Relationship between hunger and psychosocial functioning in low-income American children

Food and nutrition security definitions, constructs, frameworks, measurements, and applications: global lessons

Food security (FS) is a powerful social determinant of health (SDOH) and is crucial for human and planetary health. The objectives of this article are to (i) provide clarity on the definitions of FS and nutrition security; (ii) provide a framework that clearly explains the links between the two constructs; (iii) summarize measurement approaches, and (iv) illustrate applications to monitoring and surveillance, policy and program design and evaluation, and research, mainly based on the ongoing rich experience with food insecurity (FI) scales. A clear and concise definition of FI and corresponding frameworks are available. There are different methods for directly or indirectly assessing FI. The best method(s) of choice need to be selected based on the questions asked, resources, and time frames available. Experience-based FI measures disseminated from the United States to the rest of the world in the early 2000s became a game changer for advancing FI research, policy, program evaluation, and governance. The success with experience FI scales is informing the dissemination, adaptation, and validation of water insecurity scales globally. The many lessons learned across countries on how to advance policy and program design and evaluation through improved FS conceptualization and measurement should be systematically shared through networks of researchers and practitioners.

Antioxidant and Anti-Inflammatory Effects of Carotenoids in Mood Disorders: An Overview

Depression has a multifactorial etiology comprising family history and unemployment. This review aims to summarize the evidence available for the antioxidant and anti-inflammatory effects of carotenoids in mood disorders. This review article’s methodologies were based on a search of the PubMed database for all linked published papers. Epidemiological studies indicate that a diet rich in vegetables, fruits, nuts, fish, and olive oil may prevent the development of depression. Antioxidant supplementation has been found to combat various stress-induced psychiatric disorders, including depression and anxiety. A growing body of evidence indicates that carotenoids have both antioxidant and anti-inflammatory. Studies also suggest that poor dietary intake, particularly low intakes of fruit and vegetables and high intakes of fast food and other convenience foods, may increase the risk of developing depression. Thus, dietary interventions have the potential to help mitigate the risk of mental health decline in both the general population and those with mood disorders. Considering that carotenoids have both antioxidant and anti-inflammatory effects, it is expected that they might exert a promising antidepressant effect. Nevertheless, further studies (including interventional and mechanistic studies) assessing the effect of carotenoids on preventing and alleviating depression symptoms are needed.

Association of Food Insecurity with Mental Health Outcomes in Parents and Children

BACKGROUND

Food insecurity affects 13.7 million US households and is linked to poor mental health. Families shield children from food insecurity by sacrificing their nutritional needs, suggesting parents and children experience food insecurity differentially.

OBJECTIVE

To identify the associations of food insecurity and mental health outcomes in parents and children DATA SOURCES: PubMed, Embase, Web of Science, and PsycInfo STUDY ELIGIBILITY CRITERIA: We included original research published in English from January 1990 to June 2020 that examined associations between food insecurity and mental health in children or parents/guardians in the United States.

STUDY APPRAISAL AND SYNTHESIS METHODS

Two reviewers screened studies for inclusion. Data extraction was completed by one reviewer and checked by a second. Bias and confounding were assessed using the Agency for Healthcare Research and Quality RTI Item Bank. Studies were synthesized qualitatively, grouped by mental health outcome, and patterns were assessed. Meta-analyses were not performed due to high variability between studies.

RESULTS

We included 108 studies, assessing 250,553 parents and 203,822 children in total. Most studies showed a significant association between food insecurity and parental depression, anxiety, and stress, and between food insecurity and child depression, externalizing/internalizing behaviors, and hyperactivity.

LIMITATIONS

Most studies were cross-sectional and many were medium- or high-risk for bias or confounding.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

Food insecurity is significantly associated with various mental health outcomes in both parents and children. The rising prevalence of food insecurity and mental health problems make it imperative that effective public health and policy interventions address both problems.

Earthquake exposure, adverse childhood experiences, and psychosocial functioning in Chilean children: A longitudinal study

The impact of an 8.8 magnitude Chilean earthquake on elementary school students' psychosocial functioning was assessed along with exposure to adverse childhood experiences (ACEs). Skills for Life, a national school-based mental health program in Chile, routinely assesses first- and third-grade students' psychosocial functioning and classroom adaptation. Students (N = 19,627) were screened before (2009) and after (2011) the 2010 earthquake with parent- and teacher-report measures and with a parent-report of four ACEs (family psychopathology, child chronic illness, family social isolation, father absence). Earthquake exposure was categorized as mild, moderate, or severe for Chile's 15 regions. Multilevel models analyzed the unadjusted and adjusted impacts of earthquake exposure and ACEs on functioning while clustering for school- and district-level effects. In covariate-adjusted models, earthquake exposure and three ACEs were significantly associated with worsened psychosocial functioning; earthquake exposure and all four ACEs were significantly associated with worsened classroom adaptation. New family psychopathology, B = 1.90, p < .001; chronic illness, B = 2.25, p < .001; and severe earthquake impact, B = 1.29, p < .001, held the strongest negative effects on psychosocial well-being. Moderate, B = 3.04, p = .011, and severe earthquake exposure, B = 2.53, p = .047, and new family psychopathology, B = 1.99, p < .001, were associated with the worst classroom functioning 1-year postdisaster. Findings suggest that both exogenous and home-based stressors can have significant consequences for children's psychosocial functioning and classroom adaptation, and routine screening helps quantify how individual students are affected by chronic versus acute stressors.

Food Insecurity in the Food Allergic Population: A Work Group Report of the AAAAI Adverse Reactions to Foods Committee

Food allergies affect 32 million Americans. Restricted diets due to food allergies can be difficult to maintain especially when the household is food insecure. Food insecurity is defined as the inability to acquire food for household members due to insufficient money or resources for food. The COVID-19 pandemic has caused many people to face food insecurity for the first time with Latinx, Native American, and Black communities disproportionately affected. Because of the increase in food insecurity, this work group developed a survey regarding food insecurity screening. This survey was sent out to a random sample of American Academy of Allergy Asthma & Immunology members to assess food insecurity knowledge and practices. The majority of survey participants did not routinely screen their patients for food insecurity. The biggest barrier identified to screening was lack of knowledge of how to perform a screen and resources available when a patient screened positive. This work group report provides guidance on how to implement and perform a food insecurity screen, including federal resources and assistance programs.

The association between food insecurity, diet quality, and untreated caries among US children

BACKGROUND

The aim of this study was to examine the association between food insecurity and untreated caries among US children and the potential role of diet quality as a mediator in this relationship.

METHODS

The authors analyzed data for 4,822 children aged 5 through 17 years from the National Health and Nutrition Examination Survey cycles from 2011 through 2014. The authors measured food security as household-level food security status (full, marginal, low, very low) and overall food security status (full food secure, food insecure). They measured diet quality using the Healthy Eating Index. The primary outcome measure was untreated caries (none, ≥ 1). The authors used multiple logistic regression analysis to evaluate the relationships among food insecurity, diet quality, and untreated caries. They conducted mediation analysis using the Baron and Kenny approach.

RESULTS

Food-insecure children were more likely to have untreated caries compared with their fully food-secure counterparts, after controlling for confounding variables (odds ratio [OR], 1.38; 95% [CI, 1.11 to 1.72). Specifically, children from marginal and very low food-secure households had significantly higher odds of untreated caries (OR, 1.48; 95% CI, 1.10 to 2.01) compared with children from fully food-secure households (OR, 1.59; 95% CI, 1.12 to 2.26). Diet quality was not significantly associated with untreated caries.

