Nutritional vulnerability seen within asylum seekers in Australia

Dietary risk of donated food at an Australian food bank: an audit protocol

BACKGROUND

Sufficient, safe and nutritious food is unattainable for many people experiencing severe food insecurity, putting them at dietary risk. Food banks, a growing part of the charitable food system (CFS), are the main source of food relief in developed countries. Donations of surplus, unsalable food from supermarkets, producers and manufacturers is the main source of the food supply, and this can be unpredictable, insufficient and inappropriate. The universal performance indicator of food-banking success is a weight-based measure, complemented by various initiatives to track the nutritional quality of food provided. There is currently no method that assesses the dietary risk of donated food related to nutrition and food safety. This protocol describes a method developed to identify and assess the dietary risk of donated food at an Australian food bank including the type, amount, nutrition quality, and food safety.

METHODS

An audit of all food donated to a food bank servicing one Australian state was conducted over five consecutive days in May 2022. The audit process used a mobile device to take photographs of all incoming deliveries to the food bank. The images were manually annotated to document the type of food, product information (brand and product name, variety), the donor's name, weight (kilograms), and date-marking details. Data was extracted from the photographs and assessed against pre-determined dietary risk criterion for food safety (date marking, damaged packaging, visible food spoilage) and nutrition quality according to the principles of the Australian Guide to Healthy Eating, and the NOVA classification of level of processing.

DISCUSSION

Fifteen hundred images were required to assess the dietary risk of 86,050 kg of donated food. There were 72 separate donations, largely from supermarkets and food manufacturers. Data analysis will enable identification of dietary risk, particularly for nutrition quality and food safety. This is important given the absence of food regulation for CFS donations, and the vulnerability of the client group. This protocol highlights the need for more transparency and accountability from food donors, about the food they donate.

Prevalence and risk factors of food insecurity among Libyan migrant families in Australia

Background

The burden of food insecurity remains a public health challenge even in high income countries, such as Australia, and especially among culturally and linguistically diverse (CALD) communities. While research has been undertaken among several migrant communities in Australia, there is a knowledge gap about food security within some ethnic minorities such as migrants from the Middle East and North Africa (MENA). This study aims to determine the prevalence and correlates of food insecurity among Libyan migrant families in Australia.

Methods

A cross-sectional design utilising an online survey and convenience sampling was used to recruit 271 participants, each representing a family, who had migrated from Libya to Australia. Food security was measured using the single-item measure taken from the Australian Health Survey (AHS) and the 18-item measure from the United States Department of Agriculture Household Food Security Survey Module (USDA HFSSM). Multivariable logistic regression was used to identify independent correlates associated with food insecurity.

Results

Using the single-item measure, the prevalence of food insecurity was 13.7% whereas when the 18-item questionnaire was used, more than three out of five families (72.3%) reported being food insecure. In the multivariable logistic regression analysis for the single-item measure, those living alone or with others reported higher odds of being food insecure (AOR = 2.55, 95% CI 1.05, 6.21) compared to those living with their spouse, whereas higher annual income (≥AUD 40,000) was associated with lower odds of food insecurity (AOR = 0.30, 95% CI 0.11, 0.84). Higher annual income was also associated with lower odds of food insecurity (AOR = 0.49, 95% CI 0.25, 0.94) on the 18-item measure. On both single and 18-item measures, larger family size (AOR = 1.27, 95% CI 1.07, 1.49 and AOR = 1.21, 95% CI 1.01, 1.47 respectively) was associated with increased odds of food insecurity.

Conclusion

This study provides evidence that food insecurity amongst Libyan migrants in Australia is a widespread problem and is associated with a number of sociodemographic and socio-economic factors. The findings of this study serve to contribute to the depth and breadth of food security research among vulnerable communities, in this instance Libyan migrant families.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12202-9.

The translational implications of applying multiple measures to evaluate the nutrient quality of the food supply: a case study of two food pantries in Montana

Lower-income populations experience food insecurity, are less likely to meet dietary recommendations, and develop noncommunicable diseases at higher rates than the general U.S. population. Food pantries, which provide food to individuals in need, present an opportunity to decrease these disparities. The purpose of this study was to assess the nutrient quality of the food supply using multiple measures in two food pantry food environments and examine the methodological impactions for translation from research to practice. Nutrient quality of the food supply at two food pantries located in southwest Montana was evaluated using the Healthy Eating Index (HEI) 2015, NOVA classification system, and UnProcessed Pantry Project (UP3) framework every other month during 2018 and 2019. From a total of 63,429 pounds, 291,070 servings, and 32,818 calories of food, processed and ultraprocessed food (UPF) accounted for 57% of servings, 59% of pounds, and 67% of calories. UPF accounts for the highest proportion of food calories compared to its weight. Simutaneously, the food pantries' food supply had total HEI scores of 77.55 and 79.45 out of a total possible score of 100. NOVA, UP3, and HEI measured multiple aspects that increased the understanding of the nutrient quality of the food supply in two food pantries. A multifaceted approach should be applied, or an all-inclusive tool should be developed, to speed the translation of evidence to practice when assessing and promoting a food supply that limits UPF, increasing the availability of nutritious food and decreasing health disparities for low-income populations.

