Single-item measure of food insecurity used in the National Health Survey may underestimate prevalence in Australia

The prevalence of food insecurity amongst refugees and asylum seekers during, and prior to, their early resettlement period in Australia: A cross-sectional analysis of the 'Building a New Life in Australia' data

With over 100 million humanitarian migrants globally, there is increasing pressure on high-income countries to offer resettlement opportunities. Humanitarian migrants face many challenges during pre-settlement and resettlement. One challenge is food insecurity (FI). The Building a New Life in Australia (BNLA) longitudinal cohort study gathered data from migrating units, that is, a group of humanitarian migrants included on the same visa application (n = 1599). Data were gathered in five annual waves (2013-2018). Data included food security status in four pre-settlement situations and during resettlement. The results of this secondary analysis of BNLA Wave One indicate that FI was highest in refugee camps (71%), followed by bridging visas (30%), community detention (17%), immigration detention (11%), and during early resettlement (9%). During early resettlement, respondents who were male, those from Afghanistan or Iran, and those living in a single person household reported the highest prevalence of FI. An association was found between having spent time on a bridging visa and FI during early resettlement (p < 0.01). This study's results are an important step in understanding the scale of FI and which sub-groups are most vulnerable, so the resources and policies of high-income countries can better meet food security needs during resettlement.

Food Insecurity Is Associated with Diet Quality in Pregnancy: A Cross-Sectional Study

Household food insecurity (HFI) and poorer prenatal diet quality are both associated with adverse perinatal outcomes. However, research assessing the relationship between HFI and diet quality in pregnancy is limited. A cross-sectional online survey was conducted to examine the relationship between HFI and diet quality among 1540 pregnant women in Australia. Multiple linear regression models were used to examine the associations between HFI severity (marginal, low, and very low food security compared to high food security) and diet quality and variety, adjusting for age, education, equivalised household income, and relationship status. Logistic regression models were used to assess the associations between HFI and the odds of meeting fruit and vegetable recommendations, adjusting for education. Marginal, low, and very low food security were associated with poorer prenatal diet quality (adj β = -1.9, -3.6, and -5.3, respectively; p < 0.05), and very low food security was associated with a lower dietary variety (adj β = -0.5, p < 0.001). An association was also observed between HFI and lower odds of meeting fruit (adjusted odds ratio [AOR]: 0.61, 95% CI: 0.49-0.76, p < 0.001) and vegetable (AOR: 0.40, 95% CI: 0.19-0.84, p = 0.016) recommendations. Future research should seek to understand what policy and service system changes are required to reduce diet-related disparities in pregnancy.

Increasing food insecurity severity is associated with lower diet quality

OBJECTIVE

Food insecurity may reduce diet quality, but the relationship between food insecurity severity and diet quality is under-researched. This study aimed to examine the relationship between diet quality and severity of household food insecurity.

DESIGN

A cross-sectional, online survey used the United States Department of Agriculture Household Food Security Six-item Short Form to classify respondents as food secure or marginally, moderately or severely food insecure. The Australian Recommended Food Score (ARFS; scored 0–73) determined diet quality (ARFS total and sub-scale scores). Survey-weighted linear regression (adjusted for age, sex, income, education, location and household composition) was conducted.

SETTING

Tasmania, Australia.

PARTICIPANTS

Community-dwelling adults (aged 18 years and over).

RESULTS

The mean ARFS total for the sample (n 804, 53 % female, 29 % aged > 65 years) was 32·4 (sd = 9·8). As the severity of household food insecurity increased, ARFS total decreased. Marginally food-insecure respondents reported a mean ARFS score three points lower than food-secure adults (B = –2·7; 95 % CI (–5·11, –0·34); P = 0·03) and reduced by six points for moderately (B = –5·6; 95 % CI (–7·26, –3·90); P < 0·001) and twelve points for severely food-insecure respondents (B = –11·5; 95 % CI (–13·21, –9·78); P < 0·001). Marginally food-insecure respondents had significantly lower vegetable sub-scale scores, moderately food-insecure respondents had significantly lower sub-scale scores for all food groups except dairy and severely food-insecure respondents had significantly lower scores for all sub-scale scores.

CONCLUSIONS

Poorer diet quality is evident in marginally, moderately and severely food-insecure adults. Interventions to reduce food insecurity and increase diet quality are required to prevent poorer nutrition-related health outcomes in food-insecure populations in Australia.

A Missed Opportunity? Meal Provision in Early Childhood Education and Care Services in the Context of Socioeconomic Disadvantage

OBJECTIVES

Early childhood education and care (ECEC) services are attended by most children before school entry, reaching many living in circumstances of poverty and providing opportunity to support their nutrition. In this study, we examine the extent to which this opportunity is being met, comparing two common types of service provision: centre- versus family- provided food.

METHODS

Intensive in-situ observations were undertaken across 10 ECEC services in highly disadvantaged Australian communities. All meals provided to children aged 3.5-5 years across an ECEC day (N = 48), of which 11% were experiencing severe food insecurity, were photographed and analysed to assess nutritional adequacy with reference to national dietary standards.

RESULTS

Meals provided did not meet national dietary recommendations for quality or quantity. Nutrition was least adequate in services with policies of family-provided food. These services were also those that served families experiencing the highest levels of severe food insecurity (29%).

CONCLUSIONS

In the absence of policies for the provision of food in ECEC, services are not realising their potential to support child nutrition in the context of poverty presenting increased risk to lifetime trajectories of health and wellbeing. System level policy interventions are required to facilitate equitable access to nutritious food and attendant life chances.

Dads at Mealtimes: Associations between Food Security, Household and Work Chaos, and Paternal Feeding Practices among Australian Fathers Living with Disadvantage

Understanding how fathers engage in feeding while experiencing disadvantage is important for family-focused interventions. A cross-sectional online survey involving 264 Australian fathers was conducted to explore feeding involvement and the relationships between feeding practices, food insecurity, and household and work chaos. Practices related to coercive control, structure, and autonomy support were measured for two age groups (<2 years and 2-5 years). Multivariable linear regression was used to examine the associations for each practice. Three-quarters of the sample were food insecure, impacting adults more than children, and correlated with household chaos. Food insecurity was associated with increased 'persuasive feeding' and 'parent-led feeding' in younger children. Household chaos was positively associated with coercive control practices in both younger and older child groups, with the strongest associations for 'using food to calm' and 'overt restriction', respectively. In older child groups, household chaos was negatively associated with 'offer new foods' and 'repeated presentation of new foods'. Structure practices had no significant relationships with any factors, and work chaos did not predict any feeding practices. These findings emphasize a need for societal and structural support to address food insecurity and household chaos. Tailored strategies are crucial to support fathers in responsive feeding.

