Interpretations of the "balanced meal" household food security indicator

Properties of the Household Food Security Survey Module Scale in Young Adults with Diabetes

BACKGROUND

The Household Food Security Survey Module (HFSSM) was not tailored to people with chronic diseases or young adults (YAs).

OBJECTIVES

We aim to evaluate whether the 18-item HFSSM meets assumptions underlying the scale among YAs with diabetes.

METHODS

Data from 1887 YAs with youth-onset type 1 diabetes or type 2 diabetes were used from the SEARCH for Diabetes in Youth Study, 2016-2019, and on 925 who returned for the SEARCH Food Security Cohort Study, 2018-2021, all of whom had completed the HFSSM. Guttman scaling properties (affirmation of preceding less severe items) and Rasch model properties (probability to answer an item based on difficulty level) were assessed.

RESULTS

Items 3 (balanced meals) and 6 (eating less than one should) were affirmed more frequently than expected (nonmonotonic response pattern). At 1.2%-3.5%, item nonresponse was rare among type 1 diabetes but higher among type 2 diabetes (range: 3.1%-10.6%). Items 9 (not eating the whole day) and 3 did not meet the Guttman scaling properties. Rasch modeling revealed that item 3 had the smallest difficulty parameter. INFIT indices suggested that some responses to item 3 did not match the pattern in the rest of the sample. Classifying household food insecurity (HFI) based on items 1 and 2 compared with other 2-item combinations, including item 3, revealed a substantial undercount of HFI ranging from 5% to 8% points.

CONCLUSIONS

Use of the HFSSM among YAs with diabetes could potentially result in biased HFI reporting and affect estimates of HFI prevalence in this population.

Assessing and Monitoring Nutrition Security to Promote Healthy Dietary Intake and Outcomes in the United States

The US Department of Agriculture's Economic Research Service leads the federal government in data development and research on food security in US households. Nutrition security is an emerging concept that, although closely related, is distinct from food security. No standard conceptualization or measure of nutrition security currently exists. We review the existing research on nutrition security and how it is informed by the more robust literature on food security and diet quality. Based on this review, we propose a conceptual framework for understanding nutrition security and its relationship to food security. We identify two constructs (healthy diets and nutritional status) and multiple subconstructs that form the basis of nutrition security. The proposed framework and corresponding constructs are intended to provide (a) understanding of how nutrition security arises and how it differs from food security, (b) background on why assessment and monitoring of nutrition security is important, and (c) guidance for a research agenda that will further clarify the meaning of nutrition security and its measurement.

Differences in Measured and Self-Categorized Food Security Status and Related Coping Strategies among College Students

Qualitative studies suggest that college students with food insecurity (FI) experience stigma and misinterpret some of the USDA Adult Food Security Survey Module (AFSSM) questions, leading to misclassification of food security (FS) status. We aimed to evaluate differences in AFSSM-measured FS status and self-categorized FS status (based on USDA descriptions of the four FS levels) among college students, and to identify differences in the coping strategies and BMI of these students. Data were collected cross-sectionally from a convenience sample via web-based, self-reported surveys. Measured FS, self-categorized FS, coping strategies, and self-reported BMI were key variables of interest. Participants were 1003 undergraduate and graduate students (22.2 ± 4.6 years; 65.7% female). Of the participants measured as food insecure (40.0%), 57.8% self-categorized as food secure (MFI-SFS) and 42.2% self-categorized as food insecure (MFI-SFI). Significantly more MFI-SFI participants were AFSSM-categorized as having very low FS when compared to MFI-SFS participants (71.6% vs. 46.6%, p < 0.05). MFI-SFI participants reported significantly higher BMI (M = 24.7, SD ± 6.0 kg/m2) and coping strategies scores (M = 49.8, SD ± 7.5) when compared to MFI-SFS participants (M = 23.1, SD ± 3.6 kg/m2; M = 46.9, SD ± 7.5, respectively, p ≤ 0.01). Assessment of and interventions to address FI among college students should consider the potential influence of self-perception and students’ interpretation of survey questions.

