Beyond nutrition: hunger and its impact on the health of young Canadians

Food environment research in Canada: a rapid review of methodologies and measures deployed between 2010 and 2021

Numerous research methodologies have been used to examine food environments. Existing reviews synthesizing food environment measures have examined a limited number of domains or settings and none have specifically targeted Canada. This rapid review aimed to 1) map research methodologies and measures that have been used to assess food environments; 2) examine what food environment dimensions and equity related-factors have been assessed; and 3) identify research gaps and priorities to guide future research. A systematic search of primary articles evaluating the Canadian food environment in a real-world setting was conducted. Publications in English or French published in peer-reviewed journals between January 1 2010 and June 17 2021 and indexed in Web of Science, CAB Abstracts and Ovid MEDLINE were considered. The search strategy adapted an internationally-adopted food environment monitoring framework covering 7 domains (Food Marketing; Labelling; Prices; Provision; Composition; Retail; and Trade and Investment). The final sample included 220 articles. Overall, Trade and Investment (1%, n = 2), Labelling (7%, n = 15) and, to a lesser extent, Prices (14%, n = 30) were the least studied domains in Canada. Among Provision articles, healthcare (2%, n = 1) settings were underrepresented compared to school (67%, n = 28) and recreation and sport (24%, n = 10) settings, as was the food service industry (14%, n = 6) compared to grocery stores (86%, n = 36) in the Composition domain. The study identified a vast selection of measures employed in Canada overall and within single domains. Equity-related factors were only examined in half of articles (n = 108), mostly related to Retail (n = 81). A number of gaps remain that prevent a holistic and systems-level analysis of food environments in Canada. As Canada continues to implement policies to improve the quality of food environments in order to improve dietary patterns, targeted research to address identified gaps and harmonize methods across studies will help evaluate policy impact over time.

Food insecurity is associated with multiple psychological and behavioural problems among adolescents in five Caribbean countries

The study aimed to assess associations between food insecurity and multiple psychological and behavioural problems among adolescents in five Caribbean countries. Data from national and cross-sectional school health surveys from 9,956 adolescents (15 years, median age) in Trinidad and Tobago, Suriname, Jamaica, Anguilla and the Dominican Republic in 2016-2017 were analyzed in 2016-2017. Results show that the prevalence of moderate (rarely or sometimes) past-month food insecurity was 35.9% and severe (mostly or always) food insecurity was 4.6%. Severe food insecurity among adolescents ranged from 2.9% in Dominican Republic to 11.2% in Suriname. In adjusted logistic regression analyses, the higher severity of food insecurity was associated with negative psychological outcomes (loneliness, suicidal ideation, suicide plan, suicide attempt, anxiety, current tobacco use and any trouble from alcohol use) and negative behavioural outcomes (truancy, bullied, physically attacked, physical injury, and multiple sexual partners). Two out of five adolescents experienced some form of food security. Food interventions, such as school feeding programmes, are warranted to reduce negative psychosocial outcomes.

Food and Mood: Daily Associations Between Missed Meals and Affect Among Early Adolescents

OBJECTIVE

Youth frequently miss meals and experience hunger, yet no studies have assessed how these experiences relate to changes in daily emotional states. This daily diary study examined associations of missing breakfast, missing lunch, and hunger with daily positive and negative affect among young adolescents.

METHODS

A community sample of 133 grade 5 and 6 students (50.4% boys, Mage = 10.77, 19.5% BIPOC) from two public schools completed baseline socio-demographic measures at the beginning of the study and daily measures at the end of the school day over 5 consecutive days. Measures included positive and negative affect, breakfast, lunch, and hunger. Multilevel regression models were constructed to test the associations.

RESULTS

Among participating youth, 27.8% missed breakfast at least once, 15.0% missed lunch at least once, and 26.3% felt hungry at least once. Missing breakfast was associated with increased negative affect (B = 0.36, p = .030) and missing lunch was related to both increased negative affect (B = 0.52, p = .019) and decreased positive affect (B = -0.80, p = .002). Hunger was not related to daily affect.

CONCLUSION

This study provides a unique view of youths' experiences of missing meals, hunger, and daily emotional states. The findings underscore the importance of youth being adequately nourished through school meal programs. Clinicians should screen for and address missing meals among their young patients.

