Hunger in children in the United States: potential behavioral and emotional correlates

The burden and its determinants of mental health distress among adolescents dwelling in Africa: a systematic review and meta-analysis

BACKGROUND

Adolescent mental health issues are emerging as a significant public health concern across many low- and middle-income countries, particularly in Africa. This study aims to evaluate the aggregated prevalence and contributing risk factors of mental health distress among adolescents in Africa.

METHODOLOGY

A comprehensive search of PubMed, PsycINFO, Web of Science, Google Scholar, and HINARI databases was conducted to identify relevant articles on the prevalence and risk factors associated with mental health distress among African adolescents, published up to December 2023. The quality of the selected studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Heterogeneity among the studies was evaluated using the I² statistical test. Potential publication bias was assessed through a funnel plot and Egger's statistical test. This systematic review was registered with PROSPERO under reference number CRD42023494665.

RESULTS

Eighteen studies encompassing data from 37,016 adolescents were included in the analysis. The overall prevalence of mental health distress among adolescents in Africa was found to be 27.34% (95% CI: 23.18-31.50). The occurrence of mental health distress is observed in older adolescents at a prevalence of 29.44% (95% CI: 23.26-35.66) and in younger adolescents at 24.73% (95% CI: 11.96-37.51). Significant risk factors identified included bullying victimization, with an odds ratio (POR) of 1.30 (95% CI: 1.16, 1.46), and experiencing hunger, with an odds ratio (POR) of 2.10 (95% CI: 1.13, 3.91).

CONCLUSION

The findings indicate a high prevalence of mental health distress among adolescents in Africa, highlighting the widespread impact on this demographic. These results underscore the urgent need for targeted interventions to prevent and address mental health distress among adolescents. Further research on a global scale is essential to develop effective prevention and treatment strategies tailored to this age group.

Classification of Obesity among South African Female Adolescents: Comparative Analysis of Logistic Regression and Random Forest Algorithms

BACKGROUND

This study evaluates the performance of logistic regression (LR) and random forest (RF) algorithms to model obesity among female adolescents in South Africa.

METHODS

Data was analysed on 375 females aged 15-17 from the South African National Health and Nutrition Examination Survey 2011/2012. The primary outcome was obesity, defined as body mass index (BMI) ≥ 30 kg/m2. A total of 31 explanatory variables were included, ranging from socio-economic, demographic, family history, dietary and health behaviour. RF and LR models were run using imbalanced data as well as after oversampling, undersampling, and hybrid sampling of the data.

RESULTS

Using the imbalanced data, the RF model performed better with higher precision, recall, F1 score, and balanced accuracy. Balanced accuracy was highest with the hybrid data (0.618 for RF and 0.668 for LR). Using the hybrid balanced data, the RF model performed better (F1-score = 0.940 for RF vs. 0.798 for LR).

CONCLUSION

The model with the highest overall performance metrics was the RF model both before balancing the data and after applying hybrid balancing. Future work would benefit from using larger datasets on adolescent female obesity to assess the robustness of the models.

The effect of free school fruit on academic performance: a nationwide quasi-experiment

In past research, higher intake of fruit has been associated with better academic achievement. In Norway, the government required lower secondary schools to provide fruit to their pupils from 2007 to 2014. The present study assessed whether this policy improved academic performance. In addition to secondary schools, the policy covered schools with combined elementary and lower secondary education, but not ordinary elementary schools. This differentiation, in combination with administrative data on test scores before, during, and after the law was enforced, created a nationwide quasi-experiment. Population register data on parents' sociodemographic characteristics allowed for targeted analyses on a subsample of boys with low sociodemographic status. In analyses of 5th grade tests, the free fruit policy coincided with a slight decline in test scores among eligible compared to non-eligible pupils in the subsample (B = - 0.18, 95%CI[- 0.35, - 0.01]) and entire population (B = - 0.14, 95%CI[- 0.24, - 0.05]). Exploratory analyses of exam data in 10th grade yielded similar results, and sensitivity tests either failed to detect any effect or demonstrated a negative tendency. In a Western country with low levels of food insecurity, a policy that required schools to provide free fruit to pupils did not appear to improve academic performance.

Integrated flood risk assessment of properties and associated population at county scale for Nebraska, USA

Risk assessment of properties and associated population was conducted for the state of Nebraska, leveraging only open-source datasets. The flood risk framework consisted of interactions among drivers, i.e. hazard, exposure, vulnerability, and response, to assess the risks related to properties and associated populations. To quantify hazard on a county scale, we considered properties at risk of flooding based on a flood score (a higher score represents a greater chance of flooding). Exposure was quantified by considering population density at the county level. We quantified vulnerability under four categories: social, ecological, economic, and health. Response, a relatively newer component in flood risk assessment, was also quantified under three distinct categories: structural, non-structural, and emergency. Overall, we found that counties in eastern Nebraska (Sarpy, Dakota, Wayne, and Adams) have a higher risk of flooding consequences due to more exposure to vulnerable assets such as population and property. The assessment also observed that counties in eastern Nebraska are in the process of improving their flood control measures with dams, levees, and higher insurance coverage that can subdue the risks associated with flooding. The results from this study are anticipated to guide water managers and policymakers in making more effective and locally relevant policies and measures to mitigate flood risks and consequences.

Association of Food Insecurity Status with Resolution of Mental Health Conditions in Children and Adolescents

OBJECTIVE

Adverse consequences related to unresolved mental health issues underscore the importance of identifying factors that impede resolution of mental health conditions. Although studies have identified food insecurity as a risk factor for the diagnosis of mental health conditions, its impact on unresolved mental health issues is not understood. The objective of this study is to investigate the association of food insecurity status with resolution of depression, anxiety, and behavioral/conduct problems in children and adolescents.

METHODS

Using National Survey of Children's Health 2016 to 2019, logistic regression analyses examined the relationship of food insecurity status with the diagnosis and resolution of depression, anxiety, and behavioral/conduct problems in children (aged 5-11 years) and adolescents (aged 12-17 years).

RESULTS

Mild, moderate, and severe food insecurity were significantly associated with higher odds of being diagnosed with depression, anxiety, and behavioral/conduct problems. Severe food insecurity was significantly associated with higher odds of unresolved behavioral/conduct problems in children (adjusted odds ratio [aOR], 10.09; 95% confidence interval [CI], 2.99-34.04), after adjustment for demographic covariates. In adolescents, severe food insecurity was significantly related to greater odds of unresolved depression (aOR, 6.64; 95% CI, 2.13-20.70), anxiety (aOR, 3.27; 95% CI, 1.31-8.14), and behavioral/conduct problems (aOR, 5.57; 95% CI, 2.09-14.85). These associations of severe food insecurity with unresolved mental health conditions were significant even after adjustment for the receipt of mental health care. Mild and moderate food insecurity were not significantly associated with unresolved mental health conditions.

CONCLUSION

The findings suggest that severe food insecurity is associated with increased odds of unresolved mental health conditions in children and adolescents. This study highlights the importance of tailoring interventions to provide appropriate mental health services for children and adolescents from severely food insecure households.

Predictors of Food Insecurity and Childhood Hunger in the Bronx During the COVID-19 Pandemic

Using a community-based participatory research approach, we conducted a survey of 218 food pantry recipients in the south Bronx to determine predictors of food insecurity and childhood hunger. In adjusted multiple regression models, statistically significant risk factors for food insecurity included: having one or more children and not having health insurance. Statistically significant protectors against childhood hunger were: having a graduate degree, having health insurance and Spanish being spoken at home. Experiencing depression symptoms was positively associated with both food insecurity and childhood hunger. Frequency of food pantry use was not significantly associated with either food insecurity nor childhood hunger. This study suggests that targeting families with multiple children and without insurance will best help to promote food security among residents of the south Bronx. Social policy implications related to food security and benefit provision through the COVID-19 pandemic are also provided.