Elderly's food security and its associated socioeconomic determinants in Tehran: A cross-sectional study

INTRODUCTION

The mechanism by which a suppressed immune system of a cancer patient makes them susceptible to COVID-19 is still unclear. Any delay or discontinuation of cancer care due to the pandemic is expected to have a detrimental impact on the outcome of cancer. A few studies have addressed the incidence of COVID-19 among cancer patients, but the small sample size of such studies makes it difficult to draw inference to the general population.

METHODS

For our review, 'Pubmed' database and Google search engines were used for searching the relevant articles. The criterion used for review includes their relevance to the defined review question, which is the pathophysiological mechanism of COVID-19 among cancer patients and the relevant therapeutic interventions therewith. This review includes 20 studies and other relevant literature which address the determinants of COVID-19 among Cancer patients.

RESULTS

Delay in cancer diagnosis will increase the stage progression of cancer patients and increased mortality in the future. A short delay in administering cancer related treatment to aid the odds of patient surviving the acute SARS-CoV-2 infection, should be at the discretion of the treating Physician. Oncologists dilemma in the current situation includes titrating the density of drug doses and intensity of treatment regimen, for the optimal management of metastatic and adjuvant cancer patients. Patients are thus subjected to suboptimal treatment and undetected disease recurrence, To circumvent the immunosuppressive effects of chemotherapy, Providers need to consider staggered regimen or alternate therapies such as biological/immunotherapy, targeted therapy, anti-angiogenic drugs, hormone therapy and/or antibody-based therapeutics.

CONCLUSION

This review provides insights on the pathogenesis of SARS-CoV-2, which could enable Physicians in formulating therapeutic strategies for the management of severe patients, more so in Oncology settings, thus reducing the mortality. The key is to balance the continuation of urgent cancer care, but rationing the elective treatment according to the circumstances.

College students' interpretations of food security questions: results from cognitive interviews

BACKGROUND

Food insecurity (FI) - the lack of sufficient access to food to maintain a healthy lifestyle - among college (i.e. post-secondary or higher education institution) students has become a prominent issue in the U.S. However, it is not clear if high rates of FI among students are due to the modern experience in higher education institutions or due to underlying issues in common surveying methods. To understand if there were underlying content validity issues, the present study had two primary research questions: 1) How do students interpret the U.S. Department of Agriculture (USDA) Food Security Survey Module (FSSM) questionnaire items, and 2) How do responses of students experiencing FI compare with the theorized experiences and coping responses?

METHODS

Thirty-three undergraduate students, aged 18- to 24-years old and fluent in English were recruited from a single 4-year university. During a 60-min session, participants completed the 10-item Adult FSSM and then were cognitively interviewed about their responses using the think-aloud method. Interview transcripts were analysed by two researchers using a collaborative process and basic interpretative approach.

RESULTS

Students were on average 19.5 years old (± 1.2 years), the majority were in their freshman or sophomore (i.e., first or second) year, and 67% (n = 22) experienced FI. Results indicated that students' interpretations of key terms - such as "money for more," "balanced meals," and "real hunger" - diverge from expectations. Furthermore, students categorized as food insecure reported experiences and responses to FI that varied from theoretical dimensions of the process.

CONCLUSIONS

Though limited by sample size and representativeness, the present results indicate that the content validity of the FSSM may be compromised in this population and the managed process of FI may present differently among college students. Further psychometric research on modifications to the FSSM or with new FI assessment tools should be conducted with college students.

Are estimates of food insecurity among college students accurate? Comparison of assessment protocols

