Household food insecurity in small municipalities in Northeastern Brazil: a validation study

Effect of a conditional cash transference program on food insecurity in Mexican households: 2012-2016

OBJECTIVE

To estimate the effects of the social inclusion programme PROSPERA on food insecurity (FI) in Mexican households during 2012 and 2016.

DESIGN

Quasi-experimental study using cross-sectional data from 2012 to 2016 National Household Income and Expenditure Survey - Socioeconomic Conditions Module (in Spanish, ENIGH-MCS).

SETTING

Data were used from a 2012 sample of 56 888 Mexican households (representative of 31 206 819 households) and a 2016 sample of 70 263 Mexican households (representative of 33 445 353 households). Severity of FI was estimated with the Mexican Food Security Scale (in Spanish, EMSA). The statistical analysis estimated a differences in differences (DD) model weighted by propensity score to compare program beneficiary and non-beneficiary households in 2012 than in 2016. We estimated the effect on households with and without children (< 18 years of age). We also compared this model to a DD model without propensity score weighting.

PARTICIPANTS

Mexican households.

RESULTS

FI among all beneficiary households decreased 8·0pp as compared to non-beneficiary households over the study period. In beneficiary households with children, this decrease was 6·0pp and for beneficiary households without children, this decrease was 12·9pp (for all, P-value < 0·001).

CONCLUSIONS

The PROSPERA program had a positive effect on FI reduction at the household level through increasing food access, which usually improves nutritional outcomes in vulnerable Mexican populations.

Validation of a Scale to Assess Household Food Insecurity in One Rural and One Periurban Area of Ecuador, with a High Percentage of Migrants

Ecuador is the country that receives and integrates the largest amount of refugees and migrants of Latin America into its population and it has to have valid instruments for measuring and monitoring its food insecurity situation. A food security scale was applied to a sample of households in one rural area (n = 36), and another peri-urban one (n = 153). The validation was made following FAO recommendations. On applying the Raschse model it was observed that the theoretical severity of the questions was reflected similarly in the experiences of the households. The infit statistics for each item are placed in acceptable values (0.7-1.3). The results of the validated scale indicate that the study population finds itself in a serious food insecurity situation.

[Food Insecurity Experience Scale (FIES) in Colombia, Guatemala, and México.]

OBJECTIVE

To compare the psychometric characteristics of the Food Insecurity Experience Scale (FIES) and the grade of similitude or difference among Colombia, Guatemala, and Mexico during three years.

MATERIALS AND METHODS

Psychometric comparison using the Rasch model to calculate the relative severity of each item in FIES, INFIT and contrast in the Differential Functioning of Items (c-DIF).

RESULTS

The majority of items showed a relative severity corresponding to the theoretical construct and acceptably fit the model (INFIT=0.7-1.3). No c-DIF above 1.0 logit was observed in the comparison men vs women. In the comparison among countries by year 87% of the items showed c-DIF below 0.5 logit.

CONCLUSIONS

The FIES presents psychometric characteristics corresponding to the theoretical construct of the tool. Future studies with the inclusion of more countries and more time points are essential to evaluate the relative severity, behavior and distribution of items.

The relation of cash transfer programs and food insecurity among families with preschool children living in semiarid climates in Brazil

Abstract Background Food insecurity has important effects on human health, particularly in children’s. It continues to increase, with an estimated prevalence of 14.9% in the USA and 35% in Brazil. There have been few studies on the effect of cash transfer programs (CTPs) on the prevalence of food security in Brazil. Objective Evaluate the association between cash transfer programs and reductions in inequity and food insecurity. Method Population-based cross-sectional study in the state of Ceará, Northeast Brazil, with a sample of 8.000 households. Ceará is one of the poorest states. The state population of 8.5 million inhabitants, social security benefits and government grants, “ Bolsa Família”, have become the most stable source of income. The main outcomes measures were food insecurity and CTP participation. Multivariate logistic models were constructed to assess the association between participation in CTPs and food security. Results Participation in CTPs was found to be independently related to the prevalence of food security (APR 2.29 95% CI 1.57-3.33), as are education level, residential setting, and children’s nutritional status. Conclusions CTPs and investment in education are initiatives that might be used to reduce food insecurity.

