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

Food banks: Understanding their role in the food insecure population in the UK

The present paper reviews the growing body of literature on food insecurity and food bank use in the UK. It provides an overview of food insecurity in this context, followed by a description of the emergence of food banks, highlighting how any role that food banks play in the food insecure population is limited. Data on food insecurity and food bank use suggest many people experiencing food insecurity do not receive help from food banks. To better understand the factors influencing the relationship between food insecurity and food bank use, a conceptual framework is outlined, suggesting the relationship is far from straightforward and contingent on many factors. The nature and availability of food banks and other local support services and individual-level factors influence the likelihood of food banks being used in the context of food insecurity. Then, the extent to which food banks can impact food insecurity is also dependent on the quantity and quality of food distributed, as well as other support services offered from food banks. Closing reflections highlight rising living costs and food banks reporting that they do not have capacity to cope with increasing demand, underscoring the need for policy interventions. Reliance on food banks to respond to food insecurity may ultimately impede formulation of effective policy interventions to reduce food insecurity, giving the illusion of widespread available support, whilst food insecurity persists among those receiving help from food banks and those who experience food insecurity but do not use food banks.

Navigating cultural competence in district nursing

Cultural diversity is an evolving feature of modern-day society. It is recognised that many factors contribute to culturally competent care and evidence suggests there are still inequalities in care provision to some populations. District nurses (DN) deliver care to individuals', families and communities across varying demographics, and aim to provide high quality evidencebased, person-centred care. The scope of the DN and the community nursing team's practice is far reaching and extends across generations and an array of chronic complex health conditions. Therefore, it is imperative that DNs are aware of aspects surrounding cultural diversity, to ensure they can holistically assess and manage patients on their caseloads and support teams to practice culturally competent care. This article aims to provide an outline of key areas for exploration in cultural competence. It will highlight communication, pain, end of life, nutrition and health disparities to consider barriers and challenges for district nursing practice.

The public health implications of the cost-of-living crisis: outlining mechanisms and modelling consequences

The UK, and other high-income countries, are experiencing substantial increases in living costs. Several overlapping and intersecting economic crises threaten physical and mental health in the immediate and longer term. Policy responses may buffer against the worst effects (e.g. welfare support) or further undermine health (e.g. austerity). We explore fundamental causes underpinning the cost-of-living crisis, examine potential pathways by which the crisis could impact population health and use a case study to model potential impacts of one aspect of the crisis on a specific health outcome. Our modelling illustrates how policy approaches can substantially protect health and avoid exacerbating health inequalities. Targeting support at vulnerable households is likely to protect health most effectively. The current crisis is likely to be the first of many in era of political and climate uncertainty. More refined integrated economic and health modelling has the potential to inform policy integration, or 'health in all policies'.

Child and adolescent food insecurity in South Africa: A household-level analysis of hunger

Food insecurity impacts childhood nutritional status, physical and cognitive development, and increases lifetime risk for chronic disease. Previous South African studies have examined hunger at the sub-national level without a specific focus on children and adolescents. This study determines the national prevalence of childhood food insecurity, from birth to adolescence, and identifies factors associated with hunger within the household. Individual and household-level data were extracted from the South African National Health and Nutrition Examination Survey (SANHANES-1). Prevalence of food insecurity was assessed using the Community Childhood Hunger Identification Project (CCHIP) index. Multinomial logistic regression analyses were conducted on all households (with and without children) to determine the predictors of food insecurity, with additional analyses adjusting for child dependency and sociodemographic characteristics of household heads in households with children. Of 5 098 households surveyed, 68.6% had children and adolescents present (0-19 years). Of these households, 32.5% (95% Confidence Interval [CI]: 29.5-35.7) were experiencing hunger and 26.3% (95% CI: 23.9-28.8) were at risk of hunger. Among all the households, significant associations for experiencing hunger were the presence of children and adolescents: Adjusted Odds Ratio (AOR) = 1.68 (95% CI: 1.12-2.53); being female-headed: AOR = 1.53 (95% CI: 1.21-1.94) and informally-located; AOR = 1.6 (95% CI: 1.07-2.43). Of the racial groups, having a non-African household head, Coloured: AOR = 0.29 (95% CI: 0.19-0.44) and White/Indian/Asian: AOR = 0.12 (95% CI: 0.04-0.33) conferred lower odds of experiencing hunger; and, the household head having secondary/tertiary education conferred lower odds of experiencing hunger; AOR = 0.40 (95% CI: 0.28-0.56) as well as being at risk of hunger; AOR = 0.69 (95% CI: 0.52-0.92). Receiving social grants, pensions, or remittances more than doubled the odds of experiencing hunger; AOR = 2.15 (95% CI: 1.49-3.09). After adjusting for child dependency in households with children, having at least one older child (age 15-19 years old) did not change the odds of food insecurity. In summary, only 41% of South African households with children and adolescents were food secure. The associations between household head sociodemographics, household location and size on household food insecurity indicate a need for multi-sectoral interventions to bolster sustainable food systems for households with children and adolescents and to improve public protections for female-headed, African-headed and informally-located households dependent on social grants.

