Food insecurity and mental health: a systematic review and meta-analysis

Supplemental Nutrition Assistance Program Emergency Allotments and Food Security, Hospitalizations, and Hospital Capacity

Importance

Understanding how social policies shape health is a national priority, especially in the context of the COVID-19 pandemic.

Objective

To understand the association between politically motivated changes to Nebraska's Supplemental Nutrition Assistance Program (SNAP) policy and public health measures during the COVID-19 pandemic.

Design, Setting, and Participants

This cross-sectional study used synthetic control methods to estimate the association of Nebraska's decision to reject emergency allotments for the SNAP with food security and hospital capacity indicators. A counterfactual for Nebraska was created by weighting data from the rest of the US. State-level changes in Nebraska between March 2020 and March 2021 were included. Data were acquired from the Census Bureau's Household Pulse Survey on individual food security and mental health indicators and from the US Centers for Disease Control and Prevention on hospital-level capacity indicators. Data analysis occurred between October 2022 and June 2023.

Intervention

The rejection of additional SNAP funds for low-income households in Nebraska from August to November 2020.

Main Outcomes and Measures

Food insecurity and inpatient bed use indicators (ie, inpatient beds filled, inpatient beds filled by patients with COVID-19, and inpatients with COVID-19).

Results

The survey data of 1 591 006 respondents from May 2020 to November 2020 was analyzed, and 24 869 (1.56%) lived in Nebraska. Nebraska's population was composed of proportionally more White individuals (mean [SD], 88.70% [0.29%] vs 78.28% [0.26%]; P < .001), fewer individuals who made more than $200 000 in 2019 (4.20% [0.45%] vs 5.22% [0.12%]; P < .001), and more households sized 1 to 3 (63.41% [2.29%] vs 61.13% [1.10%); P = .03) compared with other states. Nebraska's rejection of additional funding for SNAP recipients was associated with increases in food insecurity (raw mean [SD] difference 1.61% [1.30%]; relative difference, 19.63%; P = .02), percentage of inpatient beds filled by patients with COVID-19 (raw mean [SD] difference, 0.19% [1.55%]; relative difference, 3.90%; P = .02), and percentage of inpatient beds filled (raw mean [SD] difference, 2.35% [1.82%]; relative difference, 4.10%; P = .02).

Conclusions and Relevance

In this cross-sectional study, the association between social policy, food security, health, and public health resources was examined, and the rejection of emergency allotments in Nebraska was associated with increased food insecurity. Additionally, this intervention was associated with an increased rate of hospitalizations for COVID-19 and non-COVID-19 causes.

Food Insecurity, Healthcare Utilization, and Healthcare Expenditures: A Longitudinal Cohort Study

Objective: This study examines the longitudinal association between household food insecurity and healthcare utilization and expenditure. Methods: A multi-wave longitudinal cohort study was conducted using the 2008-2019 and 2021 waves of the Korean Welfare Panel Study. The baseline data included participants aged ≥19 years with valid responses to the food insecurity and healthcare questionnaires in the 2008 wave (n = 12,166). Healthcare outcomes encompassed outpatient visits, inpatient admissions, days hospitalized, and personal healthcare expenditure. Random effects Poisson and linear regressions were estimated. Results: Severe food insecurity was associated with a higher incidence rate of outpatient visits (IRR, 1.14; 95% CI, 1.12-1.17), days of hospitalization (IRR, 1.18; 95% CI, 1.13-1.22), and inpatient admissions (IRR, 1.40; 95% CI, 1.18-1.65). Moderate food insecurity was associated with 10.4% (β = -0.11; 95% CI, -0.14 to -0.07) or 238,276 KRW reductions in personal healthcare expenditures in the subsequent year. Conclusion: Household food insecurity was linked to increased healthcare utilization and reduced personal healthcare expenditure among Korean adults. Our findings present opportunities to identify target populations for healthcare policies and interventions.

Precarious Young Adults' Mental Health during the Pandemic: The Major Impact of Food Insecurity Independently of COVID-19 Diagnosis

The COVID-19 pandemic had a major impact on mental health across populations, especially young and precarious people. Furthermore, COVID-19 diagnosis itself has been associated with psychiatric symptoms. However, only a few studies have assessed the mental health of precarious youth, and examined a possible association with food insecurity, while including COVID-19 diagnosis in their analyses. We aimed to determine the prevalence of poor mental health in precarious youth during the COVID-19 pandemic, and to investigate its possible association with food insecurity, independently of COVID-19 diagnosis. In a cross-sectional study conducted in the context of an employment program for precarious youth (18-25 years) living in Paris, France, 823 individuals were assessed for depression, anxiety, subjective distress and food insecurity during the second lockdown of 2020. A directed acyclic graph (DAG)-based approach was used to identify confounders for inclusion in a multivariate regression model. Of the 823 precarious youth, 45.93% reported significant symptoms of depression, 36.69% anxiety, 39% distress and 25.39% suicidal ideation. In the multivariate analysis based on DAG, food insecurity (less than one meal per day) was associated with depression (OR = 2.30; CI%: 1.19-4.51), anxiety (OR = 2.51; CI%: 1.29-4.88), distress (OR = 2.36; CI%: 1.23-4.57) and suicidal ideation (OR = 4.81; CI%: 2.46-9.44), independently of age, gender, education, COVID-19 contact and COVID-19 diagnosis. This study highlights the importance of food insecurity on mental health among young precarious people during the COVID-19 pandemic. Reducing food insecurity is essential to help reduce psychological distress.

Food Insecurity and Mental Health among Venezuelan Migrants and Refugees Living in Peru: Secondary Data Analysis of a Cross-Sectional Survey

The objective of this study was to analyze the association between food insecurity and mental health in Venezuelan migrants and refugees residing in Peru using data from the Survey Directed at the Venezuelan Population Residing in the Country (ENPOVE) conducted in 2022. The analysis included 7739 Venezuelan adults. The presence of mental health problems was self-reported, and household food insecurity was measured using the Food Insecurity Experience Scale. The study found that 4 out of 10 participants lived in households with moderate to severe food insecurity, and around 10% reported experiencing some mental health problem in the last month. The study identified a positive association between living in households with moderate to severe food insecurity and having some mental health problem compared to living in households without food insecurity. The findings suggest that food insecurity is a common problem among the Venezuelan migrant population residing in Peru, and measures are required to address this problem and mitigate its consequences on mental health and other health problems. The study highlights the need for international organizations to provide assistance and support to these populations and ensure adequate and sustainable follow-up of food insecurity at the national level. It is also necessary to implement early detection tests for mental health problems in the migrant population, especially in individuals exposed to food insecurity. This study provides relevant evidence for addressing public health in the Venezuelan migrant population residing in Peru.

Medical Mistrust Among Food Insecure Individuals in Appalachia

This study focused on the relationship between food insecurity and medical mistrust within Appalachia. Food insecurity has negative consequences on health, while medical mistrust can lead to a decrease in health care use, creating additive consequences to already vulnerable populations. Medical mistrust has been defined in various ways, with measures addressing health care organizations and individual health care providers. To determine whether food insecurity has an additive impact on medical mistrust, a cross-sectional survey was completed by 248 residents in Appalachia Ohio while attending community or mobile clinics, food banks, or the county health department. More than one-quarter of the respondents had high levels of mistrust toward health care organizations. Those with high food insecurity levels were more likely to have higher levels of medical mistrust than those with lower levels of food insecurity. Individuals with higher self-identified health issues and older participants had higher medical mistrust scores. Screening for food insecurity in primary care can reduce the impact of mistrust on patient adherence and health care access by increasing patient-centered communication. These findings present a unique perspective on how to identify and mitigate medical mistrust within Appalachia and call attention to the need for further research on the root causes among food insecure residents.

The Association of Food Insecurity With Asthma Control in Adults During COVID-19

BACKGROUND

Food insecurity has been associated with poorer asthma control in children, but research lacks in adults.

OBJECTIVE

To assess the frequency of food insecurity and its association with asthma control in adults during the coronavirus disease 2019 pandemic.

METHODS

An online cross-sectional survey study was conducted in US adults with asthma. Survey questions included how worried or concerned participants were about food security since the pandemic. Asthma control was assessed using the Asthma Control Test, with uncontrolled asthma defined as Asthma Control Test score less than or equal to 19. Self-report of food insecurity since the pandemic was assessed. Food insecurity variables were dichotomized into high insecurity (≥3) or low insecurity (<3). Descriptive statistics and bivariate analyses were performed.

RESULTS

Of the total participants (N = 866), 82.79% were female; mean age of participants was 44 ± 15.05 years, their mean Asthma Control Test score was 19.25 ± 4.54, and 18.48% had high food insecurity. Participants with high food insecurity were more likely to have uncontrolled asthma (74.38%) compared with those with lower food insecurity (34.99%; P < .01). The relationship between asthma control and food insecurity remained significant after adjusting for age, education, sex, race, anxiety, and living stability concerns due to the pandemic.

CONCLUSIONS

Food insecurity exists in adults with asthma and is associated with uncontrolled asthma. Providers should consider screening their patients for food insecurity when treating individuals with uncontrolled asthma.

Food Insecurity and Transmission Risks Among People with HIV Who Use Substances

Food insecurity (FI) impacts people with HIV (PWH) and those who use substances (i.e. drugs and alcohol). We evaluated the longitudinal association between FI and HIV transmission risks (unprotected sexual contacts and shared needles/syringes). Among 351 PWH who use substances in Russia, 51.6% reported FI and 37.0% past month injection drug use. The mean number of unprotected sexual contacts in the past 90 days was 13.4 (SD 30.1); 9.7% reported sharing needles/syringes in the past month. We did not find a significant association between mild/moderate FI (adjusted IRR = 0.87, 95% CI 0.47, 1.61) or severe FI (aIRR = 0.84, 95% CI 0.46, 1.54; global p = 0.85) and unprotected sexual contacts. We observed a significant association between severe FI and sharing needles/syringes in the past month (adjusted OR = 3.27, 95% CI 1.45, 7.39; p = 0.004), but not between mild/moderate FI and sharing needles/syringes in the past month (aOR = 1.40,95% CI 0.58, 3.38; p = 0.45). These findings suggest that severe FI could be a potential target for interventions to lower HIV transmission.

