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Liu J, Zhou Z, Cheng X, Zhang D, Li L, Zhang X, Vangeepuram N. Food insecurity trends and disparities according to immigration status in the US households, 2011-2021. Prev Med 2024; 187:108121. [PMID: 39208951 DOI: 10.1016/j.ypmed.2024.108121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 07/19/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Food insecurity related to immigration status remains largely underexplored. This study examined trends and disparities in household food insecurity by immigration status in the United States (US). METHODS We analyzed data from 427,942 households from the US Current Population Survey Food Security Supplement from 2011 to 2021. Immigration status categories included recent immigrants (< 5 years), long-term immigrants (≥ 5 years), naturalized citizens, and US-born citizens. Food insecurity was assessed using validated questions on consistent access to enough food for an active and healthy life. RESULTS From 2011 to 2021, food insecurity prevalence declined from 14.9 % (95 % CI, 14.5 %-15.3 %) to 10.2 % (95 % CI, 9.8 %-10.6 %). Among recent immigrants, prevalence decreased from 25.2 % (95 % CI, 23.1-27.4) in 2011 to 15.0 % (95 % CI, 12.8 %-17.2 %) in 2019, then increased to 17.7 % (95 % CI, 14.7 %-20.2 %) in 2020 and 17.4 % (95 % CI, 14.7 %-20.2 %) in 2021. Long-term immigrants' prevalence dropped from 20.4 % (95 % CI, 16.9 %-24.0 %) in 2011 to 10.2 % (95 % CI, 7.2 %-13.1 %) in 2018, then increased to 17.7 % (95 % CI, 13.7 %-21.7 %) in 2021. Naturalized citizens' prevalence decreased from 14.4 % (95 % CI, 12.9 %-15.9 %) to 9.5 % (95 % CI, 8.2 %-10.9 %). US-born citizens' prevalence decreased from 14.2 % (95 % CI, 13.8 %-14.6 %) to 9.7 % (95 % CI, 9.3 %-10.2 %). Compared to the US-born citizens, the adjusted prevalence ratio was 1.63 (95 % CI,1.57-1.69) for recent immigrants, 1.22 (95 % CI, 1.13-1.31) for long-term immigrants, and 0.94 (95 % CI, 0.90-0.98) for naturalized citizens. Significant disparities exist in subgroups. CONCLUSIONS The findings provide insights for stakeholders to address food insecurity among vulnerable immigrant groups in the US.
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Affiliation(s)
- Junxiu Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Zhiyang Zhou
- Joseph J. Zilber College of Public Health at the University of Wisconsin, Milwaukee, United States of America
| | - Xi Cheng
- The Interdisciplinary Program of Science in Analytics, Georgia Institute of Technology, Atlanta, GA, United States of America
| | - Donglan Zhang
- New York University Langone Health, New York, NY, United States of America; Long Island School of Medicine, New York University, New York, NY, United States of America
| | - Lihua Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Institute for Healthcare Delivery Science, Mount Sinai Health System, New York, NY, United States of America; Tisch Cancer Institute, New York, NY, United States of America; Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Xiaotao Zhang
- Institute for Translational Epidemiology & Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Nita Vangeepuram
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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Laurentino JSL, Brito RCDS, de Oliveira-Silva RT, Soares A, Pereira TDC, de Lima EM, dos Santos ABMV, Palmeira PDA. Association between food insecurity and chronic noncommunicable diseases in Brazil: a systematic review. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2024; 27:e240041. [PMID: 39140578 PMCID: PMC11323874 DOI: 10.1590/1980-549720240041] [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: 01/20/2024] [Revised: 04/18/2024] [Accepted: 05/07/2024] [Indexed: 08/15/2024] Open
Abstract
OBJECTIVE To analyze the association of food insecurity (FI) with chronic noncommunicable diseases (NCDs) in the Brazilian context. METHODS The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). The searches were conducted in LILACS and PubMed databases (September/2022). Observational studies carried out in the Brazilian population published since 2003 were included, in which: (1) the association of FI with NCDs was analyzed; and (2) the Brazilian Food Insecurity Scale was used. Studies on pregnant women and those that associated FI with cancer, sexually transmitted infections, and musculoskeletal and respiratory diseases were excluded. The studies were subjected to methodological quality assessment. RESULTS A total of 27 cross-sectional studies were included; nine used secondary data from national surveys, and the others used primary data. An association between FI and overweight and obesity in different age groups was verified in the studies. CONCLUSION The included articles did not produce evidence on other NCDs of interest to health in Brazil such as diabetes and high blood pressure. However, they corroborate the already-known relationship between obesity and FI. Studies on the topic, with a longitudinal design, should be encouraged.
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Affiliation(s)
| | | | | | - Amanda Soares
- Universidade Federal do Rio Grande do Norte, Graduate Program in Public Health – Natal (RN), Brazil
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Hamilton A, Beneke AA, Meisel E, Zhang C, Gao H, Portillo-Romero J. Associations Between Social Determinants of Health and Outcomes of Chronic Medical Conditions. Cureus 2024; 16:e67528. [PMID: 39310648 PMCID: PMC11416158 DOI: 10.7759/cureus.67528] [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] [Accepted: 08/21/2024] [Indexed: 09/25/2024] Open
Abstract
Social determinants of health, such as food insecurity, can significantly impact patient welfare, potentially increasing the prevalence of chronic illnesses while hindering their management, as shown in previous data collected by the National Health and Nutrition Examination Survey. This study aimed to investigate the association between food insecurity and other social determinants of health with hyperlipidemia, type 2 diabetes mellitus (T2DM), and hypertension. To that end, self-reported data on food security from clinical encounters and biological data from medical records were collected. This study utilized electronic medical record data from 349 patients aged between 18 and 85 years who answered two standard food insecurity screening questions. Each patient's current diagnoses and lab values, including blood pressure, fasting low-density lipoprotein (LDL) cholesterol, and hemoglobin A1c (HbA1c), were then collected. Among patients facing food insecurity (n = 48), 55% were diagnosed with hypertension (p = 0.019), 45% with hyperlipidemia, and 27% with T2DM (p = 0.005). By comparison, these values for food-secure patients were 39%, 54%, and 13%, respectively (n = 301, p > 0.05). Regarding control of these chronic illnesses, hypertension (defined as blood pressure >135/85 mmHg per American Academy of Family Physicians (AAFP) guidelines) was observed in 12% of food-secure patients (n = 301, p > 0.05) and 42% of food-insecure patients (n = 48, p = 0.0204), whereas differences in control of hyperlipidemia and T2DM were insignificant. These results suggest that food-insecure patients are more likely to be diagnosed with hypertension and T2DM but are less likely than food-secure patients to be diagnosed with hyperlipidemia. Consistent with previous research, this study highlights the potentially increased health risks for patients experiencing food insecurity and calls for further efforts to screen patients for social determinants of health.