Food insecurity in international and domestic students at an Australian university 2 years into the global COVID-19 pandemic

OBJECTIVES

The aim of this article is to explore the differences in the prevalence, sociodemographic determinants, and effects of food insecurity between international and domestic students in an Australian university during the COVID-19 pandemic.

METHODS

This study uses a cross-sectional online survey. The questionnaire contained the 18-item Household Food Security Survey Module to assess food security status. Logistic regression models were used to analyze the associations between student characteristics and food insecurity. A total of 467 students (376 domestic and 91 international) attending a large university in Sydney completed the survey between October 2021 and May 2022.

RESULTS

Compared with domestic students (13.0% food insecure), international students (18.7% food insecure) had higher odds of being food insecure in our sample (odds ratio = 2.02; 95% CI, 1.01-4.07; P = 0.013). Different risk factors for food insecurity were identified in these two student groups (e.g., being undergraduates and living outside the parental home, for domestic students, and, for international students, living in accommodation that provided meals that did not suit their preferences and experiencing changes in living arrangements due to the pandemic). Lower fruit intake was reported by food-insecure domestic students. Poor well-being was reported by both food-insecure domestic and international students. International students with food insecurity were more likely to use food assistance services than food-insecure domestic students.

CONCLUSIONS

International students experienced a higher risk of food insecurity than domestic students during the pandemic in Australia. More tailored interventions to address food insecurity need to be developed for international and domestic students by considering their different experiences.

A 5-year review of prevalence, temporal trends and characteristics of individuals experiencing moderate and severe food insecurity in 34 high income countries

BACKGROUND

Due to the relatively low numbers of households in high income countries experiencing food insecurity most studies conflate the levels of severity, which masks between- and within-country differences. This study aims to describe the characteristics of individuals living in high income countries who were moderately or severely food insecure and investigates temporal trends in prevalence. It assesses these characteristics in comparison to those who were food secure.

METHODS

This is a secondary analysis of data collected by the FAO Voices of the Hungry between 2014-2018. The data were collected during the annual Gallup World Polls of nationally representative samples using the Food Insecurity Experience Scale. Data from 34 highly developed, wealthy countries were analysed. The age, gender, income, education, area of residence and household structure of individuals experiencing moderate/severe food insecurity (FI), and severe FI, were compared using ANOVA, Welch's F, Pearson's Chi-square, and Linear-by-Linear Association, dependent on the variable of interest. Hierarchical cluster analysis was used to group countries according to their prevalence of moderate/severe FI, and severe FI.

RESULTS

Overall, 6.5% of the weighted sample were moderately/severely food insecure (M-SFI), while 1.6% were severely food insecure. M-SFI individuals were present in all 34 countries, in all years and across all education levels and income quintiles. The proportion of individuals experiencing moderate/severe FI varied between years and countries. Fifteen countries showed a significant downward temporal trend in prevalence of moderate/severe FI (p < 0.001), while three countries demonstrated an increasing temporal trend driven by increasing prevalence in those aged 65 years or less (p < 0.001). Comparing individuals experiencing moderate versus severe FI showed over-representation of males, single adult households and lower household income in the severe FI group.

CONCLUSIONS

Individuals across all income, education and age categories living in high income countries are experiencing moderate/severe food insecurity, but with higher prevalence in those experiencing more disadvantage. Over the study period some countries experienced escalating while others demonstrated decreasing moderate/severe FI trends. This comparison of countries with similar economic and human development indices highlights an opportunity to investigate subtle variations in social, economic and education policy that could have profound impacts on food insecurity.

Food security definition, measures and advocacy priorities in high-income countries: a Delphi consensus study

OBJECTIVE

To establish an international consensus on the definition of food security, measures and advocacy priorities in high-income countries.

DESIGN

A two-round online Delphi survey with closing in March 2020 and December 2021. Consensus was set a priori at 75 %. Qualitative data were synthesised and priorities were ranked.

SETTING

High-income countries.

PARTICIPANTS

Household food security experts in academia, government and non-government organisations who had published in the last 5 years.

RESULTS

Up to thirty-two participants from fourteen high-income countries responded to the Delphi with a 25 % response rate in Round 1 and a 38 % response rate in Round 2. Consensus was reached on the technical food security definition and its dimensions. Consensus was not reached on a definition suitable for the general public. All participants agreed that food security monitoring systems provide valuable data for in-country decision-making. Favoured interventions were those that focused on upstream social policy influencing income. Respondents agreed that both national and local community level strategies were required to ameliorate food insecurity, reinforcing the complexity of the problem.

CONCLUSIONS

This study furthers the conceptual understanding of the commonly used definition of food security and its constituent dimensions. Strong advocacy is needed to ensure food security monitoring, policy and mitigation strategies are implemented. The consensus on the importance of prioritising actions that address the underlying determinants of household food security by experts in the field from across wealthy nations provides evidence to focus advocacy efforts and generate public debate.

Ecological risk and protective factors for food insufficiency in Los Angeles County during the COVID-19 pandemic

OBJECTIVE

The COVID-19 pandemic increased food insufficiency: a severe form of food insecurity. Drawing on an ecological framework, we aimed to understand factors that contributed to changes in food insufficiency from April to December 2020, in a large urban population hard hit by the pandemic.

DESIGN

We conducted internet surveys every 2 weeks in April-December 2020, including a subset of items from the Food Insecurity Experience Scale. Longitudinal analysis identified predictors of food insufficiency, using fixed effects models.

SETTING

Los Angeles County, which has a diverse population of 10 million residents.

PARTICIPANTS

A representative sample of 1535 adults in Los Angeles County who are participants in the Understanding Coronavirus in America tracking survey.

RESULTS

Rates of food insufficiency spiked in the first year of the pandemic, especially among participants living in poverty, in middle adulthood and with larger households. Government food assistance from the Supplemental Nutrition Assistance Program was significantly associated with reduced food insufficiency over time, while other forms of assistance such as help from family and friends or stimulus funds were not.

CONCLUSIONS

The findings highlight that during a crisis, there is value in rapidly monitoring food insufficiency and investing in government food benefits.