Foods and Drinks Available from Urban Food Pantries: Nutritional Quality by Item Type, Sourcing, and Distribution Method

The overall nutritional quality of foods/drinks available at urban food pantries is not well established. In a study of 50 pantries listed as operating in the Bronx, NY, data on food/drink type (fresh, shelf-stable, refrigerated/frozen) came from direct observation. Data on food/drink sourcing (food bank or other) and distribution (prefilled bag vs. client choice for a given client's position in line) came from semi-structured interviews with pantry workers. Overall nutritional quality was determined using NuVal® scores (range 1-100; higher score indicates higher nutritional quality). Twenty-nine pantries offered zero nutrition at listed times (actually being closed or having no food/drinks in stock). Of the 21 pantries that were open as listed and had foods/drinks to offer, 12 distributed items in prefilled bags (traditional pantries), 9 allowed for client choice. Mean NuVal® scores were higher for foods/drinks available from client-choice pantries than traditional pantries (69.3 vs. 57.4), driven mostly by sourcing fresh items (at 28.3% of client-choice pantries vs. 4.8% of traditional pantries). For a hypothetical 'balanced basket' of one of each fruit, vegetable, grain, dairy and protein item, highest-NuVal® items had a mean score of 98.8 across client-choice pantries versus 96.6 across traditional pantries; lowest-NuVal® items had mean scores of 16.4 and 35.4 respectively. Pantry workers reported lower-scoring items (e.g., white rice) were more popular-appeared in early bags or were selected first-leaving higher-scoring items (e.g., brown rice) for clients later in line. Fewer than 50% of sampled pantries were open and had food/drink to offer at listed times. Nutritional quality varied by item type and sourcing and could also vary by distribution method and client position in line. Findings suggest opportunities for pantry operation, client and staff education, and additional research.

Living a Healthy Life in Australia: Exploring Influences on Health for Refugees from Myanmar

BACKGROUND

Humanitarian migrants from Myanmar represent a significant refugee group in Australia; however, knowledge of their health needs and priorities is limited. This study aims to explore the meaning and influencers of health from the perspectives of refugees from Myanmar.

METHOD

Using a community-based participatory research (CBPR) design, a partnership was formed between the researchers, Myanmar community leaders and other service providers to inform study design. A total of 27 participants were recruited from a government-funded English language program. Data were collected using a short demographic survey and four focus groups, and were analysed using descriptive statistics and thematic analysis methods.

RESULTS

Key themes identified included: (1) health according to the perspectives of Australian settled refugees from Myanmar, (2) social connections and what it means to be part of community, (3) work as a key influence on health, and (4) education and its links with work and health.

CONCLUSIONS

This study outlined the inter-relationships between health, social connections, work and education from the perspectives of refugees from Myanmar. It also outlined how people from Myanmar who are of a refugee background possess strengths that can be used to manage the various health challenges they face in their new environment.

"I Feel like I'm Eating Rice 24 Hours a Day, 7 Days a Week": Dietary Diversity among Asylum Seekers Living in Norway

Food insecurity is widespread among asylum seekers resettled in Western countries. Limited information exists on the quality of food intake in this population. The aim of this study was to investigate dietary quality among asylum seekers living in Norwegian reception centers. This study has a cross-sectional research design. Dietary intake was assessed through a qualitative 24-hour dietary recall, and the dietary diversity score (DDS) was calculated. This study was conducted in eight Norwegian reception centers. A total of 205 adult asylum seekers (131 men and 74 women) participated in the study. The asylum seekers ate on average two meals per day, and one-third ate their first meal after noon. Mean (SD) DDS was 4.0 (1.6) and 2/3 had low dietary diversity, eating from fewer than five food groups. Women had a significantly higher mean DDS (4.5) than men (3.8) (β (95% CI): 0.47 (0.00, 0.95) and a higher consumption of vegetables and fruits. The longer the period of residence in Norway, the higher the DDS, β (95% CI): 0.01 (0.00, 0.02). The asylum seekers' inadequate dietary intake reveals new forms of poverty and social exclusion in Europe. An inadequate dietary intake may increase the magnitude of difficulty involved in the settlement process and contribute to poorer health.

