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Celeste-Villalvir A, Palar K, Then-Paulino A, Wallace DD, Jimenez-Paulino G, Fulcar MA, Acevedo R, Derose KP. Perceived Impacts of Urban Gardens and Peer Nutritional Counseling for People Living With HIV in the Dominican Republic. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:478-488. [PMID: 38613552 PMCID: PMC11227956 DOI: 10.1016/j.jneb.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVE Explore participants' perceptions of urban gardens and peer nutritional counseling intervention for people with HIV and food insecurity on antiretroviral therapy in the Dominican Republic. METHODS Semistructured endline interviews (n = 21) with intervention participants about their perceptions of diet, health, and quality of life. A codebook was applied to verbatim transcripts, and coded data were analyzed using matrices to identify themes. RESULTS Participants were mostly Dominican (86%; 14% Haitian); 57% were men; the mean age was 45 years. The most salient experiences described by intervention participants were improved dietary quality and diversity, improved food security, and saving money. Participants also emphasized improved social interactions, mental health, and emotional well-being. CONCLUSIONS AND IMPLICATIONS Urban gardens and peer nutritional counseling may improve participants' diet and psychosocial well-being. Nutrition programs with marginalized populations may need to improve access to healthy foods and build camaraderie and linkages to programs addressing structural factors.
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Affiliation(s)
| | - Kartika Palar
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Amarilis Then-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Deshira D Wallace
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Gipsy Jimenez-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Maria Altagracia Fulcar
- World Food Programme, Country Office for the Dominican Republic, Santo Domingo, Dominican Republic
| | - Ramon Acevedo
- Consejo Nacional para el VIH y Sida, Santo Domingo, Dominican Republic
| | - Kathryn P Derose
- Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, MA; Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, CA.
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Bleasdale J, Morse GD, Liu Y, Leone LA, Cole K, Przybyla S. Addressing food insecurity in HIV care: perspectives from healthcare and social service providers in New York state. AIDS Care 2024; 36:927-936. [PMID: 38289486 PMCID: PMC11269021 DOI: 10.1080/09540121.2024.2309331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 01/18/2024] [Indexed: 05/05/2024]
Abstract
Ending the HIV epidemic in the United States will require addressing social determinants contributing to poor care engagement among people living with HIV (PLH), such as food insecurity. Food insecurity is associated with poor care engagement among PLH. Yet, few studies have examined the perspectives of healthcare and social services providers on addressing food insecurity in HIV care. Guided by the Social Ecological Model, we conducted semi-structured interviews with 18 providers in New York State to understand barriers and facilitators to addressing food insecurity in HIV care. Thematic analysis illustrated eight themes across various levels of the Social Ecological Model. At the patient-level, providers perceived patients' feelings of embarrassment, shame, and judgement, and low health literacy as barriers. At the provider-level, challenges included limited time. Facilitators included fostering strong, patient-provider relationships. Barriers at the clinic-level included limited funding, while clinic resources served as facilitators. At the community-level, challenges included intersecting stigmas arising from community norms towards PLH and people who receive food assistance and limited access to healthy food. Findings suggest the need to incorporate their insights into the development of interventions that address food insecurity in HIV care.
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Affiliation(s)
- Jacob Bleasdale
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Gene D. Morse
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
- Center for Integrated Global Biomedical Sciences, Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Yu Liu
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Lucia A. Leone
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Kenneth Cole
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Sarahmona Przybyla
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
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Zubizarreta D, Wirtz AL, Humes E, Cooney EE, Stevenson M, Althoff KN, Radix AE, Poteat T, Beyrer C, Wawrzyniak AJ, Mayer KH, Reisner SL. Food Insecurity Is High in a Multi-Site Cohort of Transgender Women Vulnerable to or Living with HIV in the Eastern and Southern United States: Baseline Findings from the LITE Cohort. Nutrients 2024; 16:707. [PMID: 38474837 DOI: 10.3390/nu16050707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/14/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
The prevalence and correlates of food insecurity-the unavailability of food and limited access to it-have not been adequately considered among transgender women (TW), particularly alongside other health-related conditions burdening this population, such as HIV infection. This study examined the prevalence and correlates of food insecurity among TW. Between 2018 and 2020, 1590 TW in the Eastern and Southern U.S. completed a multi-site baseline assessment (socio-behavioral survey and HIV testing). Descriptive statistics were calculated and multivariable Poisson models with robust error variance were used to estimate prevalence ratios and 95% confidence intervals for correlates of food insecurity (dichotomized as sometimes-to-always vs. seldom-to-never running out of food). Eighteen percent of TW were living with HIV and nearly half of participants (44%) reported food insecurity. Correlates of food insecurity included being Black, multiracial, or another race/ethnicity; having < college education, low income, unstable housing, and high anticipated discrimination; and a history of sex work and sexual violence (all p < 0.05). Food insecurity was highly prevalent among TW. Current programs to provide food support do not adequately meet the needs of TW. HIV pr evention and care programs may benefit from addressing food insecurity.
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Affiliation(s)
- Dougie Zubizarreta
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Elizabeth Humes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Erin E Cooney
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Meg Stevenson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Asa E Radix
- Callen-Lorde Community Health Center, New York, NY 10011, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Tonia Poteat
- Division of Healthcare in Adult Populations, School of Nursing, Duke University, Durham, NC 27710, USA
| | - Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, NC 27708, USA
| | - Andrew J Wawrzyniak
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | | | - Sari L Reisner
- The Fenway Institute, Fenway Health, Boston, MA 02215, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
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Onono MA, Frongillo EA, Sheira LA, Odhiambo G, Wekesa P, Conroy AA, Cohen CR, Bukusi EA, Weiser SD. Links between Household-Level Income-Generating Agricultural Intervention and the Psychological Well-Being of Adolescent Girls in Human Immunodeficiency Virus-Affected Households in Southwestern Kenya: A Qualitative Inquiry. J Nutr 2023; 153:3595-3603. [PMID: 37863268 PMCID: PMC10739770 DOI: 10.1016/j.tjnut.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/26/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Adolescent girls may experience poor psychological well-being, such as social isolation, shame, anxiety, hopelessness, and despair linked to food insecurity. OBJECTIVES This study aimed to investigate the experiences with and perceived effects of a household-level income-generating agricultural intervention on the psychological well-being of adolescent girls in human immunodeficiency virus (HIV)-affected households in southwestern Kenya. METHODS We conducted 62 in-depth interviews with HIV-affected adolescent girls and caregiver dyads in Adolescent Shamba Maisha (NCT03741634), a sub-study of adolescent girls and caregivers with a household member participating in Shamba Maisha (NCT01548599), a multisectoral agricultural and finance intervention trial aimed to improve food security and HIV health indicators. Participants were purposively sampled to ensure diversity in terms of age and location. Data were audiotaped, transcribed, translated, and uploaded into Dedoose (Sociocultural Research Consultants, LLC) software for management. Data were analyzed thematically based on reports from Dedoose. RESULTS We found evidence that a household-level structural intervention aimed at increasing food and financial security among persons living with HIV can contribute to better psychological well-being among adolescent girls residing in these households. The intervention also affected: 1) reduction of social isolation, 2) reduction of shame and stigma, 3) increased attendance and concentration in school, 4) improved caregiver mental health, and 5) reduced parental aggression and improved household communication. These associations were reported more commonly among those in the intervention arm than the control arm. CONCLUSIONS This study extends existing research by demonstrating how multisectoral structural interventions delivered at a household level can improve the psychological well-being of adolescents. We recommend that future research test livelihood interventions designed specifically for adolescent girls that integrate food-security interventions with other elements to address the social and psychological consequences of food insecurity holistically. This trial was registered at clinicaltrials.gov as NCT03741634.
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Affiliation(s)
- Maricianah A Onono
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States.
| | - Lila A Sheira
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California San Francisco, CA, United States
| | - Gladys Odhiambo
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Pauline Wekesa
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Amy A Conroy
- Division of Prevention Science, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, United States
| | - Craig R Cohen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sheri D Weiser
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California San Francisco, CA, United States
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Logie CH, Shannon K, Braschel M, Krüsi A, Norris C, Zhu H, Deering K. Brief Report: Social Factors Associated With Trajectories of HIV-Related Stigma and Everyday Discrimination Among Women Living With HIV in Vancouver, Canada: Longitudinal Cohort Findings. J Acquir Immune Defic Syndr 2023; 94:190-195. [PMID: 37850977 PMCID: PMC10730092 DOI: 10.1097/qai.0000000000003247] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/26/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION Women living with HIV (WLHIV) experience stigma rooted in social inequities. We examined associations between social factors (food insecurity, housing insecurity, violence, sexual minority identity, and substance use) and HIV-related stigma and Everyday Discrimination trajectories among WLHIV. METHODS This community-based open longitudinal cohort study with WLHIV living in and/or accessing HIV care in Metro Vancouver, Canada, plotted semiannual averages (2015-2019) of recent (past 6-month) HIV-related stigma and Everyday Discrimination. We examined distinct trajectories of HIV-related stigma and Everyday Discrimination using latent class growth analysis (LCGA) and baseline correlates of each trajectory using multinomial logistic regression. FINDINGS Among participants (HIV-related stigma sample: n = 197 participants with n = 985 observations; Everyday Discrimination sample: n = 203 participants with n = 1096 observations), LCGA identified 2 distinct HIV-related stigma and Everyday Discrimination trajectories: sustained low and consistently high. In multivariable analysis, concurrent food and housing insecurity (adjusted odds ratio [AOR]: 2.15, 95% confidence interval [CI] 1.12-4.12) and physical/sexual violence (AOR: 2.57, 95% CI: 1.22-5.42) were associated with higher odds of the consistently high (vs. sustained low) HIV-related stigma trajectory. Sexual minority identity (AOR: 2.84, 95% CI: 1.49-5.45), concurrent food and housing insecurity (AOR: 2.65, 95% CI: 1.38-5.08), and noninjection substance use (less than daily vs. none) (AOR: 2.04, 95% CI: 1.03-4.07) were associated with higher odds of the consistently high (vs. sustained low) Everyday Discrimination trajectory. CONCLUSIONS Social inequities were associated with consistently high HIV-related stigma and Everyday Discrimination among WLHIV. Multilevel strategies can address violence, economic insecurity, intersecting stigma, and discrimination to optimize health and rights among WLHIV.
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Affiliation(s)
- Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- United Nations University Institute for Water, Environment, and Health, Hamilton, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Candice Norris
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - Haoxuan Zhu
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - Kathleen Deering
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
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Alum EU, Obeagu EI, Ugwu OP, Samson AO, Adepoju AO, Amusa MO. Inclusion of nutritional counseling and mental health services in HIV/AIDS management: A paradigm shift. Medicine (Baltimore) 2023; 102:e35673. [PMID: 37832059 PMCID: PMC10578718 DOI: 10.1097/md.0000000000035673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Human immunodeficiency virus (HIV) infection is a public health challenge that can degenerate into acquired immunodeficiency syndrome (AIDS) if not properly managed. HIV infection shortens life expectancy to about 5 to 10 years compared to noninfected individuals. People living with HIV/AIDS (PLWHA) are prone to several health challenges as a result of a deranged immune system culminating in high morbidity and mortality. Depression is a common feature of PLWHA. Depression heightens the emergence of opportunistic infections in HIV-infected individuals, accelerates the progression to AIDS, and increased suicidal tendencies, morbidity, and mortality. Food insecurity with its resultant undernutrition contributes to HIV/AIDS-related deaths. Undernourished PLWHA are more prone to opportunistic infections due to poor immunity. Interestingly, proper diet intake can boost immunity, slow the progression of AIDS and opportunistic infections, enhance body weight, and retard depression tendencies. Undernutrition can also be ameliorated by incorporating nutritional counseling and oral nutrient supplementation in routine HIV/AIDS checkups. Therefore, to increase HIV/AIDS management outcomes, the integration of nutrition counseling, dietary supplements, and mental health services should be embraced. Thus, HIV/AIDS care centers should amplify these services. In this article, we isolated relevant studies from various databases, illuminated the interwoven relationship between HIV/AIDS, depression, and undernutrition, and also reemphasized the need for adequate nutritional intervention in the battle against HIV/AIDS. Thus, this study provides a reawakening call to focus on incorporating nutritional guides and mental health care in HIV/AIDS management protocols.
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Affiliation(s)
- Esther U. Alum
- Department of Publications and Extension, Kampala International University, Kampala, Uganda
- Department of Biochemistry, Faculty of Science, Ebonyi State University, Ebonyi State, Nigeria
| | | | - Okechukwu P.C. Ugwu
- Department of Publications and Extension, Kampala International University, Kampala, Uganda
| | | | | | - Mariam O. Amusa
- Department of Botany and Plant Biotechnology, University of Johannesburg, Johannesburg, South Africa
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Palar K, Sheira LA, Frongillo EA, Kushel M, Wilson TE, Conroy AA, Adedimeji A, Merenstein D, Cohen MH, Wentz EL, Adimora AA, Ofotokun I, Metsch LR, Turan JM, Tien PC, Weiser SD. Longitudinal Relationship Between Food Insecurity, Engagement in Care, and ART Adherence Among US Women Living with HIV. AIDS Behav 2023; 27:3345-3355. [PMID: 37067613 PMCID: PMC10783960 DOI: 10.1007/s10461-023-04053-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 04/18/2023]
Abstract
Food insecurity disproportionately affects people with HIV and women in the United States (US). More evidence is needed to understand the interplay between levels of food insecurity and levels of antiretroviral therapy (ART) adherence over time, as well as how food insecurity relates to engagement in HIV care. We used random effects models with longitudinal data from the US Women's Interagency HIV Study to estimate the (1) adjusted associations of current and 6-month lagged food security with ART adherence categories (n = 1646), and (2) adjusted associations of food security with engagement-in-care (n = 1733). Very low food security was associated with a higher relative risk of ART non-adherence at prior and current visits compared with food security, and this association increased across non-adherence categories. Very low food security was associated with lower odds of receiving HIV care and higher odds of a missed visit. Food insecurity among US women with HIV is associated with poorer engagement in care and degree of ART non-adherence over time.
