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Dennard E, Kristjansson E, Tchangalova N, Totton S, Winham D, O’Connor A. Food insecurity among African Americans in the United States: A scoping review. PLoS One 2022; 17:e0274434. [PMID: 36094921 PMCID: PMC9467341 DOI: 10.1371/journal.pone.0274434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
In 2019, the estimated prevalence of food insecurity for Black non-Hispanic households was higher than the national average due to health disparities exacerbated by forms of racial discrimination. During the COVID-19 pandemic, Black households have experienced higher rates of food insecurity when compared to other populations in the United States. The primary objectives of this review were to identify which risk factors have been investigated for an association with food insecurity, describe how food insecurity is measured across studies that have evaluated this outcome among African Americans, and determine which dimensions of food security (food accessibility, availability, and utilization) are captured by risk factors studied by authors. Food insecurity related studies were identified through a search of Google Scholar, PubMed, CINAHL Plus, MEDLINE®, PsycINFO, Health Source: Nursing/Academic Edition, and Web of Science™ (Clarivate), on May 20, 2021. Eligible studies were primary research studies, with a concurrent comparison group, published in English between 1995 and 2021. Ninety-eight relevant studies were included for data charting with 37 unique measurement tools, 115 risk factors, and 93 possible consequences of food insecurity identified. Few studies examined factors linked to racial discrimination, behaviour, or risk factors that mapped to the food availability dimension of food security. Infrequently studied factors, such as lifetime racial discrimination, socioeconomic status (SES), and income insecurity need further investigation while frequently studied factors such as age, education, race/ethnicity, and gender need to be summarized using a systematic review approach so that risk factor impact can be better assessed. Risk factors linked to racial discrimination and food insecurity need to be better understood in order to minimize health disparities among African American adults during the COVID-19 pandemic and beyond.
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Affiliation(s)
- Elizabeth Dennard
- Office of Applied Research and Safety Assessment, Food and Drug Administration, Laurel, Maryland, United States of America
- * E-mail:
| | | | - Nedelina Tchangalova
- STEM Library, University of Maryland, College Park, Maryland, United States of America
| | - Sarah Totton
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - Donna Winham
- Food Science and Human Nutrition, Iowa State University, Ames, Iowa, United States of America
| | - Annette O’Connor
- College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, United States of America
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Duncan AR, Bell SB, Salvatore AL, Hellman CM. Psychosocial factors associated with dispositional hope, agency thinking, and pathways thinking in a homeless adult population. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:3196-3209. [PMID: 35233793 DOI: 10.1002/jcop.22828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 01/25/2022] [Accepted: 02/09/2022] [Indexed: 06/14/2023]
Abstract
Adults facing homelessness often perceive themselves to be at the bottom of society, which has implications for their current and future well-being. Snyder's hope theory, which posits that agency thinking and pathways thinking are necessary for achieving a hopeful outlook on life, may be helpful for understanding drivers of well-being among individuals experiencing homelessness. In this study, we examined dispositional hope, perceived goal attainment, social support, and perceived standing in society among 123 adults experiencing homelessness who were attending a support group at a daytime drop-in center in the United States. Participants completed self-report measures related to the aforementioned variables of interest. We discovered that higher levels of self-reported goal attainment, independent of the type of goal identified, were significantly associated with total hope and both its subscales, that social support was significantly associated with total hope and pathways thinking, and that perceived standing in society was significantly associated with total hope and agency thinking.
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Affiliation(s)
- Ashten R Duncan
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Alicia L Salvatore
- Institute for Research on Equity and Community Health, Wilmington, Delaware, USA
- Department of Human Development and Family Sciences, Newark, Delaware, USA
| | - Chan M Hellman
- Anne & Henry Zarrow School of Social Work, University of Oklahoma-Tulsa, Tulsa, Oklahoma, USA
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Tucker JS, Davis JP, Perez LG, Klein DJ, D’Amico EJ. Late Adolescent Predictors of Homelessness and Food Insecurity During Emerging Adulthood. J Adolesc Health 2022; 70:736-742. [PMID: 34903427 PMCID: PMC9038616 DOI: 10.1016/j.jadohealth.2021.10.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/06/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Economic instability is a significant and growing problem among emerging adults in the U.S. This study identifies adolescent factors across multiple levels of influence that predict homelessness and food insecurity 5 years later. METHODS The analytic sample (n = 2,110) completed a survey in 2015-2016 (mean age 17) that assessed a range of demographic, behavioral health, family, peer, academic, and neighborhood factors, and a follow-up survey in 2019-2020 (mean age 23) that assessed past-year homelessness and food insecurity. Logistic regression analyses were conducted for the full sample, and by race/ethnicity. RESULTS At follow-up, 7.5% of participants reported homelessness, and 29.3% reported food insecurity. Multivariate analyses indicated that only adverse childhood experiences and weaker academic orientation predicted both outcomes. Future homelessness was additionally predicted by greater exposure to substance using peers during adolescence. Identifying as Hispanic, lower maternal education, and greater neighborhood disorganization were risk factors for future food insecurity, and living with both biological parents and better mental health were protective factors. Race/ethnicity stratified models showed variations in multilevel predictors of both outcomes, except for adverse childhood experiences, which were significant across all subgroups. CONCLUSIONS Adverse childhood experiences and weaker academic orientation emerged as the most robust predictors of economic instability in emerging adulthood. However, a range of other modifiable multilevel predictors in adolescence were identified that were unique to homelessness or food insecurity and that varied by race/ethnicity. Results suggest the need for multilevel approaches early in life to reduce risk of economic instability during emerging adulthood.
