Food insecurity is associated with poor sleep outcomes among US adults

Household Food Insecurity and the Association with Cumulative Biological Risk among Lower-Income Adults: Results from the National Health and Nutrition Examination Surveys 2007-2010

Household food insecurity has been associated with adverse health outcomes; however, the mechanisms underlying these associations are not well-defined. Using data from 5005 adults from the 2007-2010 National Health and Nutrition Examination Surveys (NHANES), we examined associations between household food insecurity and cumulative biological risk, a measure of the body's physiological response to chronic stress. Household food security was assessed using the 18-item Household Food Security Survey Module. Marginal food security refers to 1-2 positive responses, and food insecurity refers to ≥3 positive responses. The cumulative biological risk scores were calculated based on the distributions of ten biomarkers from the cardiovascular, metabolic, and immune systems. Elevated biological risk was defined as a risk score of ≥3. Multivariable regression models were used to examine associations between food security and cumulative biological risk scores, adjusting for sociodemographic characteristics. After multivariable adjustment, food insecurity was associated with a 0.14-unit higher cumulative biological risk score (95% CI 0.05-0.22, p-trend = 0.003) and higher odds of elevated biological risk (OR 1.20, 95% CI 1.05-1.37, p-trend = 0.003). These associations differed by gender. Among women, food insecurity was associated with 0.30-unit higher cumulative biological risk score (95% CI 0.14-0.45, p-trend = 0.0004) and higher odds of elevated biological risk (OR 1.61, 95% CI 1.29-2.00, p-trend < 0.0001). These associations were not observed in men. Women experiencing food insecurity demonstrated elevated levels of biological risk. These findings support the hypothesis that food insecurity may be associated with women's chronic health outcomes through the pathway of chronic stress. Further research is needed to understand why these associations were not observed in men.

Measuring Food Insecurity Using the Food Abundance Index: Implications for Economic, Health and Social Well-Being

High levels of food insecurity signal the presence of disparities and inequities in local food access, which have been shown to negatively impact the health and well-being of individuals and communities. However, the approaches used to define and measure high food insecurity, also known as a "food desert", vary widely across research study and intervention methodology. This paper describes the development and validation of a measurement tool called the "Food Abundance Index" (FAI) which is a scorecard for assessing levels of food insecurity across five key dimensions: access, diversity, quality, density, and affordability. A pilot study was conducted to examine levels of food insecurity in order to test the extent to which the FAI can detect food deserts. Nine neighborhoods were selected based on the demographic characteristics of communities shown to be related to food insecurity. Our findings provide evidence that the Food Abundance Index provides a robust measurement tool to assess the extent of food insecurity within a community or neighborhood. Thus, this multidimensional scorecard can be used in future research to detect levels of food insecurity within urban areas and help to bridge the gap between academics, policymakers and practitioners in this important area.

Acceptability and feasibility of using actigraphy to assess habitual physical activity and sleep parameters in men and women living in rural communities in conflict-affected Eastern Democratic Republic of Congo

BACKGROUND

The goals of this study were to (1) determine the feasibility and acceptability of using actigraphy to objectively measure sleep quality and habitual physical activity in rural Democratic Republic of Congo (DRC) and (2) examine the relationship between sleep parameters, self-report symptoms, daytime physical activity, and physical function, including the ability to work.

METHOD

Thirty individuals were asked to wear a wrist-worn accelerometer for 5 nights and 4 days. Nighttime sleep parameters derived were average and intra-individual variability (IIV) in total sleep time (TST), sleep onset latency (SOL), sleep efficiency (SE), and wake after sleep onset (WASO). Daytime habitual physical data derived were average and peak activity and daytime napping.

RESULTS

Ninety-three percent (n = 28) of participants completed the study. All participants who wore the device marked sleep and wake cycles and periods of non-wear using the marker. Trauma-related symptoms were not associated with mean or IIV in TST, SE, SOL, or WASO (p > 0.01). Those with higher levels of bodily pain slept longer (β = 0.633, p = 0.003, adjusted R ² = 0.279), were more likely to report that their physical health limited their physical activities (β = 0.71, p < 0.001, adjusted R ² = 0.679) and had greater difficulty doing daily work (β = 0.84, p = 0.001, adjusted R ² = 0.665).

CONCLUSION

The use of actigraphy to collect objective measures of activity and sleep quality in rural post-conflict settings is feasible and acceptable. Our preliminary findings suggest that bodily pain and not trauma-related symptoms have a significant impact on sleep and functional outcomes in men and women survivors of prolonged conflict in the DRC.

