of women should alter cultural expectations regarding marriage age and normative female roles.

Food Insecurity Among Transgender and Gender Nonconforming Individuals in the Southeast United States: A Qualitative Study

Purpose: Transgender and gender nonconforming (TGNC) people experience high rates of poverty, joblessness, and homelessness, which drive risk for food insecurity. TGNC people also face discrimination due to transphobia and cissexism, which may contribute to these drivers. Minimal empirical evidence describes experiences with food insecurity among TGNC people. This project investigated food insecurity among TGNC people and how these experiences relate to their physical and mental health. Methods: Semistructured telephone interviews were conducted with 20 TGNC people residing in the Southeast United States (U.S.), recruited through social media. Interviews were transcribed and qualitatively coded. Results: TGNC people reported living in extreme poverty. They described how the conservative sociopolitical climate of the Southeast United States made it difficult to find and maintain employment, which was a primary driver of food insecurity. Participants experienced discomfort seeking food assistance due to discrimination and concern for reducing emergency food availability for people in greater need. Stress from unemployment and underemployment, inadequate food supplies, and discrimination was reported as a contributor to poor physical and mental health, and weakened support systems. Conclusion: Poverty and food insecurity erode TGNC people's physical and mental health and support systems. TGNC people faced substantial barriers-including unemployment and underemployment and multilevel discrimination-which prevented them from affording adequate food. Public health solutions include implementing employment nondiscrimination policy to protect TGNC people in the workplace and building relationships between local food pantries and LGBT organizations to create safer environments for all persons in need of food assistance.

Assessing food insecurity prevalence and associated factors among college students enrolled in a university in the Southeast USA

OBJECTIVE

To assess rates of food insecurity (FI) among college students enrolled at a large public university system across one US state and identify factors associated with experiencing FI.

DESIGN

Cross-sectional online survey administered to eligible, enrolled students (n 38 614) across three campuses within the university system, with 5593 students responding (4824 final sample after applying exclusion criteria, 12·5 % response rate). FI was assessed using the US Department of Agriculture's Adult Food Security Survey Module. Descriptive statistics were conducted to calculate FI status and identify sample characteristics. Associations between FI status and independent variables were assessed using bivariate analyses (χ2 and ANOVA tests) and multivariate logistic regression.

SETTING

Large public university system, Southeast USA.

PARTICIPANTS

Enrolled college students (excluding freshman, <18 years of age).

RESULTS

Thirty-six per cent of students were classified as FI. After controlling for confounders, factors that were significantly associated with increased likelihood of FI included previous FI (P<0·001; OR=4·78), financial factors and self-reported grade point average ≤3·85. Seniors were significantly more likely experience FI than graduate students (P=0·004, OR=1·41). A significant relationship was not identified between FI and meal plan participation, and no differences in FI were found between graduate students and individuals with sophomore or junior standing.

CONCLUSIONS

This research identifies high rates of FI among college students enrolled in a large public university system in the Southeast USA, as well as selected factors related to FI. Programmes to assist college students experiencing FI need to be developed and tested.

Food Insecurity, Internalized Stigma, and Depressive Symptoms Among Women Living with HIV in the United States

Food insecurity, internalized HIV stigma, and depressive symptoms are independently associated with poor HIV outcomes. Food insecurity, stigma, and depression may be interrelated among women living with HIV (WLHIV). We hypothesized that food insecurity would be independently associated with internalized stigma and depressive symptoms among WLHIV in the United States (US), and would partially account for associations between stigma and depressive symptoms. We tested hypotheses using regression models and partial correlation analysis with cross-sectional data among 1317 WLHIV from the Women's Interagency HIV Study. In adjusted models, greater food insecurity was associated with internalized HIV stigma and depressive symptoms (all p < 0.05), exhibiting dose-response relationships. Food insecurity accounted for 23.2% of the total shared variance between depressive symptoms and internalized stigma. Food insecurity is associated with depressive symptoms and internalized HIV stigma among US WLHIV, and may play a role in the negative cycle of depression and internalized stigma.

Hidden hunger? Experiences of food insecurity amongst Pakistani and white British women

PURPOSE

Foodbank use in the UK is rising but, despite high levels of poverty, Pakistani women are less likely to use food banks than white British women. The purpose of this paper is to understand the lived experience of food in the context of poverty amongst Pakistani and white British women in Bradford, including perspectives on food aid.

DESIGN/METHODOLOGY/APPROACH

A total of 16 Pakistani and white British women, recruited through community initiatives, participated in three focus groups (one interview was also held as a consequence of recruitment difficulties). Each group met for two hours aided by a moderator and professional interpreter. The transcripts were analysed thematically using a three-stage process.

FINDINGS

Women in low-income households employed dual strategies to reconcile caring responsibilities and financial obligations: the first sought to make ends meet within household income; the second looked to outside sources of support. There was a reported near absence of food insecurity amongst Pakistani women which could be attributed to support from social/familial networks, resource management within the household, and cultural and religious frameworks. A minority of participants and no Pakistani respondents accessed charitable food aid. There were three reasons for the non-use of food aid: it was not required because of resource management strategies within the household and assistance from familial/social networks; it was avoided out of shame; and knowledge about its existence was poor.

ORIGINALITY/VALUE

This case study is the first examination of varying experiences of food insecurity amongst UK white British and Pakistani women. Whilst the sample size is small, it presents new evidence on perceptions of food insecurity amongst Pakistani households and on why households of varying ethnicities do not use food aid.

