Prevalence and socioeconomic and geographical inequalities of household food insecurity in the Paris region, France, 2010

Food insecurity in Norway: A cross-sectional study among patients visiting their general practitioner

AIMS

We aim to address the knowledge gap surrounding food insecurity in general practice in Norway, focusing on its prevalence among patients, sociodemographic correlates and its relationship with chronic diseases across different age groups.

METHODS

This study is cross-sectional, collecting data through 69 general practice clinics in 2022 from patients >18 years old visiting their general practitioner. They answered an anonymous questionnaire with the Cornell-Radimer hunger scale. Questions addressed hunger, concerns about food access, financial difficulties purchasing food, impact on children, patient demographics, children, and use of medications for chronic disease. We present logistic regression models with odds ratios (ORs) with 95% confidence intervals to examine associations between food insecurity and patient characteristics.

RESULTS

Among 2571 invited patients, 81.2% (n=2089) participated in the study. Of the participants, 40.1% were considered food insecure. The questions in the Cornell-Radimer hunger scale indicated that most had a mild degree of food insecurity. Food insecurity ranged from 28.9% among those >70 years old to 68.0% among those <30 years old. Food insecurity was associated with age <30 years, being migrant, inversely associated with higher educational levels (OR 0.60, 0.41-0.87) or having own children (OR 0.24, 0.18-0.31). Food insecurity was higher among participants using medications for chronic disease (OR 1.33, 1.05-1.68).

CONCLUSIONS

This study underscores the presence of food insecurity in high-income countries like Norway, particularly among specific groups such as young adults, migrants and patients with chronic diseases. These categories of patient could benefit from screening of food insecurity during medical contact.

Food insecurity and kidney disease: a systematic review

BACKGROUND

The risk of developing and worsening chronic kidney disease (CKD) is associated with unhealthy dietary patterns. Food insecurity is defined by a limited or uncertain availability of nutritionally adequate and safe food; it is also associated with several chronic medical conditions. The aim of this systematic review is to investigate the current knowledge about the relationship between food insecurity and renal disease.

METHODS

We selected the pertinent publications by searching on the PubMed, Scopus, and the Web of Science databases, without any temporal limitations being imposed. The searching and selecting processes were carried out through pinpointed inclusion and exclusion criteria and in accordance with the Prisma statement.

RESULTS

Out of the 26,548 items that were first identified, only 9 studies were included in the systemic review. Eight out of the nine investigations were conducted in the US, and one was conducted in Iran. The studies evaluated the relationship between food insecurity and (i) kidney disease in children, (ii) kidney stones, (iii) CKD, (iv) cardiorenal syndrome, and (v) end stage renal disease (ESRD). In total, the different research groups enrolled 49,533 subjects, and food insecurity was reported to be a risk factor for hospitalization, kidney stones, CKD, ESRD, and mortality.

CONCLUSIONS

The relationship between food insecurity and renal disease has been underestimated. Food insecurity is a serious risk factor for health problems in both wealthy and poor populations; however, the true prevalence of the condition is unknown. Healthcare professionals need to take action to prevent the dramatic effect of food insecurity on CKD and on other chronic clinical conditions.

When food is uncertain, how much does sustainability matter? A qualitative exploration of food values and behaviours among users of a social grocery store

A transition towards sustainable diets ensuring food security while preserving ecosystems is necessary, but remains challenging. Low-income consumers, particularly those experiencing food insecurity, require specific consideration since they face financial constraints when making food choices, leading to poorer diets. However, little is known about the place given to sustainability in their choices. This study thus aims to identify the role played by sustainability in the food values of food-insecure consumers in France. Twenty-nine semi-structured interviews with users of a social grocery store were conducted to investigate food values and actual behaviours, with a focus on the four dimensions of sustainable diets - health, economic, sociocultural and environmental. Verbatims were analysed through thematic analysis. Five core values were identified, namely health and nutrition, naturalness, trust and control, solidarity and frugality, and preferences. Participants valued all dimensions of food sustainability but notably valued less the environmental dimension. Despite various strategies, participants felt unable to adhere to their values in practice, mainly because of their socioeconomic vulnerability. They insisted on their lack of control over their food behaviour. These findings provide insights into the disempowerment experienced by consumers with low financial resources regarding more sustainable food choices. Our study calls for interventions addressing affordability issues and considering consumers' food values, while providing opportunities to make consumers feel involved in the transition of the food system.

Perspective: Food and Nutrition Insecurity in Europe: Challenges and Opportunities for Dietitians

In recent years, the interest in food and nutrition insecurity in high-income countries has skyrocketed. However, its recognition in Europe is still developing. This perspective summarizes the evidence on food and nutrition insecurity across Europe in terms of prevalence, consequences, and current mitigation strategies, with the aim of outlining the challenges and opportunities for dietitians. Prevalence in the general population ranges between 5% and 20%, with higher rates identified in women, children, older adults, single-parent households, those with low educational attainment, and on low or unstable income and/or employment. In users of food aid, the prevalence of food insecurity is above 70%. Responses to food and nutrition insecurity include welfare policies and food assistance programs at regional and national levels. However, most current strategies are not successful in tackling the structural drivers of food and nutrition insecurity, nor do they guarantee diet quality. Despite limited involvement to-date, dietitians can play an important role in addressing food and nutrition insecurity across Europe. This narrative identifies 4 areas: 1) create awareness of the existence and severity of food and nutrition insecurity, 2) advocate for comprehensive, robust data on the determinants and prevalence, 3) partner with diverse stakeholders, social assistance providers, local authorities, and nongovernmental organizations in a comprehensive, intersectoral, and integrated manner, 4) participate in the development of political instruments and interventions that ensure equitable access to high-quality safe food.

Identifying the Group Vulnerable to Unmet Medical Needs Due to Food Security: According to Children in the Household

OBJECTIVE

Adults may experience unmet medical needs for various reasons. The purpose of this study was to examine the effect of food security on unmet medical needs according to the presence of children in the household of adults, as well as to identify the medically vulnerable group considering individual and household characteristics.

METHODS

This study was conducted using data from the National Health and Nutrition Examination Survey for 2013-2015 and 2019-2020. The subjects of the study were 23,069 adults 19 years of age or older, and were divided into two groups according to whether or not children were included in the household. In order to observe the association between food security and unmet medical needs, multiple logistic regression analysis was performed. In addition, a subgroup analysis was performed in consideration of individual and household characteristics.

RESULTS

When food security was unstable for households with children, or without children, there was a high correlation with unmet medical needs. Considering individual and household characteristics, in groups with lower age and household income level, or higher number of members in household and subjective health status, food security was strongly correlated with unmet medical needs in households with children. Contrarily, households without children showed a high correlation in the opposite characteristics of households with children, excluding household income level.

