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

Sleep duration, overweight status, and the modifying role of food insecurity in a sample of 10- to 14-year-old Mexican early adolescents

OBJECTIVES

Short sleep duration has been associated with an increased risk of childhood overweight and obesity in high-income countries, but data from low- and middle-income countries are scarce. Independently, short sleep and food insecurity may increase the risk of overweight/obesity, but it is unknown whether they concurrently affect it.

METHODS

We included 3350 adolescents aged 10-14 from the 2012 and 2016 Mexican National Health and Nutrition Survey. Short sleep was categorized as less than 9 hours for ages 10-12 and less than 8 hours for ages 13-14. Overweight/obesity was assessed via anthropometry. Modified Poisson regression models assessed prevalence ratios between short sleep and overweight, examining effect modification by food security status.

RESULTS

86% met sleep duration recommendations. Short sleep was associated with an increased prevalence of overweight/obesity (prevalence ratio, 1.16; 95% CI, 1.05, 1.31). Multiplicative interaction was found between low and very low food security status and short sleep: adolescents in low food secure households with short sleep had 1.38 (95% CI: 1.10, 1.75) times the prevalence of overweight/obesity compared to adequate sleepers. Very low food secure households had 1.16 (95% CI: 1.14, 1.31) times the prevalence compared to adequate sleepers. This association was not significant in fully or marginally food secure households.

CONCLUSIONS

Short sleep is associated with an increased obesity risk among Mexican adolescents 10-14years, particularly in the context of low and very low food security. These findings highlight the importance of addressing both sleep hygiene and food security in strategies to reduce obesity risk.

Experiences of New Visitors With Low Food Security Seeking Food Assistance During the COVID-19 Pandemic

OBJECTIVE

To describe the experiences of first-time visitors with low food security seeking food assistance during the coronavirus disease 2019 pandemic.

DESIGN

A qualitative study.

SETTING

Emergency food distribution sites in West Central Florida.

PARTICIPANTS

Adults (aged 18-64 years) seeking food assistance between November, 2020 and July, 2021.

PHENOMENON OF INTEREST

Using food security as a multidimensional concept, in-depth interviews explored the impact of emergency food assistance on food availability, access, utilization, and stability.

ANALYSIS

Applied thematic analysis was conducted to identify emergent themes.

RESULTS

Participants (n = 18) were White (55.6%), female (72.2%), and aged 40-59 years (55.6%). Seven salient themes described participants' experience seeking food assistance (eg, the crisis resulting in seeking food assistance, mixed quality of pantry foods, and gaining firsthand insight on hunger). Although food assistance increased food availability and access, there were barriers to using the pantry foods (eg, foods not preferred, health/allergies).

CONCLUSIONS AND IMPLICATIONS

Study findings suggest that first-time visitors seeking emergency food assistance during the coronavirus disease 2019 pandemic may be experiencing temporary cycles of financial instability, which could impact dietary quality. Because pantry foods are often the primary source of household food supply, client-focused emergency food distribution tailored to client needs can increase food availability, access, and utilization.

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.

Persistent and Episodic Food Insecurity and Associated Coping Strategies Among College Students

OBJECTIVE

To determine the rates of episodic and persistent food insecurity among college students and whether coping strategies employed differs on the basis of food security status.

DESIGN

Online cross-sectional survey administered in March 2021.

SETTING

A large Midwestern university.

PARTICIPANTS

A random sample of students (n = 5,000) were invited to participate via email with a response rate of 20% (n = 888).

MAIN OUTCOME MEASURES

Food insecurity was assessed using the 10-item US Department of Agriculture Adult Food Security Survey Module. Food acquisition and management coping strategies were measured using modified questionnaires.

ANALYSIS

Pearson's chi-squared tests, 1-way ANOVAs, and post hoc analyses were conducted to examine associations of sociodemographic factors and coping strategies with food security status. Linear regression models were used to estimate the association between the coping strategies scale and subscales with food insecurity status.

RESULTS

The food insecurity rate was 22%, with 11% and 10% of students experiencing episodic and persistent food insecurity, respectively. Coping strategies varied significantly by food security status (P < 0.001), with students facing persistent food insecurity employing coping strategies most frequently.

CONCLUSIONS AND IMPLICATIONS

Future research is needed to better understand the persistent nature of food insecurity and coping strategies to develop tailored policies and programs for the college student population.

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.

Coping Strategies for Household Food Insecurity, and Perceived Health in an Urban Community in Southern Mozambique: A Qualitative Study

In low- and middle-income countries, food insecurity (FI) is a living reality for many households, particularly among the most vulnerable groups. The burden of household FI in Mozambique and how FI and coping strategies relate to perceived health are unknown. This study investigated the lived experiences and coping strategies of food-insecure households, along with their perceived health. Altogether, 16 in-depth interviews were performed, audio-recorded, and transcribed verbatim. A qualitative content analysis was carried out and five themes emerged: lived experiences of FI, coping strategies used in situations of FI, food choices, climate change and food security, and FI and perceived health. A wide range of lived experiences and coping strategies were reported, including cooking whatever is available, skipping meals, receiving money or food from friends and relatives, eating unsafe and low-quality foods, taking on additional work, cooking least-preferred foods, and having a monotonous and less-nutritious diet. Furthermore, the participants reported emotional distress, anxiety and depression, substance use, and other negative health outcomes. Some had diagnoses of hypertension, diabetes or HIV/AIDS. The findings suggest the need for employment creation and women’s empowerment, as well as the implementation of appropriate policies and programmes to alleviate household FI.

Food insecurity and coping strategies in international migrants in transit through Mexico

Background

Although migrants in transit through Mexico have been known to consume insufficient food, data measuring food insecurity (FI) in this vulnerable population is scarce. This study assesses FI in migrants transiting Mexico by examining economic, physical and social food access.

Methods

Using a mixed-methods design and a convenience sample of migrants residing in a temporary shelter in Saltillo, Coahuila in northern Mexico, we applied 1) the Food Insecurity Experience Scale (adapted), and 2) a semi-structured interview exploring FI coping strategies.