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Affiliation(s)
| | - Jordan P. Davis
- Suzanne Dworak-Peck School of Social Work, USC Center for Artificial Intelligence in Society, USC Center for Mindfulness Science, USC Institute for Addiction Science, University of Southern California
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Food insecurity among homeless and precariously housed children in the United States: Lessons from the past. DEMOGRAPHIC RESEARCH 2021. [DOI: 10.4054/demres.2021.45.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Grammatikopoulou MG, Gkiouras K, Pepa A, Persynaki A, Taousani E, Milapidou M, Smyrnakis E, Goulis DG. Health status of women affected by homelessness: A cluster of in concreto human rights violations and a time for action. Maturitas 2021; 154:31-45. [PMID: 34736578 DOI: 10.1016/j.maturitas.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/10/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
Health problems of women experiencing homelessness are driven either from the usual background characteristics of this population, or from the homeless lifestyle. Apart from poverty and unemployment, transition to homelessness is often associated with substance abuse, history of victimization, stress, poor mental health and human immunodeficiency virus (HIV). Water insecurity can undermine bodily hygiene and dental health, posing a greater risk of dehydration and opportunistic infections. Exposure to extreme environmental conditions like heat waves and natural disasters increases morbidity, accelerates aging, and reduces life expectancy. Nutrition-wise, a high prevalence of food insecurity, obesity, and micronutrient deficiencies are apparent due to low diet quality and food waste. Poor hygiene, violence, and overcrowding increase the susceptibility of these women to communicable diseases, including sexually transmitted ones and COVID-19. Furthermore, established cardiovascular disease and diabetes mellitus are often either undertreated or neglected, and their complications are more widespread than in the general population. In addition, lack of medical screening and contraception non-use induce a variety of reproductive health issues. All these health conditions are tightly related to violations of human rights in this population, including the rights to housing, water, food, reproduction, health, work, and no discrimination. Thus, the care provided to women experiencing homelessness should be optimized at a multidimensional level, spanning beyond the provision of a warm bed, to include access to clean water and sanitation, psychological support and stress-coping strategies, disease management and acute health care, food of adequate quality, opportunities for employment and support for any minor dependants.
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Affiliation(s)
- Maria G Grammatikopoulou
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, Alexander Campus, International Hellenic University, Thessaloniki, Greece
| | - Konstantinos Gkiouras
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aleks Pepa
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Greece
| | | | - Eleftheria Taousani
- Department of Midwifery, Faculty of Health Sciences, International Hellenic University, Alexander Campus, Thessaloniki, Greece
| | - Maria Milapidou
- Dr. Juris, Post Doc Researcher, Faculty of Law, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Redline B, Semborski S, Madden DR, Rhoades H, Henwood BF. Examining Sleep Disturbance Among Sheltered and Unsheltered Transition Age Youth Experiencing Homelessness. Med Care 2021; 59:S182-S186. [PMID: 33710093 PMCID: PMC7958980 DOI: 10.1097/mlr.0000000000001410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The estimated 3.5-million transition age youth (TAY) who experience homelessness in the United States annually are routinely exposed to inadequate sleep environments and other psychosocial risk factors for deficient sleep. Although staying in a shelter versus being unsheltered may facilitate sleep, research suggests that perceived safety wherever one sleeps may be just as important. In this study, which is the first known study to investigate sleep disturbances among TAY experiencing homelessness, we examine associations of sleep disturbances with sheltered status and perceived safety of usual sleep environment. METHODS We surveyed TAY (aged 18-25) experiencing homelessness in Los Angeles, CA about their sleep, psychosocial health, and living situations. Participants (n=103; 60% sheltered) self-reported sleep disturbances using the Patient-Reported Outcomes Measurement Information System Sleep Disturbance short form, while individual items assessed sheltered status and perceived safety where they usually slept. Regression analyses examined associations of sheltered status and perceived sleep environment safety with sleep disturbance, adjusting for age, sex, race, self-rated health, depression symptoms, serious mental illness, high-risk drinking, and severe food insecurity. RESULTS Twenty-six percent of participants reported moderate-severe sleep disturbances. Sleep disturbance was not associated with sheltered status, but was positively associated with feeling unsafe in one's sleep environment, depression symptoms, severe food insecurity, and decreased age. CONCLUSIONS Our findings suggest that sleep disturbances among TAY experiencing homelessness are associated more closely with how safe one feels rather than one's sheltered status. This highlights the importance of providing safe places to live for sheltered and unsheltered TAY.
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Affiliation(s)
- Brian Redline
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Sara Semborski
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Danielle R. Madden
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Harmony Rhoades
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Benjamin F. Henwood
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California
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Risk and Protective Factors Associated with Adolescent Food Insecurity in Baltimore. J Urban Health 2021; 98:296-307. [PMID: 33094426 PMCID: PMC8079556 DOI: 10.1007/s11524-020-00488-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
While emerging evidence is highlighting a growing problem of food insecurity among adolescents in disadvantaged neighborhoods, very little is known about the factors that may either protect or place adolescents at higher risk for food insecurity. The primary objective for this analysis, therefore, was to examine the associations between individual-, family-, and neighborhood-level risks and protective factors and food insecurity among 452 adolescents in Baltimore, Maryland. Results show that nearly 30% of our sample were food insecure (29.4%). Food insecure youth were more likely to be unstably housed (OR 5.17, 1.24-21.62), live in larger households (OR 1.14, 1.08-1.20), and perceive their neighborhoods unsafe (OR 2.37, 1.47-3.83). Protective factors included perceiving both male and female adult support (OR 0.55 and 0.47, respectively), having a higher sense of community belonging (OR 0.91, 0.32-0.95) and having positive perceptions of their neighborhood's physical environment (OR 0.93, 0.88-0.98). These results suggest that strengthening family and neighborhood relations and resources may promote the health of adolescents in disadvantaged urban areas.
