Psychometric Properties of an Adapted Version of the U.S. Household Food Security Survey Module for Assessing Food Insecurity Among Low-Income Pregnant Latinas

Prolonged Early Food Insecurity and Child Feeding Practices among a Low-Income Hispanic Population: Role of Parenting Stress

OBJECTIVE

To examine associations between prolonged early household food insecurity (FI) during pregnancy, infancy, and toddlerhood, and child feeding practices, and the mediating role of dysfunctional parent-child interactions.

METHODS

We conducted secondary longitudinal analyses of data from the Starting Early Program (StEP) randomized controlled trial, which studied a primary care-based child obesity prevention program for low-income Hispanic families. Our independent variable was FI, using the USDA Food Security Module, during the third trimester of pregnancy and at child ages 10- and 19-months. Frequency of reported FI was defined by the number of periods with FI (0, 1, 2, or 3). Our dependent variables were feeding practices at child age 28-months using the Comprehensive Feeding Practices Questionnaire. Our mediating variable was dysfunctional parent-child interactions using the Parenting Stress Index subscale at age 19-months. We used linear regression to determine associations between frequency of reported FI and feeding practices adjusting for covariates, and mediation analyses to determine if dysfunctional parent-child interactions mediate these associations.

RESULTS

Three hundred and forty four mothers completed assessments at child age 28-months. Of the 12 feeding practices examined, higher frequency of reported FI was positively associated with using food as a reward, restriction of food for weight control, and using food for emotional regulation, and was negatively associated with monitoring of less healthy foods. There was a significant indirect effect of frequency of reported FI on these practices through dysfunctional parent-child interactions.

CONCLUSION

Higher frequency of reported FI was associated with four feeding practices, through dysfunctional parent-child interactions. Understanding these pathways can inform preventive interventions.

Government transfers, COVID-19 shock, and food insecurity: Evidence from rural households in India

The coronavirus disease 2019 (COVID-19) pandemic has decimated the lives and livelihoods of people worldwide. The impact of COVID-19 has been especially devastating for low-income families in rural areas of India. Soon after the nationwide lockdown was announced, food insecurity became pervasive in rural areas, as many families relied on daily wage work to fund necessities. By providing cash transfers and additional foodgrains, Indian policymakers acted swiftly to reduce the financial impact on family income and consumption. This paper investigates the factors affecting rural families' participation in the cash transfer program and the effect of government cash transfers on food insecurity. Results indicate that India's government cash transfer program decreased moderate food insecurity by 2.4% and severe food insecurity by about 0.92% [EconLit Citations: O12, I31, I32, I38].

Psychometric properties of a modified version of Brazilian household food insecurity measurement scale - Pró-Saúde study

We present results of initial steps of the psychometric evaluation of a proposed modified version of the Brazilian Household Food Insecurity Measurement Scale aimed at assessing adults' recall of food insecurity at age 12. Data were obtained through self-administered questionnaires from civil servants at university campuses in Rio de Janeiro, who participated in the first and fourth waves of the longitudinal Pró-Saúde Study. We evaluated test-retest reliability (n=58), internal consistency, factor structure, convergent, discriminant validity (n=3,253). Test-retest reliability kappa coefficients were above 0.65; Cronbach's α coefficient was 0.84. Factor loadings were above 0.800. The composite reliability was above 0.90. The square root values of the Average Variance Extracted were positive and statistically significant. Household food insecurity during childhood was strongly associated with larger family size and several sociodemographic conditions at age 12: female head of household, residence in rural area or small town, worse standard of living, and insufficient food due to lack of money. This initial evaluation suggests good performance. Further investigation should include additional psychometric properties and other population contexts.

A Model-Based Approach to Identify Classes and Respective Cutoffs of the Brazilian Household Food Insecurity Measurement Scale

BACKGROUND

The Brazilian Household Food Insecurity Measurement Scale (EBIA) is the main tool for assessing household food insecurity (FI) in Brazil, assisting in monitoring and improving national public policies to promote food security. Based on the sum of item scores, households have been classified into 4 levels of FI, with the use of cutoffs arising from expert discussions informed by psychometric analyses and policy considerations.

OBJECTIVES

This study aimed to identify homogeneous latent groups corresponding to levels of FI, examine whether such subgroups could be defined from discriminant cutoffs applied to the overall EBIA raw score, and compare these cutoffs against those currently used.

METHODS

A cross-sectional population-based study with a representative sample of 1105 households from a low-income metropolitan area of Rio de Janeiro was conducted. Latent class factor analysis (LCFA) models were applied to the answers to EBIA's items to identify homogeneous groups, obtaining the number of latent classes for FI measured by the scale. Based on this and a thorough classification agreement evaluation, optimal cutoffs for discriminating between different severity levels of FI were ascertained. Model-based grouping and the official EBIA classification cutoffs were also contrasted.