Prevalence and socio-economic determinates of food insecurity in Veterans: findings from National Health and Nutrition Examination Survey

OBJECTIVE

To determine predictors of the association between being a Veteran and adult food security, as well as to examine the relation of potential covariates to this relationship.

DESIGN

Data collected during 2011-2012, 2013-2014 and 2015-2016 National Health and Nutrition Examination Survey (NHANES) were pooled for analyses. Veterans (self-reported) were matched to non-Veterans on age, race/ethnicity, sex and education. Adjusted logistic regression was used to determine the odds of Veterans having high food security v. the combination of marginal, low and very low food security compared with non-Veterans.

SETTING

2011-2012, 2013-2014 and 2015-2016 NHANES.

PARTICIPANTS

1227 Veterans; 2432 non-Veterans.

RESULTS

Veteran status had no effect on the proportion of food insecurities between Veterans and non-Veterans reporting high (Veterans v. non-Veteran: 79 % v. 80 %), marginal (9 % v. 8 %), low (5 % v. 6 %) and very low (8 % v. 6 %) food security (P = 0·11). However, after controlling for covariates, Veterans tended to be less likely to have high food security (OR: 0·82 (95 % CI 0·66, 1·02), P = 0·07). Further, non-Hispanic White Veterans (OR: 0·72 (95 % CI 0·55, 0·95), P = 0·02) and Veterans completing some college (OR: 0·71 (95 % CI 0·50, 0·99), P < 0·05) were significantly less likely to experience high food security compared with non-Veterans.

CONCLUSION

This study supports previous research findings that after controlling for covariates, Veterans tend to be less likely to have high food security. It also highlights ethnicity and level of education as important socio-economic determinates of food security status in Veterans.

Food insecurity and binge eating: A systematic review and meta-analysis

OBJECTIVE

This review synthesized literature on the relationship between food insecurity and binge eating.

METHODS

Relevant studies were identified by searching PubMed, CINAHL, PsycINFO, and gray literature from inception to October 2022. Eligible studies included primary research that assessed the relationship between food insecurity and binge eating. Data extraction was performed independently by two reviewers. Pooled odds ratios and 95% confidence intervals (CI) were obtained from random effect models with the R package meta. Analyses were stratified by binge eating versus binge-eating disorder (BED), study type (cross-sectional vs. longitudinal), and age (adults vs. adolescents).

RESULTS

We included 24 articles that reported on 20 studies, and 13 articles were included in the meta-analysis. Based on the random effects meta-analysis, the odds of adults in the food insecure group having binge eating were 1.66 (95% CI = 1.42, 1.93) times the odds of adults in the food secure group having binge eating. The odds of adults in the food insecure group having BED were 2.70 (95% CI = 1.47, 4.96) times the odds of adults in the food secure group having BED. Insufficient data were available for a meta-analysis on adolescents or longitudinal relationships.

CONCLUSIONS

These findings support that food insecurity is associated with binge eating in adults. There is a need for research to investigate the mechanisms underlying this relationship. Results highlight the importance of screening participants with food insecurity for disordered eating behaviors and vice versa. Future research is needed to examine whether interventions targeting food insecurity may help to mitigate disordered eating behaviors.

PUBLIC SIGNIFICANCE

Food insecurity is a common but under-recognized contributor to binge eating. In this article, we systematically reviewed research that has been published on the relationship between food insecurity and binge eating. We found support that food insecurity should be considered in the prevention and treatment of binge eating.

Food Insecurity and Blood Pressure in a Multiethnic Population

Food insecurity is a social determinant of health and is increasingly recognized as a risk factor for hypertension. Native Hawaiians bear a disproportionate burden of hypertension and known risk factors. Despite this, the relative effects of food insecurity and financial instability on blood pressure have yet to be investigated in this population. This study examines the relative effects of food insecurity and financial instability on blood pressure, controlling for potential confounders in a multiethnic sample. Participants (n = 124) were recruited from a U.S. Department of Agriculture-funded study called the Children's Healthy Living Center of Excellence. Biometrics (i.e., blood pressure, weight, and height) were measured. Demographics, physical activity, diet, psychosocial variables, food insecurity, and financial instability were assessed via self-report questionnaires. Hierarchical linear regression models were conducted. Model 1, which included sociodemographic variables and known biological risk factors, explained a small but significant amount of variance in systolic blood pressure. Model 2 added physical activity and daily intake of fruit, fiber, and whole grains, significantly improving the model. Model 3 added financial instability and food insecurity, further improving the model (R2 = 0.37, F = 2.67, p = 0.031). Food insecurity, female sex, and BMI were significantly and independently associated with increased systolic blood pressure. These results suggest a direct relationship between food insecurity and systolic blood pressure, which persisted after controlling for physical activity, consumption of fruits, fiber, and whole grains, and BMI. Efforts to reduce food insecurity, particularly among Native Hawaiians, may help reduce hypertension in this high-risk population.

Diet and Food and Nutrition Insecurity and Cardiometabolic Disease

Poor nutrition is the leading cause of poor health, health care spending, and lost productivity in the United States and globally, which acts through cardiometabolic diseases as precursors to cardiovascular disease, cancer, and other conditions. There is great interest in how the social determinants of health (the conditions in which people are born, live, work, develop, and age) impact cardiometabolic disease. Food insecurity is an example of a powerful social determinant of health that impacts health outcomes. Nutrition insecurity, a distinct but related concept to food insecurity, is a direct determinant of health. In this article, we provide an overview of how diet in early life relates to cardiometabolic disease and then continue to focus on the concepts of food insecurity and nutrition insecurity. In the discussions herein we make important distinctions between the concepts of food insecurity and nutrition insecurity and provide a review of their concepts, histories, measurement and assessment devices, trends and prevalence, and links to health and health disparities. The discussions here set the stage for future research and practice to directly address the negative consequences of food and nutrition insecurity.

Longitudinal Associations Between Food Insecurity and Suicidal Ideation Among Adults Aged ≥65 in the Korean Welfare Panel Study

Objectives : This study aimed to explore longitudinal associations between food insecurity and suicidal ideation, and the moderating roles of intervention programs. Methods: Data were derived from the 2012-2019 waves of the Korean Welfare Panel Study. Participants aged ≥65 at baseline (n = 4,425) and their annual follow-up measurements for a mean of 6.58 years were included. Conditional fixed effects logistic regressions were used to test 1) associations between food insecurity and the onset of suicidal ideation; 2); whether associations were attenuated by food assistance and income support programs. Results: Food insecurity was associated with higher odds of suicidal ideation in the full sample (OR, 1.77; 95% CI, 1.37-2.29), among women (OR, 1.67; 95% CI, 1.24-2.26) and men (OR, 2.06; 95% CI, 1.25-3.40). The association between food insecurity and suicidal ideation was attenuated by participation in home-delivered meal services (OR, 0.43; 95% CI, 0.21-0.88). Conclusion: Food insecure older adults were more likely to consider committing suicide than their food secure counterparts. Food assistance through home-delivered meal services, but not other intervention programs, could weaken this link.

"Something very taboo": a qualitative exploration of beliefs, barriers, and recommendations for improving mental health care and access for Hispanic adults in the Paso del Norte U.S.-Mexico border region

Background

Hispanic adults with mental health conditions in the United States experience disproportionate access to and utilization of professional mental health treatment. This is believed to be in part due to systemic barriers and challenges, difficulty accessing care, cultural factors, and stigma. Studies to date have failed to examine these specific factors within the unique context of the Paso del Norte U.S.-Mexico border region.

Methods

For this study, 25 Hispanic adults identifying primarily of Mexican descent participated in four focus groups exploring these topics. Three groups were facilitated in Spanish and one group in both English and Spanish. Focus groups followed a semi-structured format eliciting perspectives on mental health and mental illness, help-seeking, barriers and facilitators of help-seeking and treatment access, and recommendations for mental health agencies and providers.

Results

Qualitative data analysis yielded the following themes: understanding of mental health and help-seeking; barriers to accessing care; mental health treatment facilitators; and recommendations for agencies, providers, and researchers.

Conclusion

Findings from this study support the need for innovative mental health engagement strategies to reduce stigma, increase understanding of mental health, foster support systems, reduce individual and systemic barriers to seeking and accessing care, and to continue to engage communities in mental health outreach and research.

Socialization, Relaxation, and Leisure across the Day by Social Determinants of Health: Results from the American Time Use Survey, 2014-2016

This study used the American Time Use Survey (ATUS) to examine socialization, relaxation, and leisure activities throughout the day as related to social determinants of health (SDOH). The study population was adults aged 25 years and older who participated in the ATUS in 2014-2016, the most recent years for collecting SDOH. Descriptive analyses provide characteristics of the study population. Graphical analyses display socialization by SDOH across the hours of the day based on adjusted regression models. Quasi-binomial models analyzed the association between the numbers of minutes of various activities and SDOH. Associations between SDOH and sleeplessness (yes or no) were explored using logistic regression. For much of the day, being female, having less education, living in poverty, and having food insecurity were associated with more time socializing and relaxing. The major activities under socializing and relaxation are watching television and movies. Having a college degree was strongly associated with increased minutes of sports activity, whereas living in poverty and food insecurity were associated with fewer minutes. Less education, living in poverty, and having food insecurity were associated with sleeplessness. A possible mechanism of the effects of SODH on health is by its altering of the patterns of daily life.

