Food deprivation is integral to the ‘hand to mouth’ existence of homeless youths in Toronto

Exploring Food Security and Mental Health Among Street-Involved Canadian 2S/LGBTQI+ Youth: A Review of the Literature

The purpose of this literature review is to evaluate the extant research addressing food insecurity and mental health among street-involved 2S/LGBTQI+ youth in Canada. Searches were undertaken in academic databases, Google, and Google Scholar for relevant research articles, reports, and grey literature. Our team found nil research specifically addressing food insecurity and the mental health of street-involved 2S/LGBTQI+ youth in Canada. Given that, contextual and contributory factors affecting the mental health and food security of this population are discussed. The available research demonstrates a significant misalignment between the existing support mechanisms and the requirements of this specific population. This underscores the urgent necessity for the establishment of structurally competent, safe, and easily accessible resources. Moreover, there is a clear imperative for additional research endeavors aimed at addressing knowledge deficiencies. These efforts are crucial in empowering dietitians to facilitate enhanced interdisciplinary collaboration, thereby fostering the creation of sustainable, accessible, and appropriate food systems tailored to the needs of this vulnerable demographic.

Mental health in society's margins: poor n-3 PUFA intake and psychological well-being of homeless youth

Dietary intake of long-chain n-3 PUFA (n-3 PUFA), particularly EPA and DHA, has been associated with psychological well-being, but little is known about the n-3 PUFA intake of homeless youth. The current study determined the association between depression and anxiety symptoms and n-3 PUFA intake and erythrocytes status in homeless youth. Totally, 114 homeless youth aged 18-24 years were recruited from a drop-in centre. n-3 PUFA dietary intake was assessed using an FFQ, and erythrocytes status was determined by gas chromatography (GC). Linear regression models were used to determine the relationship between psychological well-being and n-3 PUFA intake and status. The mean intakes of EPA and DHA for all participants (0·06 ± 0·13 g/d and 0·11 ± 0·24 g/d) were well below recommended levels, and mean erythrocytes EPA + DHA (n-3 index) in the cohort (2·42 %) was lower than reported for healthy, housed adolescents and those with clinical depression. There was no association of n-3 PUFA intake and erythrocytes status with either depression or anxiety. However, the relationships of depression with dietary EPA (P = 0·017) and DHA (P = 0·008), as well as erythrocytes DHA (P = 0·007) and n 3-index (P = 0·009), were significantly moderated by sex even after adjusting for confounders. Specifically, among females, as the intake and status of these n-3 PUFA decreased, depression increased. Our findings show poor dietary intake and low erythrocytes status of n-3 PUFA among homeless youth, which is associated with depressive symptoms among females.

Impact of the COVID-19 pandemic on vulnerable groups, including homeless persons and migrants, in France: a qualitative study

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Social inequalities in health increased especially during lockdown.

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Homeless persons felt neglected as lockdown was designed for those with stable housing.

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Access to an emergency shelter had positive impacts on homeless persons.

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Sudden implementation of lockdown reminded prior violent or traumatic circumstances.

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Crisis communication should be adapted to improve adherence to preventive measures.

Social inequalities tended to increase in the context of the pandemic, particularly in relation to the measures taken to manage and reduce the risk of COVID-19. When lockdown measures required the general population “to stay home”, what were homeless people expected to do? The ECHO study is a cross-sectional, descriptive study with a convergent mixed-method design. Data were collected across shelters in France both during and immediately following the lockdown (April – June 2020). This article presents the study’s qualitative findings, with a focus on understanding both the experiences and perceptions among these populations of the measures taken to limit the COVID-19 infection. A total of 26 semi-directed individual interviews were conducted across seven shelters in both Lyon (42%) and Paris (58%). Data were analysed using thematic content analysis with partial blinded coding. Four key themes were identified: 1- Reactions to the introduction of lockdown: a sudden implementation reminiscent of prior violent or traumatic circumstances amongst participants, 2- Accommodation during lockdown: participants’ conflicting visions of the shelter, 3- Influence of the media and public communication: an abundant flow of information impacting participant’s wellbeing and representations on the pandemic, and 4- The individual impact of lockdown: perceived health and limitations to daily life activities. The most vulnerable populations have borne the heaviest burden during the pandemic. It is therefore crucial that we improve both the availability of information, and the health literacy of, all groups within the national population.

