Economic determinants and dietary consequences of food insecurity in the United States

Does Race/Ethnicity Explain Regional Inequities in Child Food Insufficiency During the Second Year of the COVID-19 Pandemic?

Historically, food insecurity prevalence was higher in the U.S. Southern region than in other regions, particularly among children, but it is not known if the COVID-19 pandemic affected this situation. Our objectives were to (1) assess regional inequities in child food insufficiency during the second year of the pandemic between Deep South states (Alabama, Georgia, Louisiana, Mississippi, and South Carolina) and non-Deep South states, and (2) examine the role of race/ethnicity and other factors in the observed differences. Data from Household Pulse Survey phases 3.1-3.2 (4/15-10/11/2021) on households with children (n=267,106) were used. The outcome was child food insufficiency, and the predictor was living in a Deep South state. Weighted crude and adjusted logistic regressions were run, adjusting for participants' race/ethnicity, age, gender, marital status, and educational attainment; number of children in the household; and household income-to-poverty ratio. Child food insufficiency prevalence was higher in Deep South (15.0%) versus non-Deep South states (11.6%). In crude models, the odds of child food insufficiency were 35% higher in Deep South, compared to non-Deep South states. With a model that adjusted for race/ethnicity, this dropped to 24% higher in Deep South states, and down to 13% higher in the fully adjusted model. Regional inequities in child food insufficiency were present in the second year of the pandemic but were not fully explained by race/ethnicity nor by other household demographic and socioeconomic factors. Assessing the contribution of state-level contexts and social policies to observed inequities may assist in explaining them and identifying appropriate solutions.

Material Need Insecurities among People on Hemodialysis: Burden, Sociodemographic Risk Factors, and Associations with Substance Use

Key Points

Food insecurity and housing instability may affect dialysis outcomes through health behaviors like treatment adherence and their effect on access to transplantation or home dialysis therapies. People on hemodialysis who were younger, with less educational attainment, with lower incomes, or experiencing financial strain were more likely to experience material need insecurities. Participant race was not associated with material need insecurities, although residential segregation moderated associations between age, sex, and food insecurity.

Background

Despite their relevance to health outcomes, reports of food insecurity and housing instability rates among adults on hemodialysis are limited. Their relation to sociodemographic and behavioral factors are unknown for this population.

Methods

We enrolled a convenience sample of people receiving hemodialysis at Baltimore and Washington, DC metropolitan area facilities. Participants completed measures of socioeconomic position, food insecurity, housing instability, and substance use disorder. We cross-referenced participant and facility zip codes with measures of area poverty and residential segregation. We examined associations between individual-level and area-level sociodemographic characteristics, food insecurity, and housing instability using multivariable logistic regression models.

Results

Of the 305 participants who completed study surveys, 57% were men and 70% were Black, and the mean age was 60 years. Thirty-six percent of the sample reported food insecurity, 18% reported housing instability, and 31% reported moderate or high-risk substance use. People on hemodialysis who were younger, with lower educational attainment, with lower incomes, or experiencing financial strain were more likely to have material need insecurities (P < 0.05 for all). Among participants living in segregated jurisdictions, men had increased odds of food insecurity compared with women (odds ratio 3.7; 95% confidence interval, 1.61 to 8.53); younger participants (age <55 years) had increased odds of food insecurity compared with older participants (odds ratio 3.3; 95% confidence interval, 1.49 to 7.32). Associations between sex or younger age category and food insecurity were not statistically significant in less segregated counties (P interaction for residential segregation×sex: P = 0.006; residential segregation×younger age category: P = 0.12).

Conclusions

Food insecurity, housing instability, and substance use were common among this sample of adults on hemodialysis. Younger adults on hemodialysis, particularly those living in residentially segregated jurisdictions, were at increased risk for food insecurity. Future research should examine whether material need insecurities perpetuate disparities in dialysis outcomes.

Podcast

This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/K360/2023_12_01_KID0000000000000279.mp3

Regional disparities in food security and depression among single-person households in the Republic of Korea

BACKGROUND

Single-person households constitute over 40% of all households in the Republic of Korea and are more vulnerable to food insecurity and depression than multi-person households. There is a lack of research on examining whether regional characteristics are associated with the degree of food insecurity and depression among single-person households. This study aimed to examine the regional disparities in food security and depression among single-person households in the Republic of Korea.

METHODS

A total of 227,873 adults from the 2019 Korean Community Health Survey was included in the analysis. According to population density and poverty rate, the residence of the participants was classified into four regions: metropolitan areas with high population density were classified into areas with low poverty rates (Region 1) and high poverty rates (Region 2), and provinces with low population density were classified into areas with low poverty rates (Region 3) and high poverty rates (Region 4). Using a single item of household food security, those who had experienced a lack of food due to financial difficulties over the past year were classified as food insecure. Depression was measured using the Patient Health Questionnaire-9. Odds ratios and 95% confidence intervals (CI) for the risk of food insecurity and depression according to regional characteristics were calculated after adjusting for potential confounding variables.

RESULTS

After adjusting for confounding variables, single-person households in regions with high population density, Regions 1 and 2, had 1.16 times (95% CI = 1.04-1.30) and 1.43 times (95% CI = 1.27-1.61) higher odds of food insecurity, respectively, compared to those in Region 4. Single-person households in regions with low poverty rates, Regions 1 and 3, had 1.54 times (95% CI = 1.34-1.77) and 1.21 times (95% CI = 1.01-1.46) higher odds of depression, respectively, than those in Region 4. Among those who lived alone, the middle-aged, having low income, receiving livelihood benefits, or having a low educational attainment had higher odds of experiencing both food insecurity and depression than their counterparts.

CONCLUSIONS

As the risk of food insecurity and depression in single-person households differs according to regional characteristics, local governments need to implement policies for single-person households in consideration of these distinct characteristics.

Food-related worry and food bank use during the COVID-19 pandemic in Canada: results from a nationally representative multi-round study

BACKGROUND

Early in the COVID-19 pandemic, nearly one in five adults in Canada worried about having enough food to meet their household's needs. Relatedly, throughout the pandemic, public messaging repeatedly urged Canadians to support food charities, including food banks. Yet few studies have examined food bank usage during the pandemic or whether food charities were widely used by Canadians worried about food access.

METHODS

This study draws on four rounds of nationally representative surveying conducted during the COVID-19 pandemic between May 2020 and December 2021 among adults 18 years and older living in Canada. Descriptive statistics were used to examine rates of food-related worry during all four survey rounds. Data from the fourth survey round, collected in December 2021, were used to explore use of food-based community programs since the onset of the pandemic, including food banks. Logistic regression analyses were used to examine differences in socio-demographic and health-related characteristics between adults who did and did not report accessing food banks before and after adjusting for household income.

RESULTS

Across survey rounds (n = 12,091), more than one in seven participants reported stress or worry related to having enough food to meet their household's basic needs in the previous two weeks. Yet, by December 2021, fewer than 4% of participants reported ever accessing a food bank during the pandemic. Younger age, living with a child, financial concerns due to the pandemic, two different measures of food worry, pre-existing mental health conditions, disability, LGBT2Q + identity, and racialized or Indigenous identity, were each statistically significantly associated with higher odds of using food banks even when controlling for household income.

CONCLUSIONS

Despite persistently high rates of food-related worry in 2020 and 2021 in Canada, relatively few adults reported accessing food banks or other charity-based community food programs. While respondents facing social, financial, and health-related inequities and reporting food worry were more likely to use food banks, most respondents did not report food bank use, regardless of financial or demographic circumstances or experiences of food worry. Findings align with previous research indicating that more adequate and comprehensive supports are needed to alleviate food-related-worry in Canada.

