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

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

OBJECTIVE

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

DESIGN

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

SETTING

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

SUBJECTS

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

RESULTS

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

CONCLUSIONS

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

Unemployment and household food hardship in the economic recession

OBJECTIVE

The present study examined the association between unemployment and household food insecurity during the 2007-2009 economic recession in the USA.

DESIGN

Longitudinal survey of the Survey of Income and Program Participation (SIPP; 2008-2011). Food insecurity was measured by five questions excerpted from an eighteen-item Food Security Scale. Unemployment was measured by a dichotomous indicator, the number of job losses and the total duration of all episodes in the observation period.

SETTING

As nationally representative data, the SIPP interviewed respondents in multiple waves with a time interval of four months.

SUBJECTS

The study created two analytic samples including working-age household heads employed at the beginning of the observation period. The size of the two samples was 14,417 and 13,080.

RESULTS

Unemployment was positively associated with food insecurity (OR=1.55; 95% CI 1.32, 1.83; P<0.001). Similar results were obtained when the analysis controlled for food insecurity status measured before unemployment (OR=1.54; 95% CI 1.27, 1.88; P<0.001). For households with the same duration of unemployment, one more episode of unemployment increased the odds of food insecurity by 8% (OR=1.08; 95% CI 1.00, 1.18; P<0.001).

CONCLUSIONS

More in-depth understanding of the relationship between unemployment and food insecurity is useful to better identify and serve the at-risk population. Connecting unemployment assistance closely to nutrition assistance could lower the prevalence of food insecurity among unemployed households. Public policy should better account for both episodes and duration of unemployment to reduce food insecurity.

Association of moderate and severe food insecurity with suicidal ideation in adults: national survey data from three Canadian provinces

PURPOSE

Although the important public health issues of food insecurity and suicide may be interconnected, they are rarely studied. Using data from a national survey, we examined whether household food insecurity was associated with suicidal ideation after adjusting for relevant covariates.

METHODS

We examined cross-sectional data from three Canadian provinces (n = 5,270) that were derived from the 2007 Canadian Community Health Survey and included adults (18+ years). Suicidal ideation was based on affirmative response to the question of whether or not the participant had seriously considered committing suicide in the previous 12 months. The Household Food Security Survey Module provided measures of moderate (indication of compromise in quality and/or quantity of food consumed) and severe (indication of reduced food intake and disrupted eating patterns) food insecurity status. Logistic regression determined associations between food insecurity and suicidal ideation with adjustment for demographics, body mass index, and presence of a mood disorder.

RESULTS

There were differences in the proportion experiencing suicide ideation according to moderate (14.7 vs 10.0 % without suicide ideation) and severe (16.4 vs 7.1 % without suicide ideation) food security (p < 0.001). With covariate adjustment, suicidal ideation was significantly associated with moderate (adjusted OR = 1.32, 95 % CI 1.06-1.64) and severe (adjusted OR = 1.77, 95 % CI 1.42-2.23) food insecurity.

CONCLUSIONS

The findings of a robust association between food insecurity and suicidal ideation suggest that interventions targeted at food security may reduce suicide-related morbidity and mortality. Longitudinal investigations that examine various dimensions of food insecurity will advance understanding of etiological pathways involved in food insecurity and suicide.

Food insecurity is associated with poor sleep outcomes among US adults

BACKGROUND

Although food insecure (FI) adults are at risk of chronic conditions, little research attention is given to their health behaviors, such as sleep.

OBJECTIVE

We examined the associations between adult food security status and sleep duration, sleep latency, and sleep complaints reported to a health care professional.

METHODS

Our population-based sample included 5637 men and 5264 women (≥22 y) who participated in the NHANES 2005-2010. Food security status was assessed with USDA's 10-item adult Food Security Survey Module. Self-reported information about sleep duration, sleep latency, and sleep complaints to a health care professional were used as sleep outcomes. Multiple linear, stratified by sex, and logistic regression models were used to estimate the association between food security status and the 3 sleep outcomes.

RESULTS

Very low food secure (FS) women reported significantly shorter sleep duration than fully FS women (difference: -30 ± 5.2 min; P < 0.01); however, no relation to sleep duration was observed among men. Among men, participants who were marginally FS (4 ± 1.1 min), low FS (4 ± 1.7 min), and very low FS (5 ± 1.8 min) reported significantly longer sleep latency than fully FS men (P < 0.05), but no association with sleep latency was observed among women. The divergent patterns in sleep duration and latency were likely because of our reference groups reporting undesirable sleep outcomes; fully FS men reported inadequate sleep and fully FS women reported long sleep latency. Among both men and women, marginally FS (OR: 1.64; 95% CI: 1.24, 2.16), low FS (OR: 1.63; 95% CI: 1.16, 2.30), and very low FS (OR: 1.99; 95% CI: 1.36, 2.92) participants were more likely to report sleep complaints than their fully FS counterparts (P < 0.05).

CONCLUSIONS

Poor sleep quantity and quality may predispose FI adults to adverse health outcomes.

Food insecurity and associated factors in the Portuguese population

BACKGROUND

The burden of food insecurity in Portugal, and the socioeconomic and demographic factors that are related to this condition, are unknown.

OBJECTIVE

To evaluate the frequency of food insecurity and to identify its associated characteristics in the Portuguese population.

METHODS

Data from 3,552 heads of family respondents of the 2005/06 Portuguese National Health Survey were analyzed in a cross-sectional study. Food insecurity was evaluated with the use of the US Department of Agriculture Household Food Security Survey Module 6-Item Short Form. Chi-square tests and multivariate logistic regression models were conducted. Significance was indicated at p < .05.

RESULTS

Among the respondents, 16.5% were food insecure and 3.5% had very low food security. The odds of being food insecure were highest for women (OR, 1.51; 95% CI, 1.20 to 1.91), smokers (OR, 1.56; 95% CI, 1.20 to 2.02), younger people (OR, 2.54; 95% CI, 1.69 to 3.80), unemployed people (OR, 3.04; 95% CI, 2.01 to 4.60), those with lower education (OR, 7.98; 95% CI, 4.73 to 13.49), and those with lower income (OR, 6.27; 95% CI, 4.23 to 9.30).

CONCLUSIONS

The present study explored for the first time the burden of food insecurity in Portugal, revealing that it was highly prevalent, affecting one in six Portuguese citizens. Low education and low income were the main factors associated with food insecurity.

Socio-economic characteristics, living conditions and diet quality are associated with food insecurity in France

OBJECTIVE

To assess the prevalence of household food insecurity (FI) in France and to describe its associations with socio-economic factors, health behaviours, diet quality and cost (estimated using mean food prices).

DESIGN

Cross-sectional nationally representative survey. FI was assessed using an adapted version of the US Department of Agriculture's Food Insufficiency Indicator; dietary intake was assessed using a 7 d open-ended food record; and individual demographic, socio-economic and behavioural variables were assessed using self-administered questionnaires and interviews. Individuals experiencing FI were compared with food-secure individuals, the latter being divided into four categories according to quartiles of their income per consumption unit (FS1 to FS4). Differences among categories were analysed using χ² tests, ANOVA and tests for trend.

SETTING

Individual and National Dietary Survey (INCA2), 2006-2007.

SUBJECTS

Adults aged 18-79 years (n 2624).

