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Negi S, Sattler KMP. The role of SNAP and WIC in the bidirectional relationship between food insecurity and maternal depressive symptoms. J Affect Disord 2024; 369:234-243. [PMID: 39326586 DOI: 10.1016/j.jad.2024.09.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 09/16/2024] [Accepted: 09/21/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND The association between food insecurity and maternal depressive symptoms has been established by many cross-sectional and longitudinal studies however the understanding of the reciprocal relationship between them remains unclear. Further, previous research demonstrates that federal nutrition assistance decreases food insecurity and promotes maternal mental well-being but further research is needed to elucidate the moderating role of these programs in the association between food insecurity and maternal depressive symptoms. Therefore, the current study examined the bidirectional associations between maternal depression probability and food insecurity using cross-lagged models and then tested the main and moderating effects of SNAP and WIC. METHODS Data were from the Future of Families and Child Wellbeing Study and the sample included 1948 mothers who participated in year 3 and year 5 of data collection. RESULTS The cross-lagged paths show that food insecurity at year 3 predicted maternal depression probability at year 5 and depression probability at year 3 predicted food insecurity at year 5. There was a significant moderating effect of WIC receipt on the association between food insecurity at year 3 and at year 5 such that when mothers with high food insecurity at year 3 received WIC, they were less food insecure at year 5. LIMITATIONS The study oversampled for unmarried mothers only two waves of data were used for the cross-lagged panel models. CONCLUSIONS Results demonstrate the need to incorporate mental health services with the existing food assistance programs and the need to destigmatize the application process and program structure.
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Affiliation(s)
- Shourya Negi
- Department of Human Development and Family Studies, University of North Carolina at Greensboro, United States of America.
| | - Kierra M P Sattler
- Department of Human Development and Family Studies, University of North Carolina at Greensboro, United States of America
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Livings MS, Bruine de Bruin W, Wasim N, Wilson JP, Lee BY, de la Haye K. Food and Nutrition Insecurity: Experiences That Differ for Some and Independently Predict Diet-Related Disease, Los Angeles County, 2022. J Nutr 2024; 154:2566-2574. [PMID: 38801862 DOI: 10.1016/j.tjnut.2024.05.020] [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] [Received: 03/10/2024] [Revised: 04/30/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND National surveillance shows that food insecurity affects ∼1 in 10 Americans each year. Recently, experts have advocated for surveillance of nutrition insecurity alongside food insecurity. Nutrition security refers to the nutritional adequacy of accessible food and factors that impact one's ability to meet food preferences. OBJECTIVES This study presents representative estimates of food insecurity and nutrition insecurity for Los Angeles County, CA, United States; compares predictors of these constructs; and examines whether they independently predict diet-related health outcomes. METHODS In December 2022, a representative sample of Los Angeles County adults participating in the Understanding America Study (N = 1071) was surveyed about household food insecurity and nutrition insecurity over the past 12 months. Data were analyzed in 2023. RESULTS Reported rates were similar for food insecurity (24%) and nutrition insecurity (25%), but the overlap of these subgroups was less than 60%. Logistic regression models indicated that non-Hispanic Asian individuals had higher odds of nutrition insecurity but not food insecurity. Moreover, nutrition insecurity was a stronger predictor of diabetes compared with food insecurity, and both constructs independently predicted poor mental health. CONCLUSIONS Food and nutrition insecurity affect somewhat different populations. Both constructs are valuable predictors of diet-related health outcomes. Monitoring nutrition insecurity in addition to food insecurity can provide new information about populations with barriers to healthy diets.
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Affiliation(s)
- Michelle Sarah Livings
- Center for Research on Child and Family Wellbeing, School of Public and International Affairs, Princeton University, Princeton, NJ, United States.
| | - Wändi Bruine de Bruin
- Department of Psychology, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, CA, United States; Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, United States; Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States; Center for Economic and Social Research, University of Southern California, Los Angeles, CA, United States
| | - Natasha Wasim
- Department of Population & Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - John P Wilson
- Department of Population & Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States; Spatial Sciences Institute, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, CA, United States; Department of Sociology, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, CA, United States; Department of Civil and Environmental Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States; Department of Computer Science, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States; School of Architecture, University of Southern California, Los Angeles, CA, United States
| | - Bruce Y Lee
- Department of Health Policy and Management, Graduate School of Public Health and Health Policy, City University of New York, NY, United States; Center for Advanced Technology and Communication in Health, City University of New York, NY, United States
| | - Kayla de la Haye
- Department of Psychology, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, CA, United States; Center for Economic and Social Research, University of Southern California, Los Angeles, CA, United States; Spatial Sciences Institute, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, CA, United States
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Tetteh J, Ekem-Ferguson G, Malm K, Yawson OA, Otchi E, Swaray SM, Yao Ntumy M, Yawson AE. Food insecurity and associated health and social determinants among older adults in Ghana: Analysis of the WHO's study on global AGEing and adult health (SAGE), 2014-2015. Prev Med Rep 2024; 41:102693. [PMID: 38560593 PMCID: PMC10981086 DOI: 10.1016/j.pmedr.2024.102693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 04/04/2024] Open
Abstract
This study was conducted to assess the prevalence and factors associated with Food Insecurity (FI) and further quantify its association with unmet need for health services and health-related outcomes among older adults aged 50 years and above in Ghana. The Ghana Study on Global AGEing and Adult Health was used. Body Mass Index (BMI), depressive episodes, functional difficulties (FD), low Quality of Life (QoL), memory decline, and Unmet Needs of Health Services (UNHS) are the the study outcomes. Ordinary Least Square, and Poisson regression analysis modified with Mahalanobis distance matching within propensity score caliper weights were employed. Stata 16.1 was used to perform analysis and a p-value < 0.05 was deemed significant. The prevalence of FI among older adults aged 50 years or older in Ghana was approximately 28 %(95 %CI = 24.5-31.7) and was strongly associated with lower educational attainment and social support. The prevalence ratio of depression, FD, low QoL and UNHS among older adults who experienced FI were; 3.43(95 %CI = 2.25-5.21), 1.18(95 %CI = 1.12-1.23), 2.01(95 %CI = 1.54-2.62), and 1.46(95 %CI = 1.01-2.11). Memory significantly decreased by 85 percentage points% among food insecure older adults [aβ(95 %CI) = -0.85(-1.62--0.07)]. Older adults with relatively higher educational attainment and social support are less likely to suffer FI and associated limited health and poor social well-being. In the national quest to achieve SDG 2, these health and social determinants of FI among older adults should be considered in the implementation of the national ageing policy to improve the health and well-being of older adults in Ghana.
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Affiliation(s)
- John Tetteh
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | | | - Keziah Malm
- National Malaria Control Programme, Ghana Health Service, Ghana
| | - Ohenewa Anita Yawson
- Ground Floor Surgical Intensive Care Unit, Department of Anaesthesia, Korle-Bu Teaching Hospital, Accra, Ghana
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Elom Otchi
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
- Medical Affairs Directorate, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Swithin M. Swaray
- National Cardiothoracic Centre, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Michael Yao Ntumy
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Ghana
| | - Alfred Edwin Yawson
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
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Tolkacz M, Reilly D, Studzinski DM, Callahan RE, DeMare A, Kawak S, Ziegler M. Food Insecurity in the Elective Enhanced Recovery After Surgery Colorectal Surgical Population: Prevalence and Implications for Surgical Outcomes. Am Surg 2024; 90:419-426. [PMID: 37703552 DOI: 10.1177/00031348231198122] [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: 09/15/2023]
Abstract
BACKGROUND Food insecurity is defined as having limited or uncertain availability of nutritionally adequate food. Approximately 10.5% of U.S. households are food-insecure. Our study aimed to determine the prevalence and postoperative implications of food insecurity in a diverse group of colorectal surgery patients admitted to a hospital in an area with a higher-than-average median income. METHODS The 6-question Household Food Security Survey was added to the colorectal surgery ERAS program preoperative paperwork. Patient demographics, comorbidities, operative parameters, length of stay, and postoperative outcomes were collected by review of electronic medical records. RESULTS A total of 294 ERAS patients (88.8%) completed the survey over an 11-month period. Thirty-three patients (11.2%) were identified as food-insecure. Food-insecure patients were more likely to be non-white (P = .003), younger (P = .009), smokers (P = .004), chronic narcotic users (P < .001), unmarried (P = .007), and have more comorbidities (P = .004). The food-insecure population had more frequent postoperative ileus (P = .044). Hospital length of stay was significantly longer in food-insecure patients (8.6 days vs 5.4 days, P < .001). Food-insecure patients also had higher rates of >30-day mortality (P = .049). DISCUSSION Food insecurity was found to occur in patients that lived in communities deemed both affluent and distressed. These patients had longer hospital stays and higher mortality. A food insecurity questionnaire can easily identify patients at risk. Further investigations to mitigate these complications are warranted.
