Position of the American Dietetic Association: domestic food and nutrition security

Dads at Mealtimes: Associations between Food Security, Household and Work Chaos, and Paternal Feeding Practices among Australian Fathers Living with Disadvantage

Understanding how fathers engage in feeding while experiencing disadvantage is important for family-focused interventions. A cross-sectional online survey involving 264 Australian fathers was conducted to explore feeding involvement and the relationships between feeding practices, food insecurity, and household and work chaos. Practices related to coercive control, structure, and autonomy support were measured for two age groups (<2 years and 2-5 years). Multivariable linear regression was used to examine the associations for each practice. Three-quarters of the sample were food insecure, impacting adults more than children, and correlated with household chaos. Food insecurity was associated with increased 'persuasive feeding' and 'parent-led feeding' in younger children. Household chaos was positively associated with coercive control practices in both younger and older child groups, with the strongest associations for 'using food to calm' and 'overt restriction', respectively. In older child groups, household chaos was negatively associated with 'offer new foods' and 'repeated presentation of new foods'. Structure practices had no significant relationships with any factors, and work chaos did not predict any feeding practices. These findings emphasize a need for societal and structural support to address food insecurity and household chaos. Tailored strategies are crucial to support fathers in responsive feeding.

Significant Nutritional Gaps in Tibetan Adults Living in Agricultural Counties Along Yarlung Zangbo River

Background

Dietary intake and nutritional assessing data from a representative sample of adult population living in an agricultural zone on Tibet Plateau are still lacking nowadays. This study aimed to assess the daily dietary intakes and respective food sources in 552 local residents (≥ 18 years old, 277 men and 275 women) living in 14 agricultural counties along the Yarlung Zangbo River on Tibet Plateau.

Methods

Food consumption data were collected using a validated cultural-specific food frequency questionnaire that contained all local Tibetan foods and analyzed with three fixed factors: gender, age, and region. Nutrient intakes were calculated using Chinese food composition tables. Nutritional gaps and the percentages of participants who had inadequate and excessive nutrient intakes were calculated by estimated average requirement (EAR) cut-point methods.

Results

Compared with the dietary reference intakes, 68.4% of nutrient intakes were inadequate. Fiber, Ca, I, Zn, Se, and vitamin (Va, Vc, and folic acid) intakes appeared to be particularly deficient. The dietary energy intake was 7838.8 ± 537.1 KJ/d, with 78 and 84% of EAR values for men and women, respectively. The dietary intakes of most nutrients were below the estimated energy requirement/EAR or adequate intake values, while more than 70% of the participants had excessive intake of carbohydrate, especially the elderly (aged ≥ 51 years). The nutritional gap of Cu was more than 300%. Almost 100% of the participants was vulnerable to fiber, Se, and Va shortfalls due to the deficiency in sole food sources. The top five food sources of Se intake were highland barley (34.2%), meat (13%), rice (12.4%), eggs (12.2%), and cultural-specific beverages (7.8%). Eggs (42.1%), tubers (62.2%), vegetables (66.4%), and highland barley (49.7%) were the first contributors of Va, Ve, Vc, and folic acid, respectively.

Conclusion

The dietary intake of a large sample of Tibetan adult population living in agricultural counties of Tibetan Autonomous Region is alarmingly insufficient. Gender inequality is common, and regional difference is widespread due to rapid urbanization. Young Tibetan adults aged 18–30 years are particularly vulnerable to micronutrient shortfalls and currently facing the risk of nutrition-insecurity-related dietary inadequacy. The respondents who belong to the elderly category (≥51 years of age) are facing the risk of “double burden of malnutrition” characterized by the coexistence of undernutrition, including micronutrient deficiencies and overweight or obesity.

How Do Disadvantaged Children Perceive, Understand and Experience Household Food Insecurity?

