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McNeely A, Borchers L, Szeszulski J, Eicher-Miller HA, Seguin-Fowler RA, MacMillan Uribe A. The role of the community café in addressing food security: Perceptions of managers and directors. Appetite 2024; 196:107274. [PMID: 38364971 DOI: 10.1016/j.appet.2024.107274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/04/2024] [Accepted: 02/13/2024] [Indexed: 02/18/2024]
Abstract
In the United States, the pay-what-you-can restaurant model (community cafes) is an increasingly popular approach to addressing food insecurity in local communities. We conducted semi-structured interviews (n = 13) with community café executive managers and directors to assess their perceptions of the role that their cafes play in addressing food security (FS). Analysis of interviews revealed two major areas of emphasis by participants. Filling an unoccupied space in the food security landscape. Interviewees regularly cited the goal of making meals available through a dependable schedule, convenient location, and welcoming atmosphere for guests to promote regular visits to the café, and they did so with an awareness of how their practices were shaped by perceived shortcomings in comparable services. In addition, guest agency and social aspects of the café as components of utilization, was another major area. Interviewees often regarded the opportunity of the food insecure guest to choose healthy options (i.e., nutritionally dense) over less healthful ones (i.e., calorically dense) from the menu as a critical component of their service. The social component of the café (e.g., community atmosphere, 'dining-out' experience) was another aspect of the café's function that promoted dignity for the guest which can lead to greater likelihood of return visits. Perceptions shared by participants of the café's role in addressing food security suggest that rather than simply adding to the available options of hunger relief services, the café model attempts to address many areas of concern, such as structural and cultural barriers, found in the traditional forms of charitable food provision.
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Affiliation(s)
- Andrew McNeely
- Institute for Advancing Health through Agriculture, Texas A&M AgriLife Dallas Research Center, 17360 Coit Rd., Dallas, TX, 75252, USA
| | - Lori Borchers
- Texas Christian University Harris College of Nursing & Health Sciences, Annie Richardson Bass Building 2101, 2800 W Bowie St, Fort Worth, TX, 76109, USA
| | - Jacob Szeszulski
- Institute for Advancing Health through Agriculture, Texas A&M AgriLife Dallas Research Center, 17360 Coit Rd., Dallas, TX, 75252, USA
| | - Heather A Eicher-Miller
- Purdue University, Department of Nutrition Science, 700 West State Street, West Lafayette, IN, 47907, USA
| | - Rebecca A Seguin-Fowler
- Institute for Advancing Health through Agriculture, Texas A&M University, 500 Research Parkway Centeq Building B, Suite 270, College Station, TX, 77845, USA
| | - Alexandra MacMillan Uribe
- Institute for Advancing Health through Agriculture, Texas A&M AgriLife Dallas Research Center, 17360 Coit Rd., Dallas, TX, 75252, USA.
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Beltrán S, Arenas DJ, Pharel M, Montgomery C, Lopez‐Hinojosa I, DeLisser HM. Food insecurity, type 2 diabetes, and hyperglycaemia: A systematic review and meta-analysis. Endocrinol Diabetes Metab 2022; 5:e00315. [PMID: 34726354 PMCID: PMC8754242 DOI: 10.1002/edm2.315] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/18/2021] [Accepted: 10/24/2021] [Indexed: 12/16/2022] Open
Abstract
AIMS Food insecurity (FIS) is a major public health issue with possible implications for type 2 diabetes mellitus (T2DM) risk. We conducted a systematic review and meta-analysis to explore the association between FIS and T2DM. METHODS We performed a systematic search in PubMed, Embase, Scopus, and Web of Science. All cross-sectional, peer-reviewed studies investigating the link between FIS and T2DM were included. Population characteristics, study sizes, covariates, T2DM diagnoses, and diabetes-related clinical measures such as fasting blood glucose (FBG) and HbA1c were extracted from each study. Outcomes were compared between food insecure and food secure individuals. Effect sizes were combined across studies using the random effect model. RESULTS Forty-nine peer-reviewed studies investigating the link between FIS and T2DM were identified (n = 258,250). Results of meta-analyses showed no association between FIS and clinically determined T2DM either through FBG or HbA1c: OR = 1.22 [95%CI: 0.96, 1.55], Q(df = 5) = 12.5, I2 = 60% and OR = 1.21 [95%CI: 0.95, 1.54], Q(df = 5) = 14; I2 = 71% respectively. Standardized mean difference (SMD) meta-analyses yielded no association between FIS and FBG or HbA1c: g = 0.06 [95%CI: -0.06, 0.17], Q(df = 5) = 15.8, I2 = 68%; g = 0.11 [95% CI: -0.02, 0.25], Q(df = 7) = 26.8, I2 = 74% respectively. For children, no association was found between FIS and HbA1c: g = 0.06 [95%CI: 0.00, 0.17], Q(df = 2) = 5.7, I2 = 65%. CONCLUSIONS Despite multiple proposed mechanisms linking FIS to T2DM, integration of the available literature suggests FIS is not associated with clinically determined T2DM or increases in FBG or HbA1c among adult patients.
