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Brostow DP, Smith AA, Bahraini NH, Besterman-Dahan K, Forster JE, Brenner LA. Nutrition and Food Security Among Veterans: Operationalizing Nutritional Functioning. Arch Phys Med Rehabil 2024; 105:1520-1528. [PMID: 38649010 DOI: 10.1016/j.apmr.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 04/03/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To assess injured military veterans' experiences, beliefs, and daily physical and psychosocial functioning in relation to food and nutrition. DESIGN We used a convergent mixed-methods study design and the International Classification of Functioning, Disability, and Health to operationalize the core constructs and influencing factors related to physical and psychosocial functioning, food, and nutrition. SETTING Three Veterans Affairs polytrauma rehabilitation centers. PARTICIPANTS Veterans who served in the United States military on or after September 11, 2001, and whose medical diagnoses met the criteria for polytrauma; at least 1 mild traumatic brain injury and at least 1 associated comorbidity (eg, posttraumatic stress disorder, chronic musculoskeletal pain, vestibular disturbances), for a total N of 43. INTERVENTIONS None. MAIN OUTCOME MEASURES Themes from survey responses and semistructured interview data were pooled into core constructs and influencing factors. RESULTS Thirty-seven veterans completed all surveys and participated in recorded interviews. Based on qualitative and quantitative data, veterans' relation to food and nutrition (ie, nutritional functioning) was found to be characterized by 5 core constructs, including food background, nutrition knowledge, meal aptitude, resource navigation, and navigation to/of food spaces. Nutritional functioning was found to be shaped by 5 influencing factors, including injuries and health conditions, ideological and cultural exposures, relations, current beliefs, and current behaviors. CONCLUSIONS Nutritional functioning (food background, nutrition knowledge, meal aptitude, resource navigation, navigation to/of food spaces) among injured veterans is complex and shaped by multiple physical, psychosocial, economic, and cultural factors.
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Affiliation(s)
- Diana P Brostow
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Alexandra A Smith
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO
| | - Nazanin H Bahraini
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Karen Besterman-Dahan
- VA VISN (Veteran Integrated Services Network) 5 Mental Illness Research Education and Clinical Center (MIRECC), Washington, DC; Department of Nutrition and Dietetics, College of Public Health, University of South Florida, Tampa, FL
| | - Jeri E Forster
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Lisa A Brenner
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO; Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Elbogen EB, Graziano RC, LaRue G, Cohen AJ, Hooshyar D, Wagner HR, Tsai J. Food Insecurity and Suicidal Ideation: Results from a National Longitudinal Study of Military Veterans. Arch Suicide Res 2024; 28:644-659. [PMID: 37165670 PMCID: PMC10636240 DOI: 10.1080/13811118.2023.2200795] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Research examining social determinants of suicide risk in veterans suggests a potential link between food insecurity and subsequent suicidal ideation in military veterans. The objective of this study is to investigate, if and how, food insecurity predicts subsequent suicidal ideation in a nationally representative longitudinal survey of veterans. METHODS A national longitudinal survey was analyzed of participants randomly drawn from over one million U.S. military service members who served after September 11, 2001. N = 1,090 veterans provided two waves of data one year apart (79% retention rate); the final sample was representative of post-9/11 veterans in all 50 states and all military branches. RESULTS Veterans with food insecurity had nearly four times higher suicidal ideation one year later compared to veterans not reporting food insecurity (39% vs 10%). In multivariable analyses controlling for demographic, military, and clinical covariates, food insecurity (OR = 2.37, p =.0165) predicted suicidal ideation one year later, as did mental health disorders (OR = 2.12, p = .0097). Veterans with both food insecurity and mental health disorders had a more than nine-fold increase in predicted probability of suicidal ideation in the subsequent year compared to veterans with neither food insecurity nor mental health disorders (48.5% vs. 5.5%). CONCLUSION These findings identify food insecurity as an independent risk marker for suicidal ideation in military veterans in addition to mental disorders. Food insecurity is both an indicator of and an intervention point for subsequent suicide risk. Regularly assessing for food insecurity, and intervening accordingly, can provide upstream opportunities to reduce odds of suicide among veterans.
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Cypel YS, Maguen S, Bernhard PA, Culpepper WJ, Schneiderman AI. Prevalence and Correlates of Food and/or Housing Instability among Men and Women Post-9/11 US Veterans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:356. [PMID: 38541355 PMCID: PMC10970277 DOI: 10.3390/ijerph21030356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 04/16/2024]
Abstract
Food and/or housing instability (FHI) has been minimally examined in post-9/11 US veterans. A randomly selected nationally representative sample of men and women veterans (n = 38,633) from the post-9/11 US veteran population were mailed invitation letters to complete a survey on health and well-being. Principal component analysis and multivariable logistic regression were used to identify FHI's key constructs and correlates for 15,166 men and women respondents (9524 men, 5642 women). One-third of veterans reported FHI; it was significantly more likely among women than men (crude odds ratio = 1.31, 95% CI:1.21-1.41) and most prevalent post-service (64.2%). "Mental Health/Stress/Trauma", "Physical Health", and "Substance Use" were FHI's major constructs. In both sexes, significant adjusted associations (p < 0.01) were found between FHI and homelessness, depression, adverse childhood experiences, low social support, being enlisted, being non-deployed, living with seriously ill/disabled person(s), and living in dangerous neighborhoods. In men only, posttraumatic stress disorder (adjusted odds ratio (AOR) = 1.37, 95% CI:1.14-1.64), cholesterol level (elevated versus normal, AOR = 0.79, 95% CI:0.67-0.92), hypertension (AOR = 1.25, 95% CI:1.07-1.47), and illegal/street drug use (AOR = 1.28, 95% CI:1.10-1.49) were significant (p < 0.01). In women only, morbid obesity (AOR = 1.90, 95%CI:1.05-3.42) and diabetes (AOR = 1.53, 95% CI:1.06-2.20) were significant (p < 0.05). Interventions are needed that jointly target adverse food and housing, especially for post-9/11 veteran women and enlisted personnel.
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Affiliation(s)
- Yasmin S. Cypel
- Health Outcomes Military Exposures, Epidemiology Program, Office of Patient Care Services, US Department of Veterans Affairs, Washington, DC 20420, USA; (P.A.B.); (W.J.C.); (A.I.S.)
| | - Shira Maguen
- San Francisco VA Health Care System, San Francisco, CA 94121, USA;
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California—San Francisco, San Francisco, CA 94143, USA
| | - Paul A. Bernhard
- Health Outcomes Military Exposures, Epidemiology Program, Office of Patient Care Services, US Department of Veterans Affairs, Washington, DC 20420, USA; (P.A.B.); (W.J.C.); (A.I.S.)
| | - William J. Culpepper
- Health Outcomes Military Exposures, Epidemiology Program, Office of Patient Care Services, US Department of Veterans Affairs, Washington, DC 20420, USA; (P.A.B.); (W.J.C.); (A.I.S.)
| | - Aaron I. Schneiderman
- Health Outcomes Military Exposures, Epidemiology Program, Office of Patient Care Services, US Department of Veterans Affairs, Washington, DC 20420, USA; (P.A.B.); (W.J.C.); (A.I.S.)