Walking the Food Security Tightrope-Exploring the Experiences of Low-to-Middle Income Melbourne Households

There is limited evidence of how Australian low-to-middle income (AUD $40,000⁻$80,000) households maintain food security. Using a sequential explanatory mixed methods methodology, this study explored and compared the food security (FS) and insecurity (FIS) experiences of these households. An initial quantitative survey categorised participants according to food security status (the 18-item United States Department of Agriculture Household Food Security Survey Module) and income level to identify and purposefully select participants to qualitatively explore food insecurity and security experiences. Of the total number of survey participants (n = 134), 42 were categorised as low-to-middle income. Of these, a subset of 16 participants (8 FIS and 8 FS) was selected, and each participant completed an in-depth interview. The interviews explored precursors, strategies to prevent or address food insecurity, and the implications of the experience. Interview data were analysed using a thematic analysis approach. Five themes emerged from the analysis: (i) food decision experiences, (ii) assets, (iii) triggers, (iv) activation of assets, and (v) consequences and emotion related to walking the food security tightrope. The leverage points across all themes were more volatile for FIS participants. Low-to-middle income Australians are facing the challenges of trying to maintain or improve their food security status, with similarities to those described in lower income groups, and should be included in approaches to prevent or address food insecurity.

Physical-psychiatric comorbidity: patterns and explanations for ethnic group differences

OBJECTIVE

This paper examines ethnic differences in the co-occurrence of physical and psychiatric health problems (physical-psychiatric comorbidity) for women and men. The following ethnic groups are included: Non-Latino Whites, African Americans, Caribbean Blacks, Spanish Caribbean Blacks, Mexicans, Cubans, Puerto Ricans, Other Latinos, Chinese, Filipinos, Vietnamese, and Other Asian Americans. In addition, the study assesses the extent to which social factors (socioeconomic status, stress exposure, social support) account for ethnic differences in physical-psychiatric comorbidity (PPC).

DESIGN

This study uses data from the Collaborative Psychiatric Epidemiology Surveys (CPES) (N = 12,787). Weighted prevalence rates of physical-psychiatric comorbidity (PPC) - the co-occurrence of physical and psychiatric health problems - are included to examine ethnic group differences among women and men. Multinomial logistic regression analysis was used to determine group differences in PPC before and after adjusting for social factors.

RESULTS

Puerto Rican men have significantly higher risk of PPC in comparison to Non-Latino White men. Among women, Blacks and Cubans were more likely than Non-Latino Whites to experience PPC as opposed to 'Psychiatric Only' health problems. Social factors account for the Puerto Rican/Non-Latino White difference in comorbid health among men, but have little explanatory power for understanding ethnic differences in comorbidity among women.

CONCLUSION

These findings have implications for medical care and can guide intervention programs in targeting a specific constellation of co-occurring physical and psychiatric health problems for diverse ethnic groups in the United States. As comorbidity rates increase, it is crucial to identify the myriad factors that give rise to ethnic group differences therein.

Overlapping geographic clusters of food security and health: Where do social determinants and health outcomes converge in the U.S?

We identified overlapping geographic clusters of food insecurity and health across U.S. counties to identify potential shared mechanisms for geographic disparities in health and food insecurity. By analyzing health variables compiled as part of the 2014 Robert Wood Johnson Foundation County Health Rankings, we constructed four health indices and compared their spatial patterns to spatial patterns found in food insecurity data obtained from 2014 Feeding America's County Map the Meal Gap data. Clusters of low and high food security that overlapped with clusters of good or poor health were identified using Local Moran's I statistics. Next, multinomial logistic regressions were estimated to identify sociodemographic, urban/rural, and economic correlates of counties lying within overlapping clusters. In general, poor health and high food insecurity clusters, "unfavorable cluster overlaps", were present in the Mississippi Delta, Black Belt, Appalachia, and Alaska. Overlapping good health and low food insecurity clusters, "favorable cluster overlaps", were less common and located in the Corn Belt and New England. Counties with higher black populations and higher poverty were associated with an increased likelihood of lying within overlapping clusters of poor health and high food insecurity. Generally consistent patterns in spatial overlaps between food security and health indicate potential for shared causal mechanisms. Identified regions and county-level characteristics associated with being located inside of overlapping clusters may be used in future place-based intervention and policy.

Food Insecurity and Behavioral Characteristics for Academic Success in Young Adults Attending an Appalachian University

In order to investigate the impact of food insecurity on college students in a highly health disparate region we (1) assessed the prevalence of food insecurity among young adults at a large, rural university in Appalachia, and (2) investigated the relationship between food insecurity and behavioral characteristics including academic performance, coping strategies, and money expenditure. A cross-sectional design was used to capture a representative sample of young adults attending a large, central Appalachian university in Fall 2016. The United States Department of Agriculture (USDA) Adult Food Security Survey was used to measure food insecurity. Independent variables include money expenditure (MES), coping strategies (CSS), academic performance (APS), and demographic, health, economic and culinary variables. Participant responses (n = 692) showed one third (36.6%) of respondents were food-insecure. Students with higher scores for MES and CSS had significantly higher odds of being food-insecure (odds ratio (OR) = 2.07; 95% confidence interval (CI) 1.81 to 2.38 and OR = 1.20; 95% CI 1.16 to 1.23, respectively). The odds of high APS scores (OR = 0.79; 95% CI 0.73 to 0.86) were inversely related to food insecurity. Results of the logistic regression showed MES, CSS, health, and school year remained a significant predictor of food insecurity in college students. These findings suggest behavioral differences in terms of coping strategies, money expenditure, and academic progress among food-insecure students and can be used to identify and target at-risk students to promote student food security and well-being.

The relation of cash transfer programs and food insecurity among families with preschool children living in semiarid climates in Brazil

Abstract Background Food insecurity has important effects on human health, particularly in children’s. It continues to increase, with an estimated prevalence of 14.9% in the USA and 35% in Brazil. There have been few studies on the effect of cash transfer programs (CTPs) on the prevalence of food security in Brazil. Objective Evaluate the association between cash transfer programs and reductions in inequity and food insecurity. Method Population-based cross-sectional study in the state of Ceará, Northeast Brazil, with a sample of 8.000 households. Ceará is one of the poorest states. The state population of 8.5 million inhabitants, social security benefits and government grants, “ Bolsa Família”, have become the most stable source of income. The main outcomes measures were food insecurity and CTP participation. Multivariate logistic models were constructed to assess the association between participation in CTPs and food security. Results Participation in CTPs was found to be independently related to the prevalence of food security (APR 2.29 95% CI 1.57-3.33), as are education level, residential setting, and children’s nutritional status. Conclusions CTPs and investment in education are initiatives that might be used to reduce food insecurity.