RESULTS

Individuals experiencing FI represented 12·2% of the population. They were on average younger, more frequently women and single parents with children compared with those in the other four categories. Their mean income per consumption unit was higher than that in the FS1 category, but they reported poorer material and housing conditions. The prevalence of smoking and the mean daily time spent watching television were also higher in the FI category. No significant difference among categories was found for energy intake, but mean intakes of fruits, vegetables and fish were lower, and diet quality was slightly but significantly poorer in the FI category. Daily diet cost was also lower in the FI category.

CONCLUSIONS

France is not spared by FI. FI should be routinely monitored at the national level and research should be promoted to identify effective strategies to reduce nutrition inequalities in France.

A survey of food bank operations in five Canadian cities

BACKGROUND

Food banks have emerged in response to growing food insecurity among low-income groups in many affluent nations, but their ability to manage this problem is questionable. In Canada, in the absence of public programs and policy interventions, food banks are the only source of immediate assistance for households struggling to meet food needs, but there are many indications that this response is insufficient. The purpose of this study was to examine the factors that facilitate and limit food bank operations in five Canadian cities and appraise the potential of these initiatives to meet food needs.

METHODS

An inventory of charitable food provisioning in Halifax, Quebec City, Toronto, Edmonton, and Victoria, Canada was conducted in 2010. Of the 517 agencies that participated in a telephone survey of their operations, 340 were running grocery programs. Multivariate regression analyses were conducted to determine the association between program characteristics, volume of service, and indicators of strain in food banks' abilities to consistently achieve the standards of assistance they had established.

RESULTS

Extensive, well-established food bank activities were charted in each city, with the numbers of people assisted ranging from 7,111 in Halifax to 90,141 in Toronto per month. Seventy-two percent of agencies indicated that clients needed more food than they provided. The number of people served by any one agency in the course of a month was positively associated with the proportion of food distributed that came from donations (beta 0.0143, SE 0.0024, p 0.0041) and the number of volunteers working in the agency (beta 0.0630, SE 0.0159, p 0.0167). Food banks only achieved equilibrium between supply and demand when they contained demand through restrictions on client access. When access to assistance was less restricted, the odds of food banks running out of food and invoking measures to ration remaining supplies and restrict access rose significantly.

CONCLUSIONS

Despite their extensive history, food banks in Canada remain dependent on donations and volunteers, with available resources quickly exhausted in the face of agencies' efforts to more fully meet clients' needs. Food banks have limited capacity to respond to the needs of those who seek assistance.

The impact of the 2008 financial crisis on food security and food expenditures in Mexico: a disproportionate effect on the vulnerable

OBJECTIVE

The present paper investigated the impact of the 2008 financial crisis on food security in Mexico and how it disproportionally affected vulnerable households.

DESIGN

A generalized ordered logistic regression was estimated to assess the impact of the crisis on households' food security status. An ordinary least squares and a quantile regression were estimated to evaluate the effect of the financial crisis on a continuous proxy measure of food security defined as the share of a household's current income devoted to food expenditures. Setting Both analyses were performed using pooled cross-sectional data from the Mexican National Household Income and Expenditure Survey 2008 and 2010.

SUBJECTS

The analytical sample included 29,468 households in 2008 and 27,654 in 2010.

RESULTS

The generalized ordered logistic model showed that the financial crisis significantly (P<0·05) decreased the probability of being food secure, mildly or moderately food insecure, compared with being severely food insecure (OR=0·74). A similar but smaller effect was found when comparing severely and moderately food-insecure households with mildly food-insecure and food-secure households (OR=0·81). The ordinary least squares model showed that the crisis significantly (P<0·05) increased the share of total income spent on food (β coefficient of 0·02). The quantile regression confirmed the findings suggested by the generalized ordered logistic model, showing that the effects of the crisis were more profound among poorer households.

CONCLUSIONS

The results suggest that households that were more vulnerable before the financial crisis saw a worsened effect in terms of food insecurity with the crisis. Findings were consistent with both measures of food security--one based on self-reported experience and the other based on food spending.

Effects of infant health on family food insecurity: evidence from two U.S. birth cohort studies

Extremely little is known about the effects of health on food insecurity despite strong associations between the two and a theoretical basis for this avenue of inquiry. This study uses data from two national birth cohort studies in the U.S., the Early Childhood Longitudinal Study-Birth Cohort (N = ∼9400) from 2001 to 2003 and the Fragile Families and Child Wellbeing Study (N = 2458) from 1998 to 2003, to estimate the effects of poor infant health on child and household food insecurity and explore the potential buffering effects of public programs that provide food, healthcare, and cash assistance. We address the issue of causality by defining poor infant health as an unexpected shock and conducting relevant specification tests. We find convincing evidence that poor infant health does not affect food insecurity but that it greatly increases reliance on cash assistance for low-income individuals with disabilities, which appears to be playing a buffering role.

Measuring food and nutrition security: tools and considerations for use among people living with HIV

As an increasing number of countries implement integrated food and nutrition security (FNS) and HIV programs, global stakeholders need clarity on how to best measure FNS at the individual and household level. This paper reviews prominent FNS measurement tools, and describes considerations for interpretation in the context of HIV. There exist a range of FNS measurement tools and many have been adapted for use in HIV-endemic settings. Considerations in selecting appropriate tools include sub-types (food sufficiency, dietary diversity and food safety); scope/level of application; and available resources. Tools need to reflect both the needs of PLHIV and affected households and FNS program objectives. Generalized food sufficiency and dietary diversity tools may provide adequate measures of FNS in PLHIV for programmatic applications. Food consumption measurement tools provide further data for clinical or research applications. Measurement of food safety is an important, but underdeveloped aspect of assessment, especially for PLHIV.

Life Course Perspective: evidence for the role of nutrition

The "Life Course Perspective" proposes that environmental exposures, including biological, physical, social, and behavioral factors, as well as life experiences, throughout the entire life span, influence health outcomes in current and future generations. Nutrition, from preconception to adulthood, encompasses all of these factors and has the potential to positively or negatively shape the individual or population health trajectories and their intergenerational differences. This paper applies the T2E2 model (timing, timeline, equity and environment), developed by Fine and Kotelchuck, as an overlay to examine advances in nutritional science, as well as the complex associations between life stages, nutrients, nutrigenomics, and access to healthy foods, that support the life course perspective. Examples of the application of nutrition to each of the four constructs are provided, as well as a strong recommendation for inclusion of nutrition as a key focal point for all health professionals as they address solutions to optimize health outcomes, both domestically and internationally. The science of nutrition provides strong evidence to support the concepts of the life course perspective. These findings lend urgency to the need to improve population health across the life span and over generations by ensuring ready access to micronutrient-dense foods, opportunities to balance energy intake with adequate physical activity and the need for biological, social, physical, and macro-level environments that support critical phases of human development. Recommendations for the application of the life course perspective, with a focus on the emerging knowledge of nutritional science, are offered in an effort to improve current maternal and child health programs, policies, and service delivery.

Unwanted childbearing and household food insecurity in the United States

Household food insecurity is a population health concern disproportionately affecting families with children in the United States. Unwanted childbearing may place unanticipated strain on families to meet basic needs, heightening the risk for household food insecurity. We investigated the association between mother's and father's report of unwanted childbearing and exposure to household food insecurity among children residing in two-parent households in the United States. Data from the Early Childhood Longitudinal Study - Birth Cohort, a nationally representative cohort of US children (n ∼ 6150), were used to estimate the odds of household food insecurity when children were aged 9 months and 2 years, separately, based on parental report of unwanted childbearing. The majority of children were reported as wanted by both parents (74.4%). Of the sample, report of unwanted childbearing by father-only was 20.0%, mother-only was 3.4% and joint mother and father was 2.2%. Household food insecurity was higher when children were 9 months compared with 2 years. In adjusted models accounting for confounders, children born to mothers and fathers who jointly reported unwanted childbearing were at higher odds of exposure to household food insecurity at 9 months [adjusted odds ratio (AOR) = 3.31; 95% confidence interval (CI): 1.97, 5.57] and 2 years (AOR = 2.52; 95% CI: 1.12, 5.68). In two-parent households, we found that children raised by parents reporting unwanted childbearing were more likely to be exposed to food insecurity and potentially related stressors. Further studies that prospectively measure wantedness before the child's birth will aid in confirming the direction of this association.