Meeting report: plant-rich dietary patterns and health

Dietary patterns (DP) rich in plant foods are associated with improved health and reduced non-communicable disease risk. In October 2021, the Nutrition Society hosted a member-led conference, held online over 2 half days, exploring the latest research findings examining plant-rich DP and health. The aim of the present paper is to summarise the content of the conference and synopses of the individual speaker presentations are included. Topics included epidemiological analysis of plant-rich DP and health outcomes, the effects of dietary interventions which have increased fruit and vegetable (FV) intake on a range of health outcomes, how adherence to plant-rich DP is assessed, the use of biomarkers to assess FV intake and a consideration of how modifying behaviour towards increased FV intake could impact environmental outcomes, planetary health and food systems. In conclusion, although there are still considerable uncertainties which require further research, which were considered as part of the conference and are summarised in this review, adopting a plant-rich DP at a population level could have a considerable impact on diet and health outcomes, as well as planetary health.

Food insecurity among Finnish private service sector workers: validity, prevalence and determinants

OBJECTIVE

To examine the prevalence and determinants of food insecurity among private sector service workers in Finland and assess validity of the Household Food Insecurity Access Scale (HFIAS) tool.

DESIGN

In this cross-sectional study, food insecurity and background characteristics were collected from Finnish private service workers via electronic questionnaires (2019) and national register data (2018-2019). We conducted univariate and multivariate logistic regression analyses to determine the variables explaining food insecurity. Validity of HFIAS was assessed with rotated principal component analysis and Cronbach's α.

SETTING

Members of the trade union for private sector service workers, Service Union United (PAM), from all municipalities in Finland participated in the study in 2019.

PARTICIPANTS

The subjects were 6435 private sector workers that were members of the Service Union United (PAM) in Finland. Mean age of participants was 44 years (sd 12·7 years).

RESULTS

Two-thirds of the participants (65 %) were food insecure with over a third (36 %) reporting severe food insecurity. Reporting great difficulties in covering household expenses and young age markedly increased the risk of severe food insecurity (OR 15·05; 95 % CI 10·60, 21·38 and OR 5·07; 95 % CI 3·94, 6·52, respectively). Not being married, low education, working in the hospitality industry, being male and living in rented housing also increased the probability of severe food insecurity. The HFIAS tool demonstrated acceptable construct and criterion validity.

CONCLUSIONS

Severe food insecurity was widespread and associated with low socio-economic status, young age and being male among Finnish private sector service workers, emphasising the need for regular monitoring of food insecurity in Finland.

'When will this end? Will it end?' The impact of the March-June 2020 UK COVID-19 lockdown response on mental health: a longitudinal survey of mothers in the Born in Bradford study

OBJECTIVES

To explore clinically important increases in depression/anxiety from before to during the first UK COVID-19 lockdown and factors related to this change, with a particular focus on ethnic differences.

DESIGN

Pre-COVID-19 and lockdown surveys nested within two longitudinal Born in Bradford cohort studies.

PARTICIPANTS

1860 mothers with a child aged 0-5 or 9-13, 48% Pakistani heritage.

