Food Insecurity in the United States

Food security and part-time work for students: do race and region play a role?

OBJECTIVE

This study explored the relationship between weekly hours worked and food security among full-time college students in the United States, as well as the extent to which this relationship depends on racial identity and regional location.

PARTICIPANTS/METHODS

We performed a secondary analysis of data from 1,450 full-time college students in the labor force who completed the 2019 Food Security Supplement to the Current Population Survey. Moderated multiple logistic regression was used to analyze the data.

RESULTS

We found that among full-time college students in the labor force, working a greater number of hours per week was not related to one's likelihood of being food insecure, with an exception for students who identified as Asian.

CONCLUSIONS

These findings highlight the importance of considering the intertwined nature of contributing factors to food security for specific groups of students.

Exploring Sociodemographic and Chronic Disease Factors Associated With Chronic, Seasonal, Intramonthly, and Intermittent Presentations of Food Security Instability

BACKGROUND

Food insecurity impacts 13.5 million US households yearly. Although food security instability (FS-I) can have many temporal presentations, these are not measured in the current US Household Food Security Survey Module.

OBJECTIVE

Explore sociodemographic and chronic disease correlates of 4 FS-I types (chronic, seasonal, intramonthly, and intermittent) using a 3-item US Household Food Security Survey Module instability supplement.

DESIGN

This study was a secondary analysis of cross-sectional survey pilot data collected to validate the US Household Food Security Survey Module instability supplement.

PARTICIPANTS AND SETTING

Adults at risk for food insecurity (n = 420) were recruited and answered the survey on their households' behalf from April to June 2021. The participants were recruited from 7 community organizations from 5 states (California, Florida, Maryland, North Carolina, and Washington).

MAIN OUTCOME MEASURES

The main outcomes were the odds of having a chronic, seasonal, intramonthly, or intermittent FS-I score ≥1 based on several sociodemographic factors and having ≥1 chronic disease.

STATISTICAL ANALYSES PERFORMED

Differences among the 4 FS-I types were analyzed using contingency tables and χ2 tests of independence. Then, mixed-effects logistic binary and conditional regressions were run for each FS-I type using clustering by state and odds ratios and 95% CI to interpret results.

RESULTS

The most common FS-I type experienced by the sample was intramonthly (n = 183 [43%]). Nonchronic food insecurity was most likely to happen during the winter, at the end of the month, or randomly with no certain time frame. FS-I in any form was associated with low income, chronic FS-I was associated with younger age and male sex, seasonal FS-I was associated with having no government-subsidized health insurance and females, intramonthly FS-I was associated with participation in nutrition assistance programs, and intermittent FS-I had lower odds among Hispanic/Latino households.

CONCLUSIONS

Further research is needed to explore other FS-I correlates and establish causative relationships; however, these results can be used with clinical judgment for targeted food insecurity screening and treatment.

Food insecurity and delayed or forgone health care among pregnant and postpartum women in the United States, 2019-2021

OBJECTIVE

Despite the growing food insecurity crisis in the United States, limited evidence exists about the effects of food insecurity on the unmet health care needs of peripartum (pregnant and postpartum) women. The aim of this study was to examine the association between food insecurity and delayed or forgone health care among peripartum women in the United States from 2019 to 2021.

METHODS

We conducted a pooled cross-sectional analysis using data from the 2019, 2020, and 2021 National Health Interview Surveys. Food security status was defined by type (high/marginal, low, and very low). Descriptive analysis and multivariable logistic regression, adjusted for sociodemographic and health-related characteristics, were conducted to estimate the overall and specific delayed or forgone health care (yes or no) between the different categories of food security.

RESULTS

Of the 1525 peripartum women (weighted, N = 5,580,186), 11% of peripartum women in the United States experienced suboptimal food security in the 12 mo between 2019 and 2021, with 5% experiencing low and 5% experiencing very low food security. This included 6% (95% confidence interval [CI], 5-8%) who reported delaying filling a medical prescription, 6% (95% CI, 5-8%) who required counseling or therapy from a mental health professional but did not receive it, 6% (5-8%) who delayed counseling or therapy from a mental health professional, 8% (95% CI, 6-10%) who needed medical care but did not receive it, and 9% (95% CI, 7-10%) who delayed medical care. Peripartum women with low and very food security were more likely to delay or forego health care due to cost concerns than food-secure peripartum women. In the multivariable analyses adjusted for predisposing, enabling, and need-based factors, women with low and very low food security had higher risk for delayed or forgone health care than those with marginal or high food security.

CONCLUSION

This study demonstrated a positive association between food insecurity and cost-related unmet health care needs among peripartum women. Future empirical studies are needed to assess the effects of peripartum health care interventions targeting food insecurity on reducing health care access disparities associated with costs and improving peripartum health outcomes.

Household food insecurity is prevalent in a cohort of postpartum women who registered in the Canada Prenatal Nutrition Program in Toronto

OBJECTIVE

To assess the prevalence, severity and socio-demographic predictors of household food insecurity among vulnerable women accessing the Canada Prenatal Nutrition Program (CPNP) and to examine associations between household food insecurity and breastfeeding practices to 6 months.

DESIGN

Cohort investigation pooling data from two studies which administered the 18-item Household Food Security Survey Module at 6 months postpartum and collected prospective infant feeding data at 2 weeks and 2, 4 and 6 months. Household food insecurity was classified as none, marginal, moderate or severe. Logistic regression analyses were performed to assess predictors of household food insecurity and associations between household food security (any and severity) and continued and exclusive breastfeeding.

SETTING

Three Toronto sites of the CPNP, a federal initiative targeting socially and/or economically vulnerable women.

PARTICIPANTS

316 birth mothers registered prenatally in the CPNP from 2017 to 2020.