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Affiliation(s)
- Kartika Palar
- Division of HIV, ID and Global Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA.
| | - Lila A Sheira
- Division of HIV, ID and Global Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Margot Kushel
- Division of General Internal Medicine at San Francisco General Hospital, UCSF, San Francisco, CA, USA
| | - Tracey E Wilson
- Department of Community Health Sciences, State University of New York Downstate Health Sciences University, School of Public Health, Brooklyn, NY, USA
| | - Amy A Conroy
- Department of Medicine, Center for AIDS Prevention Studies, UCSF, San Francisco, CA, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Mardge H Cohen
- Department of Medicine, Stroger Hospital, Chicago, IL, USA
| | - Eryka L Wentz
- Bloomberg School of Public Health, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Adaora A Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ighovwerha Ofotokun
- School of Medicine, Emory University, Atlanta, GA, USA
- Grady Healthcare System, Atlanta, GA, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Janet M Turan
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, CA, USA
- Medical Service, Department of Veteran Affairs Medical Center, San Francisco, USA
| | - Sheri D Weiser
- Division of HIV, ID and Global Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
- Department of Medicine, Center for AIDS Prevention Studies, UCSF, San Francisco, CA, USA
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8
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Bleasdale J, Liu Y, Leone LA, Morse GD, Przybyla SM. The impact of food insecurity on receipt of care, retention in care, and viral suppression among people living with HIV/AIDS in the United States: a causal mediation analysis. Front Public Health 2023; 11:1133328. [PMID: 37601182 PMCID: PMC10433761 DOI: 10.3389/fpubh.2023.1133328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Attaining The Joint United Nations Programme on HIV/AIDS 95-95-95 targets to end the HIV epidemic by 2030 will require a greater understanding of the underlying mechanisms influencing care engagement among people living with HIV/AIDS (PLWHA). One such mechanism is food insecurity, defined as limited or uncertain access to food. Food insecurity has been shown to significantly impact HIV outcomes. Yet, few studies have examined the mechanisms through which food insecurity may influence these outcomes. We aimed to examine the effects of nutritional, behavioral, and mental health mechanisms through which food insecurity may impact HIV care continuum outcomes: receipt of care, retention in care, and viral suppression. Methods We conducted a cross-sectional study of 200 PLWHA in New York State, United States from May-August 2022. Participants were recruited using convenience sampling methods. Multivariable logistic regression models were conducted to examine the associations between food insecurity and care continuum outcomes (receipt of care, retention in care, viral suppression), adjusting for age, race, ethnicity, education, income, and marital status. Individual causal mediation analyses were conducted to assess whether behavioral, mental health, and nutritional mechanisms mediated the hypothesized associations. Results The median age of participants was 30 years (IQR: 27-37 years). The majority self-identified as Black (54.0%), male (55.5%) and straight/heterosexual (63.0%). Increasing severity of food insecurity was associated with greater odds of non-retention in care (aOR: 1.35, 95% CI: 1.07, 1.70) and viral non-suppression (aOR: 1.29, 95% CI: 1.08, 1.54). For the impact of food insecurity on non-retention in care, there was an indirect relationship (natural indirect effect; NIE) mediated through Body Mass Index (BMI) (ORNIE: 1.08, 95% CI: 1.00, 1.18). For viral non-suppression, there was an indirect relationship mediated through BMI (ORNIE: 1.07, 95% CI: 1.00,1.16) and an indirect relationship mediated through depression (ORNIE: 1.27, 95% CI: 1.07, 1.47). Discussion Food insecurity was associated with greater odds of non-retention in care and viral non-suppression among PLWHA. Nutritional and mental health pathways are important mediators of these relationships. Results highlight the need for interventions to target these pathways to address food insecurity as an underlying mechanism influencing engagement in HIV care.
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Affiliation(s)
- Jacob Bleasdale
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
| | - Yu Liu
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States
| | - Lucia A. Leone
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
| | - Gene D. Morse
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
- Center for Integrated Global Biomedical Sciences, Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, United States
| | - Sarahmona M. Przybyla
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
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Essadek A, Shadili G, Bergami Goulart Barbosa P, Assous A, Widart F, Payan S, Rabeyron T, Corruble E, Falissard B, Gressier F. Precarious Young Adults' Mental Health during the Pandemic: The Major Impact of Food Insecurity Independently of COVID-19 Diagnosis. Nutrients 2023; 15:3260. [PMID: 37513678 PMCID: PMC10384015 DOI: 10.3390/nu15143260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/11/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
The COVID-19 pandemic had a major impact on mental health across populations, especially young and precarious people. Furthermore, COVID-19 diagnosis itself has been associated with psychiatric symptoms. However, only a few studies have assessed the mental health of precarious youth, and examined a possible association with food insecurity, while including COVID-19 diagnosis in their analyses. We aimed to determine the prevalence of poor mental health in precarious youth during the COVID-19 pandemic, and to investigate its possible association with food insecurity, independently of COVID-19 diagnosis. In a cross-sectional study conducted in the context of an employment program for precarious youth (18-25 years) living in Paris, France, 823 individuals were assessed for depression, anxiety, subjective distress and food insecurity during the second lockdown of 2020. A directed acyclic graph (DAG)-based approach was used to identify confounders for inclusion in a multivariate regression model. Of the 823 precarious youth, 45.93% reported significant symptoms of depression, 36.69% anxiety, 39% distress and 25.39% suicidal ideation. In the multivariate analysis based on DAG, food insecurity (less than one meal per day) was associated with depression (OR = 2.30; CI%: 1.19-4.51), anxiety (OR = 2.51; CI%: 1.29-4.88), distress (OR = 2.36; CI%: 1.23-4.57) and suicidal ideation (OR = 4.81; CI%: 2.46-9.44), independently of age, gender, education, COVID-19 contact and COVID-19 diagnosis. This study highlights the importance of food insecurity on mental health among young precarious people during the COVID-19 pandemic. Reducing food insecurity is essential to help reduce psychological distress.
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Affiliation(s)
- Aziz Essadek
- INTERPSY Laboratory, Faculty of Psychology, University of Lorraine, 54015 Nancy, France
| | - Gérard Shadili
- PCPP Laboratory, Institute of Psychology, University of Paris Cité, 75006 Paris, France
- Institut Mutualiste Montsouris, 75014 Paris, France
| | | | - Adèle Assous
- CRPMS Laboratory, Faculty of Psychology, University of Paris Cité, 75006 Paris, France
| | - Frédéric Widart
- Faculty of Psychology, University of Liège, 4000 Liège, Belgium
| | - Ségolène Payan
- Essonne Research and Social Work Institute, IRFASE, 91034 Evry, France
| | - Thomas Rabeyron
- INTERPSY Laboratory, Faculty of Psychology, University of Lorraine, 54015 Nancy, France
| | - Emmanuelle Corruble
- Department of Psychiatry, Bicêtre University Hospital, Assistance Publique Hôpitaux de Paris APHP, Hôpitaux Universitaires Paris Saclay, 94275 Le Kremlin Bicêtre, France
- CESP, INSERM U1018, Moods Team, Faculté de Médecine Paris Saclay, University Paris-Saclay, 94275 Le Kremlin Bicêtre, France
| | - Bruno Falissard
- Department of Public Health, School of Medecine, University Paris-Saclay, 94270 Le Kremlin Bicêtre, France
- CESP, INSERM 1018, University Paris-Saclay, 94275 Le Kremlin Bicêtre, France
| | - Florence Gressier
- Department of Psychiatry, Bicêtre University Hospital, Assistance Publique Hôpitaux de Paris APHP, Hôpitaux Universitaires Paris Saclay, 94275 Le Kremlin Bicêtre, France
- CESP, INSERM U1018, Moods Team, Faculté de Médecine Paris Saclay, University Paris-Saclay, 94275 Le Kremlin Bicêtre, France
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Hirsh ML, Edwards JA, Robichaux C, Brijkumar J, Moosa MYS, Ofotokun I, Johnson BA, Pillay S, Pillay M, Moodley P, Sun YV, Liu C, Dudgeon MR, Ordoñez C, Kuritzkes DR, Sunpath H, Morrow M, Anderson PL, Ellison L, Bushman LR, Marconi VC, Castillo-Mancilla JR. Food Insecurity Is Associated With Low Tenofovir Diphosphate in Dried Blood Spots in South African Persons With HIV. Open Forum Infect Dis 2023; 10:ofad360. [PMID: 37469618 PMCID: PMC10352648 DOI: 10.1093/ofid/ofad360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Indexed: 07/21/2023] Open
Abstract
Background Food insecurity has been linked to suboptimal antiretroviral therapy (ART) adherence in persons with HIV (PWH). This association has not been evaluated using tenofovir diphosphate (TFV-DP) in dried blood spots (DBSs), a biomarker of cumulative ART adherence and exposure. Methods Within a prospective South African cohort of treatment-naive PWH initiating ART, a subset of participants with measured TFV-DP in DBS values was assessed for food insecurity status. Bivariate and multivariate median-based regression analysis compared the association between food insecurity and TFV-DP concentrations in DBSs adjusting for age, sex, ethnicity, medication possession ratio (MPR), and estimated glomerular filtration rate. Results Drug concentrations were available for 285 study participants. Overall, 62 (22%) PWH reported worrying about food insecurity and 44 (15%) reported not having enough food to eat in the last month. The crude median concentrations of TFV-DP in DBSs differed significantly between those who expressed food insecurity worry versus those who did not (599 [interquartile range {IQR}, 417-783] fmol/punch vs 716 [IQR, 453-957] fmol/punch; P = .032). In adjusted median-based regression, those with food insecurity worry had concentrations of TFV-DP that were 155 (95% confidence interval, -275 to -35; P = .012) fmol/punch lower than those who did not report food insecurity worry. Age and MPR remained significantly associated with TFV-DP. Conclusions In this study, food insecurity worry is associated with lower TFV-DP concentrations in South African PWH. This highlights the role of food insecurity as a social determinant of HIV outcomes including ART failure and resistance.
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Affiliation(s)
- Molly L Hirsh
- Augusta University/University of Georgia Medical Partnership, Medical College of Georgia, Athens, Georgia, USA
| | - Jonathan A Edwards
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- School of Health and Social Care, University of Lincoln, Lincoln, United Kingdom
| | - Chad Robichaux
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jaysingh Brijkumar
- Department of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | | | - Igho Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Brent A Johnson
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Selvan Pillay
- Department of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Melendhran Pillay
- Department of Medicine, National Health Laboratory Service, Durban, South Africa
| | - Pravi Moodley
- Department of Medicine, National Health Laboratory Service, Durban, South Africa
| | - Yan V Sun
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Chang Liu
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Mathew R Dudgeon
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Claudia Ordoñez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Daniel R Kuritzkes
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Henry Sunpath
- Department of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Mary Morrow
- Department of Biostatistics and Bioinformatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Peter L Anderson
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lucas Ellison
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lane R Bushman
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Vincent C Marconi
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, National Health Laboratory Service, Durban, South Africa
- Emory Vaccine Center, Emory University, Atlanta, Georgia, USA
| | - Jose R Castillo-Mancilla
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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11
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Hamill MM, Hu F, Adebajo S, Kokogho A, Tiamiyu AB, Parker ZF, Charurat ME, Ake JA, Baral SD, Nowak RG, Crowell TA. Food and Water Insecurity in Sexual and Gender Minority Groups Living With HIV in Lagos, Nigeria. J Acquir Immune Defic Syndr 2023; 93:171-180. [PMID: 36881816 PMCID: PMC10293107 DOI: 10.1097/qai.0000000000003183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/22/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Food and water insecurity are associated with poor health outcomes that may be exacerbated by social marginalization and barriers to health care experienced by sexual and gender minorities (SGM) in resource-limited settings. We explored factors associated with food and water insecurity in SGM with HIV. SETTING A longitudinal study of 357 men who have sex with men, transgender women, and other gender-identifying people in Lagos, Nigeria. METHODS Laboratory testing, interviews, food and water assessments, and anthropometry were performed quarterly. Robust Poisson regression with generalized estimating equations was used to evaluate factors potentially associated with food and water insecurity. RESULTS From 2014 to 2018, 357 SGM with HIV completed either the food or water assessments. At baseline, participants identified as cisgender men who have sex with men 265 (74.2%), transgender women 63 (17.7%), or as nonbinary/other gender 29 (8.1%). Food insecurity and water insecurity were reported by 63/344(18.3%) and 113/357(31.7%), respectively, at any visit. Food and water insecurity each decreased with ongoing study participation. Food insecurity was associated with nonpartnered relationship status, CD4 count <500 cells/mm 3 , and lack of access to piped water. Water insecurity was associated with age 25 years or older, living with a man, transactional sex, and food insecurity. CONCLUSIONS Food and water insecurity were common among SGM in Nigeria and decreased with continued study participation, suggesting amenability to intervention when SGM are successfully engaged in care. Targeted interventions to support food and water security may improve HIV-related outcomes, such as CD4 count.