Verifying Validity of the Household Dietary Diversity Score: An Application of Rasch Modeling

BACKGROUND

The Household Dietary Diversity Score (HDDS) was developed to measure household food access, one of the levels of food security. Previous research has shown dietary diversity is related to food security. However, the validity of the HDDS in the form developed by the Food and Nutrition Technical Assistance (FANTA) project-12 food groups, 24-hour recall-and most frequently used by development organizations and nongovernmental organizations has never been verified.

OBJECTIVE

To verify the construct validity of the HDDS.

METHODS

A Rasch model was used to test the extent to which the HDDS meets the criteria required for interval scale measurement, using data from 1015 households in Colombia and Ecuador.

RESULTS

Different dietary patterns between Colombia and Ecuador and 2 cultural groups within Ecuador required data to be split into 3 subgroups. For each subgroup, the food groups meeting the criteria and their difficulty ranking were different. Refined indices, containing only those food groups meeting the criteria, contained 7 items in Colombia, 10 for Kichwa households in Ecuador, and 9 for migrant households.

CONCLUSION

The indicator in its current form does not meet all criteria. Even when analyzing culturally homogenous subgroups within a small region, the components of the indicator do not form a reliable way of measuring household-level food access.

Validation of the food access survey tool to assess household food insecurity in rural Bangladesh

Background

Perception-based Likert scale are commonly used to assess household food insecurity. The aim of this study was to evaluate the psychometric properties and external construct validity of the 9-item Food Access Survey Tool (FAST) in a population-based randomized controlled trial.

Methods

Participating women (n = 11,992) were asked to recall the frequencies of nine food insecurity experiences over the past 6 months on a 5-point Likert scale. The Rasch partial credit model was used to study the item category severity and differential item functioning (DIF) by literacy status, respondents’ age, land ownership and household sizes. Principal component analysis (PCA), non-parametric methods, and cumulative ordinal logistic regression models were applied to examine the Rasch model assumptions, namely unidimensionality, monotonicity and measurement invariance (non-DIF).

Results

All items demonstrated good model fit with acceptable values of fit statistics (infit). PCA as well as other indices (Cronbach’s alpha = 0.85, scalability coefficient = 0.48) indicated that all items fit in a single statistical dimension. The ordered responses of nine items displayed monotonic increasing item category severity as expected theoretically. All nine items were flagged with statistically significant DIF between key demographic—and socioeconomic subgroups (p < 0.001); however, none of the detected DIF was considered practically significant given small effect sizes (variance explained by group membership and interaction term < 1 %). The total summed score over the polytomous FAST was inversely associated with household wealth, dietary diversity score and maternal body mass index, demonstrating external construct validity.

Conclusion

The polytomous FAST is internally and externally valid tool to measure household food insecurity in rural Bangladesh. Validation of this type of studies are recommended for similar Likert food insecurity scales.

Insegurança alimentar entre adolescentes brasileiros: um estudo de validação da Escala Curta de Insegurança Alimentar

Objetivo Os objetivos do trabalho foram avaliar a validade interna e a capacidade preditiva da escala de segurança alimentar de seis itens aplicada a adolescentes. Métodos Foi um estudo transversal com amostra representativa de adolescentes brasileiros (N=14.690), realizado em escolas públicas e privadas nas 26 capitais de estados brasileiros e no Distrito Federal por meio de questionário online. Resultados A maior parte dos respondentes era do sexo feminino (53,2%), com idade média de 14,4 anos, sendo 72,7% de escolas públicas. O comportamento da escala, observado pelo modelo de Rasch, foi melhor sem o item cinco, apresentando valores ótimos de Infit e nível de severidade crescente entre os itens. O alfa de Cronbach foi 0,77, e as análises do funcionamento diferencial dos itens mostraram comportamento dos itens semelhante entre os subgrupos avaliados. A análise fatorial mostrou a unidimensionalidade do instrumento. Conclusão Foi proposta a retirada do item cinco e novos pontos de corte para a escala curta de segurança alimentar. A escala curta de segurança alimentar é válida e confiável para mensurar insegurança alimentar domiciliar entre adolescentes brasileiros.

