The household food insecurity gradient and potential reductions in adverse population mental health outcomes in Canadian adults

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

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

Prevalence of micronutrient inadequacy differs by severity of food insecurity among adults living in Canada in 2015

Household food insecurity is generally associated with poorer quality diets in Canada, but whether household food insecurity heightens the probability of inadequate micronutrient intakes is unknown. The objective of this research was to investigate how prevalence of micronutrient inadequacy differed by severity of household food insecurity among adults in Canada. Using the 2015 Canadian Community Health Survey Nutrition, this study included participants aged 19-64 years who completed up to two 24 h dietary recalls and provided details about household food insecurity (n = 9486). Children and older adults were not included due to sample size limitations. Usual micronutrient intake distributions were estimated by a four-level measure of food insecurity status using the National Cancer Institute method. Welch's t tests assessed differences in prevalence of inadequacy for selected micronutrients. Prevalence differed for some micronutrients among those living in marginally and moderately food insecure compared to food-secure households. The greatest differences in prevalence of inadequacy were observed between severely food-insecure and food-secure households: vitamin A (60.0%, SE = 11.9 vs. 40.6%, SE = 2.7, p < 0.0001), vitamin B6 (42.7%, SE = 9.1 vs. 12.8%, SE = 2.5, p < 0.0001), folate (39.4%, SE = 10.0 vs. 15.9%, SE = 2.2, p < 0.0001), vitamin C (63.3%, SE = 5.2 vs. 29.1%, SE = 2.8, p < 0.0001), calcium (78.6%, SE = 6.4 vs. 58.7%, SE = 1.3, p < 0.0001), magnesium (75.6%, SE = 9.5 vs. 48.7%, SE = 1.2, p < 0.0001), and zinc (34.9%, SE = 10.0 vs. 23.2%, SE = 2.4, p = 0.0009). Apparent underreporting also differed by severity of food insecurity, with increased underreporting observed with worsening food insecurity. The probability of inadequate micronutrient intakes among adults rises sharply with more severe household food insecurity in Canada.

Food insecurity and body dissatisfaction in a sample of Canadian adults

Food insecurity may predict poorer body image, which is associated with increased risk of mental health problems. However, minimal attention has been given to the food insecurity-body image link and to factors that may influence this link, such as assigned sex; importantly, females are more likely to experience both food insecurity and body dissatisfaction. The present study used data from the 2017 to 2018 Canadian Community Health Survey (N = 32,017) to investigate the effects of food insecurity and sex on body satisfaction via generalized ordered logistic regression. Results indicated: (1) Food insecurity predicted lower odds of body satisfaction, (2) Males were more likely than females to be satisfied with their bodies, and (3) Food insecurity no longer predicted body satisfaction following the inclusion of sex. Findings suggest the association between food insecurity and body satisfaction may largely be driven by the link between food insecurity and sex. Further investigation is warranted.

The relationship between household food insecurity and overweight or obesity among children and adults in Canada: a population-based, propensity score weighting analysis

Household food insecurity is independently associated with adverse health outcomes among Canadians, but its association with overweight and obesity is poorly understood partly because of limited attention to confounding. This study assessed the relationship between food insecurity status and overweight/obesity in Canada. Cross-sectional data for individuals aged 2-64 years were drawn from the 2004 and 2015 Canadian Community Health Survey-Nutrition. Overweight/obesity was defined using body mass index calculated with measured height and weight. Food insecurity status was assessed with the 18-item Household Food Security Survey Module. The relationship was examined among preschool children (n = 2007), girls (n = 5512), boys (n = 5507), women (n = 8317), and men (n = 7279) using propensity score weighted logistic regressions to control for confounding. Relative to their food-secure counterparts, girls in moderately food-insecure households (39.7% vs. 28.5%), boys in severely food-insecure households (54.4% vs. 35.0%), and women in moderately and severely food-insecure households (58.9% and 73.1% vs. 50.7%) had higher overweight/obesity prevalence; men in moderately food-insecure households had a lower prevalence (48.9% vs. 66.3%). With propensity score weighting, no association existed between food insecurity and overweight/obesity among preschool children, girls, boys, or men. For women, moderate (adjusted odds ratio (AOR): 1.61; 95% confidence interval (95%CI): 1.06-2.47) and severe (AOR: 2.33; 95%CI: 1.22-4.44) food insecurity was positively associated with overweight/obesity; the association was strongest for severe food insecurity and obesity (AOR: 3.38; 95%CI: 1.60-7.16). Additional research is needed to better understand the nature of the relationship among women. Problems of food insecurity and overweight/obesity among Canadian children and men should not be conflated in public health interventions.

The British Columbia Farmers' Market Nutrition Coupon Program Reduces Short-Term Household Food Insecurity Among Adults With Low Incomes: A Pragmatic Randomized Controlled Trial

BACKGROUND

The British Columbia Farmers' Market Nutrition Coupon Program (BC FMNCP) provides households with low incomes with coupons to purchase healthy foods from farmers' markets.

OBJECTIVE

To examine the impact of the BC FMNCP on the short-term household food insecurity, malnutrition risk, mental well-being, sense of community (secondary outcomes), and subjective social status (exploratory outcome) of adults with low incomes post-intervention and 16 weeks post-intervention.

DESIGN

Secondary analyses from a pragmatic randomized controlled trial conducted in 2019 that collected data at baseline, post-intervention, and 16 weeks post-intervention.

PARTICIPANTS/SETTING

Adults ≥18 years with low incomes were randomized to an FMNCP group (n = 143) or a no-intervention control group (n = 142).

INTERVENTION

Participants in the FMNCP group received 16 coupon sheets valued at $21 Canadian dollars (CAD)/sheet over 10 to 15 weeks to purchase healthy foods from farmers' markets and were eligible to participate in nutrition skill-building activities.

MAIN OUTCOME MEASURES

Outcomes included short-term household food insecurity (modified version of Health Canada's 18-item Household Food Security Survey Module), malnutrition risk (Malnutrition Universal Screening Tool), mental well-being (Warwick-Edinburgh Mental Well-Being Scale), sense of community (Brief Sense of Community Scale), and subjective social status (MacArthur Scale of Subjective Social Status community scale).

STATISTICAL ANALYSIS

Mixed-effects linear regression and multinomial logistic regression examined between-group differences in outcomes post-intervention and 16 weeks post-intervention.

RESULTS

The risk of marginal and severe short-term household food insecurity was lower among those in the FMNCP group compared with those in the control group (relative risk ratio [RRR] 0.15, P = 0.01 and RRR 0.16, P = 0.02) post-intervention, with sustained reductions in severe household food insecurity 16 weeks post-intervention (RRR 0.11, P = 0.01). No statistically significant differences were observed in malnutrition risk, mental well-being, sense of community, or subjective social status post-intervention or 16 weeks post-intervention.

CONCLUSIONS

The BC FMNCP reduced short-term household food insecurity but was not found to improve malnutrition risk or psychosocial well-being among adults with low incomes compared with a no-intervention control group.

Food insecurity and its association with multiple health outcomes among Indigenous peoples in Canada: the buffering role of culture-based resources

OBJECTIVES

Despite growing interest in the health disparities associated with food insecurity, research focusing on Indigenous peoples has been limited, especially in studies using nationally representative samples. This study investigates the association between food insecurity and various health outcomes - self-rated general and mental health, chronic health conditions, suicidal ideation, and obesity - among Indigenous peoples in Canada. It also explores the potential moderating effects of culture-based resources, which include cultural identity affect, cultural group belonging, cultural engagement, and cultural exploration.

DESIGN

The study utilized data from the 2017 Aboriginal Peoples Survey, a nationally representative sample of First Nations individuals living off-reserve, Métis, and Inuit across Canada (N = 15,533). Logistic regression models were used to analyze the data.

RESULTS

Food insecurity was negatively associated with all examined health outcomes. Culture-based resources demonstrated a mixture of anticipated and unexpected effects on these relationships. Consistent with the stress process model, cultural group belonging mitigated the negative impact of food insecurity on all health outcomes. A similar pattern was observed for cultural engagement. However, contrary to expectations from the stress-buffering perspective, little evidence was found to support the moderating effects of cultural identity affect and cultural exploration.

CONCLUSION

The results underscore the detrimental effects of food insecurity on the health of Indigenous peoples in Canada and suggest that culture-based resources, particularly cultural group belonging, play a crucial role in mitigating health disparities.