Severe Psychopathology and Substance Use Disorder Modify the Association Between Housing Trajectories and Food Security Among Homeless Adults

Purpose: We examined the housing trajectories of homeless people with mental illness over a follow-up period of 6 years and the association of these trajectories with food security. We then examined the modifying role of psychopathology and alcohol and substance use disorders in this association. Materials and Methods: We followed 487 homeless adults with mental illness at the Toronto site of the At Home/Chez-Soi project-a randomized trial of Housing First. Food security data were collected seven times during the follow-up period. Psychopathology (Colorado Symptom Index score) and alcohol and substance use disorders were assessed at baseline. Housing trajectories were identified using group-based trajectory modeling. Logistic regression was used to estimate the association between housing trajectory groups and food security. Results: Three housing trajectory groups were identified: rapid move to consistent stable housing (34.7%), slow and inconsistent housing (52.1%), and never moved to stable housing (13.2%). Individuals included in the rapid move to consistent housing trajectory group had higher odds of remaining food secure compared with those in the never moved to stable housing trajectory group over the follow-up period [AOR 2.9, 95% CI: 1.3-6.6, P-value: 0.009]. However, when interactions were considered, this association was significant among those with moderate psychopathology but not severe psychopathology. Individuals with substance use disorder and in the never moved to stable housing group had the lowest food security status. Discussion: Severe psychopathology and substance use disorders modified the association between housing trajectories and food security. International Standard Randomized Control Trial Number Register (ISRCTN42520374).

Food insecurity and mental health outcomes among homeless adults: a scoping review

OBJECTIVE

This review summarises and synthesises the existing literature on the relationship between food insecurity (FS) and mental health conditions among adult individuals experiencing homelessness.

DESIGN

Scoping review. Papers published between 1 January 2008 and 2 November 2018, searched in PubMed, Web of Science, Scopus, PsycINFO, Cochrane Library and CINAHL, using homelessness, food security and mental health keywords.

SETTING

Global evidence.

PARTICIPANTS

Homeless adults aged 18 years or more.

RESULTS

Nine articles (eight cross-sectional and one longitudinal) were included in the present review. FS was measured using the Household Food Insecurity Access Scale, the United States Department of Agriculture Household Food Security Survey Module, as well as single-item or constructed measures. Depression and depressive symptoms were the most common mental health conditions studied. Other mental health conditions assessed included alcohol and substance use, emotional disorders, mental health problems symptoms severity and psychiatric hospitalisations. Composite measures such as axis I and II categories and a cluster of severe mental conditions and mental health-related functioning status were also analysed. FS and mental health-related problems were considered as both exposure and outcome variables. The existing evidence suggests a potential association between FS and several mental health conditions, particularly depression, mental health symptoms severity and poor mental health status scores.

CONCLUSIONS

This review suggests the potential association between some mental health conditions and FS among homeless adults. However, there is a need for more longitudinal- and interventional-based studies, in order to understand the nature and directionality of the links between FS and mental health in this population group.

Food insecurity among formerly homeless youth in supportive housing: A social-ecological analysis of a structural intervention

A growing body of research indicates that structural interventions to provide permanent supportive housing (PSH) to homeless adults within a Housing First approach can improve their health. However, research is lacking regarding the impact of PSH on youth experiencing homelessness. This article seeks to understand how PSH for youth impacts a basic health need-food security- across multiple levels of the social-ecological environment. In January of 2014, San Francisco, California opened the city's first municipally-funded PSH building exclusively designated for transition-aged youth (ages 18-24). We conducted 20 months of participant observation and in-depth interviews with 39 youth from April 2014 to December 2015. Ethnographic fieldnotes and interview transcripts were analyzed using grounded theory. We present our social-ecological assessment regarding food insecurity for formerly homeless youth in supportive housing. We found that although housing removes some major sources of food insecurity from their lives, it adds others. Many of the participating youth were frequently hungry and went without food for entire days. Mechanisms across multiple levels of the social-ecological model contribute to food insecurity. Mechanisms on the structural level include stigma, neighborhood food resources, and monthly hunger cycles. Mechanisms on the institutional level include the transition into housing and housing policies regarding kitchen use and food storage. Interpersonal level mechanisms include food sharing within social networks. Individual level mechanisms include limited cooking skills, equipment, and coping strategies to manage hunger. Although supportive housing provides shelter to youth, effective implementation of the Housing First/PSH model for youth must ensure their access to an affordable nutritious diet.