Results

Of the 54 participants, 74.1% reported moderate or severe FI and 24.1% reported severe FI, especially reduced food quantity. Interviewees reported poverty, cargo train travel, and crime as FI contributing factors. All interviewees used FI coping strategies, principally altering food intake and using social resources. Many strategies reported implied negative consequences for both nutrition and general health.

Conclusions

This study provides a comprehensive assessment of FI in a mobile population using a standard international measure. Results confirm widespread and severe FI, highlighting a potential humanitarian crisis requiring both national and international attention. Further research is critical to inform strategies for guaranteeing the right to food access for migrants in transit through third (non-destination) countries.

The Relationship between Political, Economic, Social, and Cultural Vulnerability and Food Insecurity among Adults Aged 50 Years and Older

Individuals experience food insecurity when they worry about or have limited access to nutritious foods. Food insecurity negatively impacts older adults' health. Social exclusion is a theoretical framework describing how unequal access to rights, resources, and capabilities results in political, economic, social, and cultural vulnerability, which leads to health disparities. We used the Health and Retirement Study to cross-sectionally examine associations between vulnerability and experiencing food insecurity in adults 50 years and older using the social exclusion framework. We tested the association between experiencing food insecurity and indicators of political, economic, social, and cultural vulnerability using logistic regression controlling for demographic and health-related factors. Analyses were performed with all respondents and sub-group of respondents with incomes less than 400% of the federal poverty level (FPL). Assets (OR = 0.97 in both samples), income (OR = 0.85, 0.80 in 400% FPL sub-sample), perceived positive social support from other family (OR = 0.86, 0.84 in 400% FPL sub-sample), and perceived everyday discrimination (OR = 1.68, 1.82 in 400% FPL sub-sample) were significantly associated with food insecurity. Perceived positive social support from spouses, children, or friends and U.S. citizenship status were not significantly associated with food insecurity. Further research is needed to define and measure each dimension of vulnerability in the social exclusion framework. Interventions and policies designed to prevent food insecurity should address these vulnerabilities.

The hunger-obesity paradox: Exploring food banking system characteristics and obesity inequities among food-insecure pantry clients

Purpose

Heightened obesity risk among food-insecure food pantry clients is a health equity issue because the co-occurrence of obesity and hunger is deeply-rooted in systematic social disadvantage and historical oppression. This qualitative study examined key stakeholders’ perspectives of the relationship between the U.S. food banking system and obesity disparities among food insecure clients.

Methods

We conducted in-depth, semi-structured interviews with 10 key stakeholders (e.g., food bank director, food bank board member, advocate) who are familiar with food bank operations. Data were transcribed verbatim, coded in NVivo [v11], and analyzed using thematic analysis.

Results

Multiple themes emerged drawing linkages between structural characteristics of the food banking system and disparities in the dual burden of food insecurity and obesity: [a] access to unhealthy food from donors; [b] federal emergency food policy and programming; [c] state-level emergency food policy and programming; [d] geography-based risk profiles; and [e] inadequate food supply versus client need. Interviewees also identified social challenges between system leaders and clients that maintain disparities in obesity risk among individuals with very low food security including: [a] media representation and stereotypes about food pantry clients; [b] mistrust in communities of color; [c] lack of inclusion/representation among food bank system leaders; and [d] access to information.

Conclusion

Future efforts to alleviate obesity inequities among clients chronically burdened by food insecurity, especially among certain subpopulations of clients, should prioritize policy, systems, and environmental strategies to overcome these structural and social challenges within the food banking system.

Urban environment and dietary behaviours as perceived by residents living in socioeconomically diverse neighbourhoods: A qualitative study in a Mediterranean context

Scholars have determined that low socioeconomic status (SES) is associated with unhealthy dietary behaviours and that local food environments shape food inequality. Less is known about how residents' perceptions of their food environment affect their dietary behaviours. We conducted 37 semistructured interviews and 29 focus groups in three socioeconomically distinct neighbourhoods in Madrid. We identified the following main categories related to social and physical food environments: (a) perceptions of healthy and unhealthy dietary behaviours, (b) children's relationships with food, (c) precariousness and (d) residential food retailer types. Older adults were perceived as healthier consumers, whereas younger people were identified as fast-food consumers. In the low- and middle-SES neighbourhoods, residents saw home-cooked legume-based stews as healthy food. In the high-SES neighbourhood, television cooking programs were highlighted as a positive influence. In the low- and middle-SES neighbourhoods, grandparents played an essential role in the transmission of healthy eating habits to their grandchildren. In the high-SES neighbourhood, children's diets at home were determined by school menus. In the low- and middle-SES neighbourhoods, participants talked about a black market where food could be purchased. Food retailers with low-quality foods were also highlighted. In all neighbourhoods, residents missed traditional food stores, and in the low- and middle-SES neighbourhoods, immigrant-run food stores were not well accepted. Our study presents the concepts shaping how neighbourhood SES differences affect dietary behaviours according to residents of a large Mediterranean city.

Community Gardening as a Way to Build Cross-Cultural Community Resilience in Intersectionally Diverse Gardeners: Community-Based Participatory Research and Campus-Community-Partnered Proposal

BACKGROUND

Community-based agriculture has been found to decrease food insecurity and alleviate health inequities. Furthermore, it provides a sense of ownership, resources to help integrate new communities, and a space to nurture existing cultural identities for intersectionally diverse gardeners. This sense of belonging in connection with access to growing plots has been linked to psychological well-being and resilience. However, little is known about how the psychosocial benefits of plot ownership affect resilience and which aspects of this resilience are salient.

OBJECTIVE

This community-based participatory research (CBPR) project will examine the role of community gardens in decreasing food insecurity and facilitating various forms of resilience in food-insecure groups in Rochester, Minnesota. Since participation in community gardens nurtures various forms of resilience along individual, group, and community dimensions, our research seeks to understand how dimensions of resilience vary along intersectional lines. In addition to mapping the psychosocial benefits linked to plot ownership, we find that examining which forms of resilience are fostered in community-based agricultural projects addresses an important gap in the academic literature. This can help us propose policy-level practices that reduce health inequities connected to food and nutrition at the local level.