Effect of food insecurity on depression, anxiety, and stress among resettled Syrian refugees in Ontario

Food insecurity has been linked to adverse health outcomes, particularly among vulnerable populations such as refugees. The aim of this study was to assess the prevalence of food insecurity and its association with depression, anxiety, and stress among resettled Syrian refugee parents in Ontario. This was a cross-sectional study with a total of 540 Syrian refugee parents who resided in Ontario for an average of four years and had at least one child less than 18 years who were interviewed. Information about food insecurity was collected based on the question "During the past year, did you ever eat less because there was not enough food or money for food?". Levels of depression, anxiety, and stress were assessed using the Depression Anxiety Stress Scales (DASS-21). Multiple linear regression analyses were performed to evaluate the relationship between food insecurity and depression, anxiety, and stress after adjusting for sociodemographic, migration-, and health-related factors. 44.6% of respondents reported experiencing food insecurity. Of participants, 7.6%, 8.9%, and 8.5% reported severe to extremely severe levels of depression, anxiety, and stress, respectively. Results of the multiple linear regression analysis showed that food insecurity was significantly associated with higher levels of depression (Adjβ = 2.00, p = 0.008), anxiety (Adjβ = 1.53, p = 0.013), and stress (Adjβ = 1.87, p = 0.019). Implementation of effective government interventions and frameworks are essential to reduce food insecurity among resettled Syrian refugees to ultimately improve their mental health outcomes and overall well-being.

Queering food security research: A critical analysis of 2SLGBTQ+ People's experiences of food insecurity in Toronto during the COVID-19 pandemic

INTRODUCTION

Household food insecurity (HFI), stress, isolation, and discrimination are major determinants of health that disproportionately affect 2SLGBTQ + people. The COVID-19 pandemic potentially exacerbated these inequities. This study investigates HFI rates among 2SLGBTQ + adults living in diverse household conditions during the pandemic and explores the idea that heteronormative conceptions of the "household" may affect measurement of HFI.

METHODS

Cross-sectional survey responses were collected from 437 self-identified 2SLGBTQ + people from Toronto, Canada between March and July 2021. The survey measured HFI, sexual/gender identities, socio-demographic factors, household composition, and psycho-social stress/distress. Multinomial logistic regression was used to assess variation in odds of marginal, moderate, and severe HFI in relation to sexual/gender identities, household composition, psycho-social distress, and socio-demographic covariates.

RESULTS

Forty-two percent of respondents reported some level of HFI, with severe HFI higher among respondents who were bisexual, transgender/gender diverse, and/or assigned-female-at-birth. Living alone was associated with decreased odds of reporting marginal HFI but increased odds of moderate or severe HFI compared to living with a partner, family, or roommates; living with children was associated with decreased odds of both marginal and severe HFI. One indicator of psycho-social distress (perceived discrimination) was associated with higher odds of all levels of HFI, while the other (isolation) was associated with decreased odds of marginal HFI.

CONCLUSION

These findings highlight the high prevalence of HFI linked with discrimination among 2SLGBTQ + individuals during the pandemic. The complicated results regarding household composition and social isolation may suggest a need to revise definitions of the household when measuring, monitoring, and seeking to mitigate HFI in 2SLGBTQ + communities.

Household food insecurity is negatively associated with achievement of prenatal intentions to feed only breast milk in the first six months postpartum

Background

Household food insecurity (HFI) has been associated with suboptimal breastfeeding practices. Postpartum factors reported by caregivers include stressful life circumstances and maternal diet quality concerns. It is unknown whether prenatal breast milk feeding intentions, a well-established predictor of breastfeeding outcomes, differ by HFI status. We explored associations between HFI and prenatal intentions to feed any and only breast milk in the first 6 months postpartum, and achievement of these intentions.

Methods

We utilized data from self-identified biological mothers with children 6-12 months of age who responded to a retrospective, cross-sectional online infant feeding survey conducted in Nova Scotia, Canada. HFI (yes/no) was assessed using the Household Food Security Survey Module. Prenatal intentions to feed any and only breast milk were assessed based on responses to five options for infant milk feeding plans. Achievement of intentions was assessed by breast milk and formula feeding practices in the first 6 months. Multivariable logistic regressions were conducted, adjusting for maternal socio-demographics.

Results

Among 459 respondents, 28% reported HFI; 88% intended to feed any breast milk and 77% intended to feed only breast milk, with no difference by HFI status. Of those intending to feed any breast milk, 99% succeeded, precluding further analysis. Among mothers who intended to provide only breast milk, only 51% achieved their intention, with lower odds among those with HFI (aOR 0.54, 95% CI 0.29-0.98).

Conclusion

HFI was not associated with intentions for feeding breast milk in the first 6 months postpartum, but mothers with HFI were less likely to achieve their intention to provide only breast milk. Further research is needed to understand the underlying reasons for this and to guide intervention designs to address HFI and help mothers reach their breastfeeding goals.

Food insecurity in children and young people in Scotland

The aim of this review is to highlight the key issues in relation to food insecurity among children and young people living in Scotland. It provides an overview of the current context of food insecurity more generally within the UK and specifically in Scotland. Food insecurity has risen in Scotland evidenced through responses to national surveys and the dramatic increase in households relying on emergency food provision. Food insecurity is highest among young people, single parent families and single men. The key drivers of food insecurity include insufficient income, welfare reform, food inflation and geo-political events. Evidence suggests that food insecurity is negatively related to sufficient nutritional intake, and the implications for physical and mental health are profound. Policy actions implemented to mitigate the impact of food insecurity on children and young people include the introduction of the Scottish Child Payment, food voucher schemes, free school meals, and holiday food provision. Further evidence is required to evaluate the success of these policies in reducing or mitigating food insecurity. The review concludes by considering the ways in which a rights-based approach to food might benefit children and young people living in Scotland, and argues that wider systemic change is required.

Food Security Status in Relation to Co-operative Enrolment Among University of Waterloo Undergraduate Students: A Cross-Sectional Analysis

Purpose: Co-operative (co-op) education facilitates development of workplace competencies but may have unintended consequences for financial stability and food security. This study examined the association between co-op program enrolment and food security status among a sample of undergraduate students. Financial insufficiency and strategies to cope with it were also characterized.Methods: Cross-sectional data were collected from 167 co-op and 89 non-co-op students at the University of Waterloo from January to March 2019. Logistic regression assessed associations between co-op program enrolment and food insecurity.Results: Twenty-four percent of co-op and 39.3% of non-co-op students lived in moderately or severely food insecure households. Adjusting for confounders, the odds of living in moderately or severely food insecure households were lower among co-op students (adjusted odds ratio: 0.51, 95% CI: 0.27-0.97), though no association was observed when marginal food insecurity was included within the food insecure category. One-quarter (26.3%) of co-op students and 38.2% of non-co-op students reported financial insufficiency, which they tried to cope with by asking parents or friends for assistance or initiating paid work.Conclusions: Co-op program enrolment was weakly associated with lower odds of living in moderately or severely food insecure households, and food insecurity prevalence was high overall. Efforts are needed to alleviate food insecurity among postsecondary students.

Food Insecurity and Diet Quality Among Adults on Medicaid With and Without a Mental Illness Diagnosis

BACKGROUND

Adults with mental illnesses are more likely to have low income and diet-related chronic diseases.

OBJECTIVE

This study examined associations of mental illness diagnosis status with food insecurity and diet quality and whether the relationship between food security status and diet quality differed by mental illness diagnosis status in adult Medicaid beneficiaries.

DESIGN

This was a secondary cross-sectional analysis of baseline (2019-2020) data collected as part of the LiveWell study, a longitudinal study evaluating a Medicaid food and housing program.

PARTICIPANTS/SETTING

Participants were 846 adult Medicaid beneficiaries from an eastern Massachusetts health system.

MAIN OUTCOME MEASURES

Food security was measured with the 10-item US Adult Food Security survey module (0 = high food security, 1-2 = marginal food security, 3-10 = low/very low food security). Mental illness diagnoses included health record-documented anxiety, depression, or serious mental illness (eg, schizophrenia, bipolar disorder). Healthy Eating Index (HEI-2015) scores were calculated from 24-hour dietary recalls.

STATISTICAL ANALYSES

Multivariable regression analyses adjusted for demographics, income, and survey date.