Food stamps, food insecurity, and health outcomes among elderly Americans

This study examined associations between very low food security and health outcomes in older adults, and tested whether participation in the Supplemental Nutrition Assistance Program (SNAP) mitigates adverse health consequences associated with very low food security. Data were drawn from the 1998-2014 waves of the Health and Retirement Study (N = 148,138 from 27,281 persons). A longitudinal analysis of the relationship between very low food security and health condition depending on SNAP participation was conducted using the individual fixed effects regression. Respondents' health status was assessed by self-rated health, grip strength, and depressive symptoms. The correlations between very low food security and physical health outcomes were negatively significant prior to SNAP enrollment (p < 0.05) but became insignificant upon participation, indicating that SNAP may have prevented poor physical health resulting from very low food security. However, results concerning mental health showed that SNAP enrollment does not modify the association between very low food security and depression; very low food security remained a significant risk factor of depressive symptoms conditional on SNAP enrollment (p < 0.001). Further analyses showed that SNAP participation is correlated with negative self-attitudes (p < 0.05), and that the correlation between SNAP and depression becomes insignificant after controlling for self-attitudes. These results suggest that a stigma effect arising from welfare use may have reduced self-esteem and resulted in depressive moods. Future research needs to delve into whether reforms to the food assistance program aimed at reducing stigma can help alleviate emotional distress among welfare recipients.

Food Insecurity is Associated with Objectively Measured Sleep Problems

Objective/Background: Food Insecurity (FI) can be a profound source of stress, which may increase the risk for sleep disturbance. This is the first study to examine the association between FI and objectively and subjectively measured sleep. Participants: The sample included 785 adults living in two low-income neighborhoods (mean age = 56; 95% African American). Methods: FI was measured using a validated 10-item survey that assesses conditions and behaviors that characterize households when they lack financial resources to meet basic food needs. Sleep duration, efficiency, wakefulness after sleep onset (WASO), and variability in sleep duration were measured via actigraphy. Sleep quality was assessed via sleep diary. Sleep outcomes were analyzed as a function of FI, adjusting for covariates. Psychological distress was tested as a potential mediator. Results: Greater FI was associated with shorter actigraphy-assessed sleep duration (B = -2.44; SE = 1.24; i.e., 24 minutes shorter for the most as compared to least insecure group), poorer sleep efficiency (B = -.27; SE = .13); p's < .05), and poorer subjective sleep quality (B = -.03; SE = .01; p < .01). Greater FI was also associated with greater likelihood of short (<7 hours; OR = 1.11; CI: 1.02-1.21) and long sleep (>9 hours; OR = 1.19; CI: 1.01-1.39), compared to the recommended sleep duration of 7-9 hours. Psychological distress partially mediated the association between FI and subjective sleep quality. Conclusions: Addressing or mitigating food insecurity may present a novel opportunity for improving sleep health among low-income populations.

Food Insecurity Is Associated With Poorer Mental Health and Sleep Outcomes in Young Adults

PURPOSE

The aim of the study was to determine the association between food insecurity, mental health, and sleep outcomes among young adults. Young adulthood represents an important developmental period when educational and economic transitions may increase the risk for food insecurity; however, little is known about associations between food insecurity and health outcomes in this period.

METHODS

Cross-sectional nationally representative data of U.S. young adults aged 24-32 years from Wave IV (2008) of the National Longitudinal Study of Adolescent to Adult Health were analyzed in 2018. Multiple logistic regression analysis was conducted with food insecurity as the independent variable and self-reported mental health (depression, anxiety, and suicidality) and sleep (trouble falling and staying asleep) outcomes as the dependent variables.

RESULTS

Of the 14,786 young adults in the sample, 11% were food insecure. Food-insecure young adults had greater odds of mental health problems including a depression diagnosis (1.67, 95% confidence interval [CI] 1.39-2.01), anxiety or panic disorder diagnosis (1.47, 95% CI 1.16-1.87), and suicidal ideation in the past 12 months (2.76, 95% CI 2.14-3.55). Food insecurity was also associated with poorer sleep outcomes including trouble falling (adjusted odds ratio 1.78, 95% CI 1.52-2.08) and staying (adjusted odds ratio 1.67, 95% CI 1.42-1.97) asleep.

CONCLUSIONS

Food insecurity is associated with poorer mental and sleep health in young adulthood. Health care providers should screen for food insecurity in young adults and provide referrals when appropriate. Future research should test interventions to simultaneously combat food insecurity and mental health problems in young adulthood.

A Systematic Review and Meta-analysis of Depression, Anxiety, and Sleep Disorders in US Adults with Food Insecurity

INTRODUCTION

A large number of peer-reviewed studies, with various methodologies and populations, have addressed the effects of food insecurity (FIS) on mental health conditions such as depression, anxiety, and sleep disorders. There are currently, however, no published systematic assessments or meta-analyses of this literature.