Resistant to the recession: low-income adults' maintenance of cooking and away-from-home eating behaviors during times of economic turbulence

OBJECTIVES

We examined the effects of state-level unemployment rates during the recession of 2008 on patterns of home food preparation and away-from-home (AFH) eating among low-income and minority populations.

METHODS

We analyzed pooled cross-sectional data on 118 635 adults aged 18 years or older who took part in the American Time Use Study. Multinomial logistic regression models stratified by gender were used to evaluate the associations between state-level unemployment, poverty, race/ethnicity, and time spent cooking, and log binomial regression was used to assess respondents' AFH consumption patterns.

RESULTS

High state-level unemployment was associated with only trivial increases in respondents' cooking patterns and virtually no change in their AFH eating patterns. Low-income and racial/ethnic minority groups were not disproportionately affected by the recession.

CONCLUSIONS

Even during a major economic downturn, US adults are resistant to food-related behavior change. More work is needed to understand whether this reluctance to change is attributable to time limits, lack of knowledge or skill related to food preparation, or lack of access to fresh produce and raw ingredients.

Food insecurity among Iraqi refugees living in Lebanon, 10 years after the invasion of Iraq: data from a household survey

Iraqi refugees in Lebanon are vulnerable to food insecurity because of their limited rights and fragile livelihoods. The objective of the present study was to assess household food insecurity among Iraqi refugees living in Lebanon, almost 10 years after the invasion of Iraq. A representative survey of 800 UN High Commissioner for Refugees-registered refugee households in Lebanon was conducted using multi-stage cluster random sampling. We measured food insecurity using a modified US Department of Agriculture household food security module. We collected data on household demographic, socio-economic, health, housing and dietary diversity status and analysed these factors by food security status. Hb level was measured in a subset of children below 5 years of age (n 85). Weighted data were used in univariate and multivariate analyses. Among the Iraqi refugee households surveyed (n 630), 20·1% (95% CI 17·3, 23·2) were found to be food secure, 35·5% (95% CI 32·0, 39·2) moderately food insecure and 44·4% (95% CI 40·8, 48·1) severely food insecure. Severe food insecurity was associated with the respondent's good self-reported health (OR 0·3, 95% CI 0·2, 0·5), length of stay as a refugee (OR 1·1, 95% CI 1·0, 1·2), very poor housing quality (OR 3·3, 95% CI 1·6, 6·5) and the number of children in the household (OR 1·2, 95% CI 1·0, 1·4), and resulted in poor dietary diversity (P< 0·0001). Anaemia was found in 41% (95% CI 30·6, 51·9) of children below 5 years of age, but was not associated with food insecurity. High food insecurity, low diet quality and high prevalence of anaemia in Iraqi refugees living in Lebanon call for urgent programmes to address the food and health situation of this population with restricted rights.

Place and food insecurity: a critical review and synthesis of the literature

OBJECTIVE

In some high-income countries, a sizeable proportion of households are estimated to be food insecure. It is well known that food insecurity varies between countries and is strongly tied to household income level. The local environment may be another level of influence, which has been relatively understudied. The present review sought to synthesize and critically appraise the existing literature examining local environmental characteristics in relation to individual/household-level food insecurity in the general population.

DESIGN

A systematic search strategy was used to search MEDLINE, MEDLINE In-process and Other Non-indexed, EMBASE, PsychINFO, Social Services Abstracts and Sociological Abstracts databases for studies examining local place characteristic(s) in relation to self-reported food insecurity.

SETTING

Studies could be experimental or observational, but had to be published in a peer-reviewed journal in French or English, and involve individuals from developed countries. 'Place' was defined locally, as ranging from the street to the county level.

SUBJECTS

The target population for the review included non-institutionalized individuals in the general population.

RESULTS

After obtaining full-text articles, eighteen primary studies met the eligibility criteria. Most studies were conducted in the USA and all but one was cross-sectional. Seven of the eleven studies that examined location of residence found that rural living was inversely associated with food insecurity. Mixed results were seen for other place measures such as social capital and distance to food stores.

CONCLUSIONS

Studies were heterogeneous and had various limitations that preclude definitive conclusions from being drawn. Recommendations for future research are provided.

Women respondents report higher household food insecurity than do men in similar Canadian households

OBJECTIVE

We investigated factors accounting for the consistently higher levels of household food insecurity reported by women in Canada.

DESIGN

Two cycles of the Canadian Community Health Survey for the years 2005/2006 and 2007/2008 were pooled to examine the association between household food insecurity, measured using the Household Food Security Survey Module and other metrics, and respondent sex. We stratified households as married/cohabiting (in which case, the household respondent was chosen randomly) or non-married (single/widowed/separated/divorced) and adjusted for differences in household characteristics, including the presence of children.

SETTING

Canada.

SUBJECTS

Analysis was restricted to households dependent on employment/self-employment and whose reported annual household income was below $CAN 100,000. Exclusions included respondents less than 18 years of age, any welfare receipt, and missing food insecurity, marital status, income source and amount, or household composition data.

RESULTS

For non-married households, increased food insecurity in female- v. male-led households was accounted for by significant differences in household socio-economic characteristics. In contrast, in married/cohabiting households with or without children, higher food insecurity rates were reported when the respondent was female and neither respondent characteristics nor socio-economic factors accounted for the differences.

CONCLUSIONS

Higher rates of food insecurity in non-married households in Canada are largely attributable to women's socio-economic disadvantage. In married households, women appear to report higher levels of food insecurity than men. These findings suggest a possible bias in the measurement of population-level household food insecurity in surveys that do not account for the sex of the respondent in married/cohabiting households.

Time to eat? The relationship between food security and food-related time use

OBJECTIVES

In the present analysis, we seek to establish a relationship between time spent on food-related activities and food security status as well as between time spent on these activities and Supplemental Nutrition Assistance Program (SNAP, formerly called the Food Stamp Program) participation and benefit level.

DESIGN

After matching similar households using Coarsened Exact Matching, we estimate the relationship between food-related time, food insecurity and SNAP participation and benefit level using a comprehensive data set that combines two subsets of the Current Population Survey from years 2004-2010: the Food Security Supplement and the American Time Use Survey.

SETTING

City, suburban and rural areas of the USA.

SUBJECTS

Non-institutionalized US population over the age of 15 years. Total sample size is 10 247 households.

RESULTS

In single households, food insecurity and SNAP participation are associated with 20% more time in meal preparation and 13% less time eating. Similarly, in married households, SNAP participation and benefit level are associated with 32% less time in meal preparation while food insecurity is associated with 17% less time eating and 14% less time in grocery shopping.

CONCLUSIONS

A significant relationship exists between time spent on food-related activities and food insecurity and SNAP. This implies that federal and state government may need to consider the time constraints many low-income households face when reforming food assistance programmes.

