The 18 Household Food Security Survey items provide valid food security classifications for adults and children in the Caribbean

Relationship between Food Security, Nutrition Security, and Diabetes: The Role of Supplemental Nutrition Assistance Program Participation

Background

Inadequate nutrition and poor diet quality are associated with a heightened risk of diabetes. The connection between food insecurity measures and diabetes has been established, with evidence indicating that Supplemental Nutrition Assistance Program (SNAP) participation contributes to reductions in food insecurity. Recently developed nutrition security measures, defined as the ability to acquire healthful foods to prevent diseases, and their association with diabetes and SNAP participation are not yet understood.

Objectives

This study aimed to assess the relationship between food security and nutrition security in relation to diabetes overall and by SNAP participation and nutrition security as potential modifiers.

Methods

Secondary data analysis of cross-sectional pilot study data collected from adults in 5 US states (N = 517). Logistic regression mixed models included moderation analysis and clustering effects by state to address site-level confounding.

Results

Higher nutrition security scores among adults, after adjusting for confounders, were significantly associated with lower odds of diabetes risk (adjusted odds ratio = 0.59; 95% confidence interval: 0.40, 0.87; P value = 0.008). Statistically significant interaction effect of differences according to SNAP participation was observed for nutrition security (Phomogeneity/interaction = 0.021), adjusting for age, gender, race/ethnicity, education, employment, National School Lunch Program, Special Supplemental Nutrition Program for Women, Infants, and Children, food pantry use, household with children, survey mode, and food security. The association between food security and diabetes was not statistically significant overall. However, statistically significant interaction effect of differences according to SNAP participation was observed for food security (Phomogeneity/interaction = 0.047). Further, no interaction effect of differences in nutrition security was found between food security and self-reported diabetes/prediabetes (Phomogeneity/interaction = 0.250).

Conclusions

This study sheds light on the early exploration of the intricate relationship between nutrition security and diabetes. The findings suggest that a higher nutrition security score, after adjusting for confounders, was significantly associated with lower odds of diabetes risk. Notably, there were statistically significant interaction effects in these associations based on SNAP participation.

Investigating psychological distress and peer influence in the longitudinal path linking food insecurity to adolescent substance use: a nationwide low-income cohort study

Food insecurity (FI), defined as the limited or uncertain availability of nutritionally adequate and safe foods, remains a major life concern among many poor subpopulations. Few investigations have been made into the mechanism underlying its impact on adolescent substance use. This study aimed to examine the longitudinal relationship between FI and cigarette and alcohol use among economically disadvantaged adolescents and then explore the role of psychological distress and peer substance use in the aforementioned association. Data of 1,243 adolescents (Mage = 13.3 years; 645 males) were obtained from a nationwide cohort study on Taiwanese adolescents from low-income families. Multiple hierarchical regression analyses based on generalized linear mixed-effects models with binomial distribution found that FI was consistently associated with cigarette smoking (β = 0.458, p < 0.001) but not alcohol drinking (β = 0.142, p = 0.143) when both psychological distress and peer substance use were adjusted. In the moderated mediation analysis based on bootstrap methods, we observed that psychological distress mediated the association between food insecurity and alcohol drinking (β = 0.036, 95% CI = 0.015-0.063) but not cigarette smoking (β = 0.018, 95% CI =-0.001-0.037). Furthermore, the indirect effects varied by peer drinking status (index of moderated mediation = 0.04, 95% CI 0.015-0.072). Clinical and public health attention should be given to evaluating food-insecure adolescents' psychological well-being and peer influence when counseling their substance use issues.

The role of sexual orientation in the relationships among food insecurity, food literacy, and disordered eating

LGBTQ young adults are at increased risk for food insecurity and disordered eating behaviors. Food literacy is a related construct that may also impact disordered eating; however, research on these relationships is limited. It is also not well understood if food security and food literacy relate to disordered eating behaviors differently for LGBTQ and heterosexual individuals. The current study examined these constructs in a sample of college students (n = 572; 22 % LGBTQ), as well as examined sexual orientation as a moderator in the relationship between food insecurity/food literacy and disordered eating outcomes. Results showed that LGBTQ individuals reported greater dieting/restricting, bulimia symptoms, oral control, and binge eating symptoms than heterosexual peers. LGBTQ students were also more likely to be food insecure and had significantly lower food literacy than heterosexual students. Sexual orientation significantly moderated the relationships between food insecurity and overall disordered eating, and between food insecurity and dieting/restricting behaviors. These relationships showed that very low food security was strongly related to disordered eating symptoms for LGBTQ individuals. Sexual orientation did not moderate the relationship between food literacy and disordered eating outcomes. These findings contribute to the overall literature on food insecurity and disordered eating for the LGBTQ community through replicating past findings, and also provide new information about relationships between food literacy, food insecurity, disordered eating, and the role of sexual orientation.