Association between health care access and food insecurity among lower-income older adults with multiple chronic conditions in Washington State, USA

OBJECTIVE

Lower-income older adults with multiple chronic conditions (MCC) are highly vulnerable to food insecurity. However, few studies have considered how health care access is related to food insecurity among older adults with MCC. The aims of this study were to examine associations between MCC and food insecurity, and, among older adults with MCC, between health care access and food insecurity.

DESIGN

Cross-sectional study data from the 2019 Behavioral Risk Factor Surveillance System survey.

SETTING

Washington State, USA.

PARTICIPANTS

Lower-income adults, aged 50 years or older (n 2118). MCC was defined as having ≥ 2 of 11 possible conditions. Health care access comprised three variables (unable to afford seeing the doctor, no health care coverage and not having a primary care provider (PCP)). Food insecurity was defined as buying food that did not last and not having money to get more.

RESULTS

The overall prevalence of food insecurity was 26·0 % and was 1·50 times greater (95 % CI 1·16, 1·95) among participants with MCC compared to those without MCC. Among those with MCC (n 1580), inability to afford seeing a doctor was associated with food insecurity (prevalence ratio (PR) 1·83; 95 % CI 1·46, 2·28), but not having health insurance (PR 1·49; 95 % CI 0·98, 2·24) and not having a PCP (PR 1·10; 95 % CI 0·77, 1·57) were not.

CONCLUSIONS

Inability to afford healthcare is related to food insecurity among older adults with MCC. Future work should focus on collecting longitudinal data that can clarify the temporal relationship between MCC and food insecurity.

Screening Food Insecure during Pregnancy: Pilot Testing an Effective Brief Tool for Use in an Australian Antenatal Care Setting

The purpose of this research is: (1) to determine the prevalence of food insecurity among pregnant people using the 10-, 6-, and 2-item iterations of the USA Household Food Security Survey Module (HFSSM) and the single item measure, and (2) identify an appropriate combination of questions that could be used to identify food insecurity in a clinical setting for a population of people who are pregnant in Australia. Cross-sectional survey collecting self-reported data from pregnant people in Australia (open May 2021 to March 2022). Survey included demographic characteristics, including income/welfare use, education, age, pregnancy information, household size and composition, and two measures of food insecurity. In total, 303 participants were included in the analysis. Sensitivity and specificity of the various combinations of questions were conducted. Food insecurity was estimated using the single item, and the 2-item, 6-item, and 10-item versions of the HFSSM, food insecurity was 6.2%, 11.4%, 11.7%, and 14.3% respectively. Respondents who were living in households that were food insecure answered affirmatively to question one, two, or three of the HFSSM, with the combination of questions one and three showing the best sensitivity and specificity for the whole sample, as well as for those who have characteristics likely to lead to food insecurity. Further testing of the 2-items, comprised of items one and three from the HFSSM, need to be conducted with a larger and more diverse sample to determine if this is an appropriate screening tool in an antenatal clinical setting to determine food insecurity during pregnancy.

Testing the Feasibility and Dietary Impact of a "Produce Prescription" Program for Adults with Undermanaged Type 2 Diabetes and Food Insecurity in Australia

BACKGROUND

There is growing interest in Food is Medicine programs that incorporate food-based interventions into health care for patients with diet-related conditions.

OBJECTIVES

We aimed to test the feasibility of a "produce prescription" program and its impact on diet quality for people with type 2 diabetes (T2D) experiencing food insecurity in Australia.

METHODS

We conducted a pre-post intervention study in n = 50 adults experiencing food insecurity with T2D and glycated hemoglobin (HbA1c) ≥8%. Once enrolled, participants received healthy food boxes weekly free of charge, with the contents sufficient to create 2 meals/d, 5 d/wk for the entire household, over 12 wk. Participants were also provided with tailored recipes and behavioral change support. The primary outcome was change in diet quality assessed by 24-h diet recalls. Secondary outcomes included differences in cardiovascular disease risk factors; blood micronutrients; and feasibility indicators. Differences in the baseline and 12-wk mean primary and secondary outcomes were assessed by paired t tests.

RESULTS

Participants were older adults with mean ± SD age 63 ± 9 y (range: 40-87 y), HbA1c 9.8% ± 1.5%, and 46% were female. Overall, 92% completed the final study follow-up for the primary outcome. Compared with baseline, diet quality improved at week 12, with an increase in the mean overall diet quality (Alternate Healthy Eating Index score) of 12.9 (95% CI: 8.7, 17.1; P < 0.001), driven by significant improvements in vegetables, fruits, whole grains, red/processed meat, trans fat, sodium, and alcohol consumption. Blood lipids also improved (total:HDL cholesterol: -0.48; 95% CI: -0.72, -0.24; P < 0.001), and there was significant weight loss (-1.74 kg; 95% CI: -2.80, -0.68 kg, P = 0.002), but no changes in other clinical outcomes. Participants reported high levels of satisfaction with the program.

CONCLUSIONS

These findings provide strong support for an adequately powered randomized trial to assess effects of produce prescription as an innovative approach to improve clinical management among individuals with T2D experiencing food insecurity. This trial was registered at https://anzctr.org.au/ as ACTRN12621000404820.

The Diet Quality of Food-Insecure Australian Adults-A Nationally Representative Cross-Sectional Analysis

Poor diet quality exacerbates risks for acute and chronic conditions. People experiencing food insecurity have an increased likelihood of lower diet quality; however, this has not been investigated in the Australian context. The aim of this cross-sectional study was to examine whether the diet quality of Australian adults differed according to their household food security status. Data were analysed from a nationally representative sample (≥19 years; n = 9115) collected as part of the National Nutrition and Physical Activity Survey 2011-12. Household food security status and socio-demographic and health characteristics were assessed using data from an 18-module health interview. A 24 h dietary recall was used to estimate food and nutrient intakes and to calculate the Dietary Guidelines Index (DGI). DGI is a food-based score (0 to 130) that assesses adherence to the 2013 Australian Dietary Guidelines. Survey-weighted linear regression models, adjusted for age and sex, were used to examine diet quality (total DGI and component scores), and total energy and nutrient intake by food security status. Adults from food-insecure households had a mean total DGI score 3.5 points lower (95% CI −5.57, −1.46) than food-secure adults (p = 0.001). Adults from households experiencing food insecurity, when compared to those who were food-secure, had several lower DGI component scores including for dietary variety (1.6 vs. 2.3, p = 0.009), fruit (3.8 vs. 5.0, p = 0.001) and vegetables (3.7 vs. 4.4, p = 0.010). Adults from food-insecure households consumed on average more carbohydrates (45.6 vs. 43.3, p = 0.004) and total sugar (21.8 vs. 19.0, p = 0.003) as a percentage of daily energy and less protein (18.5 vs. 17.2, p = 0.004), mono-unsaturated fats (11.2 vs. 11.8, p = 0.026) as a percentage of daily energy, and fibre (20.1 vs. 23.0, p = 0.003), than food-secure adults. Sub-optimal diet may be one of the contributing factors to, or outcomes of, poorer health in food-insecure populations. Food security interventions are required to better address nutrition in food-insecure households and should be tailored to the health and socio-demographic characteristics of this population.

