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Owusu-Sarpong OJ, Abass K, Tutu SO, Gyasi RM. Anxiety and sleep mediate the effect of food insecurity on depression in single parents in Ghana. BMC Public Health 2024; 24:2612. [PMID: 39334047 PMCID: PMC11438176 DOI: 10.1186/s12889-024-20087-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 09/13/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Data on the association between food insecurity and depression in single parents in low- and middle-income countries (LMICs) are limited, and no study has reported the serial mediation effects of psychosocial factors in this association. This study examines the extent to which anxiety and sleep serially explain the food insecurity and depression link among single parents in Ghana. METHODS Data on 627 single parents were obtained through a multi-stage stratified sampling technique. Food insecurity was assessed using the Food and Agriculture Organization Food Insecurity Experience Scale (FIES), and depression was assessed using the Center for Epidemiological Studies Depression Scale (CES-D-10). Multivariable OLS models and bootstrapping serial mediation analyses were performed to evaluate the hypothesized associations. RESULTS The mean age (SD) was 45.0 (14.7) years; 67.3% females. After full adjustment, food insecurity was significantly associated with increases in anxiety symptoms (β = 0.61, 95%CI = 0.476 - 0.737), sleep problems (β = 0.04, 95%CI = 0.02 - 0.07), and depression (β = 0.24, 95%CI = 0.12 - 0.36). Food insecurity indirectly related to depression via anxiety (β = 0.35, 95%CI = 0.26-0.44) representing 55.8%, sleep (β = 0.03, 95%CI = 0.0032-0.0575) suggesting 4.0%, and anxiety→sleep (β = 0.013, 95%CI = 0.0024-0.0265) yielding 2.0% of the total effect. CONCLUSIONS Food insecurity was positively associated with depression. This association was partially and serially explained by generalized anxiety and sleep problems. Efforts to address depression among single parents should consider interventions for food insecurity and psychosocial problems, particularly in LMICs.
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Affiliation(s)
- Obed Jones Owusu-Sarpong
- Department of Geography and Rural Development, Faculty of Social Sciences, PBM University Post Office Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Kabila Abass
- Department of Geography and Rural Development, Faculty of Social Sciences, PBM University Post Office Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Solomon Osei Tutu
- Department of Social Science, Offinso College of Education, Offinso, Ashanti Region, Ghana
| | - Razak M Gyasi
- African Population and Health Research Center, Nairobi, Kenya
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, NSW, Australia
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2
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Meshkat S, Pang H, Tassone VK, Janssen-Aguilar R, Wu M, Jung H, Lou W, Bhat V. Depressive symptoms among adults is associated with decreased food security. PLoS One 2024; 19:e0303345. [PMID: 38843208 PMCID: PMC11156408 DOI: 10.1371/journal.pone.0303345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/23/2024] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVE We aim to evaluate the association of depressive symptoms, depressive symptoms severity and symptom cluster scores (i.e., cognitive-affective and somatic) with food security (FS). We will also evaluate the interaction effect of sex, income and ethnicity on these associations. METHODS Data from the 2005-2018 National Health and Nutrition Examination Survey cycles were used in this study. Participants included survey respondents 20+ years who had completed Depression and Food Security questionnaires. Multivariable logistic regression was used to estimate the associations between depressive symptoms and FS. RESULTS A total of 34,128 participants, including 3,021 (7.73%) with depressive symptoms, were included in this study. In both unadjusted and adjusted models, participants with depressive symptoms had lower odds of FS (aOR = 0.347, 95% CI: 0.307,0.391, p<0.001). Moreover, in both unadjusted and adjusted models, for each 1-point increase in cognitive-affective (aOR = 0.850, 95% CI = 0.836,0.864, p <0.001) and somatic symptoms (aOR = 0.847, 95% CI = 0.831,0.863, p <0.001), odds of high FS decreased correspondingly. Our study found no significant interaction effects of sex on depressive symptoms-FS association. Statistically significant interactions of ethnicity and poverty-to-income ratio on depressive symptoms-FS association were observed, revealing higher odds of FS among Non-Hispanic Black and Mexican American groups, and lower odds of FS in Non-Hispanic White and high-income subgroups. CONCLUSION Our study demonstrated an association between depressive symptoms and decreased FS. Further research is required to deepen our understanding of the underlying mechanisms and to develop focused interventions.
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Affiliation(s)
- Shakila Meshkat
- Interventional Psychiatry Program, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Hilary Pang
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Vanessa K. Tassone
- Interventional Psychiatry Program, St. Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | | | - Michelle Wu
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hyejung Jung
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Wendy Lou
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Mental Health and Addictions Services, St. Michael’s Hospital, Toronto, Ontario, Canada
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Quintero Arias C, Rony M, Jensen E, Patel R, O'Callaghan S, Koziatek CA, Doran KM, Anthopolos R, Thorpe LE, Elbel B, Lee DC. Food insecurity in high-risk rural communities before and during the COVID-19 pandemic. Heliyon 2024; 10:e31354. [PMID: 38807877 PMCID: PMC11130676 DOI: 10.1016/j.heliyon.2024.e31354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 05/10/2024] [Accepted: 05/15/2024] [Indexed: 05/30/2024] Open
Abstract
Objective To perform a geospatial analysis of food insecurity in a rural county known to have poor health outcomes and assess the effect of the COVID-19 pandemic. Methods In 2020, we mailed a comprehensive cross-sectional survey to all households in Sullivan County, a rural county with the second-worst health outcomes among all counties in New York State. Surveys of households included validated food insecurity screening questions. Questions were asked in reference to 2019, prior to the pandemic, and for 2020, in the first year of the pandemic. Respondents also responded to demographic questions. Raking adjustments were performed using age, sex, race/ethnicity, and health insurance strata to mitigate non-response bias. To identify significant hotspots of food insecurity within the county, we also performed geospatial analysis. Findings From the 28,284 households surveyed, 20% of households responded. Of 4725 survey respondents, 26% of households reported experiencing food insecurity in 2019, and in 2020, this proportion increased to 35%. In 2020, 58% of Black and Hispanic households reported experiencing food insecurity. Food insecurity in 2020 was also present in 58% of unmarried households with children and in 64% of households insured by Medicaid. The geospatial analyses revealed that hotspots of food insecurity were primarily located in or near more urban areas of the rural county. Conclusions Our countywide health survey in a high-risk rural county identified significant increases of food insecurity in the first year of the COVID-19 pandemic, despite national statistics reporting a stable rate. Responses to future crises should include targeted interventions to bolster food security among vulnerable rural populations.