The role of social enterprise in food insecurity among asylum seekers

People seeking asylum in high-income countries are vulnerable to food insecurity due to limited opportunities for social and economic participation. Given this vulnerability, nongovernment organisations are attempting to improve food security outcomes through targeted programmes. This study explored the role of a subsidised mobile fresh fruit and vegetable market (the Food Justice Truck-FJT) on the experience of food insecurity for people seeking asylum living in Melbourne, Australia. This research uses a mixed methods approach, employing surveys and semistructured interviews to explore the lived experiences of asylum seekers using the FJT, including their experiences of food insecurity. Half of the asylum seekers interviewed in this study were found to be experiencing food insecurity. Participants in this study sourced food from multiple locations, with the FJT providing a supplemental, but highly valued source of fresh produce. The FJT was identified as positive social setting for some participants included in this research. This research has identified the ability of programmes such as the FJT to act as positive social settings.

The German Food Bank System and Its Users-A Cross-Sectional Study

Although food banks are a well-known resource for low-income people struggling to meet their food needs, they have rarely been investigated on a large scale. This study aims to contribute to the actual debate about the potential and limitations of food banks to decrease the prevalence of food insecurity by providing a representative picture of the German food bank system and its users. Publicly accessible data were used to map residents, public welfare recipients, and food banks. In addition, a comprehensive survey was distributed to all 934 “Tafel” food banks. The results show that nearly all residents and welfare recipients have access to at least one food bank located in the districts in which they reside. Differences in the density of food banks exist between eastern and western Germany. Food banks provide mainly healthy fresh food, but they heavily rely on food donations from local retailers and on volunteer labor. Although changes in the number of user households by income seem to mirror trends in the number of welfare recipients, food bank users appear to represent only a fraction of the food-insecure population in Germany. Food banks might have the potential to improve users’ diet and food security, but they are not able to reach all food-insecure residents in Germany.

Food-Based Social Enterprises and Asylum Seekers: The Food Justice Truck

People seeking asylum in high-income countries are vulnerable to food insecurity due to limited opportunities for social and economic participation. While charity organizations have long sought to provide food aid to those in need, the increasing number of people seeking this assistance requires alternatives. Using a case study approach, this research investigates The Food Justice Truck, which is a social enterprise designed to provide low cost, nutritious food to people seeking asylum with an aim to reduce the food insecurity burden. Twenty-seven people seeking asylum completed a structured interview (n = 15) or a semi-structured interview (n = 12). The majority of participants were female (n = 20) with an average age of 38.3 years (Standard Deviation (SD) 7.3; range 30⁻59) and over half were from Iran (n = 16, 59.2%) with most holding a temporary visa to stay in Australia (n = 15, 55.5%). Two key findings were identified including the fact that the FJT is at risk of creating and perpetuating a power imbalance. However, as a social setting, the FJT has the potential to promote and enable a social connection and create a positive experience. This research study adds valuable information to the literature by providing research on one alternative to traditional food aid. It was found that alternatives to traditional food aid may play a role in reducing the food security burden.

Achieving the four dimensions of food security for resettled refugees in Australia: A systematic review

AIM

Food security is defined by four dimensions: food availability, access, utilisation and stability. Resettled refugees face unique struggles securing these dimensions and, thus, food security when moving to a new country. This systematic review aimed to identify the challenges Australian refugees experience in achieving the four dimensions of food security.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed; the SPIDER tool was used to determine eligibility criteria. Three databases were searched using terms relating to food in/security and refugees from 2000 to 20 May 2017.

RESULTS

Seven articles were retained for analysis. Studies were categorised against the four dimensions, with four studies identifying challenges against all dimensions. Challenges contributing to high levels of food insecurity in each dimension included: availability and cost of traditional foods, difficulty in accessing preferred food outlets, limited food knowledge and preparation skills and food stability due to low income and social support.

CONCLUSIONS

Food insecurity adversely impacts refugee health and integration. Methodical research framed by the four dimensions of food security is imperative to address challenges to securing food security in refugee groups and assisting in the development of sustainable interventions.

The Nutritional Quality of Food Provided from Food Pantries: A Systematic Review of Existing Literature

BACKGROUND

In many affluent countries, food-insecure households use food pantries to keep their family fed. The long-term dependence of many users on these programs calls for a systematic review of studies on the nutritional quality of food provided by food pantries.