CONCLUSIONS

Food insecurity was negatively associated with untreated caries among US children. Diet quality was not associated with untreated caries.

PRACTICAL IMPLICATIONS

Social factors such as food insecurity should be taken into consideration when dental clinicians perform caries risk assessment because caries risk is shown to be associated with overall health and dental health.

School absenteeism is linked to household food insecurity in school catchment areas in Southern Nevada

OBJECTIVES

Food security and school attendance are both important for health, well-being and academic performance of children and adolescents. However, their intersection remains underexamined, especially in the USA. The current study considered the association between elementary school-level absenteeism and household food insecurity.

DESIGN

The current study linked school-level absenteeism and household food insecurity rates using geographic information system mapping and applied the tobit regression model to examine their association.

SETTING

The Clark County, Nevada, public school district - the fifth largest in the USA and in a state with disproportionate food insecurity and chronic school absenteeism rates.

PARTICIPANTS

Data consisted of school-level absenteeism rates from 185 elementary schools and census tract-level household food insecurity rates.

RESULTS

Average daily attendance rates were lower for schools with catchment areas that had higher average household food insecurity (FI), decreasing by -0·0232 % per 1 % increase in FI rate (P-value = 0·022). They were also significantly associated with most absenteeism risk factors. Average daily attendance rate was negatively associated with Free and Reduced Lunch eligibility percentage (-0·010 per 1 % increase in FI, P-value < 0·001) and Individualized Education Program participation percentage (-0·039 % per 1 % increase in FI, P-value = 0·033), but positively associated with parent-teacher conference participation rate (0·006 % per 1 % increase in FI, P-value = 0·025) and white student percentage (0·011 % per 1 % increase in FI, P-value = 0·022).

CONCLUSIONS

The current study suggests a link between household food insecurity and elementary school-level absenteeism. Understanding this link is important for policy and practice because schools are frequent settings for food insecurity mitigation interventions.

Social determinants of health, personalized medicine, and child maltreatment

This review begins with a brief summary of the importance of child maltreatment as a major public health problem, given its prevalence and the substantial human and economic costs involved. The focus then shifts to consideration of personalized medicine and child maltreatment, including genetic and genomics factors, as well as the role of social determinants of health. Research on epigenetics related to child abuse and neglect is presented, followed by that pertaining to a few specific social factors, such as poverty, parental depression and substance use, and domestic (or intimate partner) violence. The review ends with a discussion of interventions to help address social determinants of health with brief descriptions of several model programs, and thoughts concerning the role of personalized medicine in addressing child maltreatment in the foreseeable future. IMPACT: This paper synthesizes knowledge on social determinants of health and advances in genetics and genomics related to the prevention of child maltreatment. It provides examples of model approaches to addressing the prevention of child maltreatment in primary care practices.

The Hunger Games: Laparoscopic Performance in Novice Surgeons is Not Altered by Food Deprivation but Influenced by the Degree of Appetite - A Randomized Controlled Trial

OBJECTIVES

Food deprivation is a common condition for visceral surgeons and especially laparoscopic approaches require high levels of concentration. The current literature does not provide adequate answers whether intraoperative breaks, especially food intake, might influence the quality of the surgical skills. Thus, the primary aim of this trial was to analyze the influence of food deprivation on the laparoscopic performance.

DESIGN SETTING AND PARTICIPANTS

37 laparoscopic novices participated from 10/2017 to 04/2018 in this single center, prospective-randomized trial and were trained during laparoscopic training sessions until they reached a predefined level of proficiency. Subsequently, participants were randomized into 3 different groups: food deprivation of 8 hours, 4 hours, or carbohydrate loading directly prior to the laparoscopic exam. The exam comprised PEG-transfer, precise cutting, gallbladder resection and surgical knot.

MAIN FINDINGS

Completion time for PEG-transfer, precise cutting, gallbladder resection and surgical knot was 63s, 139s, 192s and 272s respectively. Participants starving for 8 hours performed 3 of 4 tasks more slowly whilst participants starving for 4 hours performed 3 of 4 tasks faster than the average. Analyzing self-reported level of appetite revealed: Students with an intermediate level were significantly faster (p <0.05) during complex procedures compared to participants that reported hunger prior to performing these tasks (192s vs. 307s). Additionally, hungry students had been more inaccurate during the surgical knot (p <0.05) whilst students with intermediate appetite level tend to be most accurate (p - value 0.012).

CONCLUSIONS

The subjective level of appetite rather than the absolute number of fasting hours influences the laparoscopic performance most. Thus, any extreme level of appetite may be avoided and surgeons may achieve the best performance when they have an intermediate level of appetite. In consequence, heavy meals may be omitted immediately prior to demanding laparoscopic procedures and surgeons may have access to mini-breaks and refreshers during major procedures.

Food insecurity in households with young children: A test of contextual congruence

Household food insecurity, an inability to provide adequate nutrition for a healthy, active lifestyle, affects nearly 1 in 7 households with children in the United States. Though rates of food insecurity declined to pre-recession levels just prior to the COVID-19 pandemic, they are now once again increasing. As a result, in one of the wealthiest countries in the world, millions of young children continue to grow up in households that struggle daily with a problem that is often associated with the developing world. The result is both immediate and long-term health and development deficits for children. We propose that the degree of demographic and socioeconomic congruence between the households of young children and their neighborhood of residence lends unique insights to food insecurity. We examine this using the ECLS-K 2010-2011 for children in families with incomes below 400 percent of the federal poverty line (N = 8600). Results show that congruence between household and neighborhood education and race/ethnicity associates with the likelihood of experiencing food insecurity. For example, households with non-Hispanic black children living in neighborhoods with high proportions of non-Hispanic blacks have significantly lower probabilities of food insecurity than similar households living in neighborhoods with smaller black populations. Similarly, more highly educated families experience lower probability of food insecurity in high education neighborhoods than when they reside in low education neighborhoods. Focusing on neighborhood risk factors as absolute and independent contributors limits our understanding of how families experience food insecurity as well as any policy efforts to address it.

Exploring Dietary Behavior Differences among Children by Race/Ethnicity and Socioeconomic Status

BACKGROUND

In Spartanburg County, SC, nearly 33.7% of children are overweight or obese. The purpose of this study was to investigate differences in eating behavior of youth by race/ethnicity and socioeconomic status.

METHODS

Students (N = 997) in 4th to 5th grades completed the School Nutrition and Physical Activity Survey. School databases categorized students as either White or racial/ethnic minority and free/reduced or full paid lunch status. Dietary behaviors included 13 composite measures: unhealthy proteins, healthy proteins, dairy, refined grains, whole grains, vegetables, fruit, fried snacks, sugar-sweetened beverages, sweets, and consumption of a breakfast, evening, and/or restaurant meal. Logistic regression, controlling for sex, was used to analyze differences in consumption for each nutrition variable.

RESULTS

Minority youth were less likely to consume healthy proteins (odds ratio [OR] = 0.71, 95% confidence interval [CI] = 0.55-0.92) and more likely to eat at a restaurant (OR = 1.32, 95% CI = 1.02-1.70) compared to white youth. Lower socioeconomic status youth were less likely to eat an evening meal compared to higher socioeconomic status youth (OR = 0.59, 95% CI = 0.39-0.89).

CONCLUSIONS

Differences in dietary behaviors may result from food accessibility and insecurity in minority and/or low-income neighborhoods. Future research should explore policy strategies that can help ensure all youth maintain healthy eating habits and weight status.

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.

The Relationship Between Social Risks and the Mental Health of School-Age Children in Primary Care

BACKGROUND AND OBJECTIVE

The study's goal was to measure the association between social risks and the mental health of school-age children in primary care.

