Depression and suicide ideation in late adolescence and early adulthood are an outcome of child hunger

Adolescent Mental Health and Suicidal Behaviors in the Context of Expanded Supplemental Nutrition Assistance Program Eligibility

PURPOSE

Food insecurity is a risk factor for poor mental health and suicidal behaviors among adolescents. Prior research shows that states with policies that expand Supplemental Nutrition Assistance Program (SNAP) eligibility have a lower prevalence of food insecurity. The primary aim of this study was to compare the prevalence of feelings of sadness or hopelessness, suicidal ideation, and suicide attempts among adolescents in states that had the asset test eliminated and the income limit increased for SNAP eligibility to adolescents in states that did not have either policy.

METHODS

Using 2013-2021 data from state Youth Risk Behavior Surveys (N = 855,119) and the SNAP Policy Database, we conducted log-binomial regression with generalized estimating equations and adjusted for confounders.

RESULTS

The prevalence of persistent feelings of sadness or hopelessness was similar among adolescents in states that had the asset test eliminated only and among adolescents in states that had both the asset test eliminated and the income limit increased (i.e., both policies) compared to adolescents in states that did not have either policy. While the prevalence of suicidal thoughts was similar among adolescents in states that had the asset test eliminated only compared to adolescents in states that did not have either policy, the prevalence of suicidal thoughts (prevalence ratio = 0.91, 95% CI 0.88, 0.94) and suicide attempts (prevalence ratio = 0.82, 95% CI 0.78, 0.86) was lower among adolescents in states that had both policies compared to adolescents in states that did not have either policy.

DISCUSSION

States with policies that expand SNAP eligibility have a lower prevalence of suicidal behaviors among adolescents.

Emotional and Behavioral Problem Profiles of Preteens With Self-Injurious Thoughts and Behaviors: A Multicultural Study

OBJECTIVE

Self-injurious thoughts and behaviors (SITB) among preteen children have risen to the attention of researchers, practitioners, and policymakers. To shed light on potential treatment/prevention targets, we sought to identify empirically derived emotional and behavioral problem profiles of preteens with SITB, and to determine whether these profiles differ by age, gender and society.

METHOD

Caregivers of 46,719 children aged 6 to 12 years from 42 societies across the world completed the Child Behavior Checklist for ages 6-18 (CBCL/6-18). There were 1,656 children whose caregivers indicated that their child experienced SITB. We conducted a latent profile analysis (LPA) using scores from eight CBCL/6-18 problem scales to derive problem profiles of children with SITB. Multilevel modelling was used to estimate differences in the profiles by SITB, society, sex, and age.

RESULTS

A 4-profile model provided the best fit to the data, with profiles reflecting low problems (39.7%), mild problems (42.6%), moderate problems (15.4%), and rule-breaking/thought problems (2.3%). The low problems profile had CBCL problem scale scores nearly indistinguishable from those of children without SITB. Children in the rule-breaking/thought problems group were mostly female, whereas children in the other profile groups were mostly male. Children with the rule-breaking/thought problems profile also were most likely to have both suicidal thoughts and self-harm behaviors.

PLAIN LANGUAGE SUMMARY

In this study, authors analyzed emotional and behavioral profile of preteens who experienced self-injurious thoughts and behaviors (SITB). Caregivers of over 46,000 children aged 6-12 from 42 countries completed the Child Behavior Checklist. The authors found that most preteens with SITB had low levels of other mental health problems. This study highlights the needs to screen all children for SITBs, not just those who have have significant mental health problems.

CONCLUSION

Problem profiles of preteens with SITB are heterogeneous, with most having relatively low levels of other psychopathology. Selectively screening only children with clinically significant mental health problems for suicidal thoughts and self-harm behaviors (eg, asking about suicidal thoughts only among children with depression) risks missing many children experiencing SITB.

Food Insecurity in Greece and across the Globe: A Narrative Literature Review

Food insecurity comprises a major global public health threat, as its effects are detrimental to the mental, physical, and social aspects of the health and well-being of those experiencing it. We performed a narrative literature review on the magnitude of global food insecurity with a special emphasis on Greece and analyzed the major factors driving food insecurity, taking into consideration also the effect of the COVID-19 pandemic. An electronic search of international literature was conducted in three databases. More than 900 million people worldwide experience severe food insecurity, with future projections showing increasing trends. Within Europe, Eastern and Southern European countries display the highest food insecurity prevalence rates, with Greece reporting a prevalence of moderate or severe food insecurity ranging between 6.6% and 8% for the period 2019-2022. Climate change, war, armed conflicts and economic crises are major underlying drivers of food insecurity. Amidst these drivers, the COVID-19 pandemic had a profound impact on food insecurity levels around the globe, through halting economic growth, disrupting food supply chains and increasing unemployment and poverty. Tackling food insecurity through addressing its key drivers is essential to any progress towards succeeding the Sustainable Development Goal of "Zero Hunger".

Differing Within-Household Food Security Statuses Are Associated with Varied Maternal Mental Health Outcomes

Household food insecurity is not necessarily equally experienced by all household members, with mothers often changing their intake first when food resources are limited. The purpose of this study was to understand the association between maternal mental health and intrahousehold differences in food security statuses. A cross-sectional survey was administered to Virginia mothers with low income (August-October 2021), assessing validated measures of food security, mental and physical health and related factors. Participants (n = 570) were grouped according to the food security status of adults and children within the household. Linear regression was used to assess the outcomes of interest by group and controlled for key demographic variables. Mothers in households with any food insecurity reported worse overall mental health and used 3-4 more food coping strategies than households experiencing food security (p < 0.05). Only mothers in households where adults experienced food insecurity reported significantly greater anxiety and depressive symptoms (61.5 and 58.1, respectively) compared to households experiencing food security (55.7 and 52.4, p < 0.001). While any experience of household food insecurity is associated with worse maternal mental health, there were differences by the within-household food security status. Future research should explore screening measures that capture specific household members' food security to connect households with available resources.

Investigating key latent factors influencing alcohol consumption among the tribal male adolescents in Dooars region, West Bengal

BACKGROUND

Alcohol consumption among tribal male adolescents in India is a significant social concern. Tribal adolescents are particularly vulnerable and tend to lean toward alcohol addiction. Therefore, it is crucial to introduce some necessary footsteps to reduce alcohol consumption. The primary objective of this study is to investigate the association of various latent factors with the alcohol-drinking behavior of tribal adolescents.

METHODS

The study collected data from 600 tribal adolescents from the Dooars region, with 241 of them reported consuming alcohol. The study aimed to confirm the theoretical development of hypotheses regarding peer pressure, parental discord, stress, attitude toward alcohol, and food insecurity as exogenous latent factors influencing the alcohol-drinking behavior of tribal adolescents. In this context, the study adopted both measurement and structural models using Partial Least Squares-Structural Equation Modeling (PLS-SEM).

RESULTS

The findings revealed a significant path relationship between alcohol drinking behavior and various exogenous factors like peer pressure (β = 0.214, p = .000), parental discord (β = 0.121, p = .009), stress (β = 0.170, p = .000), attitude toward alcohol (β = 0.110, p = .004), and food insecurity (β = 0.510, p = .000). This study developed a reflective measurement model, and the evaluation of reflective measurement models was conducted, assessing internal consistency, convergent validity, and discriminant validity, yielding satisfactory results.

CONCLUSION

To tackle alcohol issues among tribal adolescents in the Dooars region, effective strategies should be employed. These include educating in schools, highlighting tribal role models, aiding peers with alcohol dependence, providing life skills training, and addressing parental discord and food insecurity through awareness campaigns, workshops, and better infrastructure.

Food Insecurity, Adolescent Suicidal Thoughts and Behaviors, and Country-Level Context: A Multi-Country Cross-Sectional Analysis

PURPOSE

Preventing adolescent suicide is a global priority. Inequalities in adolescent suicide and attempt rates are reported across countries, including a greater risk in adolescents experiencing food insecurity. Little is known about the extent to which country-level contextual factors moderate the magnitude of socio-economic inequalities in suicidal thoughts and behavior. We aimed to examine the cross-country variability and national moderators of the association between food insecurity and suicidal thoughts and behavior in school-attending adolescents.

METHODS

We analysed data on 309,340 school-attending adolescents from 83 countries that participated in the Global School-based Student Health Survey between 2003 and 2018. We used Poisson regression to identify whether suicidal thoughts and behavior were more prevalent in adolescents experiencing food insecurity compared to food-secure adolescents. Meta-regression and mixed-effects regression were used to determine whether country-level indicators moderated the magnitude of inequality.

RESULTS

Suicidal ideation, suicide planning, and suicide attempts were more prevalent in food-insecure adolescents compared to food-secure adolescents in 72%, 78%, and 90% of countries respectively; however, the magnitude of these associations varied between countries. We observed wider inequalities in countries with greater levels of national wealth and universal health coverage and lower prevalence of adolescent food insecurity. Economic inequality had no moderating role.

