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Inoue M, Masa R, Prieto L, Baruah D, Kellermeyer K, Booker E, Sweeney G. Prevalence and Correlates of Food Insecurity Among Older Adults in the United States. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024; 67:738-755. [PMID: 38739384 DOI: 10.1080/01634372.2024.2339975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 04/03/2024] [Indexed: 05/14/2024]
Abstract
This study analyzed the 2021 National Health Interview Survey (NHIS) to assess food insecurity among adults aged 65 and older. Among 8,877 older adults, 4 percent (N=287) reported low or very low food security levels. Those who identified as Black or African American and Hispanic or Latino were more likely to experience food insecurity compared to White individuals. The study found that merely surpassing the poverty threshold might not be sufficient to protect against food insecurity. It also underscored socioemotional support's protective role in older adults' food security. Social workers must recognize various factors influencing food security among older adults.
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Affiliation(s)
- Megumi Inoue
- Department of Social Work, George Mason University, Virginia, USA
| | - Rainier Masa
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lucas Prieto
- Department of Social Work, George Mason University, Virginia, USA
| | - Dicky Baruah
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Emma Booker
- Department of Social Work, George Mason University, Virginia, USA
| | - Grace Sweeney
- Department of Social Work, George Mason University, Virginia, USA
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Yang CH, Lee J, Wilcox S, Rudisill AC, Friedman DB, Hakun JG, Neils-Strunjas J, Wei J, Miller MC, Byers MD. Implementation and evaluation of a community-based mindful walking randomized controlled trial to sustain cognitive health in older African Americans at risk for dementia. BMC Geriatr 2024; 24:579. [PMID: 38965464 PMCID: PMC11225163 DOI: 10.1186/s12877-024-05090-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 05/17/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND With an increasing proportion of older adults and the associated risk of Alzheimer's Disease and Related Dementias (ADRD) around the globe, there is an urgent need to engage in ADRD risk reduction efforts. African American (AA) older adults in the U.S. are disproportionally impacted by ADRD compared to other races and ethnicities. Mindful walking integrates two potentially protective factors of ADRD by elevating mindfulness and physical activity (i.e., walking), resulting in a synergistic behavioral strategy that is feasible and safe for older adults. However, the efficacy of applying this intervention for cognitive health outcomes has not been evaluated using experimental designs. METHODS This paper documents the goal and protocol of a community-based, mindful walking randomized controlled trial to examine the short- and longer-term efficacy on cognitive and other health-related outcomes in ADRD at-risk AA older adults. The study outcomes include various brain health determinants, including cognitive function, quality of life, psychological well-being, physical activity, mindfulness, sleep, and overall health status. In addition, the estimated costs of program implementation are also collected throughout the study period. This study will recruit 114 older adults (ages 60+ years) with elevated ADRD risk from the Midlands region of South Carolina. Older adults are randomly assigned to participate in 24 sessions of outdoor mindful walking over three months or a delayed mindful walking group (n=57 in each group). Participants in both groups follow identical measurement protocols at baseline, after 12 weeks, after 18 weeks, and after 24 weeks from baseline. The outcome measures are administered in the lab and in everyday settings. Costs per participant are calculated using micro-costing methods. The eliciting participant costs for mindful walking engagement with expected results are reported using the payer and the societal perspectives. DISCUSSION This study will generate evidence regarding the efficacy of mindful walking on sustaining cognitive health in vulnerable older adults. The results can inform future large-scale effectiveness trials to support our study findings. If successful, this mindful walking program can be scaled up as a low-cost and viable lifestyle strategy to promote healthy cognitive aging in diverse older adult populations, including those at greatest risk. TRIAL REGISTRATION ClinicalTrials.gov number NCT06085196 (retrospectively registered on 10/08/2023).
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Affiliation(s)
- Chih-Hsiang Yang
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Jongwon Lee
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sara Wilcox
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - A Caroline Rudisill
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Jonathan G Hakun
- Department of Neurology, The Pennsylvania State University, College of Medicine, Hershey, PA, 17033, USA
- Department of Psychology, The Pennsylvania State University, University Park, PA, 16802, USA
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, 17033, USA
| | - Jean Neils-Strunjas
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Jingkai Wei
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Margaret C Miller
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Megan D Byers
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Gyasi RM, Asiedu HB, Siaw LP, Nyaaba E, Affum-Osei E, Lamptey RB, Muhonja F, Arthur DD, Asamoah E, Nimoh M, Adu-Gyamfi S. Food insecurity and mobility difficulty in middle-aged and older adults: The importance of bio-psychosocial factors. J Psychosom Res 2024; 184:111849. [PMID: 38950509 DOI: 10.1016/j.jpsychores.2024.111849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/21/2024] [Accepted: 06/21/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVE Food insecurity has been associated with mobility difficulty (MD) in old age. However, there is a scarcity of research on this topic from low- and middle-income countries, while the bio-psychological factors underlying this association are largely unknown. We investigated the food insecurity-MD link in Ghana and explored how sleep, anxiety, loneliness, and physical activity (PA) mediate the association. METHODS Community-based, representative cross-sectional data from the Aging, Health, Well-being, and Health-seeking Behavior Study were analyzed (N = 1201; Mage = 66.5; women = 63%). MD was assessed with items from the SF-36 of the Medical Outcomes Study. We assessed food insecurity with items on hunger and breakfast-skipping frequency due to lack of food and resources. Adjusted OLS and mediation models via bootstrapping technique evaluated the associations. RESULTS Results revealed the expected association between food insecurity and MD, such that greater food insecurity was significantly and positively associated with MD across paths (from β = 0.33 to β = 0.42, p < .001). Analyses of indirect effects showed that sleep problems (27.8%), anxiety (15.5%), loneliness (17.5%), and PA (18.0%) mediated the association between food insecurity and MD. Cross-level interactions revealed that food insecurity significantly modified the link between each mediator and MD. CONCLUSIONS Our data provide novel evidence that bio-psychological mechanisms may underlie the food insecurity-MD link and should, therefore, be considered relevant targets for interventions to prevent/manage MD in later life.
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Affiliation(s)
- Razak M Gyasi
- African Population and Health Research Center, Nairobi, Kenya; National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, NSW, Australia.
| | - Hubert Bimpeh Asiedu
- Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lawrencia Pokuah Siaw
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Nyaaba
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Affum-Osei
- Department of Human Resources, School of Business, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Richard Bruce Lamptey
- College of Science Library, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Faith Muhonja
- School of Public Health, Mount Kenya University, Kenya
| | - Dominic Degraft Arthur
- Department of History and Political Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Edward Asamoah
- Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Michael Nimoh
- Department of History and Political Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Samuel Adu-Gyamfi
- Department of History and Political Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Tetteh J, Ekem-Ferguson G, Malm K, Yawson OA, Otchi E, Swaray SM, Yao Ntumy M, Yawson AE. Food insecurity and associated health and social determinants among older adults in Ghana: Analysis of the WHO's study on global AGEing and adult health (SAGE), 2014-2015. Prev Med Rep 2024; 41:102693. [PMID: 38560593 PMCID: PMC10981086 DOI: 10.1016/j.pmedr.2024.102693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 04/04/2024] Open
Abstract
This study was conducted to assess the prevalence and factors associated with Food Insecurity (FI) and further quantify its association with unmet need for health services and health-related outcomes among older adults aged 50 years and above in Ghana. The Ghana Study on Global AGEing and Adult Health was used. Body Mass Index (BMI), depressive episodes, functional difficulties (FD), low Quality of Life (QoL), memory decline, and Unmet Needs of Health Services (UNHS) are the the study outcomes. Ordinary Least Square, and Poisson regression analysis modified with Mahalanobis distance matching within propensity score caliper weights were employed. Stata 16.1 was used to perform analysis and a p-value < 0.05 was deemed significant. The prevalence of FI among older adults aged 50 years or older in Ghana was approximately 28 %(95 %CI = 24.5-31.7) and was strongly associated with lower educational attainment and social support. The prevalence ratio of depression, FD, low QoL and UNHS among older adults who experienced FI were; 3.43(95 %CI = 2.25-5.21), 1.18(95 %CI = 1.12-1.23), 2.01(95 %CI = 1.54-2.62), and 1.46(95 %CI = 1.01-2.11). Memory significantly decreased by 85 percentage points% among food insecure older adults [aβ(95 %CI) = -0.85(-1.62--0.07)]. Older adults with relatively higher educational attainment and social support are less likely to suffer FI and associated limited health and poor social well-being. In the national quest to achieve SDG 2, these health and social determinants of FI among older adults should be considered in the implementation of the national ageing policy to improve the health and well-being of older adults in Ghana.
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Affiliation(s)
- John Tetteh
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | | | - Keziah Malm
- National Malaria Control Programme, Ghana Health Service, Ghana
| | - Ohenewa Anita Yawson
- Ground Floor Surgical Intensive Care Unit, Department of Anaesthesia, Korle-Bu Teaching Hospital, Accra, Ghana
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Elom Otchi
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
- Medical Affairs Directorate, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Swithin M. Swaray
- National Cardiothoracic Centre, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Michael Yao Ntumy
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Ghana
| | - Alfred Edwin Yawson
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
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Shea MK, Strath L, Kim M, Ðoàn LN, Booth SL, Brinkley TE, Kritchevsky SB. Perspective: Promoting Healthy Aging through Nutrition: A Research Centers Collaborative Network Workshop Report. Adv Nutr 2024; 15:100199. [PMID: 38432592 PMCID: PMC10965474 DOI: 10.1016/j.advnut.2024.100199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024] Open
Abstract
Within 20 y, the number of adults in the United States over the age of 65 y is expected to more than double and the number over age 85 y is expected to more than triple. The risk for most chronic diseases and disabilities increases with age, so this demographic shift carries significant implications for the individual, health care providers, and population health. Strategies that delay or prevent the onset of age-related diseases are becoming increasingly important. Although considerable progress has been made in understanding the contribution of nutrition to healthy aging, it has become increasingly apparent that much remains to be learned, especially because the aging process is highly variable. Most federal nutrition programs and nutrition research studies define all adults over age 65 y as "older" and do not account for physiological and metabolic changes that occur throughout older adulthood that influence nutritional needs. Moreover, the older adult population is becoming more racially and ethnically diverse, so cultural preferences and other social determinants of health need to be considered. The Research Centers Collaborative Network sponsored a 1.5-d multidisciplinary workshop that included sessions on dietary patterns in health and disease, timing and targeting interventions, and health disparities and the social context of diet and food choice. The agenda and presentations can be found at https://www.rccn-aging.org/nutrition-2023-rccn-workshop. Here we summarize the workshop's themes and discussions and highlight research gaps that if filled will considerably advance our understanding of the role of nutrition in healthy aging.