Unraveling the Channels of Food Security of the Households in Northern Kenya: Evidence from an Exclusive Dataset

Background

Most of the 10 million Kenyans lacking food security lived in the arid and semi-arid northern part of the country in a climatic condition of high temperatures and very little rainfall throughout the year. Frequent droughts had devastating effects on the livelihoods and food availability of the population.

Objectives

The objective of this study was to assess the food security status of the households in Northern Kenya and examine the factors contributing to their food security.

Methods

De-identified secondary data were used from the 2015 Feed the Future household survey conducted in 9 counties of Northern Kenya. The experience-based indicator of food security was derived from the 6-item Household Food Security Survey Module (HFSSM), which categorized sample households into 3 groups: food secure, having low food security, and having very low food security. An ordered probit model and machine learning algorithm, namely ordered random forest, were used to find the most important determinants of food security.

Results

Findings suggest that the daily per capita food expenditure, level of education of the household head, and durable asset ownership are the key predictors of food security. Households living in rural areas were likely to have low food security, but their probability of being food secure increased with at least primary education and livestock ownership, thus reflecting the importance of education and livestock production among rural communities in Northern Kenya. Access to improved water and participation in food security programs were found to be more important for food security among rural households than they were for urban households.

Conclusions

These results implied that long-term policies on improving access to education, livestock ownership, and improved water may shape the food security status of rural households in Northern Kenya.

The association of food insecurity with mental health in preschool-aged children and their parents

BACKGROUND

Household food insecurity (HFI) is associated with poor general and mental health. Prior studies assessed parent and child mental health separately and did not assess other social risks.

OBJECTIVE

To assess the relationship between HFI and both parental and child mental health.

METHODS

Parents of 3-5-year-old children completed validated measures of food insecurity and mental health. Separate linear regression models were used for unadjusted analysis for each mental health outcome (parent depression, anxiety, and stress, and child mental health). Multivariable analysis was performed using hierarchical regression to adjust for relevant covariates.

RESULTS

Children (n = 335) were racially and socioeconomically diverse. HFI was reported in 10% of participants. HFI was associated with worse parent depression and stress in unadjusted analyses; however, after adjusting for covariates, the associations became insignificant. HFI was significantly associated with worse child mental health in unadjusted and multivariable analysis (aβ 2.24, 95% CI 0.59-3.88) compared to those without HFI.

CONCLUSION

HFI was not associated with parental mental health outcomes when other social risks were included in the analyses; however, HFI was significantly associated with worse childhood mental health in all analyses. Pediatric providers should screen for and develop interventions to target both HFI and mental health.

IMPACT

Household food insecurity was associated with worse parent depression and stress in unadjusted analyses; however, after adjusting for other social risks, the associations became insignificant. Household food insecurity was significantly associated with worse child mental health, even after adjusting for demographics, other social risks, and parent mental health. Social risks are differentially associated with parent and child mental health. Understanding the complexities of family stressors can help better support parents and children struggling with mental health problems and social risks.

Windows of Vulnerability: Consequences of Exposure Timing during the Dutch Hunger Winter

Prior research on early-life exposures to famine has established in utero development as a critical period of vulnerability to malnutrition. Yet, previous research tends to focus narrowly on this stage, at the expense of a more comprehensive examination of childhood. As a result, the literature has yet to compare the severity of the consequences of exposure to malnutrition across developmentally salient periods. Such comparison is crucial not only in the magnitude of effects but also in the nature of outcomes. Using a restricted population registry-linked health survey, this study examines the Dutch Hunger Winter to provide a comprehensive examination of the long-term consequences of in utero, infant, childhood, and adolescent exposure to famine. The results show malnutrition leads to heterogeneous effects depending on when the exposure occurs. In utero exposure to malnutrition leads to deleterious conditions in physical health and lower socioeconomic attainment. For older cohorts, results suggest a resilience to the effects of malnutrition on physical health in late life, but a higher vulnerability to socioeconomic stunting. Furthermore, the results suggest important gender differences in the long-term impact of malnutrition. Males consistently show stronger negative consequences across a wider array of conditions.

The Relationship between the Frequency of Breakfast Consumption, Conversation with Parents, and Somatic Symptoms in Children: A Three-Wave Latent Growth Model

Breakfast consumption is essential for children to generate energy for the day. Parents play an important role in children's breakfast habits and spending time with parents during breakfast greatly influences children's emotional development. Therefore, this study investigated the relationship between the frequency of children's breakfast consumption, time spent in conversation with parents, and children's somatic symptoms. Data were obtained from the Korea Children and Youth Panel Survey 2018 and were initially collected from fourth-grade elementary school students and followed up for three years. SPSS 21.0 and AMOS 21.0 software were used for data analysis. Multivariate latent growth modeling was applied to analyze the effect of the breakfast consumption frequency on children's somatic symptoms and the mediating effect of parent-child conversation time on this relationship. Consequently, as children's frequency of breakfast consumption increased, their somatic symptoms decreased. Furthermore, parent-child conversation time mediated the relationship between these two variables. Therefore, students, parents, and teachers should be educated about the importance of having breakfast and communicating with parents for students' emotional health.

Association of Food Insecurity with Mental Health Outcomes in Parents and Children

BACKGROUND

Food insecurity affects 13.7 million US households and is linked to poor mental health. Families shield children from food insecurity by sacrificing their nutritional needs, suggesting parents and children experience food insecurity differentially.

OBJECTIVE

To identify the associations of food insecurity and mental health outcomes in parents and children DATA SOURCES: PubMed, Embase, Web of Science, and PsycInfo STUDY ELIGIBILITY CRITERIA: We included original research published in English from January 1990 to June 2020 that examined associations between food insecurity and mental health in children or parents/guardians in the United States.

STUDY APPRAISAL AND SYNTHESIS METHODS

Two reviewers screened studies for inclusion. Data extraction was completed by one reviewer and checked by a second. Bias and confounding were assessed using the Agency for Healthcare Research and Quality RTI Item Bank. Studies were synthesized qualitatively, grouped by mental health outcome, and patterns were assessed. Meta-analyses were not performed due to high variability between studies.

RESULTS

We included 108 studies, assessing 250,553 parents and 203,822 children in total. Most studies showed a significant association between food insecurity and parental depression, anxiety, and stress, and between food insecurity and child depression, externalizing/internalizing behaviors, and hyperactivity.

LIMITATIONS

Most studies were cross-sectional and many were medium- or high-risk for bias or confounding.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

Food insecurity is significantly associated with various mental health outcomes in both parents and children. The rising prevalence of food insecurity and mental health problems make it imperative that effective public health and policy interventions address both problems.

Earthquake exposure, adverse childhood experiences, and psychosocial functioning in Chilean children: A longitudinal study

The impact of an 8.8 magnitude Chilean earthquake on elementary school students' psychosocial functioning was assessed along with exposure to adverse childhood experiences (ACEs). Skills for Life, a national school-based mental health program in Chile, routinely assesses first- and third-grade students' psychosocial functioning and classroom adaptation. Students (N = 19,627) were screened before (2009) and after (2011) the 2010 earthquake with parent- and teacher-report measures and with a parent-report of four ACEs (family psychopathology, child chronic illness, family social isolation, father absence). Earthquake exposure was categorized as mild, moderate, or severe for Chile's 15 regions. Multilevel models analyzed the unadjusted and adjusted impacts of earthquake exposure and ACEs on functioning while clustering for school- and district-level effects. In covariate-adjusted models, earthquake exposure and three ACEs were significantly associated with worsened psychosocial functioning; earthquake exposure and all four ACEs were significantly associated with worsened classroom adaptation. New family psychopathology, B = 1.90, p < .001; chronic illness, B = 2.25, p < .001; and severe earthquake impact, B = 1.29, p < .001, held the strongest negative effects on psychosocial well-being. Moderate, B = 3.04, p = .011, and severe earthquake exposure, B = 2.53, p = .047, and new family psychopathology, B = 1.99, p < .001, were associated with the worst classroom functioning 1-year postdisaster. Findings suggest that both exogenous and home-based stressors can have significant consequences for children's psychosocial functioning and classroom adaptation, and routine screening helps quantify how individual students are affected by chronic versus acute stressors.