METHODS

A systematic search of the literature was conducted in PubMed, PsycInfo, Embase, Scopus, and Web of Science. Cross-sectional studies assessing the association between food insecurity and depression, anxiety, or sleep disorders were identified. For each of the three health outcomes, we extracted (or calculated when possible) the following effect sizes: odds ratio (OR), Hedges' g, Pearson correlation coefficients r, or bivariate coefficients. Then, for each mental health-outcome/effect-size pair, the available studies were combined using the random effect model. Heterogeneity, publication bias, and subgroup dependence, for each meta-analysis, were also assessed.

RESULTS

Fifty-seven studies provided cross-sectional data on the relationship between FIS and depression (n = 169,433), 13 on anxiety and psychological distress (n = 91,957), and 8 studies provided data on sleep disorders (n = 85,788). Meta-analysis showed that FIS is associated with an increased risk of testing positive for depression OR = 2.74 [95% CI 2.52-2.97, n = 135,500, Q(df = 41) = 69, I² = 40%], anxiety OR = 2.41 [95% CI 1.81-3.22, n = 51,541, Q(df = 3) = 8, I² = 63%], and sleep disorders OR = 1.80 [95% CI 1.51-2.15, n = 84,800, Q(df = 5) = 13, I² = 62%]. The highest risks were found for depression and anxiety which had statistically similar values. The results were robust to covariates and population groups.

DISCUSSION

This systematic review and meta-analysis demonstrates a strong association between FIS and depression, anxiety, and sleep disorders, for which more longitudinal studies addressing effect sizes are warranted to further study causation.

Food insecurity is associated with suboptimal sleep quality, but not sleep duration, among low-income Head Start children of pre-school age

OBJECTIVE

To examine the association between food insecurity and child sleep outcomes and to investigate whether parent psychosocial factors mediate such associations.

DESIGN

Cross-sectional study. Usual wake time and bedtime, bedtime routine and sleep quality were reported by parents using the adapted Brief Infant Sleep Questionnaire. Food insecurity was assessed using the eighteen-item US Department of Agriculture Household Food Security Module. Parent psychosocial factors, including perceived stress, parenting self-efficacy and depressive symptomology, were assessed using validated scales. Multivariable logistic regression models were performed to determine the association between food insecurity and sleep outcomes controlling for potential confounders. Mediation analyses and Sobel tests were applied to test the mediating effect of psychosocial factors.

SETTING

Head Start pre-school classrooms in four regions across central Pennsylvania, USA.

PARTICIPANTS

Low-income children of pre-school age (n 362) and their caregivers.

RESULTS

Prevalence of household, adult and child food insecurity was 37·3, 31·8 and 17·7 %, respectively. Food security status at any level was not associated with child sleep duration or bedtime routine. Child food insecurity, but not household or adult food insecurity, was associated with 2·25 times increased odds (95 % CI 1·11, 4·55) of poor child sleep quality in the adjusted model. Perceived stress, self-efficacy and depressive symptomology mediated less than 2 % of the observed effect (all Sobel test P > 0·6).

CONCLUSION

Food insecurity, particularly at the child level, is a potential modifiable risk factor for reducing sleep-related health disparities in early childhood. Future studies are needed to explore the plausible mechanisms underlying the associations between food insecurity and adverse child sleep outcomes.

Patient experiences and provider perspectives on a hospital-based food pantry: a mixed methods evaluation study

Objective:

The purpose of this evaluation study was to identify strengths and opportunities for improvement in programme functioning and common aspects of patients’ experiences at a hospital-based food pantry.

Design:

Semi-structured, in-depth interviews with patients and a cross-sectional survey for providers were used. Interview transcripts were coded using both inductive and deductive approaches and assessed for inter-rater reliability. Descriptive statistics were produced from quantitative data.

Setting:

An academic urban safety-net hospital in the Northeastern US offering inpatient and outpatient services.

Participants:

Thirty patients and 89 providers.

Results:

Patients expressed feeling comfortable, trusting the food, high satisfaction with food quality, convenience, and lack of stigma at the hospital-based pantry. Patients mentioned the pantry helped them eat more fruits and vegetables, but expressed concerns about the healthfulness of other foods distributed. Providers believed they should discuss food insecurity (FI) with patients (99 %) and that the pantry improves the health of patients (97 %), but faced barriers to consistently screening for FI and referring patients to the pantry, such as insufficient training on FI (53 %) and time constraints (35 %).

Conclusions:

Findings suggest hospital-based food pantries may have several advantages. Hospitals with onsite food pantries must work to eliminate barriers to FI screening and pantry referral. To optimize their impact, such pantries should develop nutritional guidelines for food donations and connect patients with nutrition education resources. Future research should examine health outcomes for patients using hospital-based food pantries.