MAIN OUTCOME MEASURES

ORs for a clinically important increase (5 points or more) in depression (eight item Patient Health Questionnaire (PHQ-8)) and anxiety (Generalised Anxiety Disorder Assessment (GAD-7)) in unadjusted regression analyses, repeated with exposures of interest separated by ethnicity to look for differences in magnitude of associations, and lived experience of mothers captured in open text questions.

RESULTS

The number of women reporting clinically important depression/anxiety increased from 11% to 20% (95% CI 10%-13%; 18%-22%) and from 10% to 16% (95% CI 8%-11%; 15%-18%), respectively. Increases in depression/anxiety were associated with loneliness (OR=8.37, 95% CI 5.70 to 12.27; 8.50, 95% CI 5.71 to 12.65, respectively); financial (6.23, 95% CI 3.96 to 9.80; 6.03, 95% CI 3.82 to 9.51), food (3.33, 95% CI 2.09 to 5.28; 3.46, 95% CI 2.15 to 5.58) and housing insecurity (3.29, 95% CI 2.36 to 4.58; 3.0, 95% CI 2.11 to 4.25); a lack of physical activity (3.13, 95% CI 2.15 to 4.56; 2.55, 95% CI 1.72 to 3.78); and a poor partner relationship (3.6, 95% CI 2.44 to 5.43; 5.1, 95% CI 3.37 to 7.62). The magnitude of associations between key exposures and worsening mental health varied between ethnic groups.Responses to open text questions illustrated a complex interplay of challenges contributing to mental ill health including: acute health anxieties; the mental load of managing multiple responsibilities; loss of social support and coping strategies; pressures of financial and employment insecurity; and being unable to switch off from the pandemic.

CONCLUSIONS

Mental ill health has worsened for many during the COVID-19 lockdown, particularly in those who are lonely and economically insecure. The magnitude of associations between key exposures and worsening mental health varied between ethnic groups. Mental health problems may have longer term consequences for public health and interventions that address the potential causes are needed.

Sex and age differences in attitudes and intention to adopt personalised nutrition in a UK sample

AIM

There has been an increase in the development of technologies that can deliver personalised dietary advice. Devising healthy, sustainable dietary plans will mean taking into consideration extrinsic factors such as individual social circumstances. The aim of this study was to identify societal groups more or less receptive to and likely to engage with personalised nutrition initiatives.

SAMPLE AND METHODS

Volunteers were recruited via a social research agency from within the UK. The resultant sample (N = 1061) was 49% female, aged 18-65 years.

RESULTS

MANOVA (Tukey HSD applied) indicated that females and younger people (aged 18-29 years) had more favourable attitudes and were more likely to intend to adopt personalised nutrition. There were no differences in attitude toward or intention to adopt personalised nutrition between different education levels, income brackets or occupational groups.

CONCLUSION

These results imply that females and younger people may be most likely to adopt personalised nutrition in the future. Initiatives to promote healthy eating should target males and older people.

Prevalence and risk factors of food insecurity among Libyan migrant families in Australia

Background

The burden of food insecurity remains a public health challenge even in high income countries, such as Australia, and especially among culturally and linguistically diverse (CALD) communities. While research has been undertaken among several migrant communities in Australia, there is a knowledge gap about food security within some ethnic minorities such as migrants from the Middle East and North Africa (MENA). This study aims to determine the prevalence and correlates of food insecurity among Libyan migrant families in Australia.

Methods

A cross-sectional design utilising an online survey and convenience sampling was used to recruit 271 participants, each representing a family, who had migrated from Libya to Australia. Food security was measured using the single-item measure taken from the Australian Health Survey (AHS) and the 18-item measure from the United States Department of Agriculture Household Food Security Survey Module (USDA HFSSM). Multivariable logistic regression was used to identify independent correlates associated with food insecurity.

