Food Insecurity and Chronic Disease in US Young Adults: Findings from the National Longitudinal Study of Adolescent to Adult Health

Beyond the Nest: The Role of Financial Independence in Young Adult Health

BACKGROUND

This study aimed to examine the impact of neighborhood conditions and household material hardship experiences on young adult health outcomes, while also considering financial autonomy as a critical determinant of health.

METHOD

We employed a cross-sectional observational design with a diverse sample of young adults from a large urban university. Structural equation modeling was used to analyze the relationships between neighborhood conditions and material hardship with health outcomes by financial autonomy.

RESULTS

Material hardship and neighborhood conditions were significantly related to various health outcomes among young adults. Food insecurity emerged as a significant mediator linking neighborhood conditions to health including global physical health, cognitive functioning, and depression. Financially independent young adults showed stronger direct and indirect effects of neighborhood conditions on health compared to financially dependent counterparts.

CONCLUSION

This study underscores the complex interplay of neighborhood conditions, household material hardship, and financial autonomy in shaping young adult health. Our findings also suggest how the impact of SDOH on young adult health may have long-term effects later in life. Future research should consider these factors comprehensively to address disparities in emerging adult health.

Association between Food Insecurity, Socioeconomic Status of the Household Head, and Hypertension and Diabetes in Maputo City

Background: Metabolic diseases such as hypertension and diabetes are increasingly recognized as not just medical issues, but as complex conditions influenced by various factors. Objectives: This study aimed to explore the association between food insecurity (FI) and hypertension and diabetes and how socioeconomic status influences this relationship. Methods: Based on a cross‑sectional study of 1,820 participants conducted in Maputo City, FI was measured using a modified version of the US Department of Agriculture scale; metabolic diseases were assessed using self‑reports of the actual diagnoses, and data were analyzed through multinomial regression and interaction terms. Results: The findings revealed significant links between FI, socioeconomic status, hypertension and diabetes. Socioeconomic status had a clear influence on the association between FI and hypertension but showed a nuanced influence on diabetes. Specifically, regarding diabetes, the heads of households with a higher socioeconomic position were more likely to have this health condition than their counterparts with a lower socioeconomic position. Conclusions: The study underscores the complex interplay between FI and socioeconomic status in influencing the risk of metabolic diseases. Addressing FI and improving socioeconomic status may be crucial steps in mitigating the risk of hypertension and diabetes among vulnerable populations, emphasizing the importance of a holistic approach to health promotion and disease prevention.

Qualitative Analysis of a Home-Delivered Produce Prescription Intervention to Improve Food and Nutrition Security

Background/Objective: In total, 17.9% of households with children experienced food insecurity (FI) in 2023. Produce prescription interventions (PRx) are a viable intervention to address FI and improve diet quality. Few studies have explored home-delivered PRxs in children. The objective of this qualitative study is to explore the experience of a novel PRx among families with young children in households at risk of experiencing FI and diet-related chronic disease. Methods: Semi-structured interviews were conducted with caretakers after the completion of a 12-month PRx. Interviews were recorded, transcribed, and analyzed using thematic analysis to identify emergent themes. Univariate descriptive statistics were used to describe baseline demographics. Results: Twenty-five families were enrolled, from which eighteen completed the program and fifteen agreed to participate in an interview. All participants were African American women. The mean age was 30.2 (±6.4) years old, and the median household size was three. Qualitative data analysis revealed three major themes. (1) The produce delivery partially alleviated financial stress, contributing to increased produce consumption patterns; (2) the intervention positively shifted the nutrition- and cooking-related knowledge and behavior of families; and (3) familial and programmatic barriers affected participation and engagement. Conclusions: PRxs are a viable option to support families to lessen the burden of FI from financial hardship and build healthy dietary habits. These insights can inform future PRx program development, delivery, evaluation, and policy or funding decisions. Future research should examine the sustained impact of PRx on healthy eating, health outcomes among caregivers and their children, and the healthcare cost and utilization rates among PRx participants.

Overcoming challenges of managing chronic obstructive pulmonary disease in low- and middle-income countries

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) ranks among the top three global causes of death, with 90% of fatalities concentrated in low- and middle-income countries (LMICs). The projected rise in COPD burden, especially in LMICs, emphasizes the need to address the challenges for effective control and reversal of this trend. We aimed to provide an overview, and propose potential solutions to these challenges.

AREAS COVERED

We highlight the challenges faced in managing COPD in LMICs and put forward the potential approaches to mitigate the same.

EXPERT OPINION

In LMICs, the effective management of COPD encounters numerous barriers. These include limited access to critical diagnostic services, inadequately trained healthcare personnel, shortages of inhaler medications, oxygen therapy, insufficient access to vaccines, and pulmonary rehabilitation programs. Compounding the above challenges is the late presentation due to misdiagnosis by health workers, and limited access to vital diagnostics. Moreover, the pharmacological armamentarium for optimal COPD therapy, notably inhaled therapies, face constraints in both access and affordability. We propose multi-level and multifaceted interventions to address the urgent need for enhanced respiratory care, human resource capacity building, relevant diagnostic approaches, increased access to medications, government, regional and global efforts to achieve optimal COPD management in LMICs.

Rethinking Our Roots: The Ground-Up Approach to Heart Health & Planetary Sustainability

Cardiovascular disease is the leading cause of death in the United States. Poor dietary habits are not only a major modifiable risk factor for cardiovascular disease and other chronic illnesses, but they also harm planetary health. Our food system is complex, shaped by agricultural practices and human behaviors. To change it, we need to understand why current agricultural practices exist and address nutrition education, food insecurity, and nutritional security. There are effective ways to make our food system healthier, more equitable, and more sustainable. The best available evidence points to plant-forward diets as the keystone to this complex issue. This manuscript reviews how human and planetary health are connected through our food system and suggests solutions for diets that prevent and treat cardiovascular disease while promoting planetary health.

Factors Associated With Uptake of an Open Access Health Center-Based Mobile Produce Market: A Case for Expanded Eligibility

BACKGROUND

Health care-based food assistance programs show promise but are underutilized. Strict eligibility requirements and program scheduling may dampen reach and outcomes.

OBJECTIVE

To explore factors associated with uptake of a health center-based mobile produce market with no eligibility requirements and few barriers to entry.

DESIGN

A cross-sectional analysis of medical record, sociodemographic, environmental, and market attendance data was used.

PARTICIPANTS/SETTING

The study sample consisted of 3071 adults (18+ years) who were patients of an urban health center in eastern Massachusetts and registered for the mobile market during the study period of August 2016 to February 2020.

MAIN OUTCOME MEASURES

The main outcome measure was monthly market attendance over the study period.

STATISTICAL ANALYSES

T-tests and χ2 tests were used to compare market users and never-users. Multiple logistic regression was used to analyze variables associated with market attendance each month.

RESULTS

In multiple variable analyses, Supplemental Nutrition Assistance Program enrollment was associated with slightly less frequent monthly market use (odds ratio [OR], 0.989; 95% CI, 0.984-0.994). Day-of, on-site market registration was associated with more frequent monthly use than self-registration on nonmarket days (OR, 1.08; 95% CI, 1.07-1.08). Having a psychiatric or substance use disorder diagnosis was associated with slightly less frequent market attendance (OR, 0.99; 95% CI, 0.98-0.99; and OR, 0.96; 95% CI, 0.95-0.97, respectively) compared with registrants without these diagnoses.

CONCLUSIONS

Individual, community-level, and organizational factors are associated with uptake of a free mobile produce market and should be considered when designing programs.

Impact of Social Determinants of Health on Hypertension Outcomes: A Systematic Review

Despite ample evidence linking social determinants of health (SDoH) and hypertension outcomes, efforts to address SDoH in the context of hypertension prevention and self-management are not commensurate with the burden and impact of hypertension. To provide valuable insights into the development of targeted and effective strategies for preventing and managing hypertension, this systematic review, guided by the Healthy People 2030 SDoH framework, aims to summarize the inclusion, measurement, and evaluation of SDoH in studies examining hypertension outcomes, with a focus on characterizing SDoH constructs and summarizing the current evidence of their influence on hypertension outcomes. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a comprehensive search of electronic databases identified 10 608 unique records, from which 57 articles meeting inclusion criteria were analyzed. The studies, conducted nationally or regionally across the United States, revealed that higher educational attainment, health insurance coverage, income, and favorable neighborhood characteristics were associated with lower hypertension prevalence and better hypertension control among US adults. The findings underscore the importance of addressing SDoH such as education, health care access, economic stability, neighborhood environments, and social context to reduce hypertension disparities. Multilevel collaboration and community-engaged practices are necessary to tackle these disparities effectively.