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Affiliation(s)
- Matthew M. Hamill
- Division of Infectious Diseases, Johns Hopkins Medicine, Baltimore, USA
| | - Fengming Hu
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, USA
| | - Sylvia Adebajo
- Maryland Global Initiatives Corporation, University of Maryland Baltimore, Baltimore, USA
| | - Afoke Kokogho
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, USA
| | - Abdulwasiu B. Tiamiyu
- HJF Medical Research International, Abuja, Nigeria
- US Army Medical Research Directorate-Africa/Nigeria, Abuja, Nigeria
| | - Zahra F. Parker
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, USA
- US Army Medical Research Directorate-Africa/Nigeria, Abuja, Nigeria
| | - Manhattan E. Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Julie A. Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
| | - Stefan D. Baral
- Department of Epidemiology, Johns Hopkins University, Baltimore, USA
| | - Rebecca G. Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Trevor A. Crowell
- Division of Infectious Diseases, Johns Hopkins Medicine, Baltimore, USA
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, USA
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12
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Nagata JM, Chu J, Cervantez L, Ganson KT, Testa A, Jackson DB, Murray SB, Weiser SD. Food insecurity and binge-eating disorder in early adolescence. Int J Eat Disord 2023; 56:1233-1239. [PMID: 37013949 PMCID: PMC10247527 DOI: 10.1002/eat.23944] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE Food insecurity is defined as lack of consistent access to adequate food for healthy living. The objective of this study was to determine the associations between food insecurity and binge-eating disorder in a national cohort of 9- to 14-year-old children. METHOD We analyzed prospective cohort data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 10,035, 2016-2020). Logistic regression analyses estimated the associations between food insecurity at baseline, year 1, or year 2 (exposure) and binge eating, subclinical binge-eating disorder (Other Specified Feeding and Eating Disorder-Binge-Eating Disorder [OSFED-BED]), and binge-eating disorder (BED) (outcome) based on the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-5) at 2-year follow-up. RESULTS The prevalence of food insecurity in the study was 15.8%. At 2-year follow-up, 1.71% of the sample received a diagnosis of BED or OSFED-BED, while 6.62% reported binge eating. Food insecurity was associated with 1.67 higher odds of BED or OSFED-BED (95% CI 1.04-2.69) and 1.31 higher odds of binge-eating symptoms (95% CI 1.01-1.71). DISCUSSION Food insecurity in early adolescence is associated with higher odds of developing future binge-eating and BED or OSFED-BED. Clinicians may consider assessing for binge eating in adolescents with food insecurity and provide support in accessing appropriate food resources. PUBLIC SIGNIFICANCE Prior research has shown that food insecurity is associated with disordered eating behaviors, including binge eating in adulthood. This study explored whether food insecurity in early adolescence increases risk for developing binge-eating disorder (BED). Targeted screening for BED in adolescents experiencing FI, and vice versa, may be warranted.
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Affiliation(s)
- Jason M. Nagata
- Department of Pediatrics, University of California, San Francisco, 550 16 Street, 4 Floor, Box 0503, San Francisco, California, 94143, USA
| | - Jonathan Chu
- Department of Pediatrics, University of California, San Francisco, 550 16 Street, 4 Floor, Box 0503, San Francisco, California, 94143, USA
| | - Levi Cervantez
- Department of Pediatrics, University of California, San Francisco, 550 16 Street, 4 Floor, Box 0503, San Francisco, California, 94143, USA
| | - Kyle T. Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, Ontario, M5S 1V4, Canada
| | - Alexander Testa
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA
| | - Dylan B. Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Stuart B. Murray
- Department of Psychiatry and Behavioral Sciences, University of Southern California, 2250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, USA
| | - Sheri D. Weiser
- Department of Medicine, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA, 94110, USA
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13
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Jackson L, Lee Y, Batey DS. Structural violence within communities and its impact on the well-being of people with HIV (PWH). AIDS Care 2023; 35:265-270. [PMID: 35727148 DOI: 10.1080/09540121.2022.2088679] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Structural violence (SV) is the concept that there are often invisible and intangible structures in place, whether political, economic, legal, cultural, religious, or social, that can inhibit individuals from reaching their full potential. There is a need to better understand the influence of SV on the well-being of people with HIV (PWH) in the Deep South. To address this gap in the literature, we interpreted data using a Structural Violence framework. In this community-based participatory research, in-depth interviews (n = 40) were conducted with PWH who previously established HIV medical care. In our study, we found that SV can have a widespread impact in communities, negatively impacting access to key tangible and emotional resources. SV themes included community crime and instability, financial insecurity, and disparate access to numerous resources known to influence health. Structures exacerbating unequal access to resources appear engrained within communities and often went unrecognized by participants as disadvantageous to achieving optimal HIV health. Greater effort is necessary to elucidate the influence and role of violent structures on access to key resources for and by PWH. A clearer understanding of SV's influence on HIV health can inform changes addressing these structural barriers to HIV health.
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Affiliation(s)
| | - Yookyong Lee
- Department of Social Work, University of Alabama at Birmingham (UAB), Birmingham, USA
| | - D Scott Batey
- Department of Social Work, University of Alabama at Birmingham (UAB), Birmingham, USA
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14
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How food support improves mental health among people living with HIV: A qualitative study. PLoS One 2023; 18:e0282857. [PMID: 36917580 PMCID: PMC10013904 DOI: 10.1371/journal.pone.0282857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/10/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Food insecurity is associated with poor mental health among people living with HIV (PLHIV). This qualitative study explored the mental health experiences of PLHIV participating in a medically appropriate food support program. METHODS Semi-structured interviews were conducted post-intervention (n = 34). Interview topics included changes, or lack thereof, in mental health and reasons for changes. Interviews were audio-recorded, transcribed, and double-coded. Salient themes were identified using an inductive-deductive method. RESULTS Positive changes in mental health self-reported by PLHIV included improved mood and reduced stress, worry, and anxiety. Participants attributed these changes to: 1) increased access to sufficient and nutritious foods, 2) increased social support, 3) reduced financial hardship, 4) increased sense of control and self-esteem, and 5) reduced functional barriers to eating. CONCLUSIONS Medically appropriate food support may improve mental health for some PLHIV. Further work is needed to understand and prevent possible adverse consequences on mental health after programs end.
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15
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Nicastro TM, Pincus L, Weke E, Hatcher AM, Burger RL, Lemus-Hufstedler E, Bukusi EA, Cohen CR, Weiser SD. Perceived impacts of a pilot agricultural livelihood and microfinance intervention on agricultural practices, food security and nutrition for Kenyans living with HIV. PLoS One 2022; 17:e0278227. [PMID: 36516159 PMCID: PMC9749965 DOI: 10.1371/journal.pone.0278227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 11/12/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Agriculture is the primary source of income and household food for >75% of rural Kenyans, including people living with HIV (PLHIV), making agricultural yields an important factor in food security and nutrition. Previous studies have shown the interconnectedness of food insecurity, malnutrition, and poor HIV health by elucidating that having one of these conditions increases the likelihood and severity of having another. However, few studies have explored the linkages between agricultural practices, food security and nutrition for PLHIV, or how agricultural livelihood interventions may affect these domains. This study aimed to examine the mechanisms through which an agricultural livelihood intervention can positively or negatively affect agricultural practices, food security, and nutrition for PLHIV. METHODS From July 2012-August 2013, we interviewed participants with HIV on antiretroviral therapy (ART) enrolled in a pilot randomized controlled trial (RCT) of an agricultural livelihood and finance intervention to understand the mechanisms through which the intervention may have affected HIV health outcomes. The intervention included agricultural and finance training and a microfinance loan to purchase the MoneyMaker hip pump, a human-powered water pump, seeds, and other farming implements. A purposive sample of 45 intervention and a random subset of 9 control participants were interviewed at 12-month endline visit with a subset of 31 intervention participants interviewed longitudinally at both the 3- and 12-month visits. Transcripts were double coded using an inductive-deductive approach and analyzed for impacts of the intervention on agricultural practices, food security, and nutrition using analytic reports for each key theme. RESULTS All intervention participants described improvements in agricultural practices and yields attributed to the intervention while many also described improvements in income; these changes in turn contributed to improved HIV health, including suppressed viral loads, and a few people noted improved immunologic parameters. Key mechanisms included the knowledge gained from agricultural training which led to improved yields and access to new markets. The use of the irrigation pump was also identified as an additional, lesser important mechanism. All intervention participants reported sustained improvements in food security and nutrition through increased yields and income from the sale of excess crops used to purchase food, and diversification of fresh fruits and vegetables consumed through agricultural production. This led to self-reported weight gain which was a nutritional mechanism towards improved health. CONCLUSIONS Agricultural and finance interventions that improve farming practices could lead to improved health outcomes through the pathways of improved food security, income, and diversified diet. The results from this study helped the team to enhance the intervention prior to implementation of the larger cluster RCT (cRCT). By understanding how agricultural livelihood interventions act upon pathways towards improved health, policy options can be developed and implemented to include components that are needed to achieve sustainable outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT01548599.
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Affiliation(s)
- Tammy M. Nicastro
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Lauren Pincus
- Independent Consultant, Washington, CT, United States of America
| | - Elly Weke
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Abigail M. Hatcher
- Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Rachel L. Burger
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Emiliano Lemus-Hufstedler
- School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Elizabeth A. Bukusi
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, United States of America
| | - Craig R. Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Sheri D. Weiser
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
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16
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Mazloomi SN, Talebi S, Kazemi M, Ghoreishy SM, Moosavian SP, Amirian P, Mohammadi H, Nouri-Majd S, Marx W, Hojjati Kermani MA, Moradi S. Food insecurity is associated with the sleep quality and quantity in adults: a systematic review and meta-analysis. Public Health Nutr 2022; 26:1-11. [PMID: 36416108 PMCID: PMC10131157 DOI: 10.1017/s1368980022002488] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/14/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We evaluated associations between food insecurity (FI) and the quality and quantity of sleep in adults (≥18 years). DESIGN The current study represented a systematic review and meta-analysis of observational studies. SETTING Databases of PubMed, Scopus, Embase and Web of Science were searched from inception until 6 June 2022. Meta-analyses were conducted using random-effects models, and effect sizes were reported as OR and 95 % CI. PARTICIPANTS Data from ten eligible observational studies, including 83 764 participants, were included. RESULTS FI was associated with an increased risk of poor sleep quality (OR = 1·45; 95 % CI (1·24, 1·70), I2 = 95, P < 0·001, n 7). Besides, subgroup analysis showed increased risk of poor sleep quality corresponding to the severity of FI across mild (OR = 1·31; 95 % CI (1·16, 1·48), I2 = 0 %, P < 0·001, n 5), moderate (OR = 1·49; 95 % CI (1·32, 1·68), I2 = 0 %, P < 0·001, n 5) and severe (OR = 1·89; 95 % CI (1·63, 2·20), I2 = 0 %, P < 0·001, n 5) levels. Similarly, subgroup analysis by sleep problems showed that FI was associated with an increased the risk of trouble falling asleep (OR = 1·39; 95 % CI (1·05, 1·83), I2 = 91 %, P = 0·002, n 3) and trouble staying asleep (OR = 1·91; 95 % CI (1·37, 2·67), I2 = 89 %, P < 0·001, n 3). Moreover, FI was associated with the odds of shorter (OR = 1·14; 95 % CI (1·07, 1·21), I2 = 0 %, P < 0·001, n 4) and longer sleep duration (OR = 1·14; 95 % CI (1·03, 1·26), I2 = 0 %, P = 0·010, n 4). CONCLUSIONS Collective evidence supports that FI is associated with poor sleep quality and quantity in adults. Preventative and management strategies that address FI may provide health benefits beyond improving nutritional status per se.
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Affiliation(s)
- Seyadeh Narges Mazloomi
- The Health of Plant and Livestock Products Research Center, Mazandaran University of Medical Sciences, Sari, Iran
- Food and Drug Administration, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sepide Talebi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Kazemi
- Hilda and J. Lester Gabrilove Division of Endocrinology, Diabetes, and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Seyed Mojtaba Ghoreishy
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Parisa Moosavian
- Department of Community Nutrition, Vice-Chancellery for Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parsa Amirian
- General Practitioner, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
| | - Hamed Mohammadi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeedeh Nouri-Majd
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Wolfgang Marx
- Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Mohammad Ali Hojjati Kermani
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sajjad Moradi
- Nutritional Sciences Department, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
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17
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Berkowitz SA, Palakshappa D, Seligman HK, Hanmer J. Changes in Food Insecurity and Changes in Patient-Reported Outcomes: a Nationally Representative Cohort Study. J Gen Intern Med 2022; 37:3638-3644. [PMID: 34993877 PMCID: PMC9585105 DOI: 10.1007/s11606-021-07293-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cross-sectional studies have found that health-related quality of life and mental health are worse among food-insecure compared with food-secure individuals. However, how these outcomes change as food insecurity changes is unclear. OBJECTIVE To evaluate how common patient-reported health-related quality of life and mental health scales change in response to changes in food security. DESIGN Retrospective cohort study using data representative of the civilian, adult, non-institutionalized population of the USA. PARTICIPANTS Food insecure adults who completed the 2016-2017 Medical Expenditure Panel Survey. MAIN MEASURES Mental health, as measured by the mental component score of the Veterans Rand 12-Item Health Survey (VR-12) (primary outcome), along physical health (physical component score of the VR-12), self-rated health status, psychological distress (Kessler 6), depressive symptoms (PHQ2), and the SF-6D measure of health utility. We fit linear regression models adjusted for baseline outcome level, age, gender, race/ethnicity, education, health insurance, and family size followed by predictive margins to estimate the change in outcome associated with a 1-point improvement in food security. KEY RESULTS A total of 1,390 food-insecure adults were included. A 1-point improvement in food security was associated with a 0.38 (95%CI 0.62 to 0.14)-point improvement in mental health, a 0.15 (95%CI 0.02 to 0.27)-point improvement in psychological distress, a 0.05 (95%CI 0.01 to 0.09)-point improvement in depressive symptoms, and a 0.003 (95%CI 0.000 to 0.007)-point improvement in health utility. Point estimates for physical health and self-rated health were in the direction of improvement, but were not statistically significant. CONCLUSIONS Improvement in food insecurity was associated with improvement in several patient-reported outcomes. Further work should investigate whether similar changes are seen in food insecurity interventions, and the most useful scales for assessing changes in health-related quality of life and mental health in food insecurity interventions.
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Affiliation(s)
- Seth A Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, 5034 Old Clinic Bldg, CB 7110, Chapel Hill, NC, 27599, USA.
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Deepak Palakshappa
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Hilary K Seligman
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
- Center for Vulnerable Populations at San Francisco General Hospital & Trauma Center, San Francisco, CA, USA
| | - Janel Hanmer
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Bleasdale J, Leone LA, Morse GD, Liu Y, Taylor S, Przybyla SM. Socio-Structural Factors and HIV Care Engagement among People Living with HIV during the COVID-19 Pandemic: A Qualitative Study in the United States. Trop Med Infect Dis 2022; 7:259. [PMID: 36288000 PMCID: PMC9607497 DOI: 10.3390/tropicalmed7100259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/14/2022] [Accepted: 09/21/2022] [Indexed: 08/22/2023] Open
Abstract
Achieving HIV prevention goals will require successful engagement in each stage of the HIV continuum. The present study sought to understand the ways in which socio-structural factors influence HIV care engagement among people living with HIV (PLH) within the context of the ongoing COVID-19 pandemic. Twenty-five PLH were recruited from January to October 2021. Semi-structured interviews discussed various socio-contextual factors that influenced engagement in HIV-related care as a result of the pandemic. A thematic content analysis reported semantic level themes describing factors influencing HIV care following an integrated inductive-deductive approach. Qualitative analysis revealed three themes that either supported or hindered engagement in care within the context of the COVID-19 pandemic: (1) social determinants of health, (2) social support, and (3) modes of healthcare delivery. The results underscore the need to assess socio-structural factors of health as means to promote successful engagement in the HIV care continuum and shed new insights to guide future practice in the era of COVID-19.