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Affiliation(s)
- Sourik Beltrán
- Department of MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Daniel J. Arenas
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Canada Montgomery
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Horace M. DeLisser
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Savin K, Morales A, Levi R, Alvarez D, Seligman H. "Now I Feel a Little Bit More Secure": The Impact of SNAP Enrollment on Older Adult SSI Recipients. Nutrients 2021; 13:4362. [PMID: 34959914 PMCID: PMC8707609 DOI: 10.3390/nu13124362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/24/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022] Open
Abstract
In June 2019, California expanded Supplemental Nutrition Assistance Program (SNAP) eligibility to Supplemental Security Income (SSI) beneficiaries for the first time. This research assesses the experience and impact of new SNAP enrollment among older adult SSI recipients, a population characterized by social and economic precarity. We conducted semi-structured, in-depth interviews with 20 SNAP participants to explore their experiences with new SNAP benefits. Following initial coding, member-check groups allowed for participants to provide feedback on preliminary data analysis. Findings demonstrate that SNAP enrollment improved participants' access to nutritious foods of their choice, contributed to overall budgets, eased mental distress resulting from poverty, and reduced labor spent accessing food. For some participants, SNAP benefit amounts were too low to make any noticeable impact. For many participants, SNAP receipt was associated with stigma, which some considered to be a social "cost" of poverty. Increased benefit may be derived from pairing SNAP with other public benefits. Together, the impacts of and barriers to effective use of SNAP benefits gleaned from this study deepen our understanding of individual- and neighborhood-level factors driving health inequities among low-income, disabled people experiencing food insecurity and SNAP recipients.
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Affiliation(s)
- Katie Savin
- School of Social Welfare, University of California, Berkeley, CA 94709, USA
- MSW Program, School of Health Sciences, University of the Pacific, Sacramento, CA 95817, USA
| | - Alena Morales
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA 94709, USA;
| | - Ronli Levi
- Center for Vulnerable Populations, University of California, San Francisco, CA 94143, USA; (R.L.); (H.S.)
| | - Dora Alvarez
- School of Medicine, University of California, San Francisco, CA 94143, USA;
- School of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Hilary Seligman
- Center for Vulnerable Populations, University of California, San Francisco, CA 94143, USA; (R.L.); (H.S.)
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Gany F, Melnic I, Ramirez J, Wu M, Li Y, Paolantonio L, Roberts-Eversley N, Blinder V, Leng J. The association between housing and food insecurity among medically underserved cancer patients. Support Care Cancer 2021; 29:7765-7774. [PMID: 34169329 PMCID: PMC8225310 DOI: 10.1007/s00520-021-06254-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/26/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the prevalence of socioeconomic needs and associations between housing characteristics and food insecurity among low-income cancer patients, among whom housing and food insecurity are particularly prevalent. METHODS Low-income cancer patients in active treatment (N = 1618) were enrolled in a comprehensive patient navigation program. Food insecurity was assessed using the 18-item US Department of Agriculture US Household Food Security Survey Module. Participants self-reported their need for assistance with housing issues/type of assistance needed, perception of overcrowding, satisfaction with living situation, and household density via a cross-sectional survey. Descriptive analyses, cross-tabulations and tests of proportions, and binary logistic regression were used in data analyses. RESULTS Seventy percent of patients were food insecure. Housing characteristics associated with food insecurity were homelessness or living in sheltered/supportive housing (83.3% food insecure), renting (71.9%), and homeownership (58.1%; p < .001); living situation satisfaction (not satisfied, 79.4%; somewhat satisfied, 25.6%; very satisfied, 66%; p < .001); need of housing assistance (79.2%; p < .001), and feeling crowded in their living unit (77.6%; p < .05). Associations of living unit type with food insecurity were significant in the binary logistic regression model (renters 1.68 OR, homeless/sheltered housing 2.80 OR vs homeowners). CONCLUSION The vulnerability to food insecurity of patients in this low-income sample was underlined by the high rates found, and clear associations with housing characteristics of homelessness, housing assistance needs, and feeling overcrowded were identified. These results could help shape priorities around screening patients for nutrition and housing needs and developing interventions to address them.