A systematic literature review of indicators measuring food security

Measurement is critical for assessing and monitoring food security. Yet, it is difficult to comprehend which food security dimensions, components, and levels the numerous available indicators reflect. We thus conducted a systematic literature review to analyse the scientific evidence on these indicators to comprehend the food security dimensions and components covered, intended purpose, level of analysis, data requirements, and recent developments and concepts applied in food security measurement. Data analysis of 78 articles shows that the household-level calorie adequacy indicator is the most frequently used (22%) as a sole measure of food security. The dietary diversity-based (44%) and experience-based (40%) indicators also find frequent use. The food utilisation (13%) and stability (18%) dimensions were seldom captured when measuring food security, and only three of the retrieved publications measured food security by considering all the four food security dimensions. The majority of the studies that applied calorie adequacy and dietary diversity-based indicators employed secondary data whereas most of the studies that applied experience-based indicators employed primary data, suggesting the convenience of collecting data for experience-based indicators than dietary-based indicators. We confirm that the estimation of complementary food security indicators consistently over time can help capture the different food security dimensions and components, and experience-based indicators are more suitable for rapid food security assessments. We suggest practitioners to integrate food consumption and anthropometry data in regular household living standard surveys for more comprehensive food security analysis. The results of this study can be used by food security stakeholders such as governments, practitioners and academics for briefs, teaching, as well as policy-related interventions and evaluations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40066-023-00415-7.

Physical Inactivity and Food Insecurity Are Associated with Social Capital: A Large-Scale Population-Based Study in Tehran

Background. There are limited studies on food security, physical activity, and social capital in the Iranian population. This study aimed to evaluate the social capital’s associations with physical inactivity and food insecurity in a large-scale study in Iran, Urban HEART-2. Methods. This cross-sectional study was conducted in 22 districts of Tehran, the capital of Iran. Residents of Tehran who were 15 years or older were selected by a multi-stage, stratified, and random sampling method. Food insecurity and physical activity were evaluated using Household Food Security Scale and Global Physical Activity Questionnaire, respectively, and their associations with social capital were evaluated. Results. A total of 5030 individuals were included in this study, with 3139 (62.4%) males. The mean age of participants was 44.08 years (SD = 16.33, range = 15–90). Participation in social events (OR = 0.893, 95% CI = 0.819–0.974, $P$  = 0.011), social network (OR = 0.849, 95% CI = 0.786, $P$  < 0.001), and voluntary activities (OR = 0.865, 95% CI = 0.812–0.921, $P$  < 0.001) were all negatively associated with food insecurity. Also, voluntary activities (OR = 0.823, 95% CI = 0.776–0.872, $P$  < 0.001) and participation in the associations activities (OR = 0.665, 95% CI = 0.582–0.759, $P$  < 0.001) were negatively associated with physical inactivity. Conclusion. The prevalence of food insecurity and physical inactivity is relatively high among Tehran residents. As a factor affecting the physical activity and food security, social capital can be targeted in interventions to improve physical activity and food security among Iranians.

Food Insecurity and Mental Well-Being Among Low-Income Families During COVID-19 Pandemic

Purpose

To examine the interaction effects of adult and child food insecurity on parents’ and children’s mental well-being.

Design

An online survey study was conducted.

Setting

Two Head Start organizations and the Qualtrics Panel.

Subjects

Four hundred and eight parents under poverty level and having a child aged 3–5 years participated.

Measures

Food insecurity was assessed by the U.S. Household Food Security Survey Module. Parents’ stress, anxiety and depression; and children’s sadness, fear, anger, and positive affect were measured using instruments from HealthMeasures.

Analysis

Multivariate general linear models were performed in SPSS.

Results

Mean age was 31 years, 17% Hispanic, 21% Black. About 51% parents and 37% children were food insecure. After adjusting for demographics and child food insecurity, parents with adult food insecurity had higher stress (B = 2.65, p = .002), anxiety (B = 3.02, p = .001), and depression (B = 3.66, p = .001); and fear in their children (B = 5.03, p = .002) than those without adult food insecurity. Similarly, parents reporting child food insecurity had greater depression than those having no child food insecurity (B = 4.61, p = .020). Black parents had lower stress (B = −1.91, p = .018), anxiety (B = −2.26, p = .012), and depression (B = −4.17, p < .001) than their White counterparts.

Conclusions

The study’s results underscore the importance of reducing food insecurity in both parents and children as a whole family system to promote mental well-being of low-income families.

Food insecurity and cardiovascular disease: Current trends and future directions

Food insecurity (FI) - a state of limited access to nutritionally adequate food - is notably more prominent among patients with cardiovascular disease (CVD) than the general population. Current research suggests that FI increases the risk of cardiovascular morbidity and mortality through various behavioral and biological pathways. Importantly, FI is more prevalent among low-income households and disproportionately affects households with children, particularly those led by single mothers. These disparities necessitate solutions specifically geared towards helping these high-risk subgroups, who also experience increased risk of CVD associated with FI. Further, individuals with CVD may experience increased risk of FI due to the financial burden imposed by CVD care. While participation in federal aid programs like the Supplemental Nutrition Assistance Program and the Special Supplemental Nutrition Program for Women, Infants, and Children has been associated with cardiovascular health benefits, residual FI and lower dietary quality among many families suggest a need for better outreach and expanded public assistance programs. Healthcare systems and community organizations can play a vital role in screening individuals for FI and connecting them with food and educational resources. While further research is needed to evaluate sociodemographic differences in the FI-CVD relationship, interventions at the policy, health system, and community levels can help address both the burden of FI and its impacts on cardiovascular health.

Classification Differences in Food Insecurity Measures between the United States and Canada: Practical Implications for Trend Monitoring and Health Research

BACKGROUND

Food insecurity, inadequate access to food due to financial constraints, is a major public health issue in the United States and Canada, where the same 18-item questionnaire is used to monitor food insecurity. Researchers often assume that findings on food insecurity from the 2 countries are comparable with each other, but there are between-country differences in how food insecurity status is determined.

