Money speaks: Reductions in severe food insecurity follow the Canada Child Benefit

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

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

Beyond Purchasing Power: The Association Between Sense of Community Belongingness and Food Insecurity Among Older Adults in Canada

Food is a basic human need, yet a significant proportion of older Canadian adults are vulnerable to food insecurity. The health risks associated with aging make food insecurity among this subgroup a critical policy issue. In Canada, policy solutions to food insecurity are however skewed toward the provision of income support to vulnerable groups. While these income support programs are timely, little emphasis is placed on social factors such as sense of community belongingness. This is despite evidence that food insecurity is a socially mediated experience that goes beyond the ability to purchase food. Drawing data from the Canadian Community Health Survey (n = 24,546) and using negative log-log regression, we examined the association between sense of community belongingness and food insecurity among older adults. Findings show that older adults with a "very weak" (odds ratio [OR] = 1.40, p < .001) and "somewhat weak" (OR = 1.23, p < .01) sense of community belongingness were significantly more likely to be food insecure compared to those with a "very strong" sense of belongingness. This study contributes to a growing body of the literature that demonstrates the need for an integrated approach to addressing food insecurity - one that goes beyond income support to include consideration of social factors like sense of community belonging.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

Public policy interventions to mitigate household food insecurity in Canada: a systematic review

OBJECTIVE

The objective of this systematic review is to synthesise the evidence on public policy interventions and their ability to reduce household food insecurity (HFI) in Canada.

DESIGN

Four databases were searched up to October 2023. Only studies that reported on public policy interventions that might reduce HFI were included, regardless of whether that was the primary purpose of the study. Title and abstract screening, full-text screening, data extraction, risk of bias and certainty of the evidence assessments were conducted by two reviewers.

RESULTS

Seventeen relevant studies covering three intervention categories were included: income supplementation, housing assistance programmes and food retailer subsidies. Income supplementation had a positive effect on reducing HFI with a moderate to high level of certainty. Housing assistance programmes and food retailer studies may have little to no effect on HFI; however, there is low certainty in the evidence that could change as evidence emerges.

CONCLUSION

The evidence suggests that income supplementation likely reduces HFI for low-income Canadians. Many questions remain in terms of how to optimise this intervention and additional high-quality studies are still needed.

The impact of rural structural and community health factors on postmastectomy complications among south central Appalachian breast cancer patients

PURPOSE

The study examined how structural and community health factors, including primary care physicians (PCP), food insecurity, diabetes, and mortality rate per county, are linked to the number and severity of postmastectomy complications among south central Appalachian breast cancer patients depending on rural status.

METHODS

Data was obtained through a retrospective review of 473 breast cancer patients that underwent a mastectomy from 2017 to 2021. Patient's ZIP Code was used to determine their rural-urban community area code and their county of residence for census data. We conducted a zero inflated Poisson regression.

FINDINGS

Results demonstrated that patients in small rural/isolated areas with low (B = -4.10, SE = 1.93, OR = 0.02, p = 0.03) to average (B = -2.67, SE = 1.32, OR = 0.07, p = 0.04) food insecurity and average (B = -2.67, SE = 1.32, OR = 0.07, p = 0.04) to high (B = -10.62, SE = 4.71, OR = 0.00, p = 0.02) PCP have significantly fewer postmastectomy complications compared to their urban counterparts. Additionally, patients residing in small rural/isolated areas with high (B = 4.47, SE = 0.49, d = 0.42, p < 0.001) diabetes and low mortality (B = 5.70, SE = 0.58, d = 0.45, p < 0.001) rates have significantly more severe postmastectomy complications.

CONCLUSION

These findings demonstrate that patients who reside in small/rural isolated areas may experience fewer and less severe postmastectomy when there is certain optimal structural and community health factors present compared to their urban counterparts. Oncologic care teams could utilize this information in routine consult for risk assessment and mitigation. Future research should further examine additional risks for postmastectomy complications.

The prevalence and predictors of household food insecurity among adolescents in Canada

OBJECTIVES

Household food insecurity is almost four times more prevalent among adolescents than among older adults in Canada, and it adversely affects their health. Our objective was to describe the sociodemographic and geographic patterning of household food insecurity among adolescents.