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Food insecurity among formerly homeless youth in supportive housing: A social-ecological analysis of a structural intervention. Soc Sci Med 2019; 245:112724. [PMID: 31838336 DOI: 10.1016/j.socscimed.2019.112724] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 01/02/2023]
Abstract
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.
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Gultekin LE, Brush BL, Ginier E, Cordom A, Dowdell EB. Health Risks and Outcomes of Homelessness in School-Age Children and Youth: A Scoping Review of the Literature. J Sch Nurs 2019; 36:10-18. [PMID: 31522583 DOI: 10.1177/1059840519875182] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Despite reports that over 1.3 million school-age children (ages 5-18) were homeless in 2019, little is known about the effects of homelessness on their overall health and well-being. To better understand where gaps exist, a scoping review of the literature was conducted to identify studies of the physical, mental, and behavioral health risks and outcomes of school-age children experiencing homelessness or housing instability. Following the Joanna Briggs Institute framework and Preferred Reporting Items (PRISMA) guidelines, seven electronic databases were searched using key words: homelessness, children, health, and well-being. Of the 4,372 records, 23 articles met inclusion criteria. Most examined mental health and high-risk activities or behavioral risks related to school achievement. Few studies tracked the long-term health outcomes of homeless school-age children. Findings have implications for school nurses who have contact with children experiencing homelessness and are in position to intervene to prevent negative health sequelae in this vulnerable population.
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Affiliation(s)
| | - Barbara L Brush
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Emily Ginier
- The Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, USA
| | - Alexandra Cordom
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
| | - Elizabeth B Dowdell
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
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Abstract
OBJECTIVE To increase our understanding about food insecurity among urban adolescents, we conducted a qualitative study in Baltimore City with adolescents to: (i) explore how adolescents experience and cope with food insecurity; and (ii) identify community-based approaches or interventions for addressing food insecurity. DESIGN A total of eight focus groups were conducted across six neighbourhoods. To gather sociodemographic characteristics and personal data on food insecurity, all consented adolescents completed a brief questionnaire. SETTING Six purposively selected neighbourhoods in Baltimore City, USA. PARTICIPANTS A total of fifty-three adolescents between the ages of 14 and 19 years participated in the study. RESULTS Although half of our sample was classified as food insecure, everyone in the focus groups was aware of adolescents who engaged in risky behaviours to get money for food. Among girls, prostituting was the most commonly mentioned behaviour, whereas for boys, it was selling drugs or stealing to get money for food. Adolescents also described tremendous stigma associated with food insecurity and agreed that food insecurity has to be viewed within a broader set of economic challenges. CONCLUSIONS Addressing food insecurity among adolescents in disadvantaged neighbourhoods should be a high priority for policy makers and practitioners. Current feeding programmes are not addressing the needs of adolescents; as a result, adolescents are at risk for a variety of harmful behaviours and outcomes, with long-term negative health and social consequences.
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Yarcusko E, Slesnick N, Hatsu I. Food Sources for Homeless Youth: An Evaluation of Food Availability at a Homeless Youth Drop-In Center. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:91-95. [PMID: 30279070 DOI: 10.1016/j.jneb.2018.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 08/03/2018] [Accepted: 08/15/2018] [Indexed: 06/08/2023]
Abstract
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.
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Affiliation(s)
- Emily Yarcusko
- Human Nutrition, Department of Human Sciences, The Ohio State University, Columbus, OH
| | - Natasha Slesnick
- Human Development and Family Science, Department of Human Sciences, The Ohio State University, Columbus, OH
| | - Irene Hatsu
- Human Nutrition, Department of Human Sciences, The Ohio State University, Columbus, OH.