A Qualitative Study of A Health Center-Based Mobile Produce Market

Healthcare-based food assistance programs have the potential to improve patients' food security, but are underutilized. We conducted a qualitative study of user and staff perceptions of an on-site mobile market at a federally-qualified health center (FQHC). Five themes were identified: 1) financial need drives the decision to use the market, 2) people attend specifically to receive healthy food, 3) users feel a connection to the FQHC, which increases participation, 4) social networks increase usage of the program, and 5) long lines, inclement weather, inaccessibility, and inconsistent marketing and communication are attendance barriers. Findings should inform implementation of future healthcare-based food assistance programs.

Exploring Sociodemographic and Chronic Disease Factors Associated With Chronic, Seasonal, Intramonthly, and Intermittent Presentations of Food Security Instability

BACKGROUND

Food insecurity impacts 13.5 million US households yearly. Although food security instability (FS-I) can have many temporal presentations, these are not measured in the current US Household Food Security Survey Module.

OBJECTIVE

Explore sociodemographic and chronic disease correlates of 4 FS-I types (chronic, seasonal, intramonthly, and intermittent) using a 3-item US Household Food Security Survey Module instability supplement.

DESIGN

This study was a secondary analysis of cross-sectional survey pilot data collected to validate the US Household Food Security Survey Module instability supplement.

PARTICIPANTS AND SETTING

Adults at risk for food insecurity (n = 420) were recruited and answered the survey on their households' behalf from April to June 2021. The participants were recruited from 7 community organizations from 5 states (California, Florida, Maryland, North Carolina, and Washington).

MAIN OUTCOME MEASURES

The main outcomes were the odds of having a chronic, seasonal, intramonthly, or intermittent FS-I score ≥1 based on several sociodemographic factors and having ≥1 chronic disease.

STATISTICAL ANALYSES PERFORMED

Differences among the 4 FS-I types were analyzed using contingency tables and χ2 tests of independence. Then, mixed-effects logistic binary and conditional regressions were run for each FS-I type using clustering by state and odds ratios and 95% CI to interpret results.

RESULTS

The most common FS-I type experienced by the sample was intramonthly (n = 183 [43%]). Nonchronic food insecurity was most likely to happen during the winter, at the end of the month, or randomly with no certain time frame. FS-I in any form was associated with low income, chronic FS-I was associated with younger age and male sex, seasonal FS-I was associated with having no government-subsidized health insurance and females, intramonthly FS-I was associated with participation in nutrition assistance programs, and intermittent FS-I had lower odds among Hispanic/Latino households.

CONCLUSIONS

Further research is needed to explore other FS-I correlates and establish causative relationships; however, these results can be used with clinical judgment for targeted food insecurity screening and treatment.

Age-related differences in the association between financial hardship and weight change during the COVID-19 pandemic

Objective

To examine the association of financial hardship with weight changes in the US during the COVID-19 pandemic.

Methods

We used data from the COVID-19's Unequal Racial Burden survey, a nationally representative, cross-sectional, online survey of diverse adults living in the US, 12/2020-2/2021. This study included 1000 Asian, Black, Latino (half Spanish-speaking), and White adults and 500 American Indian or Alaska Native, Native Hawaiian or Pacific Islander, and multiracial adults (5500 total). Age-specific (18-39, 40-59, ≥60) associations between financial hardship domains and weight change were estimated using multinomial logistic regression, adjusted for demographic and health characteristics.

Results

Financial hardship during the COVID-19 pandemic was prevalent across all age groups (18-39: 76.2 %; 40-59: 75.6 %; ≥60: 50.6 %). Among adults aged 18-39 and ≥ 60 years old, food insecurity was significantly associated with weight loss (18-39: aOR = 1.42, 95 % CI = 1.04, 1.95; ≥60: aOR = 3.67, 95 % CI = 1.50, 8.98). Among all age groups, unmet healthcare expenses was also associated with weight loss (18-39: aOR = 1.31, 95 % CI = 1.01, 1.70; 40-59: aOR = 1.49, 95 % CI = 1.06, 2.08; ≥60: aOR = 1.73, 95 % CI = 1.03, 2.91). Among adults aged 18-39 and ≥ 60 years old, lost income was significantly associated with weight gain (18-39: aOR = 1.36, 95 % CI = 1.09-1.69; ≥60: aOR = 1.46, 95 % CI = 1.04, 2.06), and among adults 40-59 years old, experiencing increased debt was significantly associated with weight gain (aOR = 1.50, 95 % CI = 1.13, 1.99).

Conclusions

For those aged 18-39 and ≥ 60 years old experiencing financial hardship during the COVID-19 pandemic was associated with both weight loss and weight gain. Less correlation was observed among adults aged 40-59.

Food insecurity and suicidal behaviours among Bangladeshi university students: a multi-institutional cross-sectional study

OBJECTIVE

Suicidal behaviours among students pose a significant public health concern, with mental health problems being well-established risk factors. However, the association between food insecurity (FIS) and suicidal behaviours remains understudied, particularly in Bangladesh. This study aimed to investigate the relationship between FIS and suicidal behaviours among Bangladeshi university students.

DESIGN

A cross-sectional survey using convenience sampling was conducted between August 2022 and September 2022. Information related to socio-demographics, mental health problems, FIS and related events and suicidal behaviours were collected. Chi-squared tests and multivariable logistic regression models, both unadjusted and adjusted, were employed to examine the relationship between FIS and suicidal behaviour.

SETTING

Six public universities in Bangladesh.

PARTICIPANTS

This study included 1480 students from diverse academic disciplines.

RESULTS

A substantial proportion of respondents experienced FIS, with 75·5 % reporting low or very low food security. Students experiencing FIS had a significantly higher prevalence of suicidal ideation, plans and attempts compared with food-secure students (18·6 % v. 2·8 %, 8·7 % v. 0·8 % and 5·4 % v. 0·3 %, respectively; all P < 0·001). In addition, students who have personal debt and participate in food assistance programmes had a higher risk of suicidal behaviours.

CONCLUSIONS

This study highlights the association between FIS and suicidal behaviours among university students. Targeted mental health screening, evaluation and interventions within universities may be crucial for addressing the needs of high-risk students facing FIS.

Homelessness and Food Insecurity During Emerging Adulthood: Associations With Changes in Behavioral and Physical Health Over a Two-Year Period

PURPOSE

For emerging adults in the United States, economic instability is a widespread problem with implications for the successful transition to adulthood. This study examines how two indicators of economic instability, homelessness and food insecurity, are associated with changes in health-related outcomes over a two-year period.

METHODS

The analytic sample (N = 2,182) completed online surveys in 2019-2020 (mean age 23 years) and 2021-2022 (mean age 25 years). Regression analyses were conducted for the full sample, as well as by sexual or gender diverse (SGD) identity (17.8% of sample identified as SGD) and race/ethnicity (76.3% identified as non-White).

RESULTS

At age 23, 8.2% of participants reported homelessness and 31.2% reported food insecurity. In the full sample, homelessness and food insecurity were associated with increased depression, anxiety, physical ailments, and drug problems two years later. A similar pattern emerged for those identifying as non-SGD. The only associations for SGD-identifying participants were food insecurity with increased anxiety, depression, and physical ailments. Racial/ethnic differences indicated that homelessness was associated with increased depression and anxiety among Hispanics, and physical ailments and drug consequences among Asians, but fewer drug problems among Whites. Food insecurity was associated with increased depression in all racial/ethnic groups, anxiety among Hispanics and Asians, physical ailments among Whites and Asians, and drug problems among Asians.

DISCUSSION

Homelessness and food insecurity predicted worse health outcomes during the transition to adulthood, with varying results across SGD and racial/ethnic subgroups. It is important for future research to continue examining long-term effects of economic instability on health disparities during this important developmental period.

Food insecurity screening and local food access: Contributions to nutritional outcomes among children and adults with cystic fibrosis in the United States

BACKGROUND

As the nutritional status of people with CF (PwCF) is associated with their socioeconomic status, it is important to understand factors related to food security and food access that play a role in the nutritional outcomes of this population. We assessed the contributions of CF program-level food insecurity screening practices and area-level food access for nutritional outcomes among PwCF.

METHODS

We conducted a cross-sectional analysis of 2019 data from the U.S. CF Patient Registry (CFFPR), linked to survey data on CF program-level food insecurity screening and 2019 patient zip code-level food access. Pediatric and adult populations were analyzed separately. Nutritional outcomes were assessed with annualized BMI percentiles (CDC charts) for children and BMI (kg/m2) for adults, with underweight status defined as BMIp <10% for children and BMI <18.5 kg/m2 for adults, and overweight or obese status defined as BMIp >85% for children and BMI >25 kg/m2 for adults. Analyses were adjusted for patient sociodemographic and clinical characteristics.