OBJECTIVE

The purpose of this systematic review was to summarize the current scientific evidence about the nutritional quality of food bags distributed by food pantries.

METHODS

A systematic literature search was conducted in the electronic databases PubMed, PsycINFO, PsycARTICLES, and Psychology Behavioral Sciences Collection to identify cross-sectional, cohort, and intervention studies reporting baseline data conducted in high-income countries and published between 1980 and 2015, which reported the nutritional quality of food bags distributed by food pantries. Identified citations were screened in two stages and data were independently extracted by two authors using a predefined data sheet. The quality of included studies was evaluated using criteria of an adapted Ottawa Scale. The systematic review was reported in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

RESULTS

Applying the two-stage screening, 9 of 1,546 articles were identified for inclusion. Nutritional quality of food bags varied widely between and within studies. Milk products, vitamins A and C, and calcium were provided in particularly low amounts. None of the studies were nationally representative and only a few studies controlled for the household composition of the recipients of food bags.

CONCLUSION

Food pantries likely have a strong influence on users' diets, but the food pantries examined in the selected studies were largely unable to support healthy diets. The distribution of more perishable foods would increase users' diet quality and may have an immense potential to address malnutrition in vulnerable population groups.

Food security among asylum seekers in Melbourne

Objectives: This research explores food insecurity among asylum seekers who are members of the Asylum Seeker Resource Centre (ASRC) in Melbourne, Australia.

Methods: Structured person‐assisted questionnaires were conducted with 56 asylum seekers. The questionnaires examined issues around access to food, cultural appropriateness of available food, transport issues, use of the ASRC Foodbank and questions about general health.

Results: Findings suggest that: 1) almost all asylum seekers in this study were food insecure; 2) most of the asylum seekers using the ASRC Foodbank have no access to food other than that provided at the centre; and 3) the reason that most asylum seekers are food insecure is related to structural problems associated with limitations imposed by different visas.

Conclusions and implications: The ability of asylum seekers to achieve food security is limited by their restricted access to welfare and government or work‐related income. Given that the current policy situation is likely to continue, providers such as the ASRC will find continuing demands on their services and increasing pressures to provide more than a ‘supplemental’ food supply.

Early childhood nutrition, active outdoor play and sources of information for families living in highly socially disadvantaged locations

AIMS

To compare nutrition and active play of children aged 0-4 years attending Supported Playgroups and mainstream services and to compare access, understanding and application of health information within these families.

METHODS

A cross-sectional study of children aged 0-4 years attending early childhood services. Following stratified random sampling, 81 parents of children attending Supported Playgroups in two highly disadvantaged municipalities of Victoria, Australia were surveyed about children's nutrition, active outdoor play/screen time and access to health information. Responses were dichotomised based on national recommendations and compared with 331 children attending maternal and child health and childcare centres (mainstream services). All outcomes except age were dichotomous and analysed using chi-square, relative risk and 95% confidence intervals.

RESULTS

More children from Supported Playgroups consumed sweet drinks (P = 0.005), 'packaged' foods (P = 0.012) and tea/coffee (P = 0.038) than mainstream children. Supported Playgroup families reported more food insecurity (P = 0.016) and excessive 'screen time' for children under 2 years (P = 0.03). Fewer Supported Playgroups parents sought advice from family members (P < 0.001) and the Internet (P = 0.014) and more experienced difficulties accessing (P < 0.001), understanding (P = 0.002) and applying health information (P < 0.001).

CONCLUSION

Despite comparable availability of child health information, Supported Playgroups children demonstrated more concerning child health practices, and families experienced greater difficulties accessing, understanding and applying advice than families from mainstream services despite living in the same highly disadvantaged locations.

A systematic review on micronutrient intake adequacy in adult minority populations residing in Europe: the need for action

This systematic review evaluated micronutrient intake inadequacy of ten micronutrients for adult ethnic minority populations residing in Europe. Pubmed was searched for studies, related references were checked and experts consulted. Ten studies were identified and six were included in the final analysis representing Albanian, Roma, Sub-Saharan African, South Asian and African-Caribbean minority groups. The Estimated Average Requirement cut point was applied to estimate inadequate intake. With the exception of a sub-Saharan African study, of seven micronutrients analysed, inadequate intakes were markedly elevated (>50 % of the population in most cases) in both genders for folate, vitamin B(12), calcium and iron (the latter in females only). A pressing need exists for intake adequacy studies with sound methodologies addressing ethnic minority groups in Europe. These populations constitute a vulnerable population for inadequate intakes and results substantiate the need for further investigation, interventions and policy measures to reduce their nutritional risk.