Caregivers' Knowledge and Food Accessibility Contributes to Childhood Malnutrition: A Case Study of Dora Nginza Hospital, South Africa

Amongst the problems facing South Africa today are malnutrition and food insecurity, and there is a need for interventions and innovative strategies to address these. The aim of the study was to determine the contribution of caregivers’ knowledge of nutrition and household food security among children aged 0 to 60 months. A cross-sectional study design was applied using a quantitative approach. A convenience sample (n = 184) of caregiver–child pairs (for children 0 to 60 months) from the Dora Nginza Hospital Paediatric Outpatient Department was used. A structured questionnaire was applied to collect data on socio-economic factors, health status, household food security, and caregivers’ knowledge. In addition, interviews were conducted, and anthropometric measurements of children were taken to determine their nutritional status. The results indicate that most caregivers were female, and more than half completed high school, yet almost 75% were unemployed. Most of the caregivers (58.2%) were either overweight or obese. The results also show that only 33.2% of households were food secure, 29.3% were at risk of hunger, and 37.5% experienced hunger. The prevalence of stunting, underweight, and wasting among children in the study was high. A significant, slightly positive correlation was found between the body mass index of the caregiver and height for age. Poor socio-economic status and food inaccessibility were identified as possible underlying contributing factors to malnutrition, contributing to food insecurity and therefore poor dietary intake.

Food insecurity, state fragility and youth mental health: A global perspective

Youth in fragile settings face disproportionate risks of experiencing food insecurity and poor mental health. Cross-national evidence is lacking on the association between food insecurity and mental health in youth populations, and on state fragility as a social determinant of these experiences. We analysed data from six cycles of the Gallup World Poll (2014-2019), an annual survey that contains multi-item scales of food insecurity, mental health problems and positive wellbeing. The analytic sample included 164,118 youth aged 15-24 years in 160 states. We linked individual responses to state-level data from the Fragile States Index-an aggregate measure of state vulnerability to collapse or conflict (coded: sustainable, stable, warning, or alert) and estimated adjusted relative risk (RR) of food insecurity as a function of state fragility. We then used linear regression to examine associations of state fragility and food insecurity with mental health and wellbeing. The prevalence of moderate or severe food insecurity rose from 22.93% in 2014 to 37.34% in 2019. State fragility (alert vs. sustainable) was related to an increased risk of food insecurity (RR = 2.28 [95% CI 1.30 to 4.01]), more mental health symptoms (b = 6.36 [95% CI 1.79 to 10.93]), and lower wellbeing (b = -4.49 [95% CI -8.28 to -0.70]) after controlling for state wealth and household income. Increased food insecurity (severe vs. none or mild) was uniquely related to more mental health symptoms (b = 18.44 [95% CI 17.24 to 19.64]) and reduced wellbeing (b = -9.85 [95% CI -10.88 to -8.83]) after state fragility was also controlled. Globally, youth experience better mental health where states are more robust and food access is more secure. The findings underscore the importance of strong governance and coordinated policy actions that may improve youth mental health.

Food insecurity is associated with mental health problems among Canadian youth

BACKGROUND

Research has linked food insecurity to mental health problems, though little is known about this relationship among Canadian youth. We investigate the association between food insecurity severity and mental illnesses in a nationally representative youth sample.

METHODS

We sampled 55 700 youth 12-24 years from recent cycles of Canadian Community Health Survey. Household food insecurity was measured using a standard 18-item questionnaire. We fitted Poisson regressions on self-rated mental health and diagnosed mood and anxiety disorders, controlling for sociodemographic confounders. Clinical assessments of emotional distress, major depression and suicidal ideation were examined in subsamples with available data. We stratified the sample by gender, age and survey cycle to test potential demographic heterogeneity.

RESULTS

One in seven youth lived in marginal (5.30%), moderate (8.08%) or severe (1.44%) food insecurity. Results showed that food insecurity was associated with higher likelihood of every mental health problem examined. The association was graded, with more severe food insecurity linked to progressively worse mental health. Notably, marginal, moderate and severe food insecurity were associated with 1.77, 2.44 and 6.49 times higher risk of suicidal thoughts, respectively. The corresponding relative risk for mood disorders were 1.57, 2.00 and 2.89; those for anxiety disorders were 1.41, 1.65 and 2.58. Moderate food insecurity was more closely associated with mental health problems in 18-24 year olds than in 12-17 year olds.