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Affiliation(s)
- Carolina Quintero Arias
- Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, NY, 10016, USA
| | - Melissa Rony
- Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, NY, 10016, USA
| | - Erica Jensen
- Touro College of Osteopathic Medicine, New York, NY, 10027, USA
| | - Rahi Patel
- Northeast Ohio Medical University, Rootstown, OH, 44272, USA
| | - Stasha O'Callaghan
- Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, NY, 10016, USA
| | - Christian A. Koziatek
- Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, NY, 10016, USA
| | - Kelly M. Doran
- Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, NY, 10016, USA
- Department of Population Health, NYU School of Medicine, New York, NY, 10016, USA
| | - Rebecca Anthopolos
- Department of Population Health, NYU School of Medicine, New York, NY, 10016, USA
| | - Lorna E. Thorpe
- Department of Population Health, NYU School of Medicine, New York, NY, 10016, USA
| | - Brian Elbel
- Department of Population Health, NYU School of Medicine, New York, NY, 10016, USA
| | - David C. Lee
- Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, NY, 10016, USA
- Department of Population Health, NYU School of Medicine, New York, NY, 10016, USA
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Suresh A, Jordanova KE, Boardman MB, Canavan CR, D'cruze TT, Dev A, Kennedy MA. "Everyone's struggling right now": Impact of COVID-19 on addressing food insecurity in rural primary care. Fam Pract 2024; 41:161-167. [PMID: 37962422 DOI: 10.1093/fampra/cmad105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Primary care practices can address food insecurity (FI) through routine screening, practice-based food programmes, and referrals to community resources. The COVID-19 pandemic had disproportionate impacts on health outcomes for food-insecure households. OBJECTIVE To describe the impact of the COVID-19 pandemic on FI screening and interventions in rural primary care practices in northern New England. METHODS We conducted semi-structured interviews with thirteen providers and staff regarding changes to FI screening and interventions, community resources and partnerships, and patient food needs during the pandemic. Themes and exemplar quotations were identified through iterative discussion. RESULTS Practices reported more frequent informal discussions with patients about FI during the pandemic. Despite limitations in site operations, practices created programmes to distribute food at practice locations or through food deliveries. The adoption of telemedicine had variable impacts on FI screening, creating challenges for some while facilitating screening outside of scheduled visits for others. Practices reported increased food availability due to new or expanded community programmes, but lack of transportation and delivery availability were challenges. New and stronger connections formed between practices and community partners. Increased awareness of FI among both patients and practice staff resulted in decreased stigma. CONCLUSION Screening for and addressing FI was a priority for rural primary care practices during the pandemic. The implementation of practice-based FI interventions was supported by stronger practice-community connections and a decrease in stigma. The experiences of providers and staff during the pandemic provide insight into best practices for engaging primary care practices in reducing FI.
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Affiliation(s)
- Arvind Suresh
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Kayla E Jordanova
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, United States
| | - Maureen B Boardman
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Chelsey R Canavan
- Population Health Department, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, United States
| | - Tiffany T D'cruze
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Alka Dev
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, United States
| | - Meaghan A Kennedy
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
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Garrity K, Krzyzanowski Guerra K, Hart H, Al-Muhanna K, Kunkler EC, Braun A, Poppe KI, Johnson K, Lazor E, Liu Y, Garner JA. Local Food System Approaches to Address Food and Nutrition Security among Low-Income Populations: A Systematic Review. Adv Nutr 2024; 15:100156. [PMID: 38616069 PMCID: PMC11031423 DOI: 10.1016/j.advnut.2023.100156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/20/2023] [Accepted: 11/14/2023] [Indexed: 04/16/2024] Open
Abstract
Food and nutrition insecurity disproportionately impact low-income households in the United States, contributing to higher rates of chronic diseases among this population. Addressing this challenge is complex because of various factors affecting the availability and accessibility of nutritious food. Short value chain (SVC) models, informally known as local food systems, offer a systemic approach that aims to optimize resources and align values throughout and beyond the food supply chain. Although specific SVC interventions, such as farmers markets, have been studied individually, a comprehensive review of SVC models was pursued to evaluate their relative impact on food security, fruit and vegetable intake, diet quality, health-related markers, and barriers and facilitators to participation among low-income households. Our systematic literature search identified 37 articles representing 34 studies from 2000-2020. Quantitative, qualitative, and mixed-method studies revealed that farmers market interventions had been evaluated more extensively than other SVC models (i.e., produce prescription programs, community-supported agriculture, mobile markets, food hubs, farm stands, and farm-to-school). Fruit and vegetable intake was the most measured outcome; other outcomes were less explored or not measured at all. Qualitative insights highlighted common barriers to SVC use, such as lack of program awareness, limited accessibility, and cultural incongruence, whereas facilitators included health-promoting environments, community cohesion, financial incentives, and high-quality produce. Social marketing and dynamic nutrition education appeared to yield positive program outcomes. Financial incentives were used in many studies, warranting further investigation into optimal amounts across varying environmental contexts. SVC models are increasingly germane to national goals across the agriculture, social, and health care sectors. This review advances the understanding of key knowledge gaps related to their implementation and impact; it emphasizes the need for research to analyze SVC potential comprehensively across the rural-urban continuum and among diverse communities through long-term studies of measurable health impact and mixed-method studies investigating implementation best practices. This trial was registered at PROSPERO as CRD42020206532.