METHODS

We conducted a cross-sectional study in an urban safety-net hospital-based pediatric clinic using data collected from 2 standardized screening tools administered at well-child care visits for children age 6 to 11. Psychosocial dysfunction was measured with the Pediatric Symptom Checklist-17 (PSC-17), and 6 social risks (caregiver education, employment, child care, housing, food security, and household heat) were measured with the WE CARE screener. Multivariable linear and logistic regression analyses were conducted to measure the association between scores while controlling for sociodemographic characteristics.

RESULTS

Among N = 943 patients, cumulative social risks were significantly associated with a positive PSC-17 total score (adjusted odds ratio [aOR] 1.2; 95% confidence interval [CI] 1.1-1.5; P = .02), indicating psychosocial dysfunction. Children with ≥3 social risks were 2.4 times more likely to have a positive PSC-17 total score compared to children with <3 social risks (95% CI 1.5-3.9; P < .001). Of the individual social risks measured, only food insecurity significantly predicted a positive PSC-17 total score (aOR 1.9; 95% CI 1.1-3.2; P = .02) and attention score (aOR 1.9; 95% CI 1.1-3.4; P = .03).

CONCLUSION

Number of risks on a social risk screener was associated with psychosocial dysfunction in school-age children. Food insecurity was the only individual risk associated with psychosocial dysfunction, in particular attention problems. Screening tools for social risks could be used to identify at-risk children whose mental health may be adversely impacted by their social conditions.

Understanding the Psychological Distress of Food Insecurity: A Qualitative Study of Children's Experiences and Related Coping Strategies

BACKGROUND

Food insecurity, a condition of inadequate household food availability, affects 15.7% of US households with children. Food insecurity is generally believed to affect the quantity and quality of food consumed. However, an understudied but important aspect of the experience of food insecurity is psychological distress.

OBJECTIVE

To critically explore the psychological distress associated with children's food insecurity using children's own reports of their experiences.

DESIGN

In-depth qualitative interviews conducted with children to better understand the psychological distress associated with food insecurity.

PARTICIPANTS/SETTING

Sixty children (aged 7 to 14 years) were recruited from the San Francisco Bay Area. Children were eligible in the case that they spoke English fluently and their parent reported any experience of household food insecurity during the past year.

RESULTS

Children discussed six themes related to the psychological distress associated with food insecurity: worrying about not having enough food, worrying about their parents' well-being, anger and frustration about not having enough food, embarrassment about their family's food situation, strain on the family's dynamics due to food insecurity, and sadness over not having enough food. After describing their experiences, children described strategies they employed to tolerate or cope with food insecurity, including distracting from or using their imagination to cope with food insecurity, increasing tolerance of their family's food situation, and appreciating their parents for providing food and resources.

CONCLUSIONS

Food insecurity contributes to children's psychological distress. Given the known effects of chronic stress in childhood, the psychological distress of food insecurity may represent an important mechanism by which food insecurity adversely influences children's growth and development and deserves investigation in future studies.

Trends and disparities in urinary BPA concentrations among U.S. emerging adults

BACKGROUND

Emerging adulthood (ages 18-25 years) is a key turning point in the life course characterized by particularly poor eating behaviors (e.g., low in fruits and vegetables, and high in fast food) and weight gain. Emerging adults are also prime consumers of personal care and other consumer products that may result in differential exposures to environmental contaminants, such as Bisphenol A (BPA), compared to adults aged 26+ years. This is of concern given BPA has been associated with adverse health outcomes such as obesity, metabolic disorders, miscarriage, infertility and breast cancer. However, no research has examined exposure to BPA among emerging adults.

OBJECTIVE

To assess trends of exposure to urinary BPA among a representative sample of emerging adults compared to adults aged 26+ years. Secondarily, we aimed to identify differential associations between BPA concentrations and sociodemographic characteristics and BMI by age group.

METHODS

This study uses National Health and Examination Surveys (NHANES) over 2003-2014 to test differences in BPA concentrations comparing emerging adults to adults aged 26+ years. Generalized linear models predicting log BPA by age group and sex, race/ethnicity, education, income, and food security status, and generalized linear models predicting BMI by log BPA, both age group and age as a continuous variable, sex, race/ethnicity, education, income, and food security status were conducted. Interactions with age group (i.e., age group x sex) were examined for the mutually adjusted models. All models controlled for survey year, month, and time of day, and were run with, and without, an adjustment for urinary creatinine.

RESULTS

In models adjusted, and not adjusted, for urinary creatinine, emerging adults had a higher log BPA concentration than adults aged 26+ years (β=0.153, p=0.004; β=0.544, p<0.001), and a significantly steeper decline in BPA concentration between 2003-2004 and 2013-2014 than adults aged 26+ years (ß=-0.051, p=0.002; ß=-0.071, p=0.001). Males' log BPA concentration were lower than that for females when urinary creatinine was included in the model, and higher when urinary creatinine was excluded from the model (ß=-0.188, p<0.001; β=0.203, p<0.001). Higher income was significantly associated with lower log BPA concentration (ß=-0.220, p<0.001; ß=-0.166, p<0.001). A significant interaction between emerging adult age group and food security status was observed, which was associated with higher BPA exposures. Log BPA concentration was associated with BMI only when urinary creatinine was excluded from the models (urinary creatinine included: β=0.031, p=0.747; β=0.022, p=0.815, urinary creatinine excluded: β=0.528, p<0.001; β=0.552, p<0.001).

CONCLUSION

Findings indicate that emerging adults had higher BPA exposures than adults aged 26+ years in 2003-2004, and that emerging adults' exposure level has decreased faster than that of adults aged 26+ years. There were suggestions that the BPA concentration of emerging adults in 2013-2014 was lower than that for adults aged 26+ years, and that BPA exposure is associated with higher BMI. Our results highlight the need for additional research to identify the sources and routes of exposure to BPA and BPA replacements among emerging adults and to better characterize the variability in exposure. Intervention studies are needed to assist emerging adults in limiting their exposure to BPA, and potentially also the BPA alternatives.

Comparing alternative methods of measuring cumulative risk based on multiple risk indicators: Are there differential effects on children's externalizing problems?

This study examined several alternative methods to measure cumulative risk (CR) based on multiple risk indicators. Several methods for measuring CR are presented and their conceptual and methodological assumptions are assessed. More specifically, at the individual risk level, we examined the implications of various measurement approaches (i.e., dichotomous, proportion- and z-scores). At the composite level, we measured CR as an observed score, and compared this approach with two variable-centered approaches (consisting of reflective and formative indicators) and two person-centered approaches (consisting of latent class analysis and latent profile analysis). A decision tree was proposed to aid researchers in comparing and choosing the alternative methods. Using a sample of 169 low-income families (children approximately 5 years old, 51% girls; 74% African American, and their primary caregiver), we specified models to represent each of the alternative methods. Across models, the multiple risk composite was based on a set of 12 individual risk indicators including low maternal education, hunger, meal and money unpredictability, maternal psychopathology, maternal substance use, harsh parenting, family stress, and family violence. For each model, we estimated the effect size of the composite CR variable on children's externalizing problems. Results indicated that the variable-centered CR composites had larger effects than the observed summary score CR indices and the person-centered methods.

