Food Insecurity and Rural Adolescent Personal Health, Home, and Academic Environments

Associations of Household Food Insecurity With Academic Outcomes in Early Adolescents

BACKGROUND

Food insecurity is characterized by limited access to adequate food due to a lack of money or resources (eg, lack of transportation to obtain food). School aged children who are experiencing food insecurity are at greater risk for poor academic outcomes, but previous studies have not examined the effects of food insecurity on specific academic outcomes over time.

METHOD

This study examined food insecurity as a risk factor for subsequent academic skills, enablers, and achievement. As part of a larger longitudinal study, middle school students (N = 112; meanage  = 12.14, SD = 0.41; 50% female; 68% black/African American, 14% white, 13% Hispanic or Latino, 5% other) reported on food insecurity at baseline, while teachers reported on students' academic skills and enablers at both baseline and 12 months later at 1 year follow up. Math and English/Language Arts grades were obtained from the schools at each wave.

FINDINGS

Food insecurity predicted lower academic skills over time but was unrelated to academic enablers and grades.

IMPLICATIONS

Considering a whole school, whole community, whole child (WSCC) framework, this study will also discuss the important role schools and communities have in reducing food insecurity in middle school students.

CONCLUSIONS

These results support negative long-term effects of food insecurity on academic skills in early adolescents.

Post-translational modifications of histones: Mechanisms, biological functions, and therapeutic targets

Histones are DNA-binding basic proteins found in chromosomes. After the histone translation, its amino tail undergoes various modifications, such as methylation, acetylation, phosphorylation, ubiquitination, malonylation, propionylation, butyrylation, crotonylation, and lactylation, which together constitute the "histone code." The relationship between their combination and biological function can be used as an important epigenetic marker. Methylation and demethylation of the same histone residue, acetylation and deacetylation, phosphorylation and dephosphorylation, and even methylation and acetylation between different histone residues cooperate or antagonize with each other, forming a complex network. Histone-modifying enzymes, which cause numerous histone codes, have become a hot topic in the research on cancer therapeutic targets. Therefore, a thorough understanding of the role of histone post-translational modifications (PTMs) in cell life activities is very important for preventing and treating human diseases. In this review, several most thoroughly studied and newly discovered histone PTMs are introduced. Furthermore, we focus on the histone-modifying enzymes with carcinogenic potential, their abnormal modification sites in various tumors, and multiple essential molecular regulation mechanism. Finally, we summarize the missing areas of the current research and point out the direction of future research. We hope to provide a comprehensive understanding and promote further research in this field.

Sex for food: a transactional sex reaction to the COVID-19-induced rise in the prevalence of hunger among in-school female adolescents in Ogun State, Nigeria

Introduction

COVID-19 has doubled the proportion of people with acute hunger globally and Nigeria is categorized as having a "severe" form of hunger. Vulnerable groups responding more to hunger stressors include the female adolescents who transact sex for both survival and luxury purposes. This study assessed the engagement in transactional sex to obtain food among female adolescents in Ogun State, Nigeria.

Methods

this descriptive cross-sectional research was conducted among 668 in-school female adolescents that were selected through a multistage sampling method. Data were collected with a structured interviewer-administered questionnaire. Food security was assessed using a standard tool while engagement in transactional sex was elicited through self-report. Data analysis was done using Statistical package for the social sciences (SPSS) version 25. Logistic regression was used to find factors associated with transactional sex. P< 0.05 was taken as statistically significant.

Results

the mean age of the respondents was 15.18±1.35 years. More than two-fifths (41.5%) were staying in households without food security. Less than one-fifth (15.3%) were engaging in transactional sex. Having emotional stress (OR = 4.33; 95 CI: 1.37-13.63), mother´s education (OR =0.163; 95% CI: 0.057- 0.461), having sexual partner (OR = 0.132; 95% CI: 0.047-0.370 and missing classes (OR 3.35, 95% CI: 1.084-10.331) were significant predictors of engaging in transactional sex among female adolescents.

Conclusion

transactional sex is commoner among female adolescents who were missing classes, had sexual partners, and were emotionally stressed. There is a need for intervention programs to protect the female adolescent, delay sexual debut and improve academic performance among them.

Eating disorder risk in rural US adolescents: What do we know and where do we go?

Adolescence is a vulnerable period for the development of eating disorders, but there are disparities in eating disorder risk among adolescents. One population that may be at increased risk but is vastly understudied, is adolescents residing in rural regions within the United States. Rural communities face many mental and physical health disparities; however, the literature on rural adolescent eating disorder risk is nearly nonexistent. In this paper we summarize the scant literature on disordered eating and eating disorder risk and prevalence among rural US adolescents. We also detail eating disorder risk factors that may have unique influence in this population, including socioeconomic status, food insecurity, healthcare access, body image, and weight stigma. Given the presence of numerous eating disorder risk factors, we speculate that rural adolescents may be a particularly vulnerable population for eating disorders and we propose critical next steps in research for understanding eating disorder risk among the understudied population of rural adolescents. PUBLIC SIGNIFICANCE: Rural adolescents may be at increased risk for eating disorders due to disproportionate burden of known risk factors, though this relationship remains understudied. We present a summary of the literature on prevalence and unique risk factors, proposing that this may be a high-risk population. We detail next steps for research to understand eating disorder risk in this population to inform future prevention, identification, and treatment efforts needed in this community.

