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Berkowitz SA, Drake C, Byhoff E. Food Insecurity and Social Policy: A Comparative Analysis of Welfare State Regimes in 19 Countries. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2024; 54:76-86. [PMID: 38087472 PMCID: PMC10954393 DOI: 10.1177/27551938231219200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/04/2023] [Accepted: 09/22/2023] [Indexed: 01/18/2024]
Abstract
We sought to determine whether a country's social policy configuration-its welfare state regime-is associated with food insecurity risk. We conducted a cross-sectional study of 2017 U.N. Food and Agriculture Organization individual-level food insecurity survey data from 19 countries (the most recent data available prior to COVID-19). Countries were categorized into three welfare state regimes: liberal (e.g., the United States), corporatist (e.g., Germany), or social democratic (e.g., Norway). Food insecurity probability, calibrated to an international reference standard, was calculated using a Rasch model. We used linear regression to compare food insecurity probability across regime types, adjusting for per-capita gross domestic product, age, gender, education, and household composition. There were 19,008 participants. The mean food insecurity probability was 0.067 (SD: 0.217). In adjusted analyses and compared with liberal regimes, food insecurity probability was lower in corporatist (risk difference: -0.039, 95% CI -0.066 to -0.011, p = .006) and social democratic regimes (risk difference: -0.037, 95% CI -0.062 to -0.012, p = .004). Social policy configuration is strongly associated with food insecurity risk. Social policy changes may help lower food insecurity risk in countries with high risk.
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Affiliation(s)
- Seth A. Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Connor Drake
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Population Health Science, Duke University School of Medicine, Durham, NC, USA
| | - Elena Byhoff
- Division of Health Systems Science, Department of Medicine, UMass Chan Medical School, Worcester, MA, USA
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Fafard St-Germain AA, Hutchinson J, Tarasuk V. The relationship between household food insecurity and overweight or obesity among children and adults in Canada: a population-based, propensity score weighting analysis. Appl Physiol Nutr Metab 2024; 49:473-486. [PMID: 38224041 DOI: 10.1139/apnm-2023-0302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Household food insecurity is independently associated with adverse health outcomes among Canadians, but its association with overweight and obesity is poorly understood partly because of limited attention to confounding. This study assessed the relationship between food insecurity status and overweight/obesity in Canada. Cross-sectional data for individuals aged 2-64 years were drawn from the 2004 and 2015 Canadian Community Health Survey-Nutrition. Overweight/obesity was defined using body mass index calculated with measured height and weight. Food insecurity status was assessed with the 18-item Household Food Security Survey Module. The relationship was examined among preschool children (n = 2007), girls (n = 5512), boys (n = 5507), women (n = 8317), and men (n = 7279) using propensity score weighted logistic regressions to control for confounding. Relative to their food-secure counterparts, girls in moderately food-insecure households (39.7% vs. 28.5%), boys in severely food-insecure households (54.4% vs. 35.0%), and women in moderately and severely food-insecure households (58.9% and 73.1% vs. 50.7%) had higher overweight/obesity prevalence; men in moderately food-insecure households had a lower prevalence (48.9% vs. 66.3%). With propensity score weighting, no association existed between food insecurity and overweight/obesity among preschool children, girls, boys, or men. For women, moderate (adjusted odds ratio (AOR): 1.61; 95% confidence interval (95%CI): 1.06-2.47) and severe (AOR: 2.33; 95%CI: 1.22-4.44) food insecurity was positively associated with overweight/obesity; the association was strongest for severe food insecurity and obesity (AOR: 3.38; 95%CI: 1.60-7.16). Additional research is needed to better understand the nature of the relationship among women. Problems of food insecurity and overweight/obesity among Canadian children and men should not be conflated in public health interventions.
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Affiliation(s)
| | - Joy Hutchinson
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Valerie Tarasuk
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
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Tariq S, Olstad DL, Beall RF, Spackman E, Lipscombe L, Dunn S, Lashewicz BM, Elliott MJ, Campbell DJ. Exploring the prospective acceptability of a healthy food incentive program from the perspective of people with type 2 diabetes and experiences of household food insecurity in Alberta, Canada. Public Health Nutr 2024; 27:e66. [PMID: 38305101 DOI: 10.1017/s1368980024000429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
OBJECTIVE FoodRx is a 12-month healthy food prescription incentive program for people with type 2 diabetes (T2DM) and experiences of household food insecurity. In this study, we aimed to explore potential users' prospective acceptability (acceptability prior to program use) of the design and delivery of the FoodRx incentive and identify factors influencing prospective acceptability. DESIGN We used a qualitative descriptive approach and purposive sampling to recruit individuals who were interested or uninterested in using the FoodRx incentive. Semi-structured interviews were guided by the theoretical framework of acceptability, and corresponding interview transcripts were analysed using differential qualitative analysis guided by the socioecological model. SETTING Individuals living in Alberta, Canada. PARTICIPANTS In total, fifteen adults with T2DM and experiences of household food insecurity. RESULTS People who were interested in using the FoodRx incentive (n 10) perceived it to be more acceptable than those who were uninterested (n 5). We identified four themes that captured factors that influenced users' prospective acceptability: (i) participants' confidence, views and beliefs of FoodRx design and delivery and its future use (intrapersonal), (ii) the shopping routines and roles of individuals in participants' social networks (interpersonal), (iii) access to and experience with food retail outlets (community), and (iv) income and food access support to cope with the cost of living (policy). CONCLUSION Future healthy food prescription programs should consider how factors at all levels of the socioecological model influence program acceptability and use these data to inform program design and delivery.