Severe food insecurity is associated with overweight and increased body fat among people living with HIV in the Dominican Republic

Food insecurity is an important risk factor for overweight and obesity among low-income populations in high income countries, but has not been well-studied among people living with HIV (PLHIV), particularly in resource-poor settings. To explore the association between food insecurity and overweight and obesity among PLHIV in the Dominican Republic, we conducted a cross-sectional study of 160 HIV-infected adults between March-December 2012 in four geographically-dispersed health centers (Santo Domingo, Puerto Plata, San Juan, and Higuey). We collected information on household food insecurity, anthropometric measurements, and socio-demographic data and ran descriptive and multivariate analyses, controlling for fixed effects of clinics and using robust standard errors. Mean age ± SD of participants was 39.9 ± 10.5 years; 68% were women, and 78% were on antiretroviral therapy (ART). A total of 58% reported severe household food insecurity. After controlling for age, gender, income, having children at home, education, and ART status, severe food insecurity was associated with increased body mass index (BMI) (β = 1.891, p = 0.023) and body fat (β = 4.004, p = 0.007). Age and female gender were also associated with increased body fat (β = 0.259, p < 0.001 and β = 8.568, p < 0.001, respectively) and age and ART status were associated with increased waist circumference (β = 0.279, p = 0.011 and β = 5.768, p = 0.046, respectively). When overweight was examined as a dichotomous variable (BMI ≥ 25.0), severe food insecurity was associated with an increased odds of 3.060 (p = 0.013); no other covariates were independently associated with overweight. The association of severe food insecurity with increased BMI, body fat, and overweight among PLHIV has important implications for clinical care as well as food security and nutrition interventions in resource-poor settings. Integrated programs that combine nutrition education or counseling with sustainable approaches to addressing food insecurity among PLHIV are needed to improve long-term health outcomes of this vulnerable population.

Measures of low food variety and poor dietary quality in a cross-sectional study of London school children

BACKGROUND/OBJECTIVES

The use of simple screening tools to measure nutritional adequacy in a public health context in developed countries are currently lacking. We explore the relationship between food variety and nutrient intake of London school children using a simple tool with potential use for screening for inadequate diets.

SUBJECTS/METHODS

A cross-sectional survey was carried out in 2010. The survey included 2579 children aged 7-10 years in 52 primary schools in East London in the United Kingdom. The analysis included 2392 children (93% of the original sample). Food variety was assessed as the total number of listed foods recorded over 24 h using the validated Child and Diet Assessment Tool (CADET) comprising 115 listed foods divided into 16 food categories. Dietary quality was determined by the proportion of children meeting recommended intakes of individual micronutrients, namely, calcium, iron, zinc, folate, vitamin A and vitamin C.

RESULTS

The mean number of CADET-listed foods consumed daily by children was 17.1 (95% CI: 16.8, 17.5). Children who consumed fewer than 11 foods on the collection day had particularly low nutrient intakes. Children consuming three different vegetables and two different fruits on average consumed 19-20 listed foods. It was estimated between 4 and 20% of children did not meet the recommended levels for individual micronutrients during the period of data collection.

CONCLUSIONS

A simple method using food counts to assess daily food variety may help public health nutritionists identify groups of children at risk of inadequate diets.

Application of a Theoretical Model Toward Understanding Continued Food Insecurity Post Hurricane Katrina

OBJECTIVE

Disaster recovery efforts focus on restoring basic needs to survivors, such as food, water, and shelter. However, long after the immediate recovery phase is over, some individuals will continue to experience unmet needs. Ongoing food insecurity has been identified as a post-disaster problem. There is a paucity of information regarding the factors that might place an individual at risk for continued food insecurity post disaster.

METHODS

Using data from a sample (n=737) of households severely impacted by Hurricane Katrina, we estimated the associations between food insecurity and structural, physical and mental health, and psychosocial factors 5 years after Hurricane Katrina. Logistic regression models were fit and odds ratios (OR) and 95% CI estimated.

RESULTS

Nearly one-quarter of respondents (23%) reported food insecurity 5 years post Katrina. Marital/partner status (OR: 0.7, CI: 0.42, 0.99), self-efficacy (OR: 0.56, CI: 0.37, 0.84), sense of community (OR: 0.7, CI: 0.44, 0.98), and social support (OR: 0.59, CI: 0.39, 0.89) lowered the odds of food insecurity and explained most of the effects of mental health distress on food insecurity. Social support, self-efficacy, and being partnered were protective against food insecurity.

CONCLUSIONS

Recovery efforts should focus on fostering social-support networks and increased self-efficacy to improve food insecurity post disaster. (Disaster Med Public Health Preparedness. 2018;12:47-56).

A Protective Association between SNAP Participation and Educational Outcomes Among Children of Economically Strained Households

With the recent cuts to the Supplemental Nutrition Assistance Program (SNAP), more information is needed to assess the impact these policies have on vulnerable children. As such, this study assesses the potential moderating effect of SNAP participation on the association between material deprivation and educational outcomes among children living in poverty (n = 10 971, and n = 14 928). SNAP participation was found to moderate the association between material deprivation and grade retention, indicating that SNAP may be contributing to grade retention among children living in poverty, which can have positive lifelong consequences.

Food insecurity partially mediates associations between social disadvantage and body composition among older adults in india: Results from the study on global AGEing and adult health (SAGE)

OBJECTIVE

Our objective was to test whether food insecurity mediates cross-sectional associations between social disadvantage and body composition among older adults (aged 50+) in India (n = 6556).

METHODS

Adjusting for key sociodemographic and dietary variables, we examined whether markers of social disadvantage (lower educational attainment, lower household wealth, belonging to a disadvantaged caste/tribe, and belonging to a minority religion) were associated with food insecurity. We then examined whether food insecurity, in turn, was associated with anthropometric measures of body composition, body mass index (BMI), and waist circumference (WC). We also tested whether food insecurity mediated the relationship between social disadvantage and body composition.