A growing body of literature suggests that post-secondary students experience food insecurity (FI) at greater rates than the general population. However, these rates vary dramatically across institutions and studies. FI assessment methods commonly used in studies with college students have not been scrutinized for psychometric properties, and varying protocols may influence resulting FI prevalence estimates. The objective of this study was to assess the performance of standard food security assessment protocols and to evaluate their agreement as well as the relative accuracy of these protocols in identifying student FI. A randomized sample of 4,000 undergraduate students were invited to participate in an online survey (Qualtrics, LLC, Provo, Utah, USA) that evaluated sociodemographic characteristics and FI with the 2-item food sufficiency screener and the 10-item USDA Adult Food Security Survey Module (FSSM; containing the abbreviated 6-item module). Four hundred sixty-two eligible responses were included in the final sample. The psychometric analysis revealed inconsistencies in college student response patterns on the FSSM when compared to national evaluations. Agreement between FI protocols was generally high (>90%) but was lessened when compared with a protocol that incorporated the 2-item screener. The 10-item FSSM with the 2-item screener had the best model fit (McFadden’s R² = 0.15 and Bayesian Information Criterion = -2049.72) and emerged as the tool providing the greatest relative accuracy for identifying students with FI. Though the 10-item FSSM and 2-item screener yields the most accuracy in this sample, it is unknown why students respond to FSSM items differently than the general population. Further qualitative and quantitative evaluations are needed to determine which assessment protocol is the most valid and reliable for use in accurately identifying FI in post-secondary students across the U.S.

Perceived access and actual intake of healthy diets among households in vulnerable Salvadoran communities

OBJECTIVE

This study aimed to examine the dietary intake of Salvadoran households according to perceived access to healthy meals (PAHD), and to identify household characteristics associated with diet quality and PAHD.

METHODS

Secondary data analysis with a sample of 139 Salvadoran households from resource-poor communities in El Salvador. Chi-square tests and ANOVA were used to assess differences in dietary intake across households classified according to PAHD.

RESULTS

High-PAHD households had higher women's education, household food security levels, overall diet quality, and variety, and higher intakes of animal products, fats, cholesterol, vitamin C, and sodium (P < .05). Diet quality was not associated with the household characteristics studied.

CONCLUSIONS AND IMPLICATIONS

Overall diet quality was associated with higher levels of PAHD, but some differences in intakes were not as expected, such as higher intakes in foods and nutrients associated with low-quality diets, among high PAHD households.

The fake food buffet – a new method in nutrition behaviour research

Experimental research in behavioural nutrition is often limited by practical applicability. In the present study, we assess the reproducibility and validity of a new experimental method using food replicas. A total of fifty-seven people were invited on two separate occasions with an interval of 2 weeks to serve themselves a meal from a fake food buffet (FFB) containing replica carrots, beans, pasta and chicken. The external validity of the FFB was assessed in a second study by comparing meals served from replica foods (beans, pasta, chicken) with meals served from a corresponding real food buffet (RFB). For the second study, forty-eight participants were invited on two separate occasions; first to serve themselves a meal from the FFB or an RFB and 2 weeks later from the other buffet. The amounts of food items served and (theoretical) energy content were compared. Correlation coefficients between the amounts of fake foods served were 0·77 (95 % CI 0·68, 0·86) for chicken, 0·79 (95 % CI 0·68, 0·87) for carrots, 0·81 (95 % CI 0·69, 0·89) for beans and 0·89 (95 % CI 0·82, 0·93) for pasta. For the FFB meal and the RFB meal, the correlations ranged between 0·76 (95 % CI 0·73, 0·91) for chicken and 0·87 (95 % CI 0·77, 0·92) for beans. The theoretical energy of the fake meal was 132 kJ (32 kcal) lower compared to the energy of the real meal. Results suggest that the FFB can be a valuable tool for the experimental assessment of relative effects of environmental influences on portion sizes and food choice under well-controlled conditions.

Improvement of meal composition by vegetable variety

Objective

Our physical environment influences our daily food choices unconsciously. Strategic changes in the food environment might therefore be potential measures to influence consumers’ food selection towards better nutrition, without affecting the consumers’ freedom of choice. The present study aimed to examine whether increased vegetable variety enhances healthy food choices and improves meal composition.

Design

A randomised experiment.

Setting

Participants were instructed to serve themselves a lunch from a buffet of food replicas. Individuals were randomly assigned to one of three food combinations: condition A – cooked carrots, pasta and chicken; condition B – cooked green garden beans, pasta and chicken; condition AB – carrot sticks, green garden beans, pasta and chicken. Two one-vegetable conditions were compared with one two-vegetable condition. Data from Zurich, Switzerland, were analysed using one-way ANOVA.

Subjects

Ninety-eight students (fifty-three men; mean age 22·8 (sd 2·2) years, minimum = 19 years, maximum = 29 years).