Food Sources for Homeless Youth: An Evaluation of Food Availability at a Homeless Youth Drop-In Center

OBJECTIVE

We utilized a validated food inventory questionnaire to assess the types and quality of food available at a homeless youth drop-in center.

METHODS

Scores for 13 food categories were computed; higher scores indicated a greater availability of foods found in that category. A summative score was computed to assess the presence of obesogenic foods.

RESULTS

Dry cereal, vegetables, and meat, were the most available foods; 83.3%, 60.9%, and 56.3% of food items in each category, respectively, were available. The food categories with least available items included candy and dairy: 26.6% and 25.4% of items in those categories, respectively. Mean obesogenic food availability score was 31 ± 4.2 (range 23-34), out of a possible score of 71.

CONCLUSIONS AND IMPLICATIONS

It is possible for a drop-in center to provide healthful foods to homeless youth. Further studies examining the extent to which drop-in centers contribute to the homeless youth food environment are warranted.

Unaccompanied homeless youth have extremely poor diet quality and nutritional status

A lack of in-depth assessment of the nutritional status of homeless youth precludes interventions that achieve nutritional adequacy. We enrolled 118 unaccompanied homeless youth to obtain sociodemographic and health data along with dietary, anthropometric, biochemical, and clinical assessments. As a reference, homeless youth data were compared to a convenience sample of 145 college students. Obesity was prevalent among homeless youth than among college students (29% vs. 8% respectively (CI: 11.2, 29.9). Among homeless youth, 74% of females versus 41% of males were overweight/obese (CI: 14.9, 51.2). Homeless youth also had poor diet quality (44.37 (SD: 12.64)). Over 70% of homeless youth had inadequate intakes of vitamins A, C, D₃ and E, as well as calcium and magnesium. Our findings show increased weight, adiposity, and suboptimal intakes of essential nutrients among unaccompanied homeless youth. Further studies are needed to inform evidence-based nutrition interventions that will aid in improving their nutritional health.

Food insufficiency is associated with depression among street-involved youth in a Canadian setting

OBJECTIVE

Food insufficiency, defined by the experience of hunger, is known to be prevalent and a source of health-related harm among-street involved youth, but little is known about its relationship with depression in this population. Therefore, we sought to assess the association between food insufficiency and symptoms of depression among a cohort of street-involved youth.

DESIGN

Multivariable logistic regression was used to assess the relationship between food insufficiency, defined as being hungry but not having enough money to buy food, and depression as measured by the Center for Epidemiological Studies Depression (CES-D) scale.

SETTING

Data from April 2006 to November 2013 were derived from the At-Risk Youth Study (ARYS), a prospective cohort of street-involved youth who use illicit drugs in Vancouver, Canada.

SUBJECTS

There were 1066 street-involved youth enrolled in the study, including 340 (31·9 %) females.

RESULTS

Of 1066 youth enrolled in the study, 724 (67·9 %) reported some food insufficiency and 565 (53·0 %) met criteria for depression. Compared with youth who did not report food insufficiency, those who reported often experiencing food insufficiency had a higher likelihood of reporting depression (adjusted OR=2·52; 95 % CI 1·74, 3·67), as did those who reported sometimes experiencing food insufficiency (adjusted OR=1·99; 95 % CI 1·47, 2·70).

CONCLUSIONS

Food insufficiency was prevalent and associated in a dose-dependent trend with symptoms of depression among street-involved youth in our setting. Findings highlight the need to address the nutritional and mental health needs of youth and identify pathways by which food insufficiency may contribute to depression among vulnerable populations.