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Affiliation(s)
- Francesca Gany
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA.
- Department of Medicine, Department of Public Health, Weill Cornell Medical College, New York, NY, USA.
| | - Irina Melnic
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA
| | - Julia Ramirez
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA
| | - Minlun Wu
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA
| | - Luke Paolantonio
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA
| | - Nicole Roberts-Eversley
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA
| | - Victoria Blinder
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA
- Department of Medicine, Department of Public Health, Weill Cornell Medical College, New York, NY, USA
| | - Jennifer Leng
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA
- Department of Medicine, Department of Public Health, Weill Cornell Medical College, New York, NY, USA
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Tang X, Blewett LA. Food Security Status among U.S. Older Adults: Functional Limitations Matter. J Nutr Gerontol Geriatr 2021; 40:108-124. [PMID: 33999782 DOI: 10.1080/21551197.2021.1924337] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aimed to assess the relationship between food security and health outcomes among older adults (age 65+) in the U.S. We used a pooled sample (2011-2015, N = 37,292) from the National Health Interview Survey (NHIS) and ordered logit models to assess characteristics associated with food security including health conditions (diabetes and hypertension) and functional activity limitations. We estimated that 1.3 million individuals aged 65+ in the U.S. had low/very low food security. Having at least one functional limitation (OR = 1.717, 95% CI = 1.436, 2.054) was significantly associated with low/very low food security. Having fair or poor health status (OR = 3.315, 95% CI = 2.938, 3.739) was also a significant factor for food security among older adults, while having health insurance coverage (OR = 0.467, 95% CI = 0.341, 0.64) was negatively associated with food insecurity. Demographics and socioeconomic characteristics were significantly related to food insecurity among seniors. Seniors with functional limitations and poor health status are at risk for food insecurity. Interventions at the clinical site of care may be useful in addressing food security issues for older adults.
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Affiliation(s)
- Xuyang Tang
- Department of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota, USA
| | - L A Blewett
- Department of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota, USA
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Abstract
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.
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Weinstein LC, Chilton M, Turchi R, Klassen AC, LaNoue M, Silvero A, Cabassa LJ. 'It's common sense that an individual must eat': Advocating for food justice with people with psychiatric disabilities through photovoice. Health Expect 2020; 24 Suppl 1:161-173. [PMID: 32671916 PMCID: PMC8137492 DOI: 10.1111/hex.13101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 03/25/2020] [Accepted: 06/24/2020] [Indexed: 01/02/2023] Open
Abstract
Background People with SMI have often been excluded in advocacy efforts focused on physical health, health care and health and social policy. Objective Following a Photovoice project focused on barriers to healthy eating and physical activity in urban neighbourhoods, participant‐researchers were invited to present their insights in community advocacy settings. The purpose of this study was to explore the feasibility and participant–researchers’ experience of these community advocacy activities. Design We held four focus groups with the eight participant‐researchers after each community advocacy activity to explore their experience with public speaking, presenting their experiences and advocating. Setting and Participants People with serious mental illness who were overweight/obese living in supportive housing. Analysis approach Qualitative analysis of the focus group transcripts, using a modified grounded theory approach followed by structured coding focused on empowerment, participation and non‐discrimination. Results Participant‐researchers gave three oral presentations of their photographs at a variety of community‐based programmes and settings and participated in a rally to advocate for SNAP benefits. Two themes emerged from analysis: (a) Empowerment (the level of choice, influence and control that users of mental health services can exercise over events in their lives) and (b) Barriers to Empowerment (obstacles to participation and well‐being). Conclusions This evaluation strengthens the evidence that it is feasible for participant‐researchers in Photovoice projects to engage in robust advocacy activities, such as presentations and discussions with local policymakers. During focus groups, participant‐researchers demonstrated realistic optimism towards their roles as change agents and influencers in spite of acknowledged systemic barriers.