Food insecurity is associated with reduced physical, social, and psychological functioning in children. There has been sparse research into child food insecurity that incorporates children’s own perspectives, as adults are often interviewed as child proxies. While a nuanced, child-centred understanding of food insecurity is needed to inform effective policy and program responses, little is known about Australian children’s firsthand understanding or experience of household food insecurity. This study aimed to fill this gap by inviting preadolescent children’s perspectives. Eleven participants aged 10–13 years (seven girls and four boys) took part in the study and were recruited from an Australian charity school holiday camp that targets severely disadvantaged youth. Children took part in individual semi-structured interviews that incorporated drawings and emoji scales. Qualitative interviews were audio recorded, transcribed, and analysed using thematic techniques. Four themes emerged from the data analysis, children had: (i) financial understanding; (ii) awareness of food insecurity and coping mechanisms; (iii) sharing, empathy, and compassion for food insecure families; and (iv) described the nature of ‘food’ preparation. This study provides a child-centric analysis, demonstrating how children’s agency is enacted and constrained in food insecure contexts. This child-derived understanding of food insecurity provides a critical basis from which to build effective approaches to assess and respond to this significant social issue.

Food Insecurity and Hunger in Rich Countries-It Is Time for Action against Inequality

Household food insecurity is a serious public health concern in rich countries with developed economies closely associated with inequality. The prevalence of household food insecurity is relatively high in some developed countries, ranging from 8 to 20% of the population. Human rights approaches have the potential to address the structural causes, not just the symptoms of food insecurity. Despite most developed countries ratifying the Covenant on Economic, Social and Cultural Rights over 40 years ago, food insecurity rates suggest current social protections are inadequate. The contemporary framing of the solution to food insecurity in developed countries is that of diverting food waste to the hungry to meet the United Nations Sustainable Development Goals agenda (Goals 2 and 12.3). An estimated 60 million people or 7.2% of the population in high income countries used food banks in 2013. Although providing food assistance to those who are hungry is an important strategy, the current focus distracts attention away from the ineffectiveness of government policies in addressing the social determinants of food insecurity. Much of the action needed to improve household food security falls to actors outside the health sector. There is evidence of promising actions to address the social determinants of food insecurity in some developed countries. Learning from these, there is a strong case for government leadership, for action within and across government, and effective engagement with other sectors to deliver a coordinated, collaborative, and cooperative response to finding pathways out of food insecurity.

Everyday Substance Insecurity Among Homeless Injection Drug Users in Israel’s Largest Open Drug Scene

Limited attention has been given to Homeless Injection Drug Users (HIDUs) perceived need for illegal substances. This study assessed self-perceived illegal drug need in HIDUs based on their experiences. Observations and in-depth qualitative interviews were conducted with 11 HIDUs and with four treatment professionals. The findings revealed three findings concerning the unique experiences and perceptions of HIDUs: (a) Everyday Substance Need caused fear and anxiety, (b) Substance Need was experienced as more urgent than basic survival needs, and (c) HIDU participants attributed misunderstanding and denial of Substance Need to the authorities. It was found that HIDUs suffer from “Substance Insecurity,” which may be defined as the uncertain availability of quality substances (or their substitutes) and uncertain ability to acquire substances/substitutes and safe injection equipment in socially acceptable (or not) ways. Increased awareness of Substance Insecurity for HIDUs as a Substance Security First (SSF) model should be adopted.

Social Dysfunction and Diet Outcomes in People with Psychosis

This analysis aimed to examine the association of social dysfunction with food security status, fruit intake, vegetable intake, meal frequency and breakfast consumption in people with psychosis from the Hunter New England (HNE) catchment site of the Survey of High Impact Psychosis (SHIP). Social dysfunction and dietary information were collected using standardised tools. Independent binary logistic regressions were used to examine the association between social dysfunction and food security status, fruit intake, vegetable intake, meal frequency and breakfast consumption. Although social dysfunction did not have a statistically significant association with most diet variables, participants with obvious to severe social dysfunction were 0.872 (95% CI (0.778, 0.976)) less likely to eat breakfast than those with no social dysfunction p < 0.05. Participants with social dysfunction were therefore, 13% less likely to have breakfast. This paper highlights high rates of social dysfunction, significant food insecurity, and intakes of fruits and vegetables below recommendations in people with psychosis. In light of this, a greater focus needs to be given to dietary behaviours and social dysfunction in lifestyle interventions delivered to people with psychosis. Well-designed observational research is also needed to further examine the relationship between social dysfunction and dietary behaviour in people with psychosis.