RESULTS

The study population included 11,971 pediatric and 14,817 adult PwCF. A total of 137 CF programs responded to the survey, representing 71% of the pediatric sample and 45% of the CFFPR adult sample. The joint models of nutritional status as a function of both program-level food insecurity screening and area-level food access produced the following findings. Among children with CF, screening at every visit vs less frequently was associated with 39% lower odds of being underweight (OR 0.61, p = 0.019), and the effect remained the same and statistically significant after adjusting for all covariates (aOR 0.61, p = 0.047). Residence in a food desert was associated both with higher odds of being underweight (OR 1.66, p = 0.036; aOR 1.58, p = 0.008) and with lower BMIp (-4.81%, p = 0.004; adjusted -3.73%, p = 0.014). Among adults with CF, screening in writing vs verbally was associated with higher odds of being overweight (OR 1.22, p = 0.028; aOR 1.36, p = 0.002) and higher BMI (adjusted 0.43 kg/m2, p = 0.032). Residence in a food desert was associated with higher odds of being underweight (OR 1.48, p = 0.025).

CONCLUSIONS

Food insecurity screening and local food access are independent predictors of nutritional status among PwCF. More frequent screening is associated with less underweight among children with CF, whereas screening in writing (vs verbally) is associated with higher BMI among adults. Limited food access is associated with higher odds of being underweight in both children and adults with CF, and additionally with lower BMI among children with CF. Study results highlight the need for standardized, evidence-based food insecurity screening across CF care programs and for equitable food access to optimize the nutritional outcomes of PwCF.

Association of Food Desert Residency and Preterm Birth in the United States

INTRODUCTION

Food deserts are a major public health concern. Inadequate access to healthy food has been associated with poor nutrition and the development of dietary related chronic conditions.

OBJECTIVE

To determine the association between geographic access to nutritious food and preterm birth and whether gestational hypertension mediates this relationship.

METHODS

Food access data was retrieved from the U.S. Department of Agriculture Food Access Research Atlas (2019) and used to quantify the percentage of Census tracts within each county that were food deserts: low-income tracts with limited access to grocery stores, supermarkets, or other sources of healthy, nutritious foods. These data were merged with US birth records from 2018 to 2019 by using the maternal county of residence (n = 7,533,319). We fit crude and adjusted logistic regression models with generalized estimating equations to determine the association between living in a food desert and the odds of preterm birth. We conducted a secondary within-group analysis by stratifying the fully adjusted model by race for non-Hispanic White and non-Hispanic Black birthing people.

RESULTS

In the fully adjusted model, we found a dose-response relationship. As the prevalence of tract-level food deserts within counties increased, so did the likelihood of preterm birth (mid-range: odds ratio (OR) = 1.04, 95% confidence interval (C.I.) 1.01-1.07; high: OR = 1.07, 95% C.I. 1.03-1.11). Similar results were seen in the White-Black stratified models. However, a disparity remained as Black birthing people had the highest odds for preterm birth. Lastly, gestational hypertension appears to mediate the relationship between nutritious food access and preterm birth (natural indirect effect (NIE) = 1.01, 95% CI = 1.00, 1.01).

CONCLUSION

It is salient, particularly for Black birthing people who experience high rates of adverse birth outcomes, that the role of food desert residency be explored within maternal and child health disparities.

Using Natural Language Processing to Explore Social Media Opinions on Food Security: Sentiment Analysis and Topic Modeling Study

BACKGROUND

Social media has the potential to be of great value in understanding patterns in public health using large-scale analysis approaches (eg, data science and natural language processing [NLP]), 2 of which have been used in public health: sentiment analysis and topic modeling; however, their use in the area of food security and public health nutrition is limited.

OBJECTIVE

This study aims to explore the potential use of NLP tools to gather insights from real-world social media data on the public health issue of food security.

METHODS

A search strategy for obtaining tweets was developed using food security terms. Tweets were collected using the Twitter application programming interface from January 1, 2019, to December 31, 2021, filtered for Australia-based users only. Sentiment analysis of the tweets was performed using the Valence Aware Dictionary and Sentiment Reasoner. Topic modeling exploring the content of tweets was conducted using latent Dirichlet allocation with BigML (BigML, Inc). Sentiment, topic, and engagement (the sum of likes, retweets, quotations, and replies) were compared across years.

RESULTS

In total, 38,070 tweets were collected from 14,880 Twitter users. Overall, the sentiment when discussing food security was positive, although this varied across the 3 years. Positive sentiment remained higher during the COVID-19 lockdown periods in Australia. The topic model contained 10 topics (in order from highest to lowest probability in the data set): "Global production," "Food insecurity and health," "Use of food banks," "Giving to food banks," "Family poverty," "Food relief provision," "Global food insecurity," "Climate change," "Australian food insecurity," and "Human rights." The topic "Giving to food banks," which focused on support and donation, had the highest proportion of positive sentiment, and "Global food insecurity," which covered food insecurity prevalence worldwide, had the highest proportion of negative sentiment. When compared with news, there were some events, such as COVID-19 support payment introduction and bushfires across Australia, that were associated with high periods of positive or negative sentiment. Topics related to food insecurity prevalence, poverty, and food relief in Australia were not consistently more prominent during the COVID-19 pandemic than before the pandemic. Negative tweets received substantially higher engagement across 2019 and 2020. There was no clear relationship between topics that were more likely to be positive or negative and have higher or lower engagement, indicating that the identified topics are discrete issues.

CONCLUSIONS

In this study, we demonstrated the potential use of sentiment analysis and topic modeling to explore evolution in conversations on food security using social media data. Future use of NLP in food security requires the context of and interpretation by public health experts and the use of broader data sets, with the potential to track dimensions or events related to food security to inform evidence-based decision-making in this area.

A comparative study of health outcomes between elderly Migrant and non-migrant population in India: Exploring health disparities through propensity score matching

Migrants constitute a vulnerable segment of the population, particularly susceptible to various health challenges. Despite this, limited research has delved into the comparative health statuses of migrants and non-migrants in the rising elderly population. This study aims to bridge this gap by exploring health disparities between these two groups. Leveraging data from a nationally representative, large-scale Longitudinal Ageing Study in India (LASI) survey (n = 29002; 3103 Migrants and 25899 Non-migrants), this research focuses on four health indicators: self-rated health (SRH), depression, multimorbidity, and functional limitations. The study undertakes descriptive and bivariate analyses for migrant and non-migrant groups and employs propensity score matching techniques to fulfil its objectives. The findings reveal that for respective migrant and non-migrant populations, the prevalence of poor-SRH was 24.04 % and 16.29 %; depression was 12.32 % and 6.62 %; multimorbidity was 26.78 % and 15.71 %, and functional limitation was 28.35 % and 23.13 %. The study uncovers a 2.4 percentage point increase in poor self-rated health, a 1.0 percentage point rise in depression, and notably, a 4.2 and 1.0 percentage point elevation in multimorbidity and functional limitations among migrants relative to non-migrants. Evident from the outcomes is a stark health disparity, emphasising migrants' heightened vulnerability across multiple health dimensions. The implication of this research highlights the necessity for policy interventions aimed at eliminating health inequalities between migrant and non-migrant populations.

Dietary Sodium and Potassium Patterns in Adults with Food Insecurity in the Context of Hypertension Risk

Background

Food insecurity (FIS), characterized by the lack of consistent access to nutritious food, is associated with hypertension and adverse health outcomes. Despite evidence of a higher prevalence of hypertension (HTN) in patients living with FIS, there is limited data exploring the underlying mechanism.

Methods

We conducted a cross-sectional analysis of 17,015 adults aged 18-65 years, using dietary recall data from the National Health and Nutrition Examination Survey (2011-2018). Univariate and multivariable analyses were used to examine the association between FIS, HTN, and dietary sodium and potassium levels.

Results

Individuals reporting FIS had a significantly lower mean intake of potassium (2.5±0.03 gm) compared to those in food-secure households (2.74±0.02 gm). No significant difference was found in the mean dietary sodium intake based on food security status. Non-Hispanic Black participants showed a high prevalence of HTN and FIS. While Non-Hispanic White and Hispanic participants had a high prevalence of FIS, it did not appear to influence their risk of HTN.

Conclusions

Adults with FIS and HTN were more likely to report a lower dietary potassium intake. Increasing access to healthy foods, particularly potassium-rich foods, for individuals facing FIS, may contribute to reducing the HTN prevalence and improving cardiovascular outcomes.