OBJECTIVES

We aimed to compare the distribution of household food insecurity in the Canadian population applying the US and Canadian classification schemes. We also examined the extent to which associations between food insecurity and adults' health differ under the 2 schemes.

METHODS

We used the population-representative Canadian Community Health Survey 2005-2017 linked to administrative health records. Food insecurity was measured by the Household Food Security Survey Module. Adults 18 y and older with valid food insecurity status were included from all jurisdictions except Quebec (n = 403,200). We cross-tabulated food insecurity status classified by the US and Canadian schemes. We also fitted logistic regressions on self-reported and objective health measures adjusting for confounders.

RESULTS

Applying the Canadian classification scheme, 7.7% of households were food insecure; the number fell to 6.0% with the US scheme. Associations between food insecurity status and health measures were mostly similar across classification schemes, although the associations between food insecurity and self-reported health were slightly larger if the US scheme was applied. Marginal food security/insecurity was associated with worse health measures irrespective of the classification scheme. United States-Canada discordance in classification of marginal food security/insecurity had a limited effect on health prediction.

CONCLUSIONS

United States-Canada differences in classification affected the apparent distribution of household food insecurity but not the associations between food insecurity and measures of adult health. Marginal food security/insecurity should be set apart from the food-secure group for trend monitoring and health research.

Psychometric properties of a modified version of Brazilian household food insecurity measurement scale - Pró-Saúde study

We present results of initial steps of the psychometric evaluation of a proposed modified version of the Brazilian Household Food Insecurity Measurement Scale aimed at assessing adults' recall of food insecurity at age 12. Data were obtained through self-administered questionnaires from civil servants at university campuses in Rio de Janeiro, who participated in the first and fourth waves of the longitudinal Pró-Saúde Study. We evaluated test-retest reliability (n=58), internal consistency, factor structure, convergent, discriminant validity (n=3,253). Test-retest reliability kappa coefficients were above 0.65; Cronbach's α coefficient was 0.84. Factor loadings were above 0.800. The composite reliability was above 0.90. The square root values of the Average Variance Extracted were positive and statistically significant. Household food insecurity during childhood was strongly associated with larger family size and several sociodemographic conditions at age 12: female head of household, residence in rural area or small town, worse standard of living, and insufficient food due to lack of money. This initial evaluation suggests good performance. Further investigation should include additional psychometric properties and other population contexts.

Sleep, Food Insecurity, and Weight Status: Findings from the Family Life, Activity, Sun, Health, and Eating Study

Background: Shorter sleep duration and lower sleep quality have been previously associated with greater obesity risk among adult samples. Food insecurity has also been found to impact sleep patterns and obesity. Yet few studies have explored associations between sleep, food insecurity, and obesity in adolescent populations, who may have more irregular sleep patterns. Thus, the objectives of this study were to determine associations between measures of sleep, food insecurity, and weight status. Methods: Data were obtained from the Family Life, Activity, Sun, Health, and Eating (FLASHE) Study, an online cross-sectional study of parent and adolescent (12-17-year old) dyads. Participants were drawn from a Consumer Opinion Panel representative of the general population of the United States with respect to sex, education, income, age, household size, and region. First, multinomial logistic regression analyses were conducted to determine associations between sleep measures (adolescent-reported average nighttime sleep duration, having a regular bedtime, and having difficulty staying asleep), food insecurity (a validated two-item parent-reported measure), and weight status (being underweight, of healthy weight, overweight, and obese). Weight status was based upon adolescent BMI z-scores using Centers for Disease Control and Prevention growth charts using information from parent report of adolescent height and weight and adolescent-reported age and sex among adolescents (N = 1544). Conditional process models were also fitted to the data to determine whether food insecurity moderates the associations between sleep measures and weight status, and to determine whether the association between food insecurity and weight status is mediated by average sleep duration. Results: Compared to those with food security, a greater percentage of those with food insecurity reported having difficulties staying asleep and a longer average sleep duration. Multinomial logistic regression models demonstrated that having a regular bedtime was associated with lower odds of having obesity, having difficulties staying asleep was associated with greater odds of being underweight, and having food insecurity was associated with greater odds of being overweight. Conditional process models demonstrated that food insecurity did not moderate associations between sleep measures and weight status and that average nighttime sleep duration did not mediate the association between food insecurity and weight status. Conclusions: This is one of the first studies to examine associations between sleep, food insecurity, and weight status among adolescents. Results provide additional support for the need to uncover mechanisms for how sleep and food insecurity affect pediatric obesity using longitudinal data.

Characteristics of successful primary school-based experiential nutrition programmes: a systematic literature review

OBJECTIVE

Diet and nutrition in childhood has been associated with the risk of chronic disease later in life. The aim of this review was to identify key characteristics of successful experiential nutrition interventions aimed to change nutrition-related cognitive and behavioural outcomes in primary schoolchildren.

DESIGN

A systematic literature review was undertaken using search terms ('food security', 'school', 'nutrition' and 'program') applied to five scientific databases (CINAHL, Scopus, Web of Science, Medline and Academic Search complete), with outcomes defined as nutrition-related knowledge, attitudes and/or dietary behaviours.

PARTICIPANTS

Primary school-aged children exposed to interventions conducted, at least partially, on school grounds.