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Affiliation(s)
- M Kyla Shea
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, United States.
| | - Larissa Strath
- College of Medicine, Department of Health Outcomes and Biomedical Informatics, the University of Florida, Gainesville, FL, United States; Clinical and Translational Science Institute, Pain Research and Intervention Center of Excellence, the University of Florida, Gainesville, FL, United States
| | - Minjee Kim
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Institute of Public Health Medicine, Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Lan N Ðoàn
- Department for Population Health, Section for Health Equity, New York University Grossman School of Medicine, New York, NY, United States
| | - Sarah L Booth
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, United States
| | - Tina E Brinkley
- Department of Gerontology and Geriatric Medicine, Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Stephen B Kritchevsky
- Department of Gerontology and Geriatric Medicine, Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, United States
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Lu I, Suss R, Lanza DV, Cohen S, Yusuf Y, Yi SS. A qualitative study to inform the development of a subsidized community-supported agriculture program for Chinese Americans in Brooklyn, New York, U.S. Prev Med Rep 2023; 36:102480. [PMID: 37920594 PMCID: PMC10618813 DOI: 10.1016/j.pmedr.2023.102480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/04/2023] Open
Abstract
The objective of this study was to inform the development of a subsidized, culturally adapted Community-Supported Agriculture (CSA) program for the Chinese American (CA) community in Brooklyn, New York (NY), USA. We conducted interviews with CA adults to understand their eating and shopping behaviors, interests in CSAs, and recommendations for educational content to inform the development of a subsidized and culturally adapted CSA. We then conducted thematic analysis of those interviews and identified major themes. CA adult participants shared interest in a CSA primarily to support their own health, interact socially with farmers and other participants, and gain access to fresh, culturally appropriate produce. Major concerns for participation, especially among older adults, included language barriers, transportation, and mobility. The unique needs and motivations of CAs should be centered in the development of alternative food access interventions for this population. CA adult participants living in Brooklyn, NY may be interested in a subsidized culturally adapted CSA that includes health information about the produce and provides in-language support. Engaging communities in the development of a health program may be important to ensure accessibility and acceptability for CA populations.
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Affiliation(s)
- Isabel Lu
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
| | - Rachel Suss
- Department Population Health, NYU Grossman School of Medicine, New York University Langone Health, United States
| | - Dalila Victoria Lanza
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, United States
| | - Sarah Cohen
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, United States
| | - Yousra Yusuf
- Department Population Health, NYU Grossman School of Medicine, New York University Langone Health, United States
| | - Stella S. Yi
- Department Population Health, NYU Grossman School of Medicine, New York University Langone Health, United States
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Saenz J, Avila JC. Late-life food insecurity and cognition: exploring timing, duration, and mechanisms among older Mexican adults. BMC Geriatr 2023; 23:788. [PMID: 38036962 PMCID: PMC10687853 DOI: 10.1186/s12877-023-04497-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Food insecurity (FI) remains a global public health problem. FI is more prevalent in low-and middle-income countries than high-income countries. FI is related with worse cognitive outcomes including cognitive function, cognitive decline, and cognitive impairment. Few studies have sought to identify how patterns of FI relate with cognitive function in old age and the potential mechanisms underlying this association. METHODS Data from the 2015 and 2018 waves of the Mexican Health and Aging Study (n = 9,654, age 50+) were used in this study. Reports of FI in 2015 and 2018 were combined to create four patterns of FI groups: "persistently food secure", "became food secure", "became food insecure", and "persistently food insecure". Linear regression was used to estimate associations between patterns of FI and cognitive task performance. The mediating roles of depressive symptoms, body mass index, and chronic conditions were tested using Karlson, Holm, and Breen methodology. RESULTS Approximately half of the sample were persistently food secure, 17% became food secure, 14% became FI, and 15% experienced persistent FI. When adjusting for demographic/socioeconomic confounders, persistent FI related with worse Verbal Learning, Verbal Recall, Visual Scanning, and Verbal Fluency performance compared to the persistently food secure. Becoming FI related with worse Verbal Learning, Visual Scanning, and Verbal Fluency. Mediation analyses provided support for depressive symptoms mediating associations between FI and poorer cognition, where 48% of the association between persistent FI and worse Verbal Recall performance was attributed to higher depressive symptoms. Becoming food secure was not associated with cognitive performance compared to the persistently food secure. CONCLUSIONS FI may represent an important modifiable risk factor for poorer cognitive outcomes among older adults. Public health efforts should focus on providing stable food access to older adults, especially those living in poverty.
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Affiliation(s)
- Joseph Saenz
- Edson College of Nursing and Health Innovation, Arizona State University, 500 N 3rd Street, Phoenix, AZ, 85004, USA.
| | - Jaqueline C Avila
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, 02125, USA
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Hardin-Fanning F, Mensah KA, Sha S. Development and Psychometric Evaluation of a Food Resource Acceptability Questionnaire. West J Nurs Res 2023; 45:1035-1042. [PMID: 37772360 DOI: 10.1177/01939459231204288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
The stigma associated with food assistance is a significant barrier to resolution of food insecurity. Interventions and policies aimed at reducing food insecurity would benefit from the inclusion of strategies aimed at minimizing food assistance stigma. We developed the Food Resource Acceptability Questionnaire (FRAQ), a scale that measures the perceptions of stigma associated with food assistance. Qualitative interviews, modified Delphi technique, and exploratory factor analysis were used to develop and evaluate the 17-item scale. The FRAQ consists of two subscales (stigma and the belief that food is a basic right) to measure the likelihood of individuals perceiving food assistance as socially and culturally acceptable. Cronbach's alphas were 0.85, 0.80, and 0.89 for the Stigma subscale, Food as a Basic Right subscale, and the overall FRAQ, respectively. Additional research is needed to determine the applicability of the FRAQ in diverse populations.
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Affiliation(s)
- Frances Hardin-Fanning
- School of Nursing, University of Louisville, Louisville, KY, USA
- University of Louisville Research Foundation, Inc., Louisville, KY, USA
| | - Kofi Amoh Mensah
- School of Nursing, University of Louisville, Louisville, KY, USA
| | - Shuying Sha
- School of Nursing, University of Louisville, Louisville, KY, USA
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Samuel LJ, Zhu J, Dwivedi P, Stuart EA, Szanton SL, Li Q, Thorpe RJ, Reed NS, Swenor BK. Food insecurity gaps in the Supplemental Nutrition Assistance Program based on disability status. Disabil Health J 2023; 16:101486. [PMID: 37353370 PMCID: PMC10527001 DOI: 10.1016/j.dhjo.2023.101486] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/23/2023] [Accepted: 05/28/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Households including someone with disabilities experience disproportionately high food insecurity rates and likely face disproportionate barriers accessing Supplemental Nutrition Assistance Program (SNAP) benefits. OBJECTIVE This article aims to examine the role of SNAP with regard to food insecurity disparities based on disability status. METHODS Modified Poisson regression models examined food insecurity risk based on disability status (household includes no one with disabilities vs. those with work-limiting disabilities or non-work-limiting disabilities) among 2018 Survey of Income and Program Participation households eligible for SNAP (income ≤130% of the poverty threshold). Weighted estimates were used to account for the study design and non-response. RESULTS Households including someone with work-limiting disabilities were more than twice as likely to be food insecure than households including no one with disabilities (PR = 2.16, 95% CI: 1.90, 2.45); households including someone with non-work-limiting disabilities were 65% more likely (PR = 1.65, 95% CI: 1.39, 1.95). However, disparities were more pronounced among households not participating in SNAP (PR = 2.67, 95% CI: 2.22, 3.23 for work-limiting disabilities and PR = 1.86, 95% CI: 1.44, 2.40 for non-work-limiting disabilities) than SNAP-participating households (PR = 1.71, 95% CI: 1.45, 2.03 and PR = 1.46, 95% CI: 1.17, 1.82, respectively). Approximately 4.2 million low-income U.S. households including someone with disabilities are food insecure. Of these, 1.4 million were not participating in SNAP and another 2.8 million households were food insecure despite participating in SNAP. CONCLUSIONS Access to SNAP benefits is not proportionate to the scale of food insecurity among households that include people with disabilities. Action is needed to strengthen food assistance for those with disabilities.
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Affiliation(s)
| | - Jiafeng Zhu
- Johns Hopkins Bloomberg School of Public Health, USA.
| | | | | | - Sarah L Szanton
- Johns Hopkins School of Nursing, Public Health, and Medicine, USA.
| | - Qiwei Li
- Johns Hopkins School of Nursing, USA.
| | | | | | - Bonnielin K Swenor
- The Johns Hopkins Disability Health Research Center, Johns Hopkins School of Nursing, USA.