METHODS

Our analytic sample comprised all 12-17-year-old respondents to the 2017-2018 Canadian Community Health Survey with complete data on household food insecurity (n = 8416). We used bivariate and multivariable logistic regression models to identify respondent- and household-level sociodemographic characteristics associated with household food insecurity.

RESULTS

The prevalence of household food insecurity among adolescents was 20.7%. The adjusted odds of food insecurity were significantly elevated among adolescents who identified as Black or Indigenous (aOR 1.80), those living with a single parent (aOR 1.60), those living with a greater number of children ≤ 5 years (aOR 1.45) or 12-17 years (aOR 1.25), those in rented accommodation (aOR 1.98), those in households with only secondary school education (aOR 1.38), and those in households reliant on social assistance (aOR 2.03). Higher before-tax income was protective (aOR 0.99). In comparison with Ontario, the adjusted odds of food insecurity among adolescents were higher in Nunavut (aOR 6.77), Northwest Territories (aOR 2.11), and Alberta (aOR 1.48), and lower in Manitoba (aOR 0.66).

CONCLUSION

The markedly higher odds of exposure to household food insecurity among adolescents who are Black or Indigenous and those living in households characterized by markers of social and economic disadvantage highlight the need for more effective policy interventions to protect vulnerable families from this hardship.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Effect of Canada Child Benefit on Food Insecurity: A Propensity Score-Matched Analysis

INTRODUCTION

Food insecurity-the inadequate access to food due to financial constraints-affects 1 in 6 households in Canada, with serious health implications. Family benefit programs supplementing income have shown potential in mitigating the risk of food insecurity, but there is little understanding of their protective effects. The authors aimed to estimate the impacts of the additional Canada Child Benefit provided to families with children aged <6 years on household food insecurity.

METHODS

The authors sampled 28,435 households receiving Canada Child Benefit with children aged <8 years from the Canadian Income Survey 2018-2020 fielded in 2019-2021 and analyzed in 2022. Households without children aged <6 years were 1:1 propensity-score matched to those with children aged <6 years, who received up to $1,068 in additional Canada Child Benefit per child annually. The authors compared the 2 groups' 12-month food insecurity likelihood after matching. Subsample analyses were performed by household income, housing tenure, and household type.

RESULTS

Receipt of the additional Canada Child Benefit ($724 on average) was associated with 2.89 (95% CI=1.35, 4.42) percentage points lower probability of experiencing food insecurity among recipients with children aged <6 years (from 24.30% to 21.42%). The association was similar across socioeconomic subgroups and significant among all but high-income earners and mortgage-free homeowners.

CONCLUSIONS

The authors found plausibly causal evidence that the more generous Canada Child Benefit for Canadian families with young children reduces their probability of food insecurity. Increasing benefits for economically disadvantaged households, characterized by low incomes, single parenthood, and renting (versus owning), may improve the program's efficiency and equity in supporting families' food security.

Food Insecurity During the COVID-19 Pandemic: A Longitudinal Mixed-Methods Study from a Cohort of HIV Clients in Uganda

The COVID-19 pandemic threatens the food security of people in low-income countries. This is important for people living with HIV (PLWH) because HIV medication should be taken with food to avoid side-effects. We used survey data (n = 314) and qualitative interviews (n = 95) to longitudinally explore how the pandemic impacted food insecurity among PLWH in Kampala, Uganda. Prior to March 2020, 19.7% of respondents were food insecure. Our regression models estimate that food insecurity rose by 9.1 percentage points in our first round of surveys (June-September 2020; p < 0.05; t = 2.17), increasing to 17.2 percentage points in the second round of surveys (July-November 2021; p < 0.05; t = 2.32). Qualitative interviews reveal that employment loss and deteriorating support systems led to reduced meals and purchasing of cheaper foods. Respondents reported continuing to take their HIV medication even in the presence of food insecurity. Strategies for ensuring that PLWH have enough food should be prioritized so that the millions of PLWH in sub-Saharan Africa can take their medication without experiencing uncomfortable side-effects.Clinical Trials Registration Number NCT03494777.