RESULTS

In adjusted models, lower household wealth [lowest quintile (Q5) vs highest quintile (Q1): odds ratio (OR) = 13.57, P < .001], having less than a high-school education (OR = 2.12. P < .005), being Muslim (OR = 1.82, P < .001), and being in a scheduled caste (historically marginalized) (OR = 1.49, P < .005) were associated with greater food insecurity. Those who were severely food insecure had greater odds of being underweight (OR = 1.36, P < .01) and lower odds of high WC (OR = 0.70, P < .01). Mediation analyses estimated that food insecurity explained 4.7%-29.7% of the relationship between social disadvantage and body composition, depending on the variables considered.

CONCLUSIONS

Our results are consistent with the hypothesis that food insecurity is a mechanism linking social disadvantage and body composition among older adults in India. These analyses contribute to a better understanding of processes leading to variation in body composition, which may help enhance the design of interventions aimed at improving population nutritional status.

Associations between the local food environment and the severity of food insecurity among new families using community food security interventions in Montreal

OBJECTIVES

To examine the association between the local food environment and the severity of food insecurity among new families using community food security interventions in Montreal.

METHODS

In this cross-sectional study, we analyzed baseline data from 785 adults aged 18-65 years enrolled in the evaluation of the effects of organizations delivering community food security interventions in Montreal. The dependent variable was household food insecurity, while the independent variable was the local food environment, assessed through: location of the most frequently used grocery store, distance between the participant's residence and the community organization used, mode of transportation, walking time to the most frequently used grocery store, satisfaction with the acceptability and affordability of food available at the most frequently used grocery store, and self-reported difficulties in accessing food. We used polytomous logistic regression to estimate the association between household food insecurity and the local food environment. In all the models, we coded food security status in three categories: food security, moderate food insecurity and severe food insecurity. The last group was used as a reference group.

RESULTS

Our data suggest that compared to households with severe food insecurity, those with moderate food insecurity (OR = 0.43, 95% CI: 0.28-0.62) and those with food security (OR = 0.13, 95% CI: 0.06-0.26) were less likely to report difficulties in accessing food due to food affordability. Food-secure households also had lower odds of reporting difficulties in accessing food due to transportation constraints (OR = 0.18, 95% CI: 0.06-0.55) compared with severe food-insecure households. Living a distance of between 1 and 2 km from the organization used was significantly correlated with moderate food insecurity (OR = 1.80, 95% CI: 1.12-2.88).

CONCLUSION

The local food environment is associated with severity of household food insecurity among new families using community food security interventions in Montreal. Future studies should study the relationship between the local food environment and food insecurity across all dimensions of food access.

Lunch at the library: examination of a community-based approach to addressing summer food insecurity

Objective

To examine a library-based approach to addressing food insecurity through a child and adult summer meal programme. The study examines: (i) risk of household food insecurity among participants; (ii) perspectives on the library meal programme; and (iii) barriers to utilizing other community food resources.

Design

Quantitative surveys with adult participants and qualitative semi-structured interviews with a sub-sample of adult participants.

Setting

Ten libraries using public and private funding to serve meals to children and adults for six to eight weeks in low-income Silicon Valley communities (California, USA) during summer 2015.

Subjects

Adult survey participants (≥18 years) were recruited to obtain maximum capture, while a sub-sample of interview participants was recruited through maximum variation purposeful sampling.

Results

Survey participants (n161) were largely Latino (71 %) and Asian (23 %). Forty-one per cent of participants screened positive for risk of food insecurity in the past 12 months. A sub-sample of programme participants engaged in qualitative interviews (n67). Interviewees reported appreciating the library’s child enrichment programmes, resources, and open and welcoming atmosphere. Provision of adult meals was described as building community among library patrons, neighbours and staff. Participants emphasized lack of awareness, misinformation about programmes, structural barriers (i.e. transportation), immigration fears and stigma as barriers to utilizing community food resources.

Conclusions

Food insecurity remains high in our study population. Public libraries are ideal locations for community-based meal programmes due to their welcoming and stigma-free environment. Libraries are well positioned to link individuals to other social services given their reputation as trusted community organizations.

Monthly food insecurity assessment in rural mkushi district, Zambia: a longitudinal analysis

Background

Perception-based scales are widely used for household food insecurity (HFI) assessment but were only recently added in national surveys. The frequency of assessments needed to characterize dynamics in HFI over time is largely unknown. The study aims to examine longitudinal changes in monthly reported HFI at both population- and household-level.

Methods

A total of 157 households in rural Mkushi District whose children were enrolled in the non-intervened arm of an efficacy trial of biofortified maize were included in the analysis. HFI was assessed by a validated 8-item perception-based Likert scale on a monthly basis from October 2012 to March 2013 (6 visits), characterizing mostly the lean season. An HFI index was created by summing scores over the Likert scale, with a possible range of 0–32. The Wilcoxon matched signed-ranks test was used to compare distribution of HFI index between visits. A random effect model was fit to quantify the sources of variance in indices at household level.

Results

The median [IQR] HFI index was 4.5 [2, 8], 5 [1, 8], 4 [1, 7], 4 [1, 6], 3 [1, 7] and 4 [1, 6] at the six monthly visits, respectively. HFI index was significantly higher in visit 1 and 2 than visit 3–6 and on average the index decreased by 0.25 points per visit. Within- and between-household variance in the index were 10.6 and 8.8, respectively.

Conclusions

The small change in mean monthly HFI index over a single lean season indicated that a seasonal HFI measure may be sufficient for monitoring purposes at population level. Yet, higher variation within households suggests that repeated assessments may be required to avoid risk of misclassification at household level and to target households with the greatest risk of food insecurity.