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Anderson B, Lehto E, Hardin-Fanning F, Hirst J, Storm J, Montgomery E, Hussain A, Caperell K. Establishing a Permanent Food Pantry in a Pediatric Emergency Department. Pediatrics 2023; 152:e2023061757. [PMID: 37697954 DOI: 10.1542/peds.2023-061757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 09/13/2023] Open
Abstract
Childhood food insecurity is associated with adverse health outcomes. Food pantries housed within healthcare facilities have the potential to reduce childhood food insecurity. An interdisciplinary team established a permanent food pantry in the pediatric emergency department of a metropolitan children's hospital. Members of the team included attending and resident physicians, nurse practitioners, nurses, patient care technicians, a volunteer coordinator, Prevention and Wellness staff, and environmental services staff. The development process, formative evaluation, and impact of the pantry during the first 15 months of use is described. Families presenting to the emergency department were notified of the food pantry and offered a bag of groceries. Data collected included number of adult and children in the household, age ranges of family members, and whether food was accepted. The food pantry provided aid to 2199 households from January 2021 to April 2022. Recipients of food assistance included 4698 children, 3565 adults, and 140 seniors. In addition, the interdisciplinary approach to the development process elucidated barriers to and facilitators of the project's success, thereby maximizing the food assistance outcome.
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Affiliation(s)
- Brit Anderson
- Norton Children's Medical Group affiliated with the University of Louisville School of Medicine Division of Pediatric Emergency Medicine, Louisville, Kentucky
| | - Elizabeth Lehto
- Norton Children's Medical Group affiliated with the University of Louisville School of Medicine Division of Pediatric Emergency Medicine, Louisville, Kentucky
| | | | - Joelle Hirst
- Norton Children's Hospital, Louisville, Kentucky
| | - Joy Storm
- Norton Children's Hospital, Louisville, Kentucky
| | | | - Amber Hussain
- Department of Pediatrics, University of Louisville, Louisville, Kentucky
| | - Kerry Caperell
- Norton Children's Medical Group affiliated with the University of Louisville School of Medicine Division of Pediatric Emergency Medicine, Louisville, Kentucky
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Fong JH. Risk Factors for Food Insecurity among Older Adults in India: Study Based on LASI, 2017-2018. Nutrients 2023; 15:3794. [PMID: 37686826 PMCID: PMC10490409 DOI: 10.3390/nu15173794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Food security is linked to the nutritional status and well-being of older adults. India is a rapidly aging nation that ranks highly on the 2022 Global Hunger Index. This paper examines the prevalence and risk factors of food insecurity in India's older population. METHODS We used data from the 2017-2018 Longitudinal Aging Study in India. The sample size was 31,532 adults aged 60 years and above. Food insecurity was measured using a four-item version of the Food Insecurity Experience scale. Multivariable logistic regressions using individual-level weights were implemented to assess the risk factors of food insecurity. RESULTS The prevalence of food insecurity was 10.5% in the weighted sample. Sociodemographic factors were important in explaining food insecurity. Older adults who were male, younger, lowly educated, socially disadvantaged, in rural areas, and outside the Northern region were most vulnerable to food insecurity, controlling for various confounders. Additionally, low economic status, no occupational pension, currently working, social isolation, physical impairment, functional disabilities, poor self-rated health, and arthritis were associated with an increased risk of food insecurity. CONCLUSIONS More active food assistance programs catering to older adults and a better provision of economic and social security are warranted to establish a food-secure environment for rapidly aging India.
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Affiliation(s)
- Joelle H Fong
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore 259771, Singapore
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12
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Ribeiro ECDS, Cherol CCDS, da Costa RS, de Castro PCP, Ferreira AA. Food insecurity and social inequalities in households headed by older people in Brazil: a secondary cross-sectional analysis of a national survey. BMC Public Health 2023; 23:1424. [PMID: 37491194 PMCID: PMC10369831 DOI: 10.1186/s12889-023-16332-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 07/18/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND The presence of food insecurity in households headed by older people is related to social inequalities. The objective of this study was to analyze the prevalence and factors associated with moderate/severe food insecurity in households headed by older people. METHODS A cross-sectional study based on a nationally representative sample of older adults aged ≥ 60 years was conducted using data from the 2017/2018 Family Budget Survey. In the study, moderate/severe food insecurity was the dependent variable, with food insecurity assessed with the Brazilian Household Food Insecurity Measurement Scale. Prevalence and odds ratio estimates were generated with 99% confidence intervals. Data analysis was performed using STATA software. FINDINGS A total of 16,314 households headed by older people were identified. Approximately 10.1% of these households were in the moderate/severe range for food insecurity. The majority are female (11.9%)and self-declared indigenous people (25.5%), with a lack of schooling (18.3%) and a per capita income of up to half of one minimum wage (29.6%). The analysis model found that color/race, region, schooling, per capita household income, and social benefits received in the household were statistically significant factors (p value < 0.01). CONCLUSION Moderate/severe food insecurity in households headed by older people is associated with the pronounced social inequalities present in Brazil, and these findings intensify the need for additional study of the challenges faced by this age group.
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Affiliation(s)
- Eloah Costa de Sant'Anna Ribeiro
- Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 373, Bloco J, 2° andar, sala 18 - Cidade Universitária, Rio de Janeiro (RJ), CEP: 21941-902, Brazil.
| | - Camilla Christine de Souza Cherol
- Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 373, Bloco J, 2° andar, sala 18 - Cidade Universitária, Rio de Janeiro (RJ), CEP: 21941-902, Brazil
| | - Rosana Salles da Costa
- Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 373, Bloco J, 2° andar, sala 18 - Cidade Universitária, Rio de Janeiro (RJ), CEP: 21941-902, Brazil
| | - Paulo Cesar Pereira de Castro
- Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 373, Bloco J, 2° andar, sala 18 - Cidade Universitária, Rio de Janeiro (RJ), CEP: 21941-902, Brazil
| | - Aline Alves Ferreira
- Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 373, Bloco J, 2° andar, sala 18 - Cidade Universitária, Rio de Janeiro (RJ), CEP: 21941-902, Brazil
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Gajda R, Jeżewska-Zychowicz M. Relationship between Food Insecurity and Nutritional Risk among Older Adults in Poland-A Preliminary Study. Nutrients 2023; 15:3232. [PMID: 37513650 PMCID: PMC10385899 DOI: 10.3390/nu15143232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/06/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Aging populations may be associated with increased nutritional risk, malnutrition, and food insecurity. This study aims to examine the relationship between food insecurity and nutritional risk, taking into account selected characteristics of the study group, and factors describing nutritional risk. It was conducted between May and July 2021, among 417 people aged 60 and older, in two regions of Poland. Questions from the SCREEN-14 questionnaire were used to assess nutritional risk. Selected questions from the HFSS questionnaire (U.S. Household Food Security Survey Module) concerning the elderly were used to assess food insecurity. A K-means cluster analysis was used to separate homogeneous clusters into food security indicators and nutritional risk factors. The Mann-Whitney U test and Kruskal-Wallis test were used to compare mean values between groups, and the Chi-square test was used to verify the differences. Two clusters were distinguished: I-"low food security and high nutritional risk" and II-"high food security and low nutritional risk". Cluster I included people aged 60-65, and over 75, living in urban areas, living alone or with family, with unfavorable economic situations and family relationships. Cluster II was composed of people aged 71-75, who were rural residents, living with a partner, with favorable economic situations and family relations. The vast majority of nutritional risk factors were found in Cluster I and among those at high nutritional risk. The largest number of people were affected by such nutritional risk factors such as difficulty in chewing or biting, loss in appetite, skipping meals, and perceiving one's weight as abnormal. Moreover, the group of people most significantly affected by high nutritional risk were in unfavorable economic situations, had poor family relationships, lived alone or with family, rated their health as worse than their peers, were overweight and obese, had metabolic disease, or impeding mobility. The results obtained can be applied to the planning of social and health policies for the elderly in Poland.
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Affiliation(s)
- Robert Gajda
- Department of Human Nutrition, Faculty of Biotechnology and Food Sciences, Wrocław University of Environmental and Life Sciences, Chełmońskiego 37, 51-630 Wroclaw, Poland
| | - Marzena Jeżewska-Zychowicz
- Department of Food Market and Consumer Research, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), Nowoursynowska 159C, 02-776 Warsaw, Poland
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14
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Ansari S, Anand A, Singh S, Hossain B. Exploring food insecurity and multimorbidity in Indian socially disadvantaged people: cross-sectional findings from LASI, 2017-18. BMC Public Health 2023; 23:1234. [PMID: 37365582 DOI: 10.1186/s12889-023-16132-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 06/16/2023] [Indexed: 06/28/2023] Open
Abstract
OBJECTIVES The present study aimed to examine the association of multimorbidity status with food insecurity among disadvantaged groups such as Scheduled Castes (SCs), Scheduled Tribes (STs), and Other Backward Class (OBCs) in India. METHOD The data for this study was derived from the first wave of the Longitudinal Ageing Study in India (LASI),2017-18, focusing on 46,953 individuals aged 45 years and over who belong to SCs, STs, and OBCs groups. Food insecurity was measured based on the set of five questions developed by the Food and Nutrition Technical Assistance Program (FANTA). Bivariate analysis was performed to examine the prevalence of food insecurity by multimorbidity status along with socio-demographic and health-related factors. Multivariable logistic regression analysis and interaction models were used. RESULTS The overall prevalence of multimorbidity was about 16% of the study sample. The prevalence of food insecurity was higher among people with multimorbidity compared to those without multimorbidity. Unadjusted and adjusted models suggested that people with multimorbidity were more likely to be food insecure than people without multimorbidity. While middle-aged adults with multimorbidity and men with multimorbidity had a higher risk of food insecurity. CONCLUSION The findings of this study suggest an association between multimorbidity and food insecurity among socially disadvantaged people in India. Middle-aged adults experiencing food insecurity tend to reduce the quality of their diet and consume a few low-cost, nutritionally deficient meals to maintain caloric intake, putting them again at risk for several negative health outcomes. Therefore, strengthening disease management could reduce food insecurity in those facing multimorbidity.
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Affiliation(s)
- Salmaan Ansari
- Centre for Health Services Studies, University of Kent, Canterbury, United Kingdom
| | - Abhishek Anand
- International Institute for Population Sciences, Mumbai, 400088, India
| | - Shalini Singh
- Department of Demography, University of Vienna, Vienna, Austria
| | - Babul Hossain
- International Institute for Population Sciences, Mumbai, 400088, India.