Child and adolescent food insecurity in South Africa: A household-level analysis of hunger

Food insecurity impacts childhood nutritional status, physical and cognitive development, and increases lifetime risk for chronic disease. Previous South African studies have examined hunger at the sub-national level without a specific focus on children and adolescents. This study determines the national prevalence of childhood food insecurity, from birth to adolescence, and identifies factors associated with hunger within the household. Individual and household-level data were extracted from the South African National Health and Nutrition Examination Survey (SANHANES-1). Prevalence of food insecurity was assessed using the Community Childhood Hunger Identification Project (CCHIP) index. Multinomial logistic regression analyses were conducted on all households (with and without children) to determine the predictors of food insecurity, with additional analyses adjusting for child dependency and sociodemographic characteristics of household heads in households with children. Of 5 098 households surveyed, 68.6% had children and adolescents present (0-19 years). Of these households, 32.5% (95% Confidence Interval [CI]: 29.5-35.7) were experiencing hunger and 26.3% (95% CI: 23.9-28.8) were at risk of hunger. Among all the households, significant associations for experiencing hunger were the presence of children and adolescents: Adjusted Odds Ratio (AOR) = 1.68 (95% CI: 1.12-2.53); being female-headed: AOR = 1.53 (95% CI: 1.21-1.94) and informally-located; AOR = 1.6 (95% CI: 1.07-2.43). Of the racial groups, having a non-African household head, Coloured: AOR = 0.29 (95% CI: 0.19-0.44) and White/Indian/Asian: AOR = 0.12 (95% CI: 0.04-0.33) conferred lower odds of experiencing hunger; and, the household head having secondary/tertiary education conferred lower odds of experiencing hunger; AOR = 0.40 (95% CI: 0.28-0.56) as well as being at risk of hunger; AOR = 0.69 (95% CI: 0.52-0.92). Receiving social grants, pensions, or remittances more than doubled the odds of experiencing hunger; AOR = 2.15 (95% CI: 1.49-3.09). After adjusting for child dependency in households with children, having at least one older child (age 15-19 years old) did not change the odds of food insecurity. In summary, only 41% of South African households with children and adolescents were food secure. The associations between household head sociodemographics, household location and size on household food insecurity indicate a need for multi-sectoral interventions to bolster sustainable food systems for households with children and adolescents and to improve public protections for female-headed, African-headed and informally-located households dependent on social grants.

Low income and schizophrenia risk: a narrative review

Despite decades of research, the precise etiology of schizophrenia is not fully understood. Ample evidence indicates that the disorder derives from a complex interplay of genetic and environmental factors during vulnerable stages of brain maturation. Among the plethora of risk factors investigated, stress, pre- and perinatal insults, and cannabis use have been repeatedly highlighted as crucial environmental risk factors for schizophrenia. Compelling findings from population-based longitudinal studies suggest low income as an additional risk factor for future schizophrenia diagnosis, but underlying mechanisms remain unclear. In this narrative review, we 1) summarize the literature in support of a relationship between low (parental) income and schizophrenia risk, and 2) explore the mediating role of chronic stress, pre- and perinatal factors, and cannabis use as established risk factors for schizophrenia. Our review describes how low income facilitates the occurrence and severity of these established risk factors and thus contributes to schizophrenia liability. The broadest influence of low income was identified for stress, as low income was found to be associated with exposure to a multitude of severe psychological and physiological stressors. This narrative review adds to the growing literature reporting a close relationship between income and mental health.

Cash transfer programs and child health and family economic outcomes: a systematic review

Objectives

Family income is an important determinant of child and parental health. In Canada, cash transfer programs to families with children have existed since 1945. This systematic review aimed to examine the association between cash transfer programs to families with children and health outcomes in Canadian children (ages 0 to 18) as well as family economic outcomes.

Methods

We reviewed academic and grey literature published up to November 2021. Additional studies were identified through reference review. We included any study that examined children 0–18 years old and/or their parents, took place in Canada and reported Canada-specific data, and reported child, youth and/or parental health outcomes, as well as family economic outcomes. Risk of bias was assessed by two reviewers using a modified Newcastle-Ottawa Scale.

Synthesis

Our search yielded 23 studies meeting the inclusion criteria out of 7052 identified. Eight studies in total measured child health outcomes, including birth outcomes, child overall health, and developmental and behavioural outcomes, and four directly addressed parental health, including mental health, injuries, and obesity. Most studies reported generally positive associations, though some findings were specific to certain subgroups. Some studies also examined fertility and labour force participation outcomes, which described varying effects.