RESULTS

A total of 3800 articles were identified from the initial search and manual searching, of which sixty-seven articles were eligible for inclusion. Forty-two articles met the criteria of being successful, defined as achieving significant differences in outcomes of interest, accompanied by a demonstrated reach. Interventions included school gardens (n 9), food provision (n 5), taste testing (n 8), cooking classes (n 10) and multicomponent programmes (n 10). Nutrition education (when combined with taste testing), cooking-related activities and gardening interventions increased children's willingness to taste unfamiliar foods including new fruits and vegetables, improved their cooking and food preparation skills and increased nutritional knowledge.

CONCLUSIONS

This review provides evidence that nutrition education programmes in primary schoolchildren that are experiential in nature are most likely to be successful if they include multiple strategies, have parental involvement and focus specifically on vegetable intake.

Is the modified household food security survey (HFSS) questionnaire a practical tool for screening food insecurity? Evidence from northwest of Iran

BACKGROUND

Adequate supplies of food and food security (FS) are the fundamental aspects of human societies, and considered one of the pivotal factors of individual and social health. The aim of the present study was to assess the applicability of the short questionnaire for screening food insecurity (FI) and to evaluate the prevalence of FI in northwest of Iran.

METHODS

In this study, 550 subjects aged ≥16 years were studied. Three-day dietary records and a short questionnaire were applied to estimate the prevalence of FI in terms of hunger and hidden hunger. The sensitivity, specificity and accuracy of the short questionnaire were assessed. Moreover, the association between the results of the short questionnaire and the criteria that were theoretically related to FI were examined. Data were presented as mean (SD), median (min-max) for the numeric normal and non-normal variables, respectively, and frequency (percent) for categorical variables. The between-group comparisons of variables were done using independent samples t test. P values less than 0.05 were considered statistically significant.

RESULTS

The prevalence of hunger and hidden hunger was 30.8 and 46.0%, respectively. Overall, 23.2% of the subjects were classified as "food secure". The sensitivity, specificity and accuracy of the short questionnaire in determining hunger were 92.8% (95% CI: 87.3-95.9), 84.2% (95% CI: 79.3-89.3), and 87% (95% CI: 84-90.2), respectively. These values for hidden hunger were 21.6% (95% CI: 15.7-29.9), 92.3% (95% CI: 88.7-99.4), and 53.4% (95% CI: 47.9-59.8), respectively. Our study showed a statistically significant association between FI and socio-economic status. FI significantly enhanced the risk of underweight, while it markedly reduced the risk of overweight and obesity. The average frequency of monthly consumption of meat, dairy products, fruits, vegetables, and rice was significantly lower in food insecure group, while the median frequency of bread consumption was markedly higher in food insecure group. The participants of insecure group were less likely to consume fruits, vegetables, dairy products, rice and meat.

CONCLUSIONS

FI was frequent in North-west of Iran. The findings indicated that the short questionnaire was a simple, low-cost and practical tool for screening FI in terms of hunger.

TRIAL REGISTRATION

IR.TBZMED.REC.1397.400.

Food Security Status and Hair Cortisol among Low-income Mother-Child Dyads

This cross-sectional study among low-income mother-child dyads examined the relationship between food security status and hair cortisol concentration (HCC), and how mother and child food security status was interactively related to mothers' perceived distress and coping. Data from 32 dyads were analyzed. Approximately 46.9% had household food insecurity, 37.5% children had food insecurity, and 34.4% mothers had food insecurity. Children with food insecurity had significantly higher HCC than those with food security. A significant interaction effect occurred between child food security status and race on children's HCC, with White children's HCC being more likely to be influenced by food security status. Mother food security and child food security status together explained about 6% of the variance in mothers' HCC, 27% in perceived distress, and 18% in perceived coping. These findings indicate that assisting low-income families with food insecurity to get enough food can benefit both children's and mothers' mental health.

Validity of the Food Insecurity Experience Scale for Use in Sub-Saharan Africa and Characteristics of Food-Insecure Individuals

BACKGROUND

The Food Insecurity Experience Scale (FIES) is a UN FAO-Voices of the Hungry project (FAO-VoH) metric of food insecurity (FI). The FAO-VoH tested the psychometric properties of FIES with the use of global 2014 Gallup World Poll (GWP) data. However, similarities in its psychometric structure in sub-Saharan Africa (SSA) to allow aggregation of SSA results were untested.

OBJECTIVES

We aimed to 1) assess the validity of FIES for use in SSA, 2) determine the prevalence of FI by country, age group, and gender, and 3) examine the sociodemographic and economic characteristics of individuals with FI.

METHODS

The Rasch modeling procedure was applied to data collected by GWP in 2014 and 2015 on 57,792 respondents aged ≥19 y in SSA.

RESULTS

FIES largely met the Rasch model assumptions of equal discrimination and conditional independence. However, 34.3% of countries had high outfits (≥2.0) for the item "went without eating for a whole day." Four countries had significant correlations for the items "were hungry but did not eat" and "ran out of food." The overall prevalence of severe FI (SFI) was 36.4%, ranging from 6.0% in Mauritius to 87.3% in South Sudan. Older adults were at significantly higher risk of SFI than younger adults (38.6% and 35.8%, respectively, P < 0.0001), and women more than men (37.3% and 35.4%, respectively, P < 0.0001). Higher proportions of individuals with SFI were rural residents, less educated, lower income, unemployed, and lived in households with many children under the age of 15 y.