Results

Using the single-item measure, the prevalence of food insecurity was 13.7% whereas when the 18-item questionnaire was used, more than three out of five families (72.3%) reported being food insecure. In the multivariable logistic regression analysis for the single-item measure, those living alone or with others reported higher odds of being food insecure (AOR = 2.55, 95% CI 1.05, 6.21) compared to those living with their spouse, whereas higher annual income (≥AUD 40,000) was associated with lower odds of food insecurity (AOR = 0.30, 95% CI 0.11, 0.84). Higher annual income was also associated with lower odds of food insecurity (AOR = 0.49, 95% CI 0.25, 0.94) on the 18-item measure. On both single and 18-item measures, larger family size (AOR = 1.27, 95% CI 1.07, 1.49 and AOR = 1.21, 95% CI 1.01, 1.47 respectively) was associated with increased odds of food insecurity.

Conclusion

This study provides evidence that food insecurity amongst Libyan migrants in Australia is a widespread problem and is associated with a number of sociodemographic and socio-economic factors. The findings of this study serve to contribute to the depth and breadth of food security research among vulnerable communities, in this instance Libyan migrant families.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12202-9.

Influences of News and Social Media on Food Insecurity and Hoarding Behavior During the COVID-19 Pandemic

OBJECTIVES

The aim of this study was to examine how sociodemographic variables and frequency of media consumption affect hoarding behavior and food insecurity concerns during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

A quantitative, nonexperimental, correlational online survey was administered using a convenience sample of 203 participants from the United Kingdom with no medical issues that affected buying behavior during the pandemic to examine perceptions related to food insecurity, and self-reported food hoarding behavior.

RESULTS

Younger adults and lower income groups reported higher food insecurity perceptions and hoarding behaviors. Consuming COVID-19 information from websites was significantly associated with food insecurity perceptions, while information from social media was significantly associated with more food hoarding behaviors.

CONCLUSIONS

Younger adults and lower income groups are vulnerable populations from the perspective of food insecurity and hoarding behavior in times of health disasters like pandemics. While social media can play a positively catalytic role during crises, excessive online information and misinformation can contribute negatively to public panic and feelings of insecurity. Implications for disaster preparedness and future research are discussed. The findings suggest that age is the main predictor of food insecurity and hoarding behavior, with younger adults more likely to be affected. They also suggest that people are turning to National Health Service (NHS) websites, which were deemed more trustworthy than social media, to avoid "news fatigue" and avoiding speculation. Suggestions for future research were made, specifically to examine people's social support during the pandemic to understand its potential link to stockpiling behavior or food insecurity concerns.

Food insecurity: Its prevalence and relationship to fruit and vegetable consumption

BACKGROUND

Food insecurity in UK households is a substantial and growing concern. The present study identified those at risk of food insecurity and explored the relationship between food security and fruit and vegetable consumption.

METHODS

Data were examined from the Food and You survey (2016) for a large representative sample (n = 3118) living in England, Wales and Northern Ireland. A 'Food Security Score' and a 'Food Changes Score' (relating to financially driven changes to food habits) were compiled and relationships with fruit and vegetable consumption were examined.

RESULTS

The prevalence of marginal, low and very low food security was 12.6%, 5.4% and 2.8%, respectively. Significant correlations were observed between food security and fruit and vegetable consumption. Food security and food changes, independently, were significant predictors for fruit and vegetable consumption. With every unit increment in the Food Security Score (i.e., more food insecure), an 11% decrease in the odds of being a high fruit and vegetable consumer was evident. Likewise, the odds of being a high fruit and vegetable consumer decreases by 5% with every increment in the financially driven Food Changes Score.

CONCLUSIONS

A notable proportion (more than one-fifth) experienced marginal, low or very low food security. Food insecurity and financially driven food changes were accompanied by decreases in the odds of being a high fruit and vegetable consumer. Findings underline the potential consequences of food insecurity, and point to further work aiming to examine other dietary implications, as well as strategies to mitigate against food insecurity and its detriment.

"The reality is that on Universal Credit I cannot provide the recommended amount of fresh fruit and vegetables per day for my children": Moving from a behavioural to a systemic understanding of food practices [version 1; peer review: 2 approved]

BACKGROUND

Evidence suggests that people living in poverty often experience inadequate nutrition with short and long-term health consequences. Whilst the diets of low-income households have been subject to scrutiny, there is limited evidence in the UK on the diet quality and food practices of households reporting food insecurity and food bank use. We explore lived experiences of food insecurity and underlying drivers of diet quality among low-income families, drawing upon two years of participatory research with families of primary school age children.

