Is the minimum enough? Affordability of a nutritious diet for minimum wage earners in Nova Scotia (2002-2012)

Overall and race-specific associations between state-level minimum wage policy and food insecurity in the United States

BACKGROUND

In the USA, states can set higher minimum wages than the federal government. We investigated the association between state minimum wages and racial/ethnic inequities in food insecurity.

METHODS

Household-level food insecurity and sociodemographic data were obtained from the cross-sectional Current Population Survey 2015-2019 (n=189 665 households) and merged by state and year with minimum wage and cost-of-living data obtained from the US Department of Labor and US Bureau of Economic Analysis, respectively. We fitted Poisson regression models with robust standard errors with 12-month or 30-day household food insecurity as the outcome, and minimum wage or inflation-adjusted minimum wage (ie, real wage) as the predictor, adjusting for cost of living, sociodemographic covariates and state fixed-effects. We tested interactions between minimum wage and race/ethnicity and ran race/ethnicity-stratified models.

RESULTS

In adjusted models, the real wage was not associated with 12-month or 30-day food insecurity. Minimum wage was associated with 5% lower prevalence rate of 12-month food insecurity (PR 0.95, 95% CI=0.93 to 0.98) and 7% lower prevalence rate of 30-day food insecurity (PR 0.93, 95% CI 0.91 to 0.96) for all households. The interaction p values for race/ethnicity with real wage and minimum wage were p<0.001. In stratified models, results were statistically significant for minimum wage and 12-month food insecurity among non-Hispanic (NH) white households (PR 0.93, 95% CI 0.89 to 0.96) and Hispanic households (PR 0.95, 95% CI 0.92 to 0.98), and minimum wage and 30-day food insecurity among NH white (PR 0.92, 95% CI 0.88 to 0.96), NH black (PR 0.94, 95% CI 0.89 to 0.99) and Hispanic (PR 0.90, 95% CI 0.85 to 0.95) households.

CONCLUSIONS

Higher state-level minimum wages, but not real wages, were associated with lower food insecurity prevalence overall and for racial/ethnic subgroups.

Advancing assessment of responsive feeding environments and practices in child care

Child care environments offer an ideal setting for feeding interventions. CELEBRATE Feeding is an approach implemented in child care environments in two Maritime Provinces in Canada to support responsive feeding (RF) to foster children's self-efficacy, self-regulation, and healthy relationships with food. This study aimed to describe RF in child care using established and enhanced scoring frameworks. The Environment and Policy Assessment and Observation (EPAO) was modified to reflect RF environments and practices, resulting in our modified EPAO and a CELEBRATE scale. Observations were conducted in 18 child care rooms. Behaviours and environments were scored on both scales, creating 21 RF scores, with a score of '3' indicating the most responsiveness. Descriptive analyses of the scores were conducted. The overall room averages were Mean (M) = 41.00, Standard Deviation (SD) = 7.07 (EPAO), and M = 37.92 SD = 6.50 (CELEBRATE). Most responsive scores among rooms within our EPAO and CELEBRATE scales, respectively, were 'educators not using food to calm or encourage behaviour' (M = 2.94, SD = 0.24; M = 2.98, SD = 0.06) and 'not requiring children to sit at the table until finished' (M = 2.89, SD = 0.47; M = 2.97, SD = 0.12). The least responsive scores within the EPAO were 'educator prompts for children to drink water' (M = 0.78, SD = 0.94) and 'children self-serving' (M = 0.83, SD = 0.38). The least responsive in the CELEBRATE scale were 'enthusiastic role modelling during mealtime' (M = 0.70, SD = 0.68) and 'praise of mealtime behaviour unrelated to food intake' (M = 0.74, SD = 0.55). The CELEBRATE scale captured unique observation information about RF to allow documenting change over time with detailed measurement to inform and support nutrition interventions within child care environments.

Food environment research in Canada: a rapid review of methodologies and measures deployed between 2010 and 2021