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Robinson LA, Colin CR, Smith KS, Greene MW, Frugé AD. Diet quality is associated with nutrition knowledge and physical activity in the US military veterans enrolled in university programmes. BMJ Mil Health 2023:e002525. [PMID: 38053275 DOI: 10.1136/military-2023-002525] [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: 07/13/2023] [Accepted: 10/27/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Military veterans are at greater risk for chronic medical conditions, many of which are associated with greater body mass index (BMI). Detrimental changes to diet and physical activity (PA) levels after separation from military service contribute to this disparity which may be mitigated by nutrition education (NE) during service. METHODS We conducted a survey in student veterans attending two southeastern US universities to determine current nutrition knowledge and hypothesised that NE received during time of service would be associated with better current diet quality (DQ), PA and BMI. Food group knowledge (FGK), and nutrient knowledge, DQ measured by Healthy Eating Index (HEI), and PA reported in metabolic equivalent minutes per week (MET-min/week) were assessed using previously validated questionnaires. Height and weight were also self-reported to calculate BMI. Differences in these variables between NE groups were assessed using Mann-Whitney U tests. Change in DQ, PA and BMI were assessed with Wilcoxon signed rank tests. Stepwise backward regression analysis was used to identify significant predictors related to HEI and BMI status. RESULTS Sixty-three out of 83 total responses were valid. Respondents were 60% male, 81% white, 43% and 27% served in the Army and Navy, respectively and 30% reported receiving NE while in the military. Veterans who received NE while serving did not have higher FGK, nutrition knowledge, current DQ, MET-min/week or BMI than their counterparts. Overall, respondents reported decreased MET-min/week (p<0.001), increased BMI (p=0.01) and no change in DQ. PA (p=0.014) and FGK (p<0.001) were significant predictors of current DQ, while no variables significantly predicted current BMI. CONCLUSIONS Inverse relationships between BMI and PA were observed after separation from duty. These results warrant the development and implementation of effective lifestyle interventions in veterans to prevent chronic disease and improve quality of life.
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Affiliation(s)
- Laura A Robinson
- College of Nursing, Auburn University, Auburn, Alabama, USA
- Department of Nutritional Sciences, Auburn University, Auburn, Alabama, USA
| | - C R Colin
- Department of Nutrition and Dietetics, University of North Florida Brooks College of Health, Jacksonville, Florida, USA
| | - K S Smith
- Moffit Cancer Institute, Tampa, Florida, USA
| | - M W Greene
- Department of Nutritional Sciences, Auburn University, Auburn, Alabama, USA
| | - A D Frugé
- College of Nursing, Auburn University, Auburn, Alabama, USA
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Gu D, Max WB, Yao T, Wang Y, Keeler C, Sung HY. Association between e-cigarette use and food insecurity among low-income adults. Tob Control 2023; 32:e212-e219. [PMID: 35279644 PMCID: PMC9464793 DOI: 10.1136/tobaccocontrol-2021-057110] [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: 10/09/2021] [Accepted: 02/14/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Previous research quantifying the relationship between tobacco use and food insecurity has focused on cigarette smoking. E-cigarette use has become popular in recent years. Drawing on large, population-based survey data, this study augments the previous research, considering the association of e-cigarette use with food insecurity among low-income adults. METHODS We analysed data from the California Health Interview Survey in 2014-2019. The study sample consisted of 25 948 respondents aged 18-64 who lived in low-income (<200% of the Federal Poverty Level) households. Multivariable logistic regression models were estimated to examine the associations of e-cigarette use as well as dual use of e-cigarettes and cigarettes with food insecurity. RESULTS Of California low-income adults, 6.4% identified as current e-cigarette users (3.0% dual users of e-cigarettes and cigarettes, and 3.4% sole e-cigarette users) and 43.0% reported food insecurity. After controlling for confounding factors, food insecurity was significantly more likely to be reported among current e-cigarette users (adjusted OR (AOR)=1.67; 95% CI 1.25 to 2.23) compared with never e-cigarette users, and among dual users (AOR=2.21; 95% CI 1.63 to 3.00), current sole e-cigarette users (AOR=1.66; 95% CI 1.15 to 2.40), and current sole cigarette smokers (AOR=1.46; 95% CI 1.22 to 1.76) compared with never tobacco users. The odds of food insecurity among dual users were significantly greater than sole cigarette smokers but not statistically different from sole e-cigarette users. CONCLUSIONS Using e-cigarette is an associated risk factor for food insecurity among low-income adults. Dual use of e-cigarettes and cigarettes has a significantly greater risk of food insecurity compared with smoking cigarettes alone.
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Affiliation(s)
- Dian Gu
- Institute for Health & Aging, School of Nursing, University of California San Francisco, San Francisco, California, USA
- The Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
| | - Wendy B Max
- Institute for Health & Aging, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Tingting Yao
- Institute for Health & Aging, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Yingning Wang
- Institute for Health & Aging, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Courtney Keeler
- Department of Population Health Sciences, School of Nursing, University of San Francisco, San Francisco, California, USA
| | - Hai-Yen Sung
- Institute for Health & Aging, School of Nursing, University of California San Francisco, San Francisco, California, USA
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Robbins R, Porter Starr KN, Addison O, Parker EA, Wherry SJ, Ikpe S, Serra MC. Prevalence and socio-economic determinates of food insecurity in Veterans: findings from National Health and Nutrition Examination Survey. Public Health Nutr 2023; 26:1478-1487. [PMID: 36912105 PMCID: PMC10346074 DOI: 10.1017/s1368980023000538] [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: 02/01/2022] [Revised: 11/30/2022] [Accepted: 02/27/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE To determine predictors of the association between being a Veteran and adult food security, as well as to examine the relation of potential covariates to this relationship. DESIGN Data collected during 2011-2012, 2013-2014 and 2015-2016 National Health and Nutrition Examination Survey (NHANES) were pooled for analyses. Veterans (self-reported) were matched to non-Veterans on age, race/ethnicity, sex and education. Adjusted logistic regression was used to determine the odds of Veterans having high food security v. the combination of marginal, low and very low food security compared with non-Veterans. SETTING 2011-2012, 2013-2014 and 2015-2016 NHANES. PARTICIPANTS 1227 Veterans; 2432 non-Veterans. RESULTS Veteran status had no effect on the proportion of food insecurities between Veterans and non-Veterans reporting high (Veterans v. non-Veteran: 79 % v. 80 %), marginal (9 % v. 8 %), low (5 % v. 6 %) and very low (8 % v. 6 %) food security (P = 0·11). However, after controlling for covariates, Veterans tended to be less likely to have high food security (OR: 0·82 (95 % CI 0·66, 1·02), P = 0·07). Further, non-Hispanic White Veterans (OR: 0·72 (95 % CI 0·55, 0·95), P = 0·02) and Veterans completing some college (OR: 0·71 (95 % CI 0·50, 0·99), P < 0·05) were significantly less likely to experience high food security compared with non-Veterans. CONCLUSION This study supports previous research findings that after controlling for covariates, Veterans tend to be less likely to have high food security. It also highlights ethnicity and level of education as important socio-economic determinates of food security status in Veterans.