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Affiliation(s)
- Michael Tolkacz
- Department of General Surgery, Corewell Health - William Beaumont University Hospital, Royal Oak, MI, USA
| | - Danielle Reilly
- Department of Surgery, Geisinger Health System, Danville, PA, USA
| | - Diane M Studzinski
- Department of General Surgery, Corewell Health - William Beaumont University Hospital, Royal Oak, MI, USA
| | - Rose E Callahan
- Department of General Surgery, Corewell Health - William Beaumont University Hospital, Royal Oak, MI, USA
| | - Alexander DeMare
- Department of General Surgery, Corewell Health - William Beaumont University Hospital, Royal Oak, MI, USA
| | - Samer Kawak
- Department of General Surgery, Corewell Health - William Beaumont University Hospital, Royal Oak, MI, USA
| | - Matthew Ziegler
- Department of Colorectal Surgery, Corewell Health - william Beaumont Hospital, Royal Oak, MI, USA
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Messiah SE, Xie L, Kapti EG, Chandrasekhar A, Srikanth N, Hill K, Williams S, Reid A, Mathew MS, Barlow SE. Prevalence of the metabolic syndrome by household food insecurity status in the United States adolescent population, 2001-2020: a cross-sectional study. Am J Clin Nutr 2024; 119:354-361. [PMID: 38042411 DOI: 10.1016/j.ajcnut.2023.11.014] [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] [Received: 06/22/2023] [Revised: 10/27/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Household food insecurity (FI) is a modifiable social determinant of health linked to chronic health outcomes. Little is known, however, about the prevalence of metabolic syndrome (MetS) in pediatric population-based studies by household FI status. OBJECTIVES The objective of the study was to estimate the prevalence of the MetS by household FI status over the past 2 decades. METHODS This cross-sectional study used data from the 2001-2020 National Health and Nutrition Examination Survey (NHANES). Participants were nonpregnant adolescents ages 12- 18 y in United States. The prevalence of MetS [elevated waist circumference and >2 of the following risk factors: elevated blood pressure, and fasting glucose, triglyceride, and/or low high-density lipoprotein (HDL) cholesterol concentrations] by FI status was evaluated using chi-square and logistic regression analyses. RESULTS The estimated prevalence of MetS was 2.66% [95% confidence interval (CI): 2.28%, 3.09%] in the final analytical sample (unweighted N = 12,932). A total of 3.39% (95% CI: 2.53%, 4.53%) of adolescents from FI households had MetS compared to 2.48% (95% CI: 2.11%, 2.9%) among adolescents with no household FI. Hispanic adolescents had the highest prevalence of MetS (3.73%, 95% CI: 3.05, 4.56) compared with adolescents who identified as non-Hispanic White (2.78%, 95% CI: 2.25, 3.43), non-Hispanic Black (1.58%, 95% CI: 1.19, 2.10). Adolescents with household FI (23.20%) were more likely to have MetS [odds ratio (OR): 1.38; 95% CI: 1.02, 1.88; I=0.039) compared with adolescents with no household FI, but in fully adjusted models this was not significant (OR: 1.13; 95% CI: 0.75, 1.72). CONCLUSIONS Using the most current NHANES data, the estimated prevalence of MetS in adolescents in United States was slightly higher among those from FI households. However, after adjusting for potential confounders, the relationship between household FI and MetS was nonsignificant, highlighting the complexity of factors contributing to MetS in this population. Hispanic adolescents share a disproportionate burden of MetS compared with their non-Hispanic counterparts.
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Affiliation(s)
- Sarah E Messiah
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health (UTHealth) Science Center at Houston, School of Public Health, Dallas, TX, United States; Center for Pediatric Population Health, UTHealth School of Public Health at Houston, Dallas, TX, United States; Department of Pediatrics, UTHealth Houston McGovern Medical School, Houston, TX, United States.
| | - Luyu Xie
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health (UTHealth) Science Center at Houston, School of Public Health, Dallas, TX, United States; Center for Pediatric Population Health, UTHealth School of Public Health at Houston, Dallas, TX, United States
| | - Eda Gozel Kapti
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health (UTHealth) Science Center at Houston, School of Public Health, Dallas, TX, United States; Center for Pediatric Population Health, UTHealth School of Public Health at Houston, Dallas, TX, United States
| | - Aparajita Chandrasekhar
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health (UTHealth) Science Center at Houston, School of Public Health, Dallas, TX, United States; Center for Pediatric Population Health, UTHealth School of Public Health at Houston, Dallas, TX, United States
| | | | - Kristina Hill
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health (UTHealth) Science Center at Houston, School of Public Health, Dallas, TX, United States; Center for Pediatric Population Health, UTHealth School of Public Health at Houston, Dallas, TX, United States; Children's Health System of Texas, Dallas, TX, United States
| | | | - Aleksei Reid
- Children's Health System of Texas, Dallas, TX, United States
| | - Mathew Sunil Mathew
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health (UTHealth) Science Center at Houston, School of Public Health, Dallas, TX, United States; Center for Pediatric Population Health, UTHealth School of Public Health at Houston, Dallas, TX, United States
| | - Sarah E Barlow
- Children's Health System of Texas, Dallas, TX, United States; Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
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Kasper G, Momen M, Sorice KA, Mayhand KN, Handorf EA, Gonzalez ET, Devlin A, Brownstein K, Esnaola N, Fisher SG, Lynch SM. Effect of neighborhood and individual-level socioeconomic factors on breast cancer screening adherence in a multi-ethnic study. BMC Public Health 2024; 24:63. [PMID: 38166942 PMCID: PMC10763410 DOI: 10.1186/s12889-023-17252-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 11/16/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Although mammography can significantly reduce breast cancer mortality, many women do not receive their annual breast cancer screening. Differences in screening adherence exist by race/ethnicity, socioeconomic status (SES), and insurance status. However, more detailed investigations into the impact of neighborhood disadvantage and access to resources on screening adherence are lacking. METHODS We comprehensively examined the effect of individual social, economic, and demographic factors (n = 34 variables), as well as neighborhood level SES (nSES) indicators (n = 10 variables) on breast cancer screening adherence across a multi-ethnic population (n = 472). In this cross-sectional study, participants were surveyed from 2017 to 2018. The data was analyzed using univariate regression and LASSO for variable reduction. Significant predictors were carried forward into final multivariable mixed-effect logistic regression models where odds ratios (OR), 95% confidence intervals and p-values were reported. RESULTS Nineteen percent of participants were non-adherent to breast screening guidelines. Race/ethnicity was not associated with adherence; however, increasing age (OR = 0.97, 95%CI = 0.95-0.99, p = 0.01), renting a home (OR = 0.53, 95%CI = 0.30-0.94, p = 0.04), food insecurity (OR 0.46, 95%CI = 0.22-0.94, p = 0.01), and overcrowding (OR = 0.58, 95% CI = 0.32-0.94, p = 0.01) were significantly associated with lower breast cancer screening adherence. CONCLUSION Socioeconomic indicators at the individual and neighborhood levels impact low breast cancer screening adherence and may help to inform future screening interventions.
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Affiliation(s)
- Gillian Kasper
- Temple University School of Medicine, Philadelphia, PA, USA.
| | - Mahsa Momen
- Temple University School of Medicine, Philadelphia, PA, USA
| | - Kristen A Sorice
- Fox Chase Cancer Center, 4th Floor Young Pavilion, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Kiara N Mayhand
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth A Handorf
- Fox Chase Cancer Center, 4th Floor Young Pavilion, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Evelyn T Gonzalez
- Fox Chase Cancer Center, 4th Floor Young Pavilion, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Amie Devlin
- Temple University School of Medicine, Philadelphia, PA, USA
| | | | | | - Susan G Fisher
- Temple University School of Medicine, Philadelphia, PA, USA
- Fox Chase Cancer Center, 4th Floor Young Pavilion, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Shannon M Lynch
- Fox Chase Cancer Center, 4th Floor Young Pavilion, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
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Inguito K, Joa B, Gardner J, Fung EN, Layer L, Fritz K. Differentials and predictors of food insecurity among Federally Qualified Health Center target populations in Philadelphia: a cross-sectional study. BMC Public Health 2023; 23:1323. [PMID: 37430317 DOI: 10.1186/s12889-023-16208-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 06/27/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Over the past decade, the prevalence of food insecurity declined in the United States but curiously climbed in Philadelphia, Pennsylvania, a sizable metropolitan area where many households experience food insecurity and are dependent on programs like SNAP. Therefore, we aimed to determine the burden of food insecurity among populations near Philadelphia Federally Qualified Health Center (FQHC) clinic sites. METHODS This cross-sectional study was conducted in North Philadelphia, a populous and impoverished section of Philadelphia with many zip codes reporting 30-45% or more of the population below the federal poverty line. Students and clinicians affiliated with a local FQHC conducted surveys on residents (n = 379) within 1-mile radiuses of three FQHC sites, using the Hunger Vital Sign™, a validated food security tool. Survey data were collected through door-to-door visits in the summer of 2019. We used simple, age-adjusted bivariable, and multivariable logistic regression models to predict food insecurity with independent variables, including age, sex, language preference, and BMI category. RESULTS Food insecurity in North Philadelphia was much higher (36.9%) than previously reported in Philadelphia and nationwide. Food insecurity was inversely associated with age (AOR = 0.98, 95% CI: 0.97, 1.00), overweight (AOR = 0.58, 95% CI: 0.32, 1.06), and obesity (AOR = 0.60, 95% CI: 0.33, 1.09). CONCLUSION In North Philadelphia, the burden of food insecurity is higher than in the greater Philadelphia area, Pennsylvania state, and the rest of the nation and is predicted by age and BMI of residents. These findings demonstrate a need for more locally targeted research and interventions on food insecurity in impoverished urban settings.