Longitudinal Associations of Food Security with Health and Dietary Factors among Food FARMacy Participants during COVID-19 in New York City

In cross-sectional studies, food insecurity is associated with adverse health and dietary outcomes. Whether self-reported health and dietary outcomes change in response to improvements in food security has not been examined. We sought to examine how increases in food security are related to changes in health and dietary factors. In this longitudinal, observational study, we included adult participants in a clinical-community emergency food assistance program in New York City from July 2020 to November 2021. Program staff measured food security with a validated six-item measure at program enrollment and six-month re-enrollment. Participants self-reported health and dietary factors (vegetable, fruit, juice, and sugar-sweetened beverage (SSB) consumption frequency). We used multivariable regression to examine associations between change in food security with change in health and dietary factors over six months. Among 310 participants, the mean food security score improved by 1.7 ± 2.3 points over six months. In unadjusted models, each point improvement in food security was associated with increased vegetable (β = 0.10 times; 95% CI: 0.05-0.15); fruit (β = 0.08 times; 95% CI: 0.03-0.14); and juice (β = 0.10 times; 95% CI: 0.05-0.15) consumption. In adjusted models, results remained significant for vegetable and fruit consumption, but not juice. Change in food security was not associated with change in health or SSB outcomes. In this cohort during COVID-19, improved food security was associated with improved vegetable and fruit consumption. Randomized trials that examine the effectiveness of clinical-community partnerships focused on improving food security and nutrition are warranted.

Association of emergency allotment discontinuation with household food insufficiency in Supplemental Nutrition Assistance Program participants: A quasi-experimental study

OBJECTIVE

The Supplemental Nutrition Assistance Program (SNAP) was modified to mitigate food insecurity faced by low-income families during the pandemic. These changes included enhancement of SNAP benefits via 2020 emergency allotments (EA). Despite the high food price inflation in 2022, 17 states ceased providing EA benefits by end of 2022. The objective of this research is to examine the impact of EA discontinuation on food insufficiency.

METHODS

Using Household Pulse Survey data from December 2021-January 2023, SNAP participants (n = 57,556) from states that discontinued EA at some point during the study period and those from states that did not discontinue EA were included. The main analyses examined the impact of EA discontinuation on food insufficiency via staggered difference-in-difference models using two-way fixed effects (TWFE) regression. Additional analyses examined this association using Callaway-Sant'Anna approach for difference-in-difference analyses.

RESULTS

Using TWFE, EA discontinuation was significantly associated with increased food insufficiency in the overall sample, as well as in individuals who were non-Hispanic White and Hispanic, and who had annual family incomes of less than $25,000. Investigation of time-varying association of EA termination with food insufficiency suggested that EA discontinuation was significantly associated with greater food insufficiency in the second week following rollback. DiD analyses using Callaway-Sant'Anna approach suggested that states' rollback of EA was significantly associated with higher food insufficiency in non-Hispanic White individuals.

CONCLUSION

Findings imply that EA discontinuation, amidst the corresponding surge in inflation, could have contributed to increased rates of household food insufficiency.

Assessing the effect of adverse economic events on severity of hunger among food pantry clients

This study assessed relationship between adverse economic events (AEE) and hunger level (i.e., little to no, moderate, severe). A cross-sectional survey was conducted from June to August 2018 in 10 food pantries with 616 food pantry users. Hunger level was assessed by the Household Hunger Scale. AEE were evaluated over the past 3 months. Participants (60.55%) experienced unexpected or increased medical expenses (17.69%), job loss (13.64%), pay reduction (11.85%), and death of a family member (9.09%). Pay reduction (OR = 1.87, 95% CI: 1.12, 3.14) and increased debt (OR = 2.71, 95% CI: 1.92, 3.84) were associated with moderate hunger; death of a family member (OR = 2.43, 95% CI: 1.21, 4.90), pay reduction (OR = 2.95, 95% CI: 1.24, 7.04), and increased debt (OR = 3.46, 95% CI: 1.98, 6.04) were associated with severe hunger. Awareness of AEE can inform public health programs and policies for people in need of additional resources, which is essential in times of increased economic instability.

Harnessing community expertise in understanding food insecurity to inform responses in a local government area in Victoria, Australia: a mixed methods photovoice study

BACKGROUND

Local food systems which support affordable, equitable, accessible, and sustainable food are important to enhance food access and reduce food insecurity. Cardinia Shire Council, a local government in Victoria, Australia has developed and endorsed a 'Community Food Strategy' to support their local food system and food security. This study aimed to explore local government community member perspectives regarding food access within their local food environment, and suggested areas to be addressed to better support access.

METHODS

A sequential mixed methods photovoice methodology was implemented. Participants aged over 18 years, who resided in Cardinia Shire, completed an online quantitative survey to explore demographics, food access and food security status and severity (18-item USDA Household Food Security Survey Module). The qualitative photovoice method was used, whereby participants were asked to take photographs that represent their experiences of food access. These photographs were used as prompts in a semi-structured interview Interview data were thematically analysed.

RESULTS

Seventeen participants completed the study, of which five participants experienced varied severity levels of food insecurity. From the photovoice interviews four themes were developed: 1) Food: a connector to self, people and place, 2) Influencers of food access and triggers for food insecurity, 3) Savvy food literacy skills to support access to food, 4) Consequences of and struggles with food insecurity. Participants suggested recommendations for action to support future food access in their community.

CONCLUSIONS

While food choice is influenced by a range of determinants, the local food environment greatly impacts both food access and food choice. A supportive local food system which promotes inclusion of a community voice, community connectedness, food literacy and physical and economic access to local produce is crucial to support food security.

Is household food insecurity related to mothers' stress, anxiety and depression in Iran?

Food insecurity is a public health concern with pervasive effects on numerous human biological factors. In addition to physical problems, food insecurity may have adverse social and psychological impacts. The present study aimed to determine the correlations between household food insecurity and stress, anxiety, and depression in mothers living in Mashhad, Iran. In this cross-sectional study we recruited 312 mothers. We collected data on the food insecurity status of households using the Household Food Insecurity Access Scale (HFIAS) and used the Depression Anxiety Stress Scale (DASS) to assess the levels of stress, anxiety, and depression in the subjects. The prevalence rate of food insecurity was 51.9%, and the prevalence rate of stress, anxiety, and depression was 70.2%, 70.2%, and 55.1%, respectively. In the food-insecure group, 94.3% of the mothers had stress, 91.4% had anxiety, and 87.1% had depression. While in the food-secure group, 60.7%, 61.3%, and 37.3% of the mothers had stressed, anxiety, and depression, respectively. In all the analytical models, food insecurity was significantly and positively associated with stress, anxiety, and depression (P < 0.001). Our results suggested that a higher level of food insecurity correlates with extreme degrees of stress, anxiety, and depression. Therefore, the improvement of mothers' mental health in terms of stress, anxiety, and depression depends on the improvement of household food insecurity.

Factors Associated with Food Delivery App use Among Young Adults

Food delivery apps are popular among young adults and often used to purchase calorie-dense foods. Limited research exists on the use of food delivery apps among young adults. The purpose of this study was to describe food delivery app use among young adults and examine the correlates of food delivery app use. Data are from a panel of U.S. young adults aged 18-25 (n = 1,576) who completed an online survey between January-April 2022. Participants were 51.8% female and 39.3% identified as non-Hispanic white, 24.4% as Hispanic/Latinx, 29.6% as non-Hispanic Black, and 6.8% as another race/ethnicity. Poisson regression was used to examine the relationship between food delivery app use and age, race, ethnicity, sex, SES, food insecurity, living arrangement, financial responsibility, and full-time student status. Young adults used food delivery apps approximately twice a week. Participants who identified as non-Hispanic Black and Hispanic/Latinx used food delivery apps more frequently than participants who identified as white. Having higher perceived subjective social status, food insecurity, financial responsibility, and being a full-time student were significantly associated with using food delivery apps more frequently. Living with someone else was associated with using food delivery apps less frequently. This study provides a first step in understanding the characteristics of young adults who use food delivery apps. Given that food delivery apps are a new technology that can both increase access to unhealthy food options as well as healthy food options, further research is needed to better understand the types of food purchased through food delivery apps.

Risk factors of food insecurity among students at diverse post-secondary education institutions: a cross-sectional examination

OBJECTIVE

Identify the prevalence of food insecurity (FI) and compare sociodemographic, mental, physical, behavioral, and environmental risk factors for FI among students at a private university, community college, and historically black college or university (HBCU).

PARTICIPANTS

Adult students attending a private university, community college, or HBCU (n = 4,140) located within the southeastern United States.