Conclusion

Cash transfer programs to families with children in Canada are associated with better child and parental health outcomes. Additional research is needed to evaluate the mechanisms of effects, and to identify which types and levels of government transfers are most effective, and target populations, to optimize the positive effects of these benefits.

Supplementary Information

The online version contains supplementary material available at 10.17269/s41997-022-00610-2.

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

OBJECTIVE

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

DESIGN

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

SETTING

Ten provinces in Canada.

PARTICIPANTS

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

RESULTS

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

CONCLUSIONS

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

Containing Hunger, Contesting Injustice? Exploring the Transnational Growth of Foodbanking- and Counter-responses- Before and During the COVID-19 Pandemic

COVID-19 caused levels of household food insecurity to spike, but the precarity of so many people in wealthy countries is an outgrowth of decades of eroding public provisions and labour protections that once protected people from hunger, setting the stage for the virus' unevenly-distributed harms. The prominence of corporate-sponsored foodbanking as a containment response to pandemic-aggravated food insecurity follows decades of replacing rights with charity. We review structural drivers of charity's growth to prominence as a hunger solution in North America, and of its spread to countries including the UK. By highlighting pre-pandemic pressures shaping foodbanking, including charities' efforts to retool themselves as health providers, we ask whether anti-hunger efforts during the pandemic serve to contain ongoing socioeconomic crises and the unjust living conditions they cause, or contest them through transformative pathways to a just food system. We suggest that pandemic-driven philanthropic and state funding flows have bolstered foodbanking and the food system logics that support it. By contextualising the complex and variegated politics of foodbanking in broader movements, from community food security to food sovereignty, we reframe simplistic narratives of charity and highlight the need for justice-oriented structural changes in wealth redistribution and food system organisation if we are to prevent the kinds of emergency-within-emergency that we witnessed as COVID-19 revealed the proximity of many to hunger.

Pain-driven emergency department visits and food insecurity: a cross-sectional study linking Canadian survey and health administrative data

BACKGROUND

As the leading cause of emergency department visits in Canada, pain disproportionately affects socioeconomically disadvantaged populations. We examine the association between household food insecurity and individuals' pain-driven emergency department visits.

METHODS

We designed a cross-sectional study linking the Canadian Community Health Survey 2005-2017 to the National Ambulatory Care Reporting System 2003-2017. Food insecurity was measured using a validated questionnaire. We excluded individuals with missing food insecurity status, individuals younger than 12 years and jurisdiction-years with partial emergency department records. We assessed emergency department visits driven by pain at different sites (migraine, other headaches, chest-throat pain, abdomen-pelvis pain, dorsalgia, joint pain, limb pain, other pain) and their characteristics (frequency, cause, acuity and time of emergency department visit) in Ontario and Alberta. We adjusted for sociodemographic characteristics, lifestyle and prior non-pain-driven emergency department visits in the models.

RESULTS

The sample contained 212 300 individuals aged 12 years and older. Compared with food-secure individuals, marginally, moderately and severely food-insecure people had 1.42 (95% confidence interval [CI] 1.20-1.68), 1.64 (95% CI 1.37-1.96) and 1.99 (95% CI 1.61-2.46) times higher adjusted incidence rates of pain-driven emergency department visits, respectively. The association was similar across sexes and significant among adults but not adolescents. Food insecurity was further associated with site-specific pain, with severely food-insecure individuals having significantly higher pain incidence than food-secure individuals. Severe food insecurity predicted more frequent, multicause, high-acuity and after-hours emergency department visits.

INTERPRETATION

Household food insecurity status is significantly associated with pain-driven emergency department visits in the Canadian population. Policies targeting food insecurity may reduce pain and emergency department utilization.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Variations in perceived stress among Syrian refugee parents resettled through different sponsorship programs in Canada

BACKGROUND

Little is known about the perceived stress level of Syrian Refugee (SR) parents residing in Canada specifically in relation to different sponsorship programs. This study aims to assess the relationship between the different sponsorship programs [Government-Assisted Refugees (GAR), Privately Sponsored Refugees (PSR) and Blended Visa Office-Referred refugees (BVOR)] and perceived stress among SR parents, with at least one child under the age of four, who resettled in the Greater Toronto area after 2015.