Numerous research methodologies have been used to examine food environments. Existing reviews synthesizing food environment measures have examined a limited number of domains or settings and none have specifically targeted Canada. This rapid review aimed to 1) map research methodologies and measures that have been used to assess food environments; 2) examine what food environment dimensions and equity related-factors have been assessed; and 3) identify research gaps and priorities to guide future research. A systematic search of primary articles evaluating the Canadian food environment in a real-world setting was conducted. Publications in English or French published in peer-reviewed journals between January 1 2010 and June 17 2021 and indexed in Web of Science, CAB Abstracts and Ovid MEDLINE were considered. The search strategy adapted an internationally-adopted food environment monitoring framework covering 7 domains (Food Marketing; Labelling; Prices; Provision; Composition; Retail; and Trade and Investment). The final sample included 220 articles. Overall, Trade and Investment (1%, n = 2), Labelling (7%, n = 15) and, to a lesser extent, Prices (14%, n = 30) were the least studied domains in Canada. Among Provision articles, healthcare (2%, n = 1) settings were underrepresented compared to school (67%, n = 28) and recreation and sport (24%, n = 10) settings, as was the food service industry (14%, n = 6) compared to grocery stores (86%, n = 36) in the Composition domain. The study identified a vast selection of measures employed in Canada overall and within single domains. Equity-related factors were only examined in half of articles (n = 108), mostly related to Retail (n = 81). A number of gaps remain that prevent a holistic and systems-level analysis of food environments in Canada. As Canada continues to implement policies to improve the quality of food environments in order to improve dietary patterns, targeted research to address identified gaps and harmonize methods across studies will help evaluate policy impact over time.

Comparison of Responsive Feeding Practices in Child Care and Home Environments in Nova Scotia

Purpose: The values, beliefs and practices between the family home and child care environment can play a role in shaping a responsive food environment for young children, but few studies have explored the differences across these settings. The purpose of this study was to compare responsive feeding practices in child care and home environments through the framework of the 2019 Canada Food Guide healthy eating recommendations.Methods: Nova Scotia families and child care providers completed an online survey on responsive feeding. Independent-samples t-tests explored the differences between family and child care respondents on variables related to the 2019 Canada's Food Guide, including: food variety, mindfulness, eating with others, cooking more often, and enjoyment of food. A directed content analysis was used to code the open-ended qualitative questions.Results: Family respondents (n = 603) were more likely to report offering a variety of foods, repeated exposures to new foods, and asking children about fullness. Child care respondents (n = 253) were more likely to sit with children during meals and less likely to encourage children to finish their food.Conclusions: The results identify potential points of intervention, including the importance of increasing communication to ensure mutually supportive messages and environments for healthy eating.

Responsive feeding values and practices among families across the Canadian Maritime provinces

Children benefit from responsive feeding practices where their internal signals of hunger and satiety are valued and met with prompt, emotionally supportive, and developmentally appropriate responses. Using an online survey, this study describes responsive feeding values and practices among parents of young children (0-5 years) (n = 1039) across 3 Canadian Maritime provinces. Independent-samples t-tests and 1-way ANOVA were performed to determine the differences in survey questions related to the responsive feeding practices and values. First-time parents and parents with younger children report implementing more consistently some of the challenging responsive feeding practices, such as avoiding pressuring their children to eat, compared with parents with multiple children and parents with children ages 3-5 years. Parents often have well-intended reasons to encourage their children to eat; however, these can coincide with non-responsive practices with food such as pressuring, rewarding, and restriction. These coercive practices may be ineffective and counterproductive as they reinforce reasons to eat unrelated to appetite and self-regulation. Preschool and early feeding interventions that support parents in understanding normal child development, including typical eating behaviours and self-regulation, could help to equip them for challenging feeding experiences and encourage long-term responsive feeding practices. Novelty: First-time parents and parents with younger children report more consistently avoiding pressuring their children to eat, compared with parents with multiple children and parents with children ages 3-5 years. Parents often have well-intended reasons to encourage their children to eat; however, these can coincide with non-responsive practices such as pressuring, rewarding, and restriction.

Development of an optimal grocery list based on actual intake from a cross-sectional study of First Nations adults in Ontario, Canada

A multi-stage sampling strategy selected 1387 on-reserve First Nations adults in Ontario. Foods from a 24-hour dietary recall were assigned to the 100 most common food groups for men and women. Nutrients from market foods (MF) and traditional foods (TF) harvested from the wild as well as MF costs were assigned based on the proportions of total grams consumed. Linear programming was performed imposing various constraints to determine whether it was possible to develop diets that included the most popular foods while meeting Institute of Medicine guidelines. Final models were obtained for both sexes with the top 100 food groups consumed while limiting the nutrient-poor foods to no more than the actual observed intake. These models met all nutrient constraints for men but those for dietary fibre, linoleic acid, phosphorus, and potassium were removed for women. MF costs were obtained from community retailers and online resources. A grocery list was then developed and MF were costed for a family of four. The grocery list underestimated the actual weekly food cost because TF was not included. Contemporary observed diets deviated from healthier historic First Nations diets. A culturally appropriate diet would include more traditional First Nations foods and fewer MF. Novelty ● Linear programming is a mathematical approach to evaluating the diets of First Nations ● The grocery list is representative of food patterns within Ontario First Nations and can be used as an alternative to the nutritious food basket used for public health food costing.