Household food insecurity is associated with higher child undernutrition in Bangladesh, Ethiopia, and Vietnam, but the effect is not mediated by child dietary diversity

Household food insecurity (HFI) is a recognized underlying determinant of child undernutrition, but evidence of associations between HFI and child undernutrition is mixed. The purpose of this study was to investigate if HFI is associated with undernutrition in children aged 6-59.9 mo in Bangladesh (n = 2356), Ethiopia (n = 3422), and Vietnam (n = 3075) and if child dietary diversity (DD) mediated this effect. We used baseline survey data from the Alive & Thrive project. Logistic regression, adjusting for potential confounding factors, was used to determine the magnitude and significance of the association of HFI with stunting, underweight, and wasting. The mediating effect of child DD was tested by using a Sobel-Goodman mediation test. The prevalences of HFI were 66%, 40%, and 32% in Ethiopia, Vietnam, and Bangladesh, respectively. The prevalences of stunting, underweight, and wasting were higher in Bangladesh (47.1%, 43.7%, and 19.1%, respectively) and Ethiopia (50.7%, 27.5%, and 5.9%, respectively) than in Vietnam (20.7%, 15.8%, and 5%, respectively). In the adjusted models, the odds of being stunted or underweight were significantly higher for children in severely food-insecure households in Bangladesh (stunting OR: 1.36; 95% CI: 1.05, 1.76; underweight OR: 1.28; 95% CI: 0.99, 1.65) and Ethiopia (stunting OR: 1.48; 95% CI: 1.09, 2.00; underweight OR: 1.68; 95% CI: 1.22, 2.30) and in moderately food-insecure households in Vietnam (stunting OR: 1.39; 95% CI: 1.16, 1.65; underweight OR: 1.69; 95% CI: 1.28, 2.23). HFI was significantly associated with wasting in Bangladesh where close to 1 in 5 children demonstrated wasting. Child DD did not mediate the relation between HFI and undernutrition in any of the countries. Further research is recommended to investigate potential mediators in this pathway.

Household food insecurity and dietary intake among Mexican-American women participating in federal food assistance programs

PURPOSE

To explore the association between food insecurity and dietary intake among Mexican-American women after controlling for sociocultural and economic factors including participation in federal food assistance programs.

DESIGN

Cross-sectional.

SETTING

Three cities in Texas.

SUBJECTS

Seven hundred seven Mexican-American women (26-44 years).

MEASURES

Demographics, anthropometrics, acculturation, and food security status were obtained using validated measures. Dietary intake was assessed by a 24-hour dietary food record.

ANALYSIS

Logistic regression was used to examine the association between individual and household characteristics on food security status. One-way analysis of covariance tested the association between food security status and dietary intake after adjusting for socio-demographic variables, acculturation, body mass index, participation in federal food assistance programs, and energy intake.

RESULTS

About 77% of food-insecure women participated in at least one federal food assistance program. Each additional child in the household increased the odds of being food insecure by 25%. A higher proportion of obese women was found in the food-insecure group. No significant differences in dietary intake were found by food security status.

CONCLUSION

Food insecurity did not negatively influence dietary intake independently of women's participation in federal food assistance programs. Food security did not ensure consumption of nutritionally adequate foods. Educational and food assistance programs need to be optimized to facilitate enrollment and improve the nutritional status of this ethnic group, food secure or not.

Is maternal food security a predictor of food and drink intake among toddlers in Oregon?

Food insecurity has detrimental effects on the mental, physical, and behavioral health of developing children. Few studies, however, have sought to determine whether associations exist between food insecurity and intake of vegetables, fresh or canned fruit, candy or cookies, French fries, fast food, water, milk, fruit juices, fruit drinks, soda, and sports drinks. To identify independent associations that exist between maternal food insecurity and food and drink intake among toddlers, population-based data from the 2006-2008 Oregon Pregnancy Risk Assessment Monitoring System follow-back survey (Oregon PRAMS-2) of 1,522 mothers of 2-year-old children were analyzed. Maternal food insecurity was defined as mothers' report of eating less because of lack of money for food. Typical weekly child food and drink intake was examined using polytomous logistic regression: 0-1 days/week, 2-3 days/week, and 4-7 days/week. Maternal food insecurity prevalence was 11.7 %. Compared to toddlers of food secure mothers, toddlers of food insecure mothers consumed vegetables (adjusted odds ratio [AOR] for 4-7 days/week = 0.31; 95 % confidence interval [CI] 0.12, 0.79) and fruit (AOR for 4-7 days/week = 0.25; 95 % CI 0.08, 0.75) fewer days of the week. Toddlers of food insecure mothers consumed soda (AOR for 4-7 days/week = 3.21; 95 % CI 1.12, 9.14) more days of the week. Maternal food insecurity is associated with weekly intake of certain foods and drinks. Among toddlers, consumption of fewer vegetables and fruit, and more soda may help explain the link between food insecurity and poor health.

Prevalence and socioeconomic and geographical inequalities of household food insecurity in the Paris region, France, 2010

Background

Food insecurity (FI) is the situation where people do not have, at all times, access to sufficient, safe and nutritious food that meets their dietary needs for an active and healthy life. The objectives of this study were to estimate the prevalence of FI in the Paris area by using, for the first time in France, a specific FI questionnaire and to identify the characteristics of food-insecure households, taking into account a potential neighbourhood effect.

Methods

This study is based on data from the third wave of the SIRS cohort study (a representative, population-based socioepidemiological study) that were analysed using a cross-sectional design. In 2010, 3000 individuals in the Paris metropolitan area (PMA) were interviewed. FI was investigated by means of the USDA’s HFSSM. We used stratified multilevel models across three household income categories to identify populations at risk for FI.

Results

In 2010, 6.30% (95% CI = [4.99-7.97]) of the households in the PMA experienced FI (up to 13.59% in the most underprivileged neighbourhoods). About 2.50% of the households experienced severe FI and 2.85% of household living with an income above 1666 € experienced food insecurity, whereas the percentage raises to 23.38% among those living below the poverty threshold (<791 €). Depending on the income level, different household characteristics emerged as being associated with FI. In the poorest households, the presence of a child under 3 years of age was associated with an increased risk of FI (OR = 2.11; p = 0.03). Among higher-income households, the household composition appeared to be strongly associated with FI.

Conclusion

FI exists in several social groups in France. Its prevalence in the most underprivileged households should be considered an indicator of vulnerability, which could permit targeted social assistance policies.

Giving voice to food insecurity in a remote indigenous community in subarctic Ontario, Canada: traditional ways, ways to cope, ways forward

BACKGROUND

Food insecurity is a serious public health issue for Aboriginal people (First Nations [FN], Métis, and Inuit) living in Canada. Food security challenges faced by FN people are unique, especially for those living in remote and isolated communities. Conceptualizations of food insecurity by FN people are poorly understood. The purpose of this study was to explore the perceptions of food insecurity by FN adults living in a remote, on-reserve community in northern Ontario known to have a high prevalence of moderate to severe food insecurity.

METHODS

A trained community research assistant conducted semi-directed interviews, and one adult from each household in the community was invited to participate. Questions addressed traditional food, coping strategies, and suggestions to improve community food security and were informed by the literature and a community advisory committee. Thematic data analyses were carried out and followed an inductive, data-driven approach.

RESULTS

Fifty-one individuals participated, representing 67% of eligible households. The thematic analysis revealed that food sharing, especially with family, was regarded as one of the most significant ways to adapt to food shortages. The majority of participants reported consuming traditional food (wild meats) and suggested that hunting, preserving and storing traditional food has remained very important. However, numerous barriers to traditional food acquisition were mentioned. Other coping strategies included dietary change, rationing and changing food purchasing patterns. In order to improve access to healthy foods, improving income and food affordability, building community capacity and engagement, and community-level initiatives were suggested.