Child health and the possibilities for childcare in a context of poverty and food insecurity: The narratives of parents attending a self-managed foodbank in Spain

Food insecurity would influence children's health and development through its effects on nutrition and household stress in the context of broader poverty-related problems. This study contributes to research regarding the characterisation of food-insecure households with children under the age of 18. In particular, it highlights the social and institutional aspects which influence and interact with parents' attempts to protect their children from hunger and destitution. In this study, we document some aspects of the harsh realities faced by mothers and fathers with children under the age of 18 living in poverty who attended a self-organised foodbank in the city of Madrid in 2015. We used a qualitative methodology consisting of 7 months of participant observation and the conduction of 15 in-depth interviews. This study shows how the possibilities for the meaningful protection of children in food-insecure households can be influenced by parental coping strategies, community resources and availability and accessibility to public help. Foodbanks can help reduce both household hunger (although not meeting all nutritional requirements) and parental psychosocial distress, which might support parents to better protect their children. In particular, self-managed foodbanks appear to help parents cope with emotional distress by reducing feelings of powerlessness and self-blame through their active involvement, and thanks to the collective caring that occurs between members. Public services are of special relevance, since their absence or an active institutional discrimination has been shown to further damage impoverished households with children. We suggest that public policies in Spain are revised and reinforced to enable a more genuine protection of children and their families living under severe deprivation, and to prevent life-long damage. Public institutions could assume that people attending a foodbank are living in severe poverty and need access to adequate and supportive public resources to address it.

Exploring the Concept of Food Insecurity and Family Hunger in Senegal, West Africa

Using a previously validated instrument, surveys were conducted by researchers in a Senegalese village to elicit data on childhood food insecurity and health outcomes. Fifty-four participants were interviewed and completed the Community Childhood Hunger Identification Project (CCHIP) survey. More than half of the adults experienced hypertension or diabetes and also reported childhood food insecurity. The role of food coping strategies and social support were identified as factors that minimized the burden of food insecurity. Further testing with instruments that include analysis of cyclic food access patterns is warranted to best determine how to combat both food insecurity and noncommunicable chronic disease incidence in Senegalese families.

The Relationship between Food Insecurity and Symptoms of Attention-Deficit Hyperactivity Disorder in Children: A Summary of the Literature

Food insecurity is a major public health concern characterized by an individual or household lacking access to adequate food to support a healthy lifestyle. Food insecurity has been associated with predisposing or exacerbating mental health symptoms in children. However, the evidence is scarce with regards to Attention-Deficit Hyperactivity Disorder (ADHD) symptoms in children. The purpose of this review is to summarize and identify gaps in the existing literature, as well as to explore associations between food insecurity and symptoms of childhood ADHD. Literature for this review was pulled from Ovid MEDLINE and PubMed library databases, with a focus on food insecurity, food insufficiency, hunger, and ADHD symptoms such as inattention, hyperactivity, and impulsivity in children. The limited evidence to date shows a predictive and inverse relationship between childhood experience of food insecurity and symptoms of ADHD, with lasting impacts into adulthood. Evidence exists to hypothesize that childhood food insecurity is associated with predisposing or exacerbating ADHD symptoms in children, yet the literature needed to confirm this relationship is scarce and utilizes inconsistent methodology. Future research is needed to further characterize this complex relationship and inspire community or public health interventions addressing food insecurity in children with ADHD. Additionally, it may be clinically useful to routinely screen for food insecurity when assessing pediatric ADHD symptoms.

School Food Policies and Student Eating Behaviors in Canada: Examination of the 2015 Cancer Risk Assessment in Youth Survey

BACKGROUND

Limited evidence exists on effects of school-based nutrition policies. This study explored the influence of mandatory versus voluntary provincial school nutrition policies on student eating behaviors.

METHODS

A cross-sectional, school-based survey assessed student eating behaviors using self-report survey measures in a representative sample of Canadian high school students from 7 provinces (N = 12,110). Provincial school nutrition policies were characterized as mandatory or voluntary. Healthful and nonhealthful eating behaviors were analyzed across sociodemographic characteristics. Regression models were used to assess the association between policy type and eating behaviors, and to explore potential moderating variables.

RESULTS

Healthful and nonhealthful eating behaviors differed significantly across several sociodemographic characteristics. Overall, neither healthful nor nonhealthful eating behaviors differed significantly between schools with voluntary and mandatory nutrition policies (odds ratio [OR] = 0.83, 95% confidence interval [CI] 0.64-1.08; OR = 1.16, 95% CI 0.83-1.64). Frequency of buying lunch at school and buying lunch out moderated the association between policy enforcement level and healthful eating behaviors (p = .0472, p = .0119). Frequency of buying lunch out moderated the association between policy enforcement levels and nonhealthful eating behaviors (p = .0009).

CONCLUSIONS

This study documents nonhealthful components of Canadian adolescents' diets, and the results highlight important areas for future research in assessing the effectiveness of school nutrition policies.

Child food insecurity in the UK: a rapid review

Background

Food insecurity (FI) is a multifaceted, socioeconomic problem involving difficulties accessing sufficient, safe and nutritious food to meet people’s dietary requirements and preferences for a healthy life. For children experiencing FI, there are some potentially negative developmental consequences and it is, therefore, important to understand the links between FI and children’s health and well-being as well as any strategies undertaken to address FI. The overall objective of this assessment was to determine the nature, extent and consequences of FI affecting children (aged ≤ 18 years) in the UK.

Objective

To determine the nature, extent and consequences of FI affecting children (aged ≤ 18 years) in the UK.

Data sources

The databases searched on 4 December 2017 included MEDLINE (including In-Process & Other Non-Indexed Citations and E-pub ahead of print files), EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Commonwealth Agricultural Bureaux (CAB) abstracts, The Cochrane Library, Education Resources Information Centre (ERIC), PsycINFO, the Social Science Citation Index and the Applied Social Sciences Index and Abstracts (ASSIA).

Methods

A rapid review of the current published and unpublished literature was conducted, including all study designs from specified high-income countries in children aged ≤ 18 years. Searches were conducted of major health-care, nutrition, education and social science databases from 1995 onwards, and websites of relevant UK and international organisations. Final searches were undertaken in December 2017.

Results

In total, 109 studies were selected. Only five studies were conducted in the UK, four of which provided qualitative data. Possible factors associated with child FI were identified, for example socioeconomic status, material deprivation, living in public housing and having unemployed or poorly educated parents. Children’s health, well-being and academic outcomes were all negatively affected by FI. The mediating effects of family stressors and parenting practices in the relationship between FI and children’s health and well-being outcomes were not clear. Food assistance programmes were generally effective in mitigating FI and improving nutritional outcomes (including hunger) in the short term, but did not eradicate FI, eliminate its effects on children’s health or have an impact on academic outcomes. No reports assessing the prevalence of child FI in the UK or the cost-effectiveness and sustainability of interventions to tackle FI were identified.

Limitations

There was a lack of consistency in how FI was defined and measured across studies. Most of the studies used indirect measurements of child FI through parental reports. The majority of studies were conducted in North America. Only five studies were conducted in the UK. Thirty potentially relevant studies were not included in the review as a result of time and resource constraints. Most studies were observational and caution is advised in interpreting their results.

Conclusions

A number of factors that were related to child FI were identified, as were negative associations between child FI and physical, mental and social outcomes. However, these findings should be interpreted with caution because of the correlational nature of the analyses and the fact that it is difficult to determine if some factors are predictors or consequences of FI.

Future research

There is an urgent requirement for the development of a reliable instrument to measure and monitor child FI in the UK and for well-designed interventions or programmes to tackle child FI.

Study registration

This study is registered as PROSPERO CRD42017084818.

Funding

The National Institute for Health Research Public Health Research programme. The Health Services Research Unit is core-funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.

