Food management practices used by people with limited resources to maintain food sufficiency as reported by nutrition educators

Food insecurity and risk of cholera: A cross-sectional study and exploratory analysis of potential mediators

BACKGROUND

Food insecurity has been independently associated with developing cholera and there is an inverse relationship between national food security and annual cholera incidence. However, the factors that mediate the risk of cholera among food insecure households remain largely unexplored.

METHODOLOGY AND PRINCIPAL FINDINGS

In a cross-sectional survey of rural households in Haiti, we explored the role of food behaviors (i.e., dietary choices and food-handling practices) as mediators of cholera risk among food-insecure families. We generated a series of multivariable regression models to test hypothesized associations between the severity of food insecurity (measured by the Household Hunger Scale), hygiene and food behaviors, and history of severe, medically-attended cholera. Moderate household hunger (Adjusted Odds Ratio [AOR] 1.47, 95% Confidence Interval (CI) 1.05-2.04; p = 0.021) and severe hunger (AOR 2.45, 95% CI 1.45-4.15; p = 0.001) were positively associated with a history of severe, medically-attended cholera compared with little to no household hunger. Household hunger was positively associated with three behaviors: antacid use, consumption of leftover non-reheated food, and eating food and beverages prepared outside of the home (i.e., at a restaurant or from a vendor). Consumption of outside food items and antacid use were positively associated with a history of cholera.

CONCLUSION

Our findings suggest that food behaviors may mediate the association between food insecurity and cholera and contribute to an understanding of how interventions could be designed to target food insecurity as part of cholera prevention and control.

Identifying Barriers to and Facilitators of Using a Mobile Fruit and Vegetable Market Intervention Delivered to Low-Income Housing Sites: A Concept Mapping Study

BACKGROUND

Mobile fruit and vegetable (F&V) markets may be a promising strategy to improve F&V intake among low-income and racial/ethnic minority groups. However, challenges remain in terms of maximizing the reach and utilization of such markets. Therefore, this study identifies perceived barriers to and facilitators of utilizing a mobile F&V market among residents who lived in low-income housing that received the markets. Specifically, this article reports the results of the follow-up acceptability study of the "Live Well, Viva Bien" (LWVB) intervention.

METHOD

We conducted concept mapping with residents in housing communities that received the Fresh to You (FTY) markets. Participants generated, sorted, and rated statements concerning barriers to and facilitators of market use. We compared the rating data by residents' level of market utilization and created a map representing how statements clustered into conceptual themes.

RESULTS

We retained 66 unique participant-generated statements. Eight thematic clusters emerged; four pertained to barriers: financial/promotion, produce-related, scheduling/knowledge, and logistic/awareness barriers, and four related to facilitators: produce/staffing, promotion, accessibility, and multilevel market facilitators. There was a strong correlation in ratings between participants who more frequently versus less frequently shopped at the markets (r = 0.94).

CONCLUSIONS

Participants identified financial barriers, market promotion, ease of market accessibility, produce variety and quality, and staffing as key factors influencing FTY market use. This study highlights the importance of identifying the perceived barriers to and facilitators of mobile F&V market use among target populations to inform future efforts to scale up such approaches.

Poverty and Food Insecurity Predict Mealtime Structure: Mediating Pathways of Parent Disciplinary Practices and Depressive Symptoms

OBJECTIVE

Structured, well-organized mealtime routines can provide many physical and mental health benefits for children. Poverty and food insecurity (FI) are socioeconomic risk factors for less effective mealtime routines. However, the specific mechanisms by which these social factors may negatively impact mealtime structure are not well-understood. We test whether poverty and FI are associated with parenting factors (mental health and parent disciplinary practices), and whether these parenting factors in turn associate with less mealtime structure.

METHODS

Low-income families (N = 270), recruited when children were approximately 6-years-old (wave 1), were followed for 2 years (wave 2). Socioeconomic and parenting factors were assessed at W1 via parent-report. Associations of poverty and FI with two measures of mealtime structure (parent-reported and observed mealtime structure at wave 1 and wave 2), mediated by parent factors (depressive symptoms, lax and overreactive parent disciplinary practices) were assessed in separate path analyses.

RESULTS

The association between higher depth of poverty and less mealtime structure in early childhood was mediated by greater parent depressive symptoms. FI was associated with less mealtime structure in early childhood, mediated by overreactive parenting, and with less mealtime structure in early and mid-childhood, mediated by lax parenting.

CONCLUSION

Poverty and food insecurity may contribute to suboptimal parent disciplinary practices and poor parent mental health, which may reduce mealtime structure for children. Addressing parent mental health and parent disciplinary practices in the context of socioeconomic adversity may be one way in which interventions can improve mealtime structure for low-income families.