Results

Participants who could choose from two vegetables derived significantly more energy (141 kJ) from vegetables compared with participants in the one-vegetable condition (104 and 84 kJ, respectively). Furthermore, in the two-vegetable condition, the relative energy of the meal derived from vegetables (10·9 %) increased significantly compared with the one-vegetable condition (8 % and 6·1 %, respectively). The total energy content of the meal (mean 1472 (sd 468) kJ) was not affected by the experimental manipulation.

Conclusions

Having a choice of vegetables increases a person's tendency to choose vegetables and leads to the selection of a more balanced meal. Serving an assortment of vegetables as side dishes might be a simple and effective strategy to improve food selection.

Adaptation of the U.S. Food Security Survey Module for Low-Income Pregnant Latinas: Qualitative Phase

The objectives of this study were to: 1) assessed the face validity of the 18-items US Household Food Security Scale Module (US HFSSM) among low-income pregnant Latinas and 2) adapt the US HFSSM to the target population. This study was conducted in the United States in Hartford, Connecticut where 40% of residents are of Latina descent. Three focus groups (N=14(total)) were held with pregnant and postpartum Latinas from April - June 2004 to assess the understanding and applicability (face validity) of the US HFSSM as well as adapt the US HFSSM based on their recommendations. This was followed by pre-testing (N=7) to make final adaptations to the US HFSSM. Overall, the items in the US HFSSM were clear and understandable to participants, but some questions sounded repetitive to them. Participants felt the questions were applicable to other pregnant Latinas in their community and shared food security related experiences and strategies. Participants recommendations led to key adaptations to the US HFSSM including reducing the scale to 15-items, wording statements as questions, including two time periods, replacing the term "balanced meals" with "healthy and varied", replacing the term "low cost foods" with "cheap foods" and including a definition of the term, and including a coping mechanism of avoiding running out of food. The adapted US HFSSM was found to have good face validity among pregnant Latinas and can be used to assess food insecurity among this vulnerable population.

Household food insecurity and coping strategies in a poor rural community in Malaysia

This cross-sectional study assessed household food insecurity among low-income rural communities and examined its association with demographic and socioeconomic factors as well as coping strategies to minimize food insecurity. Demographic, socioeconomic, expenditure and coping strategy data were collected from 200 women of poor households in a rural community in Malaysia. Households were categorized as either food secure (n=84) or food insecure (n=116) using the Radimer/Cornell Hunger and Food Insecurity instrument. T-test, Chi-square and logistic regression were utilized for comparison of factors between food secure and food insecure households and determination of factors associated with household food insecurity, respectively. More of the food insecure households were living below the poverty line, had a larger household size, more children and school-going children and mothers as housewives. As food insecure households had more school-going children, reducing expenditures on the children's education is an important strategy to reduce household expenditures. Borrowing money to buy foods, receiving foods from family members, relatives and neighbors and reducing the number of meals seemed to cushion the food insecure households from experiencing food insufficiency. Most of the food insecure households adopted the strategy on cooking whatever is available at home for their meals. The logistic regression model indicates that food insecure households were likely to have more children (OR=1.71; p<0.05) and non-working mothers (OR=6.15; p<0.05), did not own any land (OR=3.18; p<0.05) and adopted the strategy of food preparation based on whatever is available at their homes (OR=4.33; p<0.05). However, mothers who reported to borrow money to purchase food (OR=0.84; p<0.05) and households with higher incomes of fathers (OR=0.99; p<0.05) were more likely to be food secure. Understanding the factors that contribute to household food insecurity is imperative so that effective strategies could be developed and implemented.

Validation of the Radimer/Cornell food insecurity measure in rural Kilimanjaro, Tanzania

OBJECTIVE

The objective of the present study was to assess the construct validity, criterion-related validity and internal consistency of the Radimer/Cornell food insecurity measure for use in rural Tanzania.

DESIGN

A cross-sectional community-based survey was conducted from March to May 2005. Key adaptations to the nine-item Radimer/Cornell items included translation to Swahili, replacing the term 'balanced diet' with 'full meal' and constructing the items as questions rather than statements. Factor analysis and Cronbach's alpha were used to assess validity and reliability, respectively.