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Affiliation(s)
- Katharine Garrity
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University
| | | | - Hannah Hart
- College of Public Health, The Ohio State University
| | - Khawlah Al-Muhanna
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University
| | - Emily C Kunkler
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University
| | - Ashlea Braun
- Department of Nutritional Sciences, College of Education and Human Sciences, Oklahoma State University
| | | | - Kara Johnson
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University
| | - Emma Lazor
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University
| | - Yang Liu
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University
| | - Jennifer A Garner
- Division of Medical Dietetics, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University; John Glenn College of Public Affairs, The Ohio State University.
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Chai L. Food insecurity and its association with multiple health outcomes among Indigenous peoples in Canada: the buffering role of culture-based resources. ETHNICITY & HEALTH 2024; 29:371-394. [PMID: 38297918 DOI: 10.1080/13557858.2024.2311419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 01/23/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVES Despite growing interest in the health disparities associated with food insecurity, research focusing on Indigenous peoples has been limited, especially in studies using nationally representative samples. This study investigates the association between food insecurity and various health outcomes - self-rated general and mental health, chronic health conditions, suicidal ideation, and obesity - among Indigenous peoples in Canada. It also explores the potential moderating effects of culture-based resources, which include cultural identity affect, cultural group belonging, cultural engagement, and cultural exploration. DESIGN The study utilized data from the 2017 Aboriginal Peoples Survey, a nationally representative sample of First Nations individuals living off-reserve, Métis, and Inuit across Canada (N = 15,533). Logistic regression models were used to analyze the data. RESULTS Food insecurity was negatively associated with all examined health outcomes. Culture-based resources demonstrated a mixture of anticipated and unexpected effects on these relationships. Consistent with the stress process model, cultural group belonging mitigated the negative impact of food insecurity on all health outcomes. A similar pattern was observed for cultural engagement. However, contrary to expectations from the stress-buffering perspective, little evidence was found to support the moderating effects of cultural identity affect and cultural exploration. CONCLUSION The results underscore the detrimental effects of food insecurity on the health of Indigenous peoples in Canada and suggest that culture-based resources, particularly cultural group belonging, play a crucial role in mitigating health disparities.
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Affiliation(s)
- Lei Chai
- Department of Sociology, University of Toronto, Toronto, Canada
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7
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Parsons K, Yerxa K, Therrien M, Byrd-Bredbenner C, McNamara J. The influence of diet quality on health-related quality of life in undergraduates. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-7. [PMID: 38442366 DOI: 10.1080/07448481.2024.2319206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/08/2024] [Indexed: 03/07/2024]
Abstract
Objective: Explore the relationship between fruit and vegetable (FV) intake and health-related quality of life (HRQOL) in undergraduates. Participants: Undergraduates (N = 655). Methods: Using the Centers for Disease Control's Healthy Days Core Module and National Cancer Institute's (NCI) FV screener, differences in HRQOL between students who had consumed above the sample's average FV intake and their counterparts were evaluated. Multiple regression analyses assessed behaviors that predicted HRQOL. Results: Differences existed between HRQOL of students who consumed above average FV (M = 2.2 1.3) and peers, F(9,602) = 509, p < 0.001, Wilk's Δ = 0.116, partial n2 = 0.884. Predictors explained 30.0% of the variance in days per month feeling healthy (r2 = 0.29, F(4, 549) = 58.6, p < 0.001): perceived stress (β = 0.46, p < 0.001), body mass index (BMI) (β = 0.11, p < 0.01), FV intake (β = 0.16, p < 0.001), and sleep duration (β = 0.08, p < 0.05). Conclusions: FV intake and modifiable behaviors influenced HRQOL, suggesting that multifaceted interventions could improve HRQOL in this population.
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Affiliation(s)
- Kayla Parsons
- School of Food and Agriculture, University of Maine, Orono, ME, USA
| | - Kathryn Yerxa
- School of Food and Agriculture, University of Maine, Orono, ME, USA
| | - Mona Therrien
- School of Food and Agriculture, University of Maine, Orono, ME, USA
| | - Carol Byrd-Bredbenner
- Department of Nutritional Sciences, School of Environmental & Biological Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Jade McNamara
- School of Food and Agriculture, University of Maine, Orono, ME, USA
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Berkowitz SA, Seligman HK, Palakshappa D. Understanding food insecurity risk in the United States: A longitudinal analysis. SSM Popul Health 2024; 25:101569. [PMID: 38156292 PMCID: PMC10753081 DOI: 10.1016/j.ssmph.2023.101569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/27/2023] [Accepted: 11/24/2023] [Indexed: 12/30/2023] Open
Abstract
Background Food insecurity, lack of consistent access to the food needed for an active, healthy life, harms population health. Although substantial biomedical evidence examines the connections between food insecurity and health, fewer studies examine why food insecurity occurs. Methods We propose a conceptual understanding of food insecurity risk based on institutions that distribute income-the factor payment system (income distribution stemming from paid labor and asset ownership), transfers within households, and the government tax-and-transfer system. A key feature of our understanding is 'roles' individuals inhabit in relation to the factor payment system: child, older adult, disabled working-age adult, student, unemployed individual, caregiver, or paid laborer. A second feature is that the roles of others in an individual's household also affect an individual's food insecurity risk. We tested hypotheses implied by this understanding, particularly hypotheses relating to role, household composition, and income support programs, using nationally-representative, longitudinal U.S. Current Population Survey data (2016-2019). Results There were 16,884 participants (year 1 food insecurity prevalence: 10.0%). Inhabiting roles of child (Relative Risk [RR] 1.79, 95% Confidence Interval [95%CI] 1.67 to 1.93), disabled working age-adult (RR 3.74, 95%CI 3.25 to 4.31), or unemployed individual (RR 3.29, 95%CI 2.51 to 4.33) were associated with a greater risk of food insecurity than being a paid laborer. Most food insecure households, 74.8%, had members inhabiting roles of child or disabled working age-adult, and/or contained individuals who experienced job loss. Similar associations held when examining those transitioning from food insecurity to food security in year 2. Conclusions The proposed understanding accords with the pattern of food insecurity risk observed in the U.S. An implication is that transfer income programs for individuals inhabiting roles, such as childhood and disability, that limit factor payment system participation may reduce food insecurity risk for both those individuals and those in their household.