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Affiliation(s)
- Kai Inguito
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Brandon Joa
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Department of Theology and Religious Studies, Villanova University, Villanova, PA, USA
- Department of Family Medicine, Naval Hospital Camp Pendleton, Oceanside, CA, USA
| | - James Gardner
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA.
| | - Eric N Fung
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Laura Layer
- Esperanza Health Center, Philadelphia, PA, USA
| | - Karen Fritz
- Former: Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA, USA
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Lee WC, Lin S, Yang TC, Serag H. Cross-sectional study of food insecurity and medical expenditures by race and ethnicity. ETHNICITY & HEALTH 2023; 28:794-808. [PMID: 36576145 DOI: 10.1080/13557858.2022.2161090] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/14/2022] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Food insecurity is a risk factor for morbidity and mortality leading to high medical expenditures, but race/ethnicity was used as adjustments in the literature. The study sought to use race/ethnicity as a key predictor to compare racial differences in associations between food insecurity and expenditures of seven health services among non-institutionalized adults. DESIGN This cross-sectional study used Medical Expenditure Panel Survey that collects information on food insecurity in 2016 (n=24,179) and 2017 (n=22,539). We examined the association between race/ethnicity and food insecurity status and documented the extent to which impacts of food insecurity on medical expenditures varied by race/ethnicity. We fit multivariable models for each racial group, adjusting for states, age, gender, insurance, and education. Adults older than 18 years were included. RESULTS The results show that blacks experienced an inter-racial disparity in food insecurity whereas Hispanics experienced intra-racial disparity. A higher percentage of blacks (28.7%) reported at least one type of food insecurity (11.2% of whites). Around 20% of blacks reported being worried about running out of food and the corresponding number is 8.4% among whites. Hispanics reported more food insecurity issues than whites. Moreover, food insecurity is positively associated with expenditures on emergency room utilization (99% increase for other races vs. 51% increase for whites) but is negatively associated with dental care utilization (43% decrease for blacks and 44% for whites). Except for Hispanics, prescription expenditure has the most positive association with food insecurity, and food insecure blacks are the only group that did not significantly use home health. CONCLUSION The study expanded our understanding of food insecurity by investigating how it affected seven types of medical expenditures for each of four racial populations. An interdisciplinary effort is needed to enhance the food supply for minorities. Policy interventions to address intra-racial disparities among Hispanics and inter-racial disparities among African Americans are imperative to close the gap.
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Affiliation(s)
- Wei-Chen Lee
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Sherry Lin
- Department of Health Policy and Management, Texas A&M University, College Station, TX, USA
| | - Tse-Chuan Yang
- Department of Sociology, State University of New York at Albany, Albany, NY, USA
| | - Hani Serag
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
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Ing CT, Clemens B, Ahn HJ, Kaholokula JK, Hovmand PS, Seto TB, Novotny R. Food Insecurity and Blood Pressure in a Multiethnic Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6242. [PMID: 37444090 PMCID: PMC10341426 DOI: 10.3390/ijerph20136242] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023]
Abstract
Food insecurity is a social determinant of health and is increasingly recognized as a risk factor for hypertension. Native Hawaiians bear a disproportionate burden of hypertension and known risk factors. Despite this, the relative effects of food insecurity and financial instability on blood pressure have yet to be investigated in this population. This study examines the relative effects of food insecurity and financial instability on blood pressure, controlling for potential confounders in a multiethnic sample. Participants (n = 124) were recruited from a U.S. Department of Agriculture-funded study called the Children's Healthy Living Center of Excellence. Biometrics (i.e., blood pressure, weight, and height) were measured. Demographics, physical activity, diet, psychosocial variables, food insecurity, and financial instability were assessed via self-report questionnaires. Hierarchical linear regression models were conducted. Model 1, which included sociodemographic variables and known biological risk factors, explained a small but significant amount of variance in systolic blood pressure. Model 2 added physical activity and daily intake of fruit, fiber, and whole grains, significantly improving the model. Model 3 added financial instability and food insecurity, further improving the model (R2 = 0.37, F = 2.67, p = 0.031). Food insecurity, female sex, and BMI were significantly and independently associated with increased systolic blood pressure. These results suggest a direct relationship between food insecurity and systolic blood pressure, which persisted after controlling for physical activity, consumption of fruits, fiber, and whole grains, and BMI. Efforts to reduce food insecurity, particularly among Native Hawaiians, may help reduce hypertension in this high-risk population.
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Affiliation(s)
- Claire Townsend Ing
- Department of Native Hawaiian Health, University of Hawaii at Mānoa, 677 Ala Moana Boulevard, Honolulu, HI 96813, USA
| | - Brettany Clemens
- Nancy Atmospera-Walch School of Nursing, University of Hawaii at Mānoa, 2528 McCarthy Mall, Honolulu, HI 96822, USA
| | - Hyeong Jun Ahn
- Department of Complementary & Integrative Medicine, University of Hawaii at Mānoa, 651 Ilalo Street, Honolulu, HI 96813, USA
| | | | - Peter S. Hovmand
- Center for Community Health Integration, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Todd B. Seto
- Cardiovascular Diseases, Queen’s Medical Center, 550 S Beretania Street, Honolulu, HI 96813, USA
| | - Rachel Novotny
- Human Nutrition, Food and Animal Sciences, University of Hawaii at Mānoa, 1955 East-West Road, Honolulu, HI 96822, USA
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Dietary Diversity, Household Food Insecurity and Stunting among Children Aged 12 to 59 Months in N'Djamena-Chad. Nutrients 2023; 15:nu15030573. [PMID: 36771280 PMCID: PMC9920356 DOI: 10.3390/nu15030573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Household food insecurity is increasingly recognized as a global health problem, particularly in sub-Saharan Africa. This study aimed to contextualize the associations between household food insecurity, dietary diversity and stunting in N'Djamena. METHODS This study is a community-based cross-sectional study, and the SMART (Standardized Monitoring and Assessment of Relief and Transitions) methodology was used to calculate the sample size. A total of 881 households were selected for the survey. A 24-h recall evaluated the dietary diversity score (DDS), the Household Food Insecurity Access Scale (HFIAS) made it possible to assess household food insecurity (HFI), and stunting among children aged 12 to 59 months was assessed by anthropometric measurements. Logistic regression was constructed to determine the association between household food insecurity, dietary diversity, and stunting. The study was conducted from January to March 2022. RESULTS The prevalence of severe food insecurity was 16.6%, and that of stunting was 25.3%. The mean DDS was 6.5 ± 1.6. Severe food insecurity (OR 2.505, CI: 1.670-3.756) was significantly associated with stunting. The association between DDS and stunting was not significant. CONCLUSIONS This study's prevalence of household food insecurity and stunting was very high. Household food insecurity and household size were significantly associated with stunting.
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Varela EG, McVay MA, Shelnutt KP, Mobley AR. The Determinants of Food Insecurity Among Hispanic/Latinx Households With Young Children: A Narrative Review. Adv Nutr 2023; 14:190-210. [PMID: 36811589 PMCID: PMC10103006 DOI: 10.1016/j.advnut.2022.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 12/01/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022] Open
Abstract
Food insecurity has disproportionately impacted Hispanic/Latinx households in the United States, specifically those with young children. Although the literature provides evidence of an association between food insecurity and adverse health outcomes in young children, minimal research has addressed the social determinants and related risk factors associated with food insecurity among Hispanic/Latinx households with children under three, a highly vulnerable population. Using the Socio-Ecological Model (SEM) as a framework, this narrative review identified factors associated with food insecurity among Hispanic/Latinx households with children under three. A literature search was conducted using PubMed and four additional search engines. Inclusion criteria consisted of articles published in English from November 1996 to May 2022 that examined food insecurity among Hispanic/Latinx households with children under three. Articles were excluded if conducted in settings other than the US and/or focused on refugees and temporary migrant workers. Data were extracted (i.e., objective, setting, population, study design, measures of food insecurity, results) from the final articles (n = 27). The strength of each article's evidence was also evaluated. Results identified individual factors (i.e., intergenerational poverty, education, acculturation, language, etc.), interpersonal factors (i.e., household composition, social support, cultural customs), organizational factors (i.e., interagency collaboration, organizational rules), community factors (i.e., food environment, stigma, etc.), and public policy/societal factors (i.e., nutrition assistance programs, benefit cliffs, etc.) associated with a food security status of this population. Overall, most articles were classified as "medium" or higher quality for the strength of evidence, and more frequently focused on individual or policy factors. Findings indicate the need for more research to include a focus on public policy/society factors, as well as on multiple levels of the SEM with considerations of how individual and policy levels intersect and to create or adapt nutrition-related and culturally appropriate interventions to improve food security of Hispanic/Latinx households with young children.
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Affiliation(s)
- Elder Garcia Varela
- Graduate Research and Teaching Assistant, Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
| | - Megan A McVay
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
| | - Karla P Shelnutt
- Department of Family, Youth & Community Sciences, University of Florida, Gainesville, FL, USA
| | - Amy R Mobley
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA.
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Neal L, Zigmont VA. Undergraduate food insecurity, mental health, and substance use behaviors. Nutr Health 2022:2601060221142669. [PMID: 36448202 DOI: 10.1177/02601060221142669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective: Recent epidemiological research has found food insecurity to be a growing public health concern among college students. This study investigated food insecurity, mental health, and substance use behaviors among state university undergraduate students. Study Design: Cross-sectional survey. Methods: This was a secondary data analysis of the Student Health Survey. Undergraduate participants (n = 589) completed the paper-based survey, which had an 84% response rate overall. Results: Approximately 38.5% of students were considered food insecure, 24.8% experiencing low food security, and 13.8% experiencing very low food security. Having a diagnosis of depression, experience of depressive symptoms, and marijuana use in the past 30 days were associated with food insecurity. Conclusion and Implications: Food insecurity is a serious health concern for college students. The results of this study indicate collocating food security and counseling services may enhance existing student resources to better support students facing food and nutrition insecurity, substance use, and depression.
