Food Hardship and Obesity in a Sample of Low-Income Immigrants

Findings on dietary characteristics among Haitian immigrants and the threat of food insecurity: A scoping review

Objectives

This study aimed to map and describe the available evidence on dietary characteristics and diet-related health conditions among Haitian immigrants across the globe.

Study design

Scoping review.

Methods

This review was based on the international guide Preferred Reporting Items for Systematic review and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The searches were conducted in several electronic databases in July 2023. Reports focusing on diet, nutrition, and diet-related health conditions among international Haitian immigrants published in English, Portuguese, French, or Spanish with no year limit were included. The data extracted was tabulated and presented in a narrative summary.

Results

Database search retrieved 502 records, of which 30 met the inclusion criteria. The categories that emerged from the analysis were: food consumption patterns and trends, food and nutrition insecurity, cultural identity, and diet-related health conditions. Findings suggest: available evidence underrepresents Latin America and the Caribbean context; research gaps related to adolescents and the elderly and also to noncommunicable diseases except obesity; changes in food consumption after immigration towards less healthy eating; the Haitian immigrant's preference for healthy and traditional eating patterns; many experiences of food insecurity related to poverty, unemployment, and lack of social support, especially in host countries in Latin America and the Caribbean; and a high prevalence of obesity, especially among women.

Conclusions

Further research is required in countries in Latin America, mainly. Diet-related chronic diseases, adolescents, and the elderly should be targeted for further research. We recommend: longitudinal and qualitative research; field action reports describing local and global strategies to manage Haitian migration-related food and nutrition issues; culturally appropriate dietary interventions; and policies to protect and support the most vulnerable Haitian immigrants to have their fundamental right to adequate food guaranteed, reducing health inequalities.

SNAP Participation and Emergency Department Use

OBJECTIVES

To examine whether Supplemental Nutrition Assistance Program (SNAP) participation is associated with emergency department use among low-income children and whether any such association is mediated by household food hardship and child health status and/or moderated by special health care needs (SHCN) status. We hypothesized SNAP to be associated with reduced likelihoods of emergency department use, with greater effect sizes for children with SHCN and mediation by food hardship and health status.

METHODS

In this secondary analysis, we estimated a bivariate probit model (with state-level SNAP administrative policies as instruments) within a structural equation modeling framework using pooled cross-sectional samples of children in low-income households from the 2016 to 2019 iterations of the National Survey of Children's Health (n = 24 990).

RESULTS

Among children with and without SHCN, respectively, SNAP was associated with: 22.0 percentage points (pp) (95% confidence interval [CI] 12.2-31.8pp) and 17.1pp (95% CI 7.2-27.0pp) reductions in the likelihood of household food hardship exposure (4.8pp difference-in-differences, 95% CI 2.3-7.4pp), 9.7pp (95% CI 3.9-15.5pp) and 7.9pp (95% CI 2.2-13.6) increases in the likelihood of excellent health status (1.9pp difference-in-differences, 95% CI 0.7-3.0pp), and 7.7pp (95% CI 2.9-12.5pp) and 4.3pp (95% CI 1.0-7.6pp) reductions in the likelihood of emergency department use (3.4pp difference-in-differences, 95% CI 1.8-5.1pp).

CONCLUSIONS

We found SNAP participation was associated with lower likelihoods of emergency department use, that better food hardship and health statuses mediated this association, and that effect sizes were larger among children with SHCN. Food hardship relief may improve outcomes for vulnerable children and the health systems serving them.

Systematic Review and Meta-Analysis of Metabolic Syndrome and Its Components in Latino Immigrants to the USA

The Metabolic Syndrome (MetS) is an increasingly prevalent condition globally. Latino populations in the USA have shown an alarming increase in factors associated with MetS in recent years. The objective of the present systematic review was to determine the prevalence of MetS and its risk factors in immigrant Latinos in the USA and perform a meta-analysis of those prevalence. The review included cross-sectional, cohort, or case−control studies involving adult immigrant Latinos in the USA, published during the period 1980−2020 in any language. Studies involving individuals who were pregnant, aged <18 years, immigrant non-Latinos, published outside the 1980−2020 period, or with other design types were excluded. The Pubmed, Web of Science, Embase, Lilacs, Scielo, and Google Scholar databases were searched. The risk of bias was assessed using the checklists of the Joanna Briggs Institute. The review included 60 studies, and the meta-analysis encompassed 52 studies. The pooled prevalence found for hypertension, diabetes, general obesity, and abdominal obesity were 28% (95% Confidence Interval (CI): 23−33%), 17% (95% CI: 14−20%), 37% (95% CI: 33−40%), and 54% (95% CI: 48−59%), respectively. The quality of the evidence of the primary studies was classified as low or very low. Few studies including immigrants from South America were identified. Further studies of those immigrants are needed due to the cultural, dietary, and language disparities among Latin American countries. The research protocol was registered with the Open Science Framework (OSF).

How Food Insecurity and Financial Difficulty Relate to Emotional Well-Being and Social Functioning

OBJECTIVES

Medically uninsured individuals living in poverty experience poor health and face social barriers that negatively affect their health. The purpose of this study was to examine the association between social barriers, particularly healthy food availability and financial difficulty, and well-being among uninsured free clinic patients in the United States.

METHODS

Data were collected using a self-administered paper survey at a free clinic from adult patients who spoke and read English or Spanish (N = 666) from January to April 2019.

RESULTS

Better neighborhood healthy food availability is associated with better self-reported general health. Food security is related to better emotional well-being and social functioning. Having difficulty paying rent or a mortgage is linked to worse emotional well-being and social functioning.