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Affiliation(s)
- Seth A. Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hilary K. Seligman
- University of California San Francisco, Division of General Internal Medicine, San Francisco, CA, USA
- Center for Vulnerable Populations at San Francisco General Hospital & Trauma Center, San Francisco, CA, USA
| | - Deepak Palakshappa
- Section of General Internal Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Section of General Pediatrics, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Mulhern BJ, Pan T, Norman R, Tran-Duy A, Hanmer J, Viney R, Devlin NJ. Understanding the measurement relationship between EQ-5D-5L, PROMIS-29 and PROPr. Qual Life Res 2023; 32:3147-3160. [PMID: 37347395 PMCID: PMC10522725 DOI: 10.1007/s11136-023-03462-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE Many generic patient-reported instruments are available for the measurement of health outcomes, including EQ-5D-5L, and the Patient-Reported Outcome Measurement Information System (PROMIS). Assessing their measurement characteristics informs users about the consistency between, and limits of, evidence produced. The aim was to assess the measurement relationship between the EQ-5D-5L descriptive system and value sets, the PROMIS-29 and PROPr (PROMIS value set). METHODS Data were extracted from a cross-sectional survey administering measures of quality of life online in Australia. Descriptive analysis, agreement and construct validity assessment methods were used to compare instruments at the item, domain and value set level. RESULTS In total, 794 Australians completed the survey. Convergent validity analysis found that similar dimensions across instruments were highly correlated (> 0.50), but the PROMIS-29 assesses additional health concepts not explicitly covered by EQ-5D (sleep and fatigue). Known-group assessment found that EQ-5D-5L and PROPr were able to detect those with and without a condition (ES range 0.78-0.83) but PROPr could more precisely detect differing levels of self-reported health. Both instruments were sensitive to differences in levels of pain. DISCUSSION There is some consistency in what the EQ-5D-5L, PROMIS-29 and PROPr measure. Differences between value set characteristics can be linked to differences what is measured and the valuation approaches used. This has implications for the use of each in assessing health outcomes, and the results can inform decisions about which instrument should be used in which context.
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Affiliation(s)
- Brendan J Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, Australia.
| | - Tianxin Pan
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Richard Norman
- School of Population Health, Curtin University, Perth, Australia
| | - An Tran-Duy
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Janel Hanmer
- Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, Australia
| | - Nancy J Devlin
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
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Berkowitz SA, Basu S, Hanmer J. Eliminating Food Insecurity in the USA: a Target Trial Emulation Using Observational Data to Estimate Effects on Health-Related Quality of Life. J Gen Intern Med 2023; 38:2308-2317. [PMID: 36814050 PMCID: PMC10406772 DOI: 10.1007/s11606-023-08095-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/08/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Food insecurity is associated with many aspects of poor health. However, trials of food insecurity interventions typically focus on outcomes of interest to funders, such as healthcare use, cost, or clinical performance metrics, rather than quality of life outcomes that may be prioritized by individuals who experience food insecurity. OBJECTIVE To emulate a trial of a food insecurity elimination intervention, and quantify its estimated effects on health utility, health-related quality of life, and mental health. DESIGN Target trial emulation using longitudinal, nationally representative data, from the USA, 2016-2017. PARTICIPANTS A total of 2013 adults in the Medical Expenditure Panel Survey screened positive for food insecurity, representing 32 million individuals. MAIN MEASURES Food insecurity was assessed using the Adult Food Security Survey Module. The primary outcome was the SF-6D (Short-Form Six Dimension) measure of health utility. Secondary outcomes were mental component score (MCS) and physical component score (PCS) of the Veterans RAND 12-Item Health Survey (a measure of health-related quality of life), Kessler 6 (K6) psychological distress, and Patient Health Questionnaire 2-item (PHQ2) depressive symptoms. KEY RESULTS We estimated that food insecurity elimination would improve health utility by 80 QALYs per 100,000 person-years, or 0.008 QALYs per person per year (95% CI 0.002 to 0.014, p = 0.005), relative to the status quo. We also estimated that food insecurity elimination would improve mental health (difference in MCS [95% CI]: 0.55 [0.14 to 0.96]), physical health (difference in PCS: 0.44 [0.06 to 0.82]), psychological distress (difference in K6: -0.30 [-0.51 to -0.09]), and depressive symptoms (difference in PHQ-2: -0.13 [-0.20 to -0.07]). CONCLUSIONS Food insecurity elimination may improve important, but understudied, aspects of health. Evaluations of food insecurity interventions should holistically investigate their potential to improve many different aspects of health.
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Affiliation(s)
- Seth A Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Sanjay Basu
- Research and Development, Waymark, San Francisco, CA, USA
| | - Janel Hanmer
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Abstract
Poor nutrition is the leading cause of poor health, health care spending, and lost productivity in the United States and globally, which acts through cardiometabolic diseases as precursors to cardiovascular disease, cancer, and other conditions. There is great interest in how the social determinants of health (the conditions in which people are born, live, work, develop, and age) impact cardiometabolic disease. Food insecurity is an example of a powerful social determinant of health that impacts health outcomes. Nutrition insecurity, a distinct but related concept to food insecurity, is a direct determinant of health. In this article, we provide an overview of how diet in early life relates to cardiometabolic disease and then continue to focus on the concepts of food insecurity and nutrition insecurity. In the discussions herein we make important distinctions between the concepts of food insecurity and nutrition insecurity and provide a review of their concepts, histories, measurement and assessment devices, trends and prevalence, and links to health and health disparities. The discussions here set the stage for future research and practice to directly address the negative consequences of food and nutrition insecurity.