Household Food Insecurity and Psychosocial Dysfunction in Ecuadorian Elementary Schoolchildren

Household food insecurity (HFI) is a major global public health and pediatric concern due to its reported association with adverse child nutrition, growth, and health outcomes. Psychosocial dysfunction is a major cause of childhood disability. US and Canadian studies have linked HFI to poorer overall psychosocial dysfunction and specific dysfunction types in school-aged children, i.e., internalizing, externalizing, and attention behaviors. However, it is uncertain whether prior findings are generalizable to low- and middle-income country (LMIC) settings. We conducted a cross-sectional study to explore the association of HFI with psychosocial dysfunction in 6-12-year-old public elementary schoolchildren (n=279) residing in low-income neighborhoods in Quito, Ecuador. Maternal caregivers were interviewed to obtain data on child psychosocial dysfunction (Pediatric Symptom Checklist, PSC), food security (Household Food Security Survey Module), and maternal mental health (SF-36 Mental Composite Summary). Capillary blood samples were obtained from child participants to measure hemoglobin levels. The data were analyzed using general linear models with adjustment for covariates. The results revealed that HFI was associated with significantly higher overall average PSC scores (p=0.002) and with internalizing (p=0.001) and externalizing (p=0.03) but not attention subscale scores. However, anemia was independently associated with PSC attention subscale scores (p=0.015). This is the first study to report on the relationship between HFI and psychosocial dysfunction in school-aged children in a LMIC setting. It highlights the importance of improving policies and programs protecting vulnerable households from HFI. In addition to improving health and nutrition, such improvements could potentially reduce the burden of child psychosocial dysfunction.

The effect of child hunger on educational attainment and early childbearing outcomes in a longitudinal population sample of Canadian youth

Purpose

Early childhood experiences of poverty are associated with adverse developmental outcomes that have impli cations for individual and population health. Low educational attainment and early childbearing are two such important outcomes that can perpetuate childhood poverty into adulthood. Child hunger, or severe food insecurity, is an extreme manifestation of household food insecurity that is associated with the stressful experience of deep family poverty. Life-course theories suggest that childhood experiences of hunger could have adverse effects in the developmental pathway. The objective of this study was to examine the independent contribution of the child hunger experience to subsequent educational attainment and early childbearing in young adult men and women, in consideration of other latent, cumulative or shock effects associated with child poverty.

Methods

We analyzed National Longitudinal Survey of Children and Youth data using logistic regression based on 15,468 Canadian children followed over 16 years.

Results

The prevalence of the experience of child hunger was 5.0%. Child hunger was independently predictive of youth leaving high school, yet was not a factor in the achievement of higher educational attainment if youth were able to graduate from high school. Having always lived in rental accommodation and repeated reports of child hunger over time were predictive of early childbearing.

Conclusions

Interventions directed at children and youth who are at risk of poor developmental outcomes because of severe food insecurity should focus on steering families toward their income entitlements, and providing support for youth to complete high school and to avoid early fertility.

Implementation of the Good School Toolkit in Uganda: a quantitative process evaluation of a successful violence prevention program

BACKGROUND

The Good School Toolkit, a complex behavioural intervention designed by Raising Voices a Ugandan NGO, reduced past week physical violence from school staff to primary students by an average of 42% in a recent randomised controlled trial. This process evaluation quantitatively examines what was implemented across the twenty-one intervention schools, variations in school prevalence of violence after the intervention, factors that influence exposure to the intervention and factors associated with students' experience of physical violence from staff at study endline.

METHODS

Implementation measures were captured prospectively in the twenty-one intervention schools over four school terms from 2012 to 2014 and Toolkit exposure captured in the student (n = 1921) and staff (n = 286) endline cross-sectional surveys in 2014. Implementation measures and the prevalence of violence are summarised across schools and are assessed for correlation using Spearman's Rank Correlation Coefficient. Regression models are used to explore individual factors associated with Toolkit exposure and with physical violence at endline.

RESULTS

School prevalence of past week physical violence from staff against students ranged from 7% to 65% across schools at endline. Schools with higher mean levels of teacher Toolkit exposure had larger decreases in violence during the study. Students in schools categorised as implementing a 'low' number of program school-led activities reported less exposure to the Toolkit. Higher student Toolkit exposure was associated with decreased odds of experiencing physical violence from staff (OR: 0.76, 95%CI: 0.67-0.86, p-value< 0.001). Girls, students reporting poorer mental health and students in a lower grade were less exposed to the toolkit. After the intervention, and when adjusting for individual Toolkit exposure, some students remained at increased risk of experiencing violence from staff, including, girls, students reporting poorer mental health, students who experienced other violence and those reporting difficulty with self-care.

CONCLUSIONS

Our results suggest that increasing students and teachers exposure to the Good School Toolkit within schools has the potential to bring about further reductions in violence. Effectiveness of the Toolkit may be increased by further targeting and supporting teachers' engagement with girls and students with mental health difficulties.

TRIAL REGISTRATION

The trial is registered at clinicaltrials.gov , NCT01678846, August 24th 2012.

Food insecurity is associated with high risk glycemic control and higher health care utilization among youth and young adults with type 1 diabetes

AIMS

Household food insecurity (FI), i.e., limited availability of nutritionally adequate foods, is associated with poor glycemic control among adults with type 2 diabetes. We evaluated the association of FI among youth and young adults (YYA) with type 1 diabetes to inform recent clinical recommendations from the American Diabetes Association for providers to screen all patients with diabetes for FI.

METHODS

Using data from the Washington and South Carolina SEARCH for Diabetes in Youth Study sites, we conducted an observational, cross-sectional evaluation of associations between FI and glycemic control, hospitalizations, and emergency department (ED) visits among YYA with type 1 diabetes. FI was assessed using the Household Food Security Survey Module, which queries conditions and behaviors typical of households unable to meet basic food needs. Participants' HbA1c were measured from blood drawn at the research visit; socio-demographics and medical history were collected by survey.

RESULTS

The prevalence of FI was 19.5%. In adjusted logistic regression analysis, YYAs from food-insecure households had 2.37 higher odds (95% CI: 1.10, 5.09) of high risk glycemic control, i.e., HbA1c >9.0%, vs. peers from food-secure households. In adjusted binomial regression analysis for ED visits, YYAs from food-insecure households had an adjusted prevalence rate that was 2.95 times (95% CI [1.17, 7.45]) as great as those from food secure households.

CONCLUSIONS

FI was associated with high risk glycemic control and more ED visits. Targeted efforts should be developed and tested to alleviate FI among YYA with type 1 diabetes.

Timing, intensity, and duration of household food insecurity are associated with early childhood development in Kenya

This study examines the association between 3 dimensions of food insecurity (timing, intensity, and duration) and 3 domains of child development (gross motor, communication, and personal social). Longitudinal data from 303 households (n = 309 children) visited 9 times over 2 years were collected. Children in households experiencing severe food insecurity 3 months prior (timing) had significantly lower gross motor (β -0.14; 95% CI [0.27, -0.0033]; p = .045), communication (β -0.16; 95% CI [-0.30, -0.023]; p = .023), and personal social (β -0.20; 95% CI [-0.33, -0.073]; p = .002) Z-scores, using lagged longitudinal linear models controlling for current food insecurity; these results were attenuated in full models, which included maternal education, household asset index, and child anthropometry. Children in households that experienced greater aggregate food insecurity over the past 2 years (intensity) had significantly lower gross motor (β -0.047; 95% CI [-0.077, -0.018]; p = .002), communication (β -0.042; 95% CI [-0.076, -0.0073]; p = .018), and personal social (β -0.042; 95% CI [-0.074, -0.010]; p = .010) Z-scores; these results were also attenuated in full models. Children with more time exposed to food insecurity (duration) had significantly lower gross motor (β -0.050; 95% CI [-0.087, -0.012]; p = .010), communication (β -0.042; 95% CI [-0.086, 0.0013]; p = .057), and personal social (β -0.037; 95% CI [-0.077, 0.0039]; p = .076) Z-scores; these results were no longer significant in full models. Our findings suggest that acute and chronic food insecurity and child development are related, but that many associations are attenuated with the inclusion of relevant covariates.