Prospective Study of Black-White Differences in Food Insufficiency Among Homebound Elders

Objective: This study examines race differences in the association of sociodemographic and health-related characteristics with change in food sufficiency status over 1 year in homebound older adults.Method: Using sociodemographic and health-related data collected during two in-home assessments as part of the North Carolina Nutrition and Function Study, logistic regression models (binary and nominal outcomes) adjusted for covariates and examined the characteristics associated with 1-year change in risk (RFI) and presence (FI) of food insufficiency among a random sample of 268 home-delivered meals participants.Results: Not having enough money for food and having to prepare cheaper and smaller meals was associated with increased RFI and FI at 1 year; having to borrow money for food, loss of food stamps, and inadequate income increased the odds among Whites, and increased medication use among Blacks.Discussion: The findings suggest that race, independent of other characteristics, is associated with diminished food sufficiency over 1 year.

Associations between self-reported weight management methods with diet quality as measured by the Healthy Eating Index-2005

OBJECTIVE

We examine the relationship between weight management practices and diet quality.

METHOD

Regressions were used to analyze the associations between self-reported weight management methods and diet quality, as measured by the Healthy Eating Index-2005 (HEI-2005), of 1,933 respondents who tried to lose or not gain weight in the 2003-2004 National Health and Nutrition Examination Survey (NHANES). The regressions controlled for sociodemographics, lifestyle behaviors, and other health-related behaviors and perceptions.

RESULTS

Including both switching to foods with lower calories and exercise in weight management was associated with better diet quality, i.e., a higher total HEI-2005 score and higher scores in eight of the twelve HEI-2005 components than including neither method. The eight components included six components on fruit, vegetables and grains, milk, and calories from solid fat, alcohol beverages, and added sugars. Similar but smaller associations were also found among those who reported including either switching to foods with lower calories or exercise.

CONCLUSIONS

Based on self-reported data, the findings suggest that including switching to lower calorie foods and exercise in weight management, as recommended by the Dietary Guidelines for Americans (DGA), is associated with diet quality that is more consistent with the key diet-related advice of the DGA.

Relationship of household food insecurity to health-related quality of life in a large sample of rural and urban women

The authors examined the associations of household food insecurity and other characteristics with fair-to-poor general health, poor physical health, and frequent mental distress among 1,367 rural and urban women in Texas. The 2006 Brazos Valley Community Health Assessment provided data on demographic characteristics, economic risk factors, health-related quality of life, household food insecurity, and geographic residence. Multivariable logistic regression models were estimated for the three health-related quality of life measures: fair-to-poor health, poor physical health, and frequent mental distress, adjusting for confounding variables. Having less than 12 years of education, not being employed full-time, and being household food insecure were independently significantly associated with increased odds for all health-related quality of life outcomes. Rural residence and being nonwhite were associated with fair-to-poor general health, but not physical or mental health. Results from the separate urban and rural models indicated that household food insecurity was associated with fair-to-poor general health among rural women, not among urban women. Poverty and being nonwhite were also associated with increased odds of reporting fair-to-poor general health, but were significant only among urban women. These results emphasize the need for health promotion and policy efforts to consider household food access and availability as part of promoting healthful food choices and good physical and mental health among women, especially rural women.

The effect of Food Stamp Nutrition Education on the food insecurity of low-income women participants

OBJECTIVE

To determine the effect of Food Stamp Nutrition Education (FSNE) in Indiana on participants' food insecurity and food insufficiency.

DESIGN

A single-blind randomized design. A randomized experimental group completed 5 FSNE lessons as an intervention between a pre- and posttest, whereas a control group completed a pre- and posttest without FSNE intervention.

SETTING

Client homes and community locations in 24 Indiana counties.

PARTICIPANTS

Female head-of-household participants >or= 18 years old; n = 219.

INTERVENTION

FSNE lessons targeting food insecurity and nutrition.