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15
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Chen H, Dhana K, Huang Y, Huang L, Tao Y, Liu X, Melo van Lent D, Zheng Y, Ascherio A, Willett W, Yuan C. Association of the Mediterranean Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) Diet With the Risk of Dementia. JAMA Psychiatry 2023; 80:630-638. [PMID: 37133875 PMCID: PMC10157510 DOI: 10.1001/jamapsychiatry.2023.0800] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/20/2023] [Indexed: 05/04/2023]
Abstract
Importance Dementia threatens the well-being of older adults, making efforts toward prevention of great importance. Objective To evaluate the association of the Mediterranean-Dietary Approaches to Stop Hypertension (DASH) Intervention for Neurodegenerative Delay (MIND) diet with the risk of dementia in 3 prospective studies and a meta-analysis. Design, Setting, and Participants Cohort analyses included the Whitehall II study (WII), the Health and Retirement Study (HRS), and the Framingham Heart Study Offspring cohort (FOS), and the meta-analysis included 11 cohort studies. Participants were middle-aged and older women and men from WII in 2002 to 2004, HRS in 2013, and FOS in 1998 to 2001 without dementia at the study baseline. Data were analyzed from May 25 to September 1, 2022. Exposures MIND diet score was measured using food frequency questionnaires, and scores ranged from 0 to 15, with a higher score indicating higher adherence to the MIND diet. Main Outcome and Measures Incident all-cause dementia, with cohort-specific definitions. Results Included in this study were 8358 participants (mean [SD] age, 62.2 [6.0] years; 5777 male [69.1%]) from WII, 6758 participants (mean [SD] age, 66.5 [10.4] years; 3965 female [58.7%]) from HRS, and 3020 participants (mean [SD] age, 64.2 [9.1] years; 1648 female [54.6%]) from FOS. The mean (SD) baseline MIND diet score was 8.3 (1.4) in WII, 7.1 (1.9) in HRS, and 8.1 (1.6) in FOS. Over 166 516 person-years, a total of 775 participants (220 in WII, 338 in HRS, and 217 in FOS) developed incident dementia. In the multivariable-adjusted Cox proportional hazard model, higher MIND diet score was associated with lower risk of dementia (pooled hazard ratio [HR] for every 3-point increment, 0.83; 95% CI, 0.72-0.95; P for trend = .01; I2 = 0%). The associations were consistently observed in subgroups defined by sex, age, smoking status, and body mass index. In the meta-analysis of 11 cohort studies with 224 049 participants (5279 incident dementia cases), the highest tertile of MIND diet score was associated with lower risk of dementia compared with the lowest tertile (pooled HR, 0.83; 95% CI, 0.76-0.90; I2 = 35%). Conclusions and Relevance Results suggest that adherence to the MIND diet was associated with lower risk of incident dementia in middle-aged and older adults. Further studies are warranted to develop and refine the specific MIND diet for different populations.
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Affiliation(s)
- Hui Chen
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Klodian Dhana
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Yuhui Huang
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liyan Huang
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yang Tao
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoran Liu
- Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Debora Melo van Lent
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, UT Health San Antonio, San Antonio, Texas
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
- Framingham Heart Study, Framingham, Massachusetts
| | - Yan Zheng
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai, China
| | - Alberto Ascherio
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Walter Willett
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Changzheng Yuan
- School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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16
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Nicklett EJ, Cheng GJ, Morris ZA. Predictors of food insecurity among older adults before and during COVID-19 in the United States. Front Public Health 2023; 11:1112575. [PMID: 37250079 PMCID: PMC10213641 DOI: 10.3389/fpubh.2023.1112575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/29/2023] [Indexed: 05/31/2023] Open
Abstract
Background The COVID-19 pandemic has strained the health and wellbeing of older adult populations through increased morbidity, mortality, and social exclusion. However, the impact of COVID-19 on the health of older adults through food security has received relatively little attention, despite the strong impact of diet quality on the health and longevity of older adults. Objective The objective of this study was to identify sociodemographic and socioeconomic predictors of self-reported food insecurity before and early in the COVID-19 pandemic among community-dwelling older adults in the United States. Methods Using longitudinal data from the Health and Retirement Study, a nationally representative sample of middle-aged and older adults in the United States, we examined the associations between sociodemographic and socioeconomic predictors of self-reported food insecurity between 2018 (N = 2,413) and June 2020 (N = 2,216) using population-weighted multivariate logistic regression models. Results The prevalence of food insecurity doubled among participants from 2018 (4.83%) to June 2020 (9.54%). In 2018, non-Hispanic Black and rural residents were more likely to report food insecurity, while individuals with higher education and greater wealth were less likely to report food insecurity in adjusted models. In June 2020, those who were relatively younger, not working due to a disability, and renting were more likely to report food insecurity. Those with an increased number of functional limitations, a recent onset of a work-limiting disability, and those who were no longer homeowners experienced an elevated longitudinal risk for food insecurity. Conclusion Future research should examine effective policies and interventions to address the disproportionate impacts of COVID-19 on populations at a heightened risk of experiencing food insecurity.
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Affiliation(s)
- Emily Joy Nicklett
- Department of Social Work, College for Health, Community and Policy, University of Texas at San Antonio, San Antonio, TX, United States
| | - Greta Jianjia Cheng
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Zachary A. Morris
- School of Social Welfare, Stony Brook University, Stony Brook, NY, United States
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17
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Selvamani Y, Elgar F. Food insecurity and its association with health and well-being in middle-aged and older adults in India. J Epidemiol Community Health 2023; 77:252-257. [PMID: 36754599 DOI: 10.1136/jech-2022-219721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/02/2023] [Indexed: 02/10/2023]
Abstract
AIM Food insecurity is a global public health concern; however, there is limited knowledge about its health impacts in India. We examined the associations of food insecurity with socioeconomic conditions, chronic disease and various domains of health and well-being in a community sample of middle-aged and older adults (45+ years) in India. METHODS Cross-sectional nationally representative data were collected in wave 1 (2017-2018) of the Longitudinal Ageing Study in India. Food insecurity was measured by questions of access and availability of food. We used logistic regression analyses to examine associations of food insecurity with poor self-rated health, limitations in activities of daily living (ADLs), instrumental ADLs, low life satisfaction, depression, sleep problems and low body mass. RESULTS Food insecurity related to all seven indicators of poor health and well-being, even after controlling for material wealth and the presence of multimorbidity (which food insecurity also predicted). Associations with mental health were stronger for those for physical health. For instance, food insecurity related to a threefold increase in probable depression (OR=2.9, 95% CI=2.4 to 3.4) and low life satisfaction (OR=3.4, 95% CI=2.9 to 3.8). CONCLUSIONS Food insecurity is a powerful social determinant of poor health among older adults in India. Policy measures to improve population health and well-being should closely follow trends in food insecurity, particularly among those living in poverty and with multiple health conditions.
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Affiliation(s)
- Y Selvamani
- School of Public Health, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
| | - Frank Elgar
- Institute for Health and Social Policy, McGill University, Montreal, Québec, Canada
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18
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Jeżewska-Zychowicz M, Gajda R. Relationship between the Prevalence of Metabolic Disease and Impaired Mobility, Diet, Physical Activity, and Socio-Demographic Characteristics in the Polish Elderly-A Cross-Sectional Study. Life (Basel) 2023; 13:life13040864. [PMID: 37109393 PMCID: PMC10145149 DOI: 10.3390/life13040864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/05/2023] [Accepted: 03/22/2023] [Indexed: 04/29/2023] Open
Abstract
Maintaining good health for as long as possible presents a great challenge for the elderly. As the elderly population is growing, there is an ongoing need to identify health risk factors affecting older individuals. The study aimed to explore relationships between sociodemographic characteristics, diet, physical activity, and prevalence of metabolic diseases and impaired mobility in the Polish elderly. A cross-sectional study was carried out on 417 elderlies in May-July 2021. Cluster analysis was applied to separate four homogeneous clusters based on the prevalence of metabolic disease and impaired mobility. Logistic regression analysis was used to verify associations between variables. Being overweight or having obesity, as well as following a diet, increased the probability of being affected by metabolic disease. Being well educated, having a better financial situation, positive perception of own health, and having at least moderate physical activity decreased the probability of suffering from mobility impairments. Eating behaviors were not found to be predictors of the disease. However, they differentiated the selected clusters. The results confirmed the heterogeneity of factors that may impact healthy aging. Thus, they should be taken into account by public health authorities to develop health promotion actions adjusted to the needs of specific subgroups.
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Affiliation(s)
- Marzena Jeżewska-Zychowicz
- Department of Food Market and Consumer Research, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), Nowoursynowska 159C, 02-776 Warsaw, Poland
| | - Robert Gajda
- Department of Human Nutrition, Faculty of Biotechnology and Food Science, Wrocław University of Environmental and Life Sciences, Chełmońskiego 37, 51-630 Wroclaw, Poland
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Aday RH, Wallace JB, Jones SC, Pogacsnik AR, Leifker KF, Kibe-Pea EW. Understanding the Experiences of Food Insecurity in Older Adult Households. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:239-262. [PMID: 35833580 DOI: 10.1080/01634372.2022.2098443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/01/2022] [Accepted: 07/02/2022] [Indexed: 06/15/2023]
Abstract
Food insecurity is a pressing multidimensional problem that negatively impacts the health and well-being of a significant number of the older population. Finding ways to better address nutritional issues among this vulnerable population is vital to their well-being. Using a mixed-methods approach, we conducted semi-structured phone interviews with a representative sample of 434 low-income older adult households in Tennessee. The aim of this study is to assess the prevalence of food insecurity, examine ongoing barriers, and, using qualitative data, to explore the diverse daily experiences older adults face when confronted with a food insecure lifestyle. Based on the USDA Adult 10-Item Household Screening Module, we found that 30% in our sample were designated as marginally, low or very low food secure. Many of those most vulnerable (older women, widowed or divorced, poor health and below the poverty line) constantly struggled with food insecurity. Being food insecure was attributed to limited financial resources, lack of transportation, health limitations, and a poor psychological state. Utilizing food stretching practicing, governmental agencies offering food supplements, family/friends, religious groups and personal resilience were common coping strategies. Implications and recommendations for service providers are offered.