Food Insecurity and Parent Feeding Practices in Urban and Rural Children Ages 7-12 years

Objective

To examine associations between food insecurity and parent feeding practices for children ages 7-12 years; to determine differences between cohorts in urban and rural communities.

Design

Secondary analysis using baseline data from 2 randomized controlled trials: HOME Plus (urban) and NU-HOME (rural).

Participants

Convenience sample of 264 parent-child dyads. Children were 51.5% female, 9.28 ± 1.45 years.

Variables Measured

Dependent variables included the Child Feeding Questionnaire (CFQ) restrictive feeding subscale, parent modeling of fruits and vegetables score, and family meal frequency (FMF) at breakfast and the evening meal. Food insecurity was the primary independent variable.

Analysis

Multivariable linear or Poisson regression for each outcome.

Results

Food insecurity was associated with a 26% lower weekly rate of FMF at breakfast (95% CI 6%-42%; p=0.02). In stratified analysis, this association was only in the rural NU-HOME study (44% lower weekly rate; 95% CI 19%-63%; p=0.003). Food insecurity was not associated with CFQ restrictive score, parent modeling score, or FMF at the evening meal.

Conclusions and Implications

Food insecurity was associated with less frequent family breakfast, but not with other parent feeding practices. Future studies could investigate supportive mechanisms for positive feeding practices in households experiencing food insecurity.

Household and child food insecurity and CVD risk factors in lower-income adolescents aged 12-17 years from the National Health and Nutrition Examination Survey (NHANES) 2007-2016

OBJECTIVE

Household food insecurity is associated with CVD risk factors in low-income adults, but research on these associations among adolescents is inconsistent. This study investigates whether household and child food insecurity is associated with CVD risk factors in lower-income adolescents.

DESIGN

Cross-sectional. Multivariable linear regression assessed the association between household and child food security and CVD risk factors. Household and child food security was measured using the US Food Security Survey Module. The analyses were adjusted for adolescent's age, sex, race/ethnicity, smoking status, physical activity and sedentary time, as well as household income and the head-of-household's education and marital status.

SETTING

The USA.

PARTICIPANTS

The sample was comprised of 2876 adolescents, aged 12-17 years, with household incomes at or below 300 % federal poverty line from the National Health and Nutrition Examination Survey cycles 2007-2016.

RESULTS

The weighted prevalence of household food insecurity in the analytic sample was 33·4 %, and the weighted prevalence of child food insecurity was 17·4 %. After multivariable adjustment, there were no significant associations between household and child food insecurity and BMI-for-age Z-score, systolic and diastolic blood pressure, HDL-cholesterol, total cholesterol, fasting TAG, fasting LDL-cholesterol and fasting plasma glucose.

CONCLUSIONS

Despite observed associations in adults, household food insecurity was not associated with CVD risk factors in a national sample of lower-income adolescents. Child food insecurity was also not associated with CVD risk factors. More research should be conducted to confirm these associations.

Association between Hunger and Truancy among Students in Liberia: Analysis of 2017 Global School-Based Student Health Survey

BACKGROUND

About 83% and 49% of Liberians live beneath the poverty line of US$1.25/day and experience hunger, respectively. Studies have established that hunger has long-term adverse consequence on truancy among students. However, no national level study has investigated contribution of hunger on truancy among in-school students in Liberia. This paper therefore seeks to examine the association between hunger and truancy among students in Liberia. The study hypothesises that there exists a positive association between hunger and truancy.

METHODS

This study used the 2017 Liberia Global School-Based Student Health Survey (LGSSHS) and sampled 2,744 students. However, the present study was restricted to 1,613 respondents who had complete information about variable of interest analysed in the study. Hunger and truancy are the main explanatory and outcome variables for this study. At 95% confidence interval, two binary logistic regression models were built with Model I examining relationship between hunger and truancy and Model II controlled for the influence of covariates on truancy. Our findings were reported in odds ratio (OR) and adjusted odds ratio (AOR). All the analysis was done using STATA version 14.0.

RESULTS

Descriptively, 46% were truant, and 65% of students ever experienced hunger. Inferentially, students that ever-encountered hunger had higher odds to truancy (AOR = 1.32, CI = 1.06-1.65). The odds to be truant also increased among those at 15 years and above (AOR = 2.00, CI = 1.46-2.72), who witnessed bullying (AOR = 1.36, CI = 1.10-1.68), that felt lonely (AOR = 1.35, CI = 1.06-1.71), that currently smoke cigarette (AOR = 2.58, CI = 1.64-4.06), and wards whose parents go through their things (AOR = 1.26, CI = 1.03-1.55).

CONCLUSIONS

The study concluded that hunger was associated with truancy among students in Liberia. Additionally, students' age, bullying, feeling lonely, cigarette use, and parental concern also determined truancy. Governments, policy makers, and other partners in education should therefore roll out some school-based interventions, such as the school feeding program, which will help minimise the incidence of hunger among students. Such programs should consider the variations in students' background characteristics in its design.