Interventions to address household food insecurity in high-income countries

Household food insecurity is a serious public health concern in high-income countries. Canada and the USA regularly monitor household food insecurity, while in other countries, such as the UK, it has been the rapid rise of food bank usage that has drawn increased attention to this longstanding, but largely overlooked, problem. This review evaluates evidence on interventions intended to reduce household food insecurity in high-income countries. Research on social protection interventions suggests both cash transfers and food subsidies (e.g. the US Supplement Nutrition and Assistance Programme) reduce household food insecurity. In contrast, research on community-level interventions, such as food banks and other food programmes, suggests limited impacts. Although food banks have become a common intervention for food insecurity in high-income countries, evidence suggests their reliance on donations of volunteer time and food make them inevitably limited in the assistance they are able to provide. The stigma people feel using food banks may also make them untenable. Alternatives to, or enhanced, food banks such as community shops or community kitchens, have become common, but evidence also suggests they may be limited in effectiveness if they do not reach people experiencing food insecurity. This review highlights the difficulty of trying to address household food insecurity with community-based food interventions when solutions likely lie upstream in social protection policies.

'Hello, you're not supposed to be here': homeless emerging adults' experiences negotiating food access

OBJECTIVE

We aimed to examine the food-seeking experiences of homeless emerging adults (age 18-24 years) in a US urban context.

DESIGN

The study used a qualitative descriptive design, combining semi-structured interviews with a standardized quantitative measure of food insecurity. Interview data were coded using constant comparative methods to identify patterns across and within interviews. Emerging themes were confirmed and refined through member checking.

SETTING

Buffalo, a mid-sized city in the Northeastern USA.

SUBJECTS

A sample of thirty participants was recruited through community-based methods. Eligibility criteria specified that participants were aged 18-24 years and did not have a stable place to live. The sample was demographically diverse and included participants who were couch-surfing, staying on the streets and/or using shelters.

RESULTS

Participants' food access strategies varied across their living circumstances. Common strategies included purchasing food with cash or benefits (reported by 77 %), using free meal programmes (70 %) and eating at friends' or relatives' homes (47 %). Although 70 % of participants received Supplemental Nutrition Assistance Program benefits, several reported access barriers, including initial denials of eligibility due to being listed on a parent's application even when the participant no longer resided in the household. Participants described a stigma associated with using food pantries and free meal programmes and expressed preference for less institutionalized programmes such as Food Not Bombs.

CONCLUSIONS

Given endemic levels of food insecurity among homeless youth and young adults, policy modifications and service interventions are needed to improve food access for this population.

Food security among individuals experiencing homelessness and mental illness in the At Home/Chez Soi Trial

OBJECTIVE

Individuals experiencing homelessness are particularly vulnerable to food insecurity. The At Home/Chez Soi study provides a unique opportunity to first examine baseline levels of food security among homeless individuals with mental illness and second to evaluate the effect of a Housing First (HF) intervention on food security in this population.

DESIGN

At Home/Chez Soi was a 2-year randomized controlled trial comparing the effectiveness of HF compared with usual care among homeless adults with mental illness, stratified by level of need for mental health services (high or moderate). Logistic regressions tested baseline associations between food security (US Food Security Survey Module), study site, sociodemographic variables, duration of homelessness, alcohol/substance use, physical health and service utilization. Negative binomial regression determined the impact of the HF intervention on achieving levels of high or marginal food security over an 18-month follow-up period (6 to 24 months).

SETTING

Community settings at five Canadian sites (Moncton, Montreal, Toronto, Winnipeg and Vancouver).

SUBJECTS

Homeless adults with mental illness (n 2148).

RESULTS

Approximately 41 % of our sample reported high or marginal food security at baseline, but this figure varied with gender, age, mental health issues and substance use problems. High need participants who received HF were more likely to achieve marginal or high food security than those receiving usual care, but only at the Toronto and Moncton sites.

CONCLUSIONS

Our large multi-site study demonstrated low levels of food security among homeless experiencing mental illness. HF showed promise for improving food security among participants with high levels of need for mental health services, with notable site differences.