MAIN OUTCOME MEASURES

Dependent variables food insecurity and food insufficiency were quantified with the 6-item United States Household Food Security Scale and United States Department of Agriculture Food Insufficiency Question, respectively. The independent variable was the randomly assigned treatment group.

ANALYSIS

Participants' characteristics were compared with chi-square analysis. Analyses of covariance models were constructed to find the effect of treatment group on food insecurity and food insufficiency. Significance indicated at P <or= .05.

RESULTS

Food insecurity and food insufficiency in the experimental group compared with the control group were significantly improved (P = .03, P = .04, respectively).

CONCLUSIONS AND IMPLICATIONS

FSNE was successful in improving participants' food insecurity and food insufficiency, indicating nutrition education is an appropriate intervention for food insecurity.

Hunger and health among undocumented Mexican migrants in a US urban area

Objectives

To measure the occurrence and correlates of hunger and to evaluate the association between hunger and three health indicators among undocumented Mexican immigrants.

Design

Non-probability cross-sectional sample.

Setting

Neighbourhoods within New York City.

Subjects

Four hundred and thirty-one undocumented Mexican immigrants living in the USA.

Results

Hunger was indicated by approximately 28% of respondents. In a multivariate model, working as a day labourer was associated with hunger (odds ratio (OR) 3.33, 95% confidence interval (CI) 1.83–6.06) while receiving public assistance protected against hunger (OR 0.23, 95% CI 0.06–0.88). In multivariate models, respondents who reported experiencing hunger also reported poorer overall health (OR 1.69, 95% CI 0.95–3.02) and more days of poor mental (P= 0.045) and physical health (P< 0.0001). Greater amount of time lived in the USA was also associated with worse overall health (P= 0.054) and more days of poor mental and physical health (P< 0.01).

Conclusions

The present study shows that food insecurity and hunger may be problems among undocumented migrants living in the USA. Uncertain and unpredictable work schedules and limited access to public assistance may contribute to high levels of hunger, which in turn may also negatively affect mental and physical health. Increasing amount of time lived in the USA is also associated with poorer health indicators. Programmes that provide undocumented migrants with emergency access to resources may reduce food insecurity and lead to improved health outcomes among this vulnerable population.

The food insecurity-obesity paradox: a review of the literature and the role food stamps may play

During the past decade, rates of food insecurity and obesity have risen, and an association has been made between these two seemingly paradoxical states. Although this relationship has not been repeatedly seen in men, research suggests a correlation in women. Studies have not been able to consistently show a relationship in children, because findings differ based on age, race/ethnicity, household income, and sex. Several proposed hypotheses explain why a correlation between food insecurity and obesity exists in adults - especially women - but not in children. This review proposes a conceptual framework linking the Food Stamp Program and other coping strategies to the food insecurity-obesity relationship. This link has implications for Food Stamp Program policy changes, welfare reform, and poverty prevention.

Gender bias in the food insecurity experience of Ethiopian adolescents

Food insecurity is a pressing public health concern in many developing countries. Despite widespread interest in the sociocultural determinants of food insecurity, little is known about whether youths living in food insecure households experience food insecurity. The buffering hypothesis reviewed here assumes that, to the extent possible, adult members of households will buffer younger household members from the ill effects of food insecurity. A variant of the buffering hypothesis argues that only certain members of the households will enjoy the benefits of buffering. We hypothesize that within the context of Ethiopia, where girls have historically experienced discrimination, buffering is preferentially aimed at boys, especially as the household experiences greater levels of food stress. These hypotheses are tested using data from a population-based study of 2084 adolescents living in southwestern Ethiopia. Results indicate that boys and girls were equally likely to be living in severely food insecure households. Despite no differences in their households' food insecurity status, girls were more likely than boys to report being food insecure themselves. This gender difference was the largest in severely food insecure households. This same pattern was observed when comparing male-female sibling pairs living in the same household. These results are among the first to show that household level measures of food insecurity predict adolescent experiences of food insecurity, and that in the Ethiopian socio-cultural context, the relationship between household level food insecurity and adolescent food insecurity varies by gender. We also show that adolescent food insecurity is strongly associated with measures of general health and well-being.