A call for evidence to support food security interventions on college campuses

Food insecurity negatively impacts collegiate academic performance, mental and social health and overall health status. However, nothing is known on the effectiveness of evidence-based programs to address food insecurity in college students. Opportunity remains to conduct intervention-specific research targeted at reduction food insecurity prevalence on college campuses.

Addressing Equity in Rural Schools: Opportunities and Challenges for School Meal Standards Implementation

BACKGROUND

Few studies examine why rural public schools have weaker policies and practices related to school nutrition environments compared to their urban counterparts. It is important to understand this disparity because federal school meal standards aim for children to access health-promoting nutrition environments. In this study, we identify challenges and opportunities for the implementation of school meal standards in rural high schools.

METHODS

We interviewed 38 rural school professionals from 22 high schools across 7 states. School professionals included food service directors, principals, school nurses, and teachers. Team coding in Atlas.ti Qualitative Data Analysis software v8 and principles of comparative analysis were employed to generate themes related to challenges and opportunities.

RESULTS

Overall, school professionals described improvements with implementation experiences and student acceptance over time. Key challenges included the negative influences of home and community food environments and limited staff size and capacity. Key opportunities involved joining co-ops to enhance purchasing power, leveraging state technical assistance, and forming external partnerships.

CONCLUSIONS

This study offers insights from a broad range of rural school professionals' implementation experiences. The findings can inform governments and technical assistance agencies working with rural schools and school districts to facilitate implementation and sustainability of initiatives.

Meal Quality of Entrées That Can Be Sold as Competitive Foods in Schools and Potential Impact of the Proposed USDA Rollbacks

The Healthy, Hunger-Free Kids Act strengthened competitive food standards (i.e., Smart Snacks), but an exemption allows reimbursable meal entrées that do not meet Smart Snack standards to be sold as “competitive entrées” on the same day they are served in the reimbursable meal, and the following day. Proposed rollbacks would enable these competitive entrées to continue to be sold on a third day, increasing the availability of competitive foods exempt from Smart Snacks standards. This study compared the Healthy Eating Index (HEI) scores of potential competitive entrées alone versus full reimbursable school lunches, and examined the nutritional characteristics of potential competitive entrées. Data were from a national sample of 1108 schools from the School Nutrition and Meal Cost Study. Linear regression models, accounting for school-level and state and district policy characteristics, found that HEI scores of competitive entrées were an average of 30 points lower than HEI scores of reimbursable lunches, with greater differences in small and rural schools. Less than 1% of common potential competitive entrees met Smart Snack standards, primarily due to higher sodium and saturated fat levels. The proposed rollbacks are estimated to potentially add approximately 662 mg of sodium and 3 g of saturated fat over three days (1103 mg sodium and 5 g saturated fat over a week) on average relative to Smart Snacks limits. Instead of increasing opportunities to sell competitive entrées, their sales should be further limited.

Household food insecurity and educational outcomes in school-going adolescents in Ghana

OBJECTIVES

We examined the association of household food insecurity with educational outcomes and explored the moderating effect of gender and school lunch programme.

DESIGN

The study used a cross-sectional design. Data were collected in 2014 using interviewer-administered questionnaires and school administrative records. We measured household food insecurity using the Household Food Insecurity Access Scale. Educational outcomes referred to knowledge, attitudes and skills that students are expected to obtain while attending school. We obtained sixteen different measures of educational outcomes, ranging from academic grades to beliefs and attitudes towards school and education. Data were analysed using multilevel modelling with covariates at the student and school levels. We conducted moderation tests by adding a two-way interaction between food insecurity and gender, and between food insecurity and school lunch programme.

SETTING

The study was conducted in 100 schools located in fifty-four districts within Ghana's eight administrative regions in 2014.

PARTICIPANTS

Participants included 2201 school-going adolescents aged 15-19 years.

RESULTS

More than 60 % of adolescents were from food-insecure households. Household food insecurity was negatively associated with Math grade and school attendance. Food insecurity was also inversely associated with socio-emotional outcomes, including academic self-efficacy, commitment to school and academic aspirations and expectations. We did not find a moderating effect of gender and school lunch programme.

CONCLUSIONS

Food insecurity is negatively associated with wide-ranging educational outcomes related to both learning and socio-emotional abilities. Our study supports prior evidence suggesting the importance of food access on both cognitive and non-cognitive educational outcomes.

Food Insecurity and Pediatric Malnutrition Related to Under- and Overweight in the United States: An Evidence Analysis Center Systematic Review

Both food insecurity and malnutrition are associated with adverse health outcomes in the pediatric population. However, the research on the relationship between these factors has been inconsistent, leading to uncertainty regarding whether or how evaluation of food insecurity should be incorporated into nutrition screening or the nutrition care process. The objective of this systematic review was to determine the association between food insecurity and malnutrition related to undernutrition or overnutrition (defined by anthropometrics) in the pediatric population in the United States. A literature search was conducted using Medline, Embase, and CINAHL databases for studies published from January 2002 through November 2017. A total of 23 studies (19 cross-sectional and 4 prospective cohort studies) met inclusion criteria and were included in qualitative analysis. In 6 studies, there was no overall relationship between food insecurity and underweight. All included studies examined the relationship between food insecurity status and overweight/obesity and results were mixed, with large cross-sectional studies demonstrating a positive relationship between food insecurity and overweight/obesity. There were no clear patterns according to subpopulation. Evidence quality was graded as fair due to heterogeneity in how food insecurity was measured and populations included as well as inconsistency in results. Use of a 2-item food insecurity screening tool may allow for efficient, effective screening of food insecurity in order to identify potential contributors overweight and obesity.