Food Insecurity in HIV-Hepatitis C Virus Co-infected Individuals in Canada: The Importance of Co-morbidities

While research has begun addressing food insecurity (FI) in HIV-positive populations, knowledge regarding FI among individuals living with HIV-hepatitis C virus (HCV) co-infection is limited. This exploratory study examines sociodemographic, socioeconomic, behavioral, and clinical factors associated with FI in a cohort of HIV-HCV co-infected individuals in Canada. We analyzed longitudinal data from the Food Security and HIV-HCV Co-infection Study of the Canadian Co-infection Cohort collected between November 2012-June 2014 at 15 health centres. FI was measured using the Household Food Security Survey Module and classified using Health Canada criteria. Generalized estimating equations were used to assess factors associated with FI. Among 525 participants, 59 % experienced FI at their first study visit (baseline). Protective factors associated with FI (p < 0.05) included: enrolment at a Quebec study site (aOR: 0.42, 95 % CI: 0.27, 0.67), employment (aOR: 0.55, 95 % CI: 0.35, 0.87), and average personal monthly income (aOR per $100 CAD increase: 0.98, 95 % CI: 0.97, 0.99). Risk factors for FI included: recent injection drug use (aOR: 1.98, 95 % CI: 1.33, 2.96), trading away food (aOR: 5.23, 95 % CI: 2.53, 10.81), and recent experiences of depressive symptoms (aOR: 2.11, 95 % CI: 1.48, 3.01). FI is common in this co-infected population. Engagement of co-infected individuals in substance use treatments, harm reduction programs, and mental health services may mitigate FI in this vulnerable subset of the HIV-positive population.

Network Approaches to Substance Use and HIV/Hepatitis C Risk among Homeless Youth and Adult Women in the United States: A Review

During the United States economic recession of 2008-2011, the number of homeless and unstably housed people in the United States increased considerably. Homeless adult women and unaccompanied homeless youth make up the most marginal segments of this population. Because homeless individuals are a hard to reach population, research into these marginal groups has traditionally been a challenge for researchers interested in substance abuse and mental health. Network analysis techniques and research strategies offer means for dealing with traditional challenges such as missing sampling frames, variation in definitions of homelessness and study inclusion criteria, and enumeration/population estimation procedures. This review focuses on the need for, and recent steps toward, solutions to these problems that involve network science strategies for data collection and analysis. Research from a range of fields is reviewed and organized according to a new stress process framework aimed at understanding how homeless status interacts with issues related to substance abuse and mental health. Three types of network innovation are discussed: network scale-up methods, a network ecology approach to social resources, and the integration of network variables into the proposed stress process model of homeless substance abuse and mental health. By employing network methods and integrating these methods into existing models, research on homeless and unstably housed women and unaccompanied young people can address existing research challenges and promote more effective intervention and care programs.

Food Insecurity among Homeless Adults with Mental Illness

Background

The prevalence of food insecurity and food insufficiency is high among homeless people. We investigated the prevalence and correlates of food insecurity among a cohort of homeless adults with mental illness in Vancouver, British Columbia, Canada.

Methods

Data collected from baseline questionnaires in the Vancouver At Home study were analysed to calculate the prevalence of food insecurity within the sample (n = 421). A modified version of the U.S. Department of Agriculture’s Adult Food Security Survey Module was used to ascertain food insecurity. Univariable and multivariable logistic regression were used to examine potential correlates of food insecurity.

Results

The prevalence of food insecurity was 64%. In the multivariable model, food insecurity was significantly associated with age (adjusted odds ratio [aOR] = 0.97; 95% CI: 0.95–0.99), less than high school completion (aOR = 0.57; 95% CI: 0.35–0.93), needing health care but not receiving it (aOR = 1.65; 95% CI: 1.00–2.72), subjective mental health (aOR = 0.97; 95% CI: 0.96–0.99), having spent over $500 for drugs and alcohol in the past month (aOR = 2.25; 95% CI: 1.16–4.36), HIV/AIDS (aOR = 4.20; 95% CI: 1.36–12.96), heart disease (aOR = 0.39; 95% CI: 0.16–0.97) and having gone to a drop-in centre, community meal centre or program/food bank (aOR = 1.65; 95% CI: 1.01–2.68).