METHODS

Using a mixed methods approach, this ongoing community-campus partnership will examine the experiences of current and new plot owners. As a CBPR project, our data collection plan, from design to dissemination, incorporates the intellectual and creative labor of the individuals representing members of the campus community (ie, college students and faculty members engaged in other citizen science projects hosted by the garden), community growers, individuals involved in the community garden's board, and representatives of various organizational bodies. Data collection activities will consist of surveys, in-depth interviews, and photovoice.

RESULTS

This project was funded in January 2020 and approved by the University of Minnesota's Institutional Review Board in March 2020. For the 2020 growing season, we will conduct evaluative interviews about the effect of COVID-19 on community gardeners, including their experiences during this growing season. For the 2021 growing season, data collection, via pre- and postsurveys, is projected to begin in March 2021 and end in November 2021. We will also conduct in-depth interviews from January to April 2021. Data analysis will commence in April 2021. Photovoice activities (ie, data collection, analysis, synthesis, and dissemination) are expected to take place during the spring and summer of 2021.

CONCLUSIONS

Findings emerging from this study will provide the preliminary data to foreground community gardening projects and initiatives to improve physical and mental health outcomes in food-insecure communities. Also, the data collected will highlight the role of CBPR methods in disseminating information about the organizational practices of the community garden; this will assist others in planning and implementing similar projects.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/21218.

Caregiver's Self-Confidence in Food Resource Management Is Associated with Lower Risk of Household Food Insecurity among SNAP-Ed-Eligible Head Start Families

Food resource management (FRM) behaviors are key components within nutrition education programs designed to help food insecure households maximize their food dollars. However, little is known about the association between FRM self-confidence and financial practices with household food insecurity (HFI) among families with young children. Using a sample of SNAP-Ed-eligible Head Start families, this study examined associations between FRM self-confidence, FRM behaviors and financial practices by HFI. A needs assessment survey was conducted with caregivers of Head Start children (n = 365). HFI was measured using the US Household Food Security Survey Module. Chi-square and logistic regression analyses were conducted to examine if FRM self-confidence, FRM behaviors, and financial practices differed by HFI. Participants with high FRM self-confidence had lower odds of HFI (OR = 0.54, 95%CI: 0.33, 0.87), yet FRM behaviors, financial practices, and HFI were not related after adjusting for covariates. All FRM self-confidence questions significantly differed by HFI, whereas only one of six FRM behaviors and two of three financial practices differed by HFI (all p-values < 0.05). Promoting caregivers' self-confidence in FRM skills within nutrition education programs may be explored as a potential strategy to assist low-income households to stretch their food dollars in an attempt to address HFI.

Foods and Drinks Available from Urban Food Pantries: Nutritional Quality by Item Type, Sourcing, and Distribution Method

The overall nutritional quality of foods/drinks available at urban food pantries is not well established. In a study of 50 pantries listed as operating in the Bronx, NY, data on food/drink type (fresh, shelf-stable, refrigerated/frozen) came from direct observation. Data on food/drink sourcing (food bank or other) and distribution (prefilled bag vs. client choice for a given client's position in line) came from semi-structured interviews with pantry workers. Overall nutritional quality was determined using NuVal® scores (range 1-100; higher score indicates higher nutritional quality). Twenty-nine pantries offered zero nutrition at listed times (actually being closed or having no food/drinks in stock). Of the 21 pantries that were open as listed and had foods/drinks to offer, 12 distributed items in prefilled bags (traditional pantries), 9 allowed for client choice. Mean NuVal® scores were higher for foods/drinks available from client-choice pantries than traditional pantries (69.3 vs. 57.4), driven mostly by sourcing fresh items (at 28.3% of client-choice pantries vs. 4.8% of traditional pantries). For a hypothetical 'balanced basket' of one of each fruit, vegetable, grain, dairy and protein item, highest-NuVal® items had a mean score of 98.8 across client-choice pantries versus 96.6 across traditional pantries; lowest-NuVal® items had mean scores of 16.4 and 35.4 respectively. Pantry workers reported lower-scoring items (e.g., white rice) were more popular-appeared in early bags or were selected first-leaving higher-scoring items (e.g., brown rice) for clients later in line. Fewer than 50% of sampled pantries were open and had food/drink to offer at listed times. Nutritional quality varied by item type and sourcing and could also vary by distribution method and client position in line. Findings suggest opportunities for pantry operation, client and staff education, and additional research.

Unreliable and Difficult-to-Access Food for Those in Need: A Qualitative and Quantitative Study of Urban Food Pantries

For individuals who are food insecure, food pantries can be a vital resource to improve access to adequate food. Access to adequate food may be conceptualized within five dimensions: availability (item variety), accessibility (e.g., hours of operation), accommodation (e.g., cultural sensitivity), affordability (costs, monetary or otherwise), and acceptability (e.g., as related to quality). This study examined the five dimensions of access in a convenience sample of 50 food pantries in the Bronx, NY. The design was cross-sectional. Qualitative data included researcher observations and field notes from unstructured interviews with pantry workers. Quantitative data included frequencies for aspects of food access, organized by the five access dimensions. Inductive analysis of quantitative and qualitative data revealed three main inter-related findings: (1) Pantries were not reliably open: only 50% of pantries were open during hours listed in an online directory (several had had prolonged or indefinite closures); (2) Even when pantries were open, all five access dimensions showed deficiencies (e.g., limited inventory, few hours, pre-selected handouts without consideration of preferences, opportunity costs, and inferior-quality items); (3) Open pantries frequently had insufficient food supply to meet client demand. To deal with mismatch between supply and demand, pantries developed rules for food provision. Rules could break down in cases of pantries receiving food deliveries, leading to workarounds, and in cases of compelling client need, leading to exceptions. Adherence to rules, versus implementation of workarounds and/or exceptions, was worker- and situation-dependent and, thus, unpredictable. Overall, pantry food provision was unreliable. Future research should explore clients' perception of pantry access considering multiple access dimensions. Future research should also investigate drivers of mismatched supply and demand to create more predictable, reliable, and adequate food provision.