Food Hardship and Obesity in a Sample of Low-Income Immigrants

Very little work has examined the relationship between food hardship (having inconsistent financial resources to buy food) and obesity among immigrant groups. A cross-sectional study was conducted in a low-income, multi-racial/ethnic adult sample in greater Boston, MA (n = 828). Modified Poisson regression models estimated the association between food hardship obesity (BMI ≥ 30) among adults reporting food hardship; interactions were tested by place of birth. Body mass index (BMI) was based on anthropometric height and weight. In adjusted models, those experiencing food hardship were more likely to be obese (RR 1.17, CI 1.07, 1.29) than those not experiencing food hardship. Participants from Haiti reporting food hardship were more likely to be obese than those not reporting hardship (RR 1.58, CI 1.23, 2.04); this was not the case among other groups (US born, Puerto Rican, Latin American, Other). The relationship between food hardship and weight may vary among immigrant subgroups.

Longitudinal Trajectories of Food Insecurity Among Children of Immigrants

Although research consistently points to higher rates of food insecurity (FI) among children of immigrants (COI), this is the first study to examine longitudinal trajectories of FI for this group. We used growth curve modeling and data from the 1998 Early Childhood Longitudinal Study-Kindergarten Cohort to compare trajectories of FI for COI and children of U.S.-born parents. After controlling for socioeconomic status and participation in nutrition programs, first- and second-generation COI had significantly higher initial and ongoing rates of FI compared to children of U.S.-born parents. Additional analyses found that all differences between COI and children of U.S.-born parents occurred for families in poverty. We find that COI from poor families have higher rates of FI, with some differences among COI by immigrant generation. Policymakers may need to focus on avenues other than public assistance to reduce FI among COI living in poverty.

Influence of sociodemographic characteristics on different dimensions of household food insecurity in Montevideo, Uruguay

Objective

To determine the factor structure of the Latin American & Caribbean Household Food Security Scale (ELCSA) and to study the influence of sociodemographic characteristics on each of the identified dimensions in Montevideo, Uruguay.

Design

Cross-sectional survey with a representative sample of urban households. Household food insecurity was measured using the ELCSA. The percentage of respondents who gave affirmative responses for each of the items of the ELCSA was determined. Exploratory factor analysis was carried out to determine the ELCSA’s factor structure. A probit model was used to determine the impact of some individual and household sociodemographic characteristics on the identified dimensions of food insecurity.

Setting

Metropolitan area centred on Montevideo, the capital city of Uruguay, April–September 2014.

Subjects

Adults aged between 18 and 93 years (n 742).

Results

The percentage of affirmative responses to the items of the ELCSA ranged from 4·4 to 31·7 %. Two factors were identified in the exploratory factor analysis performed on data from households without children under 18 years old, whereas three factors were identified for households with children. The identified factors were associated with different severity levels of food insecurity. Likelihood of experiencing different levels of food insecurity was affected by individual characteristics of the respondent as well as characteristics of the household.

Conclusions

The influence of sociodemographic variables varied among the ELCSA dimensions. Household income had the largest influence on all dimensions, which indicates a strong relationship between income and food insecurity.

"Do You Wanna Breathe or Eat?": Parent Perspectives on Child Health Consequences of Food Insecurity, Trade-Offs, and Toxic Stress

OBJECTIVES

This study among 51 parents of young children under age four investigated how parents that report marginal, low and very low food security characterize how trade-offs associated with food insecurity affect parents' mental health and child well-being.

METHODS

We carried out 51 semi-structured audio-recorded interviews after participants responded to a survey regarding food security status and maternal depressive symptoms. Each interview was transcribed. Through a content analysis, we coded "meaning units" in each manuscript and organized them by themes in ATLAS.ti. Among participants reporting both food insecurity and depressive symptoms, we identified three primary areas of concern: trade-offs, mental health, and child well-being.

RESULTS

Parents described how trade-offs associated with food insecurity have a profound relationship with their mental health and home environment that strongly affects young children. Descriptions of hardships include anxiety and depression related to overdue bills and shut-off notices, strains with housing costs, and safety. Parents described how their own frustration, anxiety, and depression related to economic hardship have a negative impact on their children's physical health, and their social and emotional development.

CONCLUSIONS

Parents in food insecure households recognize that trade-offs between food and other basic necessities are associated with their personal stress and poor mental health that, in turn, affects their children's health and development. Partnerships between healthcare providers, policymakers, and parents are essential to successfully address and prevent the poor child health outcomes of toxic stress associated with food insecurity and poverty.

Effects of maternal depression on family food insecurity

We use data from the Early Childhood Longitudinal Study-Birth Cohort to estimate the effects of maternal depression, a condition that is fairly common and can be severe, on food insecurity, a hardship that has increased substantially in the U.S. Using various model specifications, we find convincing evidence that severe maternal depression increases the likelihood that young children experience food insecurity by 23-79%, with estimates depending on model specification and measures of depression and food insecurity. For household food insecurity, the corresponding estimates are 11-69%. We also find that maternal depression increases reliance on several types of public programs, suggesting that the programs play a buffering role.

Association between Food Insecurity and Procurement Methods among People Living with HIV in a High Resource Setting

OBJECTIVE

People living with HIV in high-resource settings suffer severe levels of food insecurity; however, limited evidence exists regarding dietary intake and sub-components that characterize food insecurity (i.e. food quantity, quality, safety or procurement) in this population. We examined the prevalence and characteristics of food insecurity among people living with HIV across British Columbia, Canada.

DESIGN

This cross-sectional analysis was conducted within a national community-based research initiative.

METHODS

Food security was measured using the Health Canada Household Food Security Scale Module. Logistic regression was used to determine key independent predictors of food insecurity, controlling for potential confounders.