Household Food Insecurity is Associated with Higher Adiposity among US Schoolchildren Ages 10-15 Years: The Healthy Communities Study

BACKGROUND

Limited research exists on the relationship between food insecurity and children's adiposity and diet and how it varies by demographic characteristics in the United States.

OBJECTIVE

The aim of this study was to assess the relationship between household food insecurity and child adiposity-related outcomes, measured as BMI (kg/m2) z score (BMI-z), weight status, and waist circumference, and diet outcomes, and examined if the associations differ by age, sex, and race/ethnicity.

METHODS

Data collected in 2013-2015 from 5138 US schoolchildren ages 4-15 y from 130 communities in the cross-sectional Healthy Communities Study were analyzed. Household food insecurity was self-reported using a validated 2-item screener. Dietary intake was assessed using the 26-item National Cancer Institute's Dietary Screener Questionnaire, and dietary behaviors were assessed using a household survey. Data were analyzed using multilevel statistical models, including tests for interaction by age, sex, and race/ethnicity.

RESULTS

Children from food-insecure households had higher BMI-z (β: 0.14; 95% CI: 0.06, 0.21), waist circumference (β: 0.91 cm; 95% CI: 0.18, 1.63), odds of being overweight or obese (OR: 1.17; 95% CI: 1.02, 1.34), consumed more sugar from sugar-sweetened beverages (β: 1.44 g/d; 95% CI: 0.35, 2.54), and less frequently ate breakfast (β: -0.28 d/wk; 95% CI: -0.39, -0.17) and dinner with family (β: -0.22 d/wk; 95% CI: -0.37, -0.06) compared to children from food-secure households. When examined by age groups (4-9 and 10-15 y), significant relationships were observed only for older children. There were no significant interactions by sex or race/ethnicity.

CONCLUSIONS

Household food insecurity was associated with higher child adiposity-related outcomes and several nutrition behaviors, particularly among older children, 10-15 y old.

Assessment of Food Safety Knowledge and Behaviors of Cancer Patients Receiving Treatment

Cancer patients receiving treatment are at a higher risk for the acquisition of foodborne illness than the general population. Despite this, few studies have assessed the food safety behaviors, attitudes, risk perceptions, and food acquisition behaviors of this population. Further, no studies have, yet, quantified the food safety knowledge of these patients. This study aims to fill these gaps in the literature by administering a thorough questionnaire to cancer patients seeking treatment in three hospitals in a Midwest, metropolitan area. Demographic, treatment, food security, and food safety knowledge, behaviors, attitudes, risk perceptions, and acquisition information was assessed for 288 patients. Specific unsafe attitudes, behaviors, and acquisition practices were identified. Most notable is that 49.4% (n = 139) of participants were not aware that they were at increased risk of foodborne infection, due to their disease and treatment. Additionally, though patients exhibited a general understanding of food safety, the participant average for correctly answering the food safety questions was 74.77% ± 12.24%. The section concerning food storage showed lowest participant knowledge, with an average score of 69.53% ± 17.47%. Finally, patients reporting low food security also reported a higher incidence of unsafe food acquisition practices (P < 0.05). These findings will help healthcare providers to better educate patients in the food safety practices necessary to decrease risk of foodborne infection, and to provide targeted food safety education to low-food-security patients.

Food insecurity among people with severe mental disorder in a rural Ethiopian setting: a comparative, population-based study

AIM

In low-income African countries, ensuring food security for all segments of the population is a high priority. Mental illness is associated consistently with poverty, but there is little evidence regarding the association with food insecurity. The aim of this study was to compare the levels of food insecurity in people with severe mental disorders (SMD) with the general population in a rural African setting with a high burden of food insecurity.

METHOD

Households of 292 community-ascertained people with a specialist-confirmed diagnosis of SMD (including schizophrenia and bipolar disorder) were compared with 284 households without a person with SMD in a rural district in south Ethiopia. At the time of the study, no mental health services were available within the district. Food insecurity was measured using a validated version of the Household Food Insecurity Access Scale. Disability was measured using the World Health Organisation Disability Assessment Schedule 2.0.

RESULT

Severe household food insecurity was reported by 32.5% of people with SMD and 15.9% of respondents from comparison households: adjusted odds ratio 2.82 (95% confidence interval 1.62 to 4.91). Higher annual income was associated independently with lower odds of severe food insecurity. When total disability scores were added into the model, the association between SMD and food insecurity became non-significant, indicating a possible mediating role of disability.

CONCLUSION

Efforts to alleviate food insecurity need to target people with SMD as a vulnerable group. Addressing the disabling effects of SMD would also be expected to reduce food insecurity. Access to mental health care integrated into primary care is being expanded in this district as part of the Programme for Improving Mental health carE (PRIME). The impact of treatment on disability and food insecurity will be evaluated.