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Affiliation(s)
- Eric J Brandt
- Division of Cardiovascular Medicine, Department of Internal Medicine (E.J.B., V.L.M.), University of Michigan, Ann Arbor, MI
- Institute for Healthcare Policy and Innovation (E.J.B.), University of Michigan, Ann Arbor, MI
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA (D.M.)
| | - Cindy W Leung
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (C.W.L.)
| | - Seth A Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine (S.A.B.)
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Internal Medicine (E.J.B., V.L.M.), University of Michigan, Ann Arbor, MI
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Kero K, Podlesek A, Kavcic V. Meaning in challenging times: Sense of meaning supports wellbeing despite pandemic stresses. SSM - MENTAL HEALTH 2023:100226. [PMID: 37359070 PMCID: PMC10199818 DOI: 10.1016/j.ssmmh.2023.100226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 05/19/2023] [Accepted: 05/20/2023] [Indexed: 06/28/2023] Open
Abstract
The COVID-19 pandemic created stress and trauma for many individuals. Traumatic experiences often trigger reflection on meaning in life, with subsequent growth or despair. This study evaluates the role of meaning in life in buffering stressors in the early stages of the COVID-19 pandemic. The purpose of this study was to determine the extent to which the negative effects of COVID-19 stressors (self-perceived stress, emotional state, and cognitive adaptation to stress in the pandemic) are influenced by meaning in life in the context of the early stages of the pandemic. Further, this study described differences in meaning in life observed across demographic groups. Web-based surveys were completed by 831 Slovenian participants in April of 2020. Demographic data; perceptions of stressors related to lacking necessities, movement restrictions, and concerns at home; meaning in life; perceived overall health status; anxiety; emotional state; and perceived stress were measured. A moderately strong sense of meaning in life (M = 5.0, SD = 0.74, range 1-7) was reported by participants, and meaning in life was associated with enhanced wellbeing (B = 0.06-.28, p < .01). Both direct and indirect relationships were observed between stressors and wellbeing outcomes. The indirect effects of meaning in life were especially prominent in the relationship between stressors related to lacking necessities and concerns at home and outcomes of anxiety, perceived stress, and negative emotions, contributing 13-27% of the total observed effects. Increased meaning in life was observed across older age groups (F(5, 825) = 4.8, p < .001) and for those in partnered relationships (t(829) = -3.397, p <.001). A strong sense of meaning in life was associated with improved well-being, even for individuals who experienced pandemic-related stressors. Public health initiatives and media may help improve resilience to pandemic trauma by emphasizing the collective meaning in challenging situations.
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Affiliation(s)
- Katherine Kero
- Institute of Gerontology, Wayne State University, Detroit, MI, United States
| | - Anja Podlesek
- Department of Psychology, Faculty of Arts, University of Ljubljana, Ljubljana, Slovenia
| | - Voyko Kavcic
- Institute of Gerontology, Wayne State University, Detroit, MI, United States
- International Institute of Applied Gerontology, Ljubljana, Slovenia
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Bhandari S, Campbell JA, Walker RJ, Thorgerson A, Dawson AZ, Egede LE. Dose response relationship between food insecurity and quality of life in United States adults: 2016-2017. Health Qual Life Outcomes 2023; 21:21. [PMID: 36890499 PMCID: PMC9997014 DOI: 10.1186/s12955-023-02103-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/21/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Food insecurity is associated with worse general health rating, but little research exists investigating whether there is a dose response relationship across levels of food security and mental and physical health domains at the population level. METHODS Data from the Medical Expenditure Panel Survey (2016-2017) with US adults aged 18 years and older was used. The physical component score (PCS) and mental component score (MCS) of Quality of Life, served as the outcome measures. Four categories of food insecurity (high, marginal, low, very low food security) served as the primary independent variable. Linear regression was used to run unadjusted followed by adjusted models. Separate models were run for PCS and MCS. RESULTS In a sample of US adults, 16.1% reported some degree of food insecurity. For PCS, marginal (β = - 2.54 (p < 0.001), low (β = - 3.41, (p < 0.001), and very low (β = - 5.62, (p < 0.001) food security was associated with worse PCS scores, compared to adults with high food security. For MCS, marginal (β = - 3.90 (p < 0.001), low (β = - 4.79, (p < 0.001), and very low (β = - 9.72, (p < 0.001) food security was associated with worse MCS scores, compared to adults with high food security. CONCLUSION Increasing levels of food insecurity were associated with decreased physical and mental health quality of life scores. This relationship was not explained by demographic factors, socioeconomic factors, insurance, or comorbidity burden. This study suggests work is needed to mitigate the impact of social risk, such as food insecurity, on quality of life in adults, and understand pathways and mechanisms for this relationship.
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Affiliation(s)
- Sanjay Bhandari
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Jennifer A Campbell
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Rebekah J Walker
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Abigail Thorgerson
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Aprill Z Dawson
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Leonard E Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA.
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.
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Mavegam Tango Assoumou BO, Coughenour C, Godbole A, McDonough I. Senior food insecurity in the USA: a systematic literature review. Public Health Nutr 2023; 26:229-245. [PMID: 36329645 PMCID: PMC11077460 DOI: 10.1017/s1368980022002415] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/30/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Understanding the factors associated with senior food insecurity is key to understanding senior-specific needs to develop targeted interventions and ultimately lower the prevalence and the incidence of food insecurity. We aimed to systematically review published literature and summarise the associated factors of food insecurity in older adults in the USA. DESIGN We searched PubMed, Scopus, Web of science, EconLit and JSTOR databases for peer-reviewed articles published in English between January 2005 and September 2019 that assessed food security or its associated factors for US adults aged 60 years and older. After a two-step screening process, twenty articles were retained and included in the review. SETTING NA. PARTICIPANTS NA. RESULTS The majority of studies were cross-sectional (70 %), consisted of data from one state (60 %), and had large sample sizes. Food-insecure individuals were more likely to be younger, less educated, Black or African American, female, a current smoker, low income, and self-report fair/poor health, have chronic conditions, and utilise government assistance programmes. Food insecurity was associated with medication non-adherence, poor mental health outcomes and limitations in physical functioning. Results were mixed for overweight/obesity status. There was no discernable pattern related to the consistency of findings by the assessed quality of the included studies. CONCLUSIONS Food insecurity is a prevalent and pervasive issue for older adults. The numerous correlates identified suggest that interventions aimed at enhancing food and nutrition safety net and medication assistance programmes are warranted, and upstream, systemic-level interventions may be best suited to deal with the correlates of food insecurity.