SETTING

Rural Kilimanjaro, Tanzania.

SUBJECTS

Analysis was restricted to data from 530 women aged 15-44 years who had children under 5 years old.

RESULTS

Principal component factor analysis revealed a two-factor solution: (1) altered eating pattern at household level and (2) altered eating pattern at child level. The two factors accounted for 66.2% of the total variance. The subscales developed had good reliability. Internal consistency of the scales was 0.853 and 0.784 for food insecurity at household level and food insecurity at child level, respectively. Only 14.0% of the women reported to be food-secure and 86.0% reported some kind of food insecurity. The Radimer/Cornell food insecurity measure showed significant associations with selected sociodemographic factors in the expected directions. There was also an association with the NHANES III (Third National Health and Nutrition Examination Survey) and CCHIP (Community Childhood Hunger Identification Project) indicators.

CONCLUSION

Our findings suggest that the adapted Radimer/Cornell measure may have some utility in assessing food insecurity in settings like rural Tanzania.

A Content Analysis of the Japanese Interpretation of “Eating a Balanced Diet”

The purpose of this study was to examine how Japanese workers ( n = 391) think about “eating a balanced diet” daily. Respondents were 263 men and 128 women whose mean age was 43.1 yr. ( SD= 10.9). Content analysis was used to analyze qualitatively responses to a survey. Responses were categorized into Eating a variety of foods, Different types of foods, and Nutritional components. The category, Eating a variety of foods, contained unique behaviors, such as “not continually eating the same foods” rather than eating specific foods or for nutrition. Because interpretations of what “eating a balanced diet” means varied, nutrition professionals should rephrase their advice into language which specifies more clearly practices for daily life.

Hunger of the body and hunger of the mind: African American women's perceptions of food insecurity, health and violence

OBJECTIVE

This qualitative study examined the relationship between health, hunger, and food insecurity among African American women in Philadelphia.

DESIGN

Four focus groups and 12 individual in-home, semistructured interviews were conducted.

SETTING

3 food pantries in Philadelphia, Pennsylvania.

PARTICIPANTS

34 women recruited from 3 food pantries.

PHENOMENON OF INTEREST

Interview topics included participants' experiences of food insecurity, food sources, and the relationship between food, hunger, and health.

ANALYSIS

A phenomenological coding scheme and network analysis was developed based on themes emerging from qualitative data.

RESULTS

The experience of food insecurity was related to violence and poor mental health. Women described 2 kinds of hunger: "hunger of the body" and "hunger of the mind." Hunger of the body referred to the outright painful sensation of hunger caused by insufficient funds. Hunger of the mind was related to trauma, encompassing feelings of depression and hopelessness. Both forms of hunger may be a physical manifestation of structural and interpersonal violence.

CONCLUSIONS AND IMPLICATIONS

There is a need for a broader framework to examine the health effects of food insecurity that addresses women's safety, economic independence, and physical and emotional well-being.

Self-administration of a food security scale by adolescents: item functioning, socio-economic position and food intakes

Objective

To evaluate the reliability and validity of a six-item food security scale when self-administered by adolescents.

Design

Cross-sectional questionnaire survey including the six-item food security measure, socio-economic variables and a food-frequency questionnaire.

Setting

Representative sample of 29 schools in Trinidad.

Subjects

In total 1903 students aged approximately 16 years.

Results

Item affirmatives ranged from 514 (27%) for the ‘balanced meal’ item to 128 (7%) for the ‘skipped or cut meals often’ item and 141 (7%) for the ‘hungry’ item. Item-score correlations ranged from 0.444 to 0.580. Cronbach's α was 0.77. Relative item severities from the Rasch model ranged from −1.622 (standard error 0.043) for the ‘balanced meal’ item to 1.103 (0.068) for the ‘skipped or cut meals often’ item and 0.944 (0.062) for the ‘hungry’ item. The ‘hungry’ item gave a slightly lower relative severity in boys than girls. Food insecurity was associated with household overcrowding (adjusted odds ratio comparing highest and lowest quartiles 2.61, 95% confidence interval 1.75 to 3.91), lack of pipe-borne water in the home, low paternal education or paternal unemployment. After adjusting for socio-economic variables, food insecurity was associated with less frequent consumption of fruit (0.75, 0.60 to 0.94) or fish (0.72, 0.58 to 0.88) but more frequent consumption of biscuits or cakes (1.47, 1.02 to 2.11).