RESULTS

Of 262 participants, 192 (73%) reported food insecurity. Sub-components associated with food insecurity in bivariate analysis included: < RDI consumption of protein (p = 0.046); being sick from spoiled/unsafe food in the past six months (p = 0.010); and procurement of food using non-traditional methods (p <0.05). In multivariable analyses, factors significantly associated with food insecurity included: procurement of food using non-traditional methods [AOR = 11.11, 95% CI: 4.79-25.68, p = <0.001]; younger age [AOR = 0.92, 95% CI: 0.86-0.96, p = <0.001]; unstable housing [AOR = 4.46, 95% CI: 1.15-17.36, p = 0.031]; household gross annual income [AOR = 4.49, 95% CI: 1.74-11.60, p = 0.002]; and symptoms of depression [AOR = 2.73, 95% CI: 1.25-5.96, p = 0.012].

CONCLUSIONS

Food insecurity among people living with HIV in British Columbia is characterized by poor dietary quality and food procurement methods. Notably, participants who reported procuring in non-traditional manners were over 10 times more likely to be food insecure. These findings suggest a need for tailored food security and social support interventions in this setting.

Differential associations of threat and deprivation with emotion regulation and cognitive control in adolescence

Research on childhood adversity has traditionally focused on single types of adversity, which is limited because of high co-occurrence, or on the total number of adverse experiences, which assumes that diverse experiences influence development similarly. Identifying dimensions of environmental experience that are common to multiple types of adversity may be a more effective strategy. We examined the unique associations of two such dimensions (threat and cognitive deprivation) with automatic emotion regulation and cognitive control using a multivariate approach that simultaneously examined both dimensions of adversity. Data were drawn from a community sample of adolescents (N = 287) with variability in exposure to violence, an indicator of threat, and poverty, which is associated with cognitive deprivation. Adolescents completed tasks measuring automatic emotion regulation and cognitive control in neutral and emotional contexts. Violence was associated with automatic emotion regulation deficits, but not cognitive control; poverty was associated with poor cognitive control, but not automatic emotion regulation. Both violence and poverty predicted poor inhibition in an emotional context. Utilizing an approach focused on either single types of adversity or cumulative risk obscured specificity in the associations of violence and poverty with emotional and cognitive outcomes. These findings suggest that different dimensions of childhood adversity have distinct influences on development and highlight the utility of a differentiated multivariate approach.

Meaning and Management of Food Security Among Rural Elders

Food insecurity is the limited or uncertain availability of nutritionally adequate and safe foods, or limited or uncertain ability to acquire acceptable foods in socially acceptable ways. This study uses fixed response and textual data obtained through in-depth interviews with adults 70 years and older from a multiethnic population in rural North Carolina to examine the incidence of food insecurity and how older adults experience food insecurity and maintain food security. We interviewed 145 elders up to five times over the course of 1 year. Responses to standard food insecurity questions indicate that only 12% of older adults experience food insecurity. However, analysis of textual data reveals common themes concerning food insecurity that suggest that these questions may underestimate the number of rural elders who are food insecure and not tap the potential vulnerability of others who are dependent on precarious nutritional self-management strategies to meet their needs.

Characteristics of African American Women and Their Partners With Perceived Concurrent Partnerships in 4 Rural Counties in the Southeastern U.S

BACKGROUND

To the individual with concurrent partners, it is thought that having concurrent partnerships confers no greater risk of acquiring HIV than having multiple consecutive partnerships. However, an individual whose partner has concurrent partnerships (partner's concurrency) is at increased risk for incident HIV infection. We sought to better understand relationships characterized by partner's concurrency among African American women.

METHODS

A total of 1013 African American women participated in a cross-sectional survey from 4 rural Southeastern counties.

RESULTS

Older age at first sex was associated with lower prevalence of partner's concurrency (prevalence ratio, 0.70; 95% confidence interval, 0.57-0.87), but the participant's age was not associated with partner's concurrency. After adjusting for covariates, ever having experienced intimate partner violence (IPV) and forced sex were most strongly associated with partner's concurrency (prevalence ratios, 1.61 [95% confidence intervals, 1.23-2.11] and 1.65 [1.20-2.26], respectively). Women in mutually monogamous partnerships were the most likely to receive economic support from their partners; women whose partners had concurrent partnerships did not report more economic benefit than did those whose partners were monogamous.

CONCLUSIONS

Associations between history of IPV and forced sex with partner's concurrency suggest that women with these experiences may particularly benefit from interventions to reduce partner's concurrency in addition to support for reducing IPV and other sexual risks. To inform these interventions, further research to understand partnerships characterized by partner's concurrency is warranted.

Low maternal education and socio-economic status were associated with household food insecurity in children under five with diarrhoea in Bangladesh

AIM

Household food insecurity (HFI) is insufficient access to nutritionally safe and adequate foods to meet the dietary needs for an active and healthy life. We examined the prevalence and determinants of HFI in Bangladeshi children under five with diarrhoea.

METHODS

This study included 365 children (55% boys) who had diarrhoea in the two weeks before the 2011 Bangladesh Demographic Health Survey (BDHS-2011). The Household Food Insecurity Access Scale (HFIAS) was used to assess HFI and Pearson's chi-square test and binary logistic regression analysis were used to investigate the association between HFI and multilevel factors.

RESULTS

The prevalence of HFI among children under five with diarrhoea in the two weeks prior to the BDHS-2011 survey was 48%. HFI was significantly higher among the children of uneducated mothers, who were two times more likely to experience HFI, with an adjusted odds ratio (OR) of 2.14 and children who were from the lowest socio-economic status families, who were more than seven times more likely to experience HFI, with an adjusted OR of 7.55.

CONCLUSION

Low maternal education and low socio-economic status were significantly associated with HFI in Bangladeshi children under five with diarrhoea and public health campaigns should take this into account.