RESULTS

Household food insecurity at 6 months postpartum was highly prevalent (44 %), including 11 % in the severe category. Risk of household food insecurity varied by CPNP site (P < 0·001) and was higher among multiparous participants (OR 2·08; 95 % CI 1·28, 3·39). There was no association between the prevalence or severity of food insecurity and continued or exclusive breastfeeding to 6 months postpartum in the adjusted analyses.

CONCLUSIONS

Household food insecurity affected nearly half of this cohort of women accessing the CPNP. Further research is needed on household food insecurity across the national CPNP and other similar programmes, with consideration of the implications for programme design, service delivery and policy responses.

Measuring Food Insecurity: The Problem with Semantics

Rising rates of hunger and food insecurity have sparked a major re-evaluation of all aspects of food systems. Because of the multifaceted nature of food insecurity, however, determining what actions should be taken is challenging, especially since reevaluation efforts are led by experts from several disciplines and there is no consensus about which indicators should be used and how they should be measured. Confusion surrounding the meaning of the terms 'food security' and 'food insecurity' has contributed to this lack of consensus. As indicators inform action, such confusion has slowed those committed to alleviating hunger in identifying the most pressing targets. This review highlights (1) the importance of clearly defining food security and food insecurity and (2) how such definitions affect measures of food insecurity in the United States. While some might say that definitions are an issue of the past or a trivial matter of semantics, we believe that the world's present rates of hunger and malnutrition are attributable, at least in part, to the lack of consensus on these definitions and their accompanying measurements and indicators. Although the present review can be helpful to academics and policy makers, the primary purpose is to be a resource to those involved in the day-to-day production of food, such as ranchers and farmers by providing an overview of definitions, indicators, and measurements used when discussing food security.

Food insecurity indicators of 14 OECD countries in a health economics aspect: A comparative analysis

Introduction

Food insecurity is a critical issue that refers to a lack of access to adequate food to support a healthy and active lifestyle. This problem has wide-reaching effects and can negatively impact health, education, and overall well-being. Addressing food insecurity requires a multifaceted approach that involves the efforts of governments, organizations, and individuals to ensure access to a balanced and nutritious diet for all.

Methods

The aim of this study is to shed light on macro-level models and evaluate food insecurity risk in international comparisons. We considered six criteria to evaluate food insecurity risk in terms of health expenditure, gross domestic product (GDP) per capita, and GDP growth rate among 14 Organisation for Economic Co-operation and Development (OECD) countries. We developed a modeling approach in three stages to compare food insecurity risk and discussed the reasons for the rankings of the countries based on the model results.

Results

According to our findings, the United States has the lowest food insecurity risk, while Colombia has the highest. The results suggest that economic factors, such as GDP per capita and GDP growth rate, play a significant role in food insecurity risk. The study highlights the importance of addressing economic disparities and promoting economic growth to reduce food insecurity.

Discussion

This study provides insights into the relationship between food insecurity and economic factors, indicating that addressing economic disparities and promoting economic growth can reduce food insecurity. Future research using similar models to link economic outcomes with important health components such as nutrition and physical activity could provide a foundation for policy development.

Prevalence and Severity of Food Insecurity Before and During the Coronavirus Disease 2019 Pandemic Among Adults and Youth in Australia, Canada, Chile, Mexico, the United Kingdom, and the United States

BACKGROUND

Disruptions from the coronavirus disease 2019 (COVID-19) pandemic potentially exacerbated food insecurity among adults and youth.

OBJECTIVES

The objective was to examine changes in the prevalence and severity of food insecurity among adults and youth from before (2019) to during (2020) the pandemic in multiple countries.

METHODS

Repeated cross-sectional data were collected among adults aged 18-100 y (n = 63,278) in 5 countries in November to December in 2018-2020 and among youth aged 10-17 y (n = 23,107) in 6 countries in November to December in 2019 and 2020. Food insecurity in the past year was captured using the Household Food Security Survey Module and the Child Food Insecurity Experiences Scale. Changes in the prevalence and severity of food insecurity were examined using logistic and generalized logit regression models, respectively. Models included age, gender, racial-ethnic identity, and other sociodemographic characteristics associated with food insecurity to adjust for possible sample differences across waves. Models were weighted to reflect each country's population.

RESULTS

Adults [adjusted OR (AOR): 1.15; 95% CI: 1.02, 1.31] and youth (AOR: 1.43; 95% CI: 1.19, 1.71) in Mexico were more likely to live in food-insecure households in 2020 compared to 2019. Adults in Australia (AOR: 0.81; 95% CI: 0.72, 0.92) and Canada (AOR: 0.87; 95% CI: 0.77, 0.99) were less likely to live in food-insecure households in 2020. Trends in severity aligned with changes in prevalence, with some exceptions. Youth in Australia (AOR: 2.24; 95% CI: 1.65, 3.02) and the United States (AOR: 1.39; 95% CI: 1.04, 1.86) were more likely to have many compared with no experiences of food insecurity in 2020 compared to 2019. There was no evidence of change among adults and youth in the remaining countries.

CONCLUSIONS

Except for Mexico, few changes in food insecurity among adults and youth were observed from before to during the COVID-19 pandemic. Action is needed to support households at risk of food insecurity. J Nutr 20XX;xx:xx-xx.

Addressing Food Insecurity: A Qualitative Study of Undergraduate Students' Perceptions of Food Access Resources

Food insecurity has emerged as a leading health care problem in the United States, impacting college students' health, well-being, and academic performance. The aims of this study were: (1) to assess the prevalence of food insecurity, (2) to identify college students' perceptions about food access resources, and (3) to explore students' expressed needs from the university in improving food security status. A mixed-methods approach was used to assess the quantitative and qualitative aspects of the study aims. An online survey to gather demographic information and assess food security status using the 6-item version of the US Household Food Security Scale Module (HFSSM) was administered. Next, qualitative focus groups with subsets of participants was conducted to gain further insight into the perceptions, coping mechanisms, and resource utilization issues related to food insecurity. This study found 34.1% of undergraduate college students to be food insecure and demonstrates that students with a meal plan are less likely to be food insecure (p = 0.012; OR = 0.68; 95% CI = 0.489, 0.918). Qualitative data identified key influencers of food insecurity: (1) personal beliefs, (2) life skills, and (3) the university. The results of this study contribute to the literature focused on food insecurity prevalence in college students and presents insight from the college student perspective. Findings may support the development of relevant interventions that are congruent with students' needs, enhancing resource utilization to increase food security status among college students.