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Affiliation(s)
- Latasha Neal
- 5762Southern Connecticut State University, New Haven, CT, USA
- Department of Health, Exercise Science and Recreation Management, 8083University of Mississippi, University, MS, USA
| | - Victoria A Zigmont
- Department of Health, Exercise Science and Recreation Management, 8083University of Mississippi, University, MS, USA
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13
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Carvajal-Aldaz D, Cucalon G, Ordonez C. Food insecurity as a risk factor for obesity: A review. Front Nutr 2022; 9:1012734. [PMID: 36225872 PMCID: PMC9549066 DOI: 10.3389/fnut.2022.1012734] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022] Open
Abstract
Obesity is considered a 21st-century epidemic and it is a metabolic risk factor for Non-Communicable Diseases such as cardiovascular diseases, type 2 diabetes, metabolic syndrome, hypertension, some types of cancer, among others. Thus, its prevention and treatment are important public health concerns. Obesity within the context of food insecurity adds an additional layer of complexity to the current obesity epidemic. Efficient policies and interventions ought to take into consideration the effects of food insecurity on the risks of developing obesity among food insecure households. This review aims to analyze the recent available evidence around the obesity – food insecurity paradox. Most of the literature has consistently shown that there is a significant association between food insecurity and obesity, specifically in women of high-income countries. However, mechanisms explaining the paradox are still lacking. Even though researchers have tried to analyze the issue using different individual and societal variables, these studies have failed to explain the mediatory mechanisms of the food insecurity–obesity relationship since the proposed mechanisms usually lack strength or are purely theoretical. The research focus should shift from cross-sectional models to other research designs that allow the exploration of pathways and mechanisms underlying the food insecurity and obesity relationship, such as longitudinal studies, which will hopefully lead to consecutive research testing the effectiveness of different approaches and scale up such interventions into diverse contexts among those affected by obesity and the different degrees of food insecurity.
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14
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Addressing Food Insecurity. Am J Nurs 2022; 122:55-56. [DOI: 10.1097/01.naj.0000874124.68201.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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15
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Oderinde FO, Akano OI, Adesina FA, Omotayo AO. Trends in climate, socioeconomic indices and food security in Nigeria: Current realities and challenges ahead. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2022. [DOI: 10.3389/fsufs.2022.940858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Food security in Nigeria is presently in dire strait owing to several factors, such as skyrocketing energy prices, climate change, and terrorism. This study is aimed at revealing the role of the aforementioned factors in shaping food affordability and availability in the country. The study used descriptive statistics and coefficients of variation and determination to ascertain the change in the trend in these factors and their correlates to food security over time. From the results of our research team, we inferred that temperature increases, political instability, rising food prices and erratic energy supply have had distressing consequences in the areas of affordability, availability and stability of food supplies. We conclude that a rapidly growing population such as Nigeria's would need crucial interventions in increasing food production, mitigating the impacts of climate change, and buffering energy supplies. Ultimately, Nigeria needs to overhaul the important components of her food systems and the respective linkages between these components in order to ensure food security for the entire population.
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Scher K, Sohaki A, Tang A, Plum A, Taylor M, Joseph C. A community partnership to evaluate the feasibility of addressing food insecurity among adult patients in an urban healthcare system. Pilot Feasibility Stud 2022; 8:59. [PMID: 35264239 PMCID: PMC8908669 DOI: 10.1186/s40814-022-01013-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 02/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Food insecurity (FI) is a significant public health problem. Possible sequelae of prolonged food insecurity include kidney disease, obesity, and diabetes. Our objective was to assess the feasibility of a partnership between Henry Ford Health System (HFHS) and Gleaners Community Foodbank of Southeastern Michigan to implement and evaluate a food supplementation intervention initiated in a hospital outpatient clinic setting. METHODS We established a protocol for using the Hunger Vital Signs to screen HFHS internal medicine patients for food insecurity and established the data sharing infrastructure and agreements necessary for an HFHS-Gleaners partnership that would allow home delivery of food to consenting patients. We evaluated the food supplementation program using a quasi-experimental design and constructing a historical comparison group using the electronic medical record. Patients identified as food insecure through screening were enrolled in the program and received food supplementation twice per month for a total of 12 months, mostly by home delivery. The feasibility outcomes included successful clinic-based screening and enrollment and successful food delivery to consenting patients. Our evaluation compared healthcare utilization between the intervention and historical comparison group during a 12-month observation period using a difference-in-differences (DID) analysis. RESULTS Of 1691 patients screened, 353 patients (20.9%) met the criteria for FI, of which 340/353 (96.3%) consented, and 256/340 (75.3%) were matched and had data sufficient for analysis. Food deliveries were successfully made to 89.9% of participant households. At follow-up, the intervention group showed greater reductions in emergency department visits than the comparison group, -41.5% and -25.3% reduction, respectively. Similar results were observed for hospitalizations, -55.9% and -17.6% reduction for intervention and control groups, respectively. DID regression analysis also showed lower trends in ED visits and hospitalizations for the intervention group compared to the comparison group. CONCLUSIONS Results suggest that community-health system partnerships to address patient-reported food insecurity are feasible and potentially could reduce healthcare utilization in these patients. A larger, randomized trial may be the next step in fully evaluating this intervention, perhaps with more outcomes (e.g., medication adherence), and additional covariates (e.g., housing insecurity and financial strain).
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Affiliation(s)
- Katherine Scher
- Population Health Management and Clinical Coordination, Henry Ford Health System, Detroit, USA
| | - Aaron Sohaki
- Population Health Management, Henry Ford Health System, Detroit, USA
| | - Amy Tang
- Department of Public Health Sciences, Henry Ford Health System, 1 Ford Place, 3E, Detroit, MI, 48202, USA
| | - Alexander Plum
- Population Health Management, Henry Ford Health System, Detroit, USA
| | - Mackenzie Taylor
- Department of Public Health Sciences, Henry Ford Health System, 1 Ford Place, 3E, Detroit, MI, 48202, USA
| | - Christine Joseph
- Department of Public Health Sciences, Henry Ford Health System, 1 Ford Place, 3E, Detroit, MI, 48202, USA.
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Gonzalez-Nahm S, Østbye T, Hoyo C, Kravitz RM, Benjamin-Neelon SE. Associations Among Food Security, Diet Quality, and Dietary Intake During Pregnancy in a Predominantly African American Group of Women from North Carolina. J Acad Nutr Diet 2022; 122:565-572. [PMID: 34481120 PMCID: PMC10880738 DOI: 10.1016/j.jand.2021.08.110] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/16/2021] [Accepted: 08/27/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Low food security during pregnancy can negatively affect women's physical and mental health. Although many women make a greater effort to eat a healthy diet during pregnancy, the influence of low food security during pregnancy on maternal diet is not well understood. OBJECTIVE This study aimed to assess the association between adult food security and maternal diet during pregnancy in a sample from North Carolina. DESIGN This was a cross-sectional, secondary data analysis of food security (marginal, low, and very low vs high) and maternal diet during pregnancy. PARTICIPANTS AND SETTING This study included 468 predominantly Black/African American women during pregnancy from the Nurture cohort, enrolled through prenatal clinics in central North Carolina between 2013 and 2016. MAIN OUTCOME MEASURE Diet quality was assessed using the Alternate Healthy Eating Index-Pregnancy and the Mediterranean Diet Score. Dietary intake from seven food groups included in the Alternate Healthy Eating Index-Pregnancy and/or Mediterranean Diet Score was assessed as well. STATISTICAL ANALYSIS PERFORMED Multiple linear regression models were used to examine the association between food security and diet quality and dietary intake during pregnancy, adjusting for race/ethnicity; participation in the Special Supplemental Nutrition Program for Women, Infants, and Children; education; prepregnancy body mass index; age; parity; and mean daily energy intake. RESULTS In this study, there was no association between maternal food security status and diet quality during pregnancy. However, researchers observed an association between low and marginal food security and greater intake of red and processed meats (marginal: β = 2.20 [P = 0.03]; low: β = 2.28 [P = 0.04]), as well as an association between very low food security and decreased vegetable consumption (β = -.43; P = 0.03). CONCLUSIONS Very low food security was associated with reduced vegetable intake. In addition, low and marginal food security were associated with greater red and processed meat intake. Future research should focus on nationally representative populations and include longitudinal assessments to allow for the study of the influence of food security on health during pregnancy.
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Affiliation(s)
- Sarah Gonzalez-Nahm
- Department of Nutrition, University of Massachusetts Amherst, Amherst, Massachusetts.
| | - Truls Østbye
- Department of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Cathrine Hoyo
- Department of Biological Sciences, North Carolina State University, Raleigh, North Carolina
| | - Richard M Kravitz
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Sara E Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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18
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Food insecurity and mental health of college students in Lebanon: a cross-sectional study. J Nutr Sci 2022; 11:e68. [PMID: 36106091 PMCID: PMC9428660 DOI: 10.1017/jns.2022.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 11/30/2022] Open
Abstract
The present study aimed to assess the prevalence of food insecurity (FI) among college students and explore its association with indicators of mental and psychosocial health. Data were collected using a cross-sectional online survey from college students in different universities in Lebanon during the Spring 2021 semester. FI was assessed using the validated eight-item food insecurity experience scale. The mental health of college students was assessed using validated screening tools for depression, anxiety and well-being, namely the Patient Health Questionnaire (PHQ-9), the General Anxiety Disorder-7 (GAD-7) and the World Health Organization (WHO-5) index, respectively. Multiple linear regression models were conducted to assess the relationship of FI with PHQ-9, GAD-7 and WHO-5 scores. A total of 745 students completed the online survey. Approximately 39 % of students in the sample were experiencing FI of which 27·4, 8·1, and 3·5 % were experiencing mild, moderate and severe FI , respectively. Low maternal education, low household monthly income and high levels of stress were significant correlates of FI among college students (P-trend < 0·001). In addition, 22·6 and 34·4 % of students showed severe symptoms of depression and anxiety, respectively. Regression models showed that FI was associated with higher scores on PHQ-9 and GAD-7 (β = 2·45; 95 % CI [1·41, 3·49]) and (β = 1·4; 95 % CI [1·1, 2·2], respectively) and lower scores on WHO-5 (β = −4·84; 95 % CI [−8·2, −1·5]). In conclusion, a remarkable proportion of college students reported experiencing different forms of FI, which was associated with poorer mental health and well-being outcomes. Public health programmes and interventions are needed to mitigate FI and improve student health-related outcomes.