Food insecurity is associated with maternal depression and child pervasive developmental symptoms in low-income Latino households

The objective of this study was to investigate associations between household food insecurity, maternal clinical depression, and child behavior problems in low-income Latino households. Data were collected from a cohort of 168 children and their Latina mothers recruited prenatally at two San Francisco hospitals from 2006 to 2007. Food insecurity at year four was associated with increased odds of maternal clinical depression at years four to five (adjusted OR 1.22, 95% confidence interval 1.03 to 1.43). Food insecurity at year four was associated with child pervasive developmental problems at year five (B=0.21, p=0.041) in adjusted models. The association between food insecurity at year four and oppositional defiant problems at year five was partially mediated (28.7% mediation, p=0.046) by maternal clinical depression in years four and five. Our results suggest that household food insecurity is associated with greater maternal depression, and both food insecurity and maternal depression uniquely predict certain types of child behavior problems. Assessing for and addressing household food insecurity may be beneficial additions to psychosocial interventions targeting maternal and child mental health.

Associations Among Food Insecurity, Academic Performance, and Weight Status in Primary Schoolchildren in Tehran, Iran: A Cross-sectional Study

OBJECTIVE

To examine the associations among household food insecurity (FI), academic performance, and weight status in urban primary schoolchildren.

DESIGN

Cross-sectional study.

SETTING

Primary schools in Tehran, Iran.

PARTICIPANTS

A total of 803 students (419 boys and 384 girls), aged 10-12 years, were recruited from 43 primary schools.

MAIN OUTCOME MEASURES

Levels of FI were measured using a locally validated, 18-item household food security survey module. Academic performance was assessed by 152 teachers through a specifically designed, 20-scale questionnaire. Standard anthropometric measurements were also taken.

ANALYSIS

Linear and multinomial regressions were conducted.

RESULTS

At the household level, FI was associated with poorer grades in all subjects studied (except for social science in FI without hunger) (P < .05). At the child level, a significant association was observed between low food security and poorer grades in all subjects studied, whereas for very low food security, this relationship was significant only for mathematics, reading, and science (P < .05). Food insecurity without hunger (odds ratio = 2.56; 95% confidence interval, 1.05-6.23) and low food security (odds ratio = 4.41; 95% confidence interval, 1.58-12.23) were associated with overweight only in girls.

CONCLUSIONS AND IMPLICATIONS

The findings confirm the need for policies and programs to improve students' dietary quality and food security to improve their health as well as educational attainment. Future research is needed to explore further the association between food security and academic performance.

Childhood hunger and depressive symptoms in adulthood: Findings from a population-based study

BACKGROUND

Several studies have linked childhood hunger to an increased risk for later depression. However, as yet, there has been little research on this relation in adults of all ages or whether there are sex differences in this association. The current study examined these issues using data from a national population-based sample.

METHODS

Data were analyzed from 5095 adults aged 25-84 collected during the Estonian Health Interview Survey 2006. Information was obtained on the frequency of going to bed hungry in childhood and on depressive symptoms using the Emotional State Questionnaire (EST-Q). Logistic regression analysis was used to examine the association between hunger and depression while controlling for other demographic, socioeconomic and health-related variables.

RESULTS

In a fully adjusted model, going to bed hungry in childhood either sometimes or often was associated with significantly increased odds for depressive symptoms. When the analysis was stratified by sex the association was more evident in men where any frequency of childhood hunger was linked to adult depression while only women who had experienced hunger often had higher odds for depressive symptoms in the final model.

LIMITATIONS

Data on childhood hunger were retrospectively reported and may have been affected by recall bias. We also lacked information on potentially relevant variables such as other childhood adversities that might have been important for the observed associations.

CONCLUSION

Childhood hunger is associated with an increased risk for depressive symptoms among adults. Preventing hunger in childhood may be important for mental health across the life course.

Association of Food Insecurity with Children's Behavioral, Emotional, and Academic Outcomes: A Systematic Review

OBJECTIVE

Food Insecurity (FI) occurs in 21% of families with children and adolescents in the United States, but the potential developmental and behavioral implications of this prevalent social determinant of health have not been comprehensively elucidated. This systematic review aims to examine the association between FI and childhood developmental and behavioral outcomes in western industrialized countries.

METHOD

This review provides a critical summary of 23 peer reviewed articles from developed countries on the associations between FI and adverse childhood developmental behavioral outcomes including early cognitive development, academic performance, inattention, externalizing behaviors, and depression in 4 groups-infants and toddlers, preschoolers, school age, and adolescents. Various approaches to measuring food insecurity are delineated. Potential confounding and mediating variables of this association are compared across studies. Alternate explanatory mechanisms of observed effects and need for further research are discussed.

RESULTS

This review demonstrates that household FI, even at marginal levels, is associated with children's behavioral, academic, and emotional problems from infancy to adolescence across western industrialized countries - even after controlling for confounders.

CONCLUSIONS

While the American Academy of Pediatrics already recommends routine screening for food insecurity during health maintenance visits, the evidence summarized here should encourage developmental behavioral health providers to screen for food insecurity in their practices and intervene when possible. Conversely, children whose families are identified as food insecure in primary care settings warrant enhanced developmental behavioral assessment and possible intervention.

The association between food insecurity and academic achievement in Canadian school-aged children

OBJECTIVE

Education is a crucial social determinant of health. Food insecurity can be detrimental to children's academic achievement, potentially perpetuating a cycle of poverty and food insecurity. We aimed to assess the relationship between food insecurity and academic achievement in Canadian school-aged children.

DESIGN

Cross-sectional study of children and parents. Parents completed the short-form Household Food Security Survey Module and questions about income and education level (socio-economic status). Children completed FFQ. Data were prospectively linked to children's performance on standardized exams written one year later. Mixed-effect logistic regression was employed to assess the relationship between food insecurity and likelihood of meeting academic expectations adjusting for socio-economic status, diet quality and potential confounders.

SETTING

Nova Scotia, Canada in 2011-2012.

SUBJECTS

Students (n 4105) in grade 5 (10-11 years; 2167 girls) and their parents.

RESULTS

Low food security was reported by 9·8 % of households; very low food security by 7·1 % of households. Students from low-income households and reporting poor diet quality were less likely to do well in school. Children who lived in households reporting very low food security had 0·65 times the odds (OR=0·65; 95 % CI 0·44, 0·96) of meeting expectations for reading and 0·62 times the odds (OR=0·62; 95 % CI 0·45, 0·86) of meeting expectations for mathematics.

CONCLUSIONS

Very low household insecurity is associated with poor academic achievement among children in Nova Scotia.

Student Hunger on Campus: Food Insecurity Among College Students and Implications for Academic Institutions

PURPOSE

To estimate the prevalence of food insecurity among students at a large mid-Atlantic publicly funded university; examine the association between food insecurity, demographic characteristics, potential financial risk factors, and self-reported physical and mental health and academic performance; and identify possible risk factors for food insecurity.

DESIGN

Cross-sectional survey.

SETTING

Large, public mid-Atlantic university.

PARTICIPANTS

Two hundred thirty-seven undergraduate students.

MEASURES

US Department of Agriculture (USDA) 18-item Household Food Security Survey Module (HFSSM) and questions on demographics, student status, economic factors, housing stability, living arrangements, academic performance, and self-rated physical health and depression symptoms.

