'You run out of hope': an exploration of low-income parents' experiences with food insecurity using Photovoice

The impact of the cost of living crisis and food insecurity on food purchasing behaviours and food preparation practices in people living with obesity

Lower income households are at greater risk of food insecurity and poor diet quality than higher income households. In high-income countries, food insecurity is associated with high levels of obesity, and in the UK specifically, the cost of living crisis (i.e., where the cost of everyday essentials has increased quicker than wages) is likely to have exacerbated existing dietary inequalities. There is currently a lack of understanding of the impact of the current UK cost of living crisis on food purchasing and food preparation practices of people living with obesity (PLWO) and food insecurity, however this knowledge is critical in order to develop effective prevention and treatment approaches to reducing dietary inequalities. Using an online survey (N = 583) of adults residing in England or Scotland with a body mass index (BMI) of ≥30 kg/m2, participants self-reported on food insecurity, diet quality, perceived impact of the cost of living crisis, and their responses to this in terms of food purchasing behaviours and food preparation practices. Regression analyses found that participants adversely impacted by the cost of living crisis reported experiencing food insecurity. Additionally, food insecurity was associated with use of specific purchasing behaviours (i.e., use of budgeting, use of supermarket offers) and food preparation practices (i.e., use of energy-saving appliances, use of resourcefulness). Exploratory analyses indicated that participants adversely impacted by the cost of living crisis and who used budgeting had low diet quality, whereas use of meal planning was associated with high diet quality. These findings highlight the fragility of food budgets and the coping strategies used by PLWO and food insecurity during the cost of living crisis. Policy measures and interventions are urgently needed that address the underlying economic factors contributing to food insecurity, to improve access to and affordability of healthier foods for all.

Living in food insecurity: A qualitative study exploring parents' food parenting practices and their perceptions of the impact of food insecurity on their children's eating

Food insecurity in rich countries is a growing problem with far reaching consequences but how it impacts parents, particularly their food parenting practices, is under researched. Food parenting practices play a critical role in the development of children's eating and may be a mechanism in the link between food insecurity and children's health outcomes; this study aims to illuminate their potential role. Twenty-one parents participated in a qualitative interview study. Their household food security was very low (18/21) or low (3/21). Reflexive Thematic Analysis generated three themes. Challenges of food insecurity: parents shielded children from hunger by eating less themselves, relying on free school meals and turning to family and food banks when in crisis. They perceived a conflict between giving children food of high nutritional quality and its cost. Practical impact of food insecurity: although motivated to provide children with healthy food, finances meant parents struggled to achieve this goal. Parents used a range of food parenting practices but their use of some that are known to be effective may have been compromised by their food insecurity. Emotional impact of food insecurity: parents described feelings of failure, despair, helplessness and shame. Food insecurity adversely effects both children and parents, and non-stigmatising services that mitigate its impact and facilitate children's exposure to food parenting practices known to be effective are needed.

"I'm Doing the Best that I Can": Mothers Lived Experience with Food Insecurity, Coping Strategies, and Mental Health Implications

Background

Food insecurity can have lasting physical and mental health consequences. The experience of food insecurity within a household may disproportionately impact mothers because they tend to manage the household food environment.

Objective

This study sought to understand the stresses faced by United States mothers experiencing food insecurity, related coping mechanisms, and the impacts of these stressors on their mental health.

Methods

Semistructured interviews were conducted in May and June 2022 with a purposive sample of Virginia mothers who reported experiences of food insecurity. Participants were recruited from a related survey and university and community LISTSERVs. Interviews were transcribed and analyzed by trained coders. A thematic analysis was conducted to describe themes that emerged from the data. Virtual interviews were 20-60 min in duration. Mothers with children living in their household, having experienced food insecurity, and living in Virginia were eligible.

Results

The following 3 themes emerged from the interviews with the mothers (n = 15): 1) food insecurity added stress to mothers' lives in multiple ways (e.g. worry about obtaining the "right" foods and internalized or experienced stigma), 2) mothers used positive and negative coping strategies to address the impacts of these stressors (e.g. use of community resources and reduced personal food intake), and 3) the stressors and coping strategies had varying impacts on mothers' mental health (e.g. added to existing mental health challenges or reduced their mental capacity to make changes).