A latent class analysis to identify socio-economic and health risk profiles among mothers of young children predicting longitudinal risk of food insecurity

BACKGROUND

The purpose of the current study was to use a social determinants of health (SDOH) framework and latent class analysis (LCA) to identify risk classes among mothers with young children. The risk classes were then used to predict food insecurity severity and stability/change of food insecurity over time.

METHOD

The secondary data from the Fragile Families and Child Wellbeing Study (n = 2,368; oversampled for non-marital births) was used in this study. Household food insecurity was assessed using the 18-items USDA Food Security Survey. A seventeen-item inventory of educational, economic stability, incarceration (i.e. social context), neighborhood safety (i.e. neighborhood and built environment), health and health care, and substance use behaviors at baseline/Year-1 were included to identify SDOH risk indicators in the LCA. Covariate-adjusted multinomial logistic regression models were used to examine the relation between risk classes at Year-1 and the severity of food insecurity at Year-3 and stability/change of food insecurity between Year-3 and Year -5.

RESULTS

LCA identified five risk classes: High utility and medical hardship (Class 1), high housing and employment hardship, high substance use, and incarceration (Class 2), high housing and medical hardship, poor health, and health care (Class 3), high employment hardship and low-income (Class 4) and low-risk (Class 5). The Class 1, Class 2 and Class 3 had greater odds of low food security and very low food security at Year-3 compared to Class 4. In addition, compared to Class 4, Class 1, Class 2 and Class 3 had greater odds unstable food insecurity and persistent food insecurity over time.

CONCLUSIONS

LCA could be used to identify distinctive family system risk profiles predictive of food insecurity. The generated risk profiles could be used by health care providers as an additional tool to identify families in need for resources to ensure household food security.

Food Insecurity in Central-Eastern Europe: Does Gender Matter?

Food insecurity (FI) remains a challenge not only in less-developed countries but also worldwide. The literature indicates higher rates of FI for women than men in some regions of the world. Thus, the main objective of this cross-sectional study was to assess differences in experiencing FI according to gender in Central-Eastern Europe—a region that has been little researched in terms of FI. The study analyzes individual-level data on FI from the Gallup World Poll (GWP) for the years 2018–2019, obtained under a license from the Food and Agriculture Organization (FAO). Dataset encompasses representative samples of individuals aged 15 and above for each studied country. Apart from bivariate analysis, the ordered logistic regression, the generalized ordered logistic regression and multinomial logistic regression models were used. It was found that women experienced mild FI more often than men. However, gender differences with respect to moderate or severe FI were not confirmed. Moreover, the significant associations of all severity levels of FI with education, employment status, social capital, social network, age, marital status, household composition and income were observed. The research findings can be used to inform policy and to design targeted assistance programs for those in need.

Conceptualising household food insecurity in Northern Ireland: risk factors, implications for society and the economy, and recommendations for business and policy response

Household food insecurity in developed nations has been identified as a significant public health concern. Although various research on the topic exists, such as contributors to food insecurity, and implications for individual physical and mental health outcomes; there is currently a lack of consideration as to how individual implications of food insecurity such as poor physical and mental health can consequently impact on business and the wider economy. In addition, there is a lack of conceptual literature related to food insecurity. Stakeholder interviews (n = 19) were conducted, and data were used to inform the conceptual model (risk factors, potential implications for individuals, the economy and business, and opportunities for business and policy response). The main suggested implications related to business and the economy were reduced contribution to the workforce and the economy, and increased cost pressures on the National Health Service. Business responses suggested included the inclusion of initiatives to address food insecurity in corporate social responsibility strategies, and further involvement of food businesses/retailers in redistributing surplus food. Policy responses suggested included policies relating to welfare, wages and work contracts, food redistribution incentives, sustainability, and community interventions in disadvantaged areas. The resulting model is unique in conceptualising food insecurity in the Northern Ireland context, with applicability to the UK and other developed nations.

Profiles of Food Insecurity: Similarities and Differences across Selected CEE Countries

Food security (FS) is influenced by primarily financial but also sociodemographic factors. Identification of correlates of food insecurity (FI) is a crucial issue in the context of achieving sustainable development goals. The aims of the study were: (1) to recognize FI in the selected Central and Eastern European (CEE) countries, (2) to examine common socioeconomic and demographic characteristics for FI. The analysis used the set of eight-item FI indicators adopted by the Food and Agriculture Organization, applying the Gallup World Poll survey data from 2017 to 2019. Multinomial logistic regressions were used to examine FI at mild and moderate or severe levels compared with FS. Differences in the profiles of FI were observed in analyzed countries: Poland, Lithuania and Slovakia. Lithuanians experienced the lowest FS, and Slovaks the highest. The FI status was associated with education, gender, age, household composition and income. It was found that the impact of these factors was not the same in the examined countries. Differences in profiles of FI in CEE countries indicate the need to analyze the problem individually for each country. Identifying groups particularly vulnerable to FI may allow appropriate targeting of instruments counteracting FI and adapt them to people with different characteristics.