METHODS

We report on a mixed-methods study of the relationship between low income, food bank use, food practices and consumption from a survey of 612 participants, including 136 free text responses and four focus groups with 22 participants. The research followed a parallel mixed-methods design: qualitative and quantitative data were collected separately, although both were informed by participatory work. Quantitative data were analysed using binary and multinomial logistic regression modelling; qualitative data were analysed thematically.

RESULTS

Lower income households and those living with food insecurity struggle to afford a level of fruit and vegetable consumption that approaches public health guidance for maintaining a healthy diet, despite high awareness of the constituents of a healthy diet. Participants used multiple strategies to ensure as much fruit, vegetable and protein consumption as possible within financial constraints. The quantitative data suggested a relationship between higher processed food consumption and having used a food bank, independent of income and food security status.

CONCLUSIONS

The findings suggest that individualised, behavioural accounts of food practices on a low-income misrepresent the reality for people living with poverty. Behavioural or educational interventions are therefore likely to be less effective in tackling food insecurity and poor nutrition among people on a low income; policies focusing on structural drivers, including poverty and geographical access to food, are needed.

Female sex and food insecurity in relation to self-reported poor or fair mental health in Canadian adults: a cross-sectional study using national survey data

BACKGROUND

Women with food insecurity are at higher risk for mental health disorders. This study examined the joint effect of female sex and food insecurity on self-reported poor or fair mental health in Canadian adults.

METHODS

The analysis was based on data from adults (age ≥ 18 yr) who participated in the Canadian Community Health Survey (CCHS) 2015-2016. We determined past-year food security level (secure, moderately insecure or severely insecure) based on 18 questions. We used log-binomial regression to explore associations of sex and food insecurity with self-reported poor or fair mental health. We measured additive interaction between female sex and food insecurity using relative excess risk due to interaction (RERI).

RESULTS

The overall response rate for the CCHS was 59.5%. Data for 61 446 respondents were analyzed. Poor or fair mental health was reported by 4107 participants (6.1% when weighted to the Canadian population). Increased risk of poor or fair mental health was associated with female sex (prevalence ratio [PR] 1.22, 95% confidence interval [CI] 1.12 to 1.31), and moderate (PR 2.50, 95% CI 2.21 to 2.82) and severe (PR 4.03, 95% CI 3.59 to 4.52) food insecurity. Significant additive interaction between female sex and severe food insecurity was found for those aged 40-64 years (RERI 1.38, 95% CI 0.29 to 2.47), and the PR for poor or fair mental health for severely food-insecure women was 5.55 (95% CI 4.48 to 6.89) compared to food-secure men of the same age group.

INTERPRETATION

Poor or fair mental health is common in the food-insecure population, and there exists synergism between female sex and severe food insecurity among middle-aged people. This suggests the need to develop targeted mental health support strategies for food-insecure people, specifically middle-aged women.

Is the modified household food security survey (HFSS) questionnaire a practical tool for screening food insecurity? Evidence from northwest of Iran

BACKGROUND

Adequate supplies of food and food security (FS) are the fundamental aspects of human societies, and considered one of the pivotal factors of individual and social health. The aim of the present study was to assess the applicability of the short questionnaire for screening food insecurity (FI) and to evaluate the prevalence of FI in northwest of Iran.

METHODS

In this study, 550 subjects aged ≥16 years were studied. Three-day dietary records and a short questionnaire were applied to estimate the prevalence of FI in terms of hunger and hidden hunger. The sensitivity, specificity and accuracy of the short questionnaire were assessed. Moreover, the association between the results of the short questionnaire and the criteria that were theoretically related to FI were examined. Data were presented as mean (SD), median (min-max) for the numeric normal and non-normal variables, respectively, and frequency (percent) for categorical variables. The between-group comparisons of variables were done using independent samples t test. P values less than 0.05 were considered statistically significant.