Pathways from Food Insecurity to Health Outcomes among California University Students

The prevalence of food insecurity (FI) among college students is alarmingly high, yet the impact on student health has not been well investigated. The aim of the current study was to examine the simultaneous relationships between food insecurity and health-related outcomes including body mass index (BMI) and overall health in a college student population. Randomly sampled students in the University of California 10 campus system were invited to participate in an online survey in spring 2015. The analytic sample size was 8705 graduate and undergraduate students. Data were collected on FI in the past year, daily servings of fruits and vegetables (FV), number of days in the past week of enough sleep and moderate- to vigorous-intensity physical activity (MVPA), height and weight, self-rated health, and student characteristics. Using path analysis, mediated pathways between FI, BMI, and poor health were examined through FV intake, number of days of MVPA and enough sleep. Analyses controlled for student characteristics. Mean BMI was 23.6 kg/m² (SD, 5.0), and average self-rated health was good. FI was directly and indirectly related to higher BMI and poor health through three pathways. First, FI was related to fewer days of enough sleep, which in turn was related to increased BMI and poor health. Second, FI was related to fewer days of MVPA, which in turn was related to increased BMI and poor health. Third, FI was related to fewer daily servings of FV, which in turn was related to poor health. FI is associated with poor health behaviors among college students, which may contribute to higher weight status and poor health. These findings highlight the importance of food security for a healthy college experience.

Prevalence and correlates of food insecurity among U.S. college students: a multi-institutional study

Background

College students may be vulnerable to food insecurity due to limited financial resources, decreased buying power of federal aid, and rising costs of tuition, housing, and food. This study assessed the prevalence of food insecurity and its sociodemographic, health, academic, and food pantry correlates among first-year college students in the United States.

Methods

A cross-sectional study was conducted among first-year students (n = 855) across eight U.S. universities. Food security status was assessed using the U.S. Department of Agriculture Adult Food Security Survey Module. Cohen’s Perceived Stress Scale, Pittsburgh Sleep Quality Index, and Eating Attitudes Test-26 were used to assess perceived stress, sleep quality, and disordered eating behaviors, respectively. Participants self-reported their grade point average (GPA) and completed questions related to meal plan enrollment and utilization of on-campus food pantries.

Results

Of participating students, 19% were food-insecure, and an additional 25.3% were at risk of food insecurity. Students who identified as a racial minority, lived off-campus, received a Pell grant, reported a parental education of high school or less, and did not participate in a meal plan were more likely to be food-insecure. Multivariate logistic regression models adjusted for sociodemographic characteristics and meal plan enrollment indicated that food-insecure students had significantly higher odds of poor sleep quality (OR = 2.32, 95% CI: 1.43–3.76), high stress (OR = 4.65, 95% CI: 2.66–8.11), disordered eating behaviors (OR = 2.49, 95% CI: 1.20–4.90), and a GPA < 3.0 (OR = 1.91, 95% CI: 1.19–3.07) compared to food-secure students. Finally, while half of the students (56.4%) with an on-campus pantry were aware of its existence, only 22.2% of food-insecure students endorsed utilizing the pantry for food acquisition.

Conclusions

Food insecurity among first-year college students is highly prevalent and has implications for academic performance and health outcomes. Higher education institutions should screen for food insecurity and implement policy and programmatic initiatives to promote a healthier college experience. Campus food pantries may be useful as short-term relief; however, its limited use by students suggest the need for additional solutions with a rights-based approach to food insecurity.

Trial Registration

Retrospectively registered on ClinicalTrials.gov, NCT02941497.

Food insecurity and physical functioning limitations among older U.S. adults

Food insecurity among U.S. older adults has more than doubled since 2001 and is higher in those who are frail. Given the growing aging population and the importance of physical functioning and adequate food intake, the increase in food insecurity is a public health concern. This study examined the association between domains of physical limitations and food security in U.S. older adults. Data were from the National Health and Nutrition Examination Survey (2007–2012) participants 60 years of age and older (n = 5969). Physical limitations were defined as some or much difficulty on 19 activities, categorized into 5 domains and an index score. Food security status was categorized as full, marginal, low, or very low, and also dichotomized into food secure and food insecure (marginal, low, or very low food security). Multinomial and logistic regression models were used to estimate odds ratios (OR) and adjusted ORs (aOR) with food security as the dependent variable and physical limitations as independent variables. Older adults with 4 or more physical limitations were more likely to report very low food security than older adults without limitations (aOR:2.62, 95% CI:1.43, 4.81). The strongest correlates of food insecurity were Instrumental Activities of Daily Living (aOR:1.49; 95% CI:1.10, 2.01), Leisure and Social Activities (aOR:1.56; 95% CI:1.37, 2.14), and General Physical Activities (aOR:1.50; 95% CI:1.08, 2.07). Physical functioning is important for food security among older adults. Interventions should incorporate assessment of physical functioning, and provide resources for food acquisition, preparation, and intake for older adults with physical limitations.