CONCLUSION

Food security was highly correlation with unmet medical needs regardless of whether or not children were included in the household. However, according to the individual and household characteristics of households with and without children, the relationship between food security and unmet medical needs was found to be different. Therefore, it is necessary to prepare a health policy that can increase access to medical services in consideration of food security and individual and household characteristics depending on whether or not children are included in the household.

The effect of non-participation on the prevalence of food insecurity in a population-based cohort in Portugal

Non-participation can be a source of selection bias. We evaluated the effect of non-participation on food insecurity prevalence among 2942 young adults from the EPITeen cohort (Portugal), which we have followed since assembling the cohort in 2003-2004. We conducted a cross-sectional study when the cohort participants were 26 years old. To examine the effect of non-participation, we statistically imputed the missing data on food security status using multivariate imputation by chained equations based on characteristics associated with food insecurity, specifically household income perception, education and household structure from 21 or 24 years of age follow-ups. In our cohort, non-participation caused ~ 2% difference in the food insecurity prevalence: 11.0% (95% CI 9.0-13.0) for 954 participants and 12.6% (95% CI 11.1-14.1) after imputation. These estimates are close to evidence from other European countries and sustain the relevance of developing public health interventions to promote food security, especially considering the negative nutritional and health outcomes associated with food insecurity.

Food Insecurity in Portugal during the COVID-19 Pandemic: Prevalence and Associated Sociodemographic Characteristics

Introduction

The current worldwide COVID-19 pandemic has been having a considerable impact not only on health but also on the economy of societies, emphasizing food insecurity as a significant public health concern.

Aim

The objective of this study was to characterize the scenario of food insecurity in Portugal during the COVID-19 pandemic and explore its related sociodemographic characteristics.

Methodology

This is a cross-sectional study, using data from an online survey, performed from November 2020 until February 2021, including 882 residents aged 18 years or older in Portugal. Data on sociodemographics and food security status were collected, the latter was evaluated using the United States Household Food Security Survey Module: Six-Item Short Form. Crude and adjusted logistic regression models were performed (covariates: education, household income perception, and the working status during the COVID-19 pandemic). The odds ratio (OR) and respective 95% confidence intervals (CI) were estimated.

Results

Most participants were women (71.3%), with a mean age of 36.8 years (SD 11.0). Food insecurity prevalence was 6.8%. Less-educated individuals (≤12 years of schooling; OR 2.966; 95% CI 1.250–7.042), and those who were and remained unemployed since the beginning of the pandemic (OR 2.602; 95% CI 1.004–6.742) had higher odds of belonging to a food-insecure household, regardless of education, working status during the COVID-19 pandemic, and household income perception. Moreover, lower odds of belonging to a food-insecure household were observed among those reporting a comfortable household income (OR 0.007; 95% CI 0.001–0.062) than those who perceived their household income as insufficient, independently of education and the working status during the COVID-19 pandemic.

Conclusions

These findings highlight the population groups that are at a greater risk of food insecurity during the current COVID-19 pandemic. Effective public health strategies should be developed aiming to address food insecurity during this crisis, especially among the higher risk groups.

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

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.

Relationships of Dietary Factors with Obesity, Hypertension, and Diabetes by Regional Type among Single-Person Households in Korea

This study aims to investigate whether dietary factors are differentially associated with metabolic abnormalities by regional type among single-person households in Korea. A total of 685,327 Korean adults aged ≥19 years who participated in the household and individual surveys of the Korea Community Health Survey 2015–2017 are included in the analysis. The regions are divided into three categories: metropolitan areas, mid-sized cities, and rural areas. Using multivariable logistic regressions, the adjusted odds ratios and 95% confidence intervals for metabolic abnormalities are estimated by regional type after adjusting for covariates. Among the total study population, 12.21% occupy single-person households, and 47.5%, 25.1%, and 27.4% of those single-person households are in rural areas, mid-sized cities, and metropolitan areas, respectively. Compared with single-person households in rural areas, those in mid-sized and metropolitan cities tend to be more familiar with and frequently refer to nutrition labels, skip breakfast, and experience food insecurity. Regional differences are found in the associations of dietary factors and behavior with obesity, hypertension, and diabetes. The use of nutritional fact labels is associated with obesity and hypertension in single-person households in rural areas, and the degree of association between food insecurity and diabetes is highest among single-person households in metropolitan areas. Our findings suggest that policies for improving unhealthy dietary factors by regional type are needed to reduce regional health disparities among single-person households in Korea.

Urban poverty and nutrition challenges associated with accessibility to a healthy diet: a global systematic literature review

BACKGROUND

There is an increasing global trend towards urbanization. In general, there are less food access issues in urban than rural areas, but this "urban advantage" does not benefit the poorest who face disproportionate barriers to accessing healthy food and have an increased risk of malnutrition.

OBJECTIVES

This systematic literature review aimed to assess urban poverty as a determinant of access to a healthy diet, and to examine the contribution of urban poverty to the nutritional status of individuals.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodology, our review included quantitative and qualitative studies published in English or in Spanish between 2000 and 2019. The articles were eligible if they focused on nutrition access (i.e. access to a healthy diet) or nutrition outcomes (i.e., anemia, overweight and obesity, micronutrient deficiency, micronutrient malnutrition) among urban poor populations. Articles were excluded if they did not meet pre-established criteria. The quality of the quantitative studies was assessed by applying Khan et al.'s methodology. Similarly, we assessed the quality of qualitative articles through an adapted version of the National Institute for Health and Care Excellence (NICE) methodology checklist. Finally, we systematically analyzed all papers that met the inclusion criteria based on a qualitative content and thematic analysis.

RESULTS

Of the 68 papers included in the systematic review, 55 used quantitative and 13 used qualitative methods. Through the analysis of the literature we found four key themes: (i) elements that affect access to healthy eating in individuals in urban poverty, (ii) food insecurity and urban poverty, (iii) risk factors for the nutritional status of urban poor and (iv) coping strategies to limited access to food. Based on the systematization of the literature on these themes, we then proposed a conceptual framework of urban poverty and nutrition.

CONCLUSIONS

This systematic review identified distinct barriers posed by urban poverty in accessing healthy diets and its association with poorer nutrition outcomes, hence, questioning the "urban advantage". A conceptual framework emerging from the existing literature is proposed to guide future studies and policies.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO Registration number: CRD42018089788 .

Post-Traumatic Stress Disorder in Homeless Migrant Mothers of the Paris Region Shelters

Migrant women are disproportionately more likely to experience traumatic events in their country of origin, during migration and after arriving in the host country. Homeless women are more likely to be exposed to multiple victimizations in childhood (emotional or physical maltreatment) and in adulthood (sexual abuse, street victimization). This study’s objective was to describe the factors associated with the likelihood of post-traumatic stress disorder (PTSD) among homeless migrant mothers in the Paris region. Face-to-face interviews were conducted by bilingual psychologists and interviewers in a representative sample of homeless families in the Paris region. PTSD was ascertained using the Mini International Neuropsychiatric Interview (MINI) (n = 691 mothers). We studied PTSD in mothers using weighted Poisson regression. Homeless migrant mothers had high levels of PTSD (18.9%) in the 12 months preceding the study. In multivariate analysis, PTSD was associated with departure from the country of origin because of violence (PR = 1.45 95% CI 1.03; 2.04), depression in the preceding 12 months (PR = 1.82 95% CI 1.20; 2.76), and residential instability (PR = 1.93 95% CI 1.27; 2.93). Homeless migrant mothers have high levels of traumatic events and PTSD. Improvements in screening for depression and PTSD and access to appropriate medical care are essential for this vulnerable group.