Conclusions

The food security scale provides a valid, reliable measure in adolescents, although young people report being hungry but not eating relatively more frequently than adults. Food-insecure adolescents have low socio-economic position and may eat less healthy diets.

Experiences of Latino immigrant families in North Carolina help explain elevated levels of food insecurity and hunger

Household food insecurity is higher among minority households in the U.S., but few data exist on households of recent minority immigrants, in part because such households are difficult to sample. Four studies of a total of 317 Latino immigrant families were conducted in different regions and during different seasons in North Carolina. A Spanish translation of the 18-item U.S. Food Security Survey Module was used to assess the prevalence of food insecurity and hunger. In 3 of the studies, a total of 76 in-depth interviews were conducted to gather information on immigrants' experiences of food insecurity. Households in the 4 studies classified as food secure ranged from 28.7 to 50.9%, compared with 82.4% in the U.S. in 2004. Food insecurity without hunger ranged from 35.6% to 41.8%, compared with 13.3% in the U.S. The highest rates of hunger reported were 18.8% (moderate hunger) and 16.8% (severe hunger) in an urban sample. Qualitative data indicate that food insecurity has both quantitative and qualitative effects on diet. Immigrants experience adverse psychological effects of food insecurity. They report experiencing a period of adjustment to food insecurity leading to empowerment to resolve the situation. Reactions to food insecurity differ from those reported by others, possibly because immigrants encounter a new and not chronic situation. Overall, these findings suggest that immigrant Latinos experience significant levels of food insecurity that are not addressed by current governmental programs.

The 18 Household Food Security Survey items provide valid food security classifications for adults and children in the Caribbean

Background

We tested the properties of the 18 Household Food Security Survey (HFSS) items, and the validity of the resulting food security classifications, in an English-speaking middle-income country.

Methods

Survey of primary school children in Trinidad and Tobago. Parents completed the HFSS. Responses were analysed for the 10 adult-referenced items and the eight child-referenced items. Item response theory models were fitted. Item calibrations and subject scores from a one-parameter logistic (1PL) model were compared with those from either two-parameter logistic model (2PL) or a model for differential item functioning (DIF) by ethnicity.

Results

There were 5219 eligible with 3858 (74%) completing at least one food security item. Adult item calibrations (standard error) in the 1PL model ranged from -4.082 (0.019) for the 'worried food would run out' item to 3.023 (0.042) for 'adults often do not eat for a whole day'. Child item calibrations ranged from -3.715 (0.025) for 'relied on a few kinds of low cost food' to 3.088 (0.039) for 'child didn't eat for a whole day'. Fitting either a 2PL model, which allowed discrimination parameters to vary between items, or a differential item functioning model, which allowed item calibrations to vary between ethnic groups, had little influence on interpretation. The classification based on the adult-referenced items showed that there were 19% of respondents who were food insecure without hunger, 10% food insecure with moderate hunger and 6% food insecure with severe hunger. The classification based on the child-referenced items showed that there were 23% of children who were food insecure without hunger and 9% food insecure with hunger. In both children and adults food insecurity showed a strong, graded association with lower monthly household income (P < 0.001).

Conclusion

These results support the use of 18 HFSS items to classify food security status of adults or children in an English-speaking country where food insecurity and hunger are more frequent overall than in the US.

Interpretations and attitudes toward healthy eating among Japanese workers

Japanese interpretations of 'healthy eating' may differ from those of people in other industrialized countries; however, no studies have addressed this question. Thus, we examined how Japanese people interpret healthy eating and investigated the factors relevant to that interpretation. In the first study, in order to investigate lay interpretations of the meaning of healthy eating, 34 adults were interviewed, and the results were analyzed as a basis for the second study. In the second study, a sample of city workers (n=1155) in Japan responded to a questionnaire concerning attitudes toward healthy eating, and relevant factors were assessed by a factor analysis. We made three findings. (1) Japanese adults interpreted 'eating a nutritionally balanced diet' and 'eating plenty of vegetables' as the most important definitions of healthy eating. (2) Healthy eating included two factors according to the factor analysis of questionnaire responses: 'eating styles and habits' and 'foods and nutrition.' (3) The relevant characteristics of the subjects regarding the two factors differed. Although these findings are unique, the external validity of this study is limited. More research is necessary to verify the present results.