Gender and marital status clarify associations between food insecurity and body weight

Prior research shows that food insecurity is associated with being overweight in women, with few and ambiguous results in men. Little is known about the characteristics and roles of individuals who are most likely to be both food insecure and overweight or obese. This study analyzed associations between food insecurity and body weight, and whether gender and marital status are involved in that relationship. Using multiple regression models, we examined food insecurity, marriage, and body weight among 4338 men and 4172 women aged > or = 20 y in the 1999-2002 NHANES. Married men were more likely to be overweight than men in all other marital-status categories except for those living with partners. Divorced men were more likely than never-married men to live in a household with very low food security. Compared with fully food-secure men, marginally food-secure men were heavier, whereas men with low food security were lighter. Compared with fully food-secure women, marginally food-secure women also showed a tendency to be overweight (P = 0.05), whereas women with low food security were more likely to be obese. When considering the interaction between food insecurity and marital status, food insecurity was related to a greater likelihood of obesity among married women, those living with partners, and widows, when compared with never-married women. Sensitivity analyses suggest this effect was concentrated among marginally food-secure women. These findings indicate that food insecurity relates differently to body weight for men and women, and that partnering plays a strong part in this relationship for women.

Reprodutibilidade de um questionário para avaliação de conhecimentos, percepções e práticas em segurança sanitária alimentar de portadores de HIV/AIDS ambulatoriais

Portadores de HIV/AIDS são vulneráveis a muitos tipos de infecções, incluindo aquelas veiculadas por água e alimentos. O alto risco às infecções gastrintestinais poderia ser minimizado através do aconselhamento dietético, no ambiente das unidades de saúde ambulatoriais, visando à adoção de práticas de segurança sanitária alimentar. A pesquisa realizada teve como objetivo, dentre outros, avaliar os conhecimentos, as percepções e práticas em segurança alimentar de portadores de HIV/AIDS ambulatoriais. Para tal, elaborou-se questionário, a partir de cinco áreas temáticas (prevenção da contaminação cruzada; higiene pessoal e ambiental; controle de temperaturas; e consumo de alimentos de risco). O que se apresenta é o estudo de reprodutibilidade desse instrumento, para o qual foi utilizado o procedimento de teste e re-teste. Os resultados deste estudo mostraram que os valores kappa oscilaram de forte para 84,6% (33), moderado para 12,8% (5), a discreto para 2,5% (1) das questões testadas. Nossos resultados sugerem que o instrumento apresenta um bom nível de reprodutibilidade sendo uma boa opção para o levantamento de informações sobre segurança alimentar de pacientes portadores de HIV/AIDS.

Eating rough: food sources and acquisition practices of homeless young people in Adelaide, South Australia

OBJECTIVE

The aim of this study was to determine the food sources and acquisition practices used by homeless youth in Adelaide. This work is part of a larger study that aimed to examine the extent and nature of food insecurity among homeless youth.

DESIGN

Cross-sectional design involving quantitative and qualitative methods.

SETTING

Four health and welfare inner-city agencies serving homeless youth in Adelaide, South Australia.

SUBJECTS

A sample of 150 homeless youth aged between 15 and 24 years recruited from these agencies. Fifteen were selected via snowball sampling for interview.

RESULTS

Use of welfare food sources was high (63%). Food from welfare agencies was supplemented by unorthodox food acquisition methods such as theft (65%), begging for money for food (61%), begging for food items (44%) and asking for help from friends and relatives (34%). Reasons given for non-usage of welfare food services included affordability, access, being too busy, shame or embarrassment.

CONCLUSIONS

Food insecurity is a salient issue for some homeless youth in Adelaide. Clarifying food acquisition practices of food-insecure homeless youth is essential for rational planning and improvement of food-related services to meet their needs. Such an understanding also underpins the development of broader public policy responses that improve individual and household skills and resources to acquire food and ensure food security. Nutrition professionals, welfare professionals and policy-makers need to work sensitively with welfare food agencies and others to improve food access and food security for homeless youth.

Knowledge and practices of Ohio nurse practitioners regarding food access of patients

PURPOSES

To assess the self-identified food security knowledge and practices of nurse practitioners (NPs) in Ohio and the relationships of food security knowledge and practices to NP characteristics.