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Affiliation(s)
- Jacob Bleasdale
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Lucia A. Leone
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Gene D. Morse
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
- Center for Integrated Global Biomedical Sciences, Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - Yu Liu
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA
| | - Shelby Taylor
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Sarahmona M. Przybyla
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
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19
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Logie CH, Sokolovic N, Kazemi M, Islam S, Frank P, Gormley R, Kaida A, de Pokomandy A, Loutfy M. Does resource insecurity drive HIV-related stigma? Associations between food and housing insecurity with HIV-related stigma in cohort of women living with HIV in Canada. J Int AIDS Soc 2022; 25 Suppl 1:e25913. [PMID: 35818863 PMCID: PMC9274209 DOI: 10.1002/jia2.25913] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/28/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Women living with HIV across global contexts are disproportionately impacted by food insecurity and housing insecurity. Food and housing insecurity are resource insecurities associated with poorer health outcomes among people living with HIV. Poverty, a deeply stigmatized phenomenon, is a contributing factor towards food and housing insecurity. HIV-related stigma-the devaluation, mistreatment and constrained access to power and opportunities experienced by people living with HIV-intersects with structural inequities. Few studies, however, have examined food and housing insecurity as drivers of HIV-related stigma. This study aimed to estimate the associations between food and housing insecurity with HIV-related stigma among women living with HIV in Canada. METHODS This prospective cohort study of women living with HIV (≥16 years old) in three provinces in Canada involved three waves of surveys collected at 18-month intervals between 2013 and 2018. To understand associations between food and housing security and HIV-related stigma, we conducted linear mixed effects regression models. We adjusted for socio-demographic characteristics associated with HIV-related stigma. RESULTS AND DISCUSSION Among participants (n = 1422), more than one-third (n = 509; 36%) reported baseline food insecurity and approximately one-tenth (n = 152, 11%) housing insecurity. Mean HIV-related stigma scores were consistent across waves 1 (mean [M] = 57.2, standard deviation [SD] = 20.0, N = 1401) and 2 (M = 57.4, SD = 19.0, N = 1227) but lower at wave 3 (M = 52.8, SD = 18.7, N = 918). On average, across time, food insecure participants reported HIV-related stigma scores that were 8.6 points higher (95% confidence interval [CI]: 6.4, 10.8) compared with food secure individuals. Similarly, participants reporting insecure housing at wave 1 tended to experience greater HIV-related stigma (6.2 points, 95% CI: 2.7, 9.6) over time compared to stably housed participants. There was an interaction between time and housing insecurity, whereby baseline housing insecurity was no longer associated with higher HIV-related stigma at the third wave. CONCLUSIONS Among women living with HIV in Canada, experiencing food and housing insecurity was associated with consistently higher levels of HIV-related stigma. In addition to the urgent need to tackle food and housing insecurity among people living with HIV to optimize wellbeing, getting to the heart of HIV-related stigma requires identifying and dismantling resource insecurity-related stigma drivers.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - Nina Sokolovic
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| | - Mina Kazemi
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Shaz Islam
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Alliance for South Asian AIDS Prevention, Toronto, Ontario, Canada
| | - Peggy Frank
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.,BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada.,Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mona Loutfy
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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20
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Nagata JM, Ganson KT, Cattle CJ, Whittle HJ, Tsai AC, Weiser SD. Food insufficiency and mental health service utilisation in the USA during the COVID-19 pandemic. Public Health Nutr 2022; 25:76-81. [PMID: 34261566 PMCID: PMC8367866 DOI: 10.1017/s1368980021003001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/18/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To estimate the association between food insufficiency and mental health service utilisation in the USA during the COVID-19 pandemic. DESIGN Cross-sectional study. Multiple logistic regression models were used to estimate the associations between food insufficiency and mental health service utilisation. SETTING US Census Household Pulse Survey data collected in October 2020. PARTICIPANTS Nationally representative sample of 68 611 US adults. RESULTS After adjusting for sociodemographic factors, experiencing food insufficiency was associated with higher odds of unmet mental health need (adjusted OR (AOR) 2·90; 95 % CI 2·46, 3·43), receiving mental health counselling or therapy (AOR 1·51; 95 % CI 1·24, 1·83) and psychotropic medication use (AOR 1·56; 95 % CI 1·35, 1·80). Anxiety and depression symptoms mediated most of the association between food insufficiency and unmet mental health need but not the associations between food insufficiency and either receiving mental health counselling/therapy or psychotropic medication use. CONCLUSIONS Clinicians should regularly screen patients for food insufficiency, especially in the wake of the COVID-19 pandemic. Expanding access to supplemental food programmes may help to mitigate the need for higher mental health service utilisation during the COVID-19 pandemic.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA94158, USA
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Chloe J Cattle
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA94158, USA
| | - Henry J Whittle
- Division of Psychiatry, University College London, London, UK
| | - Alexander C Tsai
- Center for Global Health, Mongan Institute, Massachusetts General Hospital; Harvard Medical School, Boston, MA, USA
| | - Sheri D Weiser
- Division of HIV, Infectious Diseases and Global Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
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21
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Iguna S, Getahun M, Lewis-Kulzer J, Odhiambo G, Adhiambo F, Montoya L, Petersen ML, Bukusi E, Odeny T, Geng E, Camlin CS. Attitudes towards and experiences with economic incentives for engagement in HIV care and treatment: Qualitative insights from a randomized trial in Kenya. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000204. [PMID: 36962322 PMCID: PMC10021832 DOI: 10.1371/journal.pgph.0000204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/19/2022] [Indexed: 11/18/2022]
Abstract
Growing literature has shown heterogenous effects of conditional cash incentives (CCIs) on HIV care retention. The field lacks insights into reasons why incentives impact various patients in different ways-differences that may be due to variations in psychological and social mechanisms of effect. A deeper understanding of patients' perceptions and experiences of CCIs for retention may help to clarify these mechanisms. We conducted a qualitative study embedded in the ADAPT-R trial (NCT#02338739), a sequential multiple assignment randomized trial (SMART) that evaluated economic incentives to support retention in HIV care among persons living with HIV (PLHIV) initiating antiretroviral therapy in Kenya. Participants who attended their scheduled clinic visits received an incentive of approximately $4 each visit. Interviews were conducted between July 2016 and June 2017 with 39 participants to explore attitudes and experiences with economic incentives conditional on care engagement. Analyses revealed that incentives helped PLHIV prioritize care-seeking by alleviating transport barriers and food insecurity: "I decided to forgo [work] and attend clinic […] the voucher relieved me". Patients who borrowed money for care-seeking reported feeling relieved from the burden of indebtedness to others: "I borrow with confidence that I will pay after my appointment." Incentives fostered their autonomy, and enabled them to support others: "I used the money to buy some clothes and Pampers for the children." Participants who were intrinsically motivated to engage in care ("my life depends on the drugs, not the incentive"), and those who mistrusted researchers, reported being less prompted by the incentive itself. For patients not already prioritizing care-seeking, incentives facilitated care engagement through alleviating transport costs, indebtedness and food insecurity, and also supported social role fulfillment. Conditional cash incentives may be an important cue to action to improve progression through the HIV treatment cascade, and contribute to better care retention.
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Affiliation(s)
- Sarah Iguna
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Monica Getahun
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Jayne Lewis-Kulzer
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Gladys Odhiambo
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Fridah Adhiambo
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Lina Montoya
- Division of Biostatistics, School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Maya L Petersen
- Divisions of Biostatistics and Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Elizabeth Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Thomas Odeny
- Department of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
| | - Elvin Geng
- Division of Infectious Diseases, Department of Internal Medicine, Washington University, St. Louis, Missouri, United States of America
| | - Carol S Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, California, United States of America
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22
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Nagata JM, Whittle HJ, Ganson KT, Tabler J, Hahn JA, Weiser SD. Food insecurity risk and alcohol use disorder in US young adults: Findings from the National Longitudinal Study of Adolescent to Adult Health. Am J Addict 2021; 30:601-608. [PMID: 34459059 PMCID: PMC8635415 DOI: 10.1111/ajad.13218] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 05/02/2021] [Accepted: 08/11/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The relationship between food insecurity and alcohol use disorder remains unknown. The aim of this study was to determine the association between food insecurity risk and alcohol use disorder in a nationally representative sample of young adults. METHODS Cross-sectional nationally representative data of 14,786 US young adults aged 24-32 years old from Wave IV (2008) of the National Longitudinal Study of Adolescent to Adult Health were analyzed to assess a single-item measure of food insecurity risk and Diagnostic and Statistical Manual, 5th Edition (DSM-5) alcohol use disorder. RESULTS Among young adults, 12% were found to be at risk for food insecurity. Young adults with food insecurity risk had greater odds of moderate (adjusted odds ratio [AOR]: 1.34, 95% confidence interval [CI]: 1.13-1.58) and severe (AOR: 1.67, 95% CI: 1.34-2.07) threshold alcohol use disorder than food-secure young adults, adjusting for age, sex, race/ethnicity, education, income, receipt of public assistance, household size, and smoking. Food insecurity risk was also associated with a 23% higher (95% CI: 11%-37%) number of problematic alcohol use behaviors (e.g., risky behaviors, continued alcohol use despite emotional or physical health problems). DISCUSSION AND CONCLUSIONS Food insecurity risk is associated with problematic patterns of alcohol use. Health care providers should screen for food insecurity and problematic alcohol use in young adults and provide referrals for further resources and treatment when appropriate. SCIENTIFIC SIGNIFICANCE This nationally representative study of US young adults is the first to find an association between food insecurity risk and alcohol use disorder using DSM-5 criteria.
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Affiliation(s)
- Jason M. Nagata
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | | | - Kyle T. Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Jennifer Tabler
- Department of Criminal Justice and Sociology, University of Wyoming, Laramie, WY, USA
| | - Judith A. Hahn
- Division of HIV, Infectious Diseases and Global Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sheri D. Weiser
- Division of HIV, Infectious Diseases and Global Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
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23
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Hsueh L, Layland EK, Kipke MD, Bray BC. Linking racism and homonegativity to healthcare system distrust among young men of color who have sex with men: Evidence from the Healthy Young Men's (HYM) study. Soc Sci Med 2021; 284:114219. [PMID: 34271403 PMCID: PMC8958666 DOI: 10.1016/j.socscimed.2021.114219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 07/01/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Experiences with racism predict healthcare system distrust among people of color, but Black and Latino young men who have sex with men (YMSM) also experience overlapping forms of stigma associated with their sexual identities and behaviors (i.e., homonegativity and internalized homonegativity). These forms of minority stress may drive healthcare system distrust among Black and Latino YMSM but have received far less attention. OBJECTIVES To examine the associations of racism, homonegativity, and internalized homonegativity with healthcare system distrust among a community sample of Black and Latino YMSM. METHODS Data came from waves 2-4 (years 2017-2018) of the Healthy Young Men's study, a longitudinal cohort study of Black and Latino YMSM living in Los Angeles County. Data across waves (n = 424, nobs = 1272) were combined and analyzed using a fixed effects approach and adjusting for repeated measures across participants. A series of regression models that added sets of covariates (demographics, syndemic indicators, and health-related factors) were tested to examine associations of racism, homonegativity, and internalized homonegativity with healthcare system distrust. RESULTS Adjusting for demographics and syndemic indicators, racism, but not homonegativity or internalized homonegativity, was associated with healthcare system distrust. Adjustment for health-related factors had little impact on results. CONCLUSIONS Among Black and Latino YMSM, greater exposure to racism is associated with greater healthcare system distrust. Efforts to strengthen healthcare system trust should explicitly target the institutional policies that disproportionately harm people of color.
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Affiliation(s)
- Loretta Hsueh
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
| | - Eric K Layland
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, 135 College Street, Suite 200, New Haven, CT, 06510, USA
| | - Michele D Kipke
- Children's Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, CA, 90027, USA; Departments of Pediatrics and Preventive Medicine, University of Southern California Keck School of Medicine, 1975 Zonal Ave., Los Angeles, CA, 90027, USA
| | - Bethany C Bray
- Center for Dissemination and Implementation Science, University of Illinois at Chicago, 818 South Wolcott Ave., Chicago, IL, 60612, USA
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24
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Rivera GB, Jama S, Bailey N, Gordon N, Bliss-Barsness C, Caspi CE, Pratt R. The lived experience of food pantry users in Minnesota: Qualitative findings from a statewide survey. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2021; 18:178-191. [PMID: 36950310 PMCID: PMC10027368 DOI: 10.1080/19320248.2021.1932663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives In 2017 a community-University of Minnesota collaborative conducted a statewide survey of food pantry clients. Methods Of the 188 food pantries surveyed, 4321 individual client surveys were returned, from which 2,251 open-ended responses were analyzed. Results Respondents shared gratitude for the food pantry in meeting their needs for food and support. Many described accessing healthy food that was needed to address health needs. Respondents described life circumstances and hardships that led to food pantry use. Conclusion The supportive environment provided by food pantries position them to address the needs of clients, including those with complex health needs.