Severity of Food Insecurity among Australian University Students, Professional and Academic Staff

Assessments of the severity of food insecurity within Australian university students are lacking, and the experience of food insecurity in Australian university staff is unknown. A cross-sectional online survey in March 2022 aimed to characterize the severity of food insecurity in students, professional and academic staff at the University of Tasmania (UTAS). The Household Food Security Survey Module six-item short form assessed food security status in addition to seven demographic and education characteristics for students and six demographic and employment characteristics for staff. Participants were categorized as having high, marginal, low, or very low food security. Multivariate binary logistic regression identified students and staff at higher risk of food insecurity. Among student respondents (n = 1257), the prevalence of food insecurity was 41.9% comprising 8.2% marginal, 16.5% low, and 17.3% very low food security. Younger, non-binary, first-year enrolled, on campus, and international students were at significantly higher risk of food insecurity. Among staff (n = 560), 16.3% were food insecure comprising 3.8% marginal, 5.5% low, and 7.0% very low food security. Professional staff, staff on casual contracts, and staff recently employed, were at significantly higher risk of food insecurity. Our findings suggest a high occurrence of food insecurity in UTAS students and staff, with a large proportion of food insecure staff and students experiencing very low food security. Our findings have implications for efforts towards reducing food insecurity at university campuses through a holistic and integrated approach, advocating for food systems that support healthy, sustainable, and equitable food procurement and provision for both university students and staff.

High occurrence of food insecurity in young people attending a youth mental health service in regional Australia

Aim

Despite the relationship between food insecurity and poor mental health, food insecurity in young people attending mental health services in Australia remains understudied. This study aimed to determine the occurrence and predictors of food insecurity, and the relationship with dietary factors in young people attending a mental health service.

Methods

A cross‐sectional online survey was conducted in a sample of young people (15–25 years) who attended a mental health service in Launceston, Australia. The survey utilised a single‐item food insecurity screening tool and eight demographic, health and service use questions. Five questions determined self‐reported intake of fruit, vegetables, breakfast, water, sugar‐sweetened beverages and takeaway foods. Binary logistic regression determined predictors of food insecurity. Cross‐tabulations determined differences in dietary intake according to food security.

Results

Of survey respondents (n = 48; 68% female), 40% (n = 19) were food insecure. Respondents living out of home or in unstable accommodation were at significantly higher risk of food insecurity (odds ratio [OR]: 4.43; SE: 0.696; 95% CI: 1.13–17.34; p = 0.032) compared to those living with their parents. Those receiving government financial assistance (OR: 5.00; SE: 0.676; 95% CI: 1.33–18.81; p = 0.017) were also at significantly higher risk of food insecurity. Regardless of food security status, self‐reported intake of fruits, vegetables and breakfast were low, and respondents regularly consumed takeaway foods and sugar‐sweetened beverages.

Conclusions

There was a high occurrence of food insecurity and poor dietary intake in young people attending a youth mental health service demonstrating that initiatives to support access to healthy food in this group should be a priority, with potential benefits for mental health outcomes.

Parental Feeding Practices in Families Experiencing Food Insecurity: A Scoping Review

Parental feeding practices and styles influence child diet quality and growth. The extent to which these factors have been assessed in the context of disadvantage, particularly household food insecurity (HFI), is unknown. This is important, as interventions designed to increase responsive practices and styles may not consider the unique needs of families with HFI. To address this gap, a scoping review of studies published from 1990 to July 2021 in three electronic databases was conducted. A priori inclusion criteria were, population: families with children aged 0–5 years experiencing food insecurity and/or disadvantage; concept: parental feeding practices/behaviours/style; and context: high income countries. The search identified 12,950 unique papers, 504 full-text articles were screened and 131 met the inclusion criteria. Almost all the studies (91%) were conducted in the United States with recruitment via existing programs for families on low incomes. Only 27 papers assessed feeding practices or styles in the context of HFI. Of the eleven interventions identified, two assessed the proportion of participants who were food insecure. More research is required in families outside of the United States, with an emphasis on comprehensive and valid measures of HFI and feeding practices. Intervention design should be sensitive to factors associated with poverty, including food insecurity.

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

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

Childhood food insufficiency and adulthood cardiometabolic health conditions among a population-based sample of older adults in Puerto Rico

Childhood food insufficiency negatively influences physical and psychosocial health in children, but less is known about long-term health implications. This study aimed to elucidate the association of childhood food insufficiency with older adulthood cardiometabolic conditions. We conducted cross-sectional analyses using data from the Puerto Rican Elderly: Health Conditions Project (n = 2712), a population-based sample of elderly adults (>60 y) living in Puerto Rico. Childhood food insufficiency was ascertained with a proxy question on childhood economic hardships that prevented eating. Participants self-reported hypertension, diabetes, and cardiovascular disease (CVD; including heart attack, heart disease, or stroke). Obesity was assessed as body mass index using measured height and weight. Multivariable-adjusted, sex-stratified, complex survey logistic regression models tested associations of childhood food insufficiency with each condition, number of cardiometabolic conditions (0-6), and age of onset. Nearly a third (29.4%) of the sample reported childhood food insufficiency; 68.7% reported hypertension, 29.6% reported type 2 diabetes, 34.2% reported CVD, 29.9% were categorized with obesity, and 55.4% had two or more cardiometabolic conditions. In men, but not women, childhood food insufficiency was associated with higher odds of hypertension (Odds Ratio (OR) (95% Confidence Intervals (CI)): 1.7 (1.1, 2.7)), CVD (1.7 (1.1, 2.6)), and having two (1.9 (1.0, 3.4) or three to four (2.3 (1.2, 4.4)) cardiometabolic conditions. Childhood food insufficiency was marginally associated with higher odds of early age of onset of CVD among men (2.2 (1.0, 4.7)). Childhood food insufficiency may increase the likelihood of having cardiometabolic conditions in Puerto Rican older men. Programs that enable access to sufficient, healthy food in childhood may help prevent eventual cardiovascular-related diseases.