Food and financial coping strategies during the monthly Supplemental Nutrition Assistance Program cycle

One in seven Americans participates in the Supplemental Nutrition Assistance Program (SNAP), making it the largest federally funded food assistance program. SNAP benefits are distributed once per month and both food spending and calorie consumption tend to decrease as time from benefit distribution increases. The monthly SNAP benefit cycle has serious implications for the health and financial stability of low-income families, a growing number of whom rely on SNAP as their sole source of income. Relatively little is known about the specific coping strategies households use to manage the SNAP cycle. The purpose of this study is to provide a critical exploration of the nature and timing of coping strategies for managing the SNAP cycle, including implications these coping mechanisms have for health and financial stability. This paper presents data from a prospective cohort study of mothers (n = 12) receiving SNAP benefits in Philadelphia between 2016 and 17. Both in-depth qualitative and survey methods were used. Participants reported on a variety of coping strategies they used to manage the SNAP cycle, including adjustments to shopping and eating patterns, mental accounting, emotional resilience, and social support. Instrumental social support was particularly vital in the final days of the benefit cycle, as were skipping meals and purchasing less expensive, energy-dense foods. Constant vigilance was required throughout the month to manage financial instability. The coping strategies for managing the SNAP cycle have short-term benefits, such as buffering against hunger and financial instability, however these survival strategies may have negative long-term repercussions for physical and financial health.

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Coping strategies included adjusting shopping/eating, mental accounting, and social support.

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SNAP was divided by trip type; first trip for essential food items, later trips for fill-in items.

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End-of-month diet changes included skipping meals and buying cheaper, more energy-dense foods.

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Instrumental social support was most critical in final days of the benefit cycle.

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Constant vigilance was required throughout the month to manage financial instability.

Nutritional Assessment and Intervention to Prevent and Treat Malnutrition for Fall Risk Reduction in Elderly Populations

The aging US population is increasing, and it is estimated that adults older than 65 years will make up 20% of the population by 2029 and the proportion of individuals in the United States older than 65 years will outnumber individuals younger than 18 years. In older adults, accidental falls are the leading cause of fatal and nonfatal injuries. Prevalence of chronic conditions such as sarcopenia and frailty contribute to the increased risk for fall observed in this population. Nutritional status in elderly individuals is a key predictor of both frailty and sarcopenia, thus ensuring adequacy in these populations has the potential for preventing falls. Poor nutritional status is associated with the onset of frailty. Nutrition screening, assessment and interventions can be targeted at this age group to overcome treat and prevent malnutrition to minimize fall risk.

Promoting Health Through Engagement in Occupations That Maximize Food Resources

Poverty is a complex problem in the United States with far-reaching consequences, often leading to a lack of food or lack of access to food. Proper nutrition and food intake are foundational to health and well-being. This participatory action research (PAR) project explored the challenges associated with living in poverty and managing food resources. Stakeholders engaged in a multiphase PAR process, which resulted in the development and implementation of a 7-wk occupation-based program. The program promotes graded learning of specific skills for managing food resources and emphasizes empowering each participant. Preliminary results indicate statistically significant improvements in participants' ability to make meals with certain food items and in perceived satisfaction and performance in self-identified activities related to food resource management. These findings support the feasibility of the program and the need for participant-driven, occupation-based approaches to improving food security.

Environmental impacts of food consumption by dogs and cats

In the US, there are more than 163 million dogs and cats that consume, as a significant portion of their diet, animal products and therefore potentially constitute a considerable dietary footprint. Here, the energy and animal-derived product consumption of these pets in the US is evaluated for the first time, as are the environmental impacts from the animal products fed to them, including feces production. In the US, dogs and cats consume about 19% ± 2% of the amount of dietary energy that humans do (203 ± 15 PJ yr-1 vs. 1051 ± 9 PJ yr-1) and 33% ± 9% of the animal-derived energy (67 ± 17 PJ yr-1 vs. 206 ± 2 PJ yr-1). They produce about 30% ± 13%, by mass, as much feces as Americans (5.1 ± Tg yr-1 vs. 17.2 Tg yr-1), and through their diet, constitute about 25-30% of the environmental impacts from animal production in terms of the use of land, water, fossil fuel, phosphate, and biocides. Dog and cat animal product consumption is responsible for release of up to 64 ± 16 million tons CO2-equivalent methane and nitrous oxide, two powerful greenhouse gasses (GHGs). Americans are the largest pet owners in the world, but the tradition of pet ownership in the US has considerable costs. As pet ownership increases in some developing countries, especially China, and trends continue in pet food toward higher content and quality of meat, globally, pet ownership will compound the environmental impacts of human dietary choices. Reducing the rate of dog and cat ownership, perhaps in favor of other pets that offer similar health and emotional benefits would considerably reduce these impacts. Simultaneous industry-wide efforts to reduce overfeeding, reduce waste, and find alternative sources of protein will also reduce these impacts.