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Affiliation(s)
- Lara Carson Weinstein
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mariana Chilton
- Dornsife School of Public Health, Health Management and Policy, Drexel University, Philadelphia, PA, USA
| | - Renee Turchi
- Dornsife School of Public Health, Community Health and Prevention, Drexel University, Philadelphia, PA, USA
| | - Ann C Klassen
- Dornsife School of Public Health, Community Health and Prevention, Drexel University, Philadelphia, PA, USA
| | - Marianna LaNoue
- School of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexis Silvero
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Leopoldo J Cabassa
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MI, USA
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Rowe CL, Riley ED, Eagen K, Zevin B, Coffin PO. Drug overdose mortality among residents of single room occupancy buildings in San Francisco, California, 2010-2017. Drug Alcohol Depend 2019; 204:107571. [PMID: 31581024 PMCID: PMC11105971 DOI: 10.1016/j.drugalcdep.2019.107571] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 08/14/2019] [Accepted: 08/14/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Single room occupancy (SRO) buildings, also known as residential hotels, are a form of affordable housing common to cities in North America, and residents of these buildings face elevated rates of substance use, physical and mental multimorbidity, and mortality. Identifying distinct populations at greater risk of overdose death is crucial to the planning of interventions aiming to reduce drug-related mortality, yet no studies have assessed the population burden of overdose mortality among SRO residents. The present study quantifies and characterizes drug overdose mortality among residents of SRO buildings in a large U.S. city. METHODS We used mortality records and a database of SRO buildings to calculate rate ratios comparing overdose mortality due to opioids, cocaine, and methamphetamine among SRO residents and non-SRO residents in San Francisco, CA 2010-2017 and assessed bivariate differences in decedent and death location characteristics between SRO resident and other overdose decedents. RESULTS There were 1,551 overdose deaths during the study period, with an overall rate of 21.3 per 100,000 residents (95%CI = 20.2-22.6). The rate among SRO residents (278.7, 95%CI = 252.9-306.5) was 19.3 (95%CI = 17.1-21.7) times that of non-SRO residents (21.3, 95%CI = 20.2-22.6). An additional 79 (5%) deaths among non-residents occurred in SRO buildings, and 86% of SRO resident decedents died at home compared to 64% of non-SRO residents (p < 0.05). CONCLUSIONS Overdose mortality was substantially higher among SRO residents, who were also more likely to die from overdose at home, which highlights the need for resources and targeted interventions directed towards residents of SRO buildings.
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Affiliation(s)
- Christopher L Rowe
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102, United States; University of California, Berkeley, 2121 Berkeley Way, 5th Floor, Berkeley, CA, 94702, United States.
| | - Elise D Riley
- University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA, 94143, United States
| | - Kellene Eagen
- San Francisco Department of Public Health, 230 Golden Gate Avenue, San Francisco, CA 94102, United States
| | - Barry Zevin
- San Francisco Department of Public Health, 50 Ivy Street, San Francisco, CA 94102, United States
| | - Phillip O Coffin
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102, United States; University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA, 94143, United States
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Religious Faith and Diabetes Health Beliefs in a Homeless Population: A Qualitative Study. J Christ Nurs 2019; 36:228-235. [PMID: 31490877 DOI: 10.1097/cnj.0000000000000655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This participatory action research project explored the perspectives and challenges of homeless persons living with, or at risk for, type 2 diabetes. Because these persons were sheltered in and served by a church, their perspectives provide understanding about how religious faith may influence diabetes self-management.
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Tong M, Tieu L, Lee CT, Ponath C, Guzman D, Kushel M. Factors associated with food insecurity among older homeless adults: results from the HOPE HOME study. J Public Health (Oxf) 2019; 41:240-249. [PMID: 29617886 PMCID: PMC6636692 DOI: 10.1093/pubmed/fdy063] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 02/09/2018] [Accepted: 03/15/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The US homeless population is aging. Older adults and those living in poverty are at a high risk of food insecurity. METHODS We conducted a cross-sectional analysis of baseline data from a population-based study of 350 homeless adults aged ≥50. We assessed food security and receipt of food assistance. We used multivariable logistic regression to examine factors associated with very low food security. RESULTS The majority of the cohort was male and African American. Over half (55.4%) met criteria for food insecurity, 24.3% reported very low food security. Half (51.7%) reported receiving monetary food assistance. In the multivariable model, those who were primarily sheltered in the prior 6 months, (multi-institution users [AOR = 0.44, 95% CI: 0.22-0.86]) had less than half the odds of very low food security compared with those who were unsheltered. Depressive symptoms (AOR = 3.01, 1.69-5.38), oral pain (AOR = 2.15, 1.24-3.74) and cognitive impairment (AOR = 2.21, 1.12-4.35) were associated with increased odds of very low food security. CONCLUSIONS Older homeless adults experience a high prevalence of food insecurity. To alleviate food insecurity in this population, targeted interventions must address specific risk groups.