Differential response patterns affect food-security prevalence estimates for households with and without children

To produce national prevalence estimates for "food insecurity" and "food insecurity with hunger," the USDA uses a battery of 18 survey items about symptoms of food-related hardship. Ten items refer to adults in the household, while 8 items refer to children in the household and hence are not asked of households without children. To equate food-security status in households with and without children, the USDA uses a statistical model from item response theory, known as the Rasch model. This model requires an assumption that adult-referenced items have the same severity calibrations for all households, including households with and without children. However, empirical estimates from the 2000 Current Population Survey showed significantly different severity calibrations for households with and without children. These differences have implications for observable response patterns. Holding constant the number of affirmative responses to adult-referenced items, households with children were more likely to respond that they "worried food would run out," and households without children were more likely to be unable to afford "balanced meals." In light of such differences, the Rasch model cannot be used to equate the food-security status of households with and without children. One potential solution would be to estimate household food security by using the same battery of adult-referenced survey items for all households.

Reliability and validity of a short form household food security scale in a Caribbean community

BACKGROUND

We evaluated the reliability and validity of the short form household food security scale in a different setting from the one in which it was developed.

METHODS

The scale was interview administered to 531 subjects from 286 households in north central Trinidad in Trinidad and Tobago, West Indies. We evaluated the six items by fitting item response theory models to estimate item thresholds, estimating agreement among respondents in the same households and estimating the slope index of income-related inequality (SII) after adjusting for age, sex and ethnicity.

RESULTS

Item-score correlations ranged from 0.52 to 0.79 and Cronbach's alpha was 0.87. Item responses gave within-household correlation coefficients ranging from 0.70 to 0.78. Estimated item thresholds (standard errors) from the Rasch model ranged from -2.027 (0.063) for the 'balanced meal' item to 2.251 (0.116) for the 'hungry' item. The 'balanced meal' item had the lowest threshold in each ethnic group even though there was evidence of differential functioning for this item by ethnicity. Relative thresholds of other items were generally consistent with US data. Estimation of the SII, comparing those at the bottom with those at the top of the income scale, gave relative odds for an affirmative response of 3.77 (95% confidence interval 1.40 to 10.2) for the lowest severity item, and 20.8 (2.67 to 162.5) for highest severity item. Food insecurity was associated with reduced consumption of green vegetables after additionally adjusting for income and education (0.52, 0.28 to 0.96).

CONCLUSIONS

The household food security scale gives reliable and valid responses in this setting. Differing relative item thresholds compared with US data do not require alteration to the cut-points for classification of 'food insecurity without hunger' or 'food insecurity with hunger'. The data provide further evidence that re-evaluation of the 'balanced meal' item is required.

Understanding the experience of food insecurity by elders suggests ways to improve its measurement

A full conceptualization of the elderly food insecurity experience has been lacking, leading to limitations in the definition and measurement of food insecurity in elders. Based on the qualitative analysis of two in-depth interviews 6 mo apart with each of 53 low income urban elders, using principles of grounded theory, the experience of elderly food insecurity was shown to have four components: quantitative, qualitative, psychological and social. The inability to obtain the right foods for health is a new element specific to elders. Common to each of these components were dimensions of severity, time and compromised food choice. Although money is a major cause of food insecurity, elders sometimes have enough money for food but are not able to access food because of transportation or functional limitations, or are not able to use food (i.e., not able to prepare or eat available food) because of functional impairments and health problems. These findings suggest that augmentation of the U.S. Household Food Security Survey Module (FSSM), a national measure of food insecurity based on research in younger persons, may result in more accurate assessments for elders. We developed 14 new items for possible augmentation and administered them by telephone to these same elders along with the FSSM. Elders were independently classified according to food insecurity status based on their experience from the in-depth interviews, and these definitive criteria were used to evaluate the new and existing items. The results suggest that "couldn't afford right foods for health" and two policy-relevant immediate causes, "couldn't get the food I needed" and possibly "unable to prepare," should be added, although further testing is needed.