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Affiliation(s)
- Alice Hamilton
- Internal Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Alice A Beneke
- Internal Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Emily Meisel
- Internal Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Cristian Zhang
- Internal Medicine, Albert Einstein College of Medicine, New York, USA
| | - Hanzhi Gao
- Statistics, University of Florida, Gainesville, USA
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Butler JL, Johnson CM, Hardison-Moody A, Bowen SK. Food Insecurity Associated with Higher Stress, Depressive Symptoms, and Lower Diet Quality among Women Caregivers in North Carolina. Nutrients 2024; 16:2491. [PMID: 39125371 PMCID: PMC11314069 DOI: 10.3390/nu16152491] [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: 07/01/2024] [Revised: 07/23/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Research suggests a bidirectional relationship between food insecurity and stress, but few studies have examined associations of food insecurity with stress and other indicators of cardiometabolic health, including depression, diet quality, and body weight, among lower-income women in the U.S. METHODS This cross-sectional study analyzed data from lower-income women caregivers living in North Carolina (n = 100): 42% Black/African American, 25% Hispanic/Latina, and 33% White women. Multivariable linear regression models were used to determine associations of food insecurity status with perceived stress, depressive symptoms, diet quality, and body mass index (BMI). Multivariable logistic regression models were used to determine associations of food insecurity with clinical depression and BMI ≥ 30 kg/m2. Associations were examined with and without adjustment for perceived stress. RESULTS Forty-two percent of the sample were experiencing food insecurity. Compared to food secure caregivers, food-insecure caregivers had significantly higher perceived stress (β: +7.51; 95%CI: 4.19, 10.84) and depressive symptoms (β: +3.55; 95%CI: 0.54, 6.56) and lower diet quality (β: -9.10; 95%CI: -15.81, -2.40). Associations with BMI outcomes were not statistically significant. CONCLUSION Findings support removing stigma in nutrition assistance programs and clinical interactions, motivate future longitudinal studies, and inform the development of destigmatizing interventions for health promotion or disease prevention.
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Affiliation(s)
- J. Lauren Butler
- Nutrition and Foods Program, School of Family and Consumer Sciences, Texas State University, 601 University Drive, San Marcos, TX 78666, USA;
- Nutrition and Dietetics Department, University of North Florida, Jacksonville, FL 32224, USA
| | - Cassandra M. Johnson
- Nutrition and Foods Program, School of Family and Consumer Sciences, Texas State University, 601 University Drive, San Marcos, TX 78666, USA;
| | - Annie Hardison-Moody
- Department of Agricultural and Human Sciences, North Carolina University, Raleigh, NC 27695, USA;
| | - Sarah K. Bowen
- Department of Sociology and Anthropology, North Carolina University, Raleigh, NC 27695, USA;
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Long C, Cinque F, Kablawi D, Kim DHD, Tadjo TF, Elgretli W, Ballesteros LR, Lupu A, Nudo M, Lebouché B, Kronfli N, Cox J, Costiniuk CT, De Pokomandy A, Routy JP, Klein MB, Lamonde F, Agnihotram RV, Saeed S, Sebastiani G. Material deprivation is associated with liver stiffness and liver-related outcomes in people with HIV. Liver Int 2024. [PMID: 39011563 DOI: 10.1111/liv.16022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/08/2024] [Accepted: 06/20/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Socioeconomic status (SES) is a driver of health disparities and chronic diseases. People with HIV (PWH) are at risk for chronic liver diseases. We evaluated the association between low SES and hepatic outcomes in PWH. METHODS We included PWH from a prospective cohort. SES was assessed by the Pampalon material and social deprivation index to classify the cohort into quintiles of deprivation. Multivariable linear regression was used to investigate associations of material and social deprivation with liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) as markers of hepatic fibrosis and steatosis, respectively. Incidence of outcomes was evaluated through survival analysis. RESULTS Among the 804 PWH included, 45% and 72% were living in areas of the highest material and social deprivation, respectively. Materially deprived PWH were more frequently female and of non-white ethnicity and had higher prevalence of metabolic comorbidities. After adjustments, material deprivation correlated with increased LSM (β = 1.86, 95% CI 0.53-3.17) but not with CAP (β = 6.47, 95% CI -5.55-18.49). Patients were observed for a median follow-up of 3.8 years. Incidence of liver-related events was higher in most materially deprived compared to most privileged PWH (hazard ratio 3.03, 95% CI 1.03-8.92), while there was no difference in extrahepatic outcomes or all-cause mortality. Social deprivation showed no association with either LSM or clinical outcomes. CONCLUSIONS Living in materially deprived neighbourhoods as a proxy for lower SES, is associated with LSM and liver-related events in PWH. Future strategies should explore mechanisms underlying these relationships and whether enhanced material security improves hepatic outcomes.
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Affiliation(s)
- Clara Long
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Felice Cinque
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Dana Kablawi
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Dong Hyun Danny Kim
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Thierry Fotsing Tadjo
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Wesal Elgretli
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Luz Ramos Ballesteros
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Amanda Lupu
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Michael Nudo
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Bertrand Lebouché
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nadine Kronfli
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Joseph Cox
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Cecilia T Costiniuk
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Alexandra De Pokomandy
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jean-Pierre Routy
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Marina B Klein
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Frederic Lamonde
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Ramanakumar V Agnihotram
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Sahar Saeed
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Giada Sebastiani
- Division of Infectious Diseases, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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Cheung ESL. Neighborhood Gentrification and Food Insecurity Among Urban Older Adults: Evidence From New York City. THE GERONTOLOGIST 2024; 64:gnae048. [PMID: 38761043 DOI: 10.1093/geront/gnae048] [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: 09/18/2023] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Gentrification is a prevalent neighborhood development process in urban areas across the United States. Prior studies have identified the influence of gentrification on late-life health and quality of life, yet little is known about its relationship with food insecurity, an important public health issue for older adult populations. Using New York City as a case study, this study investigated associations between living in a gentrifying neighborhood and food insecurity, as well as the mediating roles of neighborhood environment factors-social cohesion, public transportation, and food environment. RESEARCH DESIGN AND METHODS This study adopted 2 waves of annual data from the Poverty Tracker Study (2015-2016; N = 703) merged with American Community Survey and spatial data sets to measure gentrification and neighborhood factors. Adjusted logistic regressions were used to examine the associations between gentrification and food insecurity. Further mediation analyses were conducted to test the mechanisms of such associations. RESULTS Older adults in gentrifying neighborhoods were more likely to have food insecurity than those in moderate- to high-income neighborhoods. Compared to low-income neighborhoods, older adults in gentrifying neighborhoods had a lower likelihood of reporting food insecurity. Two significant mediators were found when comparing gentrification with moderate- to high-income neighborhoods: social cohesion and healthy food outlets. DISCUSSION AND IMPLICATIONS This study highlights the importance of gentrification in determining late-life food insecurity and identifies possible mechanisms with policy and social service implications to reduce the risk of food insecurity in urban areas.