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Kamdar NP, Horning ML, Geraci JC, Uzdavines AW, Helmer DA, Hundt NE. Risk for depression and suicidal ideation among food insecure US veterans: data from the National Health and Nutrition Examination Study. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2175-2184. [PMID: 33770225 DOI: 10.1007/s00127-021-02071-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Suicide and food insecurity (i.e., lack of access to food) are two major issues that affect US Veterans. PURPOSE Using a US-based sample, we evaluated the association between food insecurity and suicidal ideation among Veterans. Because depression often precedes suicide, we also examined the association between food insecurity and depression. METHODS Using data from 2630 Veterans who participated in the National Health and Nutrition Examination Survey 2007-2016, we conducted an adjusted linear regression model to evaluate the association between food insecurity (measured using 18-item Household Food Security Survey) and depression (measured using PHQ-9) and an adjusted binary logistic regression model to evaluate the association between food insecurity and suicidal ideation (measured using PHQ-9 Question 9). Models were adjusted for gender, age, income-to-poverty ratio, race/ethnicity, and education level. RESULTS Of the sample, 11.5% were food insecure, depression scores averaged 2.86 (SD = 4.28), and 3.7% endorsed suicidal ideation. Veterans with marginal (β = 0.68, 95%CI [0.09,1.28]), low (β = 1.38, 95%CI [0.70,2.05]) or very low food security (β = 3.08, 95%CI [2.34, 3.83]) had significantly increased depression scores compared to food secure Veterans. Veterans with low (OR = 2.15, 95%CI [1.08, 4.27]) or very low food security (OR = 3.84, 95%CI [2.05, 7.20]) had significantly increased odds for suicidal ideation compared to food secure Veterans. CONCLUSION Food insecurity in Veterans is associated with increased depression symptoms and suicidal ideation. This association strengthens as food insecurity worsens. Veterans with food insecurity should be screened for depression and suicidal ideation. Simultaneously, depression treatment plans and suicide prevention programs should consider basic needs like food security.
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Affiliation(s)
- Nipa P Kamdar
- VA Health Services Research and Development Center of Excellence, Michael E. DeBakey VA Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, Texas, 77021, US.
| | - Melissa L Horning
- University of Minnesota School of Nursing, 5-140 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, Minnesota, 55455, US
| | - Joseph C Geraci
- US Department of Veterans Affairs, VISN 2 Mental Illness, Research, Education, and Clinical Center, 130 W Kingsbridge Rd, The Bronx, New York City, 10468, US
| | - Alexander W Uzdavines
- VA Health Services Research and Development Center of Excellence, Michael E. DeBakey VA Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, Texas, 77021, US
| | - Drew A Helmer
- VA Health Services Research and Development Center of Excellence, Michael E. DeBakey VA Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, Texas, 77021, US
| | - Natalie E Hundt
- VA Health Services Research and Development Center of Excellence, Michael E. DeBakey VA Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, Texas, 77021, US.,Department of Psychiatry, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, 77030, US
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20
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Kamdar N, Hernandez D. Photo-elicitation: Reflections on a method to study food insecurity among low-income, post-9/11 veterans. Public Health Nurs 2021; 39:336-343. [PMID: 34636087 DOI: 10.1111/phn.12989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 11/30/2022]
Abstract
Photo-elicitation is a research method in which participants use visual images (e.g., photographs) to convey their experiences. It is a useful method for public health nurses to research complex topics among vulnerable populations. This article focuses on the granular details of one research team's implementation of photo-elicitation to study food insecurity among low-income veterans raising children. They detail three sessions with participants during which they: (1) described the process of photo-elicitation; (2) completed photo-guided interviews; and (3) sought participant input through member checking. The article also includes reflections on their experiences as researchers implementing the photo-elicitation process. Among their insights was an appreciation for the range of emotions participants experienced as they shared their narratives. These emotions and the associated photos contributed to the rich data generated from the interviews. The researchers used the images and participant captions generated through photo-elicitation to raise awareness of and build empathy for the challenges and situations veterans who are food insecure experience. In this way, photo-elicitation may be used as an advocacy tool to capture the attention of policymakers and other key stakeholders.
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Affiliation(s)
- Nipa Kamdar
- Health Services Research and Development Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Daphne Hernandez
- University of Texas Health Science Center, Cizik School of Nursing, Department of Research, Houston, Texas, USA
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Miller S, Bruine de Bruin W, Livings M, Wilson J, Weber K, Frazzini A, Babboni M, de la Haye K. Self-reported dietary changes among Los Angeles County adults during the COVID-19 pandemic. Appetite 2021; 166:105586. [PMID: 34217761 DOI: 10.1016/j.appet.2021.105586] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 01/01/2023]
Abstract
Poor diets are historically the leading cause of morbidity and mortality in the United States (U.S.), causing over 44,000 deaths each month. Dietary patterns have likely changed during the COVID-19 pandemic due to major shifts and crises in social, economic, and food systems. This study examines self-reported dietary changes in Los Angeles (L.A.) County during COVID-19, and identifies factors associated with making healthy and unhealthy changes. Data are from the Understanding Coronavirus in America Study, an internet panel of adults representative of L.A. County households (N = 1080). Multinomial logistic regression was used to test if self-reported change in diet healthiness assessed in July 2020 was associated with socio-ecological factors known to be associated with diet, assessed between April-July 2020. More than half of L.A. County residents reported making changes to their diet: 28.3% reported eating healthier food since the beginning of the pandemic, while 24.8% reported eating less healthy food. Individuals who were significantly more likely to report healthy changes were Non-Hispanic Black or Hispanic/Latino (vs. Non-Hispanic White), had received unemployment insurance, or had larger social networks. Individuals who were significantly more likely to report unhealthy changes were younger, of mixed race, had children in their household, had transportation barriers, or had obesity. Individuals who were significantly more likely to report both healthy and unhealthy changes were Asian, had experienced food insecurity, or had challenges getting food due to store closures. The pandemic may be exacerbating diet-related disease risk in some groups, such as communities of color, and among individuals with obesity and those facing transportation barriers.
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Affiliation(s)
- Sydney Miller
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, USA.
| | - Wandi Bruine de Bruin
- Sol Price School of Public Policy and Dornsife Department of Psychology, University of Southern California, USA; Schaeffer Center for Health Policy and Economics and the Center for Economic and Social Research, University of Southern California, USA
| | - Michelle Livings
- Spatial Sciences Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, USA
| | - John Wilson
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, USA; School of Architecture; Department of Sociology, Dornsife College of Letters, Arts and Sciences, University of Southern California, USA; Departments of Civil & Environmental Engineering and Computer Science, Viterbi School of Engineering, University of Southern California, USA
| | - Kate Weber
- Dornsife Public Exchange, University of Southern California, USA
| | | | - Marianna Babboni
- Dornsife Public Exchange, University of Southern California, USA
| | - Kayla de la Haye
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, USA
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22
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Bjerregaard P, Olesen I, Larsen CVL. Association of food insecurity with dietary patterns and expenditure on food, alcohol and tobacco amongst indigenous Inuit in Greenland: results from a population health survey. BMC Public Health 2021; 21:1094. [PMID: 34098910 PMCID: PMC8186081 DOI: 10.1186/s12889-021-11123-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Amongst the indigenous Greenlandic Inuit, the experience of food insecurity has been attributed to a lack of money to buy enough food of sufficient quality to sustain a family, although a preference for alcohol and tobacco over food has also been cited. The purpose of the article was to compare dietary patterns and expenditure on food, alcoholic beverages and tobacco between survey participants who reported food insecurity and those who did not. METHODS A countrywide cross-sectional health survey was carried out among 1886 adult Greenlandic Inuit in 2018. Diet was estimated by a food frequency questionnaire. Food insecurity status was based on the household hunger scale. Analyses were carried out by univariate general linear models adjusted for age, sex and social position. RESULTS Nine percent of the participants reported food insecurity. Food insecurity was higher among younger participants, men and participants with low social position. Food insecure participants more often chose an unhealthy dietary pattern (43% vs. 32%) and they reported a higher energy intake. The food insecure spent the same amount of money on food as other participants but less on nutritious food and more on non-nutritious food. The cost per kilojoule (kJ) of the food of the food insecure was lower than that of the food secure (DKK 8.0 and 9.0 per 1000 kJ, respectively). The food insecure participants also spent considerably more on alcohol and tobacco. CONCLUSIONS The results suggest that it is not only unemployment and lack of money that creates food insecurity and unhealthy dietary patterns in Greenland. Food insecure participants gave higher priority to buying non-nutritious food, alcohol and tobacco than did food secure participants. There seems to be at least two population subgroups in Greenland with poverty and substance use, respectively, as the immediate determinants for food insecurity. The results are important for the design of interventions against food insecurity and unhealthy dietary patterns.