METHODS

A convenience sample of 155 Syrian Refugee (SR) parents was recruited. Perceived levels of stress were measured using the Perceived Stress Scale (PSS-10). Multiple linear regression analysis was performed to assess the independent relation between several types of sponsorship programs and PSS adjusting for demographic, economic and social factors.

RESULTS

The overall average PSS score was found to be 12.5 ± 7.2 with BVORs presenting the highest level of moderate stress when compared to GARs and PSRs (75.0% compared to 39.5% and 35.2% respectively). Multivariate analysis showed that the mean PSS was significantly higher among BVORs when compared with GARs (Adj β = 4.8; 95% CI 0.4, 9.2). No significant difference in PSS levels was reported when PSRs were compered to GARs. Increased PSS scores were found to be associated with worse family functioning (Adj β = 4.2; 95% CI 1.0, 7.4), while decreased PSS scores were associated with increased age (Adj β = -0.4; 95% CI -0.6, -0.1).

CONCLUSION

A better understanding of the various underlying factors associated with elevated stress is essential for improving the quality of life for SRs in Canada. Results of the study may help tailor more effective preventative measures or government interventions dedicated to reducing stress levels among this population.

The Measurement of Food Insecurity in High-Income Countries: A Scoping Review

The measurement of food insecurity is essential to monitor the prevalence, risk factors, consequences and effects of food insecurity and the interventions and policies implemented to tackle it. Yet, how best to apply it remains an unsettled issue due to the multifaceted and context-dependent nature of food insecurity. We report a scoping review of measures of food insecurity at the individual and household level in high-income countries with the final purpose of facilitating a catalogue of instruments to be used by both researchers and practitioners. The scoping review was conducted following the methodological framework of Arksey and O'Malley and the Joanna Briggs Institute guidelines. We included all types of documents published between 2000-2020 using instruments that estimate food insecurity at both individual and household level in high-income countries, and with respondents including adolescents, adults, and elderly. We identified a total of 23 measurement strategies being used in 33 peer-reviewed publications and 114 documents from the grey literature. Our results show that most measures focus on the access dimension of food insecurity and that further research is required to develop measures that incorporate aspects of quality of dietary intake and relevant individual, household and social conditions related to food insecurity.

Family policy and food insecurity: an observational analysis in 142 countries

BACKGROUND

Levels of child malnutrition and hunger across the world have decreased substantially over the past century, and this has had an important role in reducing mortality and improving health. However, progress has stalled. We examined whether family policies (eg, cash transfers from governments that aim to support households with children) are associated with reduced food insecurity.

METHODS

In this observational analysis, we used a dataset of individual-level data that captured experience-based measures of food insecurity and sociodemographic characteristics collected by the Gallup World Poll in 142 countries for 2014-17. We then combined this dataset with indicators of the type and generosity of family policies in these countries, taken from the University of California, Los Angeles' World Policy Analysis Center. We used multilevel regression models to examine the association between the presence of family policies for households with children and the probability of reporting moderate or severe food insecurity or severe food insecurity (moderate or severe food insecurity was defined as a "yes" response to at least four of eight questions on the Gallup Food Insecurity Experience Scale, and severe food insecurity was defined as a "yes" response to at least seven questions). We controlled for multiple covariates, including individual-level measures of social position and country-level measures, such as gross domestic product. We further examined whether this association varied by household income level.

FINDINGS

Using data from 503 713 households, we found that, on average, moderate or severe food insecurity is 4·09 percentage points (95% CI 3·50-4·68) higher in households with at least one child younger than 15 years than in households with no children and severe food insecurity is 2·20 percentage points (1·76-2·63) higher. However, the additional risk of food insecurity among households with children is lower in countries that provide financial support (either means-tested or universal) for families than for countries with little or no financial assistance. These policies not only reduce food insecurity on average, but they also reduce inequalities in food insecurity by benefiting the poorest households most.

INTERPRETATION

In some countries, family policies have been cut back in the past decade and such retrenchment might expose low-income households to increased risk of food insecurity. By increasing investment in family policies, progress towards Sustainable Development Goal 2, zero hunger, might be accelerated and, in turn, improve health for all.