CONCLUSIONS

FIES has acceptable levels of internal validity for use in SSA. However, the item "went without eating for a whole day" may need cognitive testing in a few SSA countries. For countries with correlated items, 1 of the items may be excluded.

Household food security in an urban slum: Determinants and trends

Introduction:

As we are moving from millennium development goals to sustainable development goals, food insecurity is imposing a formidable challenge to the policymakers, especially in developing countries such as India. A survey conducted in the urban slum areas of Vellore district, 6 years back, had reported food insecurity as high as 75%. The current study was a resurvey to assess the food security status in the aforementioned area.

Materials and Methods:

A community-based survey was conducted in which data were collected using a self-administered questionnaire from 150 households, selected through multistaged cluster sampling, who had given oral consent to be a part of the survey. The prevalence of food security calculated from this study was compared with the results from a previous survey to look for any significant improvement.

Results:

Nearly 42.7% of the households were food secure, while 26.7% were food insecure without hunger and 30.6% were food insecure with some degree of hunger. Low socioeconomic status (odds ratio [OR]: 3.25, 95% confidence interval [CI]: 1.29–8.16; P < 0.012) and presence of debt (OR: 3.84, 95% CI: 1.90–7.73; P < 0.001) were the major risk factors for food insecurity. A comparison with the findings from the previous study has shown a statistically significant improvement in food security from 25.4% to 42.7% (Chi-square: 27.072, df: 2, P < 0.0001).

Conclusion:

Although food security levels have shown marked improvement over the years, much needs to be done for India to be free from the shackles of hunger.

Developing measures of food and nutrition security within an Australian context

Objective

To develop a measure of food and nutrition security for use among an Australian population that measures all pillars of food security and to establish its content validity.

Design

The study consisted of two phases. Phase 1 involved focus groups with experts working in the area of food security. Data were assessed using content analysis and results informed the development of a draft tool. Phase 2 consisted of a series of three online surveys using the Delphi technique. Findings from each survey were used to establish content validity and progressively modify the tool until consensus was reached for all items.

Setting

Australia.

Subjects

Phase 1 focus groups involved twenty-five experts working in the field of food security, who were attending the Dietitians Association of Australia National Conference, 2013. Phase 2 included twenty-five experts working in food security, who were recruited via email.

Results

Findings from Phase 1 supported the need for an Australian-specific tool and highlighted the failure of current tools to measure across all pillars of food security. Participants encouraged the inclusion of items to measure barriers to food acquisition and the previous single item to enable comparisons with previous data. Phase 2 findings informed the selection and modification of items for inclusion in the final tool.

Conclusions

The results led to the development of a draft tool to measure food and nutrition security, and supported its content validity. Further research is needed to validate the tool among the Australian population and to establish inter- and intra-rater reliability.

Influence of sociodemographic characteristics on different dimensions of household food insecurity in Montevideo, Uruguay

Objective

To determine the factor structure of the Latin American & Caribbean Household Food Security Scale (ELCSA) and to study the influence of sociodemographic characteristics on each of the identified dimensions in Montevideo, Uruguay.

Design

Cross-sectional survey with a representative sample of urban households. Household food insecurity was measured using the ELCSA. The percentage of respondents who gave affirmative responses for each of the items of the ELCSA was determined. Exploratory factor analysis was carried out to determine the ELCSA’s factor structure. A probit model was used to determine the impact of some individual and household sociodemographic characteristics on the identified dimensions of food insecurity.

Setting

Metropolitan area centred on Montevideo, the capital city of Uruguay, April–September 2014.

Subjects

Adults aged between 18 and 93 years (n 742).

Results

The percentage of affirmative responses to the items of the ELCSA ranged from 4·4 to 31·7 %. Two factors were identified in the exploratory factor analysis performed on data from households without children under 18 years old, whereas three factors were identified for households with children. The identified factors were associated with different severity levels of food insecurity. Likelihood of experiencing different levels of food insecurity was affected by individual characteristics of the respondent as well as characteristics of the household.

Conclusions

The influence of sociodemographic variables varied among the ELCSA dimensions. Household income had the largest influence on all dimensions, which indicates a strong relationship between income and food insecurity.

Household food security and breast-feeding duration among Canadian Inuit

Objective

There have been few studies investigating the association between food security and breast-feeding duration and none have been conducted among Canadian Inuit, a population disproportionately burdened with food insecurity. We evaluated the association between household food security and breast-feeding duration in Canadian Inuit children.

Design

Data were obtained from the Nunavut Inuit Child Health Survey, a population-based cross-sectional survey.

Setting

The Canadian Territory of Nunavut in 2007 and 2008.

Subjects

Caregivers of Inuit children aged 3–5 years. Participating children were randomly sampled from community medical centre lists.

Results

Out of 215 children, 147 lived in food-insecure households (68·4 %). Using restricted mean survival time models, we estimated that children in food-secure households were breast-fed for 16·8 (95 % CI 12·5, 21·2) months and children in food-insecure households were breast-fed for 21·4 (95 % CI 17·9, 24·8) months. In models adjusting for social class, traditional knowledge and child health, household food security was not associated with breast-feeding duration (hazard ratio=0·82, 95 % CI 0·58, 1·14).