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Affiliation(s)
- Peter Bjerregaard
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark.
| | - Ingelise Olesen
- Institute for Nursing and Health Research, University of Greenland, P.0. Box 1061, Manutooq 1, 3905, Nuussuaq, Greenland
| | - Christina Viskum Lytken Larsen
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark
- Institute for Nursing and Health Research, University of Greenland, P.0. Box 1061, Manutooq 1, 3905, Nuussuaq, Greenland
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Walker S, Baum JI. Eggs as an affordable source of nutrients for adults and children living in food-insecure environments. Nutr Rev 2021; 80:178-186. [PMID: 34027973 DOI: 10.1093/nutrit/nuab019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/10/2021] [Accepted: 03/02/2021] [Indexed: 01/03/2023] Open
Abstract
Food insecurity affects an estimated 12% of households in the United States. Adults and children who experience food insecurity are increased risk for development of metabolic diseases such as type 2 diabetes, obesity, and cardiovascular disease. The negative health outcomes associated with food insecurity are multifactorial; however, many of them may be caused by limited nutritional intake and poor diet quality. Dietary intake of eggs may be an applicable solution for food-insecure families who are challenged by limited nutritional intake. Eggs contain a variety of nutrients that support metabolic health. For instance, eggs are a complete source of high-quality protein and contain 16 vitamins and minerals. Furthermore, eggs are cost efficient. When comparing the relationship between foods on the basis of calories and unit cost, the energy cost of eggs is significantly less when compared with that of other animal-protein foods such as meat, poultry, and fish. However, dietary intake of eggs is controversial in regard to cardiovascular health. Thus, the aim of this review is to summarize the role of eggs in the diet and the impact eggs have on health for adults and children living in a food-insecure environment.
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Affiliation(s)
- Sam Walker
- S. Walker and J.I. Baum are with the Department of Food Science, University of Arkansas. S. Walker and J.I. Baum are with the Center for Human Nutrition, University of Arkansas System Division of Agriculture, Fayetteville, Arkansas, USA
| | - J I Baum
- S. Walker and J.I. Baum are with the Department of Food Science, University of Arkansas. S. Walker and J.I. Baum are with the Center for Human Nutrition, University of Arkansas System Division of Agriculture, Fayetteville, Arkansas, USA
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Awungafac G, Mugamba S, Nalugoda F, Sjöland CF, Kigozi G, Rautiainen S, Malyabe RB, Ziegel L, Nakigozi G, Nalwoga GK, Kyasanku E, Nkale J, Watya S, Ekström AM, Kågesten A. Household food insecurity and its association with self-reported male perpetration of intimate partner violence: a survey of two districts in central and western Uganda. BMJ Open 2021; 11:e045427. [PMID: 33789856 PMCID: PMC8016075 DOI: 10.1136/bmjopen-2020-045427] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES This study aimed to determine the lifetime prevalence of male-perpetrated intimate partner violence (IPV), and to assess the association with food insecurity, sociodemographic factors and health risk behaviours in Uganda in the year preceding COVID-19-associated lockdowns. DESIGN Population-based, cross-sectional household survey. SETTING Urban, semiurban and rural communities of the Wakiso and Hoima districts in Uganda. PARTICIPANTS A total of N=2014 males aged 13-80 years participated in the survey. The current study included males who reported having ever been in a sexual union and responded to the IPV questions (N=1314). MEASURES Data were collected face-to-face from May 2018 to July 2019 using an interviewer-mediated questionnaire. Lifetime IPV perpetration was measured as 'no physical and/or sexual IPV', 'physical' versus 'sexual violence only', and 'physical and sexual violence'. Past-year food insecurity was measured through the Food Insecurity Experience Scale and categorised into 'none', 'low' and 'high'. Multinomial logistic regression was used to determine the crude and adjusted relative risk ratios (aRRRs) of IPV perpetration in relation to self-reported food insecurity, adjusting for sociodemographic and health risk behaviours. RESULTS The prevalence of self-reported lifetime IPV perpetration was 14.6% for physical and 6.5% for sexual violence, while 5.3% reported to have perpetrated both physical and sexual IPV. Most (75.7%) males reported no food insecurity, followed by low (20.7%) and high (3.6%) food insecurity. In adjusted models, food insecurity was associated with increased risk of having perpetrated both physical and sexual violence (aRRR=2.57, 95% CI 1.52 to 4.32). IPV perpetration was also independently associated with having had more than one lifetime sexual partner and drinking alcohol, but not with education level or religion. CONCLUSION This study suggests that food insecurity is associated with male IPV perpetration, and more efforts are needed to prevent and mitigate the expected worsening of this situation as a result of the COVID-19 pandemic.
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Affiliation(s)
- George Awungafac
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Stephen Mugamba
- Africa Medical and Behavioural Science Organization, Kampala, Uganda
| | - Fred Nalugoda
- Africa Medical and Behavioural Science Organization, Kampala, Uganda
| | | | - Godfrey Kigozi
- Africa Medical and Behavioural Science Organization, Kampala, Uganda
| | - Susanne Rautiainen
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | | | - Leo Ziegel
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Gertrude Nakigozi
- Africa Medical and Behavioural Science Organization, Kampala, Uganda
| | | | - Emmanuel Kyasanku
- Africa Medical and Behavioural Science Organization, Kampala, Uganda
| | - James Nkale
- Africa Medical and Behavioural Science Organization, Kampala, Uganda
| | - Stephen Watya
- Africa Medical and Behavioural Science Organization, Kampala, Uganda
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Anna Kågesten
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
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Pooler JA, Srinivasan M, Miller Z, Mian P. Prevalence and Risk Factors for Food Insecurity Among Low-Income US Military Veterans. Public Health Rep 2021; 136:618-625. [PMID: 33478378 DOI: 10.1177/0033354920974662] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Ensuring access to sufficient foods at all times is critical to veterans' health and well-being. Food insecurity has not been well explored in the veteran population. We examined the prevalence and predictors of food insecurity among low-income veterans, because the highest rates of food insecurity are among low-income households. We also examined rates of Supplemental Nutrition Assistance Program (SNAP) participation among subgroups at the highest risk of food insecurity. METHODS We used univariate analyses and 2011-2017 National Health Interview Survey (NHIS) data on veterans aged ≥21 with family incomes <200% of the federal poverty level to estimate the prevalence of food insecurity. We used bivariate analyses to identify correlates of food insecurity and estimate SNAP participation rates among subgroups of low-income veterans. Percentages were weighted using NHIS survey weights. RESULTS Of 5146 low-income veterans, 22.5% reported being food insecure in the previous month. Food insecurity was significantly associated with being aged <65 (33.0% aged 45-64 and 29.7% aged 21-44) compared with 15.0% and 6.4% among veterans aged 65-74 and ≥75, respectively (P < .001); unemployed compared with employed or not in the labor force (39.4%, 22.7%, and 20.2%, respectively; P < .001); in fair or poor health compared with good, very good, or excellent heath (31.8% vs 18.2%; P < .001); and having experienced serious psychological distress in the past month (56.3%) compared with not having experienced such distress (19.7%; P < .001). Although overall SNAP participation among low-income veterans was estimated to be 27.0%, participation rates were highest among veterans who had experienced serious psychological distress (44.1%), were unemployed (39.2%), and were renting their home (39.0%). CONCLUSIONS Some low-income veterans are at greater risk of food insecurity than other veterans. Postseparation programs, civilian support services, and veterans' health providers should be aware of the characteristics that place veterans at highest risk of food insecurity.
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Affiliation(s)
| | | | | | - Paula Mian
- IMPAQ International, LLC, Washington, DC, USA
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Coughlin SS. Social Determinants of Health and Cancer Survivorship. JOURNAL OF ENVIRONMENT AND HEALTH SCIENCES 2021; 7:11-15. [PMID: 34621981 PMCID: PMC8494398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Steven S. Coughlin
- Department of Population Health Sciences, Augusta University, 1120 15th Street, Augusta, GA 30912,Institute of Public and Preventive Health, Augusta University, Augusta, GA
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Berger MH, Lin HW, Bhattacharyya N. A National Evaluation of Food Insecurity in a Head and Neck Cancer Population. Laryngoscope 2020; 131:E1539-E1542. [PMID: 33098320 DOI: 10.1002/lary.29188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/25/2020] [Accepted: 10/03/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the food security status of patients with a history of head and neck cancer and compare to other types of cancer. STUDY DEIGN A retrospective analysis using the National Health Interview Series. METHODS The National Health Interview Series (NHIS) for the calendar years 2014 to 18 was used to elicit food security status (secure, marginally secure/not secure) among adult patients with a history of throat/pharynx head and neck cancer (pHNC), thyroid cancer, and colon cancer. The relationship between food security and the primary site was compared and subanalyses were performed according to sex, race, and ethnicity. RESULTS The study population included 199.0 thousand patients with pHNC, with 17.7% (95% confidence interval, 10.5%-28.1%) of pHNC patients reporting their food security status as marginally secure or not secure. Food insecurity was significantly higher among pHNC patients when compared to thyroid cancer (insecurity 10.7%, [7.7%-14.7%]) and colon cancer patients (10.1%, [7.8%-13.2%]). Among pHNC patients, there was no significant difference in rates of food insecurity when stratified by gender, race, or ethnicity. However, black individuals were more likely to have food insecurity with a history of thyroid or colon cancer (P < .042) and Hispanics were more likely to have food insecurity with a history of thyroid cancer (P = .005). CONCLUSIONS Food insecurity disproportionally affects patients with a history of pHNC, though there is less demographic variability when compared to other cancer primary sites. Food security assessments should be part of the tailored approach to survivorship management in head and neck cancer. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1539-E1542, 2021.