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Affiliation(s)
- Ethan Siu Leung Cheung
- Department of Family and Consumer Studies, The University of Utah, Salt Lake City, Utah, USA
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Briggs R, Rowden H, Lagojda L, Robbins T, Randeva HS. The lived experience of food insecurity among adults with obesity: a quantitative and qualitative systematic review. J Public Health (Oxf) 2024; 46:230-249. [PMID: 38409966 PMCID: PMC11141780 DOI: 10.1093/pubmed/fdae016] [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: 04/08/2023] [Revised: 11/16/2023] [Accepted: 12/01/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Food insecurity and obesity are increasing both globally and in the UK. In this review we systematically assess the lived experiences of people with obesity who are food insecure and often turn to food banks. METHODS We systematically searched electronic databases from January 2007 until October 2022. Data from eligible studies were extracted and the studies assessed for quality. Thematic analysis and narrative synthesis approach was used to analyse the extracted data. RESULTS Six themes were identified among 25 included studies, including: the financial cost of food; psychological aspects related to food insecurity; geographical access and the food environment; food practices in the home; experience of food assistance; and parental-child relationships. The cost of healthy food and psychological factors were identified as key driving factors of the relationship between food insecurity and obesity. Psychological factors such as depression, low self-esteem and stress played an important part in the lived experience of people with obesity and food insecurity. CONCLUSION The food environment provides context in which food decisions are made, therefore, systems change is necessary to ensure families can afford the food that enables a healthy diet. For clinicians, identification, and attention to the impact of food insecurity on people with obesity are important.
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Affiliation(s)
- Rebecca Briggs
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Hope Rowden
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Lukasz Lagojda
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
- Clinical Evidence-Based Information Service (CEBIS), University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Timothy Robbins
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Harpal S Randeva
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health & Wellbeing, Coventry University, Coventry CV1 5FB, UK
- Institute of Cardiometabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
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Zangiabadi S, Alghalyini B, Zoubi F, Tamim H. Effect of food insecurity on depression, anxiety, and stress among resettled Syrian refugees in Ontario. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002571. [PMID: 38489325 PMCID: PMC10942079 DOI: 10.1371/journal.pgph.0002571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/12/2024] [Indexed: 03/17/2024]
Abstract
Food insecurity has been linked to adverse health outcomes, particularly among vulnerable populations such as refugees. The aim of this study was to assess the prevalence of food insecurity and its association with depression, anxiety, and stress among resettled Syrian refugee parents in Ontario. This was a cross-sectional study with a total of 540 Syrian refugee parents who resided in Ontario for an average of four years and had at least one child less than 18 years who were interviewed. Information about food insecurity was collected based on the question "During the past year, did you ever eat less because there was not enough food or money for food?". Levels of depression, anxiety, and stress were assessed using the Depression Anxiety Stress Scales (DASS-21). Multiple linear regression analyses were performed to evaluate the relationship between food insecurity and depression, anxiety, and stress after adjusting for sociodemographic, migration-, and health-related factors. 44.6% of respondents reported experiencing food insecurity. Of participants, 7.6%, 8.9%, and 8.5% reported severe to extremely severe levels of depression, anxiety, and stress, respectively. Results of the multiple linear regression analysis showed that food insecurity was significantly associated with higher levels of depression (Adjβ = 2.00, p = 0.008), anxiety (Adjβ = 1.53, p = 0.013), and stress (Adjβ = 1.87, p = 0.019). Implementation of effective government interventions and frameworks are essential to reduce food insecurity among resettled Syrian refugees to ultimately improve their mental health outcomes and overall well-being.
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Affiliation(s)
- Safoura Zangiabadi
- School of Kinesiology and Health Sciences, York University, Toronto, ON, Canada
| | - Baraa Alghalyini
- Department of Family and Community Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Fatmeh Zoubi
- Department of Community and Mental Health Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Hala Tamim
- School of Kinesiology and Health Sciences, York University, Toronto, ON, Canada
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Kohanmoo A, Hashemzadeh M, Teymouri M, Zare M, Akhlaghi M. Food insecurity is associated with low diet quality and unhealthy cooking and eating habits in Iranian women. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:42. [PMID: 38486251 PMCID: PMC10941397 DOI: 10.1186/s41043-024-00533-3] [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: 12/19/2022] [Accepted: 03/02/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Food insecurity affects diet and nutrition intakes. We explored the relationship between food insecurity and dietary intakes in a group of Iranian women. METHODS The cross-sectional study was performed on 190 healthy females aged 20-55 years attending primary healthcare centers in Shiraz. Food insecurity was evaluated by Household Food Insecurity Access Scale, which is a validated tool for assessing food insecurity in developing countries. Diet was assessed using a food frequency questionnaire. The association of dietary patterns and food insecurity was assessed by linear regression. RESULTS Assessment of dietary intakes revealed that consumption of red meat, poultry, fish, dairy, fruits, non-starchy vegetables, and nuts decreased whereas that of grains, processed meats, potato, and sugary foods increased with increasing food insecurity. Among nutrients, carbohydrates, fiber, vitamin A, vitamin C, folic acid, potassium, calcium, and magnesium decreased while fat and sodium increased as food insecurity increased. Three major dietary patterns were detected. Healthy dietary patterns showed inverse associations with food insecurity in the crude (β = -0.422 and - 0.435, P < 0.001) and adjusted (adjusted for age, marital status, and educational level) (β = -0.475 and - 0.341, P < 0.001) models of regression analysis but unhealthy pattern did not show an association with food insecurity. Compared to food secure participants, a higher percentage of food insecure individuals indicated unhealthy eating habits, such as skipping breakfast, lower snack ingestion, more fast and fried food consumption, and using unhealthy cooking methods. CONCLUSION Overall, this study showed that food insecurity was associated with less healthy diet and unhealthy cooking and eating habits.