CONCLUSIONS

Findings point to the continued importance of traditional food acquisition and food sharing, as well as community solutions for food systems change. These data highlight that traditional and store-bought food are both part of the strategies and solutions participants suggested for coping with food insecurity. Public health policies to improve food security for FN populations are urgently needed.

A Comparative Study of Population Health in the United States and Canada during the Neoliberal Era, 1980–2008

This article draws on the vast evidence that suggests, on one hand, that socioeconomic inequalities in health are present in every society in which they have been measured and, on the other hand, that the size of inequalities varies substantially across societies. We conduct a comparative case study of the United States and Canada to explore the role of neoliberalism as a force that has created inequalities in socioeconomic resources (and thus in health) in both societies and the roles of other societal forces (political, economic, and social) that have provided a buffer, thereby lessening socioeconomic inequalities or their effects on health. Our findings suggest that, from 1980 to 2008, while both the United States and Canada underwent significant neoliberal reforms, Canada showed more resilience in terms of health inequalities as a result of differences in: ( a) the degree of income inequality, itself resulting from differences in features of the labor market and tax and transfer policies, ( b) equality in the provision of social goods such as health care and education, and ( c) the extent of social cohesiveness across race/ethnic- and class-based groups. Our study suggests that further attention must be given to both causes and buffers of health inequalities.

Determinants of rural household food security: a comparative analysis of African and Asian studies

This paper reviews the determinants of rural household food security in Africa and Asia where more than 88% of the world's undernourished people live. A conceptual model is proposed on the basis of the three widely known components of food security: food availability, accessibility and utilisation. This model is used to select a total of 40 peer-reviewed studies carried out over the last decade (20 each from Africa and Asia). A meta-analysis technique is then used to identify which determinants of food security have been highlighted and how well the causality is demonstrated. Food availability is the most studied component in both regions, followed by food accessibility, while food utilisation is the most neglected component in these studies.

The impact of income on the incidence of diabetes: a population-based study

AIMS

Diabetes rates are increasing dramatically, and certain populations are at greater risk. Low income status is associated with higher diabetes prevalence and higher mortality. The effect of income on diabetes incidence is less well understood.

METHODS

Using a validated, population-based diabetes registry and census data from Ontario, Canada, we compared the rate of new diabetes cases among persons aged 20 years or older between April 1st 2006 and March 31st 2007 between neighborhood income quintiles, and assessed for age- and sex-based differences.

RESULTS

There were 88,886 new cases of diabetes in Ontario adults during our study period (incidence rate 8.26/1000, 95% confidence interval, CI 8.20-8.31). Rates increased with age and were higher in males versus females. Increasing income quintile was associated with a significantly decreased diabetes incidence (8.70/1000, 95% CI 8.57-8.82 in the lowest quintile, vs. 7.25/1000, 95% CI 7.14-7.36 in the highest quintile, p<0.0001). Significant interactions were found between income quintile (1, 2, and 3 vs. 5) and age groups (20-39, 40-59 vs. 80+ years) (p<0.01) and sex (p<0.01), such that the impact of income was more pronounced in younger compared to older age groups and in females versus males.

DISCUSSION

This population-based study found that diabetes risk is significantly higher in lower compared to higher income groups, and that this income gap was widest in younger persons and females. Greater diabetes preventive efforts directed toward younger and female lower-income populations are necessary, in order to lessen the lifelong burden of diabetes for an already disadvantaged population.

Reconceptualizing the Association between Food Insufficiency and Body Weight: Distinguishing Hunger from Economic Hardship

What is the association between food insufficiency and body weight? Although common sense would suggest a negative association, research often finds the opposite. We contrast commodity theories of material privation with stress theories, proposing that the seemingly counterintuitive association results from the confounding influence of economic hardship. Because it is a chronic stressor, economic hardship may contribute to overweight. Data from the WCF project of 2,402 disadvantaged women in Chicago, Boston, and San Antonio show that people who experience economic hardship weigh more; and that the true negative association between body weight and food insufficiency-especially going hungry because one cannot afford food-is revealed only after adjustment for economic hardship.

Food insecurity is associated with greater acute care utilization among HIV-infected homeless and marginally housed individuals in San Francisco

BACKGROUND

Food insecurity, or the uncertain availability of nutritionally adequate, safe foods, has been associated with poor HIV outcomes. There are few data on the extent to which food insecurity impacts patterns of health-care utilization among HIV-infected individuals.

OBJECTIVE

We examined whether food insecurity was associated with hospitalizations, Emergency Department (ED) visits, and non-ED outpatient visits.

METHODS

HIV-infected, homeless and marginally housed individuals participating in the San Francisco Research on Access to Care in the Homeless (REACH) cohort underwent quarterly structured interviews and blood draws. We measured food insecurity with the validated Household Food Insecurity Access Scale, and categorized participants as food secure, mild/moderately food insecure, and severely food insecure. Primary outcomes were: (1) any hospitalizations, (2) any ED visits, and (3) any non-ED outpatient visits. Generalized estimating equations were used to estimate model parameters, adjusting for socio-demographic (age, sex, ethnicity, education, income, housing status, health insurance) and clinical variables (CD4 nadir, time on antiretroviral therapy, depression, and illicit drug use).

RESULTS

Beginning in November 2007, 347 persons were followed for a median of 2 years. Fifty-six percent of participants were food insecure at enrollment. Compared with food-secure persons, those with severe food insecurity had increased odds of hospitalizations [adjusted odds ratio (AOR) = 2.16, 95 % confidence interval (CI) = 1.50-3.09] and ED visits (AOR = 1.71, 95 % CI = 1.06-2.30). While the odds of an outpatient visit were 41 % higher for severely food insecure individuals, the effect was not statistically significant (AOR = 1.41, 95 % CI = 0.99-2.01). Mild/moderate food insecurity was also associated with increased hospitalizations (AOR = 1.56, 95 % CI = 1.06-2.30), ED visits (AOR = 1.57, 95 % CI = 1.22-2.03), and outpatient visits (AOR = 1.68, 95 % CI = 1.20-2.17).

CONCLUSIONS

Food insecurity is associated with increased health services utilization among homeless and marginally housed HIV-infected individuals in San Francisco. Increased ED visits and hospitalizations are not related to fewer ambulatory care visits among food-insecure individuals. Addressing food insecurity should be a critical component of HIV treatment programs and may reduce reliance on acute care utilization.

Food insecurity and children's mental health: a prospective birth cohort study

Food insecurity (which can be defined as inadequate access to sufficient, safe, and nutritious food that meets individuals' dietary needs) is concurrently associated with children's psychological difficulties. However, the predictive role of food insecurity with regard to specific types of children's mental health symptoms has not previously been studied. We used data from the Longitudinal Study of Child Development in Québec, LSCDQ, a representative birth cohort study of children born in the Québec region, in Canada, in 1997-1998 (n = 2120). Family food insecurity was ascertained when children were 1½ and 4½ years old. Children's mental health symptoms were assessed longitudinally using validated measures of behaviour at ages 4½, 5, 6 and 8 years. Symptom trajectory groups were estimated to identify children with persistently high levels of depression/anxiety (21.0%), aggression (26.2%), and hyperactivity/inattention (6.0%). The prevalence of food insecurity in the study was 5.9%. In sex-adjusted analyses, children from food-insecure families were disproportionately likely to experience persistent symptoms of depression/anxiety (OR: 1.79, 95% CI 1.15-2.79) and hyperactivity/inattention (OR: 3.06, 95% CI 1.68-5.55). After controlling for immigrant status, family structure, maternal age at child's birth, family income, maternal and paternal education, prenatal tobacco exposure, maternal and paternal depression and negative parenting, only persistent hyperactivity/inattention remained associated with food insecurity (fully adjusted OR: 2.65, 95% CI 1.16-6.06). Family food insecurity predicts high levels of children's mental health symptoms, particularly hyperactivity/inattention. Addressing food insecurity and associated problems in families could help reduce the burden of mental health problems in children and reduce social inequalities in development.