RESULTS

Participants' mean (standard deviation) age was 43.1 (11.3) years, and 75% were female, 54% Hispanic, 33% non-Hispanic White, and 9% non-Hispanic Black. Fewer than half (43%) of participants reported high food security, with almost one third (32%) reporting low or very low food security. The 341 (40%) participants with one or more mental illness diagnosis had greater odds of low/very low food security (adjusted odds ratio [OR], 1.94; 95% confidence interval [CI], 1.38-2.70) and had similar mean HEI-2015 scores (53.1 vs 56.0; P = 0.12) compared with participants with no mental illness diagnosis. Mean adjusted HEI-2015 scores did not significantly differ by high vs low/very low food security for those without a mental illness diagnosis (57.9 vs 54.9; P = 0.052) or those with a mental illness diagnosis (53.0 vs 52.9; P = 0.99).

CONCLUSION

In a cohort of adults with Medicaid, those with mental illness diagnoses had higher odds of experiencing food insecurity. Overall, diet quality among adults in this sample was low but did not differ by mental illness diagnosis or food security status. These results highlight the importance of augmenting efforts to improve both food security and diet quality among all Medicaid participants.

Food Insecurity during the Pandemic in South Korea: The Effects of University Students' Perceived Food Insecurity on Psychological Well-Being, Self-Efficacy, and Life Satisfaction

This study examined the impact of university students' perceptions of food insecurity on psychological well-being, self-efficacy, and life satisfaction and observed that the students' gender plays a moderating role in this causal relationship, based on a total of 491 university students who participated in this empirical study. This study used SPSS (Version 22.0) and AMOS (Version 20.0) for the analyses. This study examines the structural relationship of this causal model. Our findings suggest that students' perceived food insecurity negatively affects the status of their psychological well-being and self-efficacy. However, contrary to expectations, perceived food insecurity has no negative effects on students' life satisfaction. In addition, the level of students' psychological well-being positively influences their life satisfaction, while self-efficacy does not. The moderating effects of gender differences in this research were also disclosed. Limitations and future research directions are also discussed.

Food-related worry and food bank use during the COVID-19 pandemic in Canada: results from a nationally representative multi-round study

BACKGROUND

Early in the COVID-19 pandemic, nearly one in five adults in Canada worried about having enough food to meet their household's needs. Relatedly, throughout the pandemic, public messaging repeatedly urged Canadians to support food charities, including food banks. Yet few studies have examined food bank usage during the pandemic or whether food charities were widely used by Canadians worried about food access.

METHODS

This study draws on four rounds of nationally representative surveying conducted during the COVID-19 pandemic between May 2020 and December 2021 among adults 18 years and older living in Canada. Descriptive statistics were used to examine rates of food-related worry during all four survey rounds. Data from the fourth survey round, collected in December 2021, were used to explore use of food-based community programs since the onset of the pandemic, including food banks. Logistic regression analyses were used to examine differences in socio-demographic and health-related characteristics between adults who did and did not report accessing food banks before and after adjusting for household income.

RESULTS

Across survey rounds (n = 12,091), more than one in seven participants reported stress or worry related to having enough food to meet their household's basic needs in the previous two weeks. Yet, by December 2021, fewer than 4% of participants reported ever accessing a food bank during the pandemic. Younger age, living with a child, financial concerns due to the pandemic, two different measures of food worry, pre-existing mental health conditions, disability, LGBT2Q + identity, and racialized or Indigenous identity, were each statistically significantly associated with higher odds of using food banks even when controlling for household income.

CONCLUSIONS

Despite persistently high rates of food-related worry in 2020 and 2021 in Canada, relatively few adults reported accessing food banks or other charity-based community food programs. While respondents facing social, financial, and health-related inequities and reporting food worry were more likely to use food banks, most respondents did not report food bank use, regardless of financial or demographic circumstances or experiences of food worry. Findings align with previous research indicating that more adequate and comprehensive supports are needed to alleviate food-related-worry in Canada.

The joint effect of female sex and food insecurity on self-reported mood disorder among Canadian adults: the Canadian community health survey

BACKGROUND

Food insecurity is prevalent in Canada and may influence mental health, particularly among females. The present study examined the joint effect of female sex and food insecurity on mood disorders.

METHODS

The study used data from 104,420 adults aged 18 years or older who participated in the 2017/2018 Canadian Community Health Survey (CCHS). Log-binomial models explored the independent and joint associations of female sex and food insecurity with the prevalence of self-reported mood disorder. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were estimated. Relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S) were used to assess the additive interaction of female sex and food insecurity. The complex survey design was taken into consideration.

RESULTS

The prevalence of mood disorder was 6.7% for males and 11.4% for females, with an adjusted prevalence ratio being 1.59 (95% CI 1.51, 1.68) for females versus males. Mood disorder was associated with moderate food insecurity (PR 2.06, 95% CI 1.91, 2.23) and severe food insecurity (PR 3.29, 95% CI 3.06, 3.55). There was a significant additive interaction between female sex and food insecurity in association with the prevalence of mood disorders among females aged 18 to 39 years (RERI 1.19, 95% CI 0.27,2.08).

CONCLUSION

Food insecurity was associated with an increased prevalence of mood disorders, especially in younger females. Interventions that facilitate access to food while being cognizant of the socioeconomic vulnerabilities of females may have substantial benefits for the prevention and management of mood disorders.

Food Insecurity and Blood Pressure in a Multiethnic Population

Food insecurity is a social determinant of health and is increasingly recognized as a risk factor for hypertension. Native Hawaiians bear a disproportionate burden of hypertension and known risk factors. Despite this, the relative effects of food insecurity and financial instability on blood pressure have yet to be investigated in this population. This study examines the relative effects of food insecurity and financial instability on blood pressure, controlling for potential confounders in a multiethnic sample. Participants (n = 124) were recruited from a U.S. Department of Agriculture-funded study called the Children's Healthy Living Center of Excellence. Biometrics (i.e., blood pressure, weight, and height) were measured. Demographics, physical activity, diet, psychosocial variables, food insecurity, and financial instability were assessed via self-report questionnaires. Hierarchical linear regression models were conducted. Model 1, which included sociodemographic variables and known biological risk factors, explained a small but significant amount of variance in systolic blood pressure. Model 2 added physical activity and daily intake of fruit, fiber, and whole grains, significantly improving the model. Model 3 added financial instability and food insecurity, further improving the model (R2 = 0.37, F = 2.67, p = 0.031). Food insecurity, female sex, and BMI were significantly and independently associated with increased systolic blood pressure. These results suggest a direct relationship between food insecurity and systolic blood pressure, which persisted after controlling for physical activity, consumption of fruits, fiber, and whole grains, and BMI. Efforts to reduce food insecurity, particularly among Native Hawaiians, may help reduce hypertension in this high-risk population.

Prevalence and sociodemographic correlates of food insecurity among post-secondary students and non-students of similar age in Canada

BACKGROUND

The results of several recent campus-based studies indicate that over half of post-secondary students in Canada are food insecure, but the vulnerability of this group has not been considered in research on predictors of food insecurity in the Canadian population. Our objectives were to (1) compare the prevalence of food insecurity among post-secondary students and non-students of similar age; (2) examine the relationship between student status and food insecurity among young adults while accounting for sociodemographic characteristics; and (3) identify the sociodemographic characteristics associated with food insecurity among post-secondary students.

METHODS

Using data from the 2018 Canadian Income Survey, we identified 11,679 young adults aged 19-30 and classified them into full-time postsecondary students, part-time post-secondary students, and non-students. Food insecurity over the past 12 months was assessed with the 10-item Adult Scale from the Household Food Security Survey Module. Multivariable logistic regression analyses were used to estimate the odds of food insecurity by student status while accounting for sociodemographic characteristics, and to identify sociodemographic characteristics predictive of food insecurity among post-secondary students.

RESULTS

The prevalence of food insecurity was 15.0% among full-time postsecondary students, 16.2% among part-time students, and 19.2% among non-students. After adjusting for sociodemographic factors, full-time postsecondary students had 39% lower odds of being food insecure as compared to non-students (aOR 0.61, 95% CI 0.50-0.76). Among postsecondary students, those with children (aOR 1.93, 95%CI 1.10-3.40), those living in rented accommodation (aOR 1.60, 95%CI 1.08-2.37), and those in families reliant on social assistance (aOR 4.32, 95%CI 1.60-11.69) had higher adjusted odds of food insecurity, but having at least a Bachelor's degree appeared protective (aOR: 0.63, 95% CI 0.41-0.95). Every $5000 increase in adjusted after-tax family income was also associated with lower adjusted odds of food insecurity (aOR 0.88, 95%CI 0.84-0.92) among post-secondary students.