FUNDING

Wellcome Trust.

Interventions to Address Food Insecurity Among Adults in Canada and the US: A Systematic Review and Meta-analysis

Importance

Inadequate access to food is a risk factor for poor health and the effectiveness of federal programs targeting food insecurity, such as the Supplemental Nutrition Assistance Program (SNAP), are well-documented. The associations between other types of interventions to provide adequate food access and food insecurity status, health outcomes, and health care utilization, however, are unclear.

Objective

To review evidence on the association between food insecurity interventions and food insecurity status, clinically-relevant health outcomes, and health care utilization among adults, excluding SNAP.

Data Sources

A systematic search for English-language literature was performed in PubMed Central and Cochrane Trials databases (inception to January 23, 2020), the Social Interventions Research and Evaluation Network database (December 10, 2019); and the gray literature using Google (February 1, 2021).

Study Selection

Studies of any design that assessed the association between food insecurity interventions for adult participants and food insecurity status, health outcomes, and health care utilization were screened for inclusion. Studies of interventions that described addressing participants' food needs or reporting food insecurity as an outcome were included. Interventions were categorized as home-delivered food, food offered at a secondary site, monetary assistance in the form of subsidies or income supplements, food desert interventions, and miscellaneous.

Data Extraction and Synthesis

Data extraction was performed independently by 3 reviewers. Study quality was assessed using the Cochrane Risk of Bias Tool, the ROBINS-I (Risk of Bias in Non-Randomized Studies of Interventions) tool, and a modified version of the National Institutes of Health's Quality Assessment Tool for Before-After Studies With No Control. The certainty of evidence was based on GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria and supplemented with mechanistic and parallel evidence. For outcomes within intervention categories with at least 3 studies, random effects meta-analysis was performed.

Main Outcomes and Measures

Food insecurity (measured through surveys; eg, the 2-item Hunger Vital Sign), health outcomes (eg, hemoglobin A1c), and health care utilization (eg, hospitalizations, costs).

Results

A total of 39 studies comprising 170 605 participants were included (8 randomized clinical trials and 31 observational studies). Of these, 14 studies provided high-certainty evidence of an association between offering food and reduced food insecurity (pooled random effects; adjusted odds ratio, 0.53; 95% CI, 0.33-0.67). Ten studies provided moderate-certainty evidence of an association between offering monetary assistance and reduced food insecurity (pooled random effects; adjusted odds ratio, 0.64; 95% CI, 0.49-0.84). There were fewer studies of the associations between interventions and health outcomes or health care utilization, and the evidence in these areas was of low or very low certainty that any food insecurity interventions were associated with changes in either.

Conclusions and Relevance

This systematic review with meta-analysis found that providing food and monetary assistance was associated with improved food insecurity measures; however, whether it translated to better health outcomes or reduced health care utilization was unclear.

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

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

Diet quality among Indigenous and non-Indigenous children and youth in Canada in 2004 and 2015: a repeated cross-sectional design

OBJECTIVE

The objectives were to describe changes in diet quality between off-reserve Indigenous and non-Indigenous children and youth from 2004 to 2015 and examine the association between food security and diet quality.

DESIGN

We utilised a repeated cross-sectional design using both the 2004 and 2015 nutrition-focused Canadian Community Health Surveys, including 24-h dietary recall. Diet quality was estimated according to the Healthy Eating Index (HEI).

SETTING

The surveys were conducted off-reserve in Canada's ten provinces.

PARTICIPANTS

Our analysis included children and youth 2-17 years old (n 18 189). Indigenous and non-Indigenous participants were matched, and using a general linear model, we tested time period and (non-)Indigenous identifiers, including their interaction effect, as predictors of HEI.

RESULTS

Both Indigenous and non-Indigenous children and youth had significantly higher HEI scores in 2015 as compared to 2004. There was not a significant (non-)Indigenous and time period interaction effect, indicating the improvements in diet quality in 2015 were similar between both Indigenous and non-Indigenous populations. Improvements in diet quality are largely attributed to reductions in percentage energy from 'other' foods, though a disparity between Indigenous and non-Indigenous children and youth persisted in 2015. Overall, food security was lower among the Indigenous population and positively, and independently, associated with diet quality overall, though this relationship differed between boys and girls.