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Affiliation(s)
- Gabrielle B Rivera
- University of Minnesota, Department of Family Medicine and Community Health
| | - Sagal Jama
- University of Minnesota, Department of Family Medicine and Community Health
| | | | - Nora Gordon
- University of Minnesota, Department of Family Medicine and Community Health
| | | | - Caitlin E Caspi
- Rudd Center for Food Policy and Obesity and University of Connecticut
| | - Rebekah Pratt
- Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware Street, Minneapolis MN 55414
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25
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Leddy AM, Zakaras JM, Shieh J, Conroy AA, Ofotokun I, Tien PC, Weiser SD. Intersections of food insecurity, violence, poor mental health and substance use among US women living with and at risk for HIV: Evidence of a syndemic in need of attention. PLoS One 2021; 16:e0252338. [PMID: 34038490 PMCID: PMC8153505 DOI: 10.1371/journal.pone.0252338] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background Food insecurity and intimate partner violence (IPV) are associated with suboptimal HIV prevention and treatment outcomes, yet limited research has explored how food insecurity and IPV intersect to influence HIV-related behaviors. To fill this gap, we conducted a qualitative study with women living with or at risk for HIV in the United States. Methods We conducted 24 in-depth interviews with women enrolled in the San Francisco and Atlanta sites of the Women’s Interagency HIV study (WIHS). Participants were purposively sampled so half were living with HIV and all reported food insecurity and IPV in the past year. Semi-structured interviews explored experiences with food insecurity and IPV, how these experiences might be related and influence HIV risk and treatment behaviors. Analysis was guided by an inductive-deductive approach. Results A predominant theme centered on how food insecurity and IPV co-occur with poor mental health and substance use to influence HIV-related behaviors. Women described how intersecting experiences of food insecurity and IPV negatively affected their mental health, with many indicating using substances to “feel no pain”. Substance use, in turn, was described to perpetuate food insecurity, IPV, and poor mental health in a vicious cycle, ultimately facilitating HIV risk behaviors and preventing HIV treatment adherence. Conclusions Food insecurity, IPV, poor mental health and substance use intersect and negatively influence HIV prevention and treatment behaviors. Findings offer preliminary evidence of a syndemic that goes beyond the more widely studied “SAVA” (substance use, AIDS, and violence) syndemic, drawing attention to additional constructs of mental health and food insecurity. Quantitative research must further characterize the extent and size of this syndemic. Policies that address the social and structural drivers of this syndemic, including multi-level and trauma-informed approaches, should be implemented and evaluated to assess their impact on this syndemic and its negative health effects.
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Affiliation(s)
- Anna M Leddy
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
| | - Jennifer M Zakaras
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
| | - Jacqueline Shieh
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
| | - Amy A Conroy
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
| | - Ighovwerha Ofotokun
- School of Medicine, Emory University and Grady Healthcare System, Atlanta, GA, United States of America
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America.,Department of Veteran Affairs Medical Center, San Francisco, CA, United States of America
| | - Sheri D Weiser
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
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26
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Bast ES, Stonbraker S, Halpern M, Lowenthal E, Gross R. Barriers to HIV treatment adherence among adults living with HIV in the eastern Dominican Republic. Int J STD AIDS 2021; 32:1014-1019. [PMID: 33990170 DOI: 10.1177/09564624211014102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite access to nationally supplied antiretroviral treatment, viral load suppression rates remain suboptimal in the Dominican Republic. Counseling and support services are available but mainly targeted to those identified as having the most need. At Clínica de Familia La Romana (CFLR) in La Romana, all patients undergo a structured baseline interview including exploration of expected barriers to care. We conducted a retrospective cohort study of a random sample of patients at CFLR with treatment initiation between 1 January 2015 and 1 December 2017 to determine if self-identified barriers to HIV care predict viral load suppression. Viral load suppression occurred in 63% of the 203 patients evaluated. Lack of food (n = 19) was significantly associated with lack of viral suppression (OR 3.0, 95% CI 1.14-7.87). Nondisclosure of HIV status (n = 24) showed evidence for a protective effect (OR 0.33; 95% CI 0.11-1.0). Further steps should be taken to address food insecurity as well as to understand associated barriers to care among individuals with food insecurity.
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Affiliation(s)
- Elizabeth S Bast
- 19994Bruce W Carter Department of Veterans Affairs Medical Center, Miami, FL, USA
| | - Samantha Stonbraker
- Clinica de Familia La Romana, La Romana, Dominican Republic.,University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, CO, USA
| | - Mina Halpern
- Clinica de Familia La Romana, La Romana, Dominican Republic
| | - Elizabeth Lowenthal
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA.,Global Health Center, 547315Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Robert Gross
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA
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27
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Nagata JM, Ganson KT, Whittle HJ, Chu J, Harris OO, Tsai AC, Weiser SD. Food Insufficiency and Mental Health in the U.S. During the COVID-19 Pandemic. Am J Prev Med 2021; 60:453-461. [PMID: 33602534 PMCID: PMC9067067 DOI: 10.1016/j.amepre.2020.12.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/23/2020] [Accepted: 12/01/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION During the COVID-19 pandemic, the rates of food insecurity and mental illness have been projected to increase in the U.S. owing to significant social and economic disruption. This study aims to estimate the prevalence of food insufficiency (often the most extreme form of food insecurity), the correlates of food insufficiency, and the associations between food insufficiency and symptoms of poor mental health in the U.S. during the COVID-19 pandemic. METHODS Cross-sectional data from 63,674 participants of the U.S. Census Household Pulse Survey were collected and analyzed in 2020. Multiple Poisson regression models were used to estimate associations with food insufficiency. RESULTS Food insufficiency rose from 8.1% to 10.0% from March to June 2020. Factors associated with food insufficiency included lower age, Black/African American or Latinx race/ethnicity, being unmarried, larger household size, recent employment loss, income below the federal poverty line, and lower education (all p<0.001). Food insufficiency was independently associated with all symptoms of poor mental health, adjusting for socioeconomic and demographic factors (adjusted RRs ranged from 1.16 to 1.42, all p<0.001). The association between food insufficiency and poor mental health was attenuated among people who received free groceries or meals. CONCLUSIONS Food insufficiency has increased during the COVID-19 pandemic and affects vulnerable populations, placing individuals at higher risk for symptoms of poor mental health. Particularly in the current crisis, clinicians should regularly screen patients for food insufficiency and mental health outcomes as well as provide support in accessing appropriate resources.
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Affiliation(s)
- Jason M Nagata
- Division of Adolescent & Young Adult Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, California.
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Henry J Whittle
- Division of Psychiatry, University College London, London, United Kingdom
| | - Jonathan Chu
- Division of Adolescent & Young Adult Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, California
| | - Orlando O Harris
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, California
| | - Alexander C Tsai
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts; Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Sheri D Weiser
- Division of HIV, Infectious Diseases & Global Medicine, School of Medicine, University of California San Francisco, San Francisco, California
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28
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Tabler J, Mykyta L, Nagata JM. The association between HIV/AIDS and food insecurity at the US-Mexico border: Experiences of low-income patients in the Rio Grande Valley. Int J STD AIDS 2020; 32:14-22. [PMID: 33241752 DOI: 10.1177/0956462420930601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
US-Mexico border communities are uniquely vulnerable to human immunodeficiency virus (HIV) transmission given the economic and social challenges these communities face. We surveyed low-income, predominantly Latinx residents receiving sexually transmitted infection testing and/or HIV/acquired immune deficiency syndrome (AIDS) care in the lower Rio Grande Valley of southernmost Texas about their experiences of food insecurity. Participants aged 18 years and over took a self-administered survey available in English or Spanish in a clinic waiting room (N = 251). Ordinary least squares regression results suggested that those with a prior HIV/AIDS diagnosis reported a response for food insecurity that was approximately 0.67 points higher than peers without a prior HIV/AIDS diagnosis (coefficient = 0.67; p < 0.05), even when adjusting for sociodemographic characteristics, social support, perceived discrimination, and neighborhood environment. Interaction results between age and HIV status indicated that younger individuals living with HIV/AIDS experienced uniquely higher food insecurity; those who reported a prior HIV/AIDS diagnosis experienced an additional reduction in food insecurity by approximately 0.06 points for each additional year of age (age × HIV/AIDS interaction coefficient = -0.06; p < 0.05). Community programs serving low-income populations should consider screening for and intervening on food insecurity, especially among young adults living with HIV/AIDS.
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Affiliation(s)
- Jennifer Tabler
- Department of Criminal Justice and Sociology, 4416University of Wyoming, Laramie, WY, USA
| | - Laryssa Mykyta
- Social, Economic and Housing Statistics Division, US.Census Bureau, Washington, DC, USA
| | - Jason M Nagata
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, 8785University of California San Francisco, San Francisco, CA, USA
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Leddy AM, Weiser SD, Palar K, Seligman H. A conceptual model for understanding the rapid COVID-19-related increase in food insecurity and its impact on health and healthcare. Am J Clin Nutr 2020; 112:1162-1169. [PMID: 32766740 PMCID: PMC7454255 DOI: 10.1093/ajcn/nqaa226] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/20/2020] [Indexed: 12/21/2022] Open
Abstract
Food insecurity, a well-established determinant of chronic disease morbidity and mortality, is rapidly increasing due to the coronavirus disease 2019 (COVID-19) pandemic. We present a conceptual model to understand the multiple mechanisms through which the economic and public health crises sparked by COVID-19 might increase food insecurity and contribute to poor health outcomes in the short- and long-term. We hypothesize that, in the short-term, increased food insecurity, household economic disruption, household stress, and interruptions in healthcare will contribute to acute chronic disease complications. However, the impact of the pandemic on food security will linger after social-distancing policies are lifted and the health system stabilizes, resulting in increased risk for chronic disease development, morbidity, and mortality among food-insecure households in the long-term. Research is needed to examine the impact of the pandemic-related increase in food insecurity on short- and long-term chronic health outcomes, and to delineate the underlying causal mechanisms. Such research is critical to inform the development of effective programs and policies to address food insecurity and its downstream health impacts during COVID-19 and future pandemics.
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Affiliation(s)
- Anna M Leddy
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA,Address correspondence to AML (e-mail: )
| | - Sheri D Weiser
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Kartika Palar
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Hilary Seligman
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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Weiser SD, Sheira LA, Palar K, Kushel M, Wilson TE, Adedimeji A, Merenstein D, Cohen M, Turan JM, Metsch L, Adimora AA, Ofotokun I, Wentz E, Tien PC, Frongillo EA. Mechanisms from Food Insecurity to Worse HIV Treatment Outcomes in US Women Living with HIV. AIDS Patient Care STDS 2020; 34:425-435. [PMID: 32941054 DOI: 10.1089/apc.2020.0009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Food insecurity (FI) contributes to HIV-related morbidity and mortality, but the mechanisms whereby FI negatively impacts HIV health are untested. We tested the hypothesis that FI leads to poor HIV clinical outcomes through nutritional, mental health, and behavioral paths. We analyzed data from Women's Interagency HIV Study (WIHS) among 1803 women living with HIV (WLWH) (8225 person-visits) collected from 2013 to 2015 biannually from nine sites across the United States participating in the WIHS. FI was measured with the US Household Food Security Survey Module. Outcomes included HIV viral nonsuppression, CD4 cell counts, and physical health status (PHS). We used longitudinal logistic and linear regression models with random effects to examine associations adjusting for covariates and path analysis to test nutritional, mental health, and behavioral paths. Increasing severity of FI was associated with unsuppressed viral load, lower CD4 counts, and worse PHS (all p < 0.05). Report of FI 6 months earlier was independently associated with most outcomes after adjusting for concurrent FI. For viral nonsuppression, the nutritional and behavioral paths accounted for 2.09% and 30.66% of the total effect, with the mental health path operating via serial mediation through the behavioral path. For CD4 count, the mental health and behavioral paths accounted for 15.21% and 17.0% of the total effect, respectively. For PHS, depressive symptoms accounted for 60.2% of the total effect. In conclusion, FI is associated with poor health among WLWH through different paths depending on the outcome. Interventions should target FI and its behavioral and mental health mechanisms to improve HIV outcomes.
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Affiliation(s)
- Sheri D. Weiser
- Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Lila A. Sheira
- Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Kartika Palar
- Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Margot Kushel
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Tracey E. Wilson
- Department of Community Health Sciences, State University of New York Downstate Medical Center, School of Public Health, Brooklyn, New York, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Dan Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Mardge Cohen
- Department of Medicine, Stroger Hospital, Chicago, Illinois, USA
| | - Janet M. Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lisa Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Adaora A. Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ighovwerha Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University, Grady Healthcare System, Atlanta, Georgia, USA
| | - Eryka Wentz
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Phyllis C. Tien
- Department of Medicine, University of California, San Francisco and Medical Service, Department of Veteran Affairs Medical Center, San Francisco, California, USA
| | - Edward A. Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
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Leddy AM, Sheira LA, Tamraz B, Sykes C, Kashuba ADM, Wilson TE, Adedimeji A, Merenstein D, Cohen MH, Wentz EL, Adimora AA, Ofotokun I, Metsch LR, Turan JM, Bacchetti P, Weiser SD. Food Insecurity Is Associated With Lower Levels of Antiretroviral Drug Concentrations in Hair Among a Cohort of Women Living With Human Immunodeficiency Virus in the United States. Clin Infect Dis 2020; 71:1517-1523. [PMID: 31608363 PMCID: PMC7486839 DOI: 10.1093/cid/ciz1007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 10/08/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Food insecurity is a well-established determinant of suboptimal, self-reported antiretroviral therapy (ART) adherence, but few studies have investigated this association using objective adherence measures. We examined the association of food insecurity with levels of ART concentrations in hair among women living with human immunodeficiency virus (WLHIV) in the United States. METHODS We analyzed longitudinal data collected semiannually from 2013 through 2015 from the Women's Interagency HIV Study, a multisite, prospective, cohort study of WLHIV and controls not living with HIV. Our sample comprised 1944 person-visits from 677 WLHIV. Food insecurity was measured using the US Household Food Security Survey Module. ART concentrations in hair, an objective and validated measure of drug adherence and exposure, were measured using high-performance liquid chromatography with mass spectrometry detection for regimens that included darunavir, atazanavir, raltegravir, or dolutegravir. We conducted multiple 3-level linear regressions that accounted for repeated measures and the ART medication(s) taken at each visit, adjusting for sociodemographic and clinical characteristics. RESULTS At baseline, 67% of participants were virally suppressed and 35% reported food insecurity. In the base multivariable model, each 3-point increase in food insecurity was associated with 0.94-fold lower ART concentration in hair (95% confidence interval, 0.89 to 0.99). This effect remained unchanged after adjusting for self-reported adherence. CONCLUSIONS Food insecurity was associated with lower ART concentrations in hair, suggesting that food insecurity may be associated with suboptimal ART adherence and/or drug absorption. Interventions seeking to improve ART adherence among WLHIV should consider and address the role of food insecurity.