Adolescent food insecurity in rural Sindh, Pakistan: a cross-sectional survey

Background

Food insecurity (FI) is alarmingly high in developing countries including Pakistan. A quarter of Pakistan’s population consists of adolescents yet there is no information on their experience of FI. FI at adolescent age have long term effect on mental and physical health hence we aimed to determine the prevalence of food insecurity (FI) among adolescents and compare it with household FI, and assess social determinants of adolescent FI.

Methods

A cross-sectional survey on 799 households with unmarried adolescents was conducted from September 2015 to June 2016 in three union councils of Hyderabad, Pakistan. Unmarried 10–19 years old girls and boys were interviewed regarding their FI status using Household Food Insecurity Assessment Scale (HFIAS). Household-level FI was also assessed by interviewing mothers of adolescents, and it was compared with adolescent’s FI. Association of adolescent’s FI with socio-demographic determinants was explored through Cox regression using STATA version 14.0. and prevalence ratios were estimated.

Results

FI was found among 52.4% of the adolescents compared to 39% of the households. Thirty percent of the adolescents were food insecure within the food secure households. Female adolescents were found to be less food insecure (Adjusted Prevalence Ratio (APR) 0.4 95% CI [0.3, 0.5]) compared to males. Social determinants like socioeconomic status (SES), crowding index or education of parents were not associated with adolescents’ FI.

Conclusion

Half of the adolescents were found to be food insecure which raises concerns regarding their health in the long run. Gender is an important social determinant of FI among adolescents which suggests an in-depth exploration of social dynamics of adolescent FI. We recommend the mixed-methods study to develop contextually relevant interventions to reduce FI among this group and improve their health status.

Community eligibility and other provisions for universal free meals at school: impact on student breakfast and lunch participation in California public schools

United States Department of Agriculture (USDA) school meal programs are an important part of the safety net for reducing food insecurity, yet not all students who qualify for free or reduced-price meals participate. In 2014-2015, the Community Eligibility Provision became available nationwide. This provision, along with Provisions 1, 2, and 3 of the USDA school meals programs, allows local school food authorities to offer universal free meals at schools with high student poverty. It is expected that adoption of a provision allowing universal free meals will increase rates of student participation in meal programs at schools where many students are at risk for food insecurity. This study examines school-level adoption of any provision for universal free meals and subsequent changes in student participation rates for the School Breakfast Program and National School Lunch Program in California from 2013-2014 to 2016-2017. A database was assembled for 10,343 public schools, including meals served, demographics, eligibility for provisions, and use of provisions in each year. Multilevel regression models were used to examine school adoption and student participation rates over time. Difference-in-difference calculations from lagged longitudinal models adjusting for school demographics showed that when eligible schools adopted provisions, participation rates increased an average of 3.48 percentage points for breakfast and 5.79 points for lunch the following year. By 2016-2017, over half of all eligible schools were using a provision for universal free meals. Among eligible schools, provision adoption was more common at schools that were larger, had predominantly Latino students, and were in rural areas. When eligible schools adopt provisions for universal free meals, student participation rates significantly increase, improving program reach among children most at risk for food insecurity. However, not all eligible schools adopt a provision for universal free meals and some adopters drop out in subsequent years. Research to better understand factors influencing the decision whether to adopt a provision or to continue it could inform policy and program leaders. Increases in breakfast participation are smaller than those for lunch, suggesting that other barriers to breakfast participation warrant further investigation.

Adolescent food insecurity: A review of contextual and behavioral factors

OBJECTIVE

The purpose of this review is to examine recent research on contextual and behavioral factors that will lead to better understanding of adolescent food insecurity and health outcomes.

DESIGN

A literature search for peer-reviewed, English language, research articles published between 2009 and 2019, using CINAHL, Embase^® , Pubmed, and the Cochrane Library.

SAMPLE

The final sample represents thirty studies on food insecurity with a sample including adolescents, and that employ a measure of food insecurity.

RESULTS

Variables of interest and results on topics such as weight-related factors, maternal parenting and behaviors, mental health, and adolescent-level behavioral factors are summarized.

CONCLUSION

Food insecurity is associated with poor adolescent health and mental health. All adolescents should be screened for food insecurity, involving pediatric and mental health care settings. Future research on adolescent food insecurity should explore parent and parenting factors, household composition and family dynamics, psychological factors, health behaviors, and stress; peer influences might also be an important area of research with adolescents. While previous research has relied on parents' reports, adolescents'experiences are unique, and they are willing and reliable research participants; they should be included in future food insecurity research.

Food insecurity is associated with lower adherence to the Mediterranean dietary pattern among Lebanese adolescents: a cross-sectional national study

PURPOSE

To derive dietary patterns (DPs) of Lebanese adolescents (10-18 years) and evaluate associations between identified DPs and household food insecurity (HFI).