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Affiliation(s)
- Ronald H Aday
- Department of Sociology & Anthropology, Middle Tennessee State University, Murfreesboro, TN, USA
| | - J Brandon Wallace
- Department of Sociology & Anthropology, Middle Tennessee State University, Murfreesboro, TN, USA
| | - Sandra C Jones
- Department of Psychology/Aging Studies, Middle Tennessee State University, Murfreesboro, TN, USA
| | - Amber R Pogacsnik
- Department of Sociology & Anthropology, Middle Tennessee State University, Murfreesboro, TN, USA
| | - Kimberly F Leifker
- Department of Sociology & Anthropology, Middle Tennessee State University, Murfreesboro, TN, USA
| | - Eva W Kibe-Pea
- Department of Sociology & Anthropology, Middle Tennessee State University, Murfreesboro, TN, USA
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Cheung ESL. Food Insecurity among Older Adults in New York City: Does Location Matter? JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2022. [DOI: 10.1080/19320248.2022.2143738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Haro-Ramos AY, Bacong AM. Prevalence and risk factors of food insecurity among Californians during the COVID-19 pandemic: Disparities by immigration status and ethnicity. Prev Med 2022; 164:107268. [PMID: 36150445 PMCID: PMC9487147 DOI: 10.1016/j.ypmed.2022.107268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 08/31/2022] [Accepted: 09/17/2022] [Indexed: 11/16/2022]
Abstract
The COVID-19 pandemic exacerbated socioeconomic disparities in food insecurity. Non-citizens, who do not qualify for most publicly-funded food assistance programs, may be most vulnerable to food insecurity during the pandemic. However, no study has examined heterogeneity in food insecurity by immigration status and ethnicity in the context of the pandemic. We analyzed the 2020 non-restricted California Health Interview Survey to examine disparities in food insecurity by ethnicity and immigration status (i.e., US-born, naturalized, non-citizen) among Asians and Latinxs (N = 19,514) compared to US-born Whites. Weighted multivariable logistic regression analyses assessed the association of immigration status and ethnicity with food insecurity. Decomposition analyses assessed the extent to which pandemic-related economic stressors, including experiencing reduced work hours or losing a job versus pre-pandemic socioeconomic position (SEP), accounted for disparities in food insecurity by ethnicity and immigration status. Regardless of immigration status, Latinxs were more likely to experience food insecurity than Whites. Based on the adjusted analyses, non-citizen, naturalized, and US-born Latinxs had a predicted probability of 12%, 11.4%, and 11.9% of experiencing food insecurity, respectively. In contrast, non-citizen Asians, but not US-born or naturalized Asians, reported greater food insecurity than Whites (12.5% vs. 8.2%). SEP accounted for 43% to 66% of the relationship between immigration status-ethnicity and food insecurity. The pandemic exacerbated economic hardship, but food insecurity was largely explained by long-standing SEP-related factors among Latinxs, regardless of immigration status, and non-citizen Asians. To address disparities in food insecurity, social assistance programs and COVID-19 economic relief should be extended to non-citizens.
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Affiliation(s)
- Alein Y Haro-Ramos
- University of California, Berkeley, School of Public Health, 2121 Berkeley Way West, Berkeley, CA 94704, United States.
| | - Adrian M Bacong
- Stanford University, School of Medicine, 1215 Welch Rd, Stanford, CA 94305, United States.
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22
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Chakraborty R, Kundu J, Jana A. Factors Associated with Food Insecurity among Older Adults in India: Impacts of Functional Impairments and Chronic Diseases. AGEING INTERNATIONAL 2022. [DOI: 10.1007/s12126-022-09510-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Zila-Velasque JP, Grados-Espinoza P, Quispe-Chura K, Valdiviezo-Morales CG, Diaz-Vélez C, Valladares-Garrido MJ. Prevalence and factors associated with food insecurity in eight high-altitude cities in Peru during the second wave of the COVID-19 pandemic: a retrospective, cross-sectional study. BMC Public Health 2022; 22:1962. [PMID: 36284287 PMCID: PMC9593981 DOI: 10.1186/s12889-022-14372-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 10/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background Food insecurity has increased during the COVID-19 pandemic, affecting an estimated 260 million people. However, little evidence is available on how pandemic-related characteristics influence food security in a high-altitude population. The objective of this study was to assess factors associated with food insecurity in high-altitude Peruvian cities during the second epidemic wave of COVID-19. Methods A retrospective, cross-sectional study was conducted in eight Peruvian cities over 1,500 m above sea level. An online survey measuring food security, presence of anxiety & depressive symptoms, sleep quality, post-traumatic stress disorder (PTSD), resilience, and sociodemographic characteristics was disseminated through social networks between December 2020 and February 2021. Generalized linear models were used to identify an association between the study variables. Results Of 700 participants, the median age was 23 years, and more than half were female (56.7%). The prevalence of food insecurity was 37.1%. Anxiety symptoms, depressive symptoms, and PTSD were present in 72.7%, 64.1%, and 15% of respondents, respectively. The prevalence of food insecurity was higher in people with fair (PR: 1.60, 95% CI: 1.23–2.07) and very bad perception of their health (PR: 4.06, 95% CI: 2.63–6.26), individuals seeking mental health support (PR: 1.42, 95% CI: 1.25–1.62), and in those who lost their job due to the pandemic (PR: 1.82, 95% CI: 1.62–2.04). Having moderate (PR: 1.52, 95% CI: 1.26–1.83) and moderate to severe depressive symptoms (PR: 1.58, 95% CI: 1.11–2.27) also increased the prevalence of food insecurity. Conclusion During the pandemic, the prevalence of food insecurity has increased in the Peruvian high-altitude population, revealing the need for preventive strategies. Identification of pandemic-related characteristics that influence food insecurity can guide interventions in at-risk individuals and reduce the long-term impact of this problem on overall health and quality of life.
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Affiliation(s)
- J. Pierre Zila-Velasque
- grid.441704.20000 0001 0087 8137School of Medicine, Universidad Nacional Daniel Alcides Carrión, Pasco, Peru ,Red Latinoamericana de Medicina en La Altitud E Investigación (REDLAMAI), Pasco, Peru
| | - Pamela Grados-Espinoza
- grid.441704.20000 0001 0087 8137School of Medicine, Universidad Nacional Daniel Alcides Carrión, Pasco, Peru ,Red Latinoamericana de Medicina en La Altitud E Investigación (REDLAMAI), Pasco, Peru
| | - Katherine Quispe-Chura
- grid.441943.f0000 0001 1089 6427School of Medicine, Universidad Nacional del Altiplano, Puno, Peru
| | - Christopher G. Valdiviezo-Morales
- grid.441932.90000 0004 0418 8231School of Medicine, Universidad Nacional de Piura, Piura, Peru ,grid.441932.90000 0004 0418 8231Scientific Society of Medical Students, Universidad Nacional de Piura, Piura, Peru
| | - Cristian Diaz-Vélez
- grid.441975.a0000 0001 0739 3319School of Medicine, Universidad Privada Antenor Orrego, Trujillo, Peru ,grid.420173.30000 0000 9677 5193Instituto de Evaluación de Tecnologías en Salud e Investigación – IETSI, EsSalud, Lima, Peru
| | - Mario J. Valladares-Garrido
- grid.441766.60000 0004 4676 8189Universidad Continental, Lima, Peru ,Oficina de Epidemiología, Hospital Regional Lambayeque, Chiclayo, Peru
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Gajda R, Jeżewska-Zychowicz M, Styczyńska M, Jarossová MA. Food Insecurity in the Households of Polish Elderly: Diversity in the Perception of Its Causes by Demographic and Socioeconomic Characteristics. Foods 2022; 11:3222. [PMCID: PMC9601627 DOI: 10.3390/foods11203222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The aging of societies and the quality of life of the elderly may be accompanied by food insecurity. The aim of the study was to find the relationships between the perceptions of various causes of food insecurity, i.e., financial, social, health, and spatial, and then between those and the selected sociodemographic characteristics. The survey was conducted in late 2018 and early 2019 among 760 people aged 65 and older in two regions of Poland. Factor analysis with the use of principal component analysis (PCA) was used to identify the main causes of the prevalence of food insecurity. Cluster analysis using Ward’s hierarchical classification and logistic regression analysis were used to assess the relationship between the identified reasons for food insecurity, demographic characteristics, and socioeconomic status (SES). Two groups of causes that favor the experience of food insecurity among the elderly were identified, i.e., economic–social reasons and spatial–health reasons. They relate to such situations of food insecurity as concerns about food shortages, lack of staple foods, limited size or frequency of meals, and skipping meals. The high importance of economic–social (HE-S) reasons was associated with the low importance of spatial–health (LS-H) reasons, and conversely, the high importance of spatial–health (HS-H) causes was associated with the low importance of economic–social (LE-S) causes. HE-S and LS-H reasons were combined with low SES and residence in a city of more than 100,000 inhabitants. HS-H causes, on the other hand, were associated with LE-S causes and living in rural areas or towns of fewer than 100,000 inhabitants, as well as high SES. This specificity should be considered in the development of strategies and interventions aimed at reducing the phenomenon of experiencing food insecurity in the elderly population.