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Affiliation(s)
| | - Courtney Coughenour
- University of Nevada, Las Vegas School of Public Health, Department of Environmental and Occupational Health, Las Vegas, USA
| | - Amruta Godbole
- University of Nevada, Las Vegas School of Public Health, Department of Epidemiology and Biostatistics, Las Vegas, USA
| | - Ian McDonough
- University of Nevada, Las Vegas Lee Business School, Department of Economics, Las Vegas, USA
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15
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Berkowitz SA, Kruse GR, Ball Ricks KA, Burch J, Ouimet E, Kitzis B, Forrest C, Terranova J, Stewart PW, Buse JB, Keyserling TC, Wexler DJ, Delahanty LM. Medically tailored meals for food insecurity and type 2 diabetes: Protocol for the Food as Medicine for Diabetes (FAME-D) trial. Contemp Clin Trials 2023; 124:107039. [PMID: 36470556 PMCID: PMC9839527 DOI: 10.1016/j.cct.2022.107039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Food insecurity is associated with worse glycemic management for individuals with type 2 diabetes mellitus (T2DM), but whether medically tailored meals (MTM), a food insecurity intervention, can improve glycemic management is unclear. OBJECTIVE To describe the protocol for a trial assessing whether an MTM plus lifestyle intervention improves hemoglobin A1c (HbA1c) and participant-reported outcomes, relative to a food subsidy (money that can be spent on foods participants choose), for adults with both T2DM and food insecurity. METHODS The Food as Medicine for Diabetes (FAME-D) randomized clinical trial (goal n = 200) is a pragmatic trial with an active comparator. Participants, who will have T2DM and report food insecurity, will be randomly assigned to a 6-month MTM plus telephone-delivered lifestyle change intervention, or a 6-month food subsidy ($40/month). The primary outcome is HbA1c at 6 months. Secondary outcomes include HbA1c at 12 months to assess whether the intervention effect (if any) is sustained, along with weight, food insecurity, diabetes distress, and health-related quality of life. Qualitative analyses of semi-structured interviews will help understand why, how, and under what circumstances the intervention achieved its observed results. CONCLUSION Results from FAME-D will help inform clinical management of food insecurity when it co-occurs with T2DM. Further, results may be useful as healthcare payors are considering coverage for MTM interventions. CLINICALTRIALS gov: NCT04828785.
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Affiliation(s)
- Seth A Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
| | - Gina R Kruse
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Katharine A Ball Ricks
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Jessica Burch
- Community Servings, Inc, Boston, MA, United States of America
| | - Ethan Ouimet
- Community Servings, Inc, Boston, MA, United States of America
| | - Beth Kitzis
- Community Servings, Inc, Boston, MA, United States of America
| | - Colleen Forrest
- Community Servings, Inc, Boston, MA, United States of America
| | - Jean Terranova
- Community Servings, Inc, Boston, MA, United States of America
| | - Paul W Stewart
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - John B Buse
- Division of Endocrinology and Metabolism, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Thomas C Keyserling
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America
| | - Deborah J Wexler
- Harvard Medical School, Boston, MA, United States of America; Diabetes Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Linda M Delahanty
- Harvard Medical School, Boston, MA, United States of America; Diabetes Unit, Massachusetts General Hospital, Boston, MA, United States of America
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16
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Aswani-Omprakash T, Shah ND. Sociocultural Considerations for Food-Related Quality of Life in Inflammatory Bowel Disease. Gastroenterol Clin North Am 2022; 51:885-895. [PMID: 36376002 DOI: 10.1016/j.gtc.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The prevalence of inflammatory bowel disease (IBD) is increasing substantially in non-White races and ethnicities in the United States. As a part of promoting quality of life in patients with IBD, the optimization of food-related quality of life (FRQoL) is also indicated. It is known that the practices of food avoidance and restrictive eating are associated with a reduced FRQoL in IBD. Gaining insight into sociocultural influences on FRQoL will aid in the provision of culturally competent interventions to improve FRQoL in patients with IBD.
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Affiliation(s)
- Tina Aswani-Omprakash
- Mount Sinai Icahn School of Medicine, New York, NY 10029, USA; South Asian IBD Alliance, New York, NY 10021, USA. https://twitter.com/@ownyourcrohns
| | - Neha D Shah
- South Asian IBD Alliance, New York, NY 10021, USA; Colitis and Crohn's Disease Center, University of California, San Francisco, CA 94115, USA; Neha Shah Nutrition, San Francisco, CA 94105, USA.