Expenditure, Coping, and Academic Behaviors among Food-Insecure College Students at 10 Higher Education Institutes in the Appalachian and Southeastern Regions

BACKGROUND

A number of studies have measured college student food insecurity prevalence higher than the national average; however, no multicampus regional study among students at 4-y institutions has been undertaken in the Appalachian and Southeast regions of the United States.

OBJECTIVES

The aims of this study were to determine the prevalence of food insecurity among college students in the Appalachian and Southeastern regions of the United States, and to determine the association between food-insecurity status and money expenditures, coping strategies, and academic performance among a regional sample of college students.

METHODS

This regional, cross-sectional, online survey study included 13,642 college students at 10 public universities. Food-insecurity status was measured through the use of the USDA Adult Food Security Survey. The outcomes were associations between food insecurity and behaviors determined with the use of the money expenditure scale (MES), the coping strategy scale (CSS), and the academic progress scale (APS). A forward-selection logistic regression model was used with all variables significant from individual Pearson chi-square and Wilcoxon analyses. The significance criterion α for all tests was 0.05.

RESULTS

The prevalence of food insecurity at the universities ranged from 22.4% to 51.8% with an average prevalence of 30.5% for the full sample. From the forward-selection logistic regression model, MES (OR: 1.47; 95% CI: 1.40, 1.55), CSS (OR: 1.19; 95% CI: 1.18, 1.21), and APS (OR: 0.95; 95% CI: 0.91, 0.99) scores remained significant predictors of food insecurity. Grade point average, academic year, health, race/ethnicity, financial aid, cooking frequency, and health insurance also remained significant predictors of food security status.

CONCLUSIONS

Food insecurity prevalence was higher than the national average. Food-insecure college students were more likely to display high money expenditures and exhibit coping behaviors, and to have poor academic performance.

Food security of food recipients of a food pantry and soup kitchen

Objective

To discern the impact of food donations provided by a food pantry and soup kitchen on food security.

Design

In this cross-sectional study, participants completed a demographic questionnaire, core food security module, FFQ and list of food donations. The FFQ was utilized to assess diet quality as estimated via the 2010 Healthy Eating Index.

Setting

Clients were selected randomly from a food pantry and soup kitchen in Central Texas, USA.

Participants

A total of 222 adults.

Results

Approximately 73 % of participants lacked food security. Compared with the food secure, the food insecure consisted of 61 % men, 42 % Caucasians, 56 % single and 67 % homeless. Also, of the food insecure, 60 % were soup kitchen clients and 64 % had an annual income <$US 1000 (P<0·01). The probability of food insecurity was reduced by ≥1·17-fold when the total dietary intake included the food donations, as these were rich in fruits, total vegetables and grains, dairy and protein foods (P<0·05).

Conclusions

Food insecurity was quite prevalent in this sample of individuals who visited food pantries and soup kitchens. The addition of food donations improved the quality of the participants’ total diet and had a positive influence on food security. Thus, community organizations should financially support these food assistance agencies and strive to offer a variety of healthy and tasty foods in adequate quantities to provide optimum diet quality.

Food Security Experiences of Aboriginal and Torres Strait Islander Families with Young Children in An Urban Setting: Influencing Factors and Coping Strategies

Evidence on Aboriginal and Torres Strait Islander peoples’ food security experiences and coping strategies used when food insecurity occurs is limited. Such evidence is important to inform policies that can reduce the consequences of food insecurity. This study investigated factors perceived by Aboriginal and Torres Strait Islander families with young children to influence household food security, and coping strategies used, in an urban setting. A qualitative research inductive approach was used. Data were collected through an iterative process of inquiry through initial interviews with 30 primary care-givers, followed by in-depth interviews with six participants to further explore emerging themes. Major topics explored were: influencing factors, food insecurity experiences, impact on food selection, and coping strategies. Food affordability relating to income and living expenses was a major barrier to a healthy diet with large household bills impacting food choice and meal quality. Access to family support was the main reported coping strategy. Food insecurity is experienced by Aboriginal and Torres Strait Islander families, it is largely intermittent occurring especially when large household bills are due for payment. Family support provides an essential safety net and the implications of this are important to consider in public policy to address food insecurity.

A High Prevalence of Food Insecurity Among University Students in Appalachia Reflects a Need for Educational Interventions and Policy Advocacy

OBJECTIVES

To measure prevalence and correlates of food insecurity among college students in Appalachia, compare food-insecure and food-secure students on correlates, and identify predictor variables.

DESIGN

Cross-sectional, online questionnaire.

SETTING

University in Appalachia.

PARTICIPANTS

Nonprobability, random sample of 1,093 students (317 male [30.1%]; 723 females [68.4%]).

MAIN OUTCOME MEASURES

Food insecurity, coping strategies, money expenditure, academic progress, and demographics.

ANALYSIS

Correlational, chi-square, and regression.

RESULTS

A total of 239 students experienced low food security (21.9%) whereas 266 had experienced very low food security (24.3%) in the past 12 months. Predictor variables were higher money expenditure and coping strategy scale scores, lower grade point averages, male gender, receiving financial aid, fair or poor self-rated health status, and never cooking for self or others. These variables accounted for 48.1% of variance in food security scores. Most frequently used coping strategies included purchasing cheap, processed food (n = 282; 57.4%), stretching food (n = 199; 40.5%), and eating less healthy meals to eat more (n = 174; 35.4%).

CONCLUSIONS AND IMPLICATIONS

Food-insecure students need interventions that teach budgeting skills and how to purchase and prepare healthy foods, as well as policies that increase access to food resource assistance.

Food Insecurity and Behavioral Characteristics for Academic Success in Young Adults Attending an Appalachian University

In order to investigate the impact of food insecurity on college students in a highly health disparate region we (1) assessed the prevalence of food insecurity among young adults at a large, rural university in Appalachia, and (2) investigated the relationship between food insecurity and behavioral characteristics including academic performance, coping strategies, and money expenditure. A cross-sectional design was used to capture a representative sample of young adults attending a large, central Appalachian university in Fall 2016. The United States Department of Agriculture (USDA) Adult Food Security Survey was used to measure food insecurity. Independent variables include money expenditure (MES), coping strategies (CSS), academic performance (APS), and demographic, health, economic and culinary variables. Participant responses (n = 692) showed one third (36.6%) of respondents were food-insecure. Students with higher scores for MES and CSS had significantly higher odds of being food-insecure (odds ratio (OR) = 2.07; 95% confidence interval (CI) 1.81 to 2.38 and OR = 1.20; 95% CI 1.16 to 1.23, respectively). The odds of high APS scores (OR = 0.79; 95% CI 0.73 to 0.86) were inversely related to food insecurity. Results of the logistic regression showed MES, CSS, health, and school year remained a significant predictor of food insecurity in college students. These findings suggest behavioral differences in terms of coping strategies, money expenditure, and academic progress among food-insecure students and can be used to identify and target at-risk students to promote student food security and well-being.