Conclusions

Study findings suggest that a multilevel and tailored approach to address diverse stressors is warranted. Future research should explore emotional coping strategies that comprehensively empower mothers to manage stressors, leverage resources, and reduce social stigma associated with food insecurity and accessing nutrition and mental health assistance. This may improve their household food security and mitigate the burden of stressors on their mental health because system-level solutions to food insecurity are pursued.

"We Want to Eat and be Healthy just like Everybody Else:" How Social Infrastructures Affect Nutrition Equity in a Racialized Urban Community in the United States

Background

Food security and nutrition equity, 2 social determinants of health, are impacted by the coronavirus disease 2019 (COVID-19) pandemic and the racialization of urban communities. Few studies to date have examined how the use of social infrastructures in the United States during COVID-19 affected the ability to achieve food security and nutrition equity.

Objectives

To describe how the use of social infrastructures impacts food security and nutrition equity in a majority Black and urban community in the United States.

Methods

Semistructured in-depth interviews were conducted with 40 low-income, urban, and predominately Black people living in Buffalo, New York in May-July 2022.A thematic analysis using a phronetic iterative approach informed by the Social Ecological Model, Walsh's Family Resilience Framework, and a framework focused on the advancement of nutrition equity.

Results

We identified 9 themes mapped across 3 interrelated domains that impact nutrition equity, including 1) meeting food needs with dignity, 2) supply and demand for fresh and healthy foods, and 3) community empowerment and food sovereignty. We found that people used coping strategies, such as food budgeting and cooking skills, paired with different social infrastructures to meet food needs. People commonly used the Supplemental Nutrition Assistance Program and food pantries to meet food needs over receiving support from family members or friends outside of the household. Poverty, challenges accessing and affording healthy food, and the inability to reciprocate support to others undermined the advancement of nutrition equity despite social infrastructures being available for use. Historical and ongoing acts of disempowerment and disinvestment also hindered the advancement of nutrition equity.

Conclusions

Sustained, community-led investment is needed to address structural inequities preventing the advancement of nutrition equity. Social infrastructures should be expanded to inclusively support low-income populations, so wealth generation is possible to address the root cause of food insecurity.

Food Insecurity and Feeding Experiences Among Parents of Young Children in Australia: An Exploratory Qualitative Study

BACKGROUND

Responsive feeding is a reciprocal process between caregiver and child that is primarily child-led. It is linked to the development of positive eating behaviors and food preferences. There is evidence that household chaos, family dynamics, the quality of mealtime routines, financial hardship, and food insecurity can impact the feeding relationship.

OBJECTIVE

This study explored factors influencing feeding experiences among Australian parents with young children experiencing financial hardship, including household chaos and food insecurity.

DESIGN

This qualitative semi-structured interview study was conducted as a component of a larger research program to design and evaluate a parent program to support responsive feeding practices in Australian families experiencing financial hardship and food insecurity.

PARTICIPANTS/SETTING

Participants were caregivers of a child aged 6 months to 3 years (n = 29), living in Australia, who self-identified as experiencing financial hardship. Interviews were conducted in person and via telephone between August 2021 and January 2022.

ANALYSIS

Transcripts were analyzed using the Framework Method of thematic analysis.

RESULTS

Five key themes were generated: family tensions heightened through hardship, making tradeoffs and sacrifices, the unseen mental load, the inescapable impact of COVID-19, and resiliency and being creative. Despite facing multiple hardships and challenges with feeding the family, parents demonstrated resilience and capabilities through creative food resource management and organizational skills. Parents experienced a high mental load through the cognitive and emotional work of planning, adapting, anticipating, and caring for the family's needs through meals and child feeding.

CONCLUSIONS

Programs to support child feeding need to consider the high mental load families with food insecurity experience and how this can impact parents' capacity. Program content should be contextually sensitive to the experience of food insecurity and consider the constraints inherent in families and communities while building on capabilities and strengths.