An Analysis of Resilience Planning at the Nexus of Food, Energy, Water, and Transportation in Coastal US Cities

Climate change poses increased risks to coastal communities and the interconnected infrastructure they rely on, including food, energy, water, and transportation (FEWT) systems. Most coastal communities in the US are ill-prepared to address these risks, and resilience planning is inconsistently prioritized and not federally mandated. This study examined the resilience plans of 11 coastal US cities to understand 1. How FEWT systems were considered within resilience plans and, 2. How nexus principles or elements critical to a nexus approach were incorporated within resilience plans. A “Nexus Index” was created to examine the incorporation of nexus principles, which included partnerships and collaborations, reference to other plans or reports, discussion of co-benefits, cascading impacts, and inclusion of interdisciplinary or cross-silo principles. These principles were used to score each action within the resilience plans. Results showed that only eight actions (1% of all actions across the 11 plans) focused on the connections among FEWT systems within the resilience plans. The transportation system was associated with the most actions, followed by the energy system, water system, and the food system. While FEWT systems were not consistently included, there was evidence from the Nexus Index that the plans included elements critical to a nexus approach, such as the inclusion of partnerships and reference to co-benefits with the actions they designed to build resilience. The heterogeneity among the systems that each plan emphasized reflects the heterogeneity among the challenges that each city faces. While context-specific differences in resilience plans across cities are expected, some consistency in addressing certain infrastructural needs and their nexus interactions may greatly benefit and improve the implementation of resilience planning.

Food insecurity among Canadian youth and young adults: insights from the Canada Food Study

OBJECTIVE

This study explored associations between socio-demographic characteristics, self-reported health, and household food security among young adults.

METHODS

National cohort study participants from Toronto, Montreal, Vancouver, Edmonton, and Halifax, Canada, aged 16-30 years (n = 2149) completed online surveys. Multinomial logistic regression, weighted to reflect age and sex proportions from the 2016 census, was conducted to examine associations between food security status and covariates.

RESULTS

Almost 30% of respondents lived in food-insecure households, with 19% in "moderately" food-insecure and 10% in "severely" food-insecure households. Respondents identifying as Black or Indigenous were more likely to live in moderately (AOR = 1.96, CI: 1.10, 3.50; AOR = 3.15, CI: 1.60, 6.20) and severely (AOR = 4.25, CI: 2.07, 8.74; AOR = 6.34, CI: 2.81, 14.30) food-insecure households compared with those identifying as mixed/other ethnicity. Respondents who found it "very difficult" to make ends meet were more likely to be moderately (AOR = 20.37, CI: 11.07, 37.46) and severely (AOR = 101.33, CI: 41.11, 249.77) food insecure. Respondents classified as "normal" weight (AOR = 0.64, CI: 0.43, 0.96) or overweight (AOR = 0.53, CI: 0.34, 0.83) were less likely to be moderately food insecure compared with those affected by obesity. Compared with "very good or excellent," "poor" health, diet quality, and mental health were each positively associated with severe food insecurity (AOR = 7.09, CI: 2.44, 20.61; AOR = 2.63, CI: 1.08, 6.41; AOR = 2.09, CI: 1.03, 4.23, respectively).

CONCLUSION

The high prevalence of correlates of food insecurity among young adults suggests the need for policies that consider the unique challenges (e.g., precarious income) and vulnerability associated with this life stage.

The Prevalence and Socio-Demographic Correlates of Food Insecurity in Poland

While food insecurity (FI) has been extensively studied in many countries, there have been few empirical contributions in Poland to date. The main objective of our research was to identify the socio-demographic factors affecting the risk of FI in Poland within 2014-2019. Moreover, we aimed to examine the effects of the family-oriented social program "Family 500+" by comparing the situation in various types of households with children a few years before and after the program was launched. The analysis was based on the set of eight-item FI indicators adopted by the Food and Agriculture Organization using the Gallup World Poll nationally representative survey data. Based on our results the most vulnerable groups in the context of FI were identified. We confirmed the importance of education, gender, age, marital status, household composition, status of employment and income in preventing FI. The effectiveness of the support program in reducing FI was demonstrated as households with at least three children experienced significant improvement in the FI status during the studied years. These findings should be especially important in the context of the impact of the COVID-19 pandemic on FI. As FI can affect the quality and quantity of food choices it is associated with a poorer health status, which increases the risk of infection, including COVID-19, and worsens recovery prognosis. Planning an efficient response to the pandemic requires a comprehension of the increased risk of exposure experienced by people, especially those who are food insecure.

Caregiver's Self-Confidence in Food Resource Management Is Associated with Lower Risk of Household Food Insecurity among SNAP-Ed-Eligible Head Start Families

Food resource management (FRM) behaviors are key components within nutrition education programs designed to help food insecure households maximize their food dollars. However, little is known about the association between FRM self-confidence and financial practices with household food insecurity (HFI) among families with young children. Using a sample of SNAP-Ed-eligible Head Start families, this study examined associations between FRM self-confidence, FRM behaviors and financial practices by HFI. A needs assessment survey was conducted with caregivers of Head Start children (n = 365). HFI was measured using the US Household Food Security Survey Module. Chi-square and logistic regression analyses were conducted to examine if FRM self-confidence, FRM behaviors, and financial practices differed by HFI. Participants with high FRM self-confidence had lower odds of HFI (OR = 0.54, 95%CI: 0.33, 0.87), yet FRM behaviors, financial practices, and HFI were not related after adjusting for covariates. All FRM self-confidence questions significantly differed by HFI, whereas only one of six FRM behaviors and two of three financial practices differed by HFI (all p-values < 0.05). Promoting caregivers' self-confidence in FRM skills within nutrition education programs may be explored as a potential strategy to assist low-income households to stretch their food dollars in an attempt to address HFI.

Economic hardship and child intake of foods high in saturated fats and added sugars: the mediating role of parenting stress among high-risk families

OBJECTIVE

Economic hardship (EH) may link to poorer child diet, however whether this association is due to resource limitations or effects on family functioning is unknown. This study examines whether parenting stress mediates the association between EH and child consumption of foods high in saturated fats and added sugars (SFAS).