Food insecurity and mental disorders in a national sample of U.S. adolescents

OBJECTIVE

To examine whether food insecurity is associated with past-year DSM-IV mental disorders after controlling for standard indicators of family socioeconomic status (SES) in a U.S. national sample of adolescents.

METHOD

Data were drawn from 6,483 adolescent-parent pairs who participated in the National Comorbidity Survey Replication Adolescent Supplement, a national survey of adolescents 13 to 17 years old. Frequency and severity of food insecurity were assessed with questions based on the U.S. Department of Agriculture's Food Security Scale (standardized to a mean of 0, variance of 1). DSM-IV mental disorders were assessed with the World Health Organization Composite International Diagnostic Interview. Associations of food insecurity with DSM-IV/Composite International Diagnostic Interview diagnoses were estimated with logistic regression models controlling for family SES (parental education, household income, relative deprivation, community-level inequality, and subjective social status).

RESULTS

Food insecurity was highest in adolescents with the lowest SES. Controlling simultaneously for other aspects of SES, standardized food insecurity was associated with an increased odds of past-year mood, anxiety, behavior, and substance disorders. A 1 standard deviation increase in food insecurity was associated with a 14% increase in the odds of past-year mental disorder, even after controlling for extreme poverty. The association between food insecurity and mood disorders was strongest in adolescents living in families with a low household income and high relative deprivation.

CONCLUSIONS

Food insecurity is associated with a wide range of adolescent mental disorders independently of other aspects of SES. Expansion of social programs aimed at decreasing family economic strain might be one useful policy approach for improving youth mental health.

Role of antiretroviral therapy in improving food security among patients initiating HIV treatment and care

OBJECTIVE

Although the physical health benefits of HIV antiretroviral therapy (ART) are well documented, the socioeconomic benefits are still being established. Few studies have examined the effects of ART on food insecurity, although studies suggest there may be a benefit via improved health and ability to work.

DESIGN

Twelve-month prospective cohort study of 602 treatment-naive patients initiating clinical care in Uganda.

METHODS

Longitudinal multivariate logistic regression was used to investigate the effect of ART on food insecurity compared to HIV care without ART. A staged regression approach was used to explore pathways through which ART may affect food insecurity.

RESULTS

Food insecurity decreased significantly for both the ART and non-ART groups over time, with the ART group experiencing greater reductions by the end of the study. ART remained a significant predictor of reduction in food insecurity over time after controlling for baseline differences in the regression model (odds ratio 0.642; P < 0.01). Improvements in work and mental health status were identified as potential pathways through which ART may improve food security.

CONCLUSION

Taken together with the well known benefits of food security on ART adherence, treatment retention and clinical outcomes in resource-poor settings, our results suggest that a positive feedback loop of improved functioning and productivity could result from the interaction between food security and ART. Policymakers could leverage this positive cycle by strengthening mental health support and promoting sustainable food security interventions as part of HIV treatment programs.

Local social environmental factors are associated with household food insecurity in a longitudinal study of children

Background

Food insecurity is a significant public health problem in North America and elsewhere. The prevalence of food insecurity varies by country of residence; within countries, it is strongly associated with household socioeconomic status, but the local environment may also play an important role. In this study, we analyzed secondary data from a population-based survey conducted in Québec, Canada, to determine if five local environmental factors: material and social deprivation, social cohesion, disorder, and living location were associated with changes in household food insecurity over a period of 6 years, while adjusting for household socioeconomic status (SES) and other factors.

Methods

Data from the Québec Longitudinal Study of Child Development, following same-aged children from 4–10 y of age, were analyzed using generalized estimating equations, to determine the longitudinal association between these environmental factors and food insecurity over a period of 6 years.

Results

Of the 2120 children originally included in the cohort, 1746 (82%) were included in the present analysis. The prevalence of food insecurity was 9.2% when children were 4 y of age (95% CI: 7.8 – 10.6%) but no significant changes were observed over time. On average over the 6 year period, three environmental factors were positively related to food insecurity: high social deprivation (OR 1.62, 95%CI: 1.16 – 2.26), low social cohesion (OR 1.45 95%CI: 1.10 – 1.92), and high disorder (OR 1.76, 95%CI: 1.37 – 2.27), while living location and material deprivation were not related to food insecurity. These associations were independent of household SES and other social variables.

Conclusion

These results highlight the potential role of the local social environment in preventing and ameliorating food insecurity at the household level. Stakeholders providing food security interventions at the community level should consider interactions with local social characteristics and perhaps changing the social environment itself. Further intervention research also examining interactions with household-level factors could lead to the development of interventions that increase both household and community-level food security.

Predictors of chronic food insecurity among adolescents in Southwest Ethiopia: a longitudinal study

BACKGROUND

Evidence on the differential impacts of the global food crisis as it translates into chronic food insecurity locally is essential to design food security interventions targeting the most vulnerable population groups. There are no studies on the extent of chronic food insecurity or its predictors among adolescents in developing countries. In the context of increased food prices in Ethiopia, we hypothesized that adolescents in low income urban households are more likely to suffer from chronic food insecurity than those in the rural areas who may have direct access to agricultural products.

METHODS

This report is based on data from the first two rounds of the Jimma Longitudinal Family Survey of Youth (JLFSY). Both adolescents and households were selected using a stratified random sampling method. A total of 1911 adolescents aged 13-17 years were interviewed on their personal experiences of food insecurity both at baseline and at year two. Multivariable logistic regression analyses were used to compare chronic adolescent food insecurity by household income, household food insecurity, and socio-demographic variables after one year of follow-up.

RESULTS

Overall, 20.5% of adolescents were food insecure in the first round survey, while the proportion of adolescents with food insecurity increased to 48.4% one year later. During the one year follow up period, more than half (54.8%) of the youth encountered transient food insecurity - that is, either during the first or the second round survey. During the follow up period, 14.0% of adolescents had chronic food insecurity (i.e. were food insecure at both rounds). Multivariable logistic regression analysis showed that adolescents in the urban households with low (OR = 1.69, P = 0.008) and middle (OR = 1.80, P = 0.003) income tertiles were nearly twice as likely to suffer from chronic food insecurity compared with those in high income tertile, while this was not the case in rural and semi-urban households. Female sex of adolescents (P < 0.01), high dependency ratio (P < 0.05) and household food insecurity (P < 0.001) were independent predictors of chronic adolescent food insecurity in urban, semi-urban, and rural areas, while educational status of the adolescents was negatively associated with chronic food insecurity (OR = 0.047, P = 0.002) in urban areas.

CONCLUSIONS

In the context of increased food prices, household income is an independent predictor of chronic food insecurity only among adolescents in the low income, urban households. Female gender, educational status of primary or less and being a member of households with high dependency ratio were independent predictors of chronic food insecurity in urban, semi-urban, and rural areas. The fact that the prevalence of chronic food insecurity increased among adolescents who are members of chronically food insecure urban households as income tertiles decreased suggests that the resilience of buffering is eroded when purchasing power diminishes and food resources are dwindling. Food security interventions should target urban low income households to reduce the level of chronic food insecurity and its consequences.