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Affiliation(s)
- Ali Kohanmoo
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maral Hashemzadeh
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Teymouri
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Morteza Zare
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoumeh Akhlaghi
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
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10
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Town M, Eke P, Zhao G, Thomas CW, Hsia J, Pierannunzi C, Hacker K. Racial and Ethnic Differences in Social Determinants of Health and Health-Related Social Needs Among Adults - Behavioral Risk Factor Surveillance System, United States, 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2024; 73:204-208. [PMID: 38451870 DOI: 10.15585/mmwr.mm7309a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Social determinants of health (SDOH) are a broad array of social and contextual conditions where persons are born, live, learn, work, play, worship, and age that influence their physical and mental wellbeing and quality of life. Using 2022 Behavioral Risk Factor Surveillance System data, this study assessed measures of adverse SDOH and health-related social needs (HRSN) among U.S. adult populations. Measures included life satisfaction, social and emotional support, social isolation or loneliness, employment stability, food stability/security, housing stability/security, utility stability/security, transportation access, mental well-being, and health care access. Prevalence ratios were adjusted for age, sex, education, marital status, income, and self-rated health. Social isolation or loneliness (31.9%) and lack of social and emotional support (24.8%) were the most commonly reported measures, both of which were more prevalent among non-Hispanic (NH) American Indian or Alaska Native, NH Black or African American, NH Native Hawaiian or other Pacific Islander, NH multiracial, and Hispanic or Latino adults than among NH White adults. The majority of prevalence estimates for other adverse SDOH and HRSN were also higher across all other racial and ethnic groups (except for NH Asian) compared with NH White adults. SDOH and HRSN data can be used to monitor needed social and health resources in the U.S. population and help evaluate population-scale interventions.
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Arillotta D, Floresta G, Guirguis A, Corkery JM, Catalani V, Martinotti G, Sensi SL, Schifano F. GLP-1 Receptor Agonists and Related Mental Health Issues; Insights from a Range of Social Media Platforms Using a Mixed-Methods Approach. Brain Sci 2023; 13:1503. [PMID: 38002464 PMCID: PMC10669484 DOI: 10.3390/brainsci13111503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
The emergence of glucagon-like peptide-1 receptor agonists (GLP-1 RAs; semaglutide and others) now promises effective, non-invasive treatment of obesity for individuals with and without diabetes. Social media platforms' users started promoting semaglutide/Ozempic as a weight-loss treatment, and the associated increase in demand has contributed to an ongoing worldwide shortage of the drug associated with levels of non-prescribed semaglutide intake. Furthermore, recent reports emphasized some GLP-1 RA-associated risks of triggering depression and suicidal thoughts. Consistent with the above, we aimed to assess the possible impact of GLP-1 RAs on mental health as being perceived and discussed in popular open platforms with the help of a mixed-methods approach. Reddit posts yielded 12,136 comments, YouTube videos 14,515, and TikTok videos 17,059, respectively. Out of these posts/entries, most represented matches related to sleep-related issues, including insomnia (n = 620 matches); anxiety (n = 353); depression (n = 204); and mental health issues in general (n = 165). After the initiation of GLP-1 RAs, losing weight was associated with either a marked improvement or, in some cases, a deterioration, in mood; increase/decrease in anxiety/insomnia; and better control of a range of addictive behaviors. The challenges of accessing these medications were a hot topic as well. To the best of our knowledge, this is the first study documenting if and how GLP-1 RAs are perceived as affecting mood, mental health, and behaviors. Establishing a clear cause-and-effect link between metabolic diseases, depression and medications is difficult because of their possible reciprocal relationship, shared underlying mechanisms and individual differences. Further research is needed to better understand the safety profile of these molecules and their putative impact on behavioral and non-behavioral addictions.
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Affiliation(s)
- Davide Arillotta
- School of Clinical Pharmacology and Toxicology, University of Florence, 50121 Florence, Italy;
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK; (G.F.); (A.G.); (J.M.C.); (V.C.); (G.M.)
| | - Giuseppe Floresta
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK; (G.F.); (A.G.); (J.M.C.); (V.C.); (G.M.)
- Department of Drug and Health Sciences, University of Catania, 95124 Catania, Italy
| | - Amira Guirguis
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK; (G.F.); (A.G.); (J.M.C.); (V.C.); (G.M.)
- Pharmacy, Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Swansea SA2 8PP, UK
| | - John Martin Corkery
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK; (G.F.); (A.G.); (J.M.C.); (V.C.); (G.M.)
| | - Valeria Catalani
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK; (G.F.); (A.G.); (J.M.C.); (V.C.); (G.M.)
| | - Giovanni Martinotti
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK; (G.F.); (A.G.); (J.M.C.); (V.C.); (G.M.)
- Department of Neurosciences, Imaging and Clinical Sciences, University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Stefano L. Sensi
- Department of Neurosciences, Imaging and Clinical Sciences, University of Chieti-Pescara, 66100 Chieti, Italy;
- Center for Advanced Studies and Technology (CAST), Institute of Advanced Biomedical Technology (ITAB), University of Chieti-Pescara, Via dei Vestini 21, 66100 Chieti, Italy
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK; (G.F.); (A.G.); (J.M.C.); (V.C.); (G.M.)
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Mossenson S, Pulker CE, Giglia R, Pollard CM. Policy approaches to nutrition-focused food banking in industrialized countries: a scoping review. Nutr Rev 2023; 81:1373-1392. [PMID: 36952286 PMCID: PMC10494020 DOI: 10.1093/nutrit/nuad004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
OBJECTIVE This review aims to synthesize the literature describing policy approaches to nutrition-focused food banking in industrialized countries, spanning the period 2000 to October 2021. BACKGROUND The charitable food system provides food assistance to increasing numbers of people experiencing food insecurity in industrialized countries. Calls to improve the nutrition quality of foods provided by foods banks, pantries, and shelves have increased, yet little is known about the challenges faced when initiating policy in this setting. METHODS A protocol based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews Guidelines was developed and registered with Open Science Framework. Four electronic databases (MEDLINE [Ovid], Global Health, ProQuest, and Scopus) were searched for peer-reviewed articles published in English. A gray literature search was conducted using Google Advanced Search. RESULTS Of 642 peer-reviewed articles screened, 15 were eligible for inclusion. In addition, 24 gray literature documents were included. These 39 papers were assessed against the Iron Triangle of Hunger Relief and the Campbell et al framework of organizational factors. Six themes were identified: (1) there is a moral imperative to take action to ensure the provision of appropriate and nutritious food for vulnerable clients; (2) nutrition policies are unlikely to be formalized; (3) the unpredictability of donated food is a barrier to providing healthy foods; (4) reliance on donations affects the sector's willingness to reduce the unhealthy inventory for fear of losing donors, and the challenges of managing donor relationships were emphasized; (5) organizational capacity (volunteer workforce, executive leadership support) must be considered; (6) the existing measure of success is a weight-based metric that does not support food banks' prioritizing of healthy foods. These, and other characteristics, were incorporated into an adapted framework. CONCLUSION There is a need and opportunity for nutrition-focused food banking. A priority action area is the adoption of an outcome metric that is based on nutritional quality, to reorient the charitable food system.