CONCLUSIONS

Providing health education programs may not be sufficient to promote healthy eating among underserved populations because of the social barriers that they experience, such as food insecurity and financial difficulty. Future research could be performed to determine how these social factors influence those of different social and cultural backgrounds than the participants in this study.

Food Insecurity and Cardiometabolic Conditions: a Review of Recent Research

PURPOSE OF REVIEW

To understand recent literature that examines associations between food insecurity and cardiometabolic conditions and risk factors. We included original research, systematic reviews, and meta-analyses on the topic of food insecurity and cardiometabolic risk published from January 1, 2017, to December 31, 2020. Editorials, perspectives, and case reports were excluded. After the initial search, 3 reviewers selected studies for inclusion based on relevance and methods. Ultimately, fifty studies were included.

RECENT FINDINGS

We included 35 studies of adults (20 cross-sectional observational studies, 5 longitudinal observational studies, 5 interventional studies, and 5 meta-analyses/reviews). In adults, food insecurity is associated with greater prevalence of overweight/obesity (especially for women). It is also associated with hypertension, diabetes (including worse glycemic control and more diabetes complications), coronary heart disease, congestive heart failure, stroke, and chronic kidney disease. We included 15 studies of children (11 cross-sectional observational studies and 4 longitudinal observational studies). In children, findings were more nuanced, and in particular, many studies did not find an association between food insecurity and overweight/obesity. However, authors noted that these conditions may not have had time to develop. With notable exceptions, many studies were cross-sectional, and there were few interventions. There is a robust association between food insecurity and cardiometabolic conditions and risk factors in adults, but the picture is less clear in children. Overt cardiometabolic clinical conditions develop more rarely in children, but childhood experiences may set a trajectory for worse health later in life. Detailed life course epidemiologic studies are needed to better understand this relationship. Future interventions should examine how to reduce the prevalence of food insecurity, and how best to improve health for those who experience food insecurity.

Food Insecurity, Chronic Disease and Quality of Life among Deaf Adults who use American Sign Language

This study examined the relationships of food insecurity, chronic diseases, and QoL in a U.S. sample of 630 deaf adults (18 to 89 years old; 55% female) who used American Sign Language (ASL). Measures of USDA Food Security Module, self-reported diagnoses of chronic diseases, and QoL were administered in ASL and English. Approximately 22% reported facing food insecurity, with low food security (11%) and very low food security (11.4%). QoL, but not the presence of chronic diseases, was significantly associated with food insecurity. Higher income and absence of depression acted as protective factors, reducing the risk for food insecurity.

An Evaluation of Food Insecurity and Its Correlates in a Filipino American Study Sample Residing in Clark County, Nevada

Purpose: Filipino Americans comprise over half of the Asian American population in Clark County, Nevada. Despite their large numbers, food insecurity rates are aggregated with the entire Asian American population. In 2016, 1.6% of Asian American households in Clark County were food insecure, yet, 22% of households reported annual incomes at or below 200% of the federal poverty level. This study aimed to assess the status and correlates of food insecurity specific to Filipino Americans in Clark County, Nevada.

Methods: The United States Department of Agriculture (USDA) Short Form Food Security Module was administered among 192 Filipino Americans residing in Clark County, NV. Results were viewed through the theoretical framework of the Social Ecological Model.

Results: 27.1% of respondents experienced food insecurity within the past year. Adjusted logistic regression revealed that incomes less than $20,000 (odds ratio [OR]=4.13, 95% confidence interval [CI]: 1.43–11.9), having no health insurance (OR=5.22, 95% CI: 1.67–16.34), and eating mainly American or Western foods (OR=7.3, 95% CI: 1.73–30.77) were significant predictors of food insecurity.

Conclusions: A significantly higher prevalence of food insecurity among Filipino American subpopulations, compared to the estimates for Asian Americans in Clark County, suggests the need to disaggregate data for Asian American subgroups. The Social Ecological Model provides greater context to the findings identifying that the intrapersonal and policy level factors were associated with food insecurity among our participants, thus suggesting the need to utilize multilevel interventions to address food insecurity in Filipino Americans. The findings may be utilized to inform future interventions aimed at improving the overall health and food security among Filipino Americans.

Community clinic-based lifestyle change for prevention of metabolic syndrome: Rationale, design and methods of the 'Vida Sana/healthy life' program

Purpose

and Objectives: The risk of diseases associated with Metabolic Syndrome (MetS) is higher for Hispanics living in the northeastern United States than for other racial and ethnic groups. Higher risk of diabetes, high blood lipids, obesity and limited access to continuity of care are all factors that also contribute to disproportionately poorer chronic disease outcomes for Hispanics.

Intervention approach

This article describes the planning and implementation of, and evaluation plans for the Vida Sana Program (VSP), a community-based group intervention created to address the identified MetS risks by encouraging healthier diet and physical activity behaviors among a low-income, largely Spanish speaking, and literacy limited uninsured population. Developed in response to recent calls for culturally-tailored interventions, VSP is conducted by trained bicultural/bilingual Navegantes, who deliver a culturally sensitive, fun and engaging eight-week, in-person educational series through group meetings. The intervention also includes a 40-page colorful, picture and graphic enhanced booklet to be used in the group setting and at home. The intervention focused on screening for MetS-associated disease risk factors, understanding chronic disease management, encouraging medication adherence, increasing physical activity, and healthful dietary changes such as limiting alcohol, sodium, unhealthy fats and excess carbohydrate intake, while emphasizing portion control, whole grains and healthy fats.

Conclusions

This creative, community-based approach fills an important gap in the community and in the public health literature, is well liked by health literacy limited patients, and will provide an important model of successfully engaging the Hispanic community on these important health issues.