CONCLUSIONS

In this large, population-representative sample, we found that young adults who did not attend post-secondary school were more vulnerable to food insecurity, particularly severe food insecurity, than full-time post-secondary students in Canada. Our results highlight the need for research to identify effective policy interventions to reduce food insecurity among young, working-age adults in general.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Developing a conceptual framework for the relationship between food security status and mental health among low-income mothers

Introduction

Building household resiliency is one strategy that may help insulate households from the effects of food system volatility that contributes to in food insecurity. A stronger understanding of the relationship between food security and mental health is needed to identify potential factors for intervention to improve household resiliency to food system stressors. Because mothers often make household food decisions, they are an important population for building household resiliency. The purpose of this study was to develop and test a conceptual framework for the relationship between food security and mental health for low-income mothers and to identify potential targets for intervention.

Methods

A conceptual framework was developed based on the existing literature on mental health and food security, as well as factors that impact both constructs. This framework was tested by a path analysis using data from a 2021 cross-sectional survey of low-income Virginia mothers that used validated scales to assess food security status, indicators of mental and physical health, food coping strategies, and social support.

Results and discussion

The initial model was systematically adapted to develop the final retained model. The retained model did not include a direct effect of food security on mental health, but highlighted two significant mediators of the relationship, food coping strategies and social support. While the effect of social support was not practically significant, the effects of food coping strategies as a mediator from food security to perceived stress and life satisfaction were small (β = 0.21, 0.14, respectively; p &lt; 0.001). The retained model provides a framework for understanding the relationship between food security and mental health and highlights potential targets for intervention. Notably, reducing the need for mothers to utilize food coping strategies should be targeted on multiple levels to reduce the impact on mental health and ultimately improve resiliency to future food system shocks.

A developmental lens on food insecurity: the role of children in the household and age groups on food insecurity impacting mental health

Objectives: The current study investigates the differential coping strategies and mental health consequences of food insecurity in relation to period of the lifespan (middle vs. late adulthood) and household composition (living with vs. without children).Method: Using a cross-sectional design, food-related coping strategies, anxiety (GAD-7), and depression (WHO-5) were compared among the following groups: middle adults with vs. without children, and middle adults without children vs. late adults without children. Predictive models using hierarchical linear regression examined the main effects of age and household composition with food insecurity predicting mental health; additionally, the interaction of food insecurity with age and household composition was tested in a separate model. Results: Middle-adults with and without children share similar frequencies in levels of food insecurity and coping strategies, which were significantly higher than late adults.Conclusion: The link between food insecurity and depression was stronger for middle-adults without children than late adults. Food insecurity was a stronger predictor of anxiety for middle-adults with children than those without.

Financial Wellbeing and Quality of Life Among a Sample of the Lebanese Population: The Mediating Effect of Food Insecurity

Background

Lebanon is undergoing multiple overlapping crises, affecting the food security, financial well-being, and quality of life (QOL) of its residents.

Objective

The primary objective was to assess the food insecurity (FI) status of a sample of the Lebanese population. The second objective was to explore factors related to QOL parameters and evaluate the mediating effect of food security between financial well-being and QOL.

Methods

The study was cross-sectional and enrolled 412 participants recruited online using the snowball sampling technique. The survey included questions related to sociodemographic and economic characteristics of Lebanese households and validated scales to assess FI, QOL measures, financial well-being, and fear of COVID-19.

Results

Almost 43% of the study participants reported being food insecure, with 31% experiencing mild FI, 10% moderate FI, and 1.5% severe FI. Compared to food-insecure participants, food secure participants had a significantly higher income (58.5% vs. 39.2%, p < 0.001), a university education level (96.6% vs. 88.1%, p = 0.002), an average perceived financial status (83.9% vs. 65.9%), higher financial well-being scores (5.14 vs. 3.19, p < 0.001), and lower crowding index (0.94 ± 0.4 vs. 1.09, p = 0.002). Multivariate analysis showed that FI was not associated with physical (Beta = −1.48, 95% CI: −3.10; 0.13) and mental (Beta = −1.46, 95% CI −3.68; 0.75) QOL, after adjusting for other demographic and socioeconomic correlates. This association remained non-significant when introducing the financial well-being variable to the model. Mediation analyses showed that the FI variable mediated the association between financial well-being and physical QOL (Beta = 0.19, 95% CI: 0.02; 0.36), but not the mental QOL (Beta = −0.02, 95% CI: −0.20; 0.14).

Conclusion

Food insecurity was prevalent in our study sample, and it mediated the association between financial well-being and physical, but not mental, QOL parameters. These findings call for evidence-based policies and programs to help improve the food security and well-being of Lebanese households amidst these unprecedented circumstances.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Household food insecurity, sense of community belonging, and access to a regular medical doctor as mediators in the relationship between mood and/or anxiety disorders and self-rated general health in Canada between 2011 and 2016: a serial cross-sectional analysis

OBJECTIVE

To assess whether (household) food insecurity, access to a regular medical doctor, and sense of community belonging mediate the relationship between mood and/or anxiety disorders and self-rated general health.

METHODS

We used six annual cycles of the Canadian Community Health Survey, including Canadian adults aged 18-59 years, between 2011 and 2016. Mediation models, adjusted for key determinants of health, were based on a series of weighted logistic regression models. The Sobel products of coefficients approach was used to estimate the indirect effect, and bootstrapping to estimate uncertainty.

RESULTS

The annual (weighted) prevalence of mood and/or anxiety disorders increased from 11.3% (2011) to 13.2% (2016). Across the 6 years, 23.9-27.7% of individuals with mood and/or anxiety disorders reported fair/poor self-rated health as compared with 4.9-6.5% of those without mood and/or anxiety disorders (p<0.001). Similarly, the 7.2-8.9% of the population reporting fair/poor self-rated health were disproportionately represented among individuals reporting food insecurity (21.1-26.2%, p<0.001) and a weak sense of community belonging (10.0-12.2%, p<0.001). A significantly lower prevalence of poor self-rated health was observed among respondents reporting having access to a regular medical doctor in 2012, 2015, and 2016. In 2016, sense of community belonging and food insecurity significantly mediated the effect of mood and/or anxiety disorders on self-rated general health. Access to a regular medical doctor did not mediate this relationship.

CONCLUSION

Efficient policies that address food insecurity and sense of community belonging are needed to decrease the mental health burden and improve health satisfaction of Canadians.

Food insecurity and severe mental illness: understanding the hidden problem and how to ask about food access during routine healthcare

Food insecurity occurs when an individual lacks the financial resources to ensure reliable access to sufficient food to meet their dietary, nutritional and social needs. Adults living with mental ill health, particularly severe mental illness, are more likely to experience food insecurity than the general adult population. Despite this, most interventions and policy reforms in recent years have been aimed at children and families, with little regard for other vulnerable groups. Initiating a conversation about access to food can be tricky and assessing for food insecurity does not happen in mental health settings. This article provides an overview of food insecurity and how it relates to mental ill health. With reference to research evidence, the reader will gain an understanding of food insecurity, how it can be assessed and how food-insecure individuals with severe mental illness can be supported. Finally, we make policy recommendations to truly address this driver of health inequality.

Food worry and mental health outcomes during the COVID-19 pandemic

Background

There is limited and inconsistent literature examining the relationship between food worry and mental health in the context of the COVID-19 pandemic. This study examined the association between food worry and mental health among community dwelling Canadian adults during the COVID-19 pandemic.

Methods

Adults age 16 years and older completed an anonymous online questionnaire between April 1, 2020 and November 30 2020. Measures of pre-pandemic and current food worry, depression (PHQ-2), anxiety (GAD-2), and sociodemographic variables were included. Multivariable logistic regression models were used to determine the association between food worry and symptoms of depression and anxiety.

Results

In total, 1605 participants were included in analyses. Worry about affording food was reported by 320 (14.78%) participants. In models adjusting for sociodemographic covariates, compared with people without food worry, participants who had food worry were 2.07 times more likely to report anxiety symptoms (aOR 2.07, 95% CI: 1.43 – 2.98, p < .001) and were 1.9 times more likely to report depressive symptoms (aOR 1.89, 95% CI: 1.39–2.57, p < .0001). Lower income, lower education, and pre-existing mental health conditions were significant predictors of symptoms of depression. Female gender, younger age, lower education, lower income, and pre-existing mental health condition were significant predictors of anxiety symptoms.