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Affiliation(s)
- Sharonna Mossenson
- School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Claire E Pulker
- School of Population Health, Curtin University, Bentley, Western Australia, Australia
- East Metropolitan Health Service, Perth, Western Australia, Australia
| | - Roslyn Giglia
- Foodbank of Western Australia, Perth Airport, Western Australia, Australia
| | - Christina M Pollard
- School of Population Health, Curtin University, Bentley, Western Australia, Australia
- Enable Institute, Curtin University, Bentley, Western Australia, Australia
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Levi R, Bleich SN, Seligman HK. Food Insecurity and Diabetes: Overview of Intersections and Potential Dual Solutions. Diabetes Care 2023; 46:1599-1608. [PMID: 37354336 PMCID: PMC10465985 DOI: 10.2337/dci23-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/24/2023] [Indexed: 06/26/2023]
Abstract
Food insecurity increases the risk of developing diabetes and its complications. In this article, we describe the complex relationship that exists between food insecurity and diabetes and describe potential mechanisms that may underlie this association. We then describe how two different types of interventions, food-is-medicine and federal nutrition assistance programs, may help address both food insecurity and health. Finally, we outline the research, policy, and practice opportunities that exist to address food insecurity and reduce diabetes-related health disparities.
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Affiliation(s)
- Ronli Levi
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA
| | - Sara N. Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Hilary K. Seligman
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA
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Thomas MK, Amstutz C, Orr-Roderick D, Horter J, Holben DH. Medical Mistrust Among Food Insecure Individuals in Appalachia. FAMILY & COMMUNITY HEALTH 2023; 46:192-202. [PMID: 37079541 PMCID: PMC10179979 DOI: 10.1097/fch.0000000000000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
This study focused on the relationship between food insecurity and medical mistrust within Appalachia. Food insecurity has negative consequences on health, while medical mistrust can lead to a decrease in health care use, creating additive consequences to already vulnerable populations. Medical mistrust has been defined in various ways, with measures addressing health care organizations and individual health care providers. To determine whether food insecurity has an additive impact on medical mistrust, a cross-sectional survey was completed by 248 residents in Appalachia Ohio while attending community or mobile clinics, food banks, or the county health department. More than one-quarter of the respondents had high levels of mistrust toward health care organizations. Those with high food insecurity levels were more likely to have higher levels of medical mistrust than those with lower levels of food insecurity. Individuals with higher self-identified health issues and older participants had higher medical mistrust scores. Screening for food insecurity in primary care can reduce the impact of mistrust on patient adherence and health care access by increasing patient-centered communication. These findings present a unique perspective on how to identify and mitigate medical mistrust within Appalachia and call attention to the need for further research on the root causes among food insecure residents.
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Affiliation(s)
- Melissa K. Thomas
- Department of Primary Care (Dr Thomas), Ohio University Heritage College of Osteopathic Medicine (Ms Amstutz), Athens, Ohio; Learning Resource Center, Ohio University Heritage College of Osteopathic Medicine/Medical Education, Athens, Ohio (Ms Orr-Roderick); Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio (Ms Horter); and Department of Nutrition and Hospitality Management, Office of Food and Nutrition Security, The University of Mississippi, University, Mississippi (Dr Holben)
| | - Ciara Amstutz
- Department of Primary Care (Dr Thomas), Ohio University Heritage College of Osteopathic Medicine (Ms Amstutz), Athens, Ohio; Learning Resource Center, Ohio University Heritage College of Osteopathic Medicine/Medical Education, Athens, Ohio (Ms Orr-Roderick); Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio (Ms Horter); and Department of Nutrition and Hospitality Management, Office of Food and Nutrition Security, The University of Mississippi, University, Mississippi (Dr Holben)
| | - Debra Orr-Roderick
- Department of Primary Care (Dr Thomas), Ohio University Heritage College of Osteopathic Medicine (Ms Amstutz), Athens, Ohio; Learning Resource Center, Ohio University Heritage College of Osteopathic Medicine/Medical Education, Athens, Ohio (Ms Orr-Roderick); Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio (Ms Horter); and Department of Nutrition and Hospitality Management, Office of Food and Nutrition Security, The University of Mississippi, University, Mississippi (Dr Holben)
| | - Julia Horter
- Department of Primary Care (Dr Thomas), Ohio University Heritage College of Osteopathic Medicine (Ms Amstutz), Athens, Ohio; Learning Resource Center, Ohio University Heritage College of Osteopathic Medicine/Medical Education, Athens, Ohio (Ms Orr-Roderick); Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio (Ms Horter); and Department of Nutrition and Hospitality Management, Office of Food and Nutrition Security, The University of Mississippi, University, Mississippi (Dr Holben)
| | - David H. Holben
- Department of Primary Care (Dr Thomas), Ohio University Heritage College of Osteopathic Medicine (Ms Amstutz), Athens, Ohio; Learning Resource Center, Ohio University Heritage College of Osteopathic Medicine/Medical Education, Athens, Ohio (Ms Orr-Roderick); Ohio University Heritage College of Osteopathic Medicine, Dublin, Ohio (Ms Horter); and Department of Nutrition and Hospitality Management, Office of Food and Nutrition Security, The University of Mississippi, University, Mississippi (Dr Holben)
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Derose KP, Then-Paulino A, Han B, Armenta G, Palar K, Jimenez-Paulino G, Sheira LA, Acevedo R, Fulcar MA, Lugo Bernard C, Veloz Camacho I, Donastorg Y, Wagner GJ. Preliminary Effects of an Urban Gardens and Peer Nutritional Counseling Intervention on HIV Treatment Adherence and Detectable Viral Load Among People with HIV and Food Insecurity: Evidence from a Pilot Cluster Randomized Controlled Trial in the Dominican Republic. AIDS Behav 2023; 27:864-874. [PMID: 36066760 PMCID: PMC9446649 DOI: 10.1007/s10461-022-03821-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 11/01/2022]
Abstract
A pilot cluster randomized controlled trial involving two HIV clinics in the Dominican Republic assessed preliminary efficacy of an urban garden and peer nutritional counseling intervention. A total of 115 participants (52 intervention, 63 control) with moderate or severe food insecurity and sub-optimal antiretroviral therapy (ART) adherence and/or detectable viral load were assessed at baseline, 6- and 12-months. Longitudinal multivariate regression analysis controlling for socio-demographics and accounting for serial cluster correlation found that the intervention: reduced the prevalence of detectable viral load by 20 percentage points at 12 months; reduced any missed clinic appointments by 34 and 16 percentage points at 6 and 12 months; increased the probability of "perfect" ART adherence by 24 and 20 percentage points at 6 and 12 months; and decreased food insecurity at 6 and 12 months. Results are promising and warrant a larger controlled trial to establish intervention efficacy for improving HIV clinical outcomes.Trial registry Clinical Trials Identifier: NCT03568682.