Stretching Food and Being Creative: Caregiver Responses to Child Food Insecurity

OBJECTIVE

To examine the strategies and behaviors caregivers use to manage the household food supply when their children experience food insecurity as measured by the US Department of Agriculture's Household Food Security Survey Module.

DESIGN

Cross-sectional survey with open-ended questions collected in person.

SETTING

Urban and nonurban areas, South Carolina, US.

PARTICIPANTS

Caregivers who reported food insecurity among their children (n = 746).

PHENOMENON OF INTEREST

Strategies and behaviors used to manage the household food supply.

ANALYSIS

Emergent and thematic qualitative coding of open-ended responses.

RESULTS

The top 3 strategies and behaviors to change meals were (1) changes in foods purchased or obtained for the household, (2) monetary and shopping strategies, and (3) adaptations in home preparation. The most frequently mentioned foods that were decreased were protein foods (eg, meat, eggs, beans), fruits, and vegetables. The most frequently mentioned foods that were increased were grains and starches (eg, noodles), protein foods (eg, beans, hot dogs), and mixed foods (eg, sandwiches).

CONCLUSIONS AND IMPLICATIONS

Caregivers use a wide variety of strategies and behaviors to manage the household food supply when their children are food insecure. Future work should examine how these strategies might affect dietary quality and well-being of food-insecure children.

Low-Income Urban Mothers' Experiences with the Supplemental Nutrition Assistance Program

BACKGROUND

Food insecurity remains a public health concern in the United States, particularly among low-income urban ethnically diverse families, even with the Supplemental Nutrition Assistance Program (SNAP). Limited phenomenologic data exist to capture how programmatic changes to SNAP address the needs of users and why a gap in SNAP use may exist.

OBJECTIVE

The primary aim of this study was to examine the experiences of low-income, Baltimore, MD, mothers in applying for and maintaining access to SNAP. Secondary aims included understanding participants' perspectives on the influence of changes in SNAP over a 3-year period and how SNAP fits into the overall system of social services for families.

DESIGN

In this qualitative, phenomenologic study, in-depth interviews were conducted with 13 mothers and three focus groups with 20 mothers, for a total sample of 33 mothers receiving SNAP benefits. Ten mothers participated in the first round of data collection (January to May 2010), and 23 in the second round (February to May 2013).

PARTICIPANTS/SETTING

Participants were 33 mothers receiving SNAP benefits in Baltimore City, MD.

MAIN OUTCOME MEASURES

Baltimore SNAP users' experiences with applying for and maintaining access to SNAP, as well as with program changes to the SNAP program.

DATA ANALYSIS

Data were analyzed using an iterative emergent design and phenomenologic approach. A constructivist perspective was implemented throughout the coding process.

RESULTS

SNAP functioned as a valuable support system within the broader social safety net for mothers living in poverty, yet participants expressed frustration about the processes of applying for and maintaining benefits due to communication problems and poor integration of services. In applying for and accessing SNAP, positive interactions with caseworkers and previous knowledge of the SNAP program were important for maintaining benefits. Interviews and focus group discussions revealed the need for additional outreach and education about the implemented program changes to build trust and improve access to SNAP among participants.

CONCLUSIONS

Improving communication and supporting participants' ability to maintain relationships with the same caseworkers, as well as developing better integration with other aid programs, could improve the SNAP program.

Strategies used by overweight and obese low-income mothers to feed their families in urban Brazil

OBJECTIVE

To describe and compare strategies adopted by overweight and obese low-income mothers living in different vulnerable contexts to deal with food constraints and feed their families.

DESIGN

Qualitative in-depth interviews. Data were analyzed with exploratory content analysis and the number of segments per theme was used to compare neighborhoods.

SETTING

Three low-income neighborhoods in Santos, Brazil.

PARTICIPANTS

A purposive sample of 21 overweight or obese mothers.

RESULTS

We identified three main types of strategies, namely, food acquisition, cooking, and eating. Food acquisition included social support and food-sourcing strategies. Social support strategies ranged from macro (governmental programs) to micro (family) levels. Food-sourcing strategies involved price research and use of credit to buy foods. Cooking approaches included optimizing food (e.g., adding water to beans), avoiding wastefulness, and substitutions (e.g., using water instead of milk when making cakes). Eating themes ranged from lack of quantity to lack of quality. Strategies to deal with the lack of food were affected by family dynamics, such as prioritizing provision of fruits to children. Food choices (e.g., low consumption of fruits and high consumption of fatty meats) derived from strategies may help promote overweight and obesity. Furthermore, for participants, financial constraints were perceived as barriers to following nutritionists' recommendations and weight loss.

CONCLUSIONS

This study highlights the barriers that low-income women face in adopting a healthy diet and sheds light on the importance of the symbolic value of food, even in the context of food insecurity. Finally, it suggests that environmental aspects could increase the accessibility to fruits and vegetables. These findings could be used to inform the planning and implementation of interventions.

Influence of sociodemographic characteristics on different dimensions of household food insecurity in Montevideo, Uruguay

Objective

To determine the factor structure of the Latin American & Caribbean Household Food Security Scale (ELCSA) and to study the influence of sociodemographic characteristics on each of the identified dimensions in Montevideo, Uruguay.

Design

Cross-sectional survey with a representative sample of urban households. Household food insecurity was measured using the ELCSA. The percentage of respondents who gave affirmative responses for each of the items of the ELCSA was determined. Exploratory factor analysis was carried out to determine the ELCSA’s factor structure. A probit model was used to determine the impact of some individual and household sociodemographic characteristics on the identified dimensions of food insecurity.

