Stretching Food and Being Creative: Caregiver Responses to Child Food Insecurity

Prevalence and Implementation Characteristics of Weekend Food Assistance Programs in U.S. Schools

INTRODUCTION

Amid national efforts to align priorities for nutrition and food assistance programs, little is known about the implementation of community-led efforts for children. This study aimed to estimate U.S. public school participation in weekend backpack programs (WBPs), to document program structure, and to consider characteristics of programs with more nutritious food offerings.

METHODS

The prevalence of WBP participation in 2022 was estimated using a state-stratified, random sample of n=413 public schools. Administrators from WBPs at 49 schools completed measures of implementation characteristics and nutritional quality of foods offered. In 2022-2023, using a multivariable-adjusted linear regression model, the authors explored the association between hypothesized implementation characteristics and Healthy Eating Index-2015 scores of foods provided.

RESULTS

Half of public schools (53.7%, 95% CI: 46.8%, 60.7%) in the national sample reported participating in WBPs. Many WBPs in the subsample were affiliated with anti-hunger organizations (41%), led by school counselors and volunteers (55%), and funded by grants (51%). WBPs spent an average of $0.56 (sd=$0.36) per item. Foods provided averaged a Healthy Eating Index-2015 score of 58.4 (sd=12.3), similar to children's average diets. About half of WBPs (41%) reported accessing nutrition resources.

CONCLUSIONS

Despite the decentralized structure and absence of dedicated funding mechanisms, WBPs were common in our national sample of schools, suggesting widespread perceptions of unmet food needs and extensive efforts from community members to mitigate weekend hunger. Further research on food procurement methods and program impacts on child nutrition outcomes is needed to advance national priorities for nutrition and food security.

A Scoping Review of Household Factors Contributing to Dietary Quality and Food Security in Low-Income Households with School-Age Children in the United States

Low-income and food-insecure households are at risk of poor dietary quality and even more severe food insecurity. Especially in childhood, consuming a nutritionally adequate diet is an essential driver of health, growth, and development. Household-level factors can present challenges to support the nutritional needs of low-income and food-insecure household members. The aim of this scoping review is to identify the contributing household factors to dietary quality and food security in US households of school-aged children 5 to 19 years and synthesize the evidence around emergent themes for application to future interventions. The scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols Extension for Scoping Reviews using search terms addressing food insecurity, low income, and dietary behaviors in the database PubMed. Screening by 3 independent reviewers of the title, abstract, and full study phases identified 44 studies. The 5 themes around which the studies grouped were: parental behaviors, child/adolescent behaviors, food procurement behaviors, food preparation behaviors, and household environment factors. Most studies were cross-sectional (n = 41, 93%) and focused on parental behaviors (n = 31, 70%), followed by food preparation and procurement behaviors. The themes identified were interrelated and suggest that incorporating education on parent and child behaviors that influence food procurement and preparation, along with strengthening organization and planning in the household environment, may hold promise to improve dietary quality and food security among food-insecure and low-income households. The findings can be used to inform future nutrition education interventions aimed at improving dietary quality and food security in households with school-aged children.

Moderate-to-severe household food insecurity is associated with depression among adolescent girls in northern Ghana: a cross-sectional analysis

OBJECTIVE

Household food insecurity is positively associated with depression; however, the association among adolescents is not well known. We examined the association between household food insecurity and depression among adolescent girls in Northern Ghana.

METHODS

We analysed data from the Ten2Twenty-Ghana randomised controlled trial end-line for adolescent girls aged 10-17 years (n=582). The girls were chosen at random from 19 primary schools in the Mion District of Ghana's northern region. The children's depression inventory and the Food Insecurity Experience Scale were used in face-to-face interviews to assess depression and household food insecurity. Hierarchical survey binary logistic regression and linear mixed models were used to examine the association between household food insecurity and depressive symptoms. We took into account a number of potential confounders in the analysis, such as life satisfaction, self-efficacy, self-esteem, health complaints, child's age, menarche status, pubertal development, anaemia, stunting, frequency of consuming fruits and vegetables, frequency of consuming animal-sourced foods, maternal age, household wealth index and size, and the intervention group the girl was assigned to in the trial.