Conclusion

Our study highlights the relationship between food worry and poor mental health. Policy supports such as improved income supports, clinical implications such as screening for food worry in primary care, referral to emergency food programs and support with meal planning may help mitigate mental health symptoms during the current pandemic, during future societal recovery from this pandemic and during future pandemics.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13410-7.

What is known about the prevalence of household food insecurity in Canada during the COVID-19 pandemic: a systematic review

INTRODUCTION

Household food insecurity (HFI) is a persistent public health issue in Canada that may have disproportionately affected certain subgroups of the population during the COVID-19 pandemic. The purpose of this systematic review is to report on the prevalence of HFI in the Canadian general population and in subpopulations after the declaration of the COVID-19 pandemic in March 2020.

METHODS

Sixteen databases were searched from 1 March 2020 to 5 May 2021. Abstract and full-text screening was conducted by one reviewer and the inclusions verified by a second reviewer. Only studies that reported on the prevalence of HFI in Canadian households were included. Data extraction, risk of bias and certainty of the evidence assessments were conducted by two reviewers.

RESULTS

Of 8986 studies identified in the search, four studies, three of which collected data in April and May 2020, were included. The evidence concerning the prevalence of HFI during the COVID-19 pandemic is very uncertain. The prevalence of HFI (marginal to severe) ranged from 14% to 17% in the general population. Working-age populations aged 18 to 44 years had higher HFI (range: 18%-23%) than adults aged 60+ years (5%-11%). Some of the highest HFI prevalence was observed among households with children (range: 19%-22%), those who had lost their jobs or stopped working due to COVID-19 (24%-39%) and those with job insecurity (26%).

CONCLUSION

The evidence suggests that the COVID-19 pandemic may have slightly increased total household food insecurity in Canada during the COVID-19 pandemic, especially in populations that were already vulnerable to HFI. There is a need to continue to monitor HFI in Canada.

Cumulative lifetime violence severity, social determinants and anxiety in a national sample of Canadian men

BACKGROUND

Despite anxiety disorders being the ninth leading cause of disability and associated with social inequities, little attention has been given to how intersections among social determinants of health and chronic stressors such as cumulative lifetime violence affect the likelihood of experiencing anxiety disorders. Our purpose was to explore the relationships among cumulative lifetime violence severity as target and perpetrator, social determinants of health and generalized anxiety disorder in Canadian men.

METHODS

Using a community sample of 592 Canadian men who self-identified as having experienced violence, we developed and tested an evidence-based model of generalized anxiety disorder including indicators of cumulative lifetime violence, gender, social location, socio-economic disparity, personal resources and other chronic stressors using logistic regression.

RESULTS

Most men (76.4%, n = 452) reported experiences as both target and perpetrator. The model accounted for 50.8% of the variance in anxiety severity χ2 (8) = 264.43, p = .000). The prevalence of probable generalized anxiety disorder was 30.9%, a rate higher than that found among Canadian men in general in the same period. Remarkably, the likelihood of generalized anxiety disorder increased by a factor of 5.30 for each increase of 1 in cumulative lifetime violence severity, and six-fold for feeling overwhelmed by demands of everyday life (aOR = 6.26). Masculine discrepancy stress, having been born in Canada, unemployment, and food insecurity also contributed significantly to increasing the likelihood of generalized anxiety disorder. Both social support and mastery had significant aORs < 1, suggesting possible protective effects. Together these findings delineate characteristics and social determinants that may heighten vulnerability to generalized anxiety disorder and influence its progression among men who have experienced lifetime violence.

CONCLUSIONS

These findings are the first evidence that Canadian men with lifetime violence histories are a sub-group disproportionately affected by chronic stressors and socio-economic disparities and that together the presence and/or severity of these factors increases their vulnerability to generalized anxiety disorder. Our results highlight the importance of strengths-based trauma- and violence-informed approaches to care, including practical resources to reduce the stress of everyday life, improve social support, and reinforce personal control and choice.

Understanding the Relationship between Food Security and Mental Health for Food-Insecure Mothers in Virginia

Food insecurity, which disproportionately impacts mothers, can have chronic consequences on physical and mental health. There is a relationship between food insecurity and mental health, but the relationship’s mechanisms are unclear. This study aimed to understand how mental health outcomes differ by food insecurity severity and race among Virginia mothers. A cross-sectional survey employed previously validated food security status measures, physical and mental health, social support, and food coping strategies. Results were analyzed using descriptive statistics, Spearman’s rank-order correlations, linear regression, and chi-squared with effect sizes. Overall, respondents (n = 1029) reported worse mental health than the U.S. average (44.3 ± 10.1 and 50, respectively). There was a large effect of food security on mental health (d = 0.6), with worse mental health outcomes for mothers experiencing very low food security (VLFS) than low food security (LFS; p < 0.001). There was a small effect of race on mental health (φc = 0.02), with Black mothers having better mental health than White mothers (p < 0.001). Compared to mothers experiencing LFS, mothers experiencing VLFS had less social support (d = 0.5) and used more food coping strategies, especially financial strategies (d = −1.5; p < 0.001). This study suggests that food-insecure mothers experience stressors and lack adequate social support, which is even more distinct for mothers experiencing VLFS.

The relationship between diet quality and the severity of household food insecurity in Canada

OBJECTIVE

To examine the relationship between the dietary quality of Canadian children and adults and household food insecurity status.

DESIGN

Dietary intake was assessed with one 24-h recall. Households were classified as food secure or marginally, moderately or severely food insecure based on their responses to the Household Food Security Survey Module. We applied multivariable analyses of variance to determine whether % energy from ultra-processed foods, fruit and vegetable intake, Healthy Eating Index (HEI) scores, macronutrient composition and micronutrient intakes per 1000 kcal differed by food insecurity status after accounting for income, education and region. Analyses were run separately for children 1-8 years and 9-18 years and men and women 19-64 years of age.

SETTING

Ten provinces in Canada.

PARTICIPANTS

Respondents to the 2015 Canadian Community Health Survey-Nutrition, aged 1-64 years, with complete food insecurity data and non-zero energy intakes, N 15 909.

RESULTS

Among adults and children, % energy from ultra-processed foods was strongly related to severity of food insecurity, but no significant trend was observed for fruit and vegetable intake or HEI score. Carbohydrate, total sugar, fat and saturated fat intake/1000 kcal did not differ by food insecurity status, but there was a significant negative trend in protein/1000 kcal among older children, a positive trend in Na/1000 kcal among younger children and inverse associations between food insecurity severity and several micronutrients/1000 kcal among adults and older children.

CONCLUSIONS

With more severe household food insecurity, ultra-processed food consumption was higher, and diet quality was generally lower among both adults and children.

Prevalence and correlates of depression among pregnant adolescents in primary maternal care in Nigeria

To examine the prevalence as well as the clinical and psychosocial factors associated with depression and depression severity in pregnant adolescents. Participants were consecutively registered pregnant adolescents presenting to 30 selected primary maternal and child healthcare centers in Ibadan, Nigeria, who were screened for enrolment into an intervention trial for perinatal depression (depression defined as a score of ≥ 12 on the Edinburg Postnatal Depression Scale [EPDS] and met the DSM-IV diagnostic criteria for depression). Of the 1359 pregnant adolescents screened, 246 (18.1%) had depression. Mean age was 18.4 (sd 1.00), 58.9% were either married or cohabiting, 91.4% were primipara, and the mean gestational age was 23.8 weeks (sd 5.4 weeks). Food insecurity (going to bed hungry at least once in the previous week because there was no food to eat) was reported by 13.3%. In bivariate analysis, younger age, not living with a partner, unemployment, and food insecurity were associated with depression. In bivariate analysis, younger age, not living with a partner, unemployment and food insecurity were associated with depression, while younger age, being single and food insecurity were independently associated with being depressed in multivariate analysis. Severity of depression was related to age, higher anxiety and disability scores, lower quality of life scores across all domains and poorer attitudes towards pregnancy. Depression was associated with indices of higher social disadvantage among adolescents. Delaying childbearing and measures aimed at alleviating poverty may be important in preventing depression in this vulnerable group.