RESULTS

The prevalence of hunger and hidden hunger was 30.8 and 46.0%, respectively. Overall, 23.2% of the subjects were classified as "food secure". The sensitivity, specificity and accuracy of the short questionnaire in determining hunger were 92.8% (95% CI: 87.3-95.9), 84.2% (95% CI: 79.3-89.3), and 87% (95% CI: 84-90.2), respectively. These values for hidden hunger were 21.6% (95% CI: 15.7-29.9), 92.3% (95% CI: 88.7-99.4), and 53.4% (95% CI: 47.9-59.8), respectively. Our study showed a statistically significant association between FI and socio-economic status. FI significantly enhanced the risk of underweight, while it markedly reduced the risk of overweight and obesity. The average frequency of monthly consumption of meat, dairy products, fruits, vegetables, and rice was significantly lower in food insecure group, while the median frequency of bread consumption was markedly higher in food insecure group. The participants of insecure group were less likely to consume fruits, vegetables, dairy products, rice and meat.

CONCLUSIONS

FI was frequent in North-west of Iran. The findings indicated that the short questionnaire was a simple, low-cost and practical tool for screening FI in terms of hunger.

TRIAL REGISTRATION

IR.TBZMED.REC.1397.400.

How COVID-19 has exposed inequalities in the UK food system: The case of UK food and poverty

This article draws upon our perspective as academic-practitioners working in the fields of food insecurity, food systems, and inequality to comment, in the early stages of the pandemic and associated lockdown, on the empirical and ethical implications of COVID-19 for socio-economic inequalities in access to food in the UK. The COVID-19 pandemic has sharpened the profound insecurity of large segments of the UK population, an insecurity itself the product of a decade of ‘austerity’ policies. Increased unemployment, reduced hours, and enforced self-isolation for multiple vulnerable groups is likely to lead to an increase in UK food insecurity, exacerbating diet-related health inequalities. The social and economic crisis associated with the pandemic has exposed the fragility of the system of food charity which, at present, is a key response to growing poverty. A vulnerable food system, with just-in-time supply chains, has been challenged by stockpiling. Resultant food supply issues at food banks, alongside rapidly increasing demand and reduced volunteer numbers, has undermined many food charities, especially independent food banks. In the light of this analysis, we make a series of recommendations. We call for an immediate end to the five week wait for Universal Credit and cash grants for low income households. We ask central and local government to recognise that many food aid providers are already at capacity and unable to adopt additional responsibilities. The government’s - significant - response to the economic crisis associated with COVID-19 has underscored a key principle: it is the government’s responsibility to protect population health, to guarantee household incomes, and to safeguard the economy. Millions of households were in poverty before the pandemic, and millions more will be so unless the government continues to protect household incomes through policy change.

Socio-demographic characteristics, diet and health among food insecure UK adults: cross-sectional analysis of the International Food Policy Study

OBJECTIVE

To estimate food insecurity (FI) prevalence among UK adults and investigate associations with socio-demographic characteristics, diet and health.

DESIGN

Weighted cross-sectional survey data. FI was measured using the USDA Adult Food Security Survey Module. Data were analysed using adjusted logistic regression models.

SETTING

United Kingdom.

PARTICIPANTS

2551 participants (aged 18-64 years); sub-sample (n 1949) used to investigate association between FI and overweight.