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Aceves-Martins M, Cruickshank M, Fraser C, Brazzelli M. Child food insecurity in the UK: a rapid review. PUBLIC HEALTH RESEARCH 2018. [DOI: 10.3310/phr06130] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundFood insecurity (FI) is a multifaceted, socioeconomic problem involving difficulties accessing sufficient, safe and nutritious food to meet people’s dietary requirements and preferences for a healthy life. For children experiencing FI, there are some potentially negative developmental consequences and it is, therefore, important to understand the links between FI and children’s health and well-being as well as any strategies undertaken to address FI. The overall objective of this assessment was to determine the nature, extent and consequences of FI affecting children (aged ≤ 18 years) in the UK.ObjectiveTo determine the nature, extent and consequences of FI affecting children (aged ≤ 18 years) in the UK.Data sourcesThe databases searched on 4 December 2017 included MEDLINE (including In-Process & Other Non-Indexed Citations and E-pub ahead of print files), EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Commonwealth Agricultural Bureaux (CAB) abstracts, The Cochrane Library, Education Resources Information Centre (ERIC), PsycINFO, the Social Science Citation Index and the Applied Social Sciences Index and Abstracts (ASSIA).MethodsA rapid review of the current published and unpublished literature was conducted, including all study designs from specified high-income countries in children aged ≤ 18 years. Searches were conducted of major health-care, nutrition, education and social science databases from 1995 onwards, and websites of relevant UK and international organisations. Final searches were undertaken in December 2017.ResultsIn total, 109 studies were selected. Only five studies were conducted in the UK, four of which provided qualitative data. Possible factors associated with child FI were identified, for example socioeconomic status, material deprivation, living in public housing and having unemployed or poorly educated parents. Children’s health, well-being and academic outcomes were all negatively affected by FI. The mediating effects of family stressors and parenting practices in the relationship between FI and children’s health and well-being outcomes were not clear. Food assistance programmes were generally effective in mitigating FI and improving nutritional outcomes (including hunger) in the short term, but did not eradicate FI, eliminate its effects on children’s health or have an impact on academic outcomes. No reports assessing the prevalence of child FI in the UK or the cost-effectiveness and sustainability of interventions to tackle FI were identified.LimitationsThere was a lack of consistency in how FI was defined and measured across studies. Most of the studies used indirect measurements of child FI through parental reports. The majority of studies were conducted in North America. Only five studies were conducted in the UK. Thirty potentially relevant studies were not included in the review as a result of time and resource constraints. Most studies were observational and caution is advised in interpreting their results.ConclusionsA number of factors that were related to child FI were identified, as were negative associations between child FI and physical, mental and social outcomes. However, these findings should be interpreted with caution because of the correlational nature of the analyses and the fact that it is difficult to determine if some factors are predictors or consequences of FI.Future researchThere is an urgent requirement for the development of a reliable instrument to measure and monitor child FI in the UK and for well-designed interventions or programmes to tackle child FI.Study registrationThis study is registered as PROSPERO CRD42017084818.FundingThe National Institute for Health Research Public Health Research programme. The Health Services Research Unit is core-funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.
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Affiliation(s)
| | | | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Miriam Brazzelli
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Hatsu I, Gunther C, Hade E, Vandergriff S, Slesnick N, Williams R, Bruno RS, Kennel J. Unaccompanied homeless youth have extremely poor diet quality and nutritional status. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2018; 24:319-332. [PMID: 31485095 PMCID: PMC6724733 DOI: 10.1080/02673843.2018.1538885] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
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.
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Affiliation(s)
- Irene Hatsu
- Human Nutrition Program, Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Carolyn Gunther
- Human Nutrition Program, Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Erinn Hade
- Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Stephanie Vandergriff
- Human Nutrition Program, Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Natasha Slesnick
- Human Development and Family Science Program, Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Rachel Williams
- Human Nutrition Program, Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Richard S Bruno
- Human Nutrition Program, Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Julie Kennel
- Human Nutrition Program, Department of Human Sciences, The Ohio State University, Columbus, OH, USA
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Food insufficiency is associated with depression among street-involved youth in a Canadian setting. Public Health Nutr 2018; 22:115-121. [PMID: 30305193 DOI: 10.1017/s1368980018002574] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
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.
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Abstract
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.
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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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Klineberg E, Vatiliotis V, Kang M, Medlow S, Sullivan L, Cummings M, Pringle G, Steinbeck K. Health status of marginalised young people in unstable accommodation. J Paediatr Child Health 2017; 53:995-999. [PMID: 28600859 DOI: 10.1111/jpc.13590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 02/27/2017] [Accepted: 03/14/2017] [Indexed: 11/29/2022]
Abstract
AIM More than 26 000 Australians aged 12-24 years experience homelessness, yet data on the health status of homeless youth remain limited. The aim of this study was to describe the health of young people attending a youth health service in Western Sydney who were experiencing homelessness. METHODS Retrospective case note review for clients aged 12-25 years attending Youth Health Services in Western Sydney. Extracted data included: homelessness status; demographics; physical health issues; mental health issues; involvement with juvenile justice; and disengagement from education or employment. RESULTS Just under half of the 180 clients attending a Youth Health Service in Western Sydney were homeless, and an additional 15 young people who were not currently homeless nominated homelessness as a presenting issue. In comparison with currently domiciled young people, homeless youth were less likely to have a regular general practitioner and more likely to nominate a physical health concern as a presenting issue, although there was no difference between groups in terms of diagnosed mental or physical health conditions. Considered as a whole, the sample showed high rates of acute physical symptoms, physical trauma, psychological distress and self-harm. CONCLUSIONS Youth homelessness is associated with risk of both poor physical and mental health. As much of youth homelessness is hidden, health-care providers need to ensure that they inquire about homelessness status, and have an awareness of potentially complex multi-morbidities in the physical and mental health of young marginalised people presenting to health services.