Food Insecurity, Associated Health Behaviors, and Academic Performance Among Urban University Undergraduate Students

OBJECTIVE

To explore associations between food insecurity, health behaviors, and academic performance among undergraduates at a private, urban US university.

METHODS

A cross-sectional web-based survey was conducted among a convenience sample of New York University undergraduates. Multivariable logistic regression estimated associations of food security (using the 6-item US Household Food Security Survey Module) and health behaviors (fruit/vegetable, beverage and alcohol intakes, and sleep), self-rated health, and academic performance.

RESULTS

Of the 257 students who completed the survey, 41% reported food insecurity. Food insecurity was associated with approximately 2-fold higher odds of sugar-sweetened beverage consumption (adjusted odds ratio, 1.97; 95% confidence interval, 1.14-3.41) and fair/poor health (adjusted odds ratio, 2.29; 95% confidence interval, 1.23-4.25).

CONCLUSIONS AND IMPLICATIONS

Increased awareness of food insecurity and associated health behaviors among students has implications for higher education's provision of on-campus food support programs.

The effects of the COVID-19 pandemic on food security in Australia: A scoping review

Aim

The COVID‐19 pandemic has disrupted the Australian food supply with potential ramifications on food security. This scoping review aimed to synthesise current evidence on the prevalence of food insecurity and changes to factors related to food insecurity during the COVID‐19 pandemic in Australia.

Methods

A comprehensive search strategy was used to search seven databases (MEDLINE, CINAHL, Embase, Global Health, Cochrane Database of Systematic Reviews, PsycINFO, Informit Online) and Google Scholar. Included studies were written in English, published in 2020–2021 and examined food security status in Australia during the COVID‐19 pandemic and/or factors associated with food insecurity in free‐living Australian residents. Articles with participants residing in institutional settings, where meals were supplied, were excluded.

Results

A total of 700 records were identified from database, grey literature and hand searching, and nine articles were included. All studies indicated that the prevalence of food insecurity had increased due to negative changes to food availability, accessibility, usability and stability. The downturn in employment and economic circumstances following the onset of the COVID‐19 pandemic appeared to create a new group of food‐insecure Australians consisting of newly unemployed, and international students.

Conclusion

COVID‐19 has exacerbated vulnerabilities in the Australian food supply and food security. Suggested actions include ongoing data collection on the long‐term impact of COVID‐19 on food supply and security in addition to coordinated national and community responses that improve the stability of the local food supply and address underlying determinants of food insecurity.

Associations between food provision and feeding practices in socially disadvantaged childcare centres

Preschool children consume a large proportion of their daily food intake in their childcare settings. These settings, therefore, provide important opportunities for children to experience food socialisation, and related positive nutrition. Yet, the extent to which these opportunities are taken, particularly in socioeconomically disadvantaged areas where risk of poor nutrition is high, is not well documented. This study focused on 10 childcare centres in socially disadvantaged locations and examined daily feeding practices via direct in-situ observation (n = 189 children observed). Centres were randomly selected based on type of food provision: centre-provided (n = 5 centres) or family-provided (n = 5 centres). Analyses showed that where food was family-provided, educators were significantly more likely to use controlling feeding practices, including pressuring children to eat, restricting food choices and rushing children into finishing meals. These practices were particularly evident during mid-morning meals, where pressuring children to eat healthy foods first, was more often observed. Further research and interventions that target feeding practices in childcare are indicated and should consider how source of food provision impacts upon these practices.

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.

Food Insecurity and Child Development: A State-of-the-Art Review

Converging research indicates that household food insecurity impedes children from reaching their full physical, cognitive, and psychosocial potential. This state-of-the-art review examines the last decade of research to: (1) describe the impact of the severity and persistence of food insecurity on child development; (2) use a socio-ecological framework to examine significant proximal and distal factors which may interplay; and (3) outline directions for future research. We conducted a systematic review of six databases of published papers from 2011 to June 2021. The search was limited to high-income countries and children aged from birth to 12 years. From 17,457 papers, 17 studies were included in the final review. Transitioning between food security and food insecurity had a significant and lasting effect on academic/cognitive function and behavior (i.e., externalizing), however less clear relationships were seen for psychosocial outcomes and other behaviors examined (i.e., internalizing). There was significant variation in the measurement and thresholds used to define both food insecurity and child development outcomes. Subsequently, comparisons across studies are difficult. Several future recommendations, including incorporation of socio-ecological factors, is provided. In conclusion, this review supports the link between food insecurity and sub-optimal child development; however, there is an imperative to improve and extend current understanding to ameliorate the causes of food insecurity.

Prevalence of food insecurity and related factors among slum households in Kerman, south of Iran

INTRODUCTION

Household food insecurity (FI) is defined as limited or uncertain access to nutritionally adequate and safe food or limited ability to obtain foods in socially acceptable ways has become a global issue in recent decades.

METHODS

This cross-sectional study was conducted in Kerman, southeast of Iran in 2019, covering 559 marginalised households. United States Department of Agriculture food security measure was used for data collection. Finally, data were analysed using t-test, χ ² , Mann-Whitney tests and logistic regression.

RESULTS

The prevalence of FI was 82% among slums households. The most important experience of FI in households was reliance on low-cost foods. There was a significant relationship between slums FI and gender of head of household, household size, household income, household education level and marital status (p ˂ 0.05). According to the results of the multivariate regression the variables of education, household income level and household size significantly determined FI (p ˂ 0.05).

CONCLUSION

The most important determinant of FI was low socioeconomic status (income, education, household size). Hence, public policies targeting socioeconomic factors should be made to improve the socioeconomic status of slum dwellers.

How Do Disadvantaged Children Perceive, Understand and Experience Household Food Insecurity?

Food insecurity is associated with reduced physical, social, and psychological functioning in children. There has been sparse research into child food insecurity that incorporates children’s own perspectives, as adults are often interviewed as child proxies. While a nuanced, child-centred understanding of food insecurity is needed to inform effective policy and program responses, little is known about Australian children’s firsthand understanding or experience of household food insecurity. This study aimed to fill this gap by inviting preadolescent children’s perspectives. Eleven participants aged 10–13 years (seven girls and four boys) took part in the study and were recruited from an Australian charity school holiday camp that targets severely disadvantaged youth. Children took part in individual semi-structured interviews that incorporated drawings and emoji scales. Qualitative interviews were audio recorded, transcribed, and analysed using thematic techniques. Four themes emerged from the data analysis, children had: (i) financial understanding; (ii) awareness of food insecurity and coping mechanisms; (iii) sharing, empathy, and compassion for food insecure families; and (iv) described the nature of ‘food’ preparation. This study provides a child-centric analysis, demonstrating how children’s agency is enacted and constrained in food insecure contexts. This child-derived understanding of food insecurity provides a critical basis from which to build effective approaches to assess and respond to this significant social issue.