RESULTS

FI prevalence was 24·3 %. Higher odds of FI were observed among participants who reported that making ends meet was difficult v. easy (OR 19·76, 95 % CI 13·78, 28·34), were full-time students v. non-students (OR 3·23, 95 % CI 2·01, 5·18), had low v. high education (OR 2·30, 95 % CI 1·66, 3·17), were male v. female (OR 1·36, 95 % CI 1·01, 1·83) and reported their ethnicity as mixed (OR 2·32, 95 % CI 1·02, 5·27) and white other (OR 2·04, 95 % CI 1·04, 3·99) v. white British. Odds of FI were higher in participants living with children v. alone, especially in single-parent households (OR 2·10, 95 % CI 1·19, 3·70). Odds of FI decreased per year of increase in age (OR 0·95, 95 % CI 0·94, 0·96) and were lower in participants not looking for work v. full-time employed (OR 0·60, 95 % CI 0·42, 0·87). Food insecure v. food secure adults had lower odds of consuming fruits (OR 0·59, 95 % CI 0·47, 0·74) and vegetables (OR 0·68, 95 % CI 0·54, 0·86) above the median frequency, and higher odds for fruit juice (OR 1·39, 95 % CI 1·10, 1·75). Food insecure v. food secure adults had higher odds of reporting unhealthy diets (OR 1·65, 95 % CI 1·31, 2·10), poor general health, (OR 1·90, 95 % CI 1·50, 2·41), poor mental health (OR 2·10, 95 % CI 1·64, 2·69), high stress (OR 3·15, 95 % CI 2·42, 4·11) and overweight (OR 1·32, 95 % CI 1·00, 1·75).

CONCLUSIONS

FI prevalence was high and varied by socio-demographic characteristics. FI was associated with poorer diet and health.

Factors associated with food insecurity among older homeless adults: results from the HOPE HOME study

BACKGROUND

The US homeless population is aging. Older adults and those living in poverty are at a high risk of food insecurity.

METHODS

We conducted a cross-sectional analysis of baseline data from a population-based study of 350 homeless adults aged ≥50. We assessed food security and receipt of food assistance. We used multivariable logistic regression to examine factors associated with very low food security.

RESULTS

The majority of the cohort was male and African American. Over half (55.4%) met criteria for food insecurity, 24.3% reported very low food security. Half (51.7%) reported receiving monetary food assistance. In the multivariable model, those who were primarily sheltered in the prior 6 months, (multi-institution users [AOR = 0.44, 95% CI: 0.22-0.86]) had less than half the odds of very low food security compared with those who were unsheltered. Depressive symptoms (AOR = 3.01, 1.69-5.38), oral pain (AOR = 2.15, 1.24-3.74) and cognitive impairment (AOR = 2.21, 1.12-4.35) were associated with increased odds of very low food security.

CONCLUSIONS

Older homeless adults experience a high prevalence of food insecurity. To alleviate food insecurity in this population, targeted interventions must address specific risk groups.

Hidden hunger? Experiences of food insecurity amongst Pakistani and white British women

PURPOSE

Foodbank use in the UK is rising but, despite high levels of poverty, Pakistani women are less likely to use food banks than white British women. The purpose of this paper is to understand the lived experience of food in the context of poverty amongst Pakistani and white British women in Bradford, including perspectives on food aid.

DESIGN/METHODOLOGY/APPROACH

A total of 16 Pakistani and white British women, recruited through community initiatives, participated in three focus groups (one interview was also held as a consequence of recruitment difficulties). Each group met for two hours aided by a moderator and professional interpreter. The transcripts were analysed thematically using a three-stage process.

FINDINGS

Women in low-income households employed dual strategies to reconcile caring responsibilities and financial obligations: the first sought to make ends meet within household income; the second looked to outside sources of support. There was a reported near absence of food insecurity amongst Pakistani women which could be attributed to support from social/familial networks, resource management within the household, and cultural and religious frameworks. A minority of participants and no Pakistani respondents accessed charitable food aid. There were three reasons for the non-use of food aid: it was not required because of resource management strategies within the household and assistance from familial/social networks; it was avoided out of shame; and knowledge about its existence was poor.

ORIGINALITY/VALUE

This case study is the first examination of varying experiences of food insecurity amongst UK white British and Pakistani women. Whilst the sample size is small, it presents new evidence on perceptions of food insecurity amongst Pakistani households and on why households of varying ethnicities do not use food aid.

Significant differences in maternal child-feeding style between ethnic groups in the UK: the role of deprivation and parenting styles

BACKGROUND

Nonresponsive maternal child-feeding interactions, such as restricting, pressurising and emotional feeding, can affect the ability of a child to self-regulate intake and increase the risk of becoming overweight. However, despite findings that South Asian and Black children living in the UK are more likely to be overweight, UK research has not considered how maternal child-feeding style might differ between ethnic groups. The present study aimed to explore variations in maternal child-feeding style between ethnic groups in the UK, taking into account associated factors such as deprivation and parenting style.