•

Food insecurity was higher among older adults with physical functioning limitations compared to those without limitations.

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All five domains of physical functioning were significantly associated with food insecurity (P<0.05).

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The association was strongest for those with limitations in certain domains of physical functioning, including those related to food preparation and food intake (P<0.01).

•

Previous studies used (i) a dichotomous measure of food security that classifies marginal food security as food secure and (ii) limited measures of physical functioning.

•

Our study used more detailed food security and physical functioning measures across three NHANES survey cycles.

Material hardship and sleep: results from the Michigan Recession and Recovery Study

OBJECTIVE

Sleep is unequally distributed in the US population. People with low socioeconomic status report worse quality and shorter sleep than people with high socioeconomic status. Past research hypothesized that a potential reason for this link could be exposure to material hardship. This study examines the associations between several material hardships and sleep outcomes.

METHODS

We use population-representative cross-sectional data (n = 730) from the Michigan Recession and Recovery Study collected in 2013 and examine the associations between 6 indicators of material hardship (employment instability, financial problems, housing instability, food insecurity, forgone medical care, and the total number of material hardships reported) and 3 sleep outcomes (short sleep, sleep problems, and nonrestorative sleep). We build multivariable logistic regression models controlling for respondents' characteristics and light pollution near their residence.

RESULTS

In unadjusted models, all material hardships were associated with negative sleep outcomes. In adjusted models, forgone medical care was a statistically significant predictor of nonrestorative sleep (average marginal effect 0.16), as was employment instability (average marginal effect 0.12). The probability of sleep problems and nonrestorative sleep increased with a greater number of hardships overall (average marginal effects of .02 and .05, respectively). We found marginally statistically significant positive associations between food insecurity and short sleep and sleep problems.

CONCLUSIONS

This study finds that, except when considering foregone medical care, employment instability, and total count of material hardships, associations between material hardship and negative sleep outcomes are not statistically significant after adjusting for a robust set of sociodemographic and health characteristics.

The Mediating Role of Sleep Quality and Quantity in the Link Between Food Insecurity and Obesity Across Race and Ethnicity

OBJECTIVE

The objective of the study was to examine the mediating role of sleep quality and quantity in the relationship between food insecurity and obesity across races/ethnicities.

METHODS

Bivariate negative binomial regression and multinomial logistic regression were used to examine direct associations between food insecurity and sleep quality and quantity among non-Hispanic Native Hawaiian and other Pacific Islanders (NHPI) relative to non-Hispanic White, Black, Asian, and Hispanic individuals with obesity. The potential outcomes approach and adjusted Wald test were used to explore the mediating role of sleep quality and quantity and the moderating role of race/ethnicity, respectively.

RESULTS

Among adults with obesity, the study found a positive and direct relationship between food insecurity and trouble falling asleep in each racial/ethnic group. Trouble staying asleep was associated with food insecurity in each racial/ethnic group, except in the Asian group. Positive and direct associations were observed between food insecurity and short/very short sleep. A positive and direct relationship was found between food insecurity and having obesity in each racial/ethnic group, except in the Black group. Sleep quality and sleep quantity partially mediated the relationship between food insecurity and obesity in non-Hispanic NHPI, White, Asian, and Hispanic individuals. Race/ethnicity moderated the indirect effects of food insecurity on sleep quality and quantity.

CONCLUSIONS

Food security and sleep hygiene should be an integral part of the fight against obesity.

Food insecurity status and mortality among adults in Ontario, Canada

BACKGROUND

Food insecurity is associated with a wide array of negative health outcomes and higher health care costs but there has been no population-based study of the association of food insecurity and mortality in high-income countries.

METHODS

We use cross-sectional population surveys linked to encoded health administrative data. The sample is 90,368 adults, living in Ontario and respondents in the Canadian Community Health Survey (CCHS). The outcome of interest is all-cause mortality at any time after the interview and within four years of the interview. The primary variable of interest is food insecurity status, with individuals classed as "food secure", "marginally food insecure", "moderately food insecure", or "severely food insecure". We use logistic regression models to determine the association of mortality with food insecurity status, adjusting for other social determinants of health.

RESULTS

Using a full set of covariates, in comparison to food secure individuals, the odds of death at any point after the interview are 1.28 (CI = 1.08, 1.52) for marginally food insecure individuals, 1.49 (CI = 1.29, 1.73) for moderately food insecure individuals, and 2.60 (CI = 2.17, 3.12) for severely food insecure individuals. When mortality within four years of the interview is considered, the odds are, respectively, 1.19 (CI = 0.95, 1.50), 1.65 (CI = 1.37, 1.98), and 2.31 (CI = 1.81, 2.93).