METHODS

Using an online survey (2017-2019), FI, sociodemographic, mental, physical, behavioral, and environmental data were collected to understand their association with FI.

RESULTS

Up to 37.1% of students experienced FI. Identifying as black, other/multi-racial, having poor sleep, federal loans, depressive symptoms, high stress, social isolation, or a chronic condition were associated with FI. These associations varied by institution.

CONCLUSIONS

FI is prevalent within diverse post-secondary institutions that serve traditional and nontraditional students with risk factors varying between institutions. The prevalence of FI and risk factors can inform institutional policy responses to ameliorate the effects of FI.

Food Insecurity and Chronic Kidney Disease: Considerations for Practitioners

The coronavirus disease 2019 pandemic has exacerbated existing health disparities related to food security status. Emerging literature suggests individuals with Chronic Kidney Disease (CKD) who are also food insecure have a greater likelihood of disease progression compared to food secure individuals. However, the complex relationship between CKD and food insecurity (FI) is understudied relative to other chronic conditions. The purpose of this practical application article is to summarize the recent literature on the social-economic, nutritional, to care through which FI may negatively impact health outcomes in individuals with CKD. While several studies have reported on the cross-sectional prevalence of FI among persons with CKD, literature is lacking about the severity and duration of exposure to FI on CKD outcomes. Future research is needed to better understand how FI impairs CKD care, nutritional and structural barriers that impact disease prevention and disease progression, and effective strategies to support patients.

A coalition-driven examination of organization capacity to address food insecurity in Greater Houston: a qualitative research study

Background

Economic and social hardships have worsened food insecurity, particularly among low income and racial-ethnic minority groups. Given the core goal of the 150+ member Houston Health Equity Collective (HEC) to reduce food insecurity by 5% in 2025, we explored member organizations' capacity and challenges faced in screening and responding to food insecurity through care coordination efforts.

Methods

A twice-administered Qualtrics XM survey (Provo, Utah) with 76 organizations, followed by five focus groups with 22 of these organizations, explored reach and response efforts to food insecurity. Qualitative assessments lasted between 0.5 to 1.5 h, were audio-recorded, cleaned, coded, and thematically analyzed using NVivo, version 11 (Burlington, Massachusetts). The qualitative study was guided by a general inductive approach. In total, over 6 h of audiovisual recording were extracted, and over 100 pages of text exported to NVivo for data analysis. The research team read and coded transcripts independently using the codebook, and met routinely to discuss and resolve codes -resulting in numerous revisions to the codebook. Coding structure was discussed at multiple meetings and differences were addressed through consensus. Predominant qualitative themes impacting food insecurity screening were "stigma and cultural-related barriers", "clinic capacity and attitudes", "need to focus on upstream influences of food insecurity and SDOH needs", "impact of COVID-19", and "need for HEC system responses". Main recommendations to enhance screening and reach included improving staff culture, enhancing cultural sensitivity across organizational practices, and using shared technology to coordinate care. Respondents stated that the HEC can drive these recommendations through networking opportunities, use of shared resource directory, and placing focus on upstream factors.

Conclusions

Recommendations to target food insecurity must focus on organizational staff responsiveness and sensitivity to patients' needs. Of equal importance is the need for increased attention to the upstream influencers and integration of systems-level interventions to holistically target the barriers impacting food insecurity.

A Scoping Review of Nutritional Biomarkers Associated with Food Security

Food insecurity affects more than 40 million individuals in the United States and is linked to negative health outcomes due, in part, to poor dietary quality. Despite the emergence of metabolomics as a modality to objectively characterize nutritional biomarkers, it is unclear whether food security is associated with any biomarkers of dietary quality. This scoping review aims to summarize studies that examined associations between nutritional biomarkers and food security, as well as studies that investigated metabolomic differences between people with and without food insecurity. PubMed, Embase, Scopus, and AGRICOLA were searched through August 2022 for studies describing food insecurity and metabolic markers in blood, urine, plasma, hair, or nails. The 78 studies included consisted of targeted assays quantifying lipids, dietary nutrients, heavy metals, and environmental xenobiotics as biochemical features associated with food insecurity. Among those biomarkers which were quantified in at least five studies, none showed a consistent association with food insecurity. Although three biomarkers of dietary quality have been assessed between food-insecure versus food-secure populations, no studies have utilized untargeted metabolomics to characterize patterns of small molecules that distinguish between these two populations. Further studies are needed to characterize the dietary quality profiles of individuals with and without food insecurity.

Food Insecurity and Blood Pressure in a Multiethnic Population

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

Screen Time from Adolescence to Adulthood and Cardiometabolic Disease: a Prospective Cohort Study

BACKGROUND

Previous studies have analyzed the relationship between screen time and cardiometabolic disease risk factors among adolescents, but few have examined the longitudinal effects of screen time on cardiometabolic health into adulthood using nationally representative data.

OBJECTIVE

To determine prospective associations between screen time and later cardiometabolic disease over a 24-year period using a nationally representative adolescent cohort.

DESIGN

Longitudinal prospective cohort data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) collected from 1994 to 2018.

PARTICIPANTS

Adolescents aged 11-18 years old at baseline (1994-1995) followed for 24 years.

MAIN MEASURES

Predictors: screen time (five repeated measures of self-reported television and video watching from adolescence to adulthood).

OUTCOMES

Five repeated measures of body mass index (BMI); two repeated measures of waist circumference, hypertension, hyperlipidemia, and diabetes collected at 15- and 24-year follow-up exams.

KEY RESULTS

For the 7105 adolescents in the sample (49.7% female, 35.0% non-white), the baseline adolescent average screen time per day was 2.86 ± 0.08 hours per day, which generally declined through 24-year follow-up. Average BMI at baseline was 22.57 ± 0.13 kg/m2, which increased to 30.27 ± 0.18 kg/m2 through follow-up. By 24-year follow-up, 43.4% of participants had obesity, 8.4% had diabetes, 31.8% had hypertension, and 14.9% had hyperlipidemia. In mixed-effects generalized linear models, each additional hour of screen time per day was associated with 0.06 (95% CI 0.04-0.09) within-person increase in BMI. Each additional hour of screen time per day was associated with higher within-person odds of high waist circumference (AOR 1.17, 95% CI 1.09-1.26), obesity (AOR 1.09, 95% CI 1.03-1.15), and diabetes (AOR 1.17, 95% CI 1.07-1.28). Screen time was not significantly associated with hypertension or hyperlipidemia.

CONCLUSIONS

In this prospective cohort study, higher screen time in adolescence was associated with higher odds of select indicators of cardiometabolic disease in adulthood.

Association of Unmet Social Needs With Level of Capability in People With Persistent Knee Pain

BACKGROUND

Musculoskeletal providers are increasingly recognizing the importance of social factors and their association with health outcomes as they aim to develop more comprehensive models of care delivery. Such factors may account for some of the unexplained variation between pathophysiology and level of pain intensity and incapability experienced by people with common conditions, such as persistent nontraumatic knee pain secondary to osteoarthritis (OA). Although the association of one's social position (for example, income, employment, or education) with levels of pain and capability are often assessed in OA research, the relationship between aspects of social context (or unmet social needs) and such symptomatic and functional outcomes in persistent knee pain are less clear.

QUESTIONS/PURPOSES

(1) Are unmet social needs associated with the level of capability in patients experiencing persistently painful nontraumatic knee conditions, accounting for sociodemographic factors? (2) Do unmet health-related social needs correlate with self-reported quality of life?

METHODS

We performed a prospective, cross-sectional study between January 2021 and August 2021 at a university academic medical center providing comprehensive care for patients with persistent lower extremity joint pain secondary to nontraumatic conditions such as age-related knee OA. A final 125 patients were included (mean age 62 ± 10 years, 65% [81 of 125] women, 47% [59 of 125] identifying as White race, 36% [45 of 125] as Hispanic or Latino, and 48% [60 of 125] with safety-net insurance or Medicaid). We measured patient-reported outcomes of knee capability (Knee injury and Osteoarthritis Outcome Score for Joint Replacement), quality of life (Patient-Reported Outcome Measure Information System [PROMIS] Global Physical Health and PROMIS Global Mental Health), and unmet social needs (Accountable Health Communities Health-Related Social Needs Survey, accounting for insufficiencies related to housing, food, transportation, utilities, and interpersonal violence), as well as demographic factors.