METHODS

Six hundred and fifty-nine UK mothers with a child who was aged 5-11 years old completed a questionnaire. Items included ethnicity and demographic data, as well as copies of the Child Feeding Questionnaire, Parental Feeding Styles Questionnaire and Parenting Styles and Dimensions Questionnaire.

RESULTS

Significant differences in perceived responsibility (P = 0.002), restriction (P = 0.026), pressure to eat (P = 0.045), instrumental feeding (P = 0.000) and emotional feeding (P = 0.000) were found between the groups. Mothers from South Asian backgrounds reported higher levels of pressure to eat, emotional feeding and indulgent feeding styles, whereas mothers from Chinese backgrounds reported greater perceived responsibility and restriction. Mothers from Black and White British backgrounds were not significantly higher with respect to any behaviour. Maternal child-feeding style was also associated with deprivation and parenting style, although these did not fully explain the data.

CONCLUSIONS

Understanding cultural factors behind maternal child-feeding style, particularly around pressurising and indulgent feeding behaviours, may play an important part in reducing levels of children who are overweight and obese in the UK.

Prevalence of food insecurity among food bank users in Germany and its association with population characteristics

The prevalence of food insecurity (FI) among food bank users in many European countries is unknown. The study aims to examine FI prevalence and associated population characteristics among this particular group of disadvantaged people in Germany. Food insecurity status was assessed among 1033 adult food bank users with a mean age of 53 years (57% female, 43% male) in Germany in 2015 using the food insecurity experience scale (FIES). About half of the participants (55.8%) were single with no children and born in Germany. Over 37% had a self-reported BMI of 30 kg/m² or above and 37.4% indicated to smoke. Over 70% of the food bank users can be described as food insecure. Of those, about 35% were considered mildly food insecure. Almost 30% were categorized as moderately food insecure while over 7% were categorized as severely food insecure. Significant associations with food insecurity were found for gender, age, subjective health status, smoking, duration of food bank use, school education and family type. Among this socially disadvantaged population, food insecurity is highly prevalent and public health efforts should be focusing on this vulnerable population taken into account the identified population and behavioral characteristics associated with food insecurity.

Characterizing Pediatric Non-Malarial Fever and Identifying the At-Risk Child in Rural Malawi

Objective. To characterize children with non–malarial fever at risk of nonrecovery or worsening in rural Malawi. Methods. This is a subgroup analysis of patients ≤14 years of age from a prospective cohort study in non–malarial fever subjects (temperature ≥37.5°C, or fever within 48 hours, and malaria negative) in southern Malawi cared for at a mobile clinic during the 2016 dry (August to September) or wet (November to December) season. Data collection included chart review and questionnaires; 14-day follow-up was conducted. We conducted univariate descriptive statistics on cohort characteristics, bivariate analyses to examine associations between characteristics and outcomes, and multivariate logistic regressions to explore factors associated with nonrecovery. Results. A total of 2893 patients were screened, 401 were enrolled, 286 of these were children, and 280 children completed follow-up. Eighty-seven percent reported symptom resolution, 12.9% reported no improvement, and there were no deaths or hospitalizations. No improvement was associated with dry season presentation (42.6% vs 75.0%, P < .0003), >2 days of symptoms (51.6% vs 72.2%, P = .03), and food insecurity (62.3% vs 86.1%, P = .007). Dry season subjects had a 4.35 times greater likelihood of nonimprovement (95% confidence interval [CI] = 1.96-11.11). Household food insecurity and being >2 hours from a permanent clinic were associated with no improvement (adjusted odds ratio [AOR] = 4.61, 95% CI = 1.81-14.29; and AOR = 2.38, 95% CI = 1.11-5.36, respectively). Conclusion. Outcomes were generally excellent in this rural, outpatient pediatric cohort, though risk factors for nonrecovery included food insecurity, access to a standing clinic, and seasonality. Ideally, this study will inform clinic- and policy-level changes aimed at ameliorating the modifiable risk factors in Malawi and throughout rural Africa.