METHODS

Data on adolescents (n = 693) were drawn from a national survey conducted in 2015 on a representative sample of Lebanese households with children. In addition to a sociodemographic questionnaire, data collection included the validated Arabic-version of the Household Food Insecurity Access Scale, used to evaluate HFI. Dietary intake was assessed using a 187-item validated food frequency questionnaire. Associations between HFI scores and DPs were examined using multiple linear regressions.

RESULTS

HFI was observed in 55.2% of the study sample. Two DPs were derived among adolescents: Western and Lebanese-Mediterranean (LM). The Western DP was characterized by higher consumption of sweetened beverages, fast foods, sweets, and refined grains, whereas the LM DP was characterized by higher intakes of fruits, vegetables, dairy products, and whole grains. Scores of the Western DP were negatively associated with fiber, calcium, iron, and vitamins A and D, while the LM DP scores were positively correlated with fiber, proteins, iron, calcium, and vitamins A and D (p < 0.01). LM DP scores were also negatively correlated with total fat, saturated and polyunsaturated fats, p < 0.05. After adjustment for sociodemographics, multiple linear regression showed that higher HFI scores were associated with lower adherence to LM DP among adolescents (β = - 0.026, 95% CI - 0.046, - 0.006).

CONCLUSIONS

HFI was associated with lower adherence to the Mediterranean pattern among Lebanese adolescents. Preventive strategies are needed to promote better diet quality among food-insecure youth.

Feasibility of a self-management intervention in adolescents with headache (SMI-AH)

PURPOSE

This study assessed the acceptability and limited efficacy of a self-management intervention to improve lifestyle behaviors and headache outcomes among rural adolescents with recurrent headache.

DESIGN AND METHODS

Participants were randomly assigned to a self-management intervention for adolescent headache (SMI-AH, n = 13) or standard care group (n = 17). The SMI-AH group participated in goal-setting, self-monitoring, and information processing to modify lifestyle behaviors (missed meals, caffeine intake, and poor sleep). Independent samples t-test was used to compare the means of outcomes at baseline and 6-week follow-up between the treatment group and control group. Linear mixed model (LMM) was used to examine the intervention effects over time.

RESULTS

The mean age was 14.8 years (sd = 1.6, range, 12-17); with female participants accounting for 80% of the sample (n = 24) and persons reporting white race were 97% (n = 29). The SMI-AH group demonstrated a greater magnitude of change in lifestyle behaviors, including increased days of eating breakfast and lunch. The multivariate LMM showed significant intervention effect of lunch intake (p = 0.042 with Cohen's d = 0.42) and borderline significant effect of breakfast intake (p = 0.064 with Cohen's d = 0.38). Participants reported the intervention was easy to use and helpful to monitor behaviors.

CONCLUSIONS

Among rural adolescents, a self-management intervention is a feasible approach for engaging youth. The SMI-AH provides an opportunity for the adolescents to talk about their behaviors and participate in goal setting as well as the plan of care with the provider. Challenges identified in this study are manageable and a full study is feasible with modifications.

Breakfast Is Brain Food? The Effect on Grade Point Average of a Rural Group Randomized Program to Promote School Breakfast

BACKGROUND

Adolescents frequently miss breakfast which may impact cognitive, academic, and health outcomes. This analysis describes the effect of a trial to assess school level changes to increase breakfast consumption on grade point average (GPA).

METHODS

Sixteen rural Minnesota high schools were randomized to a policy and environmental change intervention or delayed intervention (control) group. Baseline screening identified, randomly selected and enrolled 9th and 10th grade students who eat breakfast ≤3 times per school week for assessment. Mean unweighted GPA was provided by 13 schools for 636 students. Student-level and administrative data were used for sociodemographic and free or reduced-price meals (FRPM). Linear mixed models and latent class analysis (LCA) were used to assess change in GPA.

RESULTS

Students were 54% female, 76% white, and 34% received FRPM. Unweighted cumulative GPA mean = 2.82 (0.78) at baseline. There was no significant intervention effect on GPA postintervention or 1-year follow-up. LCA revealed two classes: "higher" (N = 495) and "lower" (N = 141) resource. There was an intervention effect among low-resource students from baseline to 1-year post only among the control condition (delayed intervention).

CONCLUSIONS

In combination with the full study results, increasing breakfast consumption may have an impact particularly for low resource students.

Child food insecurity in the UK: a rapid review

Background

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

Objective

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

Data sources

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

Methods

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

Results

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

Limitations

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

Conclusions

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

Future research

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

Study registration

This study is registered as PROSPERO CRD42017084818.

Funding

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

Spanish adaptation and validation of the Child Food Security Survey Module (CFSSM-S)

OBJECTIVE

The present study aimed to assess the: (i) internal structure of the Spanish Child Food Security Survey Module (CFSSM-S) with exploratory and confirmatory factor analysis (EFA and CFA); (ii) measurement invariance by gender, grade, weight status, socio-economic status (SES) and family affluence; and (iii) relationships with these external variables.

DESIGN

A cross-sectional study was conducted. The CFSSM-S and other tools were employed to assess food insecurity, weight status, SES and family affluence, respectively.