RESULTS

After controlling for demographic factors such as insurance status, education attained, and household income, we found that reduced knee-specific capability was moderately associated with experiencing unmet social needs (including food insecurity, housing instability, transportation needs, utility needs, or interpersonal safety) (standardized beta regression coefficient [β] = -4.8 [95% confidence interval -7.9 to -1.7]; p = 0.002 and substantially associated with unemployment (β = -13 [95% CI -23 to -3.8]; p = 0.006); better knee-specific capability was substantially associated with having Medicare insurance (β = 12 [95% CI 0.78 to 23]; p = 0.04). After accounting for factors such as insurance status, education attained, and household income, we found that older age was associated with better general mental health (β = 0.20 [95% CI 0.0031 to 0.39]; p = 0.047) and with better physical health (β = 0.004 [95% CI 0.0001 to 0.008]; p = 0.04), but effect sizes were small to negligible, respectively.

CONCLUSION

There is an association of unmet social needs with level of capability and unemployment in patients with persistent nontraumatic knee pain. This finding signals a need for comprehensive care delivery for patients with persistent knee pain that screens for and responds to potentially modifiable social risk factors, including those based on one's social circumstances and context, to achieve better outcomes.

LEVEL OF EVIDENCE

Level II, prognostic study.

Food insecurity and health outcome nexus: empirical evidence from the informal sector enterprises in Bangladesh

BACKGROUND

Food insecurity indicates the difficulty of constantly obtaining adequate food because of limited economic resources. Food insecurity challenges the desired health outcomes. Although extensive literature has examined the associations between food security and health, low-wage informal sector workers have been less frequently addressed in this topic. The present study has focused on food insecurity among the workers working in the informal sector enterprises who experienced entrenched disadvantage during COVID-19 and examines the relationship between food insecurity and health status as measured by self-reported physical and mental health conditions.

METHODS

This study has utilized cross-sectional data collected from workers working in informal manufacturing and business enterprises in Dhaka city of Bangladesh. The Food Insecurity Experience Scale (FIES) with eight items is used to screen for food insecurity, and the Short Form 12v2 (SF12v2) scale with 12 questions, and validated for use with Bengali respondents, is used to measure the health status of the informal workers. A health production function has been constructed where the health status (both physical and mental) of workers is associated with food insecurity and other socio-economic and health care factors. Empirical analyses of the study have included descriptive statistics, mean score comparisons, and multivariate regression analyses to identify the predictive factors of the physical and mental health status of the workers.

RESULTS

A moderate to severe food insecurity is found to be responsible for the poor health status (both physical and mental) of the selected working group population. Moreover, age over 40 years, having a large family, dissatisfaction with the work place, and the prevalence of occupational health risks are linked to lower physical health, while dissatisfaction with the work place and the incidence of severe diseases contribute to poor mental health status along with food insecurity.

CONCLUSIONS

Extending social and economic protection towards health coverage and basic consumption is suggested as an immediate action to save lives and ensure productivity of the informal workers. Besides, an increase in income and ensuring decent working conditions are also recommended for the health, safety and satisfaction of workers working in informal sector enterprises.

COVID-19 experiences of small-scale fishing households: The case of Lake Victoria, Kenya

Introduction

The impact of COVID-19 on small-scale fishing communities is of great concern given the importance of aquatic foods in trade, nutrition and livelihoods. Using a case study of Lake Victoria, augmented by published literature, we examine the socioeconomic dynamics and severity of COVID-19 impacts on Kenyan fishing communities.

Methods

A household level questionnaire was administered through phone interviews on a monthly basis from June 2020 to May 2021, including a focus group discussion in July 2021.

Results

We find that multifold fear of COVID-19 infection and control measures were present and varied across case rates and stringency of control measures. Fishers and traders reported being affected by disease control measures that limited market access and their ability to fish overnight. In spite of these worries, and contrary to what has been reported in the published literature regarding impacts observed in the early months of the pandemic, we see stable participation in fishing and fish trading over time despite the pandemic. Food insecurity was high before and during the COVID-19 pandemic, but did not substantially shift with the pandemic.

Conclusion

Our findings suggest that Kenyan fishing and fish trading households adopted diverse strategies to cope and balance generating income to provide for their families and staying safe. Our results underscore the need to understand ways in which acute pandemic impacts evolve over time given that effects are likely heterogeneous across small-scale fishing communities.

Interactive association of chronic illness and food insecurity with emergency department utilization among school-age children in the United States: A cross-sectional study

Background and Aims

Food insecurity combined with chronic disease conditions is a risk factor for Emergency Department (ED) utilization, an indicator of poor quality of care. However, such an association is not certain among school-age children with chronic conditions. Therefore, we aim to determine the association of food insecurity, chronic conditions, and ED utilization among school-age children in the United States.

Methods

We analyzed the data from the 2017 Medical expenditure panel survey (MEPS) among children aged 6-17 years (N = 5518). MEPS data was released electronically by the Agency for Healthcare Research and Quality (AHRQ). We identified four groups of school-age children based on the presence of food security and chronic conditions: 1) with food insecurity and chronic conditions; 2) no food insecurity and chronic conditions; 3) with food insecurity and no chronic conditions; and 4) no food insecurity and no chronic conditions. We compared ED utilization among these four groups using incidence rate ratios (IRR) after adjusting children's age, sex, race and ethnicity, household income, insurance coverage, obesity, and geographic region using count data model, specifically multivariable Poison regression. We used SAS 9.4 and STATA 14.2 for all the data analyses.

Results

There were unweighted 5518 school-age children who represented weighted 50,479,419 school-age children in the final analysis. Overall, 6.0% had food insecurity with chronic conditions. These children had higher ED utilization (19.7%) than the other three groups (13.3%, 8.8%, and 7.2%, p < 0.001). The adjusted IRR of ED utilization among school-age children with food insecurity and chronic conditions was 1.90 (95% confidence interval 1.20-3.01, p = 0.007) compared with those with food security and chronic conditions.

Conclusion

One in 16 school-age children has both food insecurity and chronic conditions. Food insecurity was positively associated with frequent ED visits in the presence of chronic conditions. Therefore, addressing food insecurity may reduce the risk of ED visits.

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

PURPOSE

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

METHODS

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

RESULTS

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

DISCUSSION

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

Household Food Insufficiency and Chronic Pain among Children in the US: A National Study

This study aimed to determine the prevalence of pediatric chronic pain by household food sufficiency status and examine whether food insufficiency would be associated with greater risk for chronic pain. We analyzed data from the 2019-2020 National Survey of Children's Health of 48,410 children (6-17 years) in the United States. Across the sample, 26.1% (95% CI: 25.2-27.0) experienced mild food insufficiency and 5.1% (95% CI: 4.6-5.7) moderate/severe food insufficiency. The prevalence of chronic pain was higher among children with mild (13.7%) and moderate/severe food insufficiency (20.6%) relative to children in food-sufficient households (6.7%, p < 0.001). After adjusting for a priori covariates (individual: age, sex, race/ethnicity, anxiety, depression, other health conditions, adverse childhood events; household: poverty, parent education, physical and mental health; community: region of residence), multivariable logistic regression revealed that children with mild food insufficiency had 1.6 times greater odds of having chronic pain (95% CI: 1.4-1.9, p < 0.0001) and those with moderate/severe food insufficiency, 1.9 higher odds (95% CI: 1.4-2.7, p < 0.0001) relative to food-sufficient children. The dose-response relationship between food insufficiency and childhood chronic pain highlights the importance of further research to identify underlying mechanisms and evaluate the impact of food insufficiency on the onset and persistence of chronic pain across the lifespan.

Public policy for healthy living: How COVID-19 has changed the landscape

The coronavirus disease 2019 (COVID-19) pandemic had a transformational impact on public policy as governments played a leading role, working alongside and coordinating with business/industry, healthcare, public health, education, transportation, researchers, non-governmental organizations, philanthropy, and media/communications. This paper summarizes the impact of the pandemic on different areas of public policy affecting healthy living and cardiovascular health including prevention (i.e., nutrition, physical activity, air quality, tobacco use), risk factors for chronic disease (hypertension, diabetes, obesity, substance abuse), access to health care, care delivery and payment reform, telehealth and digital health, research, and employment policy. The paper underscores where public policy is evolving and where there are needs for future evidence base to inform policy development, and the intersections between the public and private sectors across the policy continuum. There is a continued need for global multi-sector coordination to optimize population health.

A Novel Case-Based Learning Activity With a Focus on Food Insecurity

OBJECTIVE

Food insecurity is a social determinant of health (SDOH) affecting 1 in 10 households per year in the United States and has major impacts on the course of chronic health conditions. It is beneficial to introduce screening and appropriate treatment plans to medical students. This study utilized a novel case-based learning exercise (CBLE) to assess confidence, attitudes and improvements in knowledge on recognizing and addressing food insecurity.