RESULTS

About 20.1% of adolescent girls were classified as likely depressed, and 70.3% of their households were food insecure, with 22.9% and 18.0% being moderately and severely food insecure, respectively. Compared with girls from food-secure households, those from moderately (adjusted OR (AOR) 2.63, 95% CI (1.35 to 5.12)) and severely (AOR 3.28, 95% CI (1.66 to 6.49)) food insecure households had about three times the odds of being classified as depressed, after controlling for potential confounders. The odds of being likely depressed were about twice for adolescent girls from food-insecure households compared with their peers from food-secure households in both the crude and final adjusted model.

CONCLUSION

The study discovered high levels of household food insecurity and depression in adolescent girls in Northern Ghana, with a dose-response association between the two.

Obesity in Adolescents: Understanding the Combined Role of Food Security and Emotional and Behavioral Disorders

PURPOSE

To examine the associations and interactions between levels of food security and emotional and behavioral disorders with obesity in adolescents.

METHODS

Multiple logistic regression modeling was used to analyze the association of adolescent obesity with levels of food security and emotional and behavior disorders in children aged 12-17 years using data from National Health Interview Survey 2016-2018 combined years. Presence of emotional and behavioral disorders within food security categories was added to logistic regression modeling to examine interactions.

RESULTS

When added individually to multiple logistic regression models, marginal and low food security, Attention Deficit Hyperactivity Disorder (ADHD) and anxiety were associated with increased odds of obesity, but very low food security and depression were not. Within the group of adolescents with very low food security, those with anxiety, depression, or ADHD had a nearly two to three-fold increase in odds of obesity compared to adolescents with very low food security and no emotional and behavioral disorders. A similar increase in the odds of obesity with the presence of anxiety, depression, or ADHD was not seen in the adolescents with high food security.

DISCUSSION

This study finds a significant interaction between food security level and emotional and behavioral disorders. The distinction that very low food security in adolescents is only associated with obesity when either anxiety, depression or ADHD are present, but not independently, is an important contribution to understanding complex interactions contributing to obesity.

A latent class analysis to identify socio-economic and health risk profiles among mothers of young children predicting longitudinal risk of food insecurity

BACKGROUND

The purpose of the current study was to use a social determinants of health (SDOH) framework and latent class analysis (LCA) to identify risk classes among mothers with young children. The risk classes were then used to predict food insecurity severity and stability/change of food insecurity over time.

METHOD

The secondary data from the Fragile Families and Child Wellbeing Study (n = 2,368; oversampled for non-marital births) was used in this study. Household food insecurity was assessed using the 18-items USDA Food Security Survey. A seventeen-item inventory of educational, economic stability, incarceration (i.e. social context), neighborhood safety (i.e. neighborhood and built environment), health and health care, and substance use behaviors at baseline/Year-1 were included to identify SDOH risk indicators in the LCA. Covariate-adjusted multinomial logistic regression models were used to examine the relation between risk classes at Year-1 and the severity of food insecurity at Year-3 and stability/change of food insecurity between Year-3 and Year -5.

RESULTS

LCA identified five risk classes: High utility and medical hardship (Class 1), high housing and employment hardship, high substance use, and incarceration (Class 2), high housing and medical hardship, poor health, and health care (Class 3), high employment hardship and low-income (Class 4) and low-risk (Class 5). The Class 1, Class 2 and Class 3 had greater odds of low food security and very low food security at Year-3 compared to Class 4. In addition, compared to Class 4, Class 1, Class 2 and Class 3 had greater odds unstable food insecurity and persistent food insecurity over time.

CONCLUSIONS

LCA could be used to identify distinctive family system risk profiles predictive of food insecurity. The generated risk profiles could be used by health care providers as an additional tool to identify families in need for resources to ensure household food security.

Food insecurity and ultra-processed food consumption: the modifying role of participation in the Supplemental Nutrition Assistance Program (SNAP)

BACKGROUND

Ultra-processed foods contribute to risks of obesity and cardiometabolic disease, and higher intakes have been observed in low-income populations in the United States. Consumption of ultra-processed foods may be particularly higher among individuals experiencing food insecurity and participating in the Supplemental Nutrition Assistance Program (SNAP).

OBJECTIVES

Using data from the 2007-2016 NHANES, we examined the associations between food insecurity, SNAP participation, and ultra-processed food consumption.