Assessing the cross-sectional and inter-temporal validity of the Household Food Insecurity Access Scale (HFIAS) in Burundi

Objective

To examine the cross-sectional and inter-temporal validity of the Household Food Insecurity Access Scale (HFIAS) for rural households in Burundi.

Design

Longitudinal survey about food security and agricultural production, individually administered by trained interviewers in June 2007 and 2012.

Setting

Ngozi, north of Burundi.

Subjects

Three hundred and fourteen household heads were interviewed.

Results

Tobit models showed that the HFIAS was significantly correlated with objective measures of food security, in this case total annual food production (P<0·01), livestock keeping (P<0·01) and coffee production (P<0·01) in both 2007 and 2012. This confirms that the HFIAS is cross-sectionally valid and corroborates the findings of previous studies. However, while total food production decreased by more than 25 % in terms of energy between 2007 and 2012, households reported an improvement in their perceived food security over the same period, with the HFIAS decreasing from 13·9 to 10·8 (P<0·001). This finding questions the inter-temporal validity of the HFIAS. It may be partly explained through response shifts, in which households assess their own food security status in comparison to that of their peers.

Conclusions

The evidence from our study suggests that the HFIAS is cross-sectionally valid, but may not be inter-temporally valid, and should not be used as a single indicator to study temporal trends in food security.

The impact of the 2008 financial crisis on food security and food expenditures in Mexico: a disproportionate effect on the vulnerable

OBJECTIVE

The present paper investigated the impact of the 2008 financial crisis on food security in Mexico and how it disproportionally affected vulnerable households.

DESIGN

A generalized ordered logistic regression was estimated to assess the impact of the crisis on households' food security status. An ordinary least squares and a quantile regression were estimated to evaluate the effect of the financial crisis on a continuous proxy measure of food security defined as the share of a household's current income devoted to food expenditures. Setting Both analyses were performed using pooled cross-sectional data from the Mexican National Household Income and Expenditure Survey 2008 and 2010.

SUBJECTS

The analytical sample included 29,468 households in 2008 and 27,654 in 2010.

RESULTS

The generalized ordered logistic model showed that the financial crisis significantly (P<0·05) decreased the probability of being food secure, mildly or moderately food insecure, compared with being severely food insecure (OR=0·74). A similar but smaller effect was found when comparing severely and moderately food-insecure households with mildly food-insecure and food-secure households (OR=0·81). The ordinary least squares model showed that the crisis significantly (P<0·05) increased the share of total income spent on food (β coefficient of 0·02). The quantile regression confirmed the findings suggested by the generalized ordered logistic model, showing that the effects of the crisis were more profound among poorer households.

CONCLUSIONS

The results suggest that households that were more vulnerable before the financial crisis saw a worsened effect in terms of food insecurity with the crisis. Findings were consistent with both measures of food security--one based on self-reported experience and the other based on food spending.