Food Insecurity and Peripheral Arterial Disease in Older Adult Populations

OBJECTIVES

Food insecurity, defined as the limited or uncertain availability of nutritious and safe foods, is a complex phenomenon and is linked to poor nutrition and diet-sensitive chronic diseases. Dietary patterns that include saturated fats and meat products are potential risk factors for the progression of peripheral arterial disease (PAD). This study explored whether there is a relationship between food insecurity and PAD among a national sample of older adults.

DESIGN

We conducted a cross-sectional data analysis using data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES). Food security was assessed using the US Household Food Security Survey Module. Bivariate analyses were conducted using the Rao-Scott Chi-square test to examine associations between PAD and sociodemographic variables. Multivariable generalized logistic regression was employed to assess the effect of food security on the presence of PAD, with adjustment for respondent's socio demographic characteristics.

PARTICIPANTS

A total of 2,027 adults with PAD were included (Ankle Brachial Index (ABI) score ≤ 0.90).We excluded participants less than 60 years of age.

RESULTS

Compared to older adults who are food secure, those who are food insecure have an increased risk for PAD. Food insecurity is associated with peripheral arterial disease among older adults (adults adjusted odds ratio, 1.50 [95% CI 1.11-2.03).

CONCLUSION

Older adults with peripheral arterial disease are experiencing food insecurity. While nutrition and PAD are not well-defined, previous literature indicates there is a connection between food insecurity and diet-sensitive chronic diseases (diabetes and hypertension) which are risk factors for PAD. Food insecurity should be taken into consideration when treating older adults with PAD to help decrease poor health outcomes that are linked to an insufficient amount of nutritious foods.

Food insecurity, coping strategies and glucose control in low-income patients with diabetes

Objective

To examine the relationship between food insecurity and coping strategies (actions taken to manage economic stress) hypothesized to worsen glucose control in patients with diabetes.

Design

Using a cross-sectional telephone survey and clinical data, we compared food-insecure and food-secure individuals in their use of coping strategies. Using logistic regression models, we then examined the association between poor glucose control (glycated Hb, HbA1c≥8·0 %), food insecurity and coping strategies.

Setting

An urban medical centre, between June and December 2013.

Subjects

Four hundred and seven adults likely to be low income (receiving Medicaid or uninsured and/or residing in a zip code with >30 % of the population below the federal poverty level) with type 2 diabetes.

Results

Of respondents, 40·5 % were food insecure. A significantly higher percentage of the food-insecure group reported use of most examined coping strategies, including foregone medical care, participation in the Supplemental Nutrition Assistance Program (SNAP)) and use of emergency food programmes. Food insecurity was associated with poor glucose control (OR=2·23; 95 % CI 1·22, 4·10); coping strategies that were more common among the food insecure were not associated with poor glucose control. Among the food insecure, receipt of SNAP was associated with lower risk of poor glucose control (OR=0·27; 95 % CI 0·09, 0·80).

Conclusions

While food insecurity was associated with poor glucose control, most examined coping strategies did not explain this relationship. However, receipt of SNAP among food-insecure individuals was associated with better diabetes control, suggesting that such programmes may play a role in improving health.

Food insecurity, coping strategies and glucose control in low-income patients with diabetes

Objective

To examine the relationship between food insecurity and coping strategies (actions taken to manage economic stress) hypothesized to worsen glucose control in patients with diabetes.

Design

Using a cross-sectional telephone survey and clinical data, we compared food-insecure and food-secure individuals in their use of coping strategies. Using logistic regression models, we then examined the association between poor glucose control (glycated Hb, HbA1c≥8·0 %), food insecurity and coping strategies.

Setting

An urban medical centre, between June and December 2013.

Subjects

Four hundred and seven adults likely to be low income (receiving Medicaid or uninsured and/or residing in a zip code with >30 % of the population below the federal poverty level) with type 2 diabetes.

Results

Of respondents, 40·5 % were food insecure. A significantly higher percentage of the food-insecure group reported use of most examined coping strategies, including foregone medical care, participation in the Supplemental Nutrition Assistance Program (SNAP)) and use of emergency food programmes. Food insecurity was associated with poor glucose control (OR=2·23; 95 % CI 1·22, 4·10); coping strategies that were more common among the food insecure were not associated with poor glucose control. Among the food insecure, receipt of SNAP was associated with lower risk of poor glucose control (OR=0·27; 95 % CI 0·09, 0·80).

Conclusions

While food insecurity was associated with poor glucose control, most examined coping strategies did not explain this relationship. However, receipt of SNAP among food-insecure individuals was associated with better diabetes control, suggesting that such programmes may play a role in improving health.