Evidence on the links between water insecurity, inadequate sanitation and mental health: A systematic review and meta-analysis

BACKGROUND

Water insecurity and inadequate sanitation have adverse impacts on the mental health of individuals.

OBJECTIVE

To review and synthesize evidence on the relationship between water insecurity, inadequate sanitation, and mental health globally.

DATA SOURCES

Relevant studies were identified by searching PubMed, PsycINFO, and EMBASE databases from inception up to March 2023.

STUDY ELIGIBILITY CRITERIA

Only quantitative studies were included. The exposure was water insecurity and or inadequate sanitation. The outcome was common mental disorders (CMD: depression or anxiety), mental distress, mental health or well-being. There was no restriction on geographical location.

PARTICIPANTS

General population or people attending health facilities or other services.

EXPOSURE

Water insecurity and/ or inadequate sanitation.

RISK OF BIAS

The effective Public Health Practice Project (EPHPP) assessment tool was used to assess quality of selected studies.

SYNTHESIS OF RESULTS

A meta-analysis was conducted using a random effects statistical model.

RESULTS

Twenty-five studies were included, with 23,103 participants from 16 countries in three continents: Africa (Kenya, Ethiopia, Ghana, Uganda, South Africa, Malawi, Mozambique, and Lesotho), Asia (Nepal, Bangladesh, India, and Iran) and the Americas (Brazil, Haiti, Bolivia and Vietnam). There was a statistically significant association between water insecurity and CMD symptoms. Nine studies reported a continuous outcome (5,248 participants): overall standardized mean difference (SMD = 1.38; 95% CI = 0.88, 1.87). Five studies reported a binary outcome (5,776 participants): odds ratio 5.03; 95% CI = 2.26, 11.18. There was a statistically significant association between inadequate sanitation and CMD symptoms (7415 participants), overall SMD = 5.36; 95% CI = 2.51, 8.20.

LIMITATIONS

Most of the included studies were cross-sectional which were unable to examine temporal relationships.

CONCLUSIONS

Water insecurity and inadequate sanitation contribute to poorer mental health globally.

IMPLICATIONS OF KEY FINDINGS

Interventions to provide basic water, sanitation and psychosocial support, could substantially contribute to reducing the burden of CMD alongside other health and social benefits.

TRIAL REGISTRATION

PROSPERO registration number: CRD42022322528.

Food Insecurity, Food Assistance, and Psychological Distress among University Students: Cross-Sectional Survey Western Australia, 2020

University students have been identified as a population sub-group vulnerable to food insecurity. This vulnerability increased in 2020 due to the COVID-19 pandemic. This study aimed to assess factors associated with food insecurity among university students and the differences between students with and without children. A cross-sectional survey of (n = 213) students attending one university in Western Australia measured food insecurity, psychological distress, and socio-demographic characteristics. Logistic regression analyses were conducted to identify factors associated with food insecurity. Forty-eight percent of students who responded to the survey had experienced food insecurity in 2020. International students who were studying in Australia were nine times more likely to experience food insecurity than domestic students (AOR = 9.13; 95% CI = 2.32-35.97). International students with children were more likely to experience food insecurity than international students without children (p < 0.001) and domestic students with (p < 0.001) or without children (p < 0.001). For each unit increase in depression level, the likelihood of experiencing food insecurity increased (AOR = 1.62; 95% CI = 1.12-2.33). Findings show a higher prevalence of food insecurity among international university students and students with children during the COVID-19 pandemic and that food insecurity was associated with higher levels of psychological distress. These findings highlight the need for targeted interventions to mitigate the risk of food insecurity among Australian university students, particularly among international students, students with children, and those experiencing psychological distress.

Predictors of Food Insecurity and Childhood Hunger in the Bronx During the COVID-19 Pandemic

Using a community-based participatory research approach, we conducted a survey of 218 food pantry recipients in the south Bronx to determine predictors of food insecurity and childhood hunger. In adjusted multiple regression models, statistically significant risk factors for food insecurity included: having one or more children and not having health insurance. Statistically significant protectors against childhood hunger were: having a graduate degree, having health insurance and Spanish being spoken at home. Experiencing depression symptoms was positively associated with both food insecurity and childhood hunger. Frequency of food pantry use was not significantly associated with either food insecurity nor childhood hunger. This study suggests that targeting families with multiple children and without insurance will best help to promote food security among residents of the south Bronx. Social policy implications related to food security and benefit provision through the COVID-19 pandemic are also provided.

Patients' experiences with a community fruit and vegetable box program prescribed by their health provider

BACKGROUND

Food insecurity is "the state of being without reliable access to a sufficient quantity of affordable, nutritious food". Observational studies have associated food insecurity with many negative health effects including the development and exacerbations of chronic diseases, higher health care use and increased mortality. Health care providers prescribing food is a growing area of interest and research, however it is not known how patients feel about receiving fruit and vegetable prescriptions (FVRx) from their health provider versus other means of food provision. This pilot study was conducted to explore the experiences and opinions of Canadian adults with food insecurity who were recipients of a FVRx box program prescribed by their health provider.

METHODS

Potential participants were recruited to 3 focus groups using flyers included in their monthly food box. Questions were kept open to encourage participation of all group members. The focus groups were audiotaped, transcribed verbatim, and analyzed by the research team using descriptive qualitative research methodology.

RESULTS

Participants described shame and frustration trying to obtain enough food through local food banks. In comparison, they perceived their team dietitian, family physician or addictions physician as directly helping them with their health by prescribing food. The boxed fruit and vegetables were prepared in many ways and often shared to reduce waste and to reduce the food insecurity of extended family members. Positive effects of the FVRx on physical and mental health were reported. Participants believed that follow up with their health provider helped support them and their behavioural changes towards better nutrition. Limitations of the program included lack of choice, non-flexible pick-up times and the program being limited to 6 months. Being able to choose their own fruit and vegetables, instead of receiving a set box, was suggested by most to help meal planning and to increase autonomy.

CONCLUSIONS

Health providers prescribing FVRx boxes to adult patients with food insecurity was positively received in this study. Evaluation of similar programs in other regions in Canada and internationally, and comparison of food prescriptions to basic income guarantee programs is recommended.

Household food insecurity and associated factors in South Ari district, Southern Ethiopia: A community-based cross-sectional study

BACKGROUND

Household food insecurity is a major public health problem in Ethiopia despite the presence of various interventions implemented by the government. However, there is a dearth of evidence regarding the prevalence and responsible factors in Ethiopia, specifically in the South Ari district. This study, therefore, aimed to assess household food insecurity and associated factors in South Ari district, Southern Ethiopia.

METHODS

A community-based cross-sectional study was employed from March 11 to April 11, 2021, at South Ari district, Southern Ethiopia. A two-stage sampling technique was used to draw a sample of 717 households. Data were checked and entered into Epi-Data V3.2., and exported to SPSS V25.0 for data exploration and analysis. Variables with a p-value <0.25 in bivariable logistic regression were candidates for multivariable logistic regression. Multivariable logistic regression analysis was fitted to determine factors associated with household food insecurity. Hosmer-Lemeshow goodness-of-fit statistic was used to check model fitness and was satisfied. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to determine the strength of association. P-value <0.05 was used to declare statistical significance.

RESULT

The prevalence of household food insecurity was 44.8% (95% CI: 41.1%, 48.5%). Larger family size (8 and above) (AOR = 1.91, 95% CI: 1.10, 3.30), high dependency ratio (AOR = 2.71, 95% CI: 1.67, 4.40), medium dependency ratio (AOR = 1.72, 95% CI: 1.13, 2.62), poor wealth index (AOR = 2.30, 95% CI: 1.53, 3.46), not using agricultural extension service (AOR = 2.25, 95% CI: 1.57, 3.23), and non-beneficiary of productive safety net program (AOR = 1.71, 95% CI: 1.01, 2.87) were factors significantly associated with household food insecurity.

CONCLUSIONS

The findings of this study showed a significant proportion of households were food insecure in South Ari District. Larger family size, high and medium dependency ratio, poor wealth index, not using agricultural extension service, and non-beneficiary of productive safety net program were significant risk factors associated with household food insecurity. Therefore, rigorous work is highly needed to enhance income-generating activities, strengthen agricultural productivity, expand the productive safety net program, and limit population pressure through improved family planning use.

Did mental and emotional health of SNAP families' children improve during the COVID-19 pandemic?

The onset of the COVID-19 pandemic disproportionately affected low-income households in the United States. As part of the government's response to the pandemic, households with children participating in the Supplemental Nutrition Assistance Program (SNAP) benefited from several temporary provisions. This study examines whether the mental/emotional well-being of children in SNAP families was influenced by the SNAP temporary provisions, overall and across subpopulations by race/ethnicity and school meal programs (SMP) participation status of children. Cross-sectional data from the 2016-2020 National Survey of Children Health (NSCH) were used to study the occurrence of mental, emotional, developmental, or behavioral (MEDB) health of children (6-17 years) in SNAP families. Difference-in-Differences (DID) analyses were conducted to assess the association between MEDB health of children in SNAP families and the implementation of the SNAP provisions. Overall, finding show that between 2016 and 2020, children in SNAP families were more likely to face adverse MEDB conditions than children in non-SNAP families (p < 0.05). DID analyses indicate that children's MEDB health was not statistically affected following the first year of SNAP temporary provisions (p > 0.1). Additionally, no differential results were found by race/ethnicity of children or SMP participation (p > 0.1). Results are robust to the use of different well-being measures. These results suggest that SNAP provisions may have been associated with the reduction of the adverse effects of the pandemic on children's well-being.