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Affiliation(s)
- Ronna Robbins
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX78712, USA
- San Antonio GRECC, South Texas Veterans Health Care System, San Antonio, TX78229, USA
| | - Kathryn N Porter Starr
- Durham GRECC, Durham VA Health Care System, Durham, NC, USA
- Division of Geriatrics, Duke University School of Medicine, Durham, NC, USA
| | - Odessa Addison
- Baltimore GRECC, VA Maryland Health Care System, Baltimore, MD, USA
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Elizabeth A Parker
- Baltimore GRECC, VA Maryland Health Care System, Baltimore, MD, USA
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sarah J Wherry
- VA Eastern Colorado GRECC, Aurora, CO, USA
- Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sunday Ikpe
- Baltimore GRECC, VA Maryland Health Care System, Baltimore, MD, USA
| | - Monica C Serra
- San Antonio GRECC, South Texas Veterans Health Care System, San Antonio, TX78229, USA
- Division of Geriatrics, Gerontology and Palliative Medicine and the Sam and Ann Barshop Institute for Longevity and Aging Studies, Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
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Kamdar N, Khan S, Brostow DP, Spencer L, Roy S, Sisson A, Hundt NE. Association between modifiable social determinants and mental health among post-9/11 Veterans: A systematic review. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2023; 9:8-26. [PMID: 37886122 PMCID: PMC10601397 DOI: 10.3138/jmvfh-2022-0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Introduction As U.S. Veterans reintegrate from active duty to civilian life, many are at risk for negative modifiable social determinants of health. The prevalence of mental health conditions among Veterans is also high. Awareness of the associations between these two factors is growing. This systematic review provides a comprehensive analysis of the current state of knowledge of the associations between modifiable social determinants and mental health among U.S. Veterans. Methods The authors systematically searched four databases and identified 28 articles representing 25 unique studies that met inclusion criteria. Findings from the studies were extracted and synthesized on the basis of modifiable social determinants. Study quality and risk of bias were assessed using the Methodological Quality Questionnaire. Results The studies identified in the systematic review examined three modifiable social determinants of health: 1) housing stability, 2) employment and finances, and 3) social support. Although the lack of validity for measures of housing stability, employment, and finances compromised study quality, the overall evidence suggests that Veterans with access to supportive social determinants had better mental health status. Evidence was particularly robust for the association between strong social support and lower symptoms of posttraumatic stress disorder. Discussion Current evidence suggests the need to consider modifiable social determinants of health when designing mental health interventions. However, more research encompassing a wider range of modifiable social determinants such as food security, education, and transportation and using comprehensive methods and validated instruments is needed. Future research also needs to intentionally include Veterans from diverse racial-ethnic groups.
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Affiliation(s)
- Nipa Kamdar
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, United States
| | - Sundas Khan
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, United States
| | - Diana P. Brostow
- Veterans Health Administration Rocky Mountain Mental Illness Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, United States
| | - Lia Spencer
- Brandeis University, Waltham, Massachusetts, United States
| | - Sharmily Roy
- School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, United States
| | - Amy Sisson
- The Texas Medical Center Library, Houston, Texas, United States
| | - Natalie E. Hundt
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, United States
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Nicklett EJ, Cheng GJ, Morris ZA. Predictors of food insecurity among older adults before and during COVID-19 in the United States. Front Public Health 2023; 11:1112575. [PMID: 37250079 PMCID: PMC10213641 DOI: 10.3389/fpubh.2023.1112575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/29/2023] [Indexed: 05/31/2023] Open
Abstract
Background The COVID-19 pandemic has strained the health and wellbeing of older adult populations through increased morbidity, mortality, and social exclusion. However, the impact of COVID-19 on the health of older adults through food security has received relatively little attention, despite the strong impact of diet quality on the health and longevity of older adults. Objective The objective of this study was to identify sociodemographic and socioeconomic predictors of self-reported food insecurity before and early in the COVID-19 pandemic among community-dwelling older adults in the United States. Methods Using longitudinal data from the Health and Retirement Study, a nationally representative sample of middle-aged and older adults in the United States, we examined the associations between sociodemographic and socioeconomic predictors of self-reported food insecurity between 2018 (N = 2,413) and June 2020 (N = 2,216) using population-weighted multivariate logistic regression models. Results The prevalence of food insecurity doubled among participants from 2018 (4.83%) to June 2020 (9.54%). In 2018, non-Hispanic Black and rural residents were more likely to report food insecurity, while individuals with higher education and greater wealth were less likely to report food insecurity in adjusted models. In June 2020, those who were relatively younger, not working due to a disability, and renting were more likely to report food insecurity. Those with an increased number of functional limitations, a recent onset of a work-limiting disability, and those who were no longer homeowners experienced an elevated longitudinal risk for food insecurity. Conclusion Future research should examine effective policies and interventions to address the disproportionate impacts of COVID-19 on populations at a heightened risk of experiencing food insecurity.