Conclusions

Our research does not support the hypothesis that children living in food-insecure households were breast-fed for a longer duration than children living in food-secure households. However, we found that more than 50 % of mothers in food-insecure households continued breast-feeding well beyond 1 year. Many mothers in food-secure households also continued to breast-feed beyond 1 year. Given the high prevalence of food insecurity in Inuit communities, we need to ensure infants and their caregivers are being adequately nourished to support growth and breast-feeding, respectively.

A Model-Based Approach to Identify Classes and Respective Cutoffs of the Brazilian Household Food Insecurity Measurement Scale

BACKGROUND

The Brazilian Household Food Insecurity Measurement Scale (EBIA) is the main tool for assessing household food insecurity (FI) in Brazil, assisting in monitoring and improving national public policies to promote food security. Based on the sum of item scores, households have been classified into 4 levels of FI, with the use of cutoffs arising from expert discussions informed by psychometric analyses and policy considerations.

OBJECTIVES

This study aimed to identify homogeneous latent groups corresponding to levels of FI, examine whether such subgroups could be defined from discriminant cutoffs applied to the overall EBIA raw score, and compare these cutoffs against those currently used.

METHODS

A cross-sectional population-based study with a representative sample of 1105 households from a low-income metropolitan area of Rio de Janeiro was conducted. Latent class factor analysis (LCFA) models were applied to the answers to EBIA's items to identify homogeneous groups, obtaining the number of latent classes for FI measured by the scale. Based on this and a thorough classification agreement evaluation, optimal cutoffs for discriminating between different severity levels of FI were ascertained. Model-based grouping and the official EBIA classification cutoffs were also contrasted.

RESULTS

LCFA identified 4 homogeneous groups with a very high degree of class separation (entropy = 0.906), endorsing the classification of EBIA as a 4-level measure of FI. Two sets of cutoffs were identified to separate such groups according to household type: 1/2, 5/6, and 10/11 in households with children and adolescents (score range: 0-14); and 1/2, 3/4, and 5/6 in adult-only households (score range: 0-7).

CONCLUSION

Although roughly classifying EBIA as in previous studies, the current approach suggests that, in terms of raw score, households endorsing only one item of the scale would be better classified by being placed in the same stratum as those remaining negative on all items.

Measuring food and nutrition security: tools and considerations for use among people living with HIV

As an increasing number of countries implement integrated food and nutrition security (FNS) and HIV programs, global stakeholders need clarity on how to best measure FNS at the individual and household level. This paper reviews prominent FNS measurement tools, and describes considerations for interpretation in the context of HIV. There exist a range of FNS measurement tools and many have been adapted for use in HIV-endemic settings. Considerations in selecting appropriate tools include sub-types (food sufficiency, dietary diversity and food safety); scope/level of application; and available resources. Tools need to reflect both the needs of PLHIV and affected households and FNS program objectives. Generalized food sufficiency and dietary diversity tools may provide adequate measures of FNS in PLHIV for programmatic applications. Food consumption measurement tools provide further data for clinical or research applications. Measurement of food safety is an important, but underdeveloped aspect of assessment, especially for PLHIV.

Household food insecurity: a systematic review of the measuring instruments used in epidemiological studies

OBJECTIVE

To conduct a systematic review aimed at identifying and characterizing the experience-based household food security scales and to synthesize their psychometric properties.

DESIGN

Search in the MEDLINE, LILACS and SciELO databases, using the descriptors ('food insecurity' OR 'food security') AND ('questionnaires' OR 'scales' OR 'validity' OR 'reliability'). There was no limitation on the period of publication. All articles had their titles and abstracts analysed by two reviewers. The studies of interest were read in their entirety and the relevant information extracted using a standard form.

RESULTS

The initial bibliographic search identified 299 articles. Of these, the 159 that seemed to meet the criteria for inclusion were read fully. After consultation of the bibliographic references of these articles, twenty articles and five documents were added, as they satisfied the previously determined criteria for inclusion. Twenty-four different instruments were identified; all were brief and of easy application. The majority were devised in the USA. Forty-seven references reported results of psychometric studies. The instruments that presented the highest number of psychometric studies were the Core Food Security Measurement/Household Food Security Survey Module (CFSM/HFSSM) and the Self-Perceived Household Food Security Scale.

CONCLUSIONS

There are a number of structured scales available in the literature for characterization of household food insecurity. However, despite some psychometric studies already existing about the majority of the instruments, it is observed that, except for the studies of the CFSM/HFSSM, these are still restricted to appraisal of a few aspects of reliability and validity.

Insegurança alimentar no Nordeste e Sul do Brasil: magnitude, fatores associados e padrões de renda per capita para redução das iniquidades

O artigo analisa a insegurança alimentar em domicílios urbanos com crianças menores de sete anos de idade. Por meio de estudo transversal localizou-se, nas áreas de abrangência de unidades básicas de saúde, 5.419 domicílios na Região Nordeste e 5.081 na Região Sul do Brasil. A insegurança alimentar foi avaliada usando-se a Escala Brasileira de Insegurança Alimentar. A prevalência de insegurança alimentar moderada ou grave foi 22,9% no Nordeste e 7,5% no Sul. Em ambas as regiões, na análise ajustada, a maior probabilidade de insegurança alimentar moderada e grave foi identificada em domicílios chefiados por mulheres, com cor da pele materna preta e parda/mestiça, com menor escolaridade materna, menor renda familiar per capita e beneficiários do Bolsa Família. A insegurança alimentar moderada ou grave seria reduzida em 59,5% no Nordeste e em 45,4% no Sul, com uma renda familiar per capita mínima de R$ 175,00 ao mês. O aumento da renda familiar dos mais pobres e a melhor focalização do Bolsa Família são essenciais para a diminuição da insegurança alimentar no país.