CONCLUSIONS

Food insecurity severity was associated with poorer mental health among Canadian youth independent of household income and other socioeconomic differences. Targeted policy intervention alleviating food insecurity may improve youth mental health.

Diet Quality and Physical Fighting Among Youth: A Cross-National Study

The predictors of engaging in physical violence appear to be quite diverse, covering an array of social and psychological risk factors. The present study expands upon this literature by exploring the link between diet quality and physical fighting during early adolescence using cross-national data from the 2005/2006 Health Behaviors of School Children (HBSC) survey. The results reveal that the rate of physical fighting was 40% higher among youths with lower quality diets, whereas the odds of frequent physical fighting were 68% higher, relative to youths with better diets. Ancillary analyses reveal that (a) the link between diet quality and physical fighting was significantly larger among females and (b) significant associations between diet quality and physical fighting were detected in 38 of the 40 countries examined. Strategies designed to improve diet quality among youth may have the added benefit of reducing the likelihood of physical fighting and its negative sequelae.

Does social support moderate the association between hunger and mental health in youth? A gender-specific investigation from the Canadian Health Behaviour in School-aged Children study

BACKGROUND

Youth who go hungry have poorer mental health than their counterparts - there are gender differences in this relationship. This study investigated the role of social support in the association between hunger and mental health among a nationally representative sample of youth in Canada in gender-specific analyses.

METHODS

We used a probability-based sample of 21,750 youth in grades 6-10 who participated in the 2017-2018 Canadian Health Behaviour in School-aged Children. Self-report data were gathered on hunger, mental health (measured via the World Health Organization-5 well-being index) and five sources of support - peer, family and teacher support as well as the school climate and neighborhood support. We conducted adjusted, gender-specific, multilevel regression analyses assessing the association between mental health, social support and hunger.

RESULTS

We found that youth who reported lower support were more likely to experience going to bed hungry (relative to never hungry) across all support factors. As for the social support factors, all the social support factors were associated with a higher mental health score, even after controlling for hunger. Despite these results our final set of models showed that our measures of social support did not alleviate the negative association between hunger and mental health. As for gender-specific findings, the negative association between hunger and a mental health was more pronounced among females relative to their male counterparts. We also found that certain social support factors (i.e., family, teacher and neighborhood support) were associated with a higher mental health score among females relative to males while controlling for hunger status.

CONCLUSIONS

We find that five social support factors are associated with a higher mental health score among ever hungry youth; however, social support did not overpower the negative association between hunger and mental health. Food insecurity is a challenge to address holistically; however, hungry youth who have high social support have higher odds of better mental health.

Child food insecurity in the UK: a rapid review

Background

Food insecurity (FI) is a multifaceted, socioeconomic problem involving difficulties accessing sufficient, safe and nutritious food to meet people’s dietary requirements and preferences for a healthy life. For children experiencing FI, there are some potentially negative developmental consequences and it is, therefore, important to understand the links between FI and children’s health and well-being as well as any strategies undertaken to address FI. The overall objective of this assessment was to determine the nature, extent and consequences of FI affecting children (aged ≤ 18 years) in the UK.

Objective

To determine the nature, extent and consequences of FI affecting children (aged ≤ 18 years) in the UK.

Data sources

The databases searched on 4 December 2017 included MEDLINE (including In-Process & Other Non-Indexed Citations and E-pub ahead of print files), EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Commonwealth Agricultural Bureaux (CAB) abstracts, The Cochrane Library, Education Resources Information Centre (ERIC), PsycINFO, the Social Science Citation Index and the Applied Social Sciences Index and Abstracts (ASSIA).

Methods

A rapid review of the current published and unpublished literature was conducted, including all study designs from specified high-income countries in children aged ≤ 18 years. Searches were conducted of major health-care, nutrition, education and social science databases from 1995 onwards, and websites of relevant UK and international organisations. Final searches were undertaken in December 2017.