Income Support Policy Packages and Birth Outcomes in U.S. States: An Ecological Analysis

Research suggests that generous social welfare programs play a role in maternal and child health. However, most studies examine a single policy in isolation. Drawing from research documenting low-income families 'packaging' of social policies, we create a novel measure summarizing the value of a collection of income support policies for the working poor. This collection includes: the Supplemental Nutrition Assistance Program (SNAP), the Earned Income Tax Credit (EITC), the minimum wage, and the unemployment insurance (UI) program. Using U.S. state-level administrative data from 1996 to 2014, we estimate fixed effects regression models to examine the relationship between birth outcomes and income support policies (individually and combined). We find that increases in the combined value of the four income supports are significantly associated with reductions in preterm births and low birthweight births, but not infant mortality rates. States with the highest observed levels of combined income support had 14% fewer PTBs and 7% fewer LBWs than states with the lowest levels of income support. Of the four individual income support policies, only unemployment insurance has no significant independent effects. SNAP benefits have the largest and most consistent effects, reducing poor birth outcomes across all three indicators. An annual increase of $1000 in SNAP benefits is associated with a 3% decline in infant deaths, 5% decline in preterm births, and 2% decline in low birthweight births. These results suggest that increasing the generosity of income support policies may be a promising strategy for improving birth outcomes in the United States.

Household Food Insecurity and Associated Factors among Iranian Patients with Esophageal and Gastric Cancers

Background: Household food insecurity (HFI) which has still been one of the major global public health issues is related to adverse health outcomes in individuals. Therefore, this study aimed to determine the prevalence of HFI and its associated factors in Iranian patients with esophageal and gastric cancers. Methods: The data of this cross-sectional study was obtained from 315 patients with esophageal and gastric cancers who were selected from a gastrointestinal cancer-based cohort study conducted in Firoozgar hospital, in Tehran. Food insecurity (FI) was measured using the Iranian version of the HFI questionnaire that was completed by a trained interviewer. The multivariable logistic regression model was used to determine the independent association of each factor with HFI. A P value lower than 0.05 was considered statistically significant. Results: The mean±SD of participants' age was 63.2±12.6 years and 65.4% were men. Most of the patients (75.8%) suffered from gastric cancer and 24.2% from esophageal cancer. The overall prevalence of FI among participants' households was 35.2%. There was an independent significant association between wealth index (WI) and HFI after the use of the multivariable logistic regression model, in such a way that the odds of FI in the poorest, poor, moderate, and rich patients' households were respectively, 6.41, 5.05, 2.74 and 2.04 times higher compared with the richest households. Conclusion: More than a third of participants' households struggled with FI, which was found to have a higher prevalence in loweconomic households. Therefore, health policymakers should intervene in food-insecure households by developing, establishing, and implementing strategies and control programs to improve affordable food access.

Exploring differences in disordered eating and related appetitive traits among women based on childhood and current food security status

Despite emerging evidence that food insecurity (FI) is associated with elevated rates of eating pathology, little is known about the lasting impact of FI on eating behaviors. Studies that have explored the association between FI during childhood and eating behavior in adulthood have not accounted for current FI. The present study explored differences in disordered eating (DE) and related appetitive traits among four groups of cisgender female mothers: individuals who (1) endorsed childhood FI only (n = 96), (2) endorsed current FI only (n = 134), (3) endorsed both childhood and current FI (n = 257), and (4) denied both childhood and current FI (n = 146). Participants responded to online questionnaires including items from the USDA Household Food Security Survey Module, the 7-item Eating Disorder Examination-Questionnaire, the Eating Disorder Diagnostic Scale, and the Adult Eating Behavior Questionnaire. Adjusting for age and race/ethnicity, ANCOVAs explored mean differences between groups in DE and appetitive traits, and a modified Poisson regression model examined differences in binge-eating prevalence across the four FI groups. The "current FI only" group consistently endorsed the highest levels of DE and related appetitive traits followed by the "current and childhood FI" group, suggesting newly food-insecure women may be at highest risk for DE. Interestingly, across almost all constructs, the "childhood FI only" group did not differ significantly from the "no FI" group. These findings suggest that improved access to food may help offset risk for adult DE related to experiences of FI in childhood.

The impact of food insecurity on health outcomes: empirical evidence from sub-Saharan African countries

BACKGROUND

Food insecurity adversely affects human health, which means food security and nutrition are crucial to improving people's health outcomes. Both food insecurity and health outcomes are the policy and agenda of the 2030 Sustainable Development Goals (SDGs). However, there is a lack of macro-level empirical studies (Macro-level study means studies at the broadest level using variables that represent a given country or the whole population of a country or economy as a whole. For example, if the urban population (% of the total population) of XYZ country is 30%, it is used as a proxy variable to represent represent country's urbanization level. Empirical study implies studies that employ the econometrics method, which is the application of math and statistics.) concerning the relationship between food insecurity and health outcomes in sub-Saharan African (SSA) countries though the region is highly affected by food insecurity and its related health problems. Therefore, this study aims to examine the impact of food insecurity on life expectancy and infant mortality in SSA countries.

METHODS

The study was conducted for the whole population of 31 sampled SSA countries selected based on data availability. The study uses secondary data collected online from the databases of the United Nations Development Programme (UNDP), the Food and Agricultural Organization (FAO), and the World Bank (WB). The study uses yearly balanced data from 2001 to 2018. This study employs a multicountry panel data analysis and several estimation techniques; it employs Driscoll-Kraay standard errors (DKSE), a generalized method of momentum (GMM), fixed effects (FE), and the Granger causality test.

RESULTS

A 1% increment in people's prevalence for undernourishment reduces their life expectancy by 0.00348 percentage points (PPs). However, life expectancy rises by 0.00317 PPs with every 1% increase in average dietary energy supply. A 1% rise in the prevalence of undernourishment increases infant mortality by 0.0119 PPs. However, a 1% increment in average dietary energy supply reduces infant mortality by 0.0139 PPs.

CONCLUSIONS

Food insecurity harms the health status of SSA countries, but food security impacts in the reverse direction. This implies that to meet SDG 3.2, SSA should ensure food security.

Net worth poverty and adult health

This study broadens the traditional focus on income as the primary measure of economic deprivation by providing the first analysis of wealth deprivation, or net worth poverty (NWP), and adult health. Net worth poverty-having wealth (assets minus debts) less than one-fourth of the federal poverty line-likely exacerbates the negative effects of income poverty (IP). In 2019, one-third of US households were net worth poor, with substantially higher rates among Black (60%) relative to White (25%) households. We estimate longitudinal growth curve (i.e., linear mixed effects) models to test how NWP, IP, and the interaction of the two predict a diverse set of health measures. We also consider whether NWP resulting from either low assets or high debts is more predictive of health outcomes and test for heterogeneous associations by race. Data come from Panel Study of Income Dynamics on 8,962 individuals ages 25 to 64, observed between 2011 and 2019 (n = 26,776). Adjusting for income poverty, net worth poverty, relative to no poverty, was associated with a one-quarter to one-third increase in the likelihood of reporting poor self-rated health, psychological distress, and work limitations. Simultaneously experiencing both NWP and IP was associated with the largest deficits. Both asset-driven (low asset) and debt-driven (high debt) NWP reduced health, but asset-driven NWP had stronger associations (e.g., a 5-percentage point increase of being in poor health, twice that of debt-driven). White, relative to Black, adults exhibited statistically larger associations for psychological distress (4.3 vs 1.1 percentage points) and work limitations (3.7 vs. 1.5 percentage points). White and Black adults who were jointly net worth and income poor exhibited the most disadvantage. Findings underscore how wealth is a critical component of financial deprivation and that wealth deprivation, particularly the lack of assets, merits attention in socioeconomic studies of health inequalities.

Food insecurity, sleep, and cardiometabolic risks in urban American Indian/Alaska Native youth

OBJECTIVES

Food insecurity contributes to racial/ethnic disparities in health. This is the first study to examine associations among food insecurity, sleep, and cardiometabolic outcomes in urban American Indian/Alaska Native (AI/AN) youth.

DESIGN

Participants were 142 urban AI/AN youth (mean age = 14 years, 58% female). Food insecurity and self-reported sleep disturbance were measured using validated surveys. A multi-dimensional sleep health composite was derived using questionnaires (ie, satisfaction, alertness) and actigraphy-derived indices (ie, duration, efficiency, regularity, timing). Cardiometabolic measures included body mass index, blood pressure, glycosylated hemoglobin, waist circumference, cholesterol, and triglycerides. Covariates were sex, age, and single-parent household.