INTERPRETATION

These findings demonstrate that food insecurity is associated with higher mortality rates and these higher rates are especially large for the most severe food insecurity category. Efforts to reduce food insecurity should be incorporated into broader public health initiatives to reduce mortality.

Sleep and Obesity

Rising global prevalence and incidence of obesity lead to increased cardiovascular-renal complications and cancers. Epidemiological studies reported a worldwide trend towards suboptimal sleep duration and poor sleep quality in parallel with this obesity epidemic. From rodents and human models, it is highly plausible that abnormalities in sleep, both quantity and quality, impact negatively on energy metabolism. While excess dietary intake and physical inactivity are the known drivers of the obesity epidemic, promotion of healthy sleep habits has emerged as a new target to combat obesity. In this light, present review focuses on the existing literature examining the relationship between sleep physiology and energy homeostasis. Notably, sleep dysregulation perturbs the metabolic milieu via alterations in hormones such as leptin and ghrelin, eating behavior, neuroendocrine and autonomic nervous systems. In addition, shift work and trans-meridian air travel may exert a negative influence on the hypothalamic-pituitary-adrenal axis and trigger circadian misalignment, leading to impaired glucose tolerance and increased fat accumulation. Amassing evidence has also suggested that uncoupling of the circadian clock can increase the risk of adverse metabolic health. Given the importance of sleep in maintaining energy homeostasis and that it is potentially modifiable, promoting good sleep hygiene may create new avenues for obesity prevention and treatment.

Household Food Insecurity and Sleep Patterns Among Mexican Adults: Results from ENSANUT-2012

To examine the independent association of household food insecurity with sleep duration and quality in a nationally representative survey of adults in Mexico. The Latin American and Caribbean Food Security Scale was used to categorize households as secure, mild (43.7 %), moderate (19.0 %), or severe (11.8 %). We assessed the association between household food insecurity and self-reported sleep duration and quality among 11,356 adults using weighted multinomial and binomial logistic regression. After adjusting for potential confounders, a significant association was found between severe household food insecurity and getting less than the recommended 7-8 h of sleep [adjusted odds ratio (AOR) =1.83, 95 % confidence interval (CI) =1.37-2.43]. Compared with food-secure households, odds of poor sleep quality increased with level of severity (AOR = 1.27, 95 % CI 1.04-1.56 for mild; AOR = 1.71, 95 % CI 1.36-2.14 for moderate; and AOR = 1.89, 95 % CI 1.45-2.45 for severe household food insecurity). Household food insecurity is associated with inadequate sleep duration and poor sleep quality among Mexican adults. This study underscores the adverse effects of household food insecurity on the well-being of vulnerable populations.

Individual and community level factors with a significant role in determining child height-for-age Z score in East Gojjam Zone, Amhara Regional State, Ethiopia: a multilevel analysis

Background

In Ethiopia, child undernutrition remains to be a major public health challenge and a contributing factor for child mortality and morbidity. To reduce the problem, it is apparent to identify determinants of child undernutrition in specific contexts to deliver appropriately, targeted, effective and sustainable interventions.

Methods

An agroecosystem linked cross-sectional survey was conducted in 3108 children aged 6–59 months. Multistage cluster sampling technique was used to select study participants. Data were collected on socio-demographic characteristics, child anthropometry and on potential immediate, underlying and basic individual and community level determinants of child undernutrition using the UNICEF conceptual framework. Analysis was done using STATA 13 after checking for basic assumptions of linear regression. Important variables were selected and individual and community level determinants of child height-for-age Z score were identified. P values less than 0.05 were considered the statistical level of significance.

Results

In the intercept only model and full models, 3.8% (p < 0.001) and 1.4% (p < 0.001) of the variability were due to cluster level variability. From individual level factors, child age in months, child sex, number of under five children, immunization status, breast feeding initiation time, mother nutritional status, diarrheal morbidity, household level water treatment and household dietary diversity were significant determinants of child height for age Z score. Also from community level determinants, agroecosystem type, liquid waste disposal practice and latrine utilization were significantly associated with child height-for-age Z score.

Conclusion

In this study, a statistical significant heterogeneity of child height-for-age Z score was observed among clusters even after controlling for potential confounders. Both individual and community level factors, including the agroecosystem characteristics had a significant role in determining child height-for-age Z score in the study area. In addition to the existing efforts at the individual levels to improve child nutritional status, agroecosystem and community WASH related interventions should get more attention to improve child nutritional status in the study area.