SETTING

A secondary school (grades 7-10) in the city of Terrassa in Catalonia, Spain.

SUBJECTS

Participants included adolescent boys and girls (n 426) aged 12-17 years.

RESULTS

The cross-validation design with EFA and CFA captured a single factor, 'food insecurity'. The goodness-of-fit for the one-factor model with CFA (root-mean-square error of approximation=0·038, comparative fit index=0·984, Tucker-Lewis index=0·979) and internal consistency (ω=0·95) were excellent. The measurement invariance indicated that CFSSM-S could be used across genders, grades, weight status, SES and family affluence. Only mean differences for SES and family affluence were found which showed a linear trend, indicating higher CFSSM-S scores for participants with lower SES and family affluence. Of participants, 1·9 % experienced very low food security, 16·4 % low food security and 81·7 % were food secure.

CONCLUSIONS

The CFSSM-S is the first validated instrument to assess food insecurity with psychometric guarantees in Spanish adolescents. Researchers and health practitioners in Spain could use this self-reported questionnaire to gain more information about adolescent health in relation to food insecurity.

Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight

BACKGROUND

The global prevalence of childhood and adolescent obesity is high. Lifestyle changes towards a healthy diet, increased physical activity and reduced sedentary activities are recommended to prevent and treat obesity. Evidence suggests that changing these health behaviours can benefit cognitive function and school achievement in children and adolescents in general. There are various theoretical mechanisms that suggest that children and adolescents with excessive body fat may benefit particularly from these interventions.

OBJECTIVES

To assess whether lifestyle interventions (in the areas of diet, physical activity, sedentary behaviour and behavioural therapy) improve school achievement, cognitive function (e.g. executive functions) and/or future success in children and adolescents with obesity or overweight, compared with standard care, waiting-list control, no treatment, or an attention placebo control group.

SEARCH METHODS

In February 2017, we searched CENTRAL, MEDLINE and 15 other databases. We also searched two trials registries, reference lists, and handsearched one journal from inception. We also contacted researchers in the field to obtain unpublished data.

SELECTION CRITERIA

We included randomised and quasi-randomised controlled trials (RCTs) of behavioural interventions for weight management in children and adolescents with obesity or overweight. We excluded studies in children and adolescents with medical conditions known to affect weight status, school achievement and cognitive function. We also excluded self- and parent-reported outcomes.

DATA COLLECTION AND ANALYSIS

Four review authors independently selected studies for inclusion. Two review authors extracted data, assessed quality and risks of bias, and evaluated the quality of the evidence using the GRADE approach. We contacted study authors to obtain additional information. We used standard methodological procedures expected by Cochrane. Where the same outcome was assessed across different intervention types, we reported standardised effect sizes for findings from single-study and multiple-study analyses to allow comparison of intervention effects across intervention types. To ease interpretation of the effect size, we also reported the mean difference of effect sizes for single-study outcomes.

MAIN RESULTS

We included 18 studies (59 records) of 2384 children and adolescents with obesity or overweight. Eight studies delivered physical activity interventions, seven studies combined physical activity programmes with healthy lifestyle education, and three studies delivered dietary interventions. We included five RCTs and 13 cluster-RCTs. The studies took place in 10 different countries. Two were carried out in children attending preschool, 11 were conducted in primary/elementary school-aged children, four studies were aimed at adolescents attending secondary/high school and one study included primary/elementary and secondary/high school-aged children. The number of studies included for each outcome was low, with up to only three studies per outcome. The quality of evidence ranged from high to very low and 17 studies had a high risk of bias for at least one item. None of the studies reported data on additional educational support needs and adverse events.Compared to standard practice, analyses of physical activity-only interventions suggested high-quality evidence for improved mean cognitive executive function scores. The mean difference (MD) was 5.00 scale points higher in an after-school exercise group compared to standard practice (95% confidence interval (CI) 0.68 to 9.32; scale mean 100, standard deviation 15; 116 children, 1 study). There was no statistically significant beneficial effect in favour of the intervention for mathematics, reading, or inhibition control. The standardised mean difference (SMD) for mathematics was 0.49 (95% CI -0.04 to 1.01; 2 studies, 255 children, moderate-quality evidence) and for reading was 0.10 (95% CI -0.30 to 0.49; 2 studies, 308 children, moderate-quality evidence). The MD for inhibition control was -1.55 scale points (95% CI -5.85 to 2.75; scale range 0 to 100; SMD -0.15, 95% CI -0.58 to 0.28; 1 study, 84 children, very low-quality evidence). No data were available for average achievement across subjects taught at school.There was no evidence of a beneficial effect of physical activity interventions combined with healthy lifestyle education on average achievement across subjects taught at school, mathematics achievement, reading achievement or inhibition control. The MD for average achievement across subjects taught at school was 6.37 points lower in the intervention group compared to standard practice (95% CI -36.83 to 24.09; scale mean 500, scale SD 70; SMD -0.18, 95% CI -0.93 to 0.58; 1 study, 31 children, low-quality evidence). The effect estimate for mathematics achievement was SMD 0.02 (95% CI -0.19 to 0.22; 3 studies, 384 children, very low-quality evidence), for reading achievement SMD 0.00 (95% CI -0.24 to 0.24; 2 studies, 284 children, low-quality evidence), and for inhibition control SMD -0.67 (95% CI -1.50 to 0.16; 2 studies, 110 children, very low-quality evidence). No data were available for the effect of combined physical activity and healthy lifestyle education on cognitive executive functions.There was a moderate difference in the average achievement across subjects taught at school favouring interventions targeting the improvement of the school food environment compared to standard practice in adolescents with obesity (SMD 0.46, 95% CI 0.25 to 0.66; 2 studies, 382 adolescents, low-quality evidence), but not with overweight. Replacing packed school lunch with a nutrient-rich diet in addition to nutrition education did not improve mathematics (MD -2.18, 95% CI -5.83 to 1.47; scale range 0 to 69; SMD -0.26, 95% CI -0.72 to 0.20; 1 study, 76 children, low-quality evidence) and reading achievement (MD 1.17, 95% CI -4.40 to 6.73; scale range 0 to 108; SMD 0.13, 95% CI -0.35 to 0.61; 1 study, 67 children, low-quality evidence).