Exploring differences in disordered eating and related appetitive traits among women based on childhood and current food security status

Despite emerging evidence that food insecurity (FI) is associated with elevated rates of eating pathology, little is known about the lasting impact of FI on eating behaviors. Studies that have explored the association between FI during childhood and eating behavior in adulthood have not accounted for current FI. The present study explored differences in disordered eating (DE) and related appetitive traits among four groups of cisgender female mothers: individuals who (1) endorsed childhood FI only (n = 96), (2) endorsed current FI only (n = 134), (3) endorsed both childhood and current FI (n = 257), and (4) denied both childhood and current FI (n = 146). Participants responded to online questionnaires including items from the USDA Household Food Security Survey Module, the 7-item Eating Disorder Examination-Questionnaire, the Eating Disorder Diagnostic Scale, and the Adult Eating Behavior Questionnaire. Adjusting for age and race/ethnicity, ANCOVAs explored mean differences between groups in DE and appetitive traits, and a modified Poisson regression model examined differences in binge-eating prevalence across the four FI groups. The "current FI only" group consistently endorsed the highest levels of DE and related appetitive traits followed by the "current and childhood FI" group, suggesting newly food-insecure women may be at highest risk for DE. Interestingly, across almost all constructs, the "childhood FI only" group did not differ significantly from the "no FI" group. These findings suggest that improved access to food may help offset risk for adult DE related to experiences of FI in childhood.

Food insecurity and its association with health and well-being in middle-aged and older adults in India

AIM

Food insecurity is a global public health concern; however, there is limited knowledge about its health impacts in India. We examined the associations of food insecurity with socioeconomic conditions, chronic disease and various domains of health and well-being in a community sample of middle-aged and older adults (45+ years) in India.

METHODS

Cross-sectional nationally representative data were collected in wave 1 (2017-2018) of the Longitudinal Ageing Study in India. Food insecurity was measured by questions of access and availability of food. We used logistic regression analyses to examine associations of food insecurity with poor self-rated health, limitations in activities of daily living (ADLs), instrumental ADLs, low life satisfaction, depression, sleep problems and low body mass.

RESULTS

Food insecurity related to all seven indicators of poor health and well-being, even after controlling for material wealth and the presence of multimorbidity (which food insecurity also predicted). Associations with mental health were stronger for those for physical health. For instance, food insecurity related to a threefold increase in probable depression (OR=2.9, 95% CI=2.4 to 3.4) and low life satisfaction (OR=3.4, 95% CI=2.9 to 3.8).

CONCLUSIONS

Food insecurity is a powerful social determinant of poor health among older adults in India. Policy measures to improve population health and well-being should closely follow trends in food insecurity, particularly among those living in poverty and with multiple health conditions.

Joint Food and Water Insecurity Had a Multiplicative Effect on Women's Depression in Urban Informal Settlements in Makassar, Indonesia during the COVID-19 Pandemic

BACKGROUND

Women living in urban informal settlements may be particularly vulnerable to the detrimental effects of the COVID-19 pandemic because of increased economic and psychosocial stressors in resource-limited environments.

OBJECTIVES

The objective of this study was to assess the associations between food and water insecurity during the pandemic and depression among women living in the urban informal settlements in Makassar, Indonesia.

METHODS

We implemented surveys at 3 time points among women enrolled in the Revitalizing Informal Settlements and their Environments trial. Depression was measured using the Center for Epidemiologic Studies Depression Scale-10 (CESD-10) between November and December 2019 and again between February and March 2021. Food insecurity was measured using questions from the Innovation for Poverty Action's Research for Effective COVID-19 Reponses survey and water insecurity was measured using the Household Water Insecurity Experiences Short Form. Both were measured between August and September 2020. We built 3 multivariate quantile linear regression models to assess the effects of water insecurity, food insecurity, and joint food and water insecurity during the COVID-19 pandemic on CESD-10 score.

RESULTS

In models with the full sample (n = 323), food insecurity (β: 1.48; 95% CI: 0.79, 2.17), water insecurity (β: 0.13; 95% CI: -0.01, 0.26), and joint food and water insecurity (β: 2.40; 95% CI: 1.43, 3.38) were positively associated with CESD-10 score. In subgroup analyses of respondents for whom we had prepandemic CESD-10 scores (n = 221), joint food and water insecurity (β: 1.96; 95% CI: 0.78, 3.15) maintained the strongest relationship with CESD-10 score. A limitation of this study is that inconsistency in respondents from households across the survey waves reduced the sample size used for this study.

CONCLUSIONS

Our results find a larger association between depression and joint resource insecurity than with water or food insecurity alone, underlining the importance of addressing food and water insecurity together, particularly as they relate to women's mental health and well-being.

The association between food insecurity and cognitive impairment among the US adults: The mediation role of anxiety or depression

BACKGROUND

Using a nationally representative sample, this study aimed to examine (1) socio-demographic and health-related disparities in cognitive impairment, (2) the association between food insecurity and cognitive impairment, and (3) the mediation role of anxiety or depression in the pathway between food insecurity and cognitive impairment.

METHODS

Cross-sectional data of 28,508 adults from the 2020 National Health Interview Survey were analyzed. Multivariable logistic regression models were used to estimate associations with cognitive impairment. Mediation analyses were conducted using the four-way decomposition method under a counterfactual framework.

RESULTS

Disparities in cognitive impairment were observed across socio-demographic and health-related characteristics (all p < 0.0001). Food insecurity was significantly associated with cognitive impairment in the overall population and the magnitude of the association was greater for the young or middle-aged, females and non-Hispanic Blacks than the general population (AOR ranged from 1.19 to 2.54, all p < 0.01). With anxiety as a mediator, 28.66 % of the total effect of food insecurity on cognitive impairment was attributable to mediation only, and 22.39 % was attributable to interaction (between food insecurity and anxiety) and mediation. With depression as a mediator, 22.33 % of the total effect was attributable to mediation only, and 16.00 % was attributable to interaction (between food insecurity and depression) and mediation.

LIMITATIONS

The cross-sectional design prevents inference of causality.

CONCLUSIONS

Ensuring available and adequate food resources is important to prevent adverse cognitive outcomes. Clinical interventions or treatments for anxiety or depression may help improve cognitive function.

Risk of food insecurity in undocumented migrant households in Birmingham, UK

BACKGROUND

This study aimed to understand the extent of household food insecurity amongst undocumented migrant families in Birmingham,UK.

METHODS

Cross-sectional survey of households (n = 74) with dependent children using the USDA 18-item household food security (HFS) module. All households had an irregular immigration status and were accessing an immigration advice drop-in service (n = 98 adults; n = 138 children) in Birmingham.

RESULTS

About 95.9% of households were food insecure, and 94.6% of children lived in households with low or very low food security. Food insecurity varied within households. Around 91.8% of adults were food insecure, compared to 75.6% of children. Spearman's rank-order correlation indicated a statistically significant positive correlation between household food insecurity level and number of children (rho = 0.253, P = 0.031). A Kruskal-Wallis H Test indicated no statistically significant difference (P = 0.730) in HFS score between households supported by asylum support, children's social services or paid employment in the informal economy and those that had no regular income.

CONCLUSIONS

Prevalence of HFS was higher in this sample of undocumented migrant households with dependent children in Birmingham, UK, than in the wider population, and larger households were more food insecure. Households without a regular income were no more likely to be food insecure than households with financial support.

Prevalence of food insecurity and its association with depressive and anxiety symptoms in older adults during the COVID-19 pandemic in Mexico: A secondary analysis of ENCOVID-19 survey

Introduction

COVID-19 infection has caused high rates of morbi-mortality in older adults (OAs). In addition, conditions such as depression, anxiety, unemployment, and poverty frequently contribute to this population being at higher risk of food insecurity (FI) during the COVID-19 pandemic.

Objective

This study aimed to analyze the prevalence of FI and its association with depressive and anxiety symptoms in Mexican OAs during the COVID-19 pandemic.

Methods

This study involved a secondary analysis of the National Survey on the Effects of COVID-19 on the Wellbeing of Mexican Households (ENCOVID-19), a series of cross-sectional telephone surveys conducted between April and October 2020. The OA subsample was 1,065. FI was measured by using the Latin American and Caribbean Food Security Scale (ELCSA), and depression and anxiety symptoms were measured by using the Depression Scale of the Center for Epidemiological Studies (CESD-7) and the Generalized Anxiety Disorder Scale (GAD-2), respectively. Socioeconomic status (SES), occupation, schooling, and pension were also evaluated. ANOVA was used to compare the variables between the different FI groups, and logistic regression was used to analyze the risk between FI and the anxiety and depression variables.

Results

The mean age of the participants was 67.31 ± 6.4 years, and FI was classified as mild, moderate, and severe, with prevalences of 38.6, 15.04, and 8.16%, respectively. Overall, 28.01% of the OAs presented symptoms of anxiety and 39.09% of depression. In the comparison between groups, a higher prevalence of depressive symptoms was observed with a higher degree of FI, with 65.75% in moderate-to-severe, 10.39% in mild, and 9.40% without FI, p ≤ 0.000. Regarding anxiety symptoms, 48% of the OAs showed moderate-to-severe, 30.05% showed mild, and 15.38% were without FI, p ≤ 0.000. Using multiple logistic regression, an OR of 5.50 (95% CI 2.74–11.04) was observed for depressive symptoms when moderate-to-severe FI is present. In the case of the risk of anxiety symptoms, it was significant in all degrees of FI, in mild (OR = 2.43, 95% CI 1.66–3.59) and in moderate-to-severe (OR = 5.32, 95% CI 3.45–8.19).

Conclusion

There is a high prevalence of FI in Mexican OAs during the COVID-19 pandemic. FI increases the risk of other conditions such as depression and anxiety. It is important to design and implement programs aimed at OAs with these conditions to reduce or prevent FI.