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Berkowitz SA, Palakshappa D, Seligman HK, Hanmer J. Changes in Food Insecurity and Changes in Patient-Reported Outcomes: a Nationally Representative Cohort Study. J Gen Intern Med 2022; 37:3638-3644. [PMID: 34993877 PMCID: PMC9585105 DOI: 10.1007/s11606-021-07293-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cross-sectional studies have found that health-related quality of life and mental health are worse among food-insecure compared with food-secure individuals. However, how these outcomes change as food insecurity changes is unclear. OBJECTIVE To evaluate how common patient-reported health-related quality of life and mental health scales change in response to changes in food security. DESIGN Retrospective cohort study using data representative of the civilian, adult, non-institutionalized population of the USA. PARTICIPANTS Food insecure adults who completed the 2016-2017 Medical Expenditure Panel Survey. MAIN MEASURES Mental health, as measured by the mental component score of the Veterans Rand 12-Item Health Survey (VR-12) (primary outcome), along physical health (physical component score of the VR-12), self-rated health status, psychological distress (Kessler 6), depressive symptoms (PHQ2), and the SF-6D measure of health utility. We fit linear regression models adjusted for baseline outcome level, age, gender, race/ethnicity, education, health insurance, and family size followed by predictive margins to estimate the change in outcome associated with a 1-point improvement in food security. KEY RESULTS A total of 1,390 food-insecure adults were included. A 1-point improvement in food security was associated with a 0.38 (95%CI 0.62 to 0.14)-point improvement in mental health, a 0.15 (95%CI 0.02 to 0.27)-point improvement in psychological distress, a 0.05 (95%CI 0.01 to 0.09)-point improvement in depressive symptoms, and a 0.003 (95%CI 0.000 to 0.007)-point improvement in health utility. Point estimates for physical health and self-rated health were in the direction of improvement, but were not statistically significant. CONCLUSIONS Improvement in food insecurity was associated with improvement in several patient-reported outcomes. Further work should investigate whether similar changes are seen in food insecurity interventions, and the most useful scales for assessing changes in health-related quality of life and mental health in food insecurity interventions.
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Affiliation(s)
- Seth A Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, 5034 Old Clinic Bldg, CB 7110, Chapel Hill, NC, 27599, USA.
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Deepak Palakshappa
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Hilary K Seligman
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
- Center for Vulnerable Populations at San Francisco General Hospital & Trauma Center, San Francisco, CA, USA
| | - Janel Hanmer
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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18
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Karam J, Haddad C, Sacre H, Serhan M, Salameh P, Jomaa L. Financial Wellbeing and Quality of Life Among a Sample of the Lebanese Population: The Mediating Effect of Food Insecurity. Front Nutr 2022; 9:906646. [PMID: 35967774 PMCID: PMC9364834 DOI: 10.3389/fnut.2022.906646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/12/2022] [Indexed: 11/30/2022] Open
Abstract
Background Lebanon is undergoing multiple overlapping crises, affecting the food security, financial well-being, and quality of life (QOL) of its residents. Objective The primary objective was to assess the food insecurity (FI) status of a sample of the Lebanese population. The second objective was to explore factors related to QOL parameters and evaluate the mediating effect of food security between financial well-being and QOL. Methods The study was cross-sectional and enrolled 412 participants recruited online using the snowball sampling technique. The survey included questions related to sociodemographic and economic characteristics of Lebanese households and validated scales to assess FI, QOL measures, financial well-being, and fear of COVID-19. Results Almost 43% of the study participants reported being food insecure, with 31% experiencing mild FI, 10% moderate FI, and 1.5% severe FI. Compared to food-insecure participants, food secure participants had a significantly higher income (58.5% vs. 39.2%, p < 0.001), a university education level (96.6% vs. 88.1%, p = 0.002), an average perceived financial status (83.9% vs. 65.9%), higher financial well-being scores (5.14 vs. 3.19, p < 0.001), and lower crowding index (0.94 ± 0.4 vs. 1.09, p = 0.002). Multivariate analysis showed that FI was not associated with physical (Beta = −1.48, 95% CI: −3.10; 0.13) and mental (Beta = −1.46, 95% CI −3.68; 0.75) QOL, after adjusting for other demographic and socioeconomic correlates. This association remained non-significant when introducing the financial well-being variable to the model. Mediation analyses showed that the FI variable mediated the association between financial well-being and physical QOL (Beta = 0.19, 95% CI: 0.02; 0.36), but not the mental QOL (Beta = −0.02, 95% CI: −0.20; 0.14). Conclusion Food insecurity was prevalent in our study sample, and it mediated the association between financial well-being and physical, but not mental, QOL parameters. These findings call for evidence-based policies and programs to help improve the food security and well-being of Lebanese households amidst these unprecedented circumstances.
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Affiliation(s)
- Joanne Karam
- Nutrition Department, Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie (INSPECT-LB), Beirut, Lebanon.,School of Health Sciences, Modern University of Business and Science, Beirut, Lebanon
| | - Chadia Haddad
- Nutrition Department, Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie (INSPECT-LB), Beirut, Lebanon.,School of Health Sciences, Modern University of Business and Science, Beirut, Lebanon.,Research Department, Psychiatric Hospital of the Cross, Beirut, Lebanon
| | - Hala Sacre
- School of Health Sciences, Modern University of Business and Science, Beirut, Lebanon
| | - Mireille Serhan
- Department of Nutritional Sciences, Faculty of Health Sciences, University of Balamand, Koura, Lebanon
| | - Pascale Salameh
- School of Health Sciences, Modern University of Business and Science, Beirut, Lebanon.,Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus.,School of Medicine, Lebanese American University, Byblos, Lebanon.,Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
| | - Lamis Jomaa
- Department of Human Sciences, College of Health and Sciences, North Carolina Central University, Durham, NC, United States.,Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
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19
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Bridge G. Risk of Food Insecurity and Cardiometabolic Health-What Can Be Done? J Nutr 2022; 152:1805-1807. [PMID: 35732470 DOI: 10.1093/jn/nxac109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/26/2022] [Accepted: 05/10/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Gemma Bridge
- School of Earth and Environment, University of Leeds, Leeds, LS2 9JT, UK
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20
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O'Loughlin K, Shadowen HM, Haley AD, Gilbert J, Lail Kashiri P, Webel B, Huebschmann AG, Krist AH. Patient Preferences for Discussing and Acting on Health-Related Needs in Primary Care. J Prim Care Community Health 2022; 13:21501319221115946. [PMID: 35920033 PMCID: PMC9358340 DOI: 10.1177/21501319221115946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Addressing social needs, health behaviors, and mental health may help
patients more than traditional medical care. However, these root causes of
poor health are difficult to address and the role of primary care is
unclear. This qualitative study assesses patient’s willingness and
motivations to discuss and accept assistance for these needs from their
primary care team. Methods: In July and August of 2020, semi-structured virtual interviews were conducted
with family medicine patients (n = 6) and residents of low resource
neighborhoods (n = 11) in Richmond, Virginia. Interviews were conducted over
Zoom. We conducted a qualitative analysis of patient and resident interview
transcripts. A rapid qualitative analysis approach and
immersion-crystallization processes were used to identify themes and
categories. Results: Interviewees reported varying degrees of comfort discussing topics with their
health care team. They were less comfortable discussing needs they
considered outside the realm of “traditional primary care” including
finances, transportation, and housing, but interviewees expressed
willingness to discuss these needs under certain conditions. Important
factors were a strong patient-clinician relationship to create a trusted and
safe space for discussion, adequate time for discussion during visits,
communication of practices’ ability to provide resources to help patients,
and ensuring appropriate high quality referrals. Conclusions: Primary care provides opportunity for identifying and addressing needs that
adversely impact health. Some needs are more sensitive for patients to work
with their care team on, though, there was willingness to work on
any need when a strong provider relationship and clinic
structure for providing support were in place. This study highlights
critical care delivery factors which may be used to enhance patient comfort
accepting support for their needs and ultimately improve clinical care and
chronic disease management.