Results of a Pilot Intervention in Food Shelves to Improve Healthy Eating and Cooking Skills Among Adults Experiencing Food Insecurity

Since the start of the 2007 economic downturn, reliance on emergency food assistance suppliers (e.g., food pantries, also known as food shelves) has increased. Many food shelves strive to provide effective nutrition programs to serve their clients, even while they are faced with a scarcity of resources. Rigorous evaluation of the impact of such programming on dietary outcomes is, therefore, warranted. The aim of this study was to evaluate the effectiveness of a pilot cooking and nutrition education intervention among food shelf clients. A six-session class was conducted with 63 participants in four food shelves in Minneapolis and St. Paul, MN. Diet was assessed through a 24-hour recall from which a Healthy Eating Index (HEI) score was created. Cooking skills were assessed by survey. Average HEI scores increased from 50.9 at baseline to 58.5 post-intervention (p = 0.01, n = 43). Participants demonstrated improved cooking skills scores post-intervention (35.9 vs. 33.1 at baseline, p = 0.002, n = 45). Future research is needed to advance our understanding of how best to improve client nutrition knowledge and cooking skills. This study provides some evidence that improvements in diet and skills can be demonstrated with minimal intervention.

Food insecurity and intimate partner violence against women: results from the California Women's Health Survey

OBJECTIVE

To investigate the association between food insecurity and intimate partner violence in a population-based sample of heterosexual women.

DESIGN

Logistic regression was used to evaluate the association between three levels of food insecurity and intimate partner violence.

SETTING

Data from 6 years of the California Women's Health Survey.

SUBJECTS

Randomly selected women (n 16 562) aged 18 years and older from the State of California, USA.

RESULTS

We found: (i) that African-American women had a higher prevalence of food insecurity and were more likely to report severe intimate partner violence; (ii) a strong positive association between food insecurity and intimate partner violence; (iii) evidence of effect modification of the association between food insecurity and intimate partner violence by marital status; and (iv) higher odds of intimate partner violence among those reporting more severe food insecurity.

CONCLUSIONS

Food insecurity is an important risk indicator for intimate partner violence among women. Understanding the factors that put women, especially minority women, at greatest risk facilitates intervention development.

Food Security Status and Barriers to Fruit and Vegetable Consumption in Two Economically Deprived Communities of Oakland, California, 2013-2014

Introduction

Food security status may moderate how people perceive barriers to fruit and vegetable consumption. This study aimed to 1) describe the association between fruit and vegetable consumption and microbarriers and mezzobarriers to consumption, and 2) test whether these associations differ by food security status.

Methods

We surveyed adults (n = 531) living in 2 economically deprived communities in Oakland, California, in 2013 and 2014. Multivariate linear regression assessed associations between microbarriers (taste, cost, busyness) and mezzobarriers (produce selection, quality, and purchase ease) and fruit and vegetable consumption, derived from a 26-item dietary screener. Interactions were tested by food security status.

Results

Respondents consumed a mean 2.4 (standard deviation, 1.5) servings of fruits and vegetables daily; 39% of the sample was food insecure. Being too busy to prepare healthy foods was associated with reduced fruit and vegetable consumption (β_busyness = −0.40; 95% confidence interval [CI], −0.52 to −0.28) among all respondents. Food security moderated the relationship between fruit and vegetable consumption and taste, cost, and perceived ease of purchase of healthy foods. Among the food secure, disliking healthy food taste (β_taste = −0.38; 95% CI, −0.60 to −0.15) and cost (β_cost = −0.29; 95% CI, −0.44 to −0.15) concerns were associated with lower consumptions of fruits and vegetables. Mezzobarriers were not significantly associated with consumption in either group.

Conclusion

Perceived time constraints influenced fruit and vegetable consumption. Taste and cost influenced fruit and vegetable consumption among the food secure and may need to be considered when interpreting analyses that describe dietary intake and designing diet-related interventions.

Association between untreated dental caries and household food insecurity in schoolchildren

Abstract The aim of the present study was to assess the association between untreated dental caries (UDC) and household food insecurity (HFI) among schoolchildren in different income strata. A population-based study was carried out with a sample of 584 12-y-old schoolchildren. Oral examinations were performed and HFI was determined using a validated scale. Other independent variables were analyzed for being of interest to the stratification of the results (per capita household income) or for acting as potential confounding variables. The prevalence of UDC and HFI was 45% and 39%, respectively. The multivariate models demonstrated that the UDC was significantly more prevalent among children in food-insecure households with per capita income of up to US$ 70.71 than among those in the same income stratum that were free of HFI [PR = 1.52 (95%CI = 1.01-2.29)]. HFI was associated with a greater frequency of UDC among low-income schoolchildren, but had no significant impact on this variable among children from other income strata. Thus, ensuring access to quality food may be a good strategy for minimizing inequities in oral health and reducing dental caries experience among schoolchildren from low-income families.

Geographic access to food shelves among racial/ethnic minorities and foreign-born residents in the Twin Cities

Place-based disparities in access to affordable food sources (e.g., supermarkets) have been well documented, but geographic access to emergency food sources (e.g., food panties, also known as food shelves) is unknown. This study examined the geography of emergency food in the Twin Cities, MN. U.S. Census and American Community Survey data were used to estimate the average distance to the closest food shelf according to area racial/ethnic composition and foreign-born group composition. In adjusted models, areas with the highest proportion of minority groups had shorter distances to the nearest food shelf (0.13-1.03 log-transformed miles, p <0.05), as did census tracts with more residents born in East Africa and Latin America (0.29-0.31 log-transformed miles, p< 0.001). Areas with more racial/ethnic minorities and foreign-born groups may have access to emergency food, but efforts are needed to evaluate the healthfulness and culturally relevance of these offerings.

Race Differences in Diet Quality of Urban Food-Insecure Blacks and Whites Reveals Resiliency in Blacks

INTRODUCTION

Evidence from epidemiological studies shows a link between food insecurity and diet intake or quality. However, the moderating effect of race in this relation has not yet been studied.

METHODS

Food insecurity (USDA Food Security Module) and diet quality (Healthy Eating Index-2010; HEI) were measured in 1741 participants from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. Data were collected from 2004 to 2009 and analyzed in 2014. Multivariable regression assessed the interaction of race and food insecurity on HEI scores, adjusting for age, sex, poverty status, single parent status, drug, alcohol and cigarette use, and comorbid diseases.