Results

In total, 109 studies were selected. Only five studies were conducted in the UK, four of which provided qualitative data. Possible factors associated with child FI were identified, for example socioeconomic status, material deprivation, living in public housing and having unemployed or poorly educated parents. Children’s health, well-being and academic outcomes were all negatively affected by FI. The mediating effects of family stressors and parenting practices in the relationship between FI and children’s health and well-being outcomes were not clear. Food assistance programmes were generally effective in mitigating FI and improving nutritional outcomes (including hunger) in the short term, but did not eradicate FI, eliminate its effects on children’s health or have an impact on academic outcomes. No reports assessing the prevalence of child FI in the UK or the cost-effectiveness and sustainability of interventions to tackle FI were identified.

Limitations

There was a lack of consistency in how FI was defined and measured across studies. Most of the studies used indirect measurements of child FI through parental reports. The majority of studies were conducted in North America. Only five studies were conducted in the UK. Thirty potentially relevant studies were not included in the review as a result of time and resource constraints. Most studies were observational and caution is advised in interpreting their results.

Conclusions

A number of factors that were related to child FI were identified, as were negative associations between child FI and physical, mental and social outcomes. However, these findings should be interpreted with caution because of the correlational nature of the analyses and the fact that it is difficult to determine if some factors are predictors or consequences of FI.

Future research

There is an urgent requirement for the development of a reliable instrument to measure and monitor child FI in the UK and for well-designed interventions or programmes to tackle child FI.

Study registration

This study is registered as PROSPERO CRD42017084818.

Funding

The National Institute for Health Research Public Health Research programme. The Health Services Research Unit is core-funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.

Childhood hunger and depressive symptoms in adulthood: Findings from a population-based study

BACKGROUND

Several studies have linked childhood hunger to an increased risk for later depression. However, as yet, there has been little research on this relation in adults of all ages or whether there are sex differences in this association. The current study examined these issues using data from a national population-based sample.

METHODS

Data were analyzed from 5095 adults aged 25-84 collected during the Estonian Health Interview Survey 2006. Information was obtained on the frequency of going to bed hungry in childhood and on depressive symptoms using the Emotional State Questionnaire (EST-Q). Logistic regression analysis was used to examine the association between hunger and depression while controlling for other demographic, socioeconomic and health-related variables.

RESULTS

In a fully adjusted model, going to bed hungry in childhood either sometimes or often was associated with significantly increased odds for depressive symptoms. When the analysis was stratified by sex the association was more evident in men where any frequency of childhood hunger was linked to adult depression while only women who had experienced hunger often had higher odds for depressive symptoms in the final model.

LIMITATIONS

Data on childhood hunger were retrospectively reported and may have been affected by recall bias. We also lacked information on potentially relevant variables such as other childhood adversities that might have been important for the observed associations.

CONCLUSION

Childhood hunger is associated with an increased risk for depressive symptoms among adults. Preventing hunger in childhood may be important for mental health across the life course.

Food Insecurity and Hunger: Quiet Public Health Problems on Campus

Food insecurity and hunger are gaining traction as recognized public health problems on college campuses in the United States. Data from recent publications and reports suggest the prevalence of food insecurity among U.S. undergraduate students ranges from 14.1 to 58.8%, compared to 12.3% of U.S. households. Undergraduate students (N=1,069) were surveyed at the University of Texas at Austin in 2014-2015. The survey questionnaire included the validated 6-item short-form of the USDA food security module, was distributed and completed in class and answered anonymously. The demographic characteristics of the sample are representative of all undergraduates on campus. Food insecurity was reported by 23.5% of students surveyed; ever being hungry by 31% and 12.5% of the ever-hungry also report being food-insecure. Importantly, most of the food insecure (96%) did not report experiencing food insecurity prior to matriculation. In multiple logistic regression models, the factors associated with a higher odds ratio of food insecurity include: being a first-generation college student; Hispanic ethnicity; third-born child or later in the family; and less confident about financial management skills. The factors associated with a higher adjusted odds ratio of hunger include: being of Asian or other ethnicity (vs. non-Hispanic white) and having limited confidence about financial management skills. The results, from one of the largest surveys of food insecurity and hunger among undergraduate students on a single campus in the U.S., suggest that transition to college is a vulnerable window for the emergence of food insecurity and hunger. More research is needed on the long-term effects of food insecurity in this population and the effectiveness of campus policy and interventions addressing food insecurity and hunger.