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Affiliation(s)
| | | | - Amber D Haley
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | | | | | - Ben Webel
- Virginia Commonwealth University, Richmond, USA
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21
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Hanmer J. Measuring population health: association of self-rated health and PROMIS measures with social determinants of health in a cross-sectional survey of the US population. Health Qual Life Outcomes 2021; 19:221. [PMID: 34551778 PMCID: PMC8459525 DOI: 10.1186/s12955-021-01854-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-reported health-related quality of life is an important population health outcome, often assessed using a single question about self-rated health (SRH). The Patient Reported Outcomes Measurement Information System (PROMIS) is a new set of measures constructed using item response theory, so each item contains information about an underlying construct. This study's objective is to assess the association between SRH and PROMIS scores and social determinants of health (SDoH) to evaluate the use of PROMIS for measuring population health. METHODS A cross sectional survey of 4142 US adults included demographics, 7 PROMIS domains with 2 items each, the PROMIS-preference (PROPr) score, self-rated health (SRH), 30 social determinants of health (SDoH), and 12 chronic medical conditions. SDoH and chronic condition impact estimates were created by regressing the outcome (PROMIS domain, PROPr, or SRH) on demographics and SDoH or a single chronic condition. Linear regression was used for PROMIS domains and PROPr; ordinal logistic regression was used for SRH. RESULTS Both SRH and PROPr detected statistically significant differences for 11 of 12 chronic conditions. Of the 30 SDoH, 19 statistically significant differences were found by SRH and 26 statistically significant differences by PROPr. The SDoH with statistically significant differences included those addressing education, income, financial insecurity, and social support. The number of statistically significant differences found for SDoH varies by individual PROMIS domains from 13 for Sleep Disturbance to 25 for Physical Function. CONCLUSIONS SRH is a simple single question that provides information about health-related quality of life. The 14 item PROMIS measure used in this study detects more differences in health-related quality of life for social determinants of health than SRH. This manuscript illustrates the relative costs and benefits of each approach to measuring health-related quality of life.
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Affiliation(s)
- Janel Hanmer
- Department of General Medicine, University of Pittsburgh, 230 McKee Place, Pittsburgh, PA, 15213, USA.
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22
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Pan T, Mulhern B, Viney R, Norman R, Tran-Duy A, Hanmer J, Devlin N. Evidence on the relationship between PROMIS-29 and EQ-5D: a literature review. Qual Life Res 2021; 31:79-89. [PMID: 34181154 DOI: 10.1007/s11136-021-02911-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE EQ-5D and PROMIS-29 are both concise, generic measures of patient-reported outcomes accompanied by preference weights that allow the estimation of quality-adjusted life years (QALYs). Both instruments are candidates for use in economic evaluation. However, they have different features in terms of the domains selected to measure respondents' self-perceived health and the characteristics of (and methods used to obtain) the preference weights. It is important to understand the relationship between the instruments and the implications of choosing either for the evidence used in decision-making. This literature review aimed to synthesise existing evidence on the relationship between PROMIS-29 (and measures based on it, such as PROMIS-29+2) and EQ-5D (both EQ-5D-3L and EQ-5D-5L). METHODS A literature review was conducted in PubMed and Web of Science to identify studies investigating the relationship between PROMIS-29 and EQ-5D-based instruments. RESULTS The literature search identified 95 unique studies, of which nine studies met the inclusion criteria, i.e. compared both instruments. Six studies examined the relationship between PROMIS-29 and EQ-5D-5L. Three main types of relationship have been examined in the nine studies: (a) comparing PROMIS-29 and EQ-5D as descriptive systems; (b) mapping PROMIS-29 domains to EQ-5D utilities; and (c) comparing and transforming PROMIS-29 utilities to EQ-5D utilities. CONCLUSION This review has highlighted the lack of evidence regarding the relationship between PROMIS-29 and EQ-5D. The impact of choosing either instrument on the evidence used in cost-effectiveness analysis is currently unclear. Further research is needed to understand the relationship between the two instruments.
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Affiliation(s)
- Tianxin Pan
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health , University of Melbourne, 207 Bouverie Street, Melbourne, VIC, 3010, Australia.
- School of Population Health, Curtin University, Perth, WA, Australia.
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Richard Norman
- School of Population Health, Curtin University, Perth, WA, Australia
| | - An Tran-Duy
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health , University of Melbourne, 207 Bouverie Street, Melbourne, VIC, 3010, Australia
| | - Janel Hanmer
- Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nancy Devlin
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health , University of Melbourne, 207 Bouverie Street, Melbourne, VIC, 3010, Australia
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