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Affiliation(s)
- Emily Joy Nicklett
- Department of Social Work, College for Health, Community and Policy, University of Texas at San Antonio, San Antonio, TX, United States
| | - Greta Jianjia Cheng
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Zachary A. Morris
- School of Social Welfare, Stony Brook University, Stony Brook, NY, United States
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Valladares-Garrido MJ, Picón-Reátegui CK, Zila-Velasque JP, Grados-Espinoza P, Vera-Ponce VJ, Pereira-Victorio CJ, Valladares-Garrido D, Failoc-Rojas VE. Depression and anxiety in peruvian military personnel during the pandemic context: a cross-sectional study. BMC Public Health 2023; 23:691. [PMID: 37055833 PMCID: PMC10100618 DOI: 10.1186/s12889-023-15612-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/05/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, increased workload and stress could have increased mental health problems (anxiety and depression) in military personnel. However, the number of studies in military members is scarce, especially in regard to mental health. The objective of this study was determine the prevalence and factors associated with depression and anxiety in Peruvian military personnel. METHODS We undertook an analytical cross-sectional study. The survey was distributed face to face between November 02 and 09, 2021, during the second wave of the COVID-19 pandemic among the military personnel. We used some instruments to measure depression (Patient Health Questionnaire, PHQ-9), anxiety (Generalized Anxiety Disorder, GAD-7), insomnia (Insomnia Severity Index, ISI), food insecurity (Household Food Insecurity Access Scale, HFIAS), physical activity (International Physical Activity Questionnaires, IPAQ-S), resilience (abbreviated CD-RISC), and fear of COVID-19 scale. The exclusion criteria included those who did not completely fill out the evaluation instruments. RESULTS We analyzed the data of 615 military personnel that participated in the survey. Of them, 93.7% were male and the median age was 22 years old. There was a prevalence of 29.9% and 22.0% in regard to depression and anxiety symptoms, respectively. In addition, it was found that being married (PR: 0.63; 95% IC: 0.42-0.94), having a relative with mental health problems (PR: 2.16), having experienced food insecurity (PR: 1.48), insomnia (PR: 2.71), fear of COVID-19 (PR: 1.48), and a high level of resilience (PR: 0.65) were factors associated with depression. In regard to anxiety, the factors associated were working for more than 18 months since the beginning of the COVID-19 pandemic (PR: 0.52), a high level of resilience (PR: 0.50; 95% IC: 0.33-0.77), insomnia (PR: 3.32), fear of COVID-19 (PR: 2.43). CONCLUSION We found a prevalence of symptoms of depression and anxiety of 29.9% and 22.0%, respectively. In regard to the factors that attenuate depression, we can mention being married and having resilience; and among the aggravating factors, having a relative with mental health problems, food insecurity, insomnia, and fear of COVID-19. Finally, anxiety increased through working time, insomnia, and fear of COVID-19.
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Affiliation(s)
- Mario J. Valladares-Garrido
- Escuela de Medicina, Universidad Cesar Vallejo, Piura, Peru
- Oficina de Epidemiología, Hospital Regional Lambayeque, Chiclayo, Peru
| | | | - J. Pierre Zila-Velasque
- Facultad de Medicina Humana, Universidad Nacional Daniel Alcides Carrión, Pasco, Peru
- Red Latinoamericana de Medicina en la Altitud e Investigación (REDLAMAI), Pasco, Peru
| | - Pamela Grados-Espinoza
- Facultad de Medicina Humana, Universidad Nacional Daniel Alcides Carrión, Pasco, Peru
- Red Latinoamericana de Medicina en la Altitud e Investigación (REDLAMAI), Pasco, Peru
| | - Víctor J. Vera-Ponce
- Instituto de Investigación en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, 15039 Peru
- Universidad Tecnológica del Perú, Lima, 15046 Peru
| | | | - Danai Valladares-Garrido
- Escuela de Medicina, Universidad Cesar Vallejo, Piura, Peru
- Unidad de Epidemiología y Salud Ambiental, Hospital de Apoyo II Santa Rosa, Piura, Peru
| | - Virgilio E. Failoc-Rojas
- Research Unit for Generation and Synthesis Evidence in Health, Universidad San Ignacio de Loyola, Lima, Peru
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Berry KM, Drew JAR, Brady PJ, Widome R. Impact of smoking cessation on household food security. Ann Epidemiol 2023; 79:49-55.e3. [PMID: 36657695 PMCID: PMC9957954 DOI: 10.1016/j.annepidem.2023.01.007] [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: 09/30/2022] [Revised: 12/30/2022] [Accepted: 01/08/2023] [Indexed: 01/18/2023]
Abstract
PURPOSE Smokers can spend a substantial amount on cigarettes, potentially constraining their ability to purchase food. We tested the association of smoking cessation and household food security. METHODS Using the Current Population Survey (2001-2019), we longitudinally linked the Tobacco Use Supplement and the Food Security Supplement (n = 71,278). Among adult smokers (n = 13,144), we used modified Poisson regression to model household food insecurity as a function of quit status (continuing smokers vs. recent quitters), adjusting for sex, age, household size, children in the household, and other household smokers. We also used multinomial logistic regression to examine more detailed food security status (high, marginal, low, very low). RESULTS The adjusted probability of household food insecurity at follow-up was 11% (95% CI: 8.7%-13%) for recent quitters and 20% (95% CI: 19%-21%) for continuing smokers. Continuing smokers had a lower adjusted probability of high food security (69% vs. 80%) and a higher adjusted probability of marginal (11% vs. 9.8%), low (12% vs. 7%), and very low food security (7.8% vs. 3.6%) compared to recent quitters. CONCLUSIONS Cigarette cessation is associated with a lower risk of household food insecurity. Therefore, promoting tobacco cessation alongside food assistance and poverty reduction policies may help alleviate food insecurity.
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Affiliation(s)
- Kaitlyn M Berry
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN.
| | - Julia A Rivera Drew
- Institute on Social Research and Data Innovation, University of Minnesota, Minneapolis, MN
| | - Patrick J Brady
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Rachel Widome
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN
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Wiesmann D, Goldsmith R, Shimony T, Nitsan L, Keinan-Boker L, Shohat T. Food Insecurity in Israeli Elderly is Associated with Sociodemographic Characteristics, Disability, and Depression: Policy Implications. Curr Dev Nutr 2023; 7:100006. [PMID: 37180079 PMCID: PMC10111608 DOI: 10.1016/j.cdnut.2022.100006] [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: 04/28/2022] [Revised: 09/26/2022] [Accepted: 10/25/2022] [Indexed: 12/24/2022] Open
Abstract
Background Food insecurity (FI) and poor health can turn into a vicious cycle with detrimental effects, especially in the elderly, however, few studies have examined the relationship between FI and health in this age group. Objectives We investigated associations of FI with physical and mental health and health behaviors among community-dwelling elderly. Methods We used nationally representative, cross-sectional data from the 2014-2015 Israel National Health and Nutrition Survey of the Elderly (Rav Mabat Zahav) on FI, sociodemographic characteristics, noncommunicable diseases (NCDs), disability, self-assessed physical, oral, and mental health for 1006 individuals aged ≥65 y. Results FI affected 12.3% of all households with elderly and was significantly higher among late immigrants and Arabs. Bivariate associations of FI with the number of NCDs, depression, disability in all 6 domains (vision, hearing, mobility, self-care, remembering, communication), poor self-assessed physical and oral health, chewing and swallowing problems, feelings of loneliness, insufficient physical activity, and smoking were significant (P < 0.05). In a multivariable logistic regression controlling for population group, household size, age and sex, FI was significantly associated (P < 0.05) with lack of formal education (OR: 6.26; 95% CI: 1.66, 23.65), being in the lowest (OR: 23.56; 95% CI: 3.71, 149.76) or second-lowest (OR: 16.75; 95% CI: 2.68, 104.52) per capita household income quartile, having one (OR: 2.11; 95% CI: 1.05, 4.23) or several disabilities (OR: 4.04; 95% CI: 1.72, 9.45), and having ever been diagnosed with depression (OR: 3.34; 95% CI: 1.35, 8.28). Conclusions FI is associated with physical and mental health problems, multiple disabilities, and loneliness among Israeli elderly. Providing income support could reduce FI, and subsidized congregate and home-delivered meal services could be expanded to meet the needs of elderly with disabilities and counter social isolation. Because low education, disability, and depression are particularly prevalent among the food insecure and vulnerable groups face language barriers, assistance with applications for these services should be increased.