Hunger in Vulnerable Families in Southeastern Europe: Associations With Mental Health and Violence

Background: Hunger can influence healthy development of children and has been shown to be associated with other determinants of child health, such as violence within the family and maternal (mental) health problems. Whilst the majority of research has been conducted in high-income countries with vulnerable populations, less is known about the circumstances in low-and-middle-income countries. This study explored the experience of hunger in vulnerable families in three Southeastern European countries, and simultaneously examined relationships with four sets of risk factors—lack of financial, mental, familial, and social resources.

Methods: Families (N = 140) were recruited for a parenting intervention targeting child behavioral problems. Baseline data was collected on hunger, socioeconomic characteristics, mental health and wellbeing, family violence (i.e., child maltreatment and intimate partner violence), and social and emotional support. Univariate and multivariable risk factors of hunger were examined cross-sectionally with regression models.

Results: Overall, 31% of families experienced at least one form of hunger in the last month. Worse family functioning, current intimate partner violence, and more instances of child neglect showed univariate associations with family hunger. In hierarchical analysis, five risk factors remained significantly associated with the experience of hunger: lower adult educational, literacy level, emotional support, more children in the household and higher scores on parental depression, anxiety, and stress.

Conclusions: Hunger in Southeastern European families, among families with children showing elevated behavioral problems, was associated with more family violence, but specifically poorer mental health and less emotional support above and beyond socio-structural strains. Adapting parenting interventions to support the primary caregiver in getting more access to emotional support may potentially also change hunger and its association with health and violence. However, this hypothetical pathway of change needs explicit testing.

The Relation Between Household Food Insecurity and Children's Height in Canada and the United States: A Scoping Review

Household food insecurity is a determinant of health and marker of material deprivation. Although research has shown that food insecurity is associated with numerous adverse health, developmental and nutritional outcomes among children in high-income countries, little is known about its impact on children's height, an important marker of nutritional status and physical development. We reviewed evidence on the relation between experience-based measures of food insecurity and the height of children aged 0-18 y in Canada and the United States. The search, conducted in Embase, Medline, CINAHL, ProQuest, Web of Science, and EconLit from the inception of the databases to October 2017, identified 811 records that were screened for relevance. A total of 8 peer-reviewed studies, 2 from Canada and 6 from the United States, met the inclusion criteria and were summarized. Five studies found no association between food insecurity and children's height. One study found that having taller children in the household predicted more severe food insecurity, whereas 2 studies found that more severe experiences of food insecurity were associated with shorter height among children from ethnic minority populations. These results suggest that household food insecurity may not be associated with height inequalities among children in Canada and the United States, except perhaps in certain high-risk populations. However, the few studies identified for review provide insufficient evidence to determine whether food insecurity is or is not associated with children's height in these countries. Given the importance of optimal linear growth for current and future well-being, it is critical to understand how different modifiable environmental circumstances relate to children's height to help establish priorities for intervention. Families with children are disproportionately affected by food insecurity, and more research explicitly designed to examine the association between household food insecurity and children's height in high-income countries is needed.

Food Insecurity in Portugal Among Middle- and Older-Aged Adults at a Time of Economic Crisis Recovery: Prevalence and Determinants

BACKGROUND

To characterize the scenario of food insecurity in Portugal at a time of economic crisis recovery is of the utmost relevance.

OBJECTIVE

This study aimed to estimate the prevalence and to identify the determinants of food insecurity during economic crisis recovery in a population-based urban sample of middle- and older-aged Portuguese adults.

METHODS

A cross-sectional study including 604 participants of the EPIPorto cohort was conducted. Data on sociodemographic characteristics and on food security status were collected. Food security status was assessed using the US Household Food Security Survey Module: Six-Item Short Form. Logistic regression models, crude and adjusted for sex, age, education, and household income perception, were performed.

RESULTS

The prevalence of food insecurity was 16.6%. Women (odds ratio [OR] = 1.96; 95% confidence interval [CI]: 1.09-3.54), those less educated (OR = 5.46; 95% CI: 2.84-10.46), and those who had the perception of an insufficient household income (OR = 10.39; 95% CI: 5.00-21.56) were more likely to belong to a food insecure household. Unmarried individuals (OR = 1.79; 95% CI: 1.05-3.06) and lower white-collar workers (OR = 2.22; 95% CI: 1.03-4.77) were also more prone to live within a food insecure household, regardless of sex, age, education, and household income perception.

CONCLUSIONS

The obtained information is valuable for the development of intervention strategies to reduce food insecurity in middle- and older-aged adults, suggesting that women, unmarried, less educated individuals, less skilled workers, and lower income families should be targeted.

Anaemia and associated factors in homeless children in the Paris region: the ENFAMS survey

Background

Food insecurity is a major concern in homeless population, however nutritional consequences remain poorly documented, especially for children. The objective of this study was to assess the prevalence of anaemia and to investigate the relation between both food insecurity and dietary intake to moderate-to-severe anaemia (MSA) in homeless sheltered children.

Methods

In 2013, a cross-sectional survey was conducted on a random sample of 801 sheltered homeless families in the Paris region. Haemoglobin concentration was measured in 630 mother/child dyads and questionnaires administrated to mothers collected socio-demographic, socioeconomic, health and dietary data. Factors associated with MSA were analysed in two stratified child age groups; 0.5-5 and 6-12 years old.

Results

Anaemia was detected in 39.9% of the children and 50.6% of the mothers, and MSA in 22.3% and 25.6%, respectively. In both age groups, MSA was positively associated with maternal MSA. In the 0.5-5 years group, it was also positively associated with child food insecurity, no cooking facilities and household monthly income. In the 6-12 years group, it was positively associated with household food insecurity and children's age.

Conclusion

A higher food insecurity score was associated with greater prevalence of moderate-to-severe anaemia in children. Considering the high prevalence of anaemia among homeless mothers and their children, these findings highlight the need for reducing food insecurity in shelters so as to prevent anaemia in this vulnerable population.

Household food insecurity and socio-demographic determinants in young adults: findings from a Portuguese population-based sample

OBJECTIVES

This study evaluated the prevalence and the socio-demographic determinants of food insecurity among young adults at a time of economic crisis recovery.