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Affiliation(s)
- M Tong
- School of Public Health, University of California, Berkeley, USA
| | - L Tieu
- Division of General Internal Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, UCSF Box 1364, San Francisco, CA, USA
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, USA
| | - C T Lee
- Division of General Internal Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, UCSF Box 1364, San Francisco, CA, USA
| | - C Ponath
- Division of General Internal Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, UCSF Box 1364, San Francisco, CA, USA
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, USA
| | - D Guzman
- Division of General Internal Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, UCSF Box 1364, San Francisco, CA, USA
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, USA
| | - M Kushel
- Division of General Internal Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, UCSF Box 1364, San Francisco, CA, USA
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, USA
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Abdurahman AA, Chaka EE, Nedjat S, Dorosty AR, Majdzadeh R. The association of household food insecurity with the risk of type 2 diabetes mellitus in adults: a systematic review and meta-analysis. Eur J Nutr 2019; 58:1341-1350. [PMID: 29721679 DOI: 10.1007/s00394-018-1705-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 04/27/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The link between household food insecurity and risk of type 2 diabetes mellitus still remains controversial. Therefore, we performed a systematic review and meta-analysis to clarify the association between household food insecurity and type 2 diabetes mellitus. METHODS EMBASE, PubMed, ISI Web of Science and Scopus databases were searched up to March 2017. The selection of studies, data extraction and assessing the risk of bias in the included studies were carried out by two reviewers independently. Study-specific odds ratios (ORs) were pooled using a random effects model. RESULTS A total of 18 articles including a total of 55,353,915 adult participants were included in the meta-analysis. The pooled ORs of the cross-sectional studies revealed that household food insecurity was significantly associated with the odds of T2DM (OR 1.27, 95% CI 1.11-1.42) with no evidence of publication bias (p = 0.63) but heterogeneity between studies (I2 = 61.1%). Similarly, subgroup analyses showed that the country where the study conducted and household food insecurity assessment tool used to influence the effect of household food insecurity on the odds of T2DM. However, the pooled ORs for two case-control and one cohort studies were not significantly associated between household food insecurity and T2DM in adults. CONCLUSION This study strengthens the hypothesis of the household food insecurity effect on the odds of T2DM among adults. Further longitudinal studies based on larger, and more representative samples are needed to identify the underlying relationships between food insecurity and type 2 diabetes mellitus.
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Affiliation(s)
- Ahmed A Abdurahman
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences International Campus (TUMS-IC), Tehran, Iran
| | - Eshetu E Chaka
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences International Campus (TUMS-IC), Tehran, Iran
- College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - S Nedjat
- Department of Epidemiology and Biostatistics, School of Public Health, and Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmed Reza Dorosty
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box: 14155-6117, Tehran, Iran.
| | - R Majdzadeh
- Department of Epidemiology and Biostatistics, School of Public Health, and Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, and Community Based Participatory Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Schwartz N, Buliung R, Wilson K. Disability and food access and insecurity: A scoping review of the literature. Health Place 2019; 57:107-121. [PMID: 31026771 DOI: 10.1016/j.healthplace.2019.03.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 03/12/2019] [Accepted: 03/29/2019] [Indexed: 01/01/2023]
Abstract
A scoping review was conducted, using a social ecological model approach, of 106 articles examining the effect of disability on food access and (in)security. Results of the review show a consistently increased risk of food insecurity among people with disabilities with a higher risk for mental health disabilities, and among disabled younger adults. Mediators of this relationship were underexplored. Disability was mainly conceptualized as a problematic category preventing food access while ignoring disabling social and environmental barriers. A social model of disability can inform future research by acknowledging the role of socio-environmental influences on the production and experience(s) of disability.
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Affiliation(s)
- Naomi Schwartz
- Department of Geography and Planning, University of Toronto Mississauga, Room 3207, Davis Building, 1867 Inner Circle, Mississauga, ON, L5L IC6, Canada.
| | - Ron Buliung
- Department of Geography and Planning, University of Toronto Mississauga, Room 3272, Davis Building, 1867 Inner Circle, Mississauga, ON, L5L 1C6, Canada.
| | - Kathi Wilson
- Department of Geography and Planning, University of Toronto Mississauga, Room 3294, Davis Building, 1867 Inner Circle, Mississauga, ON, L5L 1C6, Canada.