Citizen science approaches to crowdsourcing food environment data: A scoping review of the literature

Globally, the adoption and implementation of policies to improve the healthiness of food environments and prevent population weight gain have been inadequate. This is partly because of the complexity associated with monitoring dynamic food environments. Crowdsourcing is a citizen science approach that can increase the extent and nature of food environment data collection by engaging citizens as sensors or volunteered computing experts. There has been no literature synthesis to guide the application of crowdsourcing to food environment monitoring. We systematically conducted a scoping review to address this gap. Forty-two articles met our eligibility criteria. Photovoice techniques were the most employed methodological approaches (n = 25 studies), commonly used to understand overall access to healthy food. A small number of studies made purpose-built apps to collect price or nutritional composition data and were scaled to receive large amounts of data points. Twenty-nine studies crowdsourced food environment data by engaging priority populations (e.g., households receiving low incomes). There is growing potential to develop scalable crowdsourcing platforms to understand food environments through the eyes of everyday people. Such crowdsourced data may improve public and policy engagement with equitable food policy actions.

What qualitative research can tell us about food and nutrition security in the UK and why we should pay attention to what it is telling us

Poor dietary patterns leading to poorer health and increased health care use have affected people living in disadvantaged economic circumstances in the UK for decades, which many fear will be exacerbated due to the UK's current so-called 'cost of living crisis'. The voices of experts by experience of those health and social inequalities are not routinely included in health improvement intervention development in relation to obesity prevention policy and programmes. Obesity is highly correlated with food insecurity experience in high-income country contexts (where food insecurity data are routinely collected) and is similarly socially patterned. Using a health equity lens, this review paper highlights qualitative research findings that have revealed the perspectives and direct experiences of people living with food insecurity, or those others supporting food-insecure households, that shed light on the role and influence of the socio-economic contextual factors food-insecure people live with day-to-day. Insights from qualitative research that have focused on the granular detail of day-to-day household resource management can help us understand not only how food insecurity differentially impacts individual household members, but also how behavioural responses/food coping strategies are playing into pathways that lead to avoidable ill health such as obesity, diabetes and other chronic health conditions, including mental health problems. This review paper concludes by discussing research and policy implications in relation to food-insecure households containing people with chronic health conditions, and for pregnant women and families with infants and very young children living in the UK today.

Food Insecurity and Stress Among Rural Residents in South Carolina: The Moderating Influences of Household Characteristics, Neighborhood Social Environment and Food Environment

Food insecurity is linked with poor physical and mental health outcomes, including anxiety, depression and stress. Rural residents in particular face unique challenges obtaining healthy food; the COVID-19 pandemic exacerbated the relationship between food insecurity and mental health outcomes. This study examines the relationship between food insecurity and stress, and the moderating influence of household characteristics, neighborhood social environment and food environment on this relationship, using a sample of 630 rural South Carolina (SC) residents during COVID-19. Two measures of stress were used in this study: current levels of stress and changes in stress since COVID-19. Results showed a gradient pattern between food insecurity and stress: rural residents with high food insecurity were 6.1 times more likely and those with moderate food insecurity were 3.4 times more likely to report higher level of general stress than those with low food insecurity; rural residents with high food insecurity were 3.3 times more likely and those with moderate food insecurity were 2.0 times more likely to report greater increase in stress after COVID-19 than those with low food insecurity. Neighborhood social environment and food environment provided a buffering effect on the relationship between food insecurity and stress. A stronger social environment after COVID-19 and higher levels of easiness in food access mitigated the negative impacts of food insecurity on stress. Efforts to ameliorate food insecurity should address these broader contextual variables, involving community-level factors.

Experiences of the COVID-19 pandemic among young parents with foster care backgrounds: A participatory action PhotoVoice study

The COVID-19 pandemic has had a disproportionate impact on many vulnerable populations, including youth in foster care and parents of young children. In this study, we worked with nine parenting current and former foster youth to share their experiences of the COVID-19 pandemic through photography. Data were collected between January and March 2021 during a series of three virtual PhotoVoice sessions, then transcripts of PhotoVoice sessions and participant-selected captioned photographs were analyzed using thematic analysis. Themes in participants' photographs included 1) Pandemic Parenting and 2) Making the Best of It. Findings indicate the need to expand mental health services, protect essential workers, and ensure young parents receive support navigating medical and social welfare systems and the process of receiving pandemic relief-related benefits.

Measuring food insecurity: An introduction to tools for human biologists and ecologists

OBJECTIVE

Food insecurity is a significant and growing concern undermining the wellbeing of 30% of the global population. Food in/security is a complex construct consisting of four dimensions: availability, access, utilization, and stability, making it challenging to measure. We provide a toolkit human biologists/ecologists can use to advance research on this topic.