Capacity building and personal empowerment: participatory food costing in Nova Scotia, Canada

Food insecurity impacts millions of people globally. It has been recognized as a priority and a human right by the United Nations where empowerment of women is identified as a significant goal in addressing food insecurity. In the Maritime Province of Nova Scotia (NS), Canada, more than one in five children live in food insecure households. Since 2002, participatory action research (PAR) has been an integral component of food costing in NS with an aim to support capacity building for food security. Building on earlier research that examined short-term outcomes, and recognizing a lack of research examining outcomes of PAR processes, this study aimed to explore the medium-term individual capacity building processes and outcomes of women involved in Participatory Food Costing (PFC). Findings revealed that capacities were built with respect to interrelated themes of 'awareness, participation, personal development, readiness to change, political impact, influence on others, self-esteem, project growth and project continuity'. In addition, the involvement of these women in PFC resulted in both personal empowerment and food security-related policy change. Involving vulnerable populations through PAR is valuable in influencing health-related policy.

Mathematical Optimization to Explore Tomorrow's Sustainable Diets: A Narrative Review

A sustainable diet is, by definition, nutritionally adequate, economically affordable, culturally acceptable, and environmentally respectful. Designing such a diet has to integrate different dimensions of diet sustainability that may not be compatible with each other. Among multicriteria assessment methods, diet optimization is a whole-diet approach that simultaneously combines several metrics for dimensions of diet sustainability. This narrative review based on 67 published studies shows how mathematical diet optimization can help with understanding the relations between the different dimensions of diet sustainability and how it can be properly used to identify sustainable diets. Diet optimization aims to find the optimal combination of foods for a population, a subpopulation, or an individual that fulfills a set of constraints while minimizing or maximizing an objective function. In the studies reviewed, diet optimization was used to examine the links between dimensions of diet sustainability, identify the minimum cost or environmental impact of a nutritionally adequate diet, or identify food combinations able to combine ≥2 sustainability dimensions. If some constraints prove difficult to fulfill, this signals an incompatibility between nutrient recommendations, over-monotonous food-consumption patterns, an inadequate supply of nutrient-rich foods, or an incompatibility with other dimensions. If diet optimization proves successful, it can serve to design nutritionally adequate, culturally acceptable, economically affordable, and environmentally friendly diets. Diet optimization results can help define dietary recommendations, tackle food security issues, and promote sustainable dietary patterns. This review emphasizes the importance of carefully choosing the model parameters (variables, objective function, constraints) and input data and the need for appropriate expertise to correctly interpret and communicate the results. Future research should make improvements in the choice of metrics used to assess each aspect of a sustainable diet, especially the cultural dimension, to improve the practicability of the results.

Tools to improve planning, implementation, monitoring, and evaluation of complementary feeding programmes

Adequate nutrient intake is a prerequisite for achieving good nutrition status. Suboptimal complementary feeding practices are a main risk factor for stunting. The need for systematic and user-friendly tools to guide the planning, implementation, monitoring, and evaluation of dietary interventions for children aged 6-23 months has been recognized. This paper describes five tools, namely, ProPAN, Optifood, Cost of the Diet, Fill the Nutrient Gap, and Monitoring Results for Equity System that can be used in different combinations to improve situation analysis, planning, implementation, monitoring, or evaluation approaches for complementary feeding in a particular context. ProPAN helps with development of strategies and activities designed to change the behaviours of the target population. Optifood provides guidance for developing food-based recommendations. The Cost of the Diet can provide insight on economic barriers to accessing a nutritious and balanced diet. The Fill the Nutrient Gap facilitates formulation of context-specific policies and programmatic approaches to improve nutrient intake, through a multistakeholder process that uses insights from linear programming and secondary data. The Monitoring Results for Equity System helps with analysis of gaps, constraints, and determinants of complementary feeding interventions and adoption of recommended practices especially in the most vulnerable and deprived populations. These tools, and support for their use, are readily available and can be used either alone and/or complementarily throughout the programme cycle to improve infant and young child-feeding programmes at subnational and national levels.

Reproducing or Reducing Inequity? Considerations for School Food Programs

It is important to consider health inequities when exploring the extent to which school food programs may contribute to the stigmatization and social exclusion of families experiencing food insecurity. As part of a broader school-based project, this paper considers evidence derived from a secondary analysis of research in Nova Scotia (NS). In the original research, interviews were conducted with key stakeholders involved in supporting health promotion activities across NS elementary schools. For this article, data were re-examined using tenets of critical discourse analysis to evaluate if school practices were addressing the root social issues by identifying patterns in language and institutional norms. Our findings suggested that further illumination of programs may be needed to ensure that they do not contribute to the stigmatization and social exclusion of families experiencing food insecurity. Nutrition professionals are in a position to engage families experiencing food insecurity in policy action that will shift from a focus on individual determinants towards the social-structural conditions that underlie the complex issue of food insecurity.