CONCLUSIONS

School policies may have contributed to similar improvements in diet quality among Indigenous and non-Indigenous populations. However, an in-depth sex and gender-based analysis of the relationship between food security and diet quality is required.

Food insecurity, chronic pain, and use of prescription opioids

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

Childhood food insecurity and incident diabetes: A longitudinal cohort study of 34 042 children in Ontario, Canada

AIM

To examine the association between childhood food insecurity and incident diabetes.

METHODS

Using health administrative databases linked to the Canadian Community Health Survey, we conducted a population-based cohort study of children aged <18 years from Ontario, Canada. Children without diabetes who had a household response to the Canadian Community Health Survey Household Food Security Survey Module were followed for a median of 9.5 years for incident diabetes. Multivariable Cox proportional hazards models were used to examine the association between childhood food insecurity and incident diabetes, adjusted sequentially for important clinical and socio-economic risk factors.

RESULTS

We included 34 042 children, of whom 5.3% lived in food-insecure households. There were 184 new cases of diabetes, diagnosed at a median age of 16 and 18.5 years in food-secure and food-insecure children, respectively. In unadjusted analysis, childhood food insecurity was associated with an increased risk of incident diabetes (hazard ratio 1.69, 95% CI 1.01 to 2.81). When adjusted for clinical and socio-economic confounders, the relationship was no longer statistically significant (hazard ratio 1.55, 95% CI 0.91 to 2.66, adjusted for clinical confounders; hazard ratio 1.30, 95% CI 0.72 to 2.37, adjusted for clinical/socio-economic confounders). Our results remained robust in sensitivity analyses.

CONCLUSIONS

Although food-insecure children are a medically and socially vulnerable population, they do not appear to be at increased risk of incident diabetes over a median of 9.5 years.

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

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

Food insecurity is associated with mental health problems among Canadian youth

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Food Insecurity among Low-Income Food Handlers: A Nationwide Study in Brazilian Community Restaurants

This study aims to evaluate food insecurity (FI) among Brazilian Community restaurant food handlers and its associated factors. This cross-sectional study was performed with a representative sample of 471 food handlers working in community restaurants (CR) from all Brazilian regions. Participants are mostly female (62.2%), ≤40 years old (67.7%), with a partner (52.0%), and with up to eight years of education (54.1%). Predictors of participants' socioeconomic status and CR geographic location are associated with the household food insecurity categories (p < 0.05). The predictors of socioeconomic conditions are associated with mild and moderate/severe FI category. Workers with less education are twice as likely to belong to the category with the highest FI severity. Lower per capita household income increased the chances of belonging to the mild insecurity category by 86%. It more than doubled the chance to be in the category of moderate/severe insecurity. Predictors of health status, lifestyle, and work are not associated with any multinomial outcome categories. However, working in the South, Southeast, or Midwest regions of Brazilian decreased the chances of belonging to one of the FI categories, with significance only for the mild category. Variables that show an association for this population are per capita household income for the different levels of FI and the CR region for mild FI. A high prevalence of FI in this population points to the need for more studies with low-income workers to prevent FI and its health consequences.

Very Low Food Security Among Low-Income Households With Children in California Before and Shortly After the Economic Downturn From COVID-19

We examined levels of very low food security (VLFS) among low-income households with children in California before and shortly after the economic downturn from coronavirus disease 2019 (COVID-19). Households were randomly sampled in 2018, 2019, and 2020; 11,653 mothers were administered the US Department of Agriculture 6-item Food Security Survey Module. Post–COVID-19 (April 27 to July 21, 2020, a period when stay-at-home restrictions were eased in the state), 14.0% of mothers reported VLFS versus 19.3% pre–COVID-19 (November 21, 2019, to March 14, 2020) (P = .003), 22.2% in 2019 (P < .001), and 19.0% in 2018 (P = .004). Existing systems to quickly obtain food assistance benefits in California and new federal benefits available in response to COVID-19 may have reduced VLFS.

Maternal Food Insecurity is Positively Associated with Postpartum Mental Disorders in Ontario, Canada

BACKGROUND

Household food insecurity has been associated with pregnancy complications and poorer birth outcomes in the United States and with maternal mental disorders in the United Kingdom, but there has been little investigation of the effects of food insecurity during this life stage in Canada.