RESULTS

The interaction of food insecurity and race was significantly associated with diet quality (p = 0.001). In the absence of food insecurity, HEI scores were similar across race. However, with each food insecurity item endorsed, HEI scores were substantially lower for Whites compared to Blacks. An ad hoc analysis revealed that Blacks were more likely than Whites to participate in SNAP (p < 0.05). Further, race stratified analyses revealed that Blacks participating in SNAP showed diminished associations of food insecurity with diet quality.

CONCLUSIONS

Study findings provide the first evidence that the influence of food insecurity on diet quality may be potentiated for Whites, but not Blacks. Additionally, results show that Blacks are more likely to participate in SNAP and show attendant buffering of the effects of food insecurity on diet quality. These findings may have important implications for understanding how food insecurity affects diet quality differentially by race.

Food insecurity in veteran households: findings from nationally representative data

Objective

The present study is the first to use nationally representative data to compare rates of food insecurity among households with veterans of the US Armed Forces and non-veteran households.

Design

We used data from the 2005–2013 waves of the Current Population Survey – Food Security Supplement to identify rates of food insecurity and very low food security in veteran and non-veteran households. We estimated the odds and probability of food insecurity in veteran and non-veteran households in uncontrolled and controlled models. We replicated these results after separating veteran households by their most recent period of service. We weighted models to create nationally representative estimates.

Setting

Nationally representative data from the 2005–2013 waves of the Current Population Survey – Food Security Supplement.

Subjects

US households (n388 680).

Results

Uncontrolled models found much lower rates of food insecurity (8·4 %) and very low food security (3·3 %) among veteran households than in non-veteran households (14·4 % and 5·4 %, respectively), with particularly low rates among households with older veterans. After adjustment, average rates of food insecurity and very low food security were not significantly different for veteran households. However, the probability of food insecurity was significantly higher among some recent veterans and significantly lower for those who served during the Vietnam War.

Conclusions

Although adjusting eliminated many differences between veteran and non-veteran households, veterans who served from 1975 and onwards may be at higher risk for food insecurity and should be the recipients of targeted outreach to improve nutritional outcomes.

Food security among young adults with disabilities in the United States: Findings from the National Health Interview Survey

BACKGROUND

Prior research has suggested that young adults with disabilities face economic, health and social disadvantage. Food security, an area of disadvantage that can influence overall health, has not been fully explored for this population.

OBJECTIVE/HYPOTHESIS

To examine levels of food security between young adults with and without disabilities, controlling for individual characteristics.

METHODS

Logistic regression analysis of a nationally representative sample of young adults (age 18-25) (n = 32,795) with and without disabilities, using pooled data form the 2011-2013 National Health Interview Survey.

RESULTS

Young adults with disabilities have significantly higher odds (OR: 2.58, p < 0.001) of living in a household that is food insecure than young adults without disabilities, even when controlling for individual characteristics. Odds of living in a household that is food insecure are particularly high (OR: 5.35, p < 0.001) among young adults with high levels of psychological distress, controlling for other factors.

CONCLUSIONS

Young adults with disabilities have increased odds of living in a household that is food insecure. This study has important policy and community program implications.

Validation of the food access survey tool to assess household food insecurity in rural Bangladesh

Background

Perception-based Likert scale are commonly used to assess household food insecurity. The aim of this study was to evaluate the psychometric properties and external construct validity of the 9-item Food Access Survey Tool (FAST) in a population-based randomized controlled trial.

Methods

Participating women (n = 11,992) were asked to recall the frequencies of nine food insecurity experiences over the past 6 months on a 5-point Likert scale. The Rasch partial credit model was used to study the item category severity and differential item functioning (DIF) by literacy status, respondents’ age, land ownership and household sizes. Principal component analysis (PCA), non-parametric methods, and cumulative ordinal logistic regression models were applied to examine the Rasch model assumptions, namely unidimensionality, monotonicity and measurement invariance (non-DIF).

Results

All items demonstrated good model fit with acceptable values of fit statistics (infit). PCA as well as other indices (Cronbach’s alpha = 0.85, scalability coefficient = 0.48) indicated that all items fit in a single statistical dimension. The ordered responses of nine items displayed monotonic increasing item category severity as expected theoretically. All nine items were flagged with statistically significant DIF between key demographic—and socioeconomic subgroups (p < 0.001); however, none of the detected DIF was considered practically significant given small effect sizes (variance explained by group membership and interaction term < 1 %). The total summed score over the polytomous FAST was inversely associated with household wealth, dietary diversity score and maternal body mass index, demonstrating external construct validity.

Conclusion

The polytomous FAST is internally and externally valid tool to measure household food insecurity in rural Bangladesh. Validation of this type of studies are recommended for similar Likert food insecurity scales.

Household food insufficiency is associated with dietary intake in Korean adults

Objective

To examine the association of food insufficiency with dietary intake and eating and health behaviours.

Design

A cross-sectional study.

Setting

Data were obtained from a secondary source, the Fifth Korea National Health and Nutrition Examination Survey (2010–2012).

Subjects

The sample size consisted of 15 603 adults over 19 years of age (8898 households).

Results

Significant differences in socio-economic factors were observed according to food insufficiency level (P<0·05), but BMI was similar among groups. Regarding macronutrients, lower protein intake and higher carbohydrate intake were found in the severely food-insufficient group, but we found no association with fat intake. Regarding micronutrients, Ca, Fe, vitamin A, thiamin, riboflavin niacin and vitamin C intakes were negatively associated with food insufficiency level (Ptrend<0·05). Consumption of different food groups, such as meat, fish, eggs and beans, vegetables and fruits, was significantly lower as food insufficiency level decreased after controlling for all possible variables; food group consumption also differed by sex. Overall eating and health behaviours were poorer in the mildly and severely food-insufficient groups, who received more food assistance but less nutritional education.

Conclusions

Our results showed that dietary intake as well as eating and health behaviours are adversely associated with food insufficiency. These findings suggest that specific strategies to help food-insufficient individuals should be developed in order to improve their dietary quality and health status.