The Impact of a City-Level Minimum-Wage Policy on Supermarket Food Prices in Seattle-King County

Background: Many states and localities throughout the U.S. have adopted higher minimum wages. Higher labor costs among low-wage food system workers could result in higher food prices. Methods: Using a market basket of 106 foods, food prices were collected at affected chain supermarket stores in Seattle and same-chain unaffected stores in King County (n = 12 total, six per location). Prices were collected at 1 month pre- (March 2015) and 1-month post-policy enactment (May 2015), then again 1-year post-policy enactment (May 2016). Unpaired t-tests were used to detect price differences by location at fixed time while paired t-tests were used to detect price difference across time with fixed store chain. A multi-level, linear differences-in-differences model, was used to detect the changes in the average market basket item food prices over time across regions, overall and by food group. Results: There were no significant differences in overall market basket or item-level costs at one-month (-$0.01, SE = 0.05, p = 0.884) or one-year post-policy enactment (-$0.02, SE = 0.08, p = 0.772). No significant increases were observed by food group. Conclusions: There is no evidence of change in supermarket food prices by market basket or increase in prices by food group in response to the implementation of Seattle's minimum wage ordinance.

Cost of the Diet: a method and software to calculate the lowest cost of meeting recommended intakes of energy and nutrients from local foods

BACKGROUND

When food is available, the main obstacle to access is usually economic: people may not be able to afford a nutritious diet, even if they know what foods to eat. The Cost of the Diet method and software was developed to apply linear programming to better understand the extent to which poverty may affect people's ability to meet their nutritional specifications. This paper describes the principles of the method; the mathematics underlying the linear programming; the parameters and assumptions on which the calculations are based; and then illustrates the output of the software using examples taken from assessments.

RESULTS

The software contains five databases: the energy and nutrient content of foods; the energy and nutrient specifications of individuals; predefined groups of individuals in typical households; the portion sizes of foods; and currency conversion factors. Data are collected during a market survey to calculate the average cost of foods per 100 g while focus group discussions are used to assess local dietary habits and preferences. These data are presented to a linear programming solver within the software which selects the least expensive combination of local foods for four standard diets that meet specifications for: energy only; energy and macronutrients; energy, macronutrients and micronutrients; and energy, macronutrients and micronutrients but with constraints on the amounts per meal that are consistent with typical dietary habits. Most parameters in the software can be modified by users to examine the potential impact of a wide range of theoretical interventions. The output summarises for each diet the costs, quantity and proportion of energy and nutrient specifications provided by all the foods selected for a given individual or household by day, week, season and year. When the cost is expressed as a percentage of income, the affordability of the diet can be estimated.

CONCLUSIONS

The Cost of the Diet method and software could be used to inform programme design and behaviour change communication in the fields of nutrition, food security, livelihoods and social protection as well as to influence policies and advocacy debates on the financial cost of meeting energy and nutrient specifications.

Use of Linear Programming to Develop Cost-Minimized Nutritionally Adequate Health Promoting Food Baskets

Background

Food-Based Dietary Guidelines (FBDGs) are developed to promote healthier eating patterns, but increasing food prices may make healthy eating less affordable. The aim of this study was to design a range of cost-minimized nutritionally adequate health-promoting food baskets (FBs) that help prevent both micronutrient inadequacy and diet-related non-communicable diseases at lowest cost.

Methods

Average prices for 312 foods were collected within the Greater Copenhagen area. The cost and nutrient content of five different cost-minimized FBs for a family of four were calculated per day using linear programming. The FBs were defined using five different constraints: cultural acceptability (CA), or dietary guidelines (DG), or nutrient recommendations (N), or cultural acceptability and nutrient recommendations (CAN), or dietary guidelines and nutrient recommendations (DGN). The variety and number of foods in each of the resulting five baskets was increased through limiting the relative share of individual foods.

Results

The one-day version of N contained only 12 foods at the minimum cost of DKK 27 (€ 3.6). The CA, DG, and DGN were about twice of this and the CAN cost ~DKK 81 (€ 10.8). The baskets with the greater variety of foods contained from 70 (CAN) to 134 (DGN) foods and cost between DKK 60 (€ 8.1, N) and DKK 125 (€ 16.8, DGN). Ensuring that the food baskets cover both dietary guidelines and nutrient recommendations doubled the cost while cultural acceptability (CAN) tripled it.

Conclusion

Use of linear programming facilitates the generation of low-cost food baskets that are nutritionally adequate, health promoting, and culturally acceptable.