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Affiliation(s)
- Anna M Leddy
- Division of Prevention Science, Department of Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Lila A Sheira
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Bani Tamraz
- Department of Clinical Pharmacy, University of California–San Francisco, San Francisco, California, USA
| | - Craig Sykes
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Angela D M Kashuba
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tracey E Wilson
- Department of Community Health Sciences, State University of New York Downstate Health Sciences University, School of Public Health, Brooklyn, New York, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Mardge H Cohen
- Department of Medicine, Stroger Hospital, Chicago, Illinois, USA
| | - Eryka L Wentz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Adaora A Adimora
- School of Medicine and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ighovwerha Ofotokun
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peter Bacchetti
- Department of Epidemiology and Biostatistics, University of California–San Francisco, San Francisco, California, USA
| | - Sheri D Weiser
- Division of Prevention Science, Department of Medicine, University of California–San Francisco, San Francisco, California, USA
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California–San Francisco, San Francisco, California, USA
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Whittle RS, Diaz-Artiles A. An ecological study of socioeconomic predictors in detection of COVID-19 cases across neighborhoods in New York City. BMC Med 2020; 18:271. [PMID: 32883276 PMCID: PMC7471585 DOI: 10.1186/s12916-020-01731-6] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/04/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND New York City was the first major urban center of the COVID-19 pandemic in the USA. Cases are clustered in the city, with certain neighborhoods experiencing more cases than others. We investigate whether potential socioeconomic factors can explain between-neighborhood variation in the COVID-19 test positivity rate. METHODS Data were collected from 177 Zip Code Tabulation Areas (ZCTA) in New York City (99.9% of the population). We fit multiple Bayesian Besag-York-Mollié (BYM) mixed models using positive COVID-19 tests as the outcome, a set of 11 representative demographic, economic, and health-care associated ZCTA-level parameters as potential predictors, and the total number of COVID-19 tests as the exposure. The BYM model includes both spatial and nonspatial random effects to account for clustering and overdispersion. RESULTS Multiple regression approaches indicated a consistent, statistically significant association between detected COVID-19 cases and dependent children (under 18 years old), population density, median household income, and race. In the final model, we found that an increase of only 5% in young population is associated with a 2.3% increase in COVID-19 positivity rate (95% confidence interval (CI) 0.4 to 4.2%, p=0.021). An increase of 10,000 people per km2 is associated with a 2.4% (95% CI 0.6 to 4.2%, p=0.011) increase in positivity rate. A decrease of $10,000 median household income is associated with a 1.6% (95% CI 0.7 to 2.4%, p<0.001) increase in COVID-19 positivity rate. With respect to race, a decrease of 10% in White population is associated with a 1.8% (95% CI 0.8 to 2.8%, p<0.001) increase in positivity rate, while an increase of 10% in Black population is associated with a 1.1% (95% CI 0.3 to 1.8%, p<0.001) increase in positivity rate. The percentage of Hispanic (p=0.718), Asian (p=0.966), or Other (p=0.588) populations were not statistically significant factors. CONCLUSIONS Our findings indicate associations between neighborhoods with a large dependent youth population, densely populated, low-income, and predominantly black neighborhoods and COVID-19 test positivity rate. The study highlights the importance of public health management during and after the current COVID-19 pandemic. Further work is warranted to fully understand the mechanisms by which these factors may have affected the positivity rate, either in terms of the true number of cases or access to testing.
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Affiliation(s)
- Richard S. Whittle
- Department of Aerospace Engineering, Texas A&M University, College Station, TX USA
- International Space University, Illkirch-Graffenstaden, France
| | - Ana Diaz-Artiles
- Department of Aerospace Engineering, Texas A&M University, College Station, TX USA
- International Space University, Illkirch-Graffenstaden, France
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Whittle RS, Diaz-Artiles A. An ecological study of socioeconomic predictors in detection of COVID-19 cases across neighborhoods in New York City. BMC Med 2020; 18:271. [PMID: 32883276 DOI: 10.1101/2020.04.17.20069823] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/04/2020] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND New York City was the first major urban center of the COVID-19 pandemic in the USA. Cases are clustered in the city, with certain neighborhoods experiencing more cases than others. We investigate whether potential socioeconomic factors can explain between-neighborhood variation in the COVID-19 test positivity rate. METHODS Data were collected from 177 Zip Code Tabulation Areas (ZCTA) in New York City (99.9% of the population). We fit multiple Bayesian Besag-York-Mollié (BYM) mixed models using positive COVID-19 tests as the outcome, a set of 11 representative demographic, economic, and health-care associated ZCTA-level parameters as potential predictors, and the total number of COVID-19 tests as the exposure. The BYM model includes both spatial and nonspatial random effects to account for clustering and overdispersion. RESULTS Multiple regression approaches indicated a consistent, statistically significant association between detected COVID-19 cases and dependent children (under 18 years old), population density, median household income, and race. In the final model, we found that an increase of only 5% in young population is associated with a 2.3% increase in COVID-19 positivity rate (95% confidence interval (CI) 0.4 to 4.2%, p=0.021). An increase of 10,000 people per km2 is associated with a 2.4% (95% CI 0.6 to 4.2%, p=0.011) increase in positivity rate. A decrease of $10,000 median household income is associated with a 1.6% (95% CI 0.7 to 2.4%, p<0.001) increase in COVID-19 positivity rate. With respect to race, a decrease of 10% in White population is associated with a 1.8% (95% CI 0.8 to 2.8%, p<0.001) increase in positivity rate, while an increase of 10% in Black population is associated with a 1.1% (95% CI 0.3 to 1.8%, p<0.001) increase in positivity rate. The percentage of Hispanic (p=0.718), Asian (p=0.966), or Other (p=0.588) populations were not statistically significant factors. CONCLUSIONS Our findings indicate associations between neighborhoods with a large dependent youth population, densely populated, low-income, and predominantly black neighborhoods and COVID-19 test positivity rate. The study highlights the importance of public health management during and after the current COVID-19 pandemic. Further work is warranted to fully understand the mechanisms by which these factors may have affected the positivity rate, either in terms of the true number of cases or access to testing.
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Affiliation(s)
- Richard S Whittle
- Department of Aerospace Engineering, Texas A&M University, College Station, TX, USA.
- International Space University, Illkirch-Graffenstaden, France.
| | - Ana Diaz-Artiles
- Department of Aerospace Engineering, Texas A&M University, College Station, TX, USA
- International Space University, Illkirch-Graffenstaden, France
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Douglas F, MacIver E, Yuill C. A qualitative investigation of lived experiences of long-term health condition management with people who are food insecure. BMC Public Health 2020; 20:1309. [PMID: 32859179 PMCID: PMC7456079 DOI: 10.1186/s12889-020-09299-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/26/2020] [Indexed: 12/31/2022] Open
Abstract
Background As more people are living with one or more chronic health conditions, supporting patients to become activated, self-managers of their conditions has become a key health policy focus both in the UK and internationally. There is also growing evidence in the UK that those with long term health conditions have an increased risk of being food insecure. While international evidence indicates that food insecurity adversely affects individual’s health condition management capability, little is known about how those so affected manage their condition(s) in this context. An investigation of lived experience of health condition management was undertaken with food insecure people living in north east Scotland. The study aimed to explore the challenges facing food insecure people in terms of, i. their self-care condition management practices, and ii. disclosing and discussing the experience of managing their condition with a health care professional, and iii. Notions of the support they might wish to receive from them. Methods Twenty in-depth interviews were conducted with individuals attending a food bank and food pantry in north east Scotland. Interview audio recordings were fully transcribed and thematically analysed. Results Individuals reporting multiple physical and mental health conditions, took part in the study. Four main themes were identified i.e.: 1. food practices, trade-offs and compromises, that relate to economic constraints and lack of choice; 2. illness experiences and food as they relate to physical and mental ill-health; 3. (in) visibility of participants’ economic vulnerability within health care consultations; and 4. perceptions and expectations of the health care system. Conclusions This study, the first of its kind in the UK, indicated that participants’ health condition management aspirations were undermined by the experience of food insecurity, and that their health care consultations in were, on the whole, devoid of discussions of those challenges. As such, the study indicated practical and ethical implications for health care policy, practice and research associated with the risk of intervention-generated health inequalities that were suggested by this study. Better understanding is needed about the impact of household food insecurity on existing ill health, wellbeing and health care use across the UK.
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Affiliation(s)
- Flora Douglas
- School of Nursing and Midwifery, Robert Gordon University, Aberdeen, Scotland.
| | - Emma MacIver
- School of Nursing and Midwifery, Robert Gordon University, Aberdeen, Scotland
| | - Chris Yuill
- School of Applied Social Sciences, Robert Gordon University, Aberdeen, Scotland
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Tan JY, A Sheira L, Frongillo EA, A Adimora A, Tien PC, Konkle-Parker D, Golub ET, Merenstein D, Levin S, Cohen M, Ofotokun I, A Fischl M, Rubin LH, Weiser SD. Food insecurity and neurocognitive function among women living with or at risk for HIV in the United States. Am J Clin Nutr 2020; 112:1280-1286. [PMID: 32844175 PMCID: PMC7657325 DOI: 10.1093/ajcn/nqaa209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 07/07/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Neurocognitive impairment (NCI) persists among women living with HIV. Food insecurity is also common among women and may be an important modifiable contributor of NCI. OBJECTIVE The goal of this study was to determine the association of food insecurity with neurocognitive function among women living with or without HIV. METHODS From 2013 to 2015, we analyzed data from a cross-sectional sample from the Women's Interagency HIV Study (WIHS). Measures included food insecurity and a comprehensive neuropsychological test battery assessing executive function, processing speed, attention/working memory, learning, memory, fluency, and motor function. We conducted multivariable linear regressions to examine associations between food insecurity and domain-specific neurocognitive performance, adjusting for relevant sociodemographic, behavioral, and clinical factors. RESULTS Participants (n = 1,324) were predominantly HIV seropositive (68%), Black/African-American (68%) or Hispanic (16%), and low income (48% reported <$12,000/y), with a median age of 49.6 y (IQR = 43.1, 55.5). Approximately one-third (36%, n = 479) were food insecure. Food insecurity was associated with poorer executive function (b = -1.45, SE = 0.58, P ≤ 0.01) and processing speed (b = -1.30, SE = 0.59, P ≤ 0.05). HIV serostatus modified the association between food insecurity and learning, memory, and motor function (P values <0.05). Food insecurity was positively associated with learning among women living with HIV (b = 1.58, SE = 0.77, P ≤ 0.05) and negatively associated with motor function among HIV-negative women (b = -3.57, SE = 1.08, P ≤ 0.001). CONCLUSIONS Food insecurity was associated with domain-specific neurocognitive function in women, and HIV serostatus modified associations. Food security may be an important point of intervention for ethnically diverse women with low socioeconomic status. Longitudinal studies are warranted to determine potential pathways by which food insecurity is associated with neurocognitive function among women living with or at risk for HIV.
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Affiliation(s)
- Judy Y Tan
- Address correspondence to JYT (e-mail: )
| | - Lila A Sheira
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Adaora A Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, San Francisco CA, USA,Department of Veterans Affairs Medical Center, San Francisco, CA, USA
| | | | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Susanna Levin
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Mardge Cohen
- Department of Medicine, Stroger Hospital of Cook County, Chicago, IL, USA
| | - Igho Ofotokun
- Emory University School of Medicine, Department of Medicine, Division of Infectious Disease, Atlanta, GA, USA
| | - Margaret A Fischl
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Leah H Rubin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Departments of Neurology and Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sheri D Weiser
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
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Abstract
OBJECTIVE This review summarises and synthesises the existing literature on the relationship between food insecurity (FS) and mental health conditions among adult individuals experiencing homelessness. DESIGN Scoping review. Papers published between 1 January 2008 and 2 November 2018, searched in PubMed, Web of Science, Scopus, PsycINFO, Cochrane Library and CINAHL, using homelessness, food security and mental health keywords. SETTING Global evidence. PARTICIPANTS Homeless adults aged 18 years or more. RESULTS Nine articles (eight cross-sectional and one longitudinal) were included in the present review. FS was measured using the Household Food Insecurity Access Scale, the United States Department of Agriculture Household Food Security Survey Module, as well as single-item or constructed measures. Depression and depressive symptoms were the most common mental health conditions studied. Other mental health conditions assessed included alcohol and substance use, emotional disorders, mental health problems symptoms severity and psychiatric hospitalisations. Composite measures such as axis I and II categories and a cluster of severe mental conditions and mental health-related functioning status were also analysed. FS and mental health-related problems were considered as both exposure and outcome variables. The existing evidence suggests a potential association between FS and several mental health conditions, particularly depression, mental health symptoms severity and poor mental health status scores. CONCLUSIONS This review suggests the potential association between some mental health conditions and FS among homeless adults. However, there is a need for more longitudinal- and interventional-based studies, in order to understand the nature and directionality of the links between FS and mental health in this population group.
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The Mediating Role of Depressive Symptoms in the Association Between Food Insecurity and HIV Related Health Outcomes Among HIV-HCV Co-Infected People. AIDS Behav 2020; 24:2188-2194. [PMID: 31950306 DOI: 10.1007/s10461-020-02784-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Food insecurity may lead to depressive symptoms, which are known to be associated with poor HIV related health outcomes. However, it is unclear to what extent food insecurity 'directly' affects these outcomes. We used data from the Food Security & HIV-HCV Sub-Study of the Canadian Co-Infection Cohort to assess the controlled direct effect. People experiencing severe food insecurity had 1.47 (95% CI 1.04-2.09) times the risk of having detectable HIV viral load and 0.94 (95% CI 0.87-1.02) fold change in CD4 count. After holding depressive symptoms constant, the association between severe food insecurity and HIV viral load was attenuated to a statistically non-significant level (RR 1.36, 95% CI: 0.95-1.96), whereas the association between severe food insecurity and CD4 count was unchanged. Depressive symptoms partially mediate the effect of severe food insecurity on HIV viral suppression; interventions focused on depressive symptoms alone may not be sufficient, however, to eliminate this effect.