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Affiliation(s)
- Robert Gajda
- Department of Human Nutrition, Faculty of Biotechnology and Food Sciences, Wrocław University of Environmental and Life Sciences, Chełmońskiego 37, 51-630 Wroclaw, Poland
- Correspondence:
| | - Marzena Jeżewska-Zychowicz
- Department of Food and Consumption Market Research, Faculty of Human Nutrition, Warsaw University of Life Sciences, Nowoursynowska 166, 02-787 Warsaw, Poland
| | - Marzena Styczyńska
- Department of Human Nutrition, Faculty of Biotechnology and Food Sciences, Wrocław University of Environmental and Life Sciences, Chełmońskiego 37, 51-630 Wroclaw, Poland
| | - Małgorzata Agnieszka Jarossová
- Department of Marketing, Faculty of Commerce, University of Economics in Bratislava, Dolnozemská Cesta 1, 852 35 Bratislava, Slovakia
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Choi YJ, Crimmins EM, Ailshire JA. Food insecurity, food environments, and disparities in diet quality and obesity in a nationally representative sample of community-dwelling older Americans. Prev Med Rep 2022; 29:101912. [PMID: 35911578 PMCID: PMC9326331 DOI: 10.1016/j.pmedr.2022.101912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/07/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022] Open
Abstract
Food insecurity, reflecting a household's low ability to purchase healthy food, is a public health concern that is associated with poor diet and obesity. Poor food environments, characterized as a neighborhood with low access to healthy, affordable food, may amplify the negative impact of food insecurity on diet and obesity. This study aims to investigate whether food insecurity and food environments are jointly associated with an increased risk of poor diet quality and obesity. We used data from a nationally representative sample of community-dwelling older adults in the Health and Retirement Study Health Care and Nutrition Survey and the National Neighborhood Data Archive to investigate the role of household and neighborhood characteristics on diet and obesity. Weighted regression models were estimated to examine the relationship between food insecurity and food environments as well as their interaction with diet quality and obesity. Food insecure respondents had lower Healthy Eating Index scores and were more likely to be obese than food secure respondents. Living in a poor food environment was associated with lower Healthy Eating Index scores, but not with obesity. We did not find any interaction between food insecurity and food environment in determining either healthy eating or obesity. Reducing food insecurity and increasing access to healthy food environments may encourage healthier eating among older adults, while alleviating food-related hardship may also reduce their obesity risk.
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Affiliation(s)
- Yeon Jin Choi
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Avenue #218, Los Angeles, CA, USA
| | - Eileen M. Crimmins
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Avenue #218, Los Angeles, CA, USA
| | - Jennifer A. Ailshire
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Avenue #218, Los Angeles, CA, USA
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26
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Zhang A, Wang K, Acquati C, Kamat A, Walling E. Age as a moderator for the association between depression and self-rated health among cancer survivors: a U.S. based population study. J Psychosoc Oncol 2022:1-16. [PMID: 36154823 DOI: 10.1080/07347332.2022.2124393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Self-rated health (SRH) is a salient outcome for cancer survivors. Although depression is a well-studied correlate with SRH, few studies have focused on the role of cancer survivors' age on the association between depression and SRH. This study evaluates demographic and psychosocial factors associated with cancer survivors' SRH. We also assess the moderating role of age to the association between depression and SRH. MATERIALS AND METHODS This paper analyzed 2,470 U.S. cancer survivors from the 2019 National Health Interview Survey. Two ordered logistic regression models with complex survey weights were used for analyses. Missing data was addressed using multiple imputations by chained equations. RESULTS Being female, higher education and higher income were positively associated with better SRH. While the relationship between higher education and higher income was consistent with previous findings, the positive association between being female and SRH was different from previous studies. Age significantly moderated the association between depression and SRH, evidenced by results of the joint tests of all interaction term coefficients being statistically significant, F(2, 544.6) = 5.13, p < 0.01. CONCLUSIONS The findings of the study highlighted the significance of screening for social determinants of health and health disparity when supporting cancer survivors. Additionally, findings of this study emphasized the significance of adopting an age-specific approach when evaluating and addressing depression across different age groups of cancer survivors.
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Affiliation(s)
- Anao Zhang
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Kaipeng Wang
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
| | - Chiara Acquati
- Graduate College of Social Work, University of Houston, Houston, Texas, USA.,Department of Health Disparities Research, MD Anderson Cancer Center, The University of Texas, Houston, Texas, USA
| | - Aarti Kamat
- Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily Walling
- Medical School, University of Michigan, Ann Arbor, Michigan, USA
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Influence of Social Adversity on Perceived Health Status and Depressive Symptoms among Portuguese Older People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116355. [PMID: 35681940 PMCID: PMC9180494 DOI: 10.3390/ijerph19116355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/21/2022] [Accepted: 05/21/2022] [Indexed: 02/01/2023]
Abstract
This study aims to investigate how exposure to poverty, food insecurity, and abuse at older ages relates to health outcomes. A questionnaire collecting data on sociodemographic and economic characteristics, health status, depressive symptoms, food insecurity, and abuse was administered to a sample of 677 older adults. Logistic regression was used to quantify the association of poverty, food insecurity, and abuse with perceived health status and depressive symptoms. If the older person only reported experiences of abuse, it was more likely to report the presence of depressive symptoms, even after adjustment for covariates. If it was only reported the experience of food insecurity, it was more likely to report a worse health status. Older people exposed to at least two factors of vulnerability were significantly more likely to report (very) poor perceived health status (OR: 7.11, 95% CI: 2.77–18.25) and the presence of relevant depressive symptoms (OR: 4.34; 95% CI: 2.04–9.22). Thus, the combined effect of vulnerabilities was significantly associated with worse health among older people. Public health policies to mitigate these adverse exposures should be developed to promote health and well-being in this population.
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Hadfield-Spoor M, Avendano M, Loopstra R. Food insecurity among disabled adults. Eur J Public Health 2022; 32:593-599. [PMID: 35560213 PMCID: PMC9341842 DOI: 10.1093/eurpub/ckac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The relationship between disability and food insecurity is under-researched. Risk of food insecurity may vary by type and number of disabilities. We examine the hypotheses that (i) a higher number of disabilities increases risk of food insecurity and (ii) associations of physical disabilities, mental/cognitive disabilities or a combination of both types with food insecurity may differ in strength. Methods Data came from the fifth wave of the UK’s Food Standards Agency’s Food and You survey (2018), which contains detailed information on disability and household food insecurity. We used logistic and multinomial logistic regression to model the number and type of disabilities as predictors for food insecurity outcomes, controlling for socio-demographic factors. Results Both type and number of disabilities predicted food insecurity. Every additional disability was associated with higher odds of food insecurity [odds ratio (OR): 1.60, 95% confidence interval (CI): 1.40–1.83]. Among people with a disability, every additional disability was associated with 19% higher odds of food insecurity (OR: 1.19, 95% CI: 1.05–1.34). People with both physical and mental/cognitive disabilities had increased odds of severe food insecurity (OR: 8.97, 95% CI: 3.54–22.7). Conclusion Number and type of disabilities are associated with higher risk of food insecurity. A combination of physical and mental/cognitive disabilities, as well as having multiple disabilities are each independently associated with higher risk of food insecurity. Policy-makers may thus consider using targeted and tailored policies to reduce barriers to social and financial inclusion of disabled people to reduce food insecurity.
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Affiliation(s)
| | - Mauricio Avendano
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Rachel Loopstra
- Department of Nutritional Sciences, King's College London, London, UK
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29
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Stotz SA, Hebert LE, Maddux A, Moore KR. Healthy Eating Determinants and Food Security Resource Opportunities: Urban-Dwelling American Indian and Alaska Native Older Adults Perspectives. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:186-193. [PMID: 34953642 PMCID: PMC8908730 DOI: 10.1016/j.jneb.2021.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore the perspectives of urban-dwelling American Indian and Alaska Native (AI/AN) older adults regarding determinants of healthy eating, food insecurity, and opportunities for an urban clinic to improve resources. METHODS Semistructured interviews (n = 24) with older adults (aged ≥ 60 years) at 1 urban AI/AN serving clinic. Telephone-based interviews were audio-recorded, professionally transcribed, and analyzed using thematic analysis. RESULTS Four overarching themes were revealed: (1) hunger-mitigating resources exist but do not necessarily lessen food insecurity; (2) multiple layers of challenges related to social determinants of health present barriers to healthy nutrition for AI/AN older adults; (3) unique facilitators rooted in AI/AN culture can help decrease food insecurity; and (4) many clinic-based opportunities for programs to improve food insecurity exist. CONCLUSIONS AND IMPLICATIONS Findings provide a foundation for urban-serving AI/AN clinics to develop healthy eating resources for their older adult patients. Greater benefit would result from resources that build on cultural strengths and address older adult-specific challenges to healthy eating.
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Affiliation(s)
- Sarah A Stotz
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Luciana E Hebert
- Institute for Research and Education Advancing Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, WA
| | | | - Kelly R Moore
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
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Davis J, Lim E, Taira DA, Chen J. Relation of incident chronic disease with changes in muscle function, mobility, and self-reported health: Results from the Health and Retirement Study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000283. [PMID: 36962709 PMCID: PMC10021154 DOI: 10.1371/journal.pgph.0000283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 07/28/2022] [Indexed: 11/19/2022]
Abstract
The primary objective was to learn the extent that muscle function, mobility, and self-reported health decline following incident diabetes, stroke, lung problem, and heart problems. A secondary objective was to measure subsequent recovery following the incident events. A longitudinal panel study of the natural history of four major chronic diseases using the Health and Retirement Study, a nationally representative sample of adults over age 50 years. People first interviewed from 1998-2004 were followed across five biannual exams. The study included 5,665 participants who reported not having diabetes, stroke, lung problems, and heart problems at their baseline interview. Their mean age was 57.3 years (SD = 6.0). They were followed for an average of 4.3 biannual interviews. Declines and subsequent recovery in self-reported health, muscle function, and mobility were examined graphically and modeled using negative binomial regression. The study also measured the incidence rates and prevalence of single and multiple chronic diseases across the follow-up years.Self-reported health and muscle function declined significantly following incident stroke, heart problems, lung problems, and multiple chronic diseases. Mobility declined significantly except following incident diabetes. Self-reported health improved following incident multiple chronic conditions, but recovery was limited compared to initial decline. Population prevalence after five follow-up waves reached 9.0% for diabetes, 8.1% for heart problems, 3.4% for lung disease, 2.1% for stroke, and 5.2% for multiple chronic diseases. Significant declines in self-reported health, muscle function, and mobility occurred within two years of chronic disease incidence with only limited subsequent recovery. Incurring a second chronic disease further increased the declines. Early intervention following incident chronic disease seems warranted to prevent declines in strength, mobility, and perceptions of health.