AUTHORS' CONCLUSIONS

Despite the large number of childhood and adolescent obesity treatment trials, we were only able to partially assess the impact of obesity treatment interventions on school achievement and cognitive abilities. School and community-based physical activity interventions as part of an obesity prevention or treatment programme can benefit executive functions of children with obesity or overweight specifically. Similarly, school-based dietary interventions may benefit general school achievement in children with obesity. These findings might assist health and education practitioners to make decisions related to promoting physical activity and healthy eating in schools. Future obesity treatment and prevention studies in clinical, school and community settings should consider assessing academic and cognitive as well as physical outcomes.

A Low-Cost, Grab-and-Go Breakfast Intervention for Rural High School Students: Changes in School Breakfast Program Participation Among At-Risk Students in Minnesota

OBJECTIVE

Evaluate the impact of a grab-and-go component embedded within a larger intervention designed to promote School Breakfast Program (SBP) participation.

DESIGN

Secondary data analysis.

SETTING

Rural Minnesota high schools.

PARTICIPANTS

Eight schools were enrolled in the grab-and-go only intervention component. An at-risk sample of students (n = 364) who reported eating breakfast ≤3 d/wk at baseline was enrolled at these schools.

INTERVENTIONS

Grab-and-go style breakfast carts and policies were introduced to allow all students to eat outside the cafeteria.

MAIN OUTCOME MEASURES

Administrative records were used to determine percent SBP participation (proportion of non-absent days on which fully reimbursable meals were received) for each student and school-level averages.

ANALYSIS

Linear mixed models.

RESULTS

School-level increases in SBP participation from baseline to the school year of intervention implementation were observed for schools enrolled in the grab-and-go only component (13.0% to 22.6%). Student-level increases in SBP participation were observed among the at-risk sample (7.6% to 21.9%) and among subgroups defined by free- or reduced-price meal eligibility and ethnic or racial background. Participation in SBP increased among students eligible for free or reduced-price meals from 13.9% to 30.7% and among ineligible students from 4.3% to 17.2%.

CONCLUSIONS AND IMPLICATIONS

Increasing access to the SBP and social support for eating breakfast are effective promotion strategies.

Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight

BACKGROUND

The global prevalence of childhood and adolescent obesity is high. Lifestyle changes towards a healthy diet, increased physical activity and reduced sedentary activities are recommended to prevent and treat obesity. Evidence suggests that changing these health behaviours can benefit cognitive function and school achievement in children and adolescents in general. There are various theoretical mechanisms that suggest that children and adolescents with excessive body fat may benefit particularly from these interventions.

OBJECTIVES

To assess whether lifestyle interventions (in the areas of diet, physical activity, sedentary behaviour and behavioural therapy) improve school achievement, cognitive function (e.g. executive functions) and/or future success in children and adolescents with obesity or overweight, compared with standard care, waiting-list control, no treatment, or an attention placebo control group.

SEARCH METHODS

In February 2017, we searched CENTRAL, MEDLINE and 15 other databases. We also searched two trials registries, reference lists, and handsearched one journal from inception. We also contacted researchers in the field to obtain unpublished data.

SELECTION CRITERIA

We included randomised and quasi-randomised controlled trials (RCTs) of behavioural interventions for weight management in children and adolescents with obesity or overweight. We excluded studies in children and adolescents with medical conditions known to affect weight status, school achievement and cognitive function. We also excluded self- and parent-reported outcomes.

DATA COLLECTION AND ANALYSIS

Four review authors independently selected studies for inclusion. Two review authors extracted data, assessed quality and risks of bias, and evaluated the quality of the evidence using the GRADE approach. We contacted study authors to obtain additional information. We used standard methodological procedures expected by Cochrane. Where the same outcome was assessed across different intervention types, we reported standardised effect sizes for findings from single-study and multiple-study analyses to allow comparison of intervention effects across intervention types. To ease interpretation of the effect size, we also reported the mean difference of effect sizes for single-study outcomes.