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Affiliation(s)
- Michael H Berger
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Irvine, California, U.S.A
| | - Harrison W Lin
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Irvine, California, U.S.A
| | - Neil Bhattacharyya
- Department of Otolaryngology, Massachusetts Eye & Ear and Harvard Medical School, Boston, Massachusetts, U.S.A
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Criminal offending trajectories from adolescence through young adulthood and the risk of food insecurity: evidence from the Add Health study. Ann Epidemiol 2020; 50:20-26.e1. [DOI: 10.1016/j.annepidem.2020.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/20/2020] [Accepted: 06/02/2020] [Indexed: 12/29/2022]
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Papaconstantinou E, Quick V, Vogel E, Coffey S, Miller A, Zitzelsberger H. Exploring Relationships of Sleep Duration with Eating and Physical Activity Behaviors among Canadian University Students. Clocks Sleep 2020; 2:194-207. [PMID: 33089200 PMCID: PMC7445828 DOI: 10.3390/clockssleep2020016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/22/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Students pursuing postsecondary education are a population described as vulnerable for sleep problems, poor dietary habits, weight gain, and reduced physical activity. The primary goal of this study was to examine relationships of sleep behaviors with eating and physical activity behaviors in a sample of undergraduate health sciences students. METHODS Using a cross-sectional design, undergraduate health sciences students in a small Canadian university were recruited to complete an on-line questionnaire about their sleep, eating, and physical activity behaviors using valid and reliable instruments. Key sociodemographic characteristics and self-reported height and weight data were also captured. RESULTS The participants (n = 245) were on average 23 years of age, female (86%), and the majority were full-time students (92%). The mean BMI was within a healthy range (mean 24.58 SD 5.55) with the majority reporting low physical activity levels (65%). Despite self-reports of very or fairly good (65%) sleep quality in the past month, the mean global sleep scores (scores > 5, mean 7.4, SD 3.3) indicated poor overall sleep quality. Poorer sleep quality was associated with higher BMIs (r = 0.265, p < 0.001). CONCLUSIONS The findings highlight the need to expand the scope of on-campus wellness programs to promote healthy sleep habits in a vulnerable university population.
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Affiliation(s)
- Efrosini Papaconstantinou
- University of Ontario Institute of Technology, Faculty of Health Sciences, Oshawa, ON L1G 0C5, Canada; (E.V.); (S.C.); (A.M.); (H.Z.)
| | - Virginia Quick
- Rutgers University, School of Environmental and Biological Sciences, New Brunswick, NJ 08901, USA;
| | - Ellen Vogel
- University of Ontario Institute of Technology, Faculty of Health Sciences, Oshawa, ON L1G 0C5, Canada; (E.V.); (S.C.); (A.M.); (H.Z.)
| | - Sue Coffey
- University of Ontario Institute of Technology, Faculty of Health Sciences, Oshawa, ON L1G 0C5, Canada; (E.V.); (S.C.); (A.M.); (H.Z.)
| | - Andrea Miller
- University of Ontario Institute of Technology, Faculty of Health Sciences, Oshawa, ON L1G 0C5, Canada; (E.V.); (S.C.); (A.M.); (H.Z.)
| | - Hilde Zitzelsberger
- University of Ontario Institute of Technology, Faculty of Health Sciences, Oshawa, ON L1G 0C5, Canada; (E.V.); (S.C.); (A.M.); (H.Z.)
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Keith-Jennings B, Llobrera J, Dean S. Links of the Supplemental Nutrition Assistance Program With Food Insecurity, Poverty, and Health: Evidence and Potential. Am J Public Health 2020; 109:1636-1640. [PMID: 31693420 DOI: 10.2105/ajph.2019.305325] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The Supplemental Nutrition Assistance Program (SNAP) is a highly effective program, vital to our nation's health and well-being. SNAP's entitlement funding structure allows it to provide benefits to anyone who meets the program's eligibility requirements, and this structure also enables SNAP to respond quickly when need increases. Research shows that SNAP reduces poverty for millions, improves food security, and is linked with improved health.Despite SNAP's successes, there is room to build on its considerable accomplishments. Evidence suggests that current benefit levels are not adequate for many households. Some vulnerable groups have limited SNAP eligibility, and some eligible individuals face barriers to SNAP participation.Policymakers should address these shortcomings by increasing SNAP benefits and expanding SNAP eligibility to underserved groups. The federal government and states should also continue improving policies and procedures to improve access for eligible individuals.
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Affiliation(s)
- Brynne Keith-Jennings
- Brynne Keith-Jennings, Joseph Llobrera, and Stacy Dean are with the food assistance team at the Center on Budget and Policy Priorities, Washington, DC
| | - Joseph Llobrera
- Brynne Keith-Jennings, Joseph Llobrera, and Stacy Dean are with the food assistance team at the Center on Budget and Policy Priorities, Washington, DC
| | - Stacy Dean
- Brynne Keith-Jennings, Joseph Llobrera, and Stacy Dean are with the food assistance team at the Center on Budget and Policy Priorities, Washington, DC
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Heterogeneous Impact of Supplemental Nutrition Assistance Program Benefit Changes on Food Security by Local Prices. Am J Prev Med 2020; 58:e97-e103. [PMID: 31866209 DOI: 10.1016/j.amepre.2019.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 10/20/2019] [Accepted: 10/21/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The Supplemental Nutrition Assistance Program benefit amount is fixed across all 48 states (except Hawaii and Alaska), although food prices vary widely. Hence, the real value of Supplemental Nutrition Assistance Program benefits can directly affect the purchasing power of Supplemental Nutrition Assistance Program participants and subsequently their food insecurity. Using the 2 most recent changes to the Supplemental Nutrition Assistance Program benefit formula in 2009 and 2013, this study examines whether the changes in benefit level affected food security of participants differentially depending on local food prices. METHODS Data from the Current Population Survey-Food Security Supplement 2008-2009 and 2012-2013, merged with the Regional Price Parities from the Bureau of Economic Analysis, were used. Linear regression with a differences-in-differences strategy estimated the effects of Supplemental Nutrition Assistance Program benefit changes on the food security of Supplemental Nutrition Assistance Program households, separately by those in high- and low-cost areas. The analyses were completed in 2019. RESULTS After the benefit increase, the prevalence of low food security among Supplemental Nutrition Assistance Program households living in high-cost areas declined by 11.2 percentage points (95% CI=1.6, 20.8). Following the benefit decrease, the prevalence of very low food security among Supplemental Nutrition Assistance Program households increased by 8.7 percentage points (95% CI=3.6, 13.8) in high-cost areas. In contrast, there was no statistically significant difference between Supplemental Nutrition Assistance Program and non-Supplemental Nutrition Assistance Program households in low-cost areas in response to the benefit changes. CONCLUSIONS Given the heterogeneous effects of the Supplemental Nutrition Assistance Program benefit changes on food security by local food prices, this study provides additional evidence for the ongoing policy debate regarding whether the Supplemental Nutrition Assistance Program benefit amounts should be adjusted to the cost of living.
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Penumarthy NL, Goldsby RE, Shiboski SC, Wustrack R, Murphy P, Winestone LE. Insurance impacts survival for children, adolescents, and young adults with bone and soft tissue sarcomas. Cancer Med 2019; 9:951-958. [PMID: 31838786 PMCID: PMC6997066 DOI: 10.1002/cam4.2739] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 12/18/2022] Open
Abstract
Background While racial/ethnic survival disparities have been described in pediatric oncology, the impact of income has not been extensively explored. We analyzed how public insurance influences 5‐year overall survival (OS) in young patients with sarcomas. Methods The University of California San Francisco Cancer Registry was used to identify patients aged 0‐39 diagnosed with bone or soft tissue sarcomas between 2000 and 2015. Low‐income patients were defined as those with no insurance or Medicaid, a means‐tested form of public insurance. Survival curves were computed using the Kaplan‐Meier method and compared using log‐rank tests and Cox models. Causal mediation was used to assess whether the association between public insurance and mortality is mediated by metastatic disease. Results Of 1106 patients, 39% patients were classified as low‐income. Low‐income patients were more likely to be racial/ethnic minorities and to present with metastatic disease (OR 1.96, 95% CI 1.35‐2.86). Low‐income patients had significantly worse OS (61% vs 71%). Age at diagnosis and extent of disease at diagnosis were also independent predictors of OS. When stratified by extent of disease, low‐income patients consistently had significantly worse OS (localized: 78% vs 84%, regional: 64% vs 73%, metastatic: 23% vs 30%, respectively). Mediation analysis indicated that metastatic disease at diagnosis mediated 15% of the effect of public insurance on OS. Conclusions Low‐income patients with bone and soft tissue sarcomas had decreased OS regardless of disease stage at presentation. The mechanism by which insurance status impacts survival requires additional investigation, but may be through reduced access to care.
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Affiliation(s)
- Neela L Penumarthy
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Robert E Goldsby
- Division of Oncology, Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco, CA, USA.,Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA
| | - Stephen C Shiboski
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA
| | | | - Patricia Murphy
- Division of Oncology, Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Lena E Winestone
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA.,Division of Allergy, Immunology, and BMT, Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco, CA, USA
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Prevalence of folic acid supplement consumption before and during pregnancy, and its determinants among community health center referrals. Obstet Gynecol Sci 2019; 62:454-461. [PMID: 31777742 PMCID: PMC6856478 DOI: 10.5468/ogs.2019.62.6.454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/03/2019] [Accepted: 06/07/2019] [Indexed: 12/01/2022] Open
Abstract
Objective The aim of this study is to assess the prevalence and determinants of folic acid supplementation among women referred to community health centers. Methods This was a cross-sectional study conducted in 325 women referred to community health centers. The subjects were selected from 8 community health centers, using a stratified sampling technique. Data regarding demographics, socioeconomic status, obstetrics, folic acid supplementation status, and household food security status were obtained via questionnaires. The data was analyzed in SPSS v22. Results The prevalence of folic acid supplementation both before and during pregnancy was 54.5%. The results of the study showed that folic acid supplementation had a significant positive association with education level (odds ratio [OR],0 .441; 95% confidence interval [CI], 0.199–0.977; P<0.05), being employed (OR, 0.353; 95% CI, 0.148–0.840; P<0.05), and planned pregnancy (OR, 18.113; 95% CI, 7.371–44.51; P<0.001). However, other variables, including age, husband's age, husband's education and employment status, the number of prior pregnancies, economic satisfaction, and household food security, were nonsignificant factors affecting folic acid supplementation. Conclusion Women with lower socioeconomic status are less likely to take folic acid supplements, and more effort should be made to increase their awareness of the importance of supplementation. Unplanned pregnancy is another strong risk factor for not supplementing with folic acid, and thus should be avoided.