DISCUSSION

Food insecurity could contribute to the development of adolescent suicidal thoughts and behavior, and this association is likely to be moderated by country-level context. Food insecurity may be a modifiable target to help prevent adolescent suicide, especially in countries where food insecurity is less common.

Past-Year Suicidal Ideation, Plans, and Attempts by Food Security Level in a Nationally Representative Sample of U.S. Adults

OBJECTIVE

The Interpersonal Theory of Suicide posits that suicidal behavior results from thwarted belongingness, perceived burdensomeness, and capability for suicide. Considering that food insecurity (FI) may be linked to these constructs to differing extents based on severity of FI, this study examined cross-sectional associations between levels of FI and suicidal ideation, plans, and attempts in a nationally representative sample of adults in the United States.

METHODS

Data for this study were collected in 2001-2003 from 5,552 participants in the National Comorbidity Survey Replication (Mage=44.8 ± 0.5 years; 53.8% female). Prevalence ratios (PRs) and 95% confidence intervals (CIs) were generated using modified Poisson regression to examine past-year ideation, plans, and attempts with intent of lethality by past-year FI level (assessed with a modified version of the Short Form U.S. Household Food Security Scale).

RESULTS

After controlling for sociodemographic covariates, low food security was significantly associated with elevated prevalence of suicidal ideation, plans, and attempts (ideation: PR = 2.21, 95% CI 1.32-3.70; plans: PR = 5.42, 95% CI 2.71-10.83; attempts: PR = 5.35, 95% CI 2.38-12.03). Very low food security (i.e., more severe FI) exhibited stronger associations yet with suicidal ideation, plans, and attempts (ideation: PR = 6.99, 95% CI 4.10-11.92; plans: PR = 17.21, 95% CI 8.41-35.24; attempts: PR = 14.72, 95% CI 4.96-43.69).

CONCLUSIONS

Findings indicative of a dose-response relationship between FI and suicidal ideation, plans, and attempts emphasize the need to increase reach of food assistance programs, increase availability of mental health services in food-insecure populations, and routinely screen for FI in mental health practice.

Food and Nutrition Security as Social Determinants of Health: Fostering Collective Impact to Build Equity

An overview of the state of the American diet, how it relates to public health outcomes and the obesity epidemic, and how it arises from the policy and infrastructure that have been developed over the course of the 20th and 21st centuries. The article concludes by laying out concrete solutions for urban revitalization, providing people in underserved communities sovereignty over their food supply, and work with multi-stakeholder cooperatives to overcome the effects of food insecurity and poor diet quality.

Growth in Suicide Rates Among Children During the Illicit Opioid Crisis

This article documents child suicide rates from 1980 to 2020 in the United States using the National Vital Statistics System Multiple Cause of Death database. After generally declining for decades, suicide rates among children aged 10-17 accelerated from 2011 to 2018 in an unprecedented rise in both duration and magnitude. I consider the role of the illicit opioid crisis in driving this mental health crisis. In August 2010, an abuse-deterrent version of OxyContin was introduced and the original formulation was removed from the market, leading to a shift to illicit opioids and stimulating growth in illicit opioid markets. Areas more exposed to reformulation-as measured by pre-reformulation rates of OxyContin misuse in the National Survey on Drug Use and Health-were more affected by the transition to illicit opioids and experienced sharper growth in child suicide rates. The evidence suggests that children's illicit opioid use did not increase, implying that the illicit opioid crisis engendered higher suicide propensities by increasing suicidal risk factors for children, such as increasing rates of child neglect and altering household living arrangements. In complementary analyses, I document how living conditions declined for children during this time period.

Experiences and perceived outcomes of a grocery gift card programme for households at risk of food insecurity

OBJECTIVE

This study explored programme recipients' and deliverers' experiences and perceived outcomes of accessing or facilitating a grocery gift card (GGC) programme from I Can for Kids (iCAN), a community-based programme that provides GGC to low-income families with children.

DESIGN

This qualitative descriptive study used Freedman et al's framework of nutritious food access to guide data generation and analysis. Semi-structured interviews were conducted between August and November 2020. Data were analysed using directed content analysis with a deductive-inductive approach.

PARTICIPANTS

Fifty-four participants were purposively recruited, including thirty-seven programme recipients who accessed iCAN's GGC programme and seventeen programme deliverers who facilitated it.

SETTING

Calgary, Alberta, Canada.

RESULTS

Three themes were generated from the data. First, iCAN's GGC programme promoted a sense of autonomy and dignity among programme recipients as they appreciated receiving financial support, the flexibility and convenience of using GGC, and the freedom to select foods they desired. Recipients perceived these benefits improved their social and emotional well-being. Second, recipients reported that the use of GGC improved their households' dietary patterns and food skills. Third, both participant groups identified programmatic strengths and limitations.

CONCLUSION

Programme recipients reported that iCAN's GGC programme provided them with dignified access to nutritious food and improved their households' finances, dietary patterns, and social and emotional well-being. Increasing the number of GGC provided to households on each occasion, establishing clear and consistent criteria for distributing GGC to recipients, and increasing potential donors' awareness of iCAN's GGC programme may augment the amount of support iCAN could provide to households.

Exacerbation of household food insecurity among low-income families in Hong Kong during the COVID-19 pandemic

AIM

The economic depression and reduced physical mobility associated with COVID-19 potentially affected the food security status of the poor. This study aimed to assess the possible worsening of perceived food insecurity among low-income families in Hong Kong.

METHODS

Families either receiving government subsidies or living in a subdivided flat referred by local non-governmental organisations were invited to participate in a telephone survey. Food security status before (by recalling) and during the pandemic were assessed using Household Food Insecurity Access Scale. Chi-square analysis and ANOVA were used to test the difference between the percentage of participants who responded affirmatively to survey questions and various categories of food insecurity. Paired t-test was used to examine the reported change in food insecurity score before and during the COVID-19 pandemic. Association between socio-demographic factors and change in food insecurity score was then assessed by multiple linear regression using backward stepwise elimination.

RESULTS

Findings from the 212 households revealed that, for all nine questions concerning food insecurity, there was a significantly higher percentage of affirmative responses during versus before the pandemic. The proportion of food-secure households dropped from 16.5% to 7.1% amidst the pandemic. By contrast, households with severe food insecurity increased from 19.3% to 33.5%. Regression analysis showed that those households who were living in subdivided flats and with high monthly housing expenses, were likely to experience an exacerbation of food insecurity. Meanwhile, households with divorced parents (probably due to consistent social subsidy) and high household incomes, showed resilience toward food insecurity. Concurrently, about one fifth of children in these households had an experience of starvation for a whole day due to financial constraints.

CONCLUSION

The exacerbation of food insecurity among low-income families during the COVID-19 pandemic necessitates timely assessments and the implementation of appropriate measures to prevent them from experiencing physiological harm. These initiatives can be guided by the identified at-risk socio-economic characteristics in the present study.

Associations of Household Food Insecurity With Academic Outcomes in Early Adolescents

BACKGROUND

Food insecurity is characterized by limited access to adequate food due to a lack of money or resources (eg, lack of transportation to obtain food). School aged children who are experiencing food insecurity are at greater risk for poor academic outcomes, but previous studies have not examined the effects of food insecurity on specific academic outcomes over time.

METHOD

This study examined food insecurity as a risk factor for subsequent academic skills, enablers, and achievement. As part of a larger longitudinal study, middle school students (N = 112; meanage  = 12.14, SD = 0.41; 50% female; 68% black/African American, 14% white, 13% Hispanic or Latino, 5% other) reported on food insecurity at baseline, while teachers reported on students' academic skills and enablers at both baseline and 12 months later at 1 year follow up. Math and English/Language Arts grades were obtained from the schools at each wave.

FINDINGS

Food insecurity predicted lower academic skills over time but was unrelated to academic enablers and grades.

IMPLICATIONS

Considering a whole school, whole community, whole child (WSCC) framework, this study will also discuss the important role schools and communities have in reducing food insecurity in middle school students.

CONCLUSIONS

These results support negative long-term effects of food insecurity on academic skills in early adolescents.

Association between food insecurity and depressive symptoms among adolescents aged 12-15 years from 22 low- and middle-income countries

Food insecurity may be a risk factor for depression in adolescents. However, data on this topic from low- and middle-income countries (LMICs) are scarce, despite food insecurity being most common in LMICs. Therefore, we aimed to examine the association between food-insecurity and depressive symptoms among school-going adolescents from 22 LMICs. Cross-sectional data from the Global school-based Student Health Survey were analyzed. Self-report measures assessed past 12-month depressive symptoms and past 30-day food insecurity (hunger). Multivariable logistic regression and meta-analysis were conducted to assess associations. Data on 48,401 adolescents aged 12-15 years were analyzed [mean (SD) age 13.8 (0.9) years; 51.4 % females]. The prevalence of depressive symptoms was 29.3 %, and those of moderate and severe food insecurity were 45.0 and 6.3 %, respectively. After adjustment for potential confounders, compared to no food insecurity, the pooled OR (95 %CI) of moderate and severe food insecurity were 1.36 (1.30-1.42) and 1.81 (1.67-1.97), respectively. The level of between-country heterogeneity was low. Food insecurity was associated with significantly higher odds for depressive symptoms among adolescents in LMICs. Policies to address food insecurity may also help prevent depression in this population, pending future longitudinal research.