RESULTS

Greater food insecurity was significantly associated with greater body mass index (b = 0.12, p = .015), higher systolic blood pressure (b = 0.93, p = .03), and greater sleep disturbance (b = 1.49, p < .001), and marginally associated with lower sleep health composite scores (b = -0.09, p = .08). There was a significant indirect path from greater food insecurity to greater waist circumference through poorer sleep health (0.11, 95% bootstrapping CI: [0.01, 0.30]).

CONCLUSION

Food insecurity is an important correlate of sleep and cardiometabolic health among urban AI/AN youth and should be addressed to reduce emerging health risks during this important developmental period. Policies to reduce food insecurity and increase access to healthy foods as well as sleep interventions for these youth could help, as preliminary findings suggest that sleep health may mediate the negative impact of food insecurity on cardiometabolic risks.

Dietary diversity and association with non-communicable diseases (NCDs) among adult men (15-54 years): A cross-sectional study using National Family and Health Survey, India

A healthy and diversified diet is essential for preventing several non-communicable diseases (NCDs). Given the increasing evidence of diet-related health burdens and the rising prevalence of NCDs among Indian adults, the present study aims to explore dietary diversity patterns among adult men in India and their association with non-communicable diseases (NCDs). For this purpose, the study used the fourth round of the National Family and Health Survey (NFHS-4) to analyze adult male samples (n = 1,12,122). Dietary Diversity Scores (DDS) were computed by the weighted sum of the number of different food groups consumed by an individual. The prevalence of diabetes, heart disease, and cancer among adult men is considered a non-communicable disease. Bivariate and logistic regression was carried out to examine the association between DDS and NCDs by estimating chi-squared tests (χ2-test), odds ratio (OR), and 95% confidence interval (CI). The prevalence of diabetes, heart disease, and cancer among adult men in India is 2.1 percent, 1.2 percent, and 0.3 percent, respectively. Results show a positive association between dietary diversity score and the prevalence of the non-communicable disease. High-level dietary diversity scores increase to two times the likelihood of diabetes (OR 2.15 with p<0.05) among adult men than to better-off counterparts while controlling all the covariates. However, a moderate dietary diversity score significantly decreases the likelihood of heart disease (OR 0.88 with p<0.10) and Cancer (OR 0.71 with p<0.05) for adult men compared to a lower score of dietary diversity. In addition, age, marital status, drinking and smoking habits, occupation, and wealth index are also significantly associated with the odds of non-communicable diseases among adult men.

Effects of the COVID-19 pandemic on food insecurity in El Salvador during 2020

Objective.

This study sought to quantify the prevalence of food insecurity among Salvadorian households, to identify the determinants of food insecurity and to explore the impact of the COVID-19 pandemic on food insecurity.

Methods.

A nationwide, representative random sample of 2358 households was used for this cross-sectional study. The Household Hunger Scale (HHS) was used to assess the prevalence of food insecurity during a 30-day period. For comparison, three items were used from the Household Food Insecurity Experience Scale (HFIES), which measures hunger occurring during a 12-month time frame. For determinant analysis, binary logistic regression was used for the HHS and ordered logistic regression for the HFIES.

Results.

The prevalence of food insecurity was 6.45% (152/2356) among Salvadorian households when the HHS was used, affecting 5.48% (129/2356) to a moderate degree and 0.98% (23/2356) to a severe degree. The prevalence significantly increased when the HFIES scale items were used, with 35.41% (835/2358) of households being affected, a figure closer to the national poverty level. Determinants of food insecurity according to the HHS included agricultural problems (P = 0.00, odds ratio [OR] =1.69), the household’s prepandemic income (P = 0.00, OR = 0.48) and higher educational levels (i.e. having a secondary education [P = 0.00, OR = 0.31], technical [P = 0.03, OR = 0.24] or university education [P = 0.00, OR = 0.05]). When using the HFIES, the determinants were similar (i.e. income, agricultural problems, educational level). In more than 94% (744/785) of households, participants reported that food insecurity was exacerbated by the COVID-19 pandemic.

Conclusions.

When compared with other relevant international studies, the prevalence of food insecurity identified using the HHS – only 6.45% – was low for El Salvador. However, when using the HFIES scale, the prevalence rose to 35.41% of households. Some determinants align with previous studies, namely income, educational level and agricultural problems. The COVID-19 pandemic appeared to have direct effects on food insecurity

Bayesian finite-population inference with spatially correlated measurements

Community-based public health interventions often rely on representative, spatially referenced outcome data to draw conclusions about a finite population. To estimate finite-population parameters, we are posed with two challenges: to correctly account for spatial association among the sampled and nonsampled participants and to correctly model missingness in key covariates, which may be also spatially associated. To accomplish this, we take inspiration from the preferential sampling literature and develop a general Bayesian framework that can specifically account for preferential non-response. This framework is first applied to three missing data scenarios in a simulation study. It is then used to account for missing data patterns seen in reported annual household income in a corner-store intervention project. Through this, we are able to construct finite-population estimates of the percent of income spent on fruits and vegetables. Such a framework provides a flexible way to account for spatial association and complex missing data structures in finite populations.

Food Insecurity and Delayed or Forgone Medical Care During the COVID-19 Pandemic

Objectives. To describe food insecurity in the United States in December 2020 and examine associations with underuse of medical care during the COVID-19 pandemic. Methods. We fielded a nationally representative Web-based survey in December 2020 (n = 8318). Multivariable logistic regression models and predicted probabilities were used to evaluate factors associated with food insecurity and compare the likelihood of delaying or forgoing medical care because of cost concerns by food security status. Results. In December 2020, 18.8% of US adults surveyed reported experiencing food insecurity. Elevated odds of food insecurity were observed among non-Hispanic Black, Hispanic, and low-income respondents. Experiencing food insecurity was significantly associated with a greater likelihood of forgoing any type of medical care as a result of cost concerns. Conclusions. Food insecurity during the COVID-19 pandemic disproportionately affected non-White and low-income individuals. Experiencing food insecurity was a significant risk factor for delaying or forgoing medical care, an association that could have cumulative short- and long-term health effects. Public Health Implications. Comprehensive policies that target the most at-risk groups are needed to address the high rates of food insecurity in the United States and mitigate its adverse health effects. (Am J Public Health. 2022;112(5):776-785. https://doi.org/10.2105/AJPH.2022.306724).

The link between food insecurity and psychological distress: The role of stress exposure and coping resources

This study examines the association between food insecurity and mental health over a 3-year period. It also assesses the salience of life stressors and psychosocial coping resources for this association. We utilize data from a two-wave community survey of Miami-Dade County, Florida residents (N = 1488). Findings from SEM analysis reveal that greater food insecurity at W1 is associated with greater depressive symptoms at W2, lending credence to characterizations of food insecurity as a chronic stressor. This association is partly mediated by variation over the study period in social support and mastery. However, no significant mediating effects are observed for the social stress indicators assessed. Food insecurity is associated with diminished psychosocial coping resources, which leads to greater psychological distress. We discuss how these findings extend a stress and coping model of food insecurity, and implications for research and practice.

Effects of welfare reform on household food insecurity across generations

This study estimates the effects of welfare reform in the 1990s, which permanently restructured and contracted the cash assistance system in the U.S., on food insecurity-a fundamental form of material hardship-of the next generation of households. An implicit goal underlying welfare reform was the disruption of an assumed intergenerational transmission of disadvantage; however, little is known about the effects of welfare reform on the well-being of the next generation of adults. Using intergenerational data from the Panel Study of Income Dynamics and a variation on a difference-in-differences framework, this study exploits 3 sources of variation in childhood exposure to welfare reform: (1) risk of exposure across birth cohorts; (2) variation of exposure within cohorts because different states implemented welfare reform in different years; and (3) variation between individuals with the same exposure who were more likely and less likely to rely on welfare. We found that exposure to welfare reform led to decreases in food insecurity of the next generation of households, by about 10% for a 5-year increase in exposure, with stronger effects for individuals exposed for longer durations during childhood, individuals exposed in early childhood (0-5 years), and women. We also found smaller favorable effects for individuals whose mothers had less than a high school education, indicating that in terms of food insecurity, welfare reform led to relative disadvantages among the most disadvantaged and thus could be exacerbating socioeconomic and health inequalities.