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Affiliation(s)
- Emily Klineberg
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.,Academic Department of Adolescent Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Veronica Vatiliotis
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.,Academic Department of Adolescent Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Melissa Kang
- Department of General Practice, University of Sydney, Sydney, New South Wales, Australia.,Youth Health Services, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Sharon Medlow
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.,Academic Department of Adolescent Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Lucinda Sullivan
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.,Academic Department of Adolescent Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Michael Cummings
- Youth Health Services, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Graeme Pringle
- Youth Health Services, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Katharine Steinbeck
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.,Academic Department of Adolescent Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
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18
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Dombrowski K, Sittner K, Crawford D, Welch-Lazoritz M, Habecker P, Khan B. Network Approaches to Substance Use and HIV/Hepatitis C Risk among Homeless Youth and Adult Women in the United States: A Review. Health (London) 2016; 8:1143-1165. [PMID: 28042394 PMCID: PMC5193114 DOI: 10.4236/health.2016.812119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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Affiliation(s)
- Kirk Dombrowski
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, USA
| | - Kelley Sittner
- Department of Sociology, Oklahoma State University, Stillwater, USA
| | | | | | - Patrick Habecker
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, USA
| | - Bilal Khan
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, USA
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Hsieh E. Voices of the Homeless: An Emic Approach to the Experiences of Health Disparities Faced by People Who Are Homeless. SOCIAL WORK IN PUBLIC HEALTH 2016; 31:328-340. [PMID: 27093127 DOI: 10.1080/19371918.2015.1137512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
People who are homeless are particularly vulnerable to health disparities. Rather than using population statistics to highlight the prevalence or severity of the suffering of people who are homeless, 28 undergraduate students each conducted an in-depth interview with an individual who relied on a local homeless shelter to cope with everyday life. The interview explored the participants' health concerns and strategies for health management. Due to equipment failure and incomplete recording, only 16 interviews are included in this study. The author adopted thematic analysis while focused on preserving the richness of the interactions between the participants who are homeless and the undergraduate students. The author's goal is to provide emic, intimate insights about the struggles and challenges faced by the people who are homeless. The author concluded the study by situating the findings in the larger literature of health disparities experienced by people who are homeless.
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Affiliation(s)
- Elaine Hsieh
- a Department of Communication , University of Oklahoma , Norman , Oklahoma, USA
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20
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Poole-Di Salvo E, Silver EJ, Stein REK. Household Food Insecurity and Mental Health Problems Among Adolescents: What Do Parents Report? Acad Pediatr 2016; 16:90-6. [PMID: 26530851 DOI: 10.1016/j.acap.2015.08.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 08/04/2015] [Accepted: 08/15/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate whether adolescents living in households with food insecurity have poorer parent-reported mental health (MH) than peers. METHODS We analyzed cross-sectional data from ∼8600 adolescents who participated in the 2007 (8th grade) wave of the Early Childhood Longitudinal Study-Kindergarten. Household food insecurity (HFI) was assessed by parental report on the 18-item US Household Food Security Scale. Total Difficulties score >13 on the parent-reported Strengths and Difficulties Questionnaire (SDQ) indicated problems with adolescent MH. SDQ subscale scores (Emotional, Conduct, Hyperactivity, Peer Problems) were also calculated. Associations between HFI and MH were explored in bivariate and multivariable analyses. Interactions of HFI and gender and HFI and receipt of free/reduced-price school lunch were analyzed with regard to problems with MH. RESULTS A total of 10.2% of adolescents lived with HFI; 11.2% had SDQ >13. Adolescents with HFI had higher rates of overall MH problems (28.7% vs 9.2%), emotional problems (21.6% vs 6.6%), conduct problems (26.5% vs 11.6%), hyperactivity (22.4% vs 11.3%), and peer problems (19.8% vs 8.6%) (all P < .01). After adjustment for confounders, the association between HFI and overall MH problems (odds ratio 2.3; 95% confidence interval 1.6-3.3) remained. Interactions of HFI and gender and HFI and free/reduced-price school lunch were not significant. CONCLUSIONS HFI was associated with increased risk of parent-reported MH problems among both male and female adolescents. Free/reduced-price school lunch did not significantly alter this relationship. Effective interventions to promote MH and reduce HFI among adolescents are necessary.
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Affiliation(s)
- Elizabeth Poole-Di Salvo
- Department of Pediatrics, Weill Cornell Medical College, Division of Child Development, New York, NY.
| | - Ellen J Silver
- Department of Pediatrics, Albert Einstein College of Medicine, Division of General Pediatrics, Bronx, NY; The Children's Hospital at Montefiore, Division of General Pediatrics, Bronx, NY
| | - Ruth E K Stein
- Department of Pediatrics, Albert Einstein College of Medicine, Division of General Pediatrics, Bronx, NY; The Children's Hospital at Montefiore, Division of General Pediatrics, Bronx, NY
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Bowen EA, Murshid NS. Trauma-Informed Social Policy: A Conceptual Framework for Policy Analysis and Advocacy. Am J Public Health 2015; 106:223-9. [PMID: 26691122 DOI: 10.2105/ajph.2015.302970] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Trauma-informed care is a service provision model used across a range of practice settings. Drawing on an extensive body of research on trauma (broadly defined as experiences that produce enduring emotional pain and distress) and health outcomes, we have argued that the principles of trauma-informed care can be extended to social policy. Citing a variety of health-related policy examples, we have described how policy can better reflect 6 core principles of trauma-informed care: safety, trustworthiness and transparency, collaboration, empowerment, choice, and intersectionality. This framework conveys a politicized understanding of trauma, reflecting the reality that trauma and its effects are not equally distributed, and offers a pathway for public health professionals to disrupt trauma-driven health disparities through policy action.