The Health and Nutritional Status of Children (10-18 years) Belonging to Food Insecure Households: The Korea National Health and Nutrition Examination Survey (2012-2019)

To research the health and nutritional status in Korean children and adolescents belonging to food insecure households (FI), the preregistered secondary data of 18 items from the Food Security Evaluation in the Korea National Health and Nutrition Examination Survey (KNHANES; 2012-2019) were used. Comparative analyses (food security group [FS], (n = 3150) vs. FI, (n = 405) of household characteristics, health status (anthropometrics, clinics, mentality), and nutritional status (nutrient intake, diet-quality, and pattern) were performed in children (boys: 1871, girls: 1684) aged 10-18 years. The FI comprised higher proportions of participants from low-income families, basic livelihood-security recipients, and vulnerability (characteristics: female household heads, aged ≥50, single, unemployed, with low education and unmet healthcare needs). Compared to FS, boys had higher abdominal obesity and alcohol use, whereas girls had lower high-density-lipoprotein cholesterol (HDLc) and mental vulnerability (self-perceived obesity despite FS-similar anthropometry) in FI. Inadequate protein intake among boys and girls, and high carbohydrate and inadequate fat intake among girls were especially found in the FI status. From the results of a nutrition quality test, Vit-A in boys, and protein, niacin, and iron intakes in girls were insufficient, respectively. Health-nutritional policies to improve children's lifestyles should reinforce FI-based intake of deficient nutrients.

Temporal Trends in Food Insecurity (Hunger) among School-Going Adolescents from 31 Countries from Africa, Asia, and the Americas

(1) Background: Temporal trends of food insecurity among adolescents are largely unknown. Therefore, we aimed to examine this trend among school-going adolescents aged 12-15 years from 31 countries in Africa, Asia, and the Americas. (2) Methods: Data from the Global School-based Student Health Survey 2003-2017 were analyzed in 193,388 students [mean (SD) age: 13.7 (1.0) years; 49.0% boys]. The prevalence and 95%CI of moderate (rarely/sometimes hungry), severe (most of the time/always hungry), and any (moderate or severe) food insecurity (past 30-day) was calculated for each survey. Crude linear trends in food insecurity were assessed by linear regression models. (3) Results: The mean prevalence of any food insecurity was 52.2% (moderate 46.5%; severe 5.7%). Significant increasing and decreasing trends of any food insecurity were found in seven countries each. A sizeable decrease and increase were observed in Benin (71.2% in 2009 to 49.2% in 2016) and Mauritius (25.0% in 2011 to 43.6% in 2017), respectively. Severe food insecurity increased in countries such as Vanuatu (4.9% in 2011 to 8.4% in 2016) and Mauritius (3.5% in 2011 to 8.2% in 2017). The rate of decrease was modest in most countries with a significant decreasing trend, while many countries with stable trends showed consistently high prevalence of food insecurity. (4) Conclusion: Global action is urgently required to address food insecurity among adolescents, as our data show that achieving the United Nations Sustainable Development Goal 2 to end hunger and all forms of malnutrition by 2030 would be difficult without strong global commitment.

Association of food insecurity and sleep difficulty among 189,619 school-going adolescents: a study from the global in-school students survey

Introduction

Adolescents' sleep disturbances are associated with chronic and dramatic physical, emotional, and mental development and school performance consequences. Although food insecurity could significantly contribute to these effects, few studies have explored the effect of food insecurity on sleep disturbances among adolescents. The study aimed to examine the relationship between adolescents' food insecurity and sleep disturbance.

Methods

Data on 189,619 adolescents were drawn from the cross-sectional global adolescent health surveys conducted between 2015 and 2018 in 35 countries and territories. Univariate and multivariable multinomial regression models were fitted to examine the hypothesized associations.

Results

Overall pooled prevalence of moderate [45.2% (95%CI = 43-47)] and severe [5.8% (95%CI = 5-6)] food insecurity levels were reported. About [52.6% (95%CI = 51-54)] moderate and [8.6% (95%CI = 8-9)] severe worry-induced sleep disturbances were found. Considering the fully adjusted multinomial logistic model, moderate food insecurity was significantly associated with moderate (AOR = 1.70 CI = 1.59-1.81; p < 0.0001) and severe (AOR = 1.63 CI = 1.42-1.87; p < 0.0001) sleep disturbances. Also, adolescents reporting severe levels of food insecurity had moderate (AOR = 1.88 CI = 1.68-2.11; p < 0.0001) and severe (AOR = 4.07 CI = 4.74-6.11; p < 0.0001) sleep disturbances. Females and those aged between 15 and 17 years and 18 or more were at higher risk of moderate and severe sleep disturbances in the context of food insecurity.

Conclusion

Reducing food insecurity could be an effective policy strategy for enhancing adolescent sleep quality.

Food insecurity and disordered eating behaviors in children and adolescents: A systematic review

This study is the first systematic review to investigate the relationship between food insecurity (FI) and disordered eating behaviors exclusively in children and adolescents. Database searches were conducted in PUBMED, Embase, PsycINFO, ProQuest, and Gale OneFile: Informe Académico using English and Spanish search terms. Studies were included if they were published before August 2022, included youth aged 18 years and below, included either parent- or child-report of food security status, included either parent- or child-report of child disordered eating behaviors, and examined the relationship between food security status and child disordered eating behaviors. Following independent title/abstract and full-text screening, 20 studies were included in the review. There were 13 cross-sectional studies, five longitudinal studies, and two qualitative studies, from the United States (19 studies), and Bangladesh (1 study). Sample sizes ranged from 33 to 6077. Findings generally indicated a relationship between FI and behaviors such as binge eating, loss-of-control eating, eating in the absence of hunger, unhealthy weight control behaviors, and picky eating in children and adolescents, though this association varied depending on the type of disordered eating behavior assessed and FI severity. Results highlight the importance of screening for disordered eating behaviors among youth with FI towards eating disorder prevention and intervention. However, given the limited number of primary research articles examining this relationship in youth, further hypothesis-driven research is needed. In addition, more global representation and additional longitudinal studies are needed to further examine the generalizability and temporality of FI and disordered eating in children and adolescents.

Childhood food insecurity, mental distress in young adulthood and the supplemental nutrition assistance program

Food insecurity affects 14% of US homes with children and has been associated with increased mental health problems. Few studies have examined long-term consequences for mental health and the role of social policies. This study examined the association between childhood household food insecurity (HHFI) and young adult psychological distress, and the moderating role of caregiver psychological distress and the Supplemental Nutrition Assistance Program (SNAP) using data from the Panel Study of Income Dynamics (1995-2015). The sample comprised 2782 children ages 0-12 years in 1997. Past-year HHFI was measured using the USDA 18-item questionnaire in 1997, 1999, 2001 and 2003. Young adults' non-specific psychological distress was measured with the Kessler (K6) scale in 2005, 2007, 2009, 2011, 2013 and 2015. Three trajectories of food insecurity were identified: 1) Persistent food security (70.5%); 2) Intermediate/fluctuating food insecurity (24.6%), and; 3) Persistent food insecurity (4.9%). Compared to persistent food security, fluctuating and persistent food insecurity were associated with significantly higher levels of psychological distress. This association was robust to adjusting for socio-demographic factors, caregiver psychological distress, and family access to governmental supports: [Adj. ORs (95% CI's = 1.72 (1.59-1.85) and 2.06 (1.81-2.33)]. Having a caregiver who suffered from psychological distress (1997 and/or 2002) and growing up with persistent food insecurity placed children at greater risk for mental health problems. Access to SNAP attenuated this risk. Early HHFI is associated with psychological distress in young adulthood. Interventions to increase access to SNAP and address caregivers mental health may prevent mental health problems associated with childhood HHFI.

Food insecurity is associated with multiple psychological and behavioural problems among adolescents in five Caribbean countries

The study aimed to assess associations between food insecurity and multiple psychological and behavioural problems among adolescents in five Caribbean countries. Data from national and cross-sectional school health surveys from 9,956 adolescents (15 years, median age) in Trinidad and Tobago, Suriname, Jamaica, Anguilla and the Dominican Republic in 2016-2017 were analyzed in 2016-2017. Results show that the prevalence of moderate (rarely or sometimes) past-month food insecurity was 35.9% and severe (mostly or always) food insecurity was 4.6%. Severe food insecurity among adolescents ranged from 2.9% in Dominican Republic to 11.2% in Suriname. In adjusted logistic regression analyses, the higher severity of food insecurity was associated with negative psychological outcomes (loneliness, suicidal ideation, suicide plan, suicide attempt, anxiety, current tobacco use and any trouble from alcohol use) and negative behavioural outcomes (truancy, bullied, physically attacked, physical injury, and multiple sexual partners). Two out of five adolescents experienced some form of food security. Food interventions, such as school feeding programmes, are warranted to reduce negative psychosocial outcomes.