Food Insecurity in the Food Allergic Population: A Work Group Report of the AAAAI Adverse Reactions to Foods Committee

Food allergies affect 32 million Americans. Restricted diets due to food allergies can be difficult to maintain especially when the household is food insecure. Food insecurity is defined as the inability to acquire food for household members due to insufficient money or resources for food. The COVID-19 pandemic has caused many people to face food insecurity for the first time with Latinx, Native American, and Black communities disproportionately affected. Because of the increase in food insecurity, this work group developed a survey regarding food insecurity screening. This survey was sent out to a random sample of American Academy of Allergy Asthma & Immunology members to assess food insecurity knowledge and practices. The majority of survey participants did not routinely screen their patients for food insecurity. The biggest barrier identified to screening was lack of knowledge of how to perform a screen and resources available when a patient screened positive. This work group report provides guidance on how to implement and perform a food insecurity screen, including federal resources and assistance programs.

An Assessment of the Relationship of SNAP and Anemia Among School-Aged Children and Adolescents Living in Households With Food Insecurity

Children in food-insecure households have an increased risk of anemia. Participation in Supplemental Nutrition Assistance Programs (SNAP) has several benefits. However, it is unknown if it ameliorates anemia among school-aged children and adolescents living in food-insecure households. This study aims to assess the association of SNAP participation and anemia among children and adolescents living in households experiencing food insecurity. The sample population (n = 1635), aged 6 to 18 years, were pooled from the 2003–2014 National Health and Nutrition Examination Survey (NHANES). The exposure of interest was self-reported household SNAP participation. The outcome variable was the presence or absence of anemia, classified using the blood hematocrit concentration values. Survey weighted logistic regression was performed to calculate the odds ratio (OR) and 95% Confidence Interval (CI) of the association between participation in SNAP and anemia in food-insecure children. We found that over 80% of anemic children and adolescents, living in food-insecure households, participated in SNAP, while 63% of non-anemic children and adolescents, living in food-insecure households participated in SNAP (p = .007). Among children living in food-insecure households, SNAP participants had 3-fold increased odds of anemia compared to those who do not participate in SNAP, after adjusting for confounders (OR = 3.33, 95% CI: 1.25–8.88). In this study, SNAP participation was associated with increased odds of anemia in children and adolescents living in food-insecure households. Additional research is needed to assess if these unexpected findings are related to the adequacy of SNAP, affordability, and accessibility to healthy foods, or the household and individual food preferences in food-insecure households.

Racial disparities in psychological distress in post-apartheid South Africa: results from the SANHANES-1 survey

PURPOSE

South Africa has long endured a high prevalence of mental disorders at the national level, and its unique social and historical context could be a contributor to an increased risk of mental health problems. Our current understanding is limited regarding the relative importance of various social determinants to mental health challenges in South Africa, and how existing racial inequities may be explained by these determinants.

METHODS

This study attempted to elucidate potential social determinants of mental health in South Africa using data from the nationally representative South African National Health and Nutrition Examination Survey (SANHANES-1). The main outcome of interest was psychological distress, measured with the Kessler-10 scale. Hierarchical linear regression models included covariates for demographic and socioeconomic factors, count of traumatic events, and a series of stress-related constructs. Analyses were conducted on two populations: the entire sample (n = 15,981), and the African subpopulation (n = 10,723).

RESULTS

Regression models on the entire sample indicated racial disparities in psychological distress, with Africans experiencing higher distress than White and Coloured individuals. Results within the African sub-population indicated geo-spatial disparities, with Africans in formal urban settings experiencing higher psychological distress than those living in formal and informal rural locales. Across both samples, results indicated a cumulative association between count of stressors and traumatic events and distress.

CONCLUSION

We found racial disparities across several mental health-related domains. Africans had greater exposure to traumatic events, social stressors, and psychological distress. This research is a necessary foundation for public health interventions and policy change to effectively reduce inequities in psychological distress.

Changes in psychosocial functioning among urban, school-age children during the COVID-19 pandemic

BACKGROUND

There is concern about the effect of the COVID-19 pandemic on psychosocial functioning among school-age children, who have faced unusual stressors during this time. Our goal was to assess mental health symptoms and social risks during COVID-19, compared to before the pandemic, for urban, racial and ethnic minority school-age children, and investigate the relationship between mental health and social risks.

METHODS

We conducted a cohort study from September 2019 until January 2021 of children age 5-11 years old recruited from an urban safety net hospital-based pediatric primary care practice. We measured emotional and behavioral symptoms (including attention, internalizing, and externalizing symptoms) before and during the pandemic with the Pediatric Symptom Checklist (PSC-17). We measured social risks (including food and housing insecurity) before and during the pandemic with the THRIVE screener. We measured additional mid-pandemic COVID-related stressors with items on school participation, screens/media use, illness exposure, and caregiver mental health. We compared pre- and mid-pandemic PSC-17 symptom scores across 4 domains (total, attention, internalizing, and externalizing) and used path analysis to examine the relationship between mental health and social risks pre- and mid-pandemic.

RESULTS

Caregivers of 168 children (54% non-Hispanic Black, 29% Hispanic, and 22% non-English speaking) completed the study. Children had significantly higher levels of emotional and behavioral symptoms midpandemic- vs. pre-pandemic in all domains. Significantly more children had a positive PSC-17 total score (18% vs. 8%, p < 0.01) and internalizing (depression and anxiety) score (18% vs. 5%, p < 0.001) during the pandemic vs. before, indicating clinical concerns in these areas. Caregivers reported significantly more social risks during vs. before the pandemic (p < 0.001). Mental health symptoms significantly correlated with number of social risks before the pandemic, but not during the pandemic. Less school assignment completion, increased screen time, and caregiver depression were all significantly associated with worse mid-pandemic mental health in children.

CONCLUSION

The COVID-19 pandemic has led to a dramatic increase in depression/anxiety problems and social risks among urban, racial and ethnic minority school-age children compared to before the pandemic. More research is needed to understand if these changes will persist.

Race, geographical location and other risk factors for hypertension: South African National Health and Nutrition Examination Survey 2011/12

BACKGROUND

Hypertension is the leading cardiovascular disease in Africa. It is increasing in prevalence due partly to the epidemiological transition that African countries, including South Africa, are undergoing. This epidemiological transition is characterised by a nutrition transition andurbanisation; resulting in behavioural, environmental and stress changes that are subject to racial and geographic divides. The South African National Health and Nutrition Examination Survey (SANHANES) examined the association of traditional risk factors; and less traditional risk factors such as race, geographical location, social stressors and psychological distress with hypertension in a national population-based sample of South Africans.

METHODS

Data were analysed on individuals ≥15 years who underwent a physical examination in the SANHANES (n = 7443). Hypertension was defined by blood pressure ≥140/90 mmHg or self-reported hypertension medication usage. Stepwise regression examined the association of demographic, socioeconomic, life stressors, and health risk factors with systolic blood pressure, diastolic blood pressure, and hypertension. Secondly, the risk factor associations and geographical location effects were investigated separately for the African race group.