Socioeconomic risks of food insecurity during the Covid-19 pandemic in the UK: findings from the Understanding Society Covid Survey

BACKGROUND

We estimated socioeconomic factors associated with food insecurity during the first year of the Covid pandemic in the UK and explored potential mechanisms explaining these associations.

METHODS

Data were from the April, July, and September 2020 waves of the UK Understanding Society Covid Survey. Food insecurity was measured as 'not having access to healthy and nutritious food' and 'reporting being hungry but not eating'. Logistic regression estimated the relationship between socioeconomic factors and food insecurity. A decomposition approach explored if financial vulnerability and having Covid-19 explained associations between socioeconomics factors and food insecurity.

RESULTS

Single parents and young people aged 16-30 years had a higher odds of reporting both measures of food insecurity. Financial insecurity explained 5% to 25% of the likelihood of reporting being food insecure for young people and single parents depending on the food insecurity measure used. Experiencing Covid-19 symptoms explained less than 5% of the likelihood of being food insecure for single parents but approximately 30% of not having access to healthy and nutritious food for young people.

CONCLUSION

Policies providing additional financial support may help to reduce the impact of Covid-19 on food insecurity in the UK.

The Evolution of Food Security: Where Are We Now, Where Should We Go Next?

Food security is one of the most challenging topics globally; however, the concept of food security has taken on additional dimensions that are general and are less detailed. This study aims to identify the intellectual structure of food security research and the changes in this structure. This paper analyzed 3169 documents from the Web of Science database through a bibliometric review. A review of the published documents shows an increasing trend over the past 46 years. In accordance with co-occurrence analysis, 125 keywords were grouped into five clusters: food security and sustainable development; food security and socioeconomic factors; food security policy and governance; coping strategies for poverty, inequality, and hunger; and modern food security management. This study identifies four streams within food security research: sustainability and environmental, socioeconomic, cultural, and political factors. The paper concludes that even though food security might investigate many significant areas, other new dimensions should still be considered. Further gaps in the literature emerge that present avenues for future research directions. Reviewing indicators and techniques of food security assessment and identifying high-risk groups should be a priority.

Food insecurity status is of added value in explaining poor health: a cross-sectional study among parents living in disadvantaged neighbourhoods in the Netherlands

OBJECTIVES

The aim of this study was to examine the added value of food insecurity in explaining poor physical and mental health beyond other socioeconomic risk factors.

DESIGN, SETTING, PARTICIPANTS AND OUTCOME MEASURES

Data for this cross-sectional study were collected using questionnaires with validated measures for food insecurity status and health status, including 199 adult participants with at least 1 child living at home, living in or near disadvantaged neighbourhoods in The Hague, the Netherlands. To assess the added value of food insecurity, optimism-corrected goodness-of-fit statistics of multivariate regression models with and without food insecurity status as a covariate were compared.

RESULTS

In the multivariable models explaining poor physical health (Physical Component Summary: PCS) and mental health (Mental Component Summary: MCS), from all included socioeconomic risk factors, food insecurity score was the most important covariate. Including food insecurity score in those models led to an improvement of explained variance from 6.3% to 9.2% for PCS, and from 5.8% to 11.0% for MCS, and a slightly lower root mean square error. Further analyses showed that including food insecurity score improved the discriminative ability between those individuals most at risk of poor health, reflected by an improvement in C-statistic from 0.64 (95% CI 0.59 to 0.71) to 0.69 (95% CI 0.62 to 0.73) for PCS and from 0.65 (95% CI 0.55 to 0.68) to 0.70 (95% CI 0.61 to 0.73) for MCS. Further, explained variance in these models improved with approximately one-half for PCS and doubled for MCS.

CONCLUSIONS

From these results it follows that food insecurity score is of added value in explaining poor physical and mental health beyond traditionally used socioeconomic risk factors (ie, age, educational level, income, living situation, employment status and migration background) in disadvantaged communities. Therefore, routine food insecurity screening may be important for effective risk stratification to identify populations at increased risk of poor health and provide targeted interventions.

Food-Seeking Behaviors and Food Insecurity Risk During the Coronavirus Disease 2019 Pandemic

OBJECTIVE

Food insecurity risk increases among disaster-struck individuals. The authors employed the social determinants of health framework to (1) describe the characteristics and food-seeking behaviors of individuals coping with the coronavirus disease 2019 pandemic and (2) evaluate the relationship between these factors and food insecurity risk.

DESIGN

A cross-sectional Qualtrics survey was administered May 14-June 8, 2020.

PARTICIPANTS

Adults living in New York were recruited online (n = 410).

MAIN OUTCOME MEASURE

Food insecurity risk.

ANALYSIS

Logistic regression analyses were conducted using a model-building approach.

RESULTS

A total of 38.5% of the sample was considered food insecure after the coronavirus disease 2019 outbreak. The final model revealed that not knowing where to find help to acquire food, reporting that more food assistance program benefits would be helpful, being an essential worker, having general anxiety, and being a college student were risk factors for food insecurity regardless of demographic characteristics.

CONCLUSIONS AND IMPLICATIONS

With more individuals experiencing food insecurity for the first time, there is a need for enhanced outreach and support. The findings complement emerging research on food insecurity risk during and after the pandemic and can help to inform food assistance programs and policies.

Net Worth Poverty and Child Development

The authors investigate whether net worth poverty (NWP) reduces children's well-being. NWP-having wealth (assets minus debts) less than one fourth of the federal poverty line-is both theoretically and empirically distinct from income poverty (IP) and is the modal form of poverty among children. Data come from the Panel Study of Income Dynamics and its Child Development Supplement on children ages 3 to 17 years observed between 2002 and 2019. The authors use linear mixed-effects models to investigate the associations among NWP, IP, and four cognitive and behavioral outcomes. NWP reduces children's cognitive scores and was associated with increases in both problem behavior scores. Negative associations for NWP are similar in magnitude to those found for IP. Much of the NWP effect operates through asset deprivation rather than high debt. The results illustrate the potential risks many children, previously overlooked in studies of IP, face because of wealth deprivation.

Factors related to poor diet quality in food insecure populations

It is well-known that consumption of nutrient-rich foods, especially fruits and vegetables, are low among food insecure populations. While cost is an important reason for these inadequate diets, underlying factors such as poor food purchase and management behaviors, and low levels of psychosocial factors that motivate dietary improvements, may exacerbate food insufficiency among the food-insecure. In this analysis, we examine these underlying factors across food-secure and food-insecure populations in Texas. Data on self-reported food insecurity, dietary practices, behaviors related to food purchase and management, and psychosocial factors related to food were obtained from a survey administered to a convenience sample of SNAP-eligible adults (n = 1,171) ages 18 and older, drawn from multiple low-income areas across the state of Texas in 2018 over two survey rounds. Mixed linear regression models adjusting for zip code as a random effect were used to compare mediators of diet across food-insecure and food-secure participants. Using the binary categories defined by the U.S. Household Food Security Survey Module scale 753 participants (64.3% of the sample collected) were classified as food insecure. Food insecure participants had notably unhealthier diet profiles, with significantly lower (p < .001) frequency and average serving size of fruit and vegetable consumption. They were also less likely to use food labels to make food choices (p < .001), and to cook a meal at home (p = .008). In contrast, differences across food secure and food insecure households in planning meals before going shopping, and making lists were much smaller. Finally, levels of various psychosocial precursors of healthy eating were also lower among food insecure participants, including self-efficacy for healthy eating (p = .014), self-efficacy to plan meals with vegetables (p = .048), and stage of change of fruit and vegetable consumption (p < .001). Overall, eating habits, specific food procurement and preparation practices, and levels of psychosocial precursors of healthy eating are significantly poorer among food insecure populations compared with food-secure low-income participants. Our results point to specific behaviors that can be targeted in educational and skill building interventions seeking to address poor dietary practices among the food insecure.