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Affiliation(s)
| | - Rebecca Goldsmith
- School of Public Health, The Hebrew University in Jerusalem, Ein Karem, Jerusalem, Israel
| | - Tal Shimony
- Israel Center for Disease Control (ICDC), Ministry of Health, Gertner Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Lesley Nitsan
- Israel Center for Disease Control (ICDC), Ministry of Health, Gertner Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Lital Keinan-Boker
- Israel Center for Disease Control (ICDC), Ministry of Health, Gertner Institute, Sheba Medical Center, Tel Hashomer, Israel
- School of Public Health, University of Haifa, Mount Carmel, Haifa, Israel
| | - Tamy Shohat
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Kiernan MD, Rodrigues M, Mann E, Stretesky P, Defeyter MA. The Map of Need: identifying and predicting the spatial distribution of financial hardship in Scotland's veteran community. BMJ Mil Health 2022; 168:57-63. [PMID: 33664091 PMCID: PMC8788048 DOI: 10.1136/bmjmilitary-2020-001718] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 12/03/2022]
Abstract
INTRODUCTION During military service, many household costs for both married and single service personnel are subsidised, and transition can leave veterans unprepared for the financial demands of civilian life. Armed Forces organisations such as Sailor, Soldier, Air Force Association (SSAFA) play a central role in understanding the financial challenges that UK veterans face and provide an insight into the financial hardship experienced by veterans. The aim of this study was to use SSAFA beneficiary data as a proxy to identify the nature of financial benefit, the spatial distribution of financial hardship in the Scottish SSAFA beneficiary community and explore factors that might predict where those recipients are located. METHODS Using an anonymised data set of Scottish SSAFA financial beneficiaries between 2014 and 2019, this study used a geographical methodology to identify the geospatial distribution of SSAFA benefit recipients and exploratory regression analysis to explore factors to explain where SSAFA beneficiaries are located. RESULTS Over half of benefit applicants (n=10 735) were concentrated in only 50 postcode districts, showing evidence of a clustered pattern, and modelling demonstrates association with area-level deprivation. The findings highlight strong association between older injured veterans and need for SSAFA beneficiary assistance. CONCLUSION The findings demonstrate that beneficiaries were statistically clustered into areas of high deprivation, experiencing similar challenges to that of the wider population in these areas. Military service injury or disability was strongly associated with areas of high SSAFA benefit use and in those areas high unemployment was also a significant factor to consider.
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Affiliation(s)
- Matthew D Kiernan
- Health and Life Sciences, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
| | - M Rodrigues
- Health and Life Sciences, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
| | - E Mann
- Health and Life Sciences, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
| | - P Stretesky
- Department of Social Sciences, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
| | - M A Defeyter
- Health and Life Sciences, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
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13
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Zahidi F, Khalid M, Surkan PJ, Azadbakht L. Associations Between Food Insecurity and Common Mental Health Problems Among Reproductive-Aged Women in Kabul-Afghanistan. Front Nutr 2022; 8:794607. [PMID: 35047547 PMCID: PMC8761756 DOI: 10.3389/fnut.2021.794607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/19/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Food insecurity has been linked to poor health outcomes, however this relationship is poorly understood among women of reproductive age. Therefore, we investigated the relationship between food insecurity and common mental health problems (CMHPs) in this population of women in Kabul, Afghanistan. Method: A cross-sectional study was conducted with 421 women of reproductive age from four health centers located in four randomly selected zones in the city of Kabul. We used the United State Department of Agriculture (USDA) food-insecurity questionnaire, multiple 24-h recall for dietary intake, the Depression, the Anxiety and Stress Scale (DASS-21) to assess major mental health problems, and the International Physical Activity Questionnaire (IPAQ) to assess physical activity. Result: Food insecurity affected 69.6% of reproductive-aged women. In total, 44.9, 10.9, and 13.9% of food-insecure participants had food insecurity without hunger, food insecurity with hunger, and food insecurity with severe hunger, respectively. Depression, anxiety, and stress were prevalent among food-insecure participants at 89.4, 90.8, and 85.7%, respectively. Food insecurity was associated with depression (OR = 4.9, 95% CI: 2.7–8.9), anxiety (OR = 4.7, 95% CI: 2.5–8.8), and stress (OR = 3.8, 95% CI: 2.2–6.7). Women's household ownership, family size, and hypertension, on the other hand, were not associated with food insecurity. Conclusion: This study found food insecurity was associated with CMHPs among a sample of reproductive-aged women in Kabul, Afghanistan. Further longitudinal studies are needed to confirm these findings.