RESULTS

Increasing age (AOR = 1.069, p < 0.001); male gender (AOR = 1.413, p = 0.037); diabetes (AOR = 1.66, p = 0.002); family history of high blood pressure (AOR = 1.721, p < 0.001); and normal weight, overweight and obesity (relative to underweight: AOR = 1.782, p = 0.008; AOR = 2.232, p < 0.001; AOR = 3.874, p < 0.001 respectively) were associated with hypertension. Amongst African participants (n = 5315) age (AOR = 1.068, p < 0.001); male gender (AOR = 1.556, p = 0.001); diabetes (AOR = 1.717, p = 0.002); normal weight, overweight and obesity (relative to underweight: AOR = 1.958, p = 0.006; AOR = 2.118, p = 0.002; AOR = 3.931, p < 0.001); family history of high blood pressure (AOR = 1.485, p = 0.005); and household crowding (AOR = 0.745, p = 0.037) were associated with hypertension. There was a significantly lower prevalence of hypertension in rural informal compared to urban formal settings amongst African participants (AOR = 0.611, p = 0.005). Other social stressors and psychological distress were not significantly associated with hypertension.

CONCLUSION

There was no significant association between social stressors or psychological distress and hypertension. However, the study provides evidence of high-risk groups for whom hypertension screening and management should be prioritised, including older ages, males, people with diabetes or with family history of hypertension, and Africans who live in urban formal localities.

Associations between food provision and feeding practices in socially disadvantaged childcare centres

Preschool children consume a large proportion of their daily food intake in their childcare settings. These settings, therefore, provide important opportunities for children to experience food socialisation, and related positive nutrition. Yet, the extent to which these opportunities are taken, particularly in socioeconomically disadvantaged areas where risk of poor nutrition is high, is not well documented. This study focused on 10 childcare centres in socially disadvantaged locations and examined daily feeding practices via direct in-situ observation (n = 189 children observed). Centres were randomly selected based on type of food provision: centre-provided (n = 5 centres) or family-provided (n = 5 centres). Analyses showed that where food was family-provided, educators were significantly more likely to use controlling feeding practices, including pressuring children to eat, restricting food choices and rushing children into finishing meals. These practices were particularly evident during mid-morning meals, where pressuring children to eat healthy foods first, was more often observed. Further research and interventions that target feeding practices in childcare are indicated and should consider how source of food provision impacts upon these practices.

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.

The association between food insecurity, diet quality, and untreated caries among US children

BACKGROUND

The aim of this study was to examine the association between food insecurity and untreated caries among US children and the potential role of diet quality as a mediator in this relationship.

METHODS

The authors analyzed data for 4,822 children aged 5 through 17 years from the National Health and Nutrition Examination Survey cycles from 2011 through 2014. The authors measured food security as household-level food security status (full, marginal, low, very low) and overall food security status (full food secure, food insecure). They measured diet quality using the Healthy Eating Index. The primary outcome measure was untreated caries (none, ≥ 1). The authors used multiple logistic regression analysis to evaluate the relationships among food insecurity, diet quality, and untreated caries. They conducted mediation analysis using the Baron and Kenny approach.

RESULTS

Food-insecure children were more likely to have untreated caries compared with their fully food-secure counterparts, after controlling for confounding variables (odds ratio [OR], 1.38; 95% [CI, 1.11 to 1.72). Specifically, children from marginal and very low food-secure households had significantly higher odds of untreated caries (OR, 1.48; 95% CI, 1.10 to 2.01) compared with children from fully food-secure households (OR, 1.59; 95% CI, 1.12 to 2.26). Diet quality was not significantly associated with untreated caries.

CONCLUSIONS

Food insecurity was negatively associated with untreated caries among US children. Diet quality was not associated with untreated caries.

PRACTICAL IMPLICATIONS

Social factors such as food insecurity should be taken into consideration when dental clinicians perform caries risk assessment because caries risk is shown to be associated with overall health and dental health.

Defining and Intervening on Cumulative Environmental Neurodevelopmental Risks: Introducing a Complex Systems Approach

BACKGROUND

The combined effects of multiple environmental toxicants and social stressor exposures are widely recognized as important public health problems contributing to health inequities. However cumulative environmental health risks and impacts have received little attention from U.S. policy makers at state and federal levels to develop comprehensive strategies to reduce these exposures, mitigate cumulative risks, and prevent harm. An area for which the inherent limitations of current approaches to cumulative environmental health risks are well illustrated is children's neurodevelopment, which exhibits dynamic complexity of multiple interdependent and causally linked factors and intergenerational effects.

OBJECTIVES

We delineate how a complex systems approach, specifically system dynamics, can address shortcomings in environmental health risk assessment regarding exposures to multiple chemical and nonchemical stressors and reshape associated public policies.

DISCUSSION

Systems modeling assists in the goal of solving problems by improving the "mental models" we use to make decisions, including regulatory and policy decisions. In the context of disparities in children's cumulative exposure to neurodevelopmental stressors, we describe potential policy insights about the structure and behavior of the system and the types of system dynamics modeling that would be appropriate, from visual depiction (i.e., informal maps) to formal quantitative simulation models. A systems dynamics framework provides not only a language but also a set of methodological tools that can more easily operationalize existing multidisciplinary scientific evidence and conceptual frameworks on cumulative risks. Thus, we can arrive at more accurate diagnostic tools for children's' environmental health inequities that take into consideration the broader social and economic environment in which children live, grow, play, and learn. https://doi.org/10.1289/EHP7333.

Racial Disparities in School Lunch Program Participation and Cigarette Use: Evidence from Arizona Youth Survey Data

Background: Cigarette and other tobacco product use among youth has become a serious public health issue in the United States. Thus, it is important to understand the social and contextural factors of cigarette use, especially for the young population. This study explores the relationship between participation in the National School Lunch Program (NSLP) and youth cigarettes use. Further, this study examines how this relationship differs across racial/ethnic groups. Methods: The 2016 Arizona Youth Survey (n = 34,373) data and multivariate logistic regressions were used to examine the association between NSLP participation (free and reduced-cost) and youth cigarette use, both lifetime and past 30-day smoking behaviors. In addition, subgroup analyses were conducted to test the racial disparities in NSLP participation and cigarette use. Results: Results showed that free lunch participation was associated with significantly higher odds of youth cigarette use, both lifetime (OR = 1.25; p < .001) and in the past 30-days (OR = 1.14; p < .05). However, reduced-cost lunch participation was associated with significantly higher odds only for lifetime cigarette use (OR = 1.20; p < .01). Subgroup analyses revealed differences across the six racial/ethnic groups. White and Latinx youth showed a significant relationship between NSLP participation and lifetime cigarette smoking, whereas only Latinx youth showed a significant relationship between NSLP participation and past 30-day smoking. Implications: The findings suggest that intervention approaches to smoking cessation and prevention should be tailored to different racial/ethnic groups to account for their differences. Given the findings that youth (especially Latinxs) who participate in free and reduced-cost lunch programs are at a higher risk of using cigarettes than youth who do not, this study suggests that health intervention programs can enhance their reach and effectiveness by building partnerships with schools with sizable NSLP programs.