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Brooks LK, Kalyanaraman N, Malek R. Diabetes Care for Patients Experiencing Homelessness: Beyond Metformin and Sulfonylureas. Am J Med 2019; 132:408-412. [PMID: 30472322 DOI: 10.1016/j.amjmed.2018.10.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 10/25/2018] [Accepted: 10/26/2018] [Indexed: 12/12/2022]
Abstract
On any given night in the United States, an estimated 553,742 people are homeless. Applying a broader definition of homelessness that includes unstably housed people, an estimated 1.5% of Americans experience homelessness in a given year. Rates of diabetes are increasing among individuals experiencing homelessness. The social, psychological, and physical challenges of homelessness not only contribute to the rate of diabetes, but also complicate management. Unstable housing, limited medical resources, food insecurity, and competing priorities are barriers to diabetes care among patients experiencing homelessness. Homeless patients with diabetes more frequently develop specific comorbidities that require special attention, such as cardiovascular disease, substance abuse, depression, and foot wounds. The Affordable Care Act gave states the option to expand Medicaid to those earning up to 138% of the federal poverty level. This addressed a gap in coverage for low-income individuals not eligible for Medicaid or employer-sponsored insurance. With increased insurance coverage, this has increased the variety of medications available to treat hyperglycemia from type 2 diabetes beyond metformin, sulfonylureas, and insulin. Several of the newer classes of medications have advantages for patients experiencing homelessness, but also have special considerations in this vulnerable patient population. This narrative review will provide a review of dipeptidyl peptidase-4 inhibitors, glucagon-like peptide agonists, sodium glucose cotransporter-2 inhibitors, and thiazolidinediones in individuals experiencing homelessness.
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Affiliation(s)
- Lauren K Brooks
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore
| | | | - Rana Malek
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore.
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Hunt BR, Benjamins MR, Khan S, Hirschtick JL. Predictors of Food Insecurity in Selected Chicago Community Areas. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:287-299. [PMID: 30316584 DOI: 10.1016/j.jneb.2018.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 07/23/2018] [Accepted: 08/08/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Examine associations between food insecurity and multiple demographic, socioeconomic, acculturation, social risk factor, and food access variables. DESIGN Data are from Sinai Community Health Survey 2.0, a cross-sectional, population-based probability survey of adults. SETTING Ten selected community areas in Chicago. PARTICIPANTS Adults aged 18 years and over who completed the Household Food Security Scale (HFSS) portion of the survey were included in the analysis (n = 1,041). MAIN OUTCOME MEASURES Food insecurity as defined by the HFSS was the dependent variable. Independent variables included multiple demographic, socioeconomic, acculturation, social risk factor, and food access variables. ANALYSIS Multivariate logistic regression, along with a manual backward selection process, was used to examine predictors of food insecurity. A P of .05 was used to determine statistical significance. RESULTS Respondents reporting English as their primary language (odds ratio [OR] = 0.31; P = .002) had significantly lower odds of experiencing food insecurity. Respondents who reported feeling lonely (OR = 1.86; P = .024) had significantly higher odds of experiencing food insecurity. Emergency food use (OR = 3.89; P = .001) and food stamp benefit receipt (OR = 2.79; P = .001) were also associated with food insecurity. Race/ethnicity demonstrated a strong relationship with food insecurity in early models, but this relationship appeared to be mediated by language and social risk factors. In the final adjusted model, most demographic and socioeconomic variables, including race/ethnicity, gender, and education were not significantly associated with food insecurity. CONCLUSIONS AND IMPLICATIONS The burden of food insecurity was not shared equally across populations. This analysis sheds light on significant predictors of food insecurity in several diverse communities in Chicago. Findings can help inform tailored interventions by guiding food assistance programs to those most in need.