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Affiliation(s)
- Kathryn P Derose
- Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, CA, USA.
- Department of Health Promotion and Policy, University of Massachusetts Amherst, 715 N. Pleasant St., Amherst, MA, 01003, USA.
| | - Amarilis Then-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
- Ministerio de Salud Pública, Santo Domingo, Dominican Republic
| | - Bing Han
- Economics, Sociology, & Statistics Department, RAND Corporation, Santa Monica, CA, USA
- Division of Biostatistics Research, Department of Research & Evaluations, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Gabriela Armenta
- Pardee RAND Graduate School, RAND Corporation, Santa Monica, CA, USA
| | - Kartika Palar
- Division of HIV, Infectious Disease, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Gipsy Jimenez-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Lila A Sheira
- Division of HIV, Infectious Disease, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Ramón Acevedo
- Consejo Nacional para el VIH y Sida (CONAVIHSIDA), Santo Domingo, Dominican Republic
| | - María A Fulcar
- World Food Programme, Country Office for the Dominican Republic, Santo Domingo, Dominican Republic
| | - Claudio Lugo Bernard
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Isidro Veloz Camacho
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Yeycy Donastorg
- Unidad de Vacunas e Investigación, Instituto Dermatológico Dominicano y Cirugía de Piel Dr. Huberto Bogaert Díaz, Santo Domingo, Dominican Republic
| | - Glenn J Wagner
- Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, CA, USA
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Biadgilign S. Coping Strategies to Mitigate Food Insecurity at Household Level: Evidence From Urban Setting in Addis Ababa, Ethiopia. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231206263. [PMID: 37872773 PMCID: PMC10594962 DOI: 10.1177/00469580231206263] [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: 08/19/2022] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/25/2023]
Abstract
Food insecurity is the limited or uncertain ability of households to acquire nutritionally adequate and safe foods in socially acceptable ways. There is paucity of empirical evidence on household food insecurity, level of expenditure, and coping strategies in urban setting of Ethiopia. The objective of this paper is to examine the coping strategies of food insecure households in an urban area setting of Addis Ababa, Ethiopia. This study is based on data collected from 632 mothers interviewed in 2017. Multi-stage sampling techniques were carried out to identify the study unit from selected sub-cites. From each sub-city, proportion to population sampling was applied to obtain the sample size. Simple random sampling method was used to select districts in each sub-city. Multivariable logistic regression model was used to identify factors associated with food security status. The most common coping strategies households used in response to food insecurity were: rely on less preferred and less expensive foods, borrow food, or borrow money to buy food and purchase of food on credit. Food insecure households were 3 times more likely to rely on help from a relative or friend outside the household [AOR = 2.37; 95% CI: (1.01, 5.53); P < .047] compared to food secure households. Similarly, food insecure households were approximately 4 times more likely to limit portions at mealtimes [AOR = 3.55; 95% CI: (1.36, 9.30); P < .010] compared to food secure households. Furthermore, households with no access to a bank or microfinance savings account were 3 times [AOR = 2.62; 95%: (1.21, 5.66); P < .014] more likely to become food insecure compared to those with access to financial services. Households rely on less preferred cheap foods or lending to cope with food insecurity in urban settings of Ethiopia. Encouraging households to practice urban gardening, social protection through integrated national safety net programs, and improving access to microfinance services would be vital to address food insecurity among urban households of the country to bring successful social and economic development.
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Affiliation(s)
- Sibhatu Biadgilign
- University of South Africa, Regional Learning Office Ethiopia, Addis Ababa, Ethiopia
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Diaz C, Ortiz V, Sanchez L, Fernandez J, Andrade EA, Akiyama MJ, Ross J. Harmful by Design-a Qualitative Study of the Health Impacts of Immigration Detention. J Gen Intern Med 2022:10.1007/s11606-022-07914-6. [PMID: 36451013 PMCID: PMC9713141 DOI: 10.1007/s11606-022-07914-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/28/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND The USA has the largest immigration detention system in the world with over 20,000 individuals imprisoned by Immigration and Customs Enforcement (ICE) daily. Numerous reports have documented human rights abuses in immigration detention, yet little is known about its health impacts. OBJECTIVE To characterize how the US immigration detention system impacts health from the perspective of people who were recently detained by ICE. DESIGN Qualitative study using anonymous, semi-structured phone interviews in English or Spanish conducted between July 2020 and February 2021. PARTICIPANTS Adults who had been detained by ICE for at least 30 days in the New York City metropolitan area within the previous 2 years, and that were fluent in English and/or Spanish. APPROACH We explored participants' health histories and experiences trying to meet physical and mental health needs while in detention and after release. We conducted a reflective thematic analysis using an inductive approach. KEY RESULTS Of 16 participants, 13 identified as male; five as lesbian, gay, bisexual, or queer; and four as Black; they were from nine countries. Participants had spent a median of 20 years living in the USA and spent a median of 11 months in immigration detention. Four themes emerged from our analysis: (1) poor conditions and inhumane treatment, (2) a pervasive sense of injustice, (3) structural barriers limiting access to care, and (4) negative health impacts of immigration detention. CONCLUSIONS The narratives illustrate how structural features of immigration detention erode health while creating barriers to accessing needed medical care. Clinicians caring for immigrant communities must be cognizant of these health impacts. Community-based alternatives to immigration detention should be prioritized to mitigate health harms.
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Affiliation(s)
- Chanelle Diaz
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Avenue, Bronx, NY, 10467, USA.