Socio-cultural influences on the behaviour of South Asian women with diabetes in pregnancy: qualitative study using a multi-level theoretical approach

BACKGROUND

Diabetes in pregnancy is common in South Asians, especially those from low-income backgrounds, and leads to short-term morbidity and longer-term metabolic programming in mother and offspring. We sought to understand the multiple influences on behaviour (hence risks to metabolic health) of South Asian mothers and their unborn child, theorise how these influences interact and build over time, and inform the design of culturally congruent, multi-level interventions.

METHODS

Our sample for this qualitative study was 45 women of Bangladeshi, Indian, Sri Lankan, or Pakistani origin aged 21-45 years with a history of diabetes in pregnancy, recruited from diabetes and antenatal services in two deprived London boroughs. Overall, 17 women shared their experiences of diabetes, pregnancy, and health services in group discussions and 28 women gave individual narrative interviews, facilitated by multilingual researchers, audiotaped, translated, and transcribed. Data were analysed using the constant comparative method, drawing on sociological and narrative theories.

RESULTS

Key storylines (over-arching narratives) recurred across all ethnic groups studied. Short-term storylines depicted the experience of diabetic pregnancy as stressful, difficult to control, and associated with negative symptoms, especially tiredness. Taking exercise and restricting diet often worsened these symptoms and conflicted with advice from relatives and peers. Many women believed that exercise in pregnancy would damage the fetus and drain the mother's strength, and that eating would be strength-giving for mother and fetus. These short-term storylines were nested within medium-term storylines about family life, especially the cultural, practical, and material constraints of the traditional South Asian wife and mother role and past experiences of illness and healthcare, and within longer-term storylines about genetic, cultural, and material heritage - including migration, acculturation, and family memories of food insecurity. While peer advice was familiar, meaningful, and morally resonant, health education advice from clinicians was usually unfamiliar and devoid of cultural meaning.

CONCLUSIONS

'Behaviour change' interventions aimed at preventing and managing diabetes in South Asian women before and during pregnancy are likely to be ineffective if delivered in a socio-cultural vacuum. Individual education should be supplemented with community-level interventions to address the socio-material constraints and cultural frames within which behavioural 'choices' are made.

Development of eating behavior: biology and context

Eating is necessary for survival, gives great pleasure, and can be perturbed leading to undernutrition, overnutrition, and eating disorders. The development of feeding in humans relies on complex interplay between homeostatic mechanisms; neural reward systems; and child motor, sensory, and socioemotional capability. Furthermore, parenting, social influences, and the food environment influence the development of eating behavior. The rapid expansion of new knowledge in this field, from basic science to clinical and community-based research, is expected to lead to urgently needed research in support of effective, evidence-based prevention and treatment strategies for undernutrition, overnutrition, and eating disorders in early childhood. Using a biopsychosocial approach, this review covers current knowledge of the development of eating behavior from the brain to the individual child, taking into account important contextual influences.

Feeding her children, but risking her health: the intersection of gender, household food insecurity and obesity

This paper investigates one explanation for the consistent observation of a strong, negative correlation in the United States between income and obesity among women, but not men. We argue that a key factor is the gendered expectation that mothers are responsible for feeding their children. When income is limited and households face food shortages, we predict that an enactment of these gendered norms places mothers at greater risk for obesity relative to child-free women and all men. We adopt an indirect approach to study these complex dynamics using data on men and women of childrearing age and who are household heads or partners in the 1999-2003 waves of the Panel Study of Income Dynamics (PSID). We find support for our prediction: Food insecure mothers are more likely than child-free men and women and food insecure fathers to be overweight or obese and to gain more weight over four years. The risks are greater for single mothers relative to mothers in married or cohabiting relationships. Supplemental models demonstrate that this pattern cannot be attributed to post-pregnancy biological changes that predispose mothers to weight gain or an evolutionary bias toward biological children. Further, results are unchanged with the inclusion of physical activity, smoking, drinking, receipt of food stamps, or Women, Infants and Children (WIC) nutritional program participation. Obesity, thus, offers a physical expression of the vulnerabilities that arise from the intersection of gendered childcare expectations and poverty.

Food concern and its associations with obesity and diabetes among lower-income New Yorkers

OBJECTIVE

To examine food concern (FC) and its associations with obesity and diabetes in a racially diverse, urban population.

DESIGN

Cross-sectional population-based survey.

SETTING

Five boroughs of New York City.

SUBJECTS

Lower-income adults (n 5981) in the 2004 New York City Community Health Survey.