Prevalence and Severity of Food Insecurity Before and During the Coronavirus Disease 2019 Pandemic Among Adults and Youth in Australia, Canada, Chile, Mexico, the United Kingdom, and the United States

BACKGROUND

Disruptions from the coronavirus disease 2019 (COVID-19) pandemic potentially exacerbated food insecurity among adults and youth.

OBJECTIVES

The objective was to examine changes in the prevalence and severity of food insecurity among adults and youth from before (2019) to during (2020) the pandemic in multiple countries.

METHODS

Repeated cross-sectional data were collected among adults aged 18-100 y (n = 63,278) in 5 countries in November to December in 2018-2020 and among youth aged 10-17 y (n = 23,107) in 6 countries in November to December in 2019 and 2020. Food insecurity in the past year was captured using the Household Food Security Survey Module and the Child Food Insecurity Experiences Scale. Changes in the prevalence and severity of food insecurity were examined using logistic and generalized logit regression models, respectively. Models included age, gender, racial-ethnic identity, and other sociodemographic characteristics associated with food insecurity to adjust for possible sample differences across waves. Models were weighted to reflect each country's population.

RESULTS

Adults [adjusted OR (AOR): 1.15; 95% CI: 1.02, 1.31] and youth (AOR: 1.43; 95% CI: 1.19, 1.71) in Mexico were more likely to live in food-insecure households in 2020 compared to 2019. Adults in Australia (AOR: 0.81; 95% CI: 0.72, 0.92) and Canada (AOR: 0.87; 95% CI: 0.77, 0.99) were less likely to live in food-insecure households in 2020. Trends in severity aligned with changes in prevalence, with some exceptions. Youth in Australia (AOR: 2.24; 95% CI: 1.65, 3.02) and the United States (AOR: 1.39; 95% CI: 1.04, 1.86) were more likely to have many compared with no experiences of food insecurity in 2020 compared to 2019. There was no evidence of change among adults and youth in the remaining countries.

CONCLUSIONS

Except for Mexico, few changes in food insecurity among adults and youth were observed from before to during the COVID-19 pandemic. Action is needed to support households at risk of food insecurity. J Nutr 20XX;xx:xx-xx.

Coexistence of obesity and hunger in young adolescents: Evidence from the Global School-based Student Health Survey

BACKGROUND

Hunger and obesity among young adolescents are serious public health issues; however, the relationship between these issues in this demographic has yet to be examined.

OBJECTIVE

To determine whether both obesity and hunger coexist in young adolescents from a global perspective.

METHODS

We analysed data of 142 565 adolescents (age, 12-15 years) from 60 countries from the Global School-based Student Health Survey.

RESULTS

Total prevalence of moderate and severe hunger was 22.32% and 7.8%, respectively-with the highest in Africa (29.14% and 12.14%, respectively) and the lowest in the Americas (16.83% and 5.31%, respectively). The prevalence of obesity among adolescents with severe hunger was 1.26 (95% confidence interval [CI]: 1.15-1.38) times the prevalence among those without hunger; however, this association varied across countries or regions. Moreover, the prevalence of obesity was 17% (95% CI: 1.04-1.29) higher in adolescent girls with moderate hunger in high-income countries, 91% (95% CI: 1.23-2.58) higher in adolescents with severe hunger in low-income countries and 54% (95% CI: 1.34-1.76) higher in lower middle-income countries compared to those without hunger.

CONCLUSIONS

Both obesity and hunger coexist in adolescent populations worldwide. Our findings emphasize the need for double-duty actions to simultaneously address burdens of hunger and obesity among adolescents.

Food Insecurity and Suicidal Behaviors Among US High School Students

BACKGROUND

Food insecurity (FI) rates in the United States are particularly high among households with children. This research set aims to analyze if high school students experiencing FI had higher risk for mental health and suicidal behaviors.

METHODS

Using combined data from 11 states that conducted the 2017 Youth Risk Behavior Survey, a total of 26,962 and 24,051 high school students were used to estimate race/ethnicity and sex-stratified prevalence ratios (PRs) from Poisson regression models. A single-question was used to measure the exposure of FI and outcomes of mental health and suicidal behaviors.

RESULTS

Overall, 10.8% of students reported FI. Students experiencing FI had increased risk for all mental health and suicide behavior outcomes, regardless of their race/ethnicity or sex. PRs ranged from 1.9 (95% confidence interval [CI]:1.8, 2.0) to 3.1 (CI: 2.7, 3.6). Among males, PRs for the association between FI and all outcomes were highest among non-Hispanic black students (PRs ranged from 2.4 [CI: 1.7, 3.2] to 5.5 [CI: 2.3, 13.3]). Among females, PRs were highest among non-Hispanic white students (PRs ranged from 1.9 [CI:1.7, 2.1] to 3.6 [CI:2.9, 4.5]).

CONCLUSIONS

FI is consistently associated with mental health and suicidal behaviors among different subgroups of students.

Food Security as Ethics and Social Responsibility: An Application of the Food Abundance Index in an Urban Setting

High levels of food insecurity signal the presence of disparities and inequities in local food access that have been shown to negatively impact the health and well-being of individuals and communities. Some argue that the lack of healthy, affordable and culturally relevant food within a community represents a troubling social and ethical concern for any society. The current research conducts an assessment of a specific community utilizing the framework outlined by the Food Abundance Index (FAI) scorecard. Combined with contemporary regional data on the demographics of the area, data revealed extremely low scores for both access and density dimensions. Our findings can help business, community and policymakers better understand and target evidence-based solutions to address the issue of food insecurity within this region.

Indigenous Food Systems Changes and Resiliency: A Scoping Review Protocol (Preprint)

BACKGROUND

Indigenous food systems (IFS) consider the complex relationships and connections between land, animals, plants, water, and people. These food systems may differ between regions, Indigenous cultures, and history; however, given the similar colonial histories and policies influencing Indigenous groups in Canada, the United States, Australia, and Aotearoa (New Zealand), the IFS changes and responses in these regions may follow similar trends. Climate change and pollution continue to impact the environment in catastrophic ways, and this, in turn, impacts IFS. However, to date, there has been no review of the literature on IFS, how they are changing, and how communities are responding to these changes.

OBJECTIVE

In this scoping review, we will summarize primary research in Canada, the United States, Australia, and Aotearoa related to IFS addressing the following questions: (1) What changes are IFS experiencing in the context of climate change and pollution? (2) What actions have been taken in response to IFS changes? (3) What are the characteristics of IFS research in peer-reviewed academic literature?

METHODS

We will use the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews and the Joanna Briggs Institute reviewer's manual to inform the review process. MEDLINE, SCOPUS, International Bibliography of the Social Sciences, Sociological Abstracts, and the Bibliography of Native North Americans are the databases included in this review search. All screening and extraction have been supported by Covidence software (Veritas Health Innovation) with 2 independent reviewers conducting the abstract and full-text screening. We will map concepts and themes related to the research questions to contribute to the understanding of IFS within the academic literature and provide a narrative review of the outcomes.

RESULTS

The electronic database searches for this review were conducted in May 2021. Screening and full-text review were initially completed in the winter of 2022. We are currently in the process of compiling results and aim to share findings in 2023.

CONCLUSIONS

This review will provide valuable insight into current IFS needs by summarizing the peer-reviewed literature on how IFS are changing because of climate change and pollution and how communities are responding to these changes. The results of this review will be shared with Indigenous communities, through academic publications, community conversations, and conference presentations.

TRIAL REGISTRATION

OSF Registries osf.io/xrj87; https://osf.io/xrj87.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/41627.

Food Insecurity, Dietary Intakes, and Eating Behaviors in a Convenience Sample of Toronto Youth

BACKGROUND

Food insecurity has been shown to be associated with poor dietary quality and eating behaviors, which can have both short- and long-term adverse health outcomes in children. The objective was to investigate the food security status, dietary intakes, and eating behaviors in a convenience sample of youth participating in the Maple Leaf Sports Entertainment LaunchPad programming in downtown Toronto, Ontario.

METHODS

Youth aged 9-18 years were recruited to participate in the study. Food security status, dietary intakes, and eating behaviors were collected using parent- or self-reported questionnaires online.