RESULTS

LCFA identified 4 homogeneous groups with a very high degree of class separation (entropy = 0.906), endorsing the classification of EBIA as a 4-level measure of FI. Two sets of cutoffs were identified to separate such groups according to household type: 1/2, 5/6, and 10/11 in households with children and adolescents (score range: 0-14); and 1/2, 3/4, and 5/6 in adult-only households (score range: 0-7).

CONCLUSION

Although roughly classifying EBIA as in previous studies, the current approach suggests that, in terms of raw score, households endorsing only one item of the scale would be better classified by being placed in the same stratum as those remaining negative on all items.

Measuring food and nutrition security: tools and considerations for use among people living with HIV

As an increasing number of countries implement integrated food and nutrition security (FNS) and HIV programs, global stakeholders need clarity on how to best measure FNS at the individual and household level. This paper reviews prominent FNS measurement tools, and describes considerations for interpretation in the context of HIV. There exist a range of FNS measurement tools and many have been adapted for use in HIV-endemic settings. Considerations in selecting appropriate tools include sub-types (food sufficiency, dietary diversity and food safety); scope/level of application; and available resources. Tools need to reflect both the needs of PLHIV and affected households and FNS program objectives. Generalized food sufficiency and dietary diversity tools may provide adequate measures of FNS in PLHIV for programmatic applications. Food consumption measurement tools provide further data for clinical or research applications. Measurement of food safety is an important, but underdeveloped aspect of assessment, especially for PLHIV.

Household food insecurity: a systematic review of the measuring instruments used in epidemiological studies

OBJECTIVE

To conduct a systematic review aimed at identifying and characterizing the experience-based household food security scales and to synthesize their psychometric properties.

DESIGN

Search in the MEDLINE, LILACS and SciELO databases, using the descriptors ('food insecurity' OR 'food security') AND ('questionnaires' OR 'scales' OR 'validity' OR 'reliability'). There was no limitation on the period of publication. All articles had their titles and abstracts analysed by two reviewers. The studies of interest were read in their entirety and the relevant information extracted using a standard form.

RESULTS

The initial bibliographic search identified 299 articles. Of these, the 159 that seemed to meet the criteria for inclusion were read fully. After consultation of the bibliographic references of these articles, twenty articles and five documents were added, as they satisfied the previously determined criteria for inclusion. Twenty-four different instruments were identified; all were brief and of easy application. The majority were devised in the USA. Forty-seven references reported results of psychometric studies. The instruments that presented the highest number of psychometric studies were the Core Food Security Measurement/Household Food Security Survey Module (CFSM/HFSSM) and the Self-Perceived Household Food Security Scale.

CONCLUSIONS

There are a number of structured scales available in the literature for characterization of household food insecurity. However, despite some psychometric studies already existing about the majority of the instruments, it is observed that, except for the studies of the CFSM/HFSSM, these are still restricted to appraisal of a few aspects of reliability and validity.

A pilot study examining food insecurity and HIV risk behaviors among individuals recently released from prison

Annually 700,000 individuals are released from U.S. prison, many at risk for food insecurity and HIV. The association between food insecurity and HIV risk behaviors has been established but not in this population. To investigate this association, we recruited 110 recently released prisoners to participate in a survey. Ninety-one percent of our sample was food insecure; 37% did not eat for an entire day in the past month. Those who did not eat for an entire day were more likely to report using alcohol, heroin, or cocaine before sex or exchanging sex for money compared to those who had at least a meal each day. From this pilot study, released prisoners appear to be at risk for food insecurity, and not eating for an entire day is associated with certain HIV risk behaviors. HIV prevention efforts should include longitudinal studies on the relationship between food insecurity and HIV risk behaviors among recently released prisoners.

Persistent household food insecurity, HIV, and maternal stress in peri-urban Ghana

Background

The mental health of caregivers has been shown to be important for improving HIV prevention and treatment. Household food insecurity affects hundreds of millions of individuals in Sub-Saharan Africa, a region that experiences a disproportionate burden of the HIV pandemic. Both maternal HIV diagnosis and household food insecurity may be linked with maternal stress. This in turn may lead to unhealthy coping behaviors. We examined the independent associations of HIV, persistent household food insecurity and the synergistic effect of both on maternal stress.