Food insecurity is associated with diet and bone mass disparities in early adolescent males but not females in the United States

Food insecurity is associated with decreased nutrient intake and poor health and possibly low bone mass in children. The purpose of this study was to formally investigate the relationship of diet, bone mass, and food insecurity among children aged 8-19 y (n = 5270). The data used in this cross-sectional study were drawn from children participating in the NHANES 2001-2004. Data were collected from homes and NHANES mobile examination centers across the United States. Food security status was classified using the US Children's Food Security Scale and the US Household Food Security Scale. Dietary measures were quantified by 24-h dietary recall and bone mineral content (BMC) was determined with whole body DXA. Results indicated that males 8-11 y from households with food insecurity among children were 2.5 times [OR = 2.5 (95% CI = 1.1-5.8)] more likely to have fewer than the USDA Food Guide recommended servings of dairy foods, 2.3 times [OR = 2.3 (95% CI = 1.3-4.0)] more likely to have less than the estimated average requirement for calcium intake, and more likely to have a significantly lower estimated total body (P = 0.04), trunk (P = 0.05), lumbar spine (P = 0.02), pelvis (P = 0.05), and left arm (P = 0.05) BMC compared with males 8-11 y old from households with food security among children. Calcium-related dietary factors and BMC did not differ among females by food security status. These results are evidence that health disparities persist among 8- to 11-y-old, food-insecure boys. Successful interventions to improve diet and bone health and reduce food insecurity among children are a continuing need in the United States.

Validity of an adapted Household Food Insecurity Access Scale in urban households in Iran

OBJECTIVE

To assess the validity of a locally adapted Household Food Insecurity Access Scale (HFIAS) in the measurement of household food insecurity (FI) in the city of Tehran.

DESIGN

A cross-sectional study.

SETTING

Urban households were selected through a systematic cluster sampling method from six different districts of Tehran. The socio-economic status of households was evaluated using a questionnaire by means of interviews. An adapted HFIAS was used to measure FI. Content validity was assessed by an expert panel, and the questionnaire was then tested among ten households for clarity. Criterion validity was assessed by comparing the measure with a number of determinants and consequences of FI. Internal consistency was evaluated by Cronbach's α and exploratory factor analysis. For repeatability, the questionnaire was administered twice to twenty-five households at an interval of 20 d and Pearson's correlation coefficient was calculated.

SUBJECTS

A total of 416 households.

RESULTS

In all, 11·8 %, 14·4 % and 17·5 % of the households were severely, moderately and mildly food insecure, respectively. Cronbach's α was 0·855. A significant correlation was observed between the two administrations of the questionnaire (r = 0·895, P < 0·001). Factor analysis of HFIAS items revealed two factors: the first five items as factor 1 (mild-to-moderate FI) and the last four as factor 2 (severe FI). Heads of food-secure households had higher education and higher job position compared with heads of food-insecure households (P < 0·001). Income and expenditure were lower in food-insecure households compared with food-secure households.

CONCLUSIONS

Adapted HFIAS showed acceptable levels of internal consistency, criterion validity and reliability in assessing household FI among Tehranians.

Food insecurity is associated with iron deficiency anemia in US adolescents

BACKGROUND

Food insecurity, a condition of low or very low food security, is associated with decreased nutrient intake and poor health, which can lead to nutrient deficiency in children, including iron deficiency and iron deficiency anemia.

OBJECTIVE

The purpose of this study was to formally investigate the current relation of iron status and food security status among children aged 3-19 y (n = 11,247).

DESIGN

Participants of the National Health and Nutrition Examination Survey 1999-2004 were classified for food security status by using the US Children's Food Security Scale and the US Household Food Security Scale. Iron deficiency was defined as > or =2 abnormal values for transferrin saturation, serum ferritin, and erythrocyte protoporphyrin, with the addition of abnormal hemoglobin to classify iron deficiency anemia.

RESULTS

The odds of iron deficiency anemia among children aged 12-15 y were 2.95 times (95% CI: 1.18, 7.37; P = 0.02) those for children in households with food insecurity among children compared with children in households with food security among children.

CONCLUSIONS

The results of this study indicate a continuing need for successful interventions to reduce iron deficiency anemia among food-insecure children and to improve food security among children.

Assessing the internal validity of a household survey-based food security measure adapted for use in Iran

Background

The prevalence of food insecurity is an indicator of material well-being in an area of basic need. The U.S. Food Security Module has been adapted for use in a wide variety of cultural and linguistic settings around the world. We assessed the internal validity of the adapted U.S. Household Food Security Survey Module to measure adult and child food insecurity in Isfahan, Iran, using statistical methods based on the Rasch measurement model.

Methods

The U.S. Household Food Security Survey Module was translated into Farsi and after adaptation, administered to a representative sample. Data were provided by 2,004 randomly selected households from all sectors of the population of Isfahan, Iran, during 2005.