| | - Veronica Ortiz
- Department of Pediatrics, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Lesly Sanchez
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jose Fernandez
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Elí A Andrade
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Avenue, Bronx, NY, 10467, USA
| | - Matthew J Akiyama
- Divisions of General Internal Medicine and Infectious Disease, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jonathan Ross
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Avenue, Bronx, NY, 10467, USA
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Rasul R, Rouzier V, Sufra R, Yan LD, Joseph I, Mourra N, Sabwa S, Deschamps MM, Fitzgerald DW, Pape JW, Nash D, McNairy ML. Extreme Food Insecurity and Malnutrition in Haiti: Findings from a Population-Based Cohort in Port-au-Prince, Haiti. Nutrients 2022; 14:4854. [PMID: 36432540 PMCID: PMC9695391 DOI: 10.3390/nu14224854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/27/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022] Open
Abstract
Haiti is one of the most food-insecure (FIS) nations in the world, with increasing rates of overweight and obesity. This study aimed to characterize FIS among households in urban Haiti and assess the relationship between FIS and body mass index (BMI) using enrollment data from the Haiti Cardiovascular Disease Cohort Study. FIS was characterized as no/low, moderate/high, and extreme based on the Household Food Security Scale. Multinomial logistic generalized estimating equations were used to evaluate the association between FIS categories and BMI, with obesity defined as BMI ≥ 30 kg/m2. Among 2972 participants, the prevalence of moderate/high FIS was 40.1% and extreme FIS was 43.7%. Those with extreme FIS had higher median age (41 vs. 38 years) and were less educated (secondary education: 11.6% vs. 20.3%) compared to those with no/low FIS. Although all FIS categories had high obesity prevalence, those with extreme FIS compared to no/low FIS (15.3% vs. 21.6%) had the lowest prevalence. Multivariable models showed an inverse relationship between FIS and obesity: moderate/high FIS (OR: 0.77, 95% CI: 0.56, 1.08) and extreme FIS (OR: 0.58, 95% CI: 0.42, 0.81) versus no/low FIS were associated with lower adjusted odds of obesity. We found high prevalence of extreme FIS in urban Haiti in a transitioning nutrition setting. The inverse relationship between extreme FIS and obesity needs to be further studied to reduce both FIS and obesity in this population.
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Affiliation(s)
- Rehana Rasul
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY 10017, USA
- Institute of Implementation Science in Population Health, City University of New York, New York, NY 10027, USA
| | - Vanessa Rouzier
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Rodney Sufra
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
| | - Lily D. Yan
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Inddy Joseph
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
| | - Nour Mourra
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Shalom Sabwa
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Marie M. Deschamps
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
| | - Daniel W. Fitzgerald
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Jean W. Pape
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Denis Nash
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY 10017, USA
- Institute of Implementation Science in Population Health, City University of New York, New York, NY 10027, USA
| | - Margaret L. McNairy
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
- Division of General Internal Medicine, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
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Fonseca-Pérez D, Arteaga-Pazmiño C, Maza-Moscoso CP, Flores-Madrid S, Álvarez-Córdova L. Food insecurity as a risk factor of sarcopenic obesity in older adults. Front Nutr 2022; 9:1040089. [PMID: 36337623 PMCID: PMC9630347 DOI: 10.3389/fnut.2022.1040089] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/03/2022] [Indexed: 12/02/2022] Open
Abstract
Sarcopenic obesity is characterized by the loss of muscle strength, mass and muscle functionality and increased adipose tissue (obesity) according to different criteria and cut-off points. The prevalence of sarcopenic obesity among older adults is growing worldwide, and many factors are involved in its development. Diet and food security have been described as the main contributors to the development of obesity and sarcopenia. Food insecurity consists of limited or uncertain access to adequate and nutritious foods. This narrative review aims to summarize the existing data on food insecurity as a risk factor for sarcopenic obesity in the elderly.
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Affiliation(s)
- Diana Fonseca-Pérez
- Carrera de Nutrición y Dietética, Instituto de Investigación e Innovación en Salud Integral (ISAIN), Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - Cecilia Arteaga-Pazmiño
- Carrera de Nutrición y Dietética, Facultad de Ciencias Médicas, Universidad de Guayaquil, Guayaquil, Ecuador
| | | | - Sara Flores-Madrid
- Carrera de Nutrición y Dietética, Facultad de Ciencias de la Vida, Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
| | - Ludwig Álvarez-Córdova
- Carrera de Nutrición y Dietética, Instituto de Investigación e Innovación en Salud Integral (ISAIN), Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
- Carrera de Nutrición y Dietética, Facultad de Ciencias de la Vida, Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
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20
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Lindberg R, McNaughton SA, Abbott G, Pollard CM, Yaroch AL, Livingstone KM. The Diet Quality of Food-Insecure Australian Adults-A Nationally Representative Cross-Sectional Analysis. Nutrients 2022; 14:4133. [PMID: 36235785 PMCID: PMC9572719 DOI: 10.3390/nu14194133] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 11/06/2022] Open
Abstract
Poor diet quality exacerbates risks for acute and chronic conditions. People experiencing food insecurity have an increased likelihood of lower diet quality; however, this has not been investigated in the Australian context. The aim of this cross-sectional study was to examine whether the diet quality of Australian adults differed according to their household food security status. Data were analysed from a nationally representative sample (≥19 years; n = 9115) collected as part of the National Nutrition and Physical Activity Survey 2011-12. Household food security status and socio-demographic and health characteristics were assessed using data from an 18-module health interview. A 24 h dietary recall was used to estimate food and nutrient intakes and to calculate the Dietary Guidelines Index (DGI). DGI is a food-based score (0 to 130) that assesses adherence to the 2013 Australian Dietary Guidelines. Survey-weighted linear regression models, adjusted for age and sex, were used to examine diet quality (total DGI and component scores), and total energy and nutrient intake by food security status. Adults from food-insecure households had a mean total DGI score 3.5 points lower (95% CI -5.57, -1.46) than food-secure adults (p = 0.001). Adults from households experiencing food insecurity, when compared to those who were food-secure, had several lower DGI component scores including for dietary variety (1.6 vs. 2.3, p = 0.009), fruit (3.8 vs. 5.0, p = 0.001) and vegetables (3.7 vs. 4.4, p = 0.010). Adults from food-insecure households consumed on average more carbohydrates (45.6 vs. 43.3, p = 0.004) and total sugar (21.8 vs. 19.0, p = 0.003) as a percentage of daily energy and less protein (18.5 vs. 17.2, p = 0.004), mono-unsaturated fats (11.2 vs. 11.8, p = 0.026) as a percentage of daily energy, and fibre (20.1 vs. 23.0, p = 0.003), than food-secure adults. Sub-optimal diet may be one of the contributing factors to, or outcomes of, poorer health in food-insecure populations. Food security interventions are required to better address nutrition in food-insecure households and should be tailored to the health and socio-demographic characteristics of this population.