DESIGN

Data were collected from the Fragile Families and Child Wellbeing study. EH was assessed using eight items collected when children were between 1-9 years old. Mothers reported parenting stress and frequency of child consumption of high SFAS foods when children were 9 years old. Latent growth curve modelling (LGCM) and structural equation modelling tested direct associations between the starting level/rate of change in EH and high SFAS food consumption, and parenting stress as a mediator of the association.

SETTING

Twenty US cities.

PARTICIPANTS

Mothers/children (n 3846) followed birth through age 9 years, oversampled 'high-risk', unmarried mothers.

RESULTS

LGCM indicated a curvilinear trend in EH from ages 1-9, with steeper increases from ages 3-9 years. EH did not directly predict the frequency of high SFAS foods. Average EH at 3 and 5 years and change in EH from ages 1-9 predicted higher parenting stress, which in turn predicted more frequent consumption of high SFAS foods.

CONCLUSIONS

Findings suggest it may be important to consider parenting stress in early prevention efforts given potential lasting effects of early life EH on child consumption of high SFAS foods. Future research should explore how supports and resources may buffer effects of EH-related stress on parents and children.

Stability and Change in Early Life Economic Hardship Trajectories and the Role of Sex in Predicting Adolescent Overweight/Obesity

There is evidence that poverty is related to adverse child health outcomes. Yet, evidence is lacking on how economic hardship experiences during early childhood are related to adolescent obesity, how the relationship may differ by child sex, in addition to the potential child and maternal behavioral factors that link economic hardship and adolescent obesity. The purpose of the current study was to address this gap by using longitudinal data from the Fragile Families and Child Wellbeing Study (N = 1814). The analytic sample included 50.5% girls, 20% experiencing overweight status, and 19% experiencing obesity. Majority of the adolescents were born to non-Hispanic black (49%), U.S. born (86%), married/cohabitating mothers (61%) with high school or greater level of education (75%). The economic hardship trajectory classes were determined using the latent growth mixture modeling approach and supported a 4-class trajectory model, with 5% of the adolescents in the high-increasing economic hardship trajectory class. The children in the high-increasing economic hardship class had increased odds of developing overweight/obesity in adolescence compared to those in low-stable class. This association was significantly moderated by child sex (i.e., relationship was significant for adolescent boys). Parenting stress and child snacking behaviors did not significantly mediate the association between economic hardship classes and overweight/obesity. Economic hardships that increase through early childhood need to be recognized as an obesity risk factor particularly for adolescent boys.

College students' interpretations of food security questions: results from cognitive interviews

BACKGROUND

Food insecurity (FI) - the lack of sufficient access to food to maintain a healthy lifestyle - among college (i.e. post-secondary or higher education institution) students has become a prominent issue in the U.S. However, it is not clear if high rates of FI among students are due to the modern experience in higher education institutions or due to underlying issues in common surveying methods. To understand if there were underlying content validity issues, the present study had two primary research questions: 1) How do students interpret the U.S. Department of Agriculture (USDA) Food Security Survey Module (FSSM) questionnaire items, and 2) How do responses of students experiencing FI compare with the theorized experiences and coping responses?

METHODS

Thirty-three undergraduate students, aged 18- to 24-years old and fluent in English were recruited from a single 4-year university. During a 60-min session, participants completed the 10-item Adult FSSM and then were cognitively interviewed about their responses using the think-aloud method. Interview transcripts were analysed by two researchers using a collaborative process and basic interpretative approach.

RESULTS

Students were on average 19.5 years old (± 1.2 years), the majority were in their freshman or sophomore (i.e., first or second) year, and 67% (n = 22) experienced FI. Results indicated that students' interpretations of key terms - such as "money for more," "balanced meals," and "real hunger" - diverge from expectations. Furthermore, students categorized as food insecure reported experiences and responses to FI that varied from theoretical dimensions of the process.

CONCLUSIONS

Though limited by sample size and representativeness, the present results indicate that the content validity of the FSSM may be compromised in this population and the managed process of FI may present differently among college students. Further psychometric research on modifications to the FSSM or with new FI assessment tools should be conducted with college students.

Food insecurity and dietary intake by Supplemental Nutrition Assistance Program participation status among mainland US Puerto Rican adults after the 2009 American Recovery and Reinvestment Act

OBJECTIVE

The 2009 American Recovery and Reinvestment Act (ARRA) increased monthly Supplemental Nutrition Assistance Program (SNAP) benefits and expanded SNAP eligibility, yet limited evidence exists on the potential impact of ARRA on dietary intake among at-risk individuals. We aimed to examine pre-/post-ARRA differences in food insecurity (FI) and dietary intake by SNAP participation status.

DESIGN

Pre/post analysis.

SETTING

Boston, MA, USA.

PARTICIPANTS

Data were from the longitudinal Boston Puerto Rican Health Study (2007-2015). The US Department of Agriculture ten-item adult module assessed FI. A validated FFQ assessed dietary intake. Diet quality was assessed using the Alternate Healthy Eating Index-2010 (AHEI-2010). Self-reported pre-/post-ARRA household SNAP participation responses were categorized as: sustained (n 249), new (n 95) or discontinued (n 58). We estimated differences in odds of FI and in mean nutrient intakes and AHEI-2010 scores post-ARRA.

RESULTS

Compared with pre-ARRA, OR (95 % CI) of FI post-ARRA were lower for all participants (0·69 (0·51, 0·94)), and within sustained (0·63 (0·43, 0·92)) but not within new (0·94 (0·49, 1·80)) or discontinued (0·63 (0·25, 1·56)) participants. Post-ARRA, total carbohydrate intake was higher, and alcohol intake was lower, for sustained and new participants, and dietary fibre was higher for sustained participants, compared with discontinued participants. Scores for AHEI-2010 and its components did not differ post-ARRA, except for lower alcohol intake for sustained v. discontinued participants.