Hunger and overweight in Canadian school-aged children: A propensity score matching analysis

OBJECTIVE

The last decade saw a higher prevalence of overweight reported among food-insecure families in Canada, but no robust evidence exists on the covariate-adjusted association in children. In this study, we examined the association between hunger and overweight in Canadian students, using a propensity score matching analysis to reduce confounding.

METHODS

This research used data from the 2009/2010 Canadian Health Behaviour in School-aged Children study on a representative national sample of students in Grades 6 through 10. Students self-reported their height and weight and how often they have gone to school or to bed hungry due to a lack of food at home. Multivariate logistic regression modeling was conducted on the total sample (N = 17,694) and on the sample matched on propensity scores (n = 7,788).

RESULTS

The overall prevalence of overweight among students was 20.2% with a significant difference between students who reported hunger (24.0%; 95% CI: 22.1-26.0) and students who did not (19.0%; 95% CI: 17.9-20.2). Analysis on the matched sample revealed a significant association between hunger and overweight in children (adjusted odds ratio: 1.30; 95% CI: 1.12-1.50).

CONCLUSIONS

A substantial number of Canadian students have reported being hungry because of a lack of food at home. These students are at increased risk of overweight, regardless of their social class. Child hunger and household food insecurity exist in Canada and constitute a call for policy action at a national level.

Food insecure student clients of a university-based food bank have compromised health, dietary intake and academic quality

AIM

University and college students in wealthy countries may be vulnerable to financial food insecurity. If food insecure students have suboptimal health, their ability to learn and excel in their education could be compromised. This Canadian study examined the relationship of food security status to diet and self-perceived health and academic quality among students receiving emergency food hampers from the Campus Food Bank at University of Alberta.

METHODS

A convenience sample of 58 students completed a survey.

RESULTS

Of participating students, 10.3% were food secure, 44.8% were moderately food insecure and 44.8% were severely food insecure. Overall, 32.8% rated their general health as fair/poor, 27.6% rated their mental health as fair/poor and 60.3% indicated at least one adverse academic outcome of not having enough money for food. Compared to other participating students, students with severe food insecurity had a greater likelihood of fair/poor general health (odds ratios (OR) 4.03, 95% confidence intervals (CI) 1.10-14.78); fair/poor mental health (OR 4.96, 95% CI 1.28-19.19); being unable to concentrate in class or during an exam (73.1% vs 40.6%, χ² = 6.12, P = 0.013); relying on food hampers (34.6% vs 9.7%, χ² = 5.57, P = 0.018); and, consuming fewer daily fruits, vegetables and legumes (2.12 vs 2.97 cup equivalents, P = 0.009).

CONCLUSIONS

Food insecurity compromises students' health, diet and academic quality. Campus food banks are not the solution to student hunger. Governmental and university-based programmes and policies are needed to improve the food security situation of university students.

It still takes a village: an epidemiological study of the role of social supports in understanding unexpected health states in young people

Background

This study of adolescent Canadians examines two groups who are anomalous in their health experiences: (1) those with perceived low affluence yet who perceive themselves to have excellent general health status; (2) those of perceived high affluence but who are reporting poor health status. Our hope was to explore the role of social supports in explaining such anomalies. We hypothesized that cumulative levels of social support available to these young people would have an influence on their perceived health status, with more support being associated with better self reported health.

Methods

Young people (n = 26,078 from 436 schools) aged 11–15 years were administered a general health survey in classroom settings during the 2009–10 academic school year. Descriptive and regression-based cross-sectional analyses (with an affluence-social support interaction term) were used to relate both individual and cumulative levels of social support in homes, neighborhoods, schools, and peer groups to self-reported health status.

Results

Social supports and their cumulative availability indeed were strongly related to perceived health, with more supports being associated with better self-perceived health. Less affluent children were much more likely to report excellent health in the presence of numerous social supports. More affluent children were much more likely to report poor health in the absence of such supports. The strength and dose-dependent nature of the findings were consistent and striking.

Conclusions

Study findings from this large, contemporary and national analysis affirm the importance of social supports as potential determinants of health for young people from both high and low affluent groups. Conceptually, findings affirm the wisdom of the ancient principle: “it takes a village to raise a child”.