Results

53.1 percent reported that their food had run out at some time during the previous 12 months and they did not have money to buy more, while 26.7 percent reported that an adult had cut the size of a meal or skipped a meal because there was not enough money for food, and 7.2 percent reported that an adult did not eat for a whole day because there was not enough money for food. The severity of the items in the adult scale, estimated under Rasch-model assumptions, covered a range of 6.65 logistic units, and those in the child scale 11.68 logistic units. Most Item-infit statistics were near unity, and none exceeded 1.20.

Conclusion

The range of severity of items provides measurement coverage across a wide range of severity of food insecurity for both adults and children. Both scales demonstrated acceptable levels of internal validity, although several items should be improved. The similarity of the response patterns in the Isfahan and the U.S. suggests that food insecurity is experienced, managed, and described similarly in the two countries.

The well-being of children in food-insecure households: results from The Eastern Caribbean Child Vulnerability Study 2005

OBJECTIVE

To examine the relationship between food insecurity and child well-being indicators.

DESIGN

Cross-sectional survey conducted in 2344 households with children. The main exposure measure was food insecurity status, which was categorized as food secure or food insecure based on two or more food insecurity questions answered in the affirmative. Multiple logistic regression analysis was used to model the association between food insecurity status and selected child well-being indicators.

SETTING

Barbados, St. Lucia and St. Vincent and the Grenadines (hereafter St. Vincent), three Eastern Caribbean countries, 2005.

SUBJECTS

A random sample of households with children was identified by the governments of Barbados, St. Lucia and St. Vincent. In-home interviews were conducted by social workers.

RESULTS

One-third (33%) of households were categorized as food insecure. Food-insecure households were more likely to include a chronically ill parent (OR = 2.48; 95% CI 1.76, 3.49), a recently divorced parent (OR = 1.92; 95% CI 1.21, 3.05), a child requiring multiple visits to a health-care provider for a disability (OR = 3.98; 95% CI 1.20, 13.19) or injury (OR = 1.78; 95% CI 1.12, 2.83), a child with a learning disability (OR = 2.08; 95% CI 1.16, 3.74) or a child with a physical disability (OR = 2.54; 95% CI 1.22, 5.32) after adjustment for poverty and other demographic variables.

CONCLUSIONS

The results indicate that food-insecure households were more likely to be burdened by child disability (learning and physical), family system disruption (recent divorce and chronic illness) and child health-care needs (for disability and injury) than food-secure households. The implementation of programmes and policies to minimize food insecurity in the Eastern Caribbean may be warranted.

Sensitivity and specificity of a short questionnaire for food insecurity surveillance in Iran

BACKGROUND

Food insecurity is frequent in both developed and developing countries, affecting from 5% to 25% of the general population. It has considerable health impacts on the physical, social, and psychological status of individuals in communities suffering from food insecurity.

OBJECTIVE

The aim of this study was to document the epidemiologic features of food insecurity in the northwest region of Iran and to evaluate the sensitivity and specificity of a short-form (six items) questionnaire for screening of food insecurity in the region.

METHODS

This cross-sectional study was conducted on 300 subjects (132 male and 168 female) selected randomly in the Asadabadi area of the northwest of Iran. Information on food consumption was obtained by a 24-hour food-recall questionnaire for 3 days in a week. This information was compared with the data from the Household Food Security Scale (six-item short questionnaire) to assess the applicability of this short scale for the surveillance of food insecurity. Hunger was defined as inadequate intake of energy. Hidden hunger was defined as adequate intake of energy and inadequate intake of one (or more) of four key nutrients (protein, calcium, vitamin A, and vitamin B2).

RESULTS

The prevalence of hunger and hidden hunger in the area according to the 24-hour food-recall questionnaire was 26% and 42%, respectively. Only 32% of the study population was secure in terms of having access to all key nutrients. The sensitivity, specificity, and accuracy of the short questionnaire for screening for hunger in the population were 98.7%, 85.5%, and 89%, respectively; and the corresponding values for hidden hunger were 23.5%, 96.9%, and 56.3%.

CONCLUSIONS

Our findings indicate that food insecurity is prevalent in the northwest of Iran. The short questionnaire (six items) may be used as a simple, low-cost, rapid, and useful tool for the screening of food insecurity and energy intake in similar areas.

Psychometric properties of a modified US-household food security survey module in Campinas, Brazil

OBJECTIVE

To assess the internal validity of a multiple-item measure of household food security in Brazil using statistical methods based on the single-parameter logistic (Rasch) measurement model.

SUBJECTS/METHODS

Sample of the non-institutionalized civilian population living in the municipality of Campinas selected using stratified cluster sampling. Of the 1000 households randomly chosen, 847 responded to the interview. Responses to each of the 15 questions were coded into dichotomous items indicating whether the specific food-insecure condition had occurred (other than in just 1 or 2 days) during the 3 months before the survey. Scaling analyses were conducted separately as well as jointly for adult/household-related items and child-related items. Item-fit statistics were examined to determine the extent to which the items appear to measure the same underlying phenomenon, and item severity scores were compared with those of equivalent items in the US Current Population Survey.

CONCLUSIONS

Except for one item, infit statistics were within a range considered adequate (0.80-1.2), indicating a common phenomenon being measured with approximately equal discrimination. The relative severities of the items in the Campinas survey were generally similar to those of equivalent items in the US Current Population Survey. Analysis of all 15 items together indicates a higher severity level for child-related items compared with equivalent adult-related items.