The short- and long-term effects of the Great Recession on late-life depression in Europe: The role of area deprivation

INTRODUCTION

The prevalence of depression increases in times of economic crises. Less is known about whether people living in advantaged or disadvantaged areas suffer equally from negative effects of crisis.

OBJECTIVE

To explore the role of area deprivation on the short- and long-term effects of the Great Recession in Europe on late-life depression.

METHODS

Individual panel data from Austria, Belgium, Denmark, France, Germany, Italy, Spain, Sweden, Switzerland of the SHARE (age 50+, n = 6866) between 2004 and 2017 were used. Late-life depression (LLD) was measured by the EURO-D scale (4+ symptoms). Area deprivation was assessed by a country-specific z-standardized scale measuring perceived access to various services and quality of the social and built environment. Quarterly country-level GDP and yearly unemployment data were explored to define country-specific durations of the Great Recession. Individual fixed effects panel regressions were estimated controlling for time-varying socioeconomic and health-related confounders.

RESULTS

Prevalence and incidence of late-life depression was generally higher in deprived than in non-deprived areas, and these differences in prevalence and incidence increased during the Great Recession. Regressions showed that the Great Recession was related to a 23% higher long-term risk of late-life depression (OR: 1.23, CI: 1.05-1.44) for all study participants. In the short-term of the Great Recession, people from deprived areas had a 22% higher risk of late-life depression (OR: 1.22, CI: 1.02-1.46) than people from non-deprived areas.

CONCLUSION

The findings suggest that older adults exposed to adverse area determinants suffer more from the negative short-term effects of a severe economic crisis on depression and mental health inequalities may have increased between people living in deprived versus non-deprived areas. This potential increase in mental health inequalities warrants particular attention for those people living in deprived areas.

Classification Differences in Food Insecurity Measures between the United States and Canada: Practical Implications for Trend Monitoring and Health Research

BACKGROUND

Food insecurity, inadequate access to food due to financial constraints, is a major public health issue in the United States and Canada, where the same 18-item questionnaire is used to monitor food insecurity. Researchers often assume that findings on food insecurity from the 2 countries are comparable with each other, but there are between-country differences in how food insecurity status is determined.

OBJECTIVES

We aimed to compare the distribution of household food insecurity in the Canadian population applying the US and Canadian classification schemes. We also examined the extent to which associations between food insecurity and adults' health differ under the 2 schemes.

METHODS

We used the population-representative Canadian Community Health Survey 2005-2017 linked to administrative health records. Food insecurity was measured by the Household Food Security Survey Module. Adults 18 y and older with valid food insecurity status were included from all jurisdictions except Quebec (n = 403,200). We cross-tabulated food insecurity status classified by the US and Canadian schemes. We also fitted logistic regressions on self-reported and objective health measures adjusting for confounders.

RESULTS

Applying the Canadian classification scheme, 7.7% of households were food insecure; the number fell to 6.0% with the US scheme. Associations between food insecurity status and health measures were mostly similar across classification schemes, although the associations between food insecurity and self-reported health were slightly larger if the US scheme was applied. Marginal food security/insecurity was associated with worse health measures irrespective of the classification scheme. United States-Canada discordance in classification of marginal food security/insecurity had a limited effect on health prediction.

CONCLUSIONS

United States-Canada differences in classification affected the apparent distribution of household food insecurity but not the associations between food insecurity and measures of adult health. Marginal food security/insecurity should be set apart from the food-secure group for trend monitoring and health research.

Conceptualising household food insecurity in Northern Ireland: risk factors, implications for society and the economy, and recommendations for business and policy response

Household food insecurity in developed nations has been identified as a significant public health concern. Although various research on the topic exists, such as contributors to food insecurity, and implications for individual physical and mental health outcomes; there is currently a lack of consideration as to how individual implications of food insecurity such as poor physical and mental health can consequently impact on business and the wider economy. In addition, there is a lack of conceptual literature related to food insecurity. Stakeholder interviews (n = 19) were conducted, and data were used to inform the conceptual model (risk factors, potential implications for individuals, the economy and business, and opportunities for business and policy response). The main suggested implications related to business and the economy were reduced contribution to the workforce and the economy, and increased cost pressures on the National Health Service. Business responses suggested included the inclusion of initiatives to address food insecurity in corporate social responsibility strategies, and further involvement of food businesses/retailers in redistributing surplus food. Policy responses suggested included policies relating to welfare, wages and work contracts, food redistribution incentives, sustainability, and community interventions in disadvantaged areas. The resulting model is unique in conceptualising food insecurity in the Northern Ireland context, with applicability to the UK and other developed nations.

A comparison of household food insecurity rates in Newfoundland and Labrador in 2011-2012 and 2017-2018

OBJECTIVES

The prevalence of household food insecurity in Newfoundland and Labrador (NL) fell sharply between 2007 and 2011, but it appears to have risen since then. Our objective was to compare the prevalence of food insecurity between 2011-2012 and 2017-2018 in relation to population socio-demographic characteristics.

METHODS

Our analytic sample comprised all NL households in the Canadian Community Health Survey (CCHS) cycles 2011-2012 and 2017-2018, n = 6800. We stratified the prevalence of household food insecurity for each cycle by socio-demographic characteristics and applied multivariable logistic regression models to determine food insecurity odds in 2017-2018 compared with 2011-2012 after controlling for socio-demographic covariates. Interactions of covariates with survey cycle were tested and models stratified when warranted.

RESULTS

The prevalence of food insecurity rose from 12.0% (95% CI 10.5, 13.6) in 2011-2012 to 14.7% (95% CI 13.1, 16.6) in 2017-2018. After adjusting for household socio-demographic variables, the odds of food insecurity was 1.49 (95% CI 1.27, 1.75) in 2017-2018. The prevalence of food insecurity had increased significantly among unattached individuals, renters, households with low educational attainment, and households with income above the Low Income Measure, with concomitant increases in the contribution of these groups to the total provincial prevalence of food insecurity in 2017-2018 compared with that in 2011-2012.

CONCLUSION

The odds of food insecurity among NL households increased significantly from 2011-2012 to 2017-2018. Given the serious negative health implications of household food insecurity, the province should draw on the lessons from its earlier success in food insecurity reduction to reverse the current trend.

Examining the associations between food worry and mental health during the early months of the COVID-19 pandemic in Canada

OBJECTIVE

Little is known about the association between mental health and diminished food worry during the COVID-19 pandemic. This paper examines worry about having enough food to meet household needs and its association with mental health during the early months of the pandemic in Canada.

METHODS

Data are drawn from the first round of a multi-round mental health monitoring survey. Online surveys were administered between May 14 and 29, 2020, to a nationally representative sample of Canadian adults (n = 3000). Logistic regression models were used to examine associations between food worry and mental health indicators (anxious/worried, depressed, worse mental health compared with pre-pandemic, and suicidal thoughts/feelings), after adjusting for socio-demographic characteristics and pre-existing mental health conditions. Fully adjusted models explored the impact of controlling for financial worry due to the pandemic in the previous 2 weeks.

RESULTS

Overall, 17.3% of the sample reported food worry due to the pandemic in the previous 2 weeks, with the highest prevalence found among those with a reported disability (29.3%), Indigenous identity (27.1%), or pre-existing mental health condition (25.3%). Compared with participants who did not report food worry, those who did had higher odds of reporting feeling anxious/worried (OR=1.36, 95% CI: 1.08-1.71) and suicidal thoughts/feelings (OR=1.87, 95% CI: 1.24-2.80) when controlling for socio-demographics, pre-existing mental health conditions, and financial worry.

CONCLUSION

This paper provides insights about the associations between food worry and mental health in Canada during the COVID-19 pandemic and indicates the need for improved policies and social supports to mitigate food worry and associated mental health outcomes.

Examining the relationship between food insecurity and causes of injury in Canadian adults and adolescents

BACKGROUND

Food insecurity, as an indicator of socioeconomic disadvantages and a determinant of health, may be associated with injury by increasing risk exposure and hampering risk mitigation. We examined the association between food insecurity and common causes of injury in the general population.

METHODS

Linking the Canadian Community Health Survey 2005-2017 to National Ambulatory Care Reporting System 2003-2017, this retrospective cohort study estimated incidence of injury-related emergency department (ED) visits by food insecurity status among 212,300 individuals 12 years and above in the Canadian provinces of Ontario and Alberta, adjusting for prior ED visits, lifestyle, and sociodemographic characteristics including income.