CONCLUSIONS

Post-ARRA, FI decreased for sustained participants and some nutrient intakes were healthier for sustained and new participants. Continuing and expanding SNAP benefits and eligibility likely protects against FI and may improve dietary intake.

Food insecurity among adult cancer survivors in the United States

PURPOSE

The purpose of this study was to examine the prevalence of food insecurity among US adults with a history of a cancer diagnosis and to understand if socio-demographic factors and cancer characteristics (i.e., time since diagnosis, cancer type) relate to food insecurity.

METHODS

This was a secondary analysis of cancer survivors drawn from the National Health and Nutrition Examination Surveys (NHANES) 2011-2014. Weighted analyses included descriptive, bivariate, and multinomial logistic regression.

RESULTS

Of the cancer survivors identified in the sample (n = 1,022), 8.36% were food insecure. In bivariate analysis, several factors were significantly associated with food insecurity among cancer survivors, including female gender, younger age, non-Hispanic black or Hispanic race/ethnicity, lower income, no insurance coverage, lower education, single relationship status, having children at home, having poor health or diet, and cancer characteristics (i.e., non-melanoma skin cancer, female reproductive cancer). In logistic regression analyses, odds of food insecurity decreased with older age and higher income and increased with poor health, although cancer type was no longer significant.

CONCLUSIONS

Though a low proportion of cancer survivors indicated being food insecure, food insecurity was evident, and this study identified socio-demographic factors related to food insecurity which may be important to consider in clinical and community health settings serving cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

Nutrition is essential throughout the cancer care trajectory, including survivorship. Clinicians should consider processes for screening patients, especially younger and lower income patients, for food insecurity through all stages of treatment and particularly as part of survivorship planning. Furthermore, availability and referral to community partners for nutrition and food support is essential.

Food Insecurity and Associated Factors Among University Students

BACKGROUND

Food insecurity is a growing public health issue and a barrier to students achieving adequate nutrition. Data regarding food insecurity among university students in Nigeria are scarce.

OBJECTIVE

The study assessed the prevalence of food insecurity and associated factors among university students, southeast Nigeria.

METHODS

A cross-sectional survey of 398 randomly selected students recruited from 2 universities in southeast Nigeria was conducted. Food security status was assessed using the 10-item US Household Food Security Scale Module. Anthropometric measurements and sociodemographic data were collected. Multivariate logistic regression was used to identify factors associated with food insecurity.

RESULTS

A majority of the students were categorized as food insecure. Of this, about 35.7% and 45.0% were considered to have low and very low food insecurity, respectively. Food insecurity was significantly associated with monthly allowance, daily amount spent on food, and source of income. The odds of food insecurity was significantly higher for students whose fathers were farmers (4.6, 95% confidence interval [CI]: 1.453-14.737), but lower for those whose mothers were farmers (0.18, 95% CI: 0.059-0.564).

CONCLUSION

The result provides an insight into the food security status of university students in Nigeria. The prevalence of food insecurity was high among the students. Therefore, further studies involving different urban and rural (and/or public and private) universities in Nigeria are suggested in order to have a deeper understanding of the magnitude and contributing factors among this population group.

Food Insecurity and Odds of High Allostatic Load in Puerto Rican Adults: The Role of Participation in the Supplemental Nutrition Assistance Program During 5 Years of Follow-Up

OBJECTIVE

Limited evidence demonstrates pathways linking food insecurity (FI) to chronic disease. Allostatic load (AL) may elucidate potential pathways, capturing both primary (neuroendocrine, inflammation) and secondary (metabolic, cardiovascular) physiological disturbances. We examined the longitudinal association of FI with 5-year AL and primary and secondary subsystem dysregulation and tested moderation by Supplemental Nutrition Assistance Program (SNAP) participation.

METHODS

We analyzed data from the longitudinal Boston Puerto Rican Health Study among 733 adults aged 45 to 75 years. Participants categorized as food insecure (assessed by US survey module) experienced FI at baseline and/or year 5. AL score comprised 11 biological components (5 primary, 6 secondary). We classified participants as having high scores for AL (≥6 dysregulated components), primary system (≥3), and secondary system (≥4). Multivariate models estimated odds ratios (OR), adjusting for baseline AL, sociodemographic, cultural, and behavioral characteristics.

RESULTS

By study end, 33.8% had experienced FI, 65.5% had participated in SNAP, and 37.5% had high AL. In adjusted models, FI was not associated with AL (OR [95% confidence intervals] = 1.07 [0.70-1.64]) or secondary system (0.82 [0.48-1.40]) scores, but was associated with high primary system scores (1.71 [1.25-2.36]). SNAP participation seemed to moderate the FI-primary system relationship (p = .06); food-insecure participants never receiving SNAP (mean (SE) = 2.06 (0.14)) had higher scores than food-secure participants receiving (1.72 (0.06], p = .02) or never receiving SNAP (1.64 (0.10), p = .01) and food-insecure participants receiving SNAP (1.80 (0.07), p = .08).

CONCLUSIONS

FI is associated with dysregulated components of the primary AL system, and this relationship may be stronger for those not receiving SNAP. Research is needed in additional populations to test AL as a plausible pathway connecting FI to chronic disease and SNAP as a moderator.

Hunger in Higher Education: Experiences and Correlates of Food Insecurity among Wisconsin Undergraduates from Low-Income Families

There is growing awareness that a substantial share of undergraduates are food insecure, potentially undermining investments in higher education and hindering upward social mobility. This mixed-methods paper uses survey and interview data from low-income students at 42 public colleges and universities in Wisconsin to illuminate the day-to-day experiences of food insecurity and examine how food security status varies across background characteristics. Results indicate that students who grew up in food insecure homes, self-identify as a racial/ethnic minority, live off-campus, and attend college in an urban area are significantly more likely to report the lowest level of food security, often associated with hunger. Students explain that challenges stemming from the interrelationship of lack of time and inadequate money are their biggest barriers to food security. Most rely on friends or family for support, but few students draw on the social safety net, in part due to eligibility restrictions. In recognition of the diversity of students’ experiences, we discuss the need for a multi-faceted response to promote food security and student success.