METHODS

A cross-sectional study including 954 young adults (26 years old) from the EPITeen cohort (Porto, Portugal) was conducted. Food security status was evaluated using the US Household Food Security Survey Module: Six-Item Short Form. Associations between socio-demographic characteristics (sex, education, occupation, household size and structure and household income perception) and food insecurity were estimated using logistic regression.

RESULTS

At a time of economic crisis recovery, 11.0% of young adults experienced food insecurity. A higher odds of belonging to a food insecure household was observed in participants reporting an insufficient household income (OR = 23.3; 95% CI 11.3-47.8), those with less education (OR = 1.7; 95% CI 1.0-2.8), lower white-collar workers (OR = 2.3; 95% CI 1.2-4.2) and those living within a nuclear family including a partner and/or children (OR = 2.0; 95% CI 1.1-3.7).

CONCLUSIONS

Our findings support the need for interventions targeting those from lower income, from nuclear families of young adults with a partner and/or descendants, less educated and with non-manual unskilled occupations, to reduce food insecurity, particularly in economic vulnerable settings.

Impact of fruits and vegetables vouchers on food insecurity in disadvantaged families from a Paris suburb

BACKGROUND

Social inequalities in nutrition lead a high number of families to struggle with food insecurity, even in developed countries. We aimed to assess the impact of fruits and vegetables vouchers on food security among disadvantaged households from a Paris suburb.

METHODS

We used a pre-post assessment design. Families answered face-to-face questionnaires on food consumption and food security status before and after a randomly assigned intervention. Households in the intervention group received vouchers to buy exclusively fruits and vegetables over one year. Both intervention and control groups benefitted from nutritional education through workshops performed by dieticians during the study period. The Household Food Security Module (HFSM) was used to assess food security status of households at inclusion. Food Insufficiency Indicator (FSI) was used to assess food security at inclusion and follow-up. Evolution of FSI on both groups was evaluated using McNemar test.

RESULTS

Among the 91 families included between May 2015 and May 2016, 64 completed the post assessment questionnaire. At inclusion, 68.3% of families were experiencing food insecurity and 78.1% were experiencing food insufficiency. No association was found between food consumptions and food security status. After one-year follow-up, the prevalence of food insufficiency was significantly decreased in the intervention group (61.8%, with p value = 0.03), and unchanged in the control group.

CONCLUSION

In this pilot study, food insufficiency was significantly decreased in families receiving vouchers for fruits and vegetables over a one-year period.

TRIAL REGISTRATION

NCT02461238, registered 3 June 2015 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02461238.

What can Secondary Data Tell Us about Household Food Insecurity in a High-Income Country Context?

In the absence of routinely collected household food insecurity data, this study investigated what could be determined about the nature and prevalence of household food insecurity in Scotland from secondary data. Secondary analysis of the Living Costs and Food Survey (2007–2012) was conducted to calculate weekly food expenditure and its ratio to equivalised income for households below average income (HBAI) and above average income (non-HBAI). Diet Quality Index (DQI) scores were calculated for this survey and the Scottish Health Survey (SHeS, 2008 and 2012). Secondary data provided a partial picture of food insecurity prevalence in Scotland, and a limited picture of differences in diet quality. In 2012, HBAI spent significantly less in absolute terms per week on food and non-alcoholic drinks (£53.85) compared to non-HBAI (£86.73), but proportionately more of their income (29% and 15% respectively). Poorer households were less likely to achieve recommended fruit and vegetable intakes than were more affluent households. The mean DQI score (SHeS data) of HBAI fell between 2008 and 2012, and was significantly lower than the mean score for non-HBAI in 2012. Secondary data are insufficient to generate the robust and comprehensive picture needed to monitor the incidence and prevalence of food insecurity in Scotland.

"A Lot of People Are Struggling Privately. They Don't Know Where to Go or They're Not Sure of What to Do": Frontline Service Provider Perspectives of the Nature of Household Food Insecurity in Scotland

This qualitative study explored frontline service providers' perceptions of the nature of food insecurity in Scotland in 2015 to inform national policy and the provision of locally-based support for 'at risk' groups. A country-wide in-depth interview study was undertaken with informants from 25 health, social care, and third sector organisations. The study investigated informants' perspectives associated with how food insecurity was manifesting itself locally, and what was happening at the local level in response to the existence of food insecurity. Data analysis revealed three key themes. First, the multiple faces and factors of food insecurity involving not only increased concern for previously recognised 'at risk of food insecurity' groups, but also similar concern held about newly food insecure groups including working families, young people and women. Secondly, respondents witnessed stoicism and struggle, but also resistance amongst some food insecure individuals to external offers of help. The final theme identified community participation yet pessimism associated with addressing current and future needs of food insecure groups. These findings have important implications for the design and delivery of health and social policy in Scotland and other countries facing similar challenges.

Walking the Food Security Tightrope-Exploring the Experiences of Low-to-Middle Income Melbourne Households

There is limited evidence of how Australian low-to-middle income (AUD $40,000⁻$80,000) households maintain food security. Using a sequential explanatory mixed methods methodology, this study explored and compared the food security (FS) and insecurity (FIS) experiences of these households. An initial quantitative survey categorised participants according to food security status (the 18-item United States Department of Agriculture Household Food Security Survey Module) and income level to identify and purposefully select participants to qualitatively explore food insecurity and security experiences. Of the total number of survey participants (n = 134), 42 were categorised as low-to-middle income. Of these, a subset of 16 participants (8 FIS and 8 FS) was selected, and each participant completed an in-depth interview. The interviews explored precursors, strategies to prevent or address food insecurity, and the implications of the experience. Interview data were analysed using a thematic analysis approach. Five themes emerged from the analysis: (i) food decision experiences, (ii) assets, (iii) triggers, (iv) activation of assets, and (v) consequences and emotion related to walking the food security tightrope. The leverage points across all themes were more volatile for FIS participants. Low-to-middle income Australians are facing the challenges of trying to maintain or improve their food security status, with similarities to those described in lower income groups, and should be included in approaches to prevent or address food insecurity.

Social inequalities in health and mental health in France. The results of a 2010 population-based survey in Paris Metropolitan Area

The present study aimed to assess socioeconomic inequalities in general and mental health, depression and substance use disorders (daily tobacco use, hazardous alcohol use). Data from the 2010 SIRS (French acronym for Health, Inequalities, and Social Ruptures) study, which is deemed to be representative of the French-speaking adult population living in the Paris Metropolitan Area, were analysed. Different socioeconomic position indicators were selected: education, income and perceived financial status. Absolute measures (the slope index of inequality (SII)) and relative measures (the odds ratio (OR) and relative index of inequality (RII)) of health inequalities were used. The OR, RII and SII were adjusted for age, household type and migration characteristics and all analyses were performed separately for men and women. The study included 3,006 adults. The results showed significant relative and absolute socioeconomic inequalities in general, mental health and depression for all socioeconomic position indicators considered (education, income, and perceived financial status). The absolute inequalities were greater for women than for men. Strongest inequalities were observed by perceived financial status for men and women. Education seemed to play a stronger role in inequalities for women, whereas, for men, income seemed to play a stronger role. Only few socioeconomic inequalities were found in daily tobacco use, while a reversed gradient was observed for hazardous alcohol use. We hope that these results will be regularly re-evaluated and compared across time in order to monitor socioeconomic inequalities in health.