RESULTS

Sixty-six youth (mean ± SD: 11.7 ± 1.9 years) participated in the study. The prevalence of household food insecurity was higher than the national average with at least one child under 18 years of age (27.7% vs. 16.2%). Dietary intake patterns were similar to the national trends with low intakes of fiber, inadequate intakes of calcium and vitamin D; and excess intakes of sodium, added sugar, and saturated fat. Despite a low prevalence of poor eating habits, distracted eating was the most frequently reported poor eating habit.

CONCLUSIONS

Although youth were at high risk for experiencing household food insecurity, inadequate dietary intake patterns were similar to the national trends. Our findings can be used to develop future programming to facilitate healthy dietary behaviors appropriate for the target community.

High occurrence of food insecurity in young people attending a youth mental health service in regional Australia

Aim

Despite the relationship between food insecurity and poor mental health, food insecurity in young people attending mental health services in Australia remains understudied. This study aimed to determine the occurrence and predictors of food insecurity, and the relationship with dietary factors in young people attending a mental health service.

Methods

A cross‐sectional online survey was conducted in a sample of young people (15–25 years) who attended a mental health service in Launceston, Australia. The survey utilised a single‐item food insecurity screening tool and eight demographic, health and service use questions. Five questions determined self‐reported intake of fruit, vegetables, breakfast, water, sugar‐sweetened beverages and takeaway foods. Binary logistic regression determined predictors of food insecurity. Cross‐tabulations determined differences in dietary intake according to food security.

Results

Of survey respondents (n = 48; 68% female), 40% (n = 19) were food insecure. Respondents living out of home or in unstable accommodation were at significantly higher risk of food insecurity (odds ratio [OR]: 4.43; SE: 0.696; 95% CI: 1.13–17.34; p = 0.032) compared to those living with their parents. Those receiving government financial assistance (OR: 5.00; SE: 0.676; 95% CI: 1.33–18.81; p = 0.017) were also at significantly higher risk of food insecurity. Regardless of food security status, self‐reported intake of fruits, vegetables and breakfast were low, and respondents regularly consumed takeaway foods and sugar‐sweetened beverages.

Conclusions

There was a high occurrence of food insecurity and poor dietary intake in young people attending a youth mental health service demonstrating that initiatives to support access to healthy food in this group should be a priority, with potential benefits for mental health outcomes.

Development, Validity, and Cross-Context Equivalence of the Child Food Insecurity Experiences Scale for Assessing Food Insecurity of School-Age Children and Adolescents

BACKGROUND

Children ages 6 to 17 years can accurately assess their own food insecurity, whereas parents are inaccurate reporters of their children's experiences of food insecurity. No globally applicable scale to assess the food insecurity of children has been developed and validated.

OBJECTIVES

We aimed to develop a globally applicable, experience-based measure of child and adolescent food insecurity and establish the validity and cross-contextual equivalence of the measure.

METHODS

The 10-item Child Food Insecurity Experiences Scale (CFIES) was based on items previously validated from questionnaires from the United States, Venezuela, and Lebanon. Cognitive interviews were conducted to check understanding of the items. The questionnaire then was administered in 15 surveys in 13 countries. Other items in each survey that assessed the household socioeconomic status, household food security, or child psychological functioning were selected as criterion variables to compare to the scores from the CFIES. To investigate accuracy (i.e., criterion validity), linear regression estimated the associations of the CFIES scores with the criterion variables. To investigate the cross-contextual equivalence (i.e., measurement invariance), the alignment method was used based on classical measurement theory.

RESULTS

Across the 15 surveys, the mean scale scores for the CFIES ranged from 1.65 to 5.86 (possible range of 0 to 20) and the Cronbach alpha ranged from 0.88 to 0.94. The variance explained by a 1-factor model ranged from 0.92 to 0.99. Accuracy was demonstrated by expected associations with criterion variables. The percentages of equivalent thresholds and loadings across the 15 surveys were 28.0 and 5.33, respectively, for a total percentage of nonequivalent thresholds and loadings of 16.7, well below the guideline of <25%. That is, 83.3% of thresholds and loadings were equivalent across these surveys.

CONCLUSIONS

The CFIES provides a globally applicable, valid, and cross-contextually equivalent measure of the experiences of food insecurity of school-aged children and adolescents, as reported by them.

The global and regional burden of sexual behaviors and food insecurity and their combined association on the magnitude of suicidal behaviors among 121,248 adolescent girls: An international observational study in 67 low- and middle-income and high-income countries

BACKGROUND

Food insecurity and early sexual behaviors increase the risk of suicidal behavior, however their combined association on social behaviors receive little attention. Therefore, this study estimated the magnitude of adolescent global suicidal burden, it correlates with food insecurity and sexual behaviors, and assessed the combined association of food insecurity and sexual behaviors on the burden of suicidal behaviors (SBs) among school-going adolescent girls aged between 11 and 17 years.

METHODS

The study design is multi-county, and pooled cross-sectional in nature. Data for 67 countries from the Global School-based Student Health Survey (GSHS) were used. A random-effects meta-analysis was used to generate national and overall pooled estimates of suicidal behaviors. Multinomial logistic regression analyses were employed to estimate the adjusted effect of independent factors and the combined associations of sexual behaviors and food insecurity on adolescent SBs in the context of global, regional, and country income groups and adjusted by a set of explanatory factors.

RESULTS

The study included 121,248 girls aged 11-17 years. The population-weighted prevalence of high-level (SBs) was 40.65% among school-going girls who experienced sexual intercourse and 7.41% among those who reported severe food insecurity. However, the burden of SBs varied according to type of sexual behaviors and the age. The burden of SB among girls who had sexual intercourse with 1-2 sex partners, 3-4 sex partners, or >4 sex partners was 11.49%, 13.28%, or 18.43%, respectively. The high-level SB was double (23.08%) among adolescent girls who had first sexual intercourse aged 11-13 years old compared to adolescent girls aged 14-17 years (11.49%). The burden of SBs (for at least one SB, for two SBs, or for three SBs) were significantly associated with adolescent girls who experienced sexual intercourse (relative risk ratio, RRR = 2.04, 95% confidence interval, CI:1.83-2.28; RRR = 2.24, 1.99-2.52; RRR = 1.86, 1.59-2.18), sexual intercourse with four or more sex partners (RRR = 1.44, 1.15-1.79; RRR = 1.65, 1.33-2.06; RRR = 2.47, 1.94-3.16), first sexual intercourse aged 11-13 years (RRR = 1.22, 1.02-1.46; RRR = 1.51, 1.26-1.82; RRR = 2.26, 1.81-2.83), compared to adolescents who had no experience of SBs. Compared to adolescent girls who did neither experience food insecurity nor sexual intercourse, the overall burden of SBs (for at least one SB, for two SBs or for three SBs) were significantly higher among girls reporting to have experienced both food insecurity and sexual intercourse (RRR = 1.55, 1.29-1.86; RRR = 1.70, 1.42-2.04; RRR = 1.54, 1.26-1.88); and those reporting having experienced food insecurity but have never had sexual intercourse (RRR = 1.66, 1.48-1.87; RRR = 1.45, 1.26-1.67; RRR = 1.62, 1.36-1.92). However, it was significantly lower among girls reporting to have had sexual intercourse but never experienced food insecurity. This association was extended among adolescents in the context of regional and country income groups.

CONCLUSION

The high burden of suicidal behaviors among adolescents calls for an urgent policy interventions to address food insecurity as a means to keep adolescents in school. The interventions should also aim to integrate safeguards that dissuade youngsters from early sex and protect them from sexual victimisation, and the associated adverse outcomes that that hamstring the attainment of SDG 3.4.2.

Food Insecurity and Its Association With Alcohol and Other Substance Use Among High School Students in the United States

BACKGROUND

Studies show that food insecurity is associated with adverse health behaviors for children and adults. However, published data among adolescents are limited. The objective of this study was to examine the association between food insecurity and substance use behaviors among US high school students.

METHODS

Data from the 2017 Youth Risk Behavior Survey in 10 states were combined to examine the association between household food insecurity and adolescent use of alcohol, marijuana, prescription opioid misuse, and illicit drugs using logistic regression.

RESULTS

Among surveyed respondents, 12.3% of high school students reported experiencing food insecurity. In unadjusted analyses, the prevalence of substance use was higher among students with food insecurity compared to food secure students: current binge drinking (16.2% vs 11.5%), current marijuana use (24.0% vs 16.2%), lifetime prescription opioid misuse (21.3% vs 12.6%), and lifetime use of illicit drugs (12.3% vs 5.0%) (all p < .05). In adjusted models, food insecurity was associated with lifetime prescription opioid misuse and lifetime use of illicit drugs (aPR 1.38 and 1.70, respectively).

CONCLUSION

Students with food insecurity are a potential group at a higher rise of substance misuse and may benefit from prevention programs designed to address their needs.