Setting

Metropolitan area centred on Montevideo, the capital city of Uruguay, April–September 2014.

Subjects

Adults aged between 18 and 93 years (n 742).

Results

The percentage of affirmative responses to the items of the ELCSA ranged from 4·4 to 31·7 %. Two factors were identified in the exploratory factor analysis performed on data from households without children under 18 years old, whereas three factors were identified for households with children. The identified factors were associated with different severity levels of food insecurity. Likelihood of experiencing different levels of food insecurity was affected by individual characteristics of the respondent as well as characteristics of the household.

Conclusions

The influence of sociodemographic variables varied among the ELCSA dimensions. Household income had the largest influence on all dimensions, which indicates a strong relationship between income and food insecurity.

Maternal Strategies to Access Food Differ by Food Security Status

BACKGROUND

Household food insecurity is associated with health and behavior risk. Much less is known about how food insecurity is related to strategies that adults use in accessing food: how and where they shop, use of alternative food sources, and their ability to manage resources.

OBJECTIVE

To examine how maternal behaviors, including shopping, accessing alternative sources of food, and managing resources, are related to household food security status (HHFSS).

DESIGN

Cross-sectional study collecting survey data on HHFSS, shopping behaviors, use of alternative food sources, and managing resources obtained from low-income mothers of preschool-aged children.

PARTICIPANTS

One hundred sixty-four low-income mothers of young children (55% Hispanic) from two communities in Rhode Island.

MEASURES

HHFSS was measured using 10 items from the 18-item Core Food Security Module to assess adult food security. Mothers were surveyed about where, when, and how often they shopped; the strategies they use when shopping; their use of alternative sources of food, including federal, state, and local assistance; and their ability to manage their resources.

STATISTICAL ANALYSIS

Analysis of variance and χ² analyses assessed the associations between demographic variables, shopping, accessing alternative food sources, and managing resources, and HHFSS. Multivariate logistic regression assessed the associations between HHFSS and maternal demographic variables, food shopping, strategies, alternative sources of food, and ability to manage resources.

RESULTS

Maternal age and language spoken at home were significantly associated with HHFSS; food insecurity was 10% more likely among older mothers (adjusted odds ratio [aOR] 1.10, 95% CI 1.03 to 1.17) and 2.5 times more likely among Spanish-speaking households (compared with non-Spanish speaking [aOR 3.57, 95% CI 1.25 to 10.18]). Food insecurity was more likely among mothers reporting more informal strategies (aOR 1.98, 95% CI 1.28 to 3.01; P<0.05) and perceiving greater inability to manage resources (aOR 1.60, 95% CI 1.30 to 1.98; P<0.05).

CONCLUSIONS

The results suggest that low-income mothers use a variety of strategies to feed their families and that the strategies they use vary by HHFSS. Community nutrition programs and providers will need to consider these strategies when counseling families at risk for food insecurity and provide guidance to minimize the influence on healthy food choices.

Inverse association between social support and household food insecurity in a metropolitan area of Rio de Janeiro, Brazil

OBJECTIVE

To verify the association between perceived social support and household food insecurity (HFI).

DESIGN

A cross-sectional survey.

SETTING

A population-based study with a representative sample of households from a metropolitan area of Rio de Janeiro, Brazil, conducted in 2010. HFI was estimated with the Brazilian Food Insecurity Scale (EBIA). Social support was assessed using the adapted and validated Brazilian version of the Medical Outcomes Study Social Support Survey. Multinomial logistic regression was used to evaluate the association between social support and HFI, adjusting for potential confounders.

SUBJECTS

Adults (n 1022) aged 19-60 years old (27% men, 73% women) who were responsible for feeding the household.

RESULTS

Individuals with high scores of social support were less likely to experience moderate HFI (OR=0·96; 95% CI 0·94, 0·99) and severe HFI (OR=0·96; 95% CI 0·94, 0·98).

CONCLUSIONS

These findings indicate that social support may contribute to reducing HFI in populations vulnerable to poverty. Strategies to increase social relationships should be encouraged in this group to enhance their perceived social support.

Giving Economically Disadvantaged, Minority Food Pantry Patrons' a Voice: Implications for Equitable Access to Sufficient, Nutritious Food

This study provides economically disadvantaged, minority food pantry patrons (hereafter, patrons) a meaning-ful voice by examining their experiences trying to obtain sufficient, nutritious food. Five focus groups were conducted using a semistructured discussion guide. Atlast.ti software was used to manage and analyze the data. Patrons reported that pantry staff who preserved their dignity by showing compassion were highly valued. Stigma and shame associated with pantry use were major concerns. Patrons suggested environmental and policy changes to improve their food acquisition experiences. These findings suggest that multilevel interventions addressing food access, food distribution policies, and patron-staff interactions are warranted.

Auxiliary measures to assess factors related to food insecurity: Preliminary testing and baseline characteristics of newly designed hunger-coping scales

The objective of this paper is to describe the development and preliminary testing of new scales to assess hunger-coping behaviors in a very low-income population. Very low-income adults (≥ 19 years), caregivers to at least one child (n = 306) completed a survey in a community setting (e.g., libraries). The survey included novel items assessing hunger-coping behaviors (e.g., trade-offs to purchase food, strategies to stretch and obtain food), food insecurity status, and physiological hunger. Internal consistency of hunger-coping scales, one-way ANOVAs, post-hoc analyses, Spearman's correlations among variables. Respondents were 75% female, 51% African American, 34% White, and 15% Hispanic, and 73% earned <$20,000/year. Four scales emerged: hunger-coping trade-offs, financial coping strategies, rationing coping strategies, and physiological adult hunger symptoms. All scales demonstrated acceptable internal consistency (α/KR-20 = 0.70-0.90). Predictive, construct, and content validity were demonstrated by correlations between hunger-coping scales and food insecurity (FI), measured with the USDA 6-item HFSSM (rs = 0.42-0.68, ps < 0.001). Higher levels of hunger-coping trade-offs (F(2,297) = 42.54, p < 0.001), financial coping strategies (F(2,287) = 70.77, p < 0.001), and rationing coping strategies (F(2,284) = 69.19, p < 0.001), corresponded with increasing levels of FI. These preliminary results support use of newly developed hunger-coping scales in a very low-income population and can compliment traditional food security measures to inform hunger prevention policy and programming.