Development of a spanish-language version of the U.S. household food security survey module

A survey module used to monitor the prevalence of household food insecurity and hunger in the United States was developed by a broadly based collaborative project with leadership from the USDA and the National Center for Health Statistics (NCHS). It has been administered annually since 1995 as a supplement to the Census Bureau's Current Population Survey (CPS) and is part of the National Health and Nutrition Examination Survey (NHANES) and other national surveys. Spanish is the second most common language in the United States, yet no standardized Spanish-language version of this instrument has yet been sanctioned by the relevant federal agencies. In the CPS, interviewers free-translate the questions while interviewing respondents who prefer to have the interview conducted in Spanish. National prevalence data indicate relatively high rates of food insecurity for Hispanic households, raising the question whether methodological artifacts may contribute to these rates. We analyzed eight Spanish-language versions of the instrument that have been used in published work for variability in wording and phrasing. We then conducted focus groups of low-income Spanish-speaking participants from Mexico, Central America, Puerto Rico and Cuba to refine a single Spanish-language instrument. We also employed professional translators to render the English instrument into "standard" Spanish; both instruments were then back-translated. The focus group-derived instrument uses simpler language and grammar; its back-translation integrity to the English version was slightly better than the professionally translated version. We provide the instrument for use and further testing by other investigators.

Food security stakeholders in Hawaii: perceptions of food security monitoring

OBJECTIVE

The purpose of this study was to document Hawai'i's food security stakeholders' perceptions of (1) definitions of food insecurity and hunger, (2) what should be measured, (3) how stakeholders interpret the Core Food Security Module (CFSM) and Face Valid Food Security Measure (FVFSM), and (4) the value of specific items in the CFSM.

DESIGN

Perceptions were gathered through focus groups and interviews.

SUBJECTS

The 43 stakeholders included 19 WIC nutritionists, 10 food pantry providers, 4 Hawaii foodbank board members, 4 social workers, 3 legislators, and 3 homeless food providers. ANALYSIS PERFORMED: Transcripts were analyzed using constant comparative analysis of each question asked, comparisons between groups, and comparisons with the research literature.

RESULTS

Stakeholders desired more detailed information than the CFSM currently yields and also a simple tool to measure the entire range of food insecurity that could be used to "help the needy." Participants favored the FVFSM over the CFSM because "it is more accurate as far as seeing the picture properly."

IMPLICATIONS

A "Simple Food Security Monitoring Tool," which is based on the FVFSM, was created as an alternative tool for local food security monitoring.

The core food security module scale measure is valid and reliable when used with Asians and Pacific Islanders

The Core Food Security Measure (CFSM) is used nationally to assess the extent and severity of household food insecurity in the previous 12 mo due to inadequate money for food. Both a scale measure and a categorical measure were developed from a national cross-sectional sample. The objective of this research was to determine whether the CFSM scale measure is a reliable and valid food security measure for use in Hawaii, where at least 50% of the population is of Asian or Pacific Islander descent. We completed an independent assessment of the robustness of the internal scale construct validity of the CSFM scale measure and hierarchical order of items using the same Rasch methods used previously to develop the CSFM. From a sample of 1664 respondents, data from 362 were used in the Rasch analysis. Item goodness-of-fit statistics indicated that responses to the "adults cut the size or skip meals" item and its follow-up item were redundant [outfit mean-square residual (MnSq) = 0.6, z = -2]. Responses to the "(un)able to eat balanced meals" item were erratic (outfit MnSq = 2.1, z = 2). Findings pertaining to goodness-of-fit of the respondents indicated an acceptable rate of misfit (4.7%). Rate of misfit did not vary with family status or with any ethnic group except the Samoans. Overall, the CFSM scale measure fit as well with the Hawaii data as it did with national data, although identified limitations may affect food security monitoring and research.