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Affiliation(s)
- Bijou R Hunt
- Sinai Health System, Sinai Urban Health Institute, Chicago, IL.
| | | | - Sabena Khan
- Rosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago, IL
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15
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Miewald C, McCann E, Temenos C, McIntosh A. "I do my best to eat while I'm using": Mapping the foodscapes of people living with HIV/AIDS who use drugs. Soc Sci Med 2019; 226:96-103. [PMID: 30851662 DOI: 10.1016/j.socscimed.2019.02.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/22/2018] [Accepted: 02/24/2019] [Indexed: 11/29/2022]
Abstract
Food insecurity can have negative health impacts on people who use drugs and are living with HIV/AIDS (PLHIV). These include both physical effects, including poorer health outcomes and morbidity, and also behaviors that can increase the risk of physical or psychological harm. This study used a semi-structured survey of 60 PLHIV who use drugs and service access mapping (SAM) interviews of a 20-person subset. The mapping helped to illustrate the daily routines used to access food and how food provision may contribute to both spaces of risk and care for a cohort of PLHIV who use drugs in Vancouver, BC. Study participants mapped the daily routes used to access food and discussed whether they felt that these routines increased their risk of physical harm. Additionally, study participants noted which food provision spaces provide social and health supports, which may protect against the nutritional and other harms of drug use. This study revealed that having access to space providing stable and reliable sources of food may protect individuals from experiencing certain risks associated with accessing food, including violence in food line-ups, having to enter areas of the city they considered unsafe or 'triggering' and engaging in risky behaviors in order to access food. These "spaces of care" not only provide nutrition but also social support and connections.
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Affiliation(s)
- Christiana Miewald
- Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada.
| | - Eugene McCann
- Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada.
| | - Cristina Temenos
- Geography & Manchester Urban Institute, University of Manchester, 1.036 Arthur Lewis Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Alison McIntosh
- Research Ethics & Compliance Division, 2500 University Drive N.W, Calgary, Alberta, T2N 1N4, Canada.
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Brown EM, Laraia B, Gruneisen K, Jones P, Seligman H. Food insecurity and hunger safety net use among single-room occupancy tenants in San Francisco, CA. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2018. [DOI: 10.1080/19320248.2018.1512932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Erika M. Brown
- Division of Epidemiology, UC Berkeley School of Public Health, University of California, Berkeley, CA, USA
| | - Barbara Laraia
- Department of Public Health Nutrition, UC Berkeley School of Public Health, University of California, Berkeley, CA, USA
| | - Karen Gruneisen
- Episcopal Community Services of San Francisco, ECS Administrative Offices, San Francisco, CA, USA
| | - Paula Jones
- Office of Equity and Quality Improvement, Population Health Division, Department of Public Health, San Francisco, CA, USA
| | - Hilary Seligman
- Departments of Medicine and of Epidemiology and Biostatistics, University of California San Francisco’s Center for Vulnerable Populations, San Francisco, CA, USA
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Dong KR, Tang AM, Stopka TJ, Beckwith CG, Must A. Food acquisition methods and correlates of food insecurity in adults on probation in Rhode Island. PLoS One 2018; 13:e0198598. [PMID: 29883491 PMCID: PMC5993252 DOI: 10.1371/journal.pone.0198598] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 05/22/2018] [Indexed: 11/22/2022] Open
Abstract
Background Individuals under community corrections supervision may be at increased risk for food insecurity because they face challenges similar to other marginalized populations, such as people experiencing housing instability or substance users. The prevalence of food insecurity and its correlates have not been studied in the community corrections population. Methods We conducted a cross-sectional study in 2016, surveying 304 probationers in Rhode Island to estimate the prevalence of food insecurity, identify food acquisition methods, and determine characteristics of groups most at-risk for food insecurity. We used chi-square and Fisher’s exact tests to assess differences in sociodemographics and eating and food acquisition patterns, GIS to examine geospatial differences, and ordinal logistic regression to identify independent correlates across the four levels of food security. Results Nearly three-quarters (70.4%) of the participants experienced food insecurity, with almost half (48.0%) having very low food security. This is substantially higher than the general population within the state of Rhode Island, which reported a prevalence of 12.8% food insecurity with 6.1% very low food security in 2016. Participants with very low food security most often acquired lunch foods from convenience stores (and less likely from grocery stores) compared to the other three levels of food security. Participants did not differ significantly with regards to places for food acquisition related to breakfast or dinner meals based upon food security status. In adjusted models, being homeless (AOR 2.34, 95% CI: 1.31, 4.18) and depressed (AOR 3.12, 95% CI: 1.98, 4.91) were independently associated with a greater odds of being in a food insecure group. Compared to having help with meals none of the time, participants who reported having meal help all of the time (AOR 0.28, 95% CI: 0.12, 0.64), most of the time (AOR 0.31, 95% CI: 0.15, 0.61), and some of the time (AOR 0.54, 95% CI: 0.29, 0.98) had a lower odds of being in a food insecure group. Food insecure participants resided in different neighborhoods than food secure participants. The highest density of food insecure participants resided in census tracts with the lowest median incomes for the general population. The areas of highest density for each level of food security for our participants were in the census tracts with the lowest levels of full-time employment for the general population. Conclusions The prevalence of food insecurity and very low food security were markedly higher in our probation population compared to the general RI population. These findings suggest that access to food on a regular basis is a challenge for adults on probation. Depression and being homeless were independently associated with a greater odds of being in a food insecure group. In addition to intervening directly on food insecurity, developing interventions and policies that address the contributing factors of food insecurity, such as safe housing and treatment for depression, are critical.