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Affiliation(s)
- Rebecca Lindberg
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia
| | - Sarah A. McNaughton
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia
| | - Christina M. Pollard
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- Enable Institute, Faculty of Health Sciences, Curtin University, Bentley, WA 6102, Australia
| | - Amy L. Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, NE 68154, USA
| | - Katherine M. Livingstone
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia
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Gore E, DiTursi J, Rambuss R, Pope-Collins E, Train MK. Implementing a Process for Screening Hospitalized Adults for Food Insecurity at a Tertiary Care Center. J Healthc Qual 2022; 44:305-312. [PMID: 36036781 DOI: 10.1097/jhq.0000000000000350] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Food insecurity has been linked to numerous chronic conditions and higher healthcare costs; however, screening for food insecurity lags behind screening for other social determinants of health, particularly in the hospital setting. Although our hospital serves a population with a high prevalence of food insecurity, no process previously existed to universally screen patients. Our multidisciplinary team developed and implemented a process to screen hospitalized adults for food insecurity and connect them with food resources, which we piloted on a 26-bed hospital medicine unit. We integrated a validated 2-item screen into the electronic health record (EHR) nursing admission workflow, and provided 2 weeks of nursing education before process implementation. Adherence to screening was monitored weekly and adjustments were made using plan-do-study-act cycles. After 28 weeks, 361/587 (61.5%; weekly average 61.1%) encounters were screened (compared with a baseline of 2.2%), with 21/361 (5.8%) identified as food insecure. The implementation of an EHR-based food insecurity screening process in the hospital setting increased screening and identification of food insecure patients. Through improved integration of screening questions into the existing nursing workflow and continued education, success was sustained despite challenges with nursing staff turnover and staff shortages during the COVID-19 pandemic.
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22
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Addressing Food Insecurity. Am J Nurs 2022; 122:55-56. [DOI: 10.1097/01.naj.0000874124.68201.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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The effect of non-participation on the prevalence of food insecurity in a population-based cohort in Portugal. J Public Health Policy 2022; 43:391-402. [PMID: 36038767 DOI: 10.1057/s41271-022-00362-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/21/2022]
Abstract
Non-participation can be a source of selection bias. We evaluated the effect of non-participation on food insecurity prevalence among 2942 young adults from the EPITeen cohort (Portugal), which we have followed since assembling the cohort in 2003-2004. We conducted a cross-sectional study when the cohort participants were 26 years old. To examine the effect of non-participation, we statistically imputed the missing data on food security status using multivariate imputation by chained equations based on characteristics associated with food insecurity, specifically household income perception, education and household structure from 21 or 24 years of age follow-ups. In our cohort, non-participation caused ~ 2% difference in the food insecurity prevalence: 11.0% (95% CI 9.0-13.0) for 954 participants and 12.6% (95% CI 11.1-14.1) after imputation. These estimates are close to evidence from other European countries and sustain the relevance of developing public health interventions to promote food security, especially considering the negative nutritional and health outcomes associated with food insecurity.
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Ziso D, Chun OK, Puglisi MJ. Increasing Access to Healthy Foods through Improving Food Environment: A Review of Mixed Methods Intervention Studies with Residents of Low-Income Communities. Nutrients 2022; 14:nu14112278. [PMID: 35684077 PMCID: PMC9182982 DOI: 10.3390/nu14112278] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/22/2022] [Accepted: 05/27/2022] [Indexed: 12/22/2022] Open
Abstract
Food insecurity is a broad and serious public health issue in the United States, where many people are reporting lack of access to healthy foods. The reduced availability of healthy, affordable foods has led to increased consumption of energy-dense and nutrient-poor foods, resulting in increasing the risk for many chronic diseases such as obesity, cardiovascular diseases, and type 2 diabetes mellitus. Thus, identifying promising approaches to increase access to healthy foods through improving the food environment is of importance. The purpose of this review article is to highlight how the food environment affects directly a person’s food choices, and how to increase access to healthy foods through improving environmental approaches. The literature search was focused on finding different approaches to improve food security, primarily those with an impact on food environment. Overall, potential solutions were gathered through multilevel environmental approaches, including nutrition education and peer education, community-based participatory research, and policy changes in supplemental nutrition programs. A recommendation to reduce food insecurity is learning to create meals with a variety of seasonal fruits and vegetables purchased from affordable farmers’ markets.
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Food Insecurity in Central-Eastern Europe: Does Gender Matter? SUSTAINABILITY 2022. [DOI: 10.3390/su14095435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Food insecurity (FI) remains a challenge not only in less-developed countries but also worldwide. The literature indicates higher rates of FI for women than men in some regions of the world. Thus, the main objective of this cross-sectional study was to assess differences in experiencing FI according to gender in Central-Eastern Europe—a region that has been little researched in terms of FI. The study analyzes individual-level data on FI from the Gallup World Poll (GWP) for the years 2018–2019, obtained under a license from the Food and Agriculture Organization (FAO). Dataset encompasses representative samples of individuals aged 15 and above for each studied country. Apart from bivariate analysis, the ordered logistic regression, the generalized ordered logistic regression and multinomial logistic regression models were used. It was found that women experienced mild FI more often than men. However, gender differences with respect to moderate or severe FI were not confirmed. Moreover, the significant associations of all severity levels of FI with education, employment status, social capital, social network, age, marital status, household composition and income were observed. The research findings can be used to inform policy and to design targeted assistance programs for those in need.
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Joachim-Célestin M, Rockwood NJ, Clarke C, Montgomery SB. Evaluating the Full Plate Living lifestyle intervention in low-income monolingual Latinas with and without food insecurity. WOMEN'S HEALTH 2022; 18:17455057221091350. [PMID: 35404195 PMCID: PMC9006362 DOI: 10.1177/17455057221091350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Food insecurity has long been associated with poor physical and mental health, especially among women from underrepresented minorities. Despite efforts to reduce food insecurity, rates continue to rise and remain disproportionately high among Latinx living in the United States, a group reporting worse mental health symptoms than any other ethnic group during the COVID-19 pandemic. The need to reduce the health burden associated with food insecurity among Latinas is urgent and requires a more targeted and innovative approach. Interventions using a popular education approach have proven effective among underserved populations, especially when these are delivered by community health workers. However, food insecurity status of the participants is often unreported and it is not clear whether or not results vary between those with and without food insecurity. Objectives: The aim of this quasi-experimental study was to examine physical and mental health changes among Latinas with, and without, food insecurity following a multicomponent health intervention led by community health workers using a popular education approach. Methods: Enrolled obese Latinas (N = 98) with and without food insecurity responded to demographic, health behaviors and mental health surveys and completed biometric measurements at baseline, immediately following the intervention and at 3 months. Results: At baseline, participants with food insecurity reported more anxiety and depression than those without, but average body mass index was comparable. Depression, anxiety and body mass index were lower at 3 months post and no statistically significant differences were seen between the groups. Participants with food insecurity benefited as much from the intervention as those without. We found that, although community health workers are not licensed healthcare professionals, with proper training and support, they were able to successfully reduce the risk of chronic diseases and improve mental health symptoms among food-insecure Latinas. Conclusion: Given the promising results, similar interventions should be implemented on a larger scale in Latino communities among food insecure women. Long-term sustainability should also be explored.
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Affiliation(s)
| | | | - Camille Clarke
- School of Behavioral Health, Loma Linda University, Loma Linda, CA, USA
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