Health inequalities: a global perspective

The objective of this article is to present health inequalities as a global problem which afflicts the populations of the poorest countries, but also those of the richest countries, and whose persistence represents one of the most serious and challenging health problems worldwide. Two components of global inequalities are highlighted: inequalities between groups within the same society, and inequalities between nations. The understanding that many of these inequalities are unjust, and therefore inequities, is largely derived from the inequalities that are identified between the various social groups of a given society. Inequalities between different societies and nations, while relevant and often of greater magnitude, are not always considered to be unjust. There have been several proposed solutions, which vary according to different theoretical interpretations and explanations. At the global level, the most plausible thesis has focused on improving global governance mechanisms. While that latter are attractive and have some arguments in their favor, they are insufficient because they do not incorporate an understanding of how the historical process of the constitution of the nations occurred and the importance of the position of each country in the global productive system.

Factors associated with depression among homeless mothers. Results of the ENFAMS survey

PURPOSE

Women are disproportionately likely to suffer from depression. This is especially true for those who experience socioeconomic hardship, such as homelessness. In France, among homeless mothers many are migrant. However, it is not clear whether risk factors associated with depression are specific for this group or the same as in the general population. Our objective was to describe socio-demographic, relational, living and housing conditions and health factors associated with depression among homeless mothers.

METHODS

The ENFAMS survey, conducted via face-to-face bilingual interviews with a representative sample of homeless families in the Paris region (January-May 2013, n = 733 mothers). Mothers reported their socio-demographic characteristics, housing conditions including residential mobility, as well as physical and mental health. Depression was ascertained using the Composite International Diagnostic Interview (CIDI). Factors associated with mother's depression were studied in weighted Poisson regression models with robust error variance.

RESULTS

The prevalence of depression among participating mothers was 28.8%. In multivariate analyses, depression was associated with fluency in French (PR = 1.88 95% CI 1.40; 2.51), suicide risk (PR = 2.26, 95% CI 1.82; 2.82), post-traumatic stress disorder (PR = 1.97, 95% CI 1.50; 2.60), and unmet health needs (PR = 1.68, 95% CI 1.09; 2.57).

CONCLUSIONS

Homeless mothers have high levels of depression and associated psychiatric comorbidities. Associated risk factors appear to be both specific for this group and shared with mothers in the general population. Improvements in the monitoring of mental health difficulties as well as access to appropriate medical care in this vulnerable population may help improve health and social outcomes.

Food Insecurity in Homeless Families in the Paris Region (France): Results from the ENFAMS Survey

The number of families living in shelters in the Paris region (France) has increased by a factor of three in 10 years. In 2013, a survey was performed on homeless families in order to characterize their living conditions, their health needs, and the developmental problems in children. This probability survey was conducted in 17 languages among 801 homeless families sheltered in emergency centers for asylum-seekers, emergency housing centers, social rehabilitation centers, and social hotels in the Paris region. Among the 772 families that provided data on food security only 14.0% were with food security, whereas 43.3% were with low food security and 9.8% with very low food security (a situation where children are also affected). Stratified multivariate robust Poisson models showed that some characteristics are associated with a higher risk of food insecurity and/or of falling into very low food security, such as residential instability, single parenthood, having more than three children, depressive symptoms, housing in social hostels, and difficult access to cheap or free food locally. Given the wealth of the Paris region, resources and programs should be concentrated on improving the living situation of this vulnerable population. It needs better detection of these families, a closer social follow-up, and an increase in food aid.

Adaptive Behavior of Sheltered Homeless Children in the French ENFAMS Survey

OBJECTIVES

To describe the adaptive behaviors in a large sample of homeless children and identify factors associated with developmental delay.

METHODS

Data were from a cross-sectional survey of 557 children younger than 6 years randomly sampled among homeless sheltered families in the Paris region, France (January-May 2013). An interviewer and a psychologist conducted face-to-face interviews to collect information on sociodemographic and health characteristics. We assessed adaptive behaviors using the Vineland Adaptive Behavior Scales, second edition (VABS-II).

RESULTS

The mean VABS-II composite score (SD) was 75.4 (12.0), and most participating children (80.9%) were considered developmentally delayed. Characteristics negatively associated with children's developmental score were age, birth in a country other than France, low birth weight, and past-year hospitalization.

CONCLUSIONS

There is a high prevalence of developmental delays among children growing up homeless. Public Health Implications. Long-term integrated programs improving parenting and children's opportunities for stimulation and socialization should be developed in daycare centers, schools, shelters, and medical practices to minimize negative effects of early living conditions on children's development.

Prevalence of food insecurity among food bank users in Germany and its association with population characteristics

The prevalence of food insecurity (FI) among food bank users in many European countries is unknown. The study aims to examine FI prevalence and associated population characteristics among this particular group of disadvantaged people in Germany. Food insecurity status was assessed among 1033 adult food bank users with a mean age of 53 years (57% female, 43% male) in Germany in 2015 using the food insecurity experience scale (FIES). About half of the participants (55.8%) were single with no children and born in Germany. Over 37% had a self-reported BMI of 30 kg/m² or above and 37.4% indicated to smoke. Over 70% of the food bank users can be described as food insecure. Of those, about 35% were considered mildly food insecure. Almost 30% were categorized as moderately food insecure while over 7% were categorized as severely food insecure. Significant associations with food insecurity were found for gender, age, subjective health status, smoking, duration of food bank use, school education and family type. Among this socially disadvantaged population, food insecurity is highly prevalent and public health efforts should be focusing on this vulnerable population taken into account the identified population and behavioral characteristics associated with food insecurity.

Are low-to-middle-income households experiencing food insecurity in Victoria, Australia? An examination of the Victorian Population Health Survey, 2006-2009

Food insecurity affects health and wellbeing. Little is known about the relationship between food insecurity across income levels. This study aims to investigate the prevalence and frequency of food insecurity in low-to-middle-income Victorian households over time and identify factors associated with food insecurity in these households. Prevalence and frequency of food insecurity was analysed across household income levels using data from the cross-sectional 2006-09 Victorian Population Health Surveys (VPHS). Respondents were categorised as food insecure, if in the last 12 months they had run out of food and were unable to afford to buy more. Multivariable logistic regression was used to describe factors associated with food insecurity in low-to-middle-income households (A$40000-$80000 in 2008). Between 4.9 and 5.5% for total survey populations and 3.9-4.8% in low-to-middle-income respondents were food insecure. Food insecurity was associated with limited help from friends, home ownership status, inability to raise money in an emergency and cost of some foods. Food insecurity exists in households beyond those on a very low income. Understanding the extent and implications of household food insecurity across all income groups in Australia will inform effective and appropriate public health responses.