Social Isolation, Healthy Habits, Inequality and Mental Health in the United States

The objective of this work is to deepen the analysis of the socioeconomic determinants of mental health, paying special attention to the impact of inequality, not only in income distribution but also in gender, racial, health and education inequality, social isolation, including new variables to measure loneliness, and healthy habits, on the mental health status. For this purpose, a cross-sectional model for a sample of 2735 counties in the United States is estimated using Ordinary Least Squares in its robust version to solve the detected heteroscedasticity problems. The results obtained show that inequality, social isolation and certain lifestyles, such as smoking or insomnia, are detrimental to mental health, while sexual activity prevents mental distress. On the other hand, poor counties suffer more cases of suicide, with food insecurity being the main problem for mental health. Finally, we found detrimental effects of pollution on mental health.

Food Insecurity and Cognitive Trajectories in Community-Dwelling Medicare Beneficiaries 65 Years and Older

Importance

Food insecurity has a known association with prevalent impaired cognition. However, it is unknown whether food insecurity has a longitudinal association with cognitive decline among older adults.

Objective

To determine whether food insecurity is associated with a faster decline in cognitive function among community-dwelling older adults.

Design, Setting, and Participants

This retrospective cohort study used data from a nationally representative sample of Medicare beneficiaries 65 years and older recruited for the National Health and Aging Trends Study (NHATS). Community-dwelling NHATS participants were followed up for a maximum of 7 years (mean [SD] follow-up duration, 5.4 [1.1] years). Data were collected from January 1, 2012, to December 31, 2020, and analyzed from December 23, 2021, to December 6, 2022.

Exposures

Self-reported food insecurity assessed from 2012 to 2019.

Main Outcomes and Measures

Primary outcomes were immediate memory, delayed memory, and executive function collected from 2013 to 2020. Immediate and delayed recall were assessed by a 10-item word-list memory task (range, 0-10, with higher scores indicating more words recalled). Executive function was measured by the clock drawing test (range, 0-5, with higher scores indicating more accurate depiction of a clock). Each year's cognitive functions were linked to the prior year's food insecurity data. Linear mixed-effects models with random slopes and intercepts were used to examine the association between food insecurity and cognitive decline. Analytic weights in each year were applied to represent community-dwelling Medicare beneficiaries 65 years and older in 2011.

Results

Of 3037 participants, a weighted 57.8% (raw count, 1345) were younger than 75 years, 56.2% (raw count, 1777) were women, and most (84.9% [raw count, 2268]) were White. Over 7 years, 417 (weighted proportion, 12.1%) experienced food insecurity at least once. Food insecurity was associated with a faster decline in executive function in a fully adjusted model: the mean difference of annual change in executive function score between people exposed to and not exposed to food insecurity was -0.04 (95% CI, -0.09 to -0.003) points. However, food insecurity was not associated with changes in immediate and delayed memory (0.01 [95% CI, -0.05 to 0.08] and -0.01 [95% CI, -0.08 to 0.06], respectively).

Conclusions and Relevance

Among community-dwelling older adults, food insecurity was prevalent and associated with a decline in executive function. Interventions and policies aiming to increase healthy food access or reduce food insecurity should be assessed for their impact on older adults' cognitive outcome.

Food insecurity and its association with mental health among Syrian refugees resettled in Norway: a cross-sectional study

Background

Refugees are at a higher risk of food insecurity than the general population in high-income resettling countries. Simultaneously, the prevalence rates of mental ill health among refugees surpasses the general population in receiving countries both in high- and low-income settings. This study aims to estimate the prevalence of food insecurity and to study the association between food insecurity and mental health among Syrian refugees resettled in Norway.

Methods

As part of the CHART study (Changing Health and health care needs Along the Syrian Refugees' Trajectories to Norway), 353 Syrian refugees resettled in Norway for approximately one year participated in a structured telephone survey. We assessed food insecurity with the Household Food Security Survey Module (HFSSM) and mental health (symptoms of anxiety and depression) with the Hopkins Symptom Checklist (HSCL-10). We used descriptive statistics to estimate food insecurity overall, and among women, men, and children separately. The association between food insecurity and mental health symptoms was studied using logistic regression.

Results

One year after resettlement in Norway food insecurity was reported among 22% of adult Syrian refugees and 24% of their children. The most frequently reported problems were that food did not last or that they skipped meals often or sometimes (approximately 15% for each parameter). Respondents also worried that food would run out before they got money to buy more (15%), had not been eating balanced food in the past 12 months (9%), and had been eating less than before (7%). A few participants reported that they had not been eating for a whole day (5%), had been hungry (4%), or had lost weight during the last year (3%). Most of the women did not report any food insecurity among children in their households (76%), some reported that their children were moderate food insecure (13%), and a few that their children were severely food insecure (10%). Among adults, mental ill health was significantly associated with severe food insecurity (odds ratio (OR) 6.6, 95% confidence interval (CI) 2.1-20.5) but not with moderate food insecurity (OR 1.5, 95% CI 0.4-5.8).

Conclusion

Food insecurity among refugees and their children after resettlement to high-income countries should be acknowledged and systematically targeted. The association with mental health reinforces the need to consider food insecurity in public health strategies towards refugees.

Prevalence of depression, anxiety, and suicidal ideation during the Shanghai 2022 Lockdown: A cross-sectional study

BACKGROUND

Common mental disorders and suicidal ideation are associated with exposures to COVID-19 pandemic stressors, including lockdown. Limited data is available on the effect of city-wide lockdowns on population mental health. In April 2022, Shanghai entered a city-wide lockdown that sealed 24 million residents in their homes or residential compounds. The rapid initiation of the lockdown disrupted food systems, spurred economic losses, and widespread fear. The associated mental health effects of a lockdown of this magnitude are largely unknown. The purpose of this study is to estimate the prevalence of depression, anxiety, and suicidal ideation during this unprecedented lockdown.

METHODS

In this cross-sectional study, data were obtained via purposive sampling across 16 districts in Shanghai. Online surveys were distributed between April 29 and June 1, 2022. All participants were physically present and residents of Shanghai during the lockdown. Logistic regression was used to estimate the associations between lockdown-related stressors and study outcomes, adjusting for covariates.

FINDINGS

A total of 3230 Shanghai residents who personally experienced the lockdown participated the survey, with 1657 (55.5 %) men, 1563 (44.3 %) women, and 10 (0.02 %) other, and a median age of 32 (IQR 26-39), who were predominately 3242 (96.9 %) Han Chinese. The overall prevalence of depression based on PHQ-9 was 26.1 % (95 % CI, 24.8 %-27.4 %), 20.1 % (18.3 %-22.0 %) for anxiety based on GAD-7, and 3.8 % (2.9 %-4.8 %) for suicidal ideation based on ASQ. The prevalence of all outcomes was higher among younger adults, single people, lower income earners, migrants, those in poor health, and with a previous psychiatric diagnosis or suicide attempt. The odds of depression and anxiety were associated with job loss, income loss, and lockdown-related fear. Higher odds of anxiety and suicidal ideation were associated with being in close contact with a COVID-19 case. Moderate food insecurity was reported by 1731 (51.8 %), and 498 (14.6 %) reported severe food insecurity. Moderate food insecurity was associated with a >3-fold increase in the odds of screening for depression and anxiety and reporting suicidal ideation (aOR from 3.15 to 3.84); severe food insecurity was associated with >5-fold increased odds for depression, anxiety, and suicidal ideation (aOR from 5.21 to 10.87), compared to being food secure.

INTERPRETATION

Lockdown stressors, including food insecurity, job and income loss, and lockdown-related fears, were associated with increased odds of mental health outcomes. COVID-19 elimination strategies including lockdowns should be balanced against the effects on population wellbeing. Strategies to avoid unneeded lockdown, and policies that can strengthen food systems and protect against economic shocks are needed.

FUNDING

Funding was provided by the NYU Shanghai Center for Global Health Equity.

Depressive symptoms mediate the relationship between sustained food insecurity and cognition: a causal mediation analysis

PURPOSE

This study aimed to investigate the association of change in food insecurity over time with cognitive function in midlife, and whether depressive symptoms mediated that relationship.

METHODS

We used longitudinal data from the Coronary Artery Risk Development in Young Adults study. Change in food insecurity in 2000-2005 was coded as "persistently food-secure," "persistently food-insecure," "became food-insecure," and "became food-secure." Depressive symptoms were measured in 2010, and cognitive function was measured in 2015. Multivariable linear regression controlled for sociodemographic and cardiovascular health factors was used. We also conducted causal mediation analysis.

RESULTS

Our study population included 2448 participants (57.23% female and 43.18% Black, mean age = 40.31 in 2000). Compared with persistent food security, persistently and became food-insecure were associated with worse cognition, particularly with processing speed (β_persistent = -0.20 standard unit, 95% CI = -0.36, -0.04; β_became = -0.17, 95% CI = -0.31, -0.03), and these associations appeared mediated by depressive symptoms (proportion-mediated = 14% for persistently food-insecure and 18% for became food-insecure).

CONCLUSIONS

Persistent and transition to food insecurity were associated with worse cognition, both directly and indirectly through increasing depressive symptoms. Targeting food insecurity or depressive symptoms among persistently or became food-insecure individuals may have the potential to slow premature cognitive aging.

Measuring food insecurity: An introduction to tools for human biologists and ecologists

OBJECTIVE

Food insecurity is a significant and growing concern undermining the wellbeing of 30% of the global population. Food in/security is a complex construct consisting of four dimensions: availability, access, utilization, and stability, making it challenging to measure. We provide a toolkit human biologists/ecologists can use to advance research on this topic.

METHODS

We review the strengths and limitations of common tools used to measure food access and utilization, the two dimensions most proximate to people's lived experience, and emphasize tools that provide data needed to best link food security with human biological outcomes. We also discuss methods that provide contextual data human biologists/ecologists will find useful for study design, ensuring instrument validity, and improving data quality.