Childhood exposure to hunger: associations with health outcomes in later life and epigenetic markers

Aim: To assess associations of early exposure to hunger with depressive symptoms and cardiovascular disease (CVD) and to investigate possible epigenetic pathways. Patients & methods: Data were based on a German population-based cohort of older adults (n = 9631). Regression models were performed for health outcomes in later life. An epigenome-wide association study for early-life exposure to hunger was performed in a subgroup (n = 2221) with whole blood DNA methylation data. Results: Childhood exposure to hunger was associated with CVD and depressive symptoms in later life. Prenatal or infant exposure was strongly associated with depressive symptoms. No CpG reached epigenome-wide significance after multiple testing correction. Conclusion: Childhood hunger is a risk factor for depressive symptoms and CVD at older age. DNA methylation could not explain this association.

Food insecurity in households with young children: A test of contextual congruence

Household food insecurity, an inability to provide adequate nutrition for a healthy, active lifestyle, affects nearly 1 in 7 households with children in the United States. Though rates of food insecurity declined to pre-recession levels just prior to the COVID-19 pandemic, they are now once again increasing. As a result, in one of the wealthiest countries in the world, millions of young children continue to grow up in households that struggle daily with a problem that is often associated with the developing world. The result is both immediate and long-term health and development deficits for children. We propose that the degree of demographic and socioeconomic congruence between the households of young children and their neighborhood of residence lends unique insights to food insecurity. We examine this using the ECLS-K 2010-2011 for children in families with incomes below 400 percent of the federal poverty line (N = 8600). Results show that congruence between household and neighborhood education and race/ethnicity associates with the likelihood of experiencing food insecurity. For example, households with non-Hispanic black children living in neighborhoods with high proportions of non-Hispanic blacks have significantly lower probabilities of food insecurity than similar households living in neighborhoods with smaller black populations. Similarly, more highly educated families experience lower probability of food insecurity in high education neighborhoods than when they reside in low education neighborhoods. Focusing on neighborhood risk factors as absolute and independent contributors limits our understanding of how families experience food insecurity as well as any policy efforts to address it.

Addressing Food Insecurity: An Evaluation of Factors Associated with Reach of a School-Based Summer Meals Program

BACKGROUND

One in six US households with children experiences food insecurity, with higher rates in the summer. Approximately 3 million children receive free meals each summer weekday through the US Department of Agriculture's Summer Nutrition Programs. However, participation in these programs has been declining in recent years and is lower than participation in programs that serve free or reduced-price meals during the school year.

OBJECTIVE

To identify school and site characteristics associated with greater reach by school-based free summer meals program sites.

DESIGN

This observational study combined program data, public school data, and Google Maps data to determine factors associated with site reach.

PARTICIPANTS/SETTING

LunchStop Summer Meals Program sites (N=100) and schools at which they were based during summer 2018 in Chicago, IL.

MAIN OUTCOME MEASURES

Reach of sites was measured by the mean daily meals served at each site throughout summer 2018.

STATISTICAL ANALYSES PERFORMED

Associations between site reach and each independent variable were evaluated using Mann-Whitney tests and simple linear regressions. Variables significantly associated with site reach in bivariate analyses (P<0.05) were included in a multivariate linear regression.

RESULTS

In bivariate analyses, sites with greater reach were significantly more likely to be based at schools with higher attendance percentages, higher percentages of Hispanic/Latino students, larger student populations, and locations in a network of southwest Chicago schools. Those with greater reach were also significantly more likely to have continuity in program staff and more years of site operation (all P values ≤0.01). The last four factors remained significant in multivariate analysis.

CONCLUSIONS

School-based summer meals programs may be able to reach more vulnerable children by taking into account continuity among sites and staff. Further research is needed to clarify whether the relationships between these variables and increased reach is causal.

Food Insecurity in Advanced Capitalist Nations: A Review

Food insecurity is a substantial problem in nearly every advanced capitalist nation, with sizable portions of residents in many affluent countries struggling to eat healthily every day. Over time, a very large literature has developed that documents food insecurity, evaluates programs meant to reduce that insecurity, and proposes solutions to attenuate the problem. The purpose of the current review is to provide a very broad overview of the food insecurity literature, including definitions, measurement, areas of study, and impacts on health. Importantly, this review suggests there are two major causes of food insecurity in the advanced nations: economic inequality and neoliberalism. The food insecurity literature suggests that diminished government responsibility in advanced capitalist nations corresponds to an increase in feeding programs run by non-profit and charitable organizations. This review concludes by suggesting that, while a massive amount of research on food insecurity currently exists, more research is still needed to address gaps in the literature when it comes to significant events, coping strategies and disadvantaged populations.

Prevalence of adverse childhood experiences (ACE) in the Czech Republic

A cross-sectional survey was undertaken to estimate the prevalence of child maltreatment and adverse childhood experiences in the Czech Republic, as data on these is scarce. The survey was conducted among 1760 randomly selected students from five Czech universities. Participants filled in the adverse childhood experiences survey instrument. The results showed that the prevalence of child maltreatment and other adverse childhood experiences is high: emotional abuse was reported by 20.7%, physical abuse by 17.1%, sexual abuse by 6.4%, and physical neglect by 8.0%. Household dysfunction was also high, with household street drug use reported by 4.9%, alcohol misuse by 15.3%, mental disorder by 13.4%, parental violence by 22.1% and parental separation by 23%. Thirty-eight per cent had not experienced any adverse childhood experience, while 9.9% reported experiencing four or more types of adverse childhood experiences. There was a significant association between adverse childhood experiences and health-harming behaviours such as suicide attempt, drug use, risky sexual behaviour and tobacco use. The findings suggest that there is a need to invest in prevention programmes.

The Impact of Food Insecurity on Child Health

Food insecurity (FI) has severe implications on children's health and their future health outcomes. Children with FI have limited access to healthy foods and demonstrate poorer eating behavior, leading to chronic absenteeism, school failure, and chronic disease. Given the health implications of FI, it is imperative for pediatricians to screen all children, and advocate for protecting necessary nutritional programs that exist to mitigate FI and for improved accessibility of nutritious, healthy food options, especially in locations labeled as food deserts. Given the severe consequences of FI, collaboration of multidisciplinary teams is necessary to facilitate enhanced care of all patients.

The Relationship Between Social Risks and the Mental Health of School-Age Children in Primary Care

BACKGROUND AND OBJECTIVE

The study's goal was to measure the association between social risks and the mental health of school-age children in primary care.

METHODS

We conducted a cross-sectional study in an urban safety-net hospital-based pediatric clinic using data collected from 2 standardized screening tools administered at well-child care visits for children age 6 to 11. Psychosocial dysfunction was measured with the Pediatric Symptom Checklist-17 (PSC-17), and 6 social risks (caregiver education, employment, child care, housing, food security, and household heat) were measured with the WE CARE screener. Multivariable linear and logistic regression analyses were conducted to measure the association between scores while controlling for sociodemographic characteristics.

RESULTS

Among N = 943 patients, cumulative social risks were significantly associated with a positive PSC-17 total score (adjusted odds ratio [aOR] 1.2; 95% confidence interval [CI] 1.1-1.5; P = .02), indicating psychosocial dysfunction. Children with ≥3 social risks were 2.4 times more likely to have a positive PSC-17 total score compared to children with <3 social risks (95% CI 1.5-3.9; P < .001). Of the individual social risks measured, only food insecurity significantly predicted a positive PSC-17 total score (aOR 1.9; 95% CI 1.1-3.2; P = .02) and attention score (aOR 1.9; 95% CI 1.1-3.4; P = .03).

CONCLUSION

Number of risks on a social risk screener was associated with psychosocial dysfunction in school-age children. Food insecurity was the only individual risk associated with psychosocial dysfunction, in particular attention problems. Screening tools for social risks could be used to identify at-risk children whose mental health may be adversely impacted by their social conditions.