METHODS

The study population comprised 9190 adults, aged 20-65 y, with incomes ≤300% of the federal poverty level (FPL). Food insecurity was assessed using the Household Food Security Survey Module and SNAP participation over the past 12 mo was self-reported. Dietary intake was measured from two 24-h dietary recalls. Ultra-processed food consumption (percentage of total energy intake) was defined using the NOVA food classification system. Linear regression models were used to examine the associations between food insecurity, SNAP participation, and ultra-processed food consumption, adjusting for sociodemographic and health characteristics.

RESULTS

More severe food insecurity was associated with higher intakes of ultra-processed foods (P-trend = 0.003). The adjusted means of ultra-processed food intake ranged from 52.6% for adults with high food security to 55.7% for adults with very low food security. SNAP participation was also associated with higher intakes of ultra-processed foods (adjusted mean: 54.7%), compared with income-eligible participants (adjusted mean: 53.0%). Furthermore, the association between food insecurity and ultra-processed foods was modified by SNAP participation (P-interaction = 0.02). Among income-eligible nonparticipants and income-ineligible nonparticipants, more severe food insecurity was associated with higher consumption of ultra-processed foods. Among SNAP participants, the association between food insecurity and consumption of ultra-processed foods was nonsignificant.

CONCLUSION

In a nationally representative sample of adults, food insecurity and SNAP participation were both associated with higher levels of ultra-processed food consumption.

Engaging Food Insecure Families on the Weekend to Improve Nutrition and Health

BACKGROUND

The school meals program provides food during the week, but there is limited evidence on how to address the needs of families with food insecurity (FI) on the weekend.

OBJECTIVES

We conducted a prospective mixed methods pilot study to evaluate the potential effect of a community-based program that delivers free meals to children and fresh produce to their families at different sites on weekends combined with cooking classes.

METHODS

We recruited 41 parent-child dyads from the neighborhood where a new delivery site opened. We assessed the change in children's fruit and vegetable intake and parental anxiety before and after the site opened. We conducted interviews with parents/guardians to understand perceptions of the program and how to more effectively address families' needs.

RESULTS

The majority of parents/guardians were non-Hispanic Black (90.5%) and had FI (87.8%). We found a non-significant increase in the intake of fruit/vegetable servings per day from baseline (mean, 3.39) to follow-up (mean, 3.88; p = 0.41), but no change in parental anxiety. In interviews, we identified three major themes: 1) FI affects food quality and multiple generations care for children; 2) the program provided relief to parents/guardians, allowing them to eat healthier; and 3) the need for multigenerational programs and broader policy changes to address FI.

CONCLUSIONS

Although further research is needed, a community-based program combining food delivery with cooking classes may assist families with FI. Participants reported that the program provided relief, helping them eat healthier. Multigenerational programs and broader policy changes are needed to further address FI.

In the midst of plenty: Experiences of food insecurity amongst women living with HIV in Vancouver, Canada

Globally, people living with HIV (PLWH) are disproportionately affected by food insecurity. Yet there is limited understanding of the impacts of food insecurity among cisgender and transgender women living with HIV (WLWH) in high-income countries. Thus, it is critical to examine the lived experiences of WLWH and food insecurity to inform policy and service provision. As part of the community-based SHAWNA (Sexual Health and HIV/AIDS: Women's Longitudinal Needs Assessment) study, we conducted 64 semistructured qualitative interviews with WLWH in Vancouver, Canada (2015-2017). Drawing on a socio-ecological framework, this analysis explores the lived experiences of navigating food security and health among WLWH in Metro Vancouver. Our findings indicate that WLWH relied heavily on food banks and other food-related supportive services. Despite the abundance of programs, access to nutritious foods remained difficult, and women often relied on processed foods that were more affordable and readily available. For many, food insecurity was exacerbated by unresponsive food services regulations that did not reflect the actual needs of food service users in terms of opening hours and locations, and a lack of nutritious food. Additionally, the absence of trauma-aware, women-centred and culturally responsive services, as well as, spatial and material barriers related to the recent loss of funding for HIV-specific support services, impeded food security among WLWH. Our findings emphasise that recognizing and addressing the social and structural disparities that exist for WLWH in high-income setting are essential for addressing food insecurity and ultimately optimal health among this population.