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Ayano G, Tsegay L, Solomon M. Food insecurity and the risk of depression in people living with HIV/AIDS: a systematic review and meta-analysis. AIDS Res Ther 2020; 17:36. [PMID: 32571426 PMCID: PMC7310141 DOI: 10.1186/s12981-020-00291-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 06/11/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The link between food insecurity and depression in people living with HIV/AIDS (PLWHA) has been explored in numerous studies; however, the existing evidence is inconclusive due to inconsistent results. Therefore, the objective of this systematic review and meta-analysis is to examine the relationship between food insecurity and depression in PLWHA. METHODS We systematically searched PubMed, EMBASE, and Scopus to identify relevant studies. A random-effect model was used for conducting the meta-analysis. We assessed the risk of publication bias by funnel plot and Egger's regression asymmetry test. RESULTS In this review, seven studies were included in the final analysis. Our meta-analysis revealed that food insecurity significantly increased the risk of depression in PLWHA [RR 2.28 (95% CI 1.56-3.32)]. This association remained significant after adjusting for the confounding effects of drug use [RR 1.63 (95% CI 1.27-2.10)], social support [RR 2.21 (95% CI 1.18-4.16)] as well as ART drugs [RR 1.96 (95% CI 1.17-3.28)]. Our subgroup and sensitivity confirmed the robustness of the main analysis. CONCLUSION This systematic review and meta-analysis suggest a significant association between food insecurity and increased risk of depression PLWHA. Therefore, early screening and management of food insecurity in PLWHA seem to be necessary.
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Affiliation(s)
- Getinet Ayano
- Research and Training Department, Amanuel Mental Specialized Hospital Addis Ababa, PO BOX 1971, Addis Ababa, Ethiopia
- School of Public Health, Curtin University, Perth, WA Australia
| | - Light Tsegay
- College of Health Sciences, Axum University, Axum, Ethiopia
| | - Melat Solomon
- Research and Training Department, Amanuel Mental Specialized Hospital Addis Ababa, PO BOX 1971, Addis Ababa, Ethiopia
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Associations between food insecurity and psychotropic medication use among women living with HIV in the United States. Epidemiol Psychiatr Sci 2020; 29:e113. [PMID: 32248873 PMCID: PMC7214522 DOI: 10.1017/s2045796020000232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AIMS Psychotropic prescription rates continue to increase in the United States (USA). Few studies have investigated whether social-structural factors may play a role in psychotropic medication use independent of mental illness. Food insecurity is prevalent among people living with HIV in the USA and has been associated with poor mental health. We investigated whether food insecurity was associated with psychotropic medication use independent of the symptoms of depression and anxiety among women living with HIV in the USA. METHODS We used cross-sectional data from the Women's Interagency HIV Study (WIHS), a nationwide cohort study. Food security (FS) was the primary explanatory variable, measured using the Household Food Security Survey Module. First, we used multivariable linear regressions to test whether FS was associated with symptoms of depression (Center for Epidemiologic Studies Depression [CESD] score), generalised anxiety disorder (GAD-7 score) and mental health-related quality of life (MOS-HIV Mental Health Summary score; MHS). Next, we examined associations of FS with the use of any psychotropic medications, including antidepressants, sedatives and antipsychotics, using multivariable logistic regressions adjusting for age, race/ethnicity, income, education and alcohol and substance use. In separate models, we additionally adjusted for symptoms of depression (CESD score) and anxiety (GAD-7 score). RESULTS Of the 905 women in the sample, two-thirds were African-American. Lower FS (i.e. worse food insecurity) was associated with greater symptoms of depression and anxiety in a dose-response relationship. For the psychotropic medication outcomes, marginal and low FS were associated with 2.06 (p < 0.001; 95% confidence interval [CI] = 1.36-3.13) and 1.99 (p < 0.01; 95% CI = 1.26-3.15) times higher odds of any psychotropic medication use, respectively, before adjusting for depression and anxiety. The association of very low FS with any psychotropic medication use was not statistically significant. A similar pattern was found for antidepressant and sedative use. After additionally adjusting for CESD and GAD-7 scores, marginal FS remained associated with 1.93 (p < 0.05; 95% CI = 1.16-3.19) times higher odds of any psychotropic medication use. Very low FS, conversely, was significantly associated with lower odds of antidepressant use (adjusted odds ratio = 0.42; p < 0.05; 95% CI = 0.19-0.96). CONCLUSIONS Marginal FS was associated with higher odds of using psychotropic medications independent of depression and anxiety, while very low FS was associated with lower odds. These complex findings may indicate that people experiencing very low FS face barriers to accessing mental health services, while those experiencing marginal FS who do access services are more likely to be prescribed psychotropic medications for distress arising from social and structural factors.
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Loosier PS, Haderxhanaj L, Beltran O, Hogben M. Food Insecurity and Risk Indicators for Sexually Transmitted Infection Among Sexually Active Persons Aged 15-44, National Survey of Family Growth, 2011-2017. Public Health Rep 2020; 135:270-281. [PMID: 32031921 DOI: 10.1177/0033354920904063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Food insecurity is linked to poor sexual health outcomes, especially among persons engaged in sexual behaviors that are associated with the risk of acquiring sexually transmitted infections (STIs). We examined this link using nationally representative data. METHODS We used data on adolescents and adults aged 15-44 who reported sexual activity in the past year from 6 years (September 2011-September 2017) of cross-sectional, weighted public-use data from the National Survey of Family Growth. We compared data on persons who did and did not report food insecurity, accounting for demographic characteristics, markers of poverty, and past-year STI risk indicators (ie, engaged in 1 of 4 high-risk activities or diagnosed with chlamydia or gonorrhea). RESULTS Respondents who reported at least 1 past-year STI risk indicator were significantly more likely to report food insecurity (females: adjusted risk ratio [ARR] = 1.63; 95% confidence interval [CI], 1.35-1.97; P < .001; males: ARR = 1.46; 95% CI, 1.16-1.85) than respondents who did not report food insecurity. This finding was independent of the association between food insecurity and markers of poverty (≤100% federal poverty level [females: ARR = 1.46; 95% CI, 1.23-1.72; P < .001; males: ARR = 1.81; 95% CI, 1.49-2.20; P < .001]; if the respondent or someone in the household had received Special Supplemental Nutrition Program for Women, Infants, and Children or Supplemental Nutrition Assistance Program benefits in the past year [females: ARR = 3.37; 95% CI, 2.81-4.02; P < .001; males: ARR = 3.27; 95% CI, 2.76-3.87; P < .001]). Sex with opposite- and same-sex partners in the past year was significantly associated with food insecurity (females: ARR = 1.44; 95% CI, 1.11-1.85; P = .01; males: ARR = 1.99; 95% CI, 1.15-3.42; P = .02). CONCLUSIONS Food insecurity should be considered a social determinant of health independent of poverty, and its effect on persons at highest risk for STIs, including HIV, should be considered when planning interventions designed to decrease engagement in higher-risk sexual behaviors.
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Affiliation(s)
- Penny S Loosier
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Laura Haderxhanaj
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Oscar Beltran
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew Hogben
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Tuthill EL, Miller JD, Collins SM, Widen EM, Onono M, Young SL. HIV infection, hunger, breastfeeding self-efficacy, and depressive symptoms are associated with exclusive breastfeeding to six months among women in western Kenya: a longitudinal observational study. Int Breastfeed J 2020; 15:4. [PMID: 31948438 PMCID: PMC6966845 DOI: 10.1186/s13006-019-0251-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 12/20/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Exclusive breastfeeding for the first six months of life is recommended for all infants. However, breastfeeding rates remain suboptimal; around 37% of infants are exclusively breastfed for the first six months globally. In Nyanza region, western Kenya, numerous challenges to breastfeeding have been identified, including food insecurity, hunger, depressive symptoms, and HIV infection. Yet, evidence to inform our understanding of how these problems influence women's breastfeeding behaviors across time is lacking. We therefore sought to examine these factors and how they interact to affect the initiation and duration of exclusive breastfeeding in this region. We hypothesized that women experiencing greater food insecurity, hunger, and/or depressive symptoms would be less likely to maintain exclusive breastfeeding for six months than women who were food secure or not depressed. We also hypothesized that women living with HIV would be more likely to maintain exclusive breastfeeding to six months compared to HIV-uninfected women. METHODS Women in Pith Moromo, a longitudinal cohort study in western Kenya, were surveyed at two antenatal and three postpartum timepoints (n = 275). Data were collected on breastfeeding behavior and self-efficacy, maternal food insecurity and hunger, maternal psychosocial health, and HIV status. Cox proportional hazards models were used to identify predictors of early exclusive breastfeeding cessation. RESULTS The majority of women (52.3%) exclusively breastfed for the first six months. In the final multivariable Cox proportional hazards model, living with HIV was associated with a 64% decrease in the rate of early exclusive breastfeeding cessation. Additionally, the rate of early exclusive breastfeeding cessation increased by 100 and 98% for those experiencing probable depression or hunger, respectively. Although there was no main effect of breastfeeding self-efficacy, the interaction between breastfeeding self-efficacy and hunger was significant, such that the rate of early exclusive breastfeeding cessation was predicted to decrease by 2% for every point increase in breastfeeding self-efficacy score (range: 0-56). CONCLUSIONS This study contributes to previous work demonstrating that women living with HIV more consistently exclusively breastfeed and suggests that rates of exclusive breastfeeding could be increased through targeted support that promotes maternal mental health and breastfeeding self-efficacy, while reducing maternal hunger. TRIAL REGISTRATION Study registration NCT02974972.
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Affiliation(s)
- Emily L Tuthill
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Joshua D Miller
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Shalean M Collins
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Elizabeth M Widen
- Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA
| | - Maricianah Onono
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sera L Young
- Department of Anthropology, Northwestern University, Evanston, IL, USA.
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Whittle HJ, Leddy AM, Shieh J, Tien PC, Ofotokun I, Adimora AA, Turan JM, Frongillo EA, Turan B, Weiser SD. Precarity and health: Theorizing the intersection of multiple material-need insecurities, stigma, and illness among women in the United States. Soc Sci Med 2020; 245:112683. [PMID: 31760320 PMCID: PMC7111434 DOI: 10.1016/j.socscimed.2019.112683] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 12/31/2022]
Abstract
Material-need insecurities (including insecurities in basic resources such as income, food, housing, and healthcare) are widespread in the United States (US) and may be important predictors of poor health outcomes. How material-need insecurities besides food insecurity are experienced, however, remains under-researched, including how multiple material-need insecurities might intersect and converge on the individual. Here we used qualitative methods to investigate experiences with multiple material-need insecurities among 38 food-insecure women aged over 50 years living with or at risk for HIV in the US. Our aims were: (1) to understand the co-experience of material-need insecurities beyond food insecurity; (2) to elucidate how multiple material-need insecurities might intersect; and (3) to discover how this intersection might be detrimental to health. During November 2017-July 2018, we conducted semi-structured interviews at three sites across the US (Northern California, Georgia, North Carolina) and analyzed the data using an inductive-deductive approach. We identified a common and complex picture of multiple material-need insecurities, stigma, and illness among participants across all three sites. There were five primary themes: (1) insecure income arising from a combination of precarious wage labor and federal disability benefits; (2) resultant experiences of uncertainty, compromised quality, insufficiency, and having to use socially unacceptable coping strategies across finances, food, housing, and healthcare; (3) participants' disempowerment arising from their engagement with social safety net institutions; (4) closely related experiences of intersectional stigma and discrimination; and (5) negative implications for health across a wide range of illnesses. By employing the sociological concept of precarity-a term denoting the contemporary convergence of insecure wage labor and retraction of the welfare state-we combine these themes into a unifying framework of precarity and health. This framework may prove useful for testing how the widespread intersection of multiple material-need insecurities interacts with stigma and discrimination to negatively impact physical and mental health.
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Affiliation(s)
- Henry J Whittle
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | - Anna M Leddy
- Division of Prevention Science, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Jacqueline Shieh
- Institute for Global Health Sciences, UCSF, San Francisco, CA, USA
| | - Phyllis C Tien
- Department of Medicine, UCSF and Medical Service, Department of Veteran Affairs Medical Center, San Francisco, CA, USA
| | - Ighovwerha Ofotokun
- School of Medicine, Emory University and Grady Healthcare System, Atlanta, GA, USA
| | - Adaora A Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Bulent Turan
- Department of Psychology, UAB, Birmingham, AL, USA
| | - Sheri D Weiser
- Division of HIV, ID and Global Medicine, Department of Medicine, UCSF, San Francisco, CA, USA
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Food insecurity among formerly homeless youth in supportive housing: A social-ecological analysis of a structural intervention. Soc Sci Med 2019; 245:112724. [PMID: 31838336 DOI: 10.1016/j.socscimed.2019.112724] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 01/02/2023]
Abstract
A growing body of research indicates that structural interventions to provide permanent supportive housing (PSH) to homeless adults within a Housing First approach can improve their health. However, research is lacking regarding the impact of PSH on youth experiencing homelessness. This article seeks to understand how PSH for youth impacts a basic health need-food security- across multiple levels of the social-ecological environment. In January of 2014, San Francisco, California opened the city's first municipally-funded PSH building exclusively designated for transition-aged youth (ages 18-24). We conducted 20 months of participant observation and in-depth interviews with 39 youth from April 2014 to December 2015. Ethnographic fieldnotes and interview transcripts were analyzed using grounded theory. We present our social-ecological assessment regarding food insecurity for formerly homeless youth in supportive housing. We found that although housing removes some major sources of food insecurity from their lives, it adds others. Many of the participating youth were frequently hungry and went without food for entire days. Mechanisms across multiple levels of the social-ecological model contribute to food insecurity. Mechanisms on the structural level include stigma, neighborhood food resources, and monthly hunger cycles. Mechanisms on the institutional level include the transition into housing and housing policies regarding kitchen use and food storage. Interpersonal level mechanisms include food sharing within social networks. Individual level mechanisms include limited cooking skills, equipment, and coping strategies to manage hunger. Although supportive housing provides shelter to youth, effective implementation of the Housing First/PSH model for youth must ensure their access to an affordable nutritious diet.