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Affiliation(s)
- Fawzia Zahidi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Science (TUMS), Tehran, Iran
| | - Madiha Khalid
- Toxicology and Disease Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Pamela J Surkan
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University (JHU), Baltimore, MD, United States
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Science (TUMS), Tehran, Iran.,Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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14
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Kamdar NP, Horning ML, Geraci JC, Uzdavines AW, Helmer DA, Hundt NE. Risk for depression and suicidal ideation among food insecure US veterans: data from the National Health and Nutrition Examination Study. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2175-2184. [PMID: 33770225 DOI: 10.1007/s00127-021-02071-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Suicide and food insecurity (i.e., lack of access to food) are two major issues that affect US Veterans. PURPOSE Using a US-based sample, we evaluated the association between food insecurity and suicidal ideation among Veterans. Because depression often precedes suicide, we also examined the association between food insecurity and depression. METHODS Using data from 2630 Veterans who participated in the National Health and Nutrition Examination Survey 2007-2016, we conducted an adjusted linear regression model to evaluate the association between food insecurity (measured using 18-item Household Food Security Survey) and depression (measured using PHQ-9) and an adjusted binary logistic regression model to evaluate the association between food insecurity and suicidal ideation (measured using PHQ-9 Question 9). Models were adjusted for gender, age, income-to-poverty ratio, race/ethnicity, and education level. RESULTS Of the sample, 11.5% were food insecure, depression scores averaged 2.86 (SD = 4.28), and 3.7% endorsed suicidal ideation. Veterans with marginal (β = 0.68, 95%CI [0.09,1.28]), low (β = 1.38, 95%CI [0.70,2.05]) or very low food security (β = 3.08, 95%CI [2.34, 3.83]) had significantly increased depression scores compared to food secure Veterans. Veterans with low (OR = 2.15, 95%CI [1.08, 4.27]) or very low food security (OR = 3.84, 95%CI [2.05, 7.20]) had significantly increased odds for suicidal ideation compared to food secure Veterans. CONCLUSION Food insecurity in Veterans is associated with increased depression symptoms and suicidal ideation. This association strengthens as food insecurity worsens. Veterans with food insecurity should be screened for depression and suicidal ideation. Simultaneously, depression treatment plans and suicide prevention programs should consider basic needs like food security.
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Affiliation(s)
- Nipa P Kamdar
- VA Health Services Research and Development Center of Excellence, Michael E. DeBakey VA Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, Texas, 77021, US.
| | - Melissa L Horning
- University of Minnesota School of Nursing, 5-140 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, Minnesota, 55455, US
| | - Joseph C Geraci
- US Department of Veterans Affairs, VISN 2 Mental Illness, Research, Education, and Clinical Center, 130 W Kingsbridge Rd, The Bronx, New York City, 10468, US
| | - Alexander W Uzdavines
- VA Health Services Research and Development Center of Excellence, Michael E. DeBakey VA Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, Texas, 77021, US
| | - Drew A Helmer
- VA Health Services Research and Development Center of Excellence, Michael E. DeBakey VA Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, Texas, 77021, US
| | - Natalie E Hundt
- VA Health Services Research and Development Center of Excellence, Michael E. DeBakey VA Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, Texas, 77021, US.,Department of Psychiatry, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, 77030, US
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15
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Risk Factors for Veteran Food Insecurity: Findings from a National US Department of Veterans Affairs Food Insecurity Screener. Public Health Nutr 2021; 25:819-828. [PMID: 34743780 PMCID: PMC8957505 DOI: 10.1017/s1368980021004584] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective: Food insecurity is associated with numerous adverse health outcomes. The US Veterans Health Administration (VHA) began universal food insecurity screening in 2017. This study examined prevalence and correlates of food insecurity among Veterans screened. Design: Retrospective cross-sectional study using VHA administrative data. Multivariable logistic regression models were estimated to identify sociodemographic and medical characteristics associated with a positive food insecurity screen. Setting: All US Veterans Administration (VA) medical centres (n 161). Participants: All Veterans were screened for food insecurity since screening initiation (July 2017–December 2018). Results: Of 3 304 702 Veterans screened for food insecurity, 44 298 were positive on their initial screen (1·3 % of men; 2·0 % of women). Food insecurity was associated with identifying as non-Hispanic Black or Hispanic. Veterans who were non-married/partnered, low-income Veterans without VA disability-related compensation and those with housing instability had higher odds of food insecurity, as did Veterans with a BMI < 18·5, diabetes, depression and post-traumatic stress disorder. Prior military sexual trauma (MST) was associated with food insecurity among both men and women. Women screening positive, however, were eight times more likely than men to have experienced MST (48·9 % v. 5·9 %). Conclusions: Food insecurity was associated with medical and trauma-related comorbidities as well as unmet social needs including housing instability. Additionally, Veterans of colour and women were at higher risk for food insecurity. Findings can inform development of tailored interventions to address food insecurity such as more frequent screening among high-risk populations, onsite support applying for federal food assistance programs and formal partnerships with community-based resources.
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16
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Abstract
BACKGROUND Food insecurity (FI) is an important public health issue for US veterans. For many veterans, civilian life is fraught with service-incurred health issues and socioeconomic challenges, each risk factors for FI. The FI literature on veterans is limited due to insufficient coverage of the topic's complexity and the methods used to study it in this population. No published analysis has evaluated how FI has been examined in US veterans. OBJECTIVES We assessed how FI has been examined in US military veterans by identifying (1) the major content areas, or domains, studied in association with FI and (2) the existing research gaps. METHODS A scoping literature review was conducted to map the main research domains of the FI literature and identify knowledge gaps. Electronic database and hand searches identified potentially relevant studies (n = 61). Data extraction, utilizing a standardized set of design parameters, was completed. Duplicate removal and application of inclusion/exclusion criteria resulted in the studies (n = 21) selected for critical review. RESULTS Eight research domains were determined: FI prevalence, health status, dietary practices, health care utilization, economic instability, homelessness/housing instability, food program participation, and community/emergency preparedness-the most dominant was health status and the least dominant were social determinants (ie, homelessness/housing instability, food program participation). Research on validity and usability of FI assessment methods in veterans was virtually absent. Military service factors, longitudinal effects, FI among women, intervention effectiveness, and other areas lacked sufficient inquiry. CONCLUSION Research is required on lesser examined content areas and methodology to optimize surveillance and policy for veteran FI.