Invasive Fungal Infections Acquired from Contaminated Food or Nutritional Supplements: A Review of the Literature

Fungi are an integral part of the natural environment and, therefore, play many roles in relation to food: some fungi are used in food production, some are food sources themselves, and some are agents of food spoilage. Some fungi that contaminate food can also be harmful to human health. The harmful but noninfectious health consequences of mycotoxins have been well-characterized, but the extent to which fungi in food pose a risk for invasive infections is unknown. We conducted a literature review to identify cases of invasive fungal infections (IFIs) believed to have resulted from ingestion or inhalation of food, beverages, or dietary supplements (excluding Saccharomyces infections). We identified 11 publications describing cases or small outbreaks of IFIs related to foods or beverages and three describing IFIs related to dietary supplements. These food-associated IFIs were predominantly mold infections, and the few yeast infections were associated with dairy products. Suspected foodborne IFIs appear to be rare, but are increasingly described in the electronically searchable literature. They are associated with a variety of foods, are due to a variety of fungal pathogens, and primarily occur in persons with immunosuppressive conditions or other predisposing factors. Various guidelines for high-risk patients recommend avoidance of certain food products that may contain high levels of fungi, but further work is needed to evaluate the effectiveness of these restrictive diets in preventing fungal infections. The relationships between food spoilage, food insecurity, and IFI risk are another area that may warrant further exploration.

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.

Increasing access to healthful foods: a qualitative study with residents of low-income communities

BACKGROUND

Inadequate access to healthful foods has been identified as a significant barrier to healthful dietary behaviors among individuals who live in low-income communities. The purpose of this study was to gather low-income community members' opinions about their food purchasing choices and their perceptions of the most effective ways to increase access to healthful foods in their communities.

METHODS

Spanish and English focus groups were conducted in low-income, ethnically-diverse communities. Participants were asked about their knowledge, factors influencing their food purchasing decisions, and their perceptions regarding solutions to increase access to healthful foods.

RESULTS

A total of 148 people participated in 13 focus groups. The majority of participants were female and ethnically diverse (63% Hispanic, 17% African American, 16% Caucasian, and 4% “other”). More than 75% of the participants reported making less than $1999 USD per month. Participants reported high levels of knowledge and preference for healthful foods. The most important barriers influencing healthful shopping behaviors included high price of healthful food, inadequate geographical access to healthful food, poor quality of available healthful food, and lack of overall quality of the proximate retail stores. Suggested solutions to inadequate access included placement of new chain supermarkets in their communities. Strategies implemented in convenience stores were not seen as effective. Farmers’ markets, with specific stipulations, and community gardens were regarded as beneficial supplementary solutions.

CONCLUSION

The results from the focus groups provide important input from a needs assessment perspective from the community, identify gaps in access, and offer potential effective solutions to provide direction for the future.

Food- and health-related correlates of self-reported body mass index among low-income mothers of young children

OBJECTIVE

To examine how income-related challenges regarding food and health are associated with variation in self-reported maternal body weight among low-income mothers.

DESIGN

Cross-sectional design.

SETTING

Two Northeastern cities. Seven day care centers and a Supplemental Nutrition Assistance Program outreach project.

PARTICIPANTS

Sample of 166 mothers; 67% were overweight or obese, 55% were Hispanic, and 42% reported household food insecurity (HFI).

MAIN OUTCOME MEASURES

Maternal self-reported height and weight to calculate body mass index (BMI). Independent variables were food program participation, supermarket use, 8-item food shopping practices scale, HFI, maternal depressive symptoms, and self-rated health.

ANALYSIS

Hierarchical multiple regression analysis tested relationships between maternal BMI with the independent variables of interest, adjusting for demographic confounds.

RESULTS

Shopping practices to stretch food dollars (P = .04), using community food assistance programs (P < .05), and HFI (P < .04) correlated with heavier maternal BMIs; higher self-rated health corresponded to lower BMIs (P = .004).

CONCLUSIONS AND IMPLICATIONS

Some strategies low-income mothers use to manage food resources are associated with heavier BMIs. Nutrition educators, public health practitioners, and researchers need to collaboratively address the associations between these strategies, food insecurity, poor health, and unhealthy weight.

Associations between family food behaviors, maternal depression, and child weight among low-income children

Although low-income children are at greater risk for overweight and obesity than their higher income counterparts, the majority of poor children are not overweight. The current study examined why such variation exists among diverse young children in poor families. Cross-sectional data were collected on 164 low-income, preschool aged children and their mothers living in two Rhode Island cities. Over half of the sample was Hispanic (55%). Mothers completed measures of family food behaviors and depression while trained assistants collected anthropometric data from children at seven day care centers and a Supplemental Nutrition Assistance Program outreach project. Multivariate analysis of covariance revealed that higher maternal depression scores were associated with lower scores on maternal presence when child eats (P < .05), maternal control of child's eating routines (P < .03), and food resource management skills (P < .01), and with higher scores on child control of snacking (P < .03) and negative mealtime practices (P < .05). Multiple regression results revealed that greater maternal presence whenever the child ate was significantly associated with lower child BMI z scores (β = .166, P < .05). Logistic regression analyses indicated that higher scores on food resource management skills reduced the odds of child overweight (odds ratios = .72-.95, P < .01). Maternal depression did not modify the relationship between family food behaviors and child weight. Overall, caregiver presence whenever a child eats, not just at meals, and better parental food resource management skills may promote healthier weights in low-income preschoolers. Further research is needed to identify the mechanisms that connect caregiver presence and food resource management skills to healthier weights for this age group.

Very low food security in the USA is linked with exposure to violence

OBJECTIVE

To investigate characteristics of exposure to violence in relation to food security status among female-headed households.

DESIGN

Ongoing mixed-method participatory action study. Questions addressed food insecurity, public assistance, and maternal and child health. Grounded theory analysis of qualitative themes related to violence was performed. These themes were then categorized by food security status.