MAIN RESULTS

We included 18 studies (59 records) of 2384 children and adolescents with obesity or overweight. Eight studies delivered physical activity interventions, seven studies combined physical activity programmes with healthy lifestyle education, and three studies delivered dietary interventions. We included five RCTs and 13 cluster-RCTs. The studies took place in 10 different countries. Two were carried out in children attending preschool, 11 were conducted in primary/elementary school-aged children, four studies were aimed at adolescents attending secondary/high school and one study included primary/elementary and secondary/high school-aged children. The number of studies included for each outcome was low, with up to only three studies per outcome. The quality of evidence ranged from high to very low and 17 studies had a high risk of bias for at least one item. None of the studies reported data on additional educational support needs and adverse events.Compared to standard practice, analyses of physical activity-only interventions suggested high-quality evidence for improved mean cognitive executive function scores. The mean difference (MD) was 5.00 scale points higher in an after-school exercise group compared to standard practice (95% confidence interval (CI) 0.68 to 9.32; scale mean 100, standard deviation 15; 116 children, 1 study). There was no statistically significant beneficial effect in favour of the intervention for mathematics, reading, or inhibition control. The standardised mean difference (SMD) for mathematics was 0.49 (95% CI -0.04 to 1.01; 2 studies, 255 children, moderate-quality evidence) and for reading was 0.10 (95% CI -0.30 to 0.49; 2 studies, 308 children, moderate-quality evidence). The MD for inhibition control was -1.55 scale points (95% CI -5.85 to 2.75; scale range 0 to 100; SMD -0.15, 95% CI -0.58 to 0.28; 1 study, 84 children, very low-quality evidence). No data were available for average achievement across subjects taught at school.There was no evidence of a beneficial effect of physical activity interventions combined with healthy lifestyle education on average achievement across subjects taught at school, mathematics achievement, reading achievement or inhibition control. The MD for average achievement across subjects taught at school was 6.37 points lower in the intervention group compared to standard practice (95% CI -36.83 to 24.09; scale mean 500, scale SD 70; SMD -0.18, 95% CI -0.93 to 0.58; 1 study, 31 children, low-quality evidence). The effect estimate for mathematics achievement was SMD 0.02 (95% CI -0.19 to 0.22; 3 studies, 384 children, very low-quality evidence), for reading achievement SMD 0.00 (95% CI -0.24 to 0.24; 2 studies, 284 children, low-quality evidence), and for inhibition control SMD -0.67 (95% CI -1.50 to 0.16; 2 studies, 110 children, very low-quality evidence). No data were available for the effect of combined physical activity and healthy lifestyle education on cognitive executive functions.There was a moderate difference in the average achievement across subjects taught at school favouring interventions targeting the improvement of the school food environment compared to standard practice in adolescents with obesity (SMD 0.46, 95% CI 0.25 to 0.66; 2 studies, 382 adolescents, low-quality evidence), but not with overweight. Replacing packed school lunch with a nutrient-rich diet in addition to nutrition education did not improve mathematics (MD -2.18, 95% CI -5.83 to 1.47; scale range 0 to 69; SMD -0.26, 95% CI -0.72 to 0.20; 1 study, 76 children, low-quality evidence) and reading achievement (MD 1.17, 95% CI -4.40 to 6.73; scale range 0 to 108; SMD 0.13, 95% CI -0.35 to 0.61; 1 study, 67 children, low-quality evidence).

AUTHORS' CONCLUSIONS

Despite the large number of childhood and adolescent obesity treatment trials, we were only able to partially assess the impact of obesity treatment interventions on school achievement and cognitive abilities. School and community-based physical activity interventions as part of an obesity prevention or treatment programme can benefit executive functions of children with obesity or overweight specifically. Similarly, school-based dietary interventions may benefit general school achievement in children with obesity. These findings might assist health and education practitioners to make decisions related to promoting physical activity and healthy eating in schools. Future obesity treatment and prevention studies in clinical, school and community settings should consider assessing academic and cognitive as well as physical outcomes.

School Breakfast Program Participation and Rural Adolescents' Purchasing Behaviors in Food Stores and Restaurants

BACKGROUND

Little is known about adolescents' food purchasing behaviors in rural areas. This study examined whether purchasing food at stores/restaurants around schools was related to adolescents' participation in school breakfast programs and overall diet in rural Minnesota.

METHODS

Breakfast-skippers enrolled in a group-randomized intervention in 2014 to 2015 (N = 404 from 8 schools) completed 24-hour dietary recalls and pre/post surveys assessing food establishment purchase frequency. Healthy Eating Index Scores (HEI-2010) were calculated for each student. Student-level school breakfast participation (SBP) was obtained from school food service records. Mixed-effects regression models estimated: (1) whether SBP was associated with store/restaurant use at baseline, (2) whether an increase in SBP was associated with a decrease in store/restaurant use, and (3) whether stores/restaurant use was associated with HEI-2010 scores at baseline.

RESULTS

Students with increased SBP were more likely to decrease fast-food restaurant purchases on the way home from school (OR 1.017, 95% CI 1.005, 1.029), but were less likely to decrease purchases at food stores for breakfast (OR 0.979, 95% CI 0.959, 0.999). Food establishment use was associated with lower HEI-2010 dairy component scores (p = .017).

CONCLUSIONS

Increasing participation in school breakfast may result in modest changes in purchases at food establishments.