The risk and protective factors for suicidal burden among 251 763 school-based adolescents in 77 low- and middle-income to high-income countries: assessing global, regional and national variations

BACKGROUND

Adolescent suicide is a global public health concern and the second leading cause of adolescent death worldwide. This study aimed to estimate the burden of adolescent suicidal behaviours and its association with violence and unintentional injury, psychosocial, protective, lifestyle and food security-related factors amongst school-based adolescents across 77 countries in the six World Health Organization (WHO) regions.

METHODS

This study comprised a sample of 251 763 adolescents drawn from the latest Global School-based Student Health Survey of school-based adolescents, aged 11-17 years, across 77 countries. Logistic regression analyses were employed to estimate the adjusted effect of independent factors on adolescent suicidal behaviours.

RESULTS

The population-weighted 12-month prevalence of suicidal ideation (SI), suicidal planning (SP) and suicidal attempts (SA) amongst school-based adolescents was 18, 18 and 16%, respectively. Adolescent suicidal behaviours (i.e. SI, SP and SA) were respectively associated with being physically attacked, physical fighting, high levels of anxiety, feeling lonely, being bullied, lack of parental support, poor peer support, not having close friends and high levels of sedentary behaviours. Overall, these associations also extended to the context of food insecurity across regions and country income groups, where the magnitude of association slightly varied from odds ratios of 1.25 times to 3.13.

CONCLUSIONS

The burden of school-going adolescent suicidal thoughts, suicide planning and suicide attempts is of particular concern in low-resource countries. Comprehensive suicide prevention programmes for school-going adolescents in LMICs are needed that address socio-cultural inequities related to violence and unintentional injury, social support and psychological factors, protective, and lifestyle-related factors.

Longitudinal Trajectories of Food Insecurity in Childhood and Their Associations With Mental Health and Functioning in Adolescence

IMPORTANCE

Household food insecurity has been associated with mental health problems in children independently of family income and other confounders. It is unclear whether food insecurity during childhood is also associated with mental health and functioning during adolescence.

OBJECTIVE

To evaluate longitudinal trajectories of household food insecurity during the first 13 years of life, characteristics associated with these trajectories, and the associations of the trajectories with externalizing, internalizing, substance use, and social adjustment problems at 15 years of age.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study included participants from the Québec Longitudinal Study of Child Development, a cohort of 2120 children born in Québec, Canada, in 1997 and 1998 and followed up annually or biannually from 5 months to 15 years of age (1998-2013). Data were analyzed from November 2020 to October 2021.

EXPOSURES

When children were aged 1.5, 4, 8, 10, 12, and 13 years, mothers reported whether a family member experienced hunger because the family had run out of food or money to buy food in the past 12 months.

MAIN OUTCOMES AND MEASURES

Group-based trajectory modeling was used to identify differential exposure to food insecurity from 1.5 to 13 years according to logit functions of age. At 15 years of age, adolescents completed validated questionnaires assessing externalizing, internalizing, substance use, and social adjustment problems. Associations between trajectories of food insecurity and outcomes were assessed using linear regressions.

RESULTS

A total of 2032 individuals were included in the analyses of trajectories of food insecurity (1026 [50.5%] male) and 1441 in the analysis of the association with outcomes at 15 years of age (752 [52.2%] female). Two trajectories of food insecurity were identified between 1.5 and 13 years of age: high risk (73 children [3.6%]) and low risk (1959 children [96.4%]). At 5 months, the high-risk and low-risk groups differed in household characteristics including income insufficiency (58 [80.6%] vs 405 [21.0%]), single parenthood (21 [29.2%] vs 135 [6.9%]), and parental history of depression (mothers: 30 [43.5%] vs 411 [21.7%]; fathers: 12 [32.4%] vs 209 [13.5%]). The high-risk trajectory from 1.5 to 13 years of age was associated with cannabis use (β, 0.47; 95% CI, 0.12-0.81), peer bullying (β, 0.43; 95% CI, 0.08-0.77), and dropout potential (β, 0.38; 95% CI, 0.03-0.68) at 15 years of age after adjustment for sex, household income insufficiency, and parental mental health.

CONCLUSIONS AND RELEVANCE

In this cohort study, few children experienced a persistent high risk of food insecurity, which was associated with psychosocial problems later in adolescence after adjustment for confounders including low income. Early identification of risk for food insecurity may guide the delivery of tailored interventions to improve functioning in adolescence.

Food Insecurity and Sleep Disturbance Among 223,561 Adolescents: A Multi-Country Analysis of Cross-Sectional Surveys

This study was to investigate the association between food insecurity (FI) and sleep disturbance among adolescents. Based on the cross-sectional data of the Global School-based Student Health Survey, this study analyzed self-reported data from adolescents in 68 countries. Multivariate logistic regression and meta-analysis were used to evaluate the association between FI and sleep disturbance. The final sample included 223,561 adolescents. The prevalence of severe FI and sleep disturbance was 6.4% and 8.0%, respectively. Severe FI was significantly associated with a higher risk of sleep disturbance in 48 of the 68 countries after adjusting for covariates, with a pooled OR (95% CI) of 1.94 (1.79-2.09). Overall, the association between FI and sleep disturbance was similar across countries and gender, though a large level of heterogeneity existed across upper- and middle-income countries. Identifying adolescents suffering from FI and remedying the FI severity may be important to improve sleep quality in global adolescents.

Associations of household food insufficiency with childhood depression and anxiety: a nationwide cross-sectional study in the USA

OBJECTIVE

Household food insufficiency (HFIS) is a major public health threat to children. Children may be particularly vulnerable to HFIS as a psychological stressor due to their rapid growth and accelerated behavioural and cognitive states, whereas data focusing on HFIS and childhood mental disorders are as-yet sparse. We aimed to examine the associations of HFIS with depression and anxiety in US children.

DESIGN

Cross-sectional study.

SETTING

The 2016-2018 National Survey of Children's Health, a nationally-representative study.

PARTICIPANTS

Primary caregivers of 102 341 children in the USA.

PRIMARY AND SECONDARY OUTCOME MEASURES

Physician diagnosed depression and anxiety were assessed by questionnaires administered to primary caregivers of 102 341 children. Multivariable logistic regression models estimated adjusted OR (aOR) for current depression or anxiety associated with HFIS measured through a validated single-item instrument.

RESULTS

Among children aged 3-17 years, 3.2% and 7.4% had parent-reported physician-diagnosed current depression and anxiety, respectively. Compared with children without HFIS, children with HFIS had approximately twofold higher weighted prevalence of anxiety or depression. After adjusting for covariates, children with versus without HFIS had a 1.53-fold (95% CI 1.15 to 2.03) and 1.48-fold (95% CI 1.20 to 1.82) increased odds of current depression and anxiety, respectively. Associations were slightly more pronounced among girls (aOR (95% CI): depression 1.69 (1.16 to 2.48); anxiety 1.78 (1.33 to 2.38)) than boys (1.42 (0.98 to 2.08); 1.32 (1.00 to 1.73); both P-for-interaction <0.01). The associations did not vary by children's age or race/ethnicity.

CONCLUSIONS

HFIS was independently associated with depression and anxiety among US children. Girls presented slightly greater vulnerability to HFIS in terms of impaired mental health. Children identified as food-insufficient may warrant mental health assessment and possible intervention. Assessment of HFIS among children with impaired mental health is also warranted. Our findings also highlight the importance of promptly addressing HFIS with referral to appropriate resources and inform its potential to alleviate childhood mental health issues.

Psychometric properties of a modified version of Brazilian household food insecurity measurement scale - Pró-Saúde study

We present results of initial steps of the psychometric evaluation of a proposed modified version of the Brazilian Household Food Insecurity Measurement Scale aimed at assessing adults' recall of food insecurity at age 12. Data were obtained through self-administered questionnaires from civil servants at university campuses in Rio de Janeiro, who participated in the first and fourth waves of the longitudinal Pró-Saúde Study. We evaluated test-retest reliability (n=58), internal consistency, factor structure, convergent, discriminant validity (n=3,253). Test-retest reliability kappa coefficients were above 0.65; Cronbach's α coefficient was 0.84. Factor loadings were above 0.800. The composite reliability was above 0.90. The square root values of the Average Variance Extracted were positive and statistically significant. Household food insecurity during childhood was strongly associated with larger family size and several sociodemographic conditions at age 12: female head of household, residence in rural area or small town, worse standard of living, and insufficient food due to lack of money. This initial evaluation suggests good performance. Further investigation should include additional psychometric properties and other population contexts.

Material hardship and suicidal behavior: Associations among parents and non-parents

INTRODUCTION

Material hardship is unique facet of economic distress and may be a risk factor for suicidal behavior. Parents are more likely to experience both material hardship and suicidal behavior than non-parents. The aims of this study were to (a) examine the association of material hardship with suicidal behavior and (b) assess whether associations differed for parents and non-parents.

METHODS

We used data from Waves IV and V of the National Longitudinal Study of Adolescent to Adult Health (N = 10,685). We conducted logistic regression to examine the association of one and two or more material hardships at Wave IV with suicidal behavior at Wave V.