The characteristics and experience of community food program users in arctic Canada: a case study from Iqaluit, Nunavut

BACKGROUND

Community food programs (CFPs), including soup kitchens and food banks, are a recent development in larger settlements in the Canadian Arctic. Our understanding of utilization of these programs is limited as food systems research has not studied the marginalised and transient populations using CFPs, constraining service planning for some of the most vulnerable community members. This paper reports on a baseline study conducted with users of CFPs in Iqaluit, Nunavut, to identify and characterize utilization and document their food security experience.

METHODS

Open ended interviews and a fixed-choice survey on a census (n = 94) were conducted with of users of the food bank, soup kitchen, and friendship centre over a 1 month period, along with key informant interviews.

RESULTS

Users of CFPs are more likely to be Inuit, be unemployed, and have not completed high school compared to the general Iqaluit population, while also reporting high dependence on social assistance, low household income, and an absence of hunters in the household. The majority report using CFPs for over a year and on a regular basis.

CONCLUSIONS

The inability of users to obtain sufficient food must be understood in the context of socio-economic transformations that have affected Inuit society over the last half century as former semi-nomadic hunting groups were resettled into permanent settlements. The resulting livelihood changes profoundly affected how food is produced, processed, distributed, and consumed, and the socio-cultural relationships surrounding such activities. Consequences have included the rising importance of material resources for food access, the weakening of social safety mechanisms through which more vulnerable community members would have traditionally been supported, and acculturative stress. Addressing these broader challenges is essential for food policy, yet CFPs also have an essential role in providing for those who would otherwise have limited food access.

Evaluating nutrition risk factors and other determinants of use of an urban congregate meal program by older African Americans

Rapid growth in both the number of older U.S. adults and diversity in the population suggests increased and disparate demands for nutrition services. Funded by the Older Americans Act (OAA), the primary purpose of congregate meal services is to keep older Americans nutritionally secure and living independently in the community. Understanding characteristics that influence older African Americans' use of congregate meal services is important for development of culturally sensitive networks and program policies. With a sample of 151 community-dwelling older African Americans, a descriptive exploratory design was used to explore predisposing, enabling, and need characteristics that influence use of a congregate meal service and to examine the relationship between nutritional risk and service use. Provider-oriented structural enablers (awareness and transportation) that promote or impinge on elderly persons' use of a congregate meal service were also examined. Multivariate analysis indicated that among program participants, nutrition risk and living arrangement had significant influence on service use. Additionally, nutrition risk was higher among respondents who did not participate in congregate meal service compared to their participant counterparts.

Children live, feel, and respond to experiences of food insecurity that compromise their development and weight status in peri-urban Venezuela

Children's experiences of food insecurity (FI) may be conceptually distinct and different from those of adults. Previous study of children's experiences of FI has relied primarily on their parents' perspective. This study explored, described, and conceptualized experiences of FI in children attending 5 public schools in peri-urban areas of the Miranda State, Venezuela, South America using a naturalistic approach. Children aged 10-17 y were studied through focus groups (n = 42) and individual interviews (n = 13). Interviews were recorded, transcribed, and analyzed using grounded theory. Children were cognitively aware of FI, worry in their parents, and causes both external and internal to their households. Children were also emotionally aware of FI, with feelings of concern, anguish, and sadness, and manifestations such as crying. Children reported being physically hungry, experiencing reduced quantity and quality of food intake, having smaller meals, and recognizing thinness and fainting as consequences. Children's responses to FI included reduction of quality and quantity of food, child labor, sacrifice in food consumption, food from waste, support from extended family members, and strategies for purchasing, acquiring, preparing, and cooking food. Children were not always protected, especially when the head of the family was unemployed, had drug-alcohol problems, or was extremely poor. Protection could come from parents to children and from older children to parents and younger children. Children should have certain access to food that is dignified, timely, efficient, and adequate in harmonious social conditions to prevent and resolve situations that compromise their physical, cognitive, and socio-emotional well-being.

Dietary behaviors of a racially and ethnically diverse sample of overweight and obese Californians

OBJECTIVES

To examine racial/ethnic differences in the dietary behaviors of overweight or obese adults using the 2007 California Health Interview Survey.

METHOD

Data were obtained from the 2007 California Health Interview Survey, a population-based sample of noninstitutionalized adults in California. The sample included 26,721 adults aged 18 years and older whose body mass index status indicated that they were overweight or obese (body mass index ≥ 25), with 19,264 non-Hispanic White; 1,749 African American/Black; 1,616 Asian/Pacific Islander; and 4,092 Latino respondents. Respondents were compared with regard to consumption of five categories of food: fruits, vegetables, French fries, soft drinks, and fast-food. Multivariable regression analyses were conducted to examine racial/ethnic differences in dietary behaviors, with and without adjustment for age, gender, nativity, marital status, education, income, and food insecurity.

RESULTS

The findings suggested there were significant racial/ethnic differences in food preferences and that English proficiency, in part, explained some of these differences. Overweight/obese African American/Black respondents reported eating fruit (aBeta = -0.73, [95% confidence interval = -1.29, -0.17]) and vegetables (aBeta = -0.71 [-1.18, -0.24]) fewer times per day and fast-food (aBeta = 0.21, [0.04, 0.38]) more times per day compared with their non-Hispanic White counterparts. Irrespective of language proficiency, Asian/Pacific Islanders reported eating significantly less fruit compared with non-Hispanic Whites. Limited English proficient (LEP) Asian/Pacific Islanders were found to eat vegetables (aBeta = 1.41, [0.47, 2.63]) more times per day than non-Hispanic Whites, in contrast to English proficient Asian/Pacific Islanders who were found to eat vegetables (aBeta = -0.64, [-1.11, -0.18]) fewer times per day compared with non-Hispanic Whites. Both LEP and English proficient Latinos ate vegetables less often and drank soft drinks and ate fast-food more often than non-Hispanic Whites.

CONCLUSIONS

Efforts to intervene with individuals who are overweight or obese must include culturally and linguistically tailored interventions that consider how individuals' dietary behaviors are influenced by their racial/ethnic backgrounds.

Financial Strain Is Associated with Malnutrition Risk in Community-Dwelling Older Women

This study examined the relationship between financial strain, or difficulty acquiring necessities, and malnutrition risk in a community dwelling sample of frail and nonfrail women aged 70-79 in the Women's Health and Aging Study (n = 679). Malnutrition risk was measured with a modified version of the Mini-Nutritional Assessment Short Form (MNA-SF) and defined as a score <11, financial strain was measured by (1) sufficiency of money on a monthly basis and (2) adequacy of income for food, and income was measured by ordinal categories. Mean (SD) modified MNA-SF score was 12.2 (1.80), and 14.7% of women had malnutrition risk. Women who usually did not have enough money to make ends meet had more than four-fold increased odds of malnutrition risk (OR = 4.54; 95% CI: 2.26, 9.14) compared to their counterparts who had some money left over each month. This was only slightly attenuated after control for income and education, (OR = 4.08; 95% CI: 1.95, 8.52) remaining robust. These results show an association between financial strain and malnutrition risk, independent of income, in older women. Self-reported financial strain may be preferable to income as a screener for malnutrition risk in older adults in clinical and research settings.