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Affiliation(s)
- Elizabeth A Bowen
- Elizabeth A. Bowen and Nadine Shaanta Murshid are with the School of Social Work, University at Buffalo, State University of New York
| | - Nadine Shaanta Murshid
- Elizabeth A. Bowen and Nadine Shaanta Murshid are with the School of Social Work, University at Buffalo, State University of New York
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22
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Characteristics of Mothers Caring for Children During Episodes of Homelessness. Community Ment Health J 2015; 51:913-20. [PMID: 25536936 PMCID: PMC4722539 DOI: 10.1007/s10597-014-9794-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 12/06/2014] [Indexed: 10/24/2022]
Abstract
This study provides a description of the physical, psychological, and substance use problems of adult homeless women who are and are not caring for children. We also examined differences in the characteristics of these two groups of women. Interviews were conducted with 148 homeless women from three mid-sized U.S. cities, 24.3 % of whom were caring for at least one child. Our results showed that women caring for children were more likely to be sheltered and have health insurance. Homeless women caring for children and solitary homeless women were generally similar in terms of substance abuse problems. However, rates of Borderline Personality Disorder were higher among women caring for children than among solitary homeless women. Our results are somewhat consistent with previous research, with the exception of substance abuse problems and mental health problems, which were shown to be equally problematic for all women, regardless of current caregiving status.
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23
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Prevalence and covariates of food insecurity among residents of single-room occupancy housing in Chicago, IL, USA. Public Health Nutr 2015; 19:1122-30. [DOI: 10.1017/s1368980015002384] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveEmerging evidence suggests that food insecurity is a significant public health concern among people who are homeless or marginally housed. The present study assessed prevalence of food insecurity and its covariates among a group of marginally housed individuals living in single-room occupancy (SRO) dwellings, a population for which there is little extant health or nutrition research.DesignCross-sectional survey incorporating the Household Food Insecurity Access Scale.SettingTen private SRO residences in the Uptown neighbourhood of Chicago, IL, USA, 2013.SubjectsSRO residents over 18 years of age who were able to communicate verbally in English (n153).ResultsFood insecurity was widespread among SRO residents, with 75 % of the sample considered food insecure and 52 % meeting criteria for severe food insecurity. Bivariate analyses indicated that female gender, eating most meals at a soup kitchen, having a mental health condition, problem drinking, having at least one chronic health condition, and diabetes were all significantly associated with food insecurity. In the multivariate ordered logistic regression model, eating most meals at a soup kitchen remained as the only significant correlate of food insecurity (OR=10·13).ConclusionsSRO residents and other marginally housed populations face unique food access challenges. Although targeted assistance in the form of food stamps and congregate meal programmes remains critical, efforts to prevent and address food insecurity among homeless and marginally housed individuals should include policy interventions that recognize poverty as the root cause of food insecurity and aim to increase overall income and improve housing conditions.
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24
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Crawford B, Yamazaki R, Franke E, Amanatidis S, Ravulo J, Torvaldsen S. Is something better than nothing? Food insecurity and eating patterns of young people experiencing homelessness. Aust N Z J Public Health 2015; 39:350-4. [PMID: 25902911 DOI: 10.1111/1753-6405.12371] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/01/2014] [Accepted: 01/01/2015] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Belinda Crawford
- NSW Public Health Officer Training Program, NSW Ministry of Health, New South Wales.,School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales
| | - Rowena Yamazaki
- Community Health Service, Sydney Local Health District, New South Wales
| | - Elise Franke
- Youth Health Service, South Western Sydney Local Health District, New South Wales
| | - Sue Amanatidis
- Community Health Service, Sydney Local Health District, New South Wales
| | - Jioji Ravulo
- School of Social Sciences and Psychology, University of Western Sydney, New South Wales
| | - Siranda Torvaldsen
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales
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25
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Crawford B, Yamazaki R, Franke E, Amanatidis S, Ravulo J, Steinbeck K, Ritchie J, Torvaldsen S. Sustaining dignity? food insecurity in homeless young people in urban Australia. Health Promot J Austr 2014; 25:71-8. [PMID: 25131381 DOI: 10.1071/he13090] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 05/14/2014] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Belinda Crawford
- NSW Public Health Officer Training Program, NSW Ministry of Health, Locked Bag 961, North Sydney, NSW 2059, Australia
| | - Rowena Yamazaki
- Community Health Service, Sydney Local Health District, Level 9, KGV Building, Missenden Road, Camperdown, NSW 2050, Australia
| | - Elise Franke
- Youth Health Service, South Western Sydney Local Health District, 53-56 Mitchell Street, Carramar, NSW 2163, Australia
| | - Sue Amanatidis
- Community Health Service, Sydney Local Health District, Level 9, KGV Building, Missenden Road, Camperdown, NSW 2050, Australia
| | - Jioji Ravulo
- School of Social Sciences and Psychology, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Kate Steinbeck
- Discipline of Paediatrics and Child Health, The University of Sydney, NSW 2006, Australia
| | - Jan Ritchie
- School of Public Health and Community Medicine, University of New South Wales, Level 3 Samuels Building, UNSW Australia, NSW 2052, Australia
| | - Siranda Torvaldsen
- School of Public Health and Community Medicine, University of New South Wales, Level 3 Samuels Building, UNSW Australia, NSW 2052, Australia
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26
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Dang MT. Social connectedness and self-esteem: predictors of resilience in mental health among maltreated homeless youth. Issues Ment Health Nurs 2014; 35:212-9. [PMID: 24597587 DOI: 10.3109/01612840.2013.860647] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this cross-sectional study was to explore social connectedness and self-esteem as predictors of resilience among homeless youth with histories of maltreatment. Connectedness variables included family connectedness, school connectedness, and affiliation with prosocial peers. The sample included 150 homeless youth aged 14 to 21 (mean age = 18 years) with the majority being an ethnic minority. Participants completed surveys using audio-CASI. Results revealed that youth with higher levels of social connectedness and self-esteem reported lower levels of psychological distress. When all predictor variables were controlled in the analysis, self-esteem remained significant for predicting better mental health.