Conclusions

The prevalence of food insecurity was extremely high in a cohort with longstanding homelessness and serious mental illness. Younger age, needing health care but not receiving it, poorer subjective mental health, having spent over $500 for drugs and alcohol in the past month, HIV/AIDS and having gone to a drop-in centre, community meal centre or program/food bank each increased odds of food insecurity, while less than high school completion and heart disease each decreased odds of food insecurity. Interventions to reduce food insecurity in this population are urgently needed.

Traditional and alternative community food security interventions in Montréal, Québec: different practices, different people

Food insecurity is steadily increasing in developed countries. Traditional interventions adopted to tackle food insecurity, like food banks, address the urgent need for food. By contrast, alternative interventions, such as community gardens and kitchens, are oriented towards social integration and the development of mutual aid networks. The objective of this paper is to examine whether the populations served by traditional and alternative interventions in food security differ according to measures of vulnerability. We studied newly registered participants to food security interventions. Participants were selected from a random sample of food security community organizations in a two-stage cluster sampling frame. The categorizing variable was participation in a community organization providing either traditional interventions or alternative interventions. Seven measures of vulnerability were used: food security; perceived health; civic participation; perceived social support of the primary network, social isolation, income and education. Regression multilevel models were used to assess associations. 711 participants in traditional interventions and 113 in alternative interventions were enrolled in the study. Between group differences were found with respect to food insecurity, health status perception, civic participation, education and income, but not with respect to social isolation or perceived social support from primary social network. Traditional and alternative food security interventions seem to reach different populations. Participants in traditional interventions were found to have less access to resources, compared to those in alternative interventions. Thus, new participants in traditional interventions may have higher levers of vulnerability than those in alternative interventions.

Food capacities and satisfaction in participants in food security community interventions in Montreal, Canada

Food insecurity is steadily increasing in Canada. The objective of this paper is to determine if food capacities and satisfaction of recently enrolled participants in food security interventions are associated with the intervention having either a traditional or an alternative type of approach. Participants having recently accessed traditional (n = 711) or alternative community interventions (n = 113) in the Montreal metropolitan area, Canada, were interviewed with a questionnaire. The categorizing variable was participation in a community organization providing either traditional interventions, aimed to help people cope with the urgent need of food, or alternative interventions, aimed at first assistance, in addition to the creation of long-term solutions such as social integration and skills development. Participants' food and nutrition-related capacities and food satisfaction are studied. Multilevel regression models were used to assess whether participants took part in a traditional or alternative interventions. These interventions do not reach the same population. Relative to participants in alternative food security interventions, participants in traditional interventions demonstrated less capacity for accessing information about food safety and healthiness, and perceived their diet as less healthy. Traditional food security participants also paid less attention to the nutritional properties of food and reported less satisfaction with quantity, variety and taste of the food they accessed. The reasons why individuals who may benefit the most from alternative interventions were unlikely to participate should be investigated. The potential that food security interventions may inadvertently reinforce social inequalities in health should be considered in future intervention research.

Is something better than nothing? Food insecurity and eating patterns of young people experiencing homelessness

OBJECTIVE

Food insecurity is an increasing problem in marginalised groups that affects diet quality. We aimed to examine the extent of food insecurity and the eating patterns of young people accessing support from specialist homelessness services.

METHODS

A cross-sectional survey with a researcher-administered food frequency and food insecurity questionnaire was undertaken with 50 young people experiencing homelessness, aged 14-26 years. Participants were recruited from 11 specialist homelessness services providing support and accommodation for young people in central and south-western Sydney.

RESULTS

Food insecurity was a recent experience for 70% of participants. Eighty-five per cent of participants living independently experienced food insecurity, compared to 66% of young people in supported accommodation. Consumption of core food groups was low, as almost all participants did not meet recommended daily servings of vegetables and breads and cereals. Consumption of sugar-sweetened soft drinks was high.

CONCLUSIONS

Food insecurity and poor diet quality are salient issues for this group of young people accessing support from specialist homelessness services.