What factors are associated with food security among recently arrived refugees resettling in high-income countries? A scoping review

OBJECTIVE

Refugees are vulnerable to food insecurity (FI). This is attributable to a combination of inequitable social determinants and cultural differences. In 2019, 92 % of refugee resettlement (host country provides residency/citizenship) occurred in high-income countries, but little is known about the factors impacting their food security status in this setting. The review's objective was to therefore thematically identify factors affecting food security among refugees resettling in high-income countries.

DESIGN

This review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Between May-July 2020 and February 2021, peer-reviewed studies focused on FI, and published in English from 2000-2020, were searched on Medline, CINAHL, Scopus, Informit, PsychArticles, Proquest and EmBase.

SETTING

Only studies set in high-income countries were included.

PARTICIPANTS

Fifty percent or more of study participants had to be refugees who had resettled within 5 years.

RESULTS

Twenty studies from six high-income countries were included. Culturally based food practices and priorities, confidence in navigating local foodways and transport, level of community connections and capabilities in local language and food preparation were key themes associated with food security.

CONCLUSIONS

Utilising the four themes of culture, confidence, community and capabilities, there is an opportunity to improve the cultural sensitivity of measurement tools, develop understanding of how community-based resources (such as social capital) can be leveraged as food security buffers and modify existing food security initiatives to better serve refugee needs.

Prevalence of food security in the UK measured by the Food Insecurity Experience Scale

Background

Measurement of UK food insecurity has historically been inconsistent, making it difficult to understand trends. This study contributes by reporting and analysing data from a national survey conducted in line with UN Food and Agriculture Organization (FAO) recommendations and standard methods, providing an internationally comparable pre-coronavirus disease 2019 (COVID-19) snapshot of food insecurity.

Methods

Data came from a nationally representative 2019 UK sample (N = 2000) surveyed by Ipsos-Mori. Prevalence of food insecurity was assessed using the UN FAO Food Insecurity Experience Scale. Logistic regression was used to model food insecurity in relation to geographic and socio-demographic variables.

Results

Severe food insecurity was reported by 3% of the sample, an increase of 66.7% over the last directly comparable UK analysis (Gallup World Poll data from 2016 to 2018). Indication of some degree of food insecurity was reported by 14.2% of the sample and tended to be higher amongst younger age groups, those on lower incomes, and home renters (as opposed to owners). No geographic variables were significantly associated with food insecurity prevalence.

Conclusions

The finding that prevalence of severe food insecurity was already increasing before the COVID-19 pandemic, across all areas of the UK, is cause for concern. Our results provide an important benchmark for assessing the impact of COVID-19 on food insecurity.

Gender Disparities in Food Security, Dietary Intake, and Nutritional Health in the United States

INTRODUCTION

Food insecurity is associated with negative nutritional outcomes and is experienced differently by women vs men. We evaluated the effects of gender on food insecurity and dietary intake in the United States.

METHODS

Data from the National Health and Nutrition Examination Survey (2007-2016) were analyzed. Survey-weighted linear and logistic regression models were used to evaluate predictors of food security and the effect of food security on dietary consumption and body anthropometrics. Gender was modeled as a covariable and as an effect modifier.

RESULTS

A total of 30,251 respondents were included. Approximately 15.1% (95% confidence interval [CI]: 14.1%-16.1%) of participants were food insecure. This increased over time from 11.7% in 2007-2008 to 18.2% in 2015-2016. A higher proportion of women experienced food insecurity compared with men (53.3% vs 46.7%, P = 0.02), although this was not significant after adjusting for poverty and other confounders (adjusted odds ratio 1.01; 95% CI: 0.93-1.09; P = 0.81). Among food insecure women, 32.4% (95% CI: 30.0%-34.9%) received emergency food assistance and 75.0% (95% CI: 71.5%-78.2%) received supplemental nutrition assistance benefits. Relative to men, food insecure women were less likely to meet the recommended dietary allowance of most macronutrients and micronutrients. They were also significantly more likely to be obese, have a wider waist circumference, and have higher total body fat percentage (P interaction all <0.001).

DISCUSSION

Food insecurity represents a substantial public health challenge in the United States that differentially affects women compared with men. Alternative strategies may be required to meet the nutritional requirements for food insecure women.

Association of Food Insecurity with Nutrient Intake and Depression among Korean and US Adults: Data from the 2014 Korea and the 2013-2014 US National Health and Nutrition Examination Surveys

The purpose of this study is to understand the current status of food insecurity in Korea and the US and to compare the relationship of food insecurity with nutrient intake and depression. Data from the 2014 Korea and the 2013-2014 US National Health and Nutrition Examination Surveys were analyzed, and a total of 3102 Korean and 3234 American adults aged 20-64 years were included. Study subjects were classified into three groups according to degree of food insecurity assessed by the 18-item Household Food Security Survey Module: food secure (FS), mildly food insecure (FI 1), and moderately-to-severely food insecure (FI 2) groups. Energy and nutrient intake were assessed using a 24-h dietary recall. Depression was measured using the Patient Health Questionnaire-9 (PHQ-9) screener. The prevalence of food insecurity was 17.2% in Korea and 26.4% in the US. In both countries, the people in the FI 2 group had lower incomes and education levels and were mostly single. Energy and nutrient intake differed by food insecurity status. In both Korea and the US, adults with moderate-to-severe food insecurity (FI 2) consumed fewer proteins, fiber, potassium, and vitamin C. Additionally, the FI 2 groups had higher proportions of people not meeting the Dietary Reference Intake for protein, potassium, niacin, and vitamin C than the FS groups in Korea and the US. FI 2 people were three times more likely to be depressed than FS group; this difference was stronger in Korea than the US. We found that the prevalence of food insecurity was higher in the US than in Korea, and food insecurity was associated with reduced nutrient intake and increased odds of depression in both Korean and US adults. Therefore, food insecurity is an important public health issue at both the individual and national levels. Continuous monitoring and new intervention activities to promote food security are needed.

Food Insecurity, Depression, and Race: Correlations Observed Among College Students at a University in the Southeastern United States

Food insecurity is common among college students in the United States and is associated with poorer health-related outcomes and academic performance. The aims of this study were to assess the prevalence of food insecurity at a large, public university in Mississippi, a state with the second highest rate of food insecurity in the nation, and to examine the associations between food insecurity, depression, and race in this group of students. Food security was measured using the United States Department of Agriculture Household Food Security Survey Module: Six-Item Short Form, and depression was measured using the Patient Health Questionnaire-9. In total, 131 students ages 18-24 participated in the study. Food insecurity was present in 38.2% of students surveyed. The odds of food insecurity were higher among African American students compared to Caucasian students (OR = 3.50, 95% CI: 1.38, 8.90). Students with very low food security had 4.52-times greater odds of having depression than food-secure students (p = 0.011, 95% CI: 1.42, 14.36). Neither body mass index nor body fat percentage were associated with food security status. Further research is needed on strategies to address the risk of depression among food-insecure college students and the racial disparity in food insecurity rates present among college students.

Determinants and Consequences of Food Insecurity in Artisanal Fishing Families From the Coastal Community of Sonora, Mexico

BACKGROUND

Families living from artisanal fisheries are vulnerable to food insecurity.

OBJECTIVE

This research aimed to assess the determinants and consequences of food insecurity in artisanal fishing families from the coastal community of Sonora, Mexico, and to understand how these families face food insecurity.

METHODS

This was a cross-sectional study with 116 mothers. A socioeconomic, demographic, and nutritional knowledge survey was applied to assess determinants. A survey about food in the community and food security scale were collected to evaluate food insecurity and two 24-hour dietary recalls and anthropometric measures to assess consequences. Field notes about facing food insecurity were collected.