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Affiliation(s)
- Michelle T Dang
- California State University-Sacramento, School of Nursing , Sacramento, California , USA
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27
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Tsai J, Rosenheck RA. Obesity among chronically homeless adults: is it a problem? Public Health Rep 2013; 128:29-36. [PMID: 23277657 DOI: 10.1177/003335491312800105] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We examined rates of obesity and associated characteristics in the chronically homeless population to explore how a range of factors, including sociodemographics, housing, food source, physical and mental health, and health service use, were related to being overweight or obese. METHODS We conducted multivariate regression analyses on a community sample of 436 chronically homeless adults across 11 U.S. cities to examine the prevalence of obesity. RESULTS The majority (57%) of chronically homeless adults were overweight or obese. Chronically homeless adults who were female or Hispanic appeared to be at particular risk for obesity. There were few differences on physical and mental health by weight group. Although overweight and obese chronically homeless adults were more likely to discuss exercise with a health-care provider, they reported engaging in less exercise than those who were underweight or normal weight. CONCLUSION These findings underscore the need for greater attention to obesity in chronically homeless adults and demonstrate a food insecurity-obesity paradox or poverty-obesity link.
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Affiliation(s)
- Jack Tsai
- Yale School of Medicine, New Haven, CT 06516, USA.
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The assessment of food security in homeless individuals: a comparison of the Food Security Survey Module and the Household Food Insecurity Access Scale. Public Health Nutr 2011; 14:2254-9. [PMID: 21740619 DOI: 10.1017/s1368980011001327] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
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.
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Sorsdahl K, Slopen N, Siefert K, Seedat S, Stein DJ, Williams DR. Household food insufficiency and mental health in South Africa. J Epidemiol Community Health 2011; 65:426-31. [PMID: 20427548 PMCID: PMC3195371 DOI: 10.1136/jech.2009.091462] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Both mental illness and food insufficiency are common in low and middle income countries. However, there are limited data on the relation between food insufficiency and mental disorders, despite the potential relevance of such data for the development of policy-level interventions. The relationship between food insufficiency and mental disorders within a nationally representative sample of South African adults was examined. METHODS A national survey of 4185 South African adults was conducted using the WHO Composite International Diagnostic Interview to generate psychiatric diagnoses. The survey included a widely used single-item measure of household food insufficiency. The independent effects of food insufficiency and demographic characteristics on 12-month and lifetime DSM-IV diagnosis were assessed using logistic regression. RESULTS 29% of respondents reported that their household 'sometimes' did not have enough to eat while 9% reported that they 'often' did not have enough to eat. After controlling for conventional socioeconomic and sociodemographic variables, food insufficiency was associated with having any 12-month (OR 1.44, 95% CI 1.1 to 1.9) and lifetime (OR 1.35, 95% CI 1.1 to 1.7) DSM-IV disorder. CONCLUSIONS In South Africa the prevalence of household food insufficiency is very high compared with studies conducted in the developed world, and is independently associated with having a 12-month and lifetime DSM-IV diagnosis. The relationship between food insufficiency and mental health has implications for reducing the burden of common mental disorders in South Africa since, unlike a number of major risk factors for mental illness, food insufficiency may be relatively amenable to intervention.
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Affiliation(s)
- Katherine Sorsdahl
- J-Block Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa.
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30
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Crawford DM, Trotter EC, Hartshorn KJS, Whitbeck LB. Pregnancy and mental health of young homeless women. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2011; 81:173-83. [PMID: 21486259 PMCID: PMC3383651 DOI: 10.1111/j.1939-0025.2011.01086.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Pregnancy rates among young women who are homeless are significantly higher than rates among housed young women in the United States (J. M. Greene & C. L. Ringwalt, 1998). Yet, little research has addressed mental health or risk and resilience among young mothers who are homeless. Based on a sample from the Midwest Longitudinal Study of Homeless Adolescents, this study explores pregnancy and motherhood in unaccompanied homeless young women over a period of 3 years. The data are supplemented by in-depth interviews with a subset of young women. Results show that almost half (46.4%) of sexually active young women who are homeless (n=222, M age = 17.2) had been pregnant at baseline. Among those who stated they had children between Waves 2 and 13 (n=90), only half reported caring for their children consistently over time, and one fifth reported never seeing their children. Of the participants with children in their care at the last interview (Wave 13), almost one third met criteria for lifetime major depressive episode, lifetime posttraumatic stress disorder, and lifetime drug abuse, and half met criteria for lifetime antisocial personality disorder. Twelve-month diagnoses are also reported. The impacts of homelessness on maternal and child outcomes are discussed.