IMPLICATIONS

These findings highlight the need for a greater focus on advocacy and policy action to increase social supports and improve food security and nutrition for young people experiencing homelessness.

Providing comprehensive health services for young key populations: needs, barriers and gaps

INTRODUCTION

Adolescence is a time of physical, emotional and social transitions that have implications for health. In addition to being at high risk for HIV, young key populations (YKP) may experience other health problems attributable to high-risk behaviour or their developmental stage, or a combination of both.

METHODS

We reviewed the needs, barriers and gaps for other non-HIV health services for YKP. We searched PubMed and Google Scholar for articles that provided specific age-related data on sexual and reproductive health; mental health; violence; and substance use problems for adolescent, youth or young sex workers, men who have sex with men, transgender people, and people who inject drugs.

RESULTS

YKP experience more unprotected sex, sexually transmitted infections including HIV, unintended pregnancy, violence, mental health disorders and substance use compared to older members of key populations and youth among the general population. YKP experience significant barriers to accessing care; coverage of services is low, largely because of stigma and discrimination experienced at both the health system and policy levels.

DISCUSSION

YKP require comprehensive, integrated services that respond to their specific developmental needs, including health, educational and social services within the context of a human rights-based approach. The recent WHO Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations are an important first step for a more comprehensive approach to HIV programming for YKP, but there are limited data on the effective delivery of combined interventions for YKP. Significant investments in research and implementation will be required to ensure adequate provision and coverage of services for YKP. In addition, greater commitments to harm reduction and rights-based approaches are needed to address structural barriers to access to care.

Sustaining dignity? food insecurity in homeless young people in urban Australia

ISSUE ADDRESSED

Food insecurity is recognised as an increasing problem in disadvantaged and marginalised groups. The aim of this study was to investigate issues associated with food insecurity and nutrition in young people experiencing, or at risk of, homelessness in metropolitan Australia.

METHODS

Eight focus group discussions were conducted with 48 young people (aged between 15 and 25 years) in specialist homelessness services in central and south-western Sydney.

RESULTS

Participants described daily experiences of food insecurity, persistent hunger and poverty. Structural barriers to food security and nutrition were identified and included poverty and reduced physical access to fresh foods. Participants also described a desire to save time, for convenience and to be socially connected. Despite the hardships and the chaos of youth homelessness, the groups were defined by their strength of character, resilience and hope for the future.

CONCLUSION

Homeless young people within central and south-western Sydney report varying degrees of food insecurity, despite being supported by specialist youth homelessness services. SO WHAT? A collaborative, multistrategic approach with youth participation is required to further enhance the capacity of youth services to improve food security, food access and the availability of nutritious foods for homeless young people. A greater focus on advocacy and policy action is also required to bring food security and nutrition to the forefront of national efforts to improve the health and welfare of disadvantaged groups.

Improving the nutritional quality of charitable meals for homeless and vulnerable adults. A case study of food provision by a food aid organisation in the UK

The prevalence of homelessness in the UK is rising, and demand for food aid through charitable meal services has increased. Charitable services make a substantial contribution to the food and nutrient intake of vulnerable people, and thus offer a platform for dietary improvement. This study examined food provision by a large charitable organisation in a major UK city. It had several objectives: Firstly to quantify nutritional composition of breakfast and lunch meals, secondly to understand factors that influence the composition of menus and meals, and thirdly to determine whether, within the context of these influences, improvements to the menu would be possible and whether these would be acceptable to clients. Mixed methods of ethnography, semi-structured interviews, quantitative nutrient analysis, recipe adaptation and taste tests were employed. The research team worked as volunteers in the organisation for a 3-week period and interviews were held with the kitchen staff. Food choice was recorded for 189 clients at breakfast and 251 clients at lunch over a 5-day period and nutrient content of these meals was estimated. Meals were weighted towards fat and sugar energy. Energy, potassium, calcium, vitamin C, vitamin A, zinc and magnesium content of meals were below Dietary Reference Value (DRV) targets for at least 20% of breakfast and lunch meals. Such inadequacies may be addressed by the addition of simple foods to the breakfast menu and adaptation of lunchtime recipes. Twelve lunchtime dishes were proposed and eight of these were seemingly acceptable to clients in taste testing. Barriers to provision of healthier meals include budget, food donations and acceptability of meals.