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Affiliation(s)
- James Davis
- John A. Burns School of Medicine, Honolulu, HI, United States of America
| | - Eunjung Lim
- John A. Burns School of Medicine, Honolulu, HI, United States of America
| | - Deborah A Taira
- Daniel K. Inouye College of Pharmacy, Hilo, HI, United States of America
| | - John Chen
- John A. Burns School of Medicine, Honolulu, HI, United States of America
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Choi SL, Men F. Food insecurity associated with higher COVID-19 infection in households with older adults. Public Health 2021; 200:7-14. [PMID: 34653739 PMCID: PMC8433037 DOI: 10.1016/j.puhe.2021.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/16/2021] [Accepted: 09/03/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES As a well-documented social determinant of health, food insecurity may be associated with COVID-19 infection in households with older adults. We examined whether older adults were vulnerable to COVID-19 infection during the early pandemic if they were food insecure versus food secure. STUDY DESIGN A cross-sectional study using a nationally representative population-based survey of US older adults. METHODS We used a random subsample of Health and Retirement Study (HRS) drawn in June 2020 (N = 3212). We compared the odds of reporting COVID-19 infection in a household, COVID-19 infection and mortality among acquaintances, and respondent's perceived fair or poor health across household food insecurity status resulted from financial or non-financial barriers. Baseline health and socioeconomic circumstances were adjusted in the models. RESULTS Results showed a higher COVID-19 infection rate among food-insecure households than among their food-secure counterparts during the pandemic. Food insecurity due to non-financial obstacles was associated with greater likelihood of COVID-19 infection both within respondents' households (adjusted odds ratio [aOR] = 1.73, 95% confidence interval [CI]: 1.03-2.90) and among their acquaintances (aOR = 1.32, 95% CI: 1.05-1.65). Food insecurity caused by both non-financial and financial constraints was associated with twice the likelihood of knowing someone who died from COVID-19 than their food-secure counterparts (aOR = 2.14, 95% CI: 1.27-3.61). CONCLUSIONS Food insecurity driven by non-financial constraints played an important role in the ongoing pandemic among US older adults. Policies addressing COVID-19 need to recognize the vulnerability of food-insecure older adults beyond lack of monetary resources.
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Affiliation(s)
- S L Choi
- The University of Alabama, 304 Adams Hall, Box 870158, Tuscaloosa, AL 35487, United States.
| | - F Men
- The University of Alabama, 316 Adams Hall, Box 870158, Tuscaloosa, AL 35487, United States
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32
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Harrison C, Brooks M, Goldstein JN, Papas M. Food Insecurity in Delaware: A Triangulation of Spatial Data Sources. Prev Chronic Dis 2021; 18:E81. [PMID: 34410907 PMCID: PMC8388202 DOI: 10.5888/pcd18.200555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Cecelia Harrison
- ChristianaCare, Value Institute, Newark, Delaware.,3567 Lafayette Street Philadelphia PA, 19129.
| | | | | | - Mia Papas
- ChristianaCare, Value Institute, Newark, Delaware
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Friedman C. Food insecurity of people with disabilities who were Medicare Beneficiaries during the COVID-19 pandemic. Disabil Health J 2021; 14:101166. [PMID: 34272190 PMCID: PMC8436149 DOI: 10.1016/j.dhjo.2021.101166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 11/28/2022]
Abstract
Background During the COVID-19 pandemic, 54 million people in the United States were food insecure (2020). People with disabilities (PWD) who were Medicare beneficiaries were especially vulnerable to food insecurity prior to the pandemic. Objective The aim of this study was to explore COVID-19 pandemic food insecurity among PWD who were Medicare beneficiaries. Methods We conducted a secondary analysis of the United States Census Bureau COVID-19 Household Pulse Survey data about the food security of 70,171 PWD who were Medicare beneficiaries (under 65), and a comparison group of 1.1 million non-Medicare beneficiaries (under 65). Data were weighted using frequency person-weights. Results Only 44.3% of PWD who were Medicare beneficiaries had enough of the foods they wanted to eat during the pandemic. Reasons for food insecurity included: could not afford to purchase more food (56.9%); stores did not have the food they wanted (31.4%); afraid to go out to get more food (30.0%); could not get out to get more food (21.5%); and could not get food delivered (8.5%). PWD who were Medicare beneficiaries were more likely to be food insecure than non-Medicare beneficiaries. There were also disparities in food insecurity among PWD who were Medicare beneficiaries themselves with household size, Medicaid beneficiaries, gender, race, education, martial status, household income, and Supplemental Nutrition Assistance Program (SNAP) all impacting food security. Conclusions A multipronged approach that addresses not only food-related public health, but also other systems and structures is critical to end food insecurity.
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Affiliation(s)
- Carli Friedman
- CQL
- the Council on Quality and Leadership, 100 West Road Suite 300, Towson, MD, 21204, USA.
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34
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Gajda R, Jeżewska-Zychowicz M. The importance of social financial support in reducing food insecurity among elderly people. Food Secur 2021. [DOI: 10.1007/s12571-021-01151-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AbstractThe growing number of elderly people who are at increased risk of food insecurity for a variety of reasons, including financial ones, requires the current situation to be monitored. The purpose of this research was therefore to determine: (1) how older people perceive their situation in terms of food security; (2) whether older people use any form of external financial support; and (3) the relationship between people’s perception of their food security and the use of financial support from social services and their family. The survey was conducted on a group of 1150 people aged 65 years and above at the end of 2018 and the beginning of 2019. In total, 762 questionnaires were analysed for the study. The study was conducted in the Świętokrzyskie and Śląskie voivodeships (provinces). Multivariate correspondence analysis (MCA) and the chi-square test were used to compare qualitative variables describing food security, financial assistance and socio-demographic features. Over two thirds of the respondents declared that they had no need of financial assistance from the social services or their family. Two categories of variables were selected using the MCA method: people who declared that their household had food security and that they had no need for financial assistance from social services or their family, and people who said they did not have food security and simultaneously used financial assistance or did not use such assistance but had financial problems. Place of residence and household composition were features that significantly distinguished the opinions about the lack of food security. Financial social programmes and the social education of families should be improved to minimize the risk of food insecurity in households of elderly people, especially those not benefiting from financial social support.
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Elderly Perception of Distance to the Grocery Store as a Reason for Feeling Food Insecurity-Can Food Policy Limit This? Nutrients 2020; 12:nu12103191. [PMID: 33086560 PMCID: PMC7603094 DOI: 10.3390/nu12103191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 01/10/2023] Open
Abstract
The sense of food insecurity in a group of elderly people may be determined by the perception of distance to food outlets. The aim of the study was to assess the relationship between the perception of food insecurity by the elderly and their perception of the distance between the places of residence and food purchase. A cross-sectional quantitative survey was carried out in 2019–2020 amongst 762 Polish elderly living in Świętokrzyskie and Śląskie Voivodeship. The assessment of the relationships between the perceived food insecurity due to living too far away from the grocery shops and socio-demographic features was performed using multiple correspondence analysis (MCA), chi-square tests, and Phi and Cramér’s V coefficients. Too great a distance to the place of food purchase was the cause of a lack of a sense of food security in 20.5% of the study sample, especially in men, people aged 75 and more, people living in a rural environment and people living alone. People reporting a lack of food due to the distance to the place of purchase showed socio-demographic characteristics similar to those of people declaring a lack of a sense of food security. Reduced food consumption due to the distance from the place of sale, including of fish (24.8%), some fruits (18.9%) and vegetables (15.4%) and beef (17.3%), may contribute to the deterioration of the diet and, as a result, health conditions. Including access to places of the sale of food in food policy as a factor contributing to ensuring the food security of older people can help to maintain a better quality of life and avoid exclusion. Especially in a situation of limited independence, food insecurity in elders due to causes other than financial limitations should be a focus of food policy.
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Harrison C, Goldstein JN, Gbadebo A, Papas M. Validation of a 2-Item Food Insecurity Screen Among Adult General Medicine Outpatients. Popul Health Manag 2020; 24:509-514. [PMID: 33021444 DOI: 10.1089/pop.2020.0183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Food insecurity is defined as limited access to food and is associated with adverse physical, social, and emotional health outcomes. As social needs are addressed in heath care, efficient methods to identify patients living in food insecure households are necessary. A 2-item screen (HFSS-2) derived from the US Department of Agriculture Household Food Security Scale (HFSS-18) has been validated among parents of pediatric patients with a sensitivity of 97% and specificity of 83%. The objective was to validate the HFSS-2 in adult general medicine outpatients. HFSS-18 was administered to a sample of adult general medicine outpatients in Delaware from 2018 to 2019. The authors evaluated the sensitivity and specificity of the HFSS-2. Multivariable logistic regression was used to calculate convergent validity between the HFSS-18 and the HFSS-2. Three hundred ninety patients were approached with 295 (75%) enrolling in this study; 17.6% (52/295) were food insecure. A confirmatory response to either of the 2 items from the HFSS-2 had a sensitivity of 98% (95% CI: 94%, 100%) and specificity of 91% (95% CI: 87%, 94%). Food insecurity was associated with increased odds of coronary heart disease (adjusted odds ratio [AOR] 4.63; 95% CI: 1.55, 13.79; AOR 4.19; 95% CI: 1.51, 11.59) and diabetes (AOR 4.19; 95% CI: 1.94, 9.08; AOR 3.73; 95% CI: 1.83, 7.92) using both the HFSS-18 and the HFSS-2. HFSS-2 was found to be highly sensitive and specific. This is the first study to validate this tool in this population that the authors are aware of.