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Affiliation(s)
- Devan M. Crawford
- Department of Sociology, University of Nebraska-Lincoln, 206 Benton Hall, Lincoln NE 68588-0623, (402) 472-2243,
| | - Emily C. Trotter
- Department of Sociology, University of Nebraska-Lincoln, 209 Benton Hall, Lincoln NE 68588-0623, (402) 472-3632,
| | - Kelley J. Sittner Hartshorn
- Department of Sociology, University of Nebraska-Lincoln, 209 Benton Hall, Lincoln NE 68588-0623, (402) 472-3632,
| | - Les B. Whitbeck
- Department of Sociology, University of Nebraska-Lincoln, 739 Oldfather Hall, Lincoln, NE 68588-0324, (402) 472-5562,
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31
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Weiser SD, Bangsberg DR, Kegeles S, Ragland K, Kushel MB, Frongillo EA. Food insecurity among homeless and marginally housed individuals living with HIV/AIDS in San Francisco. AIDS Behav 2009; 13:841-8. [PMID: 19644748 PMCID: PMC2758196 DOI: 10.1007/s10461-009-9597-z] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Accepted: 07/12/2009] [Indexed: 11/30/2022]
Abstract
Food insecurity is a risk factor for both HIV transmission and worse HIV clinical outcomes. We examined the prevalence of and factors associated with food insecurity among homeless and marginally housed HIV-infected individuals in San Francisco recruited from the Research on Access to Care in the Homeless Cohort. We used multiple logistic regression to determine socio-demographic and behavioral factors associated with food insecurity, which was measured using the Household Food Insecurity Access Scale. Among 250 participants, over half (53.6%) were food insecure. Higher odds of food insecurity was associated with being white, low CD4 counts, recent crack use, lack of health insurance, and worse physical and mental health. Food insecurity is highly prevalent among HIV-infected marginally housed individuals in San Francisco, and is associated with poor physical and mental health and poor social functioning. Screening for and addressing food insecurity should be a critical component of HIV prevention and treatment programs.
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Affiliation(s)
- Sheri D Weiser
- University of California San Francisco, San Francisco, CA 94143, USA.
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Food deprivation is integral to the ‘hand to mouth’ existence of homeless youths in Toronto. Public Health Nutr 2009; 12:1437-42. [DOI: 10.1017/s1368980008004291] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveTo describe homeless youths’ experiences of food insecurity and examine the relation between chronic food deprivation and food acquisition practices.DesignA cross-sectional survey of homeless youths was conducted in 2003 to assess their nutritional vulnerability and describe their food acquisition practices.SettingToronto, Canada.SubjectsTwo hundred and sixty-one youths, aged 16–24 years, who had spent ten or more of the past thirty nights sleeping in a temporary shelter, public space or friend’s place, because they had no place of their own. Most participant recruitment (70 %) occurred outdoors, but 30 % were recruited in drop-in centres.ResultsOver the past 30 d, 28 % of males and 43 % of females experienced chronic food deprivation (i.e. reduced food intake for ≥10 d), and 32 % of females and 48 % of males reported problems obtaining water to drink. Most youths routinely obtained meals at charitable programmes and panhandled for money for food, and many routinely stole food or ate day-old food obtained from restaurants. In contrast, eating food discarded by others and postponing debt payments were strategies of desperation, more common among youths experiencing chronic food deprivation. Additionally, for males, deliberately seeking the company of friends, relatives or acquaintances to obtain food, and for females, borrowing money or trading sex for food, were associated with chronic food deprivation.ConclusionsThe pervasiveness and severity of food insecurity experienced by the youths and their desperate means of food acquisition highlight the need for more effective responses to the plight of homeless youths in Canadian cities.
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Towe VL, ul Hasan S, Zafar ST, Sherman SG. Street life and drug risk behaviors associated with exchanging sex among male street children in Lahore, Pakistan. J Adolesc Health 2009; 44:222-8. [PMID: 19237107 PMCID: PMC2671069 DOI: 10.1016/j.jadohealth.2008.09.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 08/11/2008] [Accepted: 09/11/2008] [Indexed: 11/17/2022]
Abstract
BACKGROUND Throughout the developing world, children living on urban streets is a byproduct of economic deprivation. In Lahore, Pakistan, there are an estimated 5,000-7,000 street children. PURPOSE The study examined HIV risk behaviors and factors associated with exchanging sex among male street children in Lahore, Pakistan. METHODS The survey was conducted from August 2003 to March 2004 among 565 registrants, ages 5-19, of Project Smile, a program that aimed to enhance the lives of street children in Lahore. We analyzed the frequency of and correlates of recent (past 3 months) sex exchange for money, drugs, or goods. Multivariate log-binomial regression was used to evaluate the independent effect of covariates on exchange sex. RESULTS Approximately 40% of participants reported having exchanged sex during the past 3 months. In multivariate analysis, the factors associated with exchanging sex were living on the street for longer than 48 months (Prevalence Ratio [PR]=1.36, 95% Confidence Interval [CI]: 0.99-1.85), reporting ever having used drugs (PR=1.87, 1.10-3.16), cutting one's self (PR=1.66, 95% CI: 1.26-2.19), and having heard of HIV/AIDS (PR=1.36, 95% CI: 1.03-1.80) after adjusting for demographic and street life variables. CONCLUSIONS We found high rates of sex exchange among a sample of street children in Lahore, Pakistan. The finding that children who have heard about HIV/AIDS are more likely to exchange sex suggests that children at HIV risk talk about HIV, but accuracy of their conversations is unclear. Street children in Pakistan are in great need of HIV education and safe alternatives for generating income.
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Affiliation(s)
- Vivian L Towe
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland 21205, USA.
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Malekpour M. Needs assessment of runaway females in Iran from an occupational therapy perspective. Occup Ther Int 2008; 15:232-52. [DOI: 10.1002/oti.259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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