RESULTS

Sixty-eight percent of families have food insecurity. Being above the poverty line, higher father education, knowing how many glasses of water should be drunk per day, and how many minutes of physical activity should be done per day were associated with lower food insecurity. Not having medical service and lower mother education were associated with higher food insecurity. Higher food insecurity was associated with buying in a convenience store; higher food insecurity and higher mother education were associated with lower dietary score; and higher father education was associated with higher dietary score. Being below the extreme poverty line by income and number of children were associated with lower waist circumference; lower father education was associated with higher waist circumference of mothers.

CONCLUSIONS

Artisanal fishing families residing in the coastal community of Sonora, Mexico, experience high food insecurity associated with social and economic determinants and their dietary quality.

Food Insecurity and the Risk of Obesity, Depression, and Self-Rated Health in Women

Background/Introduction/Objective: Recent studies have shown that food insecurity is associated with obesity, depression, and other adverse health outcomes although little research has been focused on these relationships in underrepresented cultural and social groups. In this study we elucidate the relationship between food insecurity, community factors, dietary patterns, race/ethnicity and health among underrepresented women. Materials and Methods: The data for this investigation come from a cross-sectional survey of women drawn from five urban Utah communities of color, including African immigrants/refugees, African Americans, Hispanics, American Indians/Alaska Natives, and Pacific Islanders, and women from four rural Utah counties. Multivariate logistic regression was used to assess the relationship between food insecurity and obesity risk, self-reported depression, and self-assessed health. Results: Urban women of color were more likely to report food insecurity than rural non-Hispanic white women. Obesity and depression scores were positively associated with food insecurity. Conclusions: Utah women of color had higher levels of food insecurity than reported in state or national data, highlight an important disparity. Nutritional education initiatives, evaluating food assistance programs, and screenings in clinical settings targeting specific racial/ethnic groups may help address the disparities observed in this study.

Food insecurity among graduate students: prevalence and association with depression, anxiety and stress

OBJECTIVE

The impact of food insecurity on mental health has not yet been examined in graduate students, a population widely considered at elevated risk for financial strain and negative mental health outcomes. This study aimed to derive initial prevalence estimates of food insecurity in a sample of current graduate students at a large state university and to elucidate the relationship between food insecurity and depression, anxiety and stress in this sample.

DESIGN

Cross-sectional online survey including the US Household Food Security Survey Module: Six-Item Short Form and the Depression, Anxiety, and Stress Scales (DASS-21).

SETTING

University in the northeastern region of the USA.

PARTICIPANTS

Two hundred sixty-three graduate students.

RESULTS

In the present sample, 59·7 % of participants reported high/marginal food security, 18·5 % reported low food security and 21·8 % reported very low food security. Graduate students with very low food security reported significantly greater depression (η2 = 0·09), anxiety (η2 = 0·10) and stress (η2 = 0·10), compared with those with low food security and high food security (all P's < 0·001).

CONCLUSIONS

Food insecurity occurred in nearly half of the graduate students surveyed, and very low food security was associated with elevated levels of depression, anxiety and stress. Findings highlight the need to address food insecurity and associated elevated mental health problems present among graduate students.

Material hardship, prefrontal cortex-amygdala structure, and internalizing symptoms in children

Material hardship, or difficulty affording basic resources such as food, housing, utilities, and health care, increases children's risk for internalizing problems. The uncinate fasciculus (UNC) and two of the gray matter regions it connects-the orbitofrontal cortex (OFC) and amygdala-may play important roles in the neural mechanisms underlying these associations. We investigated associations among material hardship, UNC microstructure, OFC and amygdala structure, and internalizing symptoms in children. Participants were 5-9-year-old children (N = 94, 61% female) from socioeconomically diverse families. Parents completed questionnaires assessing material hardship and children's internalizing symptoms. High-resolution, T1-weighted magnetic resonance imaging (n = 51), and diffusion tensor imaging (n = 58) data were acquired. UNC fractional anisotropy (FA), medial OFC surface area, and amygdala gray matter volume were extracted. Greater material hardship was significantly associated with lower UNC FA, smaller amygdala volume, and higher internalizing symptoms in children, after controlling for age, sex, and family income-to-needs ratio. Lower UNC FA significantly mediated the association between material hardship and internalizing symptoms in girls but not boys. These findings are consistent with the notion that material hardship may lead to altered white matter microstructure and gray matter structure in neural networks critical to emotion processing and regulation.

Explaining Racial Inequality in Food Security in Columbus, Ohio: A Blinder-Oaxaca Decomposition Analysis

Food insecurity is a leading public health challenge in the United States. In Columbus, Ohio, as in many American cities, there exists a great disparity between Black and White households in relation to food insecurity. This study investigates the degree to which this gap can be attributed to differences in food shopping behavior, neighborhood perception, and socioeconomic characteristics. A Blinder–Oaxaca decomposition method is used to analyze a household survey dataset collected in 2014. We find a 34.2 percent point difference in food security between White and Black households. Variables related to food shopping behavior, neighborhood perception, and socioeconomic characteristics explain 13.8 percent, 11.6 percent, and 63.1 percent of the difference, respectively. These independent variables combined can explain 68.2 percent of the food security gap between White and Black households. Most of this is attributable to socioeconomic variables. Sense of friendship in neighborhood, use of private vehicles, and satisfaction of neighborhood food environment also partially contribute to the food security gap.

Extreme heat effects on perennial crops and strategies for sustaining future production

Extreme heat events will challenge agricultural production and raise the risk of food insecurity. California is the largest agricultural producer in the United States, and climate change and extreme heat may significantly affect the state's food production. This paper provides a summary of the current literature on crop responses to extreme heat, with a focus on perennial agriculture in California. We highlight contemporary trends and future projections in heat extremes, and the range of plant responses to extreme heat exposure, noting the variability in plant tolerance and response across season, crop, and cultivar. We also review practices employed to mitigate heat damage and the capacity for those practices to serve as adaptation options in a warmer and drier future. Finally, we discuss current and future research directions aimed at increasing the adaptive capacity of perennial agriculture to the increased heat exposure anticipated with climate change. Collectively, the literature reviewed makes clear the need to understand crop responses and tolerances to heat within the context of climate change and climate extremes in order to sustain crop production, preserve agricultural communities, and bolster food security at local, national, and global scales.

Beyond Net Worth: Racial Differences in Wealth Portfolios and Black-White Health Inequality across the Life Course

A large body of research links wealth and health, but most previous work focuses on net worth. However, the assets and debts that comprise wealth likely relate to health in different and meaningful ways. Furthermore, racial differences in wealth portfolios may contribute to racial health gaps. Using longitudinal data from the Panel Study of Income Dynamics (PSID) and mixed effects growth curve models, we examined the associations between various wealth components and multiple health outcomes. We also investigated whether black-white differences in wealth portfolios contributed to racial health inequality. We found that savings, stock ownership, and homeownership consistently improve health, but debt is associated with worse health, even after adjusting for total net worth. We found little evidence that home equity is associated with health. Findings also revealed differential health returns to assets by race. These findings provide new insights into the complex relationship among race, wealth, and health.

Impact of a farmers' market nutrition coupon programme on diet quality and psychosocial well-being among low-income adults: protocol for a randomised controlled trial and a longitudinal qualitative investigation

INTRODUCTION

Low-income populations have poorer diet quality and lower psychosocial well-being than their higher-income counterparts. These inequities increase the burden of chronic disease in low-income populations. Farmers' market subsidies may improve diet quality and psychosocial well-being among low-income populations. In Canada, the British Columbia (BC) Farmers' Market Nutrition Coupon Programme (FMNCP) aims to improve dietary patterns and health among low-income participants by providing coupons to purchase healthy foods from farmers' markets. This study will assess the impact of the BC FMNCP on the diet quality and psychosocial well-being of low-income adults and explore mechanisms of programme impacts.