RESULTS

The overall prevalence of obesity was 24 % and was higher among FC than non-FC white men and women, black women, US- and foreign-born whites and foreign-born blacks. In multivariable analysis, FC was marginally associated with obesity (OR = 1·18, 95 % CI 0·98, 1·42) among all lower-income New Yorkers, after controlling for socio-economic factors. The association of FC and obesity varied by race/ethnicity, with FC being positively associated with obesity only among white New Yorkers. FC whites had 80 % higher odds of obesity than whites without FC (OR = 1·80; 95 % CI 1·21, 2·68), with a model-adjusted obesity prevalence of 20 % among non-FC whites v. 31 % among FC whites. FC was not associated with diabetes after controlling for obesity and socio-economic factors.

CONCLUSIONS

The prevalence of obesity was significantly higher among FC whites and certain subgroups of blacks. FC was positively associated with obesity risk among lower-income white New Yorkers. Programmes designed to alleviate FC and poverty should promote the purchase and consumption of nutritious, lower-energy foods to help address the burden of obesity in lower-income urban populations.

A review of class I and class II pet food recalls involving chemical contaminants from 1996 to 2008

Commercial pet food in USA is generally safe, but adulteration does occur. Adulterated food has to be recalled to protect pets and public health. All stakeholders, including food firms, distributors, and government agencies such as the Food and Drug Administration (FDA) participate in food recall. The objective of this review is to describe the pet food recall procedure from start to finish, and to review class I and II pet food recalls from 1996 to 2008, with a specific focus on those due to chemical contaminants/adulterants. Information was requested from the FDA by Freedom of Information Act. Only those recalls backed by the FDA scientific review were considered. The legal framework for food recalls in the Code of Federal Regulations, Title 21, Chapter 1, Part 7 and in the Food and Drug Administration Amendments Act of 2007, Title X was reviewed. From 1996 to 2008, there were a total of 22 class I and II pet food recalls. Of these, only six (27%) were due to chemical adulterants. The adulterants were aflatoxins, cholecalciferol, methionine, and melamine, and cyanuric acid. The causes of adulteration included inadequate testing of raw materials for toxins, use of wrong or faulty mixing equipment, and misformulation of raw materials. Overall, pet food manufactured in the USA is safe. Even with shortcomings in the recall process, the incidence of illness associated with pet food adulteration is low. Added changes can only make the system better in the future to safeguard pet and public safety.

Implications of food insecurity on global health policy and nursing practice

PURPOSE

The purpose is to discuss the concept of food insecurity (FI) and its impact on current global health policy and nursing practice.

ORGANIZING CONSTRUCT

Food insecurity.

METHODS

Literature review.

FINDINGS

FI means a nonsustainable food system that interferes with optimal self-reliance and social justice. Individuals experiencing FI lack nutritionally adequate and safe foods in their diet. Resources play a significant role in FI by affecting whether or not people obtain culturally, socially acceptable food through regular marketplace sources as opposed to severe coping strategies, such as emergency food sources, scavenging, and stealing. Persons who are living in poverty, female heads of household, single parents, people living with many siblings, landless people, migrants, immigrants, and those living in certain geographical regions constitute populations at risk and most vulnerable to FI.

CONCLUSIONS

FI influences economics through annual losses of gross domestic product due to reduced human productivity. FI affects individuals and households and is largely an unobservable condition, making data collection and analysis challenging. Policy and research have focused on macronutrient sufficiency and deprivation, making it difficult to draw attention and research dollars to FI.

CLINICAL RELEVANCE

Persons experiencing FI exhibit clinical signs such as less healthy diets, poor health status, poor diabetes and chronic disease management, and impaired cognitive function. Nurses can recognize the physical, psychosocial, and personal consequences that those with FI face and manage daily.

Food Systems and Public Health Disparities

The United States has set a national goal to eliminate health disparities. This article emphasizes the importance of food systems in generating and exacerbating health disparities in the United States and suggests avenues for reducing them. It presents a conceptual model showing how broad food system conditions interplay with community food environments-and how these relationships are filtered and refracted through prisms of social disparities to generate and exacerbate health disparities. Interactions with demand factors in the social environment are described. The article also highlights the separate food systems pathway to health disparities via environmental and occupational health effects of agriculture.

Could pets be of help in achieving health literacy? A media analysis demonstration study

This paper asks whether, when seeking to reach the public, interest in the health of pets merits consideration. Our data set consisted of 128 items from Canadian media coverage, 1996-2006, that dealt with bovine spongiform encephalopathy (BSE) as well as with cats, dogs or both. Three main messages regarding pet health and human health were identified: 'do not worry', 'do worry' and 'be cautious'. A minority of articles did not convey a pet health message or a human health message (6%), and contradictory messages regarding human and animal health frequently occurred (32%). While we did not assess how members of the public actually received or interpreted these messages, media coverage dealing with pets does appear to have the potential to influence people. Media reports of British cats being harmed by BSE, in fact, may have influenced public views worldwide. Thus, professionals should give careful consideration to pets when conveying health information. Nevertheless, we do not suggest pet health information substitute for human health information. Rather, interest in pets may provide an opportunity to complement and to reinforce communication about human health.