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Nagata JM, Palar K, Gooding HC, Garber AK, Whittle HJ, Bibbins-Domingo K, Weiser SD. Food Insecurity Is Associated With Poorer Mental Health and Sleep Outcomes in Young Adults. J Adolesc Health 2019; 65:805-811. [PMID: 31587956 PMCID: PMC6874757 DOI: 10.1016/j.jadohealth.2019.08.010] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/15/2019] [Accepted: 08/10/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE The aim of the study was to determine the association between food insecurity, mental health, and sleep outcomes among young adults. Young adulthood represents an important developmental period when educational and economic transitions may increase the risk for food insecurity; however, little is known about associations between food insecurity and health outcomes in this period. METHODS Cross-sectional nationally representative data of U.S. young adults aged 24-32 years from Wave IV (2008) of the National Longitudinal Study of Adolescent to Adult Health were analyzed in 2018. Multiple logistic regression analysis was conducted with food insecurity as the independent variable and self-reported mental health (depression, anxiety, and suicidality) and sleep (trouble falling and staying asleep) outcomes as the dependent variables. RESULTS Of the 14,786 young adults in the sample, 11% were food insecure. Food-insecure young adults had greater odds of mental health problems including a depression diagnosis (1.67, 95% confidence interval [CI] 1.39-2.01), anxiety or panic disorder diagnosis (1.47, 95% CI 1.16-1.87), and suicidal ideation in the past 12 months (2.76, 95% CI 2.14-3.55). Food insecurity was also associated with poorer sleep outcomes including trouble falling (adjusted odds ratio 1.78, 95% CI 1.52-2.08) and staying (adjusted odds ratio 1.67, 95% CI 1.42-1.97) asleep. CONCLUSIONS Food insecurity is associated with poorer mental and sleep health in young adulthood. Health care providers should screen for food insecurity in young adults and provide referrals when appropriate. Future research should test interventions to simultaneously combat food insecurity and mental health problems in young adulthood.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, California.
| | - Kartika Palar
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Holly C Gooding
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Andrea K Garber
- Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Henry J Whittle
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kirsten Bibbins-Domingo
- Department of Medicine, University of California, San Francisco, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Sheri D Weiser
- Department of Medicine, University of California, San Francisco, San Francisco, California
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Kim-Mozeleski JE, Pandey R, Tsoh JY. Psychological distress and cigarette smoking among U.S. households by income: Considering the role of food insecurity. Prev Med Rep 2019; 16:100983. [PMID: 31516816 PMCID: PMC6734047 DOI: 10.1016/j.pmedr.2019.100983] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/08/2019] [Accepted: 08/29/2019] [Indexed: 11/06/2022] Open
Abstract
Psychological distress and tobacco use are known to co-occur for many reasons, including vulnerabilities associated with socioeconomic disadvantage. Food insecurity-a stressful condition due to inconsistent food access-is linked with increased psychological distress and is also an independent risk factor for smoking. We investigated the association between psychological distress and cigarette smoking, examining distress occurring with or without food insecurity, and variations in the associations by socioeconomic status. We analyzed data from the 2015 U.S. Panel Study of Income Dynamics (n = 9048). A four-category variable was constructed based on responses to validated measures of psychological distress and of food insecurity: no distress and no food insecurity; food insecurity without distress; distress without food insecurity; and distress with food insecurity. Weighted, robust Poisson regression analysis examined associations with current smoking, with analyses stratified by socioeconomic status. Smoking prevalence was highest among respondents experiencing psychological distress with food insecurity (39%). Results showed that respondents with food insecurity alone had higher smoking prevalence (33%) than respondents with psychological distress alone (20%). Only among respondents above poverty, psychological distress without food insecurity was significantly associated with current smoking (prevalence ratio = 1.44; 95% CI [1.25, 1.65]). For respondents at/below poverty, psychological distress without food insecurity was not significantly associated with current smoking. Further examining how socioeconomic stressors, such as food insecurity, intersect with psychological distress is needed to address continued socioeconomic disparities in cigarette smoking and develop effective population-based interventions.
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Affiliation(s)
- Jin E. Kim-Mozeleski
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Rajshree Pandey
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Janice Y. Tsoh
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
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Whittle HJ, Sheira LA, Wolfe WR, Frongillo EA, Palar K, Merenstein D, Wilson TE, Adedimeji A, Weber KM, Adimora AA, Ofotokun I, Metsch L, Turan JM, Wentz EL, Tien PC, Weiser SD. Food insecurity is associated with anxiety, stress, and symptoms of posttraumatic stress disorder in a cohort of women with or at risk of HIV in the United States. J Nutr 2019; 149:1393-1403. [PMID: 31127819 PMCID: PMC6675617 DOI: 10.1093/jn/nxz093] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 02/19/2019] [Accepted: 04/10/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Food insecurity, which disproportionately affects marginalized women in the United States, is associated with depressive symptoms. Few studies have examined relations of food insecurity with other mental health outcomes. OBJECTIVE The aim of this study was to investigate the associations of food insecurity with symptoms of generalized anxiety disorder (GAD), stress, and posttraumatic stress disorder (PTSD) in the Women's Interagency HIV Study (WIHS), a prospective cohort study of women with or at risk of HIV in the United States. METHODS Participants were 2553 women with or at risk of HIV, predominantly African American/black (71.6%). Structured questionnaires were conducted during April 2013-March 2016 every 6 mo. Food security (FS) was the primary predictor, measured using the Household Food Security Survey Module. We measured longitudinal outcomes for GAD (GAD-7 score and a binary GAD-7 screener for moderate-to-severe GAD). Only cross-sectional data were available for outcomes measuring perceived stress (PSS-10 score) and PTSD (PCL-C score and a binary PCL-C screener for PTSD). We examined associations of FS with the outcomes through use of multivariable linear and logistic regression, including lagged associations with GAD outcomes. RESULTS After adjusting for sociodemographic and health-related factors including HIV serostatus, current marginal, low, and very low FS were associated with increasingly higher GAD-7 scores, and with 1.41 (95% CI: 1.10, 1.80; P < 0.01), 2.03 (95% CI: 1.59, 2.61; P < 0.001), and 3.23 (95% CI: 2.43, 4.29; P < 0.001) times higher odds of screening positive for moderate-to-severe GAD, respectively. Low and very low FS at the previous visit (6 mo earlier) were independently associated with GAD outcomes at current visit. Associations of FS with PSS-10 and PCL-C scores exhibited similar dose-response relations. Very low FS was associated with 1.93 (95% CI: 1.15, 3.24; P < 0.05) times higher odds of screening positive for PTSD. CONCLUSIONS Food insecurity may be associated with a range of poor mental health outcomes among women in the United States with or at risk of HIV.
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Affiliation(s)
- Henry J Whittle
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK,Address correspondence to HJW (e-mail: )
| | | | | | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC
| | | | - Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC
| | - Tracey E Wilson
- Department of Community Health Sciences, State University of New York Downstate Medical Center, School of Public Health, Brooklyn, NY
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Kathleen M Weber
- Cook County Health and Hospitals System and Hektoen Institute of Medicine, Chicago, IL
| | - Adaora A Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ighovwerha Ofotokun
- School of Medicine, Emory University, Atlanta, GA, and Grady Healthcare System, Atlanta, GA
| | - Lisa Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Eryka L Wentz
- Bloomberg School of Public Health, Department of Epidemiology, Johns Hopkins University, Baltimore, MD
| | - Phyllis C Tien
- Department of Medicine, UCSF and Medical Service, Department of Veteran Affairs Medical Center, San Francisco, CA
| | - Sheri D Weiser
- Division of HIV, ID and Global Medicine,Center for AIDS Prevention Studies, UCSF, San Francisco, CA
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Chronic disease self-management within the monthly benefit cycle of the Supplemental Nutrition Assistance Program. Public Health Nutr 2019; 22:2248-2259. [PMID: 31104648 DOI: 10.1017/s1368980019001071] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The present study explored chronic disease management over the monthly benefit cycle among primary food shoppers from households receiving Supplemental Nutrition Assistance Program (SNAP) benefits in Philadelphia, PA, USA. DESIGN In-depth interviews, participant observation and surveys were conducted with the primary food shopper of SNAP households. SETTING Interviews and surveys were conducted in a clinical setting at Children's Hospital of Philadelphia, at participants' homes, and in food procurement settings including grocery stores, food pantries and soup kitchens. PARTICIPANTS Eighteen adults who received SNAP; five with a diet-related chronic condition, five managing the chronic condition of a family member and thirteen with overweight or obesity. RESULTS All households had at least one member with a chronic disease or condition. Households reported that the dietary demands of managing chronic illnesses were expensive and mentally taxing. Food and financial shortfalls at the end of the benefit cycle, as well as reliance on charitable food assistance programmes, often had negative impacts on chronic disease self-management. CONCLUSIONS Drawing from nearly 50 h of in-depth qualitative interviews with SNAP participants, the study highlights the dual cognitive burden of poverty and chronic disease and elucidates the particular challenges of food procurement and maintenance of diet quality throughout the benefit month faced by SNAP households with diet-related chronic diseases. Interventions targeted at reducing the cost of medically appropriate, healthy foods may help to improve chronic disease self-management within SNAP populations.
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To S, Coughenour C, Pharr J. The Environmental Impact and Formation of Meals from the Pilot Year of a Las Vegas Convention Food Rescue Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1718. [PMID: 31100792 PMCID: PMC6571599 DOI: 10.3390/ijerph16101718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/11/2019] [Accepted: 05/12/2019] [Indexed: 11/23/2022]
Abstract
Annually, millions of tonnes of leftover edible foods are sent to landfill. Not only does this harm the environment by increasing the release of greenhouse gases which contribute to climate change, but it poses a question of ethics given that nearly 16 million households are food insecure in the US, and hundreds of millions of people around the globe. The purpose of this study was to document the amount of food diverted from landfill in the pilot year of a convention food rescue program and to determine the amount of greenhouse gas (GHG) emissions avoided by the diversion of such food. In the pilot year of the convention food rescue program 24,703 kg of food were diverted. It is estimated that 108 metric tonnes of GHG emmisions were avoided as a result, while 45,383 meals for food insecure individuals were produced. These findings have significant implications for public and environmental health, as GHG emissions have a destructive effect on the earth's atmosphere and rescued food can be redistributed to food insecure individuals.
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Affiliation(s)
- Samantha To
- Coconino County Public Health Services District, Flagstaff, AZ 86001, USA.
- School of Public Health, University of Nevada Las Vegas School of Public Health, Las Vegas, NV 89154, USA.
| | - Courtney Coughenour
- School of Public Health, University of Nevada Las Vegas School of Public Health, Las Vegas, NV 89154, USA.
| | - Jennifer Pharr
- School of Public Health, University of Nevada Las Vegas School of Public Health, Las Vegas, NV 89154, USA.
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Russomanno J, Patterson JG, Jabson JM. Food Insecurity Among Transgender and Gender Nonconforming Individuals in the Southeast United States: A Qualitative Study. Transgend Health 2019; 4:89-99. [PMID: 31032424 PMCID: PMC6484349 DOI: 10.1089/trgh.2018.0024] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Transgender and gender nonconforming (TGNC) people experience high rates of poverty, joblessness, and homelessness, which drive risk for food insecurity. TGNC people also face discrimination due to transphobia and cissexism, which may contribute to these drivers. Minimal empirical evidence describes experiences with food insecurity among TGNC people. This project investigated food insecurity among TGNC people and how these experiences relate to their physical and mental health. Methods: Semistructured telephone interviews were conducted with 20 TGNC people residing in the Southeast United States (U.S.), recruited through social media. Interviews were transcribed and qualitatively coded. Results: TGNC people reported living in extreme poverty. They described how the conservative sociopolitical climate of the Southeast United States made it difficult to find and maintain employment, which was a primary driver of food insecurity. Participants experienced discomfort seeking food assistance due to discrimination and concern for reducing emergency food availability for people in greater need. Stress from unemployment and underemployment, inadequate food supplies, and discrimination was reported as a contributor to poor physical and mental health, and weakened support systems. Conclusion: Poverty and food insecurity erode TGNC people's physical and mental health and support systems. TGNC people faced substantial barriers-including unemployment and underemployment and multilevel discrimination-which prevented them from affording adequate food. Public health solutions include implementing employment nondiscrimination policy to protect TGNC people in the workplace and building relationships between local food pantries and LGBT organizations to create safer environments for all persons in need of food assistance.
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Affiliation(s)
- Jennifer Russomanno
- Department of Public Health, The University of Tennessee, Knoxville, Tennessee
| | - Joanne G Patterson
- Department of Public Health, The University of Tennessee, Knoxville, Tennessee
| | - Jennifer M Jabson
- Department of Public Health, The University of Tennessee, Knoxville, Tennessee
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Miewald C, McCann E, Temenos C, McIntosh A. "I do my best to eat while I'm using": Mapping the foodscapes of people living with HIV/AIDS who use drugs. Soc Sci Med 2019; 226:96-103. [PMID: 30851662 DOI: 10.1016/j.socscimed.2019.02.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/22/2018] [Accepted: 02/24/2019] [Indexed: 11/29/2022]
Abstract
Food insecurity can have negative health impacts on people who use drugs and are living with HIV/AIDS (PLHIV). These include both physical effects, including poorer health outcomes and morbidity, and also behaviors that can increase the risk of physical or psychological harm. This study used a semi-structured survey of 60 PLHIV who use drugs and service access mapping (SAM) interviews of a 20-person subset. The mapping helped to illustrate the daily routines used to access food and how food provision may contribute to both spaces of risk and care for a cohort of PLHIV who use drugs in Vancouver, BC. Study participants mapped the daily routes used to access food and discussed whether they felt that these routines increased their risk of physical harm. Additionally, study participants noted which food provision spaces provide social and health supports, which may protect against the nutritional and other harms of drug use. This study revealed that having access to space providing stable and reliable sources of food may protect individuals from experiencing certain risks associated with accessing food, including violence in food line-ups, having to enter areas of the city they considered unsafe or 'triggering' and engaging in risky behaviors in order to access food. These "spaces of care" not only provide nutrition but also social support and connections.
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Affiliation(s)
- Christiana Miewald
- Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada.
| | - Eugene McCann
- Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada.
| | - Cristina Temenos
- Geography & Manchester Urban Institute, University of Manchester, 1.036 Arthur Lewis Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Alison McIntosh
- Research Ethics & Compliance Division, 2500 University Drive N.W, Calgary, Alberta, T2N 1N4, Canada.
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