DATA SOURCES

This study utilized a survey approach for data collection. Participants were licensed NPs with prescriptive authority in Ohio who were randomly selected from the Ohio licensure list and responded to a questionnaire (n= 288) with demographic and food security-related questions.

CONCLUSIONS

Less than one third of respondents agreed or strongly agreed that they were knowledgeable about the topic of food security. Education of NPs about food insecurity and about incorporation of food security principles into the healthcare process is needed.

IMPLICATIONS FOR PRACTICE

Food insecurity can negatively impact compliance to prescribed treatments. NPs should address food security issues in order to provide specialized, individualized care to patients in order to achieve positive outcomes. Through evaluation of patients' food access, and factors that are related to food insecurity, this can be achieved.

Barriers to participation in the food stamp program among food pantry clients in Los Angeles

Substantial numbers of food pantry clients are eligible for food stamps but do not receive them. Background characteristics of 14317 food pantry users in Los Angeles were analyzed to provide information helpful in food stamp outreach programs. Ninety percent of food pantry users were living well below poverty level, 59% were Hispanic, and 44% were homeless. Only 15% of the food pantry clients received food stamps, with homelessness and limited English language skills acting as barriers to food stamp program participation.

Preventing obesity: a life cycle perspective

Traditional approaches to treating overweight and obese adults by focusing on individual weight loss have not been effective in stemming the tide of obesity in the population. Recent research has identified critical factors that, as they accumulate and interact over an individual's life span, may put a person at risk for obesity. These factors include rapid weight gain in infancy and childhood, early puberty, and excessive weight gain in pregnancy. Based on this research, a life cycle perspective can be used to develop comprehensive interventions that address the multiple determinants of obesity. Because obesity tracks across generations, it is essential to adopt effective obesity prevention measures now to prevent even higher rates of obesity in future generations. Dietetics professionals can reduce individual risks by providing nutritional services that support appropriate weight gain in childhood and pregnancy. We can also advocate for policies in communities, schools, and worksites that support breastfeeding, ensure access to health-promoting foods, and provide opportunities to be physically active.

Position of the American Dietetic Association: Food Insecurity and Hunger in the United States

It is the position of the American Dietetic Association that systematic and sustained action is needed to bring an end to domestic food insecurity and hunger and to achieve food and nutrition security for all in the United States. The Association believes that immediate and long-range interventions are needed, including adequate funding for and increased utilization of food and nutrition assistance programs, the inclusion of food and nutrition education in all programs providing food and nutrition assistance, and innovative programs to promote and support the economic self-sufficiency of individuals and families, to end food insecurity and hunger in the United States. Food insecurity continues to exist in the United States, with over 38 million people experiencing it sometime in 2004. Negative nutritional and nonnutritional outcomes have been associated with food insecurity in adults, adolescents, and children, including poor dietary intake and nutritional status, poor health, increased risk for the development of chronic diseases, poor psychological and cognitive functioning, and substandard academic achievement. Dietetics professionals can play a key role in ending food insecurity and hunger and are uniquely positioned to make valuable contributions through provision of comprehensive food and nutrition education, competent and collaborative practice, innovative research related to accessing a safe and secure food supply, and advocacy efforts at the local, state, regional, and national levels.

Materialism and food security

The present studies examined if materialists have an elevated concern about food availability, presumably stemming from a general survival security motivation. Study 1 found that materialists set a greater life goal of food security, and reported more food insecurity during their childhood. Materialists reported less present-day food insecurity. Study 2 revealed that materialists stored/hoarded more food at home, and that obese persons endorsed materialism more than low/normal weight persons. Study 3 found that experimentally decreasing participants' feelings of survival security (via a mortality salience manipulation) led to greater endorsement of materialism, food security as goal, and using food for emotional comfort. The results imply that materialists overcame the food insecurity of their childhood by making food security a top life goal, but that materialists' current concerns about food security may not wholly stem from genuine threats to their food supply.