Biobehavioral Factors That Shape Nutrition in Low-Income Populations: A Narrative Review

Although evidence exists for an association between income level and diet quality, a causal relationship has not been established. A number of studies found that the price of nutritious food and the time cost to prepare foods are economically driven reasons for this relationship. However, in addition to economic constraints, low-income individuals and families face a number of additional challenges linked with food choice, eating behaviors, and diet-related chronic conditions that contribute to diet quality and health. Low-income individuals have a higher burden of employment-, food-, and housing-related insecurity that threaten the livelihood of their household. Poverty and exposure to these insecurities are hypothesized to activate biobehavioral and psychological mechanisms-endocrine, immune, and neurologic systems-that influence food choice and consumption. Examples of biobehavioral and psychological factors that influence diet are stress, poor sleep, and diminished cognitive capacity. High levels of stress, poor sleep, and cognitive overload compound the challenges of economic constraints, creating a mentality of scarcity that leads to poor diet quality.

Food Insecurity And Health Outcomes

Almost fifty million people are food insecure in the United States, which makes food insecurity one of the nation's leading health and nutrition issues. We examine recent research evidence of the health consequences of food insecurity for children, nonsenior adults, and seniors in the United States. For context, we first provide an overview of how food insecurity is measured in the country, followed by a presentation of recent trends in the prevalence of food insecurity. Then we present a survey of selected recent research that examined the association between food insecurity and health outcomes. We show that the literature has consistently found food insecurity to be negatively associated with health. For example, after confounding risk factors were controlled for, studies found that food-insecure children are at least twice as likely to report being in fair or poor health and at least 1.4 times more likely to have asthma, compared to food-secure children; and food-insecure seniors have limitations in activities of daily living comparable to those of food-secure seniors fourteen years older. The Supplemental Nutrition Assistance Program (SNAP) substantially reduces the prevalence of food insecurity and thus is critical to reducing negative health outcomes.

Psychological Distress Mediates the Association between Food Insecurity and Suboptimal Sleep Quality in Latinos with Type 2 Diabetes Mellitus

BACKGROUND

Evidence increasingly indicates that poor sleep quality is a major public health concern. Household food insecurity (HFI) disproportionately affects Latinos and is a novel risk factor for poor sleep quality. Psychological distress may be a potential mechanism through which HFI affects sleep quality. Sleep, food insecurity, and distress are linked to type 2 diabetes mellitus.

OBJECTIVES

We examined the relations between HFI, psychological distress, and sleep quality and tested whether psychological distress mediates the relation between HFI and sleep in people with diabetes mellitus.

METHODS

Latinos with type 2 diabetes mellitus (n = 121) who completed baseline assessments for the CALMS-D (Community Health Workers Assisting Latinos Manage Stress and Diabetes) stress management intervention trial completed the US Household Food Security Survey, and measures of depressive symptoms [Personal Health Questionnaire Depression Scale (PHQ-8)], anxiety symptoms [Patient-Reported Outcomes Measurement Information System (PROMIS)-short], diabetes distress [Problem Areas in Diabetes Questionnaire (PAID-5)], and sleep quality [Pittsburgh Sleep Quality Index (PSQI)]. Psychological distress was operationalized with the PHQ-8, PROMIS-short, and PAID-5 scales. We used unadjusted and adjusted indirect effect tests with bias-corrected bootstrapped 95% CIs on 10,000 samples to test both relations between variables and potential mediation.

RESULTS

Mean age was 61 y, 74% were women, and 67% were food insecure. Experiencing HFI was associated with both greater psychological distress and worse sleep quality (P < 0.05). Depressive symptoms (adjusted R²: 2.22, 95% CI: 1.27, 3.42), anxiety symptoms (adjusted R²: 1.70, 95% CI: 0.87, 2.85), and diabetes mellitus distress (adjusted R²: 0.60, 95% CI: 0.11, 1.32) each mediated the relation between HFI and worse sleep quality with and without adjustment for age, education, income, marital status, and employment status.

CONCLUSIONS

Household food insecurity is a common and potent household stressor that is associated with suboptimal sleep quality through psychological distress. Efforts to improve food security and decrease psychological distress may yield improved sleep in this high-risk population. The CALMS-D stress management trial was registered at clinicaltrials.gov as NCT01578096.

Soft drinks consumption and child behaviour problems: the role of food insecurity and sleep patterns

Objective

To examine whether the association between soft drinks consumption and child behaviour problems differs by food security status and sleep patterns in young children.

Design

Cross-sectional observational data from the Fragile Families and Child Wellbeing Study (FFCWS), which collected information on food insecurity, soft drinks consumption, sleep patterns and child behaviour problems. Bivariate and multivariate ordinary least-squares regression analyses predicting child behaviour problems and accounting for socio-economic factors and household characteristics were performed.

Setting

Twenty urban cities in the USA with a population of 200 000 or more.

Subjects

Parental interviews of 2829 children who were about 5 years old.