Unmet healthcare needs in homeless women with children in the Greater Paris area in France

BACKGROUND

Despite their poor health status, homeless women encounter many barriers to care. The objectives of our study were to estimate the prevalence of unmet healthcare needs in homeless women and to analyse associated relationships with the following factors: financial and spatial access to care, housing history, migration status, healthcare utilisation, victimization history, caring for children, social network and self-perceived health status.

METHODS

We used data from 656 homeless women interviewed during the ENFAMS representative survey of sheltered homeless families, conducted in the Paris region in 2013. Structural equation models (SEM) were used to estimate the impact of various factors on homeless women's unmet healthcare needs.

RESULTS

Among those interviewed, 25.1% (95%CI[21.3-29.0]) had at least one unmet healthcare need over the previous year. Most had given up on visiting general practitioners and medical specialists. No association with factors related to financial access or to health insurance status was found. However, food insecurity, poor spatial health access and poor self-perceived health were associated with unmet healthcare needs. Self-perceived health appeared to be affected by victimization and depression.

DISCUSSION

The lower prevalence of unmet healthcare needs in homeless women compared with women in stable housing situations suggests that homeless women have lower needs perceptions and/or lower expectations of the healthcare system. This hypothesis is supported by the results from SEM. Strategies to provide better access to care for this population should not only focus on financial interventions but also more broadly on spatial healthcare access, cultural norms, and perceptions of health. Reducing their unmet needs and improving their access to healthcare and prevention must include an improvement in their living, financial and housing conditions.

Counter-intuitive plasma vitamin D and zinc status in HIV-1-infected adults with persistent low-level viraemia after treatment initiation: a pilot case-control study

Determinants of persistent low-level viraemia [PLLV, a viral load (VL) of between 50 and 500 copies/mL] have not been elucidated. In a case-control study, we evaluated the influence of micronutrients on PLLV in a population of 454 HIV-1 adults having initiated antiretroviral therapy (ART) between January 2007 and December 2011. Plasma levels of retinol (vitamin A), 25-OH vitamin D₂ + D₃, vitamin E and zinc were measured at ART initiation in cases (PLLV after 6 months of ART) and in controls (VL <50 copies/mL after 6 months). Cases and controls were matched for the CD4 cell count (±50/mm³) and ethnic origin. Intergroup differences in demographic, biological and treatment parameters and sunshine intensity at ART initiation were adjusted using a propensity score. A receiver operating characteristic (ROC) curve was used to assess intergroup differences in plasma micronutrient levels. Thirty-three of the 454 patients (7.3%) displayed PLLV (median VL: 92 copies/mL). Patients were predominantly male (89%), Caucasian (64%) and CDC stage C (25%). The median age was 38 years, the median initial VL was 5.2 log₁₀ copies/mL and the median CD4 count was 74/mm³. The 22 cases and matched controls were balanced in these respects, and had similar vitamin A/E levels. Two cases (9%) and 9 controls (41%) had a vitamin D level <10.3 ng/mL (p = 0.0015), and 2 cases (9%) and 10 controls (48%) had a zinc level <74.6 μg/dL (p = 0.04). Our results support in vitro studies suggesting that vitamin D favours HIV-1 replication and that HIV-1 is zinc-dependent. Wide-scale, prospective studies are required.

Gender differences in the prevalence of household food insecurity: a systematic review and meta-analysis

OBJECTIVE

The present review aimed to identify and synthesize literature on household food insecurity with respect to whether the respondent was male or female.

DESIGN

A systematic review of prevalence studies followed by a meta-analysis was conducted between 28 August 2014 and 19 October 2014 in seven electronic databases. The search was updated in April 2016. The included studies used experience-based measures to assess household food insecurity. Dichotomous measures of food insecurity were used. Pooled odds ratios of household food insecurity prevalence in women v. men were obtained through random-effect modelling. Quality assessment, publication bias diagnostics and subgroup analysis were also performed.

SETTING

Population-based studies (i.e. non-clinical populations).

SUBJECTS

Participants aged 18 years or over.

RESULTS

Out of the 5145 articles initially identified, forty-two studies with a total population of 233 153 were included. In general, results showed that the odds for household food insecurity was 40 % higher in studies where women were the respondent (95 % CI 1·27, 1·54; P<0·001). Besides, subgroup analysis revealed that female-headed households were 75% (95 % CI 49-96%) more likely to be food insecure than male-headed households.

CONCLUSIONS

Our results confirm the existence of gender differences in reporting household food insecurity. Furthermore, they indicate that households headed by women constitute a segment of the population that is particularly vulnerable to food insecurity.

Incorporating the gut microbiota into models of human and non-human primate ecology and evolution

The mammalian gut is home to a diverse community of microbes. Advances in technology over the past two decades have allowed us to examine this community, the gut microbiota, in more detail, revealing a wide range of influences on host nutrition, health, and behavior. These host-gut microbe interactions appear to shape host plasticity and fitness in a variety of contexts, and therefore represent a key factor missing from existing models of human and non-human primate ecology and evolution. However, current studies of the gut microbiota tend to include limited contextual data or are clinical, making it difficult to directly test broad anthropological hypotheses. Here, I review what is known about the animal gut microbiota and provide examples of how gut microbiota research can be integrated into the study of human and non-human primate ecology and evolution with targeted data collection. Specifically, I examine how the gut microbiota may impact primate diet, energetics, disease resistance, and cognition. While gut microbiota research is proliferating rapidly, especially in the context of humans, there remain important gaps in our understanding of host-gut microbe interactions that will require an anthropological perspective to fill. Likewise, gut microbiota research will be an important tool for filling remaining gaps in anthropological research.

Emotional and behavioral difficulties in children growing up homeless in Paris. Results of the ENFAMS survey

PURPOSE

Children growing up in homeless families are disproportionately more likely to experience health and psychological problems. Our objective was to describe social, environmental, individual and family characteristics associated with emotional and behavioral difficulties among homeless children living in the Paris region.

METHODS

Face-to-face interviews with a representative sample of homeless families were conducted by bilingual psychologists and interviewers between January and May 2013 (n=343 children ages 4-13 years). Mothers reported children's emotional and behavioral difficulties (Strength and Difficulties Questionnaire [SDQ]), family socio-demographic characteristics, residential mobility, and parents' and children's physical and mental health. Children were interviewed regarding their perception of their living arrangements, friendships and school experiences. We studied children's SDQ total score in a linear regression framework.

RESULTS

Homeless children had higher SDQ total scores than children in the general population of France, (mean total score=11.3 vs 8.9, P<0,001). In multivariate analyses, children's difficulties were associated with parents' region of birth (beta=1.74 for Sub-Saharan Africa, beta=0.60 for Eastern Europe, beta=3.22 for other countries, P=0.020), residential mobility (beta=0.22, P=0.012), children's health (beta=3.49, P<0.001) and overweight (beta=2.14, P=0.007), the child's sleeping habits (beta=2.82, P=0.002), the mother's suicide risk (beta=4.13, P<0.001), the child's dislike of the family's accommodation (beta=3.59, P<0.001) and the child's experience of bullying (beta=3.21, P=0.002).