Identification of factors related to food insecurity and the implications for social determinants of health screenings

Background

Food insecurity and other social determinants of health are increasingly being measured at routine health care visits. Understanding the needs and behaviors of individuals or families who screen positive for food insecurity may inform the types of resources they need. The goal of this research was to identify modifiable characteristics related to endorsement of two food insecurity screener questions to better understand the resources necessary to improve outcomes.

Methods

Analysis was conducted focusing on cross-sectional survey data collected in 2015–2016 from participants (N = 442) living in urban neighborhoods in Ohio with limited access to grocery stores. Food insecurity was assessed by the endorsement of at least one of two items. These were used to categorize participants into two groups: food insecure(N = 252) or food secure (N = 190). Using logistic regression, we estimated the association between several variables and the food insecure classification.

Results

Those that used their own car when shopping for food had lower odds of reporting food insecurity, as did those with affirmative attitudes related to the convenience of shopping for and ease of eating healthy foods. As shopping frequency increased, the odds of food insecurity increased. Food insecurity also increased with experience of a significant life event within the past 12 months. There was an 81% increase in the odds of reporting food insecurity among participants who received Supplemental Nutrition Assistance Program benefits compared to those not receiving Supplemental Nutrition Assistance Program benefits.

Conclusions

Along with referrals to SNAP, clinicians can further address screening-identified food insecurity through provision of transportation supports and linkages to other social services while collaborating on community initiatives to promote convenient and easy access to healthy foods. The needs and behaviors associated with screens indicating food insecurity also have implications for impacting other SDH, and thus, health outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11465-6.

'You run out of hope': an exploration of low-income parents' experiences with food insecurity using Photovoice

OBJECTIVE

Using an adaption of the Photovoice method, this study explored how food insecurity affected parents' ability to provide food for their family, their strategies for managing household food insecurity and the impact of food insecurity on their well-being.

DESIGN

Parents submitted photos around their families' experiences with food insecurity. Afterwards, they completed in-depth, semi-structured interviews about their photos. The interviews were transcribed and analysed for thematic content using the constant comparative method.

SETTING

San Francisco Bay Area, California, USA.

PARTICIPANTS

Seventeen parents (fourteen mothers and three fathers) were recruited from a broader qualitative study on understanding the experiences of food insecurity in low-income families.

RESULTS

Four themes were identified from the parents' photos and interviews. First, parents described multiple aspects of their food environment that promoted unhealthy eating behaviours. Second, parents shared strategies they employed to acquire food with limited resources. Third, parents expressed feelings of shame, guilt and distress resulting from their experience of food insecurity. And finally, parents described treating their children to special foods to cultivate a sense of normalcy.

CONCLUSIONS

Parents highlighted the external contributors and internal struggles of their experiences of food insecurity. Additional research to understand the experiences of the food-insecure families may help to improve nutrition interventions targeting this structurally vulnerable population.

To dine in or not to dine in: A comparison of food selection and preparation behaviours in those with and without food security

Issue addressed

Vulnerable populations are disproportionately affected by food insecurity, resulting in heightened risk of suboptimal dietary intake. Food insecure people appear to implement several coping strategies and dietary compromises to avoid hunger. Less explored in the literature is how these strategies impact consumption of food inside and outside of the home.

Methods

An online survey was completed by adults (n = 1292) residing in one of five Australian states. The questionnaire comprised of the six‐item US Household Food Security Survey Module, 12 socio‐demographic variables and 32 questions related to elements of food literacy.

Results

Food insecure respondents were more likely to frequent fast food vs (P = .002), takeaway (P < .001) and food courts (P < .001) than their food secure counterparts. Food secure respondents reported greater use of raw (P = .043) and fresh, pre‐prepared produce (P = .002) when cooking, whereas food insecure respondents were more likely to prepare food using only frozen, pre‐packaged products (P < .001). No significant differences were found between food security status and the enjoyment and social bonding derived from cooking.

Conclusions

Food insecure respondents appeared to be accessing a poorer quality of food through greater consumption of takeaway and fast food. These dietary compromises are most likely related to perceived financial, time or cooking facility constraints and to a lesser extent food literacy skills.

So what?

This study highlights some of the health and social inequities apparent within food insecure populations. Food insecure households should be supported to access healthy fresh food and in‐home cooking practices. While a multi strategy approach is required, healthy food environment policy, particularly in disadvantaged areas, should be considered to guarantee that all Australians have dignified access to nutritious food.