A structured expert judgement elicitation approach: how can it inform sound intervention decision-making to support household food security?

OBJECTIVE

To examine structured expert judgement (SEJ) elicitation as a method to provide robust, defensible data for three determinants of household food security (food cost, household disposable income and physical access) for quantifying a proof-of-concept integrating decision support system for food security.

DESIGN

SEJ elicitation is a validated method for obtaining unavailable data, but its use in household food security in high-income countries is novel. Investigate Discuss Estimate Aggregate (IDEA) elicitation protocol was implemented, including quantitative and qualitative elements. Using specific questions related to three determinants, food security experts were encouraged to Investigate - estimate individual first-round responses to these questions, Discuss - with each other evidence on the reasoning and logic of their estimates, Estimate - second-round responses, following which these judgements were combined using mathematical Aggregation.

SETTING

Victoria, Australia.

PARTICIPANTS

Five experts with a range of expertise in the area of household food insecurity participated in the SEJ elicitation process.

RESULTS

The experts' ability to provide reliable estimates was tested and informed the aggregation of the collection of individual estimates into a single quantity of interest for use in decision support. The results of the quantitative elicitation show the impact of combinations of varying household income, food cost and physical access on household food security status and severity and is supported by the experts reasoning during elicitation.

CONCLUSION

This research provides insight to the application of SEJ where elicited data can inform and support intervention decision-making specific to household food security, especially where evidence is absent or of poor quality.

Prevalence, Determinants, and Effects of Food Insecurity among Middle Eastern and North African Migrants and Refugees in High-Income Countries: A Systematic Review

Issues related to poverty and income inequality in high-income countries have led to food insecurity among some population groups, such as migrants and refugees. While there are some studies on the experience of some migrant groups (and other subpopulations), little is known about food security among Middle Eastern and African migrants and refugees. This systematic review identified the prevalence of food insecurity and its effects among Middle Eastern and North African (MENA) migrants and refugees in high-income countries. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in this systematic review. Four databases, namely MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), and PubMed were searched. Three studies met the inclusion criteria, all of which were conducted in USA: two among Sudanese migrant families, and one among Somali refugee women. The rates of reported food insecurity ranged from 40% to 71% and were significantly higher than for the general population. Food insecurity was associated with acculturation and socio-economic factors. Food insecurity adversely impacts the health of MENA migrants and refugees, creating economic implications for individuals, families, the broader community in which they now live, and for governments.

To dine in or not to dine in: A comparison of food selection and preparation behaviours in those with and without food security

Issue addressed

Vulnerable populations are disproportionately affected by food insecurity, resulting in heightened risk of suboptimal dietary intake. Food insecure people appear to implement several coping strategies and dietary compromises to avoid hunger. Less explored in the literature is how these strategies impact consumption of food inside and outside of the home.

Methods

An online survey was completed by adults (n = 1292) residing in one of five Australian states. The questionnaire comprised of the six‐item US Household Food Security Survey Module, 12 socio‐demographic variables and 32 questions related to elements of food literacy.

Results

Food insecure respondents were more likely to frequent fast food vs (P = .002), takeaway (P < .001) and food courts (P < .001) than their food secure counterparts. Food secure respondents reported greater use of raw (P = .043) and fresh, pre‐prepared produce (P = .002) when cooking, whereas food insecure respondents were more likely to prepare food using only frozen, pre‐packaged products (P < .001). No significant differences were found between food security status and the enjoyment and social bonding derived from cooking.

Conclusions

Food insecure respondents appeared to be accessing a poorer quality of food through greater consumption of takeaway and fast food. These dietary compromises are most likely related to perceived financial, time or cooking facility constraints and to a lesser extent food literacy skills.

So what?

This study highlights some of the health and social inequities apparent within food insecure populations. Food insecure households should be supported to access healthy fresh food and in‐home cooking practices. While a multi strategy approach is required, healthy food environment policy, particularly in disadvantaged areas, should be considered to guarantee that all Australians have dignified access to nutritious food.

Prevalence and Socio-Demographic Predictors of Food Insecurity in Australia during the COVID-19 Pandemic

The COVID-19 pandemic has exacerbated economic vulnerabilities and disrupted the Australian food supply, with potential implications for food insecurity. This study aims to describe the prevalence and socio-demographic associations of food insecurity in Tasmania, Australia, during the COVID-19 pandemic. A cross-sectional survey (deployed late May to early June 2020) incorporated the U.S. Household Food Security Survey Module: Six-Item Short Form, and fifteen demographic and COVID-related income questions. Survey data (n = 1170) were analyzed using univariate and multivariate binary logistic regression. The prevalence of food insecurity was 26%. The adjusted odds of food insecurity were higher among respondents with a disability, from a rural area, and living with dependents. Increasing age, a university education, and income above $80,000/year were protective against food insecurity. Food insecurity more than doubled with a loss of household income above 25% (Adjusted Odds Ratio (AOR): 2.02; 95% CI: 1.11, 3.71; p = 0.022), and the odds further increased with loss of income above 75% (AOR: 7.14; 95% CI: 2.01, 24.83; p = 0.002). Our results suggest that the prevalence of food insecurity may have increased during the COVID-19 pandemic, particularly among economically vulnerable households and people who lost income. Policies that support disadvantaged households and ensure adequate employment opportunities are important to support Australians throughout and post the COVID-19 pandemic.