Understanding the Psychological Distress of Food Insecurity: A Qualitative Study of Children's Experiences and Related Coping Strategies

BACKGROUND

Food insecurity, a condition of inadequate household food availability, affects 15.7% of US households with children. Food insecurity is generally believed to affect the quantity and quality of food consumed. However, an understudied but important aspect of the experience of food insecurity is psychological distress.

OBJECTIVE

To critically explore the psychological distress associated with children's food insecurity using children's own reports of their experiences.

DESIGN

In-depth qualitative interviews conducted with children to better understand the psychological distress associated with food insecurity.

PARTICIPANTS/SETTING

Sixty children (aged 7 to 14 years) were recruited from the San Francisco Bay Area. Children were eligible in the case that they spoke English fluently and their parent reported any experience of household food insecurity during the past year.

RESULTS

Children discussed six themes related to the psychological distress associated with food insecurity: worrying about not having enough food, worrying about their parents' well-being, anger and frustration about not having enough food, embarrassment about their family's food situation, strain on the family's dynamics due to food insecurity, and sadness over not having enough food. After describing their experiences, children described strategies they employed to tolerate or cope with food insecurity, including distracting from or using their imagination to cope with food insecurity, increasing tolerance of their family's food situation, and appreciating their parents for providing food and resources.

CONCLUSIONS

Food insecurity contributes to children's psychological distress. Given the known effects of chronic stress in childhood, the psychological distress of food insecurity may represent an important mechanism by which food insecurity adversely influences children's growth and development and deserves investigation in future studies.

Household Food Insecurity is Associated with Higher Adiposity among US Schoolchildren Ages 10-15 Years: The Healthy Communities Study

BACKGROUND

Limited research exists on the relationship between food insecurity and children's adiposity and diet and how it varies by demographic characteristics in the United States.

OBJECTIVE

The aim of this study was to assess the relationship between household food insecurity and child adiposity-related outcomes, measured as BMI (kg/m2) z score (BMI-z), weight status, and waist circumference, and diet outcomes, and examined if the associations differ by age, sex, and race/ethnicity.

METHODS

Data collected in 2013-2015 from 5138 US schoolchildren ages 4-15 y from 130 communities in the cross-sectional Healthy Communities Study were analyzed. Household food insecurity was self-reported using a validated 2-item screener. Dietary intake was assessed using the 26-item National Cancer Institute's Dietary Screener Questionnaire, and dietary behaviors were assessed using a household survey. Data were analyzed using multilevel statistical models, including tests for interaction by age, sex, and race/ethnicity.

RESULTS

Children from food-insecure households had higher BMI-z (β: 0.14; 95% CI: 0.06, 0.21), waist circumference (β: 0.91 cm; 95% CI: 0.18, 1.63), odds of being overweight or obese (OR: 1.17; 95% CI: 1.02, 1.34), consumed more sugar from sugar-sweetened beverages (β: 1.44 g/d; 95% CI: 0.35, 2.54), and less frequently ate breakfast (β: -0.28 d/wk; 95% CI: -0.39, -0.17) and dinner with family (β: -0.22 d/wk; 95% CI: -0.37, -0.06) compared to children from food-secure households. When examined by age groups (4-9 and 10-15 y), significant relationships were observed only for older children. There were no significant interactions by sex or race/ethnicity.

CONCLUSIONS

Household food insecurity was associated with higher child adiposity-related outcomes and several nutrition behaviors, particularly among older children, 10-15 y old.

Perceived Benefits and Barriers to Free Summer Meal Participation Among Parents in New York City

OBJECTIVE

To examine perceived benefits and barriers of summer meal participation among lower-income families who participate in school lunch programs during the year.

DESIGN

Semistructured phone interviews were conducted with parents of elementary-aged children, including both participants and nonparticipants in summer meals.

SETTING

Queens, Bronx, and Brooklyn, NY.

PARTICIPANTS

Participants were lower-income, racially/ethnically diverse parents of elementary-aged children. Of 20 participants, 17 were minorities (85%), 16 were women (80%), and 11 had an annual household income < $30,000 (55%).

PHENOMENON OF INTEREST

Interviews explored parents' experiences with summer meals programs, the impact on food provisioning in the summer, and benefits and barriers.

ANALYSIS

Interviews were transcribed, coded, and analyzed thematically.

RESULTS

Five themes emerged, including 3 benefits of summer meals: reducing stress for parents, fostering social support and connection, and the opportunity to develop healthier eating habits; and 2 barriers to participation: lack of cultural inclusivity and lack of widespread knowledge about summer meals.

CONCLUSIONS AND IMPLICATIONS

The main purpose of summer meals is to reduce food insecurity, but the programs also provide social and psychological benefits valued by lower-income families in New York, although participation barriers persist.

Trends and disparities in urinary BPA concentrations among U.S. emerging adults

BACKGROUND

Emerging adulthood (ages 18-25 years) is a key turning point in the life course characterized by particularly poor eating behaviors (e.g., low in fruits and vegetables, and high in fast food) and weight gain. Emerging adults are also prime consumers of personal care and other consumer products that may result in differential exposures to environmental contaminants, such as Bisphenol A (BPA), compared to adults aged 26+ years. This is of concern given BPA has been associated with adverse health outcomes such as obesity, metabolic disorders, miscarriage, infertility and breast cancer. However, no research has examined exposure to BPA among emerging adults.

OBJECTIVE

To assess trends of exposure to urinary BPA among a representative sample of emerging adults compared to adults aged 26+ years. Secondarily, we aimed to identify differential associations between BPA concentrations and sociodemographic characteristics and BMI by age group.

METHODS

This study uses National Health and Examination Surveys (NHANES) over 2003-2014 to test differences in BPA concentrations comparing emerging adults to adults aged 26+ years. Generalized linear models predicting log BPA by age group and sex, race/ethnicity, education, income, and food security status, and generalized linear models predicting BMI by log BPA, both age group and age as a continuous variable, sex, race/ethnicity, education, income, and food security status were conducted. Interactions with age group (i.e., age group x sex) were examined for the mutually adjusted models. All models controlled for survey year, month, and time of day, and were run with, and without, an adjustment for urinary creatinine.

RESULTS

In models adjusted, and not adjusted, for urinary creatinine, emerging adults had a higher log BPA concentration than adults aged 26+ years (β=0.153, p=0.004; β=0.544, p<0.001), and a significantly steeper decline in BPA concentration between 2003-2004 and 2013-2014 than adults aged 26+ years (ß=-0.051, p=0.002; ß=-0.071, p=0.001). Males' log BPA concentration were lower than that for females when urinary creatinine was included in the model, and higher when urinary creatinine was excluded from the model (ß=-0.188, p<0.001; β=0.203, p<0.001). Higher income was significantly associated with lower log BPA concentration (ß=-0.220, p<0.001; ß=-0.166, p<0.001). A significant interaction between emerging adult age group and food security status was observed, which was associated with higher BPA exposures. Log BPA concentration was associated with BMI only when urinary creatinine was excluded from the models (urinary creatinine included: β=0.031, p=0.747; β=0.022, p=0.815, urinary creatinine excluded: β=0.528, p<0.001; β=0.552, p<0.001).

CONCLUSION

Findings indicate that emerging adults had higher BPA exposures than adults aged 26+ years in 2003-2004, and that emerging adults' exposure level has decreased faster than that of adults aged 26+ years. There were suggestions that the BPA concentration of emerging adults in 2013-2014 was lower than that for adults aged 26+ years, and that BPA exposure is associated with higher BMI. Our results highlight the need for additional research to identify the sources and routes of exposure to BPA and BPA replacements among emerging adults and to better characterize the variability in exposure. Intervention studies are needed to assist emerging adults in limiting their exposure to BPA, and potentially also the BPA alternatives.