RESULTS

Food access is principally measured using experience-based instruments that emphasize economic access. Social access, such as food sharing, is under-studied and we recommend using social network analysis to explore this dimension. In terms of utilization, emphasis has been on food choice measured as dietary diversity. Food preparation and intrahousehold distribution, also part of the utilization dimension, are less studied and standardized instruments for measuring both are lacking. The embodiment of food insecurity has focused on child growth, although a growing literature addresses adult mental wellbeing and chronic and infectious disease risk.

CONCLUSIONS

We see the potential to expand outcomes to include reproductive and immune function, physical activity, and the gut microbiome. Human biologists/ecologists are well-positioned to advance understanding of the human health impacts of food insecurity and provide data to support intervention efforts.

COVID-19 Recession: Young Adult Food Insecurity, Racial Disparities, and Correlates

PURPOSE

The COVID-19 pandemic has inflicted devastating health, social, and economic effects globally. This study examines the experiences of young adults in the United States with respect to food insecurity during the pandemic and factors associated with higher and lower risk for young adult food insecurity.

METHODS

Using the U.S. Census Bureau's Household Pulse Survey, a nationally representative survey collecting information on people's experiences throughout the pandemic, we analyzed prevalence of, and factors associated with young adult food insecurity during the pandemic.

RESULTS

Overall, 13% of young adults aged 18-25 years reported often or sometimes not having enough to eat in the last 7 days at a given time during pandemic, on average, with Black and Hispanic young people facing higher rates of food insecurity (22% and 15%, respectively) than White non-Hispanic peers (11%). Over the observed pandemic period, we find a decline in food insecurity among young adults corresponding with economic policy actions. Factors associated with a higher risk of food insecurity include lower household income, expected job loss, renting as opposed to owning housing, behind on rent or mortgage payment, lack of confidence in an ability to pay next month's rent or mortgage, delayed medical care, and feeling worried or depressed.

DISCUSSION

Our analyses reveal alarming levels of food insecurity among young adults, especially Black and Hispanic young people. Policy actions should include multifaceted and sustained interventions with a focus on supporting historically disenfranchised youth and their communities. These should prevent and address food and housing insecurity and mental health needs holistically.

Food insecurity and coping strategies and their association with anxiety and depression: a nationally representative South African survey

OBJECTIVE

To investigate food insecurity and related coping strategies among South African households and their associations with anxiety and depression.

DESIGN

Cross-sectional study. Food insecurity and coping strategies were assessed using a modified Community Childhood Hunger Identification Project and the Coping Strategies Index questionnaires. The Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 were used to assess anxiety and depression risk. Ordered logistic regressions were used to test associations of food insecurity and related coping strategies with anxiety and depression.

SETTING

South Africa during COVID-19, October 2021.

PARTICIPANTS

Nationally representative sample of 3402 adults, weighted to 39,640,674 South African households.

RESULTS

About 20·4 % of South African households were food insecure, with the most affected being from the lowest socio-economic groups. Shifting from 'food secure' to 'at risk' or from 'at risk' to 'food insecure' group was associated with 1·7 times greater odds of being in a higher category of anxiety or depression (P < 0·001). All coping strategies were used to some extent in South African households, with 46·0 % relying on less preferred and less expensive foods and 20·9 % sending a household member to beg for food. These coping strategies were mostly used by food-insecure households. Although the odds of moving to a higher category of anxiety and depression were observed among all coping strategies (all P < 0·001), begging for food was associated with the highest odds (OR = 2·3).

CONCLUSIONS

Food insecurity remains a major health threat in South Africa. Public measures to address mental health should consider reductions in food insecurity as part of their strategy.

Household food insecurity before and during COVID-19 pandemic and its association with perceived stress: population-based studies

The growing prevalence of food insecurity observed in the last years, has been favored by the COVID-19 pandemic, leading to mental health issues, such as stress. We aim to analyze the prevalence of household food insecurity before and during the COVID-19 pandemic and its association with perceived stress. We analyzed data from two population-based studies conducted in 2019 and 2020-2021 in the municipality of Criciúma, State of Santa Catarina, Southern Brazil. Food insecurity and perceived stress were assessed with the Brazilian Food Insecurity Scale and the Perceived Stress Scale. The covariables were sex, age, skin color, schooling level, income, job status, marital status, household crowding, overweight, and diet quality. Crude and adjusted associations between food insecurity and perceived stress were assessed using Poisson regression. A total of 1,683 adult individuals were assessed. Prevalence of food insecurity was 25.8% in 2019, decreasing to 21.6% in 2020. Prevalence of perceived stress was about 38% for both years. Before the pandemic, food insecurity increased the prevalence of perceived stress by 29% (PR = 1.29; 95%CI: 1.02; 1.63), but no association was found during COVID-19. We found a worrying prevalence of food insecurity before and after de pandemic, nonetheless food insecurity and perceived stress were associated only in 2019. An assessment of these aspects after COVID-19 is needed to ensure basic life rights for all.

Food insecurity and health outcomes among community-dwelling middle-aged and older adults in India

The study assessed associations between food insecurity and mental, physical, and behavioural health outcomes in India. The study analysed national cross-sectional population-based data (N = 72,262;  ≥ 45 years) from in India in 2017-2018. The overall prevalence of food insecurity was 9.7%. Food insecurity was significantly positively associated with poor mental health [low life satisfaction (AOR: 2.75, 95% CI 2.35-3.23), low self-reported health (AOR: 1.61, 95% CI 1.11-1.42), insomnia symptoms (AOR: 1.64, 95% CI 1.45-1.85), depressive symptoms (AOR: 2.21, 95% CI 1.97-2.48), major depressive disorder (AOR: 2.37, 95% CI 2.03-2.77), Alzheimer's/dementia (AOR: 1.75, 95% CI 1.13-2.69), and poorer cognitive functioning (AOR: 0.68, 95% CI 0.49-0.93)], poor physical health [bone or joint disease (AOR: 1.18, 95% CI 1.04-1.34), angina (AOR: 1.80, 95% CI 1.58-2.06), underweight (AOR: 1.28, 95% CI 1.16-1.40), chronic lung disease (AOR: 1.22, 95% CI 1.03-1.45), and functional disability (AOR: 1.68, 95% CI 1.47-1.92)], and health risk behaviour [tobacco use (AOR: 1.13, 95% CI 1.01-1.25), heavy episodic drinking (AOR: 1.45, 95% CI 1.10-1.91) and physical inactivity (AOR: 1.42, 95% CI 1.21-1.67)]. Furthermore, food insecurity was negatively associated with overweight/obesity (AOR: 0.80, 95% CI 0.73-0.88). Food insecurity was associated with seven poor mental health indicators, five poor physical health conditions, and three health risk behaviours. Programmes and policies that improve food availability may help improve mental and physical health among middle-aged and older adults in India.

Senior food insecurity in the USA: a systematic literature review

OBJECTIVE

Understanding the factors associated with senior food insecurity is key to understanding senior-specific needs to develop targeted interventions and ultimately lower the prevalence and the incidence of food insecurity. We aimed to systematically review published literature and summarise the associated factors of food insecurity in older adults in the USA.

DESIGN

We searched PubMed, Scopus, Web of science, EconLit and JSTOR databases for peer-reviewed articles published in English between January 2005 and September 2019 that assessed food security or its associated factors for US adults aged 60 years and older. After a two-step screening process, twenty articles were retained and included in the review.

SETTING

NA.

PARTICIPANTS

NA.

RESULTS

The majority of studies were cross-sectional (70 %), consisted of data from one state (60 %), and had large sample sizes. Food-insecure individuals were more likely to be younger, less educated, Black or African American, female, a current smoker, low income, and self-report fair/poor health, have chronic conditions, and utilise government assistance programmes. Food insecurity was associated with medication non-adherence, poor mental health outcomes and limitations in physical functioning. Results were mixed for overweight/obesity status. There was no discernable pattern related to the consistency of findings by the assessed quality of the included studies.

CONCLUSIONS

Food insecurity is a prevalent and pervasive issue for older adults. The numerous correlates identified suggest that interventions aimed at enhancing food and nutrition safety net and medication assistance programmes are warranted, and upstream, systemic-level interventions may be best suited to deal with the correlates of food insecurity.

Food insecurity among New York City taxi and for-hire vehicle drivers

BACKGROUND

New York City's (NYC's) taxi/for-hire vehicle (FHV) drivers have occupational and demographic characteristics associated with food insecurity (low income, comorbidities, minority race/ethnicity).

OBJECTIVE

To analyze food insecurity rates in a sample of NYC drivers and to identify associated factors.

METHODS

At health fairs, we recruited a cross-sectional sample of licensed taxi/FHV drivers willing to receive study text messages. Most lacked a primary care provider. Food insecurity prevalence and associations with health and economic indicators were analyzed.

RESULTS

Of 503 participants who completed a 2-item food security screener, 39.2% were food insecure. Significantly fewer food insecure than food secure drivers reported a doctor visit within the past year (48% vs 25%; P < .001). Food insecure drivers had greater weekly traffic ticket expenditure ($34 vs $24; P = .02) and were more likely to report insufficient household income (61% vs 39%; P < .001) and history of depression (14% vs 7%; P = .02), to have elevated (>200) measured total cholesterol (50% vs 37%; P = .02), and to have Perceived Stress Scale scores indicating greater stress than food secure drivers (14 vs 11; P = .002). In a binary logistic regression analysis, drivers who reported that their total household income was enough to meet their basic needs had significantly lower odds of being food insecure (0.695 odds ratio; P = .016).

CONCLUSION

Food insecurity was high in this group of taxi/FHV drivers. Food insecurity interventions are needed and could be occupationally based, with worksite screening and resource navigation. Policies should address improving wages and healthcare access.