SETTING

Homes of low-income families in Philadelphia, PA, USA.

SUBJECTS

Forty-four mothers of children under 3 years of age participating in public assistance programmes.

RESULTS

Forty women described exposure to violence ranging from fear of violence to personal experiences with rape. Exposure to violence affected mental health, ability to continue school and obtain work with living wages, and subsequently the ability to afford food. Exposure to violence during childhood and being a perpetrator of violence were both linked to very low food security status and depressive symptoms. Ten of seventeen (59%) participants reporting very low food security described life-changing violence, compared with three of fifteen (20%) participants reporting low food security and four of twelve (33%) reporting food security. Examples of violent experiences among the very low food secure group included exposure to child abuse, neglect and rape that suggest exposure to violence is an important factor in the experience of very low food security.

CONCLUSIONS

Descriptions of childhood trauma and life-changing violence are linked with severe food security. Policy makers and clinicians should incorporate violence prevention efforts when addressing hunger.

Factors affecting low-income women's food choices and the perceived impact of dietary intake and socioeconomic status on their health and weight

OBJECTIVE

To investigate factors affecting food choice and health beliefs among low-income women in the context of their weight and socioeconomic status.

DESIGN

Two researchers conducted 14 90-minute focus groups, which were audiotaped.

SETTING

Libraries, homeless shelters, and a community center.

PARTICIPANTS

Ninety-two low-income women (18-65 years) with at least 1 child aged 9-13 years in the household.

MAIN OUTCOME MEASURES

Food choice and health beliefs of low-income women.

ANALYSIS

Transcripts were coded and reconciled; common themes and subthemes were identified.

RESULTS

Over 75% of participants were overweight/obese (body mass index [BMI] > or = 25), and most were in charge of purchasing and preparing food for their families. Health concerns included diabetes, hypertension, and overweight/obesity, and most felt their health status had genetic or metabolic origins. Although many would like to regularly consume healthful food (eg, fresh fruits and vegetables), such food was perceived as unaffordable.

CONCLUSIONS AND IMPLICATIONS

A disconnect between diet and health among low-income women calls for nutrition interventions that educate low-income families on inexpensive, healthful eating in a structured environment, and diet-disease relationships. Changes at a policy level should be considered to increase affordability and accessibility of healthful food in low-income neighborhoods and through federal food assistance programs.

Dietary intake, overweight status, and perceptions of food insecurity among homeless Minnesotan youth

Youth, 9-18 years (n = 202), living in homeless shelters in Minneapolis, Minnesota, were assessed for height, weight, dietary intake, and perceptions of food insecurity. Perceptions of food security were measured by asking youth to respond to the statements (1) "There are times when we do not have enough food in the house," (2) "I go to bed hungry at night," (3) "I do not get enough to eat at home," and (4) "Have you ever had to miss a meal (or not been able to eat) because there was no food at home?" Additionally, questions evaluated coping mechanisms used by children to ward off hunger. Fifty-five percent of the children reported not enough food in the house and 25% reported going to bed hungry. Youth had inadequate intakes of vitamin D, calcium, and potassium and the majority consumed less than the estimated average requirements (EAR) for vitamins A, C, and E, phosphorus, folate, and zinc. Fruits, vegetables, and dairy were also consumed below recommended levels. Forty-five percent of boys and 50% of girls were at risk-for-overweight or were overweight. Overeating, eating anything, eating disliked foods, and eating at the homes of family and friends were identified as strategies to cope with food insecurity. Overeating when food is available may explain why we see a hunger-obesity paradigm to the magnitude that we do among the poorest Americans. These strategies protect children from the immediate negative associations of poverty and hunger, but they may contribute to long-term weight problems currently found in the US.

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.

Measuring household food security: the global experience

Measuring household food insecurity represents a challenge due to the complexity and wide array of factors associated with this phenomenon. For over one decade, researchers and agencies throughout the world have been using and assessing the validity of variations of the United States Department of Agriculture Household Food Security Supplemental Module. Thanks to numerous studies of diverse design, size, and purpose, the Household Food Security Supplemental Module has shown its suitability to directly evaluate the perceptions of individuals on their food security status. In addition, challenges and limitations are becoming clearer and new research questions are emerging as the process advances. The purpose of this article is to describe the development, validation procedures, and use of the Household Food Security Supplemental Module in very diverse settings. The most common Household Food Security Supplemental Module related studies have been conducted using criterion validity, Rasch modeling and Cronbach-Alpha Coefficient. It is critical that researchers, policy makers, governmental and non-governmental agencies intensify their efforts to further develop tools that provide valid and reliable measures of food security in diverse population groups. Additional work is needed to synthesize a universally applicable tool able to capture the global human phenomenon of food insecurity.

Neighborhood socioeconomic deprivation and minority composition are associated with better potential spatial access to the ground-truthed food environment in a large rural area

Little is known about spatial inequalities and potential access to the food environment in rural areas. In this study, we assessed the food environment in a 6-county rural region of Texas (11,567 km2) through ground-truthed methods that included direct observation and on-site Global Positioning System technology to examine the relationship between neighborhood inequalities (e.g., socioeconomic deprivation and minority composition) and network distance from all 101 rural neighborhoods to the nearest food store (FS). Neighborhood deprivation was determined from socioeconomic characteristics using 2000 census block group (CBG) data. Network distances were calculated from the population-weighted center of each CBG to the nearest supermarket, grocery, convenience, and discount store. Multiple regression models examined associations among deprivation, minority composition, population density, and network distance to the nearest FS. The median distance to the nearest supermarket was 14.9 km one way (range 0.12 to 54.0 km). The distance decreased with increasing deprivation, minority composition, and population density. The worst deprived neighborhoods with the greatest minority composition had better potential spatial access to the nearest FS. For >20% of all rural residents, their neighborhoods were at least 17.7 km from the nearest supermarket or full-line grocery or 7.6 km from the nearest convenience store. This makes food shopping a challenge, especially in rural areas that lack public transportation and where many have no vehicular access. Knowledge of potential access to the food environment is essential for combining environmental approaches and health interventions so that families, especially those in rural areas, can make healthier food choices.