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Coughlin SS, Mann P, Vernon M, Young L, Ayyala D, Sams R, Hatzigeorgiou C. A logic framework for evaluating social determinants of health interventions in primary care. JOURNAL OF HOSPITAL MANAGEMENT AND HEALTH POLICY 2019; 3. [PMID: 31723726 DOI: 10.21037/jhmhp.2019.09.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Increasing efforts have been made in primary care settings to screen for a broad array of social determinants of health including inadequate food and nutrition, lack of education, unemployment, and inadequate housing, and to refer patients to community resources. Core tenets of primary care include integration with community resources. Methods In the course of designing a randomized controlled trial of the effectiveness of a social determinants of health intervention aimed at adult, at-risk, African American primary care clinic patients, our research team developed a logic model to assist with the evaluation of the intervention. Results In this article, we describe the logic model including elements of the intervention, mediator variables, and outcome variables. Conclusions The proposed logic framework is likely to be helpful for planning, conducting, and evaluating social determinants of health interventions in primary care settings.
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Affiliation(s)
- Steven S Coughlin
- Department of Population Health Sciences, Medical College of Georgia.,Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA
| | - Paul Mann
- Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA.,Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Marlo Vernon
- Department of Undergraduate Health Professions, College of Allied Health Sciences
| | - Lufei Young
- College of Nursing, Augusta University, Augusta, GA, USA
| | - Deepak Ayyala
- Department of Population Health Sciences, Medical College of Georgia
| | - Richard Sams
- Department of Family Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Christos Hatzigeorgiou
- Division of General Internal Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
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Hollis-Hansen K, Vermont L, Zafron ML, Seidman J, Leone L. The introduction of new food retail opportunities in lower-income communities and the impact on fruit and vegetable intake: a systematic review. Transl Behav Med 2019; 9:837-846. [PMID: 31570930 PMCID: PMC8679116 DOI: 10.1093/tbm/ibz094] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023] Open
Abstract
A lack of access to fresh fruits and vegetables (F&Vs) is associated with consumption of fewer F&Vs and higher risk of obesity, especially for lower-income individuals. It is widely believed that the addition of new food retail opportunities could improve F&V consumption and subsequently reduce the chronic disease burden. Observational studies provide some support for these hypotheses, but contradictions exist. In this study we sought to examine if the introduction of a food retailer affects F&V consumption in lower-income communities. We used a systematic PRISMA approach to conduct this study. We searched PubMed, EMBASE, and ProQuest Dissertations & Theses for academic journal references and gray literature published before August 2018. Included studies were those looking at the effect of the introduction of a new food retailer on F&V consumption. Studies were also categorized based on which dimensions of food access were targeted by the food retailer. We identified 15 studies meeting inclusion criteria: 11 studies reported a positive increase in F&V consumption attributable to the introduction of a new food retailer, of which 6 were statistically significant. The remaining 4 studies, all of which examined the impact of introducing a new retail supermarket, showed no change or a decrease in F&V intake. Results from studies which change the food environment generally support the idea that increased access to healthy food improves diet, but more studies are needed in order to assess the differences between the various types of retailers, and to identify strategies for improving impact. Understanding which types of new food retail programs are most likely to impact diet has implications for policies which incentivize new food retail.
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Affiliation(s)
- Kelseanna Hollis-Hansen
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Leah Vermont
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
| | | | - Jennifer Seidman
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Lucia Leone
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
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Evaluation of three behavioural economics 'nudges' on grocery and convenience store sales of promoted nutritious foods. Public Health Nutr 2019; 22:3250-3260. [PMID: 31331404 DOI: 10.1017/s1368980019001794] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the association between three behavioural economics 'nudges' and store sales of promoted healthier foods. DESIGN Multiple interrupted time series. SETTING Two predominantly rural counties in central North Carolina, USA. PARTICIPANTS Aggregated store transaction data from two grocery stores (one intervention, one control) and two convenience stores (one intervention, one control) were analysed using ANOVA to examine the association between three 'nudges' and store sales of promoted items. The nudges included: a 'cognitive fatigue' experiment, in which floor arrows guided customers to the produce sections; a 'scarcity' experiment, in which one sign in one area of the produce section portrayed a 'limited amount' message; and a 'product placement' experiment, where granola bars were moved into the candy bar aisle. RESULTS In convenience stores, there were no significant differences between sales of the promoted items during the intervention period for any of the nudges when implemented individually. However, compared with baseline sales, implementation of all three nudges simultaneously was associated with an increase in sales during the intervention period based on proportional computations (P = 0·001), whereas no significant changes in sales were observed in the control convenience store. Among the grocery stores, there were no significant differences in sales during the intervention period for any of the nudges or the combined intervention compared with baseline sales. CONCLUSIONS Implementing three nudges concurrently in a convenience store setting may increase sales of promoted items. However, before stores consider implementing these nudges to increase sales of nutritious foods, additional research is warranted.
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Pooler JA, Hartline-Grafton H, DeBor M, Sudore RL, Seligman HK. Food Insecurity: A Key Social Determinant of Health for Older Adults. J Am Geriatr Soc 2019; 67:421-424. [PMID: 30586154 PMCID: PMC6816803 DOI: 10.1111/jgs.15736] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Jennifer A. Pooler
- Advanced Analytics Practice Area, IMPAQ International, LLC, Columbia, Maryland
| | | | | | - Rebecca L. Sudore
- Department of Medicine, Division of Geriatrics, University of California, San Francisco, California
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Department of Medicine, Innovation and Implementation Center for Aging and Palliative Care (I-CAP), Division of Geriatrics, University of California, San Francisco, California
| | - Hilary K. Seligman
- Department of Medicine and Department of Epidemiology and Biostatistics, University of California, San Francisco
- The UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California
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Food Insecurity and Cardiovascular Disease Risk Factors among Mississippi Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15092016. [PMID: 30223555 PMCID: PMC6165024 DOI: 10.3390/ijerph15092016] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/07/2018] [Accepted: 09/13/2018] [Indexed: 11/16/2022]
Abstract
Background: Food insecurity is a public health problem. There is limited data on food insecurity in Mississippi. Methods: We analyzed data from the 2015 Mississippi Behavioral Risk Factor Surveillance System, which included the Social Context Module for 5870 respondents. Respondents who indicated that in the past 12 months they were "always", "usually", or "sometimes" "worried or stressed about having enough money to buy nutritious meals" were considered food insecure. Food insecurity was compared across sociodemographic and health characteristics using chi-square tests, and the association between food insecurity and select cardiovascular disease risk factors was assessed using logistic regression. Results: The prevalence of food insecurity was 42.9%. Compared to the referent group, Mississippi adults with high blood pressure had 51% higher odds, those with diabetes had 30% higher odds, those who were not physically active had 36% higher odds, and those who consumed fewer than five fruits and vegetables daily had 50% higher odds of being food insecure. Conclusion: Among Mississippi adults, food insecurity is associated with high blood pressure, diabetes, obesity, fruit and vegetable consumption, physical inactivity, and smoking.
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Fowokan A, Black J, Holmes E, Seto D, Lear S. Examining risk factors for cardiovascular disease among food bank members in Vancouver. Prev Med Rep 2018; 10:359-362. [PMID: 29868392 PMCID: PMC5984241 DOI: 10.1016/j.pmedr.2018.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/07/2018] [Accepted: 04/21/2018] [Indexed: 11/30/2022] Open
Abstract
Food banks provide supplemental food to low-income households, yet little is known about the cardiovascular health of food banks members. This study therefore described cardiovascular disease (CVD) risk factors among food bank members and explored associations between food insecurity and CVD risk. Adults ≥18 years (n = 77) from three food bank sites in metro Vancouver, British Columbia completed surveys and physical assessments examining a range of socio-demographic variables and CVD risk factors. A composite measure of myocardial infarction (MI) risk called the INTERHEART score was assessed and household food insecurity was measured using the Household Food Security Survey Module. Regression models were used to explore associations between food insecurity and CVD risk measures, including the INTERHEART score. Ninety-seven percent of food bank members reported experiencing food insecurity, 65% were current smokers, 53% reported either chronic or several periods of stress in the past year, 55% reported low physical activity levels and 80% reported consuming fewer than five servings of fruit and vegetables daily. Prevalence of self-reported diabetes and hypertension were 13% and 29% respectively. Fifty-two percent of the sample were at high risk of non-fatal MI. No statistically significant associations were found between increased severity of food insecurity and CVD risk factors among this sample where both severe food insecurity and high CVD risks were prevalent. Food bank members were at elevated risk for CVD compared with the general population. Strategies are needed to reduce prevalence of food insecurity and CVD risk factors, both of which disproportionately affected food bank members.
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Affiliation(s)
- A.O. Fowokan
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby V5A 1S6, BC, Canada
| | - J.L. Black
- Faculty of Land and Food Systems, Food Nutrition and Health, University of British Columbia, 2205 East Mall, Vancouver V6T 1Z4, BC, Canada
| | - E. Holmes
- Faculty of Land and Food Systems, Food Nutrition and Health, University of British Columbia, 2205 East Mall, Vancouver V6T 1Z4, BC, Canada
| | - D. Seto
- Greater Vancouver Food Bank, Vancouver, BC, Canada
| | - S.A. Lear
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby V5A 1S6, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby V5A 1S6, BC, Canada
- Division of Cardiology, Providence Health Care, Vancouver V6Z 1Y6, BC, Canada
- Corresponding author at: Healthy Heart Program, St. Paul's Hospital, 180-1081 Burrard St, Vancouver V6Z 1Y6, BC, Canada.
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