Investigating food insecurity measurement globally to inform practice locally: a rapid evidence review

The objective of this review was to examine the methods used to measure food insecurity (FI) globally, to inform considerations relating to adopting a novel, or reviewing an existing, FI measurement approach in developed countries. Considerations for measurement are examined with particular applicability to the United Kingdom (UK) which has recently announced adoption of the US Household Food Security Survey Module (HFSSM) as an indicator to facilitate annual FI monitoring. This study uses a Rapid Evidence Assessment (REA) methodological approach to systematically review the literature on FI measurement and considers: geographical jurisdiction, methodological approach, sampling strategy, FI indicator(s) used, and implications for measurement. Results found that the majority of papers reviewed emanate from North America with the US Household Food Security Scale Module (HFSSM) and its various adapted forms being the most commonly reported indicator. FI is becoming a key concern within developed countries with a range of indicators being used to report on the severity of the issue. This paper provides a contribution to knowledge by: (i) identifying various approaches to FI measurement and commonalities of existing measurement approaches; (ii) providing a summation of the methodologies and findings of studies relating to FI measurement, and associated implications for measurement, (iii) providing a justification evidenced by the literature for the adoption of the HFSSM in the UK; and (iv) assessing the methodological usefulness of a REA review. Understanding the components of robust FI indicators and their effectiveness can help inform existing and novel measurement approaches to ensure that data collected on FI are meaningful and thereby useful to inform future policy work in this area.

Sociodemographic factors associated with food insecurity: data from the 2003-2014 New South Wales Population Health Survey

OBJECTIVE

To determine the prevalence and sociodemographic factors associated with food insecurity in the state of New South Wales (NSW), Australia.

DESIGN

Cross-sectional analysis of food insecurity data collected by the NSW Population Health Survey between 2003 and 2014. Multiple logistic regression was used to examine associations with key sociodemographic variables.

SETTING

NSW, Australia.

PARTICIPANTS

212 608 survey participants responded to the food insecurity survey question between 2003 and 2014. 150 767 of them were aged ≥16 years. The survey sample was randomly selected and weighted to be representative of the NSW population.

RESULTS

On average 6 % of adults aged ≥16 years experienced food insecurity in NSW. The odds of food insecurity appeared to increase from one survey year to the next by a factor of 1·05. Food insecurity was found to be independently associated with age, sex, marital status, household size, education, employment status, household income, smoking status, alcohol intake and self-rated health. The association with income, smoking status and self-rated health appeared to be the strongest among all covariates and showed a gradient effect. Food insecurity appeared to increase significantly between the age of 16 and 19 years.

CONCLUSIONS

The prevalence of food insecurity appears to be rising over time. Given the negative health consequences of food insecurity, more rigorous measurement and monitoring of food insecurity in NSW and nationally is strongly recommended. The findings provide support for interventions targeting low-income and younger population groups.

Predictors of Food Insecurity among Australian University Students: A Cross-Sectional Study

Food insecurity is much higher among university students than the general population, and is linked with poorer mental health, diet and academic achievement. The aim of this study was to explore the level of food insecurity among a sample of Australian university students and determine which socio-demographic and student characteristics predict food insecurity. An online cross-sectional survey with students from the University of Newcastle, Australia was conducted in 2017-2018. Food insecurity was assessed using the 6-item US Department of Agriculture Food Security Survey Module, and socio-demographic (e.g., age, living situation) and student characteristics (e.g., undergraduate/postgraduate student) were captured. Multivariate logistic regression was used to determine the odds of food insecurity for each of the socio-demographic and student characteristics, and included characteristics of significance in bivariate analyses as potential confounders. Data for 366 students were analysed (mean age 27.3 ± 10.4 years, 27.3% male). Forty-eight percent of participants were food insecure. The odds of food insecurity were higher among students living in rental accommodation compared with their parents' home (OR = 2.39, 95% CI 1.41, 4.06), and undergraduate compared with postgraduate students (OR = 3.50, 95% CI 1.83, 6.69). Commencing university and moving away from parents may be key times for intervention. Strategies that can provide longstanding benefit are needed to address the high level of food insecurity among university students.

Impact of the Chicago Earned Income Tax Periodic Payment intervention on food security

This article examines the Earned Income Tax Credit Periodic Payment Pilot and its effectiveness in reducing food insecurity for low-income households. Low-income families in Chicago who were eligible for the Earned Income Tax Credit provided data over four waves of data collection between 2014 and 2015. We utilize longitudinal random effects logit models to test the likelihood of experiencing food insecurity. The sample was composed mostly by women with low educational levels. The intervention significantly decreased the likelihood of experiencing food insecurity over time (T2: β = -0.23, p = .581; T3: β = -0.89, p < .10; T4: β = -2.21, p < .01). The Periodic Payment Pilot seems effective at reducing food insecurity in low-income families. Further research should examine how changes to the Earned Income Tax Credit payment distribution could improve the lives of low-income families, specifically concerning food insecurity.

Population-based interventions addressing food insecurity in Australia: A systematic scoping review

AIM

Food insecurity (FI) is a critical public health issue in Australia. Population-based interventions aiming to address the socio-ecological determinants of FI are critical for relieving and preventing it. This review aimed to map and summarise the characteristics of population-based interventions addressing household and/or community FI in Australia.

METHODS

A systematic scoping review was undertaken. Five databases, selected for range and relevance to FI in Australia ("CINAHL plus", "Ovid MEDLINE", "Sociological Abstracts", "Australian Public Affairs Information Service", and "Rural and Remote Health") were searched in May 2018 using the terms and relevant synonyms "FI" and "interventions". In addition a systematic grey literature search using multiple Google searches was undertaken. Data synthesis included categorisation and counting intervention type. Interventions were defined and charted by influence of at least one dimension of food security and impact on the socioeconomic, cultural and environmental conditions.

RESULTS

A total of 3565 published and grey literature records were identified, with the final 60 records describing 98 interventions. Few national interventions were identified, with approaches predominantly in Victoria, Northern Territory and Tasmania. Determinants related to living and working environments, food availability and food utilisation were most frequently addressed. Interventions addressing the key determinant of FI economic access were limited. A number of interventions did not appear to be associated with rigorous evaluation.

CONCLUSIONS

While there is evidence of population responses to FI in Australia, the effectiveness of these remains limited. Importantly there is a lack of coordinated and coherent national responses that address the range of FI determinants.