Child health and the possibilities for childcare in a context of poverty and food insecurity: The narratives of parents attending a self-managed foodbank in Spain

Food insecurity would influence children's health and development through its effects on nutrition and household stress in the context of broader poverty-related problems. This study contributes to research regarding the characterisation of food-insecure households with children under the age of 18. In particular, it highlights the social and institutional aspects which influence and interact with parents' attempts to protect their children from hunger and destitution. In this study, we document some aspects of the harsh realities faced by mothers and fathers with children under the age of 18 living in poverty who attended a self-organised foodbank in the city of Madrid in 2015. We used a qualitative methodology consisting of 7 months of participant observation and the conduction of 15 in-depth interviews. This study shows how the possibilities for the meaningful protection of children in food-insecure households can be influenced by parental coping strategies, community resources and availability and accessibility to public help. Foodbanks can help reduce both household hunger (although not meeting all nutritional requirements) and parental psychosocial distress, which might support parents to better protect their children. In particular, self-managed foodbanks appear to help parents cope with emotional distress by reducing feelings of powerlessness and self-blame through their active involvement, and thanks to the collective caring that occurs between members. Public services are of special relevance, since their absence or an active institutional discrimination has been shown to further damage impoverished households with children. We suggest that public policies in Spain are revised and reinforced to enable a more genuine protection of children and their families living under severe deprivation, and to prevent life-long damage. Public institutions could assume that people attending a foodbank are living in severe poverty and need access to adequate and supportive public resources to address it.

Household Food Insecurity in Early Adolescence and Risk of Subsequent Behavior Problems: Does a Connection Persist Over Time?

OBJECTIVE

Household food insecurity is common among U.S. families, and adolescents are almost twice as likely as school-aged children to be food insecure. However, little is known about how household food insecurity relates to adolescent behavioral outcomes over time. The purpose of this study was to examine whether food security status in early adolescence is associated with behavioral problems over a 6-year period in an ethnically diverse sample of teenagers from low-income households.

METHODS

The study examined longitudinal data from the Welfare, Children, and Families: A Three-City Study. A total of 1,049 primary caregivers completed measures of child/adolescent behavioral problems and household food insecurity during the past year. Data were collected across three waves, when focal children were between 10 and 14 years old, 11 and 16 years old, and 16 and 18 years old, respectively. Generalized estimating equations were used to assess initial household food insecurity as a time-invariant effect on adolescent behavioral problems over time.

RESULTS

Baseline household food insecurity in pre- or early adolescence was significantly associated with greater internalizing problems and total behavioral problems over time.

CONCLUSIONS

These findings indicate that household food insecurity is associated with behavioral problems throughout adolescence. This suggests the need for health providers to screen for household food insecurity during scheduled health visits and highlight the need for integration of psychosocial services into pediatric care and expansions in current federal assistance programs.

The Academic, Behavioral, and Health Influence of Summer Child Nutrition Programs: A Narrative Review and Proposed Research and Policy Agenda

Since 1975, the US Department of Agriculture has sponsored the Summer Food Service Program as a nationwide strategy for providing nutritious meals to children and youth (aged 18 years or younger) in low-income communities during the summer months. Many programs are sponsored by community organizations as well as school districts that may offer the program through the Summer Food Service Program or a seamless waiver, allowing them to extend school meals programs into the summer. These summer nutrition programs are designed to decrease food insecurity and improve health outcomes among at-risk populations. However, the characteristics of these programs, including the types of participants reached, and the programs' influence on outcomes such as academics, behavior, and physical and mental health, have not been summarized. The aims of this narrative review are to present existing knowledge about the characteristics of summer nutrition programs and their influence on students, to identify knowledge gaps, and to identify future research needs. An extensive search identified eight peer-reviewed articles and 10 reports, briefs, or other documents reporting research on the Summer Food Service Program. A variety of additional literature was reviewed to provide relevant information about summer nutrition programs. The review revealed a dearth of research regarding current Summer Food Service Program implementation. Summer nutrition programs alleviated food insecurity among at-risk populations; however, little research was found about the influence of summer programs on students' dietary intake or weight outcomes. More rigorous and mixed-methods studies examining the characteristics and influence of summer nutrition programs are needed.

The Relationship between Food Insecurity and Symptoms of Attention-Deficit Hyperactivity Disorder in Children: A Summary of the Literature

Food insecurity is a major public health concern characterized by an individual or household lacking access to adequate food to support a healthy lifestyle. Food insecurity has been associated with predisposing or exacerbating mental health symptoms in children. However, the evidence is scarce with regards to Attention-Deficit Hyperactivity Disorder (ADHD) symptoms in children. The purpose of this review is to summarize and identify gaps in the existing literature, as well as to explore associations between food insecurity and symptoms of childhood ADHD. Literature for this review was pulled from Ovid MEDLINE and PubMed library databases, with a focus on food insecurity, food insufficiency, hunger, and ADHD symptoms such as inattention, hyperactivity, and impulsivity in children. The limited evidence to date shows a predictive and inverse relationship between childhood experience of food insecurity and symptoms of ADHD, with lasting impacts into adulthood. Evidence exists to hypothesize that childhood food insecurity is associated with predisposing or exacerbating ADHD symptoms in children, yet the literature needed to confirm this relationship is scarce and utilizes inconsistent methodology. Future research is needed to further characterize this complex relationship and inspire community or public health interventions addressing food insecurity in children with ADHD. Additionally, it may be clinically useful to routinely screen for food insecurity when assessing pediatric ADHD symptoms.

Assessing food insecurity prevalence and associated factors among college students enrolled in a university in the Southeast USA

OBJECTIVE

To assess rates of food insecurity (FI) among college students enrolled at a large public university system across one US state and identify factors associated with experiencing FI.

DESIGN

Cross-sectional online survey administered to eligible, enrolled students (n 38 614) across three campuses within the university system, with 5593 students responding (4824 final sample after applying exclusion criteria, 12·5 % response rate). FI was assessed using the US Department of Agriculture's Adult Food Security Survey Module. Descriptive statistics were conducted to calculate FI status and identify sample characteristics. Associations between FI status and independent variables were assessed using bivariate analyses (χ2 and ANOVA tests) and multivariate logistic regression.

SETTING

Large public university system, Southeast USA.

PARTICIPANTS

Enrolled college students (excluding freshman, <18 years of age).

RESULTS

Thirty-six per cent of students were classified as FI. After controlling for confounders, factors that were significantly associated with increased likelihood of FI included previous FI (P<0·001; OR=4·78), financial factors and self-reported grade point average ≤3·85. Seniors were significantly more likely experience FI than graduate students (P=0·004, OR=1·41). A significant relationship was not identified between FI and meal plan participation, and no differences in FI were found between graduate students and individuals with sophomore or junior standing.

CONCLUSIONS

This research identifies high rates of FI among college students enrolled in a large public university system in the Southeast USA, as well as selected factors related to FI. Programmes to assist college students experiencing FI need to be developed and tested.

"It's a Feeling That One Is Not Worth Food": A Qualitative Study Exploring the Psychosocial Experience and Academic Consequences of Food Insecurity Among College Students

BACKGROUND

The issue of food insecurity is one of growing concern among institutions of higher learning in the United States. In addition to studies on the prevalence and risk factors, research is needed to better understand the mechanisms by which food insecurity affects students' health and well-being.

OBJECTIVE

To critically explore the experience of food insecurity among college students and its impact on psychosocial health and academic performance.

DESIGN

In-depth qualitative interviews were conducted with college students to gain a better understanding of the mechanisms by which food insecurity affects their psychosocial health and academic performance.