RESULTS

Compared to those in food-secure households, individuals from moderately and severely food-insecure households had 1.16 (95% confidence interval [CI] 1.07-1.25) and 1.35 (95% CI 1.24-1.48) times higher incidence rate of ED visits due to injury, respectively, after confounders adjustment. The association was observed across sex and age groups. Severe food insecurity was associated with intentional injuries (adjusted rate ratio [aRR] 1.81; 95% CI 1.29-2.53) including self-harm (aRR 1.87; 95% CI 1.03-3.40) and violence (aRR 1.79; 95% CI 1.19-2.67) as well as non-intentional injuries (aRR 1.34; 95% CI 1.22-1.46) including fall (aRR 1.43; 95% CI 1.24-1.65), medical complication (aRR 1.39; 95% CI 1.06-1.82), being struck by objects (aRR 1.43; 95% CI 1.07-1.91), overexertion (aRR 1.31; 95% CI 1.04-1.66), animal bite or sting (aRR 1.60; 95% CI 1.08-2.36), skin piercing (aRR 1.80; 95% CI 1.21-2.66), and poisoning (aRR 1.65; 95% CI 1.05-2.59). Moderate food insecurity was associated with more injuries from violence (aRR 1.56; 95% CI 1.09-2.21), falls (aRR 1.22; 95% CI 1.08-1.37), being struck (aRR 1.20; 95% CI 1.01-1.43), and overexertion (aRR 1.25; 95% CI 1.04-1.50). Moderate and severe food insecurity were associated with falls on stairs and being struck in non-sports settings but not with falls on same level or being struck during sports. Food insecurity was not related to transport injuries.

CONCLUSIONS

Health inequity by food insecurity status extends beyond diseases into differential risk of injury, warranting policy intervention. Researchers and policymakers need to address food insecurity as a social determinant of injury to improve health equity.

Food Insecurity and its Impact on Body Weight, Type 2 Diabetes, Cardiovascular Disease, and Mental Health

Purpose of Review

Food insecurity (FI) is a serious public health issue affecting 2 billion people worldwide. FI is associated with increased risk for multiple chronic diseases, including obesity, type 2 diabetes, cardiovascular disease, and mental health. We selected these four chronic diseases given their global prevalence and comorbid associations with each other. We evaluated the most recent literature published over the past 5 years and offer strategies for the screening of FI.

Recent Findings

Recent systematic reviews and meta-analyses report an association between FI and obesity in adult women as well as adult men and women living in low- and middle-income countries. Gender differences also were observed between FI and type 2 diabetes, such that adult women showed an increased risk for type 2 diabetes. This association was influenced by social determinants of health. Very low food security (i.e., high FI) was associated with increased risk for cardiovascular disease and a higher risk for cardiovascular disease mortality. Finally, several studies showed an association between FI and adverse mental health outcomes, including increased risk for stress, depression, anxiety, sleep disorders, and suicidal ideation.

Summary

FI and its negative association with body weight, type 2 diabetes, cardiovascular disease, and mental health provide a compelling rationale for identification of FI in clinical settings. Brief, well-validated screening measures are available in multiple languages. Despite the need for FI screening, many guidelines do not address its implementation. For this reason, more research and targeted interventions are needed to increase FI screening rates and close the loop in the coordination of resources.

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

Objectives

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

Methods

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

Results

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

Conclusion

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

Food insecurity, chronic pain, and use of prescription opioids

Chronic pain has been on the rise in recent decades in Canada. Accordingly, the use of prescription opioids (PO) in Canada increased drastically between 2005 and 2014, only starting to decrease in 2015. Both pain and PO use have serious public health repercussions, disproporionately affecting select socially disadvantaged populations. Food insecurity is a strong risk factor for mental disorders and suicidal outcomes, yet its relationship to chronic pain and PO use is largely unknown. Using two recent cycles from the population representative Canadian Community Health Survey (CCHS), we examined the association of household food insecurity status with chronic pain and PO use among Canadians 12 years and older, adjusting for health and sociodemographic characteristics. Compared to food-secure individuals, marginally, moderately, and severely food-insecure individuals had 1.31 (95% confidence interval [CI] 1.15-1.48), 1.89 (95% CI 1.71-2.08), and 3.29 (95% CI 2.90-3.74) times higher odds of experiencing chronic pain and 1.55 (95% CI 1.30-1.85), 1.77 (95% CI 1.54-2.04), and 2.65 (95% CI 2.27-3.09) times higher odds of using PO in the past year, respectively. The graded association with food insecurity severity was also found in severe pain experience and pain-induced activity limitations among chronic pain patients and, less consistently, in intensive, excess, and alternative use of PO and its acquisition through means other than medical prescription among past-year PO users. Food insecurity was a much more powerful predictor of chronic pain and PO use than other well-established social determinants of health like income and education. Policies reducing food insecurity may lower incidence of chronic pain and help contain the opioid crisis.

Severe Psychopathology and Substance Use Disorder Modify the Association Between Housing Trajectories and Food Security Among Homeless Adults

Purpose: We examined the housing trajectories of homeless people with mental illness over a follow-up period of 6 years and the association of these trajectories with food security. We then examined the modifying role of psychopathology and alcohol and substance use disorders in this association. Materials and Methods: We followed 487 homeless adults with mental illness at the Toronto site of the At Home/Chez-Soi project-a randomized trial of Housing First. Food security data were collected seven times during the follow-up period. Psychopathology (Colorado Symptom Index score) and alcohol and substance use disorders were assessed at baseline. Housing trajectories were identified using group-based trajectory modeling. Logistic regression was used to estimate the association between housing trajectory groups and food security. Results: Three housing trajectory groups were identified: rapid move to consistent stable housing (34.7%), slow and inconsistent housing (52.1%), and never moved to stable housing (13.2%). Individuals included in the rapid move to consistent housing trajectory group had higher odds of remaining food secure compared with those in the never moved to stable housing trajectory group over the follow-up period [AOR 2.9, 95% CI: 1.3-6.6, P-value: 0.009]. However, when interactions were considered, this association was significant among those with moderate psychopathology but not severe psychopathology. Individuals with substance use disorder and in the never moved to stable housing group had the lowest food security status. Discussion: Severe psychopathology and substance use disorders modified the association between housing trajectories and food security. International Standard Randomized Control Trial Number Register (ISRCTN42520374).

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

Background

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

Methods

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

Results

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

Conclusions

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

Prevalence of Food Insecurity Among Pregnant Women: A Canadian Study in a Large Urban Setting

OBJECTIVE

Nutritional and financial needs increase during pregnancy, making pregnant women particularly vulnerable to food insecurity. Our objective was to document the prevalence of food insecurity among pregnant women receiving prenatal care in an urban centre in Canada and to identify factors associated with food insecurity.

METHODS

This cross-sectional study recruited pregnant women receiving prenatal care at one of two Toronto hospitals: Site 1 and Site 2 (serving a more disadvantaged population) between October 1, 2018 and October 1, 2019. Demographic information was collected, and the U.S. Household Food Security Survey Module was used to assess food security. Comparisons were made using χ² tests, two-tailed t tests, or Mann-Whitney tests for categorical and continuous variables, as appropriate. Binary logistic regression and multivariate analyses were performed to assess associations with food insecurity and differences between hospitals sites.

RESULTS

We recruited 626 participants (316 at Site 1 and 310 at Site 2). Prevalence of food insecurity was 12.8% among all participants with Site 2 having nearly 5 times the prevalence of Site 1 (66/310 [21.3%] vs. 14/316 [4.4%]; P = 0.001). Several factors were associated with food insecurity, with non-White ethnicity (OR 2.04; 95% CI 0.98-4.25, P = 0.055] and lower household income (OR 37.53; 95% CI 14.04-100, P < 0.001 when less than CAD $23 000/y) being the most robust.

CONCLUSION

This Canadian study documented the prevalence of and factors associated with food insecurity in pregnancy. Targeted interventions to help low-income women and programs geared towards non-White women may be beneficial in addressing food insecurity among pregnant women.

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

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

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More than 2 billion people lack reliable access to sufficient and nutritious food.

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Globally, food security is foundational to youth mental health and well-being.

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Youth in more fragile states are less food secure and have worse mental health.