A comparison of maternal feeding responses to child fussy eating in low-income food secure and food insecure households

Children learn to like a wide variety of healthy foods through exposure in their early feeding environment. While some children may reject foods during this learning process, parents may perceive persistent refusal as 'fussy' or 'picky' eating. Low-income parents may provide fussy children with a narrow range of foods that they will like and accept to avoid food and economic waste; inadvertently limiting children's exposure to a variety of healthy foods. This 'risk aversion' to food rejection may be particularly salient in food insecure households where resources are further constrained. We aimed to examine if food insecurity modifies the relationship between child fussy eating and parents' food provision and feeding with respect to exposure to a variety of healthy foods. Australian mothers residing in a low-income community (N = 260) completed a cross-sectional survey on their preschool-aged child's 'food fussiness', household food insecurity and food exposure practices. Food exposure practices included the home availability of fruit and vegetables, and children's tasting of a variety of fruit and vegetables (food provision); and whether parents prepared alternative meals for their child (feeding). Mothers reporting food insecurity (11%) were less likely to have fruit frequently available in the home compared to mothers reporting food security. Food insecurity moderated the relationship between fussy eating and food exposure practices insofar that food secure mothers were more likely to prepare alternative meals for fussier children. Family resources and child fussy eating behaviours are identified as important contextual factors in food provision and feeding. Findings from the current study suggest that health professionals, researchers and policymakers tailor interventions to consider both the needs of families and child eating characteristics.

Examining the Association between Food Literacy and Food Insecurity

Poor food literacy behaviours may contribute to food insecurity in developed countries. The aim of this research was to describe the apparent prevalence of food insecurity in adults at enrolment in a food literacy program and to examine the relationship between food insecurity and a range of independent variables. Individuals attending the Food Sensations^® for Adults program in Western Australia from May 2016 to April 2018 completed a pre-program questionnaire (n = 1433) indicating if they had run out of money for food in the past month (food insecurity indicator), frequency of food literacy behaviours, selected dietary behaviours, and demographic characteristics. The level of food insecurity reported by participants (n = 1379) was 40.5%. Results from multiple logistic regression demonstrated that behaviours related to planning and management, shopping, preparation, and cooking were all statistically independently associated with food insecurity, in addition to soft/soda drink consumption, education, employment status, and being born in Australia. The results are salient as they indicate an association between food literacy and food insecurity. The implications are that food insecure participants may respond differently to food literacy programs. It may be necessary to screen people enrolling in programs, tailor program content, and include comprehensive measures in evaluation to determine effect on the impact of food literacy programs on different subgroups.

Measuring and Understanding Food Insecurity in Australia: A Systematic Review

The number of Australians seeking food aid has increased in recent years; however, the current variability in the measurement of food insecurity means that the prevalence and severity of food insecurity in Australia is likely underreported. This is compounded by infrequent national health surveys that measure food insecurity, resulting in outdated population-level food insecurity data. This review sought to investigate the breadth of food insecurity research conducted in Australia to evaluate how this construct is being measured. A systematic review was conducted to collate the available Australian research. Fifty-seven publications were reviewed. Twenty-two used a single-item measure to examine food security status; 11 used the United States Department of Agriculture (USDA) Household Food Security Survey Module (HFSSM); two used the Radimer/Cornell instrument; one used the Household Food and Nutrition Security Survey (HFNSS); while the remainder used a less rigorous or unidentified method. A wide range in prevalence and severity of food insecurity in the community was reported; food insecurity ranged from 2% to 90%, depending on the measurement tool and population under investigation. Based on the findings of this review, the authors suggest that there needs to be greater consistency in measuring food insecurity, and that work is needed to create a measure of food insecurity tailored for the Australian context. Such a tool will allow researchers to gain a clear understanding of the prevalence of food insecurity in Australia to create better policy and practice responses.

Protocol for the Development of a Food Stress Index to Identify Households Most at Risk of Food Insecurity in Western Australia

Food stress, a similar concept to housing stress, occurs when a household needs to spend more than 25% of their disposable income on food. Households at risk of food stress are vulnerable to food insecurity as a result of inadequate income. A Food Stress Index (FSI) identifies at-risk households, in a particular geographic area, using a range of variables to create a single indicator. Candidate variables were identified using a multi-dimensional framework consisting of household demographics, household income, household expenses, financial stress indicators, food security, food affordability and food availability. The candidate variables were expressed as proportions, of either persons or households, in a geographic area. Principal Component Analysis was used to determine the final variables which resulted in a final set of weighted raw scores. These scores were then scaled to produce the index scores for the Food Stress Index for Western Australia. The results were compared with the Australian Bureau of Statistics’ Socio-Economic Indexes for Areas to determine suitability. The Food Stress Index was found to be a suitable indicator of the relative risk of food stress in Western Australian households. The FSI adds specificity to indices of relative disadvantage specifically related to food insecurity and provides a useful tool for prioritising policy and other responses to this important public health issue.

Using Cross-Sectional Data to Identify and Quantify the Relative Importance of Factors Associated with and Leading to Food Insecurity

Australian governments routinely monitor population household food insecurity (FI) using a single measure-'running out of food at least once in the previous year'. To better inform public health planning, a synthesis of the determinants and how they influence and modify each other in relation to FI was conducted. The analysis used data from the Health &amp; Wellbeing Surveillance System cross-sectional dataset. Weighted means and multivariable weighted logistic regression described and modelled factors involved in FI. The analysis showed the direction and strength of the factors and a path diagram was constructed to illustrate these. The results showed that perceived income, independent of actual income was a strong mediator on the path to FI as were obesity, smoking and other indicators of health status. Eating out three or more times a week and eating no vegetables more strongly followed FI than preceded it. The analysis identified a range of factors and demonstrated the complex and interactive nature of them. Further analysis using propensity score weighted methods to control for covariates identified hypothetical causal links for investigation. These results can be used as a proof of concept to assist public health planning.

Healthy Diets in Rural Victoria-Cheaper than Unhealthy Alternatives, Yet Unaffordable

Rural communities experience higher rates of obesity and reduced food security compared with urban communities. The perception that healthy foods are expensive contributes to poor dietary choices. Providing an accessible, available, affordable healthy food supply is an equitable way to improve the nutritional quality of the diet for a community, however, local food supply data are rarely available for small rural towns. This study used the Healthy Diets ASAP tool to assess price, price differential and affordability of recommended (healthy) and current diets in a rural Local Government Area (LGA) (pop ≈ 7000; 10 towns) in Victoria, Australia. All retail food outlets were surveyed (n = 40). The four most populous towns had supermarkets; remaining towns had one general store each. Seven towns had café/take-away outlets, and all towns had at least one hotel/pub. For all towns the current unhealthy diet was more expensive than the recommended healthy diet, with 59.5% of the current food budget spent on discretionary items. Affordability of the healthy diet accounted for 30⁻32% of disposable income. This study confirms that while a healthy diet is less expensive than the current unhealthier diet, affordability is a challenge for rural communities. Food security is reduced further with restricted geographical access, a limited healthy food supply, and higher food prices.