ANALYSIS

Multivariate logistic regression analysis.

RESULTS

Among students surveyed, 15% were food insecure; an additional 16% were at risk of food insecurity. Students who were African American, other race/ethnicity, receiving multiple forms of financial aid, or experiencing housing problems were more likely to be food insecure or at the risk of food insecurity (Adjusted Odds Ratio [AOR] = 4.00, 95% confidence interval [CI] = 1.83-8.71, P value < .0001; AOR = 5.26, 95% CI = 1.85-14.98, P value = .002; AOR = 3.43, 95% CI = 1.85-6.37, P value <.001; AOR = 8.00, 95% CI = 3.57-17.93, P value < .0001, respectively). Food secure students were less likely to report depression symptoms than at-risk or food insecure students.

CONCLUSION

Food insecurity among college students is an important public health concern that might have implications for academic performance, retention, and graduation rates. Universities that measure food insecurity among their students will be better positioned to advocate for policy changes at state and federal levels regarding college affordability and student financial assistance.

The National Health and Nutrition Examination Survey's Food Insecurity Questionnaire Completed by Children: Effects of Assessment Mode (Classroom versus Interview)

The National Health and Nutrition Examination Survey's food insecurity questionnaire was administered to 155 children (77 African American, 65 White, 13 "Other" [7 Hispanic; 6 mixed races]) in grade 4 twice, 28-32 days apart. Test-retest reliabilities were modest and somewhat similar for assessment mode (classroom, interview) and subgroup variables (gender, race, socioeconomic status, academic achievement, body mass index percentile, social desirability). As academic achievement increased, White and Other children reported less food insecurity, and African-American children reported slightly less. As social desirability increased, White and African-American children reported slightly more food insecurity, and Other children reported substantially more. Although the questionnaire may be acceptable for use with diverse groups of children in grade 4, validation is needed.

The pervasive effect of youth self-report of hunger on depression over 6 years of follow up

PURPOSE

We used longitudinal data to clarify the association between self-report of hunger and subsequent depression risk among youth and young adults, accounting for other risk factors.

METHODS

Youth self-report of ever experiencing hunger data were collected from cycles 4-6 of the National Longitudinal Survey of Children and Youth cohort of Canadian youth 16 years and older (n = 4139). Data on depressive symptoms (CES-D 12) were collected over three cycles (2004-2009, cycles 6-8). We used multivariable regression based on generalized estimating equations (GEE) to examine prior youth hunger on later depression risk, adjusting for time-stable, time-varying, and lagged variables (e.g., depressive symptoms in previous cycle), thereby clarifying the temporal relationship.

RESULTS

The prevalence of youth hunger experience and depression risk reached 5.9 and 15.0%, respectively. The adjusted odds ratio of depression for participants reporting hunger was 2.31 (95% CI 1.54, 3.46) and changed little [2.17 (95% CI 1.29, 3.67)] after accounting for previous CES-D 12 scores, suggesting a temporal relationship in which hunger contributes to depression risk. Unlike never-hungry youth, depression in ever-hungry youth remained comparatively elevated over time.

CONCLUSIONS

Our models support an independent and temporal relationship between youth self-report of hunger and depression in adolescence and young adulthood.

The Intergenerational Circumstances of Household Food Insecurity and Adversity

Household food insecurity is linked with exposure to violence and adversity throughout the life course, suggesting its transfer across generations. Using grounded theory, we analyzed semistructured interviews with 31 mothers reporting household food insecurity where participants described major life events and social relationships. Through the lens of multigenerational interactions, 4 themes emerged: (1) hunger and violence across the generations, (2) disclosure to family and friends, (3) depression and problems with emotional management, and (4) breaking out of intergenerational patterns. After describing these themes and how they relate to reports of food insecurity, we identify opportunities for social services and policy intervention.

Lunch at the library: examination of a community-based approach to addressing summer food insecurity

Objective

To examine a library-based approach to addressing food insecurity through a child and adult summer meal programme. The study examines: (i) risk of household food insecurity among participants; (ii) perspectives on the library meal programme; and (iii) barriers to utilizing other community food resources.

Design

Quantitative surveys with adult participants and qualitative semi-structured interviews with a sub-sample of adult participants.

Setting

Ten libraries using public and private funding to serve meals to children and adults for six to eight weeks in low-income Silicon Valley communities (California, USA) during summer 2015.

Subjects

Adult survey participants (≥18 years) were recruited to obtain maximum capture, while a sub-sample of interview participants was recruited through maximum variation purposeful sampling.

Results

Survey participants (n161) were largely Latino (71 %) and Asian (23 %). Forty-one per cent of participants screened positive for risk of food insecurity in the past 12 months. A sub-sample of programme participants engaged in qualitative interviews (n67). Interviewees reported appreciating the library’s child enrichment programmes, resources, and open and welcoming atmosphere. Provision of adult meals was described as building community among library patrons, neighbours and staff. Participants emphasized lack of awareness, misinformation about programmes, structural barriers (i.e. transportation), immigration fears and stigma as barriers to utilizing community food resources.

Conclusions

Food insecurity remains high in our study population. Public libraries are ideal locations for community-based meal programmes due to their welcoming and stigma-free environment. Libraries are well positioned to link individuals to other social services given their reputation as trusted community organizations.

Does Hunger Contribute to Socioeconomic Gradients in Behavior?

Recent research has uncovered many examples of socioeconomic gradients in behavior and psychological states. As yet there is no theoretical consensus on the nature of the causal processes that produce these gradients. Here, I present the hunger hypothesis, namely the claim that part of the reason that people of lower socioeconomic position behave and feel as they do is that they are relatively often hungry. The hunger hypothesis applies in particular to impulsivity-hyperactivity, irritability-aggression, anxiety, and persistent narcotic use, all of which have been found to show socioeconomic gradients. I review multiple lines of evidence showing that hunger produces strong increases in these outcomes. I also review the literatures on food insufficiency and food insecurity to show that, within affluent societies, the poor experience a substantial burden of hunger, despite obtaining sufficient or excess calories on average. This leads to the distinctive prediction that hunger is an important mediator of the relationships between socioeconomic variables and the behavioral/psychological outcomes. This approach has a number of far-reaching implications, not least that some behavioral and psychological differences between social groups, though persistent under current economic arrangements, are potentially highly reversible with changes to the distribution of financial resources and food.

Impacto do Programa “Bolsa Família” sobre a qualidade da dieta das famílias de Pernambuco no Brasil

Resumo Este artigo analisa o impacto do Programa Bolsa Família (PBF) sobre a qualidade da dieta dos domicílios do estado de Pernambuco utilizando dados da Pesquisa de Orçamento Familiar (POF-IBGE) entre 2008-2009. O método Propensity Score Matching, que corrige o viés de seleção amostral, foi utilizado para realizar a comparação entre as famílias beneficiárias e as não beneficiárias do Programa. Os resultados mostram que o valor médio do Índice de Qualidade da Dieta (IQD) para as famílias beneficiárias do Programa supera em 9,05 o valor médio do IQD das famílias não participantes do PBF. Os resultados corroboram a eficácia do PBF em elevar a qualidade da dieta das famílias, principalmente quanto à redução de gordura e sódio, e aumento da variedade.