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Affiliation(s)
- Yasmin S Cypel
- Epidemiology Program, Post-Deployment Health Services (12POP5), Office of Patient Care Services, 8267US Department of Veterans Affairs, Veterans Health Administration, Washington, DC, USA
| | - Jodie G Katon
- 49462US Department of Veterans Affairs (VA) Puget Sound Health Care System, Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.,Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
| | - Mark B Schure
- Department of Health & Human Development, 1705Montana State University, Bozeman, MT, USA
| | - Shanna Smith
- Epidemiology Program, Post-Deployment Health Services (12POP5), Office of Patient Care Services, 8267US Department of Veterans Affairs, Veterans Health Administration, Washington, DC, USA
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17
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Beymer MR, Reagan JJ, Rabbitt MP, Webster AE, Watkins EY. Association between Food Insecurity, Mental Health, and Intentions to Leave the US Army in a Cross-Sectional Sample of US Soldiers. J Nutr 2021; 151:2051-2058. [PMID: 33982122 DOI: 10.1093/jn/nxab089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/16/2021] [Accepted: 03/09/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Previous research has demonstrated that certain groups in the United States are at a greater risk for food insecurity. However, food insecurity has not been sufficiently characterized in active duty military populations. OBJECTIVES The primary objective of this study was to determine the prevalence of marginal food insecurity at a large US Army installation. The secondary objective was to determine how marginal food insecurity may be associated with intentions to leave the US Army after the current service period ("intentions to leave"). METHODS A cross-sectional, online survey was administered by the US Army Public Health Center at an Army installation in 2019 (n = 5677). The main predictor was the 2-item food insecurity screener (Hunger Vital Signs), and the main outcome was a 5-point Likert question, "How likely are you to leave the army after your current enlistment/service period?" that was dichotomized for this analysis. Multiple logistic regression was used to assess the association between marginal food insecurity and intentions to leave. Mental health covariates were analyzed as a potential mediator. RESULTS The sample was primarily male (83%), age <25 y (49%), and White (56%). One-third of respondents were classified as marginally food insecure using the Hunger Vital Signs, and 52% had intentions to leave. There was no significant association between marginal food insecurity and intentions to leave in the composite multivariable model, but mediation analyses revealed that food insecurity was significantly and independently associated with anxiety, depression, and suicidal ideation, which was in turn associated with intentions to leave. CONCLUSIONS The association between marginal food insecurity and mental health showed that addressing food insecurity could improve mental health and subsequently reduce intentions to leave. Solutions to reduce military food hardship include expanding Supplemental Nutrition Assistance Program eligibility requirements, improving food resources communication, and expanding healthy food choices on-post.
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Affiliation(s)
- Matthew R Beymer
- US Army Public Health Center, Behavioral and Social Health Outcomes Program, Aberdeen Proving Ground, Aberdeen, MD, USA
| | - Joanna J Reagan
- US Army Public Health Center, Health Promotion and Wellness Directorate, Aberdeen Proving Ground, Aberdeen, MD, USA
| | - Matthew P Rabbitt
- US Department of Agriculture, Economic Research Service, Kansas City, MO, USA
| | - Abby E Webster
- US Army Public Health Center, Behavioral and Social Health Outcomes Program, Aberdeen Proving Ground, Aberdeen, MD, USA
| | - Eren Y Watkins
- US Army Public Health Center, Behavioral and Social Health Outcomes Program, Aberdeen Proving Ground, Aberdeen, MD, USA
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18
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Besterman-Dahan K, Arriola NB, Bradley SE. Field Notes: * Evaluation of the impacts of a community garden program for veterans on food security and indicators of healthy diets. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2021. [DOI: 10.1080/19320248.2021.1886215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Karen Besterman-Dahan
- Research Service, James A. Haley Veterans’ Hospital & Clinics, Tampa, Florida, USA
- Department of Anthropology, University of South Florida, Tampa, Florida, USA
| | - Nora B. Arriola
- Research Service, James A. Haley Veterans’ Hospital & Clinics, Tampa, Florida, USA
| | - Sarah E. Bradley
- Research Service, James A. Haley Veterans’ Hospital & Clinics, Tampa, Florida, USA
- Department of Anthropology, University of South Florida, Tampa, Florida, USA
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19
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Kim-Mozeleski JE, Pandey R. The Intersection of Food Insecurity and Tobacco Use: A Scoping Review. Health Promot Pract 2020; 21:124S-138S. [PMID: 31908208 DOI: 10.1177/1524839919874054] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cigarette smoking is increasingly concentrated in socioeconomically disadvantaged groups, and food insecurity also disproportionately affects lower-income groups. Recent studies have suggested that smoking and food insecurity operate as risk factors for one another, but there is limited understanding of their intersection. This scoping review aimed to synthesize the published literature on the association between food insecurity and tobacco use across population groups in the United States and Canada. We searched PubMed, Web of Science, and PsycINFO using key words. Studies included were published in English between 2008 and 2018, reported empirical findings, measured both tobacco use and food insecurity, and considered either variable as a study outcome. Nineteen articles were identified; 6 examined tobacco use as an outcome variable and 13 examined food insecurity as an outcome variable. Most articles were of studies using cross-sectional designs. Study samples ranged from general populations, clinical samples, and underserved populations. For each article, we extracted information including specific findings related to the association between food insecurity and tobacco use. We synthesized the current research by formulating a model by which food insecurity and tobacco use are bidirectionally associated. This scoping review concludes that the co-occurrence of food insecurity and tobacco use exists across populations in the United States and Canada. As the evidence is largely from cross-sectional investigations, there is a need for longer term, comprehensive assessments of relationships between tobacco use and food insecurity. Such investigations can inform policies and interventions aimed toward addressing the inequitable burden of tobacco use and of food insecurity among disadvantaged populations.
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20
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Kamdar N, True G, Lorenz L, Loeb A, Hernandez DC. Getting Food to the Table: Challenges, Strategies, and Compromises Experienced by Low-Income Veterans Raising Children. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2020. [DOI: 10.1080/19320248.2020.1855284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Nipa Kamdar
- VA Health Services Research and Development Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Gala True
- South Central Mental Illness Research and Education Center, Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana, USA
- Section on Community and Population Medicine, LSU School of Medicine, New Orleans, Louisiana, USA
| | - Laura Lorenz
- Visiting Research Scholar, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Aaron Loeb
- Cizik School of Nursing, University of Texas Health Science Center, Houston, Texas, USA
| | - Daphne C. Hernandez
- Cizik School of Nursing, University of Texas Health Science Center, Houston, Texas, USA
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21
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Kamdar N, Lester HF, Daundasekara SS, Greer AE, Hundt NE, Utech A, Hernandez DC. Food insecurity: Comparing odds between working-age veterans and nonveterans with children. Nurs Outlook 2020; 69:212-220. [PMID: 33070980 DOI: 10.1016/j.outlook.2020.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/30/2020] [Accepted: 08/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Low-income, working-age Veterans with children have risk for food insecurity. Less known is extent to which their risk compares to nonveterans. PURPOSE To evaluate odds of food insecurity for working-age Veterans with children compared to socioeconomically-matched nonveterans with children. METHOD We constructed a propensity score-matched cohort using 2011-2014 National Health and Nutrition Examination Survey data. Covariate-adjusted logistic regressions estimated Veterans' odds for overall food insecurity and for each level of severity compared to nonveterans. FINDINGS We matched 155 Veterans to 310 nonveterans on gender, race/ethnicity, education, income. Models were adjusted for age, marital-status, depression, and listed matched variables. Although Veteran-status had no effect on overall food insecurity (odds ratio = 1.09, 95% confidence interval [0.62,1.93]), Veteran-status increased odds for very low food security (odds ratio = 2.71, 95% confidence interval [1.21, 6.07]). DISCUSSION Veterans do not have higher odds of food insecurity than non-veterans, but they are more likely to have the more severe very low food security (often associated with hunger) than non-veterans. Investigation of food insecurity's impact on Veteran health/well-being is needed.