RESULTS

Overall, 38.8% of participants reported material hardship at Wave IV and 7.5% reported suicidal ideation or attempts at Wave V. In the total sample, one material hardship (OR = 1.57, 95% CI 1.20, 2.06) and two or more material hardships (OR = 1.52, 95% CI 1.04, 2.21) were associated with an increased likelihood of suicidal behavior. Among parents, two or more material hardships (OR = 1.86, 95% CI 1.17, 2.94) were associated with an increased likelihood of suicidal behavior. Among non-parents, one material hardship (OR = 1.81, 95% CI 1.26, 2.59) was associated with an increased likelihood of suicidal behavior.

CONCLUSIONS

Programs and policies aimed at addressing material hardship, particularly accumulating material hardships among parents, may be an effective suicide prevention strategy.

Experiences and Situations of Shame among Food-insecure Adolescents in South Carolina and Oregon

Shame experienced with food insecurity and participating in food assistance may affect adolescents. We investigated adolescents' experiences of shame related to food insecurity and situations for these experiences in an ethnically diverse sample of 40 adolescents aged 9-15 years from South Carolina and Oregon. In-depth interviews were recorded, transcribed, coded, and analyzed. Participants described feelings of sadness, anger, and internalized shame with food insecurity. Salient situations were participating in food assistance, seeking food assistance from others or community services, and social encounters at school among peers. Adolescents felt shame knowing that peers were aware of their food insecurity and about them participating in food assistance through school.

The role of provincial social policies and economic environments in shaping food insecurity among Canadian families with children

Food insecurity, inadequate access to food due to financial constraints, affects 17.3% of Canadian children, with serious health repercussions. Capitalizing on the geo-temporal variation in social policies and economic environments across Canadian provinces between 2005 and 2018, we examined the association between provincial policies and economic environments and likelihood of experiencing food insecurity among households with children. Drawn from 13 years of the Canadian Community Health Survey, our sample comprised 123,300 households with below-median income with children under 18 in the ten provinces. We applied generalized ordered logit models on the overall sample and subsamples stratified by Low-Income Measure (LIM). Higher minimum wage, lower income tax, and lower unemployment rate were associated with lower odds of food insecurity in the overall sample. A hypothetical one-dollar increase in minimum wage was associated with 0.8 to 1.0-percentage-point decrease in probability of food insecurity. The probability of food security increased by 1.2 to 1.6 percentage points following a one-percentage-point drop in bottom-bracket income tax rate. One-percentage-point lower unemployment rate corresponded to 0.6 to 0.8-percentage-point higher probability of food security. Higher welfare income and lower housing price predicted lower likelihood of severe food insecurity in the below-LIM subsample. Higher sales tax and median wage predicted higher likelihood of food insecurity among above-LIM households. Income support policies, favorable labor market conditions, and affordable living costs were all related to reduced food insecurity among Canadian households with children. Policies that increase minimum wage, reduce taxes, and create jobs may help alleviate food insecurity.

Black-white racial disparities in household food insecurity from 2005 to 2014, Canada

Objectives

To understand the differential vulnerability to household food insecurity of the Black population as compared with white counterparts in Canada.

Methods

Using data for households with Black and white respondents in pooled Canadian Community Health Survey cycles from 2005 to 2014, the 18-question Household Food Security Survey Module was analyzed (N = 491,400). Bivariate and multivariate logistic and multinomial regression models were run using respondent’s race, immigration status, and six well-established predictors of household food insecurity in the general population. Additional multivariable logistic regression models were run, with race interacted with each predictor individually to yield predicted probabilities.

Results

The weighted prevalence of household food insecurity was 10.0% for white respondents and 28.4% for Black respondents. The odds of Black households being food-insecure as compared with white households fell from 3.56 (95% CI: 3.30–3.85) to 1.88 (95% CI: 1.70–2.08) with adjustment for household socio-demographic characteristics. In contrast with white households, there was relative homogeneity of risk of food insecurity among Black subgroups defined by immigration status, household composition, education, and province of residence. Homeownership was associated with lower probabilities of food insecurity for Black and white households, but the probability among Black owners was similar to that for white renters (14.7% vs. 14.3%). Black households had significantly higher predicted probabilities of food insecurity than their white counterparts across all main sources of household income except child benefits and social assistance.

Conclusion

Being racialized as Black appears to be an overriding factor shaping vulnerability to food insecurity for the Black population in Canada. Future research and public policy on food insecurity should seriously consider the role of racism at the systemic and institutional levels.

Food insecurity, state fragility and youth mental health: A global perspective

Youth in fragile settings face disproportionate risks of experiencing food insecurity and poor mental health. Cross-national evidence is lacking on the association between food insecurity and mental health in youth populations, and on state fragility as a social determinant of these experiences. We analysed data from six cycles of the Gallup World Poll (2014-2019), an annual survey that contains multi-item scales of food insecurity, mental health problems and positive wellbeing. The analytic sample included 164,118 youth aged 15-24 years in 160 states. We linked individual responses to state-level data from the Fragile States Index-an aggregate measure of state vulnerability to collapse or conflict (coded: sustainable, stable, warning, or alert) and estimated adjusted relative risk (RR) of food insecurity as a function of state fragility. We then used linear regression to examine associations of state fragility and food insecurity with mental health and wellbeing. The prevalence of moderate or severe food insecurity rose from 22.93% in 2014 to 37.34% in 2019. State fragility (alert vs. sustainable) was related to an increased risk of food insecurity (RR = 2.28 [95% CI 1.30 to 4.01]), more mental health symptoms (b = 6.36 [95% CI 1.79 to 10.93]), and lower wellbeing (b = -4.49 [95% CI -8.28 to -0.70]) after controlling for state wealth and household income. Increased food insecurity (severe vs. none or mild) was uniquely related to more mental health symptoms (b = 18.44 [95% CI 17.24 to 19.64]) and reduced wellbeing (b = -9.85 [95% CI -10.88 to -8.83]) after state fragility was also controlled. Globally, youth experience better mental health where states are more robust and food access is more secure. The findings underscore the importance of strong governance and coordinated policy actions that may improve youth mental health.

COVID-19 Pandemic, Determinants of Food Insecurity, and Household Mitigation Measures: A Case Study of Punjab, Pakistan

Policies centered to respond to the COVID-19 pandemic have created recessionary economic impacts. Adverse income shocks have caused malnutrition and food insecurity and have increased the need for food assistance. The present study examines the impact of the COVID-19 pandemic on food insecurity and investigates the determinants of food security and coping strategies in the Punjab province of Pakistan. Data were collected through the internet and received responses from 370 respondents. The household food insecurity access scale (HFIAS) model was applied to examine food insecurity, and a logit regression model was used to analyze its determining factors. The results illustrate that food insecurity substantially increased during the COVID-19 pandemic. Households' demographics and socioeconomic factors have influence on food insecurity. Households with a large family size and people in quarantine found more food insecurity during the COVID-19 pandemic, while financial assistance played a role in a decline in food insecurity. Households handle the negative income shocks by eating less preferred food and getting support from government and charity organizations. It is suggested that stakeholders and responsible institutes provide financial assistance to support low-income families in order to enhance food security. Furthermore, policymakers should strengthen social safety nets and aid programs such as the Ehsas income program in the province of the country.

The impact of novel and traditional food bank approaches on food insecurity: a longitudinal study in Ottawa, Canada

Background

Food insecurity is strongly associated with poor mental and physical health, especially with chronic diseases. Food banks have become the primary long-term solution to addressing food insecurity. Traditionally, food banks provide assistance in the form of pre-packed hampers based on the food supplies on hand, such that the food items often do not meet the recipients’ cultural, religious or medical requirements. Recently, new approaches have been implemented by food banks, including choice models of food selection, additional onsite programming, and integrating food banks within Community Resource Centres.

Methods

This study examined changes in food security and physical and mental health, at four time points over 18 months at eleven food banks in Ottawa, Ontario, Canada. The participants – people who accessed these food banks – were surveyed using the Household Food Security Survey Module (HFSSM) and the Short-Form Health Survey Version 2 (SF-12). Statistical analyses included: pairwise paired t-tests between the mean perceived physical and mental health scores across the four waves of data collection, and longitudinal mixed effects regression models to understand how food security changed over time.

Results

The majority of people who were food insecure at baseline remained food insecure at the 18-month follow-up, although there was a small downward trend in the proportion of people in the severely food insecure category. Conversely, there was a small but significant increase in the mean perceived mental health score at the 18-month follow-up compared to baseline. We found significant reductions in food insecurity for people who accessed food banks that offered a Choice model of food distribution and food banks that were integrated within Community Resource Centres.

Conclusions

Food banks offer some relief of food insecurity but they don’t eliminate the problem. In this study, reductions in food insecurity were associated with food banks that offered a Choice model and those that were integrated within a Community Resource Centre. There was a slight improvement in perceived mental health at the 18-month time point; however, moderately and severely food insecure participants still had much lower perceived mental health than the general population.