Social Cohesion and Food Insecurity: Insights from the Geographic Research on Wellbeing (GROW) Study

Objectives Food insecurity in the United States is a stubborn public health issue, affecting more than one in five households with children and disproportionately impacting racial and ethnic minority women and their children. Past research and policy has focused on household predictors of food insecurity, but neglected broader factors, such as perceived neighborhood social cohesion, that might protect those most vulnerable to food insecurity. Methods We use a racially and ethnically diverse data set from the Geographic Research on Wellbeing study (N = 2847) of women and their young children in California to investigate whether social cohesion influences food insecurity and whether it moderates the relationship between race/ethnicity and food insecurity. Results We find that lower levels of perceived residential neighborhood social cohesion associate with higher odds of food insecurity even after considering important household socioeconomic factors. In addition, our results suggest that social cohesion is most relevant for reducing the risk of food insecurity among racial and ethnic minority mothers. For example, the probability of food insecurity for immigrant Latina mothers is nearly 0.40 in neighborhoods where mothers perceive little to no cohesion and less than 0.10 in neighborhoods where mothers perceive high cohesion. Conclusions for Practice Higher levels of neighborhood perceived social cohesion are protective against food insecurity in households with children and especially so for racial and ethnic minority households who are at a heightened risk of food insecurity. Supporting programs that focus on building closer knit communities may be a key to reducing food insecurity overall and for reducing disparities in food insecurity by race and ethnicity.

SNAP Participation and Diet-Sensitive Cardiometabolic Risk Factors in Adolescents

INTRODUCTION

Previous research suggests participation in the Supplemental Nutrition Assistance Program (SNAP) is associated with poorer adult cardiometabolic health; the extent to which these associations extend to adolescents is unknown. Differences in diet quality, obesity, and cardiometabolic risk factors were examined among SNAP participants, income-eligible nonparticipants, and higher-income adolescents.

METHODS

The study population comprised 4,450 adolescents ≤300% federal poverty level from the 2003-2010 National Health and Nutrition Examination Survey. Generalized linear models were used to examine associations between SNAP participation and the Alternate Healthy Eating Index-2010. Linear and logistic regression models were used to examine associations between SNAP participation, obesity, and risk factors comprising the metabolic syndrome. Data were analyzed in 2015.

RESULTS

All surveyed adolescents consumed inadequate amounts of vegetables, fruits, whole grains, and long-chain fatty acids, while exceeding limits for sugary beverages, processed meats, and sodium. Although there were few dietary differences, SNAP participants had 5% lower Alternate Healthy Eating Index-2010 scores versus income-eligible nonparticipants (95% CI=-9%, -1%). SNAP participants also had higher BMI-for-age Z scores (β=0.21, 95% CI=0.01, 0.41), waist circumference Z scores (β=0.21, 95% CI=0.03, 0.39), and waist-to-height ratios (β=0.02, 95% CI=0.00, 0.03) than higher-income nonparticipants. SNAP participation was not associated with most cardiometabolic risk factors; however, SNAP participants did have higher overall cardiometabolic risk Z scores than higher-income nonparticipants (β=0.75, 95% CI=0.02, 1.49) and income-eligible nonparticipants (β=0.55, 95% CI=0.03, 1.08).

CONCLUSIONS

Adolescent SNAP participants have higher levels of obesity, and some poorer markers of cardiometabolic health compared with their low-income and higher-income counterparts.

Transitions Into Food Insecurity Associated With Behavioral Problems And Worse Overall Health Among Children

Children living in food-insecure households face myriad challenges to their well-being. The Great Recession of December 2007-June 2009 increased food insecurity to the highest levels ever measured in the United States. Using nationally representative data from the period 2010-12 for 6,300 children in the Early Childhood Longitudinal Study, Kindergarten Class of 2010-11, with household incomes below 300 percent of the federal poverty level and a dynamic measure of food insecurity transitions, we assessed the impact of transitions into and out of household food insecurity on the academic achievement, behavioral problems, and health status of young children. We found negligible impacts of food insecurity transitions on academic achievement in first grade. However, we found consistent negative impacts of the transitions on teachers' reports of children's externalizing behaviors, self-control, and interpersonal skills and on parents' reports of children's overall health status. Taken together, our findings underline the importance of food security for children's healthy development.

Can the Provision of Breakfast Benefit School Performance?

Studies of an association between school performance (enrollment, attendance, achievement, classroom behavior, and school drop-out) and nutritional status are discussed and the evidence of an effect of school meals evaluated. Many studies have shown associations between hunger, poor dietary intakes, stunting, underweight, and poor school performance after controlling for socioeconomic conditions. However, it remains possible that unmeasured socioeconomic variables could explain the relationship. Rigorous short-term studies of missing breakfast have generally found detrimental effects on children's cognition whereas studies of providing breakfast have shown benefits particularly in malnourished children. Classroom conditions may modify the effects of breakfast on behavior. There are extremely few longer term studies of the effects of giving school meals. Nearly all involved breakfast and very few had randomized controlled designs. Studies comparing participants with non-participants or comparing matched schools have found benefits (but bias due to self-selection) of receiving breakfast; inadequate matching of schools also remains possible. One longer term randomized controlled trial found benefits associated with attendance and arithmetic performance. In conclusion, most studies of giving breakfast have found benefits to school performance but many had serious design problems, were short-term, and were not conducted in the poorest countries. In order to advise policy makers correctly, there is an urgent need to run long-term randomized controlled trials of giving school meals in poor countries and to determine the effects of age and nutrition status of the children, the quality of the school, and the timing of the meal. The special needs of orphans should also be considered.

The Breakfast-Eating Habits of Inner City High School Students

This cross-sectional, descriptive correlational research study describes the breakfast-eating habits of 846 inner-city high school students. Fifty-seven percent of students reported skipping breakfast on the day of the survey, despite the free hot-breakfast program at their high school. Significantly more girls than boys skipped breakfast, and 10th grade students had the highest rate of skipping breakfast. Sixty-four percent of breakfast-skippers cited a lack of time, and 28% stated they could not eat early in the morning. More breakfast eaters reported eating at home (48%); only 14% reported eating at school, with 3% reportedly eating both at home and school. Milk, orange juice, cereal, and foods in the bread group were the most frequently eaten foods. Patterns of eating by gender and by grade level are discussed in this article, as are implications for school nursing, including assessment, teaching, and research. It is important to educate students and parents about the importance of eating breakfast, because it provides an important part of a student’s daily intake of nutrients needed for energy, growth, and learning.

"Do You Wanna Breathe or Eat?": Parent Perspectives on Child Health Consequences of Food Insecurity, Trade-Offs, and Toxic Stress

OBJECTIVES

This study among 51 parents of young children under age four investigated how parents that report marginal, low and very low food security characterize how trade-offs associated with food insecurity affect parents' mental health and child well-being.

METHODS

We carried out 51 semi-structured audio-recorded interviews after participants responded to a survey regarding food security status and maternal depressive symptoms. Each interview was transcribed. Through a content analysis, we coded "meaning units" in each manuscript and organized them by themes in ATLAS.ti. Among participants reporting both food insecurity and depressive symptoms, we identified three primary areas of concern: trade-offs, mental health, and child well-being.

RESULTS

Parents described how trade-offs associated with food insecurity have a profound relationship with their mental health and home environment that strongly affects young children. Descriptions of hardships include anxiety and depression related to overdue bills and shut-off notices, strains with housing costs, and safety. Parents described how their own frustration, anxiety, and depression related to economic hardship have a negative impact on their children's physical health, and their social and emotional development.

CONCLUSIONS

Parents in food insecure households recognize that trade-offs between food and other basic necessities are associated with their personal stress and poor mental health that, in turn, affects their children's health and development. Partnerships between healthcare providers, policymakers, and parents are essential to successfully address and prevent the poor child health outcomes of toxic stress associated with food insecurity and poverty.