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Affiliation(s)
- Saania Tariq
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, ABT2N 1N4, Canada
| | - Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, ABT2N 1N4, Canada
| | - Reed F Beall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, ABT2N 1N4, Canada
| | - Eldon Spackman
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, ABT2N 1N4, Canada
| | - Lorraine Lipscombe
- Department of Medicine, Temerty School of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sharlette Dunn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, ABT2N 1N4, Canada
| | - Bonnie M Lashewicz
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, ABT2N 1N4, Canada
| | - Meghan J Elliott
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, ABT2N 1N4, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, ABT2N 1N4, Canada
| | - David Jt Campbell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, ABT2N 1N4, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, ABT2N 1N4, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, ABT2N 1N4, Canada
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Jd Steer K, Olstad DL, Jt Campbell D, Beall R, Anstruther SM, Caron-Roy S, Spackman E. The Impact of Providing Material Benefits to Improve Access to Food on Clinical Parameters, Dietary Intake, and Household Food Insecurity in People with Diabetes: A Systematic Review with Narrative Synthesis. Adv Nutr 2023; 14:1067-1084. [PMID: 37245685 PMCID: PMC10509434 DOI: 10.1016/j.advnut.2023.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 04/20/2023] [Accepted: 05/18/2023] [Indexed: 05/30/2023] Open
Abstract
The high cost of healthy foods makes maintaining a healthy dietary pattern challenging, particularly among people with diabetes who are experiencing food insecurity. The objectives of this study were to: 1) review evidence on the impact of providing material benefits (e.g., food coupons/vouchers, free food, or financial subsidies/incentives) to improve access to food on clinical parameters, dietary intake, and household food insecurity in people with diabetes, and 2) review relevant economic evidence. Six databases were searched from inception to March 2023 for longitudinal studies with quantitative outcomes. Twenty-one studies were included in the primary review and 2 in the economic analysis. Risk of bias was high in 20 studies and moderate in 1 study. The number of randomized controlled trials and nonrandomized studies reporting statistically significant improvement, alongside Grading of Recommendations Assessment, Development, and Evaluation (GRADE) certainty of the evidence was: HbA1c: 1/6 and 4/12 (very low), systolic blood pressure: 0/3 and 1/8 (very low), diastolic blood pressure: 0/3 and 1/7 (very low), BMI: 0/5 and 2/8 (very low), body weight: 0/0 and 1/3 (very low), hypoglycemia: 1/2 and 1/2 (very low), daily intake of fruits and vegetables: 1/1 and 1/3 (very low), daily intake of whole grains: 0/0 and 0/2 (very low), overall diet quality: 2/2 and 1/1 (low), and household food insecurity: 2/3 and 0/0 (very low). The 2 studies included in the economic analysis showed no difference in Medicare spending from Supplemental Nutrition Assistance Program participation and cost-savings from medically tailored meals in an economic simulation. Overall, providing material benefits to improve access to food for people with diabetes may improve household food insecurity, fruit and vegetable intake, and overall diet quality, but effects on clinical parameters and whole grain intake are unclear. The certainty of evidence was very low to low by GRADE. PROSPERO (CRD42021212951).
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Affiliation(s)
- Kieran Jd Steer
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - David Jt Campbell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada; Department of Cardiac Sciences, Cumming School of Medicine, University Drive Northwest, Calgary, Alberta, Canada
| | - Reed Beall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Se'era M Anstruther
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stéphanie Caron-Roy
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Eldon Spackman
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Campbell DB, Lee Olstad D, Donald T, Campbell DJT. Accounting for concurrent antihyperglycemic medication changes in dietary and physical activity interventions: A focused literature review. Diab Vasc Dis Res 2022; 19:14791641221111252. [PMID: 35750483 PMCID: PMC9234854 DOI: 10.1177/14791641221111252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
AIMS To summarize methods used to account for antihyperglycemic medication changes in randomized controlled trials evaluating the effect of dietary and physical activity interventions on glycemia among adults with diabetes. METHODS Using studies included in two recently published systematic reviews of randomized controlled trials examining the glycemic effects of dietary and physical activity interventions, we evaluated how each study accounted for antihyperglycemic medication changes. Data were analyzed using summary statistics, stratified by the type of intervention studied, and each was assigned a score from 0 to 6 reflecting the strength of medication controls employed. RESULTS We evaluated 22 physical activity focused and 27 dietary focused articles. Our scoring system yielded a mean concurrent medication adjustment score of 3.9/6 for the physical activity studies and a score of 1.7/6 (p < 0.001) for the dietary studies. CONCLUSIONS We found that randomized controlled trials included in recent systematic reviews of physical activity and dietary interventions did not robustly account or control for changes in antihyperglycemic medications, with physical activity interventions doing so more robustly than dietary interventions. This is a threat to the validity of study findings, as observed glycemic changes may in fact be attributable to imbalances in concurrent medication adjustments between groups.
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Affiliation(s)
- Dennis B Campbell
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Dana Lee Olstad
- Department of Community Health Sciences,
Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Teagan Donald
- Sauder School of Business, University of British Columbia, Vancouver, BC, Canada
| | - David JT Campbell
- Department of Community Health Sciences,
Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Medicine, Cumming School of
Medicine, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming
School of Medicine, University of Calgaryy, Calgary, AB, Canada
- David JT Campbell, Department of Medicine,
University of Calgary Cumming School of Medicine, TRW Building Room 3E33, 3280 Hospital
Drive NW, Calgary, AB T2N 4Z6, Canada.
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