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Affiliation(s)
| | | | | | - Mia Papas
- Value Institute, ChristianaCare, Newark, Delaware, USA
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Ahiawodzi P, Djousse L, Ix JH, Kizer JR, Tracy RP, Arnold A, Newman A, Mukamal KJ. Non-Esterified Fatty Acids and Risks of Frailty, Disability, and Mobility Limitation in Older Adults: The Cardiovascular Health Study. J Am Geriatr Soc 2020; 68:2890-2897. [PMID: 32964434 DOI: 10.1111/jgs.16793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/22/2020] [Accepted: 07/30/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVES Non-esterified fatty acids (NEFAs) play central roles in the relationship between adiposity and glucose metabolism, and they have been implicated in the pathogenesis of cardiovascular disease, but few studies have assessed their effects on complex geriatric syndromes like frailty that cross multiple organ systems. We sought to determine the relationships between NEFAs and incident frailty, disability, and mobility limitation in a population-based cohort of older persons. METHODS We analyzed 4,710 Cardiovascular Health Study (CHS) participants who underwent measurement of circulating total fasting NEFAs in 1992-1993 and were assessed for frailty in 1996-1997 and for disability and mobility limitation annually. We used ordinal logistic regression to model incident frailty, linear regression to model components of frailty, and Cox regression to model disability and mobility limitation in relation to baseline NEFAs. To ensure proportional hazards, we truncated follow-up at 9 years for disability and 6.5 years for mobility limitation. RESULTS A total of 42 participants became frail and 510 became pre-frail over a 4-year period, and we documented 1,720 cases of disability and 1,225 cases of mobility limitation during follow-up. NEFAs were positively associated in a dose-dependent manner with higher risks of incident frailty, disability, and mobility limitation. The adjusted odds ratios for frailty were 1.37 (95% confidence interval [CI] = 1.01-1.86; P = .04) across extreme tertiles and 1.17 (95% CI = 1.03-1.33; P = .01) per standard deviation increment. The corresponding hazard ratios for incident disability were 1.14 (95% CI = 1.01-1.30; P = .04) and 1.11 (95% CI = 1.06-1.17; P < .0001); those for incident mobility limitation were 1.23 (95% CI = 1.06-1.43; P = .006) and 1.15 (95% CI = 1.08-1.22; P < .0001). Results were largely consistent among both men and women. Among individual components of frailty, NEFAs were significantly associated with self-reported exhaustion (β = .07; standard error = .03; P = .02). CONCLUSION Circulating NEFAs are significantly associated with frailty, disability, and mobility limitation among older adults. These results highlight the broad spectrum of adverse health issues associated with NEFA in older adults.
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Affiliation(s)
- Peter Ahiawodzi
- Department of Public Health, Campbell University College of Pharmacy and Health Sciences, Buies Creek, North Carolina, USA
| | - Luc Djousse
- Division of Aging, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Joachim H Ix
- Divisions of Nephrology and Preventive Medicine, University of California, San Diego, San Diego, California, USA
| | - Jorge R Kizer
- Division of Cardiology, Veterans Affairs Medical Center, University of California, San Francisco, California, USA
| | - Russell P Tracy
- Department of Pathology and Biochemistry, University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Alice Arnold
- Department of a Biostatistics, University of Washington, Seattle, Washington, USA
| | - Anne Newman
- Departments of Epidemiology and Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kenneth J Mukamal
- Division of General Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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Midlife vulnerability and food insecurity: Findings from low-income adults in the US National Health Interview Survey. PLoS One 2020; 15:e0233029. [PMID: 32658927 PMCID: PMC7357765 DOI: 10.1371/journal.pone.0233029] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/27/2020] [Indexed: 11/19/2022] Open
Abstract
Background Food insecurity, limited access to adequate food, in adulthood is associated with poor health outcomes that suggest a pattern of accelerated aging. However, little is known about factors that impact food insecurity in midlife which in turn could help to identify potential pathways of accelerated aging. Methods Low-income adults (n = 17,866; 2014 National Health Interview Survey), ages 18 to 84, completed a 10-item food security module and answered questions regarding health challenges (chronic conditions and functional limitations) and financial worry. We used multinomial logistic regression for complex samples to assess the association of health challenges and financial worry with food insecurity status and determine whether these associations differed by age group, while adjusting for poverty, sex, race/ethnicity, education, family structure, social security, and food assistance. Results Food insecurity rates were highest in late- (37.5%) and early- (36.0%) midlife, relative to younger (33.7%) and older (20.2%) age groups and, furthermore, age moderated the relationship between food insecurity and both risk factors (interaction p-values < .05, for both). The effects of poor health were stronger in midlife relative to younger and older ages. Unlike younger and older adults, however, adults in midlife showed high levels of food insecurity regardless of financial worry. Conclusions Findings suggest that food insecurity in midlife may be more severe than previously thought. Greater efforts are needed to identify those at greatest risk and intervene early to slow premature aging.
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Social Determinants of Health, From Assessment to Action:: A Review of 3 Studies from the Value Institute at ChristianaCare. Dela J Public Health 2020; 6:72-78. [PMID: 34467115 PMCID: PMC8389812 DOI: 10.32481/djph.2020.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction The COVID-19 crisis highlights the importance of screening for and managing adverse social determinants of health (SDoH). Many of the same SDoH items that put individuals at increased risk of COVID-19 infection have increased dramatically due to the economic repercussions of slowing the viral spread. Methods This is a review of 3 studies conducted by the Health Services Research Core in the Value Institute at ChristianaCare. The studies had 3 overarching goals: 1) to conduct a survey of primary care providers in Delaware to determine their current methods for collection of social determinants data, 2) to validate a 2-item screening tool for food insecurity, and 3) to assess the geographic distribution of patients with food insecurity. Results Our studies have demonstrated the importance of screening for SDoH by highlighting the inconsistent data collection of SDoH items, examining the prevalence of food insecurity and validating a standardized instrument for rapid data collection, as well as displaying geospatial differences in food insecurity prevalence across New Castle County, DE. Public Health Implications The COVID-19 pandemic has increased the prevalence of these social determinants in our communities. Therefore, it is imperative to employ screening and geospatial strategies to address the SDoH implications of the novel coronavirus.
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Wang K, Bishop NJ. Social support and monetary resources as protective factors against food insecurity among older Americans: findings from a health and retirement study. Food Secur 2019. [DOI: 10.1007/s12571-019-00945-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Petersen CL, Brooks JM, Titus AJ, Vasquez E, Batsis JA. Relationship Between Food Insecurity and Functional Limitations in Older Adults from 2005-2014 NHANES. J Nutr Gerontol Geriatr 2019; 38:231-246. [PMID: 31144612 DOI: 10.1080/21551197.2019.1617219] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: Food insecurity refers to the physical, social, and economic inability to access and secure sufficient, safe and nutritious food. Food insecurity has been found to be associated with poor health status, obesity, and chronic disease. To date, a relationship between food insecurity and functional limitations has not been described in of older adults. Methods: We examined 9309 adults ≥60 years old from the 2005-2014 National Health and Nutrition Examination Surveys (NHANES). Food security was categorized as full, marginal, low, and very low. Functional limitations were assessed as having difficulty in physical, basic or instrumental activities of daily living. Results: Of adults ≥60 years old (mean age: 70.5 ± 0.08, 51% female), the prevalence of full, marginal, low, or very low food insecurity was 7572 (81%), 717 (7%), 667 (8%), and 353 (4%), respectively. The prevalence of any functional limitations was 5895 (66.3%). The adjusted odds (OR [95%CI]) of having any functional limitation in marginal, low, and very low food security levels compared to full food security are: 1.08 [1.02-1.13], 1.16 [1.10-1.22], 1.14 [1.07-1.21], respectively. The association between levels of food insecurity and functional limitation is modified by race/ethnicity. Conclusions: Functional limitation is significantly associated with increasing food insecurity in older adults.
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Affiliation(s)
- Curtis L Petersen
- a The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth , Lebanon , NH , USA.,b Department of Epidemiology, Geisel School of Medicine at Dartmouth , Lebanon , NH , USA.,c Quantitative Biomedical Sciences Program, Geisel School of Medicine at Dartmouth , Lebanon , NH , USA
| | - Jessica M Brooks
- d Department of Psychiatry, Geisel School of Medicine and Centers for Health and Aging, Dartmouth College , Lebanon , NH , USA.,e Department of Rehabilitation and Health Services, University of North Texas , Denton , TX , USA
| | - Alexander J Titus
- b Department of Epidemiology, Geisel School of Medicine at Dartmouth , Lebanon , NH , USA.,c Quantitative Biomedical Sciences Program, Geisel School of Medicine at Dartmouth , Lebanon , NH , USA
| | - Elizabeth Vasquez
- f Department of Epidemiology, School of Public Health, SUNY Albany , Albany , NY , USA
| | - John A Batsis
- a The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth , Lebanon , NH , USA.,g Sections of General Internal Medicine and Weight & Wellness Center, Dartmouth-Hitchcock , Lebanon , NH , USA
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Pooler JA, Hartline-Grafton H, DeBor M, Sudore RL, Seligman HK. Food Insecurity: A Key Social Determinant of Health for Older Adults. J Am Geriatr Soc 2019; 67:421-424. [PMID: 30586154 PMCID: PMC6816803 DOI: 10.1111/jgs.15736] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Jennifer A. Pooler
- Advanced Analytics Practice Area, IMPAQ International, LLC, Columbia, Maryland
| | | | | | - Rebecca L. Sudore
- Department of Medicine, Division of Geriatrics, University of California, San Francisco, California
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Department of Medicine, Innovation and Implementation Center for Aging and Palliative Care (I-CAP), Division of Geriatrics, University of California, San Francisco, California
| | - Hilary K. Seligman
- Department of Medicine and Department of Epidemiology and Biostatistics, University of California, San Francisco
- The UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California
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