Results

Soft drinks consumption was associated with aggressive behaviours, withdrawn and attention problems for children aged 5 years. However, the association differed by food security status. The association was mostly statistically insignificant among food-secure children after accounting for socio-economic and demographic characteristics. On the other hand, soft drinks consumption was associated with behaviour problems for food-insecure children even after accounting for these factors. However, after accounting for child sleep patterns, the association between soft drinks consumption and child behaviour problems became statistically insignificant for food-insecure children.

Conclusions

The negative association between soft drinks consumption and child behaviour problems could be explained by sleep problems for food-insecure children. Since about 21 % of households with children are food insecure, targeted efforts to reduce food insecurity would help improve dietary (reduce soft drinks consumption) and health behaviours (improve sleep) and reduce child behaviour problems.

Prevalence of food insecurity among military households with children 5 years of age and younger

OBJECTIVE

Food insecurity increases risk of health conditions that may decrease military readiness. The aim of the present study was to define the prevalence of food insecurity among households with young children utilizing military installation childcare facilities and to describe household characteristics associated with food insecurity among this population.

DESIGN

Cross-sectional survey including demographic questions and the US Department of Agriculture Food Security Survey Module six-item short form given to households (n 248) enrolled in Joint Base San Antonio Child Development Centers (JBSA-CDC) during the spring of 2015.

SUBJECTS

Department of Defense families with at least one child less than 6 years old enrolled in a JBSA-CDC. Settings Joint Base San Antonio, TX, USA.

RESULTS

Nearly one in seven families reported food insecurity. Households were more likely to be food-insecure if the head of household's highest level of education was high school or equivalent (P=0·003) and if the head of household was unmarried/unpartnered (P=0·001). Among food-insecure households headed by military service members, all were junior enlisted or non-commissioned officers (E1-E9). Food-insecure households were less likely to live off-post in owned or rented homes compared with those who were food-secure (P=0·016). Other characteristics associated with food insecurity included at least one family member enrolled in the Exceptional Family Member Program (P=0·020) and more children in the household (P=0·029). Few families reported enrolment in government supplemental food programmes.

CONCLUSIONS

Food insecurity is prevalent in military families. Targeted interventions and policies can be developed using the demographic risk factors identified in the present study.

Massachusetts Inpatient Medicaid Cost Response to Increased Supplemental Nutrition Assistance Program Benefits

OBJECTIVES

To investigate the impact of an increase in Supplemental Nutrition Assistance Program (SNAP) benefits on Medicaid costs and use in Massachusetts.

METHODS

Using single and multigroup interrupted time series models, I examined the effect of an April 2009 increase in SNAP benefits on inpatient Medicaid cost and use patterns. I analyzed monthly Medicaid discharge data from 2006 to 2012 collected by the Massachusetts Center for Health Information and Analysis.

RESULTS

Inpatient costs for the overall Massachusetts Medicaid population grew by 0.55 percentage points per month (P < .001) before the SNAP increase. After the increase, cost growth fell by 73% to 0.15 percentage points per month (-0.40; P = .003). Compared with the overall Medicaid population, cost growth for people with the selected chronic illnesses was significantly greater before the SNAP increase, as was the decline in growth afterward. Reduced hospital admissions after the SNAP increase drove the cost declines.

CONCLUSIONS

Medicaid cost growth fell in Massachusetts after SNAP benefits increased, especially for people with chronic illnesses with high sensitivity to food insecurity.

Short sleep duration and dietary intake: epidemiologic evidence, mechanisms, and health implications

Links between short sleep duration and obesity, type 2 diabetes, hypertension, and cardiovascular disease may be mediated through changes in dietary intake. This review provides an overview of recent epidemiologic studies on the relations between habitual short sleep duration and dietary intake in adults from 16 cross-sectional studies. The studies have observed consistent associations between short sleep duration and higher total energy intake and higher total fat intake, and limited evidence for lower fruit intake, and lower quality diets. Evidence also suggests that short sleepers may have irregular eating behavior deviating from the traditional 3 meals/d to fewer main meals and more frequent, smaller, energy-dense, and highly palatable snacks at night. Although the impact of short sleep duration on dietary intake tends to be small, if chronic, it may contribute to an increased risk of obesity and related chronic disease. Mechanisms mediating the associations between sleep duration and dietary intake are likely to be multifactorial and include differences in the appetite-related hormones leptin and ghrelin, hedonic pathways, extended hours for intake, and altered time of intake. Taking into account these epidemiologic relations and the evidence for causal relations between sleep loss and metabolism and cardiovascular function, health promotion strategies should emphasize improved sleep as an additional factor in health and weight management. Moreover, future sleep interventions in controlled studies and sleep extension trials in chronic short sleepers are imperative for establishing whether there is a causal relation between short sleep duration and changes in dietary intake.

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.