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Affiliation(s)
- Kimberly R. Dong
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States of America
- * E-mail:
| | - Alice M. Tang
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States of America
| | - Thomas J. Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States of America
| | - Curt G. Beckwith
- The Miriam Hospital and the Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, RI, United States of America
| | - Aviva Must
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States of America
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18
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The association of household food insecurity with the risk of type 2 diabetes mellitus in adults: a systematic review and meta-analysis. Eur J Nutr 2018. [DOI: 10.1007/s00394-018-1705-2 [doi]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
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'Hello, you're not supposed to be here': homeless emerging adults' experiences negotiating food access. Public Health Nutr 2018; 21:1943-1951. [PMID: 29502547 DOI: 10.1017/s1368980018000356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
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.
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Food Insecurity in Homeless Families in the Paris Region (France): Results from the ENFAMS Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15030420. [PMID: 29495563 PMCID: PMC5876965 DOI: 10.3390/ijerph15030420] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/06/2018] [Accepted: 02/23/2018] [Indexed: 12/14/2022]
Abstract
The number of families living in shelters in the Paris region (France) has increased by a factor of three in 10 years. In 2013, a survey was performed on homeless families in order to characterize their living conditions, their health needs, and the developmental problems in children. This probability survey was conducted in 17 languages among 801 homeless families sheltered in emergency centers for asylum-seekers, emergency housing centers, social rehabilitation centers, and social hotels in the Paris region. Among the 772 families that provided data on food security only 14.0% were with food security, whereas 43.3% were with low food security and 9.8% with very low food security (a situation where children are also affected). Stratified multivariate robust Poisson models showed that some characteristics are associated with a higher risk of food insecurity and/or of falling into very low food security, such as residential instability, single parenthood, having more than three children, depressive symptoms, housing in social hostels, and difficult access to cheap or free food locally. Given the wealth of the Paris region, resources and programs should be concentrated on improving the living situation of this vulnerable population. It needs better detection of these families, a closer social follow-up, and an increase in food aid.
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Kim JE, Flentje A, Tsoh JY, Riley ED. Cigarette Smoking among Women Who Are Homeless or Unstably Housed: Examining the Role of Food Insecurity. J Urban Health 2017; 94:514-524. [PMID: 28589340 PMCID: PMC5533665 DOI: 10.1007/s11524-017-0166-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Smoking prevalence remains high among individuals who are homeless, partly due to stressors related to homelessness. Beyond housing insecurity, homelessness involves financial stresses and unmet subsistence needs. In particular, food insecurity contributes to negative health outcomes and other health risks. This study examined associations between food insecurity severity and smoking among homeless and marginally housed women in San Francisco, California. We used data from 247 women from a longitudinal cohort study. Generalized estimating equations were used to estimate longitudinal associations between study factors and smoking based on data from five biannual assessment points between 2009 and 2012. The longitudinal adjusted odds of smoking were higher among severely food insecure individuals compared to those who were not food insecure (AOR = 1.68, 95% CI [1.02, 2.78]), while associations with other study factors, including demographics, time, HIV status, mental health, and substance use (except marijuana use), did not reach levels of significance. Similar adjusted longitudinal results were observed when food insecurity was the dependent variable and smoking an independent variable, suggesting the possibility of a bidirectional association. Considering unmet needs, such as food and hunger, may improve comprehensive smoking cessation strategies targeting individuals for whom mainstream tobacco control efforts have not been effective. Similarly, offering improved access to smoking cessation resources should be considered in efforts to address food insecurity among individuals experiencing homelessness.
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Affiliation(s)
- Jin E Kim
- University of California San Francisco, San Francisco, CA, USA.
| | - Annesa Flentje
- University of California San Francisco, San Francisco, CA, USA
| | - Janice Y Tsoh
- University of California San Francisco, San Francisco, CA, USA
| | - Elise D Riley
- University of California San Francisco, San Francisco, CA, USA
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