Food security in older adults: community service provider perceptions of their roles

Food insecurity in older adults is influenced by financial constraints, functional disability, and isolation. Twenty-eight social- and community-service providers participated in four focus groups to report (a) perceptions and experiences with food insecurity in their older clients, (b) beliefs about their potential role(s) in promoting food security, and (c) opinions about constraints that influenced these roles. A constant comparison analysis identified key themes. The formal caregivers reported six roles for improving food security: (a) monitoring, (b) coordination, and (c) promoting services, (d) education, (e) advocacy, and (f) providing a social environment. The final theme summarizes these roles as "the need for personalization of service". Social and community service providers are involved in roles that can promote the health of older adults by addressing their food insecurity. Social service providers need to be acknowledged and supported in this health promotion role.

Nutrition education needs and resources for dementia care in the community

Nutrition problems and specificly weight loss are common in older adults with dementia living in the community. Study 1 involved interviews with 14 formal providers to identify the range of nutrition concerns they had experienced. In study 2, 74 Canadian Alzheimer Society chapters were surveyed by e-mail (23% participation rate) to determine nutrition concerns and education resources provided to clients. In all, 26 of these nutrition pamphlets or handouts were rated on content and format by 2 independent researchers using a standardized rating system. Common nutrition concerns identified in older adults with dementia living in the community include safety, weight loss, forgetting or refusing to eat, appetite, dysphagia, and unfavorable eating behaviors. Most resources provided to clients were considered low quality and did not match the nutrition concerns expressed by formal providers. Currently, there is a considerable knowledge translation gap around nutrition and dementia, and this study provides a basis for the future development of nutrition education resources.

Low-income women's dietary intakes are sensitive to the depletion of household resources in one month

Food insecurity affects individuals' dietary intakes, but there have been few direct examinations of changes in individuals' intakes in the context of declining resources. This study examined changes in dietary intake over 30 d following the receipt of income in a sample of low-income, predominantly food-insecure women with children. Data on 182 women who received the bulk of their income in 1 monthly check were drawn from 2 Canadian studies. Equivalent 30-d measures of adult food security were constructed from participants' responses to items on the Radimer-Cornell questionnaire or the U.S. Household Food Security Survey Module. Intake data from multiple 24-h dietary recalls collected over 1 mo were merged. Mixed linear models were used to examine relationships between women's energy, nutrient, and food intakes and the depletion in household resources over 30 d, as indicated by days since the receipt of the household's major source of income. Women's intakes of energy, milk products, and vegetables decreased significantly as the time since they received income increased. When their food security status was considered, women who were food secure or marginally insecure showed no significant within-month patterns, but significant declines in energy, carbohydrate, vitamin B-6, and fruit and vegetable intake were observed for women with moderate or severe adult food insecurity. The food intakes of women in deprived circumstances are sensitive to the decline in household resources following the receipt of a monthly check.

Comparative validation of standard, picture-sort and meal-based food-frequency questionnaires adapted for an elderly population of low socio-economic status

OBJECTIVE

To compare the validity of a modified Block food-frequency questionnaire (FFQ), a picture-sort administration of the FFQ (PSFFQ) and a meal pattern-based questionnaire (MPQ) in a multi-ethnic population of low socio-economic status (SES).

DESIGN

Participants completed six 24-hour dietary recalls (24HR) over six months; the FFQ, PSFFQ and MPQ were completed in random order in the subsequent month. Instruments were interviewer-administered. The PSFFQ and MPQ were developed in formative research concerning difficulties for older adults in responding to standard food-frequency instruments.

SETTING

Rural North Carolina, USA. Subjects One hundred and twenty-two African American, Native American and white adults aged > or = 65 years, with approximately one-third in each ethnic group. Inclusion criteria included education < or = 12 years and income < or = 150% of national poverty level or Medicaid recipient.

RESULTS

Comparing median intakes from the average of the 24HR with the three diet assessment instruments, the MPQ tended to overestimate intakes compared with the FFQ and PSFFQ. Correlations among nutrients obtained by the 24HR and the other three instruments were generally statistically significant and positive. Across nutrients, the PSFFQ was most highly correlated with the 24HR for women, while the FFQ was most highly correlated with the 24HR for men.

CONCLUSIONS

Dietary assessments using 24HR and FFQ were similar to results reported elsewhere, although correlations between 24HR and FFQ were somewhat lower. Interviewer-administered dietary assessments should be used with caution to evaluate dietary intake among older adults with low SES. Gender differences and the lower correlations should be investigated more thoroughly to assist in choosing dietary assessment instruments for this population.