CONCLUSIONS

Children growing up homeless experience high levels of psychological difficulties which can put them at risk for poor mental health and educational outcomes long-term. Access to appropriate screening and medical care for this vulnerable yet underserved group are greatly needed.

"When I go to bed hungry and sleep, I'm not hungry": Children and parents' experiences of food insecurity

Evidence demonstrates food insecurity has a detrimental impact on a range of outcomes for children, but little research has been conducted in the UK, and children have rarely been asked to describe their experiences directly. We examined the experiences of food insecure families living in South London. Our mixed-methods approach comprised a survey of parents (n = 72) and one-to-one semi-structured interviews with children aged 5-11 years (n = 19). The majority of parents (86%) described their food security during the preceding year as very low. Most reported they had often or sometimes had insufficient food, and almost all had worried about running out of food. Two thirds of parents had gone hungry. Most parents reported they had been unable to afford a nutritionally balanced diet for their children, and just under half reported that their children had gone hungry. Four themes emerged from the interviews with children: sources of food; security of food, nutritional quality of food, and experiences of hunger. Children's descriptions of insufficient food being available indicate that parents are not always able to shield them from the impact of food insecurity. The lack of school-meals and after-school clubs serving food made weekends particularly problematic for some children. A notable consequence of food insecurity appears to be reliance on low-cost takeaway food, likely to be nutritionally poor.

Is there still a French eating model? A taxonomy of eating behaviors in adults living in the Paris metropolitan area in 2010

BACKGROUND

Meal times in France still represent an important moment in everyday life. The model of three rigorously synchronized meals is still followed by a majority of people, while meal frequencies have flattened in other European or North-American countries. We aimed to examine the "French model" of eating behavior by identifying and characterizing distinct meal patterns.

METHODS

Analyses were based on data from the SIRS cohort, a representative survey of the adult population in the Paris area. A clustering algorithm was applied to meal variables (number, time, location, with whom the meal is usually shared and activities associated with meals). Regression models were used to investigate associations between patterns and socio-demographic, social environment and perceived food quality variables.

RESULTS

Five different patterns were identified among 2994 participants. The first three types (prevalence 33%, 17% and 24%) followed a three-meal pattern, with differences in locations and social interactions mainly related to time constraints and age. More marked differences were observed in the remaining two types. In the fourth type (prevalence 13%), individuals ate one or two meals per day, often with an irregular schedule, at home and in front of the television. They frequently were unemployed and had lower income. Breakfast skipping, increased snacking and a low adherence to dietary guidelines suggested that this behavior might have health consequences. In the fifth type (12%), people also ate two meals or less per day, possibly with the same consequences on food quality. However, meals were often taken outside the home, in social settings, and individuals following this pattern were typically active, integrated, young people, suggesting that this pattern might be an adaptation to a modern urban lifestyle.

CONCLUSIONS

While a majority of the population still follows the three-meal pattern, our analysis distinguished two other eating patterns associated with specific sociological profiles.

Food insecurity and associated factors in the Portuguese population

BACKGROUND

The burden of food insecurity in Portugal, and the socioeconomic and demographic factors that are related to this condition, are unknown.

OBJECTIVE

To evaluate the frequency of food insecurity and to identify its associated characteristics in the Portuguese population.

METHODS

Data from 3,552 heads of family respondents of the 2005/06 Portuguese National Health Survey were analyzed in a cross-sectional study. Food insecurity was evaluated with the use of the US Department of Agriculture Household Food Security Survey Module 6-Item Short Form. Chi-square tests and multivariate logistic regression models were conducted. Significance was indicated at p < .05.

RESULTS

Among the respondents, 16.5% were food insecure and 3.5% had very low food security. The odds of being food insecure were highest for women (OR, 1.51; 95% CI, 1.20 to 1.91), smokers (OR, 1.56; 95% CI, 1.20 to 2.02), younger people (OR, 2.54; 95% CI, 1.69 to 3.80), unemployed people (OR, 3.04; 95% CI, 2.01 to 4.60), those with lower education (OR, 7.98; 95% CI, 4.73 to 13.49), and those with lower income (OR, 6.27; 95% CI, 4.23 to 9.30).

CONCLUSIONS

The present study explored for the first time the burden of food insecurity in Portugal, revealing that it was highly prevalent, affecting one in six Portuguese citizens. Low education and low income were the main factors associated with food insecurity.

A general framework for a reliable multivariate analysis and pattern recognition in high-dimensional epidemiological data, based on cluster robustness: a tutorial to enrich the epidemiologists' toolkit

BACKGROUND

In an epidemiologist's toolbox, three main types of statistical tools can be found: means and proportions comparisons, linear or logistic regression models and Cox-type regression models. All these techniques have their own multivariate formulations, so that biases can be accounted for. Nonetheless, there is an entire set of natively massive multivariate techniques, which are based on weaker assumptions than classical statistical techniques are, and which seem to be underestimated or remain unknown to most epidemiologists. These techniques are used for pattern recognition or clustering – that is, for retrieving homogeneous groups in data without any a priori about these groups. They are widely used in connex domains such as genetics or biomolecular studies.

METHODS

Most clustering techniques require tuning specific parameters so that groups can be identified in data. A critical parameter to set is the number of groups the technique needs to discover. Different approaches to find the optimal number of groups are available, such as the silhouette approach and the robustness approach. This article presents the key aspects of clustering techniques (how proximity between observations is defined and how to find the number of groups), two archetypal techniques (namely the k-means and PAM algorithms) and how they relate to more classical statistical approaches.

RESULTS

Through a theoretical, simple example and a real data application, we provide a complete framework within which classical epidemiological concerns can be reconsidered. We show how to (i) identify whether distinct groups exist in data, (ii) identify the optimal number of groups in data, (iii) label each observation according to its own group and (iv) analyze the groups identified according to separate and explicative data. In addition, how to achieve consistent results while removing sensitivity to initial conditions is explained.

CONCLUSIONS

Clustering techniques, in conjunction with methods for parameter tuning, provide the epidemiologist with substantial additional tools. They differ from the usual approaches based on hypothesis-testing because no assumptions are made on the data and these clustering techniques are natively multivariate.

Socio-economic characteristics, living conditions and diet quality are associated with food insecurity in France

OBJECTIVE

To assess the prevalence of household food insecurity (FI) in France and to describe its associations with socio-economic factors, health behaviours, diet quality and cost (estimated using mean food prices).