PARTICIPANTS/SETTING

Twenty-five undergraduate students from a large public university in California who were recruited from a campus food pantry.

RESULTS

Students discussed several themes related to the psychosocial effects of food insecurity: the stress of food insecurity interfering with daily life, a fear of disappointing family, resentment of students in more stable food and financial situations, an inability to develop meaningful social relationships, sadness from reflecting on food insecurity, feeling hopeless or undeserving of help, and frustration directed at the academic institution for not providing enough support. Students also discussed how food insecurity affected their academic performance through physical manifestations of hunger and the mental trade-off between focusing on food and focusing on academics.

CONCLUSION

These findings contribute to the understanding of what it means to experience food insecurity in higher education and can inform how universities support students' basic needs.

Child food insecurity in the UK: a rapid review

Background

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

Objective

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

Data sources

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

Methods

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

Results

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

Limitations

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

Conclusions

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

Future research

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

Study registration

This study is registered as PROSPERO CRD42017084818.

Funding

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

Household Food Insecurity and Psychosocial Dysfunction in Ecuadorian Elementary Schoolchildren

Household food insecurity (HFI) is a major global public health and pediatric concern due to its reported association with adverse child nutrition, growth, and health outcomes. Psychosocial dysfunction is a major cause of childhood disability. US and Canadian studies have linked HFI to poorer overall psychosocial dysfunction and specific dysfunction types in school-aged children, i.e., internalizing, externalizing, and attention behaviors. However, it is uncertain whether prior findings are generalizable to low- and middle-income country (LMIC) settings. We conducted a cross-sectional study to explore the association of HFI with psychosocial dysfunction in 6-12-year-old public elementary schoolchildren (n=279) residing in low-income neighborhoods in Quito, Ecuador. Maternal caregivers were interviewed to obtain data on child psychosocial dysfunction (Pediatric Symptom Checklist, PSC), food security (Household Food Security Survey Module), and maternal mental health (SF-36 Mental Composite Summary). Capillary blood samples were obtained from child participants to measure hemoglobin levels. The data were analyzed using general linear models with adjustment for covariates. The results revealed that HFI was associated with significantly higher overall average PSC scores (p=0.002) and with internalizing (p=0.001) and externalizing (p=0.03) but not attention subscale scores. However, anemia was independently associated with PSC attention subscale scores (p=0.015). This is the first study to report on the relationship between HFI and psychosocial dysfunction in school-aged children in a LMIC setting. It highlights the importance of improving policies and programs protecting vulnerable households from HFI. In addition to improving health and nutrition, such improvements could potentially reduce the burden of child psychosocial dysfunction.

Pension beneficiaries' household food insecurity and associated factors in Debre Markos town, Northwest Ethiopia

Objectives

A community based cross-sectional study was conducted from March to April, 2016 in Debre Markos town, Northwest Ethiopia to assess the level of household food insecurity and associated factors among pension beneficiaries.

Results

The overall prevalence of household food insecurity among pension beneficiaries’ households was 82.5%. Among food insecure households, 4.9% were labelled as mildly, 48.5% moderately and 46.6% severely food insecure. Living in rental house (P = 0.05), being younger beneficiaries (P = 0.001), low monthly household income (P = 0.001) and poor self-reported health status (P = 0.03) were found significantly associated with household food insecurity. In conclusion, food insecurity was a public health problem among pension beneficiaries in the study area. The effort of the government to increase the pension benefit and making especial subsidy on food and health costs yield a long-term solution.

Factors Associated with Continued Food Insecurity among Households Recovering from Hurricane Katrina

In 2010, 14.5% of US households experienced food insecurity, which adversely impacts health. Some groups are at increased risk for food insecurity, such as female-headed households, and those same groups are often also at increased risk for disaster exposure and the negative consequences that come with exposure. Little research has been done on food insecurity post-disaster. The present study investigates long-term food insecurity among households heavily impacted by Hurricane Katrina. A sample of 683 households participating in the Gulf Coast Child and Family Health Study were examined using a generalized estimation model to determine protective and risk factors for food insecurity during long-term recovery. Higher income (Odds Ratio (OR) 0.84, 95% Confidence Interval (CI) 0.77, 0.91), having a partner (OR 0.93; 95% CI 0.89, 0.97), or "other" race were found to be protective against food insecurity over a five-year period following disaster exposure. Low social support (OR 1.14; 95% CI 1.08, 1.20), poor physical health (OR 1.08; 95% CI 1.03, 1.13) or mental health (OR 1.13; 95% CI 1.09, 1.18), and female sex (OR 1.05; 95% CI 1.01, 1.10) were risk factors. Policies and programs that increase access to food supplies among high-risk groups are needed to reduce the negative health impacts of disasters.

The Unequal Impact of Food Insecurity on Cognitive and Behavioral Outcomes Among 5-Year-Old Urban Children

OBJECTIVE

To examine the associations of food insecurity with children's cognitive and behavioral outcomes using quantile regression.

DESIGN

Secondary analysis of the Fragile Families and Child Wellbeing Study dataset.

PARTICIPANTS

A total of 2,046 children aged 5 years.

MAIN OUTCOME MEASURES

Child behavioral outcomes were measured using externalizing (aggressive) and internalizing (emotional) behavior problems. Child cognitive outcomes were measured using the Peabody Vocabulary test and the Woodcock-Johnson letter-word identification test. Food insecurity was measured using the US Department of Agriculture's Food Security Module.

ANALYSIS

Unconditional quantile regressions were employed. Statistical significance was set at P ≤ .05.

RESULTS

Negative associations between food insecurity and child behavior problems (externalizing and internalizing) were largest for children with the most behavior problems. For Peabody Vocabulary scores, the negative association with food insecurity was statistically significant only for children in the top half of the distribution (≥50th percentile). The analysis found mixed evidence of an association between food insecurity and the Woodcock-Johnson letter-word identification test. These associations were similar for boys and girls.

CONCLUSIONS AND IMPLICATIONS

Because children's cognitive skills and behavioral problems have long-lasting implications and effects later in life, reducing the risk of food insecurity might particularly benefit children with greater externalizing and internalizing behavior problems.

Food insecurity is associated with high risk glycemic control and higher health care utilization among youth and young adults with type 1 diabetes

AIMS

Household food insecurity (FI), i.e., limited availability of nutritionally adequate foods, is associated with poor glycemic control among adults with type 2 diabetes. We evaluated the association of FI among youth and young adults (YYA) with type 1 diabetes to inform recent clinical recommendations from the American Diabetes Association for providers to screen all patients with diabetes for FI.

METHODS

Using data from the Washington and South Carolina SEARCH for Diabetes in Youth Study sites, we conducted an observational, cross-sectional evaluation of associations between FI and glycemic control, hospitalizations, and emergency department (ED) visits among YYA with type 1 diabetes. FI was assessed using the Household Food Security Survey Module, which queries conditions and behaviors typical of households unable to meet basic food needs. Participants' HbA1c were measured from blood drawn at the research visit; socio-demographics and medical history were collected by survey.

RESULTS

The prevalence of FI was 19.5%. In adjusted logistic regression analysis, YYAs from food-insecure households had 2.37 higher odds (95% CI: 1.10, 5.09) of high risk glycemic control, i.e., HbA1c >9.0%, vs. peers from food-secure households. In adjusted binomial regression analysis for ED visits, YYAs from food-insecure households had an adjusted prevalence rate that was 2.95 times (95% CI [1.17, 7.45]) as great as those from food secure households.

CONCLUSIONS

FI was associated with high risk glycemic control and more ED visits. Targeted efforts should be developed and tested to alleviate FI among YYA with type 1 diabetes.