Understanding the sociocultural roots of childhood obesity: food practices among Latino families of Bushwick, Brooklyn

Despite prevention efforts, childhood obesity has reached epidemic proportions in the United States. This ethnographic study seeks to enhance understandings of the sociocultural dimensions of childhood obesity and inform prevention efforts. Using participant observation, interviews, and life histories, this research probes the sociocultural roots of childhood obesity by exploring the food practices and everyday lives of Latino families in Bushwick, Brooklyn, a low-income neighborhood in New York City. Mired in persistent poverty, Latino families burdened by teetering resources provide for their children using coping strategies in which everyday food practices play an important part. These practices illuminate cultural ideas about good parenting, well-being, and conceptions of the body. We argue that these practices, embedded in the neighborhood food environment, drive food choice and related activities of families, often leading to overweight and obesity in their children. They form the sociocultural roots of childhood obesity, and their implications are critically important for how public health professionals approach the relationship of food, nutrition, and obesity.

The Household Food Insecurity and Health Outcomes of U.S.–Mexico Border Migrant and Seasonal Farmworkers

Emerging evidence suggests chronic household food insecurity has an adverse effect on health. This study examined the prevalence, predictors and health outcomes associated with food insecurity in 100 migrant and seasonal farmworker (MSFW) households living on the U.S.-Mexico border. Data were collected using the U.S. Food Security Scale, California Agricultural Worker's Health Survey, and objective anthropometric, clinical and biochemical indicators. Food insecurity affected 82% of households; 49% also had hunger. Household food insecurity was predicted by the presence of minor children in the home and low maternal education. Food insecure households were more likely to have at least one member affected by symptoms of depression (deprimido), nervios (an ethnospecific condition), learning disorders, and symptoms suggestive of gastrointestinal infection. Although not directly associated with food insecurity, adult obesity, central body adiposity, elevated blood pressure, and blood lipid and glucose disturbances were common. These findings highlight the significant food security and health challenges faced by border area MSFW families.

Study finds Chapel Hill, NC, soup kitchen serves nutritious meals

Soup kitchens attempt to improve the food security of low-income individuals, but the results of their efforts are rarely researched. We focused our study on the Inter-Faith Council Soup Kitchen (IFC) near the University of North Carolina-Chapel Hill (UNC) in Chapel Hill, NC. The IFC uses no centralized nutrition planning and relies heavily on volunteer cooks, yet we found their meals to be highly nutrient-dense when averaged over a 1-month time frame and compared with the Dietary Reference Intakes (DRIs) and the Daily Reference Values (DRVs). In fact, the only nutrients needing improvement were vitamin D, folate, and calcium. The number of servings per meal was also substantially more than one third of the US Department of Agriculture Food Guide Pyramid recommendations, except for dairy at all meals, vegetables at breakfast, and fruit at dinner.

Food security status of households in Appalachian Ohio with children in Head Start

This study measured food security and hunger of households involved in Head Start in a rural Appalachian county and assessed factors that could affect food security and hunger. A convenience sample of households with children enrolled in the Head Start program in Athens County, Ohio, were sampled (n=710), with adults from 297 (42%) households responding. The survey instrument included the 18-question US Household Food Security Survey Module for measuring hunger and food insecurity. Of those responding, 152 households (51.2%) were food secure and 145 (48.8%) were food insecure. Ninety (30.3%) had experienced hunger in the previous 12 months, and 41 (13.8%) households were classified as food insecure with childhood hunger. Hunger was related to a variety of household characteristics and associated with several factors, including participation in food banks, dependence on family members and friends outside of the household for food, lacking reliable transportation, and not having a garden.

Maintaining food sufficiency: Coping strategies identified by limited-resource individuals versus nutrition educators

OBJECTIVE

This study's purposes were to identify food acquisition and management coping strategies used by limited-resource individuals to maintain food sufficiency, compare strategies named by the target audience to those previously identified by nutrition educators, and examine these strategies to advance grounded theory.

DESIGN

Eleven focus groups, conducted with 62 limited-resource individuals, elucidated coping strategies that they or others they knew used to acquire or manage food to maintain food sufficiency. The results were compared with practices as previously identified by nutrition educators who regularly worked with this audience.

SUBJECTS/SETTINGS

Subjects aged 19 to 67 from throughout New Jersey were recruited by Food Stamp agencies, low-income outreach programs, soup kitchens, welfare offices, Head Start centers, shelters, and food pantries.

RESULTS

Of the 95 coping strategies identified, 83% were known from nutrition educators previously. Ten new practices (eg, selling blood) had not previously been identified by educators. Four of 10 practices were not found in the literature (eg, repeated participation in research studies). Six practices previously reported by nutrition educators were not mentioned by the study population.

IMPLICATIONS

Educators who work with limited-resource individuals are a good resource for research with this audience. Study findings may be important considerations for nutrition program planning and policy making.