METHODS AND ANALYSIS

In a parallel group randomised controlled trial, low-income adults will be randomised to an FMNCP intervention (n=132) or a no-intervention control group (n=132). The FMNCP group will receive 16 coupon sheets valued at CAD$21/sheet over 10-15 weeks to purchase fruits, vegetables, dairy, meat/poultry/fish, eggs, nuts and herbs at farmers' markets and will be invited to participate in nutrition skill-building activities. Overall diet quality (primary outcome), diet quality subscores, mental well-being, sense of community, food insecurity and malnutrition risk (secondary outcomes) will be assessed at baseline, immediately post-intervention and 16 weeks post-intervention. Dietary intake will be assessed using the Automated Self-Administered 24-hour Dietary Recall. Diet quality will be calculated using the Healthy Eating Index-2015. Repeated measures mixed-effect regression will assess differences in outcomes between groups from baseline to 16 weeks post-intervention. Furthermore, 25-30 participants will partake in semi-structured interviews during and 5 weeks after programme completion to explore participants' experiences with and perceived outcomes from the programme.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the University of Calgary Conjoint Health Research Ethics Board, Rutgers University Ethics and Compliance, and University of Waterloo Office of Research Ethics. Findings will be disseminated through policy briefs, conference presentations and peer-reviewed publications.

TRIAL REGISTRATION NUMBER

NCT03952338.

Hunger in Vulnerable Families in Southeastern Europe: Associations With Mental Health and Violence

Background: Hunger can influence healthy development of children and has been shown to be associated with other determinants of child health, such as violence within the family and maternal (mental) health problems. Whilst the majority of research has been conducted in high-income countries with vulnerable populations, less is known about the circumstances in low-and-middle-income countries. This study explored the experience of hunger in vulnerable families in three Southeastern European countries, and simultaneously examined relationships with four sets of risk factors—lack of financial, mental, familial, and social resources.

Methods: Families (N = 140) were recruited for a parenting intervention targeting child behavioral problems. Baseline data was collected on hunger, socioeconomic characteristics, mental health and wellbeing, family violence (i.e., child maltreatment and intimate partner violence), and social and emotional support. Univariate and multivariable risk factors of hunger were examined cross-sectionally with regression models.

Results: Overall, 31% of families experienced at least one form of hunger in the last month. Worse family functioning, current intimate partner violence, and more instances of child neglect showed univariate associations with family hunger. In hierarchical analysis, five risk factors remained significantly associated with the experience of hunger: lower adult educational, literacy level, emotional support, more children in the household and higher scores on parental depression, anxiety, and stress.

Conclusions: Hunger in Southeastern European families, among families with children showing elevated behavioral problems, was associated with more family violence, but specifically poorer mental health and less emotional support above and beyond socio-structural strains. Adapting parenting interventions to support the primary caregiver in getting more access to emotional support may potentially also change hunger and its association with health and violence. However, this hypothetical pathway of change needs explicit testing.

More to offer than books: stakeholder perceptions of a public library-based meal programme

OBJECTIVE

To examine the perspectives of librarians and staff about Lunch at the Library, a library-based summer meal programme for children. The study examines: (i) motivating factors behind implementing the meal programme; (ii) issues of feasibility; and (iii) perceived programme outcomes.

DESIGN

One-on-one semi-structured interviews with library stakeholders (librarians and staff) from a purposeful sample of California libraries.

SETTING

Twenty-two library jurisdictions across California that implemented the Lunch at the Library summer meal programme in 2015 in areas of high financial need.

PARTICIPANTS

Twenty-five library stakeholders representing twenty-two of the thirty-three Californian library jurisdictions that implemented Lunch at the Library at their sites.

RESULTS

Library stakeholders recognised the need for a child meal programme during summer. Despite lack of sufficient resources and personnel, they were motivated to implement the programme not only to fill a community need but also to ensure children at their libraries were primed for learning over the summer. Library stakeholders also perceived the public library's changing role in society as shifting from reference provision to social service provision either directly or by referral.

CONCLUSIONS

The public library is an ideal place to provide social services because of its accessibility to all. Librarians and library staff are motivated to address the social needs of their communities. This study demonstrates the feasibility of implementing new social programmes at public libraries. Funding to support these programmes would increase the library's capacity to address other community needs.

Household food insecurity is associated with depressive symptoms: results from a Mexican population-based survey

The objective of this cross-sectional study was to assess the relationship between food insecurity and depression in the Mexican population. We used data from the 2012 health and nutrition survey (ENSANUT), which is representative of the Mexican population. Food insecurity was determined by the Latin American and Caribbean Food Security Scale (ELCSA). Depressive symptoms were evaluated using the Center for Epidemiological Studies Depression Scale Short-Form (CES-D-SF). Adjusted logistic regression analyses and ANCOVA were used. Out of 33,011 participants, 5788 (18%) had high depressive symptoms and 24,098 (73%) experienced food insecurity. The adjusted logistic regression analysis showed that, participants with mild food insecurity, (OR = 1.47,95% CI = 1.27 to 1.71), moderate food insecurity (OR = 2.14,95% CI = 1.85 to 2.47) and severe food insecurity (OR = 3.01,95% CI = 2.51 to 3.60,) were more likely to have high depressive symptoms than food secure participants. Participants with moderate food insecurity (OR =1.45, 95% CI = 1.28 to 1.64) and severe food insecurity (OR =2.04, 95% CI = 1.76 to 2.37) were more likely to suffer from depression as compared to participants with mild food insecurity. Participants with severe food insecurity were more likely (OR=1.41, 95% CI = 1.21 to 1.65) to suffer from depression compared to participants with moderate food insecurity. This paper provides an overview of the complex problem of food insecurity and mental health. Despite the unknown causality, the analysis suggests a strong association between depression and food insecurity. This problem calls for much more attention from the scientific community. Given the high prevalence of depression and the high prevalence of household food insecurity in Mexico, the implementation of successful public health programs to improve food security is necessary.

Factors Associated with Food Insecurity Following Hurricane Harvey in Texas

Food insecurity prevalence among disaster-affected households has been found to be higher than state prevalence in non-disaster times. This study applies a socio-ecological model of post-disaster food insecurity to a nested quota sample (n = 1002) recruited for a web survey from 41 Texas counties affected by Hurricane Harvey 12-15 months post-event. This analysis identifies risk and protective factors for food insecurity. Chi-square analysis was used to examine independent associations between individual, household, and social factors with food insecurity. A multivariate logistic model was fitted and adjusted odds ratios are reported. Economic instability (adjusted odds ratio (OR) 2.43; 95% Confidence Interval (CI) 1.73, 3.41), relocation due to Hurricane Harvey (OR 1.89; CI 1.15, 3.09), major home damage (OR 2.11; CI 1.12, 3.98), non-white race - black (OR 1.79; CI 1.01, 3.18), Hispanic (OR 1.67; CI 1.09, 2.54), other race (OR 4.39; CI 1.96, 9.82) - and community-based organization assistance (1.99; 1.11, 3.58) were risk factors while older age (45-64 years: 0.49; 0.32, 0.73; 65+ years 0.40; 0.22, 0.75), better physical health (0.46; 0.29, 0.71), better mental health (0.46; 0.32, 0.67), and high social support (0.37; 0.25, 0.55) were protective against food insecurity. Disaster policies and programs should address the disproportionate burden on households that relocate or have health conditions. Fostering social support networks, especially among relocated populations, may improve disaster health outcomes.

Understanding and addressing social determinants to advance cancer health equity in the United States: A blueprint for practice, research, and policy

Although cancer mortality rates declined in the United States in recent decades, some populations experienced little benefit from advances in cancer prevention, early detection, treatment, and survivorship care. In fact, some cancer disparities between populations of low and high socioeconomic status widened during this period. Many potentially preventable cancer deaths continue to occur, and disadvantaged populations bear a disproportionate burden. Reducing the burden of cancer and eliminating cancer-related disparities will require more focused and coordinated action across multiple sectors and in partnership with communities. This article, part of the American Cancer Society's Cancer Control Blueprint series, introduces a framework for understanding and addressing social determinants to advance cancer health equity and presents actionable recommendations for practice, research, and policy. The article aims to accelerate progress toward eliminating disparities in cancer and achieving health equity.