Food Insufficiency, Supplemental Nutrition Assistance Program (SNAP) Status, and 9-Year Trajectory of Cognitive Function in Older Adults: The Longitudinal National Health and Aging Trends Study, 2012-2020

BACKGROUND

Despite findings from cross-sectional studies, how food insecurity experience/Supplemental Nutrition Assistance Program (SNAP) status relates to cognitive decline over time has not been fully understood.

OBJECTIVES

We aimed to investigate the longitudinal associations between food insecurity/SNAP status and cognitive function in older adults (≥65 y).

METHODS

Longitudinal data from the National Health and Aging Trends Study 2012-2020 were analyzed (n = 4578, median follow-up years = 5 y). Participants reported food insecurity experience (5-item) and were classified as food sufficient (FS, no affirmative answer) and food insufficient (FI, any affirmative answer). The SNAP status was defined as SNAP participants, SNAP eligible nonparticipants (≤200% Federal Poverty Line, FPL), and SNAP ineligible nonparticipants (>200% FPL). Cognitive function was measured via validated tests in 3 domains, and the standardized domain-specific and combined cognitive function z-scores were calculated. Mixed-effect models with a random intercept were used to study how FI or SNAP status was associated with combined and domain-specific cognitive z-scores over time, adjusting for static and time-varying covariates.

RESULTS

At baseline, 96.3% of the participants were FS and 3.7% were FI. In a subsample (n = 2832), 10.8% were SNAP participants, 30.7% were SNAP eligible nonparticipants, and 58.6% were SNAP ineligible nonparticipants. Compared with the FS group in the adjusted model (FI vs. FS), FI was associated with faster decline in the combined cognitive function scores [-0.043 (-0.055, -0.032) vs. -0.033 (-0.035, -0.031) z-scores per year, P-interaction = 0.064]. Cognitive decline rates (z-scores per year) in the combined score were similar in SNAP participants (β = -0.030; 95% CI: -0.038, -0.022) and SNAP ineligible nonparticipants (β = -0.028; 95% CI: -0.032, -0.024), both of which were slower than the rate in SNAP eligible nonparticipants (β = -0.043; 95% CI: -0.048, -0.038; P-interaction < 0.0001).

CONCLUSIONS

Food sufficiency and SNAP participation may be protective factors preventing accelerated cognitive decline in older adults.

Household food insecurity risk indices for English neighbourhoods: Measures to support local policy decisions

BACKGROUND

In England, the responsibility to address food insecurity lies with local government, yet the prevalence of this social inequality is unknown in small subnational areas. In 2018 an index of small-area household food insecurity risk was developed and utilised by public and third sector organisations to target interventions; this measure needed updating to better support decisions in different settings, such as urban and rural areas where pressures on food security differ.

METHODS

We held interviews with stakeholders (n = 14) and completed a scoping review to identify appropriate variables to create an updated risk measure. We then sourced a range of open access secondary data to develop an indices of food insecurity risk in English neighbourhoods. Following a process of data transformation and normalisation, we tested combinations of variables and identified the most appropriate data to reflect household food insecurity risk in urban and rural areas.

RESULTS

Eight variables, reflecting both household circumstances and local service availability, were separated into two domains with equal weighting for a new index, the Complex Index, and a subset of these to make up the Simple Index. Within the Complex Index, the Compositional Domain includes population characteristics while the Structural Domain reflects small area access to resources such as grocery stores. The Compositional Domain correlated well with free school meal eligibility (rs = 0.705) and prevalence of childhood obesity (rs = 0.641). This domain was the preferred measure for use in most areas when shared with stakeholders, and when assessed alongside other configurations of the variables. Areas of highest risk were most often located in the North of England.

CONCLUSION

We recommend the use of the Compositional Domain for all areas, with inclusion of the Structural Domain in rural areas where locational disadvantage makes it more difficult to access resources. These measures can aid local policy makers and planners when allocating resources and interventions to support households who may experience food insecurity.

Food Insecurity Among People With Cancer: Nutritional Needs as an Essential Component of Care

A cancer diagnosis can upend work and family life, leading patients to reallocate resources away from essentials such as food. Estimates of the percentage of people navigating a cancer diagnosis and food insecurity range between 17% and 55% of the cancer patient population. The complexity of addressing food insecurity among those diagnosed with cancer during different phases of treatment is multifactorial and often requires an extensive network of support throughout each phase. This commentary explores the issue of food insecurity in the context of cancer care, explores current mitigation efforts, and offers a call to action to create a path for food insecurity mitigation in the context of cancer. Three programs that address food insecurity among those with cancer at various stages of care are highlighted, drawing attention to current impact and actionable recommendations to make programs like these scalable and sustainable. Recommendations are grounded in the National Academies of Sciences, Engineering, and Medicine social care framework through 5 essential domain areas: awareness, adjustment, assistance, alignment, and advocacy. This commentary seeks to highlight opportunities for the optimization of cancer care and reframe food access as an essential part of treatment and long-term care plans.

Mental health and the global climate crisis

AIMS

Not only is nature essential for human existence, but many of its functions and contributions are irreplaceable. Studying the impact of these changes on individuals and communities, researchers and public health officials have largely focused on physical health. Our aim is to better understand how climate change also exacerbates many social and environmental risk factors for mental health and psychosocial problems, and can lead to emotional distress, the development of new mental health conditions and a worsening situation for people already living with these conditions.

METHODS

We considered all possible direct and indirect pathways by which climate change can affect mental health. We built a framework which includes climate change-related hazards, climate change-related global environmental threats, social and environmental exposure pathways, and vulnerability factors and inequalities to derive possible mental health and psychosocial outcomes.

RESULTS

We identified five approaches to address the mental health and psychosocial impacts of climate change which we suggest should be implemented with urgency: (1) integrate climate change considerations into policies and programmes for mental health, to better prepare for and respond to the climate crisis; (2) integrate mental health and psychosocial support within policies and programmes dealing with climate change and health; (3) build upon global commitments including the Sustainable Development Goals, the Paris Agreement and the Sendai Framework for Disaster Risk Reduction; (4) implement multisectoral and community-based approaches to reduce vulnerabilities and address the mental health and psychosocial impacts of climate change; and (5) address the large gaps that exist in funding both for mental health and for responding to the health impacts of climate change.

CONCLUSIONS

There is growing evidence of the various mechanisms by which climate change is affecting mental health. Given the human impacts of climate change, mental health and psychosocial well-being need to be one of the main focuses of climate action. Therefore, countries need to dramatically accelerate their responses to climate change, including efforts to address its impacts on mental health and psychosocial well-being.

Food insecurity, morbidity, and susto: Factors associated with depression severity in Guatemala measured with the Personal Health Questionnaire 9

BACKGROUND

Depression is the largest contributor to non-fatal health loss globally and the majority of this burden occurs in low- and middle-income countries. Yet, estimates of prevalence rates and severity in these contexts may be uncertain due to limited screening, lack of mental health providers, and stigma around mental disorders which may prevent individuals from seeking care. In Guatemala, estimates of depression vary, due in part to the range of screening and diagnostic instruments used and diversity of sample populations. Most studies emphasize personal experiences with violence as a predictor of depression in Guatemala, although high rates of inequality, discrimination, and resource scarcity in the country potentially play a role.

AIMS

In this study, we examine factors associated with depression severity categories measured with the Personal Health Questionnaire 9 (PHQ-9) among a random sample of women in a small urban community in the Central Highlands of Guatemala.

METHODS

Participants were recruited through a randomized sample of households in a small urban community. Participants completed a questionnaire which included questions on demographics, illness history, food insecurity, and the PHQ-9. In total, 101 women were included in the analysis.

RESULTS

Food insecurity, 2-week symptom reporting, and experiencing susto are associated with higher depression severity categories.

CONCLUSION

This research highlights need for more research on factors related to the prevalence and severity of mental disorders, and the relationship between mental disorders and cultural constructs of distress, particularly in areas like Guatemala with limited mental health services.

Food insecurity is associated with the sleep quality and quantity in adults: a systematic review and meta-analysis

OBJECTIVE

We evaluated associations between food insecurity (FI) and the quality and quantity of sleep in adults (≥18 years).

DESIGN

The current study represented a systematic review and meta-analysis of observational studies.

SETTING

Databases of PubMed, Scopus, Embase and Web of Science were searched from inception until 6 June 2022. Meta-analyses were conducted using random-effects models, and effect sizes were reported as OR and 95 % CI.

PARTICIPANTS

Data from ten eligible observational studies, including 83 764 participants, were included.

RESULTS

FI was associated with an increased risk of poor sleep quality (OR = 1·45; 95 % CI (1·24, 1·70), I2 = 95, P < 0·001, n 7). Besides, subgroup analysis showed increased risk of poor sleep quality corresponding to the severity of FI across mild (OR = 1·31; 95 % CI (1·16, 1·48), I2 = 0 %, P < 0·001, n 5), moderate (OR = 1·49; 95 % CI (1·32, 1·68), I2 = 0 %, P < 0·001, n 5) and severe (OR = 1·89; 95 % CI (1·63, 2·20), I2 = 0 %, P < 0·001, n 5) levels. Similarly, subgroup analysis by sleep problems showed that FI was associated with an increased the risk of trouble falling asleep (OR = 1·39; 95 % CI (1·05, 1·83), I2 = 91 %, P = 0·002, n 3) and trouble staying asleep (OR = 1·91; 95 % CI (1·37, 2·67), I2 = 89 %, P < 0·001, n 3). Moreover, FI was associated with the odds of shorter (OR = 1·14; 95 % CI (1·07, 1·21), I2 = 0 %, P < 0·001, n 4) and longer sleep duration (OR = 1·14; 95 % CI (1·03, 1·26), I2 = 0 %, P = 0·010, n 4).