METHODS

A CBLE focused on food insecurity was developed to be implemented in a 2-h session as part of the curriculum for all first-year medical students at the Medical University of South Carolina. The CBLE included a case for discussion, followed by an interview with a standardized patient. Students received invitations to complete pre- and post-CBLE assessment surveys.

RESULTS

Completion of both pre- and post-surveys was achieved by 29% of students (48 out of 166). Knowledge around the formal definition of "food insecurity," how to recognize food insecurity versus hunger, and how to screen for food insecurity all increased significantly (P < .05). Responses relating to the association between certain chronic diseases and food insecurity did not change pre and post-CBLE.

CONCLUSION

This novel CBLE was successfully implemented within a 2-h teaching session and improved knowledge on recognizing food insecurity in practice. However, additional learning exercises are likely needed to improve knowledge of the relationship between food insecurity and chronic disease states. Nonetheless, the CBLE structure provided students with multiple formats of learning and integration of skills, which shows promise and may be applicable to improve knowledge of other SDOHs.

Chronic disease burden among Latino farmworkers in California

Farmworkers are an essential workforce to maintain California's extensive agricultural production. However, this mostly Latino, immigrant population is affected by high poverty rates and food insecurity, which increases their risk of chronic diseases. We analyzed clinical and interview data from three studies of Latino farmworkers in California: (1) the Mexican Immigration to California: Agricultural Safety and Acculturation (MICASA) study, (2) the PASOS SALUDABLES pilot intervention (PASOS Pilot), and (3) the PASOS Study, a cluster-randomized, controlled trial (PASOS RCT). We aimed to determine the prevalence of diet-related chronic health outcomes (obesity, elevated waist circumference, high blood pressure, and high total cholesterol) and identify sociodemographic and socioeconomic factors associated with these conditions in this population. A total of 1,300 participants were included in this study (452 from MICASA, 248 from PASOS Pilot, and 600 from PASOS RCT). Obesity prevalence ranged from 29.2 to 54.5% across samples; elevated waist circumference was observed in 29.4-54.0% of participants; high blood pressure was detected in 42.0-45.5% of participants; 23.7-25.8% of participants had high total cholesterol. Age was positively associated with each health outcome, although not for each sample; each additional year in age increased odds by 3-9%, depending on the outcome and sample. Females were at higher risk of obesity (one sample) and elevated waist circumference, but at lower risk of high blood pressure and high total cholesterol. Single, divorced or widowed participants (vs. married/living together) had 35 and 47% reduced odds of obesity and elevated waist circumference, respectively. Each additional year living in the US was associated with 3-6% increased odds of obesity, depending on the sample. Higher household income was associated with a reduction in odds of high total cholesterol up to 76% (one sample). These findings highlight the increased risk of chronic health conditions in Latino farmworkers, in particular for obesity, and among farmworkers who may lack access to health care, which represents a large proportion of this population. Differences in chronic health risks by sex suggest that clinical and public health responses might need to be sex-specific. Expansion of eligibility for supplemental nutrition programs for this low-income population could reduce their disease burden.

Impact of Health and Social Factors on the Cardiometabolic Risk in People with Food Insecurity: A Systematic Review

Food plays a key role in people's health and quality of life. Inadequate eating habits or a deficient diet can lead to the development of non-communicable diseases (NCDs). The present review aims to describe the health and social factors related to food insecurity (FI) in adults in high-income countries and evaluate their impact on cardiometabolic risk (CMR). Following the PRISMA procedures, a systematic review was conducted by searching in biomedical databases. Full articles were screened (nf = 228) and critically appraised, and 12 studies met the inclusion criteria. Based on the selected studies, the results grouped information based on (i) the characteristics of the population in FI, (ii) the impact of FI on NCDs, and (iii) the cardiovascular and all-cause mortality risk of the FI population. Considering the minimum and maximum percentage data, people of the categories female sex (46.2-57.6%), education level lower than high school (11-67.46%), non-Hispanic white ethnicity (37.4-58%), single or separated or widowed (45-64.8%), and current smoker (35.5-61.1%) make up the population with FI in high-income countries. All of these factors presented a significant association (p < 0.001) with cardiovascular risk factors. The highest odds ratios (OR) for the FI population are described for obesity (OR = 2.49, 95% CI; 1.16-5.33) and myocardial infarction (OR = 2.19, 95% CI). Interventions that integrate FI screening and the measurement of CMR factors into routine clinical care may be an important step to identify vulnerable populations and subsequently improve and prevent NCDs. Thus, food-diet policies and public-health-based interventions are needed to be included in the measurement of CMR in the assessment of FI.

COVID-19 epidemic lockdown-induced remarkable decrease in dairy products consumption of Iran population: does it really matter? National Food and Nutrition Surveillance

Background

The pandemic of the newly emerged coronavirus infection and its related disease, Covid-19, has influenced various aspects of human life including dietary habits. This study aimed to examine changes in dairy products consumption during Covid-19 lockdown period in a huge sample of Iranian households.

Methods

A cross-sectional descriptive-analytical study using a web-based electronic self-administered questionnaire designed to detect any changes in the consumption frequency of dairy products in the Iranian households during Covid-19 lockdown.

Results

A total of 21,290 households were enrolled. During Covid-19 epidemic lockdown, about 29%, 26% and 7% of the households had decreased their consumption frequency of milk, yogurt and cheese, respectively. The female-headed households were 21% more likely to decrease their consumption of milk, compared with male-headed households (OR = 1.21, 95% CI: 1.05–1.4). The households residing in food insecure provinces were 29%, 20% and 45% more likely to decrease their consumption of milk, yogurt and cheese as compared with those living in the food secure provinces. About 37%, 25.3%, 19.4% of those households who reported a decrease in consumption of dairy products had fully omitted them.

Conclusion

We found considerable decrement of dairy products consumption, especially milk and yogurt, in a high proportion of the studied households. Inadequate intake and, in some households, omission of dairy products can potentially bring about serious health outcomes with heavier economic burden. Further studies to track these changes over time and to evaluate their health consequences are warranted.

Addressing Food Insecurity: Lessons Learned from Co-Locating a Food Pantry with a Federally Qualified Health Center

Introduction:

Social determinants of health, such as food insecurity, contribute to chronic health conditions, decreased quality of life, and health disparities. Increasingly, healthcare systems seek to address social determinants of health by integrating medical and social care.

Description:

Eskenazi Health Center Pecar is a Federally Qualified Health Center providing comprehensive primary care to vulnerable patients in Indianapolis, IN, USA. This health center, in coalition with community partners, established and continually developed an integrated food pantry model to address food insecurity, improve nutrition education, and support patient access to healthy food.

Discussion:

Food insecurity and poor nutrition are common in primary care and contribute to the incidence and outcomes of chronic conditions such as obesity, hypertension, and diabetes. Long-term management of food assistance and nutrition programs requires substantial resources, partnerships, and leadership. We describe lessons learned in food pantry partnership, funding, logistics, and sustainability in a collaborative food access model integrated into healthcare. These lessons learned can be utilized by other health systems to scale up and accelerate strategies to better address food security and nutrition education. This paper articulates best practices for integrating a food pantry model within primary care with the goal of long-term sustainability and direct impact on patient health outcomes.

Are primary care providers' nutrition care and food insecurity screening practices associated with their perceptions of team-based care?

BACKGROUND

Screening for food insecurity (FI) and providing nutrition care are important management strategies for chronic diseases, but rates are low. Aspects of team-based care and providers' nutrition competence may help inform interventions to improve these services. The objectives of this study were to describe US primary care providers' FI screening and nutrition care practices (counselling, referrals, and time spent counselling) and test for associations with scored measures of their perceptions of team-based care (care continuity, patient-centredness, coordination with external providers and resources) and nutrition competence (confidence counselling and attitudes towards nutrition).

METHODS

Cross-sectional online survey data of primary care providers were described and analysed for associations using Wilcoxon rank sum tests.

RESULTS

Of provider respondents (N = 92), 35% (n = 32) worked in clinics that screen for FI and had higher team perceptions (P = 0.006) versus those who do not. Those who reported counselling >30% patients about nutrition (57%, n = 52) and referring >10% patients to nutrition professionals (24%, n = 22) had significantly better attitudes towards nutrition (P = 0.013 and P = 0.04, respectively) compared with those with lower counselling and referral rates. Half (n = 46) of the providers reported spending >3-min counselling each patient about nutrition and had higher patient-centred care (P = 0.004) and nutrition competence (P < 0.001) compared with those who spent less time counselling.

CONCLUSION

Providers in clinics that screen for FI had higher overall perceptions of team-based care, but their nutrition competence was not significantly different. Meanwhile, reported more time counselling was associated with a culture of patient-centredness. Promoting team-based care may be a mechanism for improving FI screening and nutrition care.