Difficulty in the food environment and the experience of food insecurity among refugees resettled in the United States

The objective of this cross-sectional study was to assess the prevalence and correlates of food insecurity in 281 refugees resettled in the United States. Participants were recruited through a resettlement center and word of mouth. In addition to measures of socioeconomic status, education, time in the U.S., and food insecurity, we also measured individual difficulty in navigating the food environment using a food difficulty scale. Only 23% of the sample did not endorse any of the food insecurity items. Nearly half of the sample also noted difficulty in navigating the food environment. Food insecurity scores above the median were predicted by both income and non-income variables. In a multivariable logistic model, income and having more than one year of education were associated with lower food insecurity (p < .05), while "difficulty in the food environment" was associated with high food insecurity (p < .01). Results suggest that income is an important constraint but that non-income variables may also be important determinants of food insecurity.

Housing, medical, and food deprivation in poor urban contexts: implications for multiple sexual partnerships and transactional sex in Nairobi's slums

Identifying the factors that lead to sexual risk behavior is crucial in addressing the HIV epidemic in sub-Saharan Africa. Scholars have primarily relied on traditional measures of SES (income, wealth, and education) to predict risk, overlooking measures of deprivation in important social arenas such as housing, medical care, and food expenses. Findings demonstrated that all three deprivation measures, particularly housing and health care, were robust influences of sexual risk even while controlling for traditional SES measures. A multifaceted deprivation framework appears crucial to the development of effective policy interventions to diminish HIV infection.

Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS

Food insecurity, which affects >1 billion people worldwide, is inextricably linked to the HIV epidemic. We present a conceptual framework of the multiple pathways through which food insecurity and HIV/AIDS may be linked at the community, household, and individual levels. Whereas the mechanisms through which HIV/AIDS can cause food insecurity have been fairly well elucidated, the ways in which food insecurity can lead to HIV are less well understood. We argue that there are nutritional, mental health, and behavioral pathways through which food insecurity leads to HIV acquisition and disease progression. Specifically, food insecurity can lead to macronutrient and micronutrient deficiencies, which can affect both vertical and horizontal transmission of HIV, and can also contribute to immunologic decline and increased morbidity and mortality among those already infected. Food insecurity can have mental health consequences, such as depression and increased drug abuse, which, in turn, contribute to HIV transmission risk and incomplete HIV viral load suppression, increased probability of AIDS-defining illness, and AIDS-related mortality among HIV-infected individuals. As a result of the inability to procure food in socially or personally acceptable ways, food insecurity also contributes to risky sexual practices and enhanced HIV transmission, as well as to antiretroviral therapy nonadherence, treatment interruptions, and missed clinic visits, which are strong determinants of worse HIV health outcomes. More research on the relative importance of each of these pathways is warranted because effective interventions to reduce food insecurity and HIV depend on a rigorous understanding of these multifaceted relationships.

The social context of food insecurity among persons living with HIV/AIDS in rural Uganda

HIV/AIDS and food insecurity are two of the leading causes of morbidity and mortality in sub-Saharan Africa, with each heightening the vulnerability to, and worsening the severity of, the other. Less research has focused on the social determinants of food insecurity in resource-limited settings, including social support and HIV-related stigma. In this study, we analyzed data from a cohort of 456 persons from the Uganda AIDS Rural Treatment Outcomes study, an ongoing prospective cohort of persons living with HIV/AIDS (PLWHA) initiating HIV antiretroviral therapy in Mbarara, Uganda. Quarterly data were collected by structured interviews. The primary outcome, food insecurity, was measured with the Household Food Insecurity Access Scale. Key covariates of interest included social support, internalized HIV-related stigma, HIV-related enacted stigma, and disclosure of HIV serostatus. Severe food insecurity was highly prevalent overall (38%) and more prevalent among women than among men. Social support, HIV disclosure, and internalized HIV-related stigma were associated with food insecurity; these associations persisted after adjusting for household wealth, employment status, and other previously identified correlates of food insecurity. The adverse effects of internalized stigma persisted in a lagged specification, and the beneficial effect of social support further persisted after the inclusion of fixed effects. International organizations have increasingly advocated for addressing food insecurity as part of HIV/AIDS programming to improve morbidity and mortality. This study provides quantitative evidence on social determinants of food insecurity among PLWHA in resource-limited settings and suggests points of intervention. These findings also indicate that structural interventions to improve social support and/or decrease HIV-related stigma may also improve the food security of PLWHA.

Food purchasing and food insecurity among low-income families in Toronto

PURPOSE

Factors underlying food-purchasing decisions were examined among a sample of low-income Toronto families.

METHODS

A cross-sectional survey was completed among 485 families residing in high-poverty Toronto neighbourhoods. Food-security status was assessed using the Household Food Security Survey Module. Open-ended questions were included to examine respondents' food selection and management practices and their purchasing decisions for six indicator foods. Logistic regression was used to examine associations between factors influencing food-purchasing decisions, perceived food adequacy, and severity of food insecurity.

RESULTS

Twenty-two percent of families had been severely food insecure in the past 30 days. Respondents engaged in thrifty food shopping practices, such as frequenting discount supermarkets and budgeting carefully. Price was the most salient factor influencing food-purchasing decisions; the likelihood that families would report this factor increased with deteriorating food security. Preference, quality, and health considerations also guided food-purchasing decisions, but generally to a lesser extent as food insecurity increased. Household food supplies reflected constraints on food purchasing, and they diminished with increasing food insecurity.

CONCLUSIONS

Despite their resourcefulness, low-income families struggle to feed their families. Dietitians have an important role to play as advocates for adequate income supports to promote food security and nutritional health.

Food insecurity is associated with social capital, perceived personal disparity, and partnership status among older and senior adults in a largely rural area of central Texas

This study examined the association of compositional measures of collective social functioning, composed of community and familial social capital and perceived personal disparity, with food security among older (aged 50-59 y) and senior (aged ≥ 60 y) adult residents of the largely rural Brazos Valley in Central Texas using data from the 2006 Brazos Valley Community Health Assessment (analytic N = 1059, 74% response rate). Among older adults and seniors, 18.6% reported food insecurity (5.5% often and 13.1% sometimes), defined as running out of food and not having money to buy more. Low community social capital was reported by 22.4% of participants, and 30.8% indicated they were single, widowed, or divorced, an indicator of limited familial social capital. A robust multinomial regression model found the odds of reporting greater food insecurity increased for individuals who were women, African American, residents of a household with a low or poverty-level income, individuals who perceived themselves to be worse off than others within their community, and those who had low social capital. The odds of being food insecure decreased for older respondents, partnered respondents and persons with more education (pseudo r(2) = 0.27, p < 0.0000). Compositional level measures of collective social functioning are important associates of food insecurity among older adults and seniors, regardless of severity.

Indicators of material hardship and depressive symptoms among homebound older adults living in North Carolina

This study used the concept of material hardship to understand how unmet needs related to food, housing, and health influence depressive symptoms among homebound older adults (N = 345) in North Carolina. Using data from the Nutrition and Function Study, 37% reported high levels of depressive symptoms and 17.4% indicated not receiving needed health care. Approximately 10% of respondents were food insecure; 30.7% were at risk for food insecurity; and 39.7% reported having to choose between either food and medication or food and paying bills. Adjusted logistic regression model revealed that food insecurity status (OR = 4.9) and age 60-74 y (OR = 2.4) were significantly associated with a greater number of depressive symptoms. Other indicators of material hardship, such as having a major financial difficulty, unmet health need, and inadequate housing, were not significant. By far, food insecurity was the most salient influence on depressive symptoms. These findings have important implications for service providers, researchers, and policymakers.