Overlapping geographic clusters of food security and health: Where do social determinants and health outcomes converge in the U.S?

We identified overlapping geographic clusters of food insecurity and health across U.S. counties to identify potential shared mechanisms for geographic disparities in health and food insecurity. By analyzing health variables compiled as part of the 2014 Robert Wood Johnson Foundation County Health Rankings, we constructed four health indices and compared their spatial patterns to spatial patterns found in food insecurity data obtained from 2014 Feeding America's County Map the Meal Gap data. Clusters of low and high food security that overlapped with clusters of good or poor health were identified using Local Moran's I statistics. Next, multinomial logistic regressions were estimated to identify sociodemographic, urban/rural, and economic correlates of counties lying within overlapping clusters. In general, poor health and high food insecurity clusters, "unfavorable cluster overlaps", were present in the Mississippi Delta, Black Belt, Appalachia, and Alaska. Overlapping good health and low food insecurity clusters, "favorable cluster overlaps", were less common and located in the Corn Belt and New England. Counties with higher black populations and higher poverty were associated with an increased likelihood of lying within overlapping clusters of poor health and high food insecurity. Generally consistent patterns in spatial overlaps between food security and health indicate potential for shared causal mechanisms. Identified regions and county-level characteristics associated with being located inside of overlapping clusters may be used in future place-based intervention and policy.

More than Just Not Enough: Experiences of Food Insecurity for Latino Immigrants

Undocumented Latino immigrants often struggle to provide food for their families. In an attempt to inform efforts to create effective programs and policies promoting food security, this study explored the experience of food insecurity for low-income, undocumented Latino immigrants. In-depth qualitative interviews were conducted with 24 undocumented Latino immigrants. Modified grounded theory was used to analyze the interview data. The experience of food insecurity was similar to other groups' experiences, as it entailed inadequate amount and quality of food. However, immigration and documentation status presented unique vulnerabilities for food insecurity related to unfamiliar food environments, remittances and separation, employment, and community and government resources. Cultural and structural factors that may shape the experience of and response to food insecurity are discussed along with implications for policy and programming.

Voices of the Homeless: An Emic Approach to the Experiences of Health Disparities Faced by People Who Are Homeless

People who are homeless are particularly vulnerable to health disparities. Rather than using population statistics to highlight the prevalence or severity of the suffering of people who are homeless, 28 undergraduate students each conducted an in-depth interview with an individual who relied on a local homeless shelter to cope with everyday life. The interview explored the participants' health concerns and strategies for health management. Due to equipment failure and incomplete recording, only 16 interviews are included in this study. The author adopted thematic analysis while focused on preserving the richness of the interactions between the participants who are homeless and the undergraduate students. The author's goal is to provide emic, intimate insights about the struggles and challenges faced by the people who are homeless. The author concluded the study by situating the findings in the larger literature of health disparities experienced by people who are homeless.

Unemployment and household food hardship in the economic recession

OBJECTIVE

The present study examined the association between unemployment and household food insecurity during the 2007-2009 economic recession in the USA.

DESIGN

Longitudinal survey of the Survey of Income and Program Participation (SIPP; 2008-2011). Food insecurity was measured by five questions excerpted from an eighteen-item Food Security Scale. Unemployment was measured by a dichotomous indicator, the number of job losses and the total duration of all episodes in the observation period.

SETTING

As nationally representative data, the SIPP interviewed respondents in multiple waves with a time interval of four months.

SUBJECTS

The study created two analytic samples including working-age household heads employed at the beginning of the observation period. The size of the two samples was 14,417 and 13,080.

RESULTS

Unemployment was positively associated with food insecurity (OR=1.55; 95% CI 1.32, 1.83; P<0.001). Similar results were obtained when the analysis controlled for food insecurity status measured before unemployment (OR=1.54; 95% CI 1.27, 1.88; P<0.001). For households with the same duration of unemployment, one more episode of unemployment increased the odds of food insecurity by 8% (OR=1.08; 95% CI 1.00, 1.18; P<0.001).

CONCLUSIONS

More in-depth understanding of the relationship between unemployment and food insecurity is useful to better identify and serve the at-risk population. Connecting unemployment assistance closely to nutrition assistance could lower the prevalence of food insecurity among unemployed households. Public policy should better account for both episodes and duration of unemployment to reduce food insecurity.

Assessment of Food Intake, Obesity, and Health Risk among the Homeless in Rhode Island

OBJECTIVE

The objective of this study was to examine the relationship between the nutritional status, incidence of food insecurity, and health risk among the homeless population in Rhode Island.

DESIGN AND SAMPLE

This correlational study utilized a convenience sample of 319 homeless adults from Rhode Island's largest service agency for the homeless. Information on use of services such as access to emergency foods, shelters, and the Supplemental Nutrition Assistance Program (SNAP) was requested.

MEASURES

Food security was measured by the six-item subset of the USDA Food Security Core Module. Anthropometric measures included height, weight, and waist circumference. A 24-hr dietary recall was collected to determine the food intake for a subset of participants who agreed to supply this information (n = 197).

CONCLUSION

Average dietary recall data indicated insufficient intake of vegetables, fruit, dairy, and meats/beans. It also indicated excessive intake of fats. Of the 313 participants, 29.4% were overweight and 39% were obese. Over 94% of the participants were food insecure, with 64% of this subset experiencing hunger. Fifty-five percent of the participants were currently receiving SNAP benefits. The majority of the sample was found to be food insecure with hunger.

Women respondents report higher household food insecurity than do men in similar Canadian households

OBJECTIVE

We investigated factors accounting for the consistently higher levels of household food insecurity reported by women in Canada.