DESIGN

Cross-sectional nationally representative survey. FI was assessed using an adapted version of the US Department of Agriculture's Food Insufficiency Indicator; dietary intake was assessed using a 7 d open-ended food record; and individual demographic, socio-economic and behavioural variables were assessed using self-administered questionnaires and interviews. Individuals experiencing FI were compared with food-secure individuals, the latter being divided into four categories according to quartiles of their income per consumption unit (FS1 to FS4). Differences among categories were analysed using χ² tests, ANOVA and tests for trend.

SETTING

Individual and National Dietary Survey (INCA2), 2006-2007.

SUBJECTS

Adults aged 18-79 years (n 2624).

RESULTS

Individuals experiencing FI represented 12·2% of the population. They were on average younger, more frequently women and single parents with children compared with those in the other four categories. Their mean income per consumption unit was higher than that in the FS1 category, but they reported poorer material and housing conditions. The prevalence of smoking and the mean daily time spent watching television were also higher in the FI category. No significant difference among categories was found for energy intake, but mean intakes of fruits, vegetables and fish were lower, and diet quality was slightly but significantly poorer in the FI category. Daily diet cost was also lower in the FI category.

CONCLUSIONS

France is not spared by FI. FI should be routinely monitored at the national level and research should be promoted to identify effective strategies to reduce nutrition inequalities in France.

Applying multivariate clustering techniques to health data: the 4 types of healthcare utilization in the Paris metropolitan area

BACKGROUND

Cost containment policies and the need to satisfy patients' health needs and care expectations provide major challenges to healthcare systems. Identification of homogeneous groups in terms of healthcare utilisation could lead to a better understanding of how to adjust healthcare provision to society and patient needs.

METHODS

This study used data from the third wave of the SIRS cohort study, a representative, population-based, socio-epidemiological study set up in 2005 in the Paris metropolitan area, France. The data were analysed using a cross-sectional design. In 2010, 3000 individuals were interviewed in their homes. Non-conventional multivariate clustering techniques were used to determine homogeneous user groups in data. Multinomial models assessed a wide range of potential associations between user characteristics and their pattern of healthcare utilisation.

RESULTS

We identified four distinct patterns of healthcare use. Patterns of consumption and the socio-demographic characteristics of users differed qualitatively and quantitatively between these four profiles. Extensive and intensive use by older, wealthier and unhealthier people contrasted with narrow and parsimonious use by younger, socially deprived people and immigrants. Rare, intermittent use by young healthy men contrasted with regular targeted use by healthy and wealthy women.

CONCLUSION

The use of an original technique of massive multivariate analysis allowed us to characterise different types of healthcare users, both in terms of resource utilisation and socio-demographic variables. This method would merit replication in different populations and healthcare systems.

A survey of food bank operations in five Canadian cities

BACKGROUND

Food banks have emerged in response to growing food insecurity among low-income groups in many affluent nations, but their ability to manage this problem is questionable. In Canada, in the absence of public programs and policy interventions, food banks are the only source of immediate assistance for households struggling to meet food needs, but there are many indications that this response is insufficient. The purpose of this study was to examine the factors that facilitate and limit food bank operations in five Canadian cities and appraise the potential of these initiatives to meet food needs.

METHODS

An inventory of charitable food provisioning in Halifax, Quebec City, Toronto, Edmonton, and Victoria, Canada was conducted in 2010. Of the 517 agencies that participated in a telephone survey of their operations, 340 were running grocery programs. Multivariate regression analyses were conducted to determine the association between program characteristics, volume of service, and indicators of strain in food banks' abilities to consistently achieve the standards of assistance they had established.

RESULTS

Extensive, well-established food bank activities were charted in each city, with the numbers of people assisted ranging from 7,111 in Halifax to 90,141 in Toronto per month. Seventy-two percent of agencies indicated that clients needed more food than they provided. The number of people served by any one agency in the course of a month was positively associated with the proportion of food distributed that came from donations (beta 0.0143, SE 0.0024, p 0.0041) and the number of volunteers working in the agency (beta 0.0630, SE 0.0159, p 0.0167). Food banks only achieved equilibrium between supply and demand when they contained demand through restrictions on client access. When access to assistance was less restricted, the odds of food banks running out of food and invoking measures to ration remaining supplies and restrict access rose significantly.

CONCLUSIONS

Despite their extensive history, food banks in Canada remain dependent on donations and volunteers, with available resources quickly exhausted in the face of agencies' efforts to more fully meet clients' needs. Food banks have limited capacity to respond to the needs of those who seek assistance.

Food insecurity, a determinant of obesity? - an analysis from a population-based survey in the Paris metropolitan area, 2010

OBJECTIVE

The relationship between food insecurity and obesity is discussed in the literature. The objective of this study was to determine whether food insecurity and obesity were associated in the Paris metropolitan area.

METHODS

We used data from third wave of the Health, Inequalities and Social Ruptures (SIRS) cohort study, a longitudinal population-based, representative health and socioepidemiological survey of the general population in the Paris metropolitan area. The participants' BMI (calculated using self-reported height and weight) was analyzed as a continuous variable, and a dichotomous variable (BMI < 30 kg/m(2)/BMI ≥ 30 kg/m(2)) was constructed. Food insecurity was estimated using the Household Food Security Scale Module (HFSSM) and was treated as a trichotomous variable (food security / low food security / very low food security). Multilevel models were estimated for men and women separately.

RESULTS

Obesity (BMI ≥ 30 kg/m(2)) prevalence was 10.2%. The determinant of obesity differs according to gender. After adjustment for age, income and the sociooccupational group, very low food security was associated with obesity in women (OR = 2.01, 95%CI 1.05-3.82), and women with very low food security had a higher BMI (Coef. = 1.78, 95% CI 0.24-3.31). This association, however, was not significant for men (OR = 1.84, 95%CI 0.64-5.30).

CONCLUSION

In times of economic crisis, it is increasingly essential to explore and understand the pathway through which very low food security is linked to obesity.

Socioeconomic status, food security, and dental caries in US children: mediation analyses of data from the National Health and Nutrition Examination Survey, 2007-2008

OBJECTIVES

We examined associations of household socioeconomic status (SES) and food security with children's oral health outcomes.

METHODS

We analyzed 2007 and 2008 US National Health and Nutrition Examination Survey data for children aged 5 to 17 years (n = 2206) to examine the relationship between food security and untreated dental caries and to assess whether food security mediates the SES-caries relationship.

RESULTS

About 20.1% of children had untreated caries. Most households had full food security (62%); 13% had marginal, 17% had low, and 8% had very low food security. Higher SES was associated with significantly lower caries prevalence (prevalence ratio [PR] = 0.77; 95% confidence interval = 0.63, 0.94; P = .01). Children from households with low or very low food security had significantly higher caries prevalence (PR = 2.00 and PR = 1.70, respectively) than did children living in fully food-secure households. Caries prevalence did not differ among children from fully and marginally food-secure households (P = .17). Food insecurity did not appear to mediate the SES-caries relationship.

CONCLUSIONS

Interventions and policies to ensure food security may help address the US pediatric caries epidemic.