METHODS

We review the strengths and limitations of common tools used to measure food access and utilization, the two dimensions most proximate to people's lived experience, and emphasize tools that provide data needed to best link food security with human biological outcomes. We also discuss methods that provide contextual data human biologists/ecologists will find useful for study design, ensuring instrument validity, and improving data quality.

RESULTS

Food access is principally measured using experience-based instruments that emphasize economic access. Social access, such as food sharing, is under-studied and we recommend using social network analysis to explore this dimension. In terms of utilization, emphasis has been on food choice measured as dietary diversity. Food preparation and intrahousehold distribution, also part of the utilization dimension, are less studied and standardized instruments for measuring both are lacking. The embodiment of food insecurity has focused on child growth, although a growing literature addresses adult mental wellbeing and chronic and infectious disease risk.

CONCLUSIONS

We see the potential to expand outcomes to include reproductive and immune function, physical activity, and the gut microbiome. Human biologists/ecologists are well-positioned to advance understanding of the human health impacts of food insecurity and provide data to support intervention efforts.

Undergraduate nursing and medical students’ perceptions of food security and access to healthy food in Qatar: a photovoice study

The present study explored nursing and medical students’ perceptions of food security, their access to healthy food and the circumstances that affect their access to healthy food in Qatar. The photovoice method was adopted in the present study. Students submitted their photos pertaining to food security and their access to healthy food in Qatar. Afterwards, the students completed an online synchronous semi-structured interview. The interviews were transcribed verbatim and thematically analysed. After the data analysis, a focus group discussion was conducted for member checking. The present study is a collaborative project between two universities in Qatar: The University of Calgary in Qatar (UCQ) and Qatar University (QU). Undergraduate students (seven nursing students and nine medical students) were recruited, asked to collect photos and interviewed. Four themes emerged from the data. First, food retail environments promoted unhealthy eating. Second, fast food under stressful circumstances: a sense of comfort. Third, food as a symbol of culture and socialisation. Finally, the paradox of access to affordable and healthy food in Qatar. Undergraduate students highlighted various circumstances that affect their perceptions of food security and their access to healthy food in Qatar. Future research that aims at understanding the facilitators and barriers to access healthy food at the university campus may help to improve nutrition interventions targeting those students. Future initiatives should focus on leveraging various resources to assist universities in tailoring their food initiatives to suit their students’ local needs.

Food insecurity and ultra-processed food consumption: the modifying role of participation in the Supplemental Nutrition Assistance Program (SNAP)

BACKGROUND

Ultra-processed foods contribute to risks of obesity and cardiometabolic disease, and higher intakes have been observed in low-income populations in the United States. Consumption of ultra-processed foods may be particularly higher among individuals experiencing food insecurity and participating in the Supplemental Nutrition Assistance Program (SNAP).

OBJECTIVES

Using data from the 2007-2016 NHANES, we examined the associations between food insecurity, SNAP participation, and ultra-processed food consumption.

METHODS

The study population comprised 9190 adults, aged 20-65 y, with incomes ≤300% of the federal poverty level (FPL). Food insecurity was assessed using the Household Food Security Survey Module and SNAP participation over the past 12 mo was self-reported. Dietary intake was measured from two 24-h dietary recalls. Ultra-processed food consumption (percentage of total energy intake) was defined using the NOVA food classification system. Linear regression models were used to examine the associations between food insecurity, SNAP participation, and ultra-processed food consumption, adjusting for sociodemographic and health characteristics.

RESULTS

More severe food insecurity was associated with higher intakes of ultra-processed foods (P-trend = 0.003). The adjusted means of ultra-processed food intake ranged from 52.6% for adults with high food security to 55.7% for adults with very low food security. SNAP participation was also associated with higher intakes of ultra-processed foods (adjusted mean: 54.7%), compared with income-eligible participants (adjusted mean: 53.0%). Furthermore, the association between food insecurity and ultra-processed foods was modified by SNAP participation (P-interaction = 0.02). Among income-eligible nonparticipants and income-ineligible nonparticipants, more severe food insecurity was associated with higher consumption of ultra-processed foods. Among SNAP participants, the association between food insecurity and consumption of ultra-processed foods was nonsignificant.

CONCLUSION

In a nationally representative sample of adults, food insecurity and SNAP participation were both associated with higher levels of ultra-processed food consumption.