Likelihood of using food stamps during the adulthood years

OBJECTIVE

The Food Stamp Program represents the cornerstone of the federal nutrition assistance safety net. This article estimates the likelihood that Americans will use such food assistance at some point during their adulthood. The probability and duration of food stamp use are estimated for the population as a whole and for differences in race, education, and gender. Based on these food stamp percentages, a lower boundary is also estimated with regard to the life course risk of food insecurity. DESIGN, SETTING, AND ANALYSIS: Thirty waves (1968 to 1997) of the nationally representative Panel Study of Income Dynamics (PSID) data set were merged for analysis. Food stamp use is defined as an individual being in a household that has used the Food Stamp Program at some point during the year. Approximately 260 000 person-years of information on food stamp use are analyzed using both life table techniques and logit modeling.

RESULTS

Between the ages of 20 and 65, slightly over half (50.8%) of all Americans will, at some point, receive food stamps. Use of the program takes place over relatively short periods of time but typically recurs at several points in the life course. Race and education exert a profound influence on the odds of program participation. Based on the life course patterns of food stamp use, it is estimated that at least 42% of the American population will experience food insecurity at some point between the ages of 20 and 65.

CONCLUSIONS AND IMPLICATIONS

The overall life course patterns reveal a substantial need and use of food stamps within the US population. These results also suggest a significant risk of food insecurity across the life course. The implications for nutritionists are discussed.

Nutrition intervention in the care of persons with human immunodeficiency virus infection: position of the American Dietetic Association and Dietitians of Canada

It is the position of the American Dietetic Association (ADA) and Dietitians of Canada (DC) that efforts to optimize nutritional status, including medical nutrition therapy, assurance of food and nutrition security, and nutrition education are essential components throughout the continuum of care available to people with human immunodeficiency virus (HIV) infection.

Food insufficiency is not related to the overall variety of foods consumed by young children in low-income families

This study explored the relationship between food sufficiency status and redundancy of food choices, or dietary variety, among children in low-income families using the Variety Score from the Healthy Eating Index. Two samples of children ages 2 to 3 (n=1,242) and 4 to 8 years (n=1,506) were selected from the Continuing Survey of Food Intakes by Individuals 1994-1996, 1998 and then classified as either food sufficient, food sufficient with limitations, or food insufficient. Mean variety scores were low for all children, but did not differ by food sufficiency status for either age group. However, they did differ by Special Supplemental Nutrition Program for Women, Infants, and Children participation and region of the country for the younger and older children, respectively. Results suggest the importance of nutrition education and food assistance programs that enhance dietary variety. Further research should explore how food assistance program participation is related to dietary variety and the degree to which variety within food groups is related to food security.

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.

Risk and Presence of Food Insufficiency Are Associated with Low Nutrient Intakes and Multimorbidity among Homebound Older Women Who Receive Home-Delivered Meals

This study examined the independent association of food sufficiency status with lowest nutrient intakes and multimorbidity among homebound older women who received home-delivered meals. Baseline data from the Nutrition and Function Study were used to identify three categories of food sufficiency status [food sufficient (FS), risk of food insufficiency (RFI) and food insufficient (FI)], calculate summary measures of musculoskeletal (calcium, vitamin D, magnesium and phosphorus) and overall nutrient intakes, and examine, using multivariable logistic regression models, the association of food sufficiency status with nutrition and health outcomes among 279 women who received regular home-delivered meals service (5 weekday meals/wk) and completed an in-home assessment and three 24-h dietary recalls. Independent of income and other variables, the adjusted odds for reporting lowest intakes in individual and multiple nutrients (> or = 2 musculoskeletal and > or = 5 overall) were significantly greater among women who reported RFI [odds ratio (OR) = 1.96 to 2.91] and FI (OR = 2.85 to 5.21). In addition, FI women were more likely to report a burden of multimorbidity (OR = 3.69). Considering the importance of home-delivered meals as a primary source of food assistance to homebound older women, the results of this study suggest the need to reevaluate the traditional model of home-delivered meals and to include measures of food sufficiency status as an integral component of program assessment and evaluation for the targeting and monitoring of new, innovative and cost-effective strategies to alleviate risk and the presence of food insufficiency.