OBJECTIVES

Our objective was to examine the relationship between the food insecurity status of women during pregnancy and maternal and birth outcomes and health in infancy in Canada.

METHODS

We drew on data from 1998 women in Ontario, Canada, whose food insecurity was assessed using the Household Food Security Survey Module on the Canadian Community Health Survey, cycles 2005 to 2011-2012. These records were linked to multiple health administrative databases to identify indications of adverse health outcomes during pregnancy, at birth, and during children's first year of life. We included women who gave birth between 9 months prior and 6 months after their interview date, and for whom infant outcome data were available. Multivariable Poisson regression models were used to compare outcomes by maternal food security status, expressed as adjusted relative risks (aRR) with 95% CIs.

RESULTS

While pregnant, 5.6% of women were marginally food insecure and 10.0% were moderately or severely food insecure. Food insecurity was unrelated to pregnancy complications and adverse birth outcomes, but 26.8% of women with moderate or severe food insecurity had treatment for postpartum mental disorders in the 6-month postpartum period, compared to 13.9% of food-secure women (aRR, 1.86; 95% CI, 1.40-2.46). Children born to food-insecure mothers were at elevated risk of being treated in an emergency department in the first year of life (aRR, 1.18; 95% CI, 1.01-1.38).

CONCLUSIONS

Maternal food insecurity during pregnancy in Ontario, Canada, is associated with postpartum mental disorders and a greater likelihood of infants being treated in an emergency department.

Severe food insecurity associated with mortality among lower-income Canadian adults approaching eligibility for public pensions: a population cohort study

BACKGROUND

The prevalence of food insecurity among adults over 65 in Canada is less than half of that among adults approaching 65, possibly due in part to the public pension universally disbursed from the age of 65. Given research associating food insecurity with higher risk of premature mortality, our objective was to determine the likelihood that food-insecure adults with incomes below the national median would live past 65 to collect the public pension.

METHODS

We linked respondents of the Canadian Community Health Survey 2005-15 to the death records from the Canadian Vital Statistics Database 2005-17. We assessed household food insecurity status through a validated 18-item questionnaire for 50,780 adults aged 52-64 at interview and with household income below the national median. We traced their vital status up to the age of 65. We fitted Cox proportional hazard models to compare hazard of all-cause mortality before 65 by food insecurity status while adjusting for individual demographic attributes, baseline health, and household socioeconomic characteristics. We also stratified the sample by income and analyzed the subsamples with income above and below the Low Income Measure separately.

RESULTS

Marginal, moderate, and severe food insecurity were experienced by 4.1, 7.3, and 4.5% of the sampled adults, respectively. The crude mortality rate was 49 per 10,000 person-years for food-secure adults and 86, 98, and 150 per 10,000 person-years for their marginally, moderately, and severely food-insecure counterparts, respectively. For the full sample and low-income subsample, respectively, severe food insecurity was associated with 1.24 (95% CI: 1.06, 1.45) and 1.28 (95% CI: 1.07, 1.52) times higher hazard of dying before 65 relative to food security. No association was found between food insecurity and mortality in the higher-income subsample.

CONCLUSIONS

Severely food-insecure adults approaching retirement age were more likely to die before collecting public pensions that might attenuate their food insecurity. Policymakers need to acknowledge the challenges to food security and health faced by working-age adults and provide them with adequate assistance to ensure healthy ageing into retirement.

Maximizing the impact of the Canada Child Benefit: Implications for clinicians and researchers

Child poverty remains a persistent problem in Canada and is well known to lead to poor health outcomes. The Canada Child Benefit (CCB) is a cash transfer program in effect since 2016, which increased both the benefit amount and number of families eligible for the previous child benefit. While the CCB has decreased child poverty rates, not all eligible families have participated. Clinicians can play an important role in screening for uptake of the program and helping families navigate the application process through several free resources. While prior research on past programs has shown benefit of similar cash transfer programs to both child and parental outcomes (both health and social), the CCB has not yet been extensively studied. Research would be valuable in both assessing the cost effectiveness of the program, especially across different income groups, and improving implementation in hard-to-reach populations.