Methods

Ghanaian women recruited prenatally from hospitals offering voluntary counseling and testing (VCT) were followed for 12 months after childbirth (N = 232). A locally adapted 7-item version of the US Household Food Security Survey Module was applied at four time points postpartum. We dichotomized participant households as being persistently food insecure (i.e., food insecure at each time point) or not (i.e., food secure at any time point). We dichotomized participant women as not perceiving vs. perceiving stress at 12 months postpartum in reference to the median sample score on the 4-item Cohen’s stress scale. Binary multivariate logistic regression models were used to assess the independent and interactive effects of maternal HIV and persistent household food insecurity on maternal stress.

Results

The proportion of HIV-positive women that lived in severe food insecure households increased over time. By contrast, the HIV-negative group living in severely food insecure households experienced a steady decline across time. HIV-infection (AOR = 2.31, 95% CI 1.29-4.12) and persistent household food insecurity (AOR = 3.55, 95% CI 1.13-11.13) were independently associated with maternal stress in a multivariate model. Being both HIV-positive and persistently food insecure strongly and synergistically increased the risk for maternal perceived stress (AOR = 15.35, 95% CI 1.90-124.14).

Conclusion

In agreement with syndemic theory there is a powerful synergism between maternal HIV diagnosis and household food insecurity on maternal stress. Comprehensive multi-dimensional intervention studies are needed to better understand how to reduce stress among HIV-positive women living in persistently food insecure households and how to reduce the likelihood of food insecurity in HIV-affected households in Sub-Saharan Africa.

Social support modifies the association between household food insecurity and depression among Latinos with uncontrolled type 2 diabetes

Prevalence of depression is high among individuals with type 2 diabetes (T2D). The objective of the current study was to identify the socio-demographic, psychosocial, cultural, and clinical risk factors that predispose to depression, and resources that protect from depression among low income Latinos with T2D. Participants (N = 211) were interviewed in their homes upon enrollment. Multivariate logistic regression was used to identify factors associated with depressive symptoms based on a score of ≥21 on the Center for Epidemiological Studies Depression scale. Lower household income, interference of diabetes with daily activities, and more T2D clinical symptoms were associated with depression risk in the multivariate analyses. At each level of food insecurity the risk of depression was lower the higher the level of social support (P < 0.05). Findings suggest that social support buffers against the negative influence of household food insecurity on depression risk. A comprehensive approach is necessary to address the mental health needs of low income Latinos with T2D.

Household food insecurity is associated with depressive symptoms among low-income pregnant Latinas

Latinas experience high rates of poverty, household food insecurity and prenatal depression. To date, only one USA study has examined the relationship between household food insecurity and prenatal depression, yet it focused primarily on non-Latina white and non-Latina black populations. Therefore, this study examined the independent association of household food insecurity with depressive symptoms among low-income pregnant Latinas. This cross-sectional study included 135 low income pregnant Latinas living in Hartford, Connecticut. Women were assessed at enrolment for household food security during pregnancy using an adapted and validated version of the US Household Food Security Survey Module. Prenatal depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale. A cut-off of ≥21 was used to indicate elevated levels of prenatal depressive symptoms (EPDS). Multivariate backwards stepwise logistic regression was used to identify risk factors for EPDS. Almost one third of participants had EPDS. Women who were food insecure were more likely to experience EPDS compared to food secure women (OR = 2.59; 95% CI = 1.03-6.52). Being primiparous, experiencing heartburn and reporting poor/fair health during pregnancy, as well as having a history of depression were also independent risk factors for experiencing EPDS. Findings from this study suggest the importance of assessing household food insecurity when evaluating depression risk among pregnant Latinas.

Adaptation of the U.S. Food Security Survey Module for Low-Income Pregnant Latinas: Qualitative Phase

The objectives of this study were to: 1) assessed the face validity of the 18-items US Household Food Security Scale Module (US HFSSM) among low-income pregnant Latinas and 2) adapt the US HFSSM to the target population. This study was conducted in the United States in Hartford, Connecticut where 40% of residents are of Latina descent. Three focus groups (N=14(total)) were held with pregnant and postpartum Latinas from April - June 2004 to assess the understanding and applicability (face validity) of the US HFSSM as well as adapt the US HFSSM based on their recommendations. This was followed by pre-testing (N=7) to make final adaptations to the US HFSSM. Overall, the items in the US HFSSM were clear and understandable to participants, but some questions sounded repetitive to them. Participants felt the questions were applicable to other pregnant Latinas in their community and shared food security related experiences and strategies. Participants recommendations led to key adaptations to the US HFSSM including reducing the scale to 15-items, wording statements as questions, including two time periods, replacing the term "balanced meals" with "healthy and varied", replacing the term "low cost foods" with "cheap foods" and including a definition of the term, and including a coping mechanism of avoiding running out of food. The adapted US HFSSM was found to have good face validity among pregnant Latinas and can be used to assess food insecurity among this vulnerable population.