Association of Food Insecurity with Mental Health Outcomes in Parents and Children

BACKGROUND

Food insecurity affects 13.7 million US households and is linked to poor mental health. Families shield children from food insecurity by sacrificing their nutritional needs, suggesting parents and children experience food insecurity differentially.

OBJECTIVE

To identify the associations of food insecurity and mental health outcomes in parents and children DATA SOURCES: PubMed, Embase, Web of Science, and PsycInfo STUDY ELIGIBILITY CRITERIA: We included original research published in English from January 1990 to June 2020 that examined associations between food insecurity and mental health in children or parents/guardians in the United States.

STUDY APPRAISAL AND SYNTHESIS METHODS

Two reviewers screened studies for inclusion. Data extraction was completed by one reviewer and checked by a second. Bias and confounding were assessed using the Agency for Healthcare Research and Quality RTI Item Bank. Studies were synthesized qualitatively, grouped by mental health outcome, and patterns were assessed. Meta-analyses were not performed due to high variability between studies.

RESULTS

We included 108 studies, assessing 250,553 parents and 203,822 children in total. Most studies showed a significant association between food insecurity and parental depression, anxiety, and stress, and between food insecurity and child depression, externalizing/internalizing behaviors, and hyperactivity.

LIMITATIONS

Most studies were cross-sectional and many were medium- or high-risk for bias or confounding.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

Food insecurity is significantly associated with various mental health outcomes in both parents and children. The rising prevalence of food insecurity and mental health problems make it imperative that effective public health and policy interventions address both problems.

Supporting wellness at pantries (SWAP) nutrition stoplight system aids rural food pantry clients living with chronic disease in selecting nutritious options

OBJECTIVES

Chronic disease accounts for 70% of U.S. deaths, with suboptimal nutrition an important, preventable risk factor. Food insecurity is a contributor to poor nutrition. Food pantries are a regular source of groceries for the food insecure and an ideal place for nutrition literacy programs. Supporting Wellness at Pantries (SWAP) is a stoplight nutrition ranking system based on 2015-2020 Dietary Guidelines, but has only been implemented in urban areas. Rural communities experience higher rates of poor health and food insecurity.

METHODS

This study implements SWAP at a food pantry in a rural community with high rates of food insecurity and chronic disease. Food was sorted into "green," "yellow," and "red" items on color-coded shelves, with green foods the most accessible, and signage explaining the sorting was displayed. Surveys measured whether clients found SWAP helpful in choosing nutritious foods, particularly for households with chronic diseases.

RESULTS

Clients reported that it was significantly (p <.0001) easier to choose items low in salt, sugar, and fat. The benefits of SWAP extended outside the pantry by increasing confidence in choosing nutritious foods while grocery shopping.

DISCUSSION

SWAP can be an effective tool for improving nutrition literacy among food insecure rural residents with chronic illnesses.

Effects of double burden malnutrition on energetic metabolism and glycemic homeostasis: A narrative review

Rapid changes in the food process led to greater consumption of ultra-processed foods which, associated with reduced physical activity, increased the number of overweight and obese individuals worldwide. However, in low and middle-income countries (LMICS) the growth of the obesity epidemic took place despite the high prevalence of undernutrition in children. This generated the coexistence of these two nutritional patterns, currently defined as double burden malnutrition (DBM). Several reports have already described the social, political, and economic aspects related to the causes and possible solutions for the control of DBM. Here, we highlight the metabolic alterations, related to fat deposition and glycemic homeostasis, described in experimental models of DBM and the differential effects of therapeutic strategies already tested. Therefore, this work aims to help the scientific community to understand how the DBM can lead to the development of obesity and type 2 diabetes through different mechanisms from traditional models of obesity and highlights the need to study these mechanisms and new therapeutic strategies to improve damages caused by DBM.

Household food insecurity, sense of community belonging, and access to a regular medical doctor as mediators in the relationship between mood and/or anxiety disorders and self-rated general health in Canada between 2011 and 2016: a serial cross-sectional analysis

OBJECTIVE

To assess whether (household) food insecurity, access to a regular medical doctor, and sense of community belonging mediate the relationship between mood and/or anxiety disorders and self-rated general health.

METHODS

We used six annual cycles of the Canadian Community Health Survey, including Canadian adults aged 18-59 years, between 2011 and 2016. Mediation models, adjusted for key determinants of health, were based on a series of weighted logistic regression models. The Sobel products of coefficients approach was used to estimate the indirect effect, and bootstrapping to estimate uncertainty.

RESULTS

The annual (weighted) prevalence of mood and/or anxiety disorders increased from 11.3% (2011) to 13.2% (2016). Across the 6 years, 23.9-27.7% of individuals with mood and/or anxiety disorders reported fair/poor self-rated health as compared with 4.9-6.5% of those without mood and/or anxiety disorders (p<0.001). Similarly, the 7.2-8.9% of the population reporting fair/poor self-rated health were disproportionately represented among individuals reporting food insecurity (21.1-26.2%, p<0.001) and a weak sense of community belonging (10.0-12.2%, p<0.001). A significantly lower prevalence of poor self-rated health was observed among respondents reporting having access to a regular medical doctor in 2012, 2015, and 2016. In 2016, sense of community belonging and food insecurity significantly mediated the effect of mood and/or anxiety disorders on self-rated general health. Access to a regular medical doctor did not mediate this relationship.

CONCLUSION

Efficient policies that address food insecurity and sense of community belonging are needed to decrease the mental health burden and improve health satisfaction of Canadians.

Food Insecurity and Cardiometabolic Markers: Results From the Study of Latino Youth

OBJECTIVES

Hispanic/Latino youth bear a disproportionate burden of food insecurity and poor metabolic outcomes, but research linking the two in this diverse population is lacking. We evaluated whether lower household and child food security (FS) were adversely associated with a metabolic syndrome (MetS) composite variable and clinically measured cardiometabolic markers: waist circumference, fasting plasma glucose, triglycerides, high-density lipoprotein cholesterol, and systolic and diastolic blood pressure.

METHODS

This cross-sectional study included 1325 Hispanic/Latino youth aged 8 to 16 years from the Hispanic Community Children's Health Study/Study of Latino Youth, a study of offspring of adults enrolled in the Hispanic Community Health Survey/Study of Latinos. Multivariable regression analyses were used to assess relationships between household FS (high, marginal, low, very low) and child FS (high, marginal, low/very low) status, separately, and our dependent variables, adjusting for participant age, sex, site, parental education, and poverty-income ratio.

RESULTS

For both FS measures, youth in the lowest FS category had significantly lower high-density lipoprotein cholesterol than those with high FS (household FS: -3.17, 95% confidence interval [CI]: -5.65 to -0.70, child FS: -1.81, 95% CI: -3.54 to -0.09). Low/very low versus high child FS was associated with greater fasting plasma glucose (β = 1.37, 95% CI: 0.08 to 2.65), triglycerides (β = 8.68, 95% CI: 1.75 to 15.61), and MetS expected log counts (β = 2.12, 95% CI: 0.02 to 0.45).

CONCLUSIONS

Lower FS is associated with unfavorable MetS-relevant cardiometabolic markers in Hispanic/Latino youth. These findings also support the use of a child-level versus a household-level measure to capture the health implications of food insecurity in this population.

Food security association with some risk factors of obesity-related diseases in Ardabil-Iran population

The aim of the study is the assessment of the food security status and its association with some risk factors of chronic obesity-related diseases in Ardabil-Iran population. METHODS: This cross-sectional study was done between 500 adults of Ardabil that were selected by random sampling from Persian cohort study participants, in January 2019. Food insecurity of study participants was measured using the United States Department of Agriculture 18-item questionnaire. Some risk factors of chronic diseases including fasting blood glucose, lipid profile, liver enzymes, and dietary information were measured on the day of the interview. To assess the association between variables the correlation and linear regression tests were used. RESULTS: Forty-eight and six percent of the study participants were food secure and 51.4% were in food insecurity status. There were a significant difference in weight, blood glucose, blood pressure, and serum triglyceride levels between the food security status groups (P <  0.05). The food insecurity score had significant association with participants, weight (p = 0.005,β= 1.66), serum triglycerides (p = 0.022,β= 0.027), body mass index (p = 0.003,β= 0.645) and fasting blood sugar (p = 0.0001,β= 0.664). CONCLUSION: About half of the participants were in food insecurity status. Food insecurity status can be associated with obesity and some risk factors of chronic obesity-related diseases. This problem requires main food policies to reduce food insecurity in the community.