Food insecurity is associated with mental health problems among Canadian youth

BACKGROUND

Research has linked food insecurity to mental health problems, though little is known about this relationship among Canadian youth. We investigate the association between food insecurity severity and mental illnesses in a nationally representative youth sample.

METHODS

We sampled 55 700 youth 12-24 years from recent cycles of Canadian Community Health Survey. Household food insecurity was measured using a standard 18-item questionnaire. We fitted Poisson regressions on self-rated mental health and diagnosed mood and anxiety disorders, controlling for sociodemographic confounders. Clinical assessments of emotional distress, major depression and suicidal ideation were examined in subsamples with available data. We stratified the sample by gender, age and survey cycle to test potential demographic heterogeneity.

RESULTS

One in seven youth lived in marginal (5.30%), moderate (8.08%) or severe (1.44%) food insecurity. Results showed that food insecurity was associated with higher likelihood of every mental health problem examined. The association was graded, with more severe food insecurity linked to progressively worse mental health. Notably, marginal, moderate and severe food insecurity were associated with 1.77, 2.44 and 6.49 times higher risk of suicidal thoughts, respectively. The corresponding relative risk for mood disorders were 1.57, 2.00 and 2.89; those for anxiety disorders were 1.41, 1.65 and 2.58. Moderate food insecurity was more closely associated with mental health problems in 18-24 year olds than in 12-17 year olds.

CONCLUSIONS

Food insecurity severity was associated with poorer mental health among Canadian youth independent of household income and other socioeconomic differences. Targeted policy intervention alleviating food insecurity may improve youth mental health.

Food Insecurity With Hunger and Sexual Behavior Among Adolescents From 53 Countries

Objectives: To examine the relationship of food insecurity with sexual intercourse, multiple sexual partners and non-condom use. Methods: Data on food insecurity (hunger) and sexual behaviors from 205,296 adolescents from 53 countries. Associations were analyzed using meta-analysis. Results: Overall, 16.0% of the adolescents ever had sexual intercourse and the prevalence of moderate and severe food insecurity was 44.9% and 6.2%, respectively. Moderate and severe food insecurity was associated with higher odds for sexual intercourse. Any food insecurity was significantly associated with condom nonuse at last sex. Conclusions: Food insecurity was associated with higher odds of ever having sexual intercourse dose-dependently.

Does social support moderate the association between hunger and mental health in youth? A gender-specific investigation from the Canadian Health Behaviour in School-aged Children study

BACKGROUND

Youth who go hungry have poorer mental health than their counterparts - there are gender differences in this relationship. This study investigated the role of social support in the association between hunger and mental health among a nationally representative sample of youth in Canada in gender-specific analyses.

METHODS

We used a probability-based sample of 21,750 youth in grades 6-10 who participated in the 2017-2018 Canadian Health Behaviour in School-aged Children. Self-report data were gathered on hunger, mental health (measured via the World Health Organization-5 well-being index) and five sources of support - peer, family and teacher support as well as the school climate and neighborhood support. We conducted adjusted, gender-specific, multilevel regression analyses assessing the association between mental health, social support and hunger.

RESULTS

We found that youth who reported lower support were more likely to experience going to bed hungry (relative to never hungry) across all support factors. As for the social support factors, all the social support factors were associated with a higher mental health score, even after controlling for hunger. Despite these results our final set of models showed that our measures of social support did not alleviate the negative association between hunger and mental health. As for gender-specific findings, the negative association between hunger and a mental health was more pronounced among females relative to their male counterparts. We also found that certain social support factors (i.e., family, teacher and neighborhood support) were associated with a higher mental health score among females relative to males while controlling for hunger status.

CONCLUSIONS

We find that five social support factors are associated with a higher mental health score among ever hungry youth; however, social support did not overpower the negative association between hunger and mental health. Food insecurity is a challenge to address holistically; however, hungry youth who have high social support have higher odds of better mental health.

Prevalence of suicide ideation, planning and attempts among Supplemental Nutrition Assistance Program participants in the United States

BACKGROUND

Suicide represents a substantial public health problem in the U.S. Programs like the Supplemental Nutrition Assistance Program (SNAP)-which provides services for U.S. adults who are food insecure-could be an appropriate venue for suicide prevention strategies targeting high-risk individuals.

METHODS

This cross-sectional study used multiple logistic regression to determine odds ratios (ORs) and 95% confidence intervals (CIs) for suicide ideation, planning and attempt among those who participated in SNAP vs. nonparticipants. The National Survey of Drug Use and Health provided a representative sample of U.S. adults for 2012-2018 (n = 288,730).

RESULTS

SNAP participants were more likely than nonparticipants to have serious suicidal thoughts (crude OR=1.89; 95% CI=1.79-1.99), to have a plan for suicide (crude OR=2.35; 95% CI=2.16-2.56) or to attempt suicide (crude OR=2.89; 95% CI=2.54-3.29). Associations remained for those aged <50 in age-stratified analyses that accounted for survey year, demographics, socioeconomic status, self-rated health and mental health service use.

LIMITATIONS

SNAP was assessed at the household level; thus, those who reported suicidal thoughts and/or behaviors may not personally interact with SNAP.

CONCLUSION

Using a large, nationally-representative sample of U.S. adults, this study documented greater prevalence of suicide-related outcomes among those who participate in SNAP. Suicide prevention among SNAP participants may provide a unique means to reach individuals who are often hard to engage in other health services.

Childhood exposure to hunger: associations with health outcomes in later life and epigenetic markers

Aim: To assess associations of early exposure to hunger with depressive symptoms and cardiovascular disease (CVD) and to investigate possible epigenetic pathways. Patients & methods: Data were based on a German population-based cohort of older adults (n = 9631). Regression models were performed for health outcomes in later life. An epigenome-wide association study for early-life exposure to hunger was performed in a subgroup (n = 2221) with whole blood DNA methylation data. Results: Childhood exposure to hunger was associated with CVD and depressive symptoms in later life. Prenatal or infant exposure was strongly associated with depressive symptoms. No CpG reached epigenome-wide significance after multiple testing correction. Conclusion: Childhood hunger is a risk factor for depressive symptoms and CVD at older age. DNA methylation could not explain this association.

Rotated nursing environment with underfeeding: A form of early-life adversity with sex- and age-dependent effects on coping behavior and hippocampal neurogenesis

We investigated how a unique form of early-life adversity (ELA), caused by rotated nursing environment to induce underfeeding, alters anxiety-like and stress-coping behaviors in male and female Sprague Dawley rats in adolescence and adulthood. Adult female rats underwent either thelectomy (thel; surgical removal of teats), sham surgery, or no surgery (control) before mating. Following parturition, litters were rotated between sham and thel rats every 12 h to generate a group of rats that experienced ELA (rotated housing, rotated mother, and 50% food restriction) from postnatal day 0 to 26. Control litters remained with their natal, nursing dams. Regardless of age and sex, ELA reduced activity in the periphery of the open field. ELA increased immobility in the forced swim test, particularly in adults. We used doublecortin immunohistochemistry to identify immature neurons in the hippocampus. ELA increased the number and density of immature neurons in the dentate gyrus of adolescent males (but not females) and reduced the density of immature neurons in adult males (but not females). This research indicates that a unique form of ELA alters stress-related passive coping and hippocampal neurogenesis in an age- and sex-dependent manner.

Family meal characteristics in racially/ethnically diverse and immigrant/refugee households by household food security status: A mixed methods study

While there is some research examining frequency of family meals by food insecurity (FI) status, there is little research examining other family meal characteristics (e.g., type of food served at meal, emotional atmosphere) or parent feeding practices by FI status. If food and money is scarce, it may be that the broader family meal environment looks different in families with continuous access to food (food secure, FS) compared to families with FI. Using ecological momentary assessment (EMA) and qualitative data, this study explores meal characteristics and parent feeding practices at nearly 4000 family meals in a low-income, racially/ethnically diverse and immigrant/refugee sample. For 8 days, participants (i.e., parents of 5-7-year-old children) completed a survey every time they shared a meal with their child. Additionally, parents completed a qualitative interview regarding family meals. There were many meal characteristics statistically correlated with a family being FI, including: who prepared the meal and how the meal was prepared, the makeup of people at the meal, the meal location and meal atmosphere, and the food served at the meal. Qualitative data illuminated many of these findings from EMA meal surveys. Quantitatively, families with FI and FS reported similar parent feeding practices during family meals. Qualitatively, families with FI and FS reported differences in (1) parent feeding practices; (2) food served at family meals; (3) challenges to having family meals; and 4) adults' role in the family meal. This study provides suggestions for interventionists working with families, including helping families identify time management strategies, including fruits and vegetables into family meals on a budget, reducing screen time at family meals while improving the meal's emotional atmosphere, and developing positive parent feeding practice strategies.