Experience of Caring for a Child With Type 1 Diabetes Mellitus in a Food-Insecure Household: A Qualitative Evaluation

OBJECTIVES

An earlier study from Nova Scotia showed that food insecurity (FI) is more prevalent (21.9%) in families of children with diabetes, yet little is known about its impact on these families. We aimed to describe the day-to-day experiences of families living with FI while caring for a child with type 1 diabetes (T1D).

METHODS

This investigation was a qualitative study with thematic analyses using semistructured interviews to explore perceptions of caregivers living with pediatric T1D and FI (N=13 households).

RESULTS

Three major themes emerged: 1) FI had a disproportionate impact on families after T1D diagnosis compared with before diagnosis. The cost of healthy food threatened food security before T1D; however, there is increased hardship once high-quality food and hypoglycemia supplies are required. 2) Sacrifices to combat FI have disproportionate impacts among family members. At times, caregivers sacrificed the needs (food, medicine) of other family members (including children) to prioritize the needs of the child with T1D. 3) Caregivers perceived T1D needs as posing unique barriers to traditional FI supports, such as school breakfast programs.

CONCLUSIONS

This study provides insight into the realities of life with pediatric T1D and FI. Living with T1D and FI poses challenges, and caregivers often cope by making difficult choices when providing for their family. Caregivers struggled to meet dietary recommendations while finding that T1D needs are often not met by traditional FI supports. This suggests that T1D clinicians should assess FI and help families in problem solving to mitigate its impact.

Adolescent food insecurity: A review of contextual and behavioral factors

OBJECTIVE

The purpose of this review is to examine recent research on contextual and behavioral factors that will lead to better understanding of adolescent food insecurity and health outcomes.

DESIGN

A literature search for peer-reviewed, English language, research articles published between 2009 and 2019, using CINAHL, Embase^® , Pubmed, and the Cochrane Library.

SAMPLE

The final sample represents thirty studies on food insecurity with a sample including adolescents, and that employ a measure of food insecurity.

RESULTS

Variables of interest and results on topics such as weight-related factors, maternal parenting and behaviors, mental health, and adolescent-level behavioral factors are summarized.

CONCLUSION

Food insecurity is associated with poor adolescent health and mental health. All adolescents should be screened for food insecurity, involving pediatric and mental health care settings. Future research on adolescent food insecurity should explore parent and parenting factors, household composition and family dynamics, psychological factors, health behaviors, and stress; peer influences might also be an important area of research with adolescents. While previous research has relied on parents' reports, adolescents'experiences are unique, and they are willing and reliable research participants; they should be included in future food insecurity research.

Associations Between Food Insecurity and Parental Feeding Behaviors of Toddlers

OBJECTIVE

We examined associations between household food insecurity status and parental feeding behavior, weight perception, and child weight status in a diverse sample of young children.

METHODS

Cross-sectional analysis of 2-year-old children in Greenlight, a cluster randomized trial to prevent childhood obesity. The exposure was food insecurity, defined as a positive response to a validated screen. Outcomes were parent feeding behaviors/beliefs measured by the Child Feeding Questionnaire and child weight status. t tests and linear regression were used to assess associations between food insecurity and each outcome. We adjusted for child sex, race/ethnicity, parent education, employment, site, number of children in the home, and Special Supplemental Nutrition Program for Women, Infants, and Children status.

RESULTS

Five hundred three households (37%) were food insecure. After adjusting for covariates, parents from insecure households reported more pressuring feeding behaviors (mean factor score 3.2 compared to food secure parents mean factor score 2.9, P = .01) and were more worried about their child becoming overweight (mean factor score 2.3 vs 2.0; P = .02). No differences were observed in monitoring or restrictive feeding behaviors. After adjusting for covariates, there was no difference in weight status or prevalence of overweight/obesity of children or parents based on household food insecurity status.

CONCLUSIONS

Parents from food insecure households reported more pressuring feeding behaviors. This finding underscores the need to address food insecurity and potentially prevent harmful effects on child feeding. Parents in food insecure households might benefit from linkage with resources and education to develop healthier feeding behaviors.