The health diagnoses of homeless adolescents: a systematic review of the literature

BACKGROUND

Homelessness during adolescence impacts negatively upon young people's physical and mental wellbeing. To be effective, programs aimed at addressing the health needs of this population must include knowledge of both the presenting and underlying acute and chronic conditions that characterise this high risk group of youth.

METHODS

We undertook a systematic review of the international literature for studies that used validated instruments and techniques to diagnose prevalence rates of physical and mental health disorders in homeless adolescents.

RESULTS

Twenty-one studies fulfilled the selection criteria. Of these, nine studies examined mental health diagnoses including depression, post-traumatic stress disorder, anxiety and substance abuse disorders. With one exception, the remaining twelve studies all related to sexually transmitted infections.

CONCLUSION

Homeless adolescents are diagnosed with widely varying rates of mental health disorders and high rates of sexually transmitted infection. Other likely chronic and acute physical conditions appear to be neglected in the published research.

Homeless youth's overwhelming health burden: A review of the literature

Homelessness has reached epidemic proportions in Canada. Canadian children and adolescents are the most vulnerable because youth comprise the fastest growing segment of the homeless population. A systematic literature review was undertaken using MEDLINE, Web of Science and the Homeless Hub (www.homelesshub.ca) to encompass the time frame from January 1990 to June 2009. The following terms were used as key words: 'homelessness', 'homeless youth', 'poverty', 'street youth' and 'runaway'. The present review identified an intersection among education deficits, social service insufficiencies, and poor mental and physical health in homeless youth. Health care delivery to homeless youth was often nonanticipatory, inconsistent and perceived as discriminatory. However, street youth were identified as requiring health care for pregnancy, mental health concerns, sexually transmitted illnesses, respiratory conditions, substance abuse and a myriad of other illnesses. Plenty of work is still required to reduce health inequalities and improve the daily living conditions of Canadian youth living in poverty.

The assessment of food security in homeless individuals: a comparison of the Food Security Survey Module and the Household Food Insecurity Access Scale

OBJECTIVE

To compare the Household Food Insecurity Access Scale (HFIAS), the US Food Security Survey Module (US FSSM) and a modified version of the US FSSM in which references to buying food were changed to references to getting food, in terms of their classification of food security levels among homeless individuals, and to determine which of these instruments was most preferred by homeless individuals.

DESIGN

A cross-sectional survey.

SETTING

Recruitment of participants took place at seven shelters and from three drop-in programmes that serve homeless individuals in Toronto, Canada.

SUBJECTS

Fifty individuals who were ≥18 years of age, able to communicate in English and currently homeless.

RESULTS

The modified US FSSM assigned 20% of participants to a lower ordinal food security category compared with the US FSSM, and only 8% to a higher food security category. The HFIAS assigned 30% of participants to a lower food security category compared with either the US FSSM or the modified US FSSM, and only 10-16% of participants to a higher food security category. When asked to compare all three instruments, the majority of respondents (62%) selected the HFIAS as the best instrument for people who are homeless.

CONCLUSIONS

A majority of homeless individuals selected the HFIAS as the best food security instrument for people who are homeless. Our findings suggest that the HFIAS is a more appropriate instrument than the US FSSM for measuring food security in the homeless population.

Policy directions to promote healthy dietary patterns in CanadaThis paper is one of a selection of papers published in the CSCN–CSNS 2009 Conference, entitled Are dietary patterns the best way to make nutrition recommendations for chronic disease prevention?

The effective promotion of healthy dietary patterns rests on a supportive policy environment. Given the vast, ever-expanding selection of foods in Canadian supermarkets and the proliferation of nutrition-related food marketing, more effective communication tools are needed to help consumers understand food selections within the context of a total diet. In addition, policy actions at the federal, provincial, and municipal levels are needed to lift economic and geographic barriers to food access for specific population subgroups.