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Affiliation(s)
- Nipa Kamdar
- VA Health Services Research and Development Center of Excellence, Michael E. DeBakey VA Medical Center,Houston, TX; University of Houston, Department of Health and Human Performance, Houston, TX.
| | - Houston F Lester
- VA Health Services Research and Development Center of Excellence, Michael E. DeBakey VA Medical Center,Houston, TX
| | | | - Anna E Greer
- Department of Public Health, Sacred Heart University, 5151 Park Avenue, Fairfield, CT
| | - Natalie E Hundt
- VA Health Services Research and Development Center of Excellence, Michael E. DeBakey VA Medical Center,Houston, TX; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - Anne Utech
- U.S. Department of Veteran Affairs, Washington, D.C.; Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Daphne C Hernandez
- University of Houston, Department of Health and Human Performance, Houston, TX; University of Texas Health Science Center, Cizik School of Nursing, Department of Research, Houston TX
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22
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Gyasi RM, Peprah P, Appiah DO. Association of food insecurity with psychological disorders: Results of a population-based study among older people in Ghana. J Affect Disord 2020; 270:75-82. [PMID: 32275223 DOI: 10.1016/j.jad.2020.03.088] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/25/2020] [Accepted: 03/25/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Food insecurity has been related to poor health, and the effect may be heightened in later life. This study examines age and gender differences in the association of food insecurity with psychological disorders (PD) in older people in Ghana. METHODS Ordinary Least Squares (OLS) regressions separately examined the associations between food insecurity and PD score using data from the 2016-2017 AgeHeaPsyWel-HeaSeeB Study. PD was assessed with the Kessler Psychological Distress Scale (K10) whilst food insecurity was assessed with past 30-day hunger (H), breakfast skipping (BS) and time of first daily meal. RESULTS Among 1,200 individuals aged ≥50 years, the prevalence of food insecurity indicators of hunger (36%), skipped breakfast (29%) and late intake of first daily meal (5%) were revealed. After full adjustment, moderate (H: β = 0.705, p < 0.001; BS: β = 0.824, p < 0.001) and severe (H: β = 1.813, p < 0.001; BS: β = 1.096, p < 0.001) food insecurity significantly increased PD score compared to no food insecurity. Moreover, having late daily meal was associated with increased the risk of PD (β = 1.035, p < 0.001). These associations were moderated by gender and age (men and 65+ age group had increased risk of PD compared to women and 50-64 age cohorts). CONCLUSIONS Food insecurity independently increases PD in older people. These findings are relevant for public health and policy interventions aimed at improving mental health of older people.
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Affiliation(s)
- Razak M Gyasi
- Aging and Development Unit, African Population and Health Research Center, Manga Close, Off-Kirawa Road, P. O. Box 10787 - 00100, Nairobi, Kenya.
| | - Prince Peprah
- Social Policy Research Centre, University of New South Wales, Sydney, Australia
| | - Divine Odame Appiah
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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23
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A Systematic Review and Meta-analysis of Depression, Anxiety, and Sleep Disorders in US Adults with Food Insecurity. J Gen Intern Med 2019; 34:2874-2882. [PMID: 31385212 PMCID: PMC6854208 DOI: 10.1007/s11606-019-05202-4] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 07/09/2019] [Indexed: 01/17/2023]
Abstract
INTRODUCTION A large number of peer-reviewed studies, with various methodologies and populations, have addressed the effects of food insecurity (FIS) on mental health conditions such as depression, anxiety, and sleep disorders. There are currently, however, no published systematic assessments or meta-analyses of this literature. METHODS A systematic search of the literature was conducted in PubMed, PsycInfo, Embase, Scopus, and Web of Science. Cross-sectional studies assessing the association between food insecurity and depression, anxiety, or sleep disorders were identified. For each of the three health outcomes, we extracted (or calculated when possible) the following effect sizes: odds ratio (OR), Hedges' g, Pearson correlation coefficients r, or bivariate coefficients. Then, for each mental health-outcome/effect-size pair, the available studies were combined using the random effect model. Heterogeneity, publication bias, and subgroup dependence, for each meta-analysis, were also assessed. RESULTS Fifty-seven studies provided cross-sectional data on the relationship between FIS and depression (n = 169,433), 13 on anxiety and psychological distress (n = 91,957), and 8 studies provided data on sleep disorders (n = 85,788). Meta-analysis showed that FIS is associated with an increased risk of testing positive for depression OR = 2.74 [95% CI 2.52-2.97, n = 135,500, Q(df = 41) = 69, I2 = 40%], anxiety OR = 2.41 [95% CI 1.81-3.22, n = 51,541, Q(df = 3) = 8, I2 = 63%], and sleep disorders OR = 1.80 [95% CI 1.51-2.15, n = 84,800, Q(df = 5) = 13, I2 = 62%]. The highest risks were found for depression and anxiety which had statistically similar values. The results were robust to covariates and population groups. DISCUSSION This systematic review and meta-analysis demonstrates a strong association between FIS and depression, anxiety, and sleep disorders, for which more longitudinal studies addressing effect sizes are warranted to further study causation.
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Schwartz N, Buliung R, Wilson K. Disability and food access and insecurity: A scoping review of the literature. Health Place 2019; 57:107-121. [PMID: 31026771 DOI: 10.1016/j.healthplace.2019.03.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 03/12/2019] [Accepted: 03/29/2019] [Indexed: 01/01/2023]
Abstract
A scoping review was conducted, using a social ecological model approach, of 106 articles examining the effect of disability on food access and (in)security. Results of the review show a consistently increased risk of food insecurity among people with disabilities with a higher risk for mental health disabilities, and among disabled younger adults. Mediators of this relationship were underexplored. Disability was mainly conceptualized as a problematic category preventing food access while ignoring disabling social and environmental barriers. A social model of disability can inform future research by acknowledging the role of socio-environmental influences on the production and experience(s) of disability.
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Affiliation(s)
- Naomi Schwartz
- Department of Geography and Planning, University of Toronto Mississauga, Room 3207, Davis Building, 1867 Inner Circle, Mississauga, ON, L5L IC6, Canada.
| | - Ron Buliung
- Department of Geography and Planning, University of Toronto Mississauga, Room 3272, Davis Building, 1867 Inner Circle, Mississauga, ON, L5L 1C6, Canada.
| | - Kathi Wilson
- Department of Geography and Planning, University of Toronto Mississauga, Room 3294, Davis Building, 1867 Inner Circle, Mississauga, ON, L5L 1C6, Canada.
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