Caregivers' Experiences With Food Insecurity Screening and Impact of Food Insecurity Resources

We explored caregivers' experiences with food insecurity screening in a primary care setting and the impact of resources provided. English- and Spanish-speaking food insecure caregivers of children aged 1 to 5 years were recruited. In-depth individual semistructured interviews were conducted (n = 17) eliciting caregivers' experiences with food insecurity, clinic screening, and resources provided. Interviews were audio-recorded and transcribed verbatim. Interviews were double-coded and thematic analysis was used to identify themes and subthemes. All caregivers described multiple and repeat experiences with food insecurity. Food insecurity screening was acceptable, but families were not always connected with resources. Caregivers described WIC (Women, Infants, and Children) as the most commonly used program to address food insecurity and infrequently utilized other food insecurity resources. Screening for food insecurity in primary care was generally well accepted by this sample of food insecure caregivers. Future studies are needed to determine how to improve connecting resources with families most in need.

Diet and physical activity changes among low-income families: perspectives of mothers and their children

Purpose: The current study explored how mothers and their children influence each other's diet and physical activity. Methods: We conducted semi-structured interviews with women with diabetes and their children (N = 18) from eight low-income families. Results: Two approaches to changes emerged: collaborative and non-collaborative. Families using collaborative approaches believed they could sustain positive changes through accepting family changes, encouragement, abstaining from buying certain foods, modelling and compromise. Within families using non-collaborative approaches, some challenges included using more individualistic approaches and poor communication. Lack of information and resource constraints challenged all families. Conclusion: Interventions should reinforce family collaborative approaches and teach skills for families to work together towards a healthier lifestyle.

Recommendations From SNAP Participants to Improve Wages and End Stigma

We present views of the Supplemental Nutrition Assistance Program (SNAP) from the perspective of participants. We are SNAP participants and academic researchers who have worked together for 11 years to understand, explain, and address food insecurity.SNAP is ensnared in much larger problems in US society related to the stigmatization of people who are poor and a lack of appreciation for the value and skills of their work. We encourage the public health community to think beyond SNAP, focus more assertively on wages and work supports, and replace our means-tested safety net with a new system of universal income that promotes equity, inclusion, and health for all.Although we offer recommendations to improve SNAP, the goal of most SNAP recipients has always been to move beyond the need for this program. The public health community can take the lead in finding more egalitarian, dignified, and effective ways to address poverty and food insecurity.

Association between food insecurity, cardiorenal syndrome and all-cause mortality among low-income adults

BACKGROUND

Food insecurity is known to be a major public health issue. There is limited data on food insecurity and chronic disease in the general population.

AIM

We aimed to assess effect of food insecurity on mortality of individuals with chronic disease like cardiorenal syndrome (CRS).

METHODS

The study was conducted on participants aged 20 years or older in the United States living below the 130% Federal Poverty Level. We assessed food insecurity utilizing the Household Food Security Survey Module in NHANES survey for the years 1999 to 2010 with mortality follow-up. Prospective analysis was performed using complex samples Cox regression with adjustment for known confounders to determine the relationship of food insecurity and CRS.

RESULTS

Prevalence of food insecurity among the low-income population was 16.1% among males and 21.7% among females. The mean follow-up was 6.5 years. For all-cause mortality, the overall unadjusted hazard ratio (HR) of food insecurity to no food insecurity was 1.28 (95% confidence interval [CI], 1.18-1.37, p < 0.001). Adjusted HR was elevated, 2.81 (CI 1.57-5.05, p < 0.001), among participants who were CRS-positive and food insecure but closer to 1.0 (2.48 CI 1.73-3.55, p < 0.001) among those who were CRS-positive and food secure, after controlling for medical and demographic risk factors.

CONCLUSIONS

Food insecurity is associated with higher mortality than food security. Food insecurity also may modify the effect of CRS on all-cause mortality in a representative general population. Social policy, when addressing food insecurity, should be inclusive among those with specific chronic diseases.

Parenting styles are associated with overall child dietary quality within low-income and food-insecure households

OBJECTIVE

To examine the association between parenting styles and overall child dietary quality within households that are low-income and food-insecure.

DESIGN

Child dietary intake was measured via a 24 h dietary recall. Dietary quality was assessed using the Healthy Eating Index-2005 (HEI-2005). Parenting styles were measured and scored using the Parenting Styles and Dimensions Questionnaire. Linear regressions were used to test main and interaction associations between HEI-2005 scores and parenting styles.

SETTING

Non-probability sample of low-income and food-insecure households in South Carolina, USA.