Food Insecurity amid the COVID-19 Pandemic: Food Charity, Government Assistance, and Employment

To mitigate the effects of the coronavirus disease 2019 (COVID-19) pandemic, the federal government has implemented several financial assistance programs, including unprecedented funding to food charities. Using the Canadian Perspectives Survey Series 2, we examine the demographic, employment, and behavioural characteristics associated with food insecurity in April-May 2020. We find that one-quarter of job-insecure individuals experienced food insecurity that was strongly associated with pandemic-related disruptions to employment income, major financial hardship, and use of food charity, yet the vast majority of food-insecure households did not report receiving any charitable food assistance. Increased financial support for low-income households would reduce food insecurity and mitigate negative repercussions of the pandemic.

Household food insecurity is associated with depressive symptoms in the Canadian adult population

BACKGROUND

It is essential to identify factors associated with depression as it is a highly prevalent and disabling mental disorder. The aim of this study was to examine the association between depressive symptoms and household food security status among the Canadian adult population.

METHODS

This is a cross-sectional study of the adult population in the five provinces and one territory (Northwest Territories) of Canada using data from the 2015-2016 Canadian Community Health Survey-Annual Component (n=19,118). Depressive symptoms were assessed using the 9-item Patient Health Questionnaire. Household food insecurity was measured using the Household Food Security Survey Module. A weighted logistic regression analysis with robust variance estimation technique was performed.

RESULTS

Approximately 22% of the Canadian adult population reported mild-to-severe depressive symptoms, and 8.3% were from households classified as food insecure. Household food insecurity remained a predictor of mild-to-severe depressive symptoms after adjustment for other known risk factors (OR_ajd: 2.87, 95% CI: 2.33-3.55, p<0.001). In the multivariable model, significant associations were also found with multimorbidity, lower household income, a history of illicit drug use, being a current smoker, being a widowed/divorced/separated, obesity, and being a non-drinker. Significant interactions also emerged between employment status and age (p=0.03), employment status and gender (p<0.001), and physical activity level and gender (p<0.001).

LIMITATIONS

The cross-sectional nature of the study does not allow inferring causality.

CONCLUSIONS

Household food insecurity is associated with depressive symptoms in Canadian adults. Additional longitudinal research is required to further elucidate the nature of this relationship.

Association of Food Insecurity with Nutrient Intake and Depression among Korean and US Adults: Data from the 2014 Korea and the 2013-2014 US National Health and Nutrition Examination Surveys

The purpose of this study is to understand the current status of food insecurity in Korea and the US and to compare the relationship of food insecurity with nutrient intake and depression. Data from the 2014 Korea and the 2013-2014 US National Health and Nutrition Examination Surveys were analyzed, and a total of 3102 Korean and 3234 American adults aged 20-64 years were included. Study subjects were classified into three groups according to degree of food insecurity assessed by the 18-item Household Food Security Survey Module: food secure (FS), mildly food insecure (FI 1), and moderately-to-severely food insecure (FI 2) groups. Energy and nutrient intake were assessed using a 24-h dietary recall. Depression was measured using the Patient Health Questionnaire-9 (PHQ-9) screener. The prevalence of food insecurity was 17.2% in Korea and 26.4% in the US. In both countries, the people in the FI 2 group had lower incomes and education levels and were mostly single. Energy and nutrient intake differed by food insecurity status. In both Korea and the US, adults with moderate-to-severe food insecurity (FI 2) consumed fewer proteins, fiber, potassium, and vitamin C. Additionally, the FI 2 groups had higher proportions of people not meeting the Dietary Reference Intake for protein, potassium, niacin, and vitamin C than the FS groups in Korea and the US. FI 2 people were three times more likely to be depressed than FS group; this difference was stronger in Korea than the US. We found that the prevalence of food insecurity was higher in the US than in Korea, and food insecurity was associated with reduced nutrient intake and increased odds of depression in both Korean and US adults. Therefore, food insecurity is an important public health issue at both the individual and national levels. Continuous monitoring and new intervention activities to promote food security are needed.

Female sex and food insecurity in relation to self-reported poor or fair mental health in Canadian adults: a cross-sectional study using national survey data

BACKGROUND

Women with food insecurity are at higher risk for mental health disorders. This study examined the joint effect of female sex and food insecurity on self-reported poor or fair mental health in Canadian adults.

METHODS

The analysis was based on data from adults (age ≥ 18 yr) who participated in the Canadian Community Health Survey (CCHS) 2015-2016. We determined past-year food security level (secure, moderately insecure or severely insecure) based on 18 questions. We used log-binomial regression to explore associations of sex and food insecurity with self-reported poor or fair mental health. We measured additive interaction between female sex and food insecurity using relative excess risk due to interaction (RERI).

RESULTS

The overall response rate for the CCHS was 59.5%. Data for 61 446 respondents were analyzed. Poor or fair mental health was reported by 4107 participants (6.1% when weighted to the Canadian population). Increased risk of poor or fair mental health was associated with female sex (prevalence ratio [PR] 1.22, 95% confidence interval [CI] 1.12 to 1.31), and moderate (PR 2.50, 95% CI 2.21 to 2.82) and severe (PR 4.03, 95% CI 3.59 to 4.52) food insecurity. Significant additive interaction between female sex and severe food insecurity was found for those aged 40-64 years (RERI 1.38, 95% CI 0.29 to 2.47), and the PR for poor or fair mental health for severely food-insecure women was 5.55 (95% CI 4.48 to 6.89) compared to food-secure men of the same age group.

INTERPRETATION

Poor or fair mental health is common in the food-insecure population, and there exists synergism between female sex and severe food insecurity among middle-aged people. This suggests the need to develop targeted mental health support strategies for food-insecure people, specifically middle-aged women.

Food Insecurity Is Associated with Depression among a Vulnerable Workforce: Early Care and Education Workers

Objective: We aimed to explore the association between food insecurity and depression among early care and education (ECE) workers, a vulnerable population often working in precarious conditions. Design: We utilized cross-sectional data from a study exploring the effects of wage on ECE centers. Participants were enrolled between August 2017 and December 2018. Food insecurity was measured using the validated six-item U.S. Household Food Security Survey Module and participants were categorized as food secure (score = 0–1), low food security (score = 2–4), and very low food security (score = 5–6). Depression (defined as a score ≥ 16) was measured using the 20-item Center for Epidemiologic Studies Depression Scale-Revised. We employed a logistic regression model to examine the relationship between food insecurity and depression. All models controlled for marital status, nativity, race/ethnicity, number of children in the household, job title, weekly hours of work, education, income, and study site. Setting: Participants were from Seattle (40%) and South King County (26%), Washington, and Austin, Texas (34%). Participants: Participants included 313 ECE workers from 49 ECE centers. Results: A majority of participants were female, non-Hispanic White, born in the U.S., and did not have children. Compared to being food secure, very low and low food insecurities were associated with a 4.95 (95% confidence interval (CI): 2.29, 10.67) and 2.69 (95% CI: 1.29, 5.63) higher odds of depression, respectively. Conclusions: Policies and center-level interventions that address both food insecurity and depression may be warranted, in order to protect and improve the health of this valuable, yet vulnerable, segment of the U.S. workforce.

Being on Land and Sea in Troubled Times: Climate Change and Food Sovereignty in Nunavut

Climate change driven food insecurity has emerged as a topic of special concern in the Canadian Arctic. Inuit communities in this region rely heavily on subsistence; however, access to traditional food sources may have been compromised due to climate change. Drawing from a total of 25 interviews among Inuit elders and experienced hunters from Cambridge Bay and Kugluktuk in Nunavut, Canada, this research examines how climate change is impacting food sovereignty and health. Our results show that reports of food insecurity were more pronounced in Kugluktuk than Cambridge Bay. Participants in Kugluktuk consistently noted declining availability of preferred fish and game species (e.g., caribou, Arctic char), a decline in participation of sharing networks, and overall increased difficulty accessing traditional foods. Respondents in both communities presented a consistent picture of climate change compounding existing socio-economic (e.g., poverty, disconnect between elders and youth) and health stressors affecting multiple aspects of food sovereignty. This article presents a situated understanding of how climate change as well as other sociocultural factors are eroding food sovereignty at the community-scale in the Arctic. We argue that a communal focus is required to address resilience and adaptation at the local level through programs that protect the local cultural knowledge, traditional ways of life, and indigenous sovereignty to reduce the severities of food insecurity in the Arctic stemming from climate change.