Food insecurity and socio-demographic characteristics in two UK ethnic groups: an analysis of women in the Born in Bradford cohort

Background

The use of foodbanks has risen sharply in the UK; however, the epidemiology of UK food insecurity is undeveloped. This study contributes to the field by analysing socio-demographic risk factors for food insecurity in a female, ethnically diverse population.

Methods

Data from the Born in Bradford (BiB) cohort were matched with data on food insecurity from the nested BiB1000 study (N = 1280). Logistic regression was used to model food insecurity in relation to ethnicity and socio-demographic factors.

Results

Food insecurity, reported by 13.98% of the sample, was more likely among White British than Pakistani women (crude Odds Ratio (OR) 1.94, 95% CI: 1.37; 2.74, adjusted OR 2.37, 95% CI: 1.57; 3.59). In fully adjusted analyses, food insecurity was associated with a range of socio-economic measures, particularly the receipt of mean-tested benefits (adjusted OR 2.11, 95% CI: 1.41; 3.15) and perception of financial insecurity (adjusted OR 8.91, 95% CI: 4.14; 19.16 for finding it difficult/very difficult compared to living comfortably).

Conclusions

The finding that food insecurity prevalence may be higher than previously thought and that food insecurity is highly associated with socio-economic status, notably benefit receipt, is a cause for concern necessitating an urgent policy response.

Social, demographic, and economic correlates of food and chemical consumption measured by wastewater-based epidemiology

Wastewater is a potential treasure trove of chemicals that reflects population behavior and health status. Wastewater-based epidemiology has been employed to determine population-scale consumption of chemicals, particularly illicit drugs, across different communities and over time. However, the sociodemographic or socioeconomic correlates of chemical consumption and exposure are unclear. This study explores the relationships between catchment specific sociodemographic parameters and biomarkers in wastewater generated by the respective catchments. Domestic wastewater influent samples taken during the 2016 Australian census week were analyzed for a range of diet, drug, pharmaceutical, and lifestyle biomarkers. We present both linear and rank-order (i.e., Pearson and Spearman) correlations between loads of 42 biomarkers and census-derived metrics, index of relative socioeconomic advantage and disadvantage (IRSAD), median age, and 40 socioeconomic index for area (SEIFA) descriptors. Biomarkers of caffeine, citrus, and dietary fiber consumption had strong positive correlations with IRSAD, while tramadol, atenolol, and pregabalin had strong negative correlation with IRSAD. As expected, atenolol and hydrochlorothiazide correlated positively with median age. We also found specific SEIFA descriptors such as occupation and educational attainment correlating with each biomarker. Our study demonstrates that wastewater-based epidemiology can be used to study sociodemographic influences and disparities in chemical consumption.

Low-income workers' perceptions of wages, food acquisition, and well-being

Although studies have demonstrated an association between increased economic resources and improvements in food security and health, there is a paucity of qualitative research regarding the relationships between household resources, food security, and health. Policy changes related to increasing low wages are potential opportunities to understand changes to material resources. The aims of this analysis were to describe how low-wage workers perceive household resources in relation to food acquisition and to explore how workers in low-wage jobs connect food and diet to perceptions of health and well-being. We analyzed 190 transcripts from 55 workers in low-wage jobs who were living in households with children who were part of the Seattle Minimum Wage Study (up to three in-depth qualitative interviews and one phone survey per participant, conducted between 2015 and 2017). We coded and analyzed interviews using Campbell's food acquisition framework and best practices for qualitative research. Participants relied on a combination of wages, government assistance, and private assistance from community or family resources to maintain an adequate food supply. Strategies tended to focus more on maintaining food quality than food quantity. Restricted resources also limited food-related leisure activities, which many participants considered important to quality of life. Although many low-wage workers would like to use additional income to purchase higher quality foods or increase food-related leisure activities, they often perceive trade-offs that limit income-based adjustments to food-spending patterns. Future studies should be specifically designed to examine food choices in response to changes in income.

Early maturity, shortened stature, and hardship: Can life-history trade-offs indicate social stratification and income inequality in the United States?

OBJECTIVE

Life-history strategies promote reproductive fitness and survival. Limited energy availability and competing energetic demands between life-history decisions may result in organismal trade-offs leading to selection for "optimal" traits that facilitate fitness and survival in present environmental conditions. Few life-history analyses have been conducted in food abundant/high resource human populations. Here, we use a life-history theory framework integrated with a biocultural approach to assess whether trade-offs between growth (height) and the onset of reproductive maturation (ages at menarche) were observed in a sample of adult women living in the United States.

METHODS

Adult women (18 years and older) from the National Health and Nutrition Examination Survey (NHANES) 2005 to 2006 were analyzed using complex survey regression to evaluate associations between ages at menarche, height, and biological, socio-economic, demographic, and anthropometric variables. Associations between stature, ages at menarche, and socio-economic status (household income and education level) suggest life-history trade-offs in this populations may be mitigated by access to resources and marginalization.

CONCLUSIONS

These study results have applied public health implications. We demonstrate that females who experience early menarche in the US population achieve short stature. Our study also demonstrates the need for implementing life-history analyses in Western affluent populations, where marginalization may result in life-history trade-offs.

Using a gender lens to understand eating behaviours of adolescent females living in low-income households in Bangladesh

Adolescence is a critical period characterized by rapid physical, psychological, and social development and growth. In Bangladesh, high rates of undernutrition persist among adolescent females living in low‐income households. Prevalence of adolescent marriage and pregnancy is extremely high, with almost half of Bangladeshi women giving birth by 18 years of age. Qualitative research was carried out from April to June 2017 to examine individual, social, and environmental factors influencing eating behaviours of female adolescents between 15 and 19 years of age living in low‐income families in urban and rural settings in Bangladesh. Methods included freelisting exercises (33), key informant interviews (11), in‐depth interviews (24), direct observations (16), and focus group discussions (12). Findings show that household food insecurity necessitates adjustments in meal food quality and frequency. Gender norms prescribe that females receive small meal portions and make sacrifices in food consumption so that male family members can eat more. Work and school schedules cause long breaks between meal consumption, restricting food intake of adolescent females for extended periods. Gender discrimination and its manifestations likely amplify susceptibility to psychological stresses in adolescent females. An inferior social position makes adolescent females living in food insecure households vulnerable to undernutrition, with factors affecting food deprivation increasing as they approach childbearing. Policies to increase age of marriage and reduce adolescent pregnancy must continue. Programmes must ensure that school‐going adolescents eat adequately during the school day. Prolonging school education and strengthening the economic viability of women should alter cultural expectations regarding marriage age and normative female roles.

Food Insecurity Among Transgender and Gender Nonconforming Individuals in the Southeast United States: A Qualitative Study

Purpose: Transgender and gender nonconforming (TGNC) people experience high rates of poverty, joblessness, and homelessness, which drive risk for food insecurity. TGNC people also face discrimination due to transphobia and cissexism, which may contribute to these drivers. Minimal empirical evidence describes experiences with food insecurity among TGNC people. This project investigated food insecurity among TGNC people and how these experiences relate to their physical and mental health. Methods: Semistructured telephone interviews were conducted with 20 TGNC people residing in the Southeast United States (U.S.), recruited through social media. Interviews were transcribed and qualitatively coded. Results: TGNC people reported living in extreme poverty. They described how the conservative sociopolitical climate of the Southeast United States made it difficult to find and maintain employment, which was a primary driver of food insecurity. Participants experienced discomfort seeking food assistance due to discrimination and concern for reducing emergency food availability for people in greater need. Stress from unemployment and underemployment, inadequate food supplies, and discrimination was reported as a contributor to poor physical and mental health, and weakened support systems. Conclusion: Poverty and food insecurity erode TGNC people's physical and mental health and support systems. TGNC people faced substantial barriers-including unemployment and underemployment and multilevel discrimination-which prevented them from affording adequate food. Public health solutions include implementing employment nondiscrimination policy to protect TGNC people in the workplace and building relationships between local food pantries and LGBT organizations to create safer environments for all persons in need of food assistance.