PARTICIPANTS

Parent-child dyads (n 171). Parents were ≥18 years old and children were 9-15 years old.

RESULTS

We found a significant interaction between authoritative and authoritarian parenting style scores. For those with a mean authoritarian score, each unit increase in authoritative score was associated with a higher HEI-2005 score (b = 3·36, P < 0.05). For those with an authoritarian score that was 1 sd above the mean authoritarian score, each unit increase in authoritative score was associated with a higher HEI-2005 score (b = 8.42, P < 0.01). For those with an authoritarian score that was -1 sd below the mean authoritarian score, each unit increase in authoritative score was associated with a lower HEI-2005 score; however, this was not significant (b = -1·69, P > 0·05). Permissive parenting style scores were negatively associated with child dietary quality (b = -2·79, P < 0·05).

CONCLUSIONS

Parenting styles should be considered an important variable that is associated with overall dietary quality in children living within low-income and food-insecure households.

"I worry if I will have food tomorrow": a study on food insecurity among asylum seekers living in Norway

Background

High prevalence of food insecurity has been observed among asylum seekers resettled in high-income countries. Economic constraints, lack of knowledge about new foods, difficulties with shopping, challenges with language, as well as problems complying with various religious food rules are associated with the occurrence and severity of food insecurity. However, no data on food security among asylum seekers in Norway currently exist. Thus, the aim of the study was to assess food security among asylum seekers living in Norwegian reception centers.

Methods

Using convenience sampling, we selected eight reception centers in the southeastern part of Norway and included 205 asylum seekers, including 41 families with children < 18 years of age. We measured food security using the 10-item version of the Radimer/Cornell Hunger and Food Insecurity Scale. Food insecure participants were divided into three groups: food insecurity without hunger, food insecurity with hunger, or food insecurity with child hunger. Using logistic regression models, we analyzed the association between food insecurity status and socioeconomic variables.

Results

Seven percent of the participants were categorized as food secure and 93% as food insecure, of whom 11% were food insecure without hunger, 78% were food insecure with hunger, and 4% were food insecure with child hunger. Among the families with children, 20% (8 of 41) experienced child hunger. For the participants experiencing food insecurity with hunger, 44% reported that they were hungry often, and among families with children, 14% reported that despite being aware of the child’s hunger, they did not have the resources/money to buy more food. In logistic regression models, men had higher odds of experiencing adult food insecurity with hunger than women, OR (95% CI): 4.08 (2.04, 8.16). A reduction in monthly budget by 100 euros increased the odds of experiencing adult food in-security with hunger by 1.37 times OR (95% CI), 1.37 (1.16, 1.61).

Conclusions

The prevalence of food insecurity among asylum seekers in Norway was high, in contrast to low prevalence of food insecurity in the Norwegian population. Asylum seekers are a particularly vulnerable group and initiatives to ameliorate the opportunities for an adequate diet are of the outmost importance.

A comparison of maternal feeding responses to child fussy eating in low-income food secure and food insecure households

Children learn to like a wide variety of healthy foods through exposure in their early feeding environment. While some children may reject foods during this learning process, parents may perceive persistent refusal as 'fussy' or 'picky' eating. Low-income parents may provide fussy children with a narrow range of foods that they will like and accept to avoid food and economic waste; inadvertently limiting children's exposure to a variety of healthy foods. This 'risk aversion' to food rejection may be particularly salient in food insecure households where resources are further constrained. We aimed to examine if food insecurity modifies the relationship between child fussy eating and parents' food provision and feeding with respect to exposure to a variety of healthy foods. Australian mothers residing in a low-income community (N = 260) completed a cross-sectional survey on their preschool-aged child's 'food fussiness', household food insecurity and food exposure practices. Food exposure practices included the home availability of fruit and vegetables, and children's tasting of a variety of fruit and vegetables (food provision); and whether parents prepared alternative meals for their child (feeding). Mothers reporting food insecurity (11%) were less likely to have fruit frequently available in the home compared to mothers reporting food security. Food insecurity moderated the relationship between fussy eating and food exposure practices insofar that food secure mothers were more likely to prepare alternative meals for fussier children. Family resources and child fussy eating behaviours are identified as important contextual factors in food provision and feeding. Findings from the current study suggest that health professionals, researchers and policymakers tailor interventions to consider both the needs of families and child eating characteristics.