Refinement of the Brazilian Household Food Insecurity Measurement Scale: Recommendation for a 14-item EBIA

OBJECTIVE: To review and refine Brazilian Household Food Insecurity Measurement Scale structure. METHODS: The study analyzed the impact of removing the item "adult lost weight" and one of two possibly redundant items on Brazilian Household Food Insecurity Measurement Scale psychometric behavior using the one-parameter logistic (Rasch) model. Brazilian Household Food Insecurity Measurement Scale psychometric behavior was analyzed with respect to acceptable adjustment values ranging from 0.7 to 1.3, and to severity scores of the items with theoretically expected gradients. The socioeconomic and food security indicators came from the 2004 National Household Sample Survey, which obtained complete answers to Brazilian Household Food Insecurity Measurement Scale items from 112,665 households. RESULTS: Removing the items "adult reduced amount..." followed by "adult ate less..." did not change the infit of the remaining items, except for "adult lost weight", whose infit increased from 1.21 to 1.56. The internal consistency and item severity scores did not change when "adult ate less" and one of the two redundant items were removed. CONCLUSION: Brazilian Household Food Insecurity Measurement Scale reanalysis reduced the number of scale items from 16 to 14 without changing its internal validity. Its use as a nationwide household food security measure is strongly recommended.

Measures and indicators for assessing impact of interventions integrating nutrition, health, and early childhood development

When implementing interventions integrating nutrition, health, and early childhood development, evaluation studies of effectiveness that assess the intermediate and ultimate impacts on the four domains of food and nutrition, family care, health, and child development are needed. Such studies should demonstrate impact, both benefits and potential harms, and understand mechanisms through which impact has been achieved. This article reviews and suggests measures and indicators suitable for use in evaluation studies of effectiveness of integrated interventions for children under 5 years of age. Within each of the four domains, multiple constructs and subconstructs were considered. For each construct and subconstruct, we identified measures and indicators, using several search processes, and reviewed them in relation to validity, responsiveness to intervention inputs and activities, equivalence in constructs and items across contexts with appropriate adaptation, and feasibility for use in effectiveness studies. Suggested measures and indicators for each domain, construct, and subconstruct are tabulated and described. We discuss the strengths and weaknesses of measures and indicators across domains and constructs, further research establishing validity, and guidance on adaptation of measures to particular contexts.

Persistent household food insecurity, HIV, and maternal stress in peri-urban Ghana

Background

The mental health of caregivers has been shown to be important for improving HIV prevention and treatment. Household food insecurity affects hundreds of millions of individuals in Sub-Saharan Africa, a region that experiences a disproportionate burden of the HIV pandemic. Both maternal HIV diagnosis and household food insecurity may be linked with maternal stress. This in turn may lead to unhealthy coping behaviors. We examined the independent associations of HIV, persistent household food insecurity and the synergistic effect of both on maternal stress.

Methods

Ghanaian women recruited prenatally from hospitals offering voluntary counseling and testing (VCT) were followed for 12 months after childbirth (N = 232). A locally adapted 7-item version of the US Household Food Security Survey Module was applied at four time points postpartum. We dichotomized participant households as being persistently food insecure (i.e., food insecure at each time point) or not (i.e., food secure at any time point). We dichotomized participant women as not perceiving vs. perceiving stress at 12 months postpartum in reference to the median sample score on the 4-item Cohen’s stress scale. Binary multivariate logistic regression models were used to assess the independent and interactive effects of maternal HIV and persistent household food insecurity on maternal stress.

Results

The proportion of HIV-positive women that lived in severe food insecure households increased over time. By contrast, the HIV-negative group living in severely food insecure households experienced a steady decline across time. HIV-infection (AOR = 2.31, 95% CI 1.29-4.12) and persistent household food insecurity (AOR = 3.55, 95% CI 1.13-11.13) were independently associated with maternal stress in a multivariate model. Being both HIV-positive and persistently food insecure strongly and synergistically increased the risk for maternal perceived stress (AOR = 15.35, 95% CI 1.90-124.14).

Conclusion

In agreement with syndemic theory there is a powerful synergism between maternal HIV diagnosis and household food insecurity on maternal stress. Comprehensive multi-dimensional intervention studies are needed to better understand how to reduce stress among HIV-positive women living in persistently food insecure households and how to reduce the likelihood of food insecurity in HIV-affected households in Sub-Saharan Africa.