CONCLUSIONS

Collective evidence supports that FI is associated with poor sleep quality and quantity in adults. Preventative and management strategies that address FI may provide health benefits beyond improving nutritional status per se.

Prevalence of household food insecurity among a healthy Iranian population: A systematic review and meta-analysis

Background

Food security is a fundamental human right that must be upheld to preserve excellent general welfare, and mental, physical, and social health. However, according to the United Nations Food and Agriculture Organization (FAO) report in 2020, the level of food insecurity in the world is increasing.

Objective

Determining the prevalence of food insecurity in Iran will be beneficial for Iran and other low-middle-income countries.

Methods

We searched both English and Persian (Iranian) databases including PubMed, Scopus, Web of Science, Google Scholar, SID, Irandoc, Magiran, Civilica, and Iranian Medical Sciences Theses System from 01 January 1990 to 01 February 2022. Observational studies that reported the prevalence of household food insecurity among a healthy Iranian population and assessed food insecurity at the individual or household level using validated questionnaires were included.

Results

One hundred six studies and/or theses with a total of 152, 300 participants met the review criteria. Our analyses demonstrated that the prevalence of food insecurity among the healthy Iranian population was 55.9% (95% CI: 52.6-59.2%) and the highest prevalence of food insecurity was in the western regions with 64.8% (95% CI: 57.7-72.0%). Subgroup analyses showed that food insecurity among women at 51.3% (95% CI: 45.1-57.6%) and rural inhabitants at 66.1% (95% CI: 58.8-73.4%) was significantly higher than men at 47.8% (95% CI: 41.8-53.8%) and urban residents at 47.1% (95% CI: 44.1-50.0%), respectively. Among the age groups, the highest prevalence of food insecurity was in adults at 56.5% (95% CI: 51.7-61.2%).

Conclusion

The prevalence of food insecurity in a healthy Iranian population was higher than the global average. Women, rural residents, and residents of the western regions of Iran had a higher prevalence of food insecurity. These groups should be prioritized in programs to reduce the prevalence of food insecurity in Iran.

Systematic review registration

www.crd.york.ac.uk/PROSPERO, identifier: CRD42022328473.

Association between food insecurity and kidney stones in the United States: Analysis of the National Health and Nutrition Examination Survey 2007-2014

Purpose

Although food insecurity is a major public health concern associated with various diseases, the relationship between food insecurity and kidney stones remains unclear. We aimed to investigate the association between food insecurity and kidney stones in the US population.

Materials and methods

Four continuous cycles of data from the year 2007 to 2014 were obtained from National Health and Nutrition Examination Survey (NHANES) in the current study. We utilized the Household Food Security Module to assess the food security status of individuals. The primary outcome was whether participants ever had kidney stones, and the secondary outcome was a stone recurrence. A multivariate logistic regression model adjusting for potential confounders was constructed to evaluate the independent association between food insecurity and kidney stones.

Results

A total of 21,914 participants were included in our analysis, with 8.8% having a history of kidney stones and 33.2% of these reporting stones recurrence. Food insecurity was associated with increased risks of kidney stones (odds ratio: 1.21; 95% confidence interval: 1.05-1.39; P = 0.010) and kidney stones recurrence (odds ratio: 1.33; 95% confidence interval: 1.00-1.77; P = 0.052) after adjusting for all potential confounders. In addition, participants with very low food security had 38% and 47% higher risks of kidney stones (odds ratio: 1.38; 95% confidence interval: 1.13-1.69; P = 0.002; P for trend = 0.009) and kidney stones recurrence (odds ratio: 1.47; 95% confidence interval: 1.03-2.10; P = 0.032; P for trend = 0.029), respectively.

Conclusion

There exists a significant association between food insecurity and kidney stones, which reveals the significance of the improvement of food insecurity in the alleviation of kidney stone formation and recurrence.

Evaluation of the Grow Your Groceries Home Gardening Program in Chicago, Illinois

COVID-19 exacerbated existing disparities in food security in Chicago. Home gardening can improve food security but there are often barriers to participation and the benefits are understudied. Chicago Grows Food (CGF) formed in 2020 to address food insecurity during COVID-19, and created the Grow Your Groceries (GYG) program to provide home gardening kits to families at risk of food insecurity in Chicago. A participatory program evaluation was conducted to better understand the experiences of and benefits to individuals participating in GYG. Program participants shared feedback via focus groups (n = 6) and surveys (n = 72). Qualitative data were analyzed using an iterative coding process. Quantitative data were analyzed using descriptive statistics. Most participants reported confidence in using a grow kit to grow food, increased healthy food consumption, easier access to healthy food, and high likelihood of growing food again. Additionally, participants described increased connections within their communities, increased interaction with their family, and personal growth as benefits of the program. These results demonstrate the benefits of a novel home gardening program that uses fabric grow bags to address food insecurity. A larger scale program evaluation is necessary to better understand the impacts of participating in this home gardening program.

Food insecurity associated with self-reported mental health outcomes in Peruvian households during the COVID-19 pandemic

Background

The global pandemic of COVID-19 and the social distancing efforts implemented worldwide to limit its spread have disrupted the economy, increased food insecurity, and mental health problems.

Objectives

The aim of this study was to determine the association between food insecurity and mental health outcomes (stress, depression, and anxiety) in Peruvian households during the COVID-19 pandemic.

Materials and methods

A cross-sectional investigation was conducted with 525 participants of both sexes (68% women), over 18 years of age and from the three geographic regions of Peru: Coast (54.9%), Highlands (28.4%), and Jungle (16.8%). The data were collected during the year 2021, between July 6 and September 22 through a self-administered online survey designed to assess socio-demographic, socioeconomic, food insecurity, and mental health outcomes (depression, anxiety, and stress).

Results

The majority of households (71.4%) experienced some degree of food insecurity. Mild food insecurity was the most frequent, affecting 49.1%, followed by moderate 15.4%, and severe 6.9%. Regarding mental health outcomes, 24.8% manifested depression, 26.7% anxiety, and 15.3% stress. With respect to the association between the level of food insecurity and anxiety, this was highly significant (p < 0.01). Households with mild, moderate and severe food insecurity are 2.04, 4.5, and 10.44 times, respectively, more likely to have moderate-severe anxiety. On the other hand, the mild food insecurity was not associated with moderate-severe depression. In contrast, households with moderate and severe food insecurity are 2.8 and 5.7 times, respectively, more likely to have moderate-severe depression. Finally, households with moderate food insecurity are 5.9 times more likely to have moderate-severe stress, and households with severe food insecurity are 8.5 times more likely to have moderate-severe stress, both having a highly significant association (p < 0.01).

Conclusion

In conclusion, during the second wave of the COVID-19 pandemic in Peru, household food insecurity was independently associated with worse mental health outcomes. Monitoring of both food insecurity and mental health will be important as the COVID-19 pandemic continues.

Food insecurity during COVID-19: An Australian university experience

The aim of this study was to describe the prevalence, severity, coping strategies and precipitating factors of food insecurity in university students in a large multi-campus Australian university during the COVID-19 lockdown in 2020, in context of providing information to inform institutional support. This was a cross-sectional analysis which was part of a larger university-led research project, the Thrive@Home study conducted at Monash University during the COVID-19 pandemic. The main outcome measures included: Sociodemographic characteristics, PROMIS anxiety, PROMIS depression and the six-item US Department of Agriculture Household Food Security Survey Module. All variables were reported according to the four levels of food security status (high (H), marginal (M), low (L) and very low (VL)). Chi-squared tests were used to compare all categorical variables including demographic, mental health and food security status. A multivariable regression was conducted between food security status and mental health variables. Overall, n = 1315 students were included in the analysis. Of which, 5% were classified as having VL food security, 13% L, 14% M and 68% H. As food security worsened the likelihood of being unemployed looking for work, living alone and deteriorating physical health, diet quality and mental health increased. As food security status deteriorated the prevalence of needing to ask family or friends for food, shopping at multiple outlets for discounts, accessing emergency food relief, subsidised meals and financial assistance from organisations increased (p < 0.002). In regression models adjusting for covariates, depression (b (95%CI): VL = 7.2(4.1-10.3), L = 3.7(1.7-5.7), M = 2.0(0.1-3.8)) and anxiety (VL = 7.4(4.5-10.4), L = 3.5(1.5-5.4) and M = 2.0(0.3-3.8)) were positively associated with worsening food security. Food insecurity during COVID-19 was associated with worsening mental health. This paper provides targets for future university-led initiatives to promote student food security and supporting better access to physical and mental health services.

Social Determinants of Severe Injury Among Pediatric Patients During the COVID-19 Pandemic: An Exploratory Study

INTRODUCTION

This study sought to identify social determinants of health (SDH) patterns associated with severe pediatric injuries.

METHOD

We used cross-sectional data from children (≤18 years) admitted to a pediatric trauma center between March and November 2021 (n = 360). We used association rule mining (ARM) to explore SDH patterns associated with severe injury. We then used ARM-identified SDH patterns in multivariable logistic regressions of severe injury, controlling for patient and caregiver demographics. Finally, we compared results to naive hierarchical logistic regressions that considered SDH types as primary exposures rather than SDH patterns.

RESULTS

We identified three SDH patterns associated with severe injury: (1) having child care needs in combination with neighborhood violence, (2) caregiver lacking health insurance, and (3) caregiver lacking social support. In the ARM-informed logistic regression models, the presence of a child care need in combination with neighborhood violence was associated with an increased odds of severe injury (aOR, 2.77; 95% CI, 1.01-7.62), as was caregiver lacking health insurance (aOR, 2.29; 95% CI, 1.02-5.16). In the naive hierarchical logistic regressions, no SDH type in isolation was associated with severe injury.

DISCUSSION

Our exploratory analyses suggest that considering the co-occurrence of negative SDH that families experience rather than isolated SDH may provide greater insights into prevention strategies for severe pediatric injury.