DESIGN

Two cycles of the Canadian Community Health Survey for the years 2005/2006 and 2007/2008 were pooled to examine the association between household food insecurity, measured using the Household Food Security Survey Module and other metrics, and respondent sex. We stratified households as married/cohabiting (in which case, the household respondent was chosen randomly) or non-married (single/widowed/separated/divorced) and adjusted for differences in household characteristics, including the presence of children.

SETTING

Canada.

SUBJECTS

Analysis was restricted to households dependent on employment/self-employment and whose reported annual household income was below $CAN 100,000. Exclusions included respondents less than 18 years of age, any welfare receipt, and missing food insecurity, marital status, income source and amount, or household composition data.

RESULTS

For non-married households, increased food insecurity in female- v. male-led households was accounted for by significant differences in household socio-economic characteristics. In contrast, in married/cohabiting households with or without children, higher food insecurity rates were reported when the respondent was female and neither respondent characteristics nor socio-economic factors accounted for the differences.

CONCLUSIONS

Higher rates of food insecurity in non-married households in Canada are largely attributable to women's socio-economic disadvantage. In married households, women appear to report higher levels of food insecurity than men. These findings suggest a possible bias in the measurement of population-level household food insecurity in surveys that do not account for the sex of the respondent in married/cohabiting households.

What are the determinants of food insecurity in New Zealand and does this differ for males and females?

AIMS

Food insecurity is a lack of assured access to sufficient nutritious food. We aimed to investigate the demographic and socio-economic determinants of food insecurity in New Zealand and whether these determinants vary between males and females.

METHODS

We used data from the longitudinal Survey of Families, Income and Employment (SoFIE) (n=18,950). Respondents were classified as food insecure if, in the past 12 months, they had to use special food grants or food banks, been forced to buy cheaper food to pay for other things, or had to go without fresh fruit and vegetables often. Logistic regression analyses were used to investigate the association of demographic and socio-economic factors on food insecurity. Models were repeated stratifying by males and females.

RESULTS

More than 15% of the SoFIE population in NZ were food insecure in 2004/05. The prevalence of food insecurity was much greater in females (19%) than males (12%). The adjusted odds of food insecurity was significantly higher in females compared to males (OR 1.6, 95% CI 1.5-1.8). In univariate analyses, food insecurity was associated with sole parenthood, unmarried status, younger age groups, Māori and Pacific ethnicity, worse self-rated health status, renting, being unemployed and lower socioeconomic status. Income was the strongest predictor of food insecurity in multivariate modelling (OR 4.9, 95%CI 4.0-5.9 for lowest household income quintile versus highest). The associations of demographic and socioeconomic factors with food insecurity were similar in males and females.

CONCLUSIONS

Food insecurity is a timely and relevant issue, as it affects a significant number of New Zealanders. Targeted policy interventions aimed at increasing money available in households are needed.

Food security during infancy: implications for attachment and mental proficiency in toddlerhood

OBJECTIVE

This study examined the associations between household food security (access to sufficient, safe, and nutritious food) during infancy and attachment and mental proficiency in toddlerhood.

METHODS

Data from a longitudinal nationally representative sample of infants and toddlers (n = 8944) from the Early Childhood Longitudinal Study-9-month (2001-2002) and 24-month (2003-2004) surveys were used. Structural equation modeling was used to examine the direct and indirect associations between food insecurity at 9 months, and attachment and mental proficiency at 24 months.

RESULTS

Food insecurity worked indirectly through depression and parenting practices to influence security of attachment and mental proficiency in toddlerhood.

CONCLUSIONS

Social policies that address the adequacy and predictability of food supplies in families with infants have the potential to affect parental depression and parenting behavior, and thereby attachment and cognitive development at very early ages.

Food insecurity works through depression, parenting, and infant feeding to influence overweight and health in toddlers

We used the Early Childhood Longitudinal Study-Birth Cohort 9- and 24-mo surveys (n = 8693) and Structural Equation Modeling to examine direct and indirect associations between food insecurity and toddlers' overweight (weight for length), physical health, and length for age. There were significant effects of food insecurity on parental depression and parental depression in turn influenced physical health. There were also significant effects of food insecurity on parenting practices, which in turn were significantly associated with infant feeding and subsequently toddlers' overweight. There were no significant direct or indirect associations between food insecurity and toddlers' length for age. Our results show that food insecurity influences parenting, including both depression and parenting practices. Findings suggest parental depression is a stressor on parenting behavior that social policy should address to alleviate problematic child health outcomes. Findings underscore the importance of continuing and strengthening policy initiatives to ensure that families with infants and toddlers have sufficient, predictable, and reliable food supply.

Position of the American Dietetic Association: Food Insecurity and Hunger in the United States

It is the position of the American Dietetic Association that systematic and sustained action is needed to bring an end to domestic food insecurity and hunger and to achieve food and nutrition security for all in the United States. The Association believes that immediate and long-range interventions are needed, including adequate funding for and increased utilization of food and nutrition assistance programs, the inclusion of food and nutrition education in all programs providing food and nutrition assistance, and innovative programs to promote and support the economic self-sufficiency of individuals and families, to end food insecurity and hunger in the United States. Food insecurity continues to exist in the United States, with over 38 million people experiencing it sometime in 2004. Negative nutritional and nonnutritional outcomes have been associated with food insecurity in adults, adolescents, and children, including poor dietary intake and nutritional status, poor health, increased risk for the development of chronic diseases, poor psychological and cognitive functioning, and substandard academic achievement. Dietetics professionals can play a key role in ending food insecurity and hunger and are uniquely positioned to make valuable contributions through provision of comprehensive food and nutrition education, competent and collaborative practice, innovative